Integrating Strengths-Based Nursing and Healthcare in Pediatric Nursing Education: A Case Study of the Ghana-SickKids Partnership.

There is growing recognition of the critical role nursing leadership plays in healthcare. Integrating strengths-based approaches into nursing education enables positive learning settings and empowers nurses as leaders who foster healing and well-being for patients and their families. This paper describes an effort to integrate Strengths-Based Nursing and Healthcare (SBNH) and Strengths-Based Nursing and Healthcare Leadership (SBNH-L) into the development, implementation and evaluation of a postgraduate pediatric nursing program in Ghana. In the evaluation of the program in Ghana, three themes emerged related to strengths-based nursing: transformation of teaching and learning, impact on relationships with colleagues and impact on relationships with patients.

Development of the Pediatric Integrated Nutrition Pathway for Acute Care (P-INPAC) using a modified Delphi technique.

One in three hospitalized children have disease-related malnutrition (DRM) upon admission to hospital, and all children are at risk for further nutritional deterioration during hospital stay; however, systematic approaches to detect DRM in Canada are lacking. To standardise and improve hospital care, the multidisciplinary pediatric working group of the Canadian Malnutrition Taskforce aimed to develop a pediatric, inpatient nutritional care pathway based on available evidence, feasibility of resources, and expert consensus. The working group (n = 13) undertook a total of four meetings: an in-person meeting to draft the pathway based on existing literature and modelled after the Integrated Nutrition Pathway for Acute Care (INPAC) in adults, followed by three online surveys and three rounds of online Delphi consensus meetings to achieve agreement on the draft pathway. In the first Delphi survey, 32 questions were asked, whereas in the second and third rounds 27 and 8 questions were asked, respectively. Consensus was defined as any question/issue in which at least 80% agreed. The modified Delphi process allowed the development of an evidence-informed, consensus-based pathway for inpatients, the Pediatric Integrated Nutrition Pathway for Acute Care (P-INPAC). It includes screening <24 h of admission, assessment with use of Subjective Global Nutritional Assessment (SGNA) <48 h of admission, as well as prevention, and treatment of DRM divided into standard, advanced, and specialized nutrition care plans. Research is necessary to explore feasibility of implementation and evaluate the effectiveness by integrating P-INPAC into clinical practice.

Malnutrition care in hospitalized pediatric inpatients: comparison of perceptions and experiences across two pediatric academic health sciences centres.

Malnutrition affects up to one in three Canadian children admitted to hospital. Awareness among pediatric healthcare providers (HCPs) of the prevalence and impacts of hospitalized malnutrition is critical for optimal management. The purpose of this study was to determine perceptions of malnutrition among pediatric HCP across two major academic health sciences centres, and to determine how the use of a standardized pediatric nutritional screening tool at one institution affects responses. Between 2020 and 2022, 192 HCPs representing nursing, dietetics, medicine, and other allied health were surveyed across McMaster Children's Hospital and The Hospital for Sick Children. 38% of respondents from both centres perceived rates of malnutrition between approximately one in three patients. Perceptions of the need for nutritional screening, assessment, and management were similar between centres. All respondents identified the need for better communication of hospitalized malnutrition status to community providers at discharge, and resource limitations affecting nutritional management of pediatric inpatients. This study represents the largest and most diverse survey of inpatient pediatric HCPs to date. We demonstrate high rates of baseline knowledge of hospital malnutrition, ongoing resource challenges, and the need for a systematic approach to pediatric nutritional management.

Developing a partnership to improve health care delivery to children <18 years with cancer and blood disorders in the English-speaking Caribbean: lessons from the SickKids-Caribbean Initiative (SCI).

In 2013, the SickKids-Caribbean Initiative (SCI) was formalised among The Hospital for Sick Children in Toronto, Canada, the University of the West Indies, and Ministries of Health in six Caribbean countries (Barbados, The Bahamas, Jamaica, St. Lucia, St. Vincent and the Grenadines, and Trinidad and Tobago). The aim was to improve the outcomes and quality of life of children (<18 years) with cancer and blood disorders in the partner countries. Core activities included filling a human resource gap by training paediatric haematologists/oncologists and specialised registered nurses; improving capacity to diagnose and treat diverse haematology/oncology cases; developing and maintaining paediatric oncology databases; creating ongoing advocacy activities with international agencies, decision makers, and civil society; and establishing an integrated administration, management, and funding structure. We describe core program components, successes, and challenges to inform others seeking to improve health service delivery in a multidisciplinary and complex partnership.

