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Vaccination of immunocompromised children is challenging both in regards to efficacy and safety. Chloe Watson, Barbara Davies and Claire Camara provide a brief overview Immunisation in children with a compromised immune system is not straightforward. Children with autoimmune disorders are especially at risk of vaccine-preventable diseases due to their underlying disease and the immunosuppressive treatment that is often required for a long period. This article explores some of the complexities that need to be considered when planning individual vaccination programmes.

The need to offer nutritional support to children and young people is commonplace for health professionals. This article explores the use and indication of nasogastric tubes (NGT) in children and young people, before explaining the process of inserting NGTs and the ongoing management of this method of nutritional support.

PurposeThe aim of this study was to describe the experiences of graduate students who participated in the community of practice (CoP) and identify areas for improvement to support academic success.Design/methodology/approachIn total, 19 graduate students engaged in a CoP to facilitate social interactions, knowledge sharing and learning within a culture of scholarship. A descriptive qualitative research study was conducted using semistructured interviews with eight participants who had attended the CoP meeting.FindingsAll participants were from the School of Nursing and perceived the CoP to be beneficial, particularly international students who had challenges in adapting to new academic and social environments. Areas for improvement include creating a group structure that enhances belonging and learning.Originality/valueThis is the first CoP that was implemented at the Faculty of Health Sciences at the authors’ university. It has been the authors’ experience that a CoP can benefit graduate students through networking, knowledge sharing, social support and learning. The finding of this research will be used to inform a new CoP to address the needs of graduate students. The authors will be adapting the CoP to the current context that includes a virtual platform during the COVID-19 pandemic and will include content specific for international students.

This article aims to explore the complexity of student nurse relationships with adolescent patients when placing nasogastric tubes. The potential inter-connectiveness of this relationship is debated within this article and an evaluation of current practice identifies potential implications for both patients and nursing care.

Background There is growing recognition among healthcare professionals that the sustainability of evidence-based practices (EBPs) within different settings is variable and suboptimal. Understanding why a particular EBP might be sustained in one setting and not another remains unclear. Recent reviews illustrate the need to identify and analyze existing frameworks/models/theories (F/M/Ts) that focus solely on the sustainability of EBPs in specific healthcare settings, such as acute care, to illuminate key determinants and facilitate appropriate selection to guide practice and research. Methods We conducted a systematic review to extract sustainability frameworks. This involved using two available syntheses of the literature and a systematic search of four databases from January 2015 to July 2018: CINHAL, MEDLINE, Embase, and ProQuest. We included studies published in English, and if they included sustainability F/M/Ts recommended for use in acute care or an unspecified healthcare organization/setting. F/M/Ts explicitly recommended for use in public health and or community settings were excluded. We then conducted a comparative analysis of F/M/Ts using a modified theory analysis approach, to understand the theoretical underpinnings of each F/M/T, their determinants and concepts hypothesized to influence the sustained use of EBPs within an acute care context. Results Of 2967 identified citations from the 2 available syntheses and the systematic review, 8 F/M/Ts met the inclusion criteria. We identified 37 core factors, of which 16 were recorded as common factors (occurring within 4 or more of the 8 included F/M/Ts). All factors grouped into 7 main themes: innovation, adopters, leadership and management, inner context, inner processes, outer context, and outcomes. Conclusions This systematic review is the first to include a comprehensive analysis of healthcare sustainability F/M/Ts for the sustained use of EBPs in acute care settings. Findings reveal insights into sustainability as a “process or ongoing stage of use” following initial implementation, suggesting this construct should be added to the definition of sustainability. Results provide a resource of available F/M/Ts and hypothesized factors to consider for acute care team members who are planning or currently implementing EBPs with the goal of improving patient outcomes. It also provides a basis for future research on sustainability in acute care.

The purpose of this integrative review was to explore psycho-social impacts and therapeutic interventions for parent caregivers of young people living with Duchenne’s Muscular Dystrophy (DMD). Electronic databases were searched for research publications between 2010 and 2020. This included Medline, CINAHL, PsycINFO, ERIC, ERC, and AMED. Four central themes emerged: Living with DMD; Knowing and telling; Transitioning; and Building resilience. The impact on parents caring for a child with DMD affected all aspects of their lives, changed over time, and had identifiable peak stress points. Unmet parental information and support needs left parents struggling in their role. Transition required changes to parenting behaviors and required adaptation and resilience. It is proposed that future investment should focus on anticipating family need, targeting intervention cognizant of predictable stress points and building resilience through social community. Parents may then be better positioned to support their child in looking forward.

