Parental Preference for Treatment Location and Inclusion in Decision Making in Painful Pediatric Procedures: Towards an Evidence-Based Clinical Guideline.

PURPOSE: To determine parental preference for treatment location of painful procedures for pediatric patients, and the involvement of parents in decision-making about procedure location. DESIGN AND METHOD: A descriptive survey design was applied. Parents of hospitalized children were asked what procedures their child had undergone, where the procedures were performed, who decided on the location, what their preference was, and why. Data was collected over a twelve-day period in seven wards of a tertiary pediatric hospital. RESULTS: Of 312 different procedures, 244 (78%) were performed in the patient's room. The treatment room was reserved for complex procedures such as lumbar punctures. Seventy-three percent of parents surveyed indicated a strong preference for procedures to be performed in the patient's room, with the most common reason being 'comfortability'. Parents were only involved in procedure location decision-making in 50% of the reported cases. CONCLUSIONS: For parents, the patient's room is the preferred location for many procedures. The opinion of parents was not always taken into consideration by health care professionals, in contrary to the principles of patient-centered care. These findings are important for health care professionals in pediatric settings to reconsider the location of procedures and how parents are involved in decision making.

Sleep problems and solution seeking for children with cerebral palsy and their parents.

AIM: Sleep problems are common in school-aged children with cerebral palsy (CP). Despite the significant impact of sleep disturbance and deprivation, there is a paucity of research in the area. The aims of this study were to (i) investigate the frequency of sleep problems in children with CP and their parents and (ii) understand what happens when parents ask for help with sleep problems from their health-care professionals. METHODS: This was a prospective cohort study using an online survey sent to parents/primary care givers of children with CP aged 6-12 years recruited through the Victorian Cerebral Palsy Register. The following sleep assessment tools: The Children's Sleep Habits Questionnaire, the Pittsburgh Sleep Quality Index and the Gross Motor Function Classification System Parent Rating Tool were administered along with custom-designed questions that were informed by a preceding qualitative scoping study. RESULTS: Complete data sets were received from 126 parents/care givers. Almost half (46%) of the parents reported their child had sleep problems. Of the 64 parents who reported seeking help for a child's sleep problem, only 21 indicated that their attempt was successful. If a child had poor sleep, the parent was more likely to have a sleep problem than parents who did not report poor child sleeping. CONCLUSION: Sleep problems are common in children with CP and their parents. Parents do not always seek help, and those who do may not find an effective solution. Future research should explore how sleep problems can be effectively prioritised for children with CP and their parents/care givers.

Empirical evolution of a framework that supports the development of nursing competence.

AIM: The aim of this study was to refine a framework for developing competence, for graduate nurses new to paediatric nursing in a transition programme. BACKGROUND: A competent healthcare workforce is essential to ensuring quality care. There are strong professional and societal expectations that nurses will be competent. Despite the importance of the topic, the most effective means through which competence develops remains elusive. DESIGN: A qualitative explanatory method was applied as part of a mixed methods design. METHODS: Twenty-one graduate nurses taking part in a 12-month transition programme participated in semi-structured interviews between October and November 2013. Interviews were informed by data analysed during a preceding quantitative phase. Participants were provided with their quantitative results and a preliminary model for development of competence and asked to explain why their competence had developed as it had. RESULTS: The findings from the interviews, considered in combination with the preliminary model and quantitative results, enabled conceptualization of a Framework for Developing Competence. Key elements include: the individual in the team, identification and interpretation of standards, asking questions, guidance and engaging in endeavours, all taking place in a particular context. CONCLUSION: Much time and resources are directed at supporting the development of nursing competence, with little evidence as to the most effective means. This study led to conceptualization of a theory thought to underpin the development of nursing competence, particularly in a paediatric setting for graduate nurses. Future research should be directed at investigating the framework in other settings.

Development of competence in the first year of graduate nursing practice: a longitudinal study.

