Nurses' Perceptions of the Impact of a National Educational Program in Pediatric Oncology Nursing: A Cross-Sectional Evaluation.

Background: Specific knowledge is required in pediatric oncology, and specialization of nurses has been identified as a priority. In Sweden, a national program in pediatric oncology nursing has been offered since 2003. The aim of this study was to gain knowledge of nurses' perceptions of the impact of this educational program. Methods: Eighty nurses who had completed the educational program in three cohorts (2012-2019) were invited to participate in this cross-sectional survey. An electronic study-specific questionnaire containing multiple-choice questions was used. Data were analyzed using descriptive statistics and correlation tests. Results: Fifty-nine (74%) nurses completed the survey, of whom 98% responded that they would recommend the program to a large/fairly large extent. At the time of the survey, 15 (25%) participants had left pediatric oncology care. Among the remaining 44, 31 (71%) of the nurses were working bedside, and 13 (42%) of these combined this with a special position (e.g., consultant nurse). The education resulted in career advancement, as the number of nurses with special positions increased following completion of the program, from 20% to 59%. The vast majority stated that the knowledge gained from the education contributed to increased confidence in interactions with the children/families. Discussion: Continuing education of nurses in pediatric oncology has an impact on career opportunities in clinical practice and contributes to nurses' confidence and professional work. However, education is not enough to retain competent nurses. Employers need to be aware of the role of the work environment, aspects of work-life balance and career paths.

Validação de vídeo instrucional sobre banho de ofurô em recém-nascido pré-termo para enfermeiros / Validación de video instructivo sobre baño de ofuro en recién nacido prematuro para enfermeros / Validation of an instructional video for nurses about hot tub bath for preterm newborns

Resumo Objetivo Produzir um vídeo instrucional para enfermeiros sobre o banho de ofurô em recém-nascidos pré-termo e validar seu conteúdo. Método Estudo metodológico de desenvolvimento tecnológico com ênfase na validação de conteúdo, conduzido em três etapas: revisão exploratória da literatura, produção da tecnologia educacional do tipo vídeo instrucional e validação por especialistas. Os dados foram sistematizados e organizados em planilhas e as análises foram conduzidas no pacote estatístico R. Para validar o conteúdo, aplicaram-se o Índice Kappa, para medir a concordância entre as respostas, e o Índice de Validade de Conteúdo, para estimar a representatividade do item. Resultados As publicações sobre a técnica (n=3) identificadas na revisão de literatura foram utilizadas para a produção do vídeo. O vídeo simula o cuidado em unidade neonatal e tem duração de 13 minutos. No processo de validação, o vídeo foi considerado, no geral, com representatividade de conteúdo adequada e obteve índice de concordância entre as respostas quase perfeito. Dois itens foram avaliados como "adequados com alterações" e modificados. Conclusão e implicações para a prática O material produzido foi considerado adequado para ser utilizado na capacitação de enfermeiros sobre a técnica e compartilhamento de informações, contribuindo para o cuidado de enfermagem humanizado e seguro em unidades neonatais.

Resumen Objetivo Producir un video instructivo para enfermeros sobre el baño de ofuro en recién nacidos prematuros y validar su contenido. Método Estudio metodológico de desarrollo de tecnología con énfasis en la validación de contenido, realizado en tres etapas: revisión exploratoria de la literatura, producción de tecnología educativa de tipo video instructivo y validación por expertos. Los datos fueron sistematizados y organizados en hojas de cálculo y los análisis se realizaron en el paquete estadístico R. Para validar el contenido se aplicó el Índice Kappa para medir la concordancia entre las respuestas y el Índice de Validez del Contenido para estimar la representatividad del ítem. Resultados Para la producción del video se utilizaron publicaciones sobre la técnica (n = 3) identificadas en la revisión de la literatura. El video simula la atención en una unidad neonatal y tiene una duración de 13 minutos. En el proceso de validación, el video se consideró, en general, con adecuada representación de contenido y con un índice de concordancia casi perfecto entre las respuestas. Dos ítems se evaluaron como "adecuados con cambios" y se modificaron. Conclusión e implicaciones para la práctica El material producido fue considerado por los especialistas como adecuado para uso en la formación de enfermeros sobre la técnica y el intercambio de información, contribuyendo para la atención de enfermería humanizada y segura en las unidades neonatales.

