Pediatric Nurses Research Articles

What the pediatric nurse needs to know about the Impella cardiac assist device.

Background: Cardiogenic shock in children still carries a high mortality risk despite advances in medical therapy. The use of temporary mechanical circulatory supports is an accepted strategy to bridge patients with acute heart failure to recovery, decision, transplantation or destination therapy. These devices are however limited in children and extracorporeal membrane oxygenation (ECMO) remains the most commonly used device. Veno-arterial ECMO may provide adequate oxygen delivery, but it does not significantly unload the left ventricle, and this may prevent recovery. To improve the likelihood of left ventricular recovery and minimize the invasiveness of mechanical support, the Impella axial pump has been increasingly used in children with acute heart failure in the last decade. Purpose: There are still limited data describing the Impella indications, management and outcomes in children, therefore, we aimed to provide a comprehensive narrative review useful for the pediatric nurses to be adequately trained and acquire specific competencies in Impella management.

The Voice of Travel Nurses: Facilitating Effective Staffing During Pandemic and Expansion-Related Demands in a Children's Hospital.

The aim of this study was to explore the experience and perceived value of travel nurses in a children's hospital. Children's hospitals face unique challenges related to highly specialized care requirements and workforce expansion limitations. Travel nurses can augment nurse staffing capacity during times of intense demand and may offer insights as organizations seek to strengthen work environments. Pediatric travel nurses currently contracted at the hospital were invited to participate in a focus group or interview. Content analysis was used to summarize information and identify themes. From the 56 participants, 5 themes emerged. The themes were financial, flexibility, searching for healthy work environments, nursing care, and solutions. Hearing the voices of travel nurses may offer valuable feedback to strengthen future professional practice environments.

Optimization of Pediatric Pain Management Through the Development of a Pediatric Pain Resource Nurse (PRN) Program

Optimization of Pediatric Pain Management Through the Development of a Pediatric Pain Resource Nurse (PRN) Program

Therapeutic Procedures and Care of a Child Nursing Considerations

As pediatric nurses, our mission is atraumatic care i.e. to shield children from needless trauma and pain caused by medical procedures. Child's preparation prior to the procedure includes need based assessment of the procedure and readiness for procedure, building trust and establishing rapport as well as clustering multiple procedures to minimize trauma. Prior to procedure informed consent is necessary whenever required. It is essential to follow family centred care and educate the child and family as family is the integral part of child’s life. Preparation of child according to age, utilization of age appropriate equipment and age specific techniques, keen observation of child and surrounding are important aspect of childcare. Pharmacological, non-pharmacological and psychological strategies, involvement of loved one’s aid for minimizing the pain fear anxiety and distress. The physical and psychological safety of child should be of prime concern while performing a nursing procedure on child, the aim should be to successfully complete the procedure minimizing the negative effects of the same. Therefore, it is vital that any medical procedure is ended in a positive manner.

Knowledge and Practices of Pediatric Nurses about Pre and Postoperative Care of Intestinal Obstruction

Knowledge and Practices of Pediatric Nurses about Pre and Postoperative Care of Intestinal Obstruction

Optimizing care for children with difficult-to-treat and severe asthma through specialist paediatric asthma centres: expert practical experience and advice

