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Introduction: Moral distress is widespread in health care, and nurses working in high-pressure environments, such as emergency departments, experience stress at high rates. Understanding how moral distress affects pediatric emergency nursing care is essential to moderate its negative impacts. Increased resilience has been promoted as a tool to mitigate moral distress. The purpose of this study, conducted prior to the pandemic, was to examine patterns of moral distress and the impact of moral distress on resilience among pediatric emergency nurses., Methods: A cross-sectional exploratory study of pediatric emergency nurses was performed. Moral Distress Scale-Revised (Pediatric) and Connor-Davidson Resilience Scale 25© scores were collected and calculated. Exploratory factor analysis with principal components was used to identify patterns of moral distress that impact resilience., Results: Four distinct patterns of moral distress that impact resilience were identified: (1) incompetent practice, (2) incongruent truth-telling, (3) potentially inappropriate care, and (4) discordant health care teams., Discussion: Our study was the first to identify 4 patterns of moral distress in pediatric emergency nurses. As a result, actions to promote resilience include: (1) supporting competent practice, (2) upholding appropriate truth-telling, (3) recognizing and addressing potentially inappropriate care, and (4) building concordant health care teams and systems. This pre-pandemic data provides a foundational understanding of the relationship between moral distress and resilience in pediatric emergency nurses. Identifying factors of moral distress that impact resilience has significant implications for pediatric emergency nursing, including the development of future initiatives, education, and research., (Copyright © 2023 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.)

Objective: This study aimed to evaluate the effectiveness of educational interventions in improving nurses' knowledge, attitude, and practice regarding pediatric pain management., Design: Systematic review and meta-analysis., Data Sources: A comprehensive search was conducted in MEDLINE, Scopus, Cochrane database, Google Scholar, and trial registries, supplemented by bibliography searches., Review/analysis Methods: This review included randomized controlled trials, nonrandomized trials, and quasi-experimental trials with control groups. Eligible studies involved nurses (professionals or students) caring for pediatric patients and featured any form of educational intervention for pain management. Pooled effect estimates were calculated using a random effects model, and heterogeneity was assessed using the I-squared statistic., Results: The pooled results demonstrated a significant improvement in nurses' knowledge and attitudes toward pediatric pain management postintervention, with a Standardized Mean Difference (SMD) of 2.41 (95% CI: 0.58-4.23). Additionally, the pooled results indicated a higher likelihood of effective pain medication administration (OR = 1.98; 95% CI: 1.21-3.27). However, there was no significant difference in the utilization of pain assessment tools (OR = 19.85; 95% CI: 0.29-1352.98). Pooled OR was 3.42 (95% CI: 1.93-6.07), showing significantly higher odds of ability to administer nonpharmacological interventions. Sensitivity analyses confirmed the robustness of these findings., Conclusions: Educational interventions significantly improve nurses' knowledge, attitudes, and ability to administer both pharmacological and nonpharmacological pediatric pain management interventions., (Copyright © 2024. Published by Elsevier Inc.)

Background: Nurses provide care to meet the complex needs of patients in the increasing workload in the health system and are at risk of compassion fatigue. The concept of compassion fatigue has begun drawing attention in the last decade, as it negatively affects nurses' physical and mental health, job performance and satisfaction, and therefore patient care quality., Objectives: This study was to examine compassion fatigue and predictive factors in paediatric surgery nurses., Participants and Research Context: The study was cross-sectional, predictive and quantitative. It was conducted with the 135 paediatric surgery nurses. The data were sent to the email addresses of the members via Google Survey. Research data were collected with the Nurse Information Form, Compassion Fatigue Scale, Life Satisfaction Scale and Multidimensional Perceived Social Support Scale., Ethical Considerations: After obtaining the approval of the University's ethics committee, the study was carried out after obtaining participants' informed written and verbal consent., Results: There was a difference between the level of compassion fatigue according to the paediatric surgery unit that worked the longest and the thought of changing their profession. Burn unit nurses and nurses who were considering changing professions have higher compassion fatigue scores. When the predictors of compassion fatigue were examined, the thought of changing the nursing profession and life satisfaction were significant predictors of compassion fatigue. The thought of changing the nursing profession and life satisfaction explained 22% of compassion fatigue. The same variables and the longest working period of the paediatric surgery unit were the estimators of the level of occupational burnout; explaining 29% of occupational burnout., Conclusions: Compassion fatigue, life satisfaction and perceived social support of paediatric surgery nurses are moderate. Compassion fatigue is affected by working time, the thought of changing the profession, life satisfaction and perceived social support., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Children's cardiac nursing roles have changed over the past decade. Royal College of Nursing (RCN) guidance and NHS England standards have been published with the aim of standardising and enhancing nursing care for children and young people with congenital heart disease (CHD) and their families., Aim: To explore the breath of implementation of key nursing roles in children's cardiac services across the UK and Ireland and to determine whether the roles met the RCN guidance and the NHS England standards., Method: A cross-sectional survey design was used. The 150 members of the Congenital Cardiac Nurses Association (CCNA) were invited via email to participate and were sent a link to an online survey., Findings: Of the 150 potential respondents, 31 completed the survey. Overall, respondents believed that the RCN guidance had been implemented effectively and that children's cardiac nursing roles matched the RCN's example job descriptions. Respondents' comments suggested that implementation of the NHS England standards had been challenging and that progress in setting up key roles such as lead nurse, cardiac nurse educator and children's cardiac nurse specialist had been slow. Respondents felt that political and financial factors adversely affected recruitment., Conclusion: Since publication of the NHS England standards there has been some progress in the implementation, in children's cardiac services, of key nursing roles such as lead nurse and innovative nursing roles such as advanced nurse practitioner and research nurse. The findings of this study have informed the latest edition of the RCN guidance, which now includes the role of senior research nurse., Competing Interests: None declared, (© 2023 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)

Background: The literature has revealed gaps in knowledge and attitudes regarding pediatric pain management among Ghanaian nurses and nursing students that can be attributed to inadequate education in the area. Consequently, nursing tutors teaching pain management might not have the appropriate knowledge to transfer to their students., Purpose: To explore nursing tutors' experiences of teaching pediatric pain management as well as their students' learning experiences before and after the tutors' training workshop., Design: A descriptive qualitative design was employed for the conduct of the study., Methods: Data were collected via focus groups from 32 tutors and 24 students before and after an educational workshop. Data analysis drew on Braun and Clarke's thematic analysis., Findings: Pre-workshop themes revealed knowledge deficits regarding pediatric pain management in both tutors and students due to learning having occurred in bits and pieces. Furthermore, lack of accessibility to books and pain scales perpetuated this bits-and-pieces approach to learning. Post-workshop findings revealed gains in tutors' knowledge and skills. Consequently, students gained new insights into pediatric pain management., Conclusion: Tutors and student nurses had a knowledge deficit regarding pediatric pain management. The educational workshop and the provision of learning materials resulted in enhanced knowledge and attitudes that subsequently improved tutors' ability to effectively teach the topic to their students, with a clear implication for improvements in clinical practice., Clinical Implication: Educating nursing tutors about pediatric pain is imperative to enable students and thus future nurses to be equipped with the necessary evidence-based knowledge of how to manage pediatric pain., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 American Society for Pain Management Nursing. All rights reserved.)

