Quality and capacity indicators for hospitalized pediatric oncology patients with critical illness: A modified delphi consensus.

BACKGROUND: Hospitalized pediatric hematology-oncology (PHO) patients are at high risk for critical illness, especially in resource-limited settings. Unfortunately, there are no established quality indicators to guide institutional improvement for these patients. The objective of this study was to identify quality indicators to include in PROACTIVE (PediatRic Oncology cApaCity assessment Tool for IntensiVe carE), an assessment tool to evaluate the capacity and quality of pediatric critical care services offered to PHO patients. METHODS: A comprehensive literature review identified relevant indicators in the areas of structure, performance, and outcomes. An international focus group sorted potential indicators using the framework of domains and subdomains. A modified, three-round Delphi was conducted among 36 international experts with diverse experience in PHO and critical care in high-resource and resource-limited settings. Quality indicators were ranked on relevance and actionability via electronically distributed surveys. RESULTS: PROACTIVE contains 119 indicators among eight domains and 22 subdomains, with high-median importance (≥7) in both relevance and actionability, and ≥80% evaluator agreement. The top five indicators were: (a) A designated PICU area; (b) Availability of a pediatric intensivist; (c) A PHO physician as part of the primary team caring for critically ill PHO patients; (d) Trained nursing staff in pediatric critical care; and (e) Timely PICU transfer of hospitalized PHO patients requiring escalation of care. CONCLUSIONS: PROACTIVE is a consensus-derived tool to assess the capacity and quality of pediatric onco-critical care in resource-limited settings. Future endeavors include validation of PROACTIVE by correlating the proposed indicators to clinical outcomes and its implementation to identify service delivery gaps amenable to improvement.

Holding and Mobility of Pediatric Patients With Transthoracic Intracardiac Catheters.

BACKGROUND: Nursing care of pediatric patients after cardiac surgery consists of close hemodynamic monitoring, often through transthoracic intracardiac catheters, requiring patients to remain on bed rest and limiting holding and mobility. OBJECTIVES: The primary aim of this quality improvement project was to determine the feasibility of safely mobilizing pediatric patients with transthoracic intracardiac catheters out of bed. Once feasibility was established, the secondary aim was to increase the number of days such patients were out of bed. METHODS AND INTERVENTIONS: New standards and procedures were implemented in July 2015 for pediatric patients with transthoracic intracardiac catheters. After initiation of the new policies, complications were tracked prospectively. Nursing documentation of activity and positioning for all patients with transthoracic intracardiac catheters was extracted from electronic health records for 2 fiscal years before and 3 fiscal years after the new policies were implemented. The Cochran-Armitage test for trend was used to determine whether patterns of out-of-bed documentation changed over time. RESULTS: A total of 1358 patients (approximately 250 to 300 patients each fiscal year) had activity and positioning documented while transthoracic intracardiac catheters were in place. The Cochran-Armitage test for trend revealed that out-of-bed documentation significantly increased after the new policies and procedures were initiated (P < .001). No major complications were noted resulting from patient mobility with transthoracic intracardiac catheters. CONCLUSION: Pediatric patients with transthoracic intracardiac catheters can be safely held and mobilized out of bed.

Early Mobilization Rehabilitation Program for Children With Cerebral Palsy Undergoing Single-Event Multilevel Surgery.

PURPOSE: This study investigates functional and technical outcomes to support an early mobilization approach to rehabilitation after single-event multilevel surgery (SEMLS) for children with cerebral palsy (CP), and disseminates innovative guidelines emphasizing early walking. METHODS: Twenty-three participants with spastic diplegic CP ages 7 through 17 years, Gross Motor Function Classification System levels I to III, who underwent an early mobilization program after SEMLS were reviewed. Outcomes were examined from motion analysis data and clinical documentation. RESULTS: All participants were able to return to school walking at discharge. At 1-year postoperatively, participants had returned to their prior walking level or better. Change in Gait Deviation Index and Pediatric Outcomes Data Collection Instrument indicated improvements in functional mobility and gait consistent with or greater than the literature. CONCLUSION: This intensive early mobilization program restores participation in daily activities, walking, and school within the first month postoperatively.

A nurse-driven analgesia and sedation protocol reduces length of PICU stay and cumulative dose of benzodiazepines after corrective surgery for tetralogy of Fallot.

