Children's Nurses Research Articles

Long-term nurse-parent relationships in paediatric palliative care: a narrative literature review.

Paediatric palliative care (PPC) is an active, total approach to the holistic care of the child and family. Close, long-lasting relationships between healthcare professionals and parents in paediatric palliative care enhance quality, provide emotional support and can influence how parents manage their role in the face of uncertainty. To present a narrative literature review of long-term relationships between children's nurses and parents in PPC settings. Six databases (CINAHL, PsycINFO, ASSIA, Scopus, Medline and BNI) were searched, identifying 35 articles. A grey literature search produced seven additional relevant items. Four themes were identified: bonds; attachments and trust; sharing the journey; going the extra mile; and boundaries and integrity. All themes revealed an element of tension between closeness and professionalism. Gaining a greater understanding of how closeness and professionalism are successfully managed by children's palliative care nurses could positively influence pre- and post-registration nurse education.

Provision of Care for Families Affected by Craniofacial Conditions: The Views of Nonspecialist Health Professionals.

A diagnosis of a congenital craniofacial condition can have a significant impact on the psychological well-being of the affected family. As the first health professionals likely to come into contact with families, nonspecialists, such as diagnostic sonographers, midwives, and health visitors play a crucial role in facilitating familial adjustment. Yet, previous research has demonstrated parental dissatisfaction with the care delivered by nonspecialists. The aim of this study was to investigate the provision of care for families affected by craniofacial conditions from the perspective of nonspecialist health professionals, with a view to informing the development of educational materials. Individual semistructured telephone interviews (n = 14) were conducted with 3 diagnostic sonographers, 2 fetal medicine consultants, 3 midwives, 4 health visitors, and 2 children's nurses. Participants identified a range of barriers to the delivery of optimal care, including dealing with parental reactions, time pressure, hospital protocols and resources, a lack of contact with specialist craniofacial teams, and the emotional impact of delivering a diagnosis. Most participants had received no prior training in the area of congenital craniofacial conditions, while those who had felt current training materials were insufficient. All participants expressed a desire for further training and provided guidance regarding preferred content and format. This study provides insight into the challenges faced by nonspecialists, as well as a range of information and training needs that could improve their knowledge and confidence. Suggestions for the development of educational materials for nonspecialist health professionals are made.

Research awareness among children's nurses: An integrative review.

Developing nursing research skills, awareness and research utilisation are important for improving healthcare outcomes and are key to ensuring the full understanding and knowledge base necessary for optimal delivery of care. Nevertheless, little is known about research awareness in children's nurses. To address this issue, an integrative literature review was conducted for studies published between January 2007 and January 2017 to obtain up-to-date evidence about the extent of research awareness and utilisation among children's nurses. Using PubMed, Cochrane Library, ILISI and CINAHL databases, 21 studies related to children's nurses' research awareness were included in the final review, which was later developed and structured in keeping with PRISMA checklist and guidelines. The studies isolated show that nurses' knowledge about and utilisation of research vary and that there are many existent barriers to and facilitators of evidence-based practice in the paediatric setting. Some studies report that introducing a cultural and/or change in clinical practice change to improve research utilisation can have positive impacts on healthcare outcomes and the quality of nursing care of children. It is recommended that structured approaches to improving research utilisation be considered and additional research is needed to explore the benefits of these approaches. Despite more than three decades of the evidence-based practice movement within nursing, barriers still exist among children's nurses in the use of research in practice. If the use of research to improve the delivery of children's nursing care is to become a reality, then nurses' research awareness needs to improve to underpin care delivery with optimal evidence in a cohesive informed manner.

Improving the quality of communication during handover in a Paediatric Emergency Department: a qualitative pilot study.

SummaryIntroductionThere is a dearth of literature that specifically addresses the handover reporting process among healthcare staff working in children’s Emergency Department (ED). Widespread gaps in service provision, such as gaps in communication in handover reports to ambulance staff have been noted in the general literature on the topic. There are also improvements observed in handover when a structured mnemonic was encouraged. Structured reports improve communication, safety and may reduce medication errors. Thus, the improvement of handover reporting in children’s ED has important implications for children’s healthcare practice. However, little is known about communication processes during handover reports in Italian children’s ED or its consequences for errors or risks.MethodsA qualitative description methodology was used. Semi-structured interviews were used to collect data from five children’s ED nurses. Thematic content analysis was used to identify common themes.ResultsEmergent themes were: interpersonal influences on handover; structural issues; and local contextual factors.ConclusionsThe findings of this pilot study prompted the need for a standardized tool that improves communication during handover. As such, standardizing the communication process during handover could be effectively resolved by using a mnemonic tool adapted for handover in a paediatric emergency department.

