Impact of the Nursing and Midwifery Council (2018) future nurse: Standards of proficiency for registered nurses on children's nursing curriculum - A cross-sectional study.

BACKGROUND: Student nurses in the United Kingdom undertake field-specific pre-registration education. The implementation of the Nursing and Midwifery Council (2018) Future nurse: Standards of proficiency for registered nurses, has raised concerns that the increasingly generic component of pre-registration programmes is not adequately preparing newly qualified children's nurses to care for children safely. OBJECTIVE: To investigate how the introduction of the Nursing and Midwifery Council standards in the United Kingdom has impacted the structure and field specific content of pre-registration children's nursing programmes. SETTINGS: An online survey completed by 54 programmes, field, or professional leads linked to 76 pre-registration children's nursing programmes. This represents 80 % of higher education institutions with Nursing and Midwifery Council approved pre-registration children's nursing programmes across all four United Kingdom countries. METHODS: A survey to capture the current content and changes to curricula since the introduction of the Nursing and Midwifery Council (2018) Future nurse standards. The survey included closed-ended and open-ended questions. Closed-ended questions were statistically analysed using SPSS v.28 for Windows. Open-ended questions were thematically analysed using Quircos v.2.1. RESULTS: 50 % of respondents reported changes to theoretical content. In 27 programmes (35.5 %) there was a decrease in child-specific content. Child specific teaching methods accounted for less than 30 % of the content of all programmes whereas cross-field teaching methods (Adult, Mental Health, Learning Disability and Child learners together) accounted for over 70 % of the taught content. Analysis of qualitative data identified three themes: genericism as the focus, the challenge to achieve the standards' proficiencies, and dilution of child specific content. CONCLUSIONS: The survey responses show disparities in how United Kingdom higher education institutions have interpreted the Nursing and Midwifery Council standards highlighting academics concerns on the growing genericism within pre-registration children's nurse education nationally. These findings will inform the next stage of the project comparing the impact of greater or lesser degrees of genericism on the outcomes of the programme for newly qualified children's nurses.

Advanced Practice Pediatric Oncology Nursing as Imagined or In Place in Four Lower- and Upper-Middle-Income Countries.

OBJECTIVES: The implementation of pediatric oncology advanced practice nurse (s) roles in low- and middle-income countries (LMICs) presents opportunities and challenges. The authors explore the implications of pediatric oncology advanced practice nursing roles in Pakistan, Cameroon, Turkey, and Mexico. Potential benefits and drawbacks of advanced practice nursing roles, impacts on nursing care, and strategies for advanced practice nursing role development in LMIC settings are considered. METHODS: Information from scholarly articles, policy documents, and four LMIC pediatric oncology nurse expert perspectives on existing and imagined advanced practice nursing roles in pediatric oncology in LMIC were synthesized. RESULTS: Current literature and policies point to efforts across LMICs to establish a wide variety of advanced nursing practices, not necessarily aligned with internationally accepted advanced practice nursing standards of practice or education. The LMIC nurses describe a wide range of national general nurse education and government advanced practice nurse recognition/licensing. Challenges to achieving or strengthening advanced practice nursing roles include, for example, healthcare professional resistance, government unwillingness to recognize/license advanced practice nurses, and lack of advanced practice nursing faculty. To promote a pediatric oncology advanced practice nursing role in LMICs requires navigating the national nursing scope of practice and nursing culture. CONCLUSION: The strategic introduction of pediatric oncology advanced practice nursing roles in LMICs has the potential to significantly enhance patient care by, for example, addressing healthcare workforce shortages and facilitating timely care delivery. However, challenges related to role complexity, resistance from traditional healthcare structures, and role overlap must be considered. Tailoring these roles to local contexts and fostering stakeholder collaboration are essential for successful implementation. IMPLICATIONS FOR NURSING PRACTICE: The adoption of advanced practice nursing roles can lead to improved quality of care for pediatric oncology patients and their families in LMICs, where cancer care is challenging. The positive impact of pediatric oncology advanced practice nurses on patient outcomes and healthcare delivery cannot be discounted but must align with local nursing and healthcare culture and expectations.

Child health nursing consultation and competencies for Advanced Practice Nurses.

OBJECTIVE: To analyze nurses' practice in child health nursing consultations and the presence of care management competencies proposed for Advanced Practice Nurses (APN). METHOD: Multicenter, exploratory sequential mixed methods research, carried out in 17 Basic Health Units in four Brazilian cities. Collection was carried out from May to July 2022 through filming of consultation and analysis of medical records. Consultations with compliance with the Nursing Process ≥50% were analyzed to identify the competencies proposed for APN. RESULTS: 24 child consultations carried out by 12 nurses were filmed. In the quantitative analysis, 11 nursing consultations, carried out by seven nurses, achieved ≥50% Nursing Process compliance. In the qualitative analysis of these consultations, some APN competencies in care management were identified, but incomplete. CONCLUSION: child health nursing consultations present weaknesses in carrying out the Nursing Process, and nurses demonstrated a partial and superficial application of the care management competencies proposed for APN.

