Family-centred interventions for Indigenous early childhood well-being by primary healthcare services.

BACKGROUND: Primary healthcare, particularly Indigenous-led services, are well placed to deliver services that reflect the needs of Indigenous children and their families. Important characteristics identified by families for primary health care include services that support families, accommodate sociocultural needs, recognise extended family child-rearing practices, and Indigenous ways of knowing and doing business. Indigenous family-centred care interventions have been developed and implemented within primary healthcare services to plan, implement, and support the care of children, immediate and extended family and the home environment. The delivery of family-centred interventions can be through environmental, communication, educational, counselling, and family support approaches. OBJECTIVES: To evaluate the benefits and harms of family-centred interventions delivered by primary healthcare services in Canada, Australia, New Zealand, and the USA on a range of physical, psychosocial, and behavioural outcomes of Indigenous children (aged from conception to less than five years), parents, and families. SEARCH METHODS: We used standard, extensive Cochrane search methods. The latest search date was 22 September 2021. SELECTION CRITERIA: We included randomised controlled trials (RCTs), cluster RCTs, quasi-RCTs, controlled before-after studies, and interrupted time series of family-centred care interventions that included Indigenous children aged less than five years from Canada, Australia, New Zealand, and the USA. Interventions were included if they met the assessment criteria for family-centred interventions and were delivered in primary health care. Comparison interventions could include usual maternal and child health care or one form of family-centred intervention versus another. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were 1. overall health and well-being, 2. psychological health and emotional behaviour of children, 3. physical health and developmental health outcomes of children, 4. family health-enhancing lifestyle or behaviour outcomes, 5. psychological health of parent/carer. 6. adverse events or harms. Our secondary outcomes were 7. parenting knowledge and awareness, 8. family evaluation of care, 9. service access and utilisation, 10. family-centredness of consultation processes, and 11. economic costs and outcomes associated with the interventions. We used GRADE to assess the certainty of the evidence for our primary outcomes. MAIN RESULTS: We included nine RCTs and two cluster-RCTs that investigated the effect of family-centred care interventions delivered by primary healthcare services for Indigenous early child well-being. There were 1270 mother-child dyads and 1924 children aged less than five years recruited. Seven studies were from the USA, two from New Zealand, one from Canada, and one delivered in both Australia and New Zealand. The focus of interventions varied and included three studies focused on early childhood caries; three on childhood obesity; two on child behavioural problems; and one each on negative parenting patterns, child acute respiratory illness, and sudden unexpected death in infancy. Family-centred education was the most common type of intervention delivered. Three studies compared family-centred care to usual care and seven studies provided some 'minimal' intervention to families such as education in the form of pamphlets or newsletters. One study provided a minimal intervention during the child's first 24 months and then the family-centred care intervention for one year. No studies had low or unclear risk of bias across all domains. All studies had a high risk of bias for the blinding of participants and personnel domain. Family-centred care may improve overall health and well-being of Indigenous children and their families, but the evidence was very uncertain. The pooled effect estimate from 11 studies suggests that family-centred care improved the overall health and well-being of Indigenous children and their families compared no family-centred care (standardised mean difference (SMD) 0.14, 95% confidence interval (CI) 0.03 to 0.24; 2386 participants). We are very uncertain whether family-centred care compared to no family-centred care improves the psychological health and emotional behaviour of children as measured by the Infant Toddler Social Emotional Assessment (ITSEA) (Competence domain) (mean difference (MD) 0.04, 95% CI -0.03 to 0.11; 2 studies, 384 participants). We assessed the evidence as being very uncertain about the effect of family-centred care on physical health and developmental health outcomes of children. Pooled data from eight trials on physical health and developmental outcomes found there was little to no difference between the intervention and the control groups (SMD 0.13, 95% CI -0.00 to 0.26; 1961 participants). The evidence is also very unclear whether family-centred care improved family-enhancing lifestyle and behaviours outcomes. Nine studies measured family health-enhancing lifestyle and behaviours and pooled analysis found there was little to no difference between groups (SMD 0.16, 95% CI -0.06 to 0.39; 1969 participants; very low-certainty evidence). There was very low-certainty evidence of little to no difference for the psychological health of parents and carers when they participated in family-centred care compared to any control group (SMD 0.10, 95% CI -0.03 to 0.22; 5 studies, 975 parents/carers). Two studies stated that there were no adverse events as a result of the intervention. No additional data were provided. No studies reported from the health service providers perspective or on outcomes for family's evaluation of care or family-centredness of consultation processes. AUTHORS' CONCLUSIONS: There is some evidence to suggest that family-centred care delivered by primary healthcare services improves the overall health and well-being of Indigenous children, parents, and families. However, due to lack of data, there was not enough evidence to determine whether specific outcomes such as child health and development improved as a result of family-centred interventions. Seven of the 11 studies delivered family-centred education interventions. Seven studies were from the USA and centred on two particular trials, the 'Healthy Children, Strong Families' and 'Family Spirit' trials. As the evidence is very low certainty for all outcomes, further high-quality trials are needed to provide robust evidence for the use of family-centred care interventions for Indigenous children aged less than five years.

