Children's participation rights and the role of pediatric healthcare teams: A critical review.

AIM: A critical review examined how childrens participation rights as represented in the United Nations Convention on the Rights of the Child inform the work of pediatric teams in healthcare settings. METHODS: We systematically searched peer-reviewed literature on the enactment of child participation rights, within the context of pediatric teams. Articles were evaluated using the LEGEND (Let Evidence Guide Every New Decision) tool. Data extraction and analysis highlighted themes and disparities between articles, as well as gaps. A total of 25 studies were selected. RESULTS: We reviewed studies from around the globe, with the majority of papers from the UK. Qualitative and mixed methods approaches were administered. The following observations were made: (1) limited language of children's rights exists in the literature, (2) lack of information regarding the composition of pediatric healthcare teams and how they work with children, (3) children's perspectives on what constitutes good interactions with healthcare providers are replicated, (4) minimal references to theory or philosophical underpinnings that can guide practice. CONCLUSION: Explicit references to children's participation rights are lacking in the literature which may reflect the absence of rights language that could inform pediatric practice. Descriptive understandings of the tenets of pediatric interprofessional team composition and collaboration are necessary if we are to imagine the child as part of the team along with their family. Despite these shortcomings, the literature alludes to children's ability to discern desirable interactions with healthcare providers.

Home Away from Home: How Undergraduate and Graduate Students Experience Space and Place in a new Health Sciences Building.

Buildings contribute in crucial ways to how students experience learning spaces. Four schools within a faculty (nursing, nutrition, occupational and public health, and midwifery) moved into a new Health Sciences building Fall of 2019. This new building created a unique opportunity to explore the intersection between higher education and learning space design, informed by concepts of space and place, and students' profession specific and interprofessional learning experiences in a new Health Sciences building. A qualitative descriptive design was used. All undergraduate and graduate students within the four schools were invited to participate. Focus groups were undertaken to gain a rich understanding of students' experiences and views of their space and place of learning. Data collection involved focus group data from profession specific participant users and interprofessional participant users. Inductive thematic analysis of focus group transcripts generated an initial coding scheme, key themes, and data patterns. Codes were sorted into categories and then organized into meaningful clusters. A building planning development project document relating to the vision, intentions, design, and planning for the new building provided content from which to view the study findings. The study data contributed to the conversation about space and place and its influence on higher learning within specific intraprofessional and interprofessional student groups and provided insight into the process of actualizing a vision for a new learning space and the resultant experiences and perceptions of students within that space/place.

Communication of Code Status Escalation for Nurses and Physicians in the Intensive Care Unit: A Case Study.

BACKGROUND: Interprofessional teams working in the Intensive Care Unit (ICU) care for patients requiring varying degrees of life sustaining therapy. A patient's code status can help clinicians to understand the appropriate life support measures to deliver to patients in this setting. Members of the interprofessional team, such as physicians and nurses, can experience challenges related to communication when the code status is unclear. PURPOSE: The purpose of this study was to explore how nurses and physicians in the ICU experience communication of code status escalations. METHODS: A qualitative case study approach was used. Participants were physicians and nurses, working in the medical-surgical ICU of a large, urban academic hospital. Data were collected using semi-structured interviews, observations of health care rounds and a chart review. Data were analyzed using qualitative content analysis. RESULTS: Thematic findings include: (1) engaging in an interprofessional discussion, (2) finding consistent documentation, (3) revisiting the code status, and (4) telling the patient story. The study findings also provide contextual information about participants' experiences of code status communication during the first wave (February 2020 to May 2020) of the COVID-19 pandemic. CONCLUSIONS: The results of this study could inform standard communication frameworks or practices related to dissemination of code status decisions among members of the ICU team.

Mother-nurse decision making practices for children with complex health care needs receiving homecare services: A qualitative descriptive study.

