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To define and clarify the concept of leadership in the context of digital health services using Walker's and Avant's concept analysis model.Conceptualizing leadership in the context of digital health services is needed to deliver higher quality services and advance research.Searches were conducted of MEDLINE (Ovid), Scopus, CINAHL (EBSCO) and ProQuest (ABI/INFORM). Empirical articles were included if they reported attributes, antecedents or consequences of leadership in the study context. A total of 4037 references were identified; 23 were included.Leadership attributes concerned leaders' behaviour, roles and qualities. Antecedents concerned informatics skills and competence, information and tools, understanding care systems and their complexity and education. Consequences related to organization, professionals and patient and care.Based on our results, the term 'e-leadership' should be more widely utilized in nursing practice and research.Nurse leaders need to be strong leaders; they need to be visionary and use strategic thinking to develop existing and new digital solutions. By becoming e-leaders, nurse leaders may increase the successful development and implementation of eHealth and benefit clinicians and patients.

Introduction:: The use of non-pharmacological pain relief methods and pain assessment scales during labor has received limited research attention. This study aimed to describe women’s perceptions of the pain assessment and non-pharmacological pain relief methods used during labor. Methods: A descriptive, cross-sectional survey was conducted. A convenience sample of women (n=204) from one Finnish maternity ward participated in the study. Women who had given birth were asked to respond to a validated questionnaire between November 2018 and February 2019. The statistical significance of observed differences was analyzed using the chi-squared test. Results: Less than half (46%) of the women who gave birth at the hospital were asked to assess the intensity of their pain on a pain assessment scale. The most commonly used non-pharmacological pain relief methods were encouragement (92%), the presence of a midwife (82%), and proper breathing technique that was taught by a midwife (81%). Aqua blisters (3%), reflexology (e.g. zone magnets, 5%), and music (9%) were the least commonly used non-pharmacological methods during labor. The participants’ experiences of fear and pain were significantly associated with the implementation of pain assessment. Conclusions: Women’s pain was rarely evaluated by using a certain pain assessment scale. In addition, non-pharmacological pain relief methods were inadequately used during labor. More specifically, methods that required midwives’ own personal contributions were rarely offered to the women.

Publisher Copyright: © 2021 The Authors. Nursing Open published by John Wiley & Sons Ltd. Aims: To describe a study protocol for a randomized controlled trial which will evaluate the effectiveness of a gamified mobile health intervention for children in whole day surgery care. Design: A study protocol for a two-arm randomized controlled trial. Methods: Participants will be randomly assigned to the intervention group (N = 62), in which patients receive routine care and play a mobile game designed for children or the control group (N = 62), in which patients receive routine care, including a mobile phone application that supports parents during the care path. The primary outcome is children's pre-operative anxiety, while the secondary outcome measures included fear and postoperative pain, along with parental satisfaction and anxiety. Data collection started in August 2020. Results: The results of the ongoing randomized controlled trial will determine whether the developed gamified mobile health intervention can be recommended for hospital use, and whether it could be used to educate children about their surgical treatment to decrease anxiety.

Purpose The purpose of this study was to describe nurses perceptions of infants' procedural pain assessment and alleviation with non-pharmacological methods including parental guidance in departments of neonatal and infant medicine and Neonatal Intensive Care (NICUs). Design and methods A descriptive cross-sectional survey was carried out among all nurses (n= 149) who were working in neonatal and infant departments or NICUs in Estonian hospitals. Altogether, 128 questionnaires were returned and 111 respondents were eligible (75% response rate). The data were analysed using statistical methods. Results More than half of the nurses agreed that systematic documentation of the measurement of pain is necessary for nursing care and that it affects pain alleviation in infants. Half of the respondents (51%) confirmed that pain scales are important in the measurement of infants' pain, but 58% claimed they were able to assess pain in a reliable way without using pain assessment scales. Nurses also reported that they were unfamiliar with most pain scales and they were not routinely used in everyday practice. Nurses said that the most useful non-pharmacological pain alleviation methods were touching (83%) and positioning infants (78%), the most rarely used were skin-to-skin care (12%) and encouraging mothers to breastfeed the infant (34%). The majority of respondents (79%) reported that they do not know or do not have written instructions on pain assessment in their workplace, and only a few (10%) reported that they have participated in pain management courses during the last year. Conclusions There is a need to increase the use of pain assessment scales and pain documentation in everyday practice in those hospitals in Estonia. The use of scales in pain assessment was valued by few nurses. It seems that there is a lack of knowledge on non-pharmacological methods, and nurses reported using only a few non-pharmacological pain alleviation methods and guided parents on using them. Practice implications Nurses need pain management guidelines for everyday work, and in addition to nurses, written guidelines for parents are needed.

Background Enhanced recovery after surgery (ERAS) is a multimodal approach that streamlines patient processes before, during, and after surgery. The goal is to reduce surgical stress responses and improve outcomes; however, the impact of ERAS programmes in paediatric abdominal surgery remains unclear. The authors aimed to review the effectiveness of ERAS on clinical outcomes in children undergoing abdominal surgery. Method CINAHL, CENTRAL, Embase, ProQuest, PubMed, and Scopus were searched for relevant studies published from inception until January 2021. The length of hospital stay (LOS), time to oral intake, time to stool, complication rates, and 30-day readmissions were measured. Meta-analyses and subgroup analyses were conducted using RevMan 5.4 with a random-effects model. Results Among 2371 records from the initial search, 111 articles were retrieved for full-text screening and 12 were included for analyses. The pooled mean difference (MD) demonstrated reduced LOS (MD −1.96; 95 per cent c.i. −2.75 to −1.17), time to oral intake (MD −3.37; 95 per cent c.i. −4.84 to −1.89), and time to stool (MD −4.19; 95 per cent c.i. −6.37 to −2.02). ERAS reduced postoperative complications by half and 30-day readmission by 36 per cent. Subgroup analyses for continuous outcomes suggested that ERAS was more effective in children than adolescents. Conclusion ERAS was effective in improving clinical outcomes for paediatric patients undergoing abdominal surgery.

