The Impact and Influence of Hospital Clowns on Hospitalized Children Undergoing Painful Procedures: A Mixed Methods Study.

Hospital clowns are widely used in pediatric settings. However, the field of pain and pain experience in children is complex and multifaceted. Therefore, the aim of this study was to expand knowledge on the impact and influence of hospital clowns on 4 to 15-year-old children's experiences of managing painful procedures and conditions. A convergent mixed method study was conducted integrating findings from three individual studies: a prospective non-blinded study and two focused ethnographic studies. The findings illuminated a child-clown interaction characterized by a close relationship evolving during a continuous, mutually focused attention, conceptualized as WE. This WE represent a responsive interaction between child and clown, which supported the child during the procedures, and generated three integrated findings: an age-differentiated approach; understanding the child's condition; and previous experiences as a part of the child's history. The WE approach strengthened the child's competences and ability to manage during painful procedures.

Nursing interventions for pediatric patients with cancer and their families: a scoping review protocol.

OBJECTIVE: This scoping review will identify and map available nursing interventions provided by pediatric oncology hospital services to pediatric patients with cancer and/or their family members. The aim is to develop a comprehensive overview of the characteristics of nursing interventions and to identify potential knowledge gaps. INTRODUCTION: Clinical nursing care is an essential part of pediatric oncology. In pediatric oncology nursing research, a shift from explanatory studies to intervention studies is recommended. The body of research on interventions for pediatric oncology patients and their families has grown in recent years. However, there are no reviews on nursing interventions currently available for pediatric oncology. INCLUSION CRITERIA: Studies will be considered for inclusion if they refer to pediatric patients with cancer, and/or family members of a pediatric patient with cancer, who have received non-pharmacological and non-procedural nursing interventions provided by a pediatric oncology hospital service. Studies must also be peer-reviewed, published from the year 2000 onward, and written in English, Danish, Norwegian, or Swedish. METHODS: The review will be conducted in accordance with the JBI guidelines for scoping reviews. A 3-step search strategy will be followed using the PCC mnemonic (Population, Concept, Context). The databases to be searched will include Scopus, PubMed, CINAHL, PsyclNFO, and Embase. The identified studies will be screened based on title and abstract, as well as full text, by 2 independent reviewers. Data will be extracted and managed in Covidence. A summary of the results will be presented as a narrative description, supported by tables.

Pain assessment and treatment in hospitalized infants, children, and young people.

Pain in hospitalized infants, children, and young people (ICYP) is a well-known phenomenon but remains undertreated. This study aimed to examine documented pain management practices provided for ICYP and compare practices adopted in neonatal and pediatric units. This national retrospective multi-center study was conducted in 40 of the 42 Danish neonatal and pediatric units in November 2020. Data were collected from the medical records of ICYP admitted to a participating unit. We performed a total of 846 medical record audits of which pain was assessed in 51.9% of the ICYP. Pain assessment was documented for more infants (57.8%) than for children and young people (CYP) (47.4%) (p = 0.003). CYP more often received pain treatment (37.7%) than infants (6.9%, p < 0.0001) and more frequently had a pain treatment plan (50.8% versus 10.2%, p < 0.0001). Use of non-pharmacological treatment was documented for 6.3% of the ICYP. Our findings indicate that pain assessment is insufficiently documented in Danish neonatal and pediatric units. Among cases in which pain scores indicated that the patient had experienced pain, pain treatment was documented in a larger proportion of the pediatric population than in the neonatal population.

Undergraduate students' experiences of participating in a Danish respite programme for young carers-A mixed methods study.

BACKGROUND: Age-appropriate communication and interaction are essential when meeting young carers, requiring in-depth knowledge and experience. Volunteer programmes may enhance undergraduate students' competencies in this regard. This pilot study evaluated undergraduate students' perceptions of volunteering on the Buddies for Children and Youngsters (BCY) programme by assessing the extent to which students experienced an improvement in their relational and communication competencies and/or felt better equipped for their future work. METHODS: The researchers conducted a mixed methods study with a parallel design, focussing on undergraduate students from the University College of Northern Denmark within the field of nursing, teaching, pedagogy, physiotherapy, and occupational therapy. The students participated in the programme for at least 4 months. RESULTS: Forty-two students responded to a questionnaire, and 17 students were selected to participate in four focus groups. The results showed that participation in the programme improved the students' communication and relational competencies to some degree. The programme provided the students with experience of age-related communication on both informal and difficult topics, and of building relationships and solving relational challenges. Also, the programme generally equipped students for future work with young carers and children. CONCLUSION: In conclusion, the BCY programme is a relevant supplement to regular educational activities. Decision makers within politics of health, health planning and management, should therefore consider implementation of such programmes in relevant educational areas.

