Australian Paediatric Nursing Research Survey
Led by: Professor Amanda Ullman
High-quality paediatric nursing research is needed to inform and advance nursing practice, however a a systematic description of the current state of Australian paediatric nursing research has never been undertaken. Using a cross-sectional online survey, 100 research-active paediatric nursing academics/clinicians reported diverse educational and professional backgrounds, research foci, and work locations. This study represents a first step toward developing a programmatic approach to paediatric nursing research in Australia.
myPainPal: Co-creation of an mHealth app for the management of persistent pain in young people
Led by: Professor Marie Cooke
Based on interviews with young children aged 10 to 14 years, parents and health care professionals, and with overarching guidance from an expert advisory group, we have developed a mHealth app, myPainPal. The process used to co-create the myPainPal app was an important relationship building research process, combining the knowledge and skills of researchers, healthcare mobile applications experts, health clinicians, patients and parents to create a new and valuable resource for a vulnerable group of young people. Young people with persistent pain identified four major mHealth needs (mind-body scan, strategies, goal setting, social support and engagement).
The subsequent structure for the myPainPal app incorporated these, together with feedback from the ARG and current best practice for self-management of persistent pain. The final framework consisted of four elements:
- self-monitoring diary and calendar
- goal setting
- tips and strategies
This structure is consistent with the evidence-based sociopsychobiomedical approach to the management of pediatric persistent pain and incorporates multimodal self-management strategies to optimize treatment. This project was funded by the Ian Potter Foundation (Health and Disability).
Needle-phobia during immunisation
Led by: Rebecca Doyle
Queensland Specialist Immunisation Service is conducting a research project that is piloting multidisciplinary model of care clinics for children with severe needle phobia. This is a streamlined, individualised model with input from patients and their families, occupational therapists, specialist immunisation staff, anaesthetists and psychologists.
The project aims to reduce stress and anxiety associated with immunisation and uses a variety of techniques including distraction, virtual reality and inhaled sedation. It is hoped that data from this project will facilitate the development of resources for all vaccine providers to support successful vaccination of needle phobic children.
It also hopes to provide evidence to support the commencement of a hospital-wide procedural anxiety service for all children requiring a medical procedures that cause discomfort and anxiety.
Improving the recognition and treatment of paediatric sepsis
Led by: Amanda Harley
Sepsis is a devastating infection that kills more children than road traffic accidents. CNC Amanda Harley is a key member of the team developing and implementing a statewide paediatric sepsis clinical pathway. Amanda describes sepsis as 'like an iceberg'. "The tip is something you can feel in your gut - that something is not quite right with this patient, but you can't see what's lurking ahead. What I ask clinicians is: what are your safety nets to monitor these patients? What do you do if you have a gut instinct about someone?" Sepsis affects over 500 children every year in Queensland and sepsis related deaths exceed Road Traffic tools and diseases such as leukaemia.
Poor sepsis outcomes are strongly correlated to delays in time to recognition and treatment: every hour delay in the administration of appropriate antibiotics leads to a >5% rise in mortality in patients with infection, and increases the duration of organ failure and need for ICU support. Early recognition and rapid initiation of correct antimicrobial treatment can thus not only result in dramatic reduction of sepsis mortality but result in faster recovery, shortening the need for intensive care (ICU) bed days, which represents the largest cost factor.
At present, Queensland Health does not have standardised approaches for recognition and management of sepsis in children. Queensland Health is launching a Statewide Paediatric Sepsis Collaborative to reduce the impact of sepsis on child health. The Collaborative targets Emergency Departments across the state and is designed to lead to faster delivery of recognition and treatment of sepsis using a standardized approach based on best international practice. The pathway has been developed by wide stakeholder and consumer engagement.
Normal saline And lung Recruitment with paediatric Endotracheal Suction: NARES
Led by: Jessica Schults
How do you suction? Hi there, every year in Australia and New Zealand more than 5000 children are intubated and require endotracheal suctioning to maintain their breathing tube's patency. Suction prevents mucous and mucous is bad, well for the ventilated child anyway. Suction is primarily a nursing responsibility and there is limited scientific evidence that tells us how we should be suctioning our patients.
For nurses this means there is often uncertainty regarding the appropriateness of interventions we use in our daily practice, and we base our practice decisions on previous experience and gut instinct. As a consequence of this lack of scientific evidence, endotracheal suctioning guidelines used both nationally and internationally lack the rigour of guidelines that are often used in clinical practice.
My PhD research looks at testing two commonly used suction interventions 1) normal saline installation, and 2) lung recruitment. Through a systematic review of the evidence, interviews with key stakeholders such as nurses, and a pilot trial which examines the feasibility of conducting a large clinical trial, I hope to provide some important information about why and what affects our suction practices are having on children in our care. As a nurse, it seems crazy to me that one of the most common interventions we do in the PICU lacks the evidence to really help us decide how to do it. You can find more information on the trial at ANZCTR (trial registration: ACTRN12617000609358) or alternatively flick me an e-mail at email@example.com if you have a passion for suction I'd love to hear from you.
Development of the Paediatric Michigan Appropriateness Guide for Infusion Catheters (mini-MAGIC)
Led by: Professor Amanda Ullman
PIVC (peripheral intravenous catheter) insertion and management is challenging with more than 25% of devices failing in the paediatric population. Failure may require a child to undergo traumatic reinsertion procedures, delay important medical treatment and prolong the length of hospital stay. One way to reduce PIVC failure is with effective PIVC dressing and securement, by ensuring correct catheter position in the vein.
The aim of this study is to evaluate securement devices for PIVCs in the paediatric emergency department to determine which method is most effective for reducing PIVC failure, associated costs, acceptability, and patient distress.