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The paediatric reception unit for children at risk plays an active role in raising awareness and training caregivers in the region, to facilitate the identification and care of children who are victims of sexual violence within the family (incest), within the hospital where it is based, and through its close links with child protection agencies. The nursery nurse is an essential member of this team, with her in-depth knowledge of children and their development from 0 to 18 years of age., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Background: Availability of high-level pediatric training for nurses in Malawi is limited. To address this gap, a novel pediatric critical care nurse preceptor program was developed and implemented by pediatric nurse specialists., Aim: Evaluate the effectiveness of a pediatric critical care nurse preceptor program, via change in nurses' knowledge, skills, confidence, and precepting competence., Design: A 12-month pediatric critical care nurse preceptor program with assessments at baseline, end of intensive (3 months), and end of program (6 months)., Setting: Blantyre, Malawi., Participants: Nurses with two or more years of pediatric nursing experience (N = 20) nominated by unit managers., Methods: Quantitative data were collected throughout program implementation. Assessments included: (1) multiple choice knowledge test, (2) Objective Structured Clinical Examinations in two areas (vital signs and airway, breathing, circulation, disability, exposure assessments; and blood gas and electrolyte analysis), (3) group simulations (cardiopulmonary resuscitation or respiratory distress), (4) Likert-scale clinical confidence survey, and (5) Likert-scale precepting competence survey. Data were analyzed using repeated measures ANOVA with pairwise comparisons. For Likert-scale surveys, median confidence scores were compared using a Friedman test with post hoc pairwise comparisons using Wilcoxon signed-rank tests., Results: Participants demonstrated significant improvement in clinical knowledge (p < .001), vital signs and airway, breathing, circulation, disability, exposure assessment (p = .001), blood gas and electrolyte analysis (p = .001), CPR (p < .001) and respiratory distress (p < .001) simulations, clinical confidence (p = .002), and precepting competence (p = .041)., Conclusion: This pediatric critical care nurse preceptor program was effective in improving participants' confidence and competence (knowledge and skills) in pediatric critical care nursing and precepting. Results suggest the program's potential to address the shortage of highly trained pediatric critical care nurses in Malawi. This lays groundwork for refining and expanding preceptorship, ultimately improving pediatric critical care nursing education in resource-limited settings., Competing Interests: Declaration of competing interest Seed Global Health employs AN, JM, and BvdW. KR was an employee during the study period., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Purpose: The primary objective of this study is to evaluate the effectiveness of finger puppets, abeslang puzzles, and pinwheels in reducing pain and anxiety in children aged 4-6 years during blood sampling procedures in a pediatric emergency department., Design and Methods: This study was a four-arm parallel group randomised controlled trial design conducted in the pediatric emergency department of a children's hospital in Western Türkiye between June 2023 and June 2024. Children (n = 160) were randomly assigned into four groups in a 1:1:1:1 ratio. The intervention groups consisted of children aged 4-6 years as finger puppet (n = 40), abeslang puzzle (n = 40), pinwheel (n = 40) and control group (n = 40). Data were collected using Personnel Information Form, Wong-Baker FACES Pain Rating Scale, and the Children's Anxiety Meter-State. The participants themselves, their parents, the nurse and the researcher rated the pain and anxiety levels associated with the blood sampling procedure. These trials are registered with ClinicalTrials.gov (NCT05904483)., Results: ANOVA was used to compare the mean Wong-Baker FACES Pain Rating Scale scores among the groups. According to all raters (child, parent, nurse, and researcher), the finger puppet group had the lowest mean score, followed by the pinwheel, abeslang puzzle, and control groups (p < 0.05). According to the nurse and researcher evaluations after the procedure, the finger puppet group had the lowest mean score on The Children's Anxiety Meter-State, followed by the abeslang, pinwheel and control groups (p < 0.05)., Conclusion: Finger puppet, pinwheel and abeslang puzzle methods were effective in reducing pain and anxiety during blood sampling procedure in children., Practice Implications: Pediatric nurses can safely use finger puppet, pinwheel and abeslang puzzle methods to reduce pain and anxiety during blood sampling procedure in preschool children., Competing Interests: Declaration of competing interest The author(s)declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

In Brazil, nasal irrigation is a common procedure for children hospitalized with respiratory conditions. However, it often causes stress for both the child and their family. Nurses need to rethink their approach to care, and the use of therapeutic play can be an ally in transforming the stressful context. To understand the family perceptions of nasal irrigation in hospitalized children after an educational intervention mediated by instructional therapeutic play (ITP). This descriptive, exploratory, and qualitative study was conducted from the perspective of Herbert Blumer's Symbolic Interactionism in a hospital in São Paulo, Brazil. The study included family members of hospitalized children aged 3-6 years who participated in an ITP intervention and remained for 6 hours afterward. Participants self-reported literacy with preserved cognition and verbal communication. This study was conducted between March 2023 and January 2024 using semi-structured interviews with 38 family members. Data were analyzed using Bardin's thematic content and lexical analysis with IRAMUTEQ® software. The interaction of families with ITP for nasal irrigation in children led to a redefinition of the procedure from distressing to enjoyable. ITP was evaluated as an essential and stimulating method that familiarized the child with the procedure, facilitating the understanding process for both the child and the family. ITP is a caregiving technology that nurses can use to assist with nasal irrigation, re-signifying the experiences of children and their families during the procedure.

Background: Nowadays, the quality of nursing care is one of the most essential factors in health services and patient care. The quality of end-of-life care is of high importance, especially in vulnerable groups such as children. In the final stages of life, the needs of patients and their companions, as well as stressful conditions cause avoidance of participation in treatment, and dissatisfaction of caregivers which can reduce the quality of patient care. The present study aimed to examine the quality of nursing care in children from the point of view of nurses in hospitals related to Birjand, Iran., Materials and Methods: The present descriptive study was conducted on 350 nurses. The data collection tools used in this study were demographic questionnaire and Quality Patient Care Scale (QUALPAC)., Results: A total of 270 completed questionnaires were entered into the statistical analysis. The average quality of nursing care score in dying children was 266.17 ± 27.79. Also, the results of the present study showed that the gender, age, marital status, and work experience of nurses have no significant effect on the quality of nursing care in dying children from the nurses' viewpoint., Conclusion: The quality of nursing care of dying children from the point of view of nurses was satisfactory. Nurses reported that the physical dimension of nursing care had the highest quality and the psychosocial dimension had the lowest quality. Therefore, psychological support and follow-ups for improving social support for these clients are suggested to the nursing managers and healthcare administrators., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Fatemeh Ahmadi Forg reports a relationship with Birjand University of Medical Sciences that includes: employment. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Purpose: This study aimed to clarify the recognition of ethical nursing practices, which included the psychological preparation of nurses practicing pediatric nursing in various settings, and issues for future training. Furthermore, we aimed to use the results to conduct future workshops., Design and Methods: Questionnaires were distributed to 1500 randomly selected medical facilities with pediatric departments in Japan. A total of 3000 nurses with more than two years of experience after graduation were asked to respond via an online survey, conducted in 2023. Participants provided multiple-choice and partially descriptive responses to questions on psychological preparation, ethical nursing practice for medical examinations and procedures, and demands for training., Results: In total, 422 responses were obtained, with 347 being valid (valid response rate: 11.6 %). Respondents rated that the need for psychological preparation for children was "always necessary" (64.6 %) and "necessary based on the situation" (35.4 %); none answered "not necessary." More than 90 % said that they wanted to reduce children's anxiety and that children also had the right to informed consent. In addition, 72.6 % requested learning regarding "methods of psychological preparation for children by developmental stage," and the requests were high in all years of experience and in the ward to which they belonged., Conclusions: Nurses were more likely to want to know how to prepare themselves and children psychologically and reduce their feelings of anxiety and fear than ethics, regardless of their years of experience or affiliation. The preferred method for courses was on-demand distribution and live streaming., Practice Implications: Ethical and psychological contents were important in pediatric nursing practice, and nurses should be provided opportunities to learn both perspectives for the best interest of children undergoing medical procedures in the various settings. Various programs using online and face-to-face methods can be applied to nursing education in the post-COVID-19 era., Competing Interests: Declaration of competing interest The authors report no actual or potential conflicts of interests., (Copyright © 2024 The Author. Published by Elsevier Inc. All rights reserved.)