Severe asthma in children carries an unacceptable treatment burden, yet its rarity means clinical experience in treating it is limited, even among specialists. Practical guidance is needed to support clinical decision-making to optimize treatment for children with this condition.This modified Delphi convened 16 paediatric pulmonologists and allergologists from northern Europe, all experienced in treating children with severe asthma. Informed by interviews with stakeholders involved in the care of children with severe asthma (including paediatricians, nurses and carers), and an analysis of European guidelines, the experts built a consensus focused on the gaps in existing guidance. Explored were considerations for optimizing care for patients needing biologic treatment, and for selecting home or hospital delivery of biologics. This consensus is aimed at clinicians in specialist centres, as well as general paediatricians, paediatric allergologists and paediatric pulmonologists who refer children with the most severe asthma to specialist care. Consensus is based on expert opinion and is intended for use alongside published guidelines.Our discussions revealed three key facets to optimizing care. Firstly, early asthma detection in children presenting with wheezing and/or dyspnoea is vital, with a low threshold for referral from primary to specialist care. Secondly, children who may need biologics should be referred to and managed by specialist paediatric asthma centres; we define principles for the specialist team members, tests, and expertise necessary at such centres, as well as guidance on when homecare biologics delivery is and is not appropriate. Thirdly, shared decision-making is essential at all stages of the patient’s journey: clear, concise treatment plans are vital for patient/carer self-management, and structured processes for transition from paediatric to adult services are valuable. The experts identified the potential for specialist paediatric asthma nurses to play a significant role in facilitating multidisciplinary working.Through this project is agreed a framework of practical advice to optimize the care of children with severe asthma. We encourage clinicians and policymakers to implement this practical advice to enhance patient care.

Analysis of education and previous nursing experience of certified PNPs in the United States

BackgroundEducational programs to prepare nurse practitioners (NPs) were historically built upon foundational nursing experience. Originally prepared as certificate programs in 1965, the educational requirements for nurse practitioners (NPs) rapidly shifted from certificate programs to the Master's degree (DellaBella, 2015; Fairman, 2008). As Doctor of Nursing Practice (DNP) degree programs increase in number, it is unknown whether this foundational nursing experience has changed, or if it differs by certification type for pediatric nurse practitioners (PNPs). This study aimed to evaluate the educational preparation and prior nursing experience of primary care and acute care certified PNPs. MethodsA national survey of members of the Pediatric Nurse Practitioner Certification Board (N = 17,530) was completed (Mudd et al., 2022). A sub-analysis of this data was conducted (n = 1974). Results: There was no statistical evidence among either primary or acute care PNPs of an association between previous nursing experience and type of degree preparation (Master's or DNP). There was only a weak association between educational preparation and experience among acute care nurse practitioners. Most respondents were prepared at the Master's level, and 85% of all respondents had >1 year of nursing experience prior to returning for additional PNP education. DiscussionThis study adds to the literature as it describes the educational preparation and foundational nursing experience of primary and acute care PNPs. It can serve as a benchmark as the move to the DNP continues for Advanced Practice Registered Nurse preparation.

Adaptation and validation of the Physical Restraint-Theory of Planned Behaviour Questionnaire to the paediatric context.

Physical restraint is applied in pediatric intensive care units to carry out certain painful procedures and to ensure the maintenance and continuity of life support devices. There is a need to analyse the factors that influence the behaviour or intention to use physical restraint. To create and test psychometrically a paediatric version of the Physical Restraint-Theory of Planned Behaviour Questionnaire to assess paediatric critical care nurses' intention to use physical restraint. A psychometric study. Five medical-surgical Paeditric Intensive care Units from five hospitals in Spain. The study took place in three phases. In phase 1, the questionnaire was adapted. In phase 2, the content validity of each item was determined, and a pilot test was conducted. In phase 3, we administered the questionnaire and determined its psychometric properties. The assessment of the intention to use physical restraint was extended to all critical paediatric patients, two items were eliminated from the initial questionnaire, four new items were included, and the clinical scenarios of the intention subscale were expanded from three to six. Overall content validity index for the full instrument of 0.96 out of 1. The Paediatric Physical Restraint-Theory of Planned Behaviour Questionnaire is made up of four subscales (attitude, subjective norms (SN), perceived behavioural control (PBC), and intention) subdivided into 7 factors and 51 items. The internal consistency for the attitude subscale obtained a Cronbach's Alpha of 0.80 to 0.73, for the SN it was 0.72 to 0.89, for the PBC it was from 0.80 to 0.73 and for the intention subscale it was 0.75. The Paediatric Physical Restraint-Theory of Planned Behaviour Questionnaire is an instrument composed of seven factors and 51 items that validly and reliably assesses the intention of paediatric nurses to apply PR in PICUs. Having this instrument will help health centres move towards restraint-free care by allowing managers to assess professionals' attitudes, beliefs, and intentions around the use of PR in PICUs.