Developing and nurturing a community practice clinical network for community children's nurses in Wales.

Working as a children's community nurse (CCN), especially in remote and rural locations, can evoke feelings of professional isolation. Humans are by nature 'social animals' and the consequences of feeling isolated, and coping with distances, adverse weather and risky situations, could mean that nurses choose to work instead in more familiar and comfortable environments. This can affect retention issues and increase the risk of CCNs experiencing stress, burnout and illness-related absenteeism. The children they care for often have complex needs and parents want their CCN to be 'on the ball'; they will feel concerned and frustrated if the CCN team lets them down. Two academics were approached by CCNs in Wales seeking ways of overcoming isolation. It was decided that the best course of action was to develop a community of practice clinical network for band 5 and 6 CCNs working in Wales, with the aim of supporting staff, sharing best practice, and promoting safe and quality-driven care. Alternating the networks among health boards, whereby the nurses decided the agenda, booked the venue, invited guest speakers, led the meeting and wrote up the minutes, was an excellent way to achieve the designated aim: reducing professional isolation. A range of clinically focused topics were discussed and debated, and the first six meetings were so effective in meeting the aim of the network that each health board is starting the cycle of hosting the network again.

Family-centred care of children and young people in the acute hospital setting: A concept analysis.

To provide an operational definition of family-centred care as it applies to hospitalised children. The objective was to provide clarification of the concept by comprehensively analysing the evidence. Terms associated with family-centred care include partnership-in-care, negotiated care, parental participation/involvement in care, care-by-parent and child-centred care. The absence of a universally accepted definition contributes to its inconsistent implementation. Concept analysis is acknowledged as a form of inquiry to develop the knowledge base of nursing. Rodgers' evolutionary approach to concept analysis was used as a guiding framework. The systematic literature search yielded 30 theoretical papers; the results are outlined on a PRISMA flow diagram. Surrogate terms identified include partnership-in-care, negotiated care and parent participation. Parental participation in care, the development of respectful and trusting partnerships, information sharing and all family members as care recipients were identified as attributes to family-centred care. There is limited evidence that family-centred care enhances the child's, parents' and families' experience of hospitalisation and is associated with reduced anxiety for parents. There is a lack of attention to cultural and societal changes, which impact on those receiving and delivering care. While we know that family-centred care is widely endorsed and enhances well-being, there is a lack of empirical evidence about the impact on health outcomes for children. While children's nurses have been applying some elements of family-centred care to their clinical practice for decades, the concept continues to evolve. Further research examining the effects of family-centred care for children, their families, healthcare professionals and healthcare organisations reflecting cultural diversity and norms must be conducted. This research should include the effects of family-centred care on parents caring for their child in hospital, how family-centred care supports parents to make healthcare decisions and the outcomes of family-centred care for children and families.

Care and management of children with a totally implanted central venous access device: portacath.

Research and advances in technology have enabled children and young people with life-limiting conditions to live longer. To maintain their well-being and quality of life many of these children usually require some form of intravenous access for treatment. Children's nurses should have the skills and training to ensure they are competent to practise using totally implanted central venous access devices such as portacaths (ports). This article addresses the care and management of these ports in children and the wide variation in practice that exists in the UK, and makes recommendations for practice.

International scoping exercise into expertise in children's orthopaedic nursing and educational pathways.

Maintaining competence and keeping skills and knowledge in children's orthopaedic nursing alive are problematic in both the UK and Australia. The dearth of dedicated postgraduate courses for this specialty has resulted in an array of unregulated in-house training, nurses' individual educational needs not being met and potential for children with an orthopaedic problem being put at risk of not receiving optimal care. This paper reports on a travel scholarship used to compare and contrast the UK with Australia, which supported an international scoping exercise to identify nurses' beliefs regarding expertise in children's orthopaedic nursing and explore provision for maintaining pertinent knowledge and skills. Potential ways to improve support for nurses in maintaining expertise in this field of practice are discussed.

Retained primitive reflexes in children, clinical implications and targeted home-based interventions.

