The possibilities and challenges in providing pediatric spiritual care.

The purpose of this article was to present discussions on how pediatric nurses can perform spiritual care to children and adolescents and discuss the challenges of integrating such care in health-care settings. Based on the literature, the article presents an overview of spiritual care in pediatric settings highlighting the assessment of spirituality, expected outcomes, and the corresponding nursing interventions. Spiritual care provided to children and adolescents should take into account all aspects of the developmental stage, life experiences, and familiar and sociocultural contexts. Different approaches can be used to perform spiritual care. However, lack of knowledge and time are highlighted as the main challenges in integrating spiritual care into the clinical practice. Spiritual care is crucial to the well-being of children and adolescents in times of illness and hospitalization when the goal is to provide holistic care.

Intervenciones antibullying desarrolladas por enfermeros: revisión integradora de la literatura / Intervenções antibullying desenvolvidas por enfermeiros: revisão integrativa da literatura / Antibullying interventions developed by nurses: integrative review

Objetivos: Identificar y describir las intervenciones antibullying realizadas por enfermeros. Método: Revisión integradora de la literatura realizada en seis bases de datos (CINAHL, LILACS, PsycINFO, PUBMED, SciELO y Web of Science), utilizando en las buscas descriptores relacionados al fenómeno y a la enfermería. La pregunta que orientó la investigación fue: "¿Cuáles son las intervenciones antibullying desarrolladas en escuelas con la participación de enfermeros?". Resultados: Cinco artículos compusieron el corpus de análisis de la revisión. Los resultados indicaron una variedad de enfoques en las intervenciones realizadas (dramatización/teatro, grupo de apoyo, multidimensional y vídeos). Conclusión: La revisión presenta conocimientos que pueden orientar prácticas y programas de intervención antibullying a ser desarrollados por enfermeros o equipos de salud en Brasil (AU)

Objetivos: Identificar e descrever as intervenções antibullying realizadas por enfermeiros. Método: Revisão integrativa da literatura realizada em seis bases de dados (CINAHL, LILACS, PsycINFO, PUBMED, SciELO e Web of Science), utilizando nas buscas descritores relacionados ao fenômeno e à enfermagem. A questão norteadora da pesquisa foi: "Quais são as intervenções antibullying desenvolvidas em escolas com a participação de enfermeiros?". Resultados: Cinco artigos compuseram o corpus de análise da revisão. Os resultados indicaram uma variedade de enfoques nas intervenções realizadas (dramatização/teatro, grupo de apoio, multidimensional e vídeos). Conclusão: A revisão apresenta conhecimentos que podem orientar práticas e programas de intervenção antibullying a serem desenvolvidas por enfermeiros ou equipes de saúde no Brasil (AU)

Objective: To identify and describe anti bullying interventions developed by nurses. Method: Integrative review conducted in six databases using descriptors related to the phenomenon and nursing. The guiding question was: "What are the anti bullying interventions developed in schools by nurses?" Results: Five papers composed the corpus of analysis. The results indicate a variety of types of interventions (dramatization/role-playing, support group, multidimensional and videos). Conclusions: This review presents knowledge that can support anti bullying practices and intervention programs to be developed by nurses or health teams in Brazil (AU)

Mindfulness for Novice Pediatric Nurses: Smartphone Application Versus Traditional Intervention.

PURPOSE: The current study compares the effects of a traditionally delivered mindfulness (TDM) intervention to a smartphone delivered mindfulness (SDM) intervention, Headspace, an audio-guided mindfulness meditation program, in a group of novice nurses. DESIGN AND METHODS: Novice nurses participating in a pediatric nurse residency program were asked to participate in either a TDM or SDM intervention. Participants (N=95) completed self-administered pencil and paper questionnaires measuring mindfulness skills, and risk and protective factors at the start of their residency and three months after entering the program. RESULTS: Nurses in the SDM group reported significantly more "acting with awareness" and marginally more "non-reactivity to inner experience" skills compared to the TDM group. The smartphone intervention group also showed marginally more compassion satisfaction and marginally less burnout. Additionally, nurses in the SDM group had lower risk for compassion fatigue compared to the TDM group, but only when the nurses had sub-clinical posttraumatic symptoms at the start of the residency training program. CONCLUSIONS: Smartphone delivered mindfulness interventions may provide more benefits for novice nurses than traditionally delivered mindfulness interventions. However, the smart-phone intervention may be better indicated for nurses without existing symptoms of posttraumatic stress. PRACTICE IMPLICATIONS: Mindfulness interventions delivered through smartphone applications show promise in equipping nurses with important coping skills to manage stress. Because of the accessibility of smartphone applications, more nurses can benefit from the intervention as compared to a therapist delivered intervention. However, nurses with existing stress symptoms may require alternate interventions.