Communication challenges caused by wearing masks and strategies used by pediatric nurses during the COVID-19 pandemic: A qualitative study

PurposeThe COVID-19 pandemic and the use of facemasks have caused many communication challenges for pediatric nurses. The purpose of this study was to investigate these challenges and the strategies that nurses use to overcome them during the nursing care of sick children. Design and methodsThis was a qualitative study using conventional content analysis. The nurses were selected by purpose-based sampling and interviewed semi-structurally between April and June 2023 at the Children's Educational Therapy Center in Tabriz, Iran. The sample size was determined by the data saturation principle. The report of this research followed the COREQ guidelines. ResultsTwelve nurses were interviewed. The analysis revealed four main categories: “Disturbances in communication”, “Disturbances in trust”, “Disturbances in providing care”, and “Nurses' strategies to mitigate the challenges of mask usage. To solve the challenges caused by the mask, nurses used solutions such as removing the mask and mitigating the adverse effects of mask usage they used. The central theme of the study was “Humanistic care requires trust-based communication”. ConclusionsThis study highlights the communication challenges faced by pediatric nurses due to mask-wearing during the COVID-19 pandemic. Despite these challenges, nurses have developed innovative strategies to improve communication and build trust with their young patients. Further research is needed to evaluate the effectiveness and feasibility of these strategies. Practical implicationsThese strategies can be useful for other nurses who work with children in similar conditions. Further research is needed to evaluate the effectiveness and feasibility of these strategies in different settings and populations.

Effect of peppermint inhalation versus Swedish massage on chemotherapy induced-nausea and vomiting in children with leukemia: Multi-arm randomised trial design

BackgroundChemotherapy is the foremost treatment for children with leukemia, while causing different serious side-effects. Chemotherapy-induced nausea and vomiting are the most common deliberating side effects and critical concerns of pediatric oncology nurses among those children. AimTo investigate the effect of peppermint inhalation versus Swedish massage on chemotherapy-induced nausea and vomiting in children with leukemia. DesignA multi-arm randomised trial design with three parallel groups. SettingThis study was conducted at outpatient and inpatient Hematology/leukemia Units at Alexandria University Children's Hospital at Smouha. MethodsSeventy-five children with leukemia received the first chemotherapy session. They were randomly allocated into three equal groups, 25 children in each group (control, peppermint inhalation, and Swedish massage groups). Every child is assessed for nausea and vomiting before chemotherapy administration and after for three days for consecutive three sessions of treatment. ResultsStudy findings revealed that children in peppermint inhalation and Swedish massage groups showed significant reduction in mean total score of chemotherapy-induced nausea and vomiting among peppermint inhalation and Swedish groups (15.120 ± 4.585 and 14.680 ± 3.158, respectively) was observed on third chemotherapy session than in control group (45.680 ± 5.793) (p < 0.001). ConclusionIt can be concluded that Swedish massage and peppermint inhalation therapies may have significant antiemetic effects as alleviating the chemotherapy induced nausea and vomiting for children with leukemia. Practice implicationsThis study directs the pediatric oncology nurses to incorporate peppermint inhalation and Swedish massage therapies besides antiemetic drugs in pediatric oncology unit protocols for management of chemotherapy induced nausea and vomiting.

