The North Dakota Nurse - July 2022

More documents

Recommendations

Info

Page 18 The North Dakota Nurse July, August, September 2022 Timed Repositioning Effect on Pressure Injury Incidence Appraised By: Kailey Fiske SN, Kylee Grabow SN, Courtney Hawkinson SN, Alexis Helm SN, Hailey Fried SN, Sarah Selle SN Allison Sadowsky MSN RN Assistant Professor of Practice (Faculty) (NDSU School of Nursing at Sanford Health) Clinical Question: For adult patients with decreased mobility, does the use of timed repositioning reduce the risk for pressure injuries? Sources of Evidence: Chew, H.S., Thiara, E., Lopez, V., & Shorey, S. (2018). Turning frequency in adult bedridden patients to prevent hospital-acquired pressure ulcer: A scoping review. International Wound Journal, 15(2), 225–236. https://doi.org/10.1111/iwj.12855 Cyriacks, B. (2019). Reducing HAPI by Cultivating Team Ownership of Prevention with Budget-Neutral Turn Teams. MEDSURG Nursing, 28(1), 48–52. Darvall, J. N., Mesfin, L., & Gorelik, A. (2018). Increasing frequency of critically ill patient turns is associated with a reduction in pressure injuries. Critical Care and Resuscitation, 20(3), 217-222. De Meyer, D., Van Hecke, A., Verhaeghe, S., & Beeckman, D. (2019). PROTECT – Trial: A cluster RCT to study the effectiveness of a repositioning aid and tailored repositioning to increase repositioning compliance. Journal Of Advanced Nursing, 75(5), 1085-1098. doi: 10.1111/jan.13932 Harmon, L. C., Grobbel, C., & Palleschi, M. (2016). Reducing Pressure Injury Incidence Using a Turn Team Assignment: Analysis of a Quality Improvement Project. Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society, 43(5), 477–482. https://doi-org.ezproxy.lib. ndsu.nodak.edu/10.1097/WON.0000000000000258 Kahn, M., & Jonusas, E. (2019). Turn Teams: How Do You Prevent Pressure Injuries? MedSurg Nursing, 257– 261. Synthesis of Evidence: Six articles were reviewed as evidenced in this report. A systematic review, three quasiexperimental, a descriptive correlational study, and a randomized control trial. Pressure ulcers are a result of decreased mobility due to increased pressure on body prominences and decreased blood flow to the tissue. This is important because pressure injuries are associated with increased mortality rate and cost of treatment (Kahn & Jonusas, 2019). This report will assess the effect of timed repositioning on the incidence of pressure injuries. Chew, Thiara, Lopez and Shorey (2018) conducted a systematic review which included five randomized control studies, one prospective cohort study and one literature review. These studies took place in various hospital and longterm care facilities and included immobile, elderly, hospitalized or nursing home residents with a focus on pressure ulcer prevention interventions. In total, the sample size ranged from 63-335 patients. The interventions included: pressure ulcer incidences with foam mattresses, incidence of pressure ulcer development using various repositioning schedules, stages of pressure ulcers related to differing turning schedules and lastly degree of blanchable erythema. The findings did not statistically differ from one intervention to another. The evidence was not statistically significant, however, repositioning every two hours had a pressure ulcer rate of 10.3% while repositioning every four hours had a 13.4%. This systematic review brings forward the idea of implementing facility-wide pressure redistributing air-mattresses in hospitals and nursing homes to prevent pressure ulcer development while reducing manpower needed to reposition patients. Cyriacks (2019) conducted an evidencebased quality improvement project with a quasi-experimental design. The purpose of this study was to empower nurses with direct responsibility for HAPI prevention, ensure patients were repositioned every two hours, and remove barriers to allow staff to reach this expectation. The study took place in a 36-bed medical surgical pulmonary unit in an academic medical center. The population included 36 adults that were at higher acuity with multiple risk factors for occurrence of pressure injury. The study implemented turn teams who turned the patients every two hours and found that the reduction of hospital acquired pressure injury decreased by 75%, no new pressure injuries occurred on the coccyx, sacrum, heel, or ischium for any patients, and staff benefitted in that they were engaged, teamwork was enhanced, and time saving was notable. Daravall, Mesfin, and Gorelik (2018) conducted a quasi-experimental prospective intervention evaluation study. The study was conducted at Royal Melbourne Hospital ICU and included adult critically ill patients that were admitted to the ICU; the sample included a pre-intervention group, with 1094 patients, and a post-intervention group, with 1165 patients. The total sample size was 2259 patients. The studied interventions were a five-hourly turn