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Background: Breastfeeding is recognized as the gold standard of infant feeding and nutrition. The World Health Organization recommends exclusive breastfeeding (EBF) of infants for the first 6 months of life. A variety of factors may impact breastfeeding practices in-hospital which may continue after hospital discharge, such as the use of breastmilk substitutes (BMS). The Baby-Friendly Initiative (BFI), which aims to promote and support breastfeeding practices, established a target rate of 75% for EBF from birth to hospital discharge. Currently, this target is not being met at The Ottawa Hospital (TOH), indicating there is room for improvement in EBF rates. The purpose of this study is to explore health care professionals (HCP) decision-making around use of BMS and identify factors that drive the use of BMS with and without medical indications. Methods: In this qualitative study, semi-structured interviews were conducted with HCPs within TOH from January to June 2022. All participants had experience in maternity or postpartum care and were probed on factors influencing use of BMS at this institution. Interview transcripts were coded using an inductive approach. Results: A total of 18 HCPs were interviewed including physicians, midwives, lactation consultants, and registered nurses. Multilevel barriers influencing the use of BMS were categorized into patient, HCP, and institution-level factors. Subthemes that emerged ranged from parental preferences, training differences amongst HCPs, to budget and staffing issues. Over half of HCPs were prepared to answer questions on EBF and were familiar with the BFI. Although most were supportive of this institution receiving BFI designation, a few providers raised concerns of its impact on parents who would like to supplement. Conclusions: Several modifiable factors influencing decision-making for use of BMS were identified. These findings will be used to inform unit leads, help identify effective strategies to address modifiable barriers, and develop tailored breastfeeding supports to improve EBF rates. [ABSTRACT FROM AUTHOR]

Aim: To determine the incidence of pressure injuries from medical devices in children. Background: Medical devices can cause pressure injuries on skin and soft tissues. Design: A prospective, descriptive study adhering to STROBE guidelines. Methods: This study was conducted in the third‐level Paediatric Intensive Care Unit of Ege University Hospital in İzmir, Türkiye between April 2019 and October 2019 in Türkiye. Patients aged between 1 month and 18 years with medical devices were observed for pressure injuries using Braden scales and a specific monitoring form. Results: In this study, we followed 522 medical devices applied to 96 patients. The three most commonly used medical devices were the ECG probe (21%), the blood pressure cuff (16%) and the saturation probe. Out of the 522 medical devices followed, 36 caused pressure injuries (6.8%). Conclusion: The incidence of medical device‐related pressure injuries was found to be high. Effective training and implementation strategies need to be devised for paediatric nurses to prevent pressure injuries associated with medical devices. Relevance to Clinical Practice: The results of this study reveal that pressure injuries related to medical devices are an important health problem in paediatric hospitals. Therefore, awareness‐raising and educational activities among health professionals and nurses should be accelerated. Patient or Public Contribution: No patient or public contribution in the study. [ABSTRACT FROM AUTHOR]

Aim: To examine the effects of spousal support and parent–nurse partnership on caregiver burden of parents of children with chronic disease. Background: With the trend of increasing the global number of children with chronic diseases, the parental caregiver burden has become increasingly prevalent. Design: Cross‐sectional study. Methods: The study participants included 115 parents of children diagnosed with chronic disease at a general hospital in South Korea. The study duration was 4 June 2021–30 April 2022. Self‐reported measures included the parent–nurse partnership scale, the Korean version of the Parenting Alliance Inventory and the family caregiver burden scale. T‐tests, ANOVA, Pearson's correlation coefficients and hierarchical linear multiple regression were conducted using IBM SPSS version 26.0. This study followed STROBE guideline. Results: Parental caregiver burden was significantly negatively associated with spousal support and parent–nurse partnership. Factors significantly influencing caregiver burden were parental alcohol consumption; child's inherited metabolic disease, cardiovascular disease, disease relating to haematological tumours or kidney disease diagnosis; child's health perceived as poor by parents; child's dependency perceived as high by parents; hospitalization recency; and low spousal support. These factors accounted for 65% of caregiver burden. Conclusion: Parental caregiver burden was related to spousal support and parent–nurse partnership, but the primary factor affecting caregiver burden was spousal support. Relevance to clinical practice: The results highlighted the role of healthcare professionals in educating parents of children with chronic diseases to facilitate spousal support and have implications for nursing and community‐based interventions to reduce parental caregiver burden. Furthermore, they underlined that policymakers and other stakeholders should pay attention to the parental caregiver burden through government‐based, family‐centered strategies. Patient or public contribution: Parents of children with chronic disease were recruited to perform the self‐administered survey in the phase of data collection. [ABSTRACT FROM AUTHOR]

Background: Nurses often face ethical issues in their daily work that can have an impact on their level of job embeddedness. And positive job embeddedness is essential to reduce burnout among nurses and improve professional retention in the medical industry. However, few studies have focused on the relationship between moral distress, moral resilience, and job embeddedness. Objectives: To investigate the relationship between moral distress, moral resilience, and job embeddedness, and explore the mediating role of moral resilience between moral distress and job embeddedness among nurses. Design: A quantitative, cross-sectional study. Methods: Nurses from a number of tertiary general hospitals in central China were surveyed and assessed using the Moral Distress Scale, the Nurse Moral Resilience Scale, and the nurse job embeddedness Scale from February to March 2023. The study was conducted in line with the 1964 Declaration of Helsinki. Ethical consideration: All study procedures were approved by the Ethics Committee of Hunan Normal University (No. 2023-313). Findings: Moral distress was positively correlated with moral resilience (β = 0.525, p < 0.01) and negatively correlated job embeddedness (β = −0.470, p < 0.01). Moral resilience partially mediated the relationship between moral distress with job embeddedness (β = −0.087, p < 0.01). Discussion: The findings reveal a relationship between moral distress, job embeddedness, and moral resilience among nurses. Conclusion: Moral distress and moral resilience are important correlates of job embeddedness in nurses. Interventions to reduce moral distress and increase moral resilience may have potential benefits for improving nurses' job embeddedness. It is recommended that clinical nursing administrators create a favorable ethical atmosphere, educate nurses about ethics, and increase nurses' moral resilience. [ABSTRACT FROM AUTHOR]

