Pediatric Nurses Research Articles

Subjective Study on Pediatric Emergency Department Nurses′ Perceptions of Urgency Using Q Methodology

PurposeIn the emergency department (ED), triage significantly impacts patient safety. Therefore, triage nurses must make decisions accurately and timeously. This study aims to investigate how South Korean pediatric emergency nurses perceive urgency and classify severity using the Q methodology, which examines individuals’ subjectivity. MethodsWe collected 84 statements from a Q population based on a literature review and interviews, and selected 33 Q samples. The P samples included 30 pediatric emergency nurses at a Seoul tertiary-care hospital. The principal component factor analysis method was employed to analyze data using the PC-QUANL program. ResultsFour urgency perception types were identified among pediatric ED nurses. Type 1: “Experiential coping”; Type 2: “Careful reasoning”; Type 3: “Patient-centered thinking”; and Type 4: “Intuitive prediction.” These types appear to be an integrated process of knowledge and clinical experience that considers children’s characteristics and developmental stages. ConclusionsThis study may serve as a basis for future education to improve pediatric ED nurses’ urgency judgment and severity classification skills.

A qualitative study of pediatric nurses' perception of factors affecting negotiation of care in a Pediatric Stem Cell Transplant Unit.

The adoption of a "family centered care" (FCC) philosophy is essential for the care process and its negotiation. A better understanding of nurses' perception of factors that affect the process of negotiation could allow us to better address future interventions and to improve FCC. The purpose of our study was to investigate pediatric nurses' perception of factors that affect the process of negotiation of care with stem cell transplantation pediatric patients and their parents. A qualitative research design with in-depth interviews was chosen. Sixteen interviews (16 nurses) were audio recorded and transcribed verbatim. Two researchers conducted independently a thematic analysis of the verbatim transcripts of the interviews. Four themes emerged from the data as factors that affect the process of negotiation: 1) communication; 2) personal factors; 3) specificity; and 4) organization. These themes represent interesting points for future improvement interventions. Negotiation in the stem cell transplant setting would deserve further research, with special focus on children' and parents' perception of factors affecting this important aspect. Furthermore, in the future, negotiation guidelines could be validated and implemented effectively and an already validated tool could be used to document the negotiation process in the stem cell transplant setting.

Comparing the effects of problem- and task-based learning on knowledge and clinical decision-making of nursing students concerning the use of transfusion medicine in pediatric nursing: An educational quasi-experimental study in Iran

BackgroundIn the pediatric care field, ensuring safe and effective blood transfusions, promptly identifying adverse reactions, and implementing appropriate interventions are crucial. Therefore, undergraduate nursing curricula need to be structured to meet these professional standards and prepare nursing students, as future team members, to respond to relevant clinical situations. The objective of this study was to investigate how problem- and task-based learning affects knowledge and clinical decision-making of undergraduate nursing students concerning the use of transfusion medicine in pediatric nursing. Material and methodsThis quasi-experimental study involved 82 nursing students recruited from two nursing schools in Iran using convenience sampling. Participants received educational content through either problem- (n = 40) or task-based learning (n = 42) methods. A researcher-made tool, comprising three parts and proven to be valid and reliable, was utilized for data collection. The tool was administered both before and immediately after the intervention. Data were analyzed using Wilcoxon rank-sum, Mann-Whitney U, Spearman's correlation and multivariate analysis of covariance tests via SPSS v16.0. A p-value of <0.05 was considered significant for all tests. ResultsThe median post-test knowledge and clinical decision-making scores within problem- and task-based learning groups were 62.68 vs. 74.65 and 53.33 vs. 76.67, respectively. Significant differences were observed between the mean pre- and post-test scores of both variables within both intervention groups (p < 0.05). Multivariate analysis of covariance revealed that task-based learning resulted in significant differences between the two groups in terms of knowledge (F = 87.9 %, p = 0.002, Eta2 = 0.114) and clinical decision-making (F = 99.9 %, p < 0.001, Eta2 = 0.271). ConclusionsGiven the greater effectiveness of task-based learning, nursing schools are advised to utilize this method in undergraduate nursing curricula to ensure the adequacy of the clinical skills acquired by nursing students prior to graduation.