Peer Mentorship Enhances Coping in Children, Adolescents, and Young Adults with Pectus Excavatum and Adolescent Idiopathic Scoliosis

Purpose: Children and adolescents and young adults (AYA) with pectus excavatum (PE) and adolescent idiopathic scoliosis (AIS) experience similar journeys regarding pain, body image, and self- and peer acceptance. Peer mentoring may address some of the challenges faced regarding diagnosis and treatment of PE and AIS. Before implementing a mentor program, our hospital noted an increased length of stay (LOS) and difficulty coping in those undergoing surgery for PE and AIS, emphasizing the need for additional support. The purpose of this study was to evaluate the impact of a peer mentor program for children/AYAs with PE or AIS and their parents on coping, pain, and LOS. Design and Methods: This non-randomized controlled trial included a prospective intervention group that received peer mentorship and a retrospective control group that received standard care. Self-reported surveys assessed the effect of the mentor program on coping. Qualitative data on coping were analyzed descriptively. Postoperative pain and LOS were obtained from the health record. Bivariate inferential statistics were used to compare the distribution of pain scores and LOS between intervention and control groups. Results: Children/AYAs, parents, and mentors reported enhanced coping and found peer mentorship beneficial, though it did not have a statistically significant impact on pain or LOS. Conclusions: Peer mentorship facilitates coping in children/AYAs with PE or AIS undergoing corrective surgery. Parents and mentors also perceived benefits. Practice Implications: Pediatric nurses and child life specialists can help children/AYAs, and their families prepare for surgery by connecting them with peer mentors and social support.

Nursing experiences and knowledge of paediatric delirium: Analysing knowledge-practice gaps.

Delirium commonly occurs in paediatric patients with acute critical illness and negatively affects clinical outcomes. Variations in delirium knowledge levels and its management have been noted among nurses. This study investigated nurses' experiences and knowledge levels regarding paediatric delirium. Additionally, we aimed to assess the gap between knowledge levels and practical experiences with paediatric delirium. This cross-sectional descriptive study conveniently sampled paediatric nurses from a university hospital in South Korea between September 2022 and March 2023. Nursing experiences with paediatric delirium and delirium knowledge levels were measured using structured survey questionnaires. Delirium knowledge was scored 0 to 47, and higher scores indicated higher levels of delirium-related knowledge. Data were analysed using descriptive statistics and presented as mean, standard deviation, frequency and percentage. A total of 127 paediatric nurses participated in this study; 40.2% had experience with 1-5 delirium cases in the previous year, and 86.6% (n = 110) had never used assessment tools for paediatric delirium assessment. The mean total delirium knowledge score was 34.45 ± 5.4; the mean scores of knowledge regarding aetiology, signs and symptoms and nursing management of delirium were 8.93 ± 1.31, 13.24 ± 2.81 and 12.3 ± 2.7, respectively. Interventions associated with a lower level of delirium-related knowledge and a lower performance rate included avoiding restraint use and maintaining hydration and electrolyte levels. Interventions associated with a higher level of delirium-related knowledge but a lower rate of performance comprised providing orientation, offering emotional support, allowing participants to stay with family members and administering medications to manage delirium. Although nurses working in paediatric units exhibited high rate of delirium nursing care, there was the gap between their delirium-related knowledge and practice. Nurses need to be aware of the insufficient part of delirium care, and paediatric delirium education should be reinforced. Preventing, assessing and systematically managing paediatric delirium is crucial, and considering the study results, delirium education among nurses is needed.

Developing an evidence-and ethics-informed intervention for moral distress.

The global pandemic has intensified the risk of moral distress due to increased demands on already limited human resources and uncertainty of the pandemic's trajectory. Nurses commonly experience moral distress: a conflict between the morally correct action and what they are required or capable of doing. Effective moral distress interventions are rare. For this reason, our team conducted a multi-phase research study to develop a moral distress intervention for pediatric critical care nurses. In this article, we discuss our multi-phase approach to develop a moral distress intervention-proactive, interdisciplinary meeting. Our proposed intervention is a sequential compilation of empirical work couched within a relational ethics lens thus should point to enhanced potential for intervention effectiveness.

Fallo de medro en Pediatría de Atención Primaria: recomendaciones para su abordaje y seguimiento

Failure to thrive is poor physical growth, both in weight and height, in children under three years of age. This underdiagnosed entity can affect children’s physical, intellectual, emotional and social development. Paediatric Primary Care is crucial in early diagnosis and prevention of their morbidity. This document represents a useful tool for the teamwork between paediatricians and paediatric nursing. Its objective is to carry out an early, individualized and efficient approach in these children.