Background: Early-life pain is associated with adverse neurodevelopmental consequences; and current pain assessment practices are discontinuous, inconsistent, and highly dependent on nurses' availability. Furthermore, facial expressions in commonly used pain assessment tools are not associated with brain-based evidence of pain. Purpose: To develop and validate a machine learning (ML) model to classify pain. Methods: In this retrospective validation study, using a human-centered design for Embedded Machine Learning Solutions approach and the Neonatal Facial Coding System (NFCS), 6 experienced neonatal intensive care unit (NICU) nurses labeled data from randomly assigned iCOPEvid (infant Classification Of Pain Expression video) sequences of 49 neonates undergoing heel lance. NFCS is the only observational pain assessment tool associated with brain-based evidence of pain. A standard 70% training and 30% testing split of the data was used to train and test several ML models. NICU nurses' interrater reliability was evaluated, and NICU nurses' area under the receiver operating characteristic curve (AUC) was compared with the ML models' AUC. Results: Nurses weighted mean interrater reliability was 68% (63%-79%) for NFCS tasks, 77.7% (74%-83%) for pain intensity, and 48.6% (15%-59%) for frame and 78.4% (64%-100%) for video pain classification, with AUC of 0.68. The best performing ML model had 97.7% precision, 98% accuracy, 98.5% recall, and AUC of 0.98. Implications for Practice and Research: The pain classification ML model AUC far exceeded that of NICU nurses for identifying neonatal pain. These findings will inform the development of a continuous, unbiased, brain-based, nurse-in-the-loop Pain Recognition Automated Monitoring System (PRAMS) for neonates and infants. [ABSTRACT FROM AUTHOR]

Background: Painful procedures are common in the hospital setting. Limited research has been conducted on the use and effectiveness of patient/caregiver-selected techniques to help manage pain during procedures. This study explored the effect of using a Comfort Menu tool for needlestick procedures on patients' and/or caregivers' perceptions and experience of pain, and nurses' perceptions of its benefits and ease of use. Methods: This randomized correlational study included the Wong-Baker FACES® Pain Rating Scale, the FLACC Behavioral Pain Assessment Scale, and two postprocedural surveys. Participants included 100 hospitalized children aged 0 to 18 years and/or their caregivers (50 in the experimental group provided with the Comfort Menu and 50 members in the control group provided with standard care), and 47 nurses. Results: A significant difference was found between the experimental and control groups (p = 0.0100), with those in the experimental group reporting less severe pain than control group participants. All patients and/or caregivers indicated the Comfort Menu was easy to use; 98.04% reported it made being part of their or their child's care better, and 96.08% reported it reduced their or their child's perception of pain. All 47 nurses responded favorably to the use of the Comfort Menu. Conclusion: Using the Comfort Menu improved patient and family involvement, pain perception, and the procedure experience. Findings suggest the Comfort Menu should be part of the standard pain management protocol as hospitals seek better ways to manage pain and to provide patient-and-family centered care. [ABSTRACT FROM AUTHOR]

Background: Retinopathy of Prematurity is a multi-factorial preventive cause of childhood blindness. Using POINTS of care as preventive strategies may be significantly prevent occurrence of retinopathy of premature neonates. The aim of the study was to evaluate nurses' performance regarding points of care for prevention of retinopathy of premature neonates. Subjects and Method: The study design used was descriptive. Setting: It was conducted at Neonatal Intensive Care Units of Tanta Main University Hospital & International Teaching Hospital. Subjects: All nurses (120) who are working in the aforementioned places. Tools: two tools were used: Tool I: Retinopathy Structured Interview Questionnaire, Tool II: POINTS of Care Observational Checklists. Results: nearly three quarters of the nurses had low level of overall knowledge about retinopathy of prematurity and POINTS of care. More than half of the nurses had unsatisfactory practice regarding POINTS of care. Conclusion: Nurses had low level of knowledge & unsatisfactory practice about retinopathy of prematurity and POINTS of care. Recommendations: Designing a training course for neonatal nurses concerning retinopathy of prematurity. Applying POINTS of care standardized protocol for prevention of retinopathy of premature neonates at neonatal intensive care units. [ABSTRACT FROM AUTHOR]

Dietary habits established in childhood, often persist into adulthood highlighting the importance of early intervention. However, limited interventions exist promoting "how" to establish healthful eating behaviors in children. To create impactful interventions, it is important they are based on evidence and co-designed with end-users. Fifteen child health nurses participated in this co-design study, underpinned by the Knowledge to Action Framework. Child health nurses reviewed evidence-based statements and then workshopped practical strategies. Findings from the co-design sessions were used to inform the development of a preventive intervention. The study has important health marketing implications for conducting co-design with child health nurses. [ABSTRACT FROM AUTHOR]

Copyright of Enfermería Neonatal is the property of Fundacion para la Salud Materno Infantil (FUNDASAMIN) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Mediterranean Nursing & Midwifery is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Premature neonates often experience feeding difficulties during their hospital stay, and evidence‐based interventions have been shown to improve feeding outcomes. Aim: This study investigated whether an infant‐cue based nurse educational feeding bundle accelerates the achievement of independent oral feeding in neonates in a neonatal intensive care unit. Study Design: A quality improvement study with a pre, during and post intervention test design. All premature neonates admitted to the unit were eligible. The feeding programme included a four‐month nurse training module and nurse coaching. Results: A hundred and twenty‐five nurses or nurse assistants attended the programme and 706 neonates were included. The median time to independent oral feeding (IOF) was 40, 36 and 37 days, respectively, for pre, during and post intervention. The reduction in time to IOF observed during the post‐intervention period compared with the baseline period was significant (HR = 1.32, CI 95%: 1.01–1.74). No difference was noted in the length of hospital stay between the three study periods. Conclusions: An infant‐cue based nurse educational feeding bundle can promote earlier achievement of IOF in preterm neonates. Relevance to Clinical Practice: This quality improvement study demonstrates the impact that a nurse‐driven intervention in neonatal care can have on improving practice. Feeding interventions involve the early introduction of oral feeding, non‐nutritive sucking (NNS), and oral motor stimulation, and should be individualized for each neonate. These individualized feeding interventions applied by all nurses and assistant nurses, can facilitate the achievement of earlier independent oral feeding in preterm infants and should be included in neonatal critical care nurse education programs. [ABSTRACT FROM AUTHOR]