PURPOSE: Analgesia and sedation protocols are reported to reduce the requirement of sedative and analgesic agents, duration of mechanical ventilation, and length of pediatric intensive care unit (PICU) stay. However, these studies often were conducted based on inhomogeneous cohorts. The aim of this study was the evaluation of a nurse-driven analgesia and sedation protocol in a homogenous population of infants following corrective surgery for tetralogy of Fallot (TOF). DESIGN AND METHODS: This retrospective analysis was conducted in a cardiac PICU of a tertiary referral center. Two cohorts of patients who underwent corrective surgery for TOF below the age of 7 months, were retrospectively evaluated before and after implementation of a nurse-driven analgesia and sedation protocol. We compared peak and cumulative doses of midazolam, morphine, and clonidine, length of PICU stay and time on mechanical ventilation. RESULTS: A total of 33 patients were included in the preimplementation period and 32 during the postimplementation period. Implementation of the nurse-driven analgesia and sedation protocol had no effect on time on mechanical ventilation (72 hr [24-141] vs. 49 hr [24-98]), but significantly on length of PICU stay (7 days [5-14] vs. 5 days [4-7]). Cumulative doses of midazolam (7.37 mg/kg [4.70-17.65] vs. 5.0 mg/kg [2.70-9.12]) as well as peak doses of midazolam (0.22 mg·kg-1 ·hr-1 [0.20-0.33] vs. 0.15 mg·kg-1 ·hr-1 [0.13-0.20]) and morphine (50.0 µg·kg-1 ·hr-1 [39.7-79.9] vs. 42.5 µg·kg-1 ·hr-1 [29.7-51.8]) were significantly reduced. The postimplemantation group showed no increase in postoperative complications and adverse events. PRACTICE IMPLICATIONS: The implementation of a nurse-driven analgesia and sedation protocol is safe in infants following corrective surgery for TOF. It reduces significantly the length of PICU stay, cumulative and peak doses of midazolam and peak doses of morphine.

Junctional Ectopic Tachycardia: Recognition and Modern Management Strategies.

Junctional ectopic tachycardia is a common dysrhythmia after congenital heart surgery that is associated with increased perioperative morbidity and mortality. Risk factors for development of junctional ectopic tachycardia include young age (neonatal and infant age groups); hypomagnesemia; higher-complexity surgical procedure, especially near the atrioventricular node or His bundle; and use of exogenous catecholamines such as dopamine and epinephrine. Critical care nurses play a vital role in early recognition of dysrhythmias after congenital heart surgery, assessment of hemodynamics affecting cardiac output, and monitoring the effects of antiarrhythmic therapy. This article reviews the underlying mechanisms of junctional ectopic tachycardia, incidence and risk factors, and treatment options. Currently, amiodarone is the pharmacological treatment of choice, with dexmedetomidine increasingly used because of its anti-arrhythmic properties and sedative effect.

Predictors of Hospitals' Nonachievement of Baseline Nursing Standards for Pediatric Oncology.

BACKGROUND: The International Society of Pediatric Oncology established baseline standards for pediatric oncology nursing; limited evidence is available to predict hospitals' capacity to meet these standards internationally. OBJECTIVES: The aims of this study were to (1) determine the proportion of hospitals that met, partially met or did not meet baseline standards for pediatric oncology nursing and (2) identify predictors of hospitals' nonachievement of baseline standards for pediatric oncology nursing. METHODS/ANALYSIS: A secondary analysis of International Society of Pediatric Oncology web-based survey data of baseline nursing standards was conducted. Predictor variables were derived from surveyed hospital characteristics and external data sources. Multivariable parsimonious logistic regression models identified predictors of hospitals' nonachievement of each standard. RESULTS: Nurses from 101 hospitals across 54 countries completed the survey; 12% to 66% of hospitals reported meeting each of 6 baseline standards. Predictors of nonachievement of standards included low current health expenditure as percentage of gross domestic product, World Health Organization Region of Africa, United Nations "developing or transition" country classification, countries with fewer than 3 nurses/midwives per 1000 population, and hospitals without bone marrow transplant and/or intensive care units. CONCLUSIONS: Hospitals with characteristics predictive of inability to meet baseline standards will likely require greater capacity-building support and advocacy to improve the quality of nursing care. IMPLICATIONS FOR PRACTICE: Findings from this study highlight internal and external factors that challenge the delivery of high-quality pediatric oncology nursing care internationally.

