Implementing Strengths-Based Nursing and Healthcare: A Decade of Leadership and Learning in a Canadian Pediatric Rehabilitation Setting.

The nursing context in pediatric rehabilitation is that of caring for children with disabilities and complex developmental differences and health conditions in an ever-changing and demanding environment. Rehabilitation nurses aim to continuously advance nursing leadership, practice, education and research to meet service needs. Strengths-Based Nursing and Healthcare (SBNH) is a philosophy and value-driven approach that aligns with and enables the advancement of strengths-based rehabilitation nursing and family-centred care. This paper describes the leadership approach undertaken to implement SBNH in a Canadian pediatric rehabilitation hospital context over a 10-year period. We will share what we did and what we learned.

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.

Analysis of Nursing Effect of Children with Henoch-Schonlein Purpura Based on the PDCA Nursing Model.

By applying the PDCA model to the care of children with Henoch-Schonlein purpura, the nursing process can be divided into four stages: planning, execution, inspection, and treatment. According to the age characteristics and disease progression of pediatric patients, a complete nursing plan is formulated to efficiently implement the nursing content and improve the nursing effect. This paper studies the application of the PDCA nursing model in the nursing of children with Henoch-Schonlein purpura and statistically analyzes the disappearance of skin rash, joint pain relief, disappearance of urine protein, disappearance of gastrointestinal symptoms, etc. Finally, this paper combines the experiment to evaluate the intervention effect of this nursing model and provides reference for the follow-up care of children with Henoch-Schonlein purpura. From the results of experimental research, it can be known that PDCA nursing can improve the comfort of children with Henoch-Schonlein purpura, shorten the time for symptom disappearance, and speed up the recovery process.

Reducing restrictive practice: a pertinent issue for children's services.

The reduction of restrictive practice has gained momentum in mental health services and it is now becoming evident in mainstream adult services. There remains confusion as to the definition of 'restrictive practices' across all sectors of health care, including the difference between 'restrictive practices' (such as attitudes of control, limit setting and unnecessary ward rules) and 'restrictive interventions' (including physical, chemical or mechanical restraint). This article highlights the relevance of restrictive practice to children's nursing and argues that the principles apply across all health provision. Acts of restrictive practice may result in challenging behaviour, or even restrictive interventions, strategies to minimise both restrictive practice and subsequent acts of challenging behaviour are explored. Behavioural support plans adopting a bio-psycho-pharmaco-social approach have been shown to be effective in both mental health and adult nursing and are recommended for use in children's nursing.

The pervasive relevance of COVID-19 within routine paediatric palliative care consultations during the pandemic: A conversation analytic study.

BACKGROUND: The importance of caring for children with complex and serious conditions means that paediatric palliative care must continue during pandemics. The recent pandemic of Coronavirus Disease 2019 (COVID-19) provides a natural experiment to study health communication during pandemic times. However, it is unknown how communication within consultations might change during pandemics. AIM: This study, a sub-study of a larger project, aimed to examine real-world instances of communication in paediatric palliative care consultations prior to and during the COVID-19 pandemic to understand how clinicians and families talk about the pandemic. DESIGN: Paediatric palliative care consultations prior to, during, and immediately following the initial peak of COVID-19 cases in Australia were video recorded and analysed using Conversation Analysis methods. SETTING/PARTICIPANTS: Twenty-five paediatric palliative care consultations (including face-to-face outpatient, telehealth outpatient and inpatient consultations) were video recorded within a public children's hospital in Australia. Participants included 14 health professionals, 15 child patients, 23 adult family members and 5 child siblings. RESULTS: There was a pervasive relevance of both serious and non-serious talk about COVID-19 within the consultations recorded during the pandemic. Topics typical of a standard paediatric palliative care consultation often led to discussion of the pandemic. Clinicians (55%) and parents (45%) initiated talk about the pandemic. CONCLUSIONS: Clinicians should not be surprised by the pervasiveness of COVID-19 or other pandemic talk within standard paediatric palliative care consultations. This awareness will enable clinicians to flexibly address family needs and concerns about pandemic-related matters that may impact health and wellbeing.

Implementation of a Nurse-Empowered Renal Anemia Protocol in Children.

A high proportion of patients on hemodialysis persist with low hemoglobin levels despite receiving treatment with erythropoiesis-stimulating agents. A registered nurse-driven renal anemia protocol was designed and implemented by a team in a pediatric hemodialysis unit. We compared proportion of patients achieving the target hemoglobin (Hgb) and transferrin saturation (TSAT) before and after the implementation of the protocol. There was an increase in patients achieving the target Hgb and TSAT range, with an increase in the Hgb concentration. There were no differences in the proportion of patients with left ventricular hypertrophy, erythropoiesis-stimulating agents or intravenous iron dose, transfusion rates, or hospitalization rates. The implementation of a nurse-driven anemia protocol in a pediatric hemodialysis unit increased the proportion of patients achieving target Hgb and TSAT range without a rise in medication doses.