schedule, the pre-intervention group, and a three-hourly turn schedule, the post-intervention group, and the interventions effect on pressure injury and decubitus injury incidence. The results concluded that there was a 49% reduction in the risk of pressure injuries and the rate of decubitus pressure injury fell from 62.5% to 25.0% when the turning schedule was changed from five-hourly to three-hourly. De Meyer, Van Hecke, Verhaeghe, & Beeckman (2019) conducted a three-arm, randomized, controlled pragmatic trial. This study was conducted to see the outcomes of repositioning with the Turn and Position System on patients and what that does for nurse compliance, the incidence of pressure ulcers, patient comfort, and budget. This study included 226 patients, all patients who are 18 years and older that are at risk for pressure ulcers. The intervention included repositioning that varied every one to four hours using devices such as the Prevalon Turn and Position System. The results concluded that the nurses’ compliance to repositioning was increased significantly. Few pressure ulcers and incontinence-associated dermatitis incidents occurred, 2.22% of patients compared to the mean prevalence of 20.9% before the trial. Patients reported their comfort as a 6.1/10. The cost of materials to prevent pressure ulcers increased to $15.40 per day, but the cost of treating pressure ulcers ($2.52-$83.43 per day) went down through prevention. Harmon, Grobbel, and Palleschi (2016) conducted a descriptive correlational study. The purpose of this study was to analyze outcomes of a quality improvement project that evaluated a Turn Team intervention for prevention of facilityacquired pressure injuries. The study took place in a Midwest teaching hospital with twelve surgical intensive care units. The findings were that unit acquired pressure injury occurrence declined from 24.9% to 16.8% following implementation of the intervention; evaluation of verbal cueing intervention to increase compliance with regular patient repositioning and achieved a 77.8% compliance rate; and half the participants indicated that the turn team provided adequate two-hour reminders needed for turning. Kahn & Jonusas (2019) conducted a quasiexperimental quality improvement project that looked at the effectiveness of "turn teams" in a 51-bed medical-surgical unit in the southeastern United States. The population consisted of all adult patients at risk for developing pressure injuries which was evidenced by a Braden Scale score of 18 or below and the inability to turn independently in bed. Turn Teams were used to turn these at-risk patients every two hours. Unitacquired pressure injury data was assessed 12 months before implementation of Turn Teams and 12 months after implementation. Weekly skin assessment audits were also performed for a 12-month period after implementation. The results included that the number of unit-acquired pressure injuries over a 12-month period was reduced by 54 percent. Conclusion: Five out of the six studies found a statistically significant decrease in the incidence of pressure injuries with the implementation of regular repositioning schedule. However, the study by Chew, Thiara, Lopez, and Shorey showed that having widespread pressure redistributing airmattresses in hospitals and nursing homes can be used to prevent pressure ulcer development, while reducing the need to reposition patients. Implications of Nursing Practice: Preventing pressure injuries is important because they are associated with increased mortality and cost of care. The evidence showed that the implementation of turn teams utilizing a regular timed repositioning schedule is beneficial to reduce the incidence of pressure injuries in patients with decreased mobility. Pressure relieving hospital beds can also be implemented to reduce the incidence of pressure injuries. Healthcare facilities need to implement a variety of pressure prevention interventions to prevent healthcare related pressure injuries. HILL BLAINE PHILLIPS VALLEY DANIELS SHERIDAN ROOSEVELT RICHLAND DIVIDE WILLIAMS McKENZIE RENVILLE BOTTINEAU BURKE MOUNTRAIL McHENRY WARD INVEST IN YOURSELF. SCHOLARSHIPS AVAILABLE, APPLY NOW! MC CONE McLEAN SHERIDAN FERGUS GOLDEN VALLEY STILLWATER PETROLEUM MUSSELSHELL YELLOWSTONE GARFIELD ROSEBUD TREASURE CUSTER DAWSON PRAIRIE WIBAUX FALLON GOLDEN VALLEY BILLINGS SLOPE BOWMAN DUNN MERCER OLIVER BURLEIGH MORTON STARK HETTINGER GRANT EMMONS ADAMS SIOUX If you are graduating from a high school in one of these counties you may be eligible for a full tuition and fees scholarship. Learn more at willistonstate.edu/scholarships BIG HORN POWDER RIVER CARTER CARBON 701.774.4200 1410 University Ave, Williston, ND 58801 BOOKATOUR