BACKGROUND: Many children with complex health care needs face chronic health and developmental issues that may include functional impairments, neurodevelopmental disabilities, and lifelong dependence on medical technology. Providing the necessary care and services for this unique group of children and youth places substantial demands on the health care system. Much of the focus on improvements has been in acute care settings even though homecare accounts for the largest proportion of health care utilization among children with complex health care needs. While parents assume great responsibility for their child's care at home, they indicate that the balance of power between themselves and their health care providers does not change when care shifts from the hospital to home. Given the expanding role of paediatric homecare and parents' concerns of their role in decisions related to their child's care, it is imperative to explore these practices in this unique setting. PURPOSE: The purpose of this work is to explore mother-nurse decision making practices for children with complex health care needs receiving health care services in their home. METHODS: A qualitative descriptive study design was used. Five mothers and five nurses participated. Twenty-six home observations with accompanying analytical memos and 10 semistructured interviews were conducted with five mothers and five homecare nurses. Thematic analysis of study data, using an iterative process, identified major themes. FINDINGS: Data revealed the complex and relational nature of mother-nurse decision making practices within the home setting. Three major themes were identified: (1) core areas of decision making, (2) a dynamic and collaborative process, and (3) centrality of relationships. CONCLUSIONS: Study findings enhanced our understanding of how decision making and relational care practices take place in the home for children with complex health care needs receiving homecare services, which has implications for child and family health.

Exploring the Intersection Between Academic and Professional Practice During the COVID-19 Pandemic: Undergraduate and Graduate Nursing Students' Experiences.

BACKGROUND: The coronavirus disease-2019 (COVID-19) pandemic has implications for students who are also nurses. PURPOSE AND METHODS: This qualitative descriptive study used a practice development approach to explore the intersection between academic and professional work experiences for undergraduate Post-Diploma Registered Practical Nurses bridging to Registered Nurse Bachelor of Science in Nursing students and Master of Nursing graduate nursing students during the first wave of the COVID-19 pandemic. The study incorporated critical aesthetic reflections that focused on the personal and aesthetic ways of knowing, as a data collection approach and knowledge dissemination strategy. RESULTS: Analysis of the narrative component of participants' reflections revealed the following themes: sensing a "call to duty," experiencing a myriad of emotions, shifting societal and individual perceptions of nursing, and learning in an uncertain environment. CONCLUSIONS: The results of the study can inform educational strategies and academic policies to support this unique nursing population, who are frontline practitioners as well as student learners.

Relational Aspects of Parent and Home Health Care Provider Care Practices for Children With Complex Care Needs Receiving Health Care Services in the Home: A Narrative Review.

Children with medical complexity have ongoing health needs that may require dependence on medical technologies. While hospital admissions are an important focus of care delivery for these children, a majority of the time they are cared for in their own homes. Parents' report feeling overwhelmed and stressed by the scope of their responsibilities, but they become sophisticated care providers and assume greater authority when providing their children's care at home. Communication, decision-making, and dealing with conflict with members of health care teams have been central concerns in parents' reports of their home health care experiences. The objective is to review literature on relational aspects of parent and home health care provider care practices for children with medical complexity receiving home health care services. A narrative review was conducted. A search of MEDLINE, EMBASE, EBM Reviews, PsychINFO, ERIC, and CINAHL databases for English language studies published since database inception was carried out. Eligible studies focused on relational aspects of parent and home health care provider care practices for children with medical complexity receiving home health care services. Nine empirical studies were selected for this review. Literature describes parents' and providers' experiences managing a child with medical complexity in the home and the effects for the family and the parent-health care provider relationship. Parents want to be actively involved in all aspects of care that affects their child and ultimately their family. Further investigation is needed to better understand relational aspects of parent-home health care provider care practices to support child/family health and well-being in the home setting.

Long-Term Care Nurses' Experiences With Patient Safety Incident Management: A Qualitative Study.

BACKGROUND: Global trends in the aging population will increase the demands for long-term care (LTC) resources. Due to recent pressures to deliver more complex care, there is further risk to resident safety in LTC. Emphasis on the management and the delivery in safe and quality resident care in LTC is required. PURPOSE: The purpose of this study was to describe nurses' experiences with patient safety incident (PSI) management involving residents living in LTC. METHODS: Using a qualitative descriptive approach, 9 nurses were recruited in 3 LTC homes. Semistructured interviews were conducted, and data were analyzed using inductive content analysis. RESULTS: Three main categories emerged: commitment to resident safety, workplace culture, and emotional reaction. CONCLUSIONS: Providing nurses with an opportunity to share their PSI management experiences highlights the current factors influencing frontline resident safety in LTC. Study results can inform nursing practice and policy development to support PSI identification and management.

