Publications by authors named "Myra Huth"

20 Publications

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Can't Sign Away Patient Safety.

Authors:
Myra Martz Huth

J Pediatr Nurs 2016 Sep-Oct;31(5):467-8. Epub 2016 Jun 14.

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http://dx.doi.org/10.1016/j.pedn.2016.05.003DOI Listing
September 2017

What Is 'Normal?' Evaluating Vital Signs.

Nephrol Nurs J 2016 Jan-Feb;43(1):49-58; quiz 59

Problem: Vital sign (VS) assessment and monitoring are often routinely scheduled whether they are needed or not. This practice led pediatric nurse leaders to voice concerns about the frequenty of VS at a National Summit for Pediatric and Adolescent Evidence-Based Practice. A search of databases yielded no direct evidence regarding frequency. However, we determined that before this question could be adequately addressed, we first needed answers to two other important questions concerning normative values for this population and what constitutes significant change in VS.

Clinical Questions: Among pediatric patients 1 to 5 years of age, 1) what are "normal" VS parameters, and 2) what is a significant change in VS?

Method: Additional searches, including a hand search, yielded five systematic reviews, one case-control study, five descriptive studies, and eight textbooks on normative values for children. Additionally, six articles on pediatric early warning signs (PEWS) were also reviewed.

Findings: Systematic reviews agree that vital signs are ill-defined and are a poor indicator of physical deterioration in young children. Normative VS tables are inconsistent and sometimes contradictory. Change parameters in the PEWS literature also lacked consistency. There is scarcity of high-quality, consistent research on normative VS values for children. Additionally, there is a lack of evidence to guide the frequency of assessments and use of behavioral and physiologic indicators of decline in young hospitalized children. This points to opportunities for further research in these areas. Clinicians need VS guidelines based on research to guide their clinical decision making and interventions.
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March 2016

Inpatient falls in freestanding children's hospitals.

Pediatr Nurs 2014 May-Jun;40(3):127-35

Patient falls are considered a significant safety risk, but little evidence regarding the significance of falls in children is available. A multisite, observational study of fall events occurring in pediatric inpatients (younger than 18 years of age) from Child Health Corporation of America member hospitals was conducted to determine the prevalence and significance of falls. Fall prevalence was 0.84 per 1,000 patient days with 48% classified as preventable. Injuries occurred in 32%, but only two falls resulted in an increased length of stay; none resulted in permanent disability or death. Only 47% of the children who fell were identified to be at risk for fall. Alert mechanisms were used in 60% and preventive measures in 23%. These findings suggest that while inpatient pediatric fall rates are lower than those of adults, greater diligence in identification and risk reduction may further reduce the prevalence of falls and the proportion of fall-related injuries.
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September 2014

What is 'normal?' Evaluating vital signs.

Pediatr Nurs 2013 Sep-Oct;39(5):216-24

Xavier University, Cincinnati, OH, USA.

Problem: Vital sign (VS) assessment and monitoring are often routinely scheduled whether they are needed or not. This practice led pediatric nurse leaders to voice concerns about the frequency of VS at a National Summit for Pediatric and Adolescent Evidence-Based Practice. A search of databases yielded no direct evidence regarding frequency. However, we determined that before this question could be adequately addressed, we first needed answers to two other important questions concerning normative values for this population and what constitutes significant change in VS.

Clinical Questions: Among pediatric patients 1 to 5 years of age, 1) what are "normal" VS parameters, and 2) what is a significant change in VS?

Method: Additional searches, including a hand search, yielded five systematic reviews, one case-control study, five descriptive studies, and eight textbooks on normative values for children. Additionally, six articles on pediatric early warning signs (PEWS) were also reviewed.

Findings: Systematic reviews agree that vital signs are ill-defined and are a poor indicator of physical deterioration in young children. Normative VS tables are inconsistent and sometimes contradictory. Change parameters in the PEWS literature also lacked consistency. There is scarcity of high-quality, consistent research on normative VS values for children. Additionally, there is a lack of evidence to guide the frequency of assessments and use of behavioral and physiologic indicators of decline in young hospitalized children. This points to opportunities for further research in these areas. Clinicians need VS guidelines based on research to guide their clinical decision making and interventions.
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January 2014

Codeine-related adverse drug reactions in children following tonsillectomy: a prospective study.

