Children's participation rights and the role of pediatric healthcare teams: A critical review.

AIM: A critical review examined how childrens participation rights as represented in the United Nations Convention on the Rights of the Child inform the work of pediatric teams in healthcare settings. METHODS: We systematically searched peer-reviewed literature on the enactment of child participation rights, within the context of pediatric teams. Articles were evaluated using the LEGEND (Let Evidence Guide Every New Decision) tool. Data extraction and analysis highlighted themes and disparities between articles, as well as gaps. A total of 25 studies were selected. RESULTS: We reviewed studies from around the globe, with the majority of papers from the UK. Qualitative and mixed methods approaches were administered. The following observations were made: (1) limited language of children's rights exists in the literature, (2) lack of information regarding the composition of pediatric healthcare teams and how they work with children, (3) children's perspectives on what constitutes good interactions with healthcare providers are replicated, (4) minimal references to theory or philosophical underpinnings that can guide practice. CONCLUSION: Explicit references to children's participation rights are lacking in the literature which may reflect the absence of rights language that could inform pediatric practice. Descriptive understandings of the tenets of pediatric interprofessional team composition and collaboration are necessary if we are to imagine the child as part of the team along with their family. Despite these shortcomings, the literature alludes to children's ability to discern desirable interactions with healthcare providers.

Mother-nurse decision making practices for children with complex health care needs receiving homecare services: A qualitative descriptive study.

BACKGROUND: Many children with complex health care needs face chronic health and developmental issues that may include functional impairments, neurodevelopmental disabilities, and lifelong dependence on medical technology. Providing the necessary care and services for this unique group of children and youth places substantial demands on the health care system. Much of the focus on improvements has been in acute care settings even though homecare accounts for the largest proportion of health care utilization among children with complex health care needs. While parents assume great responsibility for their child's care at home, they indicate that the balance of power between themselves and their health care providers does not change when care shifts from the hospital to home. Given the expanding role of paediatric homecare and parents' concerns of their role in decisions related to their child's care, it is imperative to explore these practices in this unique setting. PURPOSE: The purpose of this work is to explore mother-nurse decision making practices for children with complex health care needs receiving health care services in their home. METHODS: A qualitative descriptive study design was used. Five mothers and five nurses participated. Twenty-six home observations with accompanying analytical memos and 10 semistructured interviews were conducted with five mothers and five homecare nurses. Thematic analysis of study data, using an iterative process, identified major themes. FINDINGS: Data revealed the complex and relational nature of mother-nurse decision making practices within the home setting. Three major themes were identified: (1) core areas of decision making, (2) a dynamic and collaborative process, and (3) centrality of relationships. CONCLUSIONS: Study findings enhanced our understanding of how decision making and relational care practices take place in the home for children with complex health care needs receiving homecare services, which has implications for child and family health.

Long-Term Care Nurses' Experiences With Patient Safety Incident Management: A Qualitative Study.

BACKGROUND: Global trends in the aging population will increase the demands for long-term care (LTC) resources. Due to recent pressures to deliver more complex care, there is further risk to resident safety in LTC. Emphasis on the management and the delivery in safe and quality resident care in LTC is required. PURPOSE: The purpose of this study was to describe nurses' experiences with patient safety incident (PSI) management involving residents living in LTC. METHODS: Using a qualitative descriptive approach, 9 nurses were recruited in 3 LTC homes. Semistructured interviews were conducted, and data were analyzed using inductive content analysis. RESULTS: Three main categories emerged: commitment to resident safety, workplace culture, and emotional reaction. CONCLUSIONS: Providing nurses with an opportunity to share their PSI management experiences highlights the current factors influencing frontline resident safety in LTC. Study results can inform nursing practice and policy development to support PSI identification and management.

A scoping review of interprofessional education within Canadian nursing literature.

The purpose of this scoping review is to examine the nature of the interprofessional education (IPE) discussion that the Canadian nursing profession is having within the Canadian peer-reviewed nursing literature. An electronic database search of CINAHL was conducted using a modified Arksey & O'Malley scoping review framework. Peer-reviewed, English-language articles published in Canadian nursing journals from January 1981 to February 2016 were retrieved. Articles were included if they discussed IPE, or described an educational activity that met our conceptual definition of IPE. A total of 88 articles were screened, and 11 articles were eligible for analysis. Analysis revealed that this body of literature does not seem to be purposefully engaging Canadian nurses in a critical discourse about the role of IPE. The majority of articles located were reflective or commentaries. At the time of this review, there was a paucity of theoretically informed empirical research articles on IPE in the nursing literature. While IPE may be viewed by some critical scholars as a means of shifting the control of healthcare delivery traditionally held by medicine to other professions, our results suggest that this may not be the case in the Canadian nursing profession.

Bourdieu at the bedside: briefing parents in a pediatric hospital.