Effectiveness of self-instructional module regarding therapeutic use of play materials among pediatric nurses in selected hospitals, Bengaluru

Effectiveness of self-instructional module regarding therapeutic use of play materials among pediatric nurses in selected hospitals, Bengaluru

A case-control study to investigate determinants of undernutrition in community-dwelling children.

This study aimed to examine determinants of undernutrition among children under 2 years of age. A matched case-control study design was conducted to recruit 300 mothers comprising 100 mothers with an undernourished child (case group) and 200 mothers with a healthy child (control group). Measurements consisted of demographic characteristics of children data, mother's data, household data, mother's knowledge of child undernutrition, mother's knowledge of nutrition, complementary feeding practices, and undernutrition parameters of the children. A conditional logistic regression was used to identify determinants of undernutrition. The risk of undernutrition was estimated by odds ratios (ORs) and 95% confidence intervals (CIs). Statistical significance was defined as any p value of <.05. Findings showed that mother's knowledge of undernutrition (AOR: 0.95; 95% CI: 0.91-0.98), mother's knowledge of nutrition (AOR: 0.90; 95% CI: 0.85-0.96), and mother's knowledge (AOR: 0.78; 95% CI: 0.67-0.91) and behavior of complementary feeding practices (AOR: 0.97; 95% CI: 0.94-0.99) were significant determinants of undernutrition (p < .05). Mothers with high scores on knowledge of undernutrition, knowledge of nutrition, and knowledge and behaviors of complementary feeding practices would benefit the children under 2 years to reduce the risk of undernutrition. Healthcare professionals (i.e., pediatric nurses and community health nurses) should provide early assessment of knowledge related to undernutrition, nutrition, and complementary feeding practices for mothers with children under 2 years.

Just-in-Time Video Using QR Codes: An Approach to Pediatric Trauma Nursing Education.

High acuity trauma and patients in cardiopulmonary arrest are not frequently seen in all pediatric Level I trauma centers. Yet, nurses are required to manage these patients in fast-paced, high-pressure environments. This project aims to develop and evaluate an education program for high-risk, low-volume equipment and skills in the pediatric emergency department setting. This is a pre- and post-quality improvement study conducted in a Northeastern United States pediatric Level I trauma center. Emergency department nurses were invited to view videos detailing high-risk, low-volume equipment use. For the convenience of access, Quick Response (QR) codes linked to the videos were placed on each piece of equipment reviewed. General self-efficacy and levels of self-efficacy in using the equipment were assessed before the intervention and again after 4 weeks from January to February 2023. A total of 43 pediatric emergency nurses participated in the education. The mean aggregate general self-efficacy score was 32.93. Mean scores in all areas (Level 1 rapid infuser, fluid warmer, blood administration, and securing an endotracheal tube) improved after the intervention. Easily accessible, brief refresher videos linked to QR codes in the pediatric emergency department can help empower nurses who need to use high-risk, low-volume equipment.

Nurses’ Understanding and Practice of Minimal Stimulation in the Pediatric Intensive Care Unit

Background Pediatric patients receiving neurologic and neurosurgical critical care undergo many procedures that result in stimulation of the sympathetic nervous system, which increases their risk of poor outcomes. Nurses typically implement a variety of interventions to minimize such stimulation; however, minimal stimulation has not been specifically defined in the literature or described as a standardized bundle of care. Objective To examine pediatric intensive care unit nurses’ interpretation and practice of minimal stimulation in patients with neurologic and neurosurgical conditions and specifically to triangulate nurses’ descriptions of this practice with related findings in the literature. Methods This was a qualitative, descriptive, exploratory study that used naturalistic inquiry. Results A total of 13 pediatric intensive care unit nurses participated in the study. Three primary themes were identified regarding minimal stimulation: (1) new knowledge and practice, (2) communication, and (3) impact of minimal stimulation. Conclusions The findings of this study help to establish a working definition of the nursing practice of minimal stimulation and provide a basis for future research. More detailed study is needed on the concept of a standardized minimal stimulation bundle and its impact on patient outcomes.

