Incorporating Technology in Pediatric Care

Noah M Carpenter

Missouri Southern State University

NURS 456: Evidence-Based Practice

Professor Kathleen Cowley

April 7th, 2024

 Introduction

Families of pediatric patients in hospital care experience increased issues related to

holistic care and patient satisfaction due to the higher stress involved between both the patient

and their caregivers. Research has shown that, “Many parents experience substantial stress from

being away from their child and not receiving timely, open communication that is presented in an

easily understood manner” (Shawley & Whiteman, 2023). To alleviate this, a focus should be put

on holistic care for these pediatric patients. For this paper, holistic care is defined as care that is

not just centered on the patient, but on their family as well. Being able to care for both the patient

as well as the family is crucial for positive outcomes in the patient and reduced stress in their

caregivers. Since having their child in a hospital setting is stressful and traumatizing enough,

being able to ease the burden of the caregiver(s) by having open communication and utilizing

technological advances is crucial.

Problem Statement

In pediatric patients, what is the effect of using technology including virtual and digital

treatments, compared to current practices, on holistic care of patients and their families?

SMART Outcome

A SMART outcome is a goal that achieves the standards of the acronym that it’s named

after. SMART stands for specific, measurable, achievable, relevant, and time-bound.

Specific–the goal clearly states what will be done and who will do it; Measurable–the goal

includes how the action will be measured; Achievable–the goal is realistic and can be attained;

Relevant–the goal makes sense; Time-based–the goal has time-oriented steps and can be
followed. The use of a SMART outcome ensures that the goal is organized as well as purposeful,

and helps to put steps in place to achieve this goal. As related to this problem statement, the

SMART outcome of this paper is–hospitals will improve holistic care in pediatric patients within

the next five years by implementing virtual and digital treatments, evidenced by health outcomes

alongside improved patient and family satisfaction surveys upon discharge.

Search Method

Literature Research

The research engine used was an institutionally funded program that allowed access to

various different databases in one combined service. This service has their own collection of

numerous academic journals, articles, and similar writings that cover a vast amount of topics and

help aid in research.

Search Criteria

The key terms used included various combinations of (a) pediatric care, (b) holistic care,

(c) technology in hospitals, (d) intensive care, (e) atraumatic care, and (f) advancements in

hospital technology. These terms were chosen to cover a scope of information that encompassed

any and all articles that discussed the use of technology in current practice that had potential

effects on pediatric patients and their families. The use of various combinations of search terms

helps to both narrow down the view onto articles that help to support research while also

broadening the perspective to include articles that may have not been recognized by the system

as relevant.

Exclusion Criteria
 Documents were limited to only include those that are (a) published within the last five

years, (b) included the full text, (c) scholarly, and (d) peer-reviewed. These parameters were to

ensure that the sources included only the most recent of information to prevent the possible use

of outdated information, as well as scholarly and peer-reviewed to guarantee that these

documents were legitimate and factual.

Source Table

Source Author(s) Study Study Design Sample Population Study Aim and Evidence
and Year Location Method Strength

