Space For Children: improving mastery and reducing negative emotions about COVID-19 in youth via mobile interactive storytelling.

BACKGROUND: The COVID-19 pandemic has been a complex event for children and adolescents, significantly impacting their daily activities. In this scenario, our study aims at verifying if "Space for Children," an ad-hoc developed game based on interactive storytelling about the pandemic, can increase mastery and reduces negative emotions about COVID-19. METHODS: The app Space for Children has been sponsored and spread online by email and social media platforms for a limited time period (from May 2021 to January 2022). Before and after the interactive storytelling, participants answered two questionnaires containing a couple of critical questions regarding their emotional state and their perceived mastery about COVID-19. RESULTS: Two hundred thirty-six participants (M=116; F=120) between 7 and 12 years old completed the Space for Children interactive experience. Our results show a significant effect of the game experience on emotional state and perceived mastery regarding COVID-19. Indeed, before the interactive storytelling unpleasant emotional states prevail (reported by 77% of participants) while after the game a clear prevalence of pleasant emotions emerges (reported by 68% of participants). Regarding perceived mastery, results show that self-reported very expert participants passed from 49% to 88%. All the results hold irrespective of age group and sex. CONCLUSIONS: This study presents preliminary findings that highlight the potential benefits of utilizing new technologies based on Interactive Storytelling for Children to effectively convey age-appropriate information about complex real-life events, such as the COVID-19 pandemic, while also mitigating associated negative emotional responses.

Being a nurse between research and clinic: What challenges and opportunities for a PhD-prepared nurse? Overview from an Italian paediatric hospital.

AIM: To report a reflection on the role, challenges and opportunities for nurses with advanced education in research outside the academic field. DESIGN: A discursive paper. DATA SOURCES: We reported the case of an Italian paediatric research hospital where PhD-prepared nurses started to apply their knowledge and competencies in different fields, both in clinical and organizational settings. From this experience, an overview of the possible barriers and challenges that PhD-prepared nurses may face up within the hospital setting. DISCUSSION: The application of PhD-prepared nurses in hospital settings could be an opportunity to advance high standards of quality of care in managerial and clinical areas and to create networks between highly specialized professional figures and different clinical-care realities. CONCLUSION: More research is needed to explore how to apply the advanced competencies of PhD-prepared nurses within healthcare organizations to provide high-quality and safe care and services. This paper can provide insights for a reflection on applying and developing PhD-prepared nurses' skills and competencies within the hospital setting in clinical, research and managerial areas. This can enhance the effective application of highly competent nursing professional figures. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution, due to study design.

Essential elements nurses have to address to promote a safe discharge in paediatrics: A systematic review and narrative synthesis.

AIM: The aim of the study was to synthesize the evidence on the essential elements, nurses must address when they perform therapeutic education to patients and their caregivers to promote a safe paediatric hospital-to-home discharge. DESIGN: A systematic review and narrative synthesis. METHODS: The search strategy identifies studies published between 2016 and 2023. The quality of the included studies was assessed using the Critical Appraisal Skills Programme checklists. The protocol of this review was not registered. A search of three electronic databases (PubMed, CINAHL and Web of Science) and a search in the reference lists of the included studies was conducted in February 2021 and June 2023. RESULTS: Fifteen studies met the inclusion criteria. The essential elements identified are grouped into the following topics: emergency management, physiological needs, medical device and medications management, long-term management and short-term management. Nurses have a critical role in ensuring patient safety and quality of care, and the nurses' competence makes the difference in the discharge's related outcomes. Our results can help the nursing profession implement comprehensive discharge projects. Our results support the improvement of nurse-led paediatric discharge programmes. Nurse managers can identify the grey areas of therapeutic education provided in their units and work for their improvement. Following the implementation of therapeutic education on these topics, measuring the discharge's related outcomes could be interesting. This study addresses the problem of managing a safe and efficient nurse-led discharge in a paediatric setting. It presents evidence on the essential elements to promote a safe paediatric discharge at home. These could impact nursing practice by using them to implement project and discharge pathways. We have adhered to relevant EQUATOR guidelines-PRISMA guidelines for reporting systematic review. No patients, service users, caregivers or public members were involved in this study due to its nature (systematic review).

Informal carers' experiences with their children's care during hospitalization in Italy: Child HCAHPS results from RN4CAST@IT-Ped cross-sectional study.

PURPOSE: To examine informal carers' experiences during their child's hospitalization and evaluate the associations with care received and care context. DESIGN AND METHODS: What is described in this article is only a part of the larger study, RN4CAST@IT-Ped, a multicenter cross-sectional study, with multi-level data collection through convenience sampling, the Child Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey was used to collect data from informal carers of pediatric patients, applying the "top box" approach. RESULTS: Nine hospitals, 1472 nurses, and 635 children's parents were involved. A correlation was found between patient safety and satisfaction outcomes and nursing staff characteristics. Adequate workloads for nurses improved carers' assessment of their experience in the hospital. CONCLUSION: Adequate staffing management could significantly improve informal carers' satisfaction with the care provided to their children during hospitalization. PRACTICE IMPLICATIONS: Children's informal carers greatly value the care they receive in pediatric hospitals. Adequate workloads for nurses improve carers' overall evaluation of the care their children receive during hospitalization. Nursing management should consider improving these aspects to ensure high-quality care in children's hospitals.

