Table of Contents

HK J Paediatr (New Series)
Vol 18. No. 4, 2013

HK J Paediatr (New Series) 2013;18:230-265

Proceedings of Congress

Joint Annual Scientific Meeting 2013 - Oral Presentation (Nurse's Session)

The Hong Kong Paediatric Society and Hong Kong Paediatric Nurses Association

The Effects of Mentoring on a Healthy Ambassador Training Programme for Primary School Students

LTR Lee, HNS Cheng, HNX Leung, CYT Chow, CMT Wu

School of Nursing, The Hong Kong Polytechnic University, WHO Collaborating Centre, Hong Kong; Hong Kong School Nurses Association

Background: Overweight and obesity are the nation's fastest-rising public health concern and have become a top priority in Hong Kong, with a prevalence rate of 21.7% in 2010. Adequate exercise and healthy eating have an important role to play in the prevention of child and adolescent obesity. School nurses developed an 8-month mentorship programme to engage Chinese primary school students in promoting healthy lifestyle behaviours in the school community. The aim of mentoring programme was to develop nursing students' roles and responsibility and to deliver primary health care through a community service-learning project with the aim of cultivating their social responsibility. The School Health Ambassadors (SHA) training programme aims to achieve significant and lasting effects on the schoolchildren's adoption of healthy lifestyle behaviors and in the prevention of childhood obesity. It is an innovative and effective approach for communicating important health information to peers and their family members.

Methods: This was a mixed method approach. It included a quasi-experimental research design with pre- and post-tests and followed by focus group interviews. Thirty-four Chinese primary school students, aged 10-12 were recruited from three primary schools, and four nursing students provided mentorship. The paired t-test, independent t-test and Chi-squared test were used to test the impact of the SHAs on health ambassadors' knowledge, skills and practice after attending a 2-day training programme. The study tool included a programme evaluation tool, a 5-item self-reported questionnaire measuring students' knowledge and a 10-item scale measuring their attitudes toward carrying out the tasks assigned to them as school health ambassadors.

Results: P.4-5 primary school children (N=34); males (n=12, 36%); females = (n=22, 65%); mean (s.d.) age=11.5 (1.5) years were recruited to the intervention. There was a significant difference between the scores for school health ambassadors' knowledge level at the pre-test (M=0.530, SD=0.183) and at the post-test (M=0.690, SD=0.198), with t= -4.385 and p=0.000. All the school health ambassadors (100%) agreed that the 2-day training programme had enhanced their competencies in performing the assigned tasks as health ambassadors. Relatively, health ambassadors reported increasing their health knowledge (97.1%) and meeting their expectations (94.1%), and stated that the programme had helped them to become competent health ambassadors (97.1%). Lessons were learned on how to develop relevant, focused SHA training programmes that are low-cost, sustainable and effective. The programme was evaluated for its acceptability and feasibility, and for evidence of its benefit. It was well received; with high attendance levels (95% of participants attended all planned activities). In addition, typical evaluations given by the participating health ambassadors in four focus group interviews included "I enjoyed the training programme very much", "The programme was useful and helpful to me in performing the assigned tasks such as dressing change, taking blood pressure and teaching [about] healthy snacks", and "I feel very good about being able to teach our peers and family members all this health information". This study examined the short-term impacts of the mentorship programme and key learning from the planned SHA training programme. The results were in line with the objectives of the study.

Conclusion: The study demonstrated that the SHA mentorship training programme was effective in helping Chinese primary school students to become trained health ambassadors. School nurses can plan SHA training programmes to enable young leaders to promote health with a sense of belonging in the school community.

Acknowledgement: This project was funded by the TDK TDK-SAE Corporate Social Responsibility (TDK-SAE CSR) Innovative Service-Learning Fund 2012/13.

Transferring Knowledge Into the Daily Practice - Implementation of the Protocol on the Use of 24% Sucrose for Analgesia in Neonates and Young Infants

WM Lee, J Lee, M Yeung, E Suen

Department of Paediatrics & Adolescent Medicine, Queen Mary Hospital, Hong Kong

The analgesic effect of 24%-sucrose on neonatal procedural pain has been well studied over the past 20 years and there were many recommendations that sucrose should be routinely used for analgesia in painful procedures performed on neonates and young infants.

To understand the effectiveness of repeated dose of sucrose combined with pacifier in relieving pain and distress in premature babies who undergo one of the known painful procedures, namely the eye examination for screening Retinopathy of Prematurity (ROP), a randomised doubleć¼€linded placebo-controlled study on the analgesic effect of sucrose during the ophthalmologic examination for ROP was conducted in the Neonatal care unit of Queen Mary Hospital (QMH). The result demonstrated that the loading dose of sucrose two minutes prior to the procedure and the repeated dose just before the procedure were effective in reducing pain responses in premature babies.

To what extent can the knowledge gained by this particular study together with the best available evidences by other institutes be transferred to the daily practice? A discussion on how to adopt the new practice of sucrose use was started among the members of neonatal team in 2012. Early this year, a departmental protocol was developed to address several important issues, namely, the age range, indications and contraindications, the safety dosage, proper administration procedure as well as documentation.