1 Emily USA “Nurses 36-bed academic, To test if offering III

Shawley, offered tertiary care telerounds to
Kimberly telerounds to pediatric hospital families who
Whiteman pediatric during the couldn’t round
(2023) intensive care COVID-19 daily would
unit family pandemic improve
members who outcomes
could not
attend rounds,
they received a
link to
telerounds
using a secure
connection.”
(Shawley &
Whiteman,
2023)
They then
filled out a
survey at the
end of the stay
on the unit.
2 Paines, L. Brazil “quantitative, children below one To identify the IV
P., Ribeiro, documentary, year of age coming demographic and
A. C., and from the pediatric clinical profile of
Kegler, J. J., retrospective emergency room, technology-depen
Monteiro, study based on with a history of dent children and
A. S., medical conditions, the use adolescents at the
Sehnem, G. records of of long-term time of hospital
D., & technology-dep medication, and the discharge from a
Neves, E. T. endent prevalence of Pediatric
(2023) children/adoles diseases of the Intensive Care
cents admitted respiratory system Unit
to the PICU of and congenital
a teaching malformations
hospital in
southern
Brazil”
(Paines et al.,
2023)
3 Denise Australia, “participant Clinicians in To see the IV
Alexander, Ireland, the took part in an PICUs, or closely meaning
Mary Netherlands unstructured allied to the care of clinicians give to
Quirke, and the interview with children in PICUs, the bioethical
Carmel United one of the six in four countries considerations
Doyle, States interviewers in associated with
Katie Hill, the research the availability of
Kate team, increasingly
Masterson, participants sophisticated
Maria were asked to technology
Brenner recall a recent
(2023) experience they
had of a child
who needed, or
who had,
invasive long
term
ventilation
initiated to
sustain life”
(Alexander et
al., 2023)
4 Isabel Spain “ literature “52 critical care “to protocolize IV
Muñoz review was beds distributed and centralize the
Ojeda, conducted to among 3 ICUs: management of
Marina determine medical ICU (17 high-alert
Sánchez-Cu accurate beds), coronary medications in
ervo, Ángel administration ICU (15 beds), and acute care settings
Candela-To rate limits for general surgical and to implement
ha, Dolores the high-alert ICU (20 beds)” smart intravenous
R. analgesic and (Ojeda et al., 2023) infusion pump
Serrano-Lóp sedative IV technology in
ez, Teresa medications” intensive care
Bermejo-Vi (Ojeda et al., units”
cedo, Juan 2023) (Ojeda et al.,
Miguel 2023)
Alcaide-Lóp
ez-de-Lerm
a
(2023)
5 McGoron, USA “Participants five parent Efficacy and V
Lucy, first saw the participants and usability of online
Towner, initial five physician behavioral parent
Elizabeth check-up, participants in each training for
K., Martel, Participants iteration, from the parents of
Michelle were then same large city, children
M., asked interview with a high
Trentacosta, questions about concentration of
Christopher the initial poverty, in the
J., check-up. Midwest. Parents
Purkayestha Participants were recruited at
, Sharmi, saw a pick-up and
Friedrich, document with drop-off times at
Florentine a list of childcare centers
S., Traylor, modules along and a participant
Parris, with a brief registry if they had
Ondersma, explanation” a child between the
Steven J. (McGoron et ages of two and
(2023) al., 2023). five years old.
 6 Jef Willems, Belgium “observational mixed PICU of a To see if the IV
Adeline prospective Belgian tertiary COSARAPed-pla
Heyndrickx, cohort study hospital tform allowed for
Petra comparing better quality of
Schelstraete patient handover with a
, Bram handovers lower risk of
Gadeyne, during IDWRs omission
Pieter De using the
Cock, Stien COSARAPed-
Vandendries platform to
sche, Pieter those with
Depuydt access only to
(2024) conventional
resources”
(Willems et al.,
2024)

Synthesis of Findings

When looking at the first source by Shawley and Whiteman, there is a clear result that

families and nurses are very satisfied by the use of telerounding. When given surveys after the

telerounding was implemented, “ Nine family members (56%) returned satisfaction surveys

revealing an overall satisfaction level of 9.9 out of 10. Thirty nurses reported an overall

satisfaction level of 8.8 out of 10. Eleven physicians reported a mean satisfaction level of 8.8 out

of 10” (Shawley & Whiteman, 2023). This is a very significant result and should be further

tested in future studies, but shows a strong plausibility that telerounding will improve holistic

care in pediatric settings.

The second source by Paines et al. discusses the difficulty involved in treating children in

an intensive care setting, as well as the difficulty it puts on their caregivers. In regards to holistic

outcomes, it is discovered that, “healthcare teams must plan care actions considering the child or

adolescent and their caregivers to ensure the delivery of comprehensive care” (Paines et al.,
2023). Healthcare staff should be mindful of both the patient as well as their families and/or

caregivers to ensure holistic care–care for not just the patient but the patient’s family and

caregivers as well.