Purpose: To describe the nurses' use of non-pharmacological pain and stress management (N-PPSM) in pediatric wards and their perceptions of the benefits and perceived barriers that encourage and limited their use of these methods., Methods: This was a descriptive cross-sectional study involving 125 nurses working in the pediatric ward of an Indonesian hospital. Data collection utilized modified non-pharmacological method questionnaires, and data analysis involved t-tests and ANOVA., Results: The most widely used N-PPSM by nurses are cognitive methods such as providing education (48%), physical methods by positioning (40%), emotional support (36%), environmental support (45%), and family support (60%). Nurses stated that N-PPSM had few side effects (50.4%), were inexpensive (49.6%), could be performed independently (51.2%), and were easy to use (52.8%). However, during its implementation, there were several obstacles including lack of experience (42.4%), lack of training (48%), lack of equipment (45.6%), nurse belief (36.8%), lack of time (44%), patient unwilling (47.2%), and patient belief (41.6%). Work experience influences the overall utilization of N-PPSM (p-value = .043)., Conclusion: The findings from this research emphasize the significance of enhanced training for nurses working in the utilization of N-PPSM in pediatric wards., Clinical Implications: Findings from this study can enhance nurses' knowledge and competence in using N-PPSM in pediatric wards, thus improving patient care. Hospitals may consider implementing new policies, education, training, and infrastructure to support N-PPSM. Educational institutions can also incorporate these methods into nursing curricula, increasing nurses' awareness and skills in using N-PPSM in pediatric patients., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Background: Pain is a nursing diagnosis. As such, it should be evaluated and recorded regularly. Nurses should possess a high level of pain management knowledge and a positive attitude toward pain, as these are the most important factors affecting pain control and management in children., Aim: To evaluate the effect of the pain management training provided to pediatric nurses on their pain knowledge and attitudes., Methods: The study, conducted as a pretest-posttest experiment with a control group, was carried out from January-March 2019 with 61 nurses in the institutions of the Ministry of Health in Turkey. The content of the pain management for children education consisted of the definition of pain, pain theories, factors affecting pain, pain in children, the effects of pain on children, pain symptoms in children, perception of pain according to the developmental levels of children, false beliefs, and facts about pain, pain assessment, and factors preventing pain control in children. Data were obtained using the Personal Information Form, the Pediatric Pain Information form, and an Attitude Scale. Data were analyzed using descriptive statistics, a chi-square test, a t test, and validity and reliability analyses. All ethical principles were adhered to., Results: No significant difference was found between the nurses' pain knowledge and attitudes on the pretest scores in the experimental and control groups, while the mean posttest scores of the nurses in the experimental group increased significantly (p < .001). As for the pain and knowledge sub-dimensions of nurses in the experimental and control groups, no significant difference was found between the pretest scores for care, pain physiology, painless medication methods, pain relief with medication, pain psychology, and sociology. The mean posttest scores in all subdimensions increased significantly in favor of nurses in the experimental group (p < .001)., Conclusions: Mean posttest scores of pain knowledge and attitude and subdimensions of the nurses in the experimental group increased significantly, indicating that nurses' knowledge deficiencies in the realm of strong pediatric pain management can be overcome by education, and that their attitudes can be improved., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Introduction: The national pediatric mental and behavioral health crisis dramatically increased emergency department mental and behavioral health visits and changed emergency nursing practice. Acuity assessment determines patient severity level and supports appropriate resources and interventions. There are no established nursing tools that assess pediatric mental or behavioral health acuity in the emergency department setting. Our goal was to develop and implement the novel pediatric emergency nurse Emergency Behavioral Health Acuity Assessment Tool., Methods: This quality-improvement project used the plan, do, study, act model to design/refine the Emergency Behavioral Health Acuity Assessment Tool and a non-experimental descriptive design to assess outcomes. The setting was a 47-bed urban level 1 pediatric trauma center with more than 60,000 annual visits. The team designed the tool using published evidence, emergency nurse feedback, and expert opinion. The tool objectively captured patient acuity and suggested acuity-specific nursing interventions. Project outcomes included acuity, length-of-stay, restraint use, and patient/staff injuries. Analyses included descriptive statistics and correlations., Results: With over 3000 annual mental/behavioral-related visits, the emergency department had an average daily census of 23 mental and behavioral health patients. Implementation occurred in August 2021. The Emergency Behavioral Health Acuity Assessment Tool dashboard provided the number of patients, patient location, and acuity. Length-of-stay did not change; however, patient restraint use and patient/staff injuries declined. Number of restraints positively correlated with moderate acuity levels (r = 0.472, P = 0.036)., Discussion: For emergency nurses, the Emergency Behavioral Health Acuity Assessment Tool provided an objective measure of patient acuity. Targeted interventions can improve the care of this population., (Copyright © 2024 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.)

Background: Cardiogenic shock in children still carries a high mortality risk despite advances in medical therapy. The use of temporary mechanical circulatory supports is an accepted strategy to bridge patients with acute heart failure to recovery, decision, transplantation or destination therapy. These devices are however limited in children and extracorporeal membrane oxygenation (ECMO) remains the most commonly used device. Veno-arterial ECMO may provide adequate oxygen delivery, but it does not significantly unload the left ventricle, and this may prevent recovery. To improve the likelihood of left ventricular recovery and minimize the invasiveness of mechanical support, the Impella axial pump has been increasingly used in children with acute heart failure in the last decade. Purpose: There are still limited data describing the Impella indications, management and outcomes in children, therefore, we aimed to provide a comprehensive narrative review useful for the pediatric nurses to be adequately trained and acquire specific competencies in Impella management., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Picture books are often part of children's socialisation processes, contributing to the children forming images of the world, including ideas about (categories of) people, such as nurses. The study aims to explore how nurses/nursing are portrayed in children's picture books in a Swedish context. Through a systematic search, 44 books were included for analysis using thematic analysis and a theoretical lens inspired by Goffman. The results were presented in three themes: 'The costume characterised and designated nurses', 'Nurses and nursing were defined through specific activities and accessories', and 'Nurses' role as caregivers and decency practitioners'. The results showed that nurses were depicted/described in varied contexts, performing their roles mainly front stage in 'hands-on work' in close contact with patients and relatives. Nurses were attributed different accessories and personality characteristics. Nurses/nursing were generally set within a healthcare context, oftentimes within an overarching medical logic. Historical depictions of nurses' uniforms still appeared as a signifier for nurses/nursing. The presentation of nurses/nursing might have potential implications on children's understanding of and for reputations of nurses/nursing in the long term as primary socialisation and related understandings of the (sub)world(s) are deeply rooted in humans., (© 2023 John Wiley & Sons Ltd.)