Incident Management in Health Care: A Pan-Canadian Perspective.

BACKGROUND: Nearly 10% of patients experience a harmful patient safety incident in the hospital setting. Current evidence focuses on incident reporting, whereas little is known about how incidents are managed within organizations. PURPOSE: The aim of this study was to explore processes, tools, and resources for incident management in Canadian health care organizations. METHODS: Qualitative focus groups were conducted with key stakeholders, representing clinicians, managers, executives, governors, patients, and families (n = 45). RESULTS: Qualitative data were thematically analyzed and presented as 3 themes: (1) variations in incident reporting and management; (2) simplification of the incident management process; and (3) need for leadership to support just culture and redefine harm. CONCLUSION: The study findings support and inform efforts to create a patient safety culture in Canadian and international health care organizations. There is a need to develop a standardized, accessible incident reporting and management system for use across health care sectors to promote continuous learning and improvement about patient safety.

Group-based storytelling in disease self-management among people with diabetes.

OBJECTIVE: We explored the underlying mechanisms by which storytelling can promote disease self-management among people with type 2 diabetes. METHODS: Two, eight-session storytelling interventions were delivered to a total of eight adults with type 2 diabetes at a community health center in Toronto, Ontario. Each week, participants shared stories about diabetes self-management topics of their choice. Using a qualitative descriptive approach, transcripts from each session and focus groups conducted during and following the intervention were coded and analyzed using NVivo software. Through content analysis, we identified categories that describe processes and benefits of the intervention that may contribute to and support diabetes self-management. RESULTS: Our analysis suggests that storytelling facilitates knowledge exchange, collaborative learning, reflection, and making meaning of one's disease. These processes, in turn, could potentially build a sense of community that facilitates peer support, empowerment, and active engagement in disease self-management. CONCLUSION: Venues that offer patients opportunities to speak of their illness management experiences are currently limited in our healthcare systems. In conjunction with traditional diabetes self-management education, storytelling can support several core aspects of diabetes self-management. Our findings could guide the design and/or evaluation of future story-based interventions.

Apoiando a educação em pesquisa dos graduandos de enfermagem / Apoyando la educación para la investigación de los estudiantes de enfermería de pregrado / Sustaining undergraduate nursing students' research education

Resumo Objetivos Descrever a experiência da implementação de um programa de treinamento de assistente de pesquisa voluntário para graduandos canadenses de Enfermagem, objetivando o desenvolvimento de habilidades de comunicação verbal e escrita, métodos de pesquisa e análise de dados, pensamento crítico e resolução de problemas, assim como o planejamento de suas carreiras e o avanço de seus papéis relacionados à pesquisa e às oportunidades administrativas e de liderança. Método Estudo descritivo com relato de experiência sobre o processo de treinamento para um novo papel profissional relativo ao engajamento dos graduandos em 11 oficinas, cada uma com duração de uma hora e o processo de apoiá-los para assumir papéis profissionais e de liderança. Resultados Os graduandos demonstraram comprometimento em todas as fases do treinamento. Destaca-se, ainda, o interesse por assumirem a liderança em atividades práticas que redefinem seu perfil profissional. Essa experiência contribuiu para construir e nutrir relações intelectuais docentes-graduandos. Os graduandos expandiram suas redes profissionais e a relação com o mentor de carreira, estão desenvolvendo suas habilidades práticas e relataram confiança em se candidatar para cargos de assistentes de pesquisa. Conclusão e implicações para a prática O treinamento pode instrumentalizá-los para escolhas de planos de carreira, ingresso no mercado de trabalho e a construção de plano para desenvolvimento profissional. O desejo genuíno dos docentes de Enfermagem, apoiando uma nova geração de enfermeiros, culminou nessa experiência de empoderamento mútuo.