Background: The effectiveness of pediatric care is made more challenging to analyze by the need for specialist nursing and by the specific characteristics of pediatric patients, as opposed to adult patients, such as ongoing rapid growth and development, and different physical, cognitive, and emotional demands. Previous research has identified "Pediatric Nursing-Sensitive Outcomes" (PNSOs) in intensive care unit settings, though pediatric intensive care beds only represent a very limited percentage of hospital beds. To improve care quality and safety for a larger population of patients, this study aims to identify PNSOs in lower and medium-complexity care units (LMCCUs)., Methods: This study uses the Delphi method to gather expert opinion on priority PNSOs in LMCCUs, with a 75 % consensus pass threshold. A preliminary list of PNSOs was identified from a literature review and used as inputs for two Delphi rounds conducted between January and March 2023., Results: 27 panelists were recruited and passed 17 PNSOs: pressure injury; failure to rescue; patient/family experiences; central line-associated bloodstream infections; surgical site infections; healthcare-associated infections; medication errors; hospitalization breastfeeding continuity; peripheral intravenous infiltrate or extravasation; pediatric falls; pain assessment and management; vital sign monitoring; nutrition; discharge planning; family-centered care practice; healthcare environment; nurse voluntary turnover., Conclusion: This study contributes to research on PNSOs and builds consensus on priorities for LMCCUs. Future research should clinically evaluate these PNSOs and their association with organizational and professional variables often investigated in an adult but not a pediatric setting., Competing Interests: Declaration of competing interest We declare, as authors of this article, that we have neither any competing interest nor conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: This study aimed to investigate the opinions and experiences of parents whose children are hospitalized in a pediatric surgery clinic in Turkey regarding care practices., Design and Methods: Sixteen in-depth interviews with parents whose children were hospitalized in a pediatric surgery clinic were conducted and analyzed between October and December 2023, by grounded theory methodology. The COREQ guidelines guided the reporting of this study., Results: A core category was identified, 'Preoperative information helps my child and I experience less anxiety and fear' demonstrating that parents are aware of their situation. Analyzing resulted in an interpretive theory of two interrelated categories: 'Quality Nursing Care' and 'Patient and Parent Satisfaction'., Conclusion: Children and parents who received accurate, sufficient, and timely information experienced less anxiety and fear in the preoperative. Quality nursing care significantly affects the well-being of parents and pediatric patients. As a result of all these, high patient and parent satisfaction is an important care outcome., Practice Implications: Reducing the anxiety and fears of pediatric patients and parents in the preoperative is an important goal. Quality nursing care is one of the most important perceived factors in achieving this goal. Providing in-service training on this subject can increase awareness, especially for nurses new to the pediatric surgery clinic., Competing Interests: Declaration of competing interest The author declares that there are no competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Quality caregiver-infant interaction is crucial for infant growth, health, and development. Traditional methods for evaluating the quality of caregiver-infant interaction have predominantly relied on rating scales or observational techniques. However, rating scales are prone to inaccuracies, while observational techniques are resource-intensive. The utilization of easily collected medical records in conjunction with machine learning techniques offers a promising and viable strategy for accurate and efficient assessment of caregiver-infant interaction quality., Methods: This study was conducted at a follow-up outpatient clinic at two tertiary maternal and infant health centers located in Shanghai, China. 68 caregivers and their 3-15-month-old infants were videotaped for 3-5 min during playing interactions in non-threatening environment. Two trained experts utilized the Infant CARE-Index (ICI) procedure to assess whether the caregivers were sensitive or not in a dyadic context. This served as the gold standard. Predictors were collected through Health Information Systems (HIS) and questionnaires, which included accessible features such as demographic information, parental coping ability, infant neuropsychological development, maternal depression, parent-infant interaction, and infant temperament. Four classification models with fivefold cross-validation and grid search hyperparameter tuning techniques were employed to yield prediction metrics. Interpretable analyses were conducted to explain the results., Results: The score of sensitive caregiver-infant interaction was 6.34 ± 2.62. The Random Forest model gave the best accuracy (83.85%±6.93%). Convergent findings identified infant age, care skills of infants, mother age, infant temperament-regulatory capacity, birth weight, positive coping, health-care-knowledge-of-infants, type of caregiver, MABIS-bonding issues, ASQ-Fine Motor as the strongest predictors of interaction sensitivity between infants and their caregiver., Conclusions: The proposed method presents a promising and efficient approach that synergistically combines rating scales and artificial technology to detect important features of caregiver-infant interactions. This novel approach holds several implications for the development of automatic computational assessment tools in the field of nursing studies., (© 2024. The Author(s).)

Background: Pediatric pain management is a constantly developing field. Despite extensive research, several studies have concluded that children's pain is still underestimated and undertreated. Nurses working with children have an important professional and ethical responsibility to possess up-to-date knowledge of pediatric pain management., Purpose: The purpose of this study was to identify nurses' knowledge and attitudes regarding pain management in pediatric surgical wards and to investigate the short- and long-term effects of a tailored educational intervention., Methods: This study has a quasi-experimental design without a control group and uses a previously validated questionnaire, the Pediatric Nurses' Knowledge and Attitudes Survey Regarding Pain-Norwegian version (PNKAS-N). Nurses in four pediatric surgical wards in one university hospital in Norway answered the survey once before and three times after a tailored educational intervention., Results: Eighty-three nurses answered the PNKAS-N at baseline (response rate of 75%). The nurse's total PNKAS-N mean score was 27.8 (77.3%) at baseline. We identified knowledge and attitude deficits regarding items related to opioid doses, the risk of drug addiction, the risk of respiratory depression, and the choice of pain medication for children. The total PNKAS-N mean score was statistically significantly increased after the intervention, at T2 (85.2%), as compared to baseline, and this improvement was sustained at T3 (83.8%) and T4 (81.4%)., Conclusion: The tailored educational intervention had a significant effect on nurses' knowledge and attitudes about pediatric pain management., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Compassion is a crucial aspect in the management of pediatric oncology patients as it has the potential to enhance nurse satisfaction levels, thereby further enhancing the quality and safety of the care they deliver. This study aimed to investigate nurses' understanding and experience of compassionate care when working in pediatric oncology departments., Methods: This research utilized a qualitative descriptive design. Content analysis was used to make sense of data collected via individual and semi-structured interviews conducted with nurses (n = 32) working in pediatric oncology departments., Results: Nurses' understanding of compassionate care for children with cancer was organized into two categories: Humanistic compassionate care and compassionate end-of-life care. The humanistic compassionate care category comprised of three subcategories: (1) empathy, (2) altruism, and (3) respect for the cultural values and beliefs of the family. The compassionate end-of-life care category comprised of two subcategories: (1) facilitating parents' presence at the child's bedside and (2) creating suitable conditions for accepting the death of a child., Conclusion: Compassionate care for children with cancer is marked by a strong emphasis on humanistic, cultural, and end-of-life considerations. Our findings further emphasize the paramount importance of taking families' presence, wishes and beliefs into consideration within this context., (© 2024. The Author(s).)

