Agreement between quality of life assessed using family proxy and child self-reports among children with hematologic malignancy.

Evidence-based literature recognizes that the different degrees of agreement between a child self-report and a proxy-report depend on the characteristics of the domains, the child's age and illness, the proxy's own perspective on QoL, and family attendance during the child's hospitalization. This study aims to determine the degree of agreement between proxy-reports and child self-reports on quality of life (QoL) for children with hematologic malignancy ranging in age from 5 to 18 years who are undergoing treatment. We retrieved clinical QoL data from a study titled "Dynamic change in QoL for Vietnamese children with hematologic malignancy" from April 2021 to December 2022. To evaluate the magnitude of agreement between self-reports and proxy-reports, intraclass correlation coefficients (ICCs) for 259 pairs of measurements were quantified. Using independent t tests, the mean differences between self-reports and proxy-reports were tested. Moderate agreement was consistent through all age groups for five subscales, including physical, psychosocial, pain, nausea, and procedural anxiety (ICCs ranged from 0.53 to 0.74). The weakest agreement appeared in two groups, subjects aged 5-7 years and 13-18 years on six domains (school, treatment anxiety, worry, cognitive problems, perceived physical appearance, and communication) (-0.01 to 0.49). Child self-rating was consistently higher than that of proxies for the physical, emotional, and nausea domains among children aged 5-7 years and for procedural anxiety, treatment anxiety, and cognitive problems among children aged 8-12 years.    Conclusion: The agreement level of self-reports and proxy-reports was differently distributed by child age and the PedsQL domains. The proxy children agreement on QoL among children with hematologic malignancy was divergent according to the different age groups, which could potentially be explained by proxy-child bonding at different stages of childhood development. Our recommendation for future studies is to explore children's age as a potential factor influencing proxy agreement on QoL among children with cancer. What is Known: • Children and their proxies may think differently about quality of life (QoL). • Comparing two sources of data (i.e., child and proxy) on aspects of QoL can help identify the discrepancies between children's perceptions of their QoL and their parents' perceptions. This can be useful in terms of identifying potential areas for improvement or concern and may also be helpful in making decisions about treatment and care. What is New: • Our study results demonstrated that proxies who comprised children aged 5-7 years or 13-18 years reported differently among domains that cannot be expressed verbally or with body language, including cognitive problems, perceived physical appearance, and communication. • Children generally perceived their QoL to be better than their proxies. Therefore, a more comprehensive understanding of children's QoL may require the consideration of multiple sources of data from various perspectives.

Factors impacting the demonstration of relational autonomy in medical decision-making: A meta-synthesis.

BACKGROUND: Relational autonomy is an alternative concept of autonomy in which an individual is recognized as embedded into society and influenced by relational factors. Social context, including social location, political structure, and social forces, significantly influence an agent to develop and exercise autonomy skills. The relational approach has been applied in clinical practice to identify relational factors impacting patient autonomy and decision-making, yet there is a knowledge gap in how these factors influence the demonstration of relational autonomy in the context of medical decisions of adults. OBJECTIVE: The present study targeted the existing knowledge of what and how relational factors impact individuals making medical decisions using the theoretical framework of relational autonomy. METHODS: A meta-synthesis study was utilized. Four electronic databases, including Embase, OVID Medline, CINAHL, and PubMed, were searched, along with gray literature and reference lists, to identify relevant studies. RESULTS: 23 studies reporting 21 qualitative and two mixed-method studies were reviewed. Four themes emerged from the qualitative findings: (1) supportive relationships facilitate an individual's relational autonomy; (2) obtaining comprehensive information from broader sources helps individuals exercise relational autonomy; (3) undue family pressure impedes the exercising of patient relational autonomy; and (4) healthcare providers' dominant voice hampers the demonstration of relational autonomy. CONCLUSIONS: Applying relational autonomy to assist adults in making well-considered decisions is essential. The meta-synthesis suggests establishing a supportive relationship between individuals, healthcare providers, and family. A supportive relationship will allow healthcare providers to make judgments in line with an individual's values and wishes with the aim of promoting relational autonomy. Advance care planning was proposed as the effective solution to obtain a consensus between individuals and their families while respecting an individual's values and preferences. Furthermore, it is considered crucial for healthcare providers to appreciate an individual's values and incorporate their preferences into recommendations.