Video game distraction and anesthesia mask practice reduces children's preoperative anxiety: A randomized clinical trial.

PURPOSE: The study aims to evaluate the effectiveness of combined video game distraction and anesthesia mask exposure and shaping intervention as compared to conventional preoperative preparation on the preoperative anxiety, anesthesia induction compliance and emergence delirium of children undergoing day-case surgery. DESIGN AND METHODS: The CONSORT guidelines were followed in the current study; a randomized clinical trial, two groups, pre posttest, between subjects design with 1:1 allocation ratio was employed. Children (5-11 years of age; N = 128) admitted for day case surgery were invited to participate in the study. Sixty-four children were assigned to the intervention group receiving combined videogame distraction and anesthesia mask exposure and shaping intervention, and 64 children were assigned to the control group. RESULTS: The results showed that children in the intervention group reported statistically significant lower anxiety scores than the children in the control group at three preoperative points of time: postintervention t = 4.48, p < .001, at the time of transfer to the operation room t = 10.18; p < .001 and during anesthesia induction t = 7.76; p < .001. In addition, compared with the children in the control group, fewer children in the intervention group demonstrated poor anesthesia induction compliance χ2 = 3.91; p = .04. The results, however, did not reveal statistically significant differences in children's emergence delirium scores. PRACTICE IMPLICATION: Combined video game distraction and anesthesia mask exposure and shaping are simple, safe, and time-effective intervention that the nurses can implement at the day of surgery to mitigate children anxiety and to enhance their anesthesia induction compliance.

Fifteen-minute consultation: Assessing the child with a Blalock-Taussig shunt who is unwell in a district general hospital.

Univentricular heart disease accounts for ~1.25% of all congenital heart disease. Such cases remain among the most challenging to manage, typically requiring a three-staged palliation. The first stage involves placement of a systemic to pulmonary shunt. While a variety of shunt types, including ductal stenting, can be used to manage univentricular conditions, the archetype remains the Blalock-Taussig (BT) shunt. While waiting future palliative intervention at home, intercurrent illness may necessitate presentation to a district general hospital where subspecialist advice and assessment is remote. This review aims to present the general paediatrician with a straightforward BT shunt physiology overview highlighting unique complications which may complicate intercurrent illness.

Use of nursing technologies for safe perioperative pediatric care / Uso de tecnologías de enfermería para la atención perioperatoria pediatría segura / Uso das tecnologias de enfermagem para uma assistência segura no perioperatório pediátrico

ABSTRACT Objective: To understand the nursing team's perception about the use of technology for safe perioperative pediatric care, through photographs. Method: A qualitative study using the theoretical framework of Nietsche Specific Nursing Technology, with a total of 18 perioperative nursing professionals from a general hospital in southern Brazil. Data collection occurred from June to August 2018, from a semi-structured interview and photograph production. They were analyzed through the Thematic Content Analysis. Approved by the Research Ethics Committee of the Federal University of Santa Catarina. Results: The Nursing Technologies category used for the safety of the pediatric patient in the perioperative period, with 250 photographs illustrating facts, situations and artifacts considered nursing technologies used in safe care. Conclusions: In the team's perception, patient safety involves the use of technologies integrated to perioperative care and structural, physical and input aspects.

RESUMEN Objetivo: Entender la percepción del equipo de Enfermería sobre el uso de la tecnología para una assistência segura en el perioperatory, por medio de la imagen. Método: Investigación cualitativa, utilizó la referencia teórica a la Tecnología de Enfermería Específica de Nietsche, con 18 profesionales de enfermería perioperatoria de un hospital general de la región sur de Brasil. La recopilación de datos se llevó a cabo de junio a agosto de 2018, a partir de una entrevista semiestructurada y la producción de imágenes. Analizado a través del Análisis de Contenido Temático. Aprobado por el Comité de Ética de la Universidad Federal de Santa Catarina. Resultados: La categoría Tecnologías de enfermería utilizadas para la seguridad del paciente pediátrico en el período perioperatory, con 250 fotografías que ilustran hechos, situaciones y artefactos considerados tecnologías de enfermería utilizadas en la atención segura. Conclusiones: Según la percepción del equipo, la seguridad del paciente implica el uso de tecnologías integradas en la atención perioperatoria y aspectos estructurales, físicos y de insumos.