How to support fathers of preterm infants in early parenthood - An integrative review.

PROBLEM: Preterm birth is a stressful event. Paternal experiences of having a preterm infant indicate a need for tailored support. However, it is unclear which interventions work best. This review presents the evidence on existing healthcare interventions to support fathers of preterm infants in early parenthood, how effective they are and paternal experiences with the interventions. ELIGIBILITY CRITERIA: The integrative review process of Whittemore and Knafl was used to guide the study. A structured and comprehensive literature search was conducted in PubMed (MEDLINE), Embase, CINAHL, PsycInfo, Cochrane, Scopus, Web of Science, SweMed+, and Proquest Dissertation & Thesis Global. SAMPLE: A total of 18 qualitative and quantitative studies were included in the review. The Mixed Methods Appraisal Tool was used to assess quality. RESULTS: Three overall themes were identified in the analysis: 1) Skin-to-skin contact supported interaction between infant and father, 2) information impacted paternal experiences of stress, anxiety, and development of fatherhood, 3) fathers' relationships with the nurses oscillated between conflict and assistance. CONCLUSIONS: Our findings show that targeted interventions could support father-infant interaction and reduce stress among fathers of preterm infants. IMPLICATIONS: Fathers of preterm infants rely on nurses to support their engagement in early parenthood, while nurses facilitate the interventions that engage the fathers. It is also essential to develop a culture within the neonatal intensive care unit that encourages the presence of fathers and enhances educational nursing strategies for supporting fathers of preterm infants during early parenthood.

Nurses' Clinical Decision-Making in a Changed COVID-19 Work Environment: A Focus Group Study.

This study aims to explore how a changed COVID-19 work environment influences nurses' clinical decision-making. Data were collected via three focus groups totaling 14 nurses working in COVID-19 pandemic wards at a Danish university hospital. The factors influencing decision-making are described in three themes; navigating in a COVID-19 dominated context, recognizing the importance of collegial fellowship, and the complexities of feeling competent. A strong joint commitment among the nurses to manage critical situations fostered a culture of knowledge-sharing and drawing on colleagues' competencies in clinical decision-making. It is important for nurse leaders to consider multiple factors when preparing nurses not only to work in changing work environments, but also when nurses are asked to work in environments and specialties that deviate from their usual routines.

Nursing care during COVID-19 at non-COVID-19 hospital units: A qualitative study.

The maintenance of physical distance, the absence of relatives and the relocation of registered nurses to COVID-19 units presumably affects nursing care at non-COVID-19 units. Using a qualitative design, this study explored registered nurses' experiences of how COVID-19 influenced nursing care in non-COVID-19 units at a Danish university hospital during the first wave of the virus. The study is reported using the COREQ checklist. The analysis offered two findings: (1) the challenge of an increased workload for registered nurses remaining in non-COVID-19 units and (2) the difficulty of navigating the contradictory needs for both closeness to and distance from patients. The study concluded that several factors challenged nursing care in non-COVID-19 units during the COVID-19 pandemic. These may have decreased the amount of contact between patients and registered nurses, which may have contributed to a task-oriented approach to nursing care, leading to missed nursing care.

Young carers' experiences of having a "buddy" on the Buddies for Children and Youngsters programme in Denmark - A qualitative interview study.

