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Purpose: To describe, in a sample of pediatric onco-hematological patients, the rate of occlusions in unused central venous catheters (CVC) flushed once a week with a 0.9% sodium chloride solution through a positive-pressure-valve needleless connector., Method: Retrospective cohort study. Subjects aged 0-17 years were identified through a manual search in medical and nursing records and were observed for two years or until the occurrence of one of the following events: start or resume of continuous infusion; CVC removal; death. The primary study outcome was the frequency of CVC occlusion (partial or complete)., Results: Fifty-one patients were identified (median age 6 years). The median duration of follow-up was 169 days (IQR 111-305). During the follow up period, 14 patients (27%) had one CVC occlusion, in 2 cases (4%) the occlusion was complete, in 12 (23%) partial. All the occlusions were solved without the need for catheter removal. The lumen diameter ≤ 4.2 vs > 4.2 French showed a statistically significant association with occlusion at multivariate analysis (OR 4.0; 95% CI 1.1-14.7)., Conclusions: Our findings are reassuring with respect to the management of the CVC using the adopted protocol. The study provides useful information for patient care, by verifying the performance of the adopted CVC management protocol and by identifying critical areas for nursing care., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: It is known that registered nurses' (RNs') work context is related to their use of research and that it can affect nurse and patient satisfaction, as well as the outcomes of care. However, little is known about the relationship between work context and nurses' adherence to clinical practice guidelines. The aim of this study was to describe RNs' adherence to a clinical practice guideline (CPG) on the management of peripheral venous catheters (PVCs), their perceptions of work context, and how nurses' work context and characteristics relate to guideline adherence., Methods: This cross-sectional survey was conducted at a large pediatric university hospital in Sweden. Data were collected through a questionnaire on RNs' adherence to components of a CPG and by using the Alberta Context Tool to assess the nurses' perceptions of work context, including leadership, culture, feedback processes, and other organizational characteristics., Results: Work context--in the form of structural and electronic resources, information sharing activities, and feedback processes--was in different ways associated with the adherence to the CPG components. The RNs' adherence on unit level varied: half the units demonstrated complete adherence on disinfection of hands, whereas a majority of the units reported less than 70% adherence on the use of disposable gloves and the daily inspection of a PVC site., Linking Evidence to Action: Our findings indicate that components in one CPG might require diverse implementation strategies because they are linked to different contextual factors., (© 2014 Sigma Theta Tau International.)

This study investigated the use of, and reasoning by, experienced nurses regarding non-pharmacological pain approaches to care for children in hospitals, with the aim of increasing our understanding, and hence optimizing, these approaches. Three focus-group interviews with 14 experienced nurses, were conducted in 2009. Our findings emphasized the role of non-pharmacological methods in building and maintaining cooperation with the child and in caring for the child by individualizing the use of non-pharmacological methods., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Aim: The aim of this paper is to report an analysis of the concept of spiritual care of a child with cancer at the end of life., Background: Spirituality is a vital dimension of a child's experience at the end of life; providing comfort; support; and a sense of connection. Spiritual care is paramount to address the substantial spiritual distress that may develop., Design: Rodgers' method of evolutionary concept analysis guided the review process., Data Sources: The literature search was not limited by start date and literature through the end of 2012 was included. English, peer-reviewed texts in the databases CINAHL, ATLA and PubMed were included., Methods: Critical analysis of the literature identified surrogate terms, related concepts, attributes, antecedents and consequences., Results: The analysis identified six attributes: assessing spiritual needs; assisting the child to express feelings; guiding the child in strengthening relationships; helping the child to be remembered; assisting the child to find meaning; and aiding the child to find hope. Antecedents include existential questions and spiritual distress. Consequences include a peaceful death, spiritual growth, a relationship of trust and enhanced end-of-life care., Conclusion: Spiritual care is a vital aspect of holistic nursing care; however, gaps in knowledge and practice prevent children from receiving adequate spiritual care at the end of life. Nurses would benefit from increased awareness, skills and knowledge about spiritual care. Research is needed to identify interventions that exert the greatest effect on patient care outcomes., (© 2013 John Wiley & Sons Ltd.)

