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Background: Health literacy assessment is key to better meeting family needs and developing informed strategies to promote positive health outcomes for children. The objective of this study was to describe the health literacy of caregivers who use Canadian pediatric emergency departments and relate it to demographic and visit-specific variables. Methods: This study utilized a descriptive, cross-sectional survey design with medical record review. A bilingual survey was electronically administered to caregivers presenting to 10/15 Canadian pediatric emergency departments. Health literacy was assessed using the Newest Vital Sign tool. Results: 1957 caregivers completed the Newest Vital Sign assessment. Caregivers' mean age was 37.8 ± 7.7 years, 74.3% (1449/1950) were mothers and 51.9% (993/1912) had a university/professional degree. 12.0% (235/1957) had a high likelihood of limited health literacy, 16.5% (323/1957) had possible limited health literacy and 71.5% (1399/1957) demonstrated adequate health literacy. Adequate health literacy scores were associated with having a university/professional degree [aOR 1.47 (95% CI 1.11–1.94)] and having a household annual income of over $25,000 [aOR 4.10 (2.66–6.31)]; they were inversely associated with having a total of 4 or more children [aOR 0.61 (0.40–0.91)] and having a main language at home other than English or French [aOR 0.32 (0.23–0.43)]. Interpretation: With over 1/4 caregivers facing health literacy challenges, health care providers in emergency departments must be cognizant of their communication and education approach when caring for families and providing at-home care guidance. Clinicians should consider applying health literacy principles to all family encounters to help address healthcare disparities. [ABSTRACT FROM AUTHOR]

Objectives Emergency department (ED) visits can be stressful for families and can affect caregiver willingness to consent to participating in research. Our objective was to describe when and how caregivers wish to be informed about clinical research during their child's ED visit. Methods An electronic survey was performed for families presenting to 10 Canadian paediatric EDs. A convenience sample of 1456 caregivers with children aged 0 to 17 years were enrolled. The survey tool was created (with an expert panel) using published methodological guidelines, including item generation/reduction, pre- and pilot-testing, and clinical sensibility assessment. Research-specific questions included the best time to be approached, the breadth of study opportunities presented, and best ways to encourage families to participate. Results Caregivers reported that the best times to be approached regarding research were in the waiting room (45.3%, 653/1441), after physician assessment (39.0%, 562/1441), or just prior to discharge (9.9%, 143/1441). 52.2% (351/672) wanted to hear about all available research studies, while 47.8% (321/672) wanted to be informed of studies relevant only to their child's condition. Reported best ways to encourage families to participate in research included: incentives (e.g. gift cards/parking passes [31.2%, 230/737]), providing a clear explanation of study intent (30.7%, 226/737), and appealing to altruism (25.4%, 187/737). Conclusions There is wide variability in family preferences for timing of research-related conversations, suggesting that families could be approached in the waiting room, and if that is inconvenient or impractical, they could be offered a deferred conversation (i.e. after physician assessment or prior to discharge). [ABSTRACT FROM AUTHOR]

Background: Optimizing a child's emergency department (ED) experience positively impacts their memories and future healthcare interactions. Our objectives were to describe children's perspectives of their needs and experiences during their ED visit and relate this to their understanding of their condition. Methods: 514 children, aged 7–17 years, and their caregivers presenting to 10 Canadian pediatric EDs completed a descriptive cross-sectional survey from 2018–2020. Results: Median child age was 12.0 years (IQR 9.0–14.0); 56.5% (290/513) were female. 78.8% (398/505) reported adequate privacy during healthcare conversations and 78.3% (395/504) during examination. 69.5% (348/501) understood their diagnosis, 89.4% (355/397) the rationale for performed tests, and 67.2% (338/503) their treatment plan. Children felt well taken care of by nurses (90.9%, 457/503) and doctors (90.8%, 444/489). Overall, 94.8% (475/501) of children were happy with their ED visit. Predictors of a child better understanding their diagnosis included doctors talking directly to them (OR 2.21 [1.15, 4.28]), having someone answer questions and worries (OR 2.51 [1.26, 5.01]), and older age (OR 1.08 [1.01, 1.16]). Direct communication with a doctor (OR 2.08 [1.09, 3.99]) was associated with children better understanding their treatment, while greater fear/ 'being scared' at baseline (OR 0.59 [0.39, 0.89]) or at discharge (OR 0.46 [0.22, 0.96]) had the opposite effect. Interpretation: While almost all children felt well taken care of and were happy with their visit, close to 1/3 did not understand their diagnosis or its management. Children's reported satisfaction in the ED should not be equated with understanding of their medical condition. Further, caution should be employed in using caregiver satisfaction as a proxy for children's satisfaction with their ED visit, as caregiver satisfaction is highly linked to having their own needs being met. [ABSTRACT FROM AUTHOR]