July, August, September 2022 The North Dakota Nurse Page 19 Play Therapy in Autistic Children Appraised By: McKenna Johnson SN,Jessica Hansen SN, Ryley Gunderson SN, Kimberly San Juan SN, Rachel Leblanc SN Allison Sadowsky MSN RN Assistant Professor of Practice (Faculty) (NDSU School of Nursing at Sanford) Clinical Question: In autistic children, what is the effect of play therapy on behavior? List of Articles: Baranek, G.T., Boyd, B.A., Crais, E.R., Dykstra, J.R., Watson, L.R. (2012). The impact of the Advancing Social-communication And Play (ASAP) intervention on preschoolers with autism spectrum disorder. Sage Pub, 16 (1), 27-44. Hillman, H. (2018). Child-centered play therapy as an intervention for children with autism: A literature review. International Journal of Play Therapy, 27(4), 198-204. https://doi.org/10.1037/pla0000083 Schottelkorb, A. A., Swan, K. L., & Ogawa, Y. (2020). Intensive Child-Centered Play Therapy for Children on the Autism Spectrum: A Pilot Study. Journal of Counseling & Development, 98(1), 63–73. https://doi-org.ezproxy.lib.ndsu.nodak. edu/10.1002/jcad.12300 Tilmont Pittala, E., Saint-Georges-Chaumet, Y., Favrot, C., Tanet, A., Cohen, D., & Saint-Georges, C. (2018). Clinical outcomes of interactive, intensive and individual (3i) play therapy for children with ASD: a two-year follow-up study. BMC pediatrics, 18(1), 165. https://doi-org Tseng, K. C., Tseng, S. H., & Cheng, H. Y. (2016). Design, development, and clinical validation of therapeutic toys for autistic children. Journal of physical therapy science, 28(7), 1972–1980. https://doi.org/10.1589/jpts.28.1972 Synthesis of Evidence: Autism spectrum disorder (ASD) is the fastest growing neurodevelopmental disorder in the U.S. The prevalence of ASD calls for study on symptoms of autism, etiology, and treatments. Symptoms of ASD include communication and language deficits, social impairment, and restricted and repetitive behaviors. ADHS, oppositional defiant disorder (ODD), obsessive-compulsive disorder (OCD), and generalized anxiety disorder (GAD) are common in children on the autism spectrum. These children are at risk for emotional and behavioral problems. Children diagnosed with ASD may have decreased quality of life, adaptive functioning, and educational achievement. As stated above, further study is needed on treatments/management for autism (Schottelkorb, 2020). Five articles including a single case study, a systemic review of four case studies, a randomized control trial, quasi-experimental and quantitative exploratory studies were reviewed as evidence in this report. Baranek (2012) conducted a single case study to examine the effect of the Advancing Social-communication And Play (ASAP) intervention on preschoolers with autism in public school classrooms. The study addressed if the implementation improved social-communication and play skills in these children and if the implementation of ASAP in both a group setting and one-to-one setting resulted in further improvements. The design utilized three phases for each participant. In Phase A, pre-data was collected as children received their typical instruction in the classroom. In Phase B, teachers and/or teaching assistants were trained and began implementing the ASAP interventions during already occurring group activities in the classroom. In Phase C, the speech-language pathologist was trained and began to implement ASAP, making social-communication and play intervention a part of both one-to-one and group settings. The study results showed at least some improvement in social communication and play skills. All participants showed either increases in frequency or more stability in targeted behaviors such as initiating social interactions. Hillman (2018) conducted a systematic review of four studies. The systematic review had two case studies and two single case designs. They threw out one of the studies so I will only talk about three of them. The studies included nine children ages 4-11 that had autism and were receiving play therapy, seven boys and two girls in all the studies. The intervention they used was child centered play therapy, which is when the children, instead of the therapist, control the pace, direction, and content of the therapeutic journey. The findings overall showed an increase in social and emotional behaviors, and a reduction in ritualistic behaviors from the use of playtherapy. Schottelkorb, A. A., Swan, K. L., & Ogawa, Y. (2020) conducted a randomized control trial that aimed to test the efficacy of Child-Centered Play Therapy (CCPT) using validated rating scales to measure core autism symptoms, attention problems, aggression problems, and externalizing problems. Participants were recruited from five elementary schools in the Northwestern United States. Play therapy rooms were established at each participant’s school. The participants consisted of 23 children aged 4-10 (19 male, four female) who displayed moderate to severe symptoms on the SRS- 2 scale. The items of the SRS-2 were used on a likert scale to measure the symptoms of social impairment. Additionally, the items of the Child Behavior Checklist