Preterm infant cues during breastfeeding and its measurement: A scoping review.

Background: Preterm infants display certain behaviors to communicate their needs, known as preterm infant cues. However, the existing research on preterm infant cues primarily draws from studies conducted on bottle-fed infants rather than breastfed infants. Objective: This study aimed to investigate the concept of preterm infant cues during breastfeeding and its appropriate instruments. Design: A scoping review. Data Sources: The articles published up to January 2022 were searched from multiple sources from EBSCOhost Web, namely CINAHL Plus with Full Text, MEDLINE, ERIC, and E-Journals. Review Methods: The articles retrieved for this review were screened using PICO (Population, Intervention, Comparison, and Outcomes) format. Preferred Reporting Items for Systematic Reviews (PRISMA) checklist was used in selecting the articles, and Joanna Briggs Institute Critical Appraisal was utilized by two independent authors to assess the articles' quality. A descriptive method was used to analyze the data. Results: The initial review stage found 183 potential articles, but only four satisfied the criteria. The notion of preterm infant cues during breastfeeding is centered on the actions of preterm infants while positioned on their mother's chest. These feeding cues are identifiable before, during, and after breastfeeding and include cues for hunger, self-regulation, stress, satiation, approach, avoidance, and sucking quality. To effectively recognize these cues, tools such as the Preterm Infants Cues Coding System (PFCCS), Infant Driven Scale (IDS), Newborn Individualized Developmental Care and Assessment Program (NIDCAP), and Preterm Breastfeeding Behavior Scale (PIBBS) can be utilized. Conclusion: The study findings highlight the importance of recognizing preterm infant cues during breastfeeding to facilitate proper feeding and developmental care. Observational studies have proven to be an effective means of observing these cues during breastfeeding. By leveraging the cues identified in this review alongside tools such as PFCCS, IDS, NIDCAP, and PIBBS, nurses can accurately interpret preterm infants' breastfeeding cues in neonatal care settings of all levels. This, in turn, can aid in developing care plans that promote better feeding ability outcomes.

Evaluating Self-Concept Measurements in Adolescents: A Systematic Review.

(1) Background: To evaluate the self-concept of adolescents, a proper evaluation of several existing self-concept measurements is needed. The objectives of this study are to conduct a systematic review of the available measures used to assess self-concept in adolescents, to evaluate the psychometric properties of each measurement, and to assess the attributes of patient-reported outcome measurements (PROMs) of self-concept in adolescents. (2) Methods: The systematic review was conducted on six databases: EMBASE, MEDLINE, Cochrane, PubMed, CINAHL, and Web of Science, from inception to 2021. A standardized evaluation of psychometric properties was carried out using the Evaluating the Measurement of Patient-Reported Outcomes (EMPRO). The review was conducted independently by two reviewers. Each attribute in EMPRO was assessed and analyzed to obtain an overall score. Only scores that exceeded 50 were considered acceptable. (3) Results: From 22,388 articles, we reviewed 35 articles with five self-concept measurements. Four measurements were obtained that had values above the threshold (SPPC, SPPA, SDQ-II, and SDQII-S). However, there is not enough evidence to support the interpretability attribute in self-concept measurement. (4) Conclusions: There are various measurements of self-concept in adolescents accompanied by their psychometric properties. Each measurement of adolescent self-concept has a characteristic of psychometric properties and measurement attributes.

Adolescent assent in research: a relational ethics approach.

Researchers often neglect adolescents' willingness to participate in research. The granting of permission by parents is sometimes not in accordance with the unwillingness of adolescents. Relational ethics is the right approach to overcome inconsistencies between legal and ethical agreements in granting parental permission and adolescent's assent. This is because relational ethics is based on building relationships among many parties. The focus of this case study is to improve understanding of the assent of adolescents through intensive study of research conflict, reinforced using existing research and to understand how relational ethics can be used as an approach in decision-making, especially in conflicts between parental permission and assent from adolescents.

Effects of Distraction on Reducing Pain During Invasive Procedures in Children with Cancer: A Systematic Review and Meta-Analysis.

