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Background: Students often have difficulty engaging with evidenced-based practice (EBP) courses that are largely theoretical and lack clinical relevance. This may result in graduates lacking vital skills to critique practice and participate in quality improvement. Approach: This paper describes the development and implementation of a collaborative academic and healthcare industry-based course that linked theoretical aspects of EBP. Students undertook a quality improvement project during clinical practice experience. Course assessments were designed to provide feedback on the progression of projects, the integration of theoretical and practical aspects of EBP and dissemination of findings. Conclusions: The course required substantial collaboration between the university and industry partners to identify clinically relevant projects and coordinate academic and clinical mentorship to support the students. The course demonstrated a significant level of clinical and academic partnership that resulted in relevant clinical quality improvements and increased student engagement with learning about, producing and implementing EBP.

To synthesise published literature exploring online venous thromboembolism (VTE) prevention education programmes to identify, test and refine a program theory supporting translation of knowledge into practice for registered nurses.Venous thromboembolism is a leading cause of preventable morbidity and mortality in hospitalised patients. Successful implementation of prevention strategies can be impeded by a lack of education and translation of knowledge to practice. Continuing professional development programs using e-learning platforms are increasingly common, however, there is little published literature exploring effective translation of such education to practice.Realist Review.Searches were conducted in seven healthcare databases prior to July 2020 and updated in March 2022. Synthesis was informed by the unified theory of acceptance and use of technology (UTAUT) model and followed stages of a realist review outlined by Pawson et al. The results were reported according to the RAMESES publication standards.Eight context-mechanism-outcome combinations were identified to explain engagement, completion and adoption of VTE e-learning into practice. Mechanisms included valuing content as relevant to practice, having confidence in the ability to use the technology and empowerment to enact change based on learning. Contextual factors that may constrain the completion of learning include the support of managers and organisations through time, and the availability of resources.Translation of e-learning is critical to ensure clinical excellence. This realist review demonstrated the varying mechanisms contributing to engagement, completion and adoption of learning. These illustrate the complex nature of education for professional development. It demonstrates that the UTAUT model is suitable for guiding the design, implementation and adoption of e-learning programmes.This review used a common clinical practice (VTE) to provide a program theory that can guide clinical educators to understand mechanisms which can facilitate engagement with, completion and adoption of e-learning into practice by nurses.The focus of this realist review was on e-learning for registered nurses. As such, no patient or public contribution was sought or given in the development, progress and writing of the submitted manuscript.

Chronic pain is common in young people aged 10-14 years. Interdisciplinary, clinician-delivered treatments, while effective, are often criticized for failing to be readily accessible. Mobile health applications (mHealth apps) have been proposed as effective treatment adjuncts that address these challenges, while meeting the needs of tech-savvy young people. The objectives of this study were to co-create a mHealth app with consumers and health care professionals and evaluate the acceptability and feasibility of the resulting mHealth app (myPainPal). A phased, qualitative approach within a consumer engagement framework was employed. Interviews with young people (

