2009 Pediatric Trends Conference

Synopses

Day 1
Keynote Address

Silence to Voice
This presentation focuses on communication strategies that nurses can employ on an everyday basis to strengthen nurse-patient communication and improve public perceptions of nursing work. It presents a number of ways that nurses can individually and collectively communicate the content and importance of their work to patients, families, and members of the public, as well as to physicians, administrators, the media, and politicians and policy makers.

Breakout Sessions

Understanding Healthcare Design: Designing Patient Care Spaces that Work
Nearly $200 billion of healthcare construction is expected by the year 2015.  There are 600 documented studies that show hospital design can significantly influence patient outcomes. (Center for Health Design, http://www.healthdesign.org/).  The environment in which we work affects our performance and the health and well-being of patients.  Standardization and designing for care giving processes impacts patient safety.  Space and design that supports family involvement promotes patient's and families well-being. The presenters will share their experiences as nurse leaders in promoting healthy hospital design for Children’s National Medical Center's patients and families.

Critical thinking in Ambulatory Care Nursing: Making Decision in Complex Practice Situations
Critical thinking in nursing is paramount to providing safe and effective patient care.  The presenter will focus on developing critical thinking framework which could be applied in complex ambulatory practice situations. Developing personal characteristics of a critical thinker will be emphasized which are necessary in developing empathy, and analysis of dealing with the perspectives of patients, families and the multi-disciplinary team.

Complementary Enteral Nutrition via Nocturnal Nasogastric Feeding In Patients with Anorexia Nervosa
Anorexia nervosa (AN) is a complex medical-psychiatric disorder characterized by abnormal eating patterns, dramatic weight loss, body image distortion, unrealistic fear of weight gain and a refusal to maintain an ideal body weight.  Nutritional rehabilitation and attainment of an ideal body weight is paramount to recovery.  It is known that weight restoration leads to improved outcomes over the course of treatment.  Recent research has demonstrated that the use of complementary nocturnal nasogastric refeeding (NNGR) is more effective than oral refeeding alone in weight restoration in hospitalized adolescents.  In 2006 Children’s National Medical Center implemented an eating disorder pathway with NNGR which has confirmed that this methodology can be safely and successfully used within the context of multidisciplinary treatment plan, augmenting the chance of treatment progress through earlier weight optimization.
Related presentation: Nutritional Rehabilitation In the Anorexic Patient

Teaching and Learning with Simulation: An Avenue for Establishing and Sustaining Safe Work Environments
In an effort to align with CNMC’S mission related to safety transformation and meet the recommendations of the Institute of medicine, in a highly complex healthcare environment, Nurse and Physician Educators are challenged to employ innovative and creative methods to provide clinicians with extensive learning opportunities. Over a decade of aviation research has demonstrated that effective teamwork is essential to flight safety. Simulation allows teamwork lessons learned in aviation to be organized into training for healthcare teams.

Teaching and learning through simulation is used to provide both introductory and advanced skills and competencies. Through the enactment of case scenarios, using a human simulator, participants will have the opportunity to improve assessment and intervention skills, problem-solving and critical-thinking skills, crisis management and interdisciplinary collaboration and communication skills, concepts of patient safety and reflection skills.

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Integrating the Child with Chronic Illness into General Pediatric Nursing Practice: The Model of Childhood Cancer Survivorship.
Medical innovations and improved treatments are not only increasing the survival rates of pediatric malignancies, but also of many other childhood illnesses including cystic fibrosis, sickle cell disease, hemophilia, congenital cardiac defects, as well as many others.  It is essential that these children, all with unique issues, be successfully integrated into general pediatric nursing practice.  Childhood cancer survivorship can serve as a model of integration for all chronic illnesses of childhood.  This presentation will focus on how nurses can help patients and families navigate the heath care system and integrate the late or chronic effects of illness to live productive and meaningful lives.

