Abstract
In pediatric units, the safety of children is a priority along with the provision of high-quality care. The problem is that it is necessary to prevent safety issues, including possible child abduction, and avoid ethical issues associated with the relationships between caregivers and patients and caregivers and the staff. As a result, there is a need for using certain identification systems for caregivers like the application of wristbands for infants and their parents. The purpose of this quantitative project is to determine how the use of identification wristbands for caregivers in the pediatric unit of Newark Beth Israel Hospital can affect children’s safety according to nurses’ views. A descriptive research design is selected for conducting this project to determine the differences in using or not identification wristbands in caregivers in the chosen pediatric unit with a focus on changes in safety of children referring to nurses’ perceptions. The results of the project contribute to theory and practice as they cover the gap in evidence of how identification wristbands used not in patients but in caregivers can influence the safety of hospitalized children.
Keywords: identification wristbands, patient safety, pediatric nursing, caregivers.
Introduction
The safety of children in pediatric units is one of the most challenging issues in the scope of practical healthcare and nursing. It is important to note that when providing healthcare services for children, nurses need to ensure that they guarantee safety and quality of care for these minors (Linnard-Palmer & Coats, 2016; Silva et al., 2019). Still, specialized pediatric facilities and different types of pediatric units in hospitals are characterized by a range of challenges and barriers for young patients in terms of their safety and adaptation to new unfamiliar environments.
In this context, parents as caregivers and other visitors, including family members, who can provide support to children, are typical of these settings. This situation creates the necessity of identifying caregivers as the members of a young patient’s family in order to prevent a situation when strangers can visit a pediatric unit and affect the safety of children (Silva et al., 2019; Tase & Tronchin, 2015). It is difficult to identify caregivers and parents among all hospital visitors who have the right to communicate with young patients if there are no bands or other identification signs for the personnel to notice.
From this perspective, the area of young patients’ safety in pediatric units includes such issues as risks of accidents and cases of child abduction. There are situations when strangers can access young patients in pediatric units if there are no effective safety measures to protect children (Mahalakshmi, Abarna, & Meena, 2018). Child kidnapping is reported to be typical of any country, and the main prevention strategies in this case are the developed security system and effective safety procedures adopted in hospitals (Linnard-Palmer & Coats, 2016; Mahalakshmi et al., 2018; Tase & Tronchin, 2015). Thus, the reason determined for conducting this project is the necessity to implement the change in a pediatric unit in order to promote safety and avoid risky situations for young patients. As a result, the purpose of the planned change is to reduce any possible risks for hospitalized children regarding their communication with people other than medical workers and their caregivers. Additionally, it will be possible to decrease the number of errors in pediatric units that are associated with the misuse of bands for identification in both patients and caregivers.
The purpose of this Capstone Project is to describe the process of implementing the change in the pediatric unit at Newark Beth Israel Hospital regarding the promotion of using identification wristbands for caregivers. This chapter will present the problem statement guiding the project, background information on the problem, the purpose statement, and the discussion of the nature of this project with reference to a research design. Additionally, the research questions to address during the project completion and a summary will be provided in this introductory chapter.
Problem Statement
It is not known how to effectively identify caregivers among visitors in pediatric units to prevent safety risks for young patients, and the use of identification wristbands can be viewed as an appropriate solution. While the existing literature indicates that identification bands are effectively used in pediatric units for children, it is not known how this solution can be used for parents (Bernal, Raimondi, Oliveira, Inoe, & Matsuda, 2018). In order to ensure safety for children in pediatric units, the implementation of this change can be regarded as a necessary action because risks of child abduction still remain high in hospitals (Linnard-Palmer & Coats, 2016; Mahalakshmi et al., 2018). Additionally, nurses and other healthcare professionals need to know to whom they communicate when discussing different issues related to young patients to avoid the violation of ethical and legal norms (Mahalakshmi et al., 2018).
Therefore, the problem is that safety accidents can be observed in different healthcare units, and the focus is on preventing child abduction in pediatric units. It is necessary to decrease risks of children’s interactions with strangers to minimum (Mahalakshmi et al., 2018). There is a clear need for the implementation of identification wristbands in pediatric units in healthcare facilities in order to reduce threats to children and ethical concerns because of misidentifying caregivers. The relationship between the implementation of identification wristbands in pediatric units and changes in safety will be determined with the help of the selected research design.