Background Preterm infants and neonates with respiratory conditions commonly require intubation and conventional mechanical ventilation (CMV) to maintain airway patency and support their respiration. Whilst this therapy is often lifesaving, it simultaneously carries the risk of lung injury. The use of lung recruitment manoeuvres (LRMs) has been found to reduce the incidence of lung injury, and improve oxygenation and lung compliance in ventilated adults. However, evidence pertaining to their use in neonates is limited, and there is no consensus of opinion as to whether LRMs are appropriate or effective in this population. Objectives To determine the effects of LRMs on mortality and respiratory outcomes in mechanically ventilated neonates, when compared to no recruitment (routine care). Search methods We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2020, Issue 4) in the Cochrane Library, MEDLINE via Ovid (1946 to 13 April 2020), and CINAHL via EBSCOhost (1989 to 13 April 2020). We also handsearched the reference lists of retrieved studies to source additional articles. Selection criteria We included randomised controlled trials (RCTs), quasi‐RCTs and randomised cross‐over studies that compared the effect of LRMs to no recruitment (routine care) in mechanically ventilated neonates. Data collection and analysis Two review authors independently assessed trial eligibility, extracted data and evaluated risk of bias in the included studies. When studies were sufficiently similar, we performed a meta‐analysis using mean difference (MD) for continuous data and risk ratio (RR) for dichotomous data, with their respective 95% confidence intervals (CIs). We used the GRADE approach to assess the certainty of the evidence for key (clinically important) outcomes. Main results We included four studies (152 participants in total) in this review. Three of these studies, enrolling 56 participants, contributed data to our prespecified outcomes. Two studies enrolling 44 participants on CMV for respiratory distress syndrome compared a stepwise LRM with positive end‐expiratory pressure (PEEP) to routine care. Meta‐analysis demonstrated no evidence of a difference between the LRM and routine care on mortality by hospital discharge (RR 1.00, 95% CI 0.17 to 5.77; low‐certainty evidence), incidence of bronchopulmonary dysplasia (RR 0.25, 95% CI 0.03 to 2.07; low‐certainty evidence), duration of supplemental oxygen (MD ‐7.52 days, 95% CI ‐20.83 to 5.78; very low‐certainty evidence), and duration of ventilatory support (MD ‐3.59 days, 95% CI ‐12.97 to 5.79; very low‐certainty evidence). The certainty of the evidence for these outcomes was downgraded due to risk of bias, imprecision, and inconsistency. Whilst these studies contributed data to four of our primary outcomes, we were unable to identify any studies that reported our other primary outcomes: duration of continuous positive airway pressure therapy, duration of neonatal intensive care unit stay, and duration of hospital stay. The third study that contributed data to the review enrolled 12 participants on CMV for respiratory and non‐respiratory causes, and compared two different LRMs applied after endotracheal tube suctioning to routine care. It was determined that both LRMs may slightly improve end‐expiratory lung volume at 120 minutes' post‐suctioning, when compared to routine care (incremental PEEP LRM versus routine care: MD ‐0.21, 95% CI ‐0.37 to ‐0.06; double PEEP LRM versus routine care: MD ‐0.18, 95% CI ‐0.35 to ‐0.02). It was also demonstrated that a double PEEP LRM may slightly reduce mean arterial pressure at 30 minutes' post‐suctioning, when compared with routine care (MD ‐16.00, 95% CI ‐29.35 to ‐2.65). Authors' conclusions There is insufficient evidence to guide the use of LRMs in mechanically ventilated neonates. Well‐designed randomised trials with larger sample sizes are needed to further evaluate the potential benefits and risks of LRM application in this population.

As of the 31st July 2020, more than 17 million confirmed COVID-19 cases with over 668k deaths have been reported worldwide (World Health Organisation (WHO), 2020). The COVID-19 virus is genetically similar to the Severe Acute Respiratory Syndrome (SARS) and the Middle East Respiratory Syndrome (MERS) (Schmidt, Davids, & Malinga., 2020; Zhao et al., 2020). However, initial investigations of the basic reproduction number (Ro) of COVID-19 shows higher transmissibility than SARS and MERS (Zhao et al.,2020). The mode of transmission of COVID-19 is mainly through close contacts via droplets from human to human (World Health Organisation (WHO), 2020). Whilst researchers around the world are focused on developing a vaccine for COVID-19, transmission preventative measures become the most effective means of response.

Aim: This review aims to present a case series on pressure injury (PI) formation secondary to limb-splinting for preservation of peripheral intravascular catheter (PIVC) access in neonatal and pediatric patients. A literature review was undertaken to analyze the existing knowledge base on this phenomenon. Background: Medical devices and attachments are considered a risk factor for PI development in neonates, infants, and children. Three cases of PI formation caused by contact with limb boards used to preserve PIVC access were identified in an Australian tertiary pediatric facility during 2016. Methods: A literature search was conducted during December 2017 using the Cumulative Index of Nursing and Allied Health, Excerpta Medica database, MEDLINE, PubMed, and the Cochrane Library. Keywords used were pressure injury(ies), pressure ulcer, pressure ulcers, decubitus ulcer, and decubitus ulcers. Articles were excluded if published before 2006, patients were adolescents or adults, and if injuries were not caused by PIVC-associated limb-splinting. Patients included in the case series were identified through screening of admissions in one ward of a tertiary paediatric hospital. Results: Five low-quality studies were included in the literature review. Three children were included in the case series. Each child acquired a PI subsequent to limb-splinting and taping adjacent to a PIVC. Hydration, nutritional state, and oxygenation did not appear to contribute to PI development in these cases. Conclusions: There is a gap in the evidence base pertaining to PIVC splinting and its involvement with PI formation in neonates, infants, and children. The existing literature provides low-quality evidence this problem exists; thus, further research is recommended.