Purpose: This study aimed to identify the effects of pediatric nurses' perception of patient safety culture and their partnership with patients' parents on pediatric patient safety nursing activities., Methods: This descriptive study was conducted over a two-month period, from October to November 2022, utilizing self-reported questionnaires. The study included 165 nurses, each having at least 6 months of working experience in wards where children were admitted. These nurses were selected from 13 pediatric specialty hospitals, general hospitals, and university hospitals across seven regions. The data analysis was performed using the SPSS/WIN 26.0 program (IBM Corp.) for descriptive statistics, t-test, One-way ANOVA, Scheffé test, Pearson correlation coefficients, and multiple regression analysis., Results: The average scores for awareness of patient safety culture, partnership with patients' parents, and pediatric patient safety nursing activities were 3.37±0.41, 3.94±0.41, and 4.50±0.38, out of 5 points respectively. The factors influencing pediatric patient safety nursing activities were identified as a partnership with patients' parents (β=.41, p<.001). Among hospital-related characteristics, safety management committee (β=.16, p=.029) and safety management regulations (β=.17, p=.016) were also analyzed as factors influencing patient safety nursing activities. These factors accounted for 29.2% of the explanatory power for pediatric patient safety nursing activities., Conclusion: Based on the above study results, we found that to promote safe nursing activities for pediatric patients, developing and implementing training programs that enhance partnerships with patient's parents was imperative, and establishing work regulations and a safety management committee to systematically manage safety management tasks was deemed important.

Purpose: This study aimed to systematically review studies on the effect of peer tutoring on pediatric nursing education for nursing students and identify its contents and characteristics., Methods: A comprehensive search was conducted from November to December 2023 across databases including PubMed, Embase, CENTRAL, CINAHL, ProQuest, and others. We included both published and unpublished literature in English or Korean. Three reviewers independently screened and selected eligible studies that involved undergraduate nursing students participating in peer tutoring programs focused on pediatric nursing education. We analyzed quantitative outcomes related to learning effects and learner responses. The quality of the studies was assessed using the revised Cochrane risk-of-bias tool for randomized trials and the risk of bias assessment tool for non-randomized studies., Results: Five studies were reviewed, encompassing randomized controlled trials, a non-randomized controlled trial, a cohort study, and a before-after study. These interventions were conducted in school settings or pediatric clinical environments and featured different forms of peer teaching: horizontal, near-peer, and reciprocal. The tutor-to-tutee ratios ranged from 1:3 to 1:36.5. The educational content covered nursing care for major neonatal diseases, communication skills, medication administration, and resuscitation techniques. Significant improvements in cognitive knowledge and communication skills were observed among nursing students. However, there was noticeable variability in the design and reporting of the studies., Conclusion: Peer tutoring programs can effectively enhance pediatric nursing education by improving nursing students' knowledge and skills. For future meta-analyses, more studies in this field reported according to reporting guidelines are needed.

Purpose: Hybrid simulation has emerged to increase the practicality of simulation training by combining simulators and standardized patient (SP) that implement realistic clinical environments at a high level. This study aimed to develop a hybrid simulation program focused on case of pediatric cardiac catheterization and to evaluate its effectiveness., Methods: The hybrid simulation program was developed according to the Analyze, Design, Develop, Implement, and Evaluate (ADDIE) model. And deep learning-based analysis program was used to analyze non-verbal communication with SP and applied it for debriefing sessions. To verify the effect of the program, a quasi-experimental study using a random assignment design was conducted. In total, 48 nursing students (n=24 in the experimental group; n=24 in the control group) participated in the study., Results: Knowledge (F=3.53, p=.038), confidence in clinical performance (F=9.73, p<.001), and communication self-efficacy (F=5.20, p=.007) showed a significant difference in both groups and interaction between time points, and the communication ability of the experimental group increased significantly (t=3.32, p=.003)., Conclusion: Hybrid simulation program developed in this study has been proven effective, it can be implemented in child nursing education. Future research should focus on developing and incorporating various hybrid simulation programs using SP into the nursing curriculum and evaluating their effectiveness.

This scoping review mapped the academic literature focused on the therapeutic itinerary of children who seek care in health services and proposed an explanatory model to expand the concept and classification of these health itineraries. A total of 789 articles were reviewed, of which 28 were eligible for inclusion. In these 28 it was possible to observe that the child's therapeutic itinerary is more than a physical path, but also encompasses all choices within a specific social and cultural environment in which the child is inserted. Our proposal is to expand the concept beyond the therapeutic, classifying the itinerary also according to the objective, the decision-making agent, respect for the presence of company, the health subsystem used, according to the physical continuity of the itinerary, the perception of efficacy of the patient, the nature of the illness, the administration of healthcare, the means of transport used, the person providing information about the itinerary, the planning of the itinerary and its completeness. Knowing the child's itineraries toward healthcare allows the development of innovative discourses and practices for future public policies, through which the principles of comprehensiveness and resoluteness in children's health would be strengthened. There is still a need to deepen knowledge about the meanings and feelings regarding their interpretations of the events suffered in childhood., (© 2024 John Wiley & Sons Ltd.)

Purpose: The purpose of this study was to identify the factors influencing pediatric nurses' job stress, including their level of fatigue and partnerships with the parents of patients. This investigation aimed to findings of this study may lead to the development of strategies to reduce pediatric nurse's job stress., Design and Methods: Participants were recruited from pediatric, pediatric intensive care, and neonatal intensive care units across seven general hospitals. Eligibility requires a minimum of 6 months of experience in pediatric nursing. The sample size was determined using the G*power program, considering various variables, including age, marital status, presence of children, and work-related characteristics, leading to a final sample size of 135, adjusted for a 10% dropout rate. Data collection was conducted through self-report questionnaires, and analysis involved frequency, percentage, mean, standard deviation, t-tests, ANOVA, and stepwise multiple regression, using SPSS Statistics 27.0., Results: This study confirmed a significant correlation between pediatric nurses' fatigue and job stress, with higher levels of fatigue associated with increased job stress. Stepwise regression analysis showed that fatigue and age were significant predictors of job stress among pediatric nurses, explaining 23% of the variance. However, detailed analysis showed that younger nurses had lower job stress scores compared to older nurses. This result suggests that more experienced nurses may experience higher job stress due to increased responsibilities and emotional burdens., Practice Implications: This study identified the need for effective strategies to manage fatigue and reduce job stress among pediatric nurses during the COVID-19 pandemic. Younger nurses, particularly those under 25 and between 26 and 30 years old, experience lower job stress compared to older nurses. Comprehensive support systems should be developed, including workload management, emotional support, and programs to enhance partnerships between nurses and parents. These strategies can improve job satisfaction and the quality of care provided to young patients. Additionally, they ensure a more resilient and effective healthcare workforce during pandemics and similar crises., (© 2024 Wiley Periodicals LLC.)