Abstract Objective To produce an instructional video for nurses about hot tub bath for preterm newborns and to validate its content. Method Methodological study of technological development with emphasis on content validation, conducted in three stages: exploratory literature review, production of an instructional video educational technology and expert validation. The data were systematized and organized in spreadsheets and the analyses were carried out in the statistical package R. For content validation, the Kappa Index was calculated to measure response agreement and the Content Validity Index was employed to estimate item representativeness. Results Publications about the technique (n=3) identified in the literature review were used for video production. The video simulates care in a neonatal unit and lasts 13 minutes. In the validation process, the video was considered, in general, to have an adequate content representation and had an almost perfect response agreement index. Two items were assessed as "adequate after revision" and modified. Conclusion and implication for the practice The produced material was considered by the experts as suitable for use in training nurses on the technique and sharing information, contributing to a humanized and safe nursing care in neonatal units.

A sustainable model for pediatric oncology nursing education and capacity building in Latin American hospitals: Evolution and impact of a nurse educator network.

Through an "educate-the-educator" twinning model, pediatric oncology nurse educator roles and programs have been established at hospitals in Latin America since 2008. However, with increasing demand for nurse educator programs in the region, a twinning approach was no longer sustainable. Thus, a "nurse educator network" approach was established to scale adaptable, standardized multisite education and quality initiatives. The development, expansion, and impact of a sustainable network approach for pediatric oncology nursing capacity building in Latin America is described. The educator network approach serves as a potential model for other geographical regions. Coronavirus disease 2019 (COVID-19) impact and adaptations are addressed.

Uso do sistema de infusão contínua de insulina em crianças e adolescentes com diabetes mellitus tipo 1: revisão de mapeamento sistemático / Use of continuous insulin infusion systems in children and adolescents with type 1 diabetes mellitus

Um dos avanços tecnológicos no tratamento do diabetes mellitus tipo 1 (DM1) é o uso do sistema de Infusão Contínua de Insulina (SICI). Essa revisão sistemática de mapeamento teve como objetivo agrupar e descrever as evidências dos estudos relacionados ao uso do SICI em crianças e adolescentes com DM1. A estratégia de busca foi estruturada a partir da ferramenta PCO, utilizando-se uma combinação de descritores e palavras-chaves. Buscas bibliográficas foram conduzidas nas seguintes bases de dados: PubMed, Embase, CINAHL, Lilacs e PsycINFO, aplicando-se um único filtro, que foi o temporal, delimitando-se a publicação dos estudos até dezembro de 2020. Os critérios de inclusão foram: estudos primários e secundários, quantitativos e qualitativos, que tivessem como objetivo abordar o uso do SICI em crianças e adolescentes (0-18 anos) com DM1; e estudos que abordassem as perspectivas das próprias crianças e adolescentes, dos profissionais de saúde e dos familiares. Constituíram critérios de exclusão: estudos que comparassem a terapia de múltiplas injeções de insulina com a terapia por meio do SICI ou que incluíssem adultos jovens e adultos conjuntamente às crianças e adolescentes, participantes com diabetes mellitus tipo 2 (DM2) ou usuários do SICI com foco no sistema de monitorização contínua de glicose (CGM) ou pâncreas artificial. Utilizou-se o software Rayyan para exclusão das referências duplicadas e para a triagem dos títulos e resumos das referências capturadas, a qual foi conduzida por dois revisores independentes. Os dados dos estudos incluídos foram analisados com auxílio de uma ferramenta de extração adaptada e validada por pesquisadores especialistas em diabetes e com experiência no desenvolvimento de métodos de síntese de conhecimento. Os resultados foram analisados segundo a técnica de análise de conteúdo. Incluiu-se um total de 113 estudos na revisão, dentre eles, estudos originais, revisões de literatura e publicações de literatura cinzenta. Mapas de geocodificação dos estudos foram produzidos com auxílio do software ArcGis 10.5 para ilustrar o local de desenvolvimento dos estudos. A análise geográfica dos estudos possibilitou identificar maior concentração de publicações conduzidas em países desenvolvidos. Esta revisão reuniu as evidências para o uso do SICI em crianças e adolescentes com DM1, as quais foram apresentadas por meio das seguintes categorias: indicações e contraindicações para o uso do SICI; controle metabólico; redes de apoio; e benefícios e desafios do uso do SICI. As indicações para o uso do SICI superam as contraindicações. Apesar de grande parte dos estudos evidenciar melhora do controle metabólico de crianças e adolescentes em uso do SICI, a piora desse controle foi descrita em algumas pesquisas, o que sugere que esse parâmetro não deve ser analisado de forma isolada. As redes de apoio foram citadas como um dos fatores que influenciam os parâmetros de controle metabólico, conformando as subcategorias: apoio familiar e apoio da equipe de saúde e escola. Foram elencados desafios para o uso do SICI na população pediátrica, porém, vale ressaltar que parte destes desafios tem sido superada com o avanço da ciência e da tecnologia moderna. Múltiplos benefícios também foram descritos na literatura, os quais podem auxiliar profissionais de saúde na tomada de decisão para a melhor escolha e acompanhamento do tratamento do DM1 em crianças e adolescentes. Esta revisão reúne evidências sobre o uso do SICI em crianças e adolescentes com DM1 e contribui com o corpo de conhecimento relacionado à temática