Knowledge Levels of Pediatric Nurses on Newborn Skin Care: A Multicenter Study

Objective: The aim of this study is to determine the level of knowledge among nurses regarding newborn skin care and the factors influencing this knowledge level. Method: The research was conducted among nurses working in various hospitals in Burdur and Antalya (n=114). Demographic and professional characteristics of the participants such as age, gender, education level, and years of experience in the profession were recorded. A pre-developed questionnaire was used to measure the level of knowledge on newborn skin care. Data analysis was performed using the SPSS statistical package. Results: According to the research findings, the level of knowledge among nurses regarding newborn skin care is generally above average. Factors such as age, gender, education level, and professional experience were observed to influence knowledge levels (p

The Effectiveness of Parent Education in Discharge-Symptom Management (PED-SM) on Parental Readiness to Care for Children with Cancer

Introduction: Cancer in children is a life-threatening disease that has been steadily increasing over the past few decades. Parents are concerned about how to appropriately care for children due to the physical symptoms experienced by children with cancer. Objective: The purpose of this study was to determine the effect of Parent Education in Discharge Symptom Management (PED-SM) on parental readiness to care for children with cancer. Methods: This research utilized a quasi-experimental design with intervention and control groups, measured using a pre-post test design. Respondents in this study were parents of children aged 3 to 12 years newly diagnosed with cancer. A convenience sampling method was employed. The instrument used in this study was the I-PCS (Preparedness of Caregiving Scale-Indonesian) with a Cronbach's alpha of 0.73-0.78, where a Pearson's r 0.320 indicates validity. Results: A total of 58 respondents agreed to participate in this study. The mean age of parents was higher in the control group (39.48), while the mean age of children was lower (7.38). More than half of the children were boys with ALL/AML cancer types. Parents mostly worked full time, had education up to junior or senior high school, and had a monthly income of 4.9 million. There was a statistically significant difference after the intervention in both groups, with a p-value 0.005. However, the mean score after intervention (45.76 ± 5.81) was higher compared to the control group (32.34 ± 4.41). Employment showed a significant contribution of 6.52 to parental readiness among parents of children with cancer (β: 1.87, 95% CI: 1.29 – 32.97, p-value: 0.02). The intervention of PED-SM can be implemented by pediatric nurses in cancer units as one of educational tool aimed at reducing readmissions and enhancing the quality of life for children. Conclusion: The PED-SM module can serve as a reference for educating families of children newly diagnosed with cancer.

The effects of a hospital-to-home care transition program on perceived stress and readiness for hospital discharge in mothers of children with congenital heart disease undergoing corrective surgery

BackgroundThe aim of this study was to investigate the effects of a hospital-to-home care transition (H2H-CT) program on perceived stress and readiness for hospital discharge (RHD) in mothers of children with congenital heart disease (CHD) undergoing corrective surgery. MethodsThis study used a quasi-experimental design and involved 78 mother-child dyads, 40 dyads in the intervention group and 38 dyads in the control group, who were affected by CHD undergoing corrective surgery. The participants received the H2H-CT program, which consisted of six face-to-face training sessions during hospitalization and six telephone counselling sessions. For perceived stress, data were collected at four intervals, including baseline, immediately, one month and three months after completion of the intervention. For RHD, data were collected at two times: baseline and immediately after the intervention. ResultsThe results demonstrated a statistically significant reduction in the mean perceived stress score in mothers of children with CHD in intervention group before, immediately, four weeks and eight weeks after H2H-CT (P < 0.001). The results also indicated a significant increase in the mean RHD score in the intervention group following H2H-CT (P < 0.001). ConclusionThe H2H-CT program was found to be an effective intervention in reducing perceived stress and increasing RHD in mothers of children with CHD who undergoing corrective surgery. Implications to practiceThe results can be used by the nursing planners, nursing instructors, and pediatric nurses to use the results to enhance the mental health of mothers and enable them to provide quality care at home.

