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Show EHSL EBP Gallery Annie Walton, BSN Candidate Fall 2020 Title: Implementation of a Visual Schedule for Pediatric Patients to Ease Transitions of Care During Hospitalization Summary: The use of a visual schedule should be implemented as a communication tool for pediatric neuroscience patients because it has been shown to decrease challenging behaviors and may ease transition times between cares. Implementation of a Visual Schedule for Pediatric Patients to Ease Transitions of Care During Hospitalization a Annie Walton, Student Nurse NURS 4605 Fall 2020 Background PICOT Question • A lack of structure for patients in the acute care setting can cause pediatric patients to feel powerless. They may respond with anxiety or aggression when they lack control (3). • Both underlying behavioral and medical causes need to be considered during transitions because untreated pain and anxiety can result in challenging behaviors including noncompliance, sensory defensiveness, hyperactivity, and self-injury (2). • A visual schedule can significantly reduce anxiety of children (1). • Picture schedules support psychosocial adjustment during health care encounters by helping children visualize the sequence of events (4). For pediatric neuroscience patients, how does a posted visual schedule that outlines the cares and treatments for the day, as compared to no visual schedule, used to ease transitions of care during hospital admission, affect caregiver/family satisfaction scores with patient care over a 90-day period? Implementation Training would be provided to the healthcare team on how to use the visual schedule to communicate with children during transitions of care. Proposed Intervention Following current best practice, a new policy is proposed to ease transitions between care for pediatric neuroscience patients: • A visual schedule will be made for each patient upon admission. • The admitting nurse would collaborate with the child and their primary caregiver to tailor the daily schedule to include both the child’s plan of care such as therapies and elements of their home routine such as reading a book before bedtime. • The visual schedule would be posted in the child’s room and reviewed with the patient during transition time between activities/interventions. During bedside report, nurses would review the daily plan of care using the visual schedule and set associated goals for the shift. Healthcare team members would review the schedule using “first…, then…” language during transitions to prepare the child for what is going to happen next and what to anticipate after. References 1. Grofer Klinger, L., Ence, W., & Meyer, A. (2013). Caregiver-mediated approaches to managing challenging behaviors in children with autism spectrum disorder. Dialogues in Clinical Neuroscience, 15(2), 225–233. 2. Johnson, N. L., & Rodriguez, D. (2013). Children with autism spectrum disorder at a pediatric hospital: A systematic review of the literature. Pediatric Nursing, 39(3), 131–141. 3. Lerwick J. L. (2016). Minimizing pediatric healthcare-induced anxiety and trauma. World Journal of Clinical Pediatrics, 5(2), 143–150. https://doi.org/10.5409/wjcp.v5.i2.143 4. Straus, J., Coburn, S., Maskell, S., Pappagianopoulos, J., & Cantrell, K. (2019). Medical encounters for youth with autism spectrum disorder: A comprehensive review of environmental considerations and interventions. Clinical Medicine Insights: Pediatrics, 13, 1-7. https://doi.org/10.1177/1179556519842816 COLLEGE OF NURSING |
