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Background: Several studies in pediatric oncology have shown the successful effects of using hypnotic communication techniques (HCTech) during painful medical procedures. Since no studies assessed the precise use of these techniques with a validated tool, it is unsure that the observed relationships involve the use of HCTech., Objectives: To develop a scale evaluating healthcare professionals' behaviours when using HCTech and to evaluate its inter-rater reliability., Methods: This study involved the preliminary steps of the Sainte-Justine Hypnotic Communication Assessment Scale (SJ-HCAS) development process. As part of a larger intervention study, the SJ-HCAS was developed in three steps by five experts and four lay raters using an iterative process applied to subsets of video-recorded nurse-patient interactions. The development aimed to maximize clarity and precision of items as well as minimize redundancy amongst items. Inter-rater reliability was assessed in a randomly selected sample of 1/3 of collected video-recorded interactions (n=42)., Results: The final version of the scale is composed of 11 items categorized in two domains pertaining to Relationship and Technique. We found excellent inter-rater reliability for both subscores and total score in two independent inter-rater comparisons (median ICC=0.879), with most items showing very good to perfect inter-rater reliability (median Kappa=0.847)., Conclusions: The results support further work with the SJ-HCAS. The scale has the potential to help ensure the integrity of hypnotic communication training in children which could ultimately promote the dissemination of the practice of HCTech., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Purpose: Vascular access in pediatric patients can be challenging even with the currently available technological resources. This nurse-driven research study explored time, cost, and resources for intravenous access to determine if a biomedical device, VeinViewer ® Vision, would facilitate improvements in pediatric access. In addition, this study looked at nurse perceptions of skills and confidence around intravenous insertion and if the use of the VeinViewer ® impacted these perceptions. Literature examining pediatric intravenous access success rates compared with nurse perceived skills and confidence is lacking., Design: Nonblinded randomized control trial of pediatric nurses working in an acute care hospital setting., Methods: A preliminary needs assessment solicited feedback from nurses regarding their practice, perceived skills, and confidence with placing peripheral intravenous catheters (PIVs). Due to the results of the preliminary needs assessment, a research study was designed and 40 nurses were recruited to participate. The nurses were randomized into either a VeinViewer ® or standard practice group. Nurse participants placed intravenous catheters on hospitalized pediatric patients using established procedures while tracking data for the study., Results: Needs assessment showed a majority of nurses felt a biomedical device would be helpful in building their intravenous insertion skills and their confidence. The study results did not demonstrate any clinically significant differences between VeinViewer ® use and standard practice for intravenous catheter insertion in pediatric patients for success of placement, number of attempts, or overall cost. In addition, no difference was noted between nurses in either group on perceived skills or confidence with insertion of PIVs., Practice Implications: The ongoing need for resources focused on building nurse skills and confidence for PIV insertion was highlighted and organizations should continue to direct efforts toward developing skills and competency for staff that are responsible for pediatric vascular access. This study illustrates the importance of data-driven decision-making for expensive hospital-funded equipment purchases. This nursing led research study highlights how perceptions do not always align with outcomes. The lessons gleaned from this study may aid in decision-making around pediatric intravenous access practice., (© 2018 Wiley Periodicals, Inc.)

Purpose: Pediatric nurses play a significant role in all phases of traumatic brain injury (TBI) recovery, particularly during the hospital stay. Although evidence-based nursing practice is known to improve patient outcomes, limited research exists on nurses' evidence-based perceived knowledge and beliefs specific to TBI care. As nurses' perceived knowledge and beliefs are known to guide their practice behaviors, this assessment is important to overall TBI outcomes. The purpose of this study was to evaluate pediatric nurses' evidence-based perceived knowledge and beliefs in providing care for children and adolescents with moderate-to-severe TBI., Design and Methods: Data for this study were obtained from a larger parent study on nurses' perceptions of caring for patients of all ages with moderate-to-severe TBI. The parent study was an exploratory, cross-sectional electronic survey of registered nurses across all hospital departments within a large Midwestern health system. Only data specific to pediatric nurses (n = 330) were analyzed for this study. Descriptive statistics and latent class analysis (LCA) were performed., Results: Pediatric nurses, on average, were 38.79 years, female (90.37%), had over a decade of nursing experience (13.55 years), and practiced as a staff nurse (80.07%) on an inpatient unit (45.51%). Findings indicated pediatric nurses reported overall low levels of evidence-based perceived knowledge and had inaccurate beliefs about caring for patients with TBI. LCA indicated two distinct homogenous subgroups specific to evidence-based perceived knowledge: low (41%) and high (59%). Nurses in the low evidence-based perceived knowledge group were younger, had less nursing experience, worked primarily on an inpatient unit, and cared for patients with TBI at a higher frequency compared to high evidence-based perceived knowledge nurses. Additionally, there were significant differences in beliefs about sex-based patient differences after TBI and the role of nurses in caring for patients with TBI based on level of evidence-based perceived knowledge., Practice Implications: Assessing nurses' perceived knowledge and beliefs of evidence-based practice is a foundational step toward implementing evidence-based care for patients with moderate-to-severe TBI. Implications of these findings indicate the need to provide additional education to increase pediatric nurses' perceived knowledge and ensure accurate beliefs about evidence-based TBI care., (© 2018 Wiley Periodicals, Inc.)