Career motivation of 1st year nursing and midwifery students

This paper presents findings from a cross-sectional study into the motivational factors of students who chose nursing and midwifery as a career. 189 students from the University of Bedfordshire (UoB) and 223 students from Canterbury Christ Church University (CCCU) completed a questionnaire at the start of their studies in 2018. The findings are generated from the first stage of the Placement, Impact, Experience and Destination (PIED) study into student belongingness on placement and the influence of practice on the first career destination of newly qualified nurses and midwives. An in-class questionnaire was administered to 1st year pre-registration adult, child and mental health nursing and midwifery students to identify the intrinsic and extrinsic factors that influenced their motivation to choose nursing or midwifery as a career. A mix methods study design was adopted for the PIED study where participants completed a survey that collected quantitative and qualitative data and administered during the course induction period. Motivation scores were found to be high in both cohorts, with students at both sites endorsing intrinsic motivational factors over extrinsic at statistically significant levels. The strongest intrinsic factors appeared to be a desire to help and care for people and play a useful role in society, whereas the strongest extrinsic factors were career stability and the ability to work in different regions and countries. The study suggests that the influence of family and friends continues to exert a strong intrinsic motivational influence on the career choices of students, particularly those under the age of 25. Identifying the motivational factors of first year nursing and midwifery students presents employers with an opportunity to tailor strategies to recruit apprentices, enable placement partners to enculturate prospective employees into the workforce and understand the relationship between extrinsic factors and practice learning to successfully recruit graduates.

Infant feeding and criticality in children.

Data support the protective effects of human breast milk (HBM) feeding in acute illness but little is known about the impact of HBM feeding on the criticality of infants. To explore the relationship between early HBM feeding and severity of illness and recovery in critically ill children requiring intubation and mechanical ventilation for acute respiratory failure (ARF). Prospective cohort study of mothers of patients aged 1-36 months who participated in the acute and follow-up phases of the Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) clinical trial. Participants completed a survey describing HBM dose fed during their infant's first month of life. Of 138 patients, 70 (51%) received exclusive HBM feedings (90%-100% total feeds) and 68 (49%) did not. We found no group differences in severity of illness on paediatric intensive care unit (PICU) admission or severity of paediatric acute respiratory distress syndrome (PARDS) within the first 24-48 h of intubation/mechanical ventilation (Pediatric Risk of Mortality [PRISM] III-12 score median: 5 vs. 5, p = .88; moderate/severe PARDS: 53% vs. 54%, p = .63). While median time to recovery from ARF was reduced by 1 day in patients who received exclusive HBM feedings, the difference between groups was not statistically significant (median 1.5 vs. 2.6 days, hazard ratio 1.40 [95% confidence interval, 0.99-1.97], p = .06). Human breast milk dose was not associated with severity of illness on PICU admission in children requiring mechanical ventilation for ARF. Data support the protective effects of HBM during acute illness and data from this study support a clinically important reduction in time to recovery of ARF. Paediatric nurses should continue to champion HBM feeding to advance improvements in infant health.