Purpose: The study examined nurses' perceptions of barriers and needs when caring for pediatric patients with behavioral health needs in inpatient non-psychiatric units during the pandemic., Design and Methods: A quantitative descriptive comparative design was used. Members of Society of Pediatric Nurses and National Pediatric Nurse Scientist Collaborative were recruited. The survey included questions about perceived barriers and needs in caring for children with behavioral health needs in their units., Results: A total of 335 nurses across the United States participated. Descriptive statistics, chi-square, and Kruskal-Wallis evaluated responses. Nurses in Southeast/Southwest regions were less fearful when caring for pediatric patients with behavioral health needs (p = .03), more often knew what to do (p = .01), and were supported by a behavioral health team with regular rounding (p = .035). Nurses in adult/pediatric hospitals were less likely to have adequate education to feel competent (p = .012). Nurses in the emergency department were less fearful (p = .02), more confident (p = .025), and more competent (p = .006). Nurses with up to two years of experience were likelier to feel assignments reflected the patient workload (p = .001) and more familiar with trauma-informed care protocols (p = .013)., Conclusions: This study illustrated significant variations in competence, readiness, and attitudes among nurses across different regions, hospital types, departments, and experience levels when caring for pediatric patients with behavioral health needs., Practice Implications: Results from this study could lead to the development of clinical practice guidelines, protocols, or policies to guide practice., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Purpose: We studied the views of nursing students on family-centered care (FCC) and their knowledge, opinions, self-rated competence, current practice, and perceived implementation barriers with regard to trauma-informed pediatric nursing care., Methods: This survey was a descriptive correlational study. The sample consisted of 261 nursing students, 3rd and 4th years, who had completed the Child Health and Diseases Nursing Course. The data were obtained using the "Student Information Form," "Family-Centered Care Attitude Scale," and "trauma-informed care (TIC) Provider Survey.", Results: Nursing students were knowledgeable and held favorable opinions about TIC. The survey showed that students with higher levels and those with a hospitalization experience during childhood had higher scores regarding TIC. A positive relationship was found between the students' TIC to mean score and FCC attitude mean score., Conclusions: Nursing students are not competent to practice TIC, especially with pediatric patients. Therefore, they need to develop relevant skills for helping pediatric patients., Practice Implications: Efforts to improve nursing students' trauma-informed pediatric care should highlight specific skills related to helping pediatric patients manage emotional responses to difficult medical experiences. By integrating TIC into the baccalaureate curricula, nursing educators can provide the students with appropriate skills and facilities so that they can provide holistic and highly effective care to highly vulnerable patients., Competing Interests: Declaration of competing interest The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2023 Elsevier Inc. All rights reserved.)

By applying the PDCA model to the care of children with Henoch-Schonlein purpura, the nursing process can be divided into four stages: planning, execution, inspection, and treatment. According to the age characteristics and disease progression of pediatric patients, a complete nursing plan is formulated to efficiently implement the nursing content and improve the nursing effect. This paper studies the application of the PDCA nursing model in the nursing of children with Henoch-Schonlein purpura and statistically analyzes the disappearance of skin rash, joint pain relief, disappearance of urine protein, disappearance of gastrointestinal symptoms, etc. Finally, this paper combines the experiment to evaluate the intervention effect of this nursing model and provides reference for the follow-up care of children with Henoch-Schonlein purpura. From the results of experimental research, it can be known that PDCA nursing can improve the comfort of children with Henoch-Schonlein purpura, shorten the time for symptom disappearance, and speed up the recovery process., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 Shuai Qin et al.)

Purpose: Information can help parents of children with cancer by reducing uncertainty and giving them a sense of control in a chaotic situation. Although providing information to parents is a core activity of paediatric oncology nursing, few studies focus on interventions for informing parents. Thus, the aim of this study is to evaluate parents' experiences after participating in a person-centred information intervention for parents of children with cancer., Method: This study is part of a process evaluation of a person-centred informational intervention in paediatric oncology for patients' parents. Qualitative semi-structured interviews with 13 parents who had taken part in the intervention were analysed using qualitative content analysis., Results: An opening for healing emerged as the overarching theme, consisting of three categories. Gaining a deeper understanding of the entire situation describes how parents benefitted from processing current topics and moving forward by learning. Caring reflections in a safe space describes how parents appreciated having a moment just for themselves and feeling better by venting their feelings. Meeting a competent and compassionate nurse describes how parents experienced trust and being listened to., Conclusion: Having individual information meetings integrated as a primary nursing responsibility, mediated by competent and compassionate nurses also responsible for the care of the child, could enhance person-centred care and individualise parental education., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective: The objective of this survey is to assess nurses and pe-diatric nurses' knowledge about pediatric procedures and to evaluate, according to the results, whether it may be useful to provide handbooks that include the main techniques, courses or CME., Materials and Methods: This study is a cross-sectional survey car-ried out from 31st of May 2020 to 21st July 2020 including a sample of 811 subjects. To analyze data obtained from questionnaire, it has been used Distribution Frequency, analysis of variance and multiple regression analysis., Results: The sample analyzed, 585 nurses and 226 pediatric nurses, aged >20years, originates from central Italy (54,7%). Most profes-sionals had a post degree training (66,8%) According to ANOVA, the subjects with major knowledge of pediatric procedures are male (p=<0,001) and pediatric nurses (p=< 0,001); furthermore, post degree training (p=0,004) and a larger amount of years of service (p= <0,001) could affect significantly professionals training. Moreover, based on multiple linear regression analysis, what played a major role in a better nurse education was the higher age, 31-40 years old (p= <0,001) and origin from northern Italy (p=<0,001)., Conclusions: After a literature review on the main database, this study appears to be the first of its genre. The Survey demonstrates how pediatric nursing techniques are poorly known within nursing environment. To give a contribution for a better improvement in this field it is requested a pediatric nursing degree or at least a master in pediatrics and continue training.