Aim: To describe hospital nurse leaders’ experiences with digital technologies. Design: A qualitative descriptive study. Methods: Semi-structured focus group interviews in one university-affiliated hospital in Finland. Data were collected from October to November 2021 and analysed using content analysis an e-leadership framework. Results: A total of 20 frontline nurse leaders and middle-managers participated. Leaders had different kinds of experiences that concerned their traits, cognition, affect and behaviour with digital technologies. Leaders experienced that they needed to be open-minded towards digitalization, which sometimes eased their work by making it more efficient. Occasionally, they also got frustrated with digitalization, which caused them stress. Leading digital technologies required collaboration with several different stakeholders, and leaders were especially responsible for ensuring nurses’ digital competence. Also, leaders own digital capability was highlighted, although some leaders experienced that their digital capability was low. Conclusion: The e-leadership framework is useful for describing the conduct of leadership roles in the context of digital services. Digitalization has transformed leadership, yet nurse leaders’ education and training do not seem to have been sufficiently modified to these rapid changes. In addition, more attention should be given to how nurse leaders can be distressed by digitalization. Impact: This study provides insight into leadership in the context of digitalized specialized medical care based on nurse leaders’ direct statements. Furthermore, the results highlight nurse leaders’ educational needs concerning digitalization. Adequately educating nurse leaders to become e-leaders is crucial to successful digitalization in the nursing domain. Patient or public contribution: The study focused on nurse leaders’ experiences.

Objective The objective of this review is to evaluate the effectiveness of technology-based interventions in relieving procedural pain in hospitalized neonates compared with other non-pharmacological interventions. Introduction Neonates requiring hospital care often experience acute pain during medical procedures. The current best practice for relieving pain in neonates is the use of non-pharmacological interventions, such as oral solutions or intervention-based human touch. Technological solutions (such as games, eHealth applications, and mechanical vibrators) have become more commonplace in pediatric pain management over recent years. However, there is a knowledge gap about how effective technology-based interventions are at relieving pain in neonates. Inclusion criteria This review will consider experimental trials that include technology-based non-pharmacological interventions for relieving procedural pain in hospitalized neonates. Primary outcomes of interest include pain response to a procedure measured by a validated pain assessment scale for neonates, behavioral indicators, and/or changes in physiological indicators. Methods MEDLINE (Ovid), CINAHL (EBSCO), Scopus (Elsevier), Cochrane Central Register of Controlled Trials, and the MEDIC databases will be searched for studies published in English, Finnish, and Swedish. Critical appraisal and data extraction will be conducted by two independent researchers following JBI methodology. Quantitative data will be pooled in statistical meta-analyses. If statistical analysis is not possible, the findings will be reported narratively. Systematic review registration PROSPERO CRD42021254218.

Family integrated music therapy approaches may contribute significantly to the prevention and management of procedural pain in infants, and the discipline of music therapy requires more sophistication in understanding how and why. In this perspective article, we advocate for the unique role parents play in neonatal pain management and for the importance of supporting and educating parents to actively engage in music therapy as procedural support. Infant-directed singing can be an apt medium for parents and infants to communicate in affective mutual relationship during painful procedures. Music therapists can collaborate with parents in a way that positions parents as experts and assures they are empowered in their roles. In doing so, music therapy both coordinates with and extends the interdisciplinary team’s initiatives to provide individualized, family integrated developmental care. Neonatal pain research is an interdisciplinary field where music therapy has just started to publish results. Theory development is essential in advancing music therapy research and practice in this field. In our perspective paper, we present the theoretical underpinnings of a family integrated approach to music therapy as neonatal procedural support where parents are the primary (re)sources for nurture and pain alleviation.Keywords: music therapy, parental infant-directed singing, family integrated care, procedural support.

Background: The importance of integrating palliative care (PC) education into undergraduate nursing studies has been recognized. Still, there is considerable variation in the PC education of nurses. Objective: To study the nursing students’ views of the PC contents during the nursing education; students’ self-assessed levels of PC competence; and whether prior education or work experience influence these views. Methods: A cross-sectional study. Data were collected using a questionnaire which was tested for its content and construct validity and internal consistency. The sample consisted of final-year undergraduate nursing students (n = 1331) from Finland. Results: The response rate was 94%. Of the students, 94.4% considered PC education to be quite or very useful, but only 51.9% reported the achieved PC teaching as quite or very good. Teaching on mental symptoms, existential issues and multicultural aspects were considered incomplete. Over half of the students wanted more education on pharmacological- and non-pharmacological pain management. Students with previous education assessed their PC competence as quite or very good more often than other students (70.1% vs. 54%, P

Purpose To describe the feasibility and clinical utility of the Finnish FLACC scale when assessing children's pain in a Pediatric Intensive Care Unit (PICU). Design and methods A non-experimental, descriptive cross-sectional study design was used to describe the feasibility and clinical utility in a Finnish PICU between May and August 2018. The nurses were asked to complete a data collection questionnaire about the feasibility and clinical utility of the Finnish FLACC every time they used the scale to assess pain in children. In total, the data consisted of 157 pain assessments cases. Quantitative data were analyzed statistically and responses to open-ended questions were analyzed using content analysis. Results In most cases, the nurses agreed that the Finnish FLACC scale was clearly structured (97%), easy to use (98%), helpful in assessing pain intensity (77%), and useful when reassessing pain after interventions (67%). Nurses found the scale more useable for children over one year old than for younger children. When assessing cry and consolability, pain was easier to score if the child was not intubated. Conclusions The Finnish FLACC scale exhibits adequate feasibility and clinical utility when assessing pain in children in a PICU. However, more information is needed about its use during painful short-term procedures and with children under one year old. Practice implications The Finnish FLACC scale is a helpful tool for nurses when assessing children's pain in a PICU. However, the Finnish version of the modified FLACC is needed for use with intubated children in the future.