For three decades, Julie Metzger has fostered dialogue between preteens and parents.

Purpose: Determine if the pediatric peripheral vascular access algorithm (PPVAA) led to differences in first-attempt and overall peripheral intravenous (PIV) success, staff attempting PIV access per episode and overall attempts and first PIV attempt success by provider., Design/methods: A two-cohort pre-/post-implementation comparative design involved pediatric nurses and patients. The PPVAA included four components: a patient comfort plan, PIV grading score, nurses' self-assessed IV access capability and nurse decision to stop-the-line. Two sample t-test or Wilcoxon rank sum test and Pearson's chi-square test were used to evaluate differences between groups and measures., Results: Healthcare providers (N=96) attempted 721 PIV insertions (pre-PPVAA, n=419 and post-PPVAA, n=302). Of 78 nurse providers, mean (SD) age was 37.4 (11.0) years and 20.0% self-assessed PIV capability as expert. Of children, mean age was 8.3 (7.0) years. Post-PPVAA, first-attempt (p=0.86) and overall (p=0.21) success did not change, though fewer staff were needed per episode to initiate PIV; p=0.017. Overall rate of success after one attempt in the post-PPVAA period compared to pre-PPVAA was reduced (p=0.002), reflecting greater awareness to stop-the-line. Compared to pre-PPVAA, advanced practice nurses and non-clinician providers were more likely to achieve success on first attempt., Conclusions: The PPVAA did not increase first-attempt or overall PIV success; however, it decreased overall IV attempts and the number of staff attempting access per episode., Practice Implications: The multi-component PPVAA provided a guide for nurses during PIV and assisted decision making to stop attempts in difficult cases., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Purpose: Noise levels remain high in clinical settings, which may result in stress and sleep disruption, and can lead to immunosuppression, delayed healing, confusion, disorientation, delusions, and increased length of hospital stay. The purpose of this quality improvement project was to assess effects of a multidisciplinary noise reduction program on a pediatric unit in an acute care hospital in a developing country., Methods: A quality improvement project was carried out over 15 months in a pediatric unit. A three-phase study was conducted where the first phase included obtaining patient satisfaction ratings and recording sound levels, the second phase included implementing a noise reduction program and designing a noise detector machine, and the third phase included obtaining patient satisfaction data and recording noise levels over a 1-year period., Results: There was a significant decrease in noise of 8 A-weighted decibels when comparing the values before and after implementing the quality improvement project at t = 6.44, p < 0.000. There was no significant difference in patient satisfaction ratings., Clinical Implications: Noise in the pediatric unit exceeded recommended guidelines; however, decreasing the levels was possible and sustainable, which can improve the psychological and physiological wellbeing of hospitalized children.

Background: Patients admitted to pediatric intensive care units (PICUs) often experience prolonged periods without nutrition support, which may result in hospital-induced malnutrition and longer length of stay. Nurse-driven feeding protocols have been developed to prevent unnecessary interruptions or delays to nutrition support. The primary objective of this study was to identify compliance and reasons for noncompliance to a feeding protocol at a tertiary care hospital PICU in Canada. The secondary aim was to determine the mean time (hours) spent without any form of nutrition and to identify reasons for time spent without nutrition., Materials and Methods: This was a prospective cohort audit, consisting of 150 consecutive PICU admissions (January-February 2016). Exclusion criteria consisted of patient mortality within 48 hours (n = 1) and patients who were still admitted at the end of the data collection timeframe (n = 7). The remaining cohort consisted of 142 consecutive admissions. Data collection took place in real time and included patient demographics, diagnostic categories, time spent without nutrition, reasons for interruptions to nutrition support, and reasons for noncompliance to the protocol. Observations were obtained through paper and computer charts and conversing with clinicians., Results: There was a 95% compliance rate to the protocol and an average of 25.6 hours spent without nutrition per patient. The most prevalent reason for noncompliance was an avoidable delay to restart feeds before/after procedures or after surgery., Conclusions: A nurse-driven feeding protocol may reduce time spent without nutrition. Future research is required to examine the relationship between adherence to feeding protocols and clinical outcomes., (© 2017 American Society for Parenteral and Enteral Nutrition.)

Despite the lifecourse focus of nursing clinical care, nursing research largely remains cross-sectional or process-oriented within silos determined by patient characteristics such as age, acuity, or disease process. Incorporating interdisciplinary lifecourse theory into pediatric nursing research provides the opportunity to expand nursing theories and research beyond practice, age, and disease silos. One such theory is the Lifecourse Health Development (LCHD) framework. LCHD takes a more expansive view of health development from preconception through old age based on the premise that health is a consequence of transactions between genetic, biological, behavioral, social, and economic contexts that change as a child develops over time (Halfon & Hochstein, 2002). LCHD also explains how intergenerational influences and prevention during early life help predict health development and disease over the lifespan. The preventive and lifecourse focus of LCHD is well-aligned with the lifespan wellness foci of pediatric nurses. The purpose of this article is to introduce pediatric nurse researchers to LCHD and discuss proposed augmentations and implications related to expanding LCHD into pediatric nursing research., (Copyright © 2017 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.)