One of the technological advances in type 1 diabetes mellitus (T1DM) treatment is the use of Continuous Subcutaneous Insulin Infusion (CSII). The aim of this systematic mapping review was to group and describe the evidence from research on the use of CSII in children and adolescents with T1DM. The search strategy was structured based on the PCO tool, using a combination of descriptors and keywords. Bibliographic searches were undertaken in the following databases: PubMed, Embase, CINAHL, Lilacs and PsycINFO, applying a single time-based filter to delimit the publication of studies until December 2020. The inclusion criteria were: primary and secondary studies, quantitative and qualitative, aimed at discussing the use of CSII in children and adolescents (0-18 years) with T1DM; and studies addressing the perspectives of the actual children and adolescents, the health professionals and Family members. Exclusion criteria were: studies that compared multiple insulin injection therapy with therapy using CSII or that included young adults and adults together with the children and adolescents, participants with type 2 diabetes mellitus (T2DM), or with CSII users focusing on the continuous glucose monitoring (CGM) system or artificial pancreas. The software Rayyan was used to exclude duplicated references and to screen the titles and abstracts of the collected references, which was conducted by two independent reviewers. The data from the included studies were analyzed with the help of an extraction tool, adapted and validated by researchers with diabetes expertise and knowledgeable on the development of knowledge synthesis methods. The content analysis technique was used to analyze the results. In total, 113 studies were included in the review, covering original studies, literature reviews and grey literature publications. Geocoding maps of the studies were produced in ArcGis 10.5 to illustrate where the studies had been developed. Through the geographic analysis of the studies a greater concentration of publications in developed countries was identified. This review gathered evidence on the use of CSII in children and adolescents with T1DM, presented in the following categories: indications and contraindications for the use of CSII; metabolic control; support networks; and benefits and challenges of CSII use. The indications in favor of using CSII outweigh the contraindications. Although most of the studies evidence improved metabolic control in children and adolescents who use CSII, some studies described worse control, suggesting that this parameter should not be analyzed in isolation. The support networks were mentioned as one of the factors that influence the metabolic control parameters. This category includes the following subcategories: family support and support from the health team and school. Challenges were listed for the use of CSII in the pediatric population, although it should be highlighted that advanced science and modern technology have overcome some of these. Multiple benefits have also been described in the literature, which can help health professionals to make decisions in order to better choose and monitor T1DM treatment in children and adolescents. This review gathers evidence on the use of CSII in children and adolescents with T1DM and contributes to the body of knowledge on the theme

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.

Distance-Based Education for Nurses Caring for Children With Cancer in Sub-Saharan Africa.

Nursing specialization in the care of children with cancer provides the foundation for implementing successful childhood cancer and blood disorder treatment programs throughout the world. Excellence in nursing education is at the center of all that is needed to maximize cures for children with cancer in low- and middle-income countries (LMIC). While the burden of childhood cancer care is the highest in LMIC, opportunities for continuing nursing education and specialization are extremely limited. Capacity-building programs using distance-based learning opportunities have been successful in sub-Saharan Africa and provide insight into successful, continuing professional development. The Global Hematology-Oncology Pediatric Excellence (HOPE) program part of Texas Children's Hospital in Houston, Texas, has developed and implemented a distance-based training program designed for nurses working in sub-Saharan Africa. Following a needs assessment, Global HOPE developed a program using both the Moodle (modular object-oriented dynamic learning environment) distance-based learning platform and computer notebooks that hold the course content. The program teaches basic principles of nursing care for a child with cancer and has been implemented in Malawi, Uganda, and Botswana. Courses are taught using a modular approach and core competencies are established for each module. Frequent teaching sessions using Zoom and WhatsApp reinforce independent learning experiences. Formal course evaluation includes written pre- and posttests, self-competency assessments, and simulated checkoffs on essential pediatric oncology nursing competencies. The success of this distance-based learning program emphasizes the importance of formal training for nurses in LMIC to become full-time specialists in pediatric oncology nursing.