RESUMO Objetivo: Compreender a percepção da equipe de enfermagem quanto ao uso da tecnologia para uma assistência segura no perioperatório pediátrico, por meio da imagem. Método: Pesquisa qualitativa, utilizou o referencial teórico a Tecnologia Específica de Enfermagem de Nietsche, com 18 profissionais de enfermagem do perioperatório de um hospital geral da região sul do Brasil. A coleta de dados ocorreu de junho a agosto de 2018, a partir de entrevista semiestruturada e a produção de imagens. Analisados por meio da Análise Temática de Conteúdo. Aprovado pelo Comitê de Ética da Universidade Federal de Santa Catarina. Resultados: A categoria Tecnologias de Enfermagem utilizadas para a segurança do paciente pediátrico no perioperatório, com 250 fotografias ilustrando fatos, situações e artefatos considerados tecnologias de enfermagem usadas na assistência segura. Conclusões: Na percepção da equipe, a segurança do paciente envolve uso de tecnologias integradas à assistência perioperatória e a aspectos estruturais, físicos e de insumo.

Caring for the Pediatric, Adolescent, or Young Adult Patient with Acute Lymphoblastic Leukemia.

OBJECTIVE: To summarize the issues pediatric, adolescent, and young adult patients face during and after a diagnosis of acute lymphoblastic leukemia (ALL) and guide appropriate nursing care for patients with ALL in these young age groups. DATA SOURCES: Peer-reviewed journal articles, published guidelines, patient and family resources, and data from the Surveillance, Epidemiology, and End Results Program. CONCLUSION: Nursing care of children, adolescents, and young adults with ALL requires a comprehensive approach that is appropriate for the developmental needs of patients in this age group. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses must be aware of the unique developmental challenges that pediatric, adolescent, and young adult patients face while dealing with a diagnosis of ALL, and have knowledge of resources available for these patients to effectively guide them through treatment and its side effects, fertility options, psychosocial challenges, and survivorship.

Nursing Practice With Transthoracic Intracardiac Catheters in Children: International Benchmarking Study.

BACKGROUND: Transthoracic intracardiac catheters are central catheters placed in the operating room at the conclusion of cardiac surgery for infants and children. Complications associated with these catheters (eg, bleeding, migration, premature removal, infection, leakage, and lack of function) have been described. However, no researchers have addressed the nursing management of these catheters in the intensive care unit, including catheter dressing and securement, mobilization of patients, and flushing the catheters, or the impact of these interventions on patients' outcomes. OBJECTIVES: To internationally benchmark current nursing practice associated with care of infants and children with transthoracic intracardiac catheters. METHODS: In a cross-sectional, descriptive study of nursing practice in infants and children with transthoracic intracardiac catheters, a convenience sample of bedside and advanced practice nurses was recruited to complete an online survey to benchmark current practice. The survey included questions on criteria for catheter insertion and removal, dressing care, flushing practice, securement, and mobilization of patients. RESULTS: Transthoracic intracardiac catheters are used by most centers that provide care for infants and children after open heart surgery. A wide range of practices was reported. CONCLUSIONS: Standardizing the use and care of transthoracic intracardiac catheters can improve the safety and efficacy of their use in infants and children and promote safe and early postoperative mobilization of patients.

The Power of Reiki: Feasibility and Efficacy of Reducing Pain in Children With Cancer Undergoing Hematopoietic Stem Cell Transplantation.