Purpose: Understanding parents' perceptions of their child's health status is important as parents are drivers of healthcare utilization in the pediatric setting. Understanding parent-perceived disease-severity and its effects on a child's health-related quality of life (HRQOL) in children with congenital heart disease (CHD) is necessary to evaluate outcomes of care, improve care coordination, and inform policies focused on advancing family-centered care for pediatric cardiac patients. The impact of CHDs and disease-severity on the child's HRQOL has been investigated with inconsistent results. The overall aim of this study was to examine parents' perceptions of HRQOL in their school-age child with CHD, and to compare HRQOL among patients with CHD across severity categories., Design: This was a descriptive correlational study design., Methods: A total of 71 parents of school-age children aged 5-12 years completed the Pediatric Quality of Life Inventory 4.0 Generic Core Scale (PedsQL) (including total, physical health, and psychosocial health summary scores) and cardiac-specific HRQOL Scale (PedsQL 3.0). PedsQL scores among CHD severity categories were compared by analysis of variance., Results: School-age children with CHDs had an overall good HRQOL with significant differences among disease severity categories for all scores. Parents reported lower scores on their HRQOL of older children compared to younger children across severity groups (p < .01) and for those children with more severe disease (p < .01)., Practice Implications: Based on the results of this study, interventions should focus on targeting psychosocial health in older children with CHD and physical health in younger children with CHD. This information is useful in providing practical recommendations in caring for children with CHDs while informing relevant policies., (© 2017 Wiley Periodicals, Inc.)

Purpose: To describe the quality of care for children in emergency departments (ED) as perceived by the nursing staff, and to compare the quality of care for children in a pediatric ED and in a general ED and to identify care quality factors that predict nursing staff's satisfaction with pediatric care in an ED., Design and Methods: A cross-sectional survey study was performed using the 41-item Children Revised Humane Caring Scale (CRHCS) to collect data (n=147) from acute hospitals' pediatric EDs and general EDs in November 2015. The data were analyzed using descriptive statistics and multiple linear regression., Results: Nurses evaluated the quality of professional practice to be high. Children were treated in a respectful and friendly fashion, and received help when needed. The nurses perceived a lack of human resources in the studied EDs. Nurses in pediatric EDs gave more positive evaluations of the quality of care for children than nurses in general EDs. Positive assessments of professional practice, interdisciplinary collaboration and human resources by nursing staff predicted higher satisfaction with the quality of ED care for children., Conclusions: The quality of children's care seemed to be higher in the pediatric ED than in the general ED. Key predictors of quality in children's care are professional practices of nursing staff, interdisciplinary collaboration and adequate human resources., Practice Implications: In EDs, children should be treated by nursing staff and facilities designated for them. Pediatric nursing and teamwork skills should be maintained in the training of nurses., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Providing end-of-life care to children with cancer is most ideally achieved by initiating palliative care at the time of diagnosis, advocating for supportive care throughout the treatment trajectory, and implementing hospice care during the terminal phase. The guiding principles behind offering palliative care to pediatric oncology patients are the prioritization of providing holistic care and management of disease-based symptoms. Pediatric hematology-oncology nurses and clinicians have a unique responsibility to support the patient and family unit and foster a sense of hope, while also preparing the family for the prognosis and a challenging treatment trajectory that could result in the child's death. In order to alleviate potential suffering the child may experience, there needs to be an emphasis on supportive care and symptom management. There are barriers to implementing palliative care for children with cancer, including the need to clarify the palliative care philosophy, parental acknowledgement and acceptance of a child's disease and uncertain future, nursing awareness of services, perception of availability, and a shortage of research guidance. It is important for nurses and clinicians to have a clear understanding of the fundamentals of palliative and end-of-life care for pediatric oncology patients to receive the best care possible.

In 1992, a paper published in the Journal of Child and Adolescent Psychiatric Nursing detailed the work of psychiatric nursing staff on inpatient child/adolescent psychiatric units. The paper was organized around five therapeutic processes seen to organize nursing interventions into the essential functions of a therapeutic milieu. This paper updates that scheme as well as the nursing interventions that operationalize these therapeutic processes. The model is now organized according to four therapeutic categories: Safety, Structure, Support, and Self-Management. Each of these categories is explained and updated with recent nursing literature and psychiatric inpatient research. The support category highlights recent qualitative research focused on adolescents' perceptions of their psychiatric hospitalization experience. Recommendations for future directions for nursing milieu practice are suggested., (© 2018 Wiley Periodicals, Inc.)

Background: Although the role of pediatric palliative care (PPC) is well described in oncology, neonatal, and pediatric intensive care patients, the involvement of PPC in patients with congenital heart disease (CHD) is not well explored. CHD is a leading cause of neonatal morbidity and can cause ongoing morbidity throughout the course of a child's life. PPC, with its focus on quality of life and longitudinal care through the course of an illness, could be of benefit to this population., Objective: This case description reviews the role of PPC teams in the care of patients with complex CHD., Design: Case study and analysis of three pediatric patients with complex CHD who also received PPC services., Conclusions: Involvement of PPC teams in patients with complex CHD can be beneficial for both families and caregivers. PPC teams can aid with advance care planning, goal setting, medical decision making, and bereavement support. Further research is needed to better quantify the benefits of PPC teams' involvement in this population.