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.

Implementation of the m-ISHAPED Tool for Nursing Interdepartmental Handoffs.

BACKGROUND: Handoffs can pose risks to patients. LOCAL PROBLEM: Nurses throughout a children's hospital understood patient handoffs differently, resulting in handoff errors (failures) across departments. METHODS: Lean principles were used to modify and implement the ISHAPED (Introduction, Story, History, Assessment, Plan, Error Prevention, and Dialogue) tool. INTERVENTIONS: The team implemented a modified ISHAPED (m-ISHAPED) tool to align the content shared and the expectations for interdepartmental handoff. RESULTS: Improvements were seen in reported patient safety events from 6.84 to 1.57 per 100 patient days (P < .001) and nurse satisfaction from 81.1% to 90.6% (P < .001). CONCLUSIONS: A standardized process for interdepartmental nursing handoff was successfully implemented.

Assessment of the Role of the Pediatric Nurse in Patient Education and Follow-up of Patients Receiving Oral Anticancer Treatment.

Objective: To assess the role of the pediatric nurse/advanced practice provider in patient education and follow-up of patients receiving oral anticancer therapy. Methods: Association of Pediatric Hematology/Oncology Nurses members were invited to participate in a survey that focused on the nurses' roles in patient education of patients taking oral oncolytic agents. Data were collected via a 16-item questionnaire. Respondents included 197 nurses and advanced practice providers. Content analysis techniques were used to describe the qualitative data while Fisher's exact test and chi-square test were used in the quantitative statistical analysis. Results: Seventy-one percent of respondents reported some type of involvement in patient education. Knowledge as well as comfort level improved as years of oncology nursing experience increased. Generally, policies and procedures are in place; however, nurses noted there is a need for improved oral oncolytic guidelines. Nurses also reported a need for improved and updated educational resources. Conclusion: While the development of oral oncolytic agents continues to rise, findings show a need to develop evidence-based guidelines for nurses, which include management of oral oncolytic dosing, adverse events, and safety issues.

The voice of paediatric oncology nurses: A longitudinal diary study of professional development.

PURPOSE: There is a limited amount of studies with results on professional development of paediatric oncology nurses. This study seeks to increase the understanding of the factors associated with the professional development of paediatric oncology nurses through the continuous education programme from the paediatric nurses' perspective. METHOD: The descriptive, qualitative study used the text of participants' electronic diaries as data during a two-year continuing professional education programme in 2016-2018. The sample consisted of 17 paediatric oncology nurses who were working in three different university hospitals. The data were analysed with the inductive content analysis method. RESULTS: Professional development is linked with a strong knowledge base in nursing, which involves the use of nursing methods and up-to-date nursing practices. Professional development is also linked with the use of medical knowledge, which manifests as a deep understanding of cancers and their treatment. CONCLUSIONS: Research results show that a strong knowledge base in nursing alone is not sufficient for the professional development of paediatric oncology nurses. They also need to use their medical knowledge in order to gain an adequately deep understanding of children's cancers and their treatment. Nursing must be organised so that nurses have the opportunity to compare, share, question and argue for the methods they use with their colleagues in their own unit and other hospitals. Further research is needed on the professional development of paediatric oncology nurses and factors affecting it in order for a career development model to be created for this specific yet demanding area of nursing.

O brinquedo terapêutico na graduação de enfermagem: da teoria à prática / The therapeutic play in nursing graduation: from theory to practice / El juguete terapéutico en la graduación de enfermería: de la teoría a la práctica

Objetivo: identificar o uso do brinquedo terapêutico pelos acadêmicos de enfermagem no cuidado à criança hospitalizada e discutir as implicações de seu uso na trajetória do acadêmico de enfermagem. Método: pesquisa qualitativa, desenvolvida em uma Escola de Enfermagem Federal no Rio de Janeiro com 17 acadêmicos. A coleta de dados foi realizada em outubro e novembro de 2016 por meio de entrevista semiestruturada e tratados com a técnica de análise de conteúdo temática. Resultados: o brinquedo terapêutico é apresentado ao aluno no conteúdo teórico, porém sem a oportunidade de aplicá-lo na prática. Sua aplicação prática o deixaria mais seguro para prestar assistência à criança, somado à qualidade do cuidado prestado e os benefícios para ela. Conclusão: o ensino do brinquedo terapêutico deve acontecer em campo prático, e não somente no teórico, contribuindo, assim, para melhor formação do enfermeiro e melhoria da qualidade da assistência pediátrica