Purpose: Reiki is a growing complementary therapy in pediatric oncology that needs evidence to become more credible among the health community. A within-subject design experiment was conducted to pilot testing the feasibility and efficacy of Reiki to provide pain relief among pediatric patients undergoing hematopoietic stem cell transplantation (HSCT). Method: Pediatric patients undergoing HSCT during the inpatient phase in the Stem Cell Transplantation Unit were eligible to participate to the pilot study. Short and medium effects were assessed investigating the increase or decrease of patient's pain during three specific time periods ("delta") of the day: morning of the Reiki session versus assessment before Reiki session (within subjects control period), assessment before Reiki session versus assessment after Reiki session (within subjects experimental period) and assessment after Reiki session versus morning the day after Reiki session (within subject follow-up period). The long-term effects were verified comparing the pain evolution in the day of the Reiki session with the following rest day. Results: The effect of 88 Reiki therapy sessions in nine patients (Mage = 12; Female = 61%) was analyzed following a short, medium, and long-term perspective. Repeated-measures analysis of variance revealed a significant difference among the three periods (F = 17,17 p < .0001): A decrease of the pain occurred in the experimental period in short and medium term, while in the follow-up period, the pain level remained stable. Conclusions: This study demonstrates the feasibility of using Reiki therapy in pediatric cancer patients undergoing HSCT. Furthermore, these findings evidence that trained pediatric oncology nurses can insert Reiki into their clinical practice as a valid instrument for diminishing suffering from cancer in childhood.

Inspire Certification Among Pediatric Hematology Oncology Nurses.

Professional certification validates nurses' knowledge and expertise in their specialty. In support of professional development, nursing excellence as a Magnet® designated hospital, and commitment to improve patient outcomes, increasing the number of certified pediatric hematology oncology nurses at Children's Hospital Los Angeles is a priority. Expert certified nurses and educators assessed current staff nurse perceptions of and motivations for becoming certified. A nurse survey was completed, and the results identified barriers to certification and the need for an onsite review course to encourage more nurses to take the Certified Pediatric Hematology Oncology Nurse (CPHON®) exam. The Oncology Nursing Certification Corporation (ONCC) CPHON® test blueprint guided the development of the Children's Hospital Los Angeles review course curriculum. Certified nurse experts volunteered as course instructors to present an overview of pediatric cancer, pediatric hematology, psychosocial review, chemotherapy and related medications, and long-term effects. In addition to course didactics, interactive learning sessions were included to allow participants to question, discuss, and apply new knowledge. Sample test questions were provided to each participant for independent study post-course attendance. Each participant completed course evaluations to measure the usefulness of the content, environment, and teaching methods. Since the implementation of this course, the overall number of certified hematology oncology nurses has increased by 15.3%.

Nursing interventions in palliative care in Pediatric Oncology: an integrative review.

OBJECTIVE: to identify, in scientific productions, nursing interventions in palliative care in children and adolescents with cancer. METHOD: integrative review of the literature through the databases: CINAHL, MEDLINE, IBECS, LILACS and SCIELO, carried out in October and November 2017. RESULTS: we analyzed 18 articles that met the inclusion criteria. The results showed that, among the articles selected, Brazil is the country with the largest number of publications and that interventions such as music therapy, massage, ludic application, early consultation of palliative care, social interventions and physical exercises aimed at the resolution of a specific symptom obtained better results when compared to interventions that aimed at the comprehensiveness of palliative care. FINAL CONSIDERATION: we conclude that greater emphasis should be given to palliative care in academic and professional training and that further studies in search of the best evidence should be conducted to support nursing Evidence-Based Practices.

The meaning of a "good nurse" in pediatric care: a concept analysis / El significado de la "buena enfermera" en el cuidado pediátrico: un análisis de concepto / O significado da "boa enfermeira" no cuidado pediátrico: uma análise de conceito

ABSTRACT Objective: to analyze the attributes, antecedents and consequences of the concept a "good nurse" in the context of Pediatrics. Method: concept analysis study based on Rodgers' evolutionary method. Theoretical stage consisted of searching for articles in the CINAHL, Embase and Pubmed databases and a practical stage of semi-structured interviews with pediatric nurses. The final analysis unified the two stages by categories of antecedents, attributes and consequences of the concept. Results: 20 articles and 10 interviews were analyzed revealing as antecedents aspects related to education, scientific development and ethical-moral skills and values. Responsibility, compassion, honesty and advocacy stand out as attributes of the "good nurse." The consequences describe implications for children and families, as well as for professionals. Final Consideration: the analysis of the concept of the "good nurse" allowed us to clarify fundamental aspects for the execution of good practices, establishing parameters for investment in professional development programs.