Aims and objectives: To describe the views on the needs of health specialists to consider when developing a digital gaming solution for children and families in a paediatric day surgery. Background: Children's day surgery treatment is often cancelled at the last minute for various reasons, for example due to the lack of information. Digital gaming solutions could help families to be better oriented to the coming treatment. Despite the increasing demands for mHealth systems, there is not enough evidence-based information from the health specialist perspective for developing a digital gaming solution. Design: A qualitative descriptive study was conducted. Methods: Health specialists (N = 15) including 11 nurses, one physiotherapist and four doctors from different areas from one university hospital in Finland were recruited using a snowball sampling method. Semi-structured, face-to-face interviews were conducted in March and April 2019. The data were analysed using inductive conduct analyses. The COREQ checklist was used to report the data collection, analysis and the results. Results: The data yielded 469 open codes, 21 sub-categories, three upper categories and one main category. The main category the digital gaming solution to support knowledge, care and guidance in children’s day surgery included three upper categories: (a) support for preoperative information and guidance, (b) support for intra-operative information and care, and (c) support for postoperative information, care and guidance. Conclusion: Digital gaming solutions could be used to help children and families to be better prepared for upcoming treatments, to support communication in different languages and to improve children’s pain management after operations. Relevance to clinical practice: Evidence-based information is important to ensure that future digital solutions answer the real needs of the staff and patients. There is a need for families and children’s views to be taken into consideration when developing digital gaming solutions in the hospital context.

Purpose The purpose of this study was to translate and culturally adapt the Family Centered Care Assessment Scale (FCCAS) to evaluate family-centered care in the context of Finnish pediatric nursing. Design and methods The translation and cultural adaptation were done according guidelines of International Society for Pharmacoeconomics and Outcomes (ISPOR), which constitute a systematic process including ten phases. The presented research included cognitive interviews conducted with the end user of the scale: parents of hospitalized children. Results The FCCAS was successfully translated and culturally adapted to the Finnish context. Translational, clinical and parental expertise were used to develop the scale. Conceptual equivalence was achieved in the translation. In the cultural adaptation, some of the items were modified based on experts' assessments to make them comprehensible and appropriate to the Finnish culture. The scale showed good evidence of content. Reporting of the study adheres to the COSMIN checklist. Conclusions Combining ISPOR guidelines and cognitive interviews are recommended to use in the translation and cultural adaptation process. Nursing staff and parents' involvement and awareness of family-centered care have been concretized. Systematic translation and cultural adaptation have prepared a Finnish version of the scale for psychometric testing. Practice implications The study outlines how rigorous methodological approaches can be applied to the translation and cultural adaptation of a measurement tool. The developed scale includes items which comprehensively cover family-centered care characteristics. In following study, it will be possible to evaluate the extent to which family-centered care is implemented in Finnish pediatric nursing.

Evidence-based practice (EBP) has been shown to improve patient safety as well as quality of care. Advanced practice nurses (APNs) have a vital role in the implementation of EBP. This study aimed to describe APNs’ experiences of EBP implementation. The study was a descriptive qualitative study and data were collected between May and August 2019 through interviews with APNs ( n = 12). The data were analyzed using inductive content analysis. The study was reported according to COREQ guidelines. The responses were divided into four main categories: EBP in clinical nursing; EBP leadership; implementation of supporting structures for EBP; and EBP in APNs’ work. APNs experienced: that the realization of EBP varied in clinical nursing, that there was a need for development in the leadership of EBP, variation in nurse leaders’ competence in EBP leadership, and a lack of resources for EBP.

Purpose: Describe interprofessional collaboration (IPC) in the context of pain management in neonatal intensive care based on healthcare team members’ perceptions of partnership, cooperation and coordination. Design: A descriptive cross-sectional study design was used. Background: IPC improves the quality of pain management for neonates. IPC is teamwork involving both professionals and the neonates’ parents. Parents play an important role in the holistic care of their infant, which includes pain management. Methods: Data was collected with Assessment of Interprofessional Collaboration Scale (AITCS-II) from the healthcare teams featuring representatives (n = 132) of multiple professional groups who were working in neonatal intensive care units (n = 4) in Finland. Descriptive statistical methods and the Mann-Whitney or Kruskal-Wallis nonparametric tests were used to analyze the data. Results: The results were examined in three subscales of IPC (partnership, cooperation and coordination) on three different levels: “need to focus on developing collaborative practice”, “moving towards collaboration” and “good collaboration”. Participants perceived all the subscales as well as the overall level of IPC for pain management in neonatal intensive care to be at level “moving towards collaboration”. Conclusion: Participants appreciated each other as professionals and were willing to cooperate, but they had different perceptions of parental involvement in IPC. Attention should be paid to IPC in specific contexts such as pain management.

To evaluate how effective preparatory interventions for paediatric day surgery are at reducing parents' anxiety and stress and children's pain and fear.A systematic review was conducted according to Joanna Briggs Institute (JBI) guidelines and reported using the PRISMA 2020 checklist. PubMed, CINAHL (EBSCO), Scopus, Medic and Web of Science were screened for original research published up until December 2020, while Mednar and EBSCO Open Dissertations were used to identify any relevant grey literature. The methodological quality and risks of bias were evaluated according to JBI guidelines by two authors. The eligibility criteria were parents of a preschool (2- to 6-year-old) child going through day surgery with preparatory interventions, outcomes measured anxiety, stress (parent), fear and pain (child), and randomised controlled trial (RCT).Two thousand and three hundred and fourteen RCTs were screened. Fifteen studies (including 1514 participants) were chosen for narrative synthesis of parental anxiety and stress and children's fear and pain. Nine studies underwent a meta-analysis of parental anxiety (n = 970). The interventions were categorised as functional, informative or a combination of both. Four interventions reduced parents' anxiety while two significantly alleviated children's postoperative pain. The interventions found to be effective combined various ways of providing information. The meta-analysis did reveal a statistically significant impact on parents' anxiety (SMD =0.22, 95% Cl [0.03, 0.41], z = 2.28, p = .023). None of the studies dealt with parental stress or fear in children.The studied interventions used various preparatory approaches, some of which were effective at reducing parental anxiety. More RCT studies are needed to find the most effective methods for preparing parents and their children for day surgery.Preparation for day surgery through appropriate interventions can reduce anxiety among parents and postoperative pain in children.