Safety and health immigrant paediatric oncology patients: a qualitative study.

BACKGROUND: A "risky situation" is a situation that potentially can lead to adverse event. Studies describe how language barriers can have an impact on patient safety. Several studies describe a lack in management of language barriers (detecting, reporting and bridging) in the hospital paediatric care. Immigration and cancer care are rarely discussed in the paediatric literature. The present study was inspired by our previous study where it was highlighted that the paediatric nurses in a Department of Paediatric Haematology and Oncology perceived how sometimes the paediatric patient and his family were at risk. We surmise that in the case of paediatric health immigrant patients, the issue of correct understanding deserves more care than in communication among adults only. METHODS: A qualitative approach was used. 56 paediatric nurses were interviewed. Semi-structured-interviews were recorded, transcribed verbatim and analyzed using qualitative techniques for recurrent themes. Nurses were interviewed until data saturation was achieved. Analysis was conducted using the thematic synthesis approach. RESULTS: The results include the three main themes: "language barriers" , "therapeutic education" (sub-themes: hygiene, food beverages, behavioural rules), "resources". These mentioned factors seem influence, in turn, the safety of the paediatric patient . CONCLUSIONS: The results suggest linguistic barriers put at risk the whole relationship of care patient-family-nurse and is likely to jeopardize the patient's safety. Nurses are conscious they have to take under control the nursing process to care the patient and the family. Nurse would like to bridge difficulties to improve the safety for this kind of patient.

COVID-19: yesterday, today and tomorrow. The quality of COVID-19 management and the evaluation of the "Health" chapter of the Recovery Plan.

Introduction: The COVID-19 pandemic represented an unprecedented challenge for the healthcare world and the introduction of a new stronger and believable project plays a fundamental role for the quality of work and the provision of qualitative care. Aim: The survey provided by Italian Association for the Quality of Health and Social Care (ASIQUAS) aims to examines the impact of "Health" chapter included in the Recovery Plan, through the assessment of management quality of the COVID-19 pandemic. Methods: Starting from a literature review, in September 2021, a web-based survey has been conducted and administered by e-mail. It has been taken into account measures widely used by different healthcare structures in order to analyze the projects implemented in the face of pandemic and to evaluate the new real possibility to invest funds in new healthcare structures and projects. Results: The survey consists of 19 multiple choices and respondents were from different types of structures, including regional departments and regional health agencies (1.4%), universities, research centers and scientific hospitalization and treatment institutes (IRCCS) (11%), hospitals and university polyclinics (34.2%), Local Health Authorities (39.7%), socio-health organizations and Others (13.7%). The pandemic has highlighted many vulnerabilities at both hospitals and territorial level. The major weaknesses revealed by the survey are mainly due to the lack of support from new staff units and poor availability of specific training tools for COVID-19 procedures. The Recovery Plan is still unclear with a lot of concern about the implementation and many limits of diffusion. Conclusions: It becomes essential to guarantee a new effective and interoperative model of integration. Today we can start more aware for the implementation of a system closer to everyone's needs, making shortcomings the new strength and starting point.

Exploring Care Left Undone in Pediatric Nursing.

OBJECTIVES: This study aimed to investigate the association between nursing care left undone in pediatrics and factors related to nursing staff characteristics and work environment. METHODS: The data of the present study were extracted from our RN4CAST@IT-Ped database, a cross-sectional observational study, which included 13 hospitals belonging to the Italian Association of Paediatric Hospitals. Through convenience sampling, nurses and pediatric nurses providing direct care in routine pediatric wards were enrolled in the study. Data aggregated by clinical care area were analyzed, through descriptive and inferential statistics methods using IBM SPSS 22.0 software. RESULTS: We collected data from 399 pediatric nurses working in surgical wards, 1208 in medical wards, and 631 in critical care units. Some of the investigated factors have shown an association with the risk of omitting essential nursing activities, like health care judged of poor quality, patient safety judged as poor, and nurses' intention-to-leave the job. For every nursing activity under investigation, we found some significant statistical associations. CONCLUSIONS: Our results are consistent with the international literature showing that nurses miss some activities more frequently. Understanding the associations underpinning care left undone could be a starting point for the implementation of patient-centered care and the improvement of the quality and safety of care in pediatric settings, as well as the work environment.

Why and how to open intensive care units to family visits during the pandemic.

Since the lockdown because of the pandemic, family members have been prohibited from visiting their loved ones in hospital. While it is clearly complicated to implement protocols for the admission of family members, we believe precise strategic goals are essential and operational guidance is needed on how to achieve them. Even during the pandemic, we consider it a priority to share strategies adapted to every local setting to allow family members to enter intensive care units and all the other hospital wards.

A qualitative study of pediatric nurses' perception of factors affecting negotiation of care in a pediatric stem cell transplant unit.