AIM: To determine the extent to which competence develops in the first year of nursing practice in a paediatric setting. BACKGROUND: Among all the literature related to nursing competence, there have been few studies that have used a standardized tool to determine the development of professional nursing competence in the first year of practice. DESIGN: A quantitative longitudinal design was applied as part of a mixed methods study. METHODS: Forty seven nurses commencing a 12-month graduate nurse programme were invited to undertake a self-assessment of their level of competence at four time points; commencement, 3 months, 6 months and 12 months, between January 2013-February 2014. The assessment was completed using the Nurse Competence Scale; a questionnaire with 73 items across seven domains of competence. Each item is scored along a visual analogue scale (0-100). Response rates varied from 100% at commencement to 68% at 12 months. RESULTS: At commencement, the self-assessed level of overall competence was 41·4, 61·1 at 3 months, 72·9 at 6 months and 76·7 at 12 months. Similar patterns were seen for each domain. Mixed effects model analysis for longitudinal data revealed gains in competence for each of the domains and overall, was statistically significant from commencement to 3 months and 3 months to 6 months. While gains were made between 6-12 months, the results were not statistically significant. CONCLUSION: Graduate nurses showed significant gains in competence in the first 6 months of transition from nursing students to Registered Nurses.

Engaging a Nursing Workforce in Evidence-Based Practice: Introduction of a Nursing Clinical Effectiveness Committee.

This column shares the best evidence-based strategies and innovative ideas on how to facilitate the learning of EBP principles and processes by clinicians as well as nursing and interprofessional students. Guidelines for submission are available at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1741-6787.

How competent are they? Graduate nurses self-assessment of competence at the start of their careers.

For many decades there has been ongoing debate about what it means to be competent and how competence develops and is assessed. A particular target in the debate has been graduate nurses. Despite the extent of competence of graduate nurses being questioned, very little research has examined graduate nurse competence at the time of commencing employment. This study sought to redress this gap. Forty-seven graduate nurses starting a graduate nurse programme in a large paediatric hospital were invited to participate in a study investigating the development of competence. All graduate nurses agreed to participate and completed the Nurse Competence Scale, a 73 item questionnaire across seven domains related to nurse competence: helping role, teaching-coaching, diagnostic functions, managing situations, therapeutic interventions, ensuring quality and work role. Each item is scored along a Visual Analogue Scale (0-100) where 0 is very low and 100 is very high. For descriptive purposes levels of competence are separated as low (0-25), rather good (> 25-50), good (> 50-75) and very good (> 75-100). Graduate nurses self-assessed their competence as rather good for overall competence and each of the domains. They indicated most competence in the domain of ensuring quality and least for teaching-coaching. Across all domains graduate nurses self-assessed a lower level of competence than in other studies using the NCS with nurses with more experience. The self-assessed level of competence in ensuring quality found in this study may reflect the emphasis on critical thinking and utilisation of evidence in practice in undergraduate studies. The findings of this study suggest graduate nurses have a lower level of self-assessed competence at time of commencing practice than nurses with more experience. Future research is warranted to understand to what extent, when, why and how competence develops in this population.

Employing a clinical governance framework to engage nurses in research.

The theoretical benefits of engaging in quality and research activities are readily apparent; however, engagement of clinical nurses in these pursuits remains challenging. In addition, the separation of quality improvement and research as distinct endeavors can impair desired improvements in patient outcomes. We propose that employing a clinical governance framework to inform nursing research in the clinical setting enhances the engagement of nurses in the generation and utilization of evidence to improve the quality of care.

Parents' experience of family-centred care in the post-anaesthetic care unit during non-clinical delays: A qualitative study.

The qualitative exploratory descriptive study explored parents' experience of family-centred care during delayed transfer from a paediatric post-anaesthetic care unit to an inpatient ward. Data were collected in a tertiary children's hospital in Melbourne, Australia, using in-depth, semi-structured interviews. Participants (n = 15) were parents of children (n = 10, aged 6 months to 16 years) delayed in a Stage 1 post-anaesthetic care unit for longer than 30 min. Elements of the family-centred care framework guided thematic analysis, the core concepts of which are respect and dignity, information sharing, participation and collaboration. Respect and dignity was most often identified, expressed in three subthemes: (1) the caring behaviour of staff, (2) being present with their child and (3) a journey shared with other families. Information sharing was also common, illustrated through (1) being told information and (2) being heard. Participation, the third element of the framework, was infrequently identified by participants; however, parents of children under 6 years of age alluded to contributing to their child's care. The final element, collaboration, was not identified in the study data. Only two of four elements of the family-centred care framework were common in parents' experiences: respect and dignity, and information sharing. 'Being with' their child emerged as a central concern for parents' perceptions of family-centred care.