were used on a likert scale to examine emotional and behavioral problems as well as adaptive functioning. The children in the CCPT group showed a decrease of eight points on the SRS-2, while the control group’s score increased by four. In addition, the children in the CCPT group showed an eight-point decrease in attention problems, a six-point decrease in aggressive problems, and a five-point decrease in externalizing problems, while the children in the control group showed a two-point increase in attention and externalizing problems (aggressive behavior remained the same). Tilmont Pittala, Saint-Georges-Chaumet, Favrot, Tanet, Cohen, and Saint-Georges (2018) conducted a quantitative prospective exploratory study. The study aimed to “assess the outcome of 20 Autism spectrum disorder (ASD) subjects who followed the 3i method for 24 months.” Using appropriate scales, they estimated the course of developmental and behavioral skills and autism severity. The 3i method was used as the intervention in this study which included the study occurring in a specific room for one on one interaction and designed to reduce unwanted sensorial stimuli, focuses on sensory specificities of the child, provides participants with developmental roadmap that improves understanding of the present abilities and difficulties on their developmental path and it distinguished three developmental age stages in their corresponding agenda (0-18 months, 18-36 months, and older than 36 months). The study found an increase by 83% in the socialization and an increase by 34% in communication. There was an increase in imitation scores by 53%. CARS (Chilhood Autism Rating Score) scores dropped significantly since the beginning of the study where 94% of the patients were considered severely autistic and 6% were moderately autistic and at the end only 21% remained severely autistic and 53% progressed to moderate autistic and 26% could be considered to no longer have autism. Tseng (2016) conducted a quasi-experimental study aimed at helping autistic children to “experience healthy growth and development and improve their language ability, behavior, and social interaction.” The study had four stages, all except one took place in a playroom at Taiwan university hospital. This playroom used direct observation with hidden cameras and microphones and measured the interaction using the Penn Interactive Peer Play Scale (PIPPS). The first stage included two autistic boys and results showed mainly passive behavior; the second stage included 13 boys and showed the interaction increased significantly between neurotypical child; the 3rd stage included just the psychiatrists and they discussed the effectiveness of the toys from their point of view and concluded that the play needed fixed rules and progressive variations; the last stage only discussed types of toys and beneficial features. Overall test results showed after the introduction of the cooperative play toy into the autism play therapy, the interaction between the children increased significantly; 2.1419 whereas it was 2.8571. Conclusions: The studies conducted in the articles included: a systematic review, a single case study, a randomized control trial, a quasi-experimental study and a quantitative prospective exploratory study with 3-23 participants in each study. Each study implemented some sort of play therapy such as the use of blocks, sensory play or pretend play. The results of all five articles indicated an improvement in social interaction with the implementation of play therapy in children with ASD. Implementing play therapy improves social and emotional behaviors and reduces negative behaviors. Implications for Nursing Practice: There is evidence to suggest implementing play therapy into interactions with children who have ASD improves social interaction and decreases negative behavior (ex. aggression). The evidence supports improvement in both group settings and one-on-one settings. The effects of this implementation will be beneficial to children with ASD and to healthcare team members when working with this specific pediatric population in all healthcare settings. Collaborating with Child Life Specialists to implement the delivery of developmentally appropriate play activities within the healthcare settings, whether it be in the patient’s room or in the play room, will promote positive behavior and social communication. The goal of implementing play therapy is to promote healthy growth, development, and improve their language ability, behavior, and social interaction. Using cooperative play to create a bridge between staff and the child with autism to overall improve the delivery of care.
Page 1 and 2: The North Dakota Nurse NORTH DAKOTA
Page 3 and 4: July, August, September 2022 The No
Page 17: July, August, September 2022 The No

The North Dakota Nurse - July 2022

Create successful ePaper yourself

Delete template?

Save as template?