Beneficios del masaje infantil. Percepción de las madres en un centro de Atención Primaria / Benefits of the infant massage noticed by mothers in a Primary Care

OBJETIVOS. El objetivo principal del estudio fue confirmar los beneficios del masaje infantil (MI) que perciben las madres. Como objetivos secundarios se planteó conocer datos sociodemográficos de las madres que realizan el MI en casa y el tipo de lactancia predominante. MATERIAL Y MÉTODOS. Estudio descriptivo longitudinal que incluyó a las madres que acudían al taller de masaje infantil de un centro de Atención Primaria de la provincia de León, con una muestra final de 49 madres. El periodo de recogida de datos fue de febrero de 2014 a febrero de 2015. Se entregó una encuesta diseñada para este estudio que recogía: tipo de lactancia, variables sociodemográficas (edad materna, estudios y etnia), los beneficios del masaje, si lo realizan en casa y si acuden acompañadas por su pareja. Para el análisis estadístico se utilizó el programa SPSS.13. RESULTADOS. Los beneficios más percibidos por las madres son el aumento del vínculo materno filial y la relajación, con un 95.9 % de respuesta positiva, seguido del aumento de la calidad del sueño en un 65.3 %. La disminución del llanto y la reducción de los cólicos tuvieron un 63.3 %. El 93.3 % de las madres realizan el masaje en casa. El tipo de lactancia predominante es la materna, con un 53.1 %. CONCLUSIONES. Las madres perciben los beneficios del masaje infantil en sus bebés y realizan la técnica en casa (AU)

OBJECTIVES. The main objective of the study was to confirm the infant massage benefits noticed by mothers. As for secondary objectives, the aim was to establish the sociodemographic characteristics of the mothers who practice the infant massage at home and the main type of feeding. MATERIAL AND METHODS. Longitudinal descriptive study which included the mothers who came to the infant massage workshop in a Primary Care Centre in León, with a sample composed of 49 mothers. Data were collected from February 2014 to February 2015. A questionnaire designed for this study was given, which contained: sociodemographic characteristics (mothers’ age, studies and ethnic group), benefits of the infant massage, if they did it at home and if the couple came to the workshop. For the statistical analysis, the software manager SPSS.13. was used. RESULTS. The main noticed benefits were increasing mother-child bond and relaxation, with a 95.9 % of positive answer, followed by the increasing of the sleep quality, in a 65.3 %. Less crying and decreasing of the colic had a 63.3 %. Most of the mothers, 93.3 %, did the massage at home. The main type of feeding was breast-feeding, 53.1 %. CONCLUSIONS. Mothers noticed the benefits of the infant massage and they do it at home (AU)

A Mixed-Methods Research Framework for Healthcare Process Improvement.

UNLABELLED: The healthcare system in the United States is spiraling out of control due to ever-increasing costs without significant improvements in quality, access to care, satisfaction, and efficiency. Efficient workflow is paramount to improving healthcare value while maintaining the utmost standards of patient care and provider satisfaction in high stress environments. This article provides healthcare managers and quality engineers with a practical healthcare process improvement framework to assess, measure and improve clinical workflow processes. DESIGN AND METHODS: The proposed mixed-methods research framework integrates qualitative and quantitative tools to foster the improvement of processes and workflow in a systematic way. The framework consists of three distinct phases: 1) stakeholder analysis, 2a) survey design, 2b) time-motion study, and 3) process improvement. RESULTS: The proposed framework is applied to the pediatric intensive care unit of the Penn State Hershey Children's Hospital. The implementation of this methodology led to identification and categorization of different workflow tasks and activities into both value-added and non-value added in an effort to provide more valuable and higher quality patient care. CONCLUSIONS: Based upon the lessons learned from the case study, the three-phase methodology provides a better, broader, leaner, and holistic assessment of clinical workflow. The proposed framework can be implemented in various healthcare settings to support continuous improvement efforts in which complexity is a daily element that impacts workflow. PRACTICAL IMPLICATIONS: We proffer a general methodology for process improvement in a healthcare setting, providing decision makers and stakeholders with a useful framework to help their organizations improve efficiency.