An exploratory case study investigating the implementation of a novel knowledge translation strategy in a pandemic: the Pandemic Practice Champion.

BACKGROUND: The clinical Pandemic Practice Champion (PPC) role was created in a large tertiary pediatric hospital as a knowledge translation (KT) strategy for implementing COVID-19 evidence-based knowledge. We aimed to describe the core components of the PPC role, the process of implementing the role, and the factors that hindered or facilitated role implementation. METHODS: An exploratory case study was undertaken. Semi-structured interviews were conducted virtually with stakeholders including PPC, managers, and front-line health care professionals (HCP). A directed approach to qualitative content analysis consistent with the Consolidated Framework for Implementation Research (CFIR) guided the analytic process. Inductive analyses and three stages of thematic synthesis were also conducted. RESULTS: Four PPC, 3 managers, and 6 HCP were interviewed. The core components of the PPC role consisted of (a) acting as knowledge experts and educators, (b) problem-solving for complex patient care issues, (c) conducting crisis management, and (d) acting as a resource to management, HCP, and families. Facilitators for successful implementation included access to external information, a supportive organizational context and culture, dedicated time and resources, and leadership support. Lack of clarity of role definition, insufficient time, pandemic uncertainty and fatigue, inability to change infrastructure, and access to external information hindered implementation. CONCLUSION: The PPC role was successfully implemented within a crisis context. Key barriers (role clarity, time, resources) and facilitators (organizational and leadership support) need to be considered when implementing the PPC role in practice. Future studies are needed to determine the intervention effectiveness of the champion role in changing HCP behavior and health outcomes and further examine implementation processes and mechanisms.

Canadian Nationwide Survey on Pediatric Malnutrition Management in Tertiary Hospitals.

Background: Disease-associated malnutrition (DAM) is common in hospitalized children. This survey aimed to assess current in-hospital practices for clinical care of pediatric DAM in Canada. Methods: An electronic survey was sent to all 15 tertiary pediatric hospitals in Canada and addressed all pillars of malnutrition care: screening, assessment, treatment, monitoring and follow-up. Results: Responses of 120 health care professionals were used from all 15 hospitals; 57.5% were medical doctors (MDs), 26.7% registered dietitians (RDs) and 15.8% nurses (RNs). An overarching protocol for prevention, detection and intervention of pediatric malnutrition was present or "a work in progress", according to 9.6% of respondents. Routine nutritional screening on admission was sometimes or always performed, according to 58.8%, although the modality differed among hospitals and profession. For children with poor nutritional status, lack of nutritional follow-up after discharge was reported by 48.5%. Conclusions: The presence of a standardized protocol for the clinical assessment and management of DAM is uncommon in pediatric tertiary care hospitals in Canada. Routine nutritional screening upon admission has not been widely adopted. Moreover, ongoing nutritional care of malnourished children after discharge seems cumbersome. These findings call for the adoption and implementation of a uniform clinical care pathway for malnutrition among pediatric hospitals.

Work readiness, transition, and integration: The challenge of specialty practice.

AIM: To determine how extended orientation enhances the work readiness of new graduate nurses as they transitioned to their professional role in a specialty care hospital. BACKGROUND: Given increased complexity of care and high-patient acuity, there is concern about the work readiness of new graduate nurses in specialty areas. DESIGN: Qualitative exploratory study using an inductive approach. METHODS: An integrative literature review was conducted to abstract characteristics of work readiness among new graduate nurses. Semistructured interviews were conducted with 41 participants from a large paediatric specialty hospital in Ontario, Canada, in 2014. The sample of nurses was stratified and included nurse managers, new graduates, and preceptors. Interview texts were interpreted using thematic analysis. RESULTS: A framework for enhancing work readiness of new graduates transitioning to specialty care was developed from the interview and literature findings. Interview data demonstrate an extended orientation that includes mentorship, a gradual increase in clinical responsibilities, and involvement in the professional role during the early stages of a nurse's career can enhance work readiness of new graduates. Four key areas of work readiness were identified in the literature: personal characteristics, clinical characteristics, relational characteristics, and organizational acuity. CONCLUSION: Based on the study results, new graduate nurses can be an integral part of the team in specialty care provided certain conditions are met during their transition to practice. Our study gives further evidence that extended orientation enhances new graduates' work readiness as they transit to their professional role.