The desire for career advancement has been identified as a cause of nurse turnover. In order to prevent nurses wanting to advance in their career from leaving the organization, a program was developed to transition nurses from pediatric acute and intermediate care to the intensive care unit. The intervention included classroom training, social support, and a formal orientation. Turnover rates are lower for participants in the program, and transitions to the intensive care unit have been successful.

Background: Hospitalized children have the right to "partake in practices related to their treatment and care." Midwives and nurses have important roles and responsibilities regarding the protection and enforcement of these rights, such as providing information and advocating for children., Objectives: This study aims to determine the attitudes of midwives and nurses toward their roles and responsibilities in the implementation of child rights in healthcare services and the factors affecting their attitudes., Methods: This descriptive cross-sectional study included 122 midwives and nurses in total. The data were collected through a questionnaire., Ethical Considerations: Written permission was obtained from an ethics committee in the center of the city where the research was conducted., Results: The mean age of the participants was 36.70 ± 8.03 years; 58.9% of midwives and nurses stated that they understood the child's consent about the treatment by looking at the child's facial expression; 36% of midwives and nurses stated that children could not participate in decisions regarding their own health. It was observed that obtaining the child's consent in matters related to treatment does not make any difference between midwives and nurses. The rate of the midwives stating that they would report suspicious violence-neglect and abuse was found to be higher., Conclusion: The variables of the unit of employment, the state of having children, choosing the profession and practicing in it willingly, and getting training on children's rights make a difference in terms of children's rights in healthcare services. Midwives and nurses should be reminded of child rights in healthcare services through regular in-service training programs.

Background: The professional knowledge and personal attitudes of pediatric clinicians regarding pediatric pain are the most important factors impacting pediatric pain relief care. Few studies have investigated the knowledge and attitudes regarding pediatric pain management of clinicians in Taiwan., Purpose: Research purposes were to evaluate the knowledge and attitudes of pediatric clinicians regarding pain management and to describe the barriers of applying pain management across pediatric and neonatal settings., Design and Methods: A cross-sectional descriptive comparative design was used. Pediatric clinicians from two medical centers and three general hospitals in Taiwan were recruited to complete a questionnaire., Results: A total of 264 clinicians participated. On 33 questions measuring knowledge of pain management, the average correct response rate was 23.67. A significantly positive relationship was identified between clinicians' knowledge and prior training experience. Professional degree attainment significantly impacted clinicians' attitudes about pediatric pain management. Clinicians at pediatric wards showed more positive attitudes than did clinicians at either pediatric intensive care units or neonatal intensive care units. Five barriers to pediatric pain management were found., Conclusion: The findings of this study suggest that pediatric clinicians in Taiwan need further education regarding pediatric pain management. This study will also helpful in implementing multidisciplinary pediatric pain management programs to improve the quality of pediatric practice in pediatric care settings of hospitals., (© 2020 Wiley Periodicals LLC.)

Aims: To explore the meaning of comfort and know the factors that contribute to it from the point of view of the young adults who received care in a paediatric intensive care unit, the family of the patient and the interdisciplinary team attending the patient., Findings: A total of 30 people were invited to participate in the focus groups; 24 did so. Thematic analysis yielded the following common categories: meaning of comfort, environmental factors in paediatric intensive care unit, family accompaniment during paediatric intensive care unit stay, management of information in the paediatric intensive care unit and, finally, the intimacy and privacy of the critically ill paediatric patient and their family., Conclusions: Paediatric intensive care unit professionals need to consider not only the environmental input that may lead to discomfort but also aspects such as continuous family accompaniment, the sharing of complete information with the family and the promoting of privacy., (© 2019 Nordic College of Caring Science.)

Objective: The importance of palliative care education for nurses has been recognized worldwide. The study aims to explore the experiences of nurses working with children with palliative care needs and to identify any related educational needs., Methods: The electronic databases of CINAHL, Cochrane, PubMed, OVID, Social Care Online, Web of Science, Scopus, and ProQuest were searched for the period 2000-2015., Results: Finding revealed that working with children with palliative care needs is an emotionally struggling job for nurses, especially when they try to manage the transition of pediatric patients from curative to palliative care. Staffing level and time constraints comprise a major obstacle in pediatric palliative care. Focusing on invasive treatment and technology in spite of the feelings that it will not improve patients' health status intensifies the feeling of guilt and helplessness for nurses. Finally, nurses asserted the importance of receiving pediatric palliative care education, especially how to communicate with children with palliative care needs and their families., Significance of Results: Further research is recommended with regard to nurses' experience in communication with children with palliative care needs. Nursing education in pediatric palliative care is significantly important, especially how to communicate with children with palliative care needs and their families.

Objectives: to describe a theoretical model of nursing care for children with obesity in Primary Health Care., Methods: Grounded Theory and the theoretical/philosophical framework of Virginia Henderson were used. The research was conducted in Family Basic Health Units and in Specialized Services in the city of Campina Grande, Paraíba, Brazil. A total of 24 participants composed four sample groups. Data were collected through semi-structured interviews, between April and October 2015, and analyzed by the constant comparison method. The analysis occurred by initial coding, construction of diagrams and memos, axial coding, selective coding and reflection on the paradigm and on the emerging theory., Results: six categories emerged from the data. Nurses worrying about the care of children with obesity as a neglected area in Primary Health Care was the theoretical model., Final Considerations: the phenomenon is related to the individuality of nursing care and the need for shared responsibilities.

Objectives: to understand how the dramatic therapeutic play session occurs within the care of hospitalized children., Methods: qualitative multiple case study, using theoretical references, such as symbolic interactionism and Vygotsky's theory of symbolic play. Twenty play sessions performed with six children from 3 to 10 years old were analyzed, each corresponding to one case., Results: these sessions demonstrated that a dramatic therapeutic play session is a process of four interdependent and complementary steps: bonding, exploring, dramatizing, and play cessation. They also revealed the imaginary situations externalized by the child, the importance of the exploration step for which they manage the imaginary situation and catharsis, and how her higher psychological faculties are articulated during this process., Final Considerations: the results contribute to the understanding of the conduct and analysis of the dramatic therapeutic play session, reinforcing the importance of its use in pediatric nursing care practice.