Resumen Objetivos Informar sobre la experiencia de un equipo de profesionales de enfermería y desarrollo profesional en la implementación de un programa de asistente voluntario de investigación para estudiantes universitarios canadienses de pregrado en enfermería con el objetivo de desarrollar la comunicación escrita y verbal, métodos de investigación, análisis de datos, pensamiento crítico y habilidades de resolución de problemas, así como en su planificación y avance profesional para funciones relacionadas con la investigación y oportunidades de empleo administrativo y de liderazgo. Método Un diseño descriptivo con el informe de la experiencia de los investigadores de enfermería y desarrollo profesional sobre el proceso de apoyo para la formación de los estudiantes para un nuevo rol profesional. La experiencia se refiere a 11 talleres que durarán una hora sobre los temas relacionados con la investigación. Resultados Los estudiantes demostraron compromiso con la capacitación. Relevante es su interés en liderar actividades prácticas para redefinir su perfil profesional. Esta experiencia contribuyó a construir y fomentar relaciones significativas e intelectuales entre los profesores y los estudiantes. Los estudiantes amplían sus redes profesionales y obtienen una relación con un mentor de carrera. Conclusión e implicaciones para la práctica La capacitación puede equipar mejor a los estudiantes para elegir trayectorias profesionales, entrar en el mercado laboral y elaborar un plan para el avance profesional. Fue el deseo genuino de los profesores de enfermería de apoyar a una nueva generación de enfermeras que culminó en esta experiencia de empoderamiento mutuo.

Abstract Objective To describe the experience of implementing a research assistant program for Canadian undergraduate nursing students, which aimed to develop written and verbal communication, critical thinking and problem-solving skills, as well as knowledge of various research methods. Engagement in this program was intended to support students' career planning and advancement in research related roles, including administrative and leadership employment opportunities. Method A descriptive design with the report of experience of nursing researchers and career advisers pertaining to: engagement in an 11 one-hour research focused workshop; and the process of supporting students to assume professional and leadership roles. Results Students demonstrated commitment to the training program throughout its phases. They expressed interest in leading practical activities to redefine their professional profile. This experience contributed to building and nurturing intellectual teacher-student relationships. Students are expanding their professional networks and a relationship with a career mentor, while demystifying the research assistant role. Students are developing practical skills and reporting confidence in applying for research assistant positions. Conclusion and Implications for practice Participating in the training program better equips students for choosing their career path, entering the job market, and building a plan for further career advancement. Nursing faculty's genuine desire for and purposeful actions to support a new generation of nurses informed this mutually empowering experience.

Undergraduate nursing students' experiences of anxiety-producing situations in clinical practicums: A descriptive survey study.

BACKGROUND: Clinical practicums are regarded as one of the most anxiety-producing aspects of the curriculum by nursing students. Practicum-associated anxiety has negative impacts on learning, performance, and well-being. Little is known about what makes final year nursing students anxious during their practicum experience and the impact of clinical and student characteristics on their level of anxiety. OBJECTIVES: The objectives of the study were (1) to explore which clinical situations final year nursing students perceive as anxiety-producing; (2) to identify if perceived level of anxiety associated with clinical tasks differ by clinical and student characteristics; and (3) to determine the relationship between clinical and student characteristics and perceived level of anxiety among nursing students. DESIGN: Descriptive, cross-sectional survey. SETTING: One university in Ontario, Canada. PARTICIPANTS: A convenience sample of 93 final year undergraduate nursing students. METHODS: The Clinical Experience Anxiety Form (CEAF) was administered to assess perceived level of anxiety associated with common practicum tasks. Descriptive statistics, one-way analysis of variance, and Pearson's correlation tests were used to address the research questions. Content analysis was conducted for open-ended questions. RESULTS: Participants reported the following three situations as most anxiety-producing: fear of making mistakes, being observed by instructors, and initial clinical experience on a unit. Differences were noted between younger (18 to 24 years-old) and older (25 to 34 years-old) students, with the older student group reporting lower levels of anxiety associated with the following clinical situations: being observed by instructors and asking questions of faculty. Age was also found to be negatively correlated with CEAF scores wherein younger students reported higher CEAF scores. Content analysis indicated common areas that worried participants most about their practicum and their academic year. CONCLUSIONS: Findings emphasize the importance of nursing educators to recognize anxiety-producing practicum situations and develop anxiety management interventions to ensure optimal learning.

Storytelling to Support Disease Self-Management by Adults With Type 2 Diabetes.