Objective. To test the hypothesis that PROMPT reduces permanent brachial plexus palsy and perineal tears. Design. A prospective/retrospective cohort study. Setting. Hanover Medical School, Germany. Population/Sample. A self-selected population. Methods. The training period is from November 9th, 2017, until December 31st, 2019; control: January 1st, 2004, until November 8th, 2017. Main Outcome Measures. Shoulder dystocia, nonpermanent and permanent brachial plexus injuries (BPIs), perineal tears III°/IV°, manual manoeuvres, and asphyxia. Results. There was a total of 22,640 births, and shoulder dystocia increased from 48/18,031 (0.27%) to 23/4,609 (0.50%) ((p = 0.017), OR: 1.88, 95% CI: (1.14; 3.09)), whereas BPIs decreased from 7/48 (14.6%) to 1/23 (4.3%) (p = 0.261). There was 1/7 (14.2%) of permanent BPI before and 0/1 (0%) case after. Perinatal asphyxia increased from 3/48 (6.3%) to 4/23 (17.4%) (p = 0.23). However, adverse outcomes after one year were zero. McRoberts' manoeuvre increased from 37/48 (77.1%) to 23/23 (100%) ((p = 0.013), OR: 1.62, 95% CI: (1.33; 1.98)), and internal rotation manoeuvres and manual extraction of the posterior arm from 6/48 (12.5%) to 5/23 (21.7%) (p = 0.319). Episiotomies decreased from 5,267/18,031 (29.2%) to 836/4,609 (18.1%) ((p < 0.001), OR: 0.54, 95% CI: (0.49, 0.58)), whereas perineal tears III°/IV° associated with shoulder dystocia increased from 1/48 (2.1%) to 1/23 (4.8%) (p = 0.546). Vaginal operative deliveries remained constant (6.5% vs. 7%). Conclusions. PROMPT significantly improves the management of shoulder dystocia and decreases permanent brachial plexus injuries but not perineal tears III°/IV°. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, numerous studies have shown the high prevalence of occupational stress (OS) of health workers, affecting the quality of health care provided. To date, there is no study regarding OS of emergency care pediatric nurses working in Greece. This study aimed to examine the pediatric nurses' OS working in tertiary public hospitals in Greece. In this cross-sectional study, a total of 104 pediatric nurses were recruited randomly from summer 2020 to summer 2021. The Expanded Nursing Stress Scale (ENSS), which consists of 59 items grouped into nine categories, was used to assess nurses OS. The overall OS mean score was 141.04 (SD = 33.48), indicating mild stress. Among nine categories, pediatric nurses were more stressed about patients and families (mean = 22.83, SD = 5.71), as well as death and dying (mean = 19.33, SD = 5.22), whereas they were less stressed about discrimination (mean = 4.21, SD = 4.09) and problems with peer support (mean = 12.11, SD = 4.58). Sex, age, and shifts did not correlate with OS. Borderline correlation was present between age and inadequate emotional preparation for less experienced nurses (p = 0.047), while higher educated pediatric nurses were more stressed because of workload than lower educated pediatric nurses (p = 0.044). Greek pediatric nurses sufferedmild OS during the COVID-19 pandemic. There is a great need for further research and implementation of supportive sustainable programs aimed to the minimization of OS and the optimization of health care provided during and after the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to identify the infant-rearing experiences of parents during the coronavirus disease 2019 (COVID-19) pandemic and provide foundational data for the development of infant-rearing support programs during pandemic situations. Methods: Convergent mixed methods were used to better understand the research outcomes by converging both quantitative and qualitative data. A total of 149 parents with infant- rearing experiences during the pandemic responded to a self-report survey, and 10 parents participated in the interviews. Data were analyzed using Colaizzi's method, descriptive statistics, t-test, one-way analysis of variance, the Scheffé test, Pearson correlation coefficients, and hierarchical regression. Results: Analysis of qualitative data yielded the following three categories: five theme clusters, ten themes, and thirty-nine subthemes. The factors influencing infant-rearing behavior were nuclear family (β=.34, p<.001) and rearing stress (β=-.39, p<.001). The explanatory power of the regression equation was 26.6%. Conclusion: Infectious disease disasters, such as the COVID-19 pandemic, can quickly alter infant-rearing conditions, causing heightened parental anxiety. This may affect infant-rearing behaviors and hinder healthy infant development. Future research should develop a comprehensive tool to measure holistic health-related parenting behaviors across the different stages of child development. Additionally, pediatric nurse practitioners can play an active role in educating parents, supporting parenting, and promoting healthy infant development in their communities, making pediatric nurse practitioners a highly relevant and necessary healthcare profession during infectious disease disasters. Thus, there is a need to improve institutions and build infrastructure at the national level to support them. [ABSTRACT FROM AUTHOR]

Background: Intensive care units (ICUs) are often too noisy, exceeding 70–80 dBA, which can have negative effects on staff. The corresponding recommendation of the World Health Organization (average sound pressure level below 35 dBA) is often not achieved. To date there is a lack of intervention studies examining the extent to which unit-based noise management in ICUs contributes to a reduction in noise exposure for the staff. The study therefore aims to provide answers to 1) how unit-based noise management sustainably reduces the subjective noise exposure among staff, and 2) how this intervention affects other noise-related topics. Methods: We performed a monocentric prospective longitudinal study with three measurement points in a German university hospital in three ICUs. We collected data from different healthcare professionals and other professional groups between October 2021 and August 2022 using an online questionnaire. Data were analyzed using descriptive and inference statistics. Results: A total of n = 179 participants took part in the surveys. The majority of participants were nurses or pediatric nurses. Most participants worked more than 75% full-time equivalent. Staff on the three ICUs reported high levels of noise exposure. No significant changes in noise exposure over time were observed. Participants were already aware of the topic and believed that a behavior change could positively influence the noise environment. Conclusions: This study provides an initial insight into how a unit-based noise management could contribute to a reduction in the subjective noise exposure among staff in ICUs. The results of this study highlight the importance of this topic. Future studies should aim to research aspects of adherence and their facilitators or barriers, which promote the sustained implementation of noise-reducing measures by staff. Trial registration: German Clinical Trials Register (DRKS): DRKS00025835; Date of registration: 12.08.2021. [ABSTRACT FROM AUTHOR]