BACKGROUND: The adoption of a 'family-centered-care' philosophy is essential for the care process and its negotiation. A better understanding of nurses' perception of factors that affect the process of negotiation could allow us to better address future interventions and to improve FCC. The purpose of our study was to investigate pediatric nurses' perception of factors that affect the process of negotiation of care with Stem Cell Transplantation pediatric patients and their parents. METHODS: A qualitative research design with in-depth interviews was chosen. Sixteen interviews (16 nurses) were audio recorded and transcribed verbatim. Two researchers conducted independently a thematic analysis of the verbatim transcripts of the interviews. RESULTS: Four themes emerged from the data as factors that affect the process of negotiation: (a) communication, (b) personal factors (c) specificity, and (d) organization. CONCLUSIONS: These themes represent interesting points for future improvement interventions. Negotiation in the Stem Cell Transplant setting would deserve further research, with special focus on children' and parents' perception of factors affecting this important aspect. Furthermore, in the future, negotiation guidelines could be validated and implemented effectively and an already validated tool could be used to document the negotiation process in the Stem Cell Transplant setting.

Validation of the Italian version of Behavioral Pain Scale in sedated, intubated, and mechanically ventilated pediatric patients.

BACKGROUND AND AIM: Pain assessment in pediatric intensive care unit (PICU) is a demanding challenge. The COMFORT-B scale is recognized as the gold standard in such patients. However, the use of this instrument in PICU setting is disputed. The Behavioral Pain Scale (BPS), instead, is considered to be the gold standard for pain assessment in deeply sedated, mechanically ventilated adult patients. The BPS has been validated in Italian, requires a short observation time compared to the COMFORT-B and does not increase workloads. A first evaluation of BPS was made in PICU with good results regarding face validity and content validity, however suggesting further studies given the small sample on which it was tested. The aim of this study was the validation of the BPS in sedated, intubated, and mechanically ventilated pediatric patients. METHODS: A descriptive, comparative design was used. A convenience sample of 84 non-verbal, sedated and mechanically ventilated critical care pediatric patients was included. Patient pain was assessed concurrently with three observational scales (BPS, COMFORT-B, NRS) before, during and after routine procedures that are considered painful and non-painful. RESULTS: Internal consistency was α = .86. Correlations between BPS and the other instruments were high, demonstrating a good concurrent validity of the BPS. T test and assessment of ROC curves demonstrated a good discriminant validity of the BPS. CONCLUSIONS: The BPS proved to be valid and reliable for the assessment of pain also in the use with pediatric patients.

How to communicate with families living in complete isolation.

IMPORTANCE: During the SARS-CoV-2 pandemic, a complete physical isolation has been worldwide introduced. The impossibility of visiting their loved ones during the hospital stay causes additional distress for families: in addition to the worries about clinical recovery, they may feel exclusion and powerlessness, anxiety, depression, mistrust in the care team and post-traumatic stress disorder. The impossibility of conducting the daily meetings with families poses a challenge for healthcare professionals. OBJECTIVE: This paper aims to delineate and share consensus statements in order to enable healthcare team to provide by telephone or video calls an optimal level of communication with patient's relatives under circumstances of complete isolation. EVIDENCE REVIEW: PubMed, Cochrane Database of Systematic Reviews, Database of Abstracts and Reviews of Effectiveness and the AHCPR Clinical Guidelines and Evidence Reports were explored from 1999 to 2019. Exclusion criteria were: poor or absent relevance regarding the aim of the consensus statements, studies prior to 1999, non-English language. Since the present pandemic context is completely new, unexpected and unexplored, there are not randomised controlled trials regarding clinical communication in a setting of complete isolation. Thus, a multiprofessional taskforce of physicians, nurses, psychologists and legal experts, together with some family members and former intensive care unit patients was established by four Italian national scientific societies. Using an e-Delphi methodology, general and specific questions were posed, relevant topics were argumented, until arriving to delineate position statements and practical checklist, which were set and evaluated through an evidence-based consensus procedure. FINDINGS: Ten statements and two practical checklists for phone or video calls were drafted and evaluated; they are related to who, when, why and how family members must be given clinical information under circumstances of complete isolation. CONCLUSIONS AND RELEVANCE: The statements and the checklists offer a structured methodology in order to ensure a good-quality communication between healthcare team and family members even in isolation, confirming that time dedicated to communication has to be intended as a time of care.

An online international learning project in an undergraduate children's nursing programme.

Internationalisation of the curriculum (IoC) is a focus for higher education institutions. IoC aims to equip students with essential enhanced skills in relation to becoming global citizens and ensuring that their practice is culturally competent. Undergraduate courses must furnish children's nursing students with learning opportunities that meet the outcomes of the 2018 Nursing and Midwifery Council standards of proficiency. The standards require that nursing education, supervision and training should provide students with the learning opportunities needed to achieve the desired proficiencies and programme outcomes. This article analyses and evaluates the implementation of an online international learning (OIL) project in an undergraduate children's nursing programme in the UK. The pilot project has been identified as a useful and successful teaching method for promoting intercultural awareness among students and provides guidance for future OIL design. Finally, this article offers recommendations on how to address barriers and challenges related to this teaching method.