Purpose: The study was conducted to determine the effect of the therapeutic play method implemented on the pre- and postcircumcision pain and anxiety levels of children and mothers' anxiety levels in the pediatric surgery clinic., Design: Prospective, randomized clinical trial., Methods: The study consisted of children between the ages of 3 to 6 admitted to the pediatric surgery clinic and their mothers (N = 120; Therapeutic playgroup = 60, Control group = 60). As a therapeutic play method the children and their mothers used play dough during the structured conversation for about 10 minutes before and after the operation. A questionnaire, the Face, Legs, Activity, Cry, Consolability (FLACC) pain scale, the Children's Emotional Manifestation Scale (CEMS) anxiety scale, and State-Trait Anxiety Inventory-S (STAI-S) anxiety scale for parents were used to collect data., Findings: In the pre- and postcircumcision period, the pain and anxiety levels of children and mothers' anxiety levels in the therapeutic playgroup were statistically lower compared to the control group (P < .05). In the postoperative period, a positive and significance correlation was found between anxiety levels of the mothers and pain and anxiety levels of children in the control group (P < .05)., Conclusions: The therapeutic play method was effective in reducing the pain and anxiety levels of children and mothers' anxiety in the pre- and postcircumcision period., Competing Interests: Declaration of Competing Interest None to report., (Copyright © 2024 The American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.)

The purpose of this study is to understand institutional violence (IV) in the relationships between health professionals, hospitalized children, and family members. This is a qualitative study developed at the pediatric inpatient unit of a university hospital in the city of Salvador, Bahia, Brazil. The research participants consisted of 39 health professionals who specialized in pediatrics and 10 family members of hospitalized children. Semi-structured interviews were the method used for data collection. Using discourse analysis as a basis and taking a Foucauldian perspective, the researchers observed that the expressions of IV could be traced to abusive power relations within the system. We found four discursive forms within the data set: communication problems as IV, violence through inattention and neglect, violence as an action and consequent materialization on the body, and psychological violence as a submission mechanism. Based on these findings, we argue that professionals, managers, the scientific community, and users might be able to better guarantee the safety of children by recognizing IV and effectively intervening in it., (© 2024 John Wiley & Sons Ltd.)

Background: Assessment of signs and symptoms in hospitalized children presents unique challenges due to the children's age-related differences, such as vital signs and the broad range of medical conditions that affects children. Early detection of clinical changes in children is crucial to prevent deterioration, and while standardized tools exist, there is a growing recognition of the need to consider subjective factors based on experienced nurses' knowledge and intuition., Objective: To explore which signs and symptoms, apart from vital signs, that trigger nurses' concern regarding deterioration of hospitalized children and adolescents., Design: This study used a descriptive qualitative design., Settings: The study was conducted at three pediatric departments in Denmark and a nursing department of a university in Norway, offering post graduate education programs for health care professions working with children and adolescents throughout Norway., Participants: A total sample of 29 registered nurses with varying levels of experience participated., Method: Four focus group interviews were used to collect data and analyzed with inductive content analysis approach., Results: Nurses' knowledge about children's clinical conditions is influenced by the nurses experience, their use of senses like touching the child with their hands, and the use of various approaches. Information from parents about the child's normal behavior are considered valuable. These sources of information, often difficult to verbalize, might be referred to as intuition or "gut feeling" and often guides the nurses' actions when vital signs appear normal, and nurses rely on their senses to assess the child's condition. Specific indicators triggering concern include changes in respiration, circulation, level of consciousness, and facial expressions. Challenges arise from nighttime assessments, interactions with parents, the presence of electronic devices, and children's ability to compensate. Clinical experience is a significant factor in nurses' ability to recognize changes in in the child's condition., Conclusion: This study highlights the multifaceted nature of nurses' assessments of clinical conditions in hospitalized children. Nurses draw on their experiences, intuition, and interactions with parents to complement vital signs-based assessments. Their intuition, or "gut feeling" serves as a valuable tool when vital signs do not fully capture the child's clinical status. Specific signs and symptoms that trigger nurses' concern, along with the challenges they face, contribute to a comprehensive understanding of the complexity of assessing children's clinical conditions. These findings, emphasize the role of nurses in early recognition of clinical deterioration in hospitalized children and the need for assessments that go beyond vital signs., Tweetable Abstract: Both objective assessments and intuitive clinical judgment play an important role in identifying potential deterioration in pediatric patients., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: The study aimed to develop and validate the Pediatric Atraumatic Care Attitude Scale (PACAS) for pediatric nurses, measuring attitudes toward atraumatic care practices., Methods: This methodological and correlational study included 336 pediatric nurses from various clinics in Turkey, between January and August 2024. Construct validity was evaluated using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Internal consistency was assessed through item-total score correlation, test-retest reliability, and Cronbach's α coefficients., Results: The content validity index (CVI) for PACAS items ranged from 0.84 to 1.00. The Kaiser-Meyer-Olkin (KMO) coefficient was 0.978, and Bartlett's test of sphericity was significant (χ 2  = 14,110.425, P < .001), supporting factor analysis. EFA revealed a two-factor structure with 31 items, explaining 76.7 % of the variance. The factors, "Knowledge and Awareness" and "Practice and Family Involvement," had loadings between 0.716 and 0.901 and 0.751-0.962, respectively. CFA confirmed the model fit (χ 2 /df = 2.77, RMSEA = 0.073, NFI = 0.92, NNFI = 0.97, CFI = 0.94, GFI = 0.91). Cronbach's α was 0.985, with subscale coefficients of 0.978 and 0.983. Test-retest reliability showed strong correlations (r = 0.980, r = 0.985, r = 0.957), with no significant differences between test and retest scores (P > .05)., Conclusions: PACAS is a reliable and valid tool for assessing pediatric nurses' attitudes toward atraumatic care, with the potential to enhance pediatric nursing practices by improving adherence to atraumatic care principles., Implications to Practice: PACAS helps integrate atraumatic care into nursing, enhancing pediatric care quality and outcomes., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: Blended learning is a teaching approach that integrates online self-learning and classroom teaching. It emphasizes students' self-directed learning, actively engaging, as well as communication and collaboration. Blended learning develops the qualities in nursing undergraduate students with problem-solving ability, clinical thinking, and communication skills as nurses have. Currently, learners' experience has become an important factor in determining the success of blended learning., Aim: To learn about the experiences and perceptions of undergraduate nursing students regarding blending learning in pediatric nursing., Methods: A mixed methods design beginning with a quantitative data collection and analysis phase to inform the subsequent qualitative phase was utilized. This study was conducted among undergraduate nursing students at one university in China. In the quantitative study phase, a convenience sample of 59 students completed the online survey while the qualitative study phase included nine students recruited by purposive sampling. The qualitative data were collected using individual semistructured in-depth interviews. Audio data were transcribed and subjected to thematic analysis. The findings from those two phases were integrated into the final analysis., Results: The majority (89.8%) of students reported satisfaction with blended learning. Among various teaching methods, case-based learning (CBL) was the most preferred (98.3%). Regarding the qualitative data, students reported positive experiences with blended learning including well-organized course structure, resourceful course content, and high teacher quality. They stated that blended learning improved the learning outcomes such as improving problem-solving ability and developing clinical thinking. They also provided suggestions for achieving better learning outcomes, including providing stressful learning activities, optimizing online course design, and improving the quality of group learning., Conclusions: The blended learning model of pediatric nursing based on the Community of Inquiry framework provides a positive learning experience for nursing undergraduate students. However, ongoing assessment and improvement of the blended learning process are also needed., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Purpose: This study investigates the relationship between burnout levels of moral distress and missed nursing care in pediatric nurses., Design and Method: A cross-sectional study was conducted between November and December 2023. Pediatric nurses working in two hospitals and providing direct care to children (n = 140) completed the Moral Distress Scale-Revised Pediatric Nurses, MISSCARE Survey - Pediatric Version and Burnout Measure-Short Version questionnaire. Multivariate regression analysis modeling was applied to test the mediating effect on the relationship between burnout, moral distress, and missed nursing care., Results: There was a significant positive correlation between the Moral Distress Scale-Revised Pediatric Nurses and its sub-dimensions and the Burnout Measure-Short Version (p < 0.05). There was a significant positive correlation between the mean MISSCARE- Survey-Ped score of the nurses participating in the study and its sub-dimensions and Burnout Measure-Short Version (p < 0.05). Providing Benefit-Do No Harm, one of the Moral Distress Scale-Revised Pediatric Nurses sub-dimensions, and Labour Resources, one of the MISSCARE sub-dimensions, were found to be predictors of burnout. The ethical principle of Providing Benefit-Do No Harm was found to mediate between moral distress and burnout and reduce burnout associated with missed care., Conclusions: Accordingly, as the nurses' moral distress and inability to meet the necessary patient care increase, their burnout levels also increase. Providing Benefit-Do No Harm is an basic ethical principle that will positively affect the burnout level of pediatric nurses., Practice Implications: This study may provide insights into ethics training, communication improvement strategies, and individual support intervention programs aimed at reducing moral distress, and burnout and improving the coping mechanisms of nurses working in pediatric wards., Competing Interests: Declaration of competing interest The authors report no actual or potential conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: The aim of this study was to describe nurses' experiences of the prerequisites for implementing family-centered care to prevent pediatric delirium., Design: The research employed a qualitative, descriptive study design., Methods: A total of 10 nurses working in the pediatric intensive care unit at 1 university hospital participated in the study. The quality data were collected using individual semistructured interviews, and the data were then analyzed by inductive content analysis., Results: The prerequisites for implementing family-centered care to prevent delirium among pediatric patients consisted of 30 subcategories that were grouped into 11 generic categories. The generic categories were further grouped into 5 main categories: (1) an environment that supports family presence, (2) psychosocial support for the family, (3) individual family involvement, (4) family participation in shared decision-making, and (5) nurses' professional competence., Conclusions: According to the nurses' experiences, the implementation of a family-centered approach to preventing delirium in pediatric patients requires creating a supportive environment for families, providing psychosocial support, encouraging family involvement in decision-making, and ensuring that all nurses have the necessary skills., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Competing Interests: Declaration of competing interest None.