Aim: Tonsillectomy procedures are a core element of paediatrics; however, perioperative management differs. This study aimed to describe tonsillectomy management, including the burden of pain, nausea and delayed recovery. Methods: A prospective cohort study was undertaken through an audit of tonsillectomy perioperative practice and recovery and survey interviews with family members 7–14 days post‐surgery. The study was undertaken at an Australian tertiary referral paediatric hospital between June and September 2016. Results: The audit included 255 children undergoing tonsillectomy, with 127 family members interviewed. Most participants underwent adenotonsillectomy (n = 216; 85%), with a primary diagnosis of obstructive sleep apnoea (n = 205; 80%) and a mean age of 7 years (standard deviation; 3.9). A variety of intra‐operative pain relief and antiemetics was administered. Pain was present in 29% (n = 26) of participants at ward return, increasing to 32–45% at 4–20 h and decreasing to 21% (n = 15) at discharge. A third of the children (32%; n = 41) had moderate to severe pain at post‐discharge interview, and 30% (n = 38) experienced nausea at home. Most parents (82%; n = 104) were still giving regular paracetamol at 7 days post‐operatively, and 31% (n = 39) had finished their oxycodone. Of the participants, 14% (n = 26) presented to the emergency department within 7 days of discharge; 8% (n = 20) of the total cohort were re‐admitted. Conclusions: There was variety in perioperative and post‐discharge care. Pain scores were infrequently documented post‐tonsillectomy, and parents are generally dissatisfied with the management of post‐operative pain and nausea. Further research is needed to provide a more consistent approach to perioperative management to promote recovery.

Aims and objective: To synthesise the evidence on the use of evaluation frameworks by nurses and midwives in research designed to improve healthcare services and practice. A secondary aim was to identify the attributes and elements of evaluation frameworks. Background: Evaluation is an integral component of any initiative to improve outcomes or change clinical practice. Yet often an evaluation may not yield the information required to sustain or integrate an initiative into practice. Evaluation frameworks can support effective evaluations, but there is a lack of consensus regarding elements and attributes of frameworks that support use. Methods: We undertook an integrative review to synthesise the use of evaluation frameworks in practice guided by the Preferred Reporting Items for Systematic review and Meta-Analysis flow diagram and checklist 2009 (Supporting Information File 4). The protocol was registered with PROSPERO (CRD42018087033). A broad range of electronic databases were systematically searched using keywords. Findings: Twenty-five papers were included from a diverse range of clinical areas and across high-, middle- and low-income nations. Twenty of the research projects had used nine existing frameworks, and five had developed an evaluation specific to an initiative. Frameworks supported the processes of evaluation and made them more meaningful by simplifying a complex process (providing structure and guidance for the evaluation processes); identifying and including stakeholders; explaining reasons for outcomes; generating transferable lessons; and identifying the mechanisms driving or inhibiting change. Conclusion: Nurses and midwives reported that frameworks were useful in undertaking evaluations. Each framework had positive attributes and missing or confusing elements. When undertaking an evaluation, it is pertinent to review the elements and attributes of a framework to ensure it includes evaluation measures that are relevant to specific projects. Relevance to clinical practice: Nurses are actively involved in evaluation of clinical practice. This review identifies important elements to consider when choosing a framework for evaluation.

Background The complexity and variation in ventilator associated pneumonia (VAP) definitions in paediatrics may pose threats to the reliable identification of VAP. The revision of the surveillance definition to ventilator-associated event (VAE) has been mandated in adult populations, to overcome these issues. However, the evidence for application of the definition is unknown in children. Objectives To review the evidence on the application of the new VAE surveillance definition in paediatric population and examine the potential challenges in clinical practice. Review methods A systematic approach was used to locate and synthesise the relevant paediatric literature. Studies were appraised according to epidemiological appraisal instrument (EAI) and the grades of evidence in the National Health Medical Research Council (NHMRC) guidelines. Results Seven studies met the inclusion criteria. Quality of study methods was above 50% on the EAI. The overall grade of evidence was assessed as C (satisfactory). The incidence of VAE in children ranged from 1.1 to 20.9 per 1000 ventilator days as a result of variations in surveillance criteria across included studies. There is little agreement between the new VAE and PNU/VAP surveillance definition in the identification of VAP. Challenges in the application of VAE surveillance were related to; the difference in modes of ventilation used in children versus adults, inconclusive criteria tailored to paediatric samples and a lack of data that support for automatic data extraction applied in paediatric studies. Conclusion This review demonstrated promising evidence using the new VAE surveillance definition to define the VAE in children, but the level of the evidence is low. Before the possibility of real implementation in clinical settings, challenges related to VAE paediatric specific criteria’ and the value of automated data collection need to be considered.

