Adaptation and validation of the Physical Restraint-Theory of Planned Behaviour Questionnaire to the paediatric context.

OBJECTIVE: To create and test psychometrically a paediatric version of the Physical Restraint-Theory of Planned Behaviour Questionnaire to assess paediatric critical care nurses' intention to use physical restraint. DESIGN: A psychometric study. SETTING: Five medical-surgical Paeditric Intensive care Units from five hospitals in Spain. METHODS: The study took place in three phases. In phase 1, the questionnaire was adapted. In phase 2, the content validity of each item was determined, and a pilot test was conducted. In phase 3, we administered the questionnaire and determined its psychometric properties. RESULTS: The assessment of the intention to use physical restraint was extended to all critical paediatric patients, two items were eliminated from the initial questionnaire, four new items were included, and the clinical scenarios of the intention subscale were expanded from three to six. Overall content validity index for the full instrument of 0.96 out of 1. The Paediatric Physical Restraint-Theory of Planned Behaviour Questionnaire is made up of four subscales (attitude, subjective norms (SN), perceived behavioural control (PBC), and intention) subdivided into 7 factors and 51 items. The internal consistency for the attitude subscale obtained a Cronbach's Alpha of 0.80 to 0.73, for the SN it was 0.72 to 0.89, for the PBC it was from 0.80 to 0.73 and for the intention subscale it was 0.75. CONCLUSIONS: The Paediatric Physical Restraint-Theory of Planned Behaviour Questionnaire is an instrument composed of seven factors and 51 items that validly and reliably assesses the intention of paediatric nurses to apply PR in PICUs. RELEVANCE FOR CLINICAL PRACTICE: Having this instrument will help health centres move towards restraint-free care by allowing managers to assess professionals' attitudes, beliefs, and intentions around the use of PR in PICUs.

The effect of a live music therapy intervention on critically ill paediatric patients in the intensive care unit: A quasi-experimental pretest-posttest study.

BACKGROUND: Music therapy as a nonpharmacological means of managing patient pain, anxiety, and discomfort is a recognised technique, although it is not widely used in the paediatric intensive care unit (PICU). AIM: The aim of this study was to assess the clinical effect of a live music therapy intervention on vital signs and levels of discomfort and pain for paediatric patients in the PICU. METHODS: This was a quasi-experimental pretest-posttest study. The music therapy intervention was carried out by two music therapists who were specifically trained, each possessing a master's degree in the field of hospital music therapy. Ten minutes before the start of the music therapy session, the investigators recorded the vital signs of the patients and assessed their levels of discomfort and pain. The procedure was repeated at the start of the intervention; at 2, 5, and 10 min during the intervention; and at 10 min following the conclusion of the intervention. RESULTS: Two hundred fifty-nine patients were included; 55.2% were male, with a median age of 1 year (0-21). A total of 96 (37.1%) patients suffered a chronic illness. The main reason for PICU admission was respiratory illness, at 50.2% (n = 130). Significantly lower values were observed for heart rate (p = 0.002), breathing rate (p < 0.001), and degree of discomfort (p < 0.001) during the music therapy session. CONCLUSIONS: Live music therapy results in reduced heart rates, breathing rates, and paediatric patient discomfort levels. Although music therapy is not widely used in the PICU, our results suggest that using interventions such as that used in this study could help reduce patient discomfort.

Level of discomfort in critically ill paediatric patients and its correlation with sociodemographic and clinical variables, analgosedation and withdrawal syndrome. COSAIP multicentre study (Phase 2).