Background
The safety of young patients needs to be guaranteed in healthcare facilities with the help of a variety of tools, technologies, instructions, and guidelines nurses and physicians are expected to follow and use. The reason is that child abduction should be prevented in pediatric units as it is a challenging issue that requires its appropriate solution. According to Mahalakshmi et al. (2018), there are different systems that are proposed to be used in hospitals in order to prevent potential risks for children. These approaches include personal authentication systems, bimodal biometrics systems, and ID bands among others (Kamaraj, Sunadaram, & Shobana, 2018; Mahalakshmi et al., 2018). Depending on the quality of the applied system, wristbands or ankle bands can be used not only for identifying a child but also for sending signals for healthcare personnel. The purpose of these tools is to help the medical personnel to determine where young patients are located, what procedures need to be applied to children, and what specifics in treatment should be followed. Thus, typical bands for identification include such information as patients’ names, date of birth or age, ID, and other related medical information.
However, the majority of tools, including identification bands, discussed in the literature on the problem of child kidnapping in hospitals are supposed to be used only in children. Another infant abduction and identification approach is the use of matching bands for infants, mothers, and fathers in a pediatric unit (Bernal et al., 2018). Still, there is not enough evidence on how these bands can be used as a wide practice in different healthcare facilities in order to prevent not only child abduction but also a variety of ethical issues. Thus, it is important to pay attention to the issue that there is a limited discussion of cases in the literature when identification tools can be used for not patients but for their caregivers. This situation indicates the presence of a problem of misidentifying and errors in a healthcare setting that can be evaluated as critical for young patients (Tase & Tronchin, 2015). If there are no identification bands, badges, or other similar tools used by caregivers in pediatric units, the risk of infant abduction, ethical issues, identification errors, and other related problems increases significantly.
The safety policy that is followed in most countries is the necessity of using identification wristbands in pediatric units since a child’s birth. Since these bands include the information on a child to contribute to his or her identification by the staff, the possibility of errors and medical mistakes decreases significantly (Hoffmann et al., 2019; Silva et al., 2019). Still, mistakes in identification of children are frequent because patients or their caregivers can remove wristbands, and there are cases of using wrong bands (Linnard-Palmer & Coats, 2016; Silva et al., 2019). In most cases, both mothers and infants wear matching identification wristbands, and in other cases, fathers are also allowed to use such bands (Bernal et al., 2018). As it was stated in the literature, when identification wristbands are not applied appropriately or not used, the risks of medical errors, ethical issues, and other safety-related problems increase (Silva et al., 2019). As a result, the approach based on using bands can be discussed as an effective security measure in order to prevent child abduction or other problems related to the identification of a patient or a caregiver.
In the pediatric unit at Newark Beth Israel Hospital, there is no practice of using identification wristbands for caregivers and parents in order to be allowed to enter the unit and contact children. However, there is a need for improving security measures in order to guarantee that the cases of child abduction can be successfully prevented because there were situations when strangers passed the nursing station without being identified and could enter rooms with babies. Additionally, there is a need for preventing situations when the nursing staff communicates health problems or treatment decisions related to some young patients to wrong caregivers because of the lack of identity data to use.
Much attention should be paid to avoiding situations when mothers and fathers do not wear identification bands, and when it is rather problematic to identify the caregivers of a certain patient. The recognition of risks associated with misidentifying caregivers in a pediatric unit and allowing strangers to visit the unit created the need for implementing a specific improvement change in a setting. Thus, the use of an identification wristband has been selected as a tool in order to improve the safety of young patients in the pediatric unit at Newark Beth Israel Hospital.
Purpose
The purpose of this quantitative descriptive project is to determine how the use of identification wristbands for parents in the pediatric unit of Newark Beth Israel Hospital can improve safety according to nurses’ views. In this context, it is necessary to determine whether and how the implementation of identification wristbands for parents in the selected pediatric unit affects the safety of children with reference to nurses’ ability to recognize visitors as parents or caregivers. If a visitor is easily recognized by a nurse as a caregiver of a certain child, the risk of child abduction and other misunderstanding is reduced. These aspects can be viewed as the main aims of the change implementation in order to guarantee a range of positive outcomes for children.
It is important to determine how the use of identification wristbands for caregivers can influence safety and protection of children in pediatric units because there is a lack of evidence and research on the problem. In spite of the fact that researchers accentuate the effectiveness of bands for children, they do not refer to the role of using identification bands in parents (Hoffmann et al., 2019). From this perspective, the necessity of this project is determined by the lack of evidence on the topic to address the problem. The project will contribute to expanding evidence on the relationship between the use of wristbands for identification and possible changes in safety of children in pediatric units.