Purpose: Effective nurse-child communication is a fundamental aspect of delivering pediatric nursing care. Family caregivers' global ratings to hospital are considered a proxy-reported measure for assessing a child's inpatient stay experience. We investigate the associations between nurse-child communication and family caregivers' global ratings to hospital., Design and Methods: A retrospective analysis of a national child patient experience survey data was conducted. Patient experience with nurse-child communication and the family caregivers' global ratings of hospital were measured using the Child Hospital Consumer Assessment of Healthcare Providers and Systems. Hierarchical linear models were constructed to examine the association between nurse-child communication measures and family caregivers' global ratings to hospital., Results: Data from 1010 patients at six National Regional Centers for Pediatric in China were collected. The overall rating of hospitals and the willingness to recommend the hospital showed increasing trends as the nurse-child communication score increased. How often nurses encourage children to ask questions was significantly associated with family caregivers' overall ratings of hospital and the family caregivers' willingness to recommend the hospital., Conclusions: Effective communication by nurses with the child is associated with significantly higher global ratings to the hospital by family caregivers during inpatient care. Encouraging children to ask questions is a promising contributor to caregivers' global ratings to hospital., Practice Implications: Pediatric nurses should emphasis encouraging children to ask questions for effective communication in nursing practice. Future research is also needed to develop more targeted strategies to assist pediatric nurse to communicate with child better., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To illuminate child healthcare nurses' experiences of communication with 4-year-old children during their visit to the child healthcare center., Design: A qualitative method, using data collected from individual interviews., Sample: Fifteen semistructured interviews with nurses working in a child healthcare center., Measurements: The results were analyzed using reflexive thematic analysis., Results: The analysis resulted in three themes and eight subthemes: Adapting to the child in the conversation, based on the subthemes Preparing for the visit, Listening in and observing, and Creating a welcoming environment; Combining strategies for the conversation, based on the subthemes Engaging the child, Using visual tools, and Parental involvement; and Challenges due to language barriers, based on the subthemes Using an interpreter and Parent acts as interpreter., Conclusion: Child healthcare nurses focus on the child when communicating and strive to create joy and a welcoming environment. The communication strategies employed during the visit include engaging the child directly, involving parents in the conversation, and balancing the parental involvement. Communication challenges related to language barriers are addressed, particularly during interpreter-assisted conversations. The study indicates a need for tailored strategies, collaboration, and sensitivity to ensure a child-centered approach., (© 2024 The Author(s). Public Health Nursing published by Wiley Periodicals LLC.)

Purpose: Attitudes 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 Methods: A 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)., Results: Most 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., Conclusions: Findings 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 Implications: Understanding 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., Competing Interests: Declaration of competing interest The authors declare that they have no potential conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: 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., Aims: 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., Study Design: 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., Results: 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., Conclusions: 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., Relevance to Clinical Practice: Preventing, assessing and systematically managing paediatric delirium is crucial, and considering the study results, delirium education among nurses is needed., (© 2024 The Authors. Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)