Specialist nurse's health promotion work with the national childhood immunization programme: A qualitative study.

PURPOSE: Childhood immunizations have proven to be one of the most beneficial interventions to promote public health and prevent childhood deaths due to disease. However, global coverage of childhood immunization has decreased throughout the world due to guardians' growing hesitancy towards immunizations. This study aims to describe how specialist nurses promote legal guardians to adhere to national childhood immunization programmes. DESIGN AND METHODS: This study had a qualitative design. Semistructured interviews with 11 specialist nurses, who were paediatric primary care nurses or nurse practitioners, were conducted. Data were analysed using qualitative content analysis. RESULTS: The findings, with four main categories including four subcategories, showed nurses using both local guidelines and national guidelines to promote guardians to adhere to the childhood immunization programme. The main intervention the nurses did to promote childhood immunization coverage was giving legal guardians general information about the programme. With hesitant guardians, adopting a person-centred approach towards the legal guardian improved adherence. PRACTICE IMPLICATIONS: Further research should focus on how specialist nurses can respond to guardians who decline immunization for their children, as this study identified difficulties in this area. Furthermore, research on guardians' perspectives towards childhood immunization may also help generate further effective guidance on how to promote immunization coverage among children.

'We are pulled to the four corners': Qualitative role descriptions of advanced practice children's nurses in Malawi.

PURPOSE: This study investigated emerging roles among specialist child health nurses (CHNs) in Malawi. Advanced nursing role development is globally advocated. Nursing role descriptions provide an evidential basis for workforce planning. Rigorously developed role descriptions are scarce worldwide, especially for Africa. Advanced nursing roles were introduced in Malawi's child health system a decade ago. DESIGN AND METHODS: We followed guidance on generating nursing role descriptions to collect and analyse qualitative data from interviews and focus groups, using qualitative content analysis. We used COREQ reporting standards. RESULTS: More than half (41/80) of Malawi's child health nursing workforce participated. Richly descriptive accounts of roles elicited three themes: leading and developing new services and improving existing ones; holding rare knowledge which uplifts care quality; and responsibility for developing the role. These responsibilities are experienced as a privilege and a burden, often meaning CHNs are 'pulled to the four corners'. PRACTICE IMPLICATIONS: We found evidence of remarkable achievements by Malawi's CHNs but also suggestions that they are under heavy strain. Because multi-stakeholder agreement about role content is crucial to successfully implementing advanced nursing roles, we hope the approach taken by this study, and the information generated, could be useful as part of human resources for health strategy development in other lower-resourced countries globally.

The quality of nursing care from the perspective of hospitalized school-age children.

PURPOSE: Hospitalized children's satisfaction with the care they receive is the main indicator for evaluating the way nurses should provide services and the quality of these services. The current study aimed to examine school-aged children's perceptions of nursing care quality. METHODS: In this cross-sectional study, 144 children aged 7-11 years were selected through a convenience sampling method. The data collection tool included The Child Care Quality at Hospital Questionnaire, and the personal- and family-related and disease-related factors questionnaire. Independent t-test, one-way analysis of variance, Pearson's correlation coefficient and multiple linear regression test were used for data analysis. RESULTS: Based on the findings, the highest score of nursing care quality was related to characteristics domain (13 ± 1.7). In addition, the children's age, father's education and history of hospitalization were related to nurses' characteristics domain; mother's education and length of hospital stay were related to nursing activities domain; and mother's education, father's occupation and length of hospital stay were related to nursing environment domain. CONCLUSION: The results of the present study showed that children's nurses can provide better quality care to children by paying attention to nurses' characteristics and then the scope of activities and care environment. PRACTICE IMPLICATIONS: Considering the factors affecting the nursing care quality, a conscious step should also be taken for strategic planning of care.

Developing and validating a 2D digital version of the Brazilian Children's anxiety questionnaire.