Examining pediatric care for newly immigrated families: Perspectives of health care providers.

Respect for the ethnicity and cultural background of families are important components of health care delivery. However, the needs of new immigrants in pediatric care systems remain under-addressed in the literature. This study utilized a qualitative approach of interpretive description to elicit the pediatric health care experiences and needs of new immigrants to Canada, from the perspective of health care providers who worked extensively with newcomers. Two focus groups of multidisciplinary health care providers were conducted in a tertiary-level pediatric hospital. Results identify that the needs of new immigrant families are often insufficiently met by existing pediatric care practices. Needs include subsistence requirements such as income, transportation, and family understanding about the complex processes of health care in the new society. Newly immigrated families reportedly experience emotional adjustment and social support struggles and needs. Information and support to navigate the health care system are warranted. These formidable challenges invite proactive approaches, including navigation and resource finding supports as well as culturally responsive family-centered care.

Working Toward a Competency-Based Preceptor Development Program.

Preceptorship programs are widely used in nursing education and transition to practice. This article describes a variety of improvements implemented in an academic health sciences center on the basis of findings from a study previously conducted with preceptors in the same institution. A long-standing preceptor preparation program was redesigned and expanded into two levels-an introductory workshop directed toward meeting the needs of new preceptors, and an advanced workshop for experienced preceptors. Organization-specific preceptor competencies were developed as a foundation for preceptor practice. The competencies also informed the revised preceptor development program that included selection, ongoing development, and evaluation. A more structured support system, a standardized performance feedback process, and additional recognition strategies were incorporated in the new competency-based preceptor program. J Contin Educ Nurs. 2016;47(9):427-432.

Strategic Workforce Planning for Health Human Resources: A Nursing Case Analysis.

Background Health-care organizations provide services in a challenging environment, making the introduction of health human resources initiatives especially critical for safe patient care. Purpose To demonstrate how one specialty hospital in Ontario, Canada, leveraged an employment policy to stabilize its nursing workforce over a six-year period (2007 to 2012). Methods An observational cross-sectional study was conducted in which administrative data were analyzed to compare full-time status and retention of new nurses prepolicy and during the policy. The Professionalism and Environmental Factors in the Workplace Questionnaire® was used to compare new nurses hired into the study hospital with new nurses hired in other health-care settings. Results There was a significant increase in full-time employment and a decrease in part-time employment in the study hospital nursing workforce. On average, 26% of prepolicy new hires left the study hospital within one year of employment compared to 5% of new hires during policy implementation. The hospital nurses scored significantly higher than nurses employed in other health-care settings on 5 out of 13 subscales of professionalism. Conclusions Decision makers can use these findings to develop comprehensive health human resources guidelines and mechanisms that support strategic workforce planning to sustain and strengthen the health-care system.

Bridging the Distance in the Caribbean: Telemedicine as a means to build capacity for care in paediatric cancer and blood disorders.

Over the past 50 years, survival for children in high-income countries has increased from 30% to over 80%, compared to 10-30% in low and middle income countries (LMIC). Given this gap in survival, established paediatric cancer treatment centres, such as The Hospital for Sick Children (SickKids) are well positioned to share clinical expertise. Through the SickKids Centre for Global Child Health, the SickKids-Caribbean Initiative (SCI) was launched in March 2013 to improve the outcomes and quality of life for children with cancer and blood disorders in the Caribbean. The six participating Caribbean countries are among those defined by the United Nations as Small Island Developing States, due to their small size, remote location and limited accessibility. Telemedicine presents an opportunity to increase their accessibility to health care services and has been used by SCI to facilitate two series of interprofessional rounds. Case Consultation Review Rounds are a forum for learning about diagnostic work-up, management challenges and treatment recommendations for these diseases. To date, 54 cases have been reviewed by SickKids staff, of which 35 have been presented in monthly rounds. Patient Care Education Rounds provide nurses and other staff with the knowledge base needed to safely care for children and adolescents receiving treatment. Five of these rounds have taken place to date, with over 200 attendees. Utilized by SCI for both clinical and non-clinical meetings, telemedicine has enhanced opportunities for collaboration within the Caribbean region. By building capacity and nurturing expert knowledge through education, SCI hopes to contribute to closing the gap in childhood survival between high and low-resource settings.