The clinical learning environment, supervision and future intention to work as a nurse in nursing students: a cross-sectional and descriptive study.

BACKGROUND: Clinical practice is a core component of nurse education. It is believed that nursing students' clinical placement experiences can affect their learning outcomes, satisfaction, as well as influence their choice of future career. To examine nursing students' perception of clinical learning environment and mentoring in hospital where they perform their clinical placement and the connection of these factor with intention to work as a nurse once graduated. METHODS: Nursing students enrolled in clinical practice at least 6 months in hospitals in China were surveyed between January-March 2021. Percentages, frequencies, mean, standard deviation, t-test, ANOVA, and regression analysis were used to analyse the data. RESULTS: Of the five scales in the CLES+T, 'Leadership style of the ward manager' scored the highest mean while 'Pedagogical atmosphere at the ward' scored the lowest. Nursing students with lower educational level, those supervised by fixed preceptor, and those intent to be a nurse in the future were significantly more satisfied with the CLES+T. Most of the nursing students are intent to work as a nurse in the future. CLES+T total scores and sub-dimensions (Premises of nursing on the ward) have significantly effectiveness on the intention to be a nurse in the future. CONCLUSIONS: Given the significant correlation of between learning environments and nursing students intention to be a nurse in the future, ward managers need to build a good clinical teaching atmosphere and promote opportunities for theoretical and practical connections among students through effective feedback mechanisms, which can enable students to experience a better clinical learning environment and meaningful experiences to build their professional roles and competencies, thus helping to enhance students' willingness to pursue nursing careers in the future.

Nurses' Perceptions and Attitudes toward Family-Centered Care in Acute Pediatric Care Settings in Jordan.

PURPOSE: Perceptions and attitudes toward working with parents may influence nurses' family-centered clinical care practices. There is a paucity of research measuring family-centered care among nurses working with children and their parents in Jordan. The purpose of this study was to explore nurses' perceptions of family-centered care by examining nurses' attitudes toward working with children and their parents, as well as toward family-centeredness. Also investigated was the extent to which the selected demographic characteristics of nurses explain the discrepancies between their child- and parent-focused attitudes. DESIGN AND METHODS: Using a cross-sectional descriptive study, 246 nurses completed the 'Working with families' questionnaire. A paired t-test used to compare the working with children versus working with parents' attitude scores, and independent t-test and ANOVA to explore the influence of nurses' demographic characteristics attitude scores. RESULTS: The nurses scored higher for working with children than with parents, suggesting more positive attitudes toward the former than the latter (p < 0.001). The family-centeredness scores varied with nurses' years of clinical experience (p < 0.001) and years of employment (p < 0.005). CONCLUSIONS: The applicability of the family-centered care model in Jordan's hospitals is challenged by the fact that pediatric nurses register more positive attitudes for working with children than with parents. PRACTICE IMPLICATIONS: Nurses' attitude toward working with children's families requires more evaluation prior to implementing family-centered care in practice. Further research is needed to explore factors contributing to discrepancies between child- and parent-focused attitudes among nurses.

How nurses in a developing country perceive and experience leadership: A qualitative study.