Aim: This study was carried out to adapt a measurement tool that can be used to measure the perceived satisfaction level of parents of pediatric patients hospitalized in a pediatric clinic with care from pediatric nurses and to examine its psychometric properties., Design and Method: The study was conducted methodologically with 301 parents of children who were hospitalized in the pediatric clinic of a university hospital between September and December 2023. Explanatory and confirmatory factor analyses were performed on the data to establish the validity of the scale, Cronbach's alpha reliability coefficient, split-half, item-total score methods were utilized to test its reliability., Results: The scale consisted of 26 items and a single dimension. It was determined that the total explained variance ratio was 79.246%. According to the confirmatory factor analysis results, goodness of fit values were determined as RMSEA = 0.077, CFI = 0.96, IFI = 0.97, RFI = 0.92, NFI = 0.93, and TLI = 0.96. Cronbach's alpha coefficient was calculated as α = 0.989 for the total scale., Conclusion: The Parents' Perception of Satisfaction with Care from Pediatric Nurse Practitioners Instrument is a valid and reliable measurement tool that can be used to measure the perceived satisfaction level of parents of pediatric patients hospitalized in a pediatric clinic with nursing care., Implications for Practice: The scale can contribute to determining the perceived satisfaction levels of parents of pediatric patients hospitalized in the pediatric clinic with nursing care and, if there is a problem, to providing regular in-service training for pediatric nurses who are responsible for pediatric patient safety and quality of care., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Children's vaccination mainly depends on their parents' decisions. Therefore, it is important to understand parents' acceptance and attitudes toward vaccinating their children against COVID-19., Aim: The study aimed to assess the pediatric nurses' acceptance and attitudes toward COVID-19 vaccines for their children at Assiut University Children Hospital., Materials and Method: A cross-sectional descriptive design was used on a convenience sample of 270 nurses who worked at Assiut University Children Hospital., Tools: Tool one involved the demographic characteristics of pediatric nurses and their children. Tool two consisted of pediatric nurses' acceptance and attitudes toward COVID-19 vaccines for their children: RESULTS: The results indicated that 79.3% of pediatric nurses had higher acceptance of vaccines and immunization of their children. Results also revealed that 80.0% of pediatric nurses had positive attitudes toward vaccines and their children's immunizations., Conclusion: It was concluded that most of pediatric nurses had high acceptance and positive attitudes toward vaccines and immunization of their children. Also, it was clarified that there was a positive statistically significant correlation between nurses' acceptance of vaccines and immunization of their children and their attitudes., Recommendations: Continuing education and tailored intervention should be implemented to correct misinformation and negative conceptions about the safety of vaccines for children., Competing Interests: Declaration of competing interest The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: This study aimed to explore the real experiences and needs of neonatal intensive care unit (NICU) preterm intergenerational caregivers for discharge preparation and provide a basis for nursing staff to formulate systemic and personalized health education plans and continuous nursing plans for preterm discharge., Design and Methods: This was a descriptive qualitative study. An objective sampling method was used to select 16 intergenerational caregivers of preterm infants admitted to the NICU of tertiary obstetrics and gynecology hospitals in Zhejiang and Jilin provinces from December 2023 to February 2024. Semi-structured interviews were conducted on the day of discharge of the preterm infants and six weeks after discharge. Colaizzi's seven-step analysis method was used to analyze the interview data., Results: Based on the existence, relatedness, and growth (ERG) theory, the discharge preparation experiences and needs of neonatal intergenerational caregivers in the NICU were summarized into three themes: psychological condition, care capacity condition, and multi-party support needs., Conclusions: In the process of hospital discharge preparation, intergenerational caregivers of premature infants in NICU have multiple needs, including enhancing nursing ability and obtaining psychological and multi-party support. It is helpful to take effective interventions to improve their readiness for discharge., Practice Implications: The nursing staff should develop personalized discharge health education plans and continuous nursing plans to improve the level of discharge preparation., Patient or Public Contributions: There were no patient or public contributions., Competing Interests: Declaration of competing interest None., (Copyright © 2024. Published by Elsevier Inc.)

Background: The education-to-practice gap is magnified in pediatric nursing due to decreasing pediatric content offered in undergraduate programs, including less pediatric clinical time and inconsistent and inadequate clinical experiences., Purpose: Examine student perceptions of learning and confidence by comparing a high-fidelity pediatric simulation series and acute care pediatric clinical., Methods: The SET-M tool compared settings and included open-ended questions to add insight., Sample: In an undergraduate nursing program in a university in the Midwest United States, 124 students completed the anonymous survey rating each experience for learning and confidence in assessment, clinical decision-making, communication, and safety., Results: Students rated the simulation series higher than clinical for all categories except patient communication., Conclusion: Student perceptions of learning in high-fidelity simulation revealed increased confidence and competence and the belief that simulation complements the clinical experience and bridges the theory and clinical courses., Competing Interests: Declaration of competing interest The author has no conflicts of interest to disclose. This research received no specific grant from the public, commercial, or not-for-profit funding agencies., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: Automated pupillometry (AP) facilitates objective pupillary assessment. In this study, we aimed at assessing nursing perspective about the utility of AP in neurocritically ill children to understand acceptance and usage barriers to guide development of a standardized use protocol., Methods: We conducted a web-based, cross-sectional, anonymous, Google™ survey of nurses at two independent pediatric ICUs which have been using AP over last four years. The survey included questions related to user-friendliness, barriers, acceptance, frequency of use, and method of documenting AP findings., Results: A total of 31 nurses responded to the survey. A total of 25 nurses (80.6%) used the automated pupillometer and 19 (61.3%) nurses preferred to use the automated pupillometer on critically ill intubated patients. Respondents rated the pupillometer a median [IQR] frequency of use of 7/10 [4-9] and a mean user-friendliness of 8/10 [7-10]. Barriers to pupillometer use included pupillometer unavailability, technical issues, lack of perceived clinical significance, and infection control., Conclusion: Nurses have widely adopted the use of automated pupillometer in the PICU especially for critically ill intubated patients and rate it favorably for user-friendliness. Barriers against its use include limited resources, infection concerns, technical issues, and a lack of perceived clinical significance and training. Implementation of standardized PICU protocol for AP usage in critically ill children, may enhance the acceptance, increase usage and aid in objective assessments., Practice Implications: These findings can be used to create a standardized protocol on implementing automated pupillometry in the PICU for critically ill children., Competing Interests: Declaration of competing interest None of the authors have any conflicts of interest to disclose., (Published by Elsevier Inc.)

Purpose: In 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 Methods: A 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., Results: In 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., Conclusions: The findings revealed that pediatric nurses achieved safe and effective medication administration and generally adhered to the ten right principles., Practice Implications: This 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., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Equitable access to appropriate care, emergency department services, and in-home support aids are needed to minimize the occurrences of adverse events that have a significant impact on families. However, many families of children with medical complexity (CMC) lack consistent care due to issues of health inequity. We conducted 11 qualitative interviews with primary caregivers who were asked about their experiences of providing care to children who have a tracheostomy and are supported by multiple life-saving machines at home. Guided by ecological systems theory, we identified three themes that contextualize the lived experiences of the participants who expressed needs that arose from poor interactions within the mesosystem. Findings convey participant frustrations that result from insufficient support, ineffective training, and inadequate healthcare coverage. Although each theme is organized systematically to emphasize specific concerns within the mesosystem, together these themes emphasize the inextricable relationship between daily needs with systemic barriers to care. We provide a discussion of these needs with a broader context that also impacts the perceived quality of care among families managing the needs of their children who are supported by life-saving technology. By addressing existing challenges and identifying opportunities for improvement within the healthcare system, we seek to contribute to the collective effort of advocating for ethical systemic change on behalf of CMC and their families., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Aim: This study aimed to conduct a meta-synthesis to explore the experiences of paediatric nurses in communication with children., Method: We conducted a meta-synthesis review, following the outline proposed by Sandelowski, Barrosso & Voils. Our search encompassed six electronic databases, namely PubMed, Scopus, EBSCO (MEDLINE), Web of Science, SAGE, and Wiley. The Primary keywords used were "nurse", "child", "communication", and "qualitative". We included qualitative articles in English within the field of paediatric nursing between 1990 and 2023. Initially, 1980 records were identified which reduced to 1339 references after removing duplicates. Subsequently, we assessed 112 full-text articles for eligibility and 14 relevant studies were ultimately included in our review. Quality appraisal was conducted using the Critical Appraisal Skill Programme checklist with no study being excluded based on quality criteria. Data were synthesized using the qualitative thematic analysis method., Results: The data analysis yielded three themes and seven sub-themes. These themes include swinging between triadic and dyadic communication, applying a hybrid of communication methods, and influential factor in communication., Conclusions: This study highlighted the significance of establishing a balanced approach between dyadic communication (nurse and child) and triadic communication (nurse-parent-child) in paediatric care. Paediatric nurses emphasized the simultaneous use of verbal and non-verbal methods to enhance effective communication. Additionally, identifying the influential factors in communication can aid in developing and improving nurses' competency in communication skills within paediatric departments., Implications: Understanding the communication process and the factors that influence it can be instrumental in equipping paediatric nurses with enhanced communication skills in their practice., Impact: Establishing a balanced approach between dyadic communication (nurse and child) and triadic communication (nurse-parent-child) in paediatric care is crucial. Paediatric nurses emphasized the simultaneous use of verbal and non-verbal methods to enhance effective communication. Identifying the influential factors in communication can aid in developing and improving nurses' competency in communication skills within paediatric departments., (© 2024 John Wiley & Sons Ltd.)