Preceptors' perceptions of their role in a pediatric acute care setting.

BACKGROUND: This study explored preceptors' perceptions of the benefits, rewards, and supports associated with the preceptor role and their commitment to the role in a pediatric acute care setting. METHOD: A survey with a quantitative and semi-qualitative design was used. RESULTS: The survey was completed by 266 preceptors, who reported that their experience was mainly positive. They perceived the preceptor role as preparation for other leadership opportunities. The preceptors reported that they experienced pride in the role of preceptor and described the challenges they faced, such as workload and the need to adapt to different learning styles. Years of nursing experience and age were significant factors that influenced their perceptions of enjoyable aspects of the role and the types of support that they needed as preceptors. CONCLUSION: Preceptors perceived sufficient benefits and rewards to remain committed to the role and identified workload as a significant challenge. Further research is needed to explore whether additional supports or recognition tailored to level of experience and age may be beneficial.

Conflicting messages: examining the dynamics of leadership on interprofessional teams.

PURPOSE: Despite the importance of leadership in interprofessional health care teams, little is understood about how it is enacted. The literature emphasizes a collaborative approach of shared leadership, but this may be challenging for clinicians working within the traditionally hierarchical health care system. METHOD: Using case study methodology, the authors collected observation and interview data from five interprofessional health care teams working at teaching hospitals in urban Ontario, Canada. They interviewed 46 health care providers and conducted 139 hours of observation from January 2008 through June 2009. RESULTS: Although the members of the interprofessional teams agreed about the importance of collaborative leadership and discussed ways in which their teams tried to achieve it, evidence indicated that the actual enactment of collaborative leadership was a challenge. The participating physicians indicated a belief that their teams functioned nonhierarchically, but reports from the nonphysician clinicians and the authors' observation data revealed that hierarchical behaviors persisted, even from those who most vehemently denied the presence of hierarchies on their teams. CONCLUSIONS: A collaborative approach to leadership may be challenging for interprofessional teams embedded in traditional health care, education, and medical-legal systems that reinforce the idea that physicians sit at the top of the hierarchy. By openly recognizing and discussing the tensions between traditional and interprofessional discourses of collaborative leadership, it may be possible to help interprofessional teams, physicians and clinicians alike, work together more effectively.

Can an evidence-based guideline reminder card improve asthma management in the emergency department?

OBJECTIVE: Asthma is the most common chronic disease in children. Previous studies described significant variations in acute asthma management in children. This study was conducted to examine whether asthma management in the pediatric emergency department (ED) was improved through the use of an evidence-based acute asthma care guideline reminder card. METHODS: The Pediatric Acute Asthma Management Guideline (PAMG) was introduced to the ED of a pediatric tertiary care hospital in Ontario, Canada. Medical charts of 278 retrospective ED visits (January-December 2002) and 154 prospective visits (July 2003-June 2004) were reviewed to assess changes in acute asthma management such as medication treatment, asthma education, and discharge planning. Logistic and linear regressions were used to determine the effect of PAMG on asthma management in the ED. The propensity score method was used to adjust for confounding. RESULTS: During the implementation of PAMG, patients who visited the ED were more likely to receive oral corticosteroids (Adjusted Odds Ratio [AOR] = 2.26, 95% CI: 1.63-3.14, p < 0.0001) and oxygen saturation reassessment before ED discharge (AOR = 2.02, 95% CI: 1.45-2.82, p < 0.0001). They also received 0.23 (95% CI: 0.03-0.44, p = 0.0283) more doses of bronchodilator in the first hour of ED stay. Improvements in asthma education and discharge planning were noted, but the changes were not statistically significant. CONCLUSIONS: After the implementation of an evidence-based guideline reminder card, medication treatment for acute asthma in the ED was significantly improved; however, asthma education and discharge planning remained unchanged. Future efforts on promoting guideline-based practice in the ED should focus on these components.