The Benefits of a Nurse-Driven, Patient- and Family-Centered Pediatric Palliative Care Program.

This article describes the program and outcomes of a nurse driven, patient- and family-centered pediatric advanced comprehensive care team (PACCT) palliative program. This care delivery model improved patient outcomes by providing care across the healthcare continuum for pediatric patients. Since the inception of PACCT, no child has died on a ventilator in the pediatric ICU associated with end-of-life-related issues.

Tratamiento del trastorno por déficit de atención e hiperactividad (tdah). Implicaciones para enfermería / Treatment of attention deficit and hyperactivity disorder (adhd): nursing implications

OBJETIVO. Esta revisión pretende conocer el papel de la enfermera en el tratamiento del TDAH, identificando las opciones terapéuticas más adecuadas entre las intervenciones de enfermería y el tratamiento farmacológico. DESARROLLO. En el TDAH, la labor de la enfermera es responder a las necesidades de las familias acerca de la eficacia de la medicación, el tratamiento de modificación del comportamiento y otras alternativas menos ortodoxas. Se plantean intervenciones de psicoeducación con la familia que favorecen el proceso de recuperación del niño. A través de la Educación para la Salud, la enfermera debe promocionar la combinación del tratamiento comportamental y farmacológico como el único capaz de mejorar la calidad de vida del niño. CONCLUSIONES. Las enfermeras tienen un rol privilegiado por su experiencia en la Educación para la Salud; esto contribuye a que sean un agente competente para proporcionar a las familias información indispensable sobre el tratamiento de la enfermedad. Las escuelas españolas carecen de una figura que represente la salud como una asignatura relevante en el proceso vital, de ahí la necesidad de la enfermera escolar (AU)

OBJECTIVE. This review aims to know the role of the nurse in ADHD treatment, identifying the most appropriate therapeutic options between nursing interventions and pharmacological treatment. DEVELOPMENT. In ADHD, the role of the nurse is to respond family needs about the effectiveness of medication, behavior modification treatment and other alternatives. There are family interventions of psychoeducation that assist the child in the recovery process. Through the education for health, the nurse should promote the combination of behavioral therapy and pharmacological as the only one able to improve child’s quality of life. CONCLUSIONS. Nurses have a privileged role due to its experience in education for health; this contributes to being a competent agent that provides families essential information about the disease treatment. Spanish schools are lacking a figure that represent health as a relevant subject in the vital process, hence the need of the school nurse (AU)

Evidence of improved quality of life with pediatric palliative care.

Pediatric nurses provide holistic family-centered care for children with life-limiting illnesses while being sensitive to children's growth and developmental needs. To learn how pediatric palliative care programs benefit children and their families, the following clinical question was asked: Among children with a life-limiting illness, does the use of a palliative care program compared with not using a palliative care program improve quality of life for patients and their families? Evidence from two studies found that palliative care services improve quality of life for children with life-limiting illness and their families in the areas of the child's emotional well-being and parental perception of preparation for the child's end of life, resulting in a low grade for the body of evidence. Future research should include high quality studies with larger sample sizes and control groups, and include children's perspectives--from both patients and siblings--to give a more complete picture of how best to improve their quality of life. A reliable tool is needed that includes a spiritual component and sensitive indicators specific to children with a life-limiting illness. Future research using this tool will more fully answer how palliative care services improve children's quality of life.

Avoiding inappropriate paediatric admission: facilitating General Practitioner referral to Community Children's Nursing Teams.