Background: One of the most common problems in children that pain can not be managed adequately by the health workers. Knowledge level of nurses is an important factor in effective pain management., Aims: This study was designed to determine intern nursing students' level of pediatric pain management knowledge (PPMK) and the affecting factors., Design: The study used a descriptive, comparative, correlational, and cross-sectional design., Settings: Research was conducted at a Nursing School of a State University., Participants/subjects: The study was carried out on 72 pediatric nursing internship students., Methods: Data were collected using a demographic data form for affecting factors such as grade point averages, age, gender, previous pain education, and self-sufficiency, and a pain management knowledge questionnaire consisting of six subdimensions: awareness of pain, pain physiopathology, barriers to pain management, pain diagnosis, pain assessment, and pain control. Data were analyzed using quartiles, correlation, regression analysis, and the Structural Equation Model., Results: The mean age of the participants was 22.64 ± 1.02, and 63.9% of them self-evaluated their current knowledge as inadequate. The PPMK score was 67.58 ± 7.37 and the students got medium level scores from the overall subdimensions. On the other hand, they got the lowest scores from the pain control (29.35 ± 4.29) and the highest scores from the pain assessment (5.49 ± 1.55). A moderate level of significant relationship was found in the Structural Equation Model (p < .05)., Conclusions: The students were determined to have a moderate PPMK level and get the lowest scores, particularly from the pain control., (Copyright © 2019 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Purpose: To investigate whether nonpharmacologic distraction as a supplement to conventional pain management can reduce children's assessment of pain in the postanesthesia care unit (PACU), and if parental assessment is a reliable proxy in assessing children's postoperative pain., Design: A nonmatched case-control study., Methods: The sample included 241 children aged 2 to 7 years assigned to one of five intervention groups or a control group. Children's and parents' assessments of pain were registered on arrival to PACU and repeated after 15, 30, and 45 minutes using the Wong-Baker FACES Pain Rating Scale., Findings: Positive effects of interventions were found in both children's and parental assessments. Results indicate a positive correlation between children's and parental assessments in children older than 3 years (P < .001)., Conclusions: Nonpharmacologic distraction is recommended as a supplement to conventional postoperative pain management. Parental assessment is a reliable proxy in assessing postoperative pain in children younger than 5 years., (Copyright © 2019 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.)

Improvements in devices and techniques used to provide life support for patients at intensive care units have reduced patient mortality. Increases in the number of survivors from a critical illness have brought long-term complications experienced during the post-intensive care period into question. The term post-intensive care syndrome (PICS) is defined as a new and deteriorating disorder in the cognitive, mental, and physical health status experienced by the survivor after intensive care unit discharge that might continue for months or even years. Opioid and sedation exposure, the severity of illnesses and injuries, dense life support interventions, length of stay in the intensive care unit, and social isolation constitute risk factors for PICS in children. These factors cause the child to experience deterioration in physical, cognitive, and psychological health domains. Such deteriorations occur on various levels and have negative effects on quality of life. The purpose of this article is to raise awareness and help pediatric nurses to develop an understanding of the condition. Increasing awareness by pediatric nurses about the magnitude and effects of complications after discharge from the intensive care unit will be the first step to protect survivors from new problems, to provide assistance for ongoing problems, and to develop follow-up strategies. PICS-related morbidities affect the majority of children discharged from PICUs. We need to understand the scope of those morbidities and develop efficient nursing interventions accordingly. It is time to expand our goal for critical and noncritical care from life-saving into improvement of functional health status and quality of life.

Problem: Despite knowing the importance of the early detection of adverse experiences, mental health disorders beginning or occurring during early childhood can be difficult to recognize. To address this gap, this manuscript describes the care of a parent-child dyad utilizing the nursing process in an illustrative case., Methods: This illustrative case provides a scenario that includes the early detection of infant mental health (IMH) in primary care with referral to a psychiatric mental health advanced practice nurse (PMHNP) and highlights how integrative care with PMHNP can facilitate the use of the nursing process to promote optimal early childhood growth and development and prevent long-term mental health problems., Findings: The collaboration between the primary care provider and PMHNP in addressing a common diagnosis observed in IMH (i.e., feeding disorder) where a 6-month-old infant presented with poor weight gain due to detached parenting, secondary to maternal depression, resulted in early infant-parent intervention that reduced maternal depression and normalized infant growth., Conclusions: The screening of IMH in pediatric primary care promotes early referral and collaboration with the PMHNP to address IMH problems to promote optimal growth and social-emotional development in early childhood., (© 2019 Wiley Periodicals, Inc.)

Background: Empathy is a central competence for nursing students in delivering compassionate care. Empathy training might improve the communication skills in children's nursing students., Objectives: To evaluate the effectiveness of the Knowledge, Simulation, and Sharing training programme on empathy skills among children's nursing students., Design: A controlled pre-post intervention study with a quasi-experimental design., Setting: Tertiary children's hospital in China., Participants: Children's nursing students (n = 250) in clinical internship., Methods: A Knowledge, Simulation, and Sharing (KSS) module related to empathy learning was developed and tested during a 10-month period in 2017. Nursing students were divided into an experimental group (n = 125) and control group (n = 125). Both groups received the standard internship programme. The experimental group received the KSS training. Outcome measures were: Jefferson Scale of Empathy-Health Professions Student, Clinical Communication Competence Scale and Professional Identity Scale., Results: At the end of the internship the experimental groups had significantly higher empathy scores than the control group (114.57 versus 110.36; p = .016). The communication skills improved significantly in the experimental group after the training; experimental group mean 90.22 versus control group mean 87.41 (p = .042). The professional identity scores were significantly higher in the experimental group at the end of the internship compared to the control group (mean 116.43 versus 107.68; p < .001). Subgroup analysis revealed only significant differences on professional identity outcomes between experimental and control groups on diploma level (mean 115.78 versus 107.72; p < .001); and bachelor's level (mean 120.05 versus 108.00; p < .016)., Conclusion: The KSS training can enhance empathy and communication skills and the professional identity in children's nursing students. Further long-term effectiveness of the training needs to be tested, ideally with reported outcomes measures of children and parents., (Copyright © 2019. Published by Elsevier Ltd.)

Objectives: to develop and validate management tools for the systematization of nursing care for children with pressure injuries., Methods: methodological study in which the focus group technique was used for validation of tools in three different groups of 17 nurses. Conducted in April and May 2018 at a large pediatric hospital., Results: two management tools were developed. The first was the Nursing care systematization instrument for children with pressure injury with three parts: a) risk factors; b) Psychobiological Basic Human Needs; c) signs of wound infection. The second was the Flowchart of pressure injury risk and prevention in pediatric patients with three categories: a) risk factors; b) Braden Q scale; c) nursing care. Final Considerations: the tools will support nurses in the care of children with pressure injuries by aiming at an individualized and systematized assessment based on a theoretical framework.