Copyright of Turkiye Klinikleri Journal of Nursing Sciences is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Blinding of treatment allocation from treating clinicians in neonatal randomised controlled trials can minimise performance bias, but its effectiveness is rarely assessed. Methods: To examine the effectiveness of blinding a procedural intervention from treating clinicians in a multicentre randomised controlled trial of minimally invasive surfactant therapy versus sham treatment in preterm infants of gestation 25–28 weeks with respiratory distress syndrome. The intervention (minimally invasive surfactant therapy or sham) was performed behind a screen within the first 6 h of life by a 'study team' uninvolved in clinical care including decision-making. Procedure duration and the study team's words and actions during the sham treatment mimicked those of the minimally invasive surfactant therapy procedure. Post-intervention, three clinicians completed a questionnaire regarding perceived group allocation, with the responses matched against actual intervention and categorised as correct, incorrect, or unsure. Success of blinding was calculated using validated blinding indices applied to the data overall (James index, successful blinding defined as > 0.50), or to the two treatment allocation groups (Bang index, successful blinding: −0.30 to 0.30). Blinding success was measured within staff role, and the associations between blinding success and procedural duration and oxygenation improvement post-procedure were estimated. Results: From 1345 questionnaires in relation to a procedural intervention in 485 participants, responses were categorised as correct in 441 (33%), incorrect in 142 (11%), and unsure in 762 (57%), with similar proportions for each of the response categories in the two treatment arms. The James index indicated successful blinding overall 0.67 (95% confidence interval (CI) 0.65–0.70). The Bang index was 0.28 (95% CI 0.23–0.32) in the minimally invasive surfactant therapy group and 0.17 (95% CI 0.12–0.21) in the sham arm. Neonatologists more frequently guessed the correct intervention (47%) than bedside nurses (36%), neonatal trainees (31%), and other nurses (24%). For the minimally invasive surfactant therapy intervention, the Bang index was linearly related to procedural duration and oxygenation improvement post-procedure. No evidence of such relationships was seen in the sham arm. Conclusion: Blinding of a procedural intervention from clinicians is both achievable and measurable in neonatal randomised controlled trials. [ABSTRACT FROM AUTHOR]

Background. Trauma is one of the most common causes of death in childhood, but data on severely injured Swiss children are absent from existing national registries. Our aim was to analyze trauma activations and the profiles of critically injured children at a tertiary, non-academic Swiss pediatric emergency department (PED). In the absence of a national pediatric trauma database, this information may help to guide the design of infrastructure, processes within organizations, training, and policies. Methods. A retrospective analysis of pediatric trauma patients in a prospective resuscitation database over a 2-year period. Critically injured trauma patients under the age of 16 years were included. Patients were described with established triage and injury severity scales. Statistical evaluation included logistic regression analysis. Results. A total of 82 patients matched one or more of the study inclusion criteria. The most frequent age group was 12–15 years, and 27% were female. Trauma team activation (TTA) occurred with 49 patients (59.8%). Falls were the most frequent mechanism of injury, both overall and for major trauma. Road-traffic-related injuries had the highest relative risk of major trauma. In the multivariate analysis, patients receiving medicalized transport were more likely to trigger a TTA, but there was no association between TTA and age, gender, or Injury Severity Score (ISS). Nineteen patients (23.2%) sustained major trauma with an ISS > 15. Injuries of Abbreviated Injury Scale severity 3 or greater were most frequent to the head, followed by abdomen, chest, and extremities. The overall mortality rate in the cohort was 2.4%. Conclusions: Major trauma presentations only comprise a small proportion of the total patient load in the PED, and trauma team activation does not correlate with injury severity. Low exposure to high-acuity patients highlights the importance of deliberate learning and simulation for all professionals in the PED. Our findings indicate that high priority should be given to training in the management of severely injured children in the PED. The leading major trauma mechanisms were preventable, which should prompt further efforts in injury prevention. [ABSTRACT FROM AUTHOR]

Study Aim: To investigate whether use of admission lanyards improves nurse confidence, care coordination, and infant health outcomes during neonatal emergency admissions. Methods: Admission lanyards that defined team roles, tasks, and responsibilities were evaluated in a mixed-methods, historically controlled, and nonrandomized intervention study. Methods included (i) 81 pre- and postintervention surveys to explore nurse confidence, (ii) 8 postintervention semistructured interviews to elicit nurse perceptions of care coordination and nurse confidence, and (iii) a quantitative comparison of infant care coordination and health outcomes for 71 infant admissions before and 72 during the intervention. Results: Nurse participants reported that using lanyards during neonatal admissions improved clarity of roles and responsibilities, communication, and task delegation, contributing to better admission flow, team leadership, accountability, and improved nurse confidence. Care coordination outcomes showed significantly improved time to stabilization for intervention infants. Radiographies for line placement were performed 14.4 minutes faster, and infants commenced intravenous nutrition 27.7 minutes faster from time of admission. Infant health outcomes remained similar between groups. Conclusion: Admission lanyards were associated with improved nurse confidence and care coordination during neonatal emergency admissions, significantly reducing time to stabilization for infants, shifting outcomes closer to the Golden Hour. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Nursology is the property of Ataturk University Coordinatorship of Scientific Journals and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Nurses working in pediatric wards should communicate with children well and have appropriate caring behaviors according to the age of their patients, so distance education is very suitable for them due to its availability. This study aimed to determine the effect of online education on the principles of pediatric nursing care on the caring behaviors of nurses working in pediatric wards. Methods: This interventional (quasi-experimental) study used a simple random method to select 70 nurses working in pediatric wards and pediatric intensive care units in Kerman. The nurses in the intervention group received online training in the sky room three days a week, while nurses in the control group received routine pediatric care. The study instruments were the demographic information questionnaire and the Caring behaviors Questionnaire, which were completed by two groups before and one month after the intervention. Data were analyzed with SPSS 25. The significance level was set at P < 0.05. Results: The independent samples t-test indicated no significant differences in the mean scores of care behaviors between the intervention (256.61 ± 5.16) and control groups (257.52 ± 3.99) before the intervention (P = 0.23) but indicated a significant difference in the mean scores of caring behaviors between the intervention (275.69 ± 6.52) and control groups (254.21 ± 3.15) after the intervention. Therefore, online education increased the score of caring behaviors in the intervention group. Conclusion: Distance education had an impact on the caring behaviors of nurses in pediatric wards and we recommend the use of e-learning to improve the caring behaviors and the quality of care of nurses. [ABSTRACT FROM AUTHOR]