Purpose: This review focuses on identifying (1) evidence of the effectiveness of care bundle methodology to reduce hospital-acquired pressure ulcers (HAPUs) in pediatric and neonatal patients receiving extracorporeal membrane oxygenation (ECMO) therapy and (2) barriers to implementing HAPU care bundles in this at-risk population., Design and Methods: An integrative review was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A search of the scientific literature was performed. Studies included were published between January 2011 and February 2016. A total of seven articles met inclusion criteria. Data were extracted from each published article and analyzed to identify common themes, specifically bundle methodology and barriers to implementing HAPU bundles, in this population., Results: There is limited research on effectiveness of care bundle methodology in reducing HAPUs in children, and no research specific to its effectiveness in pediatric or neonatal ECMO patients. No research was identified studying barriers to implementation of HAPU care bundles in this population., Practice Implications: Nurses are well poised to test innovative strategies to prevent HAPUs. Nurses should consider implementing and testing bundle methodology to reduce HAPU in this at-risk population, and conduct research to identify any barriers to implementing this strategy. There is literature to support the use of nurses as unit-based skin care champions to facilitate teamwork and reliable use of the bundle, both critical components to the success of bundle methodology., (© 2017 Wiley Periodicals, Inc.)

The objectives of our study are to: (1) identify the factors associated with lack of stable home healthcare nursing services for children with medical complexity, and (2) describe the implications of unstable home healthcare nursing for children, caregivers, nurses, and home healthcare agencies. We collected qualitative data in 20 semistructured in-depth interviews (15 English, 5 Spanish) with 26 primary caregivers of children with medical complexity, and 4 focus groups of 18 home healthcare nurses inquiring about their experiences about home healthcare nursing services for children with medical complexity. During an iterative analysis process, we identified recurrent themes related to stability of home healthcare nursing. Lack of stability in home healthcare nursing was common. These include: (1) not finding nurses to cover shifts, (2) nurse turnover, (3) nurses calling out frequently, and (4) nurses being fired by caregivers. Reasons for lack of stability of home healthcare nursing services were multifactorial and included: nurse-level, child-level, caregiver-level, residence-level, agency-level, and system-level factors. Lack of stable home healthcare nursing affected the well-being of children with medical complexity, and contributed to substantial caregiver burden. There were negative implications of unstable home healthcare services for nurses and home healthcare agencies as well. Lack of stable home healthcare nursing services is a major problem in the home care of children with medical complexity. Although some of the factors for unstable home healthcare nursing services are not modifiable, there are others that are potentially modifiable. Ensuring stable home healthcare nursing services will likely improve care of children and reduce caregiver burden.

Purpose: To explore inpatient pediatric nurses' current experiences and perspectives on medication teaching., Design and Methods: A descriptive qualitative study was conducted at a Midwest pediatric hospital. Using convenience sampling, 26 nurses participated in six focus groups. Data were analyzed in an iterative group coding process., Results: Three themes emerged. 1) Medication teaching is an opportunity. 2) Medication teaching is challenging. Nurses experienced structural and process challenges to deliver medication teaching. Structural challenges included the physical hospital environment, electronic health record, and institutional discharge workflow while process challenges included knowledge, relationships and interactions with caregivers, and available resources. 3) Medication teaching is amenable to improvement., Conclusion: Effective medication teaching with caregivers is critical to ensure safe, quality care for children after discharge. Nursing teaching practices have not changed, despite advances in technology and major changes in hospital care. Nurses face many challenges to conduct effective medication teaching. Improving current teaching practices is imperative in order to provide the best and safest care., Practice Implications: This study generated knowledge regarding pediatric nurses' teaching practices, values and beliefs that influence teaching, barriers, and ideas for how to improve medication teaching. Results will guide the development of targeted interventions to promote successful medication teaching practices., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Aim: This study explored parent and staff perceptions of family centred care (FCC) within a paediatric high dependency in one New Zealand hospital., Background: FCC is a partnership approach to healthcare delivery where the child's treatment is aligned to the family's needs. Despite widespread endorsement of FCC, variations between parents and staff in healthcare settings continues to be evident., Method: A descriptive qualitative cross-sectional design was used with a convenience sample where written responses for one open ended question from 91 parents and 66 staff resident with their child or working within a paediatric high dependency unit in New Zealand., Results: The parents' responses generated three themes (family, treatment and relationships) and the staff's responses generated two themes (family and treatment)., Conclusion: Whilst there were similarities in describing the meaning of family centred care between parents and staff, their views on the central focus of this differed.

Background: To deliver quality healthcare to diverse patients, effective commmunication is key. Little evidence exists about what factors influence nurse-to-parent communication in culturally sensitive pediatric care., Objective: The aim of this study was to explore factors that influence nurse-to-parent communication in the provision of culturally sensitive pediatric care., Design: This study employed a qualitative content analysis., Method: The participants included 25 nurses and 9 parents from pediatric wards of hospitals located in Northwest and Central Iran. Semi-structured interviews were conducted. Data were analyzed using Graneheim and Lundman's method of content analysis., Results: Factors that influenced the nurse-to-parent communication in pediatric culturally sensitive care were 1-organizational factors (inefficient policies and professional factors) and 2-human factors (nurse-related factors and unique characteristics of the family). Sub-categories included: lack of definitive policies for delivering cultural healthcare, insufficient cultural healthcare education, professional status of nursing in society, time, individual characteristics, cultural knowledge, cultural differences, and family's health literacy., Conclusion: The Iranian healthcare system requires a paradigm shift regarding the provision of culturally sensitive care.