Background: A parent's cancer may have disruptive impact on his/her adolescent children. Currently, nurses have been regarded as central actors in direct involvement with patients' minor children. Development of an extended nursing role has become a pertinent issue., Objective: Adolescents' needs tend to be overlooked by nurses because of inexperience with this population. The aim of this study was to explore nurses' experiences of direct involvement with these adolescents, to get a deeper understanding about this phenomenon., Methods: Using a constructivist grounded theory approach, 12 interviews were conducted among Norwegian nurses within the cancer care context. The category insufficient competence was explored through analyzing participants' experiences of direct involvements with adolescents., Results: The recognition of insufficient competence became visible as nurses experienced being involved with a population about whom they held inadequate and limited knowledge. Adolescents were perceived as unpredictable and rejecting nurses' approaches. Consequently, nurses feared involvement and experienced failing on their assignments. After completing more or less failed attempts to establish good relationships with adolescents, the nurses request for more knowledge and experience in order to support this group., Conclusions: Nurses are recognizing insufficient competence in direct involvement with adolescents, which calls for extended competence. Because nurses are not the only responsible actors performing in this field, building competence requires a broadened attention at both an individual and organizational level, across several healthcare disciplines, as well as through user participation., Implications for Practice: Competence building should be considered in light of organizational frameworks, collective learning possibilities across disciplines, and opportunities for involving adolescents/young adults as user participants.

Children with cancer suffer from symptoms and burdensome treatments that often cause distress to children and their families. Mortality is one aspect of cancer diagnosis, while another is the quality of life and well-being during and after the treatment. By supporting children's communication, self-efficacy and coping ability in the care situation, children are given the possibilities for increased independence and participation and are allowed to develop an influence over their care. The aim of this study was to develop and evaluate the feasibility and acceptability of an adult-facilitated pretend play intervention for children with cancer. Five children with ongoing treatment for cancer were invited to a play intervention that consisted of six to eight sessions of structured pretend play aimed at increasing participation, independence, and well-being. A mixed method design was used to evaluate the feasibility and acceptability of the play intervention. Measures were collected before and after interventions, and in conjunction with every play session. Results suggest that the children enjoyed the play intervention. Findings indicate small improvements regarding self-efficacy in care situations and equal or increased quality of life for participants. A main finding was that no adverse events or increased worrying was reported in conjunction with play sessions. Therefore, the intervention is regarded as safe, feasible, and acceptable as reported by participants and their primary caregivers and a possible means of increasing participation and independence in children with a cancer diagnosis.

Objective: To understand, from the family's perspective, the meaning of admitting the child in the hospital with the use of the instructional therapeutic play., Method: A phenomenological research with 12 families of children aged four to nine years old, recently admitted to a public and teaching hospital, in the inland of the state of São Paulo, from October to December 2016. They participated in an instructional therapeutic play session focusing on the procedures performed at hospital admission: weight, height, and vital sign measurements and test collection. The families, in turn, were invited to participate in a phenomenological interview the day after the session., Results: The instructional therapeutic play collaborated in the therapeutic procedures by understanding and modifying the child's behavior. Also stressed by the families was the need for the toy to be incorporated as nursing care., Conclusion: Given the benefits to the child, the family believes that this strategy should be performed as a routine nursing care and, therefore, performed systematically during child hospitalization.

Objective: To understand the nursing team's perception about the use of technology for safe perioperative pediatric care, through photographs., Method: A qualitative study using the theoretical framework of Nietsche Specific Nursing Technology, with a total of 18 perioperative nursing professionals from a general hospital in southern Brazil. Data collection occurred from June to August 2018, from a semi-structured interview and photograph production. They were analyzed through the Thematic Content Analysis. Approved by the Research Ethics Committee of the Federal University of Santa Catarina., Results: The Nursing Technologies category used for the safety of the pediatric patient in the perioperative period, with 250 photographs illustrating facts, situations and artifacts considered nursing technologies used in safe care., Conclusions: In the team's perception, patient safety involves the use of technologies integrated to perioperative care and structural, physical and input aspects.

Aims and Objectives: To develop and evaluate the psychometric properties of a self-report instrument measuring 6- to 12-year-old children's own experiences of participation in health care., Background: Validated measures to evaluate children's participation in health care can play a critical role in strategic work towards supporting children's participation at an individual level and in working towards quality improvements at an organisational level. There are, however, no available instruments to achieve this., Methods: An instrument development design was used, together with the TRIPOD checklist. Item construction was based on research about children's perspectives on participation in health care and Shier's model for participation. The face and content validity was evaluated by 14 healthy children, 9 paediatric nurses and 8 children with different diseases. The construct validity, internal consistency and stability reliability were evaluated based on data from 138 children visiting a paediatric clinic., Results: The testing of the face and content validity resulted in an instrument with child-friendly language, additional instructions and visual attractive presentation. The principle component analysis resulted in the four-factor solution: "To be included," "To trust professionals," "To take control," and "To understand information." Internal consistency and intraclass correlation coefficients were acceptable., Conclusion: We conclude that the child participation in health care (ChiPaC) instrument has adequate reliability and validity when used to evaluate children's participation in health care. The involvement of children in the development of ChiPaC resulted in a brief, colourful and user-friendly instrument for use in paediatric health care., Relevance to Clinical Practice: This new questionnaire, ChiPaC, is adapted for children between 6-12 years measuring participation in health care from a child perspective. ChiPaC can be used in the practical work of supporting individual children's participation in health care as well as in the strategical work towards quality improvements on an organisational level., (© 2019 John Wiley & Sons Ltd.)