An evaluation of pediatric asthma educational resources.

The purpose of this study was to evaluate newly developed educational resources for children with asthma. Children with asthma, their parents, and pediatric health care professionals were invited to review age-appropriate asthma resources. Key findings revealed: (1) the perceived usefulness of these resources, particularly for creating discussion opportunities between children and their caregivers through implemented resource use; (2) the need for health education materials to balance goals of depth of information versus child enjoyment in order to increase effective knowledge transfer and application; and (3) a renewed call for future educational resources to be both relevant and interactive in their outreach and engagement of children, potentially involving mediums of advanced technology. Clinical experience and the literature note a current lack of pediatric asthma education materials. The positive findings of this review of novel educational materials in asthma address an important gap relative to pediatric practice, resource evaluation, and knowledge translation.

Risk factors for repeat adverse asthma events in children after visiting an emergency department.

OBJECTIVE: The aim of this study was to identify risk factors for long-term adverse outcomes in children with asthma after visiting the emergency department (ED). METHODS: A prospective observational study was conducted at the ED of a pediatric tertiary hospital in Ontario, Canada. Patient outcomes (ie, acute asthma episodes and ED visits) were measured at baseline and at 1- and 6-months post-ED discharge. Time trends in outcomes were assessed using the generalized estimating equations method. Multiple conditional logistic regressions were used to model outcomes at 6 months and examine the impact of drug insurance coverage while adjusting for confounders. RESULTS: Of the 269 children recruited, 81.8% completed both follow-ups. ED use significantly reduced from 39.4% at baseline to 26.8% at 6 months (P < .001), whereas the level of acute asthma episodes remained unchanged. Children with drug insurance coverage were less likely to have acute asthma episodes (adjusted odds ratio [AOR] = 0.36; 95% CI, 0.15-0.85; P < .02) or repeat ED visits (AOR = 0.45; 95% CI, 0.20-0.99; P < .05) at 6 months. Other risk factors for adverse outcomes included previous adverse asthma events and certain asthma triggers (eg, cold/sinus infection). Washing bed linens in hot water weekly was protective against subsequent acute asthma episodes. CONCLUSIONS: Our study demonstrated significant improvements in long-term outcomes in children seeking acute care for asthma in the ED. Future efforts remain in targeting the sustainability of improved outcomes beyond 6 months. Risk factors identified can help target vulnerable populations for proper interventions, which may include efforts to maximize insurance coverage for asthma medications and strategies to improve asthma self-management through patient and provider education.

Patient safety in a pediatric centre: partnering with families.

Patient Centred Care (PCC) is a recognized pillar of quality healthcare. According to the Institute of Medicine (Kohn et al. 2000), PCC respects and is responsive to individual patient preferences, needs and values, and ensures they guide all clinical decisions. In a pediatric setting, both the child and family's preferences and values are critical; as a result, the concept of PCC is broadened to include the entire family, and is termed Family Centred Care (FCC). True FCC requires transparent and ongoing collaboration between the child, family, and all members of the healthcare team. An institution's commitment to Family Centred Care must be explicit and permeate all aspects of healthcare provisions. At Toronto's Hospital for Sick Children (SickKids), the Families as Partners in Patient Safety Committee has proven to be a successful initiative based on Family Centred Care principles. This interdisciplinary committee includes healthcare providers, parents and representatives from our hospital's Children's Council. The mandate of the group is to: (1) identify patient safety (PS) issues, (2) make recommendations to improve PS and (3) increase awareness and promote the partnership between parents and staff in PS. Key initiatives to date include developing PS information for families, a combined hand hygiene campaign and a campaign to make the hospital 100% smoke-free. A task-oriented partnership between families and healthcare workers has proven to be a productive model for advancing pediatric patient safety.