Aim Children with cancer identify staff members, who work with them in paediatric units, as their most important comforters. This study aimed to shed light on how those staff members deliver this comfort. Methods Semi-structured interviews were performed and the content then analysed. Nine families (n=9) and eight staff members (n=8) participated in the study. Findings The staff described caring for the children and the whole family. They implemented certain comforting measures with the child, and described how they provided support to parents. Staff described how they felt comforted by relating to the children they were caring for. Conclusion Staff working in paediatric units develop good relationships with children and parents and comfort them using methods described in the literature. The quality of the staff's positive relationships with the children marked all their actions.

Objectives: To describe evidence of international literature on the safe care of the hospitalised child after the World Alliance for Patient Safety and list contributions of the general theoretical framework of patient safety for paediatric nursing., Method: An integrative literature review between 2004 and 2015 using the databases PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Scopus, Web of Science and Wiley Online Library, and the descriptors Safety or Patient safety, Hospitalised child, Paediatric nursing, and Nursing care., Results: Thirty-two articles were analysed, most of which were from North American, with a descriptive approach. The quality of the recorded information in the medical records, the use of checklists, and the training of health workers contribute to safe care in paediatric nursing and improve the medication process and partnerships with parents., Conclusion: General information available on patient safety should be incorporated in paediatric nursing care.

Purpose: The purpose of this study was to explore the perceptions of child maltreatment among inpatient pediatric nurses., Design and Methods: A cross-sectional survey was used to obtain responses to an online survey designed to examine perceptions of child maltreatment from inpatient pediatric nurses., Results: Many nurses surveyed (41.25%) indicated that they had not received adequate training or had never received training on child maltreatment identification and many (40%) also indicated they were not familiar with the applicable reporting laws., Conclusions: Due to the serious immediate and long term effects of child maltreatment, it is imperative that pediatric inpatient nurses have adequate training on how to identify potential abuse and neglect cases, as well as legal reporting requirements, since they are in a unique position to identify potential cases of maltreatment., Practice Implications: There is a continuing need for training on child maltreatment identification and reporting laws for inpatient pediatric nurses., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Purpose: This study explored the sequential relationships of parent perceptions of the quality of their discharge teaching and nurse and parent perceptions of discharge readiness to post-discharge outcomes (parental post-discharge coping difficulty, readmission and emergency department visits)., Design/methods: In this secondary analysis of data from a longitudinal pilot study of family self-management discharge preparation, the correlational design used regression modeling with data from a convenience sample of 194 parents from two clinical units at a Midwest pediatric hospital. Data were collected on the day of discharge (Quality of Discharge Teaching Scale; Readiness for Hospital Discharge Scale), at 3weeks post-discharge (Post-Discharge Coping Difficulty Scale), and from electronic records (readmission, ED visits)., Results: Parent-reported quality of discharge teaching delivery (the way nurses teach), but not the amount of content, was positively associated with parent perception (B=0.54) and nurse assessment (B=0.16) of discharge readiness. Parent-reported discharge readiness was negatively associated with post-discharge coping difficulty (B=-0.52). Nurse assessment of discharge readiness was negatively associated with readmission; a one point increase in readiness (on a 10 point scale) decreased the likelihood of readmission by 52%., Conclusion: There is a sequential effect of quality of discharge teaching delivery on parent discharge readiness, which is associated with parent coping difficulty and child readmission., Practice Implications: Efforts to improve discharge outcomes should include strategies to build nurse teaching skills for high-quality delivery of discharge teaching. In addition, routine nurse assessment of discharge readiness can be used to identify children at risk for readmission and trigger anticipatory interventions., (Copyright © 2017 Elsevier Inc. All rights reserved.)

The objective of this pilot study was to determine women's perceptions of their levels of maternal role competence at discharge from a Baby-Friendly hospital. A convenience sample of 30 women completed two self-report questionnaires: a demographic questionnaire and the Perceived Maternal Parenting Self-Efficacy scale. Women report that they perceived high levels of maternal role competence with a mean total score of 69.80 (standard deviation = 6.86) out of 80. As women experience breastfeeding in Baby-Friendly hospitals, maternal role competence may develop with appropriate support., (© 2017 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses.)

Healthcare staff routinely use clinical holding to help infants, children or young people stay still when treatment is being administered, to prevent children or young people from interfering with the treatment, or when invasive examinations are being carried out. However, healthcare staff rarely have any formal discussion with children and young people, or their parents, on the techniques used for clinical holding. Visual tools are important when talking to children or young people about their healthcare, and a website with images of clinical holds would allow staff to discuss relevant holds with their patients. In this article, we describe a collaboration between Birmingham City University and Birmingham Children's Hospital to develop a website that presents 3D images of clinical holds, outlining how we introduced it to staff in the clinical areas that would benefit from it and how we have been evaluating its effectiveness. We hope this website will formalise the professional discussion of clinical hold techniques. This will allow information on the appropriate holds for different situations to be documented, which will enhance best practice. In addition, the website should provide information needed to allow children, young people and their parents to give true, informed consent for any procedures they need.