BACKGROUND: In Indonesia, information on and research into how Indonesian nurses perceive and experience leadership and leadership roles is limited. AIMS: This study was designed to identify Indonesian nurses' perceptions and experiences of leadership and nurse leadership roles in the hospital setting. DESIGN: A qualitative study with semi-structured interviews. METHODS: The study was conducted in a large, urban hospital in Indonesia. Twenty nurses who had worked in this hospital for more than a year were interviewed. A thematic approach was used for data analysis. This study is conducted and reported according to the SRQR checklist. RESULTS: The participants' perceptions and experiences of leadership were organized within three themes: searching for a description of leadership, viewing leadership and management as the same, and experiencing limited leadership opportunities. IMPACT STATEMENTS: The study revealed little evidence that nurses were being empowered to provide leadership within the organization. Although nurses in many developed countries now serve on governing boards, this is not immediately foreseeable for nurses in Indonesia. CONCLUSIONS: The participants' view of leadership in nursing was not overtly critical. Perhaps they did not understand that leadership is a dynamic concept and that it might be perceived differently depending on the context.

ActiveYou I - a new web-based measure of activity preferences among children with disabilities.

BACKGROUND: Children's preferences for activities are one of the most important predictors for participation. Currently no web-based measure of activity preferences exists for children with disabilities. AIM: To develop and investigate feasibility and internal consistency of a new web-based measure of activity preferences, ActiveYou I for children with disabilities. MATERIALS AND METHODS: The ActiveYou I was developed in three steps using a mixed-methods design. A review of the preferred goal activities of 149 children with disabilities was used to identify relevant activities. A pilot version of ActiveYou I was tested with 341 children with disabilities. Semi-structured group interviews and cognitive interviews were conducted with therapists and children with disabilities. RESULTS: Nineteen physical activities were included in the pilot version. The pilot trial resulted in two activities being excluded, and one activity added, leaving the instrument with eighteen activities. Internal consistency was acceptable (Cronbach's α ≥ 0.77). Interviews with therapists and children showed that ActiveYou I included relevant activities and was easy to answer. CONCLUSION: ActiveYou I proves to be a valid and feasible, web-based instrument for mapping activity preferences in children and adolescents with disabilities. SIGNIFICANCE: Preferences are an important mediator for participation; consequently it is essential to seek activities that match the children's preferences.

Early disease surveillance in young children with cystic fibrosis: A qualitative analysis of parent experiences.

BACKGROUND: Sensitive measures of early lung disease are being integrated into therapeutic trials and clinical practice in cystic fibrosis (CF). The impact of early disease surveillance (EDS) using these novel and often intensive techniques on young children and their families is not well researched. METHODS: The Australian Respiratory Early Surveillance Team for Cystic Fibrosis (AREST CF) has operated a combined clinical and research early disease surveillance program, based around annual chest CT scan, bronchoscopy and lung function from newborn screening diagnosis until age 6 years, for over two-decades. To explore parental experiences of EDS in their child, a qualitative study was conducted using audio-recorded, semi-structured interviews in n=46 mothers and n=21 fathers of children (aged 3-months to six years) attending CF centres in Perth and Melbourne, Australia. Themes were developed iteratively using thematic analysis and assessed for validity and confirmability. RESULTS: Parents' experiences were positive overall; affording a sense of control over CF, disease knowledge, and belief that EDS was in the best interests of their child. Challenges included poor understanding about EDS measures leading to anxiety and distress, self-blame surrounding adverse findings, and emotional burden of surveillance visits. Tailored information regarding the practical and psychosocial aspects of EDS were endorsed. CONCLUSION: While experiences were generally positive there is need for information and psychosocial support for parents to mitigate anxiety and develop positive coping strategies surrounding surveillance procedures and results. Managing expectations regarding risks and benefits of disease surveillance in clinical and research settings are important aspects of care.

Bridging the Child and Family Centered Care Gap: Therapeutic Conversations with Children and Families.

Professor Linda Shields and Dr Mandie Foster from Charles Sturt University and Edith Cowan University in Australia discuss several models of care for children and families that exist and the prospect of using conversations with children and families as an intervention within healthcare to facilitate a child and family centered care approach.

Matthew Flinders Senior (1751-1802): Surgeon and 'man midwife'.