BACKGROUND: Children's emergency admissions in England are increasing. Community Children's Nursing Teams (CCNTs) have developed services to manage acutely ill children at home to reduce demand for unscheduled care. Referral between General Practitioners (GPs) and CCNTs may reduce avoidable admissions and minimise the psychosocial and financial impact of hospitalisation on children, families and the NHS. However, facilitators of GP referral to CCNTs are not known. The aim of this study was to identify facilitators of GP referral to CCNTs. METHODS: Semi-structured interviews with 39 health professionals were conducted between June 2009 and February 2010 in three Primary Care Trusts served by CCNTs in North West England. Interviewees included GPs, Community Children's Nurses (CCNs), consultant paediatricians, commissioners, and service managers. Qualitative data were analysed thematically using the Framework approach in NVivo 8. RESULTS: Five facilitators were identified: 1) CCN/CCNT visibility; 2) clear clinical governance procedures; 3) financial and organisational investment in the role of CCNTs in acute care pathways; 4) access and out of hours availability; 5) facilitative financial frameworks. CONCLUSION: GPs required confidence in CCNs' competence to safely manage acutely ill children at home and secure rapid referral if a child's condition deteriorated. Incremental approaches to developing GP referral to CCNTs underpinned by clear clinical governance protocols are likely to be most effective in building GP confidence and avoiding inappropriate admission.

Challenges in the management of support and care programmes for child-headed households in South Africa.

AIMS: The present study reports on data collected in a larger study on 'A situational analysis of child-headed households in South Africa'. The purpose of this study was to explore the management and control of available and required services, resources and safety nets for children in child-headed households. BACKGROUND: The significance of having a better understanding of the challenges, limitations but importance for government structures to manage and control programmes will enhance the implementation and maintenance of focused and sustainable support structures and programmes which will effectively address the needs of child-headed households. METHOD: An exploratory and descriptive, quantitative survey was conducted to provide information on government structures at a national level and the nine provinces in South Africa. The population consisted of the Departments of Social Development, Education, Health and Agriculture, at both national and provincial levels. RESULTS: The main findings included a lack of clarity regarding the concept and definition of a child-headed household, lack of empirical data, a diversity of needs and challenges in terms of location and geographical distribution of available infrastructure and support systems; programmes that are not inclusive and integrated; and contradictions in the stipulations and implementation of existing policies and capacity and human resources shortages. CONCLUSIONS: It was concluded that the magnitude, uniqueness and complexity of the phenomenon necessitate effective and sound scientific management principles. This is achieved by providing legal clarity of the concept; developing relevant policies and ensuring effective implementation thereof; rigorous monitoring and evaluation based on comprehensive empirical data; and protecting the rights and safety of these children and ensuring an enabling environment for all stakeholders to address needs and challenges. IMPLICATIONS FOR NURSING MANAGEMENT: The role of the nurse manager is to ensure a holistic approach to children living in child-headed households by acting as a facilitator, advocate, leader, coordinator and consultant.

The relationships among adaptive behaviors of children with autism, family support, parenting stress, and coping.

BACKGROUND: As the number of children diagnosed with autism continues to rise, resources must be available to support parents of children with autism and their families. Parents need help as they assess their unique situations, reach out for help in their communities, and work to decrease their stress levels by using appropriate coping strategies that will benefit their entire family. METHODS: A descriptive, correlational, cross-sectional study was conducted with 75 parents/primary caregivers of children with autism. Using the McCubbin and Patterson model of family behavior, adaptive behaviors of children with autism, family support networks, parenting stress, and parent coping were measured. FINDINGS AND CONCLUSIONS: An association between low adaptive functioning in children with autism and increased parenting stress creates a need for additional family support as parents search for different coping strategies to assist the family with ongoing and new challenges. Professionals should have up-to-date knowledge of the supports available to families and refer families to appropriate resources to avoid overwhelming them with unnecessary and inappropriate referrals.

The high impact actions for nursing and midwifery 8: ready to go--no delays.

In recent years, discharge initiatives that aim to free up hospital beds have become commonplace. However, new systems, such as bed management, have left many nurses feeling disengaged from the management of patient admission and discharge. They feel pressurised into speeding up discharge by the increasing focus on bed capacity and patient turnover, which can make them feel distanced from their primary role of caring for patients. Although new roles and initiatives can be valuable, changing the way nurses engage with discharge is key. Ensuring that the process is nurse led will lead to a faster discharge and less frustration for patients who are waiting to go home. This article, the last in our series on the high impact actions for nursing and midwifery, looks at how nursing staff can respond to the issue of discharge planning.