The third source written by Alexander et al. talks about bioethical considerations that

clinicians have to face when caring for pediatric patients. With the addition of newer

technologies being able to implement life-saving measures younger and younger, morality comes

into play when deciding if it is right or wrong to intubate a very young child with the chance of

them being on a ventilator for a majority if not the remainder of their lifetime. Due to this,

Alexander et al. recognize that the current day and age is a, “time of technological change, and of

change in the way decisions can be made and how they are made” (Alexander, 2023). This

means that clinicians will have to have more frequent and more open communication with

families to keep them informed about potential life saving options for their children, and doing

so has shown to lead to increased patient outcomes and improved holistic care as the families

have the burden of the unknown partially relieved.

The fourth source by Ojeda et al, talks about the use of newer technology to improve

safety regarding high-alert medications such as those for anesthesia and sedation. Through the

use of protocolization and centralization, mainly in areas where the critically ill are being treated,

potentially serious medication errors may be omitted. Ojeda et al. also speak highly about the use

of updated technologies in the hospital, and go on to say that, “technology must be accompanied

by a hospital culture in which the technology is actually used” (Ojeda, 2023). A hospital may

have the best technology in the area but if their staff are unequipped to utilize it properly then it

is of no use. An important part of implementing telerounding, medication reviewing technology,

and various other improvements is involving the nurses, clinicians, and anyone who may use the

technology in training courses or seminars to ensure proper utilization.

The fifth source, written by McGoron et al., researches the use of technology-based

young children check-up interventions involving behavior problems. Parents of misbehaving

children may have difficulty finding a specialist to help with their child’s behavior, due to time or

financial situations, but being able to utilize an online program led to increased satisfaction in

these parents. This study brings about the possibilities of further implementation of online

resources for parents such as telehealth or telerounding for children in hospitals. McGoron et al.

state numerous times throughout the dialogue that, “Technology is a promising high-reach and

accessible method for delivery of evidence-based content” (McGoron, 2023). They recognize

that technology will allow for much higher patient satisfaction and increased holistic care, both

in and out of the hospital setting.

The final source by Williams et al. talks about how new technologies have further

improved outcomes of patients as well as their satisfactions upon discharge. Technology being

incorporated into the patients care also gives clinicians an easier way to consider bioethical

dilemmas, such as placing these children on ventilators or intubating them, to be able to prolong

their lives. Being able to allow parents of children that are in extreme isolation precautions due

to a disease to visit through the use of telerounding allows them to better understand and accept

procedures that clinicians may have to take to better the child's health outcomes. As evidenced

by the use of telerounding as well as clinician and patient/family satisfactions, Williams et al.

note that, “Technological advances are a key feature of pediatric intensive care” (Willems et al.,

2024).
 Recommendation

To achieve the aforementioned SMART goal, we can implement some of the

recommendations given from the articles. The implementation of telerounding in intensive care

settings discussed by Shawley and Whiteman would allow for family and caregivers of children

in acute care to visit their child and foster a sense of connection without requiring them to take

extended time away from their jobs for the duration of their child’s stay. This would also give the

child a sense of encouragement, if they are of the age to recognize so, and fend off any sense of

abandonment while allowing those involved to do normal activities of life as they need to.

As discussed by Ojeda et al., there would need to be an adequate amount of educational

and learning material for both those in the hospital setting, as well as parents and caregivers at

home to be able to ensure proper utilization of the technologies leading to the desired outcome of

improved patient and family satisfaction surveys upon discharge. This may include but is not

limited to: educational videos and reading, mock examples of how to perform certain tasks,

clinical testing groups to research how user-friendly and intuitive the technology is, or a 24/7

support line for users to contact regarding assistance in their use of the technology.

Roles and Responsibilities of the RN

The nurse must be aware of this EBP as it is crucial to the outcomes of pediatric patients

in critical care and their families. To be able to accomplish this, the nurse must be responsible for

keeping up to date on the necessary learning involved in utilizing the technology, and advocating

for the use of said technology in their care where it may not be implemented yet.