Aim: To evaluate how closely double-checking policies are followed by nurses in paediatric areas and also to identify the types, frequency and rates of medication administration errors that occur despite the double-checking process., Background: Double-checking by two nurses is an intervention used in many UK hospitals to prevent or reduce medication administration errors. There is, however, insufficient evidence to either support or refute the practice of double-checking in terms of medication error risk reduction., Design: Prospective observational study., Methods: This was a prospective observational study of paediatric nurses' adherence to the double-checking process for medication administration from April-July 2012., Results: Drug dose administration events (n = 2000) were observed. Independent drug dose calculation, rate of administering intravenous bolus drugs and labelling of flush syringes were the steps with lowest adherence rates. Drug dose calculation was only double-checked independently in 591 (30%) drug administrations. There was a statistically significant difference in nurses' adherence rate to the double-checking steps between weekdays and weekends in nine of the 15 evaluated steps. Medication administration errors (n = 191) or deviations from policy were observed, at a rate of 9·6% of drug administrations. These included 64 drug doses, which were left for parents to administer without nurse observation., Conclusion: There was variation between paediatric nurses' adherence to double-checking steps during medication administration. The most frequent type of administration errors or deviation from policy involved the medicine being given to the parents to administer to the child when the nurse was not present., (© 2013 John Wiley & Sons Ltd.)

Background: Prolonging the duration of peripheral venous catheters (PVC) as long as possible in children is a nursing priority. However, available studies provide conflicting evidence on what kind of flush/lock solution should be used to increase the life of PVCs in children., Objectives: To describe the clinical behavior of nurses working in Italian pediatric units with regards to PVCs flushing and locking practices., Methods: Cross-sectional study. Nurses were invited to participate using the network of the Italian Society of Pediatric Nursing Science. Those participating completed an online questionnaire available on a website established for this specific purpose. Results: 405 questionnaires were completed., Results: The majority of nurses reported using Normal saline solution (NS) to flush 22 gauge PVCs: 77.6% in children up to 6 months of age, 74.7% in children 6 months to 2 years, and 74.6% in children over 2 years. Nurses tend to use heparin solutions (HS) more frequently when a smaller gauge PVC is used (24 instead of 22) and when access is less frequent. The use of HS for PVC lock is more common in onco-hematology units (54.5% in children over 6 months with 24 gauge PVC), pediatric surgery units (35%), and in short-stay units (55.6%), whereas NS is used more frequently in Intensive care units (9.4%) and neonatology units (12.2%)., Conclusion: Although the majority of respondents use NS, we found a high variability in practices among Italian nurses. More research on the effectiveness and safety of HS in maintaining the patency of PVCs is needed.

Childhood overweight and obesity is a major health concern in the United States. It is recommended that every well-child examination include body mass index measurements and obesity prevention discussions that encourage healthy eating habits, regular physical exercise, and limited television and computer screen time. Providers can make a difference through strategic intervention., (Copyright 2014, SLACK Incorporated.)

Purpose: The purpose of this review is to heighten the awareness of the increased use and risks of synthetic cannabinoids (SCs) and associated clinical manifestations among adolescents and young adults., Conclusions: Reviewed case studies suggest that the use of SCs have unpredictable negative psychological and physiological effects. Predominant manifestations reported were anxiety, agitation, paranoia, hallucinations, tachycardia, nausea and vomiting, and diaphoresis., Practice Implications: Nurses provide the most direct and supportive care to patients who present for medical treatment after the use of SCs. Knowledge of clinical manifestations can facilitate supportive management of patients suspected of SCs use., (© 2013, Wiley Periodicals, Inc.)

Purpose: The aims of this review were to examine pain measures for hospitalized children with cognitive impairment who are unable to self-report and to describe the best available evidence for their clinical utility in acute care settings., Design and Methods: Electronic searches to identify published evidence were conducted and studies reviewed. Reported psychometrics and feasibility of the Non-Communicating Child's Pain Checklist-Postoperative Version, Individualized Numeric Rating scale, Pediatric Pain Profile, and revised Face, Leg, Activity, Cry, and Consolability scale were examined., Conclusions: These four measures have established validity and reliability. However, clinical utility findings varied., Practice Implications: The revised Face, Leg, Activity, Cry, and Consolability scale has demonstrated feasibility in acute care settings related to ease of use, time requirements, and flexibility regarding caregiver input., (© 2014, Wiley Periodicals, Inc.)

Purpose: The current study investigated the effects of using the combination of a urine alarm and simple reward system to treat nocturnal enuresis (NE) for three children who failed to fully respond to the urine alarm alone., Design and Methods: A withdrawal design (i.e., ABACA) embedded within a delayed multiple baseline design across participants was used to evaluate the effects of the urine alarm alone and in combination with a reward system on participants' frequency of wet nights per week. Results were analyzed through visual and descriptive methods., Results: The urine alarm in combination with a reward system resulted in improvements in all three participants' NE. These results are contrasted with the urine alarm alone, which produced less frequent dry nights., Practice Implications: Nursing professionals in primary care settings are positioned to provide evidence-based treatment recommendations to families with children with NE. Findings from the current study provide a promising approach to the treatment of NE for those children who fail to respond fully to the urine alarm., (© 2014, Wiley Periodicals, Inc.)