Family Presence in the ED Code Room
Parents in the code room?  Can it really be successful? This lecture will discuss one pediatric emergency department’s journey to bring family presence to trauma and medical alerts using evidence based practice. How to overcome obstacles, prepare and educate  a multi-disciplinary staff, document the event , and collect  data  to ensure positive outcomes will be detailed in this step by step guide to implementation.
Target Audience: Advance beginner through Expert

Translation of Nursing Practice into the Electronic Healthcare Record Systems: Now & In Our Future
James Grant, a prior Director of UNICEF said that his tenure as Director that 80% of the children who died did so needlessly because the knowledge to save them existed – but was not available when and where it was needed.  This so called “know-do” gap illustrates the translational latency that holds us back from providing higher quality, safer and more effective care.  What we know and what we do are slowed by an inability to rapidly transfer knowledge from Point A to Point B. 

The use of Healthcare Information Technology (HIT) will enable us to bridge this gap, and has the potential to fundamentally change healthcare delivery.  The impact on nursing practice and the nursing role could be considerable, requiring change in the way we educate nurses, the way we interact with patients and members of the healthcare team, and how we work.  Nurses, as vital members of the healthcare team who stand at the interface of the patient and the healthcare system have a unique opportunity to influence how nursing practice is translated into the HIT of the future.  To take advantage of this opportunity, nursing leadership is required.  As Pasteur said “Chance favors the prepared mind”.
Related presentation: Remember When? A Historical Review of Clinical Technology at Children’s National

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Keeping it Simple: Making the connection between health literacy and patient safety
Health Literacy is the ability to read, understand, and act on health care information. Nearly 20% of Americans are functionally illiterate, unable to read and understand. This workshop will give an overview of health literacy, how to assess for low health literacy, and provide tools and methods to use in clinical practice to promote safety and positive health outcomes.

Time to Turn: An Initiative to Reduce Nosocomial Pressure Ulcer
The VA medical center initiated a nurse driven quality improvement and education program to reduce pressure ulcer incidence and improve documentation, intervention and quality of care in 176 bed acute care inpatient facility.  A nursing knowledge survey was conducted and resources were assessed and upgraded.  Based on the survey the Certified Wound Care Nurses developed and implemented a program “Time to Turn”.  The program was developed using the Braden Scale for guidelines on effective prevention and treatment protocols.  A team of unit based resource nurses were trained for additional support.  Prevalence and incidence documentation data was collected at the start of the project and quarterly over an 18 month implementation period according to NDNQI guidelines.  Incidence at the start of the study in January 2007 was 19.44% and documentation compliance was 75%.  Throughout the 18 month implementation period pressure ulcer incidence consistently dropped to 3.96% in July 2008.  Nursing documentation of risk assessment on admission increased consistently and was maintained over two quarters at 100%.  Reduction in pressure ulcer care incidence can be achieved through collaborative effort using education, targeted actions plans, and monitoring of process measures and outcomes.

From Pain to Sleep: Listening to Patient-reported Outcomes
The ability of pediatric patients to report their symptom experiences is increasingly being recognized in clinical care and research efforts. Being consistently at the point of care, nurses are well positioned to monitor and study pediatric patients’ symptom reports and to alter care based on the study of those reports. 

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Advances in Genetic Medicine: Addressing the future now
Since the mapping of the human genome in 2001, substantial progress has brought a focus on genetics in the media and medicine. The roadmap put forth by Francis Collins, for genetics in medicine addressed some of these advances but some progress has occurred in unexpected ways. This presentation will address these current advances, the integration of genetics in medicine and the need for a translational approach. In order to facilitate a true translational approach of genetic medicine, a multidisciplinary approach is necessary.  Because nurses are at the frontline of the healthcare system, they need to be aware of these advances and how they can be integrated into patient care.