BACKGROUND: Distraction is a known behavioral intervention that is widely used for pain management in the pediatric population. However, there is a shortage of reviews reporting the efficacy of distraction for procedural pain reduction in pediatric oncology settings. AIM: To determine the current evidence on the effects of distraction on procedural pain in children with cancer. DESIGN: This systematic review and meta-analysis was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines SETTINGS: Six different databases from 1990 to June 2019. METHOD: A literature search was conducted to identify the effects of distraction on procedural pain reduction in children with cancer. A meta-analysis was undertaken along with applying a mixed effect model to quantify the standardized mean difference in the 95% confidence interval (CI) as the overall effects. RESULTS: Ten randomized controlled trials were included. Distraction during an invasive procedure had a large effect on pain intensity (-0.92, 95% CI -1.48 to -0.36, p = .001) and on needle insertion as well (-1.12, 95% CI -1.52 to -0.72, p = .000), but only a moderate effect on lumbar puncture procedures (-0.57, 95% CI -1.02 to -0.12, p = .012). Uncertain effects on pain relief showed up in a virtual reality (VR) distraction (-0.93, 95% CI -2.63 to 0.76, p = .28) and during active distraction (-0.72, 95% CI -1.48 to 0.03, p = .06). CONCLUSIONS: Distraction is an efficacious intervention to reduce procedural pain during needle insertion or lumbar puncture procedures in children with cancer. However, the efficacy of active distraction and VR remain uncertain. Future research should focus on specific comparisons of different forms of distractions with larger sample sizes.

When and how do healthcare professionals introduce specialist palliative care to the families of children with life-threatening conditions in Taiwan? A qualitative study.

BACKGROUND: Specialist palliative care (SPC) is often needed to manage complex or refractory problems in children with life-threatening conditions during end-of-life. This study explores the perceptions of healthcare professionals (HPs) to determine the triggers leading to and experiences with introducing SPC among families of children with life-threatening conditions. METHODS: A secondary analysis of 13 semi-structured interviews with HPs conducted from September 2019-June 2020 was carried out in a pediatric ward and a neonatal and pediatric intensive care unit in Taiwan. A thematic analysis was conducted. Competence Theory was used to guide the research questions and the interpretive framework. FINDINGS: Seven nurses, four pediatricians, one psychologist, and one respiratory therapist were interviewed. The need for shared knowledge regarding wishes for care and end-of-life decision-making were found to be the indicators for introducing SPC, along with having a fear of causing harm to the family-professional relationship and the patient. HPs value harmony in the form of clarifying misconceptions, building trust, and holding the moral bottom line. The theme of 'seeking the competent self' encompasses the values and expectations related to improving skills and creating a sense of fulfillment as HPs achieve good quality care. DISCUSSION: Discussions about SPC facilitate better communication and decision-making. Careful attention should be paid to the needs related to clarifying misconceptions and protecting the child's right to life when SPC is suggested. APPLICATION TO PRACTICE: Communication, empathy, and conflict resolution training may be helpful with developing HP competencies related to introducing SPC.

A preliminary study of current situation and competences of doctoral nursing education in Taiwan: A multi-methods research design.

AIM: To explore the status and overall competency of Taiwan's doctoral nursing programs. BACKGROUND: Taiwan has 11 universities offer doctoral degree programs in nursing from 1997 to 2020. As the demand for educators of higher nursing education increases, whether the nursing talent requirements have been satisfactorily fulfilled. DESIGN: A two-stage data collection based on a multi-methods survey was conducted. METHODS: The first stage from December 2017 to the end of December 2019, involved collecting admission brochures for 12 doctoral nursing programs provided by 11 universities and 14 Internet databases. In the second stage, convenience sampling was performed to recruit 115 graduates of national doctoral nursing programs to collect data through a self-administered questionnaire online survey from July to the end of September 2018. RESULTS: A systematic review of the vision and core competencies of each university revealed a general emphasis on nursing knowledge, research, leadership, international perspective and competence, innovation, social practice and policy. More specifically, universities aim to cultivate five core competencies in students, for example, nursing knowledge, scientific and innovative research capabilities and participation in the formulation and promotion of nursing policies. Of the 115 graduates of national doctoral nursing programs surveyed, the online questionnaire revealed that more than half of the respondents were aged 41-50 years (n = 62, 53.9%), 81.8% occupied a teaching position and most had 2.4-9.8 years of study in the program (mean = 6.09 ± 1.81 years). Respondents who completed a doctoral nursing program in Taiwan could learn orderly teaching, research and leadership capabilities with scored 4.12, 4.11 and 3.65, respectively. CONCLUSIONS: The overall orientation of the doctoral nursing programs in Taiwan aligns approximately with global trends in nursing. This study suggests that international and national resources should be incorporated into the cultivation of various competencies and curriculum quality control; moreover, industry, academia and the government should hold regular meetings to formulate suitable evaluation mechanisms.