This qualitative study sheds light on how some young carers aged between 6- and 16-years experienced participation in a volunteer respite programme named Buddies for Children and Youngsters (BCY). The programme was held in Northern Denmark and was based on the knowledge that young carers need a space for respite and support through conversation. The young carers were healthy children who had experienced serious, chronic somatic or mental illness and/or death in their immediate family. Over a minimum 4-month period, students ("buddies") from University College of Northern Denmark offered respite to young carers in the form of their preferred social or other activities. From February to August 2020, 12 semi-structured individual interviews were conducted with young carers who had participated in the programme for at least 4 months. A thematic analysis generated four main themes: (1) A "buddy" is someone special, (2) feeling happier and less lonely, (3) Experiencing a social and personal influence, and (4) Experiencing influence on family life. Most of the young carers experienced a special relationship with their "buddy" - a relationship unlike but with some similarities to their relationships with peer friends and family, and one which gave them the opportunity for conversations about difficult topics. The time spent with the "buddy" was generally experienced as a respite space, leading to feelings of being happier and less lonely. Furthermore, for some of the young carers, the relationship influenced them socially and personally and caused their parents to pay more attention to them. The findings may increase awareness of young carers' experiences of support which can benefit future initiatives provided to this group.

Parents' friends and families in neonatal intensive care units: A cross-national qualitative study on staff perceptions and experiences.

AIMS AND OBJECTIVES: This study aimed to explore staff attitudes and experiences of parents' friends and families' social presence and involvement in neonatal intensive care units (NICUs). BACKGROUND: In NICUs, parents need emotional and practical support during infant hospitalisation. Friends and families of parents may constitute the most significant providers in this support, but few studies are available on when and how these 'important others' can be present and involved. DESIGN: This qualitative descriptive study was based in the philosophical tenets of naturalistic inquiry. METHODS: Seven focus groups were conducted where 67 staff from Denmark, Finland, Iceland and Sweden participated. Data were analysed using thematic analysis. The study was reported following the COREQ guidelines and checklist. RESULTS: The overarching theme showed that 'important others' were an unaddressed group of potential supporters in the periphery. The five identified themes described how staff recognised 'important others' as the parents' territory, but that 'important others'' presence and involvement needed to be negotiated with staff. Although the staff regarded 'important others' as necessary for parents' emotional, practical and social support, they felt less obligated to support them as part of their work remit. The staff also felt that inclusion of 'important others' was an essential step forward in achieving family centred care. CONCLUSIONS: The findings indicate that 'important others'' involvement was primarily guided by proactive parents and unit care culture rather than by staff's formal written guidelines or guidance. Single-family rooms seemed to enhance the presence and involvement of 'important others'. RELEVANCE TO CLINICAL PRACTICE: There is a need for more staff resources to enable and support the participation of 'important others'. Parents need to be included during the development of policies to provide their experiences. Finally, more research is needed on what parents wish from their 'important others'.

Familiar in the Unfamiliar - Children's, Parents', and Healthcare Professionals' Experiences of Procedure-Related Anesthesia in the Pediatric Oncological Ward.

PURPOSE: To explore children's, parents', and healthcare professionals', experiences of anesthesia related to pediatric oncological treatment performed at the pediatric oncology ward. DESIGN AND METHODS: The study was a qualitative study. 11 children and 12 parents were recruited for individual or dyadic interviews and two focus groups with a total of 12 healthcare professionals were recruited through purposeful and convenience sampling procedures. RESULTS: Thematic analysis generated one main theme, the familiar in the unfamiliar, and two subthemes, the room creates an atmosphere and relational continuity. CONCLUSIONS: Changing the physical environment and composition of the team positively influenced the experience of anesthesia in pediatric cancer treatment for both children, parents, and healthcare professionals. Familiarity was important for all involved and familiarity was associated with continuity related to the physical environment, as well as the relational and procedural professional continuity. Parents expressed that they never felt good about anesthesia as there were feelings of leaving your child's life into the hands of others. However, familiarity in trusting relationships with healthcare professionals helped to moderate these aspects. PRACTICE IMPLICATIONS: Familiarity should be considered important with continuity in trusting relations and collaborations between nurses and families, as well as between healthcare staff. Pediatric oncology ward is a preferred safe familiar setting for procedure-related anesthesia. Parents and children value individualized flexible nursing care, that takes the child's and parents habits and preferences into account during procedure-related anesthesia in pediatric oncological treatment.

Parents' experiences of emotional closeness to their infants in the neonatal unit: A meta-ethnography.