Implementing a pediatric oncology nursing multisite trial.

PURPOSE/BACKGROUND: The Parent Educational Discharge Support Strategies (PEDSS) nursing study includes 16 magnet pediatric oncology institutions across the United States and one in Saudi Arabia, evaluating a nurse-led parent educational discharge support strategy for families experiencing a child newly diagnosed with cancer. METHODS: During the first 3 months of the study, a research implementation survey was administered electronically to each site principal investigator to evaluate facilitators and barriers in the research process for this multisite nurse-led pediatric oncology study. RESULTS: Facilitators included nursing leadership support and commitment from the nursing staff. Common barriers reported were the Institutional Review Board process, the consent process, the timing of the intervention, data collection, as well as nursing time for the study. Results from the survey suggest nurse-led research teams were motivated and felt the intervention was easy to deliver. PRACTICE IMPLICATIONS: Nursing practice is enhanced when nurses participate in research and generate evidence regarding best practices within pediatric oncology nursing care. CONCLUSION: Nursing research endeavors focusing on collaborative approaches for implementation can lead to successful nursing studies with careful planning, training and administrative support.

[The lead nurse in a paediatric haemostasis unit]. / L'infirmière référente en centre de traitement pédiatrique des troubles de l'hémostase.

In an approach of global collaboration, the lead nurse in a paediatric haemostasis unit uses her technical and educational role to participate in the management of the child's specific disorder. As a resource person, she coordinates the care and ensures the continuity of the child's care.

Pediatric Nurses' Role in Health Care Transition Planning: National Survey Findings and Practice Implications.

PURPOSE: Youth and young adults (YYA) with chronic illness and/or disability (CID) face numerous challenges in transition from pediatric to adult health care. Established evidence supports interdisciplinary team approaches to preparing youth and families for transition and transfer. The purpose of this national survey was to address a gap in current knowledge specific to pediatric nursing professionals' roles and responsibilities in health care transition planning (HCTP). METHODOLOGY: A quantitative descriptive study using a survey questionnaire validated by experts in the field investigated respondents' role in HCTP, inclusion of HCTP in job description, levels of HCTP knowledge, and ratings of importance of HCTP elements. A volunteer sample of 1814 respondents was drawn from two professional organizations. RESULTS: Over 64% of respondents performed HCTP activities related to complex chronic illness management. Only 18% reported specialized training in HCTP. The highest-ranking items in regard to perceived importance were educating and supporting disease self-management and speaking with families about complex needs. Predictors of perceived importance were role, inclusion of transition planning in a job description, percentage of time in direct care, caring for those aged 14 years and older, and level of knowledge about HCTP. CONCLUSIONS: The findings highlight key aspects of the pediatric nurse role in HCTP and identify specific elements that can be addressed to support future HCTP role development. PRACTICE IMPLICATIONS: Pediatric nurses perform a vital role in HCTP for YYA with CID that may be enhanced with the inclusion of HCTP activities in job descriptions and specialized interdisciplinary HCTP training related to this emerging and growing population.

The Family-Centered Care Assessment Scale: Development and Psychometric Evaluation in a Turkish Sample.

PURPOSE: The purpose of this study was to develop a family-centered care assessment scale for the parents of hospitalized children and to evaluate the psychometric characteristics of the new scale. METHOD: This is a methodological study carried out in three phases. The study was conducted between on September 2017 and February 2018 with the parents of 360 children treated at the pediatric clinics of two medical faculty hospitals in Konya. DESIGN/METHODS: The study was conducted with parents (n = 360). The data was collected via the Socio-demographic Information Form, the Family-Centered Care Scale (parallel form) and the draft scale developed by the researcher. Data was analyzed by construct validity index, exploratory and confirmatory factor analyses. End of the exploratory factor analysis FCCAS consisted of 21 items and three sub-dimensions. The content validity index was 0.92. The internal consistency coefficient (Cronbach's Alpha) was 0.94 for the total scale. The strong correlations was found between test and re-test (r = 0.90, p < .001). Confirmatory factor analysis has confirmed the three-factor structure. CONCLUSION: In this study developed family-centered care assessment scale (FCCAS) is a valid and reliable measurement tool. PRACTICE IMPLICATIONS: This scale can be used to evaluate family-centered care in pediatric clinics (excluding neonatal care units). It can be used as a measurement tool in descriptive and intervention studies examining family centered care.

Pediatric pain management in the emergency department.