Obesity in Hong Kong Chinese preschool children: where are all the nurses?

We report an ethnographic study of 10 preschool children aged 2-6 years recruited from kindergartens in Hong Kong, 6 of whom were overweight or obese. Each was followed for 12-18 months. We confirmed previously described risk factors and showed how these interacted to produce obesity in some but not all at-risk children. Despite much rhetoric in the literature about holistic care of the preschool child, we were struck by the lack of coordinated professional input to the needs of children at risk of obesity and by the absence of nursing input in particular. We argue that a "whole-systems" nursing role, based in the community and with remit that includes clinical care, education, and policy, is urgently needed, as well as review examples of such roles from other countries.

The role of the nurse practitioner in level II trauma at Nationwide Children's Hospital.

Most institutions undoubtedly value the role of nurse practitioners (NPs) in a variety of specialties. The NPs derive diagnostic decision-making skills from their educational training, which is rooted in the medical model, and through patient-centered, diagnostic reasoning and care planning. Ultimately, NPs provide cost-effective yet comprehensive medical care complemented by a holistic nursing approach. The trauma department at Nationwide Children's Hospital, Columbus, Ohio, has set forth a goal to have all trauma patients either discharged or admitted within 3 hours of arrival to the emergency department. This article is designed to evaluate the efficacy of NP response to level II trauma transfers and the attempt to improve length of stay. Evaluation of the available date does in fact demonstrate that when the NP is available to respond to the level II transfers, the patient length of stay is significantly decreased.

Learning to live with childhood cancer: a literature review of the parental perspective.

This article presents an analysis of literature on paternal and maternal development and resilience through the experience of having a child diagnosed, treated, and possibly die from cancer. The methods and analysis of findings from research conducted in this area are assessed, as are the data's relevance and implications for practice. The review required an in-depth search of relevant health-care databases using appropriate search terms. Findings were then culled and analysed based on the inclusion and exclusion criteria, and two papers were deemed appropriate for selection. Four contrasting themes emerged from each article. It was generally acknowledged that mothers and fathers enduring such an experience stated that changes occurred in their lives. The mothers felt a need to become tougher for their child and family, and the fathers recognized a need to focus quickly on what needed to be done to treat their child's illness. However, analytically the differences in each paper are vast. The research was conducted in Japan and the United States, where contrasting cultural and societal beliefs and influences are apparent, therefore inadvertently affecting the research findings. Furthermore, a gap in research in this area has been detected, and much more research specifically focused on this subject is required if the children's nurse is to provide evidence-based holistic care in this area on a continual basis.

Magic as a therapeutic intervention to promote coping in hospitalized pediatric patients.

Magic as a therapeutic intervention is used in an innovative, hospital-based program to address the psychosocial issues children and adolescents often experience as a result of illness and hospitalization. A child life specialist and a magician with an MBA collaborated, blending clinical expertise with business acumen and professional-level magic skills to create the program. The program has two distinct components: (1) magicians using interactive, close-up magic and humor as a technique to promote socialization, enhance self-esteem, and increase opportunities for choice and control, and (2) magicians providing the personal instruction and materials that enable chronically ill and long-term patients to learn and perform magic to promote a sense of empowerment and feelings of mastery. Positive responses from patients, families, and staff to the program at one hospital led to the creation of Open Heart Magic, a non-profit children's foundation that maintains and staffs bedside, interactive therapeutic magic programs in five hospitals in the Chicago metropolitan area.

Discharge readiness: an integrative review focusing on discharge following pediatric hospitalization.

PURPOSE: This review aims to identify factors associated with parental discharge readiness following pediatric hospitalization, with focus applicability to solid organ transplant patients. DESIGN AND METHODS: Thirty-eight publications, including research and clinical practice papers, were identified using Cooper's methodology for conducting integrative research reviews (1982). RESULTS: Four concepts emerged influencing discharge readiness: support, identification of unique and individual needs, education, and communication and coordination. Synthesis of themes resulted in two overarching concepts: meaningful interactions and confidence building. PRACTICE IMPLICATIONS: Nurses have a singular opportunity to enhance meaningful interactions and confidence building, ultimately promoting a successful transition home.