BACKGROUND: Physical and emotional parent-infant closeness activate important neurobiological mechanisms involved in parenting. In a neonatal care context, most research focuses on physical (parental presence, skin-to-skin contact) aspects; insights into emotional closeness can be masked by findings that overemphasise the barriers or challenges to parenting an infant during neonatal care. AIM: To explore existing qualitative research to identify what facilitates and enables parents' experiences of emotional closeness to their infants while cared for in a neonatal unit. STUDY DESIGN: A systematic review using meta-ethnographic methods. Search strategy involved searches on six databases, author runs, and backward and forward chaining. Reciprocal translation was used to identify and compare key concepts of parent-infant emotional closeness. RESULTS: Searches identified 6992 hits, and 34 studies from 17 countries that involved 670 parents were included. Three overarching themes and associated sub-themes were developed. 'Embodied connections' describes how emotional closeness was facilitated by reciprocal parent-infant interactions, spending time as a family, and methods for parents to feel connected while physically separated. 'Inner knowing' concerns how knowledge about infant and maternal health and understanding the norms of neonatal care facilitated emotional closeness. 'Evolving parental role' relates to how emotional closeness was intertwined with parental identities of contributing to infant health, providing direct care, and being acknowledged as a parent. CONCLUSION: Parent-infant closeness evolves and is facilitated by multifaceted biopsychosocial factors. Practice implications include creating private and uninterrupted family time, strategies for parents to maintain an emotional connection to their infant when separated, and neurobiology education for staff.

Parental Experiences of Continuous Glucose Monitoring in Danish Children with Type 1 Diabetes Mellitus.

PURPOSE: To explore parents 'experience of having a child aged 4-9 years with type 1 diabetes mellitus (T1DM) using continuous glucose monitor (CGM). DESIGN AND METHODS: The study was a qualitative study. Twelve families were recruited for individual or dyadic interviews through purposeful and convenience sampling procedures. RESULTS: Thematic analysis generated three main themes: 1) Living in the context of the unpredictability of diabetes 2) Establishing a sense of control and security with the CGM 3) Learning to use and trust the CGM and educating other caregivers. CONCLUSIONS: Living in the context of the unpredictability of T1DM causes a loss of stability and control as T1DM pervades family life and transforms everyday routines. CGM use seems to increase opportunities for other family activities, as it provides parents with a sense of control and moderates the pervasiveness of T1DM. Yet the parents have to learn how to trust and use the CGM and take on the burdensome task of training and trusting other caregivers. PRACTICE IMPLICATIONS: The CGM is used as an integral part of T1DM care in everyday life. Therefore, it should be accessible to families. Health-care professionals should be aware of how to assist parents with how to use and trust the CGM. Furthermore, parents may need help and support in educating other caregivers on how to use the CGM. This could be done through teaching sessions, written materials and recorded demonstrations of CGM use.

Health is not all about salads: An ethnographic study on health perceptions and health behavior among socially marginalized Danish men.

BACKGROUND: The effects of social marginalization and health are well-documented, revealing a complex association between health perceptions and health behavior. This is especially evident among socially marginalized men. OBJECTIVE: This study aims to explore health perceptions and health behaviors influencing overall health among socially marginalized men who seem to not benefit from existing municipal health care in a large Danish municipality. These men have varying health challenges and engage in risky health behaviors, such as alcohol drinking, tobacco smoking, and lack of physical activity. DESIGN AND SAMPLE: This was an ethnographic study including 200 hr of participant observations and 25 interviews with socially marginalized men aged 45-65. RESULTS: Health was perceived as related to the ability to participate in daily life activities, such as getting around effortlessly and the ability to work. Alcohol drinking appeared to be part of a complex approach in managing everyday life, including various personal physical and mental health challenges and admission to social networks. CONCLUSION: Overall, the results provide important insight into how health perceptions and health behaviors are embedded in the men's everyday lives. This knowledge may be used by public health nurses and other health professionals in providing and developing health services.

Photo-Based Range-of-Motion Measurement: Reliability and Concurrent Validity in Children With Cerebral Palsy.

PURPOSE: To investigate intrarater and interrater reliability, agreement, and concurrent validity of a smartphone photography-based application compared with a universal goniometer in children with cerebral palsy. METHODS: Range of motion of hip abduction, popliteal angle, and ankle dorsiflexion was measured with a universal goniometer and a photography-based application in children with cerebral palsy, Gross Motor Function Classification System levels I to V.A 2-way random-effects intraclass correlation coefficients and Bland-Altman plots, standard error of measurement, and smallest detectable change were used for analyses. RESULTS: The application had good to excellent reliability and concurrent validity compared with a universal goniometer, while the large measurement error of both methods suggests that changes of 10° to 23° are needed to be certain that changes over time are not results of measurement error. CONCLUSIONS: A photography-based goniometer can be a reliable and valid tool when measuring range of motion in children with cerebral palsy.