Adequate analgesia is critical in the management of pediatric patients in the emergency department. Suboptimal treatment of pain can have deleterious effects in the short term, and it can also affect a patient's development and reaction to future painful experiences. Tools exist to quantify a patient's pain level regardless of age or developmental stage. Both pharmacologic and nonpharmacologic methods can be effective in the management of pediatric pain. Emergency clinicians must remain vigilant in the recognition, treatment, and reassessment of pediatric pain, as patients' developmental level may limit their ability to independently express their pain experience without prompting or tools. This issue reviews pain scales that are suitable for pediatric patients and discusses pediatric pain management using nonpharmacologic methods, topical, local, and regional anesthesia as well as systemic agents.

Developing and nurturing a community practice clinical network for community children's nurses in Wales.

Working as a children's community nurse (CCN), especially in remote and rural locations, can evoke feelings of professional isolation. Humans are by nature 'social animals' and the consequences of feeling isolated, and coping with distances, adverse weather and risky situations, could mean that nurses choose to work instead in more familiar and comfortable environments. This can affect retention issues and increase the risk of CCNs experiencing stress, burnout and illness-related absenteeism. The children they care for often have complex needs and parents want their CCN to be 'on the ball'; they will feel concerned and frustrated if the CCN team lets them down. Two academics were approached by CCNs in Wales seeking ways of overcoming isolation. It was decided that the best course of action was to develop a community of practice clinical network for band 5 and 6 CCNs working in Wales, with the aim of supporting staff, sharing best practice, and promoting safe and quality-driven care. Alternating the networks among health boards, whereby the nurses decided the agenda, booked the venue, invited guest speakers, led the meeting and wrote up the minutes, was an excellent way to achieve the designated aim: reducing professional isolation. A range of clinically focused topics were discussed and debated, and the first six meetings were so effective in meeting the aim of the network that each health board is starting the cycle of hosting the network again.

The children's nursing workforce in Kenya, Malawi, Uganda, South Africa and Zambia: generating an initial indication of the extent of the workforce and training activity.

BACKGROUND: This study sought to identify, as far as possible, the extent of the specialist children's nursing workforce in five selected African countries. Strengthening children's nursing training has been recommended as a primary strategy to reduce the under-five mortality rate in African nations. However, information about the extent of the specialist children's nursing workforce in this region is not routinely available. Developing an accurate depiction of the specialist children's nursing workforce is a necessary step towards optimising children's health service delivery. METHODS: This study used a convergent parallel mixed methods design, incorporating quantitative (surveys) and qualitative (questionnaire and interview) components, to generate data addressing three related questions: how many children's nurses are believed to be in practice nationally, how many such nurses are recorded on the national nursing register and how many children's nurses are being produced through training annually. RESULTS: Data provide insights into reported children's nursing workforce capacity, training activity and national training output in the five countries. Findings suggest there are approximately 3728 children's nurses across the five countries in this study, with the majority in South Africa. A total of 16 educational programmes leading to a qualification in paediatric nursing or child health nursing are offered by 10 institutions across the countries in this study, with Kenya, Malawi and Zambia having one institution each and South Africa hosting seven. Data suggest that existing human resources for health information systems do not currently produce adequate information regarding the children's nursing workforce. Analysis of qualitative data elicited two themes: the role of children's nurses and their position within health systems, and the capacity of HRH information systems to accurately reflect the specialist children's nursing workforce. CONCLUSION: The data generated provide an initial indication of the size of the children's nursing workforce in these five countries, as well as an overview of associated training activity. We hope that they can start to inform discussion about what would represent a viable and sustainable regional children's nursing workforce for the future.

Pediatric Staff Nurses' Conceptualizations of Professional Development.

PURPOSE: Despite professional developments' (PD) multiple benefits, many nurses grapple with its meaning. The purpose of this study was to comprehensively examine what PD means to nurses working in a pediatric hospital. DESIGN AND METHODS: A correlational study design was used. A 33 item survey was used to collect data. RESULTS: A total of 74 pediatric nurses completed the survey. The average age and years of experience were 33.5 and 8.3 respectively. Continuing nursing education was the highest ranked component while professional organization membership was lowest. The top ranked motivator was to increase patient care knowledge base while salary was lowest. Highest barrier to pursing PD opportunities was family commitments and lowest was PD knowledge. Younger nurses placed more importance on seeking degrees for their PD compared with older nurses. Continuing education was more important to nurses with bachelor's and master's degrees versus those with A.D.N. or diplomas. Younger nurses placed greater importance on PD to expand job opportunities than their older counterparts. CONCLUSION: Study findings suggested that most nurses' main motivation to seek PD opportunities was to provide safe, quality care. The fact that committee involvement, research, and professional organization membership were the lowest ranked components suggested that many nurses may need encouragement and education regarding how these too are important components of PD. PRACTICE IMPLICATIONS: Findings may help nurses to further embrace this concept and grow professionally. Approaches for encouraging nurses to seek PD opportunities may need to vary depending upon the nurse's age and education level.