Background: The challenge is to identify pain assessment counselling that are effective and reliable to the woman during labour while also supporting appropriate management of labour pain. Objective: This study aimed to describe women’s perceptions of their counselling on pain assessment and pain management during labour. Design: A descriptive, cross-sectional study. Participants: The sample consisted of women who had given birth (n=204) at a university hospital in Finland; 250 parturients were recruited by convenience sampling. Methods: Data were collected using a questionnaire (P-PAPM) between November 2018 and February 2019. The statistical significance of observed differences was analysed using the Chi-squared test and Fischer’s exact test. Results: Eighty percent of women reported that they had received counselling on pharmacological treatments from midwives, but only 33 % received counselling on pain assessment. The non-pharmacological methods for alleviating labour pain most commonly taught by midwives were proper breathing techniques, cold/heat treatments, and trying different positions and movements. Women were less commonly counselled to try listening to music, thinking about pleasant and positive things, or concentrating their thoughts on something other than pain. The two most commonly used counselling methods were demonstrations and written material and least used Internet-based resources. The personal issue that midwives discussed most frequently during counselling was the women’s individual hopes concerning pain management (91%), while the issue discussed least often was previous experiences of pain (58%). The participants’ experiences of fear, age, and education were significantly associated with aspects of counselling on pain assessment and management. Conclusions: Women’s counselling on pain assessment and management during labour varied widely. Therefore, to improve its quality, counselling should be routinely integrated into daily midwifery work. In particular, the counselling given on non-pharmacological pain relief methods during labour was inadequate. More varied counselling methods should be used in the future. Finally, the results indicate that midwives’ knowledge of counselling should be increased and they should be encouraged to routinely offer counselling on pain assessment and management for parturing women.

Background According to previous studies, gender-related differences have been found in relation to the experience of well-being. There are also research results indicating that environment and seasonal variation have an influence on the well-being. Aim The aim of the study was to describe how adolescent girls living in northern Finland experience nature, winter and seasonal changes and meaning of these to their well-being. Methods In this descriptive, qualitative research, 17 girls aged 13-16 who live in northern Finland participated in five focus group interviews where they presented photographs of nature they took themselves. Participation for the girls was voluntary, and the data were analysed by using content analysis. Findings Three main categories were found: winter which expresses participative and confrontational meanings, natural environment that provides meaningful stimulus and seasonal variations binding experiences. Winter had a dual effect on girls' well-being. Nature's healing elements were described by the girls as invigorating, varying and stimulating of a wide range of senses. Nature offered soothing and revitalising experiences for the girls. On the one hand, seasonal changes were seen as a refreshing change, but on the other hand, the changes were described oppressive and burdensome. Conclusion The girls described how they experienced the multiple elements of nature and environment through different senses. These sensations and feelings seem to transport the girls to a larger experience in which nature and seasonal changes were partially elements that fulfilled the girls' needs but also required adaptation. Relevance to clinical practice This experiential description encourages us to develop new means of promotive actions and brings a novel perspective and understanding about how to incorporate and implement these findings to enhance girls' well-being. Findings from this study need to be understood in this particular context in northern Finland among adolescent girls.

Background: According to previous studies, the natural environment positively influences well-being, including that of adolescent girls. However, knowledge is lacking on what motivates adolescent girls to spend time in nature. A secondary analysis of qualitative data was conducted employing three preexisting sets of interview data that had formed the basis of previously published research reports. A novel perspective on what motivates adolescent girls in the Arctic to spend time in nature was uncovered—a finding that previous articles have not reported. Aim: The aim was to describe what motivates adolescent girls in the Arctic to spend time in nature. Methods: The participants were adolescent girls aged 13 to 16 living in the province of Finnish Lapland. The girls wrote about well-being (n = 117) and were interviewed (n = 19) about the meaning of seasonal changes, nature and animals’ influence on well-being. Also, five focus group interviews (n = 17) were held. The materials were analyzed by inductive content analysis. Results: After the secondary analysis, three generic categories were found: 1) wanting to have pleasant emotions, 2) the possibility of participating in activities and 3) a desire to feel better. The main category of “need to experience positive sensations” was formed. Conclusion: Based on these results, through personalized guidance and advice, it is possible to strengthen adolescent girls’ willingness to spend time in nature.

