PubMed · 12964329
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M Bliss. 2001. Reducing the pressure.. https://pubmed.ncbi.nlm.nih.gov/12964329/
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PURPOSE: To explore how information about children's sleeping arrangements contributes to nurse practitioners' (NPs) assessment of children's developmental progress at toddlerhood. DATA SOURCES: Selected research articles and a survey of NPs' assessments of development for toddlers engaged in solitary and shared sleeping arrangements. CONCLUSIONS: Research does not provide definitive information regarding the connection between children's engagement in different sleeping arrangements and children's development. In this study, information about how sleeping arrangements played a role in NPs' ratings of toddlers' current and predicted social development and autonomy, but not toddlers' language skills, is presented. NPs' ratings of the development of boys who engaged in shared sleeping arrangements suggested that NPs' viewed this sleeping arrangement as a risk factor for both social development and autonomy. Shared sleeping arrangements for girls were not identified as a risk factor, with some analyses suggesting that shared sleep may have a positive impact on girls' social development. IMPLICATIONS FOR PRACTICE: Assessing children's developmental progress is one task completed by Family and Pediatric NPs. NPs gather information across many sources in making these developmental assessments. Type of sleeping arrangement can be one of these sources as it has been connected to children's developmental progress. However, information available in the literature is inconclusive and often contradictory in regard to how sleeping arrangements impact development. To help clarify how NPs currently use information concerning sleeping arrangements to assess developmental progress, this report describes how sleeping arrangements influenced ratings of 18-month-old toddlers' current and later predicted levels of development. This information can help NPs develop strategies for assessing development in light of information regarding sleep arrangements.
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Advancing technology, an aging population, increasing attention to appropriate resource use, and growing concerns about patient safety and professional liability combine to complicate support surface choice. Cognizant of these factors, staff in a 600-bed tertiary care hospital in a large urban center in western Canada decided to evaluate an existing specialty support surface decision tool and update the instrument based on current published literature (no older than 3 years), expert opinion, and results of pilot testing. Elements included in the existing tool were the patient's Braden Score, mobility/activity indicators, and identification of existing skin breakdown. The tool allowed considerable latitude in decision-making based on other clinical factors and established professional practices and had not been formally evaluated. The revised tool addressed relevant assessment criteria such as risk category, patient weight, presence of existing skin breakdown/number of ulcers, flap surgery, pulmonary complications, palliative care, positioning, and Braden score, as well as oversight of support service choice. Although the incidence of nosocomial pressure ulcers did not change significantly during the trial period, costs incurred for support surface use decreased 26% overall, underscoring the need for improved guidelines for support surface selection.