Biomedical subjects
Mary Jo Gilmer
Publications and source records attributed to Mary Jo Gilmer.
Circumstances surrounding the deaths of hospitalized children: opportunities for pediatric palliative care.
OBJECTIVES: Little is known regarding the assessment and treatment of symptoms during end-of-life (EOL) care for children. This study was conducted to describe the circumstances surrounding the deaths of hospitalized terminally ill children, especially pain and symptom management by the multidisciplinary pediatric care team. DESIGN: Patients in the neonatal intensive care unit, pediatric critical care unit, or general pediatric units of Vanderbilt Children's Hospital who were hospitalized at the time of death, between July 1, 2000, and June 30, 2001, were identified. Children eligible for the survey had received inpatient EOL care at the hospital for at least 24 hours before death. A retrospective medical record review was completed to describe documentation of care for these children and their families during the last 72 hours of life. RESULTS: Records of children who had received inpatient EOL care were identified (n = 105). A majority (87%) of children were in an intensive care setting at the time of death. Most deaths occurred in the pediatric critical care unit (56%), followed by the neonatal intensive care unit (31%). Pain medication was received by 90% of the children in the last 72 hours of life, and 55% received additional comfort care measures. The presence of symptoms other than pain was infrequently documented. CONCLUSIONS: The duration of hospitalization for most children dying in this inpatient setting was sufficient for provision of interdisciplinary pediatric palliative care. Management of pain and other symptoms was accomplished for many children. The documentation of pain and symptom assessment and management can be improved but requires new tools.
Youth characteristics and contextual variables influencing physical activity in young adolescents of parents with premature coronary heart disease.
This study examined influences on physical activity of young adolescents whose parents have premature coronary heart disease (CHD). Consistent with Bronfenbrenner's theory, the influences examined were personal characteristics of the subjects and selected contextual variables (peers, family, and community). Subjects were 113 youths, aged 11 to 14, 53% boys, 73% Caucasian, all with parents with premature CHD. Children were most likely to be active if their fathers were active, and those living in the coastal region were less likely to be active than other children. Peer influence interacted with both pubertal status and geographic region in its effect on children's activity. Children were more active when they had active peers only when the youth were midpubertal or when they were in the coastal region. Results emphasize the importance of nursing interventions to influence behaviors of these vulnerable children.
Beginning students' definitions of nursing: an inductive framework of professional identity.
Nursing identity is a developmental process that evolves throughout professional nurses' careers. Educational systems that prepare nurses include experiences that are important in the early development of nursing identity. Therefore, faculty in nursing programs are interested in understanding how their students perceive and define professional identity. For this study, a qualitative design was selected to explore students' early beliefs and concepts about nursing. Data were collected on the students' first day of the nursing program using the open-ended question, "What is your definition of nursing?" Using a qualitative descriptive approach, thematic analyses of the data are provided. Results revealed an inductive framework of professional nursing identity based on students' descriptions and definitions of nursing. These results demonstrate that nursing students come to an educational program with more than a rudimentary conception of professional identity. Use of these data may lead to opportunities to improve nursing students' educational experiences and foster the development of professional identity. Faculty can use knowledge of students' definitions of nursing to enrich student learning.
Web-based testing procedure for nursing students.
Web-based testing has been used to assess achievement of course objectives in a nursing school. Initial logistical challenges were met with collaboration and problem solving. Students and faculty reported satisfaction with Web-based testing.
Pediatric palliative care: a family-centered model for critical care.
Melanie's case and the associated concerns are not unique. Children with life-threatening conditions and their families and communities may benefit from a family-centered model of pediatric palliative care. Benefits from its implementation are not just at the end of life, but throughout the course of therapy. Compassion coupled with a holistic approach incorporating humane and family-centered care is essential in meeting physical, mental, and spiritual needs. An interdisciplinary and collaborative model of pediatric palliative care involves the work of many, including nurses, physicians, social workers, chaplains, child life specialists, pharmacists, ethicists, bereavement counselors, ancillary staff, volunteers, and families themselves. They must incorporate key elements of the model, including clinical services, education and training, support services, and research that address physical, mental, and spiritual needs of families, children, and communities faced with life-threatening conditions.