End Note Speaker

Taking What You Do Seriously, But Yourself Lightly In A Quest For Nursing Excellence
(It’s Not What Happens To You That Counts, It’s What You Make Happen That You Can Count On!)
The focus of this presentation will be to examine humor as an effective way to deal with life’s distress and communicate in our day-to-day world.  Change can be chaotic and lead to varying levels of distress. Seeing change as a creative opportunity reduces the negative impact of the change process.  A creative climate increases the probability that the individual and the organization will successfully reach their goals such as Magnet Hospital Status.  Research has found that spontaneity, brainstorming and humor encourage high levels of creativity, achievement, physical and mental health.  The participants will be asked to better understand themselves and their sense of humor.  There will be examples of how humor can be introduced into the work place, into our daily lives and interactions with others.

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Day 2

Special Session on Genomics in Nursing

Genomic Healthcare: A New Era in Healthcare for Pediatric Nurses (2.25 contact hours)

Since the human genome was completely mapped and sequenced in 2003, our understanding of the role of genes in health and disease has expanded beyond rare genetic diseases to common diseases such as cancer and diabetes. The new era of healthcare – genomic healthcare – is rapidly advancing. Genomic healthcare provides a powerful means for tailoring health care at the individual level by using a person’s unique genomic information, from design of more effective medications to prescribing the best treatment for each patient, and avoiding adverse drug reactions. These new advances are ushering in new directions in the provision of healthcare, and will have a significant impact on healthcare professionals including pediatric nurses. Nurses in all practice settings will increasingly be called upon to use genetic and genomic-based approaches and technologies in their patient care. In recognition of the implications of genomic healthcare for nurses, the Essential Nursing Competencies and Curricula Guidelines for Genetics and Genomics have been created. This presentation will be based on the Essential Nursing Competencies, beginning with a simple overview of basic genetics; how genes are passed on (inherited) in families and current and emerging genetic and genomic research as a foundation for pediatric nurses to learn about the applications of genetics and genomics to nursing care. Family history assessment, genetic screening and testing, pharmacogenetics and pharmacogenomics, and direct-to-consumer (DTC) genetic testing will be described. Ethical and social issues related to genetics and genomics will also be presented. Genetics and genomics educational and clinical resources will be provided to support pediatric nurses in providing competent genomic healthcare.

Conference participants will be able to:

• Define genomic healthcare.
• Describe the role of genes in health and disease.
• Describe three new genomic research efforts.
• Discuss the nursing role in family history assessment.
• List two new ways that genetic testing is being used in pediatric practice.
• Identify ethical issues of concern with regard to genomic healthcare.

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Pharmacogenetics: Everyone’s just a little different!
The Declaration of Independence states that we are all created equal. However, in the world of pharmacology and therapeutics there are many instances where we are not.  In this seminar we will discuss Pharmacogentics, the study of how genetic variability between individual patients or populations can give rise to differences in pharmacokinetic or pharmacodynamic parameters that ultimately can change the potential for efficacy or toxicity from drugs. 

Understanding Anticoagulants: The Good and the Bad
Anticoagulants are among some of the most likely medications to cause serious harm to patients (adult or child) if improperly used or monitored. Accordingly the Joint Commission’s National Patient Safety Goals for 2008 highlight the need for institutions to fully understand the impact of these drugs. In this presentation we will examine the cause and mechanisms for hemostasis / thrombosis followed by a thorough review of the basic and clinical pharmacology of the various anticoagulant classes (warfarin, heparins, factor Xa inhibitors, direct thrombin inhibitors and antiplatelet drugs). It is hoped that the information provided will help to reduce the likelihood of patient harm associated with the use of anticoagulation therapy.

Psychotropic Drugs in Children: New Perspectives on Therapy & Abuse
In this presentation we will review and update the use of psychotropic drugs used for treating psychiatric and/or behavioral disorders in children. We will discuss what’s new with antipsychotics, antidepressants and stimulants. Additionally, we will examine newer statistics and issues surrounding the rising trend of prescription and non-prescription drug abuse, particularly in adolescent populations

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