OBJECTIVES: This pilot project aimed to examine the acceptability and feasibility of a group storytelling intervention to support self-management among adults living with type 2 diabetes. METHODS: Two waves of a single-arm storytelling intervention, consisting of 8 sessions at a community health centre, were delivered to 8 adults with type 2 diabetes. Diabetes educators facilitated each session, in which patients shared stories about diabetes-self-management topics of their choice. Focus groups with both patients and facilitators explored the feasibility and acceptability of the sessions. External raters assessed the fidelity of the intervention's implementation. RESULTS: Overarching themes describe the acceptability and feasibility of the intervention: 1) the facilitation of patient self-direction, group cohesion, collective learning and support; 2) roles of facilitator educator, and peer learner; 3) the intervention's customization to patients' preferences. The sessions were delivered with high fidelity (averaging 84.4%). CONCLUSIONS: Informal group storytelling enables patients to discuss, understand and give personal meaning to the information that was exchanged, and facilitates educators' better understanding of patients' concerns and gaps in knowledge and how-to strategies that can inform their practice. The group storytelling intervention is acceptable to patients and educators and can be delivered with high fidelity. Further research into effective patient recruitment methods and evaluation of the intervention's impact on diabetes self-management is required.

Exploring Health Care Professionals' Perceptions of Incidents and Incident Reporting in Rehabilitation Settings.

OBJECTIVES: Research exploring patient safety in rehabilitation settings is limited. This study's aim was to describe team members' perceptions of incidents and incident reporting in rehabilitation settings. METHODS: Semistructured interviews were conducted with 18 health care professionals from multiple rehabilitation units (medical, neurological, and orthopedic) at 2 inner-city rehabilitation centers. Five hypothetical scenarios were presented to participants during the interviews. Participants were asked to classify the scenarios and whether they would report any identified incidents. Data were analyzed using a descriptive thematic approach. RESULTS: Participants classified events based on 2 parameters: the nature of the outcome and deviation from professional practice. Factors influencing participants' decisions to file incident reports included their classification of the events in the scenarios (i.e., events classified as critical incidents were more often reported than those classified as incident or near miss); the severity of the impact on the client; and their profession's perceived role in reporting specific incidents. When participants said they would report incidents, all agreed that they would report only objective facts. CONCLUSIONS: The study findings demonstrate gaps between incident-reporting policy and practice, and opportunities to address these gaps. Organizational leaders can work with all health care professions to support their roles in reporting. Interprofessional team building, focused on valuing all team members, may improve interprofessional communication and reporting. Setting standards for classifying events could increase consistency in reporting. Ultimately, encouraging reporting of near misses and incidents can create a culture of learning focused on problem solving and improved patient safety.

Looking beyond the checklist: An ethnography of interprofessional operating room safety cultures.

The Surgical Safety Checklist (SSC) has been adopted in operating rooms (OR) worldwide to reduce medical errors, increase patient safety and improve interprofessional communication. Despite often high compliance rates, recent studies suggested the SSC has not been associated with significant reductions in operative mortality or complications. This ethnographic study sought to understand this disconnection through approximately 50 hours of observation in the OR and 10 in-depth semi-structured interviews with surgeons, nurses, and anaesthesiologists in orthopaedic surgery. Inductive thematic analysis was used to analyse the data. By spending time in the OR and listening to the staff, this study was able to look beyond what "ought" to be happening in the OR and garner a deep understanding of the realities of OR work that acknowledges the complexities of surgical culture in which the SSC is being implemented. This study found SSC compliance was influenced by the perceived (un)importance of individual checklist items within the orthopaedic setting. Additionally, there remains a need to further explore patients' involvement in their operative experience.

Using Critical Creativity to Reveal Nursing Student Learning in Long-Term Care.