Background Due to the rapid digitalization of health care, leadership is becoming more complex. Leadership in digital health services is a term that has been used in the literature with various meanings. Conceptualization of leadership in digital health services is needed to deliver higher quality digital health services, update existing leadership practices, and advance research. Objective The aim of this study is to outline a concept analysis that aims to clarify and define the concept of leadership in digital health services. Methods The concept analysis will be performed using the Walker and Avant model, which involves eight steps: concept selection, determination of aims, identification of uses, determination of defining attributes, construction of a model case, construction of additional cases, identification of antecedents and consequences, and definition of empirical referents. A scoping literature search will be performed following the search protocol for scoping reviews by the Joanna Briggs Institute to identify all relevant literature on leadership in digital health services. Searches will be conducted in 6 scientific databases (CINAHL, MEDLINE, Scopus, ProQuest, Web of Science, and the Finnish database Medic), and unpublished studies and gray literature will be searched using Google Scholar, EBSCO Open Dissertations, and MedNar. Results An initial limited search of MEDLINE was undertaken on October 19, 2020, resulting in 883 records. The results of the concept analysis will be submitted for publication by July 2021. Conclusions A robust conceptualization of leadership in digital health services is needed to support research, leadership, and education. The concept analysis model of Walker and Avant will be used to meet this need. As leadership in digital health services appears to be an interprofessional and intersectoral collaboration, defining this concept may also facilitate collaboration between professionals and sectors. The concept analysis to be conducted will also expand our understanding of leadership in digital health services. International Registered Report Identifier (IRRID) PRR1-10.2196/25495

BACKGROUND Due to the rapid digitalization of health care, leadership is becoming more complex. Leadership in digital health services is a term that has been used in the literature with various meanings. Conceptualization of leadership in digital health services is needed to deliver higher quality digital health services, update existing leadership practices, and advance research. OBJECTIVE The aim of this study is to outline a concept analysis that aims to clarify and define the concept of leadership in digital health services. METHODS The concept analysis will be performed using the Walker and Avant model, which involves eight steps: concept selection, determination of aims, identification of uses, determination of defining attributes, construction of a model case, construction of additional cases, identification of antecedents and consequences, and definition of empirical referents. A scoping literature search will be performed following the search protocol for scoping reviews by the Joanna Briggs Institute to identify all relevant literature on leadership in digital health services. Searches will be conducted in 6 scientific databases (CINAHL, MEDLINE, Scopus, ProQuest, Web of Science, and the Finnish database Medic), and unpublished studies and gray literature will be searched using Google Scholar, EBSCO Open Dissertations, and MedNar. RESULTS An initial limited search of MEDLINE was undertaken on October 19, 2020, resulting in 883 records. The results of the concept analysis will be submitted for publication by July 2021. CONCLUSIONS A robust conceptualization of leadership in digital health services is needed to support research, leadership, and education. The concept analysis model of Walker and Avant will be used to meet this need. As leadership in digital health services appears to be an interprofessional and intersectoral collaboration, defining this concept may also facilitate collaboration between professionals and sectors. The concept analysis to be conducted will also expand our understanding of leadership in digital health services. INTERNATIONAL REGISTERED REPORT PRR1-10.2196/25495

Purpose To explore the perceptions of parents regarding the preparation of their children for surgery. Design and methods A qualitative descriptive study was conducted. Sixteen parents of children who were undergoing various types of elective surgery in a public tertiary hospital in Singapore were recruited. Data were collected through face-to-face interviews and analyzed using thematic analysis. Results Five themes were derived: (1) assumed roles of the parents; (2) communication, decision-making, and emotional challenges; (3) factors facilitating the preparation of children for surgery; (4) surgery-related and financial concerns; and (5) the desire for more information and better management. While preparing their children for surgery, parents undertook several roles to ensure readiness and to provide support. Parents faced challenges while communicating with their children regarding their surgeries, experiencing negative emotions and dilemmas in making decisions for surgery. Factors such as previous experiences, children's positive mentality, and access to information helped to facilitate their preparation. Parents expressed surgery-related concerns such as anesthesia and a successful outcome of the surgery, the timing of the surgery, and postoperative care. Parents expressed a desire for easier to understand information through the use of visual materials, and improvements in current practices and management. Conclusion This study provides a greater understanding of parents' perceptions of their roles, challenges, influencing factors, concerns, and needs when preparing their children for surgery. Practice implications The study findings provide insightful aspects for improving current healthcare practices and informing future research studies in exploring better surgery preparation programs for both parents and children.

BACKGROUND The parents of hospitalized children are often dissatisfied with waiting times, fasting, discharge criteria, postoperative pain relief, and postoperative guidance. Parents’ experiences help care providers to provide effective, family-centered care that responds to parents’ needs throughout the day surgery pathway. OBJECTIVE The objective of our study was to describe parental experiences of the pediatric day surgery pathway and the needs for a digital gaming solution in order to facilitate the digitalization of these pathways. METHODS This was a descriptive qualitative study. The participants (N=31) were parents whose children were admitted to the hospital for the day surgical treatments or magnetic resonance imaging. The data were collected through an unstructured, open-ended questionnaire; an inductive content analysis was conducted to analyze the qualitative data. Reporting of the study findings adheres to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. RESULTS Parental experiences of the children’s day surgery pathway included 3 main categories: (1) needs for parental guidance, (2) needs for support, and (3) child involved in his or her own pathway (eg, consideration of an individual child and preparation of child for treatment). The needs for a digital gaming solution were identified as 1 main category—the digital gaming solution for children and families to support care. This main category included 3 upper categories: (1) preparing children and families for the day surgery via the solution, (2) gamification in the solution, and (3) connecting people through the solution. CONCLUSIONS Parents need guidance and support for their children’s day surgery care pathways. A digital gaming solution may be a relevant tool to support communication and to provide information on day surgeries. Families are ready for and are open to digital gaming solutions that provide support and guidance and engage children in the day surgery pathways.

Purpose To explore the experiences and needs of parents while waiting for their children undergoing surgery. Designs and Methods A descriptive qualitative study was conducted. A purposive sample of 11 parents who went through their first waiting experiences during their children's surgeries in a Singapore public hospital was recruited. Children younger than or equal to 16 years of age were included. A semi-structured interview guide facilitated the individual face-to-face interviews. Thematic analysis was used. Results Four themes were identified: “Care and care provision affecting waiting experiences”, “Parental concerns and surgery affecting waiting experiences”, “Coping strategies used during waiting periods” and “Recommendations to improve waiting experiences”. Pre-operative instructions, the professionalism of medical teams, and a lack of timely updates affected parental experiences. Parents expressed their worries. The complexities and types of surgery influenced how they felt. Their concerns included potential complications, surgical outcomes, anesthesia-related side effects, and post-operative care including pain. They spent their waiting times eating, resting, using their smart devices, and coping with a support system. Environmental improvements, more updates, and mobile applications were recommended by the participants. Conclusion For a parent, the wait during his/her child's surgery can be unsettling. Our results give insights into parental waiting experiences and needs during their children's surgeries. Practice implications These findings can guide the improvement of the current practise based on our evidence or the implementation of newer technology to provide better waiting experiences for parents during their children's surgeries and to enhance the quality of clients' experiences in the hospital.