The Nature of the Project
A quantitative methodology is selected for this project in contrast to a qualitative methodology because it is necessary to describe how the application of wristbands can contribute to children’s safety using numerical terms. A qualitative method is not appropriate for this study as it will help to present only subjective thoughts of nurses, health care providers or caregivers regarding the issue. Quantitative methodologies allow for analyzing objective numerical data, and the findings can be generalized to be applied to a wider population (Boswell & Cannon, 2018). In the context of a quantitative methodology, a selected research design should be descriptive. The reason for choosing a descriptive design is that it is necessary to determine how the use of identification wristbands by parents can be viewed by nurses with a focus on possible changes in children’s safety in pediatric units (Boswell & Cannon, 2018). This design is appropriate to be applied when it is important to measure averages in the variables that are not controlled by a researcher.
In the context of this project, the choice of a descriptive research design is more appropriate than a case study because of the possibility to involve more participants in a data collection process. Additionally, referring to the scope of the planned project and the absence of a necessity to measure the variables before and after the intervention, the application of experimental and quasi-experimental designs is also viewed as unnecessary and inefficient (Boswell & Cannon, 2018). To address the purpose of the current project, it is possible to utilize a descriptive research design based on the application of a survey method and a Likert scale. This approach is necessary to collect the required information on nurses’ views regarding the efficiency of using identification bands to address children’s safety in a pediatric unit in a numerical form (Boswell & Cannon, 2018; Tase & Tronchin, 2015). Averages will be used to determine differences in the variables.
Applying a correlational research design based on a quantitative methodology should be recommended for further research on this topic. It will be possible to determine how the intervention associated with using identification bands can be viewed as a predictor of positive changes in safety. The determination of this relationship is important in order to conclude regarding the effectiveness of applying the intervention in the selected unit to improve the situation with children’s safety (Bernal et al., 2018; Boswell & Cannon, 2018). From this perspective, the selection of a descriptive quantitative design can be discussed as efficient at this stage to realize the purpose of this project and address the question formulated in the next section.
Research Question
The problem and purpose statements formulated for this project guide the development of a question to be addressed. It is important to refer to the population of nurses working with children in the pediatric unit at Newark Beth Israel Hospital who most often communicate with caregivers. During their interaction with children and visitors, nurses need to easily and quickly identify strangers or people who have no right to visit a pediatric unit. The use of certain colorful identification wristbands that can also include important information on patients can be discussed as an effective tool to help nurses identify parents and caregivers (Linnard-Palmer & Coats, 2016). From this perspective, the following question guides this quantitative project in order to address the purpose:
RQ: According to nurses’ views, how can the use of identification wristbands for parents and other caregivers in the pediatric unit of Newark Beth Israel Hospital comparing to non-using bands improve children’s safety?
Summary
In this chapter, the discussion of the problem guiding this project and its purpose has been presented. The problem is in the fact that it is not known how the identification wristbands can be correlated with the safety of children in the pediatric unit of Newark Beth Israel Hospital. The issue to address is the necessity of preventing child abduction in pediatric units and improving security strategies, not allowing strangers to enter units with young patients. The problem statement has been supported and expanded with the help of the information provided in the background section of this chapter. In addition, the nature of the project with reference to a selected research design and the fitting research question has also been provided in Chapter 1. Thus, Chapter 2 will present the review and evaluation of the literature on the problem to be addressed in this project along with a theoretical framework.
Literature Review
Introduction
The aim of Chapter 2 is to provide a review of the literature that will further guide the project on the problem of using identification wristbands in parents to contribute to the safety of children. In this chapter, it is important to present the historical overview of the problem and the theoretical framework to guide this project. The current findings on the problem presented in the existing literature will be evaluated to conclude regarding the presence of any gaps in examining the issue of applying identification bands for caregivers in pediatric units.
Historical Overview
The application of identification bands and badges among other tools to determine the identity of a person has been typical for healthcare settings for many years, especially for pediatric units. The reason is that identification tools are important to help in recognizing newborns and other patients, as well as their parents. The practice of using identification bands for wrists and ankles is actively discussed in seminal works and new studies on safety in pediatric units (Ferguson, Hickman, Macbean, & Jackson, 2019; Linnard-Palmer & Coats, 2016). Their effectiveness is supported with the help of evidence presented in the literature as identification bands are required to include important personal information on a young patient and his parent.