Copyright of Turkiye Klinikleri Journal of Nursing Sciences is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: To evaluate knowledge, attitude and implementation of Skin‐to‐Skin Care (SSC) among nurses and to assess the implementation of SSC in the perinatal setting. Design: A cross‐sectional study design was implemented utilizing survey distributed among critical care paediatric and neonatal nurses. Methods: The data collection form was pre‐structured validated tool consisted of two main sections; socio‐demographic characteristics and Likert scale of 20 items covering four main domains in; knowledge, attitude, education and implementation of SSC. Results: The vast majority of the sample 91 (98%) were females with mean age and mean years of experience 33.5 ± 6.5 and 9.7 ± 6.5 years respectively. Almost half of them 45 (48.4%) work in obstetric and labor and delivery units. Correlation coefficient revealed a significant association between the total educational years of nursing degree and SSC. The results showed nurses with bachelor or master significantly more knowledgeable and skilled in implementing SSC compared to others. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To review your understanding of the philosophical foundations underpinning novel mixed methods research methodologies • To evaluate examples of optimal use and appraisal of mixed methods grounded theory methodology • To consider applying these guidelines in future mixed methods grounded theory studies Background: Nurse researchers are constantly seeking novel methods of maintaining philosophical congruence while advancing their knowledge of the human condition using paradigmatically diverse means. Aim: To provide an overview of the research philosophies underpinning the mixed methods grounded theory (MM-GT) methodology, illustrate its optimal use and introduce a quality-appraisal tool being developed with reference to extant literature. Discussion: The utility of MM-GT has been effectively demonstrated in the nursing and health literature. Yet, there are examples of how it has been under-used and sub-optimally applied. This article includes a two-phase MM-GT study protocol guided by a pragmatic research philosophy and best practice recommendations that aims to explain neonatal nurses' professional quality of life. Conclusion: Optimal use of MM-GT's five essential components – purposive sampling, constant comparative methods with iterative coding and analysis, theoretical saturation, memoing and theory development – combine to produce high-quality, defensible research outputs and new nursing theory. Implications for practice: Research outputs, such as publication and presentation, expounding the multifactorial influences affecting neonatal nurses' professional quality of life will not only benefit the neonatal nursing community but also contribute to the corpus of nursing and midwifery research and enhance the health, well-being and retention of nurses and midwives more broadly. [ABSTRACT FROM AUTHOR]

Aim: To understand the lived experiences of nurses resuscitating children in community hospital emergency departments. Background: Emergency department nurses exposed to paediatric resuscitations are at a high risk of developing post‐traumatic stress. This may be especially true in community hospital emergency departments, where nurses have less exposure to, knowledge about, and resources for managing these events. Interventions to proactively prevent nurse trauma in these contexts remain largely uninvestigated. To inform such interventions, a detailed understanding of the largely unknown lived experiences of these nurses is necessary. Design and methods: In‐depth, semi‐structured interviews were conducted with four registered nurses that had experienced at least one paediatric resuscitation while working in a community hospital emergency department in Ontario, Canada. Data were analysed using interpretive phenomenological analysis. Reporting follows the COREQ checklist. Results: Analysis revealed three superordinate themes (i.e. 'Conceptualising Paediatric Resuscitations', 'Seeing What I See', and 'Making Sense of What I Saw') and nine corresponding subthemes. Conclusion: This study provides insight into the infrequent, but profound experiences of nurses resuscitating children in community hospital emergency departments. Nurses, who conceptualise these events as unnatural, emotional, and chaotic, are comforted by those who understand their experiences and are distressed by those who cannot see what they see. To reconcile what they have seen, nurses may reflect and ruminate on the event, ultimately restructuring their experiences of themselves, others, and the world to make room for a new reality where the safety of childhood is not certain. Relevance to clinical practice: Our findings contribute to pragmatic recommendations for interventions to proactively prevent nurse distress in these contexts, including psychoeducation, psychological support and in‐situ simulation activities. Nursing leaders should consider staff that have resuscitated children as valuable sources for information on how to improve practice settings. [ABSTRACT FROM AUTHOR]

Background: Neonatal nurses have a main role which include promote and facilitate breastfeeding in the Neonatal Intensive Care Unit (NICU). This study was conducted to determine the practices and attitudes of nurses towards breastfeeding support, in NICU during the Covid-19 pandemics. Materials and Methods: The study was a cross-sectional descriptive survey design conducted with 252 nurses who were members of the Neonatology Nurses Society. The Data Collection Form, Survey Questionnaire, and the Iowa Infant Feeding Attitude Scale (IIFAS) were used for data collection. Results: The IIFAS median score of the participants was 70.0 (IQR=9.0). Statistically differences in the IIFAS scores were found according to age (x2=11.703, p=0.008), education status in nursing (x2=9.257; p=0.01), and status of attending to international scientific meetings (Z=-2.360; p=0.018). Participants who were age between 26-30 years (n=76, 30.2%), had post-education degree in nursing (n=32, 12.7%), and attended to international scientific meetings (n=47, 18.6) had higher positive attitudes of breastfeeding. The nurses (n=126, 50%) stated that it was difficult to reach mothers in terms of breastfeeding for newborns, and 61.8% of them (n=156) stated that they had difficulty initiating the mother-baby attachment process in the NICU. Conclusions: Although the attitudes of NICU nurses towards breast milk and breastfeeding were at a moderate level in our study, they struggled to support and maintain the lactation and they implemented to a number of supportive feeding practice in NICUs. [ABSTRACT FROM AUTHOR]