Barriers and Facilitators to Seeking Sleep Solutions for Children With Cerebral Palsy: A Qualitative Study.

Background: Published evidence to date suggests that sleep problems are common in children with cerebral palsy (CP). This qualitative study is a follow up to a previously published quantitative phase on the experience and impact of sleep problems in this population. Aims: The aim of this study was to explore the experience and impact of sleep disturbance and seeking of sleep solutions for parents of school aged children with CP. Materials and Methods: Semi-structured 19 qualitative interviews were conducted with parents of children with CP aged 6-12 years. Interview data were transcribed verbatim and the thematic analysis techniques by Braun and Clarke was used to identify themes. Results: Thematic analysis identified 7 themes: (1) My Child Doesn't Fit into the Box, (2) A Mother's Ears are Always On, (3) Sleep Disturbance is like Water Torture, (4) Sleep is One of Many Spot Fires, I Put it on the Backburner, (5) Luck, Money or Jumping Up and Down, (6) There is Never One Silver Bullet and (7) Help: The Earlier the Better. The key finding was that parents of children with CP often described their child's needs being distinct from what is provided by systems and services. Conclusion: Parents face significant challenges sourcing effective sleep solutions for their child with CP. Sleep is often not a priority for either the parent or the clinician as other health problems take precedence. Parents reflected that early sleep intervention for their child was or would have been helpful. The barriers and facilitators to sleep care identified in this study should be used to inform clinical change in care for children with CP. Sleep needs to be prioritized in healthcare for children.

Vaccination in people with disability: a review.

People with disabilities are vulnerable to complications from vaccine-preventable diseases, and every effort should be made to ensure equitable access to immunization for this population. This paper aims to summarize the research on immunizations in people with disabilities, in order to ensure a comprehensive understanding of knowledge in this area and direct further research. The literature is weighted towards coverage data that is difficult to synthesize because of the different definitions of disability, and the variety of settings, vaccinations and age groups across the studies. In-depth qualitative data and data from a variety of health-care providers and people with disability is notably lacking. This is vital to redress in order to develop effective immunization interventions in this population.

The uptake of adolescent vaccinations through the School Immunisation Program in specialist schools in Victoria, Australia.

BACKGROUND: As part of the National Immunisation Program (NIP) students in Australia receive adolescent immunisations through the School Immunisation Program at 12 to 13 years. For children with disabilities attending specialist schools, no vaccine uptake data is collected at this time point. We aimed to determine uptake of diphtheria-tetanus-pertussis (dTpa) and Human Papillomavirus (HPV) immunisations amongst young people with disabilities in specialist schools in Victoria. METHODS: A prospective cohort study was conducted in Victoria, Australia. Data was collected on immunisation days in the 2017 school year from specialist schools in Victoria. The school immunisation coordinator entered data online for eligible students for receipt of dTpa and HPV on each school immunisation day. Demographic data, motor and intellectual function of students and reasons for non-receipt of dTpa and HPV vaccine were recorded. Data were analysed using descriptive statistics. RESULTS: Of 73 eligible specialist schools in Victoria, 28 (38%) participated. dTpa was received by 63% (237/374) of participating students and HPV dose 1 (HPV1) was received by 66% (76/114) females and 67% (174/260) male students respectively. Three doses of HPV were received by only 41% (100/241) of students. The main reasons for missed immunisation were absence from school, lack of consent and inability to immunise due to the student's behaviour and/or anxiety. CONCLUSION: This is the first study in Australia to report that uptake of adolescent immunisations in specialist schools for young people with a disability is significantly lower than in mainstream settings. Comparative data during the same time period for students in mainstream schools demonstrated higher uptake, at 89% for dTpa and 75% for three doses of HPV. These data highlight the inequity of receipt of school-based immunisations for this group of adolescents, the barriers to which could be more thoroughly explored through qualitative inquiry from a socio-ecological perspective.