Purpose: This study explored pediatric nurses' choices to use distraction for managing painful procedures., Design and Methods: Using interpretive description approaches, interviews with pediatric nurses provided descriptions of choices to manage procedural pain., Results: Nurses' distress influenced distraction use to mitigate the suffering of children and themselves. Newer nurses described task mastery as influencing distraction choices. Nurses' accounts of performing painful procedures on children mirrored children's descriptions of pain from the literature., Practice Implications: Nurses' distress and competency performing painful procedures on children influenced practice. Future qualitative studies could extend understanding of pain management choices by pediatric nurses and the impact on undermanaged pain., (© 2014, Wiley Periodicals, Inc.)

Research-based descriptions of the contents of the habilitation nursing of children with developmental disabilities are lacking. The objective of this qualitative study was to describe the habilitation nursing of children with developmental disabilities in a Finnish children's neurological ward. In addition, the purpose was to outline the principles that directed the nursing functions (which consisted of various nursing interventions). The data collection included observation, a retrospective think-aloud method with video-taped nursing situations, the nursing records, and an open-ended questionnaire. The data were analysed with a qualitative content analysis of the manifest and latent content. The findings show that habilitation nursing in a children's neurological ward consists of assessing the child's skills, supporting the child's development, and collaborating with the child's immediate adults. When implementing those functions with nursing interventions, the nurses demonstrated four principles: client-originated and professional-originated principles, and individual-centred and community-centred principles. Becoming conscious of these principles and the theoretical frameworks behind them enables the development of a nursing science-based model for habilitation nursing.

Meningococcal disease is a leading cause of death in children and young people. Part 1 of this two-part series discussed its epidemiology, pathophysiology, signs and symptoms (Dowson, 2014). Part 2 reviews the diagnosis, management and prevention of this disease.

Children state that among their worst fears during hospitalization are those related to various nursing procedures and to injections and needles. Nurses thus have a responsibility to help children cope with needle-related medical procedures (NRMP) and the potentially negative effects of these. The aim of the study is to describe the lived experience of supporting children during NRMP, from the perspective of nurses. Fourteen nurses took part in the study, six of whom participated on two occasions thus resulting in 20 interviews. A reflective lifeworld research approach was used, and phenomenological analysis was applied. The result shows that supporting children during NRMP is characterized by a desire to meet the child in his/her own world and by an effort to reach the child's horizon of understanding regarding these actions, based on the given conditions. The essential meaning of the phenomenon is founded on the following constituents: developing relationships through conversation, being sensitive to embodied responses, balancing between tact and use of restraint, being the child's advocate, adjusting time, and maintaining belief. The discussion focuses on how nurses can support children through various types of conversation and by receiving help from the parents' ability to be supportive, and on whether restraint can be supportive or not for children during NRMP. Our conclusion is that nurses have to see each individual child, meet him/her in their own world, and decide on supportive actions while at the same time balancing their responsibility for the completion of the NRMP. This work can be described as "balancing on a tightrope" in an unpredictable situation.

Neonates receiving care in intensive care units are highly likely to experience pain due to investigations and/or treatments carried out by the health care providers. Neonates are a vulnerable population because they are unable to vocalize their pain. Unaddressed and mismanaged pain can not only affect the child's comfort, but also may alter the development and cognitive abilities of the child in a later part of his/her life. Therefore it is entirely the caregiver's responsibility to accurately assess and manage neonatal pain. We assessed and compared the knowledge and attitudes regarding neonatal pain among the nurses posted in the various units of a pediatric department [pediatric ward, pediatric intensive care unit (PICU) and neonatal intensive care unit (NICU)]. An appropriately modified Knowledge and Attitudes Survey Regarding Pain questionnaire was consensually validated, pretested, and then administered to the nursing staff of the pediatric department at a department at a hospital in Gujarat. Data were entered in Epi-Info and analyzed with the use of SPSS 14.0. The questionnaire was administered to 41 nurses working in the Department of Pediatrics, and the response rate was 97.5%. Mean age of the nurses in the study sample was 25.75 years (SD 5.513). The mean total score of the participants was 8.75 out of 17 (SD 2.549), which was unsatisfactory. The mean correct answer rate was 49.67% among the staff of NICU and 48.67% among the pediatric ward and PICU staff. The attitudes among the nurses were assessed. It was concluded that the nurses lack knowledge and that their attitudes also were hindering pain management. One of the barriers identified by the nurses was that physicians do not prescribe analgesics for managing neonatal pain. So not only the nursing staff, but all of the caregivers involved in neonatal care may be lacking in knowledge and hold perceptions and attitudes that hamper neonatal pain management., (Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