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Many healthcare professionals base their perceptions of pediatric pain on their knowledge of the subject. Therefore, knowledge deficits in this area may yield negative attitudes toward pain management and add to the complexity of pain management in hospitalized children. This study evaluated the knowledge of pediatric clinicians in China regarding pediatric pain management. Adopting a cross-sectional descriptive comparative design, we surveyed pediatric clinicians using a structured questionnaire. Inclusive criteria were pediatric clinicians, both pediatricians and nurses, with professional pediatric experience of over one year. A total of 507 pediatric clinicians participated. Most were aware of the importance of pain management in sick children but misunderstood pediatric pain, lacked knowledge for performing pediatric pain assessments and lacked knowledge for providing pain relief interventions. Background factors including differing professions (pediatricians and nurses; p = 0.012), age (p < 0.05) and hospital setting of employment (p = 0.003) were significantly related to clinicians' knowledge regarding pain management. Participating pediatricians had higher levels of knowledge of pediatric pain management than nurses. Research revealed four barriers affecting clinicians' knowledge, including misconception of pain in children, lack of professional knowledge and confidence in the practice of pediatric pain assessment, lack of professional knowledge to provide pain relief interventions, and a significant knowledge gap between pediatricians and nurses. The results point out a crucial need for multidisciplinary education to remedy these deficiencies. Further study is needed to explore strategies to strengthen clinicians' knowledge of this vital area of practice. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Pediatric Emergency & Intensive Care Medicine / Çocuk Acil ve Voğun Bakım Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Nursing has been characterized as one of the most stressful professions that affect nurses' quality of work life negatively. Aim: This study aimed to assess the Quality of Nursing Work Life in a sample of pediatric oncology nurses in Greece. Methodology: This is a cross-sectional comparative study. We assessed the quality of work life in a convenience sample of pediatric oncology and pediatric nurses working in the two major pediatric public hospitals in Greece, with the use of the Quality of Nursing Work Life (QNWL) Questionnaire. Data analysis was performed using Statistical Package SPSS version 23.0 (SPSS, Inc., Chicago, IL). The significance level was set at 0.05. Results: The study participated in total 119 nurses (79 pediatric oncology nurses and 40 pediatric nurses). The quality of work life was assessed as moderate (138.87 ± 24.198). The vast majority were female nurses (N=103, 86.6%) working for more than ten years in a pediatric hospital setting (N = 74, 62.2%). Pediatric oncology nurses showed statistically significant differences in subscale "Work Life / Home Life" (p = 0.003) and "Work Design" (p = 0.002) as well as in the overall QNWL scale score, with a significantly increased mean score (145.08 ± 27,064) against non-oncology pediatric nurses (135.72 ± 22.132). Conclusions: The quality of work life is a factor that affects the professional performance of nurses as well as their individual family life. Therefore, its regular assessment is important in order to address problems in work life that may result in provision of poorer quality services to patients and directly affect nurses' personal quality of life. The systematic assessment of the quality of nurses' work life is essential in order to identify its' determinants and possible barriers. [ABSTRACT FROM AUTHOR]

Background: Pediatric oncology nurses (PONs) present higher levels of occupational stress (OS) related to the nature of the care they provide, along with the extreme workload and the emotional distress related to the loss of a patient. Aim: The aim of this study was to assess the level of OS that PONs experience in Greece in comparison to the stress experienced by general pediatric nurses (PNs). Methodology: This is a non-invasive comparative cross-sectional study. We assessed the stress level in a sample of 60 PNs and 60 PONs, working in the two biggest pediatric public hospitals in Greece, using the Nurse Stress Scale (NSS). The self-reported stress levels among these groups were compared. X² test and t-test were used to investigate the relationship between variables. The significance level was set at 0.05. Results: In all NSS' subscales PONs stated higher levels of stress in comparison to PNs, but this was statistically significant only in the death & suffering (p = 0.033) and lack of staff support subscales (p = 0.027). The majority of PNs are experiencing occasional OS on almost all NSS questions. Workload, death & suffering, conflicts with other nurses and supervisors, with medical staff, treatment uncertainty were noted as particularly stressful factors in both groups. Conclusions: PONs experience greater stress than PNs, but more evidence is needed to support the hypothesis and reveal the related factors. However, younger age, exposure to patients' death and suffering, lack of support from colleagues seem to be the core determinants related to PONs stress. [ABSTRACT FROM AUTHOR]

Background: Peripheral intravenous catheters (PIVCs) are the most widely used intravenous treatment tools for hospitalized patients. Compared to adult patients, PIVC fixation issues are more likely to occur in pediatric patients and can be more complex. However, research on PIVC fixation in pediatric patients is rare. This study aimed to investigate the pass rate for PIVC fixation in pediatric patients and the factors that influence pediatric nurses' knowledge, attitude, and practice (KAP) concerning PIVC fixation. Methods: An on-site investigation using a self-designed PIVC fixation standard inspection checklist for first insertion and routine maintenance in pediatric patients and a follow-up questionnaire survey investigating pediatric nurses' KAP concerning PIVC fixation was conducted in a hospital in China between November 1 and December 31, 2019. Data were analyzed using SPSS 21.0. Results: The pass rate for PIVC fixation in pediatric patients was 52.02%. The pediatric nurses' knowledge, attitude and practice scores on PIVC fixation were 7.2 ± 1.36, 28.03 ± 2.42, and 31.73 ± 2.94, respectively. The multivariate linear regression analysis results show that department (where nurses are working in) and job position are the factors that influence knowledge score (B > 0, P < 0.05); department is also a factor that influences attitude score (B > 0, P < 0.05); and department and nursing hierarchy are the factors that influence practice score (B > 0, P < 0.05). Conclusion: PIVC fixation in pediatric patients is affected by multiple factors. The level of pediatric nurses' KAP on PIVC fixation needs to be improved. It is suggested that guidelines for PIVC fixation in pediatric patients be formulated and that training on PIVC fixation in pediatric patients be provided for pediatric nurses in an effort to raise the pass rate in terms of PIVC fixation in pediatric patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: Tobacco smoke exposure leads to numerous adverse health effects in children. Providing cessation interventions to caregivers who smoke during pediatric hospitalizations can help protect children from such exposure. Both pediatric registered nurses (RNs) and pediatric respiratory therapists (RTs) are well positioned to provide these interventions. Little is known about their rates of participation in cessation efforts. Our objective was to compare the attitudes and practice of pediatric RNs versus pediatric RTs to evaluate their relative cessation-intervention practices in the in-patient pediatric setting. METHODS: An online survey was sent to pediatric RNs and RTs at 4 tertiary pediatric hospitals in California. The survey assessed individual demographics, work environment, experience, beliefs, and practices related to smoking cessation activities. Questions used 3-point and 5-point Likert scales and were compared with the chi-square test. Institutions with a response rate < 20% were excluded. RESULTS: A total of 401 respondents were included in the final analysis (292 RNs, 109 RTs). RTs versus RNs were older (42.0 y vs 35.4 y, respectively, P < .001) and more likely to be former smokers (29.9% vs 13.3%, respectively, P < .001). RNs reported lower levels of confidence in discussing smoking cessation with parents, with 11.7% saying they felt "very confident" compared to 29.0% of RTs (P = .001). RNs also reported screening for smoke exposure less frequently than RTs, with 18.8% responding "often" or "always" compared to 28.9% of RTs (P = .033). RNs had lower rates of advising parents "to make a smoke-free home policy" compared to RTs (ie, 13.4% vs 26.9%, respectively, P = .002). CONCLUSIONS: Compared to in-patient pediatric RNs, RTs reported higher rates of confidence in providing cessation interventions, screening for smoke exposure, and counseling on reducing smoke exposure, suggesting that they may be better positioned for intervening. These results can inform the design of an in-patient cessation intervention for caregivers of hospitalized children. [ABSTRACT FROM AUTHOR]