Laryngoscope 2014 May 13;124(5):1242-50. Epub 2013 Nov 13.

Division of Human Genetics, University of Cincinnati, Cincinnati, Ohio; Division of Pharmacy, University of Cincinnati, Cincinnati, Ohio.

Objectives/hypothesis: To prospectively determine factors associated with codeine's adverse drug reactions (ADRs) at home in a large homogenous population of children undergoing outpatient tonsillectomy.

Study Design: Prospective, genotype blinded, observational study with a single group and repeated ADR measures documented by parents at home.

Methods: A total of 249 children 6 to 15 years of age scheduled for tonsillectomy were enrolled. The primary outcome was number of daily codeine-related ADRs. We examined the number and type of ADR by race and by days and further modeled factors potentially associated with ADR risk in a subcohort of white children. Sedation following a dose of codeine was a secondary outcome measure. Parents recorded their children's daily ADRs and sedation scores during postoperative days (POD) 0 to 3 at home.

Results: Diaries were returned for 134 children, who were given codeine. A total of 106 (79%) reported at least one ADR. The most common ADRs were nausea, lightheadedness/dizziness for white children and nausea, and vomiting for African American children. In a subcohort of white children ≤ 45 kg, increased ADR risk was associated with the presence of one or more full function CYP2D6 alleles (P < 0.001), POD (P < 0.001), and sex (P = 0.027). Increased pain intensity (P = 0.009) and PODs 0 and 1 (P = 0.001) contributed to a higher sedation risk. Neither obstructive apnea nor predicted CYP2D6 phenotype were associated with sedation risk.

Conclusions: Our results provide evidence that multiple factors are associated with codeine-related ADRs and support the FDA recommendation to avoid codeine's routine use following tonsillectomy in children.
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http://dx.doi.org/10.1002/lary.24455DOI Listing
May 2014

Re: Preparing nurses for the 21st century: perceptions of nurse managers, nursing faculty, and staff nurse.

J Pediatr Nurs 2012 Jun 2;27(3):194. Epub 2012 Mar 2.

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http://dx.doi.org/10.1016/j.pedn.2012.02.010DOI Listing
June 2012

Pediatric inpatient falls and injuries: a descriptive analysis of risk factors.

J Spec Pediatr Nurs 2012 Jan 10;17(1):10-8. Epub 2011 Nov 10.

Research and Evidence-Based Practice, Center for Professional Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.

Purpose: This study identified patient characteristics and environmental factors related to falls and injuries at one pediatric hospital.

Design And Methods: This descriptive study was part of a multisite study based on inpatient pediatric falls reported over a 6-month period.

Results: Fall prevalence was .84/1,000 patient days. Thirty-one of the 53 falls (58.5%) resulted in injury; 17% required treatment. Of the injured children, 83% were developmentally appropriate, 58% were in the hospital room, and five fell from a bed.

Practice Implications: Comprehensive fall prevention programs are required to promote patient safety.
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http://dx.doi.org/10.1111/j.1744-6155.2011.00315.xDOI Listing
January 2012

The effect of suit wear during an intensive therapy program in children with cerebral palsy.

Pediatr Phys Ther 2011 ;23(2):136-42

Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.

Purpose: To examine the effects of suit wear during an intensive therapy program on motor function among children with cerebral palsy.

Method: Twenty children were randomized to an experimental (TheraSuit) or a control (control suit) group and participated in an intensive therapy program. The Pediatric Evaluation of Disability Inventory (PEDI) and Gross Motor Function Measure (GMFM)-66 were administered before and after (4 and 9 weeks). Parent satisfaction was also assessed.

Results: No significant differences were found between groups. Significant within-group differences were found for the control group on the GMFM-66 and for the experimental group on the GMFM-66, PEDI Functional Skills Self-care, PEDI Caregiver Assistance Self-care, and PEDI Functional Skills Mobility. No adverse events were reported.

Conclusions: Children wearing the TheraSuit during an intensive therapy program did not demonstrate improved motor function compared with those wearing a control suit during the same program.
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http://dx.doi.org/10.1097/PEP.0b013e318218ef58DOI Listing
September 2011

Aligning the forces of magnetism to achieve exemplary professional practice.