Wendy Gifford,1 Ian D Graham,2,3 Mark G Ehrhart,4 Barbara L Davies,5,6 Gregory A Aarons7 1School of Nursing, Faculty of Health Sciences, University of Ottawa, ON, Canada; 2Centre for Practice-Changing Research, Ottawa Hospital Research Institute, 3School of Epidemiology, Public Health and Preventive Medicine, Facility of Medicine, University of Ottawa, Ottawa, ON, Canada; 4Department of Psychology, San Diego State University, San Diego, CA, USA; 5Nursing Best Practice Research Center, University of Ottawa, Ottawa, ON, Canada; 6Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA; 7Child and Adolescent Services Research Center, University of California, San Diego, CA, USA Purpose: Leadership in health care is instrumental to creating a supportive organizational environment and positive staff attitudes for implementing evidence-based practices to improve patient care and outcomes. The purpose of this study is to demonstrate the alignment of the Ottawa Model of Implementation Leadership (O-MILe), a theoretical model for developing implementation leadership, with the Implementation Leadership Scale (ILS), an empirically validated tool for measuring implementation leadership. A secondary objective is to describe the methodological process for aligning concepts of a theoretical model with an independently established measurement tool for evaluating theory-based interventions.Methods: Modified template analysis was conducted to deductively map items of the ILS onto concepts of the O-MILe. An iterative process was used in which the model and scale developers (n=5) appraised the relevance, conceptual clarity, and fit of each ILS items with the O-MILe concepts through individual feedback and group discussions until consensus was reached.Results: All 12 items of the ILS correspond to at least one O-MILe concept, demonstrating compatibility of the ILS as a measurement tool for the O-MILe theoretical constructs.Conclusion: The O-MILe provides a theoretical basis for developing implementation leadership, and the ILS is a compatible tool for measuring leadership based on the O-MILe. Used together, the O-MILe and ILS provide an evidence- and theory-based approach for developing and measuring leadership for implementing evidence-based practices in health care. Template analysis offers a convenient approach for determining the compatibility of independently developed evaluation tools to test theoretical models. Keywords: leadership, implementation, evidence-based practice, template analysis, theoretical models, leadership development, knowledge translation

The aim of this article is to explore the concept of medical futility and the withdrawal of care for children in intensive care units. There have been several recent cases where medical staff have considered that there was no possibility of recovery for a child, yet their clinical judgments were challenged by the parents. The private anguish of these families became public, social media heightened emotions and this was followed by political and religious intrusion. Innovations in medical treatment and technological advances raise issues for all those involved in the care of children and young people especially when decisions need to be made about end of life care. Healthcare professionals have a moral and legal obligation to determine when treatment should cease in cases where it is determined to be futile. The aim should be to work collaboratively with parents but all decisions must be made in the best interests of the child. However, medical staff and parents may have differing opinions about care decisions. In part, this may be as a result of their unique relationships with the child and different understanding of the extent to which the child is in discomfort or can endure pain.

Background Networks are a vehicle for mobilizing knowledge, but there is little research about evidence-informed decision-making in community settings. Breastfeeding is a powerful intervention for population health; combined system and community interventions can increase exclusive breastfeeding rates by 2.5 times. This study examined evidence-informed decision-making within an interorganizational network, including the facilitators and barriers to achieving network goals. Methods A mixed method case study design was used. The primary sources of data were focus group discussion and questionnaire administration. Data were analyzed concurrently using framework analysis and social network analysis. Results Key findings were at the interorganizational and external levels: 1) Relationships and trust are connected to knowledge exchange 2) Need for multiple levels of leadership. Conclusions The findings of this study have potential implications for enhancing the use of evidence-informed decision-making as other networks work toward Baby Friendly Initiative (BFI) designation and also highlights the potential for network maps to be used as a knowledge mobilization tool.

Aim In this article, the authors discuss a multiphase approach for developing quality indicators based on pain practice guidelines, and the challenges associated with the process. The presentation is based on previously published reporting standards for guideline-based quality indicators. Methods The following steps of the indicator development process were undertaken: topic selection; guideline selection; extraction of recommendations; quality indicator selection and practice test. Results Eleven practice guidelines were reviewed for quality, and three high-quality guidelines were compared for pertinent recommendations. From these three guidelines, 12 recommendations were extracted and judged appropriate to examine the practice gap for nursing students and clinicians on an oncology and palliative care unit. Quality indicators were then identified by a consensus process, resulting in 24 discrete indicators that were included in the practice test. Conclusion Quality indicators can be used to examine gaps in pain management practice, and to evaluate change after guideline implementation. However, their development can be challenging, and guideline developers could facilitate uptake of guidelines by including clear, relevant quality indicators as part of guideline creation and presentation.