This article discusses problems such as learning difficulties and behavioural problems that children may experience when they have retained primitive reflexes, which are typically only present in the first few months of life. The authors outline different types of primitive reflex present in infants and how each may affect a child when retained beyond the time when they are normally inhibited. Where relevant health professionals with expertise in this area are not available, children's nurses may need to assess and manage children with retained reflexes. This article explains how a nurse can assess a child for each primitive reflex and describes exercises that can be taught to a child and his or her parents to carry out at home to reintegrate the reflex.

Skills for safe practice - A qualitative study to evaluate the use of simulation in safeguarding children teaching for pre-registration children's nurses.

Safeguarding children teaching is a required component in all pre-registration nursing curricula. A structured approach to this teaching as part of preparation for registration as a children's nurse was developed jointly by the Course Leader and the Designated Nurse for Safeguarding Children. This approach aims to equip children's nurses with the necessary theoretical knowledge and practical skills needed for safe practice. A key element in this curriculum is simulation, where students must assess injuries on manikins, select and complete appropriate documentation, and perform a nursing handover. Simulation has recognised value in nurse education but its use in safeguarding children teaching for student children's nurses has not previously been widely reported. This small-scale qualitative study explored the student experience and the impact of simulation teaching in the development of relevant knowledge and the core safeguarding skill set of observation, interpretation, documentation and communication. The methodology for this small, qualitative study was triangulated, comprising observation of the simulation teaching and two sets of semi-structured interviews. The resultant data was investigated using thematic analysis. The outcome of the study suggested that students were able to transfer learning from the simulation into clinical practice, and that simulation as an approach to safeguarding children teaching resonated with the students' preferred learning style and merits further consideration and evaluation.

Causes of ATtrition in CHIldren's NursinG (CATCHING): An exploratory mixed method study.

Professional, financial and ethical reasons necessitate nursing improves its understanding of student attrition. Previous studies identify causes of attrition as multifactorial. However, few studies focus on children's nursing. This study aimed to explore causes of pre-registration children's nursing attrition. Exploring the causes of attrition was achieved through quantitative and qualitative approaches. Three years of quantitative data relating to attrition rates and causes was obtained. These data informed semi-structured interviews of children's nursing students, from four London universities. These students had faced challenges and either 'left' (n = 5) or 'stayed on' (n = 13) their pre-registration programme. Most attrition occurred in the first year of programmes and was primarily due to academic failure or personal circumstances; clinical placements also played a role. Emergent themes were 'expectations of pre-registration children's nursing'; 'realities of a pre-registration children's nursing course', and 'factors that influence students leaving or staying on the course'. Many participants reported a reluctance to disclose issues while on their course. Support to continue on the programme was frequently obtained away from university and students described relying on self-determination to complete programmes. Findings indicated several areas of potential improvement for student support including targeted interventions focusing on a student's first year and reducing variation in support services provided.

Understanding fluid homoeostasis in infants and children: part 2.

Part two of this article focuses on the care and management of infants and children who are seriously ill and who have lost so much fluid that they have entered a state of shock. The pathophysiology of shock is reviewed and the types and stages of shock are considered. The challenges of identifying shock are explored and the management of fluid resuscitation with colloids rather than crystalloids is analysed. An overview of the complex management of a young person in shock is provided using a case history format. The article offers the opportunity to extend readers' knowledge of some of the special tests that may be required to support the diagnosis of shock and provides an overview of the expected results.

Development of a paediatric short-stay observation and assessment unit.

In recent years children's emergency admissions have risen by 18%. In 2011 a team at a city district general hospital in England recognised that children were being admitted to the general children's ward and often only staying for short periods of time. After a review of the service a plan was put forward for the development of a paediatric short-stay observation and assessment unit. The unit has led to a reduction in ward admissions and offered opportunities for children's nurses to extend their roles in assessment and treatment. This article explores the planning, delivery and audit of this unit and offers an exemplar for other trusts considering a similar change to service delivery.

An exploration of predictors of children's nurses' attitudes, knowledge, confidence and clinical behavioural intentions towards children and young people who self-harm.