Until the eighteenth century, midwifery was the sole domain of women, but changes in medical science saw it appropriated by medical men and the 'man-midwife' emerged. This paper demonstrates the work of a man-midwife in a small English village in one year, 1775, using his accounts and correspondence. The man was Matthew Flinders Senior, 'surgeon and man-midwife' at Donington, Lincolnshire. He was the father of Captain Matthew Flinders, the famous navigator who mapped the coast line of Australia and who coined that name. Primary sources, published as a collection by the Lincoln Record Society, were used. Flinders Senior made a good living from his midwifery, charging rates commensurate with those charged by obstetricians today (with reduced costs for the poor). His descriptions of his practice show how midwifery was conducted in rural England during the development of medicine as a high-status profession. The paper uses data from one year to provide a snap shot of the work of a rural surgeon and man-midwife, but much more is available in the published collection, providing ready access for researchers who may like to pursue such work further.

A PRISMA assessment of the reporting quality of systematic reviews of nursing published in the Cochrane Library and paper-based journals.

OBJECTIVE: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) was released as a standard of reporting systematic reviewers (SRs). However, not all SRs adhere completely to this standard. This study aimed to evaluate the reporting quality of SRs published in the Cochrane Library and paper-based journals. METHODS: The SRs which evaluate the effectiveness of nursing interventions in 2016 were identified via PubMed. The reporting quality of selected articles was evaluated using the PRISMA checklist. For comparison, we divided these articles into Cochrane review (CR) and non-Cochrane review (NCR). Based on the satisfaction of the applicable criteria, each article is assigned an accumulated score and a total percentage score. RESULTS: Overall, 41.7% articles were concentrated in 19.0 to 22.5 points which represent the moderate quality, 22% articles were high quality. There were still 36.5% articles with low quality. The mean PRISMA score was 20.54 ±â€Š2.367 for CRs, and 18.81 ±â€Š2.536 for NCRs. Although no significant difference was exit between overall CR and NCR scores, there were differences between items 1, 5, 8, 16, 23. Analysis indicated that CR was significantly associated with the overall PRISMA score. CONCLUSION: Compliance of CR and NCR with PRISMA checklist exhibited different strengths and weaknesses. Our study underscores that nursing researchers should pay more attention to comprehensive reporting of SRs in nursing to follow the PRISMA statement. IMPLICATIONS FOR NURSING AND/OR HEALTH POLICY: Nursing researchers who participate in SRs should follow the latest Cochrane Handbook to prepare such study. Meanwhile, the PRISMA statement should be followed strictly to report SRs, so as to improve the quality of SRs.

Toward developing consensus on family-centred care: An international descriptive study and discussion.

Nurses around the world have described family-centred care (FCC) in various ways. With limited evidence regarding its implementation and with dissent among professionals regarding outcomes that are amorphously defined across age groups, systems and global settings, a group of children's nursing experts from around the world collaborated to seek clarification of the terms, deconstruct the elements in the model and describe empirically a consensus of values toward operationally defining FCC. A modified Delphi method was used drawing on expert opinions of participants from eight countries to develop a contemporary and internationally agreed list of 27 statements (descriptors of FCC) that could form the foundation for a measure for future empirical psychometric study of FCC across settings and countries. Results indicated that even among FCC experts, understandings of FCC differ and that this may account for some of the confusion and conceptual disagreement. Recommendations were identified to underpin the development of a clearer vision of FCC.

Nurse participation in legal executions: An ethics round-table discussion.

A paper was published in 2003 discussing the ethics of nurses participating in executions by inserting the intravenous line for lethal injections and providing care until death. This paper was circulated on an international email list of senior nurses and academics to engender discussion. From that discussion, several people agreed to contribute to a paper expressing their own thoughts and feelings about the ethics of nurses participating in executions in countries where capital punishment is legal. While a range of opinions were presented, these opinions fell into two main themes. The first of these included reflections on the philosophical obligations of nurses as caregivers who support those in times of great need, including condemned prisoners at the end of life. The second theme encompassed the notion that no nurse ever should participate in the active taking of life, in line with the codes of ethics of various nursing organisations. This range of opinions suggests the complexity of this issue and the need for further public discussion.

Parents' experiences of Family Centred Care practices.