Background Research into evidence-based practice has been extensively explored in nursing and there is strong recognition that the organizational context influences implementation. A range of barriers has been identified; however, the research has predominantly taken place in Western cultures, and there is little information about factors that influence evidence-based practice in China. The purpose of this study was to explore barriers and facilitators to evidence-based practice in Hunan province, a less developed region in China. Methods A descriptive qualitative methodology was employed. Semi-structured interviews were conducted with staff nurses, head nurses and directors (n = 13). Interviews were translated into English and verified for accuracy by two bilingual researchers. Both Chinese and English data were simultaneously analyzed for themes related to factors related to the evidence to be implemented (Innovation), nurses’ attitudes and beliefs (Potential Adopters), and the organizational setting (Practice Environment). Results Barriers included lack of available evidence in Chinese, nurses’ lack of understanding of what evidence-based practice means, and fear that patients will be angry about receiving care that is perceived as non-traditional. Nurses believed evidence-based practice was to be used when clinical problems arose, and not as a routine way to practice. Facilitators included leadership support and the pervasiveness of web based social network services such as Baidu (百度) for easy access to information. Conclusion While several parallels to previous research were found, our study adds to the knowledge base about factors related to evidence-based practice in different contextual settings. Findings are important for international comparisons to develop strategies for nurses to provide evidence-based care. Electronic supplementary material The online version of this article (10.1186/s12912-018-0295-x) contains supplementary material, which is available to authorized users.

The purpose of this study was to assess the impact of a mentored guideline implementation (Registered Nurses’ Association of Ontario Prevention of Falls and Falls Injuries in the Older Adult Best Practice Guideline) focused on enhancing sustainability in reducing fall rates and number of serious falls and the experience of staff in three acute care hospitals. The National Health Service (NHS) Sustainability Model was used to guide the study. Interviews and focus groups were held with 82 point-of-care professional staff, support staff, volunteers, project leaders, clinical leaders, and senior leaders. Study results supported the importance of the factors in the NHS model for sustainability of the guideline in these practice settings. There were no statistically significant decreases in the overall fall rate and number of serious falls. The results supported strategies of participating hospitals to become senior friendly organizations and provided opportunities to enhance staff collaboration with patients and families.

Objective The objective of this systematic review was to summarize the evidence pertaining to the use of social media by health professionals to facilitate chronic disease self-management with their patients. Methods A systematic approach was used to retrieve and extract relevant data. A total of 5163 citations were identified, of which seven unique studies met criteria for inclusion; one was a randomized controlled trial, two were prospective cohort studies, and four were qualitative studies. The following social media platforms were evaluated: discussion forums (6 studies) and collaborative project (1 study). Results The available evidence suggests that health professionals perceived discussion forums and collaborative projects to be useful social media platforms to facilitate chronic disease self-management with patients. No relevant evidence was found regarding the use of other social media platforms. Most studies indicated positive findings regarding health professionals’ intention to use discussion forums, while the one study that used a collaborative project also indicated positive findings with its perceived ease of use as health professionals felt that it was useful to facilitate chronic disease self-management with patients. Mixed findings were seen in regards to health professionals’ perceived ease of use of discussion forums. The most common barrier to using social media platforms was the lack of time in health professionals’ schedules. Conclusions Discussion forums and collaborative projects appear to be promising resources for health professionals to assist their patients in self-managing their chronic conditions; however, further research comparing various social media platforms is needed.