However, it is also important to note that researchers pay much attention to identifying potential weaknesses of using these means that are associated with misusing bands. In spite of the fact that the use of bands is included in hospitals’ safety policies, there are many cases of their inappropriate use (Silva et al., 2019). Still, it is also important to note that the practice of using identification wristbands for caregivers in pediatric units is not widely covered in traditional literature on the problem of child abduction and patient safety (Linnard-Palmer & Coats, 2016). Therefore, the detailed review and evaluation of recent studies on the problem are required.
Theoretical Framework
The theory selected as a framework for conducting this project is Kurt Lewin’s Theory of Change. According to Lewin’s assumptions, the process of change in an organization is realized under the impact of certain restraining forces and barriers that need to be overcome. There are also driving forces of the process that help to realize the change (Wojciechowski, Pearsall, Murphy, & French, 2016). The purpose of managers promoting the change in their organizations is to achieve a balance between driving forces and restraining forces. This balance can be reached with a focus on coping with the three steps of Lewin’s model (Wojciechowski et al., 2016). These steps are Unfreezing, Moving, and Refreezing; thus, choosing the direction of change, organizations overcome these stages in order to achieve a balance and improve the situation.
Lewin’s Theory of Change is actively applied in studies in the fields of nursing and healthcare, as well as in clinical and nursing practice. The reason is that this theory-based model is effective to transform the process and care in healthcare settings. The first step is Unfreezing that is characterized by forming the understanding of the necessity of change associated with the problem awareness. At this stage, nurses and healthcare providers are informed about the need for changing the process of care to achieve higher health and safety outcomes for patients (Wojciechowski et al., 2016). The second step is Moving as the process of changing the procedure and implementing the improvement. Thus, the specifics of the change are tested and implemented at this stage to bring improvement to the situation in a healthcare setting (Wojciechowski et al., 2016). As a result, restraining forces should be effectively addressed at this stage with the help of training the personnel and adopting new processes.
The third step is Refreezing, during which the process of monitoring and evaluating the change results is realized in order to prevent problems and guarantee the effective integration of the improvement into practice. The application of Lewin’s Theory of Change is discussed in a lot of literature on problems in nursing and patient care (Wojciechowski et al., 2016). Therefore, this theory can be viewed as effective to provide a relevant framework for this project.
Current Findings
In the current studies on the problem of using identification wristbands in pediatric units, much attention is paid to applying this tool in order to identify newborns and mothers. According to a cross-sectional study by Bernal et al. (2018), which was conducted in Brazil, the absence of such measures for children as identification wristbands negatively affects verification procedures and safety. It is possible to state that the results of the study are credible to demonstrate the relationship between the use of identification wristbands in a pediatric unit and security. The study indicates the necessity of the effective application of bands for identification in pediatric units in order to improve the processes associated with promoting safety for hospitalized children and newborns.
It is important to note that the majority of studies on this topic were conducted in Brazil, and the research on the problem in other countries is rather limited. Silva et al. (2019) claimed that medical data on protocols and records and identification bands for newborns should match in order to guarantee the security of children. They also paid attention to the importance of educating caregivers regarding the necessity of these bands because it was noticed in some cases that newborns examined by nurses did not wear wristbands. Despite the fact that the conducted descriptive study based on a survey method was rather effective to analyze the role of wearing identification bands for the safety of newborns in hospitals, the use of bands for caregivers was not examined. Still, the results of the study provide important evidence that the presence of a wristband system can contribute to improving safety in pediatric units as problems can be observed when the system is not used.
However, the limited research is present on the question of using specific wrist or ankle bands for identifying caregivers of hospitalized children in pediatric units. Tase and Tronchin (2015) conducted a quantitative study on using wristband identification for women in obstetrics units. The researchers found out that the wristband were used effectively and helped the medical personnel to identify mothers and newborns when their placement and wearing were monitored. Currently, there are no effective policies or systems to guarantee that wristband systems can be applied accurately in order to promote children’s safety. In their qualitative study, Hoffmann et al. (2019) found out that caregivers were concerned regarding the absence of any identification tool and criterion to determine who could enter a room in a pediatric unit. Thus, the lack of identification was named among the key safety issues, such as infant feeding, medication procedures, hygiene issues, and reports of falling among others, that were observed by caregivers in hospitals. This study is effective to present the problem of the lack of identification instruments to be used in pediatric units from the perspective of parents and other caregivers.