J Pediatr Nurs 2011 Apr;26(2):108-13

Center for Professional Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

This clinical paper presents the evolution of a Point of Care Scholars (POCS) program, which embodies three components of the Magnet model: exemplary professional practice, new knowledge, innovations, and improvements, and empirical outcomes. The drive to achieve Magnet designation and redesignation provides a focused approach on innovation. The innovative POCS program is structured to introduce new knowledge to point-of-care staff with improvements that will lead to quality outcomes. Empirical outcomes of the POCS program include practice and policy changes, improved safety, program cost, dissemination, professional advancement, and program satisfaction.
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http://dx.doi.org/10.1016/j.pedn.2010.12.004DOI Listing
April 2011

Education changes Mexican nurses' knowledge and attitudes regarding pediatric pain.

Pain Manag Nurs 2010 Dec;11(4):201-8

Center for Professional Excellence-Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA.

This study explored the effectiveness of a pain education intervention on Mexican nurses' knowledge and attitudes toward pediatric pain. A convenience sample of 106 registered nurses from three hospitals in Mexico City was recruited. A Pediatric Pain Education Program (PPEP) was developed, implemented, and evaluated by a nurse researcher, clinical nurse specialist, and a child life specialist. The 4-hour program, which was translated into Spanish, consisted of pain assessment, physiology, and management, including pharmacology and nonpharmacology. The effects of PPEP were measured in a one-group pretest-posttest design using a translated Spanish version of the Pediatric Nurses' Knowledge and Attitudes Survey (PNKAS). A total of 79 nurses completed both tests. A paired t test indicated significant differences between pre- and posttest results (p < .0001) on the PNKAS. The hospital site and years of nursing experience were significantly related to nurses' pre- and post-PNKAS scores. One test item on children's ability to reliably report their pain had a significantly lower score after the intervention (p = .016). The intervention was effective in improving Mexican pediatric nurses' knowledge and attitudes. However, it is not known how long this effect was maintained. Health care professionals can share a common vision for pain management by increasing international collaborative efforts and by advancing pediatric pain knowledge.
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http://dx.doi.org/10.1016/j.pmn.2009.11.001DOI Listing
December 2010

Evaluation of the Magic Island: Relaxation for Kids, compact disc.

Pediatr Nurs 2009 Sep-Oct;35(5):290-5

Center for Professional Excellence-Research and Evidence-Based Practice, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

Managing post-operative pain continues to elude health care professionals despite children's reports of severe pain. Although research has demonstrated that guided imagery is a beneficial complementary treatment for pain, clinicians rarely incorporate it into their practice. This study evaluated the effectiveness of a guided imagery audio compact disc (CD) in reducing post-operative pain, increasing relaxation, and stimulating imagery in children by child life specialists in the clinical setting. This cross sectional study compared pain and relaxation scores before and after the use of the CD. Sixteen children (7 to 12 years of age) reported pain on a 0 to 10 scale and relaxation on a 1 to 5 scale, and answered questions about what they imagined. Pain scores were significantly decreased, with no significant differences in relaxation scores. Findings support that school-age children are capable of using guided imagery, and relaxation may not be necessary to achieve pain reduction.
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December 2009

Evidence-based practice and the road to Magnet status.

J Nurs Adm 2008 Feb;38(2):97-102

University of Cincinnati College of Nursing, 3110 Vine Street, Cincinnati, OH 45221, USA.

Conducting research and using evidence-based practice play a major role in achieving Magnet status, the sought-after recognition awarded by the American Nurses Credentialing Center to healthcare institutions that exhibit nursing excellence. The authors present a synopsis of a conference sponsored by a Sigma Theta Tau International consortium in which a panel of nurse leaders distinguishes between research and evidence-based practice and discusses strategies to achieve both in the journey to Magnet status.
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http://dx.doi.org/10.1097/01.NNA.0000310715.07850.b8DOI Listing
February 2008

Improving healthcare and outcomes for high-risk children and teens: formation of the National Consortium for Pediatric and Adolescent Evidence-Based Practice.

Pediatr Nurs 2007 Nov-Dec;33(6):525-9

Arizona State University College of Nursing & Healthcare Innovation, Phoenix 85004, USA.