Aims: To evaluate the effectiveness of web-based mobile health interventions on paediatric patients and their parents in the day surgery context, where the primary outcome was children's pre-operative anxiety and secondary outcomes were postoperative pain and parents’ anxiety and satisfaction with entire course of the day surgery. Design: A systematic review and meta-analysis of randomized controlled trials. Data Sources: CENTRAL, CINAHL, Scopus, Ovid MEDLINE, and Web of Science were systematically searched without time limits (up to December 2018). Review Methods: Studies were appraised using the Cochrane risk of bias tool. A random effect meta-analysis of children's pre-operative anxiety was performed. Results: Eight studies with a total of 722 patients were included in the analysis. The effectiveness of web-based mobile health interventions, including age-appropriate videos, web-based game apps, and educational preparation games made for the hospital environment, was examined in pre-operative settings. A meta-analysis (N = 560 children) based on six studies found a statistically significant reduction in pre-operative anxiety measured by the Modified Yale Pre-operative Anxiety Scale with a moderate effect size. Three studies reported parental satisfaction. Conclusion: Web-based mobile health interventions can reduce children's pre-operative anxiety and increase parental satisfaction. Web-based mobile health interventions could be considered as non-pharmacological distraction tools for children in nursing. There is not enough evidence regarding the effectiveness of reducing children's postoperative pain and parental anxiety using similar interventions. Impact: Web-based mobile health interventions reduce children´s pre-operative anxiety and could therefore be considered as non-pharmacological distraction tools for children in nursing.

Background: Palliative care exists in diverse healthcare settings. Nurses play a crucial role in its provision. Different levels of palliative care provision and education have been recognized in the literature. Therefore, nurses need a set of various competencies to provide high-quality palliative care. Aims: To systematically synthesize the empirical evidence of (1) nursing competencies needed in palliative care and (2) whether these competencies differ across the level of palliative care. Design: Systematic integrative review with thematic synthesis. Prospero: CRD42018114869. Data sources: CINAHL, PubMed, Academic Search Premier, Scopus and Medic databases. Studies on nursing competencies linked to palliative care reported in English, Swedish, Finnish, Spanish, Portuguese or German were considered. Search terms: ‘palliative care or hospice care or end-of-life care’, ‘competency or professional competence or skills’ and ‘nursing’. Articles were independently screened and reviewed by two researchers. Quality appraisal was conducted following Hawker’s criteria. Results: A total of 7454 articles were retrieved, 21 articles were included in the analysis. Six diverse nursing competencies dimensions, namely leadership, communication, collaboration, clinical, ethico-legal and psycho-social and spiritual were identified. The reports rarely defined the level of palliative care and covered a wide array of healthcare settings. Conclusion: Nurses need a wide range of competencies to provide quality palliative care. Few studies focused on which competencies are relevant to a specific level of palliative care. Further research is needed to systematize the nursing competencies and define which nursing competencies are central for different levels of palliative care to enhance palliative care development, education and practice.

Objective To describe parents' use of nonpharmacologic methods to manage infant procedural pain in the NICU and determine the demographic factors related to such use. Design A cross-sectional and descriptive study design. Setting Level III and Level II NICUs (seven units) of four University Hospitals in Finland. Participants Parents (N = 178) whose infants were treated in Finnish NICUs. Methods Parents were asked to respond to a structured questionnaire during their infants' hospitalizations. We analyzed the data using the nonparametric Kruskal–Wallis one-way analysis of variance and Mann–Whitney U test. Results Most parents reported that they used physical methods, such as touching, holding, and positioning, nearly always/always (86%, 76%, and 55%, respectively). However, less commonly used strategies included recorded music (2%), breastfeeding (2%), and non-nutritive sucking with oral sucrose (6%). Many characteristics of the infants, such as their gestational ages and their conditions, were significantly related to the implementation of nonpharmacologic methods. Conclusion There is a clear need to extend parents' use of nonpharmacologic methods to manage their infants' procedural pain in the NICU. Because many methods were not considered as pain-relieving strategies, it is important to increase knowledge about the effectiveness of these interventions among parents and nurses.

Purpose To describe parents' perceptions of their responsibilities for their infant's care during admission to a single family room in a neonatal intensive care unit (NICU). Design and methods A qualitative study with semi-structured individual interviews conducted at a family-centered level III Finnish NICU in late 2016 and early 2017. The participants were 10 mothers and nine fathers of infants aged from six days to eight months. The data were analyzed with inductive content analysis. Results The parents wanted to take responsibility for their infant's care during their stay in a single family room in the NICU, because it prepared them for their infant's discharge. The mothers and fathers reported that their responsibilities supported them as they grew into parenthood and enabled their infants' rights. On the other hand, the parents needed nurses to empower them to commit to, and take, responsibility for their infant's care and share decision making. The nurses also taught the parents caring skills. Conclusions Empowering parents to take responsibility enabled their infant's rights during their stay in a single family room in the NICU. More research is needed about how nurses transfer these responsibilities to parents and how those are connected to the infant's rights and well-being. Practice implications Organizations who provide single family rooms in NICUs need to develop guidelines that facilitate the responsibilities that parents and nurses have to care for the infants. Although parents are the infant's primary caregivers, they depend on nurses to ensure their infant is safely cared for.