PURPOSE: The aim of this study was to gain knowledge and understanding of how parents experience Family Centred Care (FCC) using a relatively new tool, and to identify aspects of FCC practice for further development. DESIGN AND METHODS: A cross-sectional study involving a convenience sample of 48 parents of hospitalised children completed a seven-item instrument that measures importance and consistency associated with the core aspects of FCC practice, in addition to an open-ended question about what does FCC mean to parent. RESULTS: Eighty-five percent of parents reported positive experiences of receiving FCC practice from nurses, with lower consistency reported in parents' feelings of being seen as important in their child's care, feeling valued as a team member, or well cared for by nurses. Parents definition of FCC were concise and involved informal expressions such as allowing parents to stay with their hospitalised child, and family inclusion in child's care and care for the whole family. CONCLUSIONS: Although recent FCC debate represent the 'unit of care' in FCC as 'a child within the family context', parents' perspectival view of FCC places themselves as care recipient with a strong understanding of the ideals of partnership-in-care. PRACTICE IMPLICATIONS: Nurses and service providers can use current findings to promote the consistent application of Family Centred Care in their everyday practice, and to recognise current barriers to the effective implementation of Family Centred Care in nursing practice.

Incidence and Characteristics of Low-Speed Vehicle Run-Over Events in Australian Aboriginal and/or Torres Strait Islander Children and Other Australian Children Aged 0 to 14 Years in Queensland: An 11-Year (1999-2009) Retrospective Analysis.

The main objective of this study is to describe incidence rates (IRs) of low-speed vehicle run-over events among children aged 0 to 14 years in Queensland, Australia, from 1999 to 2009, by Indigenous Australian status. Data on low-speed vehicle run-over events among children aged 0 to 14 years in Queensland were obtained for 11 calendar years (1999-2009) from all relevant data sources using International Classification of Diseases (ICD) codes, text description, word searches, and medical notes and were manually linked. Crude fatal and nonfatal IRs were calculated for Indigenous and non-Indigenous children; trends over time were analyzed by chi-square test for trend. Relative risks (RRs) were also calculated. Data on demographics, health service usage/outcomes, incident characteristics, and injury characteristics were obtained. Descriptive and multivariate analyses were performed in order to investigate whether these characteristics varied with Indigenous status. IRs were higher among Indigenous Australian children aged 0 to 14 years (21.76/100,000/annum) than other Australian children (14.09), for every year of the 11-year study. The age group most at risk for low-speed vehicle run-over events were young children aged 0 to 4 years, where incidence was 2.13 times greater among Indigenous Australian children (95% confidence interval [CI] = 1.67-2.71). There were no significant changes in incidence of low-speed vehicle run-overs among Indigenous Australian children for 0 to 4, 5 to 9, and 10 to 14 years or overall (0-14 years), during the 11-year study period. Over three quarters (n = 107) of low-speed vehicle run-over events involving Indigenous Australian children occurred outside of major cities (43.7% in other Australian children). These data indicate that Indigenous Australian children are at increased risk of low-speed vehicle run-over events and that characteristics of these events may vary as a function of Indigenous status. These results highlight that culturally specific interventions to reduce low-speed vehicle run-over events are required.

Development, Implementation and Evaluation of an Educational Intervention to Prevent Low Speed Vehicle Run-Over Events: Lessons Learned.

There is a growing body of literature regarding low speed vehicle runover (LSVRO) events among children. To date, no literature exists on evaluation of interventions to address this serious childhood injury. Knowledge, attitudes, and behaviour regarding LSVROs were assessed via survey at a shopping centre (pre-intervention), then five months later (post-intervention), to investigate the effect of a population level educational intervention in Queensland, Australia. Participants' knowledge regarding frequency of LSVRO events was poor. No participant demonstrated 'adequate behaviour' in relation to four safe driveway behaviours pre-intervention; this increased at post-intervention (p < 0.05). Most of the sample perceived other's driveway behaviour as inadequate, and this reduced significantly (<0.05). Perceived effectiveness of LSVRO prevention strategies increased from pre- to post-intervention, but not significantly. TV was the greatest source of knowledge regarding LSVROs pre- and post-intervention. This study provides some evidence that the educational campaign and opportunistic media engagement were successful in increasing awareness and improving behaviour regarding LSVROs. While there are several limitations to this study, our experience reflects the 'real-world' challenges associated with implementing prevention strategies. We suggest a multi-faceted approach involving media (including social media), legislative changes, subsidies (for reversing cameras), and education to prevent LSVROs.