Background: Paediatric musculoskeletal matters (PMM-www.pmmonline.org) is a free, evidence-based and peer reviewed open e-resource for paediatric musculoskeletal (MSK) medicine targeting non-MSK specialists. Since launch (Nov-2014) PMM has reached 190 countries with >78,000 users, >244,500 hits. Users who have declared their training background on the website are mainly non-MSK specialists. Feedback from users has requested further content to reflect international healthcare systems. PMM India was developed in collaboration with the Indian Academy of Paediatrics (IAP; Sept-2015, >3,700 users, 16,000 hits to date) and showcases successful partnership with local clinicians in developing PMM with local context. Further ‘internationalisation’ is now ongoing with additional global partners to develop PMM International. Here, we describe the process for international development. Methods: Paediatric rheumatologists in 11 countries around the world were approached to peer-review and identify additional PMM content to reflect paediatric MSK medicine in their health care systems (e.g., case mix, clinical presentations, care pathways), with a focus on knowledge relevant for non-MSK specialists. New content was developed by local teams identified by the paediatric rheumatologist(s) who then collated and provided expert overview before submission for editorial review. All contributions were provided in English. Additional cases and images were included with appropriate consent. Results: PMM International additions to the original website brings new content predominately focused on infections/infection-related disease with MSK features or as differential diagnoses for rheumatic disease. Most content is in English with requests for translation of some content (e.g., pGALS which is available in 11 languages to date). PMM International will be further peer reviewed with open access to all. A PMM app is planned to facilitate access where internet capacity is limited. Conclusion: Rapid globalisation necessitates appropriate e-resources with content that reflect international health care contexts. PMM International targets non-MSK specialist audiences to raise awareness and early recognition of MSK pathology. Our work reflects strong collaborative global partnerships within the paediatric rheumatology community. PMM has been endorsed by the Paediatric Rheumatology European Association (PReS) as an educational resource. Implementation of PMM International has yet to be formally evaluated (i.e., change in knowledge, practice), but data thus far supports wide reach and positive uptake from the target audience user groups.

In Ontario, Canada, the Registered Nurses' Association promotes a Best Practice Spotlight Organization initiative to enhance evidence-based practice. Qualifying organizations are required to implement strategies, evaluate outcomes, and sustain practices aligned with nursing clinical practice guidelines. This study reports on the development and evaluation of a multifaceted implementation strategy to support adoption of a nursing clinical practice guideline on the assessment and management of acute pain in a pediatric rehabilitation and complex continuing care hospital. Multiple approaches were employed to influence behavior, attitudes, and awareness around optimal pain practice (e.g., instructional resources, electronic reminders, audits, and feedback). Four measures were introduced to assess pain in communicating and noncommunicating children as part of a campaign to treat pain as the fifth vital sign. A prospective repeated measures design examined survey and audit data to assess practice aligned with the guideline. The Knowledge and Attitudes Survey (KNAS) was adapted to ensure relevance to the local practice setting and was assessed before and after nurses' participation in three education modules. Audit data included client demographics and pain scores assessed annually over a 3-year window. A final sample of 69 nurses (78% response rate) provided pre-/post-survey data. A total of 108 pediatric surgical clients (younger than 19 years) contributed audit data across the three collection cycles. Significant improvements in nurses' knowledge, attitudes, and behaviors related to optimal pain care for children with disabilities were noted following adoption of the pain clinical practice guideline. Targeted guideline implementation strategies are central to supporting optimal pain practice.

Aims The aim of this study was to determine the effects of an Action Learning intervention on nurses’ use of a fetal health surveillance (FHS) guideline during labor of women who were low risk on admission for delivery. Methods Using a pragmatic randomized controlled trial, nurses were randomized to Action Learning (n = 44) or Usual Care (n = 45). Low-risk women were assigned to either an Action Learning nurse (n = 122) or a Usual Care nurse (n = 148). Data on practices during an episode of care (nurses’ FHS practices from admission through to delivery in low-risk women) were collected at three trial time points: 1 month prior, during 6 months, and 1 month following. Guideline adherence, women's perception of birth experience, and enablers and inhibitors to intermittent auscultation (IA) were collected. Multivariate logistic regression determined the variables (chosen by the nurses) that predicted Action Learning nurses’ adherence to FHS practices. Findings Statistically significant change was not evident between nurses’ rate of FHS practices in the Action Learning group compared with Usual Care (Δ6.8%, odds ratio [OR] 0.16, 95% confidence interval [CI] 0.84–2.83). Postpartum, women reported high satisfaction with no significant difference by study group. Two labor events, epidural and narcotic analgesia, most influenced guideline appropriate care (p = .000, OR –4.04; p = .000, OR = 2.89) within the experimental group. Linking Evidence to Action Despite lack of between-group significant changes in FHS practices, Action Learning nurses, who chose areas of practice that presented obstacles to their guideline adherence ability (epidurals and narcotics), significantly changed their FHS practices. Researchers need to consider whether practice is long-standing acceptance of the evidence by healthcare providers, and the provider's intentions for implementation effectiveness when choosing an implementation strategy. Supportive nurses, Doppler availability, and clear policies support adherence to an IA guideline. Deimplementation of ineffective practice is warranted.