RESUMEN Objetivo: analizar los atributos, antecedentes y consecuencias del concepto la "buena enfermera" en el contexto de la Pediatría. Método: estudio de análisis de concepto basado en el modelo evolucionista de Rodgers. Se realizó una etapa teórica que consistió en la búsqueda de artículos en las bases CINAHL, Embase y Pubmed y etapa práctica de entrevistas semiestructuradas con enfermeros de pediatría. El análisis final unificó las dos etapas por medio de categorías sobre antecedentes, atributos y consecuencias del concepto. Resultados: 20 artículos y 10 entrevistas fueron analizadas revelando como antecedentes los aspectos relacionados a la educación, el desarrollo científico y habilidades y valores ético-morales. Responsabilidad, compasión, honestidad y abogacía se destacan como los atributos de la "buena enfermera". Las consecuencias describen las implicaciones para los niños y las familias, así como para los profesionales. Consideraciones Finales: el análisis del concepto de la "buena enfermera" permitió aclarar aspectos fundamentales para la ejecución de buenas prácticas, estableciendo parámetros para la inversión en programas de desarrollo profesional.

RESUMO Objetivo: analisar os atributos, antecedentes e consequências do conceito "boa enfermeira" no contexto da Pediatria. Método: estudo de análise de conceito baseado no modelo evolucionista de Rodgers. Realizou-se uma etapa teórica que consistiu na busca de artigos nas bases CINAHL, Embase e Pubmed e etapa prática de entrevistas semiestruturadas com enfermeiros de pediatria. A análise final unificou as duas etapas por meio de categorias sobre antecedentes, atributos e consequências do conceito. Resultados: 20 artigos e 10 entrevistas foram analisados revelando como antecedentes aspectos relacionados à educação, desenvolvimento científico e habilidades e valores ético-morais. Responsabilidade, compaixão, honestidade e advocacia destacam-se como atributos da "boa enfermeira". As consequências descrevem implicações para as crianças e famílias, bem como, para os profissionais. Considerações Finais: a análise do conceito da "boa enfermeira" permitiu esclarecer aspectos fundamentais para execução de boas práticas, estabelecendo parâmetros para investimento em programas de desenvolvimento profissional.

Nursing interventions in palliative care in Pediatric Oncology: an integrative review / Intervenciones de enfermería en los cuidados paliativos en Oncología Pediátrica: una revisión integrativa / Intervenções de enfermagem nos cuidados paliativos em Oncologia Pediátrica: revisão integrative

ABSTRACT Objective: to identify, in scientific productions, nursing interventions in palliative care in children and adolescents with cancer. Method: integrative review of the literature through the databases: CINAHL, MEDLINE, IBECS, LILACS and SCIELO, carried out in October and November 2017. Results: we analyzed 18 articles that met the inclusion criteria. The results showed that, among the articles selected, Brazil is the country with the largest number of publications and that interventions such as music therapy, massage, ludic application, early consultation of palliative care, social interventions and physical exercises aimed at the resolution of a specific symptom obtained better results when compared to interventions that aimed at the comprehensiveness of palliative care. Final Consideration: we conclude that greater emphasis should be given to palliative care in academic and professional training and that further studies in search of the best evidence should be conducted to support nursing Evidence-Based Practices.

RESUMEN Objetivo: identificar, en las producciones científicas, las intervenciones de enfermería en los cuidados paliativos en niños y adolescentes con cáncer. Método: revisión integradora de la literatura en las bases de datos: CINAHL, MEDLINE, IBECS, LILACS e SCIELO, realizado en octubre y noviembre 2017. Resultados: se analizaron 18 artículos que cumplieron los criterios de inclusión. Los resultados mostraron que, entre los artículos seleccionados, Brasil es el país con más publicaciones y intervenciones como: musicoterapia, masaje, aplicación del lúdico, consulta precoz de cuidados paliativos, intervenciones sociales y ejercicios físicos que objetivaron la resolución de un síntoma específico obtuvieron mejores resultados si se compararon las intervenciones que objetivaban la integralidad de los cuidados paliativos. Consideraciones Finales: concluimos que el mayor énfasis debe ser dado a los cuidados paliativos en la formación académica y profesional y que nuevos estudios en la búsqueda de las mejores evidencias deben ser realizados para basar las prácticas de enfermería basadas en evidencias.