Assessing the professional quality of life in the context of pediatric care.

This study examines the professional quality of life (ProQOL), including compassion satisfaction (CS) and compassion fatigue (CF), burnout (BO) and secondary traumatic stress (STS) among registered nurses in the context of pediatric care in Riyadh city in Saudi Arabia. This study utilised a random multistage sampling method and a survey to collect data from 250 participants on personal characteristics, work-related aspects, lifestyle, and professional quality of life. The study participants were all female. Only 2.0% were under 25, with 27.2% aged between 25 and 30 years, 24.0% aged between 31 and 35, and 26.4% over 40 years old. The majority, 74%, were non-Saudis. The participants reported low compassion satisfaction (CS) and compassion fatigue (CF) levels. The CS, burnout (BO), and secondary traumatic stress (STS) scores were 3.23±0.764, 2.75±0.68, and 2.69±0.54, respectively. The study found a significant difference in ProQOL level based on factors such as age, nationality, previous experience, department, shift length, overtime work, state of overtime (mandatory versus optional), and salary. Working with vulnerable groups poses unique challenges for pediatric nurses. The nationality, salary, and state of overtime were found to be significantly different when compared to CS scores. Additionally, age, department, previous experience, shift length, and overtime work were very different compared to CF scores. However, lifestyle factors did not affect CS and CF scores significantly. To improve their well-being and interest in activities, pediatric nurses should practice self-compassion and utilise available educational resources such as workshops. They should also strive to achieve a work-life balance and adopt healthy habits to reduce CF.

Çocuklarda Postoperatif Dönemde Ağrı Tedavisinde Nonfarmakolojik Yöntemlerin Kullanımının İncelenmesi: Sistematik Bir İnceleme

Background: The aim of this study was to examine the non-pharmacological methods used by nurses in postoperative pain management in pediatric patients aged 0-18 years and the effectiveness of the methods used in reducing the level of pain.&#x0D; Material and Methods: In this descriptive study, the research population consisted of studies that were accessed from the National Thesis Center database by using the keywords "pediatric", "pain", "surgical", "postoperative", "non-pharmacological" in different combinations in the literature search and that examined non-pharmacological methods used for pain management in the postoperative period in pediatric patients between the ages of 0-18 years in the last seven years and were conducted in experimental design. This systematic review was carried out using the PRISMA flowchart steps.&#x0D; Results: A total of 1185 individuals, including 905 children and 280 parents, took part in 11 studies. The mean age of the children in the studies was 6.6 years (min-max). The most preferred scale to measure pain in the postoperative period was the Wong Baker Facial Pain Scale (7 studies). Non-pharmacologic methods used in the studies included distraction (5 studies), therapeutic play (3 studies), distraction and therapeutic play (1 study), massage therapy (1 study) and music therapy (1 study).&#x0D; Conclusion: Different non-pharmacological methods used in the postoperative period are effective in reducing pain levels in children.&#x0D; Practice implications: It is possible for pediatric nurses to use non-pharmacological methods to reduce pain in the postoperative period. Further research is needed to determine the effectiveness of these interventions on pain.