Evidence provided in the literature indicates that the problem of children’s safety in hospitals and child abduction, as well as a variety of medical and ethical errors, can be avoided if identification systems are used. If the wristband identification is promoted in pediatric units and applied accurately for young patients and their caregivers, it is possible to expect positive changes in the aspect of safety (Bernal et al., 2018; Ferguson et al., 2019; Silva et al., 2019). In other cases, caregivers and nurses seem to be concerned regarding security measures in spite of the fact that identification wristbands are viewed as effective tools in this case (Hoffmann et al., 2019; Silva et al., 2019; Tase & Tronchin, 2015). It is also possible to state that the experience of neonatal units in using bands for patients and their parents can be applied to pediatric units (Bernal et al., 2018; Ferguson et al., 2019). Thus, the use of identification wristbands can be discussed as an evidence-based practice that is effective to promote the safety of children in pediatric units.
The lack of research on applying identification bands in caregivers to increase safety in pediatric units caused the review of related studies on the topic of infant abduction as a security concern in pediatric units. In their study, Mahalakshmi et al. (2018) discussed the effectiveness of using smart wearable devices for children in pediatric units and birth centers in order to decrease the threat of kidnapping for them. The problem of child abduction and technologies for improving safety for newborns in hospitals was also studied by Kamaraj et al. (2018). Still, these studies cannot be discussed as directly related to the topic of this project that indicates the absence of relevant literature and evidence on using identification wristbands for caregivers. The review of the most relevant studies on the relationship between the use of wristband identification systems and children’s safety (see Appendix) has indicated the possibility of using this system in other pediatric units with reference to caregivers. The reason is that the authors of the conducted studies recommend applying bands in pediatric units with a focus on using them more accurately.
Conclusion
The findings of the reviewed research accentuate the necessity of conducting the project in order to understand whether the application of identification wristband can be correlated with positive changes in pediatric hospitals regarding children’s safety. There is a lack of research on applying any identifying elements for caregivers in order to ensure that only parents can be present in pediatric units (Linnard-Palmer & Coats, 2016). Still, the literature indicates that the use of wristbands can be an effective method for identification when it is used correctly, and when patients and parents are educated regarding the importance of wearing bands. This method of using bands is recommended in the literature as a typical procedure in hospitals.
On the one hand, the application of wristbands for identification in pediatric units is a usual safety practice, and it is common to be used for newborns and mothers. According to the results of the studies by Bernal et al. (2018) and Silva et al. (2019), identification bracelets are important to promote safety in healthcare units, and errors typically occur when patients or nurses misuse wristbands. On the other hand, the application of similar bands for caregivers is typical only for mothers of newborns, and this practice is not widely discussed with reference to other caregivers to prevent child abduction and improve security (Hoffmann et al., 2019). This aspect creates the gap in the research and the need for conducting a project on this problem.
Thus, it is possible to conclude that the reviewed literature does not provide enough evidence for discussing the utilization of bands for identification of caregivers in hospitals. However, evidence on the effectiveness of identification wristbands to be used in hospitals is widely available with a focus on patients’ experiences (Bernal et al., 2018; Ferguson et al., 2019; Tase & Tronchin, 2015). The question to be answered in this project is how the use of identification wristbands for caregivers in pediatric units can improve children’s safety. As a result, the further investigation related to this project will allow for expanding the current research on the problem. Therefore, it is possible to note that there is a continued need for this Capstone Project based on the reviewed literature to address the set research question.
Summary
Chapter 2 has presented the results of the review of the literature on the problem of the safety of children in pediatric units and the application of wristbands for the identification of caregivers. It has been found out that a lot of evidence is related to discussing the relationship between the use of bands and patient safety accidents. Less attention is paid to using identification bands in mothers and fathers of newborns and other children, and limited research is related to the use of bands in caregivers. According to the results of the literature review, the use of identification wristbands is supported to be an effective strategy to contribute to improving safety in pediatric units. Especially, the practice can contribute to matching mothers and newborns. As a result, the focus on the implementation of this practice in a pediatric unit for all caregivers can be discussed as potentially beneficial for young patients and for increasing the levels of safety in a unit.
References
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Hoffmann, L. M., Wegner, W., Biasibetti, C., Peres, M. D. Á., Gerhardt, L. M., & Breigeiron, M. K. (2019). Patient safety incidents identified by the caregivers of hospitalized children. Revista Brasileira de Enfermagem, 72(3), 707-714.
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