The administration of injections is a fundamental nursing skill; however, it is not without risk. Children receive numerous vaccines, and pediatric nurses administer the majority of these vaccines via the intramuscular route, and thus must be knowledgeable about safe and evidence-based immunization programs. Nurses may not be aware of the potential consequences associated with poor injection practices, and historically have relied on their basic nursing training or the advice of colleagues as a substitute for newer evidence about how to administer injections today. Evidence-based nursing practice requires pediatric nurses to review current literature to establish best practices and thus improved patient outcomes.

Procedural pain management is an underused practice in children. Despite the availability of efficacious treatments, many nurses do not provide adequate analgesia for painful interventions. Complementary therapies and nonpharmacologic interventions are additionally essential to managing pain. Owing to the increasing awareness of inadequate nursing utilization of pharmacologic measures for procedural pain, this paper focuses only on analgesic treatments. The aim of this review was to examine how varying degrees of quality improvement affect nursing utilization of treatments for routine pediatric procedural pain. A comprehensive search of databases including Cinahl, Medline/Pubmed, Web of Science, Google Scholar, Psycinfo, and Cochrane Library was performed. Sixty-two peer-reviewed research articles were examined. Ten articles focusing on quality improvement in pediatric pain management published in English from 2001 to 2011 were included. Three themes emerged: 1) increasing nursing knowledge; 2) nursing empowerment; and 3) protocol implementation. Research critique was completed with the use of guidelines and recommendations from Creswell (2009) and Garrard (2011). The literature reveals that nurses still think that pediatric pain management is essential. Quality improvement increases nursing utilization of procedural pain treatments. Although increasing nursing knowledge improves pediatric pain management, it appears that nursing empowerment and protocol implementation increase nursing compliance more than just education alone. Nurses providing pain management can enhance their individual practice with quality improvement measures that may increase nursing adherence to institutional and nationally recommended pediatric procedural pain management guidelines., (Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Various nonpharmacological strategies to relieve hospitalized children's pain propose play as a central element. Play is considered an essential resource to improve the negative psychosocial effects of the disease and the hospitalization itself. However, the empirical research of play in health settings has not received much attention. The goal of this study was to determine the effect of a program to promote play in the hospital on postsurgical pain in pediatric patients. The research hypothesis was that children will manifest less pain if they are distracted through play during the postsurgical period. We carried out a randomized parallel trial with two groups, an experimental group and a control group. The control group did not receive any specific treatment, only the standard attention contemplated in the hospital. The parents of the children from the experimental group received instructions to play with their children in the postsurgical period and specific play material with which to play. The results obtained support the research hypothesis. On average, the children from the experimental group scored lower on a pain scale than the children from the control group. This occurred in the three postsurgical measurements of pain. It is concluded that the program to promote play can decrease children's perception of pain., (Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

