Children’s Hospital Awareness Initiative: Improving Employee Communication with Pediatrics

Abstract Appropriate communication with children is key for any children’s hospital. As Lehigh Valley Health Network is not exclusively pediatric, it is important to train all staff members on how to interact with children. A survey was completed by 18% of all staff highlighting the need for more education for distraction techniques and communication skills. A TLC is being developed to become mandatory staff training, developed by Child Life Specialists. It involves discussions about how to earn a child’s trust, as well as how to describe difficult procedures in appropriate manners. Examples of such may involve the use of a movie or the comfort of sitting on a parent’s lap. The main focus of this study was to highlight education needs amongst all employees and distribute materials to increase reports of higher knowledge and comfort communicating with pediatric patients. Keywords: distraction techniques, communication, education, pediatrics Children’s Hospital Awareness Initiative: Improving Employee Communication with Pediatrics Background Since the establishment of the Children’s Hospital at Lehigh Valley Health Network, pediatrics has become a focus in relation to areas of improvement. To gain higher rankings as a children’s hospital, the quality of care and comfort that a child receives at Lehigh Valley Hospital must become a priority. Unlike other children’s hospitals in the area, the Children’s Hospital at Lehigh Valley Health Network is a hospital within a hospital, meaning that both pediatric and adult patients are treated under the same roof. As a result, some staff members are trained to work with pediatrics, and others are not. The focus of the Children’s Hospital Awareness work group is to establish barriers between pediatric patients and an extraordinary level of care. As many clinical employees are trained in providing clinical care to children, this was not a large concern. However, communicating with children is taught less frequently, and often approached inappropriately. The purpose of the task group was to establish these difficulties, and create educational plans to remedy them. Methods A survey was distributed to the over 12,000 employees of the Lehigh Valley Health Network, with a return rate of about 18%, or 2137 responses. Baseline questions such as whether the employee was clinical or non-clinical, and what department they worked with was preliminarily asked as a system in which responses could be sorted. Then, questions such as “What is your level of comfort to provide clinical care” were asked, followed by five different age groups (infants/newborns, toddlers, preschool aged, school aged, and adolescents). Other questions revolved around knowledge and comfort with communication and distraction techniques for the above age groups. This survey was completed prior to the writer’s involvement in the research program, and results were retrieved, analyzed, and compiled. Results While the overall results of the survey were above satisfactory, there were some definite areas in need of improvement, mostly related to communication with pediatric patients. For example, below is a graph depicting reported levels of knowledge of clinical care: Alternately, below is graph of the same scale, but showing knowledge of communication techniques: These graphs were created using data from the group of respondents whom identified as working in inpatient pediatrics clinically. Essentially, even those who work full time with pediatrics do not have communication skills that are on par with their clinical skills. In contrast, the graph below will show the data retrieved from the survey results of those who identified as “Other” when referring to their department, in relation to their knowledge of distraction techniques. Through further analysis, many of those who chose the “Other” category did so because there was no option for departments who see both pediatric and adult patients. Upon the conclusion of data analysis, it was established that communication was an area in which all departments seemed to lack universally. From that point on, staff education surrounding communication and the use of distraction techniques became the work group’s focus. Future Steps As of the date of writing, Child Life Specialists within the hospital have been recruited to develop an educational tool in which all employees could increase their knowledge and comfort concerning communication with pediatric patients. It was determined that a TLC would be the most effective route of relaying the information, and the goal is to strive for including the TLC in the next mandatory staff bundle. In order to ensure full absorption of the information provided, the TLC will be interactive in nature, including quizzes and self-reflection questions, as opposed to simply reading educational materials. Communication While many people are fully capable of carrying out a conversation with a school age or preschool age child, they may balk at the task of explaining an important medical procedure to that child in a way that will lessen their anxiety and include no false information. For example, if one were to tell a child “This needle won’t hurt one bit!” and then it causes immense pain for that child, they will label one as a liar and fear any other procedures one must complete. Or, for example, you would not blow bubbles to pacify a teenager who is having a nasogastric tube placed, but that would be appropriate for an infant or toddler (Martin, 2013). Building trust with a patient not only makes their stay more enjoyable, but it makes the jobs of those who care for them infinitely easier as well. Simple fixes, such as allowing a small child to sit upon a parent’s lap while a needle is being inserted can calm a child and make them feel protected (Cavender, Goff, Hollon, & Guzzetta, 2004). Watching a movie was shown to soothe a younger child much more effectively than simply doing the procedure without any distraction (MacLauren & Cohen, 2005). Conclusion The results of this survey and study have demonstrated a need for mandatory staff training on age-appropriate distraction techniques and communication skills by age group. The intention of this education is to improve patient satisfaction in pediatric patients, as well as satisfaction from their guardians. It will provide patients with all three aspects of the Triple Aim. Patients will experience better care, in that they will have staff working with them in a way that is less traumatizing and more comforting. Better health will be achieved by procedures being completed more easily. And lastly, better cost will be evident by fewer rescheduled procedures, such as CT scans and MRIs, due to higher patient compliance. Departments may also run more efficiently due to fewer backed-up schedules. Works Cited Cavender, K., Goff, M., Hollon, E., & Guzzetta, C. (2004). Parents\u27 positioning and distracting children during venipuncture. Effects on children\u27s pain, fear, and distress. Journal of Holistic Nursing, 22(1), 32-56. MacLaren, J. E., & Cohen, L. (2005). A Comparison of Distraction Strategies for Venipuncture Distress in Children. Journal of Pediatric Psychology, 30(5), 387-396. Martin, V. (2013). Using distraction techniques with children. Nursing, 43(11), 68

