Tokenism or true partnership: Parental involvement in a child's acute pain care.

AIMS AND OBJECTIVES: To explore parental involvement in the child's acute pain care and establish ways in which parental preferences for involvement in their child's care can be identified, facilitated and enhanced by nurses. BACKGROUND: Despite growing evidence supporting effective acute pain management in children and the availability of national and international practice guidelines, children still experience acute pain. Involving parents in their child's pain care has been identified as being a central tenet of pain management in children. DESIGN AND METHODS: A qualitative study using an ethnographical approach with nonparticipant observation and follow-up semi-structured interviews was undertaken. Nurses (n = 14), parents (n = 41), grandparents (n = 2), other relative (n = 1) and children (n = 30) participated. The framework approach underpinned data analysis. Consolidated criteria for reporting qualitative research (COREQ) enabled comprehensive reporting of the study. RESULTS: Three concepts emerged from the data: "parents as advocates for their child," "nurses promoting involvement and partnership" and "nurses unintentionally preventing involvement and partnership." Variations in the way parents were involved in their child's pain care were identified. Despite family-centred care being the dominant model of involving families in their child's care, evidence of this being implemented was limited. Parents attempted to advocate effective pain care for their child, whether or not they were supported by nurses. CONCLUSIONS: Parental involvement in their child's acute pain care can improve the child's pain experience, reduce parental anxiety and increase parents' satisfaction in care. Nurses aspired to involve parents in pain care, but did not always enact this in practice. RELEVANCE FOR PRACTICE: Children deserve optimum pain care, which includes parental involvement. Parental involvement underpinned by the principles of family-centred care was poorly implemented. Parents attempted to be involved and advocate for their child's pain care whether or not they were supported by nurses. An alternative approach for supporting parents to advocate in their child's acute pain care is offered, the "Partnership in Pain Care Model."

Mental health nurses' understandings and experiences of providing care for the spiritual needs of service users: A qualitative study.

WHAT IS KNOWN ON THE SUBJECT?: Addressing spiritual issues to maintain a sense of hope, meaning and purpose can be an important aspect of mental health care which goes beyond simply providing facilities for religious observance. Expressions of spiritual need from service users can potentially be confused with symptoms of mental ill health. Little is known about how mental health nurses understand or provide this aspect of care for service users. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: An understanding from the mental health nurse perspective of how mental health nurses understand and care for service users' spiritual needs, and what influences their practice in this area. Ideas about how education and opportunities for good practice in this area might be advanced. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses need more education and guidance as well as supportive team and management cultures so that they feel comfortable and able to deliver this important aspect of care. Abstract Introduction Mental health nurses have a professional obligation to attend to service users' spiritual needs, but little is known about specific issues related to provision of care for spiritual need faced by mental health nurses or how nurses understand this aspect of care and deliver it in practice. Aim/Question To explore mental health nurses' ́understandings of spiritual need and their experiences of delivering this care for service users. Method A qualitative study was conducted in one NHS mental health service. Interviews were undertaken with seventeen mental health nurses practising in a variety of areas. Results Four themes were generated from thematic analysis of data in the template style: Expressing personal perspectives on spirituality; Expressing perspectives on spirituality as a nursing professional; Nursing spiritually; and Permeating anxiety (integrative). Discussion Participants had complex understandings of spiritual need and evident anxieties in relation to this area of care. Two different approaches to nursing spiritually are characterised as (a) pragmatic (concerned with procedural aspects of care) and (b) spiritually empathetic. Mental health nurses were uncertain about the acceptability of attention to spiritual issues as part of care and anxious about distinguishing between symptoms of mental ill health and spiritual needs. Implications for practice Educational experiences need to emphasise both pragmatic and empathetic approaches, and work needs to be organised to support good practice.

The use of reflective journals in the promotion of reflection and learning in post-registration nursing students.

The aim of this qualitative case study was to examine the use of reflective journals in promoting reflection and learning in post-registration nursing students. A purposive homogenous sample of 42 part-time post-registration students who had undertaken a module either as part of the Diploma in Professional Studies in Palliative Care or Breast Care Nursing within a UK University took part in the study. Data were collected from reflective journals and interviews. The students' journals were analysed to determine the extent and level of reflection using a model devised by Boud [Boud, D., Keogh, R., Walker, D. (Eds.), 1985. Reflection: Turning Experience into Learning. Kogan Page, London] and adapted by Wong [Wong, F.K.Y., Kember, D., Chung, L.Y.F., Yan, L., 1995. Assessing the levels of student reflection from reflective journals. Journal of Advanced Nursing 22, 48-57]. A model devised by Mezirow [Mezirow, J., 1990. How critical reflection triggers transformative learning. In: Mezirow, J. et al. (Eds.), Fostering Critical Reflection in Adulthood: A Guide to Transformative and Emancipatory Learning. Jossey-Bass, San Francisco, pp. 1-20; Mezirow, J., 1991. Transformative Dimensions of Adult Learning. Jossey-Bass, San Franscisco] was used to identify non-reflectors, reflectors and critical reflectors. The findings suggest that student writing can be used as evidence for the presence or absence of reflective thinking. Evidence also suggests that journals are a useful tool for promoting reflection and learning. However, some students appear to benefit more from their use than others.

OC05 - Tokenism or true partnership - parental involvement in a child's acute pain care.

UNLABELLED: Theme: Parenting/parenthood. INTRODUCTION: Family-centred care (FCC) is widely acknowledged as underpinning children's nursing. Delivering FCC requires nurses to advocate for family involvement, particularly in areas where evidence suggest the child's needs are not being met, such as pain care. AIM: To explore parental involvement in their child's acute pain care. METHODS: A qualitative ethnographical approach was adopted, with non-participant observation and follow-up interviews. The framework approach underpinned data analysis. RESULTS: Partnership between nurses and parents is not overtly evident in relation to pain care. Involvement is often 'unspoken', indicating that neither the nurse nor parent are clear about the extent to which parents can, or are, involved in care. DISCUSSION: Parents want greater involvement in their child's pain care and often initiate involvement by advocating for their child, with or without support from nurses. CONCLUSIONS: The 'Pillars of Partnership in Pain Care' model offers an alternative approach to involving parents.