Introduction: This study aims to evaluate the effects of live music therapy on heart rate variability (HRV) and self-reported stress and anxiety among hospitalized women with high-risk pregnancies. A total of 102 women at an antenatal ward due to pregnancy-related complications participated in a randomized controlled trial. Methods: The participants were randomly assigned to a music therapy group (N = 52) or control group (N = 50). The women in the music therapy group received live music therapy on three consecutive days, for half an hour at a time. The participants belonging to the control group were instructed to rest for equally long time periods. The physiologic stress of the participants was assessed using HRV measures. The participants also rated their perceived stress and anxiety. The physiologic stress of the participants was assessed using 12 HRV measures. Results: The SD2 measure of HRV increased significantly more in the music therapy group than in the control group during the therapy sessions. Moreover, the low frequency (LF) HRV measure decreased during the three-day therapy period. The self-reported stress was not significantly altered after the intervention. For women with high initial self-reported anxiety in both groups, their anxiety was significantly reduced during the three-day period.

Despite growing knowledge of parents' important role in their infants' pain management, the extent to which nurses in neonatal intensive care units (NICUs) provide guidance to parents on nonpharmacological methods is unclear. This study aimed to describe and compare the perceptions of parental guidance in using nonpharmacological pain-relieving methods among neonates in NICUs from the viewpoints of nurses and parents, and to examine the participants' demographics related to the guidance. A cross-sectional, descriptive, correlational study using questionnaire surveys was conducted. Eight NICUs of 5 university hospitals in Finland. A total of 427 participants, including 294 nurses and 178 parents. The participants indicated that the methods of touching and holding were the most commonly introduced strategies in infants' pain alleviation, as they were given as an alternative "nearly always/always" (nurses 91%, 87% and parents 61%, 58%, respectively). In contrast, music and breast-feeding were the less commonly introduced nonpharmacological methods (nurses 11%, 6% and parents 1%, 6%, respectively). A significant difference (p .001) was found between the parents' and nurses' perceptions of parental guidance; nurses reported providing more guidance about all nonpharmacological methods compared with parents. In addition, many demographic factors of the nurses, the parents, and their infants were related to the parental guidance. Our findings indicate that parental guidance should not be based on nurses' evaluations of their activities without taking into account parents' perspectives. When counseling parents to use nonpharmacological methods, neonatal nurses should actively interact with families and discuss parents' individual needs.

Background The parents of hospitalized children are often dissatisfied with waiting times, fasting, discharge criteria, postoperative pain relief, and postoperative guidance. Parents’ experiences help care providers to provide effective, family-centered care that responds to parents’ needs throughout the day surgery pathway. Objective The objective of our study was to describe parental experiences of the pediatric day surgery pathway and the needs for a digital gaming solution in order to facilitate the digitalization of these pathways. Methods This was a descriptive qualitative study. The participants (N=31) were parents whose children were admitted to the hospital for the day surgical treatments or magnetic resonance imaging. The data were collected through an unstructured, open-ended questionnaire; an inductive content analysis was conducted to analyze the qualitative data. Reporting of the study findings adheres to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Results Parental experiences of the children’s day surgery pathway included 3 main categories: (1) needs for parental guidance, (2) needs for support, and (3) child involved in his or her own pathway (eg, consideration of an individual child and preparation of child for treatment). The needs for a digital gaming solution were identified as 1 main category—the digital gaming solution for children and families to support care. This main category included 3 upper categories: (1) preparing children and families for the day surgery via the solution, (2) gamification in the solution, and (3) connecting people through the solution. Conclusions Parents need guidance and support for their children’s day surgery care pathways. A digital gaming solution may be a relevant tool to support communication and to provide information on day surgeries. Families are ready for and are open to digital gaming solutions that provide support and guidance and engage children in the day surgery pathways.

Aim of study was to evaluate the effects of a multi-component intervention on nursing students’ knowledge of evidence-based hand-hygiene. A quasi-experimental design was used. Nursing students (N = 146) from two universities of applied sciences (experimental group n = 107, control group n = 39) completed an instrument based on international clinical guidelines related to hand hygiene that consisted of 17 Likert-scale items. Data were collected at three time points (baseline, after university-based training and after clinical training) between autumn 2014 and spring 2016. Group differences were examined using chi-squared or Fisher Exact tests, the Mann-Whitney and U test. Within-group differences were assessed with the McNemar test for paired nominal data. At the first and second time points the experimental group had better hand hygiene knowledge than the controls. There were no group differences in responses to items concerning the appropriate length of hand disinfection. The experimental group showed improvements in the practice of washing hands with soap and water, but not in the other statements concerning hand disinfection. Theoretical recap and training at school seemed to influence students’ hand hygiene knowledge, but reinforcement during clinical training may be required to ensure that learning practical evidence-based skills, such as hand-hygiene, may be established.

Several pain scales are available for neonates, but, unfortunately they are only rarely used in clinical practice. To help with the current situation of unrecognized and under-treated pain in neonatal intensive care units (NICUs), we developed an assessment tool in close collaboration with clinical staff.To develop a multidimensional scale, NIAPAS (the Neonatal Infant Acute Pain Assessment Scale), that is sensitive to the needs of infants in neonatal intensive care units, and to test the validity, reliability, feasibility and clinical utility of the scale for this population.Instrument development and psychometric analysis.Pain assessments (n=180) were made of 34 neonates born between 23 and 42 weeks gestational age who were undergoing 60 painful procedures (heel lance 77%, tracheal suctioning 23%) in the NICU. Using bedside video recordings, each neonate was observed through three phases of the procedure: 1 min before the procedure, during the procedure (lasting from 0.6 to 11.2 min, mean 2.6), and 1 min after the procedure. In addition, an expert panel (n=5) and nurses (n=26) participated in the validation of the scale.A pool of 8 pain indicators (5 behavioral and 3 physiological indicators), including the gestational age of neonates as a contextual factor, was identified based on the nurses' expertise in neonatal intensive care. Scores on the NIAPAS changed significantly across the phases (p0.001), indicating a good construct validity of the scale. Correlations between the NIAPAS and NIPS (the Neonatal Infant Pain Score) were high (0.751-0.873). The study also demonstrated high coefficients for inter-rater (r=0.991-0.997) and intra-rater reliability (r=0.992-1.00), with an internal consistency of 0.723. The content validity was very good (Mean I-CVI 1.00), as evaluated by the expert group. The nurses agreed that the scale was easy to administer and that it helped decision-making in the pain management of infants.The NIAPAS was shown to be a valid and reliable scale for assessing acute pain in preterm and full-term infants in the NICU. It allows nurses to evaluate infants' acute pain especially during painful procedures and help to provide pain relief for the infants.