Teaching Entrepreneurial and Management Skills to Extension Audiences

Training programs for business manager-entrepreneurs can have important positive impacts on economic development. A 15-week course of this type has been taught seven times in the last 3 years in rural Idaho communities, largely by county Extension faculty. Interest in the course has been high. This article describes what we have found to be the important topics to cover in this course, some things we have learned about how best to teach the course, and some suggestions for using the course as the basis for synergistic partnerships and collaborations

Prospective examination of the effect of injunctive drinking norms on the association between social anxiety and coping motivated and problematic drinking

While most students “mature out” of normative undergraduate problematic drinking, many do not. Research demonstrates that drinking for coping motives impedes that maturing out process (Littlefield, Sher, & Wood, 2010). Social anxiety (SA) may be a particularly relevant risk factor for problematic drinking during these formative years. Drinking in university often occurs in (anxiety provoking for some) social situations and heavy drinking is often promoted and normalized by peers in these contexts. The goal of this study was to investigate SA as a risk factor for continued problematic drinking during the transition out of university. It was hypothesized that SA would be a positive predictor of drinking for coping motives and problematic drinking during the 9-months post-graduation, but only for those who believed that peers approved of heavy/risky drinking (i.e., high injunctive norms). Graduating students (N = 120 at baseline) completed online surveys pre- and post-graduation (3-, 6-, 9-month follow-ups). SA, injunctive norms, drinking motives, and problematic drinking were assessed. Latent growth curve modeling was used to test injunctive norms (between subject) as a moderator of the effect of SA (between subject) on within person change in coping drinking motives, alcohol use, and alcohol-related problems. Only the interactive effect on alcohol-related problems was supported. Counter to hypotheses, elevated SA was associated with a more rapid decline in alcohol-related problems, if injunctive norms were high. These results suggest that the transition out of university may be somewhat protective in terms of reducing risk for problematic drinking for some high SA individuals

Perceived Approval of Risky Drinking in Undergraduate Students: Measurement Development and Testing the Association with Problematic Alcohol Use

Undergraduate students engage in risky alcohol use; this includes heavy drinking and drinking that leads to problems. The theory of planned behaviour and reasoned action approach identify injunctive norms – perceived approval of drinking behaviour – as central in predicting risky drinking. However, research linking injunctive norms and risky drinking has provided mixed support, thereby contributing to a possible under-utilization of injunctive norms in interventions. The unclear association of injunctive norms and risky drinking may be a result of extensive variability in the operationalization of injunctive norms and the utilization of injunctive norms measures that have poor psychometric properties. The first aim of this research is to improve the measurement of injunctive norms via the development of an injunctive norms measure in undergraduates. The second aim is to utilize this measure to investigate the social anxiety risk pathway to alcohol-related problems in undergraduates. In the first study, using best practices in scale construction, we developed and validated the Perceived Approval of Risky Drinking Inventory (PARDI), which assesses perceived friend, parent, and typical student approval of four risky drinking domains: heavy drinking, drinking-related problems, coping-related drinking, and sexual-risk taking. Psychometric evaluation indicated satisfactory scale score and composite reliability, support for convergent validity, and invariance across gender and drinking status. Utilization of the PARDI may allow researchers to ask more nuanced questions pertaining to undergraduate risky drinking aetiology. In the second study, we investigated the effect of social anxiety and injunctive norms (perceived friend approval of drinking-related problems) on undergraduate alcohol-related problems. Undergraduates completed assessments of injunctive norms, social anxiety, and alcohol-related problems every four months for one year. Controlling for age and sex, higher participant injunctive norms were positively associated with alcohol-related problems (between-subjects analysis) and when injunctive norms were elevated in comparison to participants’ own means, there was a concurrent elevation in alcohol-related problems (within-subjects analysis). Age, but not sex or social anxiety, moderated the within-person association: within-person injunctive norms was more strongly related to alcohol-related problems as age increased, suggesting that injunctive norms exert an increasing influence on risky drinking as students progress through university