Relationship between mental workload and musculoskeletal disorders with intention to leave service among nurses working at neonatal and pediatric departments: a cross-sectional study in Iran

BackgroundDespite the challenge of nursing shortage in the world and its subsequent impact on care quality as well as aggravation of the situation by intention to leave service, this issue has not been properly addressed, especially among neonatal and pediatric nurses. The present study aims to identify the relationship between mental workload and musculoskeletal disorders with intention to leave the service among nurses working at neonatal and pediatric departments.MethodsThis descriptive-analytical study was conducted on 145 nurses working at neonatal and pediatric departments in six hospitals in Bushehr Province using full-census method. The data were collected using national aeronautics and space administration-task load index (NASA-TLX), Cornell musculoskeletal discomfort questionnaire(CMDQ) and Mobley and Horner’s voluntary turnover questionnaire. The data were analyzed using descriptive statistics, independent t-test, Mann-Whitney U test, one-way analysis of variance (ANOVA), Kruskal-Wallis test, Pearson’s and Spearman correlation tests and hierarchical linear regression in simultaneous model in SPSS 19.0.ResultsThe mean score of intention to leave the service was 9.57 ± 3.20 (higher than the moderate level) and the mean mental workload was 71.65 ± 15.14 (high level). Pain in at least one of the legs (100%), back (77.3%) and knees (76.6%) was highly prevalent. However, no statistically significant correlation was found between musculoskeletal disorder categories and intention to leave the service (p > 0.05). The regression analysis results revealed among mental workload domains, only effort-induced workload was negatively and significantly correlated with intention to leave the service (p = 0.003; β=-0.078). However, the number of night shifts per month was positively and significantly correlated with intention to leave the service (p = 0.001; β = 0.176).ConclusionsPlanning for appropriate allocation of night shifts, investigating the etiology of musculoskeletal disorders and providing solutions for reducing mental workload should be prioritized by policymakers, while maintaining pediatric nurses’ motivation for making efforts.

Barriers and facilitators of nurse-led self-management support for adolescents with epilepsy: A mixed-methods study in transition preparation

AimsTo gain insight into the readiness for evidence-based practice of self-management support during transition for adolescents with epilepsy among pediatric nurses, and to explore the promoting and hindering factors. DesignA mixed-methods design with an explanatory sequential approach was employed. SettingThree specialty children's hospitals in southwest regions of China. MethodsIn phase 1, a total of 126 participants were included in the Survey of Clinical Readiness of Evidence-Based Nursing Assessment (CREBNA) from Dec 2022 to Feb 2023. Total scale and subscale scores were calculated. In phase 2, we developed the interview outline based on the analysis of the quantitative results. In-depth interviews (n = 15) were conducted from Feb 2023 to Apr 2023 to explain and supplement the quantitative phase results. ResultsThe total score of CREBNA indicated that teams have good readiness and capacity for implementation of evidence-based nursing practice Compared with the norm. The scores of the three subscales of evidence factors, organizational environment, and promoting factors were normal. In subsequent interviews and integration, we extracted four themes based on the Knowledge-To-Action (KTA) framework: 1. organization barriers (incentive mechanism, interdisciplinary cooperation process, information aids); 2. operational barriers (Exemplary evidence-based practice, time pressure, gaps in patient and family understanding of evidence); 3. individual-level barriers (evidence-based and professional knowledge reserve, professional autonomy, shared decision-making roles, dependence on habitual clinical behaviors); and 4. facilitating factors (leadership commitment, self-management identity, transition service needs, patient- and family-centered care culture). A conceptual model was constructed based on the KTA. ConclusionIt is feasible to carry out evidence-based practice of nurse-led self-management support in transition preparation. Nursing researchers and managers should carry out knowledge selection and tailoring based on barriers at the organizational, operational, and individual levels to promote favorable factors and improve the smooth transition of adolescents with chronic diseases.