Although major healthcare and professional organizations as well as key leaders have long emphasized the importance of evidence-based practice (EBP) in improving patient care and outcomes, the majority of healthcare professionals do not implement EBP. There is a huge gap in time that exists between the generation of research findings and the translation of those findings into clinical practice. Many efficacious interventions are not being used in clinical practice even though research findings suggest that they improve child and adolescent health and development. Conversely, many clinical practices are being implemented without sufficient evidence to support their use. Because of the need to accelerate EBP and to generate evidence to support best practices, the first EBP Leadership Summit focused on children and adolescents was conducted in February 2007. Several nationally recognized EBP experts and healthcare leaders from a number of children's hospitals and colleges of nursing across the U.S. participated in the Summit. This article describes the process used and outcomes generated from this landmark event in child and adolescent healthcare, including the launching of the new National Consortium for Pediatric and Adolescent EBP (NCPAEP). Future directions of the consortium also are highlighted.
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March 2008

A snapshot of children's postoperative tonsillectomy outcomes at home.

J Spec Pediatr Nurs 2007 Jul;12(3):186-95

Center for Professional Excellence, Research and Evidence-Based Practice, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

Purpose: To describe home outcomes of pain, medication use, fluid intake, and emesis 24 hr after tonsillectomy and adenoidectomy. The theory of unpleasant symptoms provided a conceptualizing framework.

Design And Methods: A secondary analysis was conducted. Outcomes for 76 children were recorded on a home diary that included: self-reported pain, analgesic use, fluids ingested, and emesis. Descriptive and inferential statistics were used.

Results: Children reported moderate pain. Children who received analgesics received less than recommended standards. Only 11% of the children drank the recommended fluids, and 31% of the children vomited at home.

Practice Implications: Parents need to become partners in pain management. Recommend multimodal discharge teaching and follow-up phone call at home to ensure adequate analgesic administration and fluid intake.
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http://dx.doi.org/10.1111/j.1744-6155.2007.00111.xDOI Listing
July 2007

Functional changes in children, adolescents, and young adults with cerebral palsy.

Res Dev Disabil 2007 Jul-Sep;28(4):331-40

Center for Infants and Children with Special Needs, Cincinnati Children's Hospital Medical Center, Universty of Cincinnati College of Medicine, ML 7009, Cincinnati, OH 45229-3039, USA.

Children with multiple handicaps, including cerebral palsy (CP), often lose or regress in their functional ability through adolescence and adulthood. The purpose of this study was to examine functional and psychological changes in children, adolescents and young adults with CP. A retrospective chart review and a prospective telephone interview of 30 patients (11-29 years, M = 16.8, S.D. = 4.9) was conducted. Seventy-three percent of the patients were male (n = 22) and 83% (n = 25) had spastic CP. According to the McNemar's test, four significant functional losses were found including crawling (p = 0.03), standing independently (p = 0.05), walking with or without assistance (p = 0.014), and eating by mouth (p = 0.01). Standing function loss was significantly related to walking function loss (p = 0.02). Sixty-three percent (n = 19) of the patients experienced anxiety and 10% (n = 3) reported depression. Results of this study indicate that a validated yearly assessment tool is needed to measure functional and emotional changes in children with CP rather than relying on parent recall. This data may also lead to a review of the current physical therapy national standards.
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http://dx.doi.org/10.1016/j.ridd.2006.03.005DOI Listing
October 2007

Playing in the park: what school-age children tell us about imagery.

J Pediatr Nurs 2006 Apr;21(2):115-25

Center for Professional Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.

The purpose of this exploratory study was to describe children's use of imagery before and after ambulatory surgery (AS). The study sample was a subset of 75 children (7-12 years) who were randomly assigned to the treatment group (n = 38) from five AS settings in a larger study on the effectiveness of imagery after surgery. They listened to an audiotape of imagery before surgery, after surgery, and after discharge from AS. Imagery use was evaluated with the Imagery Assessment Questionnaire and a home diary. Imagery tapes were used significantly more times at home after surgery than before surgery. There were no significant changes in the children's Imagery Assessment Questionnaire scores at any time point. Children most often imagined going to the park when they used the tape.
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http://dx.doi.org/10.1016/j.pedn.2005.06.010DOI Listing
April 2006

The effects of massage therapy in improving outcomes for youth with cystic fibrosis: an evidence review.

Pediatr Nurs 2005 Jul-Aug;31(4):328-32

Center for Professional Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

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December 2005

Imagery reduces children's post-operative pain.