Archiva: Volume 3, Issue 2

https://digitalcommons.imsa.edu/archiva/1000/thumbnail.jp

Prevalence and Predictors of Social Support Utilization among Cancer Patients Undergoing Treatment

Background. The purpose of this study was to quantify the prevalence of cancer patients utilizing social support services while undergoing treatment and to identify patient and clinical factors associated with utilization of such services. Methods. This was a cross-sectional study. Surveys were distributed to three cancer clinics at 11 locations in the greater Kansas City metropolitan area in 2010. Study inclusion criteria included being at least 18 years old and undergoing treatment for cancer at the time of survey completion. Results. A total of 465 oncology patients completed surveys. Two-thirds (67.5%, n = 314) were undergoing treatment for cancer and were included in the final analysis. More than half (63.7%, n = 198) were female, and the average age was 58.9 ± 13.3 years. More than one-third (37.4%, n = 117) reported using cancer-related social support services. Additionally, 22% (n = 69) reported not using support services but were interested in learning more about those services. Patients had increased odds of having used support services if they were female (OR = 2.67; 95% CI = 1.47, 4.82), were younger adults, or had stage I-III (OR = 2.67; 95% CI 1.32, 5.26) or stage IV cancer (OR = 2.3; 95% CI 1.14, 4.75) compared to those who did not know their cancer stage. Conclusions. More than one-third of patients reported using social support services. A substantial portion of participants reported not using support services but were interested in learning more about those services. Increasing social support service utilization might be especially important to explore for men, those who do not know their cancer stage, and older adults

The Relationship Between Childhood Physical and Sexual Abuse and Adolescent Cannabis Use: A Systematic Review

Background: Among adolescents, cannabis use is a health concern due to associations with drug addiction and mental health disorders across the life course. It has been shown that childhood maltreatment is associated with drug addiction in adulthood. However, a better understanding of the relationship between maltreatment and drug use may improve targeted prevention and interventions. The aim of this systematic review is to describe the association between exposure to childhood maltreatment, specifically physical and sexual abuse, with adolescent cannabis use. Methods: A systematic search strategy was applied to Embase, PsycINFO, and Ovid MEDLINE(R) databases. Methods followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Abstract and title screening was performed to identify papers which reported an estimate of the association between childhood physical or sexual abuse and adolescent cannabis use. Full text screening of each paper was performed, and data were extracted and study quality assessed. Weighted means meta-analysis was performed on studies reporting odds ratios as effect estimates. Results: Of 8,780 screened articles, 13 were identified for inclusion. Eight papers received a quality rating score indicating lower risk of bias. Eleven papers reported the relationship between childhood sexual abuse and adolescent cannabis use; effect estimates ranged from AOR 0.53-AOR 2.18 (weighted mean OR 1.29, 95% CI 1.08-1.49). The relationship between childhood physical abuse and adolescent cannabis use was reported in 7 papers; effect estimates ranged from AOR 1.25-AOR 1.87 (weighted mean OR 1.39, 95% CI 1.12-1.66). Differences in the strength of the evidence were observed by the method of exposure ascertainment, and there was some evidence of differences in association by gender, age of cannabis initiation, and the severity of the abuse. Conclusions: This systematic review indicates childhood physical or sexual abuse may increase risk of adolescent-onset cannabis use. Few studies considered variation in timing of onset, or by gender. Adolescent cannabis use precedes is strongly associated with increased risk of negative mental health outcomes; further exploration of adolescent cannabis use's place on the causal pathway between childhood abuse and adult mental health problems is warranted to improve intervention

Patients’ views on variants of uncertain significance across indications

As genomic sequencing expands into more areas of patient care, an increasing number of patients learn of the variants of uncertain significance (VUSs) that they carry. Understanding the potential psychosocial consequences of the disclosure of a VUS can help inform pre- and post-test counseling discussions. Medical uncertainty in general elicits a variety of responses from patients, particularly in the growing field of medical genetics and genomics. It is important to consider patients’ responses to the ambiguous nature of VUSs across different indications and situational contexts. Genetic counselors and other providers ordering genetic testing should be prepared for the possibility of their patients’ misinterpretation of such results. Pre-test counseling should include a discussion of the possibility of VUSs and what it would mean for the patient’s care and its potential psychosocial impacts. When a VUS is found, post-test counseling should include additional education and a discussion of the variant’s implications and medical management recommendations based on the results. These discussions may help temper subjective interpretations, unrealistic views, and decisional regret