For decades, nurses (RNs) have identified barriers to providing the optimal pain management that children deserve; yet no studies were found in the literature that assessed these barriers over time or across multiple pediatric hospitals. The purpose of this study was to reassess barriers that pediatric RNs perceive, and how they describe optimal pain management, 3 years after our initial assessment, collect quantitative data regarding barriers identified through comments during our initial assessment, and describe any changes over time. The Modified Barriers to Optimal Pain Management survey was used to measure barriers in both studies. RNs were invited via e-mail to complete an electronic survey. Descriptive and inferential statistics were used to compare results over time. Four hundred forty-two RNs responded, representing a 38% response rate. RNs continue to describe optimal pain management most often in terms of patient comfort and level of functioning. While small changes were seen for several of the barriers, the most significant barriers continued to involve delays in the availability of medications, insufficient physician medication orders, and insufficient orders and time allowed to pre-medicate patients before procedures. To our knowledge, this is the first study to reassess RNs' perceptions of barriers to pediatric pain management over time. While little change was seen in RNs' descriptions of optimal pain management or in RNs' perceptions of barriers, no single item was rated as more than a moderate barrier to pain management. The implications of these findings are discussed in the context of improvement strategies., (Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Purposes: This study evaluates students' learning experiences in a clinical pediatric nursing course adopting Problem Based Learning (PBL) and investigates how students' cultural background impacts on self directed learning., Methods: A mixed-methods approach combining quantitative and qualitative methods was utilized to answer the research objectives. An observational technique for the PBL teaching sessions was employed; and 226 third-year students were asked to complete PBL evaluation questionnaire., Results: Fifty seven percent (n = 130) responses to the questionnaire were analyzed. Overall, students considered PBL to be moderately effective in their learning experience, with a mean of 3.64 (S.D = 1.18). Students qualitative responses fell within four thematic categories including: developing cognitive abilities, independent learning, motivation to learn, and group learning. Difficulties encountered by students were: it is time-consuming, it has unclear objectives, it is a stressful process, and it results in an increased workload. A small number of students indicated that PBL tutorials were boring and complained about lack of contribution from instructors and limited recourses. Learning is intertwined with culture; students' previous educational experiences, uncertainty, English language proficiency, computer resources, gender, and achievement were identified as the most important cultural issues that impact the learning process and outcomes., Conclusion: Successful implementation of PBL does not come easily; teachers should be alert to the issues of culture in designing curriculum., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Background: Anxiety is the most common mental health problem in children, yet less than one third of children with anxiety disorders seek treatment. Cognitive-behavioral therapy (CBT) is recommended as a first-line treatment for childhood anxiety. However, current practice generally does not include CBT due to issues of feasibility, affordability, and transportability., Aims: The primary purpose of this review was to appraise current literature regarding the effectiveness of individual CBT for childhood anxiety. Secondary purposes were to identify reasons for the discrepancy between current evidence and practice as well as to offer suggestions to overcome this dilemma., Methods: A systematic review of the literature published between 2007 and 2012 was conducted, searching four databases--Cochrane, PubMed, CINAHL, and PsycINFO., Findings: In all 10 studies reviewed, individual CBT significantly reduced rates of anxiety diagnoses when compared with controls, and was equally effective or superior to comparison therapies. The only exception was when CBT was compared to a combination of CBT and pharmacological management, in which case the latter was more effective., Linking Evidence to Action: Each study included in this review employed hour-long sessions over a minimum of 12 visits. In order to meet clinical demands and patient preferences, affordability, and feasibility of CBT interventions must be addressed. A brief, manualized CBT program that can be supported to be clinically effective is proposed as an evidence-based solution for anxious children in outpatient mental health and primary care settings., (© 2014 Sigma Theta Tau International.)

Body temperature measurement is most commonly taken to confirm the presence or absence of fever. Many decisions concerning the investigation and treatment of children are based on the results of temperature measurement alone. Determining the presence of fever in young children is particularly important. A missed fever is serious, but a false-positive fever reading can result in unnecessary septic workups. The axillary, rectal, oral and tympanic membrane sites are most commonly used to record body temperature, and electronic and infrared thermometers are the devices most commonly used. Each site and device has numerous advantages and disadvantages, which are described in this article. The search for the means of measuring body temperature that best combines accuracy, speed, convenience, safety and cost-effectiveness goes on. The infrared thermometer and the tympanic site appear to offer such a combination. Electronic thermometers are also suitable when used orally or at the axilla in newborn babies.

Story is an intimate human resource to describe our being within the world. This article demonstrates the use of this human resource within a patient- and family-centered care initiative developed with and for the pediatric patient population. It describes the purpose, objectives, and design of the MyStory initiative as well as its impact on patient satisfaction scores. Finally, this article challenges current methods of data collection and assessment to include patient stories in order to involve children in care planning and decision making to ensure whole-person care.

Trust is integral to nursing; yet little is known about how nurses establish trust when working with patients. This grounded theory study explored nurses' perspectives of how to build trust with a child and family in the context of paediatric acute health care. Seven paediatric acute care nurses were asked what they did when they cared for a child admitted to an acute care ward from emergency department or intensive care unit following a severe traumatic accident. Building trust emerged as the basic social process for an effective working relationship between a nurse and family to promote the rehabilitation of the child. This paper argues that building trust is critical to nurses developing a working relationship with both child and family to promote optimal health, and enables nurses to effectively step out and handover the care of the child to the family.

Objective: This study examined the accuracy of temporal artery and axillary temperatures compared with rectal temperatures in pediatric ED patients younger than 4 years., Methods: A method-comparison study design was used to examine the agreement between a temporal artery or axillary thermometer and a nondisposable, rectal electronic thermometer, which is the clinical reference standard for temperature measurement in children. Temperatures were taken with each device in a convenience sample of stable, pediatric ED patients who were younger than 4 years. Bias and precision were calculated to quantify the differences between the 2 devices, as well as the percentage of temporal artery and axillary temperatures that were >±1.0°C and >±1.5°C higher or lower than the rectal temperature., Results: A total of 52 pediatric ED patients were studied over a 10-month period. Bias and precision for the temporal artery and axillary devices were -0.46°C ± 0.50°C and -0.93°C ± 0.49°C, respectively. The percentage of temporal artery and axillary temperatures that were >±1.0°C and/or >±1.5°C above or below the clinical reference temperature were 15% and 6%, respectively, for the temporal artery thermometer and 39% and 14%, respectively, for the axillary thermometer., Discussion: Bias and precision values for the temporal artery, but not the axillary temperature, were within the acceptable range set by experts to use as a noninvasive substitute for core body temperature measurements. If properly used by ED staff, temporal artery thermometers could be used to obtain temperature in pediatric patients younger than 4 years, thus avoiding physical and psychological discomfort for the child and parent associated with obtaining rectal thermometers., (Copyright © 2014 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.)