Mental illness is the number one health issue facing 14-25 year olds in England, which contributes to almost half the burden of disease in this age group ( Kessler et al 2005 , Kim-Cohen et al 2003 ). A total of 75% of all mental health disorders are established by the age of 18 which is a critical point of emotional, educational and social development. All nurses working with children and young people (CYP) across all health and social care settings should be familiar with national guidelines and the services available to treat CYP with mental health conditions such as depression.

A reluctance to diagnose asthma in children under three who have recurrent cough and wheeze causes delays in the commencement of appropriate asthma treatment. Timely inhaled corticosteroid use may reduce asthma exacerbations and unnecessary visits to the emergency department and GPs. To address this delay, an advanced nurse practitioner in one children's community nursing team set up a respiratory assessment clinic for children under three who had recurrent respiratory difficulties. This article describes the rationale and the evidence base that supports a clinic of this kind and reports on its initial results.

If you are a children's nurse working with highly dependent children in stressful clinical areas, such as critical care, emergency departments and acute wards, you may think children's outpatient departments are for staff who can't cope with the fast lane or who seek a pre-retirement career option.

Aim: This study provided an overview of manipulating oral medicines given to hospitalised children and evaluated this practice in two hospitals. It focused on the type of manipulation and the dosage forms that were manipulated., Method: This was a cross-sectional, prospective study, carried out on the paediatric wards at two Norwegian hospitals for four weeks in 2013. A medicine was said to have been manipulated if it was not administered as described in the Norwegian summary of product characteristics., Results: This study showed that 17% of the 3070 administrations of oral medicines to the hospitalised children involved manipulation. Tablets, including modified release preparations, were the most frequently manipulated medicines. In approximately half of these cases, only a segment of the unit dose was administered. No manipulation of oral liquids was seen. The bioavailability of as much as 44% of the most frequent given substances may be sensitive to such manipulations due to limited aqueous solubility. Various routines for splitting and handling the unit doses were observed., Conclusion: Manipulation of oral medication was regularly performed on paediatric wards. There is an urgent need for age-appropriate medicines, documented and standardised processes for manipulating medicines and staff training on the consequences of manipulation., (©2016 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Lymphatic malformation (LM) is a benign congenital childhood growth that presents primarily at birth, with the remainder becoming evident by age 2 years. LM can cause devastating complications such as respiratory failure, dyspnea, dysphagia, organ compression, and nerve compression. Surgery is the preferred treatment option, although resection is not always an option due to the anatomic location of the malformation. Other treatments that have been tried with success include sclerotherapy, radiofrequency ablation, propranolol, and sirolimus. Nurses have an important role in caring for the child with LM, as with any complex disease. Nurses provide care at the bedside, education to the family, case coordination, and psychosocial support. LM is a rare disease in infancy necessitating pediatric nurses to support families through prolonged treatments and potential complications.

Research has shown that self-esteem and hopefulness are positively related among female childhood cancer survivors (CCS) and contribute to their health-related quality of life (HRQOL). HRQOL remains a significant outcome of treatment for CCS. This study examined the relationships among self-esteem, hopefulness, and HRQOL in young adult female CCS to inform the development of evidence-based practice guidelines for pediatric oncology nursing practice. An online survey was conducted with a sample of young adult female CCS from 58 treatment centers across the United States at 4 time points: at baseline and at 6 weeks, 3 months, and 6 months after initial measurement time. The relationships between self-esteem, hopefulness, and HRQOL were statistically significant (Time 1, P = .05; Times 2, 3, and 4, P = .01) across all measurement times. These findings identify hopefulness and self-esteem as determinants of HRQOL and suggest that caring practices among pediatric oncology nurses that support psychosocial adjustment through promoting self-esteem and hopefulness have the potential to support HRQOL among young adult female CCS. These outcomes support the development of evidence-based practice guidelines to influence HRQOL outcomes among these survivors.

Aims and Objectives: To test whether a combined intervention of art therapy and clown visits could enhance the efficacy of oral medication in reducing children's anxiety at parental separation prior to induction of anaesthesia., Background: Approximately 50% of children undergoing surgery report high anxiety at anaesthesia induction. Complementary therapies have been used to decrease children's anxiety, but no study has evaluated the efficacy of a combination of such therapies., Design: This is an observational study, which involved allocating different interventions to two groups and measuring their anxiety at two time points., Methods: This study assigned 78 children (aged 3-11 years) undergoing general anaesthesia for surgery to two conditions. The control group underwent general anaesthesia following standard practice, and the intervention group received an intervention of integrated art therapy and clown visits upon their arrival at the hospital and throughout their time in the preoperating room. Each child in both groups received 0·5 mg/kg oral midazolam 30 minutes before surgery and had a parent present throughout their time in the preoperating room. Each child's anxiety was evaluated twice using the Modified Yale Preoperative Anxiety Scale: at baseline and at separation from parents. Repeated measures anova was used to test for differences between the time points and the two groups., Results: Children in the intervention group showed a significant (p < 0·001) reduction in Modified Yale Preoperative Anxiety Scale scores at parental separation compared to those in the control group. Additionally, the majority of parents and nurses evaluated the intervention to be effective for reducing children's anxiety., Conclusions: This study found that an intervention based on art therapy and clown visits enhanced the effect of midazolam in reducing children's anxiety at preoperative separation from parents., Relevance to Clinical Practice: Paediatric staffs may consider using such a combination of strategies in preparing children for anaesthesia induction., (© 2016 John Wiley & Sons Ltd.)