Attitudes towards patient safety culture among pediatric nurses at government tertiary hospital in Vietnam

Pediatric patients are vulnerable to medication errors. Nurses have essential roles in patient safety and their quality of care. Therefore, nurses' attitudes regarding safety culture help nurses gain a profound insight into patient safety problems as well as potential solutions to cope with them. Motivating nursing professionals to understand safety culture and how they act about patient safety is one of the first steps to improving patient safety in healthcare institutions. This study aims to investigate attitudes towards patient safety culture among pediatric nurses and related factors. A cross-sectional descriptive correlational design was used with a sample size of 105 pediatric nurses at a selected government hospital in the Mekong Delta, Vietnam. Nurses’ attitudes towards patient safety culture were examined using a 4-likert questionnaire including 30 items divided into six subscales. Data analysis was performed in SPSS Version 26.0 using descriptive statistics and analysis of variance (ANOVA). The study findings showed that the overall mean score of attitude towards patient safety culture was 3.30 (SD = 0.45). Among subscales of attitudes, teamwork climate had the lowest mean scores. There were statistically significant associations between the level of education, experience, and nurses’ attitudes. According to the results, nurses’ attitudes regarding patient safety culture were good. However, there were some aspects that should be enhanced. It is strongly recommended that specific training interventions be performed to enhance the teamwork climate in the hospital.

PiccPed® app impact on nurses' knowledge to prevent adverse events for peripherally inserted central catheters (PICC) in pediatric and neonatal healthcare: A quasi-experimental study

BackgroundThe PiccPed® health application was developed to support clinical decision-making in peripherally inserted central catheter (PICC) management. We aimed to evaluate its impact on nurses' knowledge regarding the prevention of PICC-associated adverse events in pediatrics and neonatology. MethodsA quasi-experimental, pre-post intervention study, was conducted with a dependent/paired sample of pediatric and neonatal nurses from two tertiary hospitals in South Brazil. Data were collected from October 2022 to January 2023 across three phases: pre-, intervention (use of the PiccPed®) and post-test. Study outcomes were a knowledge test (15 questions) of evidence-based PICC maintenance procedures, and PiccPed® app time spent and screens used. ResultsA total of 56 nurses completed the study. The post-test mean score was significantly higher (12/15; standard deviation (SD) 1.9) in comparison with the pre-test (mean 9/15; SD 2.2). The change in scores was significantly higher for nurses without postgraduate qualifications, in comparison to those with (Mean Difference 1.26; p = 0.039). Each minute using the app resulted in a significant increase of 0.04 points (95% confidence interval 0.01–0.08; p = 0.014) on the mean post-test score (10.94 points). Conclusion: The research demonstrated that PiccPed® enhances nurses' learning regarding the prevention of adverse events associated with PICC maintenance in pediatrics and neonatology. Application to practiceThe app can be safely and effectively used for training and continuing education of nurses who care for children and neonates with PICCs.

Mother's perception of early introduction of complementary feeding affecting stunting in Ghana: A qualitative research

AbstractObjectivesThe study aimed to explore mothers' perceptions for timely introduction of complementary feeding through interviews with 2–12‐month‐old infants' mothers in Ghana.MethodsQualitative descriptive research with 16 semi‐structured interviews with mothers attending the Child Welfare Clinic at Ejisu Hospital was conducted from June 2022 to May 2023. The study was guided by the Declaration of Helsinki, and all participants were instructed about informed consent for the study. Interviews and analysis were guided by Theory of Planned Behavior. NVivo 1.5 was used throughout the coding procedure. This study was conducted after the approval from St. Luke's International University.ResultsFour themes were revealed: (1) attitude toward the behavior based on the mothers' experience raising children, (2) attitude toward the behavior influenced by subjective norm (grandmothers' recommendation), (3) attitude toward the behavior influenced by perceived behavioral control (difficulty in continuing breastfeeding), and (4) mothers who are worried about underweight despite timely introduction of complementary feeding. Attitudes toward the behavior were influenced by mothers' experiences raising children and grandmothers' recommendations. Surroundings disruptive of breastfeeding also influenced attitudes toward intentions and behavior. Moreover, some mothers suffered from underweight even if they introduce complementary feeding at an optimal time.ConclusionSupporting to continue breastfeeding and conducting re‐education for grandmothers is a key recommendation for midwives and pediatric nurses. Moreover, pediatric nurses are required to further enhance not only health education regarding the timing of initiating complementary feeding but also support after the introduction.