PURPOSE: This study aims to transpose the printed Brazilian Children's Anxiety Questionnaire (CAQ BR) into a 2D digital format, validate it with nurses and hospitalized children, and analyze the association between the printed and 2D digital format versions. DESIGN AND METHOD: This is a descriptive and multicentric study, conducted from 2021 to 2022 on working in pediatric care at two hospitals in Brazil. The nurses analyzed the printed and digital instruments and subsequently applied them to a child and proposed suggestions. A cutoff score of 0.80 on the content validity index was used; items that scored an average lower than the CVI in the study were adequate. Eighty children responded to the questionnaires sequentially according to the randomization table. A 90% agreement rate was used. RESULTS: The digital instrument was validated in content by 51 experts, with a CVI of 0.95. Face validation data for 80 children (mean age = 7.9 years) shows a 90% agreement rate. The intraclass correlation index for the general score was 0.87 and 95% CI (0.79-0.91), which shows good stability of the children's responses in both questionnaires. In addition, 59% (n = 47) of the children reported a preference for the digital questionnaire. CONCLUSIONS: The digital CAQ BR can be used as an audiovisual instrument by nurses when implementing the systematization of nursing care in pediatrics. PRACTICAL IMPLICATIONS: The digital 2D version was successfully applied and can be used in hospitals to measure children's self-reported anxiety.

The Effect of Pain Management Education on Nurses' Pain Knowledge and Attitudes.

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.

Developing a NAPNAP Research Agenda to Guide Future Research and Quality Improvement in Pediatrics: Process, Challenges, and Future Directions.

INTRODUCTION: This study aimed to develop a revised pediatric Research Agenda that highlights the clinical and research priorities for pediatric-focused advanced practice registered nurses and is culturally sensitive and inclusive. METHOD: The National Association of Pediatric Nurse Practitioners (NAPNAP) Research Committee developed the Research Agenda 2021-2026 by conducting a cross-sectional study that surveyed the membership on their research and clinical priorities in June 2020. Twenty-four priorities were identified within seven areas of focus. RESULTS: Among the 7,509 National Association of Pediatric Nurse Practitioners members, 273 (3.6%) responded to the email and 199 completed the survey. DISCUSSION: This revised Research Agenda is a bold and innovative guide for grant funding, publications, continuing education offerings, conference planning, and abstract submissions for posters and podium presentations aimed at improving pediatric health care. A discussion of the process and considerations for the future development of pediatric Research Agendas is described.

Development of the clinical competency assessment scale in child and adolescent mental health nursing.

WHAT IS KNOWN ON THE SUBJECT?: Children and adolescents' mental health problems, such as autism spectrum disorder, anxiety disorder and attention-deficit hyperactivity disorder, are a global public health concern, and nurses require advanced expertise and skills to properly care for this population. There is a gap between the required competencies and the actual skills and knowledge of CAMHN practitioners. Previous studies suggest that educational interventions for nurses are necessary to enhance the quality of care for children and adolescents with mental health problems. However, the corresponding evaluation indicators have not been verified, making it difficult to determine the most effective methods. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The present study developed the two-factor (direct care for children and their family members and approach to the care environment) Clinical Competency Assessment Scale in Child and Adolescent Mental Health Nursing (CCAS-CAMHN). We demonstrated that the assessment scale was reliable and valid, based on its adequate internal consistency and temporal stability, the acceptable range of its model-fit indexes, and its good concurrent and divergent validity. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The newly developed scale is useful for assessing nurses' competency and could help them identify their difficulties in CAMHN. The scale could contribute to the development of effective educational interventions to enhance the quality of care for children and adolescents with mental health problems. ABSTRACT: INTRODUCTION: Caring for children and adolescents with mental health problems, such as autism spectrum disorder, anxiety disorder and attention-deficit hyperactivity disorder, requires expertise and skills. A quantitative clinical competency measurement tool in child and adolescent mental health nursing (CAMHN) is needed to evaluate the indicators of advanced expertise. AIM: The aim of this study was to develop a clinical competency assessment scale in CAMHN and evaluate its psychometric properties. METHOD: Scale items were derived from previous studies and adjusted based on cognitive interviews with five CAMHN experts. In total, 505 nurses in CAMHN from 29 hospitals in Japan participated in the self-administered survey. The scale's construct validity, criterion-related validity, internal consistency and test-retest reliability were assessed. RESULTS: A two-factor (direct care for children and their family members and approach to the care environment) scale was constructed. A secondary structural model showed that a two-factor model fits best. The total score was significantly and positively correlated with excellence in nursing practice, amount of clinical experience and mental status. The overall scale exhibited good validity and reliability. DISCUSSION: The scale is reliable and valid for assessing CAMHN clinical competency. IMPLICATIONS FOR PRACTICE: The scale is useful for assessing nurses' competency and evaluating educational interventions' effectiveness for nurses.

Exploring the implementation of key nursing roles in children's cardiac services.

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.