A learning needs analysis was undertaken in a newly formed workforce. The goal of the learning needs analysis was to establish both the skill set and educational needs in the nursing workforce prior to moving to a new purpose built facility. The results would then enable nurse educators to develop, plan and deliver appropriate educational strategies. Staff (73%) completed an online survey; the results were collated and analysed. The results of the learning needs analysis suggested an experienced workforce that had great capacity to care for children across a wide spectrum of acute clinical needs. Interestingly the results of the learning needs analysis conflicted with the clinical reality. To investigate possible reasons for this difference we conducted a focus group session with nurse educators. The focus group findings highlighted the significance of change and how that impacted on the clinical capacity of experienced staff. We concluded that the results of the learning needs analysis were representative however they needed careful interpretation in the context of substantial change.

Ventilator Associated Lung Injury (VALI) is an iatrogenic phenomena that significantly impacts on the morbidity and mortality of critically ill patients. The hazards associated with mechanical ventilation are becoming increasingly understood courtesy of a large body of research. Barotrauma, volutrauma and biotrauma all play a role in VALI. Concomitant to this growth in understanding is the development of strategies to reduce the deleterious impact of mechanical ventilation. The majority of the research is based upon adult populations but with careful extrapolation this review will focus on paediatrics. This review article describes the physiological basis of VALI and discusses the various lung protective strategies that clinicians can employ to minimise its incidence and optimise outcomes for paediatric patients.

BACKGROUND: Respiratory support is a central component of the management of critically ill children. It can be delivered invasively via an endotracheal tube or non‐invasively via face mask, nasal mask, nasal cannula or oxygen hood/tent. Invasive ventilation can be damaging to the lungs, and the tendency to use non‐invasive forms is growing. However, non‐invasive delivery is often poorly tolerated by children. High‐flow nasal cannula (HFNC) oxygen delivery is a relatively new therapy that shows the potential to reduce the need for intubation and be better tolerated by children than other non‐invasive forms of support. HFNC therapy differs from other non‐invasive forms of treatment in that it delivers heated, humidified and blended air/oxygen via nasal cannula at rates > 2 L/kg/min. This allows the user to deliver high concentrations of oxygen and to potentially deliver continuous distending pressure; this treatment often is better tolerated by the child. OBJECTIVES: To determine whether HFNC therapy is more effective than other forms of non‐invasive therapy in paediatric patients who require respiratory support. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2013, Issue 4); MEDLINE via PubMed (January 1966 to April 2013); EMBASE (January 1980 to April 2013); CINAHL (1982 to April 2013); and LILACS (1982 to April 2013). Abstracts from conference proceedings, theses and dissertations and bibliographical references to relevant studies were also searched. We applied no restriction on language. SELECTION CRITERIA: We planned to included randomized controlled trials (RCTs) and quas‐randomized trials comparing HFNC therapy with other forms of non‐invasive respiratory support for children. Non‐invasive support encompassed cot, hood or tent oxygen; low‐flow nasal cannulae (flow rates ≤ 2 L/min); and continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) delivered via facial or nasal mask/cannula. Treatment failure was defined by the need for additional respiratory support. We excluded children with a diagnosis of bronchiolitis. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed all studies for selection and data extraction. We used standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS: Our search yielded 922 records. A total of 109 relevant records were retrieved with reference to our search criteria. After duplicates and irrelevant studies were removed, 69 studies were further scrutinized. Of these, 11 studies involved children. No study matched our inclusion criteria. AUTHORS' CONCLUSIONS: Based on the results of this review, no evidence is available to allow determination of the safety or effectiveness of HFNC as a form of respiratory support in children.