Introduction: Sexual Assault Nurse Examiners (SANEs) are specialized nurses who provide sexual assault (SA) examinations and forensic evidence collection. Currently, Adult/Adolescent (A/A) SANEs in Massachusetts are trained and certified to care only for patients 12 years and older who present acutely to EDs. The purpose of this study was to describe the attitudes of SANEs regarding the possibility of cross-training to care for younger patients (<12 years)., Methods: This qualitative, descriptive study included a sample of 45 A/A SANEs who participated in a series of 6 focus groups. The focus groups were audiotape-recorded and transcribed verbatim. Content analysis was used to analyze the raw data. Units of in vivo coding assisted in the identification of initial broad categories that were winnowed to represent final themes that described the participants' attitudes., Results: Although the majority of SANEs enthusiastically endorsed the option of pediatric cross-training, a smaller portion of participants expressed strong opposition to the proposal. The SANEs' concerns included the emotional toll of caring for children who have been sexually assaulted, and the need for an adequate infrastructure within the SANE Program to educate, train, and support the cross-training effort., Discussion: This research fills a gap in the forensic and ED nursing literature by providing insights into the attitudes and concerns of SANEs who care for some of the most vulnerable patients. The findings of this study can inform the acute care and evidence collection practices that are used when caring for pediatric patients who have experienced SA., (Copyright © 2014 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.)

Autism spectrum disorders (ASDs) are a group of developmental disabilities that can cause significant social, communication, and behavioral challenges for children and families. An estimated one in 88 children in the United States are affected by an ASD. Early identification and intervention have been shown to improve outcomes for these children, and the routine well-child visit is a critical opportunity for pediatric health care providers to obtain developmental information relating to ASD identification. Although current recommendations suggest ASD screening at 18 and 24 months of age, research suggests that ASD-specific behaviors and delays emerge earlier in infancy. The purpose of this article is to identify key developmental tasks that can be assessed by pediatric primary care providers to determine increased risk for ASD in infants at nine, 12, and 15 months prior to formal screening for ASD at 18 and 24 months.

This study set out to obtain a picture of pediatric pain management practices in one English hospital. Data were collected on two wards. Nonparticipant observation combined with a chart audit was used to collect data about actual practices. Questionnaires were used to collect information from parents and young people. Observational data showed that practices conformed to current guidelines in some but not all areas. When prescribed, the dosage of analgesic drugs complied with the hospital's guidelines, and drugs were usually administered as prescribed. There was some involvement of parents in decision making but this was usually initiated by them rather than the nurses. Pain assessment tools were not always used nor was a pain history routinely taken. Documentation about pain management was limited and there was little evidence of nonpharmacologic methods of pain relief being used. Parents and young people felt that their pain management was of an acceptable level or very good. This was despite the fact that 58% of children experienced severe pain and 24% moderate pain. The results provide a snapshot of pain management in one English hospital. As in other studies, pain management practices do not adhere to current guidelines in all areas, and children appear to be experiencing moderate to severe pain. Despite this, parents and children indicated that they were happy with the quality of pain management. There is a need to explore this further and to identify strategies that support the implementation of guidelines in practice., (Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of this article is to provide examples of Dr. Brazelton's important influence on pediatric nursing, and by extension, the work of child psychiatric mental health nurses, the care of children and families, and ultimately, the healthcare delivery system., Sources: Dr. Brazelton's professional colleagues, research, professional journals, and books., Conclusion: Over the past 40 years, T. Berry Brazelton has had a major impact on the development of pediatric nursing, infant mental health, and the nurse practitioner movement. He has influenced the growth and development of nursing organizations, nursing education, nursing research, nursing practice, and health policy affecting nurses., (© 2013 Wiley Periodicals, Inc.)

The life of a military child has several challenges that can provide opportunities for resilience or risk for vulnerability. Nurses in emergent/urgent care may encounter military children when they are in a stressful transition such as during a move or deployment. Understanding the unique lifestyle of military children and implementing some key suggestions for practice can improve outcomes for this population. This article highlights the exceptional context of military children, military transitions, and opportunities to recognize families who are at risk and strategies to reach out using the I CARE (identify, correlate, ask, ready resources, and encourage) framework., (Copyright © 2013 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.)