Psychometric Evaluation of the Nurses Professional Values Scale-3: Indonesian Version.

The Nurses Professional Values Scale-3 (NPVS-3) is an important instrument for measuring the development and sustainability of professional values in nurses and nursing students. The translation, adaptation, and validation on this scale, including in Indonesia, is still very limited. The purpose of this study was to examine the Indonesian version of NPVS-3. This study used forward and backward translation methods and a cluster random sampling of 600 nurses participated. The 28-item scale of NPVS3-I was tested using EFA, applying the principal axis factoring extraction method and varimax with Kaiser normalization rotation method. The CFA used SEM with AMOS. Findings suggested sufficient content validity, construct validity, and reliability of the Indonesian version of NPVS-3. The I-CVI values ranged between 0.80 to 1.00 and the S-CVI was 0.99. Construct validity was supported with loading factors ranging from 0.49 to 0.84 for three factors (Caring, Activism, and Professionalism). The CFA goodness-of-fit indices were X2 (df) = 1516.95 (347), p < 0.001, normed chi-square (X2/df) = 4.37, RMSEA = 0.106, SRMR = 0.079, and CFI = 0.735. The Indonesian version of the NPVS3 showed good internal consistency with Cronbach's alphas for the instrument of 0.97 and 0.94, 0.95, and 0.89 for Caring, Activism, and Professionalism, respectively. The Indonesian version of the NPVS-3 is valid and reliable for use in Indonesia.

Efficacy of Scenario Simulation-Based Education in Relieving Parental Anxiety about Fever in Children.

PURPOSE: This study was designed to evaluate the short- and long-term effects of a scenario simulation-based education intervention on parental anxiety about fever in their children. DESIGN AND METHODS: This experimental research was conducted using a two-group pretest-posttest design. One hundred and sixty parents of 3-month to 5-year-old children enrolled in preschools and kindergartens with childcare services were recruited as participants using cluster random sampling. The participants were divided randomly into an experimental group (80) and a control group (80). The former participated in a scenario simulation-based education intervention and received a fever education booklet. The latter received the booklet only. Data were collected using the Children's Fever Anxiety Inventory at three time points: before the intervention (pretest, T1) and at six-month (T2) and 12-month (T3) posttests. RESULTS: Significant intergroup differences in fever anxiety were found at both T2 and T3 (p < .001). For both groups, the scores at T2 and T3 were significantly lower than at T1 (p < .001) and the difference between T2 and T3 did not attain statistical significance (p > .05). Although both groups experienced reduced fever anxiety over time, this reduction was significantly greater in the experimental group than in the control group (p < .001). CONCLUSION: Simulation-based education may be used in conjunction with the traditional fever education booklet to further reduce parent fever anxiety over time. PRACTICE IMPLICATIONS: This simulation-based education approach significantly and positively impacts parental anxiety about fever in their children. Furthermore, the approach may be generalizable to other childhood healthcare settings.

Impact of palliative care on end-of-life care and place of death in children, adolescents, and young adults with life-limiting conditions: A systematic review.