Clinical Question

As an RN, you would have the same responsibilities discussed prior, as well as ensuring

that the family of the patient is able to properly understand how to utilize the technology. As
discussed by Ojeda et al., it is very important for the family of the patient to be able to

completely understand how to utilize the telerounding and implemented technologies. It would

change my practice as I would have to have an in-depth discussion with the families about how

to utilize their new technologies. Other RNs would also have their practices changed as they

would have to have the same teaching discussion with their patients and families.

Going Forward

Moving forward, I will use this EBP in my practice as I will ask any families with

pediatric patients in the CVICU or any acute care setting if they would like to utilize

telerounding and utilize the ability to see their child remotely whenever they would want to.

Stakeholder

For this EBP to actually be implemented, there would need to be many things addressed

and created. There would have to be the normalization of telerounding in all hospitals, and then

there would have to be the creation of a more simple system to ensure a more successful

outcome. The stakeholder required would be someone who is an advocate for the creation and

implementation of this system, and who has the power to present this idea to hospital leaders.

They would need to show this idea to those in charge and introduce them to the idea as well as

the pros and cons, and work with them to create this system.

Challenges

There were many challenges that I experienced during this research, and the majority of it

was related to finding sources that weren’t locked behind paywalls. Having to find sources that

were available to anyone who wanted to read them proved difficult, and the sources that I did

find tended to have lesser research than the others that I had wanted to read.

Strengths
 I had an “ah-hah” moment when I was at work and was caring for a pediatric patient,

whose parents were having difficulty processing their child being alone in the CVICU. I enjoyed

piecing together all of the sources and building them into a sturdy argument and seeing my final

product come together. I will use this evidence based practice in my real practice, since it creates

a better holistic care for the patient as well as their family.

 References

Shawley, E., & Whiteman, K. (2023). Interprofessional Telerounds in a Pediatric Intensive Care

Unit: A Quality Improvement Project. Critical Care Nurse, 43(5), 9–16.

https://doi.org/10.4037/ccn2023416

Paines, L., Cammarano Ribeiro, A., Kegler, J. J., Monteiro, A. S., Dutra Sehnem, G., &

Tatsch Neves, E. (2023). The profile of technology-dependent children and adolescents in

a pediatric intensive care unit. Revista de Enfermagem Referência, 6, 1–9.

https://doi.org/10.12707/RVI22028

Alexander, D., Quirke, M., Doyle, C., Hill, K., Masterson, K., & Brenner, M. (2023, August 28).

Technology solutionism in paediatric intensive care: Clinicians’ perspectives of

bioethical considerations - BMC Medical Ethics. BioMed Central.

https://doi.org/10.1186/s12910-023-00937-6

Ojeda, I. M., Sánchez-Cuervo, M., Candela-Toha, Á., Serrano-López, D. R., Bermejo-Vicedo, T.,

& Alcaide-López-de-Lerma, J. M. (2023). Protocolization of Analgesia and Sedation

Through Smart Technology in Intensive Care: Improving Patient Safety. Critical Care

Nurse, 43(4), 30–38. https://doi.org/10.4037/ccn2023271

McGoron, L., Towner, E. K., Martel, M. M., Trentacosta, C. J., Purkayestha, S.,

Friedrich, F. S., Traylor, P., & Ondersma, S. J. (2023). Developing the technology-based

parenting young children check-up intervention for disruptive behavior problems

identified in pediatric primary care. Clinical Practice in Pediatric Psychology.

https://doi.org/10.1037/cpp0000498.supp

Willems, J., Heyndrickx, A., Schelstraete, P., Gadeyne, B., De Cock, P., Vandendriessche, S., &
Depuydt, P. (2024). The use of information technology to improve interdisciplinary

communication during infectious diseases ward rounds on the paediatric intensive care

unit. Scientific Reports, 13(1), 1–7. https://doi.org/10.1038/s41598-024-51986-9