Background: Working time is a non-renewable and important element in the management of an organization. The implementation of changes in the structure of working time may be facilitated by the insight into activities undertaken by employees during work. Such an approach plays an important role since the effective use of time improves the quality of care, prevents timewasting and optimizes the use of the full potential of employees, including nurses. The objective of the study was to determine the structure of working time of pediatric nurses in hospital wards of 2 referential levels., Material and Methods: The study was conducted in 2 wards (2nd and 3rd levels of reference) in the Regional Specialist Children's Hospital in Olsztyn. The research method involved the measurement of working time, as well as continuous and snap-shot observation techniques. Standardized research instruments were used in the study; 8 continuous observations and 2333 snap-shot observations were carried out., Results: In the structure of working time of pediatric nurses indirect nursing-related activities predominated (52.2%). Direct nursing made 28.7% of the working time. The nurses devoted the smallest amount of time to coordination and organization - 8%. The percentage of time associated with non-duty activities and breaks at work was 11.1%. In direct nursing activities associated with diagnosing (9%) and treatment (11.7%) prevailed. In indirect nursing activities pertaining to documentation of activities related to direct nursing made 24.6%., Conclusions: Pediatric nurses devote insufficient amount of time to direct nursing. Activities associated with documentation of activities related to direct nursing, preparation for direct nursing, as well as treatment and diagnosing predominate in the working time structure of nurses. Med Pr 2017;68(1):95-103., (This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.)

What does it mean to be a "DAISY nurse"? Moral distress and end-of-life issues are difficult in any situation but, within the context of a pediatric setting, can be even more difficult. In this column, a DAISY nurse shares her thoughts on her role, her professional journey to explore moral distress and ethical decision making, and the lessons learned that led to her recognition with The DAISY Award and the joyful celebration.

Aims: A discussion of partnership in the context of family-centred care in the acute paediatric setting, through a critical analysis of partnership models., Background: Paediatric healthcare practitioners understand the importance of family-centred care, but struggle with how to translate the core tenets into action and are confused by several rival terms. Partnering relationships are included in definitions of family-centred care, yet less is known about strategies to fully engage or support parents in these partnerships. A rigorous examination of concepts embedded in family-centred care such as partnership may provide a better understanding of how to implement the broader concept and support exemplary care in today's clinical practice environment., Design: Discussion paper., Data Sources: Electronic search (January 2000 - December 2014) performed on CINAHL, Medline, EMBASE, Sociological Abstracts and PsychINFO using keywords partnership, family-centred care and conceptual framework. Eligible references were drawn from the databases, reference lists and expert sources. Eight models met inclusion criteria and had currency and relevance to the acute paediatric setting., Implications for Nursing: Nurses should continue exploring partnership in various paediatric contexts given the wide-ranging definitions, lack of operational indicators and need for stronger relational statements in current models. An examination of key strategies, barriers and facilitators of partnership is recommended., Conclusion: One partnership model had both high overall maturity and best fit with family-centred care principles. All models originate from Western and developed countries, indicating that future partnership models should be more geographically, culturally and economically diverse., (© 2016 John Wiley & Sons Ltd.)

Accurate assessment of pain and its management is a challenging aspect of pediatric care. Nurses, usually the primary caregivers, showed inadequate knowledge and restrictive attitudes toward pain assessment. We evaluated an educational intervention to improve nurses' assessment of pain in a teaching hospital in India. A convenient sample of nurses working in the neonatal intensive care unit, pediatric ward, pediatric intensive care unit, and pediatric cardiac intensive care unit were included in the study. Workshops to improve understanding of pain, its assessment, and management strategies were conducted. A modified and consensually validated Knowledge and Attitudes Survey Regarding Pain questionnaire-2008 consisting of 25 true/false questions, eight multiple choice questions, and two case scenarios was administered before, immediately after, and 3 months after the workshops to evaluate impact of the intervention. Eighty-seven nurses participated. Mean (standard deviation) experience was 4.04 (5.9) years. Thirty-seven percent felt that they could assess pain without pain scales. About half (49.4%) of the nurses had not previously heard of pain scales, while 47.1% reported using a pain scale in their routine practice. Significant improvement was observed between pretest and post-test total scores (15.69 [2.94] vs. 17.51 [3.47], p < .001) as well as the pretest and retention score (15.69 [2.94] vs. 19.40 [4.6], p < .001). Albeit the study site and sampling frame may limit the reliability of the findings, the educational intervention was successful, and better retention test scores suggest a cascading effect. Pain assessment and management education of children should be incorporated in the nursing curriculum and should be reinforced in all pediatric units., (Copyright © 2016 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Aims and Objectives: To investigate the experience and personal impact of a group leadership course for child healthcare nurses., Background: During their child's first year, all parents in Sweden are invited to participate in parental groups within the child health service; however, only 49% choose to participate. Despite extensive experience, child healthcare nurses find managing parental groups challenging and express a need for training in group dynamics and group leadership., Design: The study was designed as a controlled study with a pretest/post-test design where the participants form their own control group., Methods: A group leadership course was given to 56 child healthcare nurses and evaluated in a pre- and postintervention questionnaire, a course evaluation and an interview with the course leaders., Results: The child healthcare nurses felt their group leadership skills were strengthened and the majority (96%) felt that the course had changed their way of leading parental groups. They felt that the group leader role had been clarified and that they had obtained several new tools to use in their groups., Conclusions and Relevance to Clinical Practice: Clarifying the role of group leader and adding knowledge about group leadership and dynamics seems to have increased the self-confidence for child healthcare nurses in group leadership. Improved confidence in group management might motivate the child healthcare nurses to further develop parental groups to attract the parents who currently choose not to participate., (© 2016 John Wiley & Sons Ltd.)