RESUMO Objetivo: identificar, nas produções científicas, as intervenções de enfermagem nos cuidados paliativos em crianças e adolescentes com câncer. Método: revisão integrativa da literatura através das bases de dados: CINAHL, MEDLINE, IBECS, LILACS e SCIELO, realizado em outubro e novembro de 2017. Resultados: foram analisados 18 artigos que atenderam aos critérios de inclusão. Os resultados mostraram que, dentre os artigos selecionados, o Brasil é o país com maior número de publicações e que as intervenções como: musicoterapia, massagem, aplicação do lúdico, consulta precoce de cuidados paliativos, intervenções sociais e exercícios físicos que objetivaram a resolução de uma sintoma específico obtiveram melhores resultados se comparadas as intervenções que objetivavam a integralidade dos cuidados paliativos. Considerações Finais: concluímos que maior ênfase deve ser dada aos cuidados paliativos na formação acadêmica e profissional e que novos estudos em busca das melhores evidências devem ser realizados para embasar as práticas de enfermagem baseadas em evidências.

Disparities in the delivery of pediatric oncology nursing care by country income classification: International survey results.

BACKGROUND: In 2014, a task force of the International Society of Paediatric Oncology (SIOP) Paediatric Oncology in Developing Countries Nursing Workgroup published six baseline standards to provide a framework for pediatric oncology nursing care in low- and lower-middle income countries (L/LMIC). We conducted an international survey in 2016-2017 to examine the association between country income level and nurses' resporting of conformity to the standards at their respective institutions. PROCEDURE: Data from a cross-sectional web-based survey completed by nurses representing 54 countries were analyzed (N = 101). Responses were clustered by relevance to each standard and compared according to the 2017 World Bank-defined country income classification (CIC) of hospitals. RESULTS: CIC and nurse-to-patient ratios in inpatient wards were strongly associated (P < 0.0001). Nurses in L/LMIC prepared chemotherapy more often (P < 0.0001) yet were less likely to have access to personal protective equipment such as nitrile gloves (P = 0.0007) and fluid-resistant gowns (P = 0.011) than nurses in high-resource settings. Nurses in L/LMIC were excluded more often from physician/caregiver meetings to discuss treatment options (P = 0.04) and at the time of diagnosis (P = 0.002). Key educational topics were missing from nursing orientation programs across all CICs. An association between CIC and the availability of written policies (P = 0.009) was found. CONCLUSIONS: CIC and the ability to conform to pediatric oncology baseline nursing standards were significantly associated in numerous elements of the baseline standards, a likely contributor to suboptimal patient outcomes in L/LMIC. To achieve the goal of high-quality cancer care for children worldwide, nursing disparities must be addressed.

Productivity of subjectivity and autonomy of nursing professionals in Pediatrics / Producción de subjetividad y autonomía en los profesionales de enfermería en la Pediatría / Produção de subjetividade e autonomia nos profissionais de enfermagem na Pediatria

ABSTRACT Objective: To know the aspects involved in the production of subjectivity and autonomy of nursing professionals working in Pediatric Units. Method: An exploratory and descriptive study, with a qualitative approach, performed with users, professionals and nursing managers, totaling 44 participants. Data collection took place in the pediatric hospitalization units of two University Hospitals through semi-structured interviews, organized and treated by Nvivo 10 software and then submitted to content analysis. Results: The production of subjectivity and autonomy in nursing workers involves both the conditions of the work environment as the relation of the nursing team, the relation of hierarchy and the profile of the professional that works in the Pediatric Unit. Final considerations: The valorization path of the nursing profession emerges, whose knowledge and competence in the area of work contribute to the construction of autonomous subjectivities.

RESUMEN Objetivo: Conocer los aspectos involucrados en la producción de subjetividad y autonomía de los profesionales de enfermería actuantes en Unidades Pediátricas. Método: Estudio exploratorio y descriptivo, con abordaje cualitativo, realizado con usuarios, profesionales y gestores de enfermería, totalizando 44 participantes. La recolección de datos ocurrió en las unidades de internación pediátrica de dos Hospitales Universitarios por medio de entrevistas semiestructuradas, organizadas y tratadas por el software Nvivo 10 y posteriormente sometidas al análisis de contenido. Resultados: La producción de subjetividad y autonomía en los trabajadores de enfermería involucra tanto las condiciones del ambiente de trabajo como la relación del equipo de enfermería, la relación de jerarquía y el perfil del profesional que actúa en la unidad de pediatría. Consideraciónes finales: Se desprende la trayectoria de valorización de la profesión de enfermería, cuyo conocimiento y competencia en el área de actuación contribuyen en la construcción de subjetividades autónomas.