Pediatric nurses' experiences of implementing the ‘ten right principles’ in safe medication management: A descriptive phenomenological study

PurposeIn medication management, the ten right principles framework is an accepted global nursing standard and an important component of medication safety. Especially pediatric patients have a higher risk of harm in medication administration compared to adults. This study aimed to examine the experiences of pediatric nurses in implementing the ten right principles in safe medication management. Design and methodsA descriptive phenomenological approach was used in this study. The study was conducted with 16 pediatric nurses in a public hospital's Pediatric Service and Neonatal Intensive Care Unit. Pediatric nurses' medication practices were observed, and semi-structured interviews were conducted with the nurses after the observation. Observations were conducted using an observation tool, and interviews were conducted using a semi-structured interview form. Qualitative data were analyzed using thematic analysis. ResultsIn this study, it was observed that although pediatric nurses generally adhered to the ten right principles, they had the most difficulties with the right dose and time principles. As a result of the interviews conducted after the observation, two themes (factors facilitating the implementation of the ten right principles and difficulties in implementing the ten right principles) were formed. ConclusionsThe findings revealed that pediatric nurses achieved safe and effective medication administration and generally adhered to the ten right principles. Practice implicationsThis study highlights the positive contribution of pediatric nurses to patient safety by using multiple sources of information and clinical reasoning strategies despite the difficulties they experience in drug administration.

The mediating role of nurses' attitude towards reporting child abuse and neglect

PurposeAttitudes towards reporting child abuse and neglect play a significant role in determining the tendency to report abuse and neglect. In addition, Cognitive Response Theory (Shen, 2020) suggests that individuals actively process messages by producing pro and/or counter arguments referred to as “Gain – loss thoughts”. However, literature positioning the variable, attitudes towards reporting, as a mediator, as well as its importance, are limited. The purpose of the study was to investigate the mediating effect of pediatric nurses' attitudes between “gain-loss thoughts” and the tendency to report child abuse and neglect. Design and methodsA cross-sectional study examined 124 pediatric nurses working in central Israel's hospital departments concerning nurses' tendency to report (tendency to report = TTR), attitudes towards reporting, and “gain-loss thoughts” (positive and negative consequences for the child). ResultsMost of the nurses had professional experience of 11 years or more (n = 75; 62.5%). According to the findings, nurses' attitudes towards reporting mediate the effect of gain-loss on the TTR child abuse and neglect. ConclusionsFindings from this study contributed to our understanding of the importance of pediatric nurses' attitudes in determining the TTR abuse and neglect. Only nurses' positive attitudes towards reporting child abuse had a mediating effect on TTR. Practice implicationsUnderstanding the importance of attitudes and gain-loss thoughts can serve as a strategy for training programs and in the assimilation of reporting obligations by health professionals in general and nurses in particular.

Attitudes, Self-Confidence, and Knowledge of Primary Care Professionals towards School Bullying.

Attitudes, practices, and knowledge about bullying were evaluated in a sample of 274 primary care professionals, including general practitioners, pediatricians, community, pediatric and school nurses, and residents of these specialties. This study was based on a mixed method with a parallel convergent design without dominance between phases, data were collected concurrently, and conversion of the results from both phases was carried out during data interpretation. The quantitative phase had a cross-sectional observational design, using The Healthcare Provider's Practices, Attitudes, Self-confidence, and Knowledge Regarding Bullying Questionnaire as an instrument. Descriptive and bivariate analyses were performed, which showed a positive correlation between higher self-confidence and knowledge scores and a greater predisposition to detect cases. However, although the dimensions of attitudes and knowledge yielded generally high data, low self-confidence was evident in addressing this problem. In addition, a lack of clear guidelines in the workplace was expressed, highlighting the need to create and provide specific resources to intervene in bullying in said context, which could develop an improvement in self-confidence, leading to greater well-being for the educational community regarding bullying.