BACKGROUND: The use of teaching-learning strategies that emphasize critical reflection aids students in making sense of complex clinical placement settings, such as those in long-term care (LTC) settings. METHOD: A qualitative descriptive research design was used to explore the assumptions, anticipations, and realizations of six undergraduate nursing students regarding aging, gerontological nursing, and LTC as they engaged in facilitated critical reflection activities during a 12-week LTC placement. RESULTS: The content analysis process revealed four main categories describing the student learning experience: Exploring the Therapeutic Nurse-Resident Relationship, Navigating Preceptor Relationships, Expanding Awareness of Context, and Embracing Many Feelings. CONCLUSION: Students placed in LTC were challenged by the realization of LTC as a complex setting, especially with minimal support from preceptors. Educators should present LTC as a challenging environment, rich with complex issues. There is potential in easing the strain on preceptors by leveraging the faculty educator role in facilitating student learning through critically creative approaches. [J Nurs Educ. 2018;57(3):150-153.].

Views of children, parents, and health-care providers on pediatric disclosure of medical errors.

Despite the prevalence of medical errors in pediatrics, little research examines stakeholder perspectives on the disclosure of adverse events, particularly in the case of children's own perspectives. Stakeholder perspectives, however, are integral to informing processes for pediatric disclosure. Building on a systematic review of the literature, this article presents findings from a series of focus groups with key pediatric stakeholders where perspectives were sought on the disclosure of medical errors. Focus groups were conducted with three stakeholder groups. Participants included child members of the Children's Council from a large pediatric hospital (n = 14), parents of children with chronic medical conditions (n = 5), and health-care providers including physicians, nurses, and patient safety professionals (n = 27). Children acknowledged various disclosure approaches while citing the importance of children's right to know about errors. Parents generally identified the need for full disclosure and the uncovering of hidden errors. Health-care providers were concerned about the process of disclosure and whether it always served the best interest of the child or family. While some health-care providers addressed the need for more clarity in pediatric policies, most stakeholders agreed that a case-by-case approach was necessary for supporting variations in how medical errors are disclosed.

The Varying Roles of Nurses During Interfacility Care Transitions.

This study explored health care professionals' perceptions and experiences associated with the role of point-of-care nurses during care transitions from an acute care hospital to a rehabilitation setting to being discharged home. We used a qualitative exploratory design and semistructured interviews. Content analysis revealed 3 themes that point to the ambiguity related to the roles that nurses enact with older patients during care transitions. We suggest ways to better support nurses to engage in quality care transitions.

The role of caregivers in interfacility care transitions: a qualitative study.

A qualitative design was used to explore the nature of caregiver involvement in care transitions of patients being transferred from an acute care hospital to a rehabilitation hospital. Participants included older adults (n=13), informal caregivers (n=9), and health care professionals (n=50) from inpatient orthopedic units in two academic health science centers and one orthopedic inpatient rehabilitation unit. Semistructured interviews were conducted, audio-taped, and transcribed. Directed content analysis revealed the following four themes: watching, being an active care provider, advocating, and navigating the health care system. Participants described being actively involved in the care of their family member, yet they were not actively engaged by health care professionals to be involved in the care of their family member. There is a need to reconcile the tension between the level of involvement of caregivers in the care of family members who are patients and the level of engagement throughout the care transition. By providing relevant information and authentically engaging caregivers as equal partners in the care transition, they are better able to navigate the health care system post-transfer to the rehabilitation setting and discharge to home.

Elucidating the information exchange during interfacility care transitions: Insights from a Qualitative Study.

OBJECTIVE: To explore the perceptions of patients, their caregivers and healthcare professionals associated with the exchange of information during transitioning from two acute care hospitals to one rehabilitation hospital. DESIGN: An exploratory qualitative study using semi-structured interviews and observation. PARTICIPANTS AND SETTING: Patients over the age of 65 years admitted to an orthopaedic unit for a non-elective admission, their caregivers and healthcare professionals involved in their care. Participating sites included orthopaedic inpatient units from two acute care teaching hospitals and one orthopaedic unit at a rehabilitation hospital in an urban setting. FINDINGS: Three distinct themes emerged from participants' narrative of their transitional care experience: (1) having no clue what the care plan is, (2) being told and notified about the plan and (3) experiencing challenges absorbing information. Participating patients and their caregivers reported not being engaged in an active discussion with healthcare professionals about their care transition plan. Several healthcare professionals described withholding information within the plan until they themselves were clear about the transition outcomes. CONCLUSION: This study highlights the need to increase efforts to ensure that effective information exchanges occur during transition from acute care hospital to rehabilitation settings.