Purpose: This study aimed to determine pediatric emergency nurses' experiences and opinions regarding child-friendly care within Watson's Human Care Model framework., Design and Methods: This study is qualitative research conducted with nurses in the pediatric emergency unit of a university hospital between 06 March and 06 April 2024. This study used a purposive sampling method and conducted semi-structured interviews with 17 nurses. All interviews were audio recorded and transcribed. Inductive thematic analysis method was used. The study was written based on the COREQ checklist., Findings: This study determined two themes, five sub-themes, and 13 categories. The theme "challenges to child-friendly healthcare implementation" included a lack of physical space and agitated and violent families. It has been reported that physical space, especially where privacy is not protected, makes child-friendly care complex, and the violent reactions of families are significant obstacles. The second theme, "facilitators for an ideal child-friendly pediatric emergency unit," included the design of the pediatric emergency unit/improving physical environment, availability of appropriate equipment, and effective communication strategies. This theme emphasizes the importance of colorfully designing the physical space and equipment in a way that does not scare children., Conclusion: It has been determined that the healing environment and care processes are essential for child-friendly care. During the care processes, communication according to the age of the children and communication with agitated families was emphasized as an essential component of care., Practice Implications: The study results will guide hospital management, healthcare professionals working in the field, and future studies on designing the child-friendly emergency unit that children deserve., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interests., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: The 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., Methods: A 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., Results: A 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 Practice: The app can be safely and effectively used for training and continuing education of nurses who care for children and neonates with PICCs., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Problem: Trust is central to the development of nurse-patient relationships. Pediatric nurses encounter difficulties developing trust with children and their caregivers. The purpose of this scoping review was to identify, examine, and summarize available evidence on the concept of trust among nurses and children/caregivers when admitted to hospital inpatient care units., Eligibility Criteria: Using the Joanna Briggs Institute (JBI) methodology for conducing and reporting scoping reviews, CINAHL, MEDLINE, PsycINFO, Cochrane DSR, Cochrane Central, and JBI EBP were searched for qualitative, quantitative, mixed methods, and review studies with no time limits published in English. Included studies presented findings on the experiences of developing trust between pediatric nurses and children under 18 years of age and their caregivers within inpatient care units., Results: A total of 12,269 titles and abstracts were reviewed independently by two reviewers. 366 full-text articles were retrieved, a final of 81 studies were included in the review., Conclusions: Trust was bi-directional between nurses and children/caregivers, developed over time during multiple interactions, and foundational to the development of relationships. Distinct facilitators and barriers to the development of trust between nurses and children/caregivers were identified. The development of trust was rewarding and enriching for both nurses and children/caregivers and was the fundamental to the provision of safe and high-quality nursing care., Implications: Findings provide nurses with direction and strategies on how to develop and maintain trust with children/caregivers on inpatient care units. The development of training programs and interventions geared at equipping nurses with the skills to develop trust with children/caregivers is needed., Competing Interests: Declaration of competing interest There is no conflict of interest to be declared by authors of this manuscript., (Copyright © 2024. Published by Elsevier Inc.)

