Developing rights-based standards for children having tests, treatments, examinations and interventions: using a collaborative, multi-phased, multi-method and multi-stakeholder approach to build consensus.

Children continue to experience harm when undergoing clinical procedures despite increased evidence of the need to improve the provision of child-centred care. The international ISupport collaboration aimed to develop standards to outline and explain good procedural practice and the rights of children within the context of a clinical procedure. The rights-based standards for children undergoing tests, treatments, investigations, examinations and interventions were developed using an iterative, multi-phased, multi-method and multi-stakeholder consensus building approach. This consensus approach used a range of online and face to face methods across three phases to ensure ongoing engagement with multiple stakeholders. The views and perspectives of 203 children and young people, 78 parents and 418 multi-disciplinary professionals gathered over a two year period (2020-2022) informed the development of international rights-based standards for the care of children having tests, treatments, examinations and interventions. The standards are the first to reach international multi-stakeholder consensus on definitions of supportive and restraining holds.    Conclusion: This is the first study of its kind which outlines international rights-based procedural care standards from multi-stakeholder perspectives. The standards offer health professionals and educators clear evidence-based tools to support discussions and practice changes to challenge prevailing assumptions about holding or restraining children and instead encourage a focus on the interests and rights of the child. What is Known: • Children continue to experience short and long-term harm when undergoing clinical procedures despite increased evidence of the need to improve the provision of child-centred care. • Professionals report uncertainty and tensions in applying evidence-based practice to children's procedural care. What is New: • This is the first study of its kind which has developed international rights-based procedural care standards from multi-stakeholder perspectives. • The standards are the first to reach international multi-stakeholder consensus on definitions of supportive and restraining holds.

Learning critical thinking skills online: can precision teaching help?

Critical thinking is identified as a key educational outcome in higher education curricula; however, it is not trivial to support students in building this multifaceted skill. In this study, we evaluated a brief online learning intervention focusing on informal fallacy identification, a hallmark critical-thinking skill. The intervention used a bite-sized video learning approach, which has been shown to promote student engagement. Video-based learning was implemented within a precision teaching (PT) framework, which modulates the exposure of individual learners to the learning material to enable them to build 'fluency' in the targeted skills. In one of the learning conditions, PT was applied synergistically with domain-general problem-based training to support generalisation. The intervention consisted of two learning episodes and was administered to three groups (learning conditions) of 19 participants each: a PT fluency-based training group; a PT + group, where PT was combined with problem-based training; and a self-directed learning control group. All three groups showed comparable improvements in fallacy identification on taught (post-episode tests) and unseen materials (post-intervention assessment), with lower-scoring participants showing higher gains than high-scoring participants. The results of the knowledge retention tests a week later were also comparable between groups. Importantly, in the domain-general fallacy-identification assessment (post-intervention), the two PT groups showed higher improvements than the control group. These findings suggest that the integration of bite-sized video learning technologies with PT can improve students' critical-thinking skills. Furthermore, PT, on its own or combined with problem-based training, can improve their skill to generalise learning to novel contexts. We discuss the educational implications of our findings.

Role of retrieval nurse practitioners in safely transferring critically ill adults and children during COVID-19.

This article explores the experiences of South Thames Retrieval Service (STRS) retrieval nurse practitioners in providing inter-hospital transfers of critically ill babies and children during the coronavirus disease 2019 (COVID-19) pandemic. As well as its usual cohort of patients, the STRS also transferred critically ill and ventilated adults. The authors present a comparative analysis of pre-pandemic and pandemic retrievals over two six-week periods, one year apart. In the first period, from December 2019 to the end of January 2020, STRS retrieval nurse practitioners transported 47 critically ill children. One year later, during the second wave of the COVID-19 pandemic, STRS retrieval nurse practitioners transported 50 critically ill children and 26 critically ill adults with COVID-19 and a premature baby who was a COVID-19 contact. The latter two groups are not usually transported by the service. All of the patients retrieved by the STRS team during the COVID-19 pandemic were safely transported. This initiative demonstrated how nurses worked flexibly during the pandemic within the limits of their professional competence.

Supporting children's nurses to deliver trauma-informed care.

World events, such as the conflict in Ukraine, the humanitarian crisis in Afghanistan and the coronavirus disease 2019 pandemic, have highlighted the effects of trauma and adverse childhood experiences on children and young people. Adverse childhood experiences can lead to suboptimal health and risk-taking behaviours during adolescence and adulthood, while multiple adverse childhood experiences can manifest as complex trauma, toxic stress, anxiety or depression across a person's lifespan. This article discusses adverse childhood experiences and the concept of trauma-informed care, which involves recognising and understanding the negative events that have affected a person and how these relate to suboptimal health. The author suggests that developing resilience and using self-care strategies can support nurses to adopt a trauma-informed approach to care. This can assist them to recognise, understand and reflect on the effects of adverse childhood experiences in themselves as well as in their patients. The author also outlines a hybrid approach to debrief that can support staff to manage stressful situations and challenging workplace experiences.