To ensure the knowledge and the details of the protocol are properly disseminated to staff caring neonates and infants, a number of training sessions were arranged for all staff working in neonatal units, day wards and Out-patient Department (OPD) of our unit. Also, repeated seminars on neonatal pain management were given to staff of paediatric unit and obstetric unit. Finally, resource nurse groups were set up in different neonatal & paediatric areas as well as postnatal wards to monitor the practice and feedback on problems encountered.

At the end of June 2013, the sucrose protocol is fully implemented in the whole paediatric unit. By the end of September 2013, this protocol is expected to be implemented in postnatal wards, the obstetric OPD and the paediatric cardiac unit.

This protocol was also presented to the hospital nursing management teams on July 2013 for the promotion of this protocol to other departments where infants are treated.

Enhancing Competence of Junior Nurses in Transportation of Critically Ill Patients Through Simulation Program

SK Tang, WPR Chu, FM Hui, CM Ng, KYT Kwong

Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong

Background: Transportation of critically ill patient is a high risk process for patients. It requires well planning before transfer, strong clinical judgment to detect any change of condition during the process and well communication among different health care team. Nurse is one of the key members of health care team. However, 30% of nurses in the unit are less than 3 years' clinical experience which might increase the risk during the transportation. Simulation training provides a safe environment to enhance clinical experience and clinical exposure. In order to enhance the clinical experience of junior nurses in transportation of critically ill patient, a simulation program was developed.

Methodology: Based on the past clinical near miss situations, three difference clinical scenarios and a skills checklist were developed. The duration of each session of training was one hour. Team of three nurses was participated in the scenario and they were assigned with different clinical roles in the scenario. The skills were assessed by the skill checklist. After 20 minutes of clinical exposure, a debriefing session by clinical facilitators had been conducted to ensure the objectives and the learning points of the clinical exposure would be discussed. Lastly, an evaluation form was distributed to all participants to evaluation the effectiveness of the training.

Results: Total 25 nurses were participates in the training program which is 90% of nurses whose clinical experience less than 3 years. Ninety-six percent of the participants responded that the training had achieved the learning objectives and the training content was practical for use. They commented that the training session provided a good opportunity to refresh knowledge and skills in handling of the transportation. Eighty percent of the participants rated that the program duration was appropriate. All participants recommended this training to other nursing colleagues.

Conclusion: Simulation training is an effective mode of training and learning modality to enhance nurses' clinical experience to handle transportation of critically ill patients.

Age-Differentiated Emergency Transport Bags to Ensure the Safety and Efficiency of Transport of Paediatric Patients

LY Wong, WK Lam, WK Chiu, YF Chan, PK Ma, HB Chan

Department of Paediatric and Adolescent Medicine, United Christian Hospital, Hong Kong

Introduction: Intra-hospital and inter-hospital transport of pediatric patients are common as patients have to undergo various investigations in different departments or to receive treatment from different specialties in other hospitals. Paediatric patients range from 29 days to 18 years of age. The equipments needed for transport of patients of different age groups vary significantly. Preparation of the appropriate transport equipment is time consuming. Inappropriate equipment and medical consumables might cause mortality and morbidity to the children in transport. Therefore it will be logical to prepare different emergency transport bags according to different age groups. Age-differentiated emergency transport bags program was commenced on October, 2011.

Objectives: (1) Provide safe, efficient and time-saving intra- and inter-hospital transport. (2) Prevent any omission of important medical equipment. (3) Improve patient's safety during transport. (4) Standardise the emergency transport bag in the department.

Methodology: The emergency transport bag is age-differentiated. It is divided according to three age groups: infants (<15 kg), children (15-30 kg) and young adults (>30 kg). Each bag is prepacked with different-sized intubation equipment, intravascular access device, suction tubing and tray with commonly used resuscitation drugs (pre-packed by pharmacy) according to the three age groups. In the past, pediatric nurses collected all the necessary equipment immediately before the transport. With the use of new transport bag, time is saved, and mistakes are avoided.

The same age-differentiated emergency transport bag is being introduced to all the pediatric and adolescent wards, as well as the pediatric intensive care unit. The uniformity brings efficiency and decreases errors.

Questionnaires concerning the use of old and new emergency transport bag are being distributed to Paediatrics and Intensive Care Unit (PICU) nurses.

Results and outcome: The questionnaires in 2/2012, 100% PICU nurses preferred new transport bag compared with the old one. New questionnaires of the bag conducted one year after (2/2013) implementation. It targeted the user involved medical and nursing disciplines in general ward and PICU which total 52 of peoples. Over 98% agreed the new E-bags increased effectiveness and shorten prepare time in transportation.

Conclusion: The use of age-differentiated E-Bags ensures the safety and efficiency of transport of patients. Meanwhile, time can be saved for patient care, for communication with the other departments and the receiving hospital.