Introduction High flow nasal cannula is an emerging treatment option in Paediatric Intensive Care Units for paediatric patients in acute respiratory distress. Yet there is a paucity of literature describing its clinical application in various presenting pathophysiologies. Aim To describe three cases with differing underlying pathophysiologies and their response to high flow nasal cannula oxygen therapy. Method Patients admitted to the Paediatric Intensive Care Unit with bronchiolitis, asthma and cardiomyopathy, and treated with high flow nasal cannula therapy were searched in the Paediatric Intensive Care database. The most representative cases were chosen to review. Results One infant and two children were reviewed. All were commenced on high flow nasal cannula therapy in the Paediatric Intensive Care Unit and all demonstrated an improvement in their work of breathing. There was also a substantial improvement in their haemodynamic status. No patient required escalation to other forms of respiratory therapy. Conclusion High flow nasal cannula therapy is a viable treatment option for a range of patients presenting to the Paediatric Intensive Care Unit with acute respiratory distress. More invasive methods of respiratory support may be avoided by the use of high flow nasal cannula therapy.

Lung recruitment is used as an adjunct to lung protective ventilation strategies. Lung recruitment is a brief, deliberate elevation of transpulmonary pressures beyond what is achieved during tidal ventilation levels. The aim of lung recruitment is to maximise the number of alveoli participating in gas exchange particularly in distal and dependant regions of the lung. This may improve oxygenation and end expiratory levels. Restoration of end expiratory levels and stabilisation of the alveoli may reduce the incidence of ventilator induced lung injury (VILI). Various methods of lung recruitment have been studied in adult and experimental populations. This review aims to establish the evidence for lung recruitment in the pediatric population.

Recruitment manoeuvres play an important role in minimising ventilator associated lung injury (VALI) particularly when lung protective ventilation strategies are employed and as such clinicians should consider their application. This paper provides evidence-based recommendations for clinical practice with regard to alveolar recruitment. It includes recommendations for timing of recruitment, strategies of recruitment and methods of measuring the efficacy of recruitment manoeuvres and contributes to knowledge about the risks associated with recruitment manoeuvres. There are a range of methods for recruiting alveoli, most notably by manipulating positive end expiratory pressure (PEEP) and peak inspiratory pressure (PIP) with consensus as to the most effective not yet determined. A number of studies have demonstrated that improvement in oxygenation is rarely sustained following a recruitment manoeuvre and it is questionable whether improved oxygenation should be the clinician's goal. Transient haemodynamic compromise has been noted in a number of studies with a few studies reporting persistent, harmful sequelae to recruitment manoeuvres. No studies have been located that assess the impact of recruitment manoeuvres on length of ventilation, length of stay, morbidity or mortality. Recruitment manoeuvres restore end expiratory lung volume by overcoming threshold opening pressures and are most effective when applied after circuit disconnection and airway suction. Whether this ultimately improves outcomes in adult or paediatric populations is unknown.

Background - Mechanically ventilated children are at risk of chronic de-recruitment with low tidal volume ventilation and acute de-recruitment with each disconnection from the circuit and application of suction. Lung recruitment manoeuvres have demonstrated gain in end expiratory levels (EEL) in both adult and experimental studies. Aim - To quantify the impact of two different methods of manipulating PEEP on EEL and regional gas distribution as measured by electrical impedance tomography (EIT) . Method - A randomised crossover clinical trial in 60 intubated and mechanically ventilated children in a PICU. Forty children underwent two methods of lung recruitment following endotracheal suctioning: a double baseline PEEP manoeuvre – held for two minutes and an incremental PEEP manoeuvre, each step held for one minute. Twenty children acted as controls. EIT measurements to quantify EEL were taken at baseline and at 15 minute intervals throughout the study period. Results - The Double PEEP manoeuvre showed significant and sustained improvement in global EEL from baseline up to 120 min (P < 0.01 ANOVA). Global EEL did not change with the Incremental PEEP manoeuvre or in the control group. The Double PEEP manoeuvre also demonstrated preferential ventilation distribution towards the dependent regions of the lung (P = 0.03 ANOVA). Nil adverse events were observed. Conclusion - Significant increases in EEL were achieved globally with a simple Double PEEP manoeuvre. The magnitude of the dependent ventilation also increased, suggesting genuine alveolar recruitment in dependent regions of the lung that was sustained for up to 120 min.