Aim: To report on the development of a factorial survey to explore nurses' participation in restricting children's movement for clinical procedures in hospital., Background: Exploration of implicit practices, such as restriction, is essential in ensuring that the care delivered to children addresses their developmental needs., Data Sources: A questionnaire was developed that consisted of two sections: vignettes and the professional and personal characteristics of the nurse. It was sent to 166 nurses and 105 questionnaires were returned, resulting in a response rate of 63.3 per cent., Review Methods: The development of the factorial survey included identifying and determining the levels of the independent variables, identifying the dependent variable, writing the vignette frame and associated questions, and randomly generating vignettes., Discussion: Reliability of the tool was established as a significant correlation was found for responses with Pearson's r=0.80. There was a small correlation between five of the 14 variables and the dependent variable 'likelihood of restricting a child for a clinical procedure'., Conclusion: A factorial survey was found to be a robust tool in exploring a sensitive issue, allowing for the inclusion of multiple variables for consideration in the analysis., Implications for Research/practice: The factorial survey enables rigorous exploration of the influences of personal and professional characteristics of a profession across a broad spectrum of clinical scenarios, and offers in-depth insight into the effect of differentiations in these characteristics on a variety of care delivery situations and how they influence behavioural intentions.

"Knowing the patient" is an essential element of nursing practice. Despite a key finding in prior studies, few scholars have directly inquired about the meaning of knowing the patient with nurses. We aimed to describe the meaning of knowing the patient and investigate how nurses obtain the information needed to support knowing the patient. A descriptive qualitative study was conducted with 12 nurses caring for pediatric patients on intensive care units. Nurses described knowing the patient as knowing clinical and personal information for individualized care. Verbal, paper-based, and electronic information sources were used to gather information needed to know the patient. The use of a paper-based supportive tool was the most valuable information source for nurses to know their patients. Future studies must further investigate the use of these paper-based tools and offer electronic solutions to support nurses in knowing their patients.

Background: Acute illness is common in childhood, and it is difficult for healthcare professionals to distinguish seriously ill children from the vast majority with minor or self-limiting illnesses. Safety netting provides parents with advice on when and where to return if their child deteriorates, and it is widely recommended that parents of acutely sick young children should be given safety netting advice. Yet little is known about how and when this is given. We aimed to understand what safety netting advice first contact clinicians give parents of acutely sick young children, how, when, and why., Methods: This was a qualitative study. Interviews and focus groups were held with doctors and nurses in a general practice surgery, a District General Hospital emergency department, a paediatric emergency department, and an out-of-hours service. Data were analysed using the method of constant comparison., Results: Sixteen clinicians participated. They described that safety netting advice includes advising parents what to look for, when and where to seek help. How safety netting was delivered and whether it was verbal or written was inconsistent, and no participants described being trained in this area. Safety netting appeared to be rarely documented, and was left to individual preference. Limitations of written materials, and structural barriers to the provision of safety netting, were perceived. Participants described that safety netting was influenced by clinicians' experience, confidence, time and knowledge; and perceived parental anxiety, experience, and competence. Participants noted several limitations to safety netting including not knowing if it has been understood by parents or been effective; parental difficulty interpreting information and desire for face-to-face reassurance; and potential over-reassurance., Conclusion: First contact clinicians employ a range of safety netting techniques, with inconsistencies within and between organisations. Structural changes, clinician training, and documentation in patient notes may improve safety netting provision. Research is needed into the optimal components of safety netting advice so that clinicians can consistently deliver the most effective advice for parents.

Background: In the UK and elsewhere, family-centred care is the cornerstone of children's nursing. Fathers' roles in families have evolved in recent decades and they are increasingly involved in their children's lives and healthcare. However, few studies of parents' experiences of their children's hospitalisation refer to fathers. To address this gap in the evidence and to support family-centred care, we focused this research on fathers' experiences during their acutely ill children's stay in hospital., Aim: To gain an understanding of fathers' experiences of care during their child's unplanned admission and their interactions with children's nurses., Method: An ethnographic design was used that involved participant observation and interviews with fathers and nurses., Results: Fathers played active roles during hospitalisation. They adopted a protective role, continued to provide for their families through paid work, provided emotional and material support to mothers and siblings and participated directly in care. Despite this active involvement, children's nurses sometimes perceived fathers as marginal to their child's care., Conclusion: Fathers are active participants in care and children's nurses need to be aware of the importance of practising truly family-centred care.