INTRODUCTION: There are clinical and sociodemographic factors that have an impact on the comfort of the critically ill paediatric patient. The main aim of this study was to determine the level of discomfort of paediatric patients admitted to different national hospitals, and to analyse its correlation with sociodemographic and clinical variables, analgosedation, and withdrawal syndrome. METHODS: An observational, analytical, cross-sectional, and multicentre study was conducted in five Spanish hospitals. The level of analgosedation was assessed once per shift over a 24 h period, using a BIS sensor, and pain with scales adapted to paediatric age population. The intensity of withdrawal syndrome was determined using the Withdrawal Assessment Tool (WAT-1) scale once per shift for 3 days. Discomfort level was simultaneously assessed using COMFORT Behaviour Scale-Spanish version (CBS-S). RESULTS: A total of 261 critically ill paediatric patients with median age of 1.61 years (IQR = 0.35-6.55) were included. An overall discomfort score of 10.79 ±â€¯3.7 was observed during morning compared to 10.31 ±â€¯3.3 during the night. When comparing analgosedation and non-analgosedation groups, statistical differences were found in both shifts (χ2: 45.48; P = .001). At the same time, an association was observed (P < .001) between low discomfort scores and development of withdrawal syndrome development assessed with WAT-1. CONCLUSIONS: As there is a percentage of the studied population with discomfort, specific protocols need to be developed, guided by valuated and clinically tested tools, like the COMFORT Behaviour Scale-Spanish version.

[Level of discomfort in critically ill paediatric patients and its correlation with sociodemographic and clinical variables, analgosedation and withdrawal syndrome. COSAIP multicentre study (Phase 2)]. / Grado de disconfort del paciente crítico pediátrico y correlación con variables sociodemográficas y clínicas, analgosedación y síndrome de abstinencia. Estudio multicéntrico COSAIP (Fase 2).

INTRODUCTION: There are clinical and sociodemographic factors that have an impact on the comfort of the critically ill paediatric patient. The main aim of this study was to determine the level of discomfort of paediatric patients admitted to different national hospitals, and to analyse its correlation with sociodemographic and clinical variables, analgosedation, and withdrawal syndrome. METHODS: An observational, analytical, cross-sectional, and multicentre study was conducted in five Spanish hospitals. The level of analgosedation was assessed once per shift over a 24h period, using a BIS sensor, and pain with scales adapted to paediatric age population. The intensity of withdrawal syndrome was determined using the Withdrawal Assessment Tool (WAT-1) scale once per shift for 3 days. Discomfort level was simultaneous assessed using COMFORT Behaviour Scale-Spanish version (CBS-S). RESULTS: A total of 261 critically ill paediatric patients with median age of 1.61 years (IQR=0.35-6.55) were included. An overall discomfort score of 10.79±3.7 was observed during morning compared to 10.31±3.3 observed during the night. When comparing analgosedation and non-analgosedation groups, statistically differences were found in both shifts (χ2: 45.48; P=.001). At the same time, an association was observed (P<.001) between low discomfort scores and development of withdrawal syndrome development assessed with WAT-1. CONCLUSIONS: As there is a percentage of the studied population with discomfort, specific protocols need to be developed, guided by valuated and clinically tested tools, like the COMFORT Behaviour Scale-Spanish version.

Impacto de la enfermedad oncológica infantil. PErcepción de las familias y de las enfermeras. Proyecto de investigación / Research project. The impact of pediatric oncologic disease: families' and nurses' perception

Introducción. Vivir la experiencia de tener un hijoa con cáncer es una situación que genera una crisis en la familia que afecta no solo a nivel estructural, sino también emocional. Las enfermeras son las profesionales miembros del equipo multidisciplinar que se relacionan más tiempo con estas familias, por lo que es interesante saber cómo evidencian esta experiencia para poder mejorar la práctica asistencial, que debe contemplar una orientación holística dentro de los cuidados de alta complejidad que precisa un niño oncológico. Objetivos. Analizar el impacto en las familias producido por el debut de una enfermedad oncológica infantil; describir la percepción de las enfermeras sobre el impacto y la vivencia de las familias en el inicio de una enfermedad oncológica infantil y comparar la percepción que tienen las familias con la percepción de las enfermeras con respecto al debut de la enfermedad oncológica infantil. Ámbito de estudio. Unidad de Oncología y Hospital de Día del Hospital Sant Joan de Déu de Barcelona. Metodología. Estudio cualitativo siguiendo un enfoque basado en la fenomenología hermenéutica de Heidegger. Los participantes serán las familias de niños con cáncer y las enfermeras dedicadas a su cuidado. Para la recogida de datos se utilizará la entrevista en profundidad y, si se considerara pertinente, el grupo de discusión. El tipo de análisis utilizado será el de la temática bajo el método de análisis del contenido, siguiendo el método de análisis Guía QUAGOL (Qualitative Analysis Guide of Leuven) (AU)