Objective: To identify the use of therapeutic toys by nursing students when caring for hospitalized children and to discuss the consequences of their use in the path of nursing students. Method: Qualitative research, developed at a Federal Nursing School in Rio de Janeiro with 17 students. Data were collected in October and November 2016, through semistructured interviews, and they were processed with the thematic content analysis technique. Results: The therapeutic toy is introduced to the student in the theoretical content, but without the opportunity to apply it in practice. Its practical application would make it safer to provide care to the child, added to the quality of the care provided and the benefits for it. Conclusion: The therapeutic toy teaching should happen in the practical field, not only in the theoretical field, thereby contributing to a better training of nurses and improvement of the quality of the pediatric care

Objetivo: Identificar el uso del juguete terapéutico por los académicos de enfermería en la atención al niño hospitalizado y discutir las consecuencias de su uso en la trayectoria del académico de enfermería. Método: Investigación cualitativa, desarrollada en una Escuela Federal de Enfermería en Río de Janeiro con 17 académicos. Los datos se recolectaron en octubre y noviembre 2016 mediante entrevista semiestructurada y se trataron con la técnica de análisis de contenido temático. Resultados: El juguete terapéutico se presenta al alumno en el contenido teórico, pero sin oportunidad de aplicarlo en la práctica. Su aplicación práctica lo dejaría más seguro para ayudar al niño, sumado a la calidad de la atención ofrecida y los beneficios para él. Conclusión: La enseñanza del juguete terapéutico debe ocurrir en el campo práctico, y no sólo en el teórico, contribuyendo así para mejor formación del enfermero y mejoramiento de la calidad de la asistencia pediátrica

Pediatric palliative care nursing.

Palliative care is patient- and family-centered care that enhances quality of life throughout the illness trajectory and can ease the symptoms, discomfort, and stress for children living with life-threatening conditions and their families. This paper aims to increase nurses' and other healthcare providers' awareness of selected recent research initiatives aimed at enhancing life and decreasing suffering for these children and their families. Topics were selected based on identified gaps in the pediatric palliative care literature. Published articles and authors' ongoing research were used to describe selected components of pediatric palliative nursing care including (I) examples of interventions (legacy and animal-assisted interventions); (II) international studies (parent-sibling bereavement, continuing bonds in Ecuador, and circumstances surrounding deaths in Honduras); (III) recruitment methods; (IV) communication among pediatric patients, their parents, and the healthcare team; (V) training in pediatric palliative care; (VI) nursing education; and (VII) nurses' role in supporting the community. Nurses are in ideal roles to provide pediatric palliative care at the bedside, serve as leaders to advance the science of pediatric palliative care, and support the community.

Training and evaluation of professional competency in pediatric nursing: perspective of university professors / Formación y evaluación de la competencia profesional en enfermería pediátrica: perspectiva de docentes universitarios / Formação e avaliação da competência profissional em enfermagem pediátrica: perspectiva de docentes universitários

ABSTRACT Objective: To analyze the training and evaluation of professional competency to work in the area of pediatric nursing based on the conceptions and experiences of university professors. Method: A qualitative study conducted with pediatric nursing professors from six public undergraduate courses in the state of São Paulo, Brazil. The data were collected by semi-structured interview and analyzed by the Content Analysis method. Results: Sixteen professors participated. Five main themes emerged: competency definition, attributes to act with children, advances in the training of professional competency, challenges to enable training pediatric competency, and methods and instruments for evaluating competency acquisition to work in the area of pediatric nursing. Conclusion: The findings of this study point to the importance of a balanced approach in the cognitive, psychomotor and affective dimensions in training and evaluating professional competency in pediatric nursing, as well as extending the curricular valorization of this area of knowledge and practice.