The Effectiveness of the Paediatric Diabetes Improvement Program

SL Lau, YY Tung, PK Ma, DM Team

Department of Paediatrics and Adolescent Medicine, United Christian Hospital, Hong Kong

Introduction: An increasing phenomenon of elevated incidents of diabetes mellitus in childhood and adolescent is commonly world-wide. Poor adherence on treatment and irregular medical attendance affect glycaemic control leading to multi-organ complications. Therefore, a paediatric diabetes mellitus service improvement programme was launched in the United Christian Hospital since 2010.

Objectives: It aimed to determine the effectiveness of the improvement programme with the following objectives:

  1. To improve patients' HbA1c levels and glycaemic control.
  2. To decrease default outpatient attendance rate.
  3. To titrate the dosage of insulin for the patients with frequent hypoglycaemia.
  4. To empower patient's self-management.
  5. To help adolescents smooth transition to adult service.

Methodology: The program included inpatient and outpatient care with an interdisciplinary and family centered care approach. For the inpatient care, the nursing education for diabetes care was started after stabilisation of patient's condition with individualised plan according to the age and developmental stage. Checklists for blood glucose monitor and insulin injection, booklets as well as audio-visual disks had been used to empower patients' self-management and their families. School teachers and school social workers had been liaised by the nurse coordinator with providing special care and advice in school. A pocket size diabetes alert card was given to patients before discharge. For the outpatient one-stop clinic, phone contact to patient is carried out to remind the follow up appointments. A monthly "Diabetes Mellitus Nurse Specialist/ Dietitian/ Paediatrician Attendance Record" was used to monitor multidisciplinary out-patient follow-ups and advice was given to the patients accordingly. Monitoring HbA1c levels quarterly, case discussion, telephone support and support group referral were provided to facilitate the better glycemic control. The data to determine the effectiveness of the program between 2010 to 2012 included measuring mean pre and post HbA1c levels, non-attendance rates, counting of the attendance of Diabetes Mellitus Nurse Specialist/ Dietitian/ Paediatrician were collected by author. Nevertheless, a self-reported survey regarding the knowledge of hypoglycaemia management was conducted in outpatient diabetes center from 20 January 2012 to 21 December 2012. All patients aged under 18 were recruited in this study. The surveys were distributed by the clerks when the patients attended in the outpatient clinic and returned the survey forms voluntarily. Apart from these, "My Health Passport" and "Transitional Care Booklet" were used to facilitate patient's transitional care when they aged 14 or above by discussion with the adolescent nurses at least yearly in the outpatient clinic since the year of 2011. The feedbacks of the transitional care from the patients and the care givers were also obtained to evaluate the effect of the transitional care from 14 July 2012 to 18 January 2013.

Results: Thirty patients with a mean age 14 years in 2010, thirty-one patients with a mean age 12.7 years in 2011 and forty-six patients with a mean age 13.8 years in 2012 were included. The result showed that the mean pre HbA1c values were 8.8%, 9.47% and 9.04% whereas the post HbA1c values were 7.8%, 7.69% and 7.9% in 2010, 2011 and 2012 respectively. There was average decreasing 1% HbA1c values by comparing the post HbA1c values of the year in 2010, 2011 and 2012 to the HbA1c value (8.9%) in 2009 when this program had not been started yet.

The results of the non-attendance rates were 10.27%, 8.78% and 5.18% in 2010, 2011 and 2012 respectively. This reflected that there was improved in the patient follow up after the program was launched. The frequencies of appointments seen annually (consultation/patient/year) by paediatrician, diabetes nurse specialist and dietitian were 4.3, 3.5, 1.9 in 2010, 4.35, 2.45, 1.23 in 2011 and 4.2, 2.37, 1.11 in 2012 respectively. The results presented that there was decreasing trend of the patient attendant frequency in diabetes nurse and dietitian consultations. This might be caused by the increasing newly diagnosed patients, limited manpower and more time consuming for providing education to the complicated patients as said by diabetes nurse and dietitian.

The return rate of hypoglycaemia survey was 68.9%. There were 18.8% patients had experienced hypoglycaemia (hypo) attack in the past twelve months. Twent-eight percent experienced frequency of hypo attack more than 5 and 56.8% experienced one time hypoglycaemia at night. 73.8% patients were alert during hypo. Ninty-five percent patients ate sugars and 36% treated with CHO foods in addition. The records were passed to the paediatricians, diabetes nurse consultant to make titration of the dosage of insulin in order to prevent or minimise hypo attacks.

In the transitional care feedback surveys, total 18 patients (aged 14 to 18) and 20 care givers were interviewed by the adolescent nurses in 2011 and 2012 respectively. Seventy-seven percent patients and 100% care givers agreed that transitional care were important to them. They found that it could help them coping well with the change to the adult service and facilitate them more self understanding.

Conclusion: This program showed improvement in diabetic control by interdisciplinary collaboration and enhanced liaison with patients, families and schools. A multi-pronged approach to care is a crucial factor for program success. Through the team's effort, the patients and their care givers may be empowered to tackle with this lifelong disease.


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