Purpose: The purpose of this study was to examine the effects of unstructured play activities on the anxiety levels of hospitalized children., Methods: A nonequivalent control group pretest posttest design was employed for this study. The sample included children (N = 165) ages 4-7 years admitted to a large pediatric referral center in the United Arab Emirates. The control group (n = 84) received usual care, while the experimental group (n = 81) engaged in age-appropriate unstructured play activities using disposable games and toys. Parents and siblings, if present, were encouraged to participate. Research assistants conducted the play activities twice a day, with 30-min morning and evening sessions. Anxiety was measured at baseline and at the end of days 2 and 3 with a translated form of the Short-State-Trait Anxiety Inventory for Children., Results: Anxiety scores in both groups were similar at baseline and decreased significantly over the 3 days. Compared with the control group, anxiety scores in the intervention group were significantly lower on day 2 (12.7 ± 2.3 vs. 10.7 ± 2.5, p = .003) and day 3 (10.6 ± 2.2 vs. 9.47 ± 2.4, p < .001). The greatest decrease occurred in the percentage of children in the experimental group with medium-level anxiety scores: baseline (n = 61, 75%), day 2 (n = 24, 30%), and day 3 (n = 0, 0%)., Conclusions: This simple, low-cost play intervention implemented by nurses resulted in statistically and clinically significant decreases in the anxiety levels of children in an acute inpatient setting., (© 2016, Wiley Periodicals, Inc.)

Purpose: Hospitalisation can lead to distress for children. Creative play may reduce the adverse effects of hospitalisation on children, as it could lead to children associating satisfaction and fun with their hospital experience. The aim of the current study is to investigate the impact of a creative play intervention on service-care satisfaction measurements of children and their parents., Design and Methods: A mixed-methods design consisting of quantitative pre/post-assessments and qualitative interviews was used within this study. The research was conducted with 30 children (n experimental group = 15; n control group = 15). Their parents (n = 30) and their nurse practitioners (n = 20) were also contacted in order to capture their reflections of this intervention which included creative activities with unused clean medical materials. Child participants completed the Patient's Nursing Care Perception Tool and their parents completed the PedsQL Health Care Satisfaction Tool., Results: The two groups did not differ in relation to the Patients' Nursing Care Satisfaction Tool (PNCST) (t(28): 0.348, p = .730) and the PedsQL (t(28): -0.189, p = .852) scores at Time 1 before the intervention; however, significant differences were observed at the end at Time 2 (PNCST: t(28): -11.63, p < .001; PedsQL: t(28): -12.416, p < .001). In qualitative interviews, nurses indicated that their play skills with children had been enhanced by this intervention. Family attendants reported that the intervention improved the nurse-child relationship and their satisfaction with care., Practice Implications: The results have shown that creative play intervention are a feasible nursing intervention which has a strong potential to be effective on child patients' and their attendants' satisfaction with care services., (© 2017 Wiley Periodicals, Inc.)

This mixed methods study explored stress in families whose children were hospitalized in the pediatric intensive care unit (PICU) for more than one week. The study aim was to describe sources of stress for families whose children require extended hospitalization in the PICU. Data collection included semi-structured interviews and completion of the Family Inventory of Life Events and Family System Stressor Strength Inventory. Themes reported in this paper are separation, not knowing, and the child's illness and distress. Additional research is needed to validate these findings in families of other cultures and structures, and in other PICUs., (Copyright © 2016 Elsevier Inc. All rights reserved.)

By incorporating focused feedback from families and other stakeholders a multidisciplinary team redesigned a single nurse home visit to improve transitions to home for pediatric patients following short-stay, acute care hospitalizations. Refinements to the nurse-led transitional home visit included standardization of teaching focused on condition- and medication-specific concerns, the use of red flags or warning signs to prompt caregiver action, and the provision of reassurance.

Almost 50% of children who visit the pediatric emergency department are exposed to tobacco smoke. However, pediatric emergency nurses do not routinely address this issue. The incorporation of a clinical decision support system into the electronic health record may improve the rates of tobacco exposure screening and interventions. We used a mixed-methods design to develop, refine, and implement an evidence-based clinical decision support system to help nurses screen, educate, and assist caregivers to quit smoking. We included an advisory panel of emergency department experts and leaders and focus and user groups of nurses. The prompts include the following: (1) "Ask" about child smoke exposure and caregiver smoking; (2) "Advise" caregivers to reduce their child's smoke exposure by quitting smoking; (3) "Assess" interest; and (4) "Assist" caregivers to quit. The clinical decision support system was created to reflect nurses' suggestions and was implemented in five busy urgent care settings with 38 nurses. The nurses reported that the system was easy to use and helped them to address caregiver smoking. The use of this innovative tool may create a sustainable and disseminable model for prompting nurses to provide evidence-based tobacco cessation treatment., Competing Interests: None