Problem: Adverse events occur in up to 19% of pediatric hospitalized patients, often associated with delays in recognition or treatment. While early detection is recognized as a primary determinant of recovery from deterioration, most research has focused on profiling patient risk and testing interventions, and less on factors that impact surveillance efficacy. This integrative review explored actions and factors that influence the quality of pediatric nursing surveillance., Eligibility Criteria: Original research on nursing surveillance, escalation of care, or cardiopulmonary deterioration in hospitalized pediatric patients in non-critical environments, published in English in peer reviewed journals., Sample: Twenty-four studies from a literature search within the databases of CINAHL, PubMed, and Web of Science were evaluated and synthesized using a socio-technical systems theory framework. Study quality was assessed using The Mixed Methods Appraisal Tool., Results: Assessment, documentation, decision-making, intervening and communicating were identified as activities associated with surveillance of deterioration. Factors that influenced nurses' detection of deterioration were patient acuity, nurse education, experience, expertise and confidence, staffing, standardized assessment and communication tools, availability of emergency services, team composition and opportunities for multidisciplinary care planning., Conclusions: Research provides insight into some aspects of nursing surveillance but does not adequately explore factors that affect clinical data interpretation and synthesis, and role integration between nurse and parents, and nurse and other clinicians on surveillance of clinical stability., Implications: Research is needed to enhance understanding of the contextual factors that impact nursing surveillance to inform intervention design to support nurses' timely recognition and mitigation of clinical deterioration., Competing Interests: Declaration of competing interest None., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Nurses play an important role in children's pain assessment and management because they spend the majority of the time with them and provide care on a 24-hour basis. However, research studies continue to report on nurses' inadequate assessment and management of children's pain, which may be partly attributed to their insufficient education in this area., Objectives: This integrative review sought to examine the effect of strategies used in educating nurses on pediatric pain assessment and management., Design: An integrative review., Data Sources: Cumulative Index to Nursing and Allied Health Literature, Cochrane, PubMed/ Medline and Scopus., Review/analysis Methods: Four databases were searched up to February 2018 based on a prescribed eligibility criteria. The review included 37 studies with varied methodologic quality., Results: Our findings revealed that various types of educational strategies improve nurses' knowledge, attitudes, and practice of pain assessment, management, and/or documentation., Conclusions: Developing a responsive program that includes expectations of beneficiaries, integrating it into existing facility training systems and delivering it through multidisciplinary collaboration, offers the benefit of securing sustainability of the educational gains., (Copyright © 2019 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Objective: to understand the meaning of the care of hospitalized children for the nursing professionals of a pediatric unit., Method: phenomenological study, based on the existential phenomenology of Martin Heidegger. Ten nursing professionals were interviewed with the guiding question: "What is the care of hospitalized children for you? Tell me, in detail, your experience with taking care of hospitalized children.", Results: the meaning of the care of hospitalized children materializes between the profession and the various ways of preoccupation. By engaging in/worrying about the ways of being of everyday life, the professionals tend to improperness when trying to mediate and level all possibilities of being. However, when they extrapolate reassurance and do not get caught up in themselves, they achieve empathy, respect, and indulgence., Final Considerations: it is necessary to reassess the teaching and practice of care, so that authentic care is offered to children and their families in the context of hospitalization.

Objective: To identify how children's stories can be used in child care., Method: Integrative literature review, conducted in databases between 2000 and 2018, in three languages. Full research articles were included that agreed with the following question: "How can children's stories be used in child care?"., Results: From the analysis of 16 selected articles, three categories emerged: The use of stories in the hospital; Specialized nursing intervention; and Stories in the educational dimension., Final Considerations: Evidence shows benefits to children, families, institutions and nursing. The use of children's stories as a care intervention can occur in different situations and settings, values; boosts bonds, reduces anxiety in children and families, encourages children's participation in care, and promotes health education. It is a low-cost and still incipient strategy in nursing.

Background Examining nursing pedagogical strategies is important to assure that nursing students have opportunities to become knowledgeable and skilled clinicians. However, little is known about the nursing pedagogical strategy of using schools for pediatric practicum. The purpose of this review is to integrate the evidence regarding the use of schools as practicum sites for nursing students to obtain pediatric clinical experience. Method Searches were conducted in three electronic databases resulting in 70 publications; eight publications met the inclusion criteria. Results Five themes were identified using content analysis: description of practicum settings; level of education, number of students, clinical time and geographic region of the college; theoretical framework; nursing student activities and assignments; nursing student outcomes, evaluation of pediatric practicum experience, and school student health outcomes. Conclusion Findings support the use of schools for pediatric practicums.  This practicum broadens nursing students' knowledge of promoting health among well and chronically ill children.

Introduction: Pediatric emergency nurses who are directly involved in clinical care are in key positions to identify the needs and concerns of patients and their families. The 2010 Institute of Medicine report on the future of nursing supports the active participation of nurses in the design and implementation of solutions to improve health outcomes. Although prior efforts have assessed the need for research education within the Pediatric Emergency Care Applied Research Network (PECARN), no systematic efforts have assessed nursing priorities for research in the pediatric ED setting., Methods: The Delphi technique was used to reach consensus among emergency nurses in the PECARN network regarding research priorities for pediatric emergency care. The Delphi technique uses an iterative process by offering multiple rounds of data collection. Participants had the opportunity to provide feedback during each round of data collection with the goal of reaching consensus about clinical and workforce priorities., Results: A total of 131 nurses participated in all 3 rounds of the survey. The participants represented the majority of the PECARN sites and all 4 regions of the United States. Through consensus 10 clinical and 8 workforce priorities were identified., Discussion: The PECARN network provided an infrastructure to gain expert consensus from nurses on the most current priories that researchers should focus their efforts and resources. The results of the study will help inform further nursing research studies (for PECARN and otherwise) that address patient care and nursing practice issues for pediatric ED patients., (Copyright © 2019 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.)

Primary palliative care improves access to symptom control and quality-of-life care for children and families and can reduce moral distress in clinicians. This article describes the application of a nursing theory framework for an evidence-based practice/quality improvement project that embedded pediatric primary palliative care into a hospital-based setting using unit-specific projects. An evidence-based practice/quality improvement project, guided by the Comfort Theory™, provided primary palliative care education and mentorship to improve knowledge, skills, and attitudes of direct care clinicians. Training consisted of didactic and self-directed learning, mentoring, and completion of unit-based projects to establish meaning and impact best practices and policies. A total of 149 direct care clinicians, comprising 3 cohorts, enrolled in the program. Improvements in interdisciplinary collaboration in care were demonstrated through 21 unit-based projects, the development of triggers for specialty palliative care consults in several high-risk populations, and the development of institutional guidelines for end-of-life care. The Comfort Theory™ guided integration of palliative care for children with serious illness and their families. This project empowered direct care clinicians in caring for patients, providing support to clinical staff, and in developing best practices.