Objectives: To describe the extent to which caregivers' emotional and communication needs were met during pediatric emergency department (PED) visits. Secondary objectives included describing the association of caregiver emotional needs, satisfaction with care, and comfort in caring for their child's illness at the time of discharge with demographic characteristics, caregiver experiences, and ED visit details. Study design: Electronic surveys with medical record review were deployed at ten Canadian PEDs from October 2018 –March 2020. A convenience sample of families with children <18 years presenting to a PED were enrolled, for one week every three months, for one year per site. Caregivers completed one in-PED survey and a follow-up survey, up to seven days post-visit. Results: This study recruited 2005 caregivers who self-identified as mothers (74.3%, 1462/1969); mean age was 37.8 years (SD 7.7). 71.7% (1081/1507) of caregivers felt their emotional needs were met. 86.4% (1293/1496) identified communication with the doctor as good/very good and 83.4% (1249/1498) with their child's nurse. Caregiver involvement in their child's care was reported as good/very good 85.6% (1271/1485) of the time. 81.8% (1074/1313) of caregivers felt comfortable in caring for their child at home at the time of discharge. Lower caregiver anxiety scores, caregiver involvement in their child's care, satisfactory updates, and having questions adequately addressed positively impacted caregiver emotional needs and increased caregiver comfort in caring for their child's illness at home. Conclusion: Approximately 30% of caregivers presenting to PEDs have unmet emotional needs, over 15% had unmet communication needs, and 15% felt inadequately involved in their child's care. Family caregiver involvement in care and good communication from PED staff are key elements in improving overall patient experience and satisfaction. [ABSTRACT FROM AUTHOR]

Background: Wound assessment is a critical part of the care of hospitalized infants in neonatal intensive care. Early recognition and initiation of appropriate treatment of wounds are imperative to facilitate wound healing and avoid complications such as secondary infection and wound dehiscence. There are, however, no validated tools for assessing surgical wounds in infants. Purpose: The aim of this study was to develop and interrogate a tool for the assessment of surgical wounds. Specific aims for the tool included interrater reliability (give a consistent and dependable result independent of user) and test criterion validity (give an accurate assessment of the wound compared with an expert). Methods: This was an exploratory cohort study involving a structured wound tool applied by nursing staff to 40 surgical wounds. The wounds were also assessed by wound experts (a pediatric wound care nurse and a pediatric surgeon). Comparisons were made to elucidate estimates of reliability and validity. Results: The wound tool demonstrated interrater reliability with intraclass correlation coefficient of 0.775 (95% CI, 0.665-0.862) as well as criterion validity with rank correlation coefficient of 0.55 (95% CI, 0.34-0.76) to 0.71 (95% CI, 0.53-0.88). To obtain 100% sensitivity to distinguish mild from moderate-severe wounds, a low cutoff score was needed. Implications for Practice and Research: Wound assessment continues to be a subjective exercise, even with the utilization of a tool. Additional research is needed for strategies to support the assessment of surgical wounds in infants. Such tools are needed for future research, particularly when multiple institutions are involved. [ABSTRACT FROM AUTHOR]