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Addressing multidrug resistant pathogens in pediatric palliative care patients-the nurses point of view: A
Pia Schmidt1,2, Almut Hartenstein-Pinter1,2, Julia Wager1,2
1Paediatric Palliative Care Centre and German Paediatric Pain Centre, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany.
Insights
A new hygiene concept, PALLINI, was implemented in pediatric palliative care to balance infection control and social participation for children with multidrug-resistant pathogens. Nurses showed mixed feelings, highlighting challenges in balancing safety with patient well-being and social inclusion.
Area of Science:
- Pediatric Palliative Care
- Infection Control
- Healthcare Management
Background:
- Multidrug-resistant pathogens pose significant healthcare challenges, particularly for children with life-limiting conditions.
- Isolation of colonized children conflicts with social participation goals in pediatric palliative care.
- The PALLINI hygiene concept was developed to address these conflicting interests.
Purpose of the Study:
- To explore nurses' attitudes and opinions regarding the PALLINI hygiene concept.
- To understand the challenges and benefits of implementing a new hygiene protocol in a specialized care setting.
Main Methods:
- Qualitative study involving guideline-oriented interviews with nurses (N=14) on a pediatric palliative care unit.
- Content analysis was used to interpret interview data, identifying key themes.
Main Results:
- Nurses expressed ambivalence across four categories: safety, effort, quality of care, and participation.
- Conflicts identified include infection control vs. family noncompliance, workload vs. resources, and parental relationships vs. child care.
- Nurses emphasized the importance of facilitating social participation despite these challenges.
Conclusions:
- Implementing new hygiene concepts like PALLINI in pediatric palliative care is complex.
- Addressing nurses' ambivalence is crucial for successful integration of the PALLINI concept.
- Balancing infection control with social participation remains a key challenge.
Background:
Multidrug resistant pathogens are a large-scale healthcare issue. In particular, children with life-limiting conditions have a significantly increased risk of multidrug resistant pathogen colonization. Official hygiene requirements recommend children, who are colonized with multidrug resistant pathogens, to be isolated. In the context of pediatric palliative care, such isolation adversely affects the aim of social participation. To overcome this challenge of conflicting interests on a pediatric palliative care inpatient unit, a hygiene concept for patients colonized with multidrug resistant pathogens, called PALLINI, was implemented.
Aim:
The aim of this study was to identify the nurses' attitudes and opinions toward PALLINI.
Methods:
Nurses (N = 14) from the pediatric palliative care unit were queried in guideline-oriented interviews. Interviews were analyzed qualitatively by means of content analysis.
Results:
The following four categories were identified: (1) safety, (2) effort, (3) quality of care, and (4) participation. All categories demonstrated ambivalence by nursing staff regarding PALLINI. Ambivalence arose from guaranteeing infection control versus noncompliance by the families, additional workload for patients with multidrug resistant pathogens versus lack of resources, impaired relationship with the parents versus enabling better care for the child, as well as enabling some limited contact versus the larger goal of genuine social participation. Despite this, nurses reported the importance of arranging everyday-life for the patients so that they experience as much social participation as possible.
Conclusion:
The implementation of a new hygiene concept is challenging. Despite positive reception of PALLINI from the nurses, ambivalence remained. Addressing these ambivalences may be critical to best implement the new hygiene concept.
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