RESUMEN Objetivo: Analizar la formación y evaluación de la competencia profesional para actuar en el área de enfermería pediátrica, desde las concepciones y experiencias de docentes universitarios. Método: Estudio de cuño cualitativo, realizado con docentes de enfermería pediátrica de seis carreras universitarias públicas del Estado de São Paulo, Brasil. Se recogieron los datos mediante entrevista semiestructurada y estos fueron analizados por el método de Análisis de Contenido. Resultados: Participaron 16 docentes. Surgieron cinco temas principales: definición de competencia, atributos para actuar con niños, avances en la formación de competencia profesional, retos para viabilizar la formación de competencia pediátrica y métodos e instrumentos para la evaluación de la adquisición de competencia para actuar en el área de enfermería pediátrica. Conclusión: Los hallazgos de este estudio señalan la importancia del abordaje equilibrado de las dimensiones cognitivas, psicomotoras y afectivas en la formación y evaluación de la competencia profesional en enfermería pediátrica, así como la ampliación de la valorización curricular de esta área de conocimiento y práctica.

RESUMO Objetivo: Analisar a formação e a avaliação de competência profissional para atuar na área de enfermagem pediátrica, a partir das concepções e experiências de docentes universitários. Método: Estudo de cunho qualitativo, realizado com docentes de enfermagem pediátrica de seis cursos de graduação públicos do estado de São Paulo, Brasil. Os dados foram coletados por entrevista semiestruturada e analisados pelo método de Análise de Conteúdo. Resultados: Participaram 16 docentes. Emergiram cinco principais temas: definição de competência, atributos para atuar com crianças, avanços na formação de competência profissional, desafios para viabilizar a formação de competência pediátrica e métodos e instrumentos para a avaliação da aquisição de competência para atuar na área de enfermagem pediátrica. Conclusão: Os achados deste estudo apontam a importância da abordagem equilibrada das dimensões cognitivas, psicomotoras e afetivas na formação e avaliação da competência profissional em enfermagem pediátrica, como também a ampliação da valorização curricular desta área de conhecimento e prática.

Consult, Negotiate, and Involve: Evaluation of an Advanced Communication Skills Program for Health Care Professionals.

Effective communication is central to children, young people, and their families' experiences of health care. Most patient complaints in developed health care systems result from ineffective communication, including inadequate information provision, not feeling listened to, failure to value patients concerns, and patients not feeling involved in care decisions. Advanced communication skills training is now embedded within cancer care policy in the United Kingdom and now features prominently within cancer education in many countries. Here, we share findings from a research evaluation of an advanced communication skills training program dedicated to health professionals caring for children and young people with cancer. We evaluated participants' (n = 59) perceptions of the program, impact on their skills, knowledge, competence, and confidence. An appreciative inquiry design was adopted; data included interviews, precourse-postcourse evaluations, e-mail blog survey, and 360-degree reflective work records. The framework approach underpinned data analysis and triangulation of data sets. Key findings highlighted good and poor practice in health professionals' engagement with children, young people, and their families; the purpose of communicating effectively was not always consistent with collaborative working. Attending a program helped participants expand their knowledge of communication theories and strategies. Participants valued using simulated scenarios to develop their skills and were keen to use their new skills to enhance care delivery. Our emphasis within this evaluation, however, remained on what was communicated, when and how, rather than to what effect. The impact of programs such as these must now be evaluated in terms of patient benefit.

Efetividade de intervenções educativas sobre contracepção na adolescência: revisão sistemática da literatura / The effectiveness of educational interventions about contraception in adolescence: a systematic review of the literature

O objetivo foi investigar a efetividade das intervenções educativas sobre contracepção na adolescência. Realizou-se busca nas bases de dados da Literatura Latino-Americana e do Caribe (LILACS), Cumulative Index to Nursing & Allied Health Literature(CINAHL), Web of Science e no portalNational Library of Medicine (PubMed/Medline), obedecendo aos critérios de inclusão: estudos que avaliem a efetividade de intervenções educativas sobre contracepção na adolescência, disponíveis na íntegra, nos idiomas português, inglês e espanhol. Observando os critérios de elegibilidade, obteve-se uma amostra de oito artigos. Observaram-se diferentes estratégias educativas sobre contracepção na adolescência utilizadas em diversos contextos e cenários, cujas intervenções mostraram-se efetivas, promovendo mudanças no conhecimento e/ou nas atitudes, evidenciando autoeficácia na prevenção de gravidez e infecções sexualmente transmissíveis. Conclui-se, portanto, que as intervenções educativas se mostraram efetivas na promoção da saúde sexual e reprodutiva dos adolescentes.