OBJECTIVE: To determine the impact of palliative care (PC) on end-of-life (EoL) care and the place of death (PoD) in children, adolescents, and young adults with life-limiting conditions. METHOD: Eight online databases (PubMed, Medline, EMBASE, Cochrane Library, CINAHL, Airiti, GARUDA Garba Rujukan Digital, and OpenGrey) from 2010 to February 5, 2020 were searched for studies investigating EoL care and the PoD for pediatric patients receiving and not receiving PC. RESULTS: Of the 6,468 citations identified, 14 cohort studies and one case series were included. An evidence base of mainly adequate- and strong-quality studies shows that inpatient hospital PC, either with or without the provision of home and community PC, was found to be associated with a decrease in intensive care use and high-intensity EoL care. Conflicting evidence was found for the association between PC and hospital admissions, length of stay in hospital, resuscitation at the time of death, and the proportion of hospital and home deaths. SIGNIFICANCE OF RESULTS: Current evidence suggests that specialist, multidisciplinary involvement, and continuity of PC are required to reduce the intensity of EoL care. Careful attention should be paid to the need for a longer length of stay in a medical setting late in life, and earlier EoL care discussion should take place with patients/caregivers, especially in regard to attempting resuscitation in toddlers, adolescents, and the young adult population. A lack of robust evidence has identified a gap in rigorous multisite prospective studies utilizing data collection.

Knowledge and comfort related to palliative care among Indonesian primary health care providers.

This study investigated Indonesian primary health care providers' knowledge and comfort towards palliative care. A descriptive cross-sectional design was used. From August 2017 to February 2018, the research team approached 70 primary care centres in the Yogyakarta province of Indonesia and invited health care providers to complete the Palliative Care Quiz for Nursing - Indonesia and describe their comfort in caring for terminally ill patients. Data were obtained from 516 health care providers. The mean (±s.d.) score of palliative care knowledge was low (7.8±3.3 of a possible score of 20). Current comfort level in providing palliative care was also low (1.6±2.7 of a possible score of 10). Only 11.3% of palliative care knowledge was explained by respondents understanding of palliative care definition, their education levels and experience in providing palliative care in hospital. However, 82.9% of provider comfort was explained by their experiences for caring for terminally ill patients in primary healthcare centres, palliative care training and years of work experience in primary healthcare centres. Indonesian evidence-based palliative care standards and guidelines must be established with education offered to all providers.

[Nursing Experience of a Child With Difficulty Breathing With End-Stage Niemann-Pick Disease Type C].

This case report describes a nursing experience providing end-of-life care to a child with Niemann-Pick disease type C. The period of nursing care was from April to June 2018. After comprehensive nursing and family assessment, dyspnea and caregiver's role strain were identified as the primary nursing-care problems. Niemann-Pick is a rare disease caused by genomic abnormalities. Patients with this disease are unable to metabolize lipids, which accumulate in organs, causing hepatosplenomegaly, dyspnea, and central nervous system degeneration. There is a lack of relevant experience in medical and nursing care due to the small number of cases worldwide. It is difficult to predict the progress of this disease and the life expectancy of the patient. The complex indications of this disease complicate the caregiver burden and process of end-of-life care. Thus, the multi-disciplinary team integrated the discharge preparations, symptom control skills, and related resources to build consensus with the family. We provided nursing care continuously from hospital to home as well as improved quality of care and family cohesion and reduced caregiver load. We hope that sharing this experience provides a reference for discharge planning and end-of-life care for children with rare diseases.

[The Clinical Application of Developmental Care in Retinopathy of Prematurity Eye Examinations].

Retinopathy of prematurity (ROP) is a disorder affecting the development of retinal blood vessels in preterm infants. Eye screening examinations are important to the early detection and treatment of ROP. However, several studies have associated eye examinations with pain, stress, and negative physiological effects. Developmental care has been provided as part of neonatal care in recent decades, and some studies indicate that this care positively affects pain scores, stress response, and recovery time during ROP eye screenings. In this article, five elements of developmental care that are applicable for preterm infants undergoing eye examinations for ROP are highlighted and described. These five elements include environmental modifications (e.g., provide a quite environment and dim room lighting), positioning (e.g., offer a nest or positing support and promote the infant to achieve neuromotor development), oxygen delivery (provide adequate oxygen support according to clinical conditions), approach and interaction (e.g., talk softly to infants and gently touch them before the eye examination), and cue-based individual care (e.g., soothe infants, give them a short break or soother based on observations of needs and cue-based behavior). Effectively addressing these five elements may minimize the pain, stress, and energy consumption during ROP eye screenings and provide individualized care that is comfortable, supportive, and promotes the healthy development of preterm infants.