Purpose: Improvements in patient satisfaction are perpetual goals for health care organizations, and nurses are the health care providers most frequently in contact with patients and families. Understanding relationships between compassion satisfaction (CS), compassion fatigue (CF), and nurses' perceptions of their role with patient satisfaction may identify opportunities for improvement. Methods: A quality improvement survey pilot project was undertaken to establish data on the prevalence of CS and CF, as well as nurses' demographics and perceptions regarding patient satisfaction from a representative sample of hospital registered nurses from five clinical units. Descriptive statistics were used to analyze quantitative data, and for qualitative data, semantic content analysis was used. Outcomes: A total of 102 nurses voluntarily participated, and findings indicated moderate-high prevalence of CS (3.83 to 4.05) and moderate-low prevalence of CF (2.04 to 2.39) across all five pilot units without significant relationships with unit patient satisfaction ratings. Nurses (60%) perceived themselves as accountable for patient satisfaction and identified similar codes (> 75%) in open-ended responses. Conclusion: Implications for pediatric nursing were increased risk for CF, which can be mediated with proactive interventions that support nurse resiliency, and CS. Further investigation of correlations between nurse satisfaction and patient satisfaction, nursing work environment, communication, and family care in pediatrics is warranted. [ABSTRACT FROM AUTHOR]

Aim: This study was conducted to determine the effects of learned resourcefulness, work‐life quality, and burnout level on the pediatric nurses' intention to leave work. Design and Method: The study was conducted with 268 nurses. Data were evaluated by Pearson correlation and multiple regression analysis. Findings: In this study, 40.7% of nurses showed the intention to leave their jobs. Work‐life quality, burnout level, and learned resourcefulness explained intention to leave the job in the rate, respectively, of 21.5%, 27.6%, and 12.1%. These three factors indicate that intention to leave the job is 41%. Practice Implication: Nurse managers can reduce nurses' intention to leave the job by providing safe, comfortable, accessible, appropriate working conditions, increasing the learned resourcefulness level, and supporting nurses. [ABSTRACT FROM AUTHOR]

Objective To explore the effect of APN scheduling method based on nurse level management on job burnout and competence of pediatric responsible nurses. Method The department of pediatrics of Nantong Second People's hospital began to implement nurse-level management and APN scheduling method in January of 2019. The nurses at different levels were reasonably matched, and the children were treated with responsibility system. The changes of nurses' job burnout and competence before and after the implementation of APN scheduling method were investigated and compared. Results After the implementation of hierarchical management and APN scheduling method, the emotional exhaustion and depersonalization scores of nurses' job burnout were significantly lower than before the implementation (all P <0. 05), and the personal achievement scores were significantly higher than before the implementation (P < 0. 05). The scores of all indicators of nurse job competence were significantly higher than before the implementation (all P < 0. 05). Conclusion The use of nurse level management and APN scheduling method can effectively reduce the job burnout of pediatric responsible nurses and promote the improvement of nurses' job competence. [ABSTRACT FROM AUTHOR]

Background: Febrile convulsion is seizure correlating with fever in the presence of central nervous system or a cut infection electrolyte imbalance child old one month of age without notice. It is commonly infected of (3% - 4%) of children under six years of age. Objective: The study aims: 1-Assess knowledge of nurses toward nursing care procedure for children with febrile convulsions . 2- Find out- relation between nurses' knowledge and demographic information (age,gender, marital status, level of education, Years' experience in the domain pediatric nursing, Years' experience in the neonatal intensive care unit, participate to training on Febrile convulsions). Methodology: Descriptive design (cross sectional research design) performed on stage nursing care on febrile convulsions for patient . in order Knowledge Toward Procedure Nursing Care on febrile convulsions patient the study has been conducted for nurses in emergency unit in AL- Nasiriyah City Hospitals including Muhammad AL-Mawsawi pediatric Hospital, Bint Al -Huda Maternity & Children Hospital .starting from (20th September 2019) to (30th of August 2020). A non-probability (Purposive) sample of (100) nurse from emergency unit in AL- Nasiriyah City Hospitals, including Muhammad AL-Mawsawi pediatric Hospital,Bint Al- Huda Maternity & Children Hospital . consisting study tool of two section : The first section is regarding that demographic characteristic of nurse and the another section is regarding that nurses' knowledge toward procedure nursing care on febrile convulsions for Patient. The results by using SPSS (Statistical Package for the Social Sciences) software version 25 descriptive data analysis include) frequencies and percentages, mean and standard deviation). inferential analysis (D.F. and Chi-Square) at P value 0.05. Results: indicates that nurses are within age group of (20 -- 29) years were female. The majority of the sample are married . Regarding the level of education the majority participant of them college of nursing. Showed that non-significant correlation between the nurses' knowledge with their demographic characteristic at (p > 0.05), except their gender and years' experiencethem significant. Conclusion: Majority of the sample are age group of (20-29) years old .There is non-significant correlation between the nurses' knowledge with their demographic characteristic at (p > 0.05), except their gender and years' experience in domain of pediatric nursing revealed significant differences relationship with their knowledge. [ABSTRACT FROM AUTHOR]