Purpose/objectives: To test the effectiveness of a two-to-three session family therapeutic conversation intervention (FAM-TCI) for primary and partner caregivers of children and adolescents in active cancer treatment on perceived family support and on expressive family functioning., Design: Quasiexperimental; one group pre- and post-test., Setting: Inpatient cancer unit and a day treatment cancer unit at the Children's Hospital in Reykjavik, Iceland., Sample: 19 parent caregivers (10 primary, 9 partner) of children in active cancer medical treatment., Methods: The caregivers completed baseline measure questionnaires and were offered the first sessions of the FAM-TCI. About four to eight weeks later, the second session was administered and then the caregivers were offered a third session, if needed, one week later. When the caregivers had finished all sessions, they answered the same set of questionnaires about one week later., Main Research Variables: The FAM-TCI for primary and partner caregivers, family support, and expressive family functioning., Findings: Primary caregivers perceived significantly higher family support after the intervention compared to before. Those caregivers also reported significantly higher expressive family functioning and significantly higher emotional communication after the intervention. Partner caregivers, however, reported significantly lower verbal communication after the FAM-TCI compared to before., Conclusions: Shortening hospital stays in pediatric oncology populations has focused attention on effective short-term psychosocial interventions. The FAM-TCI is promising as an effective short-term intervention but requires additional testing., Implications for Nursing: The FAM-TCI strengthened pediatric oncology caregivers in their caregiving activities and was found to benefit primary caregivers regarding their perception of family support and expressive family functioning; therefore, the intervention might benefit future families of children and adolescents in active cancer treatment., Knowledge Translation: The FAM-TCI was brief, easy to provide, and well fitted. Pediatric oncology nurses can offer brief, beneficial interventions to families of children and adolescents with cancer who are in active treatment. Knowing that primary caregivers experienced support and information may result in more effective evidence-based family care.

This study examined the frequency of information-seeking coping behaviors in 37 African-American children (ages 5-17 years) with sickle cell disease during venipuncture. The relationships between coping behaviors and child- and parent-reported pain and observational distress were also assessed. The majority of children attended to the procedure, but did not seek information via questions. This pattern of coping was only partially effective at reducing distress and had no relation to pain. This pattern of coping is discussed within the context of cultural factors that may be important in understanding responses to procedural pain in pediatric sickle cell disease., (Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Children continue to experience unrelieved pain during hospitalization, despite the evidence to guide nurses' pain management practices being readily available. Nurses' knowledge and attitudes have been identified as a possible reason for suboptimal pain management. This study examines the validity and reliability of an existing questionnaire to validate it for use in the population of interest. Initial testing demonstrated low reliability and validity. Modifications to the questionnaire were made on the basis of these results and the feedback provided by experts in pediatric pain management. Subsequent testing demonstrated good validity and reliability, suggesting that the questionnaire is appropriate for measuring nurses' knowledge and attitudes in relation to pediatric pain management., (Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Background: The American Academy of Pediatrics Back to Sleep program in 1992 dramatically increased the incidence of posterior plagiocephaly in infants. In 2000, the craniofacial disorders program at Oregon Health & Science University established a plagiocephaly screening clinic staffed by pediatric nurse practitioners., Methods: Electronic medical records of patients seen in a single accredited craniofacial disorders clinic from 2005 to 2011 were reviewed retrospectively to identify patients screened independently by pediatric nurse practitioners for positional plagiocephaly versus synostosis., Results: Over a 7-year period, 1228 patients were independently screened. Over half [638 patients (52 percent)] were followed through subsequent visits for craniofacial disorders without any direct surgeon input. Of these, 169 (26 percent) were treated with orthotic consultation for a molding helmet, 385 (60 percent) received a combination of counseling and/or physical therapy for torticollis, and 84 (13 percent) were lost to follow-up. No patient managed by pediatric nurse practitioners was identified to have cranial synostosis and no patient underwent early or delayed surgery. All returning patients [n=554 (86 percent)] showed improvement in, or resolution of, their presenting deformity. The remaining 590 patients (48 percent) were referred by the pediatric nurse practitioner for surgical consultation. Computed tomographic imaging revealed synostosis in 121 patients., Conclusions: Pediatric nurse practitioners accurately screened over half of patients referred to a high-volume craniofacial disorders program for positional plagiocephaly versus synostosis, without surgeon input. Based on available information, no synostosis diagnosis was overlooked using this approach. With specific training, pediatric nurse practitioners working in a craniofacial disorders program can safely and independently screen for positional versus synostotic plagiocephaly., Clinical Question/level of Evidence: Diagnostic, III.