Purpose: This study described pediatric nurses' professional quality of life during COVID-19 and explored demographic/clinical practice factors independently associated with compassion satisfaction (CS), burnout (BO), and secondary traumatic stress (STS)., Design and Methods: The Relational Caring Complexity Theory was used. This study employed a cross-sectional, descriptive, correlational design to describe professional quality of life of pediatric nurses (demographic questionnaire and ProQOL 5 measure) working during the COVID-19 pandemic., Results: From 150 pediatric nurses, the mean scores were CS 40.8 (± 4.8), BO 22.6 (± 4.7), and STS 22.8 (± 5.8). Results of the multiple regression revealed that two variables, deployed to the same unit versus not deployed (β = 2.424, p = .02) and currently practicing in perioperative/ambulation settings versus intensive care (β = -0.272, p = .03), were independently associated with CS. Deployed to the same unit versus not deployed was found to be independently and significantly associated with BO (β = -0.28, p = .005). The number of patients cared for with COVID-19 (β = 0.196, p = .03) was significantly associated with STS., Conclusions: While the overall response was positive, these nurses were more likely to experience BO when deployed to the same area (likely a COVID-19 adult unit) and STS as they cared for more patients with COVID-19., Practice Implications: Leaders should be aware of the impact of caring in times of crisis. Decentralized staffing may help meet emergent needs on a particular shift, but ensuring deployed nurses are well-supported is vital., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Patient safety is the cornerstone of quality healthcare. Nurses have a duty to provide safe care, particularly to vulnerable populations such as paediatric patients. Demands on staff and resources are rising and burnout is becoming an increasingly prevalent occupational hazard in paediatric healthcare today. Occupational stress is a barrier to maintaining a positive patient safety culture., Purpose: This paper seeks to explore the impact of burnout on paediatric nurses' attitudes about patient safety., Methods: A systematic review approach was used. Embase, Cochrane Library, Medline, CINAHL, and PsycINFO were the databases searched. All quantitative, primary, empirical studies, published in English, which investigated associations between burnout and attitudes to patient safety in the paediatric nursing workforce were included., Results: Four studies were eligible for inclusion. These studies examined a total of 2769 paediatric nurses. Pooled data revealed overall moderate to high levels of burnout. All studies exposed a negative association between emotional exhaustion and safety attitude scoring (r = -0.301- -0.481). Three studies demonstrated a negative association to job satisfaction (r = -0.424- -0.474). The potential link between burnout and an increased frequency of adverse events was also highlighted., Conclusions: Burnout may negatively impact paediatric nurses' attitudes to patient safety in the acute hospital setting. Targeted interventions to tackle burnout are urgently required to protect both paediatric nurses and patients., Implications: Managers and policy makers must promote nurse well-being to safeguard staff and patients. Educational interventions are required to target burnout and promote patient safety. Further research is required to investigate the long-term impact of burnout., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Epilepsy is the most prevalent chronic neurological condition in childhood, affecting approximately 0.5%-1% of children worldwide., Objective: This study aimed to (1) develop an "Epilepsy Knowledge Scale for Parents", (2) evaluate the content validity of the scale, and (3) assess its psychometric properties., Methods: This methodological study was conducted in a tertiary hospital's pediatric neurology outpatient clinic in Turkey. The study comprised two stages involving 500 parents of children with epilepsy. The first stage included validity and reliability analyses, while the second stage involved the calculation of the scale scoring., Results: Exploratory Factor Analysis for the preliminary scale development with 36 items based on expert opinions yielded 29 items and three dimensions. The factors explained 62.83% of the total variance, and the scale exhibited high reliability (Cronbach's alpha = 0.885). Confirmatory Factor Analysis, it was determined that the fit indices were at acceptable (CFI = 0.957, NFI = 0.932) or good level (χ2/df = 2.32, RMSEA = 0.048, GFI = 0.951). Consequently, a final structure comprising 29 items and three dimensions was obtained. The scale score's cutoff value was set at 15.50 points, with scores above this value indicating diagnostic value with 55.6% sensitivity and 80.2% specificity., Conclusions: The study demonstrated that the "Epilepsy Knowledge Scale for Parents (EKS-P)", designed to assess parents' knowledge of epilepsy, is a reliable and valid measurement tool for the Turkish population., Implications for Practice: This scale (EKS-P) developed for parents is recommended to be used in clinical settings and both experimental and non-experimental research., Competing Interests: Declaration of competing interest The author(s) declare that they have no conflict of interests., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Respiratory infections are common in children and can quickly deteriorate, necessitating vigilant nursing care. Simulation training provides a valuable tool for nursing students to learn how to manage children with respiratory infections. Peer tutoring has demonstrated benefits, including the creation of a safe, supportive learning environment and the perception of peer tutors as beneficial role models. This study aimed to develop a simulation education program for the care of children with respiratory infections, involving peer tutoring among nursing students, and to assess its effectiveness., Methods: This mixed-methods study, conducted between July and December 2022, utilized surveys to gather both quantitative and qualitative data. A peer tutoring-based simulation education program for providing care to children with respiratory infections was developed specifically for nursing students. The study was implemented with 49 nursing students from a South Korean university (25 in the experimental group and 24 in the control group). The students' self-efficacy, disposition towards critical thinking, problem-solving ability, and satisfaction with practice were evaluated and analyzed using the unpaired t -test, the chi-square test, and repeated-measures analysis of variance. The learning experiences of the students in the experimental group were further examined using qualitative content analysis., Results: The experimental group demonstrated greater growth in self-efficacy and satisfaction with practice than the control group. However, no significant difference was observed between the experimental and control groups in terms of changes in disposition towards critical thinking and problem-solving ability. From the nursing students who participated in the implementation, three categories were identified: "enhancement of learning," "psychologically secure environment," and "novel experience.", Conclusions: The peer tutoring-based simulation education focused on caring for children with respiratory infections effectively improved the self-efficacy and satisfaction of nursing students. This method will be utilized to enhance the learning experience of nursing students in the field of pediatric respiratory care., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Aim: This study was conducted to determine the mediating role of pediatric nursing competence in the relationship between self-efficacy in pediatric drug administration and medical error tendency in nursing students., Background: The self-efficacy of nursing students towards drug administration knowledge and practices is one of the determinants of achieving the goals of nursing education programs related to drug administration., Design: The sample of the descriptive and correlational study consisted of a total of 303 3rd and 4th-year students taking the Pediatric Health and Diseases Nursing course at the Department of Nursing. Data were collected using the Pediatric Nursing Competency Scale (PNCS), the Medication Administration Self-Efficacy Scale in Children for Nursing Students (MASSC) and the Medical Errors Tendency Scale (METS). Pearson correlation analysis, linear regression analysis, independent groups t-test, one-way analysis of variance (ANOVA) and post hoc (Tukey, LSD) test were used to analyze the data. In addition, hierarchical regression analyses regarding the mediation effect were performed using PROCESS Model 4 developed by Hayes (2013) for SPSS., Results: When the correlation levels between the total scores of MASSC, PNSC and METS were analyzed, a positive moderate correlation was found between PNSC and MASSC total scores, a positive weak correlation was found between METS and MASSC total scores and a positive weak correlation was found between METS and PNSC total scores (p<0.05). As a result of the analysis, the model was found to be significant and the total change in METS was explained by 17.3 % of the total change in METS (F=63.289;p=0.000). It was found that PNSC was a partial mediator variable between MASSC and METS., Conclusion: As a result of the study, it was determined that pediatric nursing competence had a partial mediating role in the relationship between pediatric drug administration self-efficacy and medical error tendency in nursing students., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interests., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Abstract: BACKGROUND: Pediatric neurocritical care (PNCC) and pediatric neurointensive care units (neuro-PICU) are growing fields. Although some institutions have established independent neuro-PICUs meeting most Neurocritical Care Society (NCS) standards for neurocritical care units, many centers lack the resources to do so. We describe an alternative neuro-PICU model as a designated unit within a mixed pediatric intensive care unit (PICU) and its effects on nursing sentiment. METHODS: We established a 6-bed neuro-PICU within a 36-bed noncardiac PICU. Charge nurses were tasked with admitting PNCC patients into these beds. For nursing expertise, we used a core group of 12 PNCC specialty nurses and instituted PNCC nursing education to PICU nurses. We observed the number of PNCC patients admitted to neuro-PICU beds and surveyed charge nurses to identify barriers to assigning patients. We surveyed PICU nursing staff to explore sentiment regarding PNCC before and after establishing the neuro-PICU. Nursing criteria were compared with NCS standards. RESULTS: In the 40-month period, our PICU saw 2060 PNCC admissions. Overall, occupied neuro-PICU beds housed PNCC patients 74.1% of the time. The biggest barriers to patient placement were too many competing placement requests, not enough neuro-PICU beds when specialty census was high, and difficulty assigning one nurse to two PNCC patients. In surveys after establishing the neuro-PICU, compared to before, experienced nurses reported being more interested in obtaining Emergency Neurological Life Support certification (94.2% vs 80.6%, P = .0495), and inexperienced nurses reported being more familiar with PNCC clinical pathways (53.5% vs 31.7%, P = .0263). Most NCS criteria related to nursing organization were met. CONCLUSIONS: Focused neuro-PICUs should be developed to complement advances in the field of PNCC. Alternative neuro-PICU models are possible and can increase nursing interest in further education and awareness of clinical pathways, but barriers exist that require institutional commitment to nursing development to sustain the delivery of specialized care to this population., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 American Association of Neuroscience Nurses.)

Aim: To gain insight into child-health nurses' experiences of using pictorial support in health visits within child-health services., Methods: A qualitative study involving interviews conducted with 17 child-health nurses in Sweden. The interview data were analysed using content analysis., Results: The nurses experienced that pictorial support could facilitate communication with families and increase opportunities for children to participate in child-health services, although it may come with challenges. This theme can be broken down into three main categories: (1) Pictorial support makes interaction with families clearer and easier and is used in different ways; (2) The design and extensiveness of the pictorial support can create obstacles; and (3) Pictorial support influences children's attitudes towards, and participation in, health visits., Conclusion: Pictorial support is an important and useful tool in child-health nurses' own work and improves their communication with children and caregivers during health visits. It can also increase children's participation and help them express themselves. Communicative tools such as pictorial support are very helpful to healthcare professionals striving to offer child- and family-centred care., (© 2024 The Author(s). Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)

Purpose: In 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., Methods: We 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 used to analyze data using the PC-QUANL program., Results: Four 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., Conclusion: This study may serve as a basis for future education to improve pediatric ED nurses' urgency judgment and severity classification skills., (Copyright © 2024. Published by Elsevier B.V.)

Background: 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., Methods: 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., Results: Four themes emerged from the data as factors that affect the process of negotiation: 1) communication; 2) personal factors; 3) specificity; and 4) organization., Conclusions: 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.