Aims This study aimed to describe pain assessment and management practices for neonates based on nurses' perceptions in neonatal intensive care units (NICUs). Design A descriptive cross-sectional survey was conducted in Finland. Methods Of all nurses (N = 422) working in the NICUs in the country's five university hospitals, 294 responded to a questionnaire. The data were analysed by statistical methods. Results Nurses agreed that pain assessment is important, but over half of them reported being able to assess pain in a reliable way without using pain assessment scales. Physiological parameters and changes in neonate's behaviour were reported as routinely observed, but many specific facial expressions indicative of pain were less often observed. Only a few pain assessment scales were known, and they were not routinely used in clinical practice. Most nurses reported using physical methods and giving oral sucrose along with non-nutritive sucking. Counselling parents to continue breastfeeding or guiding them to use skin-to-skin care or music was rarely reported as used to alleviate infants' pain. Conclusions Educational interventions for nurses are needed to improve pain assessment and management practices in the NICUs. In addition, there is a need for national guidelines in order to ensure the equal treatment to all neonates.

Background: In Finland, children spend a lot of time outdoors in winter. Outdoor recreation in winter has a wide variety of effects on children’s well-being. Although children are a subgroup that is vulnerable to cold exposure, remarkably little research has been done on the subject. Objective: The aim of this study was to describe children’s outdoor recreation, cold exposure and symptoms in winter in Northern Finland. Design: This was a descriptive quantitative study. The participants consisted of 30 children aged 7–8 years who were living in the provinces of Lapland and Northern Ostrobothnia in Finland. Data were collected by using electronic data-logging thermometers fixed on children’s outerwear for a month. The thermometers recorded the environmental temperature every five minutes and from that temperature data, we were able to discern the exact amount and duration of children’s outdoor recreation. In addition, information on the children’s cold symptoms was collected with structured daily entries. Results: Cold weather was not an obstacle to children’s outdoor activities in Finland. However, the duration of outdoor recreation shortened when the outdoor air temperature decreased. There were no significant differences between boys and girls in terms of time spent outdoors. Remarkably, every child reported symptoms associated with cold. Almost half of the children reported experiencing respiratory symptoms and some children also experienced cold pain and numbness. Conclusions: The results of this study illustrate the many and varied effects that cold exposure can have on children’s health and well-being. In order to prevent negative health effects of cold exposure on children, structured prevention strategies are needed: therefore, children’s exposure to cold should be studied more. Future research should also bring out more the positive health effects of outdoor recreation on children’s growth and development.​​​​

Background Preterm infants are exposed to a variety of painful procedures in a neonatal intensive care unit (NICU) and repeated and untreated pain can cause adverse consequences. Music is one of the non-pharmacological interventions that has been used increasingly in this vulnerable patient group. Objectives The objective was to systematically search, appraise and synthesize the best available evidence related to the effectiveness of music on pain among preterm infants for painful procedures in the NICU. Inclusion criteria Preterm infants born in or before 37 weeks of gestational age treated in the NICU were chosen as the population. The intervention included any type of music, which was implemented for infants by a music therapist or any health care providers during painful procedures for the purposes of research. The comparison group received no music intervention. Outcomes included level of pain measured by pain scores and physiological, behavioral and hormonal pain indicators. The review considered only experimental study designs including randomized controlled trials (RCTs) for inclusion. Search strategy Searches were conducted of 10 electronic databases of published studies and five sources of unpublished studies, in collaboration with a librarian covering January 2000−April/May 2013. The search did not impose any language restrictions. A total of 702 potentially relevant papers were identified. Six hundred forty-eight were excluded based on the evaluation of titles and abstracts, thus 54 papers remained. After excluding duplicates, 13 papers were retrieved for detailed examination. Eleven papers were excluded after review of the full text papers. Finally, two papers, which were experimental with cross-over design, were included. Methodological quality The methodological quality of eligible studies was assessed by two independent reviewers using a standardized critical appraisal tool for experimental studies (MAStARI) from the Joanna Briggs Institute. Data collection and synthesis Data were extracted from the studies that met the criteria for methodological quality. Two reviewers independently extracted the details about the interventions, populations, study methods and outcomes of significance to the review question and specific objectives. The data were synthesized using a narrative review, because heterogeneity in population, music interventions used and outcome measurements limited the possibility to pool data. The results concerning the effectiveness of music were reported using p-values and 95% CIs if appropriate. Results The effect of recorded music was examined in both studies relating to heel stick as a painful procedure. Music seemed to have a positive effect on physiological (heart rate and oxygenation) and behavioral pain indicators, as well as the pain scores (NIPS, NFCS) when considering the preterm infants’ pain in the neonatal intensive care unit. Hormonal pain indicators were not reported in the included studies. Conclusions Music may be effective in relieving preterm infants’ pain related to painful procedures in the NICU. However, the results cannot be generalized due to the fact that these studies employed sample size and their wide heterogeneity by population, outcome measurements and interventions.