Pain 2004 Jul;110(1-2):439-48

Center for Professional Excellence MLC 11016, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA.

This un-blinded experimental study investigated the effectiveness of imagery, in addition to routine analgesics, in reducing tonsillectomy and/or adenoidectomy pain and anxiety after ambulatory surgery (AS) and at home. Seventy-three children, aged 7-12, were recruited from five AS settings. Thirty-six children randomly assigned to the treatment group watched a professionally developed videotape on the use of imagery and then listened to a 30-min audio tape of imagery approximately 1 week prior to surgery (T1). They listened to only the audio tape 1-4 h after surgery (T2), and 22-27 h after discharge from AS (T3). The 37 children in the attention-control group received standard care. Pain and anxiety were measured at each time-point in both groups. Measures of sensory pain were the Oucher and amount of analgesics used in AS and home; affective pain was measured with the Facial Affective Scale (FAS). Anxiety was measured using the State Trait Anxiety Inventory for Children (STAIC). When controlling for trait anxiety and opioid and non-opioid intake 1-4 h before the pain measures, MANCOVA showed significantly lower pain and anxiety in the treatment group at T2, but not at T3. When controlling for trait anxiety, a two-way RM MANCOVA indicated no significant group differences in combined opioid and non-opioid use between the groups, or between times. Appropriately trained health care providers should use imagery to reduce post-operative pain following tonsillectomy and/or adenoidectomy in AS. Teaching parents about adequate home administration of analgesics may increase the effectiveness of imagery at home.
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http://dx.doi.org/10.1016/j.pain.2004.04.028DOI Listing
July 2004

Controlled-release oxycodone for the management of pediatric postoperative pain.

J Pain Symptom Manage 2004 Apr;27(4):379-86

Jane B. Pettit Pain and Palliative Care Center, Chidren's Hospital of Wisconsin, Milwaukee, 53201, USA.

Studies addressing pain management after pediatric spinal fusion surgery have focused on the use of patient-controlled or epidural analgesia during the immediate postoperative period. Controlled-release (CR) analgesics have been found to be safe and effective in adults. The purpose of this study was to describe the use of oxycodone-CR in pediatric patients after the immediate postoperative period. A retrospective chart review of 62 postoperative spinal fusion patients (10-19 years) was conducted. The mean initial oxycodone-CR dose was 1.24 mg/kg/day. The mean ratio of conversion from parenteral morphine equivalents to oxycodone-CR was 1:1. Mean pain scores decreased from 4.2/10 to 3.7/10 with the transition to oxycodone-CR. Common side effects included dizziness, constipation, and nausea. Oxycodone-CR was used for an average of 13.3 days, which included an average wean time of 6 days. Results of this study demonstrate safe and effective use of oxycodone-CR in the pediatric spinal fusion population.
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http://dx.doi.org/10.1016/j.jpainsymman.2003.08.007DOI Listing
April 2004

A study of the effectiveness of a pain management education booklet for parents of children having cardiac surgery.

Pain Manag Nurs 2003 Mar;4(1):31-9

Jane B. Pettit Pain and Palliative Pain Center, Children's Hospital of Wisconsin, Milwaukee 53201-1997, USA.

Parents need education about pain so they can support their hospitalized child and manage their child's pain at home. The purpose of this study was to examine the effectiveness of a pain booklet on parental pain support to children experiencing postoperative pain. A randomized, repeated measures, experimental design using a pain education booklet and a standard care comparison group was used to study parents of 51 children (3 to 16 years of age) having cardiac surgery. Measurement techniques used to assess differences in parental pain management included: attitudes about pain medication, child and parent pain ratings (Oucher), opioids used, recovery, satisfaction, and comfort in communication. Results indicate that children do report moderate levels of pain postoperatively. Parents who were exposed to the pain assessment and management for parents education booklet preoperatively significantly increased their knowledge and attitudes toward pain medication scores from pre- to post-test, whereas those in the control group remained stable. Post-test scores were not significantly different between groups. Child and parent pain ratings were significantly and positively correlated. Practice implications include the use of an educational booklet about pain with parents before surgery to increase their knowledge about and attitudes toward pain management. Additionally, a parent may provide an alternative pain report when a child is unable to or unwilling to self-report their pain.
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http://dx.doi.org/10.1053/jpmn.2003.7DOI Listing
March 2003