RESUMO Objetivo: Conhecer os aspectos envolvidos na produção de subjetividade e autonomia dos profissionais de enfermagem atuantes em Unidades Pediátricas. Método: Estudo exploratório e descritivo, com abordagem qualitativa, realizado com usuários, profissionais e gestores de enfermagem, totalizando 44 participantes. A coleta de dados ocorreu nas unidades de internação pediátrica de dois Hospitais Universitários por meio de entrevistas semiestruturadas, organizadas e tratadas pelo software Nvivo 10 e, posteriormente, submetidas à análise de conteúdo. Resultados: A produção de subjetividade e autonomia nos trabalhadores de enfermagem envolve tanto as condições do ambiente de trabalho como a relação da equipe de enfermagem, a relação de hierarquia e o perfil do profissional que atua na unidade de pediatria. Considerações finais: desponta a trajetória de valorização da profissão de enfermagem, cujo conhecimento e competência na área de atuação contribuem na construção de subjetividades autônomas.

The use of children's stories in nursing care for the child: an integrative review / El uso de historias infantiles en la atención de enfermería al niño: revisión integradora / O uso de histórias infantis no cuidado de enfermagem à criança: revisão integrativa

ABSTRACT Objective: To identify how children's stories can be used in child care. Method: Integrative literature review, conducted in databases between 2000 and 2018, in three languages. Full research articles were included that agreed with the following question: "How can children's stories be used in child care?". Results: From the analysis of 16 selected articles, three categories emerged: The use of stories in the hospital; Specialized nursing intervention; and Stories in the educational dimension. Final considerations: Evidence shows benefits to children, families, institutions and nursing. The use of children's stories as a care intervention can occur in different situations and settings, values; boosts bonds, reduces anxiety in children and families, encourages children's participation in care, and promotes health education. It is a low-cost and still incipient strategy in nursing.

RESUMEN Objetivo: Identificar cómo las historias infantiles se pueden utilizar en la atención al niño. Método: Revisión integradora de la literatura, realizada en bases de datos, entre 2000 y 2018, en tres idiomas. Se incluyeron artículos de investigación disponibles en su totalidad y que estaban de acuerdo con la siguiente pregunta: ¿Cómo las historias infantiles pueden ser utilizadas en la atención al niño? Resultados: A partir del análisis de 16 artículos seleccionados surgieron tres categorías: El uso de historias en el hospital; Intervención de enfermería especializada; e Historias en la dimensión educativa. Consideraciones finales: Las evidencias apuntan beneficios a los niños, a las familias, a las instituciones y a la Enfermería. El uso de historias infantiles como intervención de atención puede ocurrir en diferentes situaciones y escenarios, pues valoriza y estimula vínculos, reduce la ansiedad de los niños y sus familiares, estimula la participación de los niños en la atención, y promueve educación en Salud. Es una estrategia de bajo costo, y aún incipiente en la Enfermería.

RESUMO Objetivo: Identificar como as histórias infantis podem ser utilizadas no cuidado à criança. Método: Revisão integrativa da literatura, realizada em bases de dados, entre 2000 e 2018, em três idiomas. Foram incluídos artigos de pesquisa disponíveis na íntegra e que estavam de acordo com a seguinte questão: "Como as histórias infantis podem ser utilizadas no cuidado à criança?". Resultados: A partir da análise de 16 artigos selecionados, emergiram três categorias: O uso de histórias no hospital; Intervenção de enfermagem especializada; e Histórias na dimensão educativa. Considerações finais: As evidências apontam benefícios às crianças, às famílias, às instituições e à Enfermagem. O uso de histórias infantis como intervenção de cuidado pode ocorrer em diferentes situações e cenários, valoriza e estimula vínculos, reduz ansiedade das crianças e familiares, estimula a participação das crianças no cuidado, e promove educação em saúde. É uma estratégia de baixo custo e ainda incipiente na Enfermagem.