Consulting with a folk deity before making decisions: spiritual practices in parents facing end-of-life decisions for their child on life support with brain stem dysfunction.

Background: Adolescents with brain stem dysfunction may undergo many invasive treatments, and parents are often faced with making the decision to withdraw treatment. However, in the face of their child's death, the spiritual practices of parents dealing with end-of-life decision-making remain under investigated.Purpose: This study explores the spiritual practices in parents making end-of-life decisions for adolescents on life support with brain stem dysfunction.Method: A descriptive phenomenological study was conducted through in-depth interviews with three parents of two adolescents in Taiwan. Data were analysed using Colaizzi's seven-step protocol.Results: Three main themes emerged: (1) faith during decision-making, (2) struggles during decision-making, (3) transformation during decision-making. The findings indicate that "transforming the nature of hope" is the essence of the experience.Conclusion: Family-centred care, gaining insight into parental spiritual practices, and developing culturally-appropriate care are recommended.

[The Ethical Issues in Research on Child Abuse].

Child abuse is a sensitive research topic. Improving the health of the victims of abuse through research, rights protection, and preemption of harm are important and debatable ethical issues. The ethical considerations related to research into child abuse cover two dimensions: 1) using children as subjects and 2) concerns regarding the physical and mental health of children who are targeted by related research. This paper focuses on several common ethical issues in the field of child abuse research, starting from the formulation of the research problem, sampling, data collection, and results reporting. Ethical issues include obtaining informed consent, assuring the autonomy of maltreated children and adults with childhood abuse histories, ensuring a sense of control and safety during data collection, and establishing the role of researchers as mandated reporters. As a researcher, rigorous research design and methodology and self-preparation on the issue of childhood trauma and abuse are essential in order to reduce the risk of harm to victims. This paper is intended to provide suggestions for researchers and institutional review board committees to assess the ethics of conducting research on sensitive issues.

[Helping a Preterm Infant Through the Transitional Feeding Period Using a Cue-Based Feeding Approach of Developmental Care].

The aim of this case report was to identify the optimal point to start oral feeding in order to help a preterm infant successfully pass through the transitional feeding period. Because all preterm infants must go through a transitional feeding period, going through this period successfully is very important. This case report described a nursing experience related to caring for a low-birth-weight preterm infant who showed hunger cues before feeding at around 31gestational weeks during the tube-feeding period. An assessment revealed that the preterm infant did not exhibit good sucking, breathing, and swallowing coordination. Therefore, we decided to design a nursing care plan to help the preterm infant transition smoothly from tube feeding to oral feeding. The nursing care period was from September 21st to November 2th, 2017. The care processes included: 1) the oral stimulation phase: provision of oral stimulation to increase oral motor function, 2) the oral feeding training phase: use of the Preterm Oral Feeding Readiness Scale (POFRAS) assessment tool to assess feeding readiness before oral feeding, 3) use of a cue-based approach to decide the starting and stopping points, and, finally, 4) the transition to the demand feeding phase. As the preterm infant grew, the body weight and feeding amount both increased positively and without complications. This experience may serve as a model for developing clinical guidelines for a cue-based feeding approach for preterm infants during the transitional feeding period.

Unmet supportive care needs and psychological distress among parents of children with cancer in Indonesia.

OBJECTIVE: The aim of this study was to investigate the needs and associating factors, psychological distress of parents, when taking care of children with cancer in Indonesia. METHODS: A cross-sectional study was conducted among 100 parents of children with cancer from the pediatric ward of two hospitals in Indonesia. The parents were assessed using the Indonesian version of the Supportive Care Needs Survey for Partner and Caregiver (unmet needs) and the Hospital Anxiety Depression Scale (psychological distress). The factors associated with unmet needs were analyzed using hierarchical linear regression. RESULTS: Among the surveyed parents, 83% had over 10 unmet needs. Among these unmet needs, need for information was the highest one. In the self-report measure using a clinical cut-off, 49% of the parents reported signs of anxiety, and 25% had signs of depression. Parents reporting clinically relevant levels of anxiety had more unmet needs than parents without clinically relevant anxiety. Having fewer children was correlated with higher work and social needs, and higher levels of education were correlated with more psychological needs. However, the children's clinical variables were not associated with the overall needs in the regression model. CONCLUSIONS: Most parents of children with cancer reported a need for more information and reported signs of anxiety and depression. Parents with fewer children and higher levels of education were identified as a vulnerable population due to having greater needs. The result of this study can be used to improve supportive care for parents of children with cancer in hospital settings.