Aim: Perinatal death is often preceded by an end-of-life decision (ELD). Disparate hospital policies, complex legal frameworks and ethically difficult cases make attitudes important. This study investigated attitudes of neonatologists and nurses towards perinatal ELDs.Methods: A survey was handed out to all neonatologists and neonatal nurses in all eight neonatal intensive care units in Flanders, Belgium in May 2017. Respondents indicated agreement with statements regarding perinatal ELDs on a Likert-scale and sent back questionnaires via mail.Results: The response rate was 49.5% (302/610). Most neonatologists and nurses found nontreatment decisions such as withholding or withdrawing treatment acceptable (90-100%). Termination of pregnancy when the foetus is viable in cases of severe or lethal foetal problems was considered highly acceptable in both groups (80-98%). Physicians and nurses do not find different ELDs equally acceptable, e.g. nurses more often than physicians (74% vs 60%, p = 0.017) agree that it is acceptable in certain cases to administer medication with the explicit intention of hastening death.Conclusion: There was considerable support for both prenatal and neonatal ELDs, even for decisions that currently fall outside the Belgian legal framework. Differences between neonatologists' and nurses' attitudes indicate that both opinions should be heard during ELD-making. [ABSTRACT FROM AUTHOR]

This article provides an overview of the differences and similarities in educational preparation of nurse practitioners (NPs) and physician assistants (PAs) along with requirements for entry into each program, graduation, and certification. Using an exploratory descriptive design, a convenience sample of 50 NP and 50 PA programs was accessed over the Internet. The major finding in this study is that high-quality educational requirements exist for both NPs and PAs. NPs and PAs are educated under very different models of practice. PA programs tend to follow a medical model tradition of education with a generalist preparation, while NP programs build on a baccalaureate nursing educational framework and require students to choose a specialty NP program (i.e., family, adult, women's health, pediatric, acute care, etc.). NP education is completed primarily on a part-time basis while PA education required a full-time commitment. Entry into practice requirements is also different; while all NPs are required to have a minimum of a master's degree in nursing, PAs can currently practice with a certificate, associate, baccalaureate, or master's degree. NP and PA programs also have different requirements for admission. NP candidates must have the equivalent of a bachelor's degree in nursing, and many programs prefer a minimum of 2,000-4,000 hr of professional nursing experience. Requirements for all PA programs consist of 2 years of college coursework in the basic premedical sciences; along with appropriate healthcare experience (most schools prefer some healthcare-related experience; American Academy of Physician Assistants, 2006). A PA student entering a master's level program must also have a baccalaureate degree. In comparing educational curriculums, didactic content is very similar among both programs. Didactic and clinical hours required for graduation are also examined. A detailed discussion of the similarities and differences in educational preparation of NPs and PAs is presented. [ABSTRACT FROM AUTHOR]

Context: Making end-of-life decisions (ELDs) in neonates involves ethically difficult and distressing dilemmas for health care providers. Insight into which factors complicate or facilitate this decision-making process could be a necessary first step in formulating recommendations to aid future practice.Objectives: This study aimed to identify barriers to and facilitators of the ELD-making process as perceived by neonatologists and nurses.Methods: We conducted semistructured face-to-face interviews with 15 neonatologists and 15 neonatal nurses, recruited through four neonatal intensive care units in Flanders, Belgium. They were asked what factors had facilitated and complicated previous ELD-making processes. Two researchers independently analyzed the data, using thematic content analysis to extract and summarize barriers and facilitators.Results: Barriers and facilitators were found at three distinct levels: the case-specific context (e.g., uncertainty of the diagnosis and specific characteristics of the child, parents, and health care providers, which make decision making more difficult), decision-making process (e.g., multidisciplinary consultations and advance care planning, which make decision making easier), and overarching structure (e.g., lack of privacy and complex legislation making decision making more challenging).Conclusion: Barriers and facilitators found in this study can lead to recommendations, some simpler to implement than others, to aid the complex ELD-making process. Recommendations include establishing regular multidisciplinary meetings to include all health care providers and reduce unnecessary uncertainty, routinely implementing advance care planning in severely ill neonates to make important decisions beforehand, creating privacy for bad-news conversations with parents, and reviewing the complex legal framework of perinatal ELD making. [ABSTRACT FROM AUTHOR]

Purpose: The objectives of this study were to describe (a) the frequency of interruptions experienced by a pediatric nurse per hour, (b) the sources of interruptions experienced by a pediatric nurse, and (c) the interruption outcomes during pediatric medication administration. Design and Methods: This design of this study was a cross‐sectional observational study. A convenience sample of pediatric nurses was used in this study. The interruption observation sheet was used to collect data about the frequency, sources, and outcomes of interruptions. Results: There was a total of 43 nurses were observed in more than 180 medication administration rounds. An interruption rate of 94.51% occurred during pediatric medication administration. The frequency of interruptions was three or more times (51.04%). The most common source of interruption was attributed to the working environment (32.37%). The second most frequent reason for interruption came from personnel, such as caregivers (24.48%), followed by physicians (10.79%), and other nursing staff (9.54%). The third most common source of interruption was communication issues, including patient interviews, patient reports, and case discussion (8.71%). Six errors (2.49%) were reported out of 241 interruptions as a result of interruptions. In specific, causes of errors during pediatric medication administration were due to wrong medication dose. Practice Implications: This study provides important information on interruptions experienced by pediatric nurses during medication administration in Chinese hospital settings and found that interruptions frequently occur in pediatric units. [ABSTRACT FROM AUTHOR]