Research on Family-Centered Care in pediatric patients: A Bibliometric Analysis

ObjectiveThis study is conducted as a bibliometric analysis to determine the trends in studies related to family-centered care in children. Materials and methodsThe Web of Science database was used to collect study data. A search was conducted on Web of Science using the keywords “family-centered care”, “family centered care”, “family-centred care”, “family centred care”, “family-integrated care”, “family integrated care”, “patient and family centered care”, “patient- and family-centered care” and “child” or “pediatric” or “pediatrics” or “child” or “newborn” or “neonatal” or “adolescent” together. The VOSviewer program was used for data analysis and visualization. The analysis included the number of publications by year, distribution by journals, most cited studies, countries with the highest publication output, most frequently used keywords, and co-authorship dimensions, presented with visual maps. ResultsA total of 2525 studies conducted from 1980 onwards were analyzed. The analysis revealed that the initial publications related to the subject emerged in 1980, and the United States was identified as the country with the highest number of publications, based on the Web of Science database. The Journal of Pediatric Nursing: Nursing Care of Children and Families (JPN) was determined as the journal with the highest number of publications, while the journal receiving the most citations was PEDIATRICS. ConclusionThe study found an increasing importance given to the Family-Centered Care Approach since the 1980s, with a majority of studies being descriptive in nature. It was determined that the studies were concentrated in the USA indicating a lack of global interest in the Family-Centered. Practical implicationsNursing researchers can build upon this study in the field of family-centered care by conducting more specific and in-depth investigations. This contributes to adding new information to the nursing literature and filling gaps in this area.

Effect of mHealth-based relaxation program on stress coping and anxiety levels in mothers of children with cancer: A randomized controlled study

ObjectiveThis study aimed to explore the effects of a mHealth-based relaxation program on anxiety and stress coping levels in mothers of children with cancer. MethodsThis randomized controlled, single-blind, parallel-group trial was conducted in the pediatric hematology-oncology unit of a university hospital. The study was completed by 50 mothers (intervention group: n = 25; control group: n = 25). The mothers in the intervention group participated in a mHealth-based relaxation program for eight weeks (including progressive muscle relaxation, guided imagery, and the four-leaf clover of mindfulness). Videos of the relaxation program were sent to mothers’ WhatsApp accounts. The mothers in the control group received routine care. The State-Trait Anxiety and Stress Coping Scales were administered during the first and eighth weeks. The registration number of this study on ClinicalTrials.gov is NCT05807295. ResultsMothers who participated in the relaxation program had lower anxiety levels and higher stress-coping scores than those in the control group (p < 0.05). ConclusionProgressive muscle relaxation exercises, guided imagery, and cognitive-based therapeutic approaches were effective in reducing mothers’ anxiety and stress coping. Practice implicationsPediatric oncology nurses can apply mHealth-based relaxation programs to support caregivers, particularly mothers. In this way, ensuring the continuity and integrity of care is easy.

Opportunities to Diversify the Pediatric Nursing Workforce: A Focus on Male Nurses

Pediatric nursing has been a profession dominated by women, but patients benefit from representation of both men and women. We describe characteristics associated with male pediatric nurses and consider potential pathways to greater male pediatric nurse workforce participation. We used data from the 2018 National Sample Survey of Registered Nurses, a nationally representative survey of nurses that estimates characteristics of the workforce. We present summary statistics to describe demographic, work setting and work environment characteristics of male and pediatric nurse workforces. Analyses accounted for complex survey design and weighting. Only 7% (N = 108,752) of the pediatric registered nurse workforce and 3% (N = 779) of the pediatric nurse practitioner workforces were male. Notable demographic and educational difference exist among compared workforces. Males are significantly underrepresented in pediatric nursing. Much effort and intention need to be directed towards increasing male representation in pediatric nursing.

Discursive analysis of nursing care toward childhood fever and its contextual differences: An ethnomethodological study.

Fever is the most common clinical sign during infancy. Nurses deal with fever in children most directly and it is an integral aspect of their role as pediatric nurses. The objective of this study is to analyze the perceptions, knowledge and attitudes toward childhood fever of nurses in three health contexts: pediatric hospitalization, pediatric emergency and primary care. To respond this objective, a qualitative study with ethnomethodological approach has been carried out. In-depth interviews were conducted and theoretical clinical cases were presented to nurses working in pediatrics in the three settings studied. After the analysis of the discourses, the codes were classified into three categories: static and number-centric knowledge, dependent nursing attitude, and unconscious model nurses. On the one hand, when we analyze and compare the perceptions, attitudes and knowledge of the nurses between the different contexts, we find differences that consist mainly of what the context requires of them. On the other hand, in general and regardless of the context, the nurses interviewed place themselves in a traditional framework when faced with the phenomenon of fever in children.