The aim was to investigate the effectiveness of educational interventions about contraception in adolescence. Searches were conductedin the databases Latin American and Caribbean Center on Health Sciences Information (LILACS), Cumulative Index to Nursing & Allied Health Literature (CINAHL), Web of Science and in the National Library of Medicine (Pubmed/Medline). The inclusion criteria were followed: studies assessing the effectiveness of educational interventions about contraception in adolescence, fully available, in the languages Portuguese, English, andSpanish. Observing the eligibility criteria, eight papers composed the sample. There were different educational interventions about contraception in adolescence used in diverse contexts and scenarios, where the interventions were effective, promoting changesin the knowledge and/orattitudes; thus showing self-efficacy for prevention of pregnancy and sexually transmitted diseases. Therefore, the educational interventions were effectiveto promote sexual and reproductive health in adolescents.

Vivência do professor no cotidiano da criança com estomia: abordagem da Fenomenologia Social / Experience of teachers in the daily life of a child with stoma: a Social Phenomenology approach

Este estudo procurou compreender a vivência de professores no processo de inclusão de crianças com estomia, tendo como referencial a Fenomenologia Sociológica. Foram realizadas entrevistas, com cinco professores, no período entre dezembro de 2015 e janeiro de 2016. A coleta de dados foi efetuada por narração do professor, posterior transcrição e análise dos dados. Emergiram quatro categorias temáticas: sentimentos vividos pelos professores; fatores que interferem nos cuidados; estratégias eficazes para o cuidado; estratégias para melhoria dos cuidados. Os professores, valorizaram a integração da criança com estomia na escola; consideram que esta ocorre com a modificação da formação pedagógica; e apontaram a necessidade da presença do enfermeiro nas escolas. Os resultados mostram a importância do desenvolvimento de ações e estratégias de apoio aos professores e aos alunos com estomia no contexto de uma escola inclusiva, considerando que o enfermeiro escolar é determinante para a promoção em saúde destas crianças.

This study has sought to understand the experience of teachers in the process of inclusion of children with stoma, being Sociological Phenomenology the reference. Interviews were conducted with five teachers between December 2015 and January 2016. Data collection was carried out from the narration of teachers, with later transcription and data analysis. Four thematic categories emerged: feelings experienced by teachers, factors that interfere with care, effective strategies for care, and strategies to improve care. The teachers valued the integration of the child with stoma in the school; they consider that this happens with the modification of the pedagogical formation, and they also pointed out the need for the presence of nurses in schools. The results show the importance of the development of actions and strategies to support teachers and students with stoma in the context of an inclusive school, considering that the school nurse is a determining factor for the health promotion of these children.

Melhores práticas de enfermagem em educação em diabetes à criança hospitalizada: uma revisão integrativa / Best nursing practices in diabetes education for the hospitalized child: an integrative review

A incidência do Diabetes Mellitus tipo 1 (DM1) tem aumentado nos últimos anos, com consequente incremento de hospitalizações de crianças por primodescompensação diabética, com crescente necessidade de processo educativo. Diante desta realidade, objetivou-se identificar na literatura as melhores práticas de enfermagem em educação em diabetes para crianças com DM1 hospitalizadas e sua família. Foi realizada uma revisão integrativa, com os descritores: Diabetic Ketoacidosis, Diabetes Education, Nursing e Child, Hospitalized, e busca livre em revistas de referência e artigos similares. Foram selecionados quatro estudos, e identificadas três categorias: Envolvimento e Empoderamento da Família no Processo Educativo em Diabetes; Atuação da Equipe Multiprofissional; Definição e Conteúdo do Processo Educativo, concluindo que o processo educativo deve incluir a família, ser realizado por uma equipe multiprofissional e fundamentado em evidências científicas. Poucos estudos foram encontrados, evidenciando necessidade de mais pesquisas na área.

The incidence of Diabetes Mellitus type 1 (DM1) has increased in the last years, with a consequent growth of child hospitalizations due to diabetic prime decompensation, with growing need of an educational process. Thus, our objective was to identify in the literature the best nursing practices in diabetes education for hospitalized children with DM1 and their families. We conducted an integrative review with the descriptors: Diabetic Ketoacidosis, Diabetes Education, Nursing and Child, Hospitalized, and the free search in reference journals and similar articles. We selected four studies, and we identified three categories: Family Involvement and Empowerment in the Diabetes Educational Process; Performance of the Multi-professional Team; Definition and Content of the Educational Process. We concluded that the educational process should include the family, it should be conducted by a multi-professional team and based on scientific evidence. We identified few studies, showing the need for more studies in the field.