The first 3 minutes: Optimising a short realistic paediatric team resuscitation training session.

Inadequate resuscitation leads to death or brain injury. Recent recommendations for resuscitation team training to complement knowledge and skills training highlighted the need for development of an effective team resuscitation training session. This study aimed to evaluate and revise an interprofessional team training session which addressed roles and performance during provision of paediatric resuscitation, through incorporation of real-time, real team simulated training episodes. This study was conducted applying the principles of action research. Two cycles of data collection, evaluation and refinement of a 30-40 minute resuscitation training session for doctors and nurses occurred. Doctors and nurses made up 4 groups of training session participants. Their responses to the training were evaluated through thematic analysis of rich qualitative data gathered in focus groups held immediately after each training session. Major themes included the importance of realism, teamwork, and reflective learning. Findings informed important training session changes. These included; committed in-situ training; team diversity; realistic resources; role flexibility, definition and leadership; increased debriefing time and the addition of a team goal. In conclusion, incorporation of interprofessional resuscitation training which addresses team roles and responsibilities into standard medical and nursing training will enhance preparedness for participation in paediatric resuscitation.

Creating a journal club competition improves paediatric nurses' participation and engagement.

BACKGROUND: To improve journal club participation, innovative approaches are required but few have been described. It was unknown if adding an element of competition, to an established journal club, would increase nurses' participation. OBJECTIVE: To explore the impact on attendance and participation in a hospital-wide nursing journal club through the introduction of an element of competition. DESIGN: A descriptive exploratory study. SETTING AND PARTICIPANTS: An Australian specialist tertiary paediatric hospital with over 1600 nurses. METHODS: In 2013, 12 hospital wards/departments were randomly assigned a month each to present journal club. Nurses were supported to evaluate an article according to a published framework. A predetermined rubric guided marking. Post competition, all hospital nurses received an anonymous online survey invitation. Demographic, Likert scale and qualitative data were collected. Questions elicited attitudes and perceived barriers or facilitators to participation in the journal club. RESULTS: Compared to 2012, there was a statistically significant increase in journal club attendance (2013 median=20.5 [IQR=18.2, 27.7] vs. 2012 median=9 [IQR=6.5, 12.5], Mann-Whitney U test, p<0.01). Full online survey responses were received from 289/1674 (response rate 17.3%) of sent invitations (Non-Attendees n=224, Attendees n=65 (including 18 presenters). Overall, Attendees reported journal club had a positive impact on their professional engagement. Presenters rated the journal club format highly as it developed skills and increased their confidence in journal club presentation. Emergent themes were time and location, engagement, topics and content. CONCLUSION: A competition format can increase nurses' journal club attendance and participation. Further work is required to establish applicability of this format to other settings.

Pediatric pressure injuries: does modifying a tool alter the risk assessment outcome?

The aim of this study was to determine whether assessing patient risk of developing pressure injuries in Pediatric Intensive Care (PICU) and Neonatal Units (NNU) using a modification of the Glamorgan Scale (mGS) would alter the risk identification when compared to the Glamorgan Scale (GS). Prospective data were collected from a convenience sample of patients admitted to PICU or NNU during a 2-month period. The patients' pressure injury risk score using both instruments was collected by observing patients, reviewing patient records, and clarifying information with bedside nurses. Chi square analysis was used to compare the risk category allocations. A total of 133 patients were assessed with complete data available for 112 (PICU = 68, NNU = 65). The total number of admissions during the data collection period was 202 in PICU and 100 in NNU. There was an extensive spread of patients allocated to the "High Risk" and "Very High Risk" categories in both units. Only one was in the lower "At Risk" category. There was little difference in allocated risk category between the mGS and the GS (p = 0.982). Only one patient was not allocated to the same risk category by both tools. In addition to identifying little difference in risk identification the mGS was found to be easier to complete. The mGS delivered the same risk rating as the GS when applied to patients in the PICU and NNU. It is not clear if a similar agreement exists in the general pediatric population. When modifying a validated tool for local use consideration should be given as to how those modifications might alter outcomes.