The philosophy of family-centered care (FCC) promotes partnerships between families and staff to plan, deliver, and evaluate services for children and has been officially adopted by a majority of pediatric hospitals throughout North America. However, studies indicated that many parents have continued to be dissatisfied with their decision-making roles in their child's care. This is particularly salient for parents of children with chronic ongoing complex health problems. These children are dependent upon medical technology and require frequent hospitalizations during which parents must contribute to difficult decisions regarding their child's care. Given this clinical issue, an alternative theoretical perspective was explored to redress this problem. Pierre Bourdieu's theoretical concepts of field, capital, and habitus were used to analyze the hierarchical relationships in pediatric acute care hospitals and to design a briefing intervention aimed at improving parents' satisfaction with decision making in that health care setting.

The experience of developing a faculty research cluster using the creativity of the narrative reflective process.

Faculty development that builds research capacity is a significant yet challenging expectation in academia. The School of Nursing faculty at Ryerson University established several research clusters to support research collaborations and productivity. This article explicates one cluster's development process, and specifically, its adoption of the narrative reflective process (NRP). Engaging in NRP permitted the group to creatively enter into critical dialogue, address both individual and collective needs, and establish a supportive environment that nurtures the creative process--all of which ultimately enhances scholarship and academic productivity.

Home Away from Home: How Undergraduate and Graduate Students Experience Space and Place in a new Health Sciences Building.

Buildings contribute in crucial ways to how students experience learning spaces. Four schools within a faculty (nursing, nutrition, occupational and public health, and midwifery) moved into a new Health Sciences building Fall of 2019. This new building created a unique opportunity to explore the intersection between higher education and learning space design, informed by concepts of space and place, and students' profession specific and interprofessional learning experiences in a new Health Sciences building. A qualitative descriptive design was used. All undergraduate and graduate students within the four schools were invited to participate. Focus groups were undertaken to gain a rich understanding of students' experiences and views of their space and place of learning. Data collection involved focus group data from profession specific participant users and interprofessional participant users. Inductive thematic analysis of focus group transcripts generated an initial coding scheme, key themes, and data patterns. Codes were sorted into categories and then organized into meaningful clusters. A building planning development project document relating to the vision, intentions, design, and planning for the new building provided content from which to view the study findings. The study data contributed to the conversation about space and place and its influence on higher learning within specific intraprofessional and interprofessional student groups and provided insight into the process of actualizing a vision for a new learning space and the resultant experiences and perceptions of students within that space/place.

Relational Aspects of Parent and Home Health Care Provider Care Practices for Children With Complex Care Needs Receiving Health Care Services in the Home: A Narrative Review.

Children with medical complexity have ongoing health needs that may require dependence on medical technologies. While hospital admissions are an important focus of care delivery for these children, a majority of the time they are cared for in their own homes. Parents' report feeling overwhelmed and stressed by the scope of their responsibilities, but they become sophisticated care providers and assume greater authority when providing their children's care at home. Communication, decision-making, and dealing with conflict with members of health care teams have been central concerns in parents' reports of their home health care experiences. The objective is to review literature on relational aspects of parent and home health care provider care practices for children with medical complexity receiving home health care services. A narrative review was conducted. A search of MEDLINE, EMBASE, EBM Reviews, PsychINFO, ERIC, and CINAHL databases for English language studies published since database inception was carried out. Eligible studies focused on relational aspects of parent and home health care provider care practices for children with medical complexity receiving home health care services. Nine empirical studies were selected for this review. Literature describes parents' and providers' experiences managing a child with medical complexity in the home and the effects for the family and the parent-health care provider relationship. Parents want to be actively involved in all aspects of care that affects their child and ultimately their family. Further investigation is needed to better understand relational aspects of parent-home health care provider care practices to support child/family health and well-being in the home setting.

Exploring the Intersection Between Academic and Professional Practice During the COVID-19 Pandemic: Undergraduate and Graduate Nursing Students' Experiences.

BACKGROUND: The coronavirus disease-2019 (COVID-19) pandemic has implications for students who are also nurses. PURPOSE AND METHODS: This qualitative descriptive study used a practice development approach to explore the intersection between academic and professional work experiences for undergraduate Post-Diploma Registered Practical Nurses bridging to Registered Nurse Bachelor of Science in Nursing students and Master of Nursing graduate nursing students during the first wave of the COVID-19 pandemic. The study incorporated critical aesthetic reflections that focused on the personal and aesthetic ways of knowing, as a data collection approach and knowledge dissemination strategy. RESULTS: Analysis of the narrative component of participants' reflections revealed the following themes: sensing a "call to duty," experiencing a myriad of emotions, shifting societal and individual perceptions of nursing, and learning in an uncertain environment. CONCLUSIONS: The results of the study can inform educational strategies and academic policies to support this unique nursing population, who are frontline practitioners as well as student learners.