Introduction. Going through the experience of having a child with cancer often results in a structural and emotional crisis for the family. Nurses, as professional members of a multidisciplinary team, interrelate the most with the families of oncologic pediatric patients. It is of great interest to provide evidence of nurses’ experience, in order to improve the care practice for children with cancer. Due to these patients’ highly complex needs in terms of care, a holistic approach is required. Objectives. To design a study which will determine the impact that the debut of an oncologic disease on a child has on families, by comparing nurses’ perception on the impact and experience of families going through this process to those of the actual family. Field of study. Oncology Unit and Day Hospital Sant Joan de Déu, Barcelona. Methodology. A qualitative study based on Heidegger’s hermeneutic phenomenology. The subjects of study will be parents of children with cancer and nurses involved in their care. For data collection, interviews and group discussions (if considered relevant) will be collected. The type of analysis used will be content analysis, following the QUAGOL Guide (Qualitative Analysis Guide of Leuven) (AU)

Colaborar con África: la experiencia del retorno / Work with Africa: The experience of returning

El Hospital de San Juan de Dios colabora desde 2002 con el St. John of God Hospital en Mabesseneh (Sierra Leona) cuando éste retoma la actividad asistencial tras la guerra civil del 1991. Parte de la colaboración consiste en enviar cada dos meses un pediatra y una enfermera. Todos estos profesionales inician el proyecto con un concepto de salud occidental, con ideas de cambio... Al volver ¿Qué ha sucedido? ¿Han cambiado el mundo africano o éste les ha cambiado? De estos interrogantes parte nuestra investigación. Metodología: Se realizaron entrevistas no directivas a siete enfermeras colaboradoras con el programa. El enfoque utilizado en esta investigación es el fenomenológico. Los datos se analizaron mediante el enfoque de Taylor y Bogdan para el análisis de datos cualitativos.Resultados: las personas entrevistadas dicen que aprendes a valorar lo que existe en el mundo occidental. La práctica enfermera al principio parece que cambia, pero el ser humano se adapta al entorno tanto cuando uno llega a África como cuando retorna. La impregnación de estas experiencias construye la persona. Encontramos escasas diferencias en personas que han ido más de una vez.Conclusiones: Las experiencias de cada persona pueden ser muy distintas teniendo en cuenta los objetivos de los que se parte. Al igual que la impregnación de lo vivido. Pero sí se hace evidente que, tras el tiempo pasado, el cambio en la práctica asistencial no es significativo (AU)

The Hospital de San Juan de Dios collaborates since 2002 with the Hospital from St. John of God Hospital in Mabesseneh (Sierra Leone) when the last resumed its activity after the Civil war of 1991. A part of this collaboration consists in sending a nurse and a paediatrician every two months. All these professional start the project with a "Western" concept of Health, with some ideas of change.... When they are back at home... What has happened? Have they changed the African world or has it changed then? These are the main questions where our investigation comes from.Methodology: Non-directive interviews to seven nurses who had collaborated with the program. The obtained data were analysed by using The Taylor and Bogdan's method for the analysis of qualitative data.Results: The interviewed people affirm that, after the experience, one learns to appreciate what is available in the Western World. At the beginning it looks as if the nursery practice changes but, indeed, the human beings can adapt themselves to the environment either when arriving to Africa or when departing from. The imprint of these experiences makes the person. Very little differences are observed for people who have travelled more than once.Discussion-Conclusions: The experiences of each individual can be very different having in mind the objectives initially planned. The same can be said for the imprint of these experiences. But it is clear that, after a quite short time, any change in the nursing practice is not significant (AU)