Background: Cultural sensitivity is a core concept to establish awareness and knowledge about various ethnicities, cultures, genders and additional diversity characteristics to understand individual's requests and respond appropriately to them. A need for further development of the concept is warranted, especially in the context of paediatric nursing., Aims: The purpose of this paper was to determine the main elements of cultural sensitivity in the context of paediatric nursing in Iran., Methods: The Hybrid method was implemented consisting of three phases: theoretical, fieldwork and final analysis. In the theoretical phase, articles from 2007 to 2017 were reviewed for relevance. In the phase of fieldwork, 25 nurses and nine parents were interviewed to explore the aspects of cultural sensitivity in paediatric nursing. The interviews were transcribed, and content analysis was conducted. In the final phase, an overall analysis of the two previous phases was performed., Results: In the theoretical phase, the following attributes were determined: cultural encounter and awareness, acceptance of cultural diversity and designing programmes in accordance with family culture. The fieldwork phase explored three themes of intercultural encounters, intercultural communication and adapting the care plan with family culture. The final synthesis yielded that sensitivity to family requests and beliefs, effective intercultural communication and integration of family culture with the care plan are the main elements of cultural sensitivity in Iranian paediatric nursing., Conclusion: With a deeper understanding of the term cultural sensitivity, nurses will have a foundation to improve paediatric nursing care and align the care plan with the patient's culture to provide trust, child/parent participation, secure care, effective communication and satisfaction. Since the concepts are the building blocks that underpin theory, the present concepts identified can help to serve as the foundation for the development of a theoretical model., (© 2019 Nordic College of Caring Science.)

Theoretical Principles: Children and adolescents are faced with ubiquitous daily stressors. When faced with various stressors, they will either recover or stay distressed. For those unable to recover, acute daily stressors have potential to turn chronic with long term negative mental health outcomes. Nurturing resilience is one way to prevent distress from turning to mental health disorders. With the ability of adolescents and children to access nurses with various specialties, it is imperative nurses understand the nuances of resilience and the core elements to nurture resilience in youth., Phenomena Addressed: The purpose of building the concept of nurturing resilience is to clarify the meaning of this concept in children and adolescents, develop a conceptual definition of nurturing resilience, and provide a conceptual model of nurturing resilience based on the building process. The concept was formulated utilizing Liehr and Smith's practice-based approach to concept building., Research Linkages: Concept building defines nurturing resilience as developing secure connections with another to support self-acceptance that aids in tempering reactivity when faced with environmental hardships. Resilience is a protective mechanism which keeps youth balanced while promoting positive mental health when faced with adversities by allowing one to bounce back after adversity to an original, fundamental state. Understanding patterns and processes of resilience enables nurses to nurture resilience. Nurturing resilience provides adolescents and children the ability to change in response to difficult circumstances; in turn, mental distress is reduced, and mental health of youth are optimized., (Copyright © 2019 Elsevier Inc. All rights reserved.)

The Japanese nursing education system only requires a general nursing qualification. After graduation, many Japanese nurses work within pediatric departments where they receive specialized training in pediatric care. An intervention program for promoting ethical nursing practices among patients and their families was implemented for pediatric nurses with 0-5 years pediatric nursing experience. The objective of this study was to clarify changes in nurses' recognition and behaviors, as well as the intervention's post-initiation durability. The pediatric nursing care model (PNCM), defining 24 nursing approaches, was developed to show simple examples of ethical nursing practices for pediatric patients and their families. An intervention program included an initial session that consisted of a 30-minute mini-lecture. Nurses also described details of approaches previously performed and conducted a peer-review. Concerning the PNCM, the frequency of implementing each approach was examined using a 4-point Likert scale both before and at 2-month post-intervention initiation. Recognition of intervention feasibility was evaluated using a 4-point Likert scale at the end of the first session. Furthermore, during the second month, reflection and outcome content was evaluated by examining approaches the nurses performed and described. During the third month, the nurses were asked to describe changes in their behavior in terms of ethical nursing practices, along with those observed by patient and family responses, and any recognition of future challenges. Regarding the care model items, feasible practices were recognized immediately post-intervention, and 18 of 24 items (75.0%) revealed significant improvement. Implementation frequency for 10 out of 18 items (55.6%) was higher than before the intervention, and there was a significant difference among four items. The intervention program led to improvements in highly feasible and basic ethical nursing practices, including an increase in greetings and self-introductions, verbal explanations for children, quantitative and qualitative alterations in order to improve children's coping behaviors, changes in nurses' active attitudes for reducing children's fear and attitudes for feasible future implementation. Changes in practices at 3-month post-initiation corresponded to the four components of "child assent" or the final three goals of our conceptual framework.

Nurses play a key role in administering sedation to mechanically ventilated children, which impacts children's psychological, physiological and cognitive changes in the paediatric intensive care unit. This study aimed to survey the sedation practices of paediatric intensive care unit nurses on mechanically ventilated children in China and explored the influencing factors. A cross-sectional survey was conducted based on electronic questionnaires comprised of the Nurse Sedation Practices Scale (Chinese version) in 14 different types of paediatric intensive care units of 11 academic hospitals in China from 15 February to 15 April 2017. A convenience sample of 495 nurses [73·4% response rate, (674)] completed the survey. Seven units applied Ramsay Sedation Scale as a sedative assessment tool. The majority of the nurses used observed behaviours and physiological changes of the ventilated children as indicators to assess the sedation level, and they had a positive attitude and intention, which may influence practice positively, whereas high clinical workload and the lack of communication between the nurses and families might hinder practice. The practice of sedation varied greatly in different regions, and the respondents of the northwest region scored lower. Paediatric nurses in China rarely used a validated paediatric instrument to assess sedation, and most nurses relied on physiological and behavioural cues. The quality of sedation training, nursing workload and regional economic disparity affected the sedation practice. The restricted visiting policy and lack of clearly defined nursing responsibilities around sedation may hinder effective sedation assessment and management. This study found that there was no paediatric-validated tool popularized in paediatric intensive care units in China and explored influencing factors. We suggest that a validated tool, high-quality training and hospital's policy, such as visiting regulation, should be promoted to improve the sedation practice., (© 2019 British Association of Critical Care Nurses.)

Introduction: The American Academy of Pediatrics (AAP) recommends primary care-based health promotion for obesity prevention at all visits, focusing on nutrition and activity., Methods: In this quality improvement project, a primary care innovation was developed to support parents in promoting healthy habits in their children ages 2 to 5 years old. Nurse-led telephone support using motivational interviewing was implemented during two follow-up phone calls aimed at helping parent-child dyads reach self-created activity or nutrition goals., Results: Parent-rated confidence and motivation related to meeting these goals showed significant increases. During the second call, 80% self-reported goal completion and high satisfaction with the visits. Registered nurses reported a significant increase in their self-efficacy of communication with parents., Discussion: This project showed the feasibility of using nurse telephone visits in an urban low-income primary care setting to improve parental recognition and understanding of healthy habits that align with American Academy of Pediatrics recommendations for obesity prevention., (Copyright © 2019 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.)