A modified developmental care bundle reduces pain and stress in preterm infants undergoing examinations for retinopathy of prematurity: A randomised controlled trial.

AIMS AND OBJECTIVES: To determine the comparative efficacy of developmental care versus standard care for reducing pain and stress in preterm infants during examinations for retinopathy of prematurity (ROP). BACKGROUND: ROP examinations are routinely performed in neonatal intensive care units to detect these lesions. Pain scores recorded during and after eye examinations have revealed physiological and behavioural manifestations of pain and stress. DESIGN: A randomised crossover trial was conducted. METHODS: Fourteen preterm infants were evaluated. The modified developmental care bundle included environmental modifications, positioning and containment, oxygen supplementation, interaction and approach and cue-based individual care, which were applied before, during and after the ROP examination. The primary outcomes were obtained from pain and stress scores using the premature infant pain profile-revised (PIPP-R) and a behavioural evaluation. The secondary outcomes were recovery time to the baseline of the vital signs and oxygen saturation. RESULTS: Statistical significances were found in the care type comparison (p = 0.013), time comparison (p < 0.001) and type-by-time interaction (p = 0.005) in the PIPP-R, and also in the care type comparison (p < 0.001), time comparison (p < 0.001) and type-by-time interaction (p = 0.001) in the behavioural evaluation scores using a generalised estimating equation (GEE) analysis. Recovery time for the developmental care (N = 13, mean = 8.6 ± 11.5 min, 95% CI = 1.68-15.57) was significantly shorter than for the standard care (N = 11, mean = 25.5 ± 20.8 min, 95% CI = 11.45-39.46), which was found to be statistically significant according to the Wilcoxon signed-rank test (N = 11, p = 0.003). CONCLUSIONS: A bundled developmental care intervention significantly reduced pain and stress responses and the time needed for infants to recover their physiological status following the procedure. RELEVANCE TO CLINICAL PRACTICE: Since the results show the benefits of developmental care in an ROP examination, it can be the practical evidence basis by which to develop a standard of procedure or guideline for clinical practice.

Information Reception and Expectations Among Hospitalized Elderly Patients in Taiwan: A Pilot Study.

BACKGROUND: Communicating with patients, especially geriatric patients, is a challenge for medical professionals. Medical message receiving and expectations among hospitalized elderly patients have not been studied. PURPOSE: The aim of this study was to explore medical message receiving and expectations concerning medical information among hospitalized elderly patients in Taiwan. METHODS: A descriptive study design was used. Convenience sampling was applied, and the research was conducted in a geriatric ward in a medical center in southern Taiwan. Patients were recruited who were 65 years or older and capable of verbal communication. Data were collected using a self-developed semistructured questionnaire. For each participant, data were collected in one regular ward round. The messages of the physician were recorded. During the first and fourth hours after the ward round, the researcher collected the medical messages that were conveyed by the physician in the ward round and that could be repeated by the patients. Open-ended questions were used to collect data about patient expectations of medical messages during the first hour after the ward round. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using content analysis. RESULTS: Thirty patients participated in this study. All of the participants remembered the visit of the physician. Seventeen participants (56.6%), however, could not repeat the messages, and the total message repetition rate was 17.8% at the first hour after the ward round. By the fourth hour, the message repetition rate fell to 8.9%. Furthermore, three participants (10%) reported messages incorrectly. Participants reported the importance and necessity of physicians conveying medical messages. "Desire to know the reasons for discomfort" and "discharge date" were the messages most expected by the participants. CONCLUSIONS: This study suggests that most hospitalized elderly patients cannot repeat medical messages that are conveyed by their physicians. Written materials and the involvement of principal caregivers in the medical informing process may be necessary. Besides, before providing medical information, medical professionals should be cognizant of the key concerns of their patients.