Perspectives of Pediatric Providers on Patients With Complex Chronic Conditions: A Mixed-Methods Sequential Explanatory Study.

BACKGROUND: Children with complex chronic conditions present unique challenges to the pediatric intensive care unit, including prolonged length of stay, complex medical regimens, and complicated family dynamics. OBJECTIVES: To examine perspectives of pediatric intensive care unit health care providers regarding pediatric patients with complex chronic conditions, and to explore potential opportunities to improve these patients' care. METHODS: A prospective mixed-methods sequential explanatory study was conducted in a tertiary medical-surgical pediatric intensive care unit using surveys performed with REDCap (Research Electronic Data Capture) followed by semistructured interviews. RESULTS: The survey response rate was 70.6% (77 of 109). Perspectives of health care providers did not vary with duration of work experience. Ten semistructured interviews were conducted. Eight overarching themes emerged from the interviews: (1) the desire for increased formal education specific to pediatric complex chronic care patients; (2) designation of a primary intensivist; (3) modifying delivery of care to include a discrete location for care provision; (4) establishing daily, short-term, and long-term goals; (5) monitoring and documenting care milestones; (6) strengthening patient and family communications with the health care team; (7) optimizing discharge coordination and planning; and (8) integrating families into care responsibilities. CONCLUSIONS: Pediatric intensive care unit health care providers' perspectives of pediatric patients with complex chronic conditions indicated opportunities to refine the care provided by establishing daily goals, coordinating discharge planning, and creating occasions for close communication between patients, families, and providers.

Quality and capacity indicators for hospitalized pediatric oncology patients with critical illness: A modified delphi consensus.

BACKGROUND: Hospitalized pediatric hematology-oncology (PHO) patients are at high risk for critical illness, especially in resource-limited settings. Unfortunately, there are no established quality indicators to guide institutional improvement for these patients. The objective of this study was to identify quality indicators to include in PROACTIVE (PediatRic Oncology cApaCity assessment Tool for IntensiVe carE), an assessment tool to evaluate the capacity and quality of pediatric critical care services offered to PHO patients. METHODS: A comprehensive literature review identified relevant indicators in the areas of structure, performance, and outcomes. An international focus group sorted potential indicators using the framework of domains and subdomains. A modified, three-round Delphi was conducted among 36 international experts with diverse experience in PHO and critical care in high-resource and resource-limited settings. Quality indicators were ranked on relevance and actionability via electronically distributed surveys. RESULTS: PROACTIVE contains 119 indicators among eight domains and 22 subdomains, with high-median importance (≥7) in both relevance and actionability, and ≥80% evaluator agreement. The top five indicators were: (a) A designated PICU area; (b) Availability of a pediatric intensivist; (c) A PHO physician as part of the primary team caring for critically ill PHO patients; (d) Trained nursing staff in pediatric critical care; and (e) Timely PICU transfer of hospitalized PHO patients requiring escalation of care. CONCLUSIONS: PROACTIVE is a consensus-derived tool to assess the capacity and quality of pediatric onco-critical care in resource-limited settings. Future endeavors include validation of PROACTIVE by correlating the proposed indicators to clinical outcomes and its implementation to identify service delivery gaps amenable to improvement.

Holding and Mobility of Pediatric Patients With Transthoracic Intracardiac Catheters.

BACKGROUND: Nursing care of pediatric patients after cardiac surgery consists of close hemodynamic monitoring, often through transthoracic intracardiac catheters, requiring patients to remain on bed rest and limiting holding and mobility. OBJECTIVES: The primary aim of this quality improvement project was to determine the feasibility of safely mobilizing pediatric patients with transthoracic intracardiac catheters out of bed. Once feasibility was established, the secondary aim was to increase the number of days such patients were out of bed. METHODS AND INTERVENTIONS: New standards and procedures were implemented in July 2015 for pediatric patients with transthoracic intracardiac catheters. After initiation of the new policies, complications were tracked prospectively. Nursing documentation of activity and positioning for all patients with transthoracic intracardiac catheters was extracted from electronic health records for 2 fiscal years before and 3 fiscal years after the new policies were implemented. The Cochran-Armitage test for trend was used to determine whether patterns of out-of-bed documentation changed over time. RESULTS: A total of 1358 patients (approximately 250 to 300 patients each fiscal year) had activity and positioning documented while transthoracic intracardiac catheters were in place. The Cochran-Armitage test for trend revealed that out-of-bed documentation significantly increased after the new policies and procedures were initiated (P < .001). No major complications were noted resulting from patient mobility with transthoracic intracardiac catheters. CONCLUSION: Pediatric patients with transthoracic intracardiac catheters can be safely held and mobilized out of bed.