Using Critical Creativity to Reveal Nursing Student Learning in Long-Term Care.

BACKGROUND: The use of teaching-learning strategies that emphasize critical reflection aids students in making sense of complex clinical placement settings, such as those in long-term care (LTC) settings. METHOD: A qualitative descriptive research design was used to explore the assumptions, anticipations, and realizations of six undergraduate nursing students regarding aging, gerontological nursing, and LTC as they engaged in facilitated critical reflection activities during a 12-week LTC placement. RESULTS: The content analysis process revealed four main categories describing the student learning experience: Exploring the Therapeutic Nurse-Resident Relationship, Navigating Preceptor Relationships, Expanding Awareness of Context, and Embracing Many Feelings. CONCLUSION: Students placed in LTC were challenged by the realization of LTC as a complex setting, especially with minimal support from preceptors. Educators should present LTC as a challenging environment, rich with complex issues. There is potential in easing the strain on preceptors by leveraging the faculty educator role in facilitating student learning through critically creative approaches. [J Nurs Educ. 2018;57(3):150-153.].

Evaluating the feasibility of a parent-briefing intervention in a pediatric acute care setting.

PURPOSE: The purpose of this study was to test the feasibility of a parent-briefing intervention for parents of hospitalized children with complex healthcare needs. DESIGN AND METHODS: A phase I, single-group, posttest study. There were 18 physicians, 25 nurses, and 31 parents who participated in the study. Participants were asked to sit while carrying out the briefings with parents. Parents and clinicians completed a feasibility questionnaire post briefings. RESULTS: Sixty-eight briefings were carried out. Parents and nurses evaluated the briefings in a favorable manner, whereas physicians' ratings were mixed. PRACTICE IMPLICATIONS: Further inquiry is recommended to understand the effects of a structured communication intervention on parent-professional decision-making practices.

Fostering person-centered care among nursing students: creative pedagogical approaches to developing personal knowing.

Person-centered care (PCC) is grounded in principles of respect, autonomy, and empowerment and requires the development of interpersonal relationships. For nursing students to engage in PCC, they need to intentionally develop personal knowing, which is an essential attribute of therapeutic relationships. Developing personal knowing, as well as professional knowledge, positions students to enact PCC in their practice. Faculty members play a vital role in fostering the development of personal knowing by creating opportunities for students in which genuine and respectful dialogue, reflection, self-awareness, and critical thinking can take place. This article explores several creative approaches faculty have used to actualize these qualities in their teaching-learning encounters with nursing students at various stages of their students' professional development. These approaches offer experiential teaching-learning opportunities that foster the development of personal knowing, as well as constructive and respectful relationships between faculty and students, therefore laying the groundwork for PCC in practice settings.

A conceptual framework for advanced practice nursing in a pediatric tertiary care setting: the SickKids' experience.

Advanced practice nurses (APNs) at The Hospital for Sick Children (SickKids) are pediatric healthcare providers who integrate principles and theories of advanced nursing with specialty knowledge to provide autonomous, independent, accountable, ethical and developmentally appropriate care in complex, often ambiguous and rapidly changing healthcare environments. Caring for children and adolescents requires culturally sensitive and family-centred approaches to care that incorporate a unique body of knowledge. Family-centred care is an approach to planning, delivery and evaluation of healthcare that is governed by the establishment of mutually beneficial partnerships among APNs, health professionals and children/families. The cornerstone of APN practice at SickKids is the recognition of "family" as the recipients of care. By valuing and developing relationships with families, APNs promote excellence in healthcare across the care continuum to optimize the child's and family's physical, emotional, social, psychological and spiritual well-being. This paper outlines the evolution of advanced practice nursing at SickKids, beginning with the introduction of APN roles in the 1970s and culminating in the current critical mass of APNs who have been integrated throughout the hospital's infrastructure. We describe the process used to create a common vision and a framework to guide pediatric advanced nursing practice.

Development of professional practice based on a family systems nursing framework: nurses' and families' experiences.

The purpose of this evaluation project was to elicit nurses'and families' experiences about differences and changes for nurses and families and the family-nurse relationship when a family systems nursing approach was used to guide practice. Following nurses' involvement in an educational workshop, the evaluation examined changes in nurses'and families' experiences over an 8-week period of a child's hospitalization in a pediatric rehabilitation center. A total of 17 nurses and 13 parents participated in the project. Nurses and parents completed questionnaires and participated in semi-structured interviews and focus groups. Nurses completed journals reflecting on their interactions with families. Data were analyzed using descriptive statistics and content analysis. Findings indicate that a family systems nursing approach had a positive impact on how nurses viewed their nursing practice and their work with families, thereby enhancing family-nurse relationships. Such findings have relevance to clinical nursing practice, professional development, and evaluation research design.