A escola na perspectiva de adolescentes da Geração Z / The school from the perspective of adolescents of the Generation Z

Objetivou-se analisar o sentido da escola para estudantes da Geração Z de uma escola de Ensino Médio de uma capital do norte brasileiro. Estudo qualitativo do qual participaram 57 adolescentes. A coleta de dados ocorreu por meio de grupos focais e analisados por meio da análise de conteúdo, modalidade temática. Os resultados evidenciaram dois núcleos temáticos: Escola, espaço para aprender e preparar para o futuro e, Impasses e em passos, construindo novas perspectivas sobre a escola. Os adolescentes compreendem a escola como espaço de construção da aprendizagem, porém consideram o ambiente virtual também como espaço de construir conhecimento. Esse estudo oferece contribuições para repensar a educação direcionada à geração digital, no sentido de incorporar ao ensino novas linguagens e inovações, além de orientar a definição de planos e linhas de cuidado e atenção à saúde que considerem as novas relações entre os adolescentes e a tecnologia.

The objective was to analyze the school meaning for students part of the Generation Z from a High School of a capital city in the north region of Brazil. We conducted a qualitative study with 57 participating adolescents. We collected data through focus groups, and we analyzed it using content analysis, thematic modality. The results showed two thematic nuclei: School, a space to learn and to prepare for the future; and, Standoff and in steps, the school that needs to re-discover itself. Adolescents comprehend the school as a space to build learning, but they consider the virtual environment also as a space to build knowledge. This study offers contributions to rethink the education directed to the digital generation, as an effort to incorporate new languages and innovations to teaching, besides guiding the definition of plans and routes of care and, health attention that considers the new relationships between adolescents and technology.

Controlling Phlebotomy Volume Diminishes PICU Transfusion: Implementation Processes and Impact.

BACKGROUND AND OBJECTIVES: Phlebotomy excess contributes to anemia in PICU patients and increases the likelihood of red blood cell transfusion, which is associated with risk of adverse outcomes. Excessive phlebotomy reduction (EPR) strategies may reduce the need for transfusion, but have not been evaluated in a PICU population. We hypothesized that EPR strategies, facilitated by implementation science methods, would decrease excess blood drawn and reduce transfusion frequency. METHODS: Quantitative and qualitative methods were used. Patient and blood draw data were collected with survey and focus group data to evaluate knowledge and attitudes before and after EPR intervention. The Consolidated Framework for Implementation Research was used to interpret qualitative data. Multivariate regression was employed to adjust for potential confounders for blood overdraw volume and transfusion incidence. RESULTS: Populations were similar pre- and postintervention. EPR strategies decreased blood overdraw volumes 62% from 5.5 mL (interquartile range 1-23) preintervention to 2.1 mL (interquartile range 0-7.9 mL) postintervention (P < .001). Fewer patients received red blood cell transfusions postintervention (32.1% preintervention versus 20.7% postintervention, P = .04). Regression analyses showed that EPR strategies reduced blood overdraw volume (P < .001) and lowered transfusion frequency (P = .05). Postintervention surveys reflected a high degree of satisfaction (93%) with EPR strategies, and 97% agreed EPR was a priority postintervention. CONCLUSIONS: Implementation science methods aided in the selection of EPR strategies and enhanced acceptance which, in this cohort, reduced excessive overdraw volumes and transfusion frequency. Larger trials are needed to determine if this approach can be applied in broader PICU populations.

Evaluating Cultural Competence of Pediatric Oncology Nurses at a Teaching Hospital: A Pilot Study.

This cross-sectional descriptive study evaluated registered nurses' self-ratings of cultural competence on the hematology/oncology unit at a large Northeastern urban children's hospital. The Inventory for Assessing the Process of Cultural Competence among Healthcare Professionals was used to measure 5 constructs of cultural competence. The study findings show that there were significant correlations between the knowledge and skill subscales (ρ = .57, P < .001) and the knowledge and desire subscales (ρ = .42, P < .05). The highest mean among the 5 subscales was cultural desire (mean = 15.5), indicating that nurses were motivated to engage in the process of becoming culturally competent. The lowest mean among the 5 subscales was cultural knowledge (mean = 11.2), followed by cultural skill (mean = 11.8), indicating that nurses did not perceive themselves to be well informed in these areas. The findings from this pilot study suggest that nurses on this pediatric oncology unit are most likely to possess cultural desire and cultural awareness, but there is certainly opportunity to engage and educate the staff. Targeted interventions to improve cultural competence on this inpatient unit are being explored and a larger scale study is being planned to assess the cultural competence of nurses across the hospital.