Talk to Me, Not at Me: An Ethnographic Study on Health-Related Help-Seeking Behavior Among Socially Marginalized Danish Men.

Research shows that men tend to have delayed health-related help-seeking behavior. In this ethnographic study, we explored influential factors related to health-related help-seeking behavior among socially marginalized men who seem not to benefit from existing municipal health care services in a large Danish municipality. The study included 200 hours of participant observations and 25 ethnographic interviews with men between 45 and 65 years of age in their own homes and in public parks among their peers. In this study, we found that the men had several complex and interacting social- and health-related conditions, which seemed to affect their health-related help-seeking behavior. We conclude that collaborative initiatives between the outreach team who occasionally visits bench sites in the public parks and the municipal health care services in the local areas could lay the groundwork for encouraging men's health-related help-seeking behavior and aid men in supporting each other.

An ongoing WE: A focused ethnographic study of the relationship between child and hospital clown during recurrent pain-related procedures and conditions.

Aim: This study explored the interaction between child and hospital clown during recurrent hospitalizations for repeated pain-related procedures and conditions. Background: Despite improvements in the management of pain in hospitalized children, procedural pain in particular is a common experience for hospitalized children, and they continue to report undertreated pain. Hospital clowns are widely used as a nonpharmacological intervention in hospitalized children. Little research has examined the influence of hospital clowns during recurrent hospitalizations on repeated painful procedures. Design and methods: Ethnographic fieldwork using focused ethnography was conducted. Data were collected during October-December 2017 using participant observation and informal interviews with children at one pediatric unit at a Danish university hospital. Data include 61 interactions between children aged 4-14 years and hospital clowns. The participants comprised 13 children undergoing recurrent hospitalizations. The data were coded using thematic analysis, and the research team verified the resulting themes. Results: The overarching theme was defined as An ongoing WE, based on two identified themes, that is, Stronger in a WE and Hope in the WE. The WE was characterized by a responsive interaction between the child and clown, which evolved over the course of an ongoing relationship. Conclusion: This study demonstrates how an ongoing WE was constructed with children during repeated painful procedures and conditions. Specifically, the study emphasizes the importance of developing a trusting relationship on the child's terms. Children seemed to experience enhanced coping with painful procedures during the recurring hospital clown encounters, thus reinforcing their competence and hope for coping with future painful procedures. These findings may improve psychosocial care for hospitalized children undergoing repeated painful procedures and conditions and may facilitate multidisciplinary initiatives, such as nurses' advocacy for the inclusion of hospital clowns during recurrent hospitalizations for repeated painful procedures to ensure optimal pain management.

Acute Procedural Pain in Children: Intervention With the Hospital Clown.

INTRODUCTION: Hospitalized children often describe needle-related procedures as the worst pain possible and such procedures may be emotionally traumatic. The use of hospital clowns (HCs) related to painful medical procedures in children may offer pain relief, but this has not been systematically evaluated. The objective of this study was to assess the effect of a therapeutic clown in comparison with standard care on the experience of pain in children receiving venipuncture. MATERIALS AND METHODS: A sample of 116 children aged 4 to 15 years consecutively admitted to the hospital was allocated to either the experimental (presence of HC) or control group (standard care) before venipuncture. Self-reported pain after the procedure was assessed using the Faces Pain Scale combined with a 0 to 10 Numerical Rating Scale. Separate analysis was conducted in age groups from 4 to 6 (N=37) and 7 to 15 (N=74) years. RESULTS: Without the clown present, the mean pain score (2.7±2.8) was not significantly different between the 2 age groups. Children aged 7 to 15 years had lower pain scores when the clown was present compared with the control group (P=0.025). Children aged 4 to 6 years had higher pain scores with the clown present, although the difference was not statistically significant (P=0.054). Children with pain (N=49) or previous experiences with venipuncture (N=56) did not score pain significantly differently. DISCUSSION: Assessing the pain experience of children receiving venipuncture with the presence of an HC indicates a pain relieving effect for children older than 6 years. However, future studies should carefully study the effects on younger children where mixed effects may be present.