To explore the potential predictors of children's nurses' attitudes, knowledge and confidence towards caring for children and young people admitted to hospital with self-harm. Admissions to paediatric inpatient settings for individuals who have self-harmed are growing. Limited previous research suggests that nurses have mixed attitudes towards people who have self-harmed and potentially lack the confidence to provide effective care. There is a specific paucity of research in this area for children's nurses. A cross-sectional descriptive survey was used to gather data for exploration of variables associated with attitudes, confidence, knowledge and clinical behavioural intentions of 98 registered children's nurses in a single tertiary children's hospital, colocated in a large acute NHS Trust in the UK. Data were collected over a 4weeks in 2015, using an online survey tool. The predictive effect of several demographic variables was tested on the outcomes of attitudes, knowledge, confidence and behavioural intentions, which were collected using relevant, previously used outcome measures. Increased experience was found to be associated with improved attitudes relating to negativity. Previous training in caring for children who had self-harmed was found to be associated with improved attitudes around perceived effectiveness of their care. Higher academic qualifications and having undertaken previous training on self-harm were each found to be associated with increased knowledge of self-harm, and increased age was associated with reduced knowledge of self-harm. This study provides an initial exploration of variables associated with attitudes, knowledge, confidence and behaviour intentions of registered children's nurses in relation to caring for CYP who have self-harmed. Targeted training on caring for CYP who have self-harmed should be considered as a component of continuing education for registered children's nurses in the UK to improve the experience and outcomes for this patient group.

Adrenal insufficiency, steroid sick day rules and the paediatric endocrine nurse.

Clinical governance processes are important for improving patient care. Patients with adrenal insufficiency are at significant risk if they have an adrenal crisis and require steroid therapy. Families should receive education on managing illness or stress, that is, steroid sick day rules. Most of this education is delivered by children's nurses. Two local cases of mortality related to adrenal insufficiency were reviewed and a questionnaire audit was undertaken to compare the steroid sick day rules education provided to patients and their families with published standards. Most training (75%) was delivered by nurses. Most families/patients (94%) had received written information on oral dosing for steroid sick day rules, and were confident about when/how to double up oral steroid doses (78%). Fewer families recalled being given written information about the emergency hydrocortisone injection (53%), and fewer were confident about how to give the injection (46%). Several important changes and modifications to clinical practice have been implemented in response to the clinical governance findings. These include setting up notification 'red flags' on patients' electronic records and holding specialist family teaching sessions on steroid sick day rules.

Childbirth support by children's nurses from the mother and baby welfare protection service

As the stay in maternity hospitals gets shorter, parents often feel helpless upon their return home. It is therefore necessary to identify resource professionals to help them on the continuation of the care pathway. The children's nurses from the mother and infant welfare protection service, a frontline service accessible to everyone, provide their expertise to meet the basic needs of the child and support the parents in the development of their skills.

Play Within the Pre-registration Children's Nursing Curriculum Within the United Kingdom: A Content Analysis of Programme Specifications

PurposeTo determine the number of programme specifications which cite play within the curriculum and in what context. Play is an essential part of childhood. Therefore we might expect nurses caring for children to be trained in how to facilitate play within their clinical areas. Programme specifications provide information on course aims, the intended learning outcomes and what the learner is expected to achieve. Design and MethodInductive qualitative content analysis. ResultsOnly 13% (seven out of 54) programme specifications published by Higher Education Institutions cite play. Where play is mentioned there is a clear link made to use play as a communication tool. Also distraction figured prominently within the same sentence as play, despite these two terms being quite distinct. The availability of the programme specifications was also noted with 49% (28 out of 57) were easily accessible from the university web sites. A further 16% (9 out of 57) provided web links when access was requested. 35% were not publicly accessible without requesting access. Three Universities declined to be involved. ConclusionIt is clear that even if play is embedded within the child field nursing curriculum, it is not clearly stated as a priority within 87% of universities programme specifications which make no mention of it. Practice ImplicationsIf play is not part of programme specifications its importance could be lost to educators already delivering a full curriculum. Nurses could be qualifying with little or no knowledge around their role in facilitating play for their patients.

Current Situation of Children Nursing Care Service in Health Sector

Current Situation of Children Nursing Care Service in Health Sector

小児の主体性を支えるデザイン : 小児看護とデザインの協働( 子どものためのデザイン01)

小児の主体性を支えるデザイン : 小児看護とデザインの協働( 子どものためのデザイン01)

Alliance of skills to fight pain of premature babies

Premature babies are particularly vulnerable and exposed to pain and discomfort. To improve the quality of care, an alliance of skills between nurses, children's nurses and the psychomotor therapist has been set up in a neonatal intensive care unit.