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.

Family-centred care for families living with cystic fibrosis in a rural setting: A qualitative study.

AIMS AND OBJECTIVES: To explore experiences of family-centred care among parents of children with cystic fibrosis living far from tertiary treatment centres and to understand what such distances mean to their care. BACKGROUND: Australia is a large continent. However, many families with a child with cystic fibrosis live in regional areas, often thousands of kilometres away from the primary treatment centres located in Australia's coastal capital cities. DESIGN: A qualitative, phenomenological design using a Van Manen () approach. METHODS: Individual, semi-structured interviews were conducted with parents (n = 7) of a child with cystic fibrosis who lived in regional Australia. Thematic content data analysis was used. RESULTS: The essence of the participants' experience was their seeking certainty and continuity in the changeable realm of cystic fibrosis while negotiating a collaborative approach to their child's care. Five core themes and two subthemes were identified: "Daily care: a family affair," including the subtheme "Accessing expert care"; "Family-centred care: seeking inclusion"; "Control versus collaboration: seeking mutual trust," with the subtheme "The team who grows with you"; "Future projections"; and "The CF circle." CONCLUSION: Some concerns are not unlike those of their city counterparts, but can be intensified by their sense of distance and isolation. RELEVANCE TO CLINICAL PRACTICE: Insight into this unique milieu from the parents' perspective is requisite so that care is appropriate to such a challenging environment and incorporates the whole family.

The rural mother's experience of caring for a child with a chronic health condition: An integrative review.

AIMS AND OBJECTIVES: To identify and review the literature on rural mothers' experiences in caring for a child with a chronic health condition. BACKGROUND: Families living with a child who has a chronic health condition experience many challenges; these are often amplified for families living in rural areas, where issues such as the distance from services add further challenges the family must manage. Like many children, rural children with chronic health conditions are primarily cared for by their mothers. The additional strain of geography creates its own unique experiences for mothers who need to access the high-quality care that their child requires. DESIGN: Integrative literature review using the Equator PRISMA guidelines. METHODS: A search of databases; Cochrane, CINAHL, Ovid, PubMed, ProQuest Health and Medicine, Informit and Scopus for studies published between 2005-2016 using an integrative review approach. A total of 1,484 studies were identified with an additional six studies found through snowballing. The search resulted in seven studies being meeting the inclusion criteria after using the Critical Appraisal Skills Programme. RESULTS: Data from the seven articles were analysed, and the mothers' experiences were synthesised into five themes: "struggling for resources," "barriers in accessing services," "strain of decision-making," "mother's physical and emotional breakdown" and "the daily management of family activities". These five themes formed the basis of this article. CONCLUSIONS: The findings indicate that mothers from rural areas face additional barriers related to their rurality, including transportation difficulties, socioeconomic status and social isolation, and are challenged by limited access to specialty medical services, educators and allied health professionals. The literature review outcome will assist in informing nursing practice through identifying and allocating resources to reduce these barriers; rural mother experience will assist in enabling the child to reach their full developmental potential. RELEVANCE TO CLINICAL PRACTICE: There is a need for health professionals to understand the challenges and barriers rural mothers face in accessing services. Nurses can assist rural mothers to navigate and access the appropriate services in order to reduce health inequity, increase accessibility to services and reduce rural disadvantage for their child. Nurses and health professionals are in an ideal position to develop future models of care that optimise health outcomes and enable equity and access to services for rural children with chronic conditions similar to those experienced by their urban counterparts.

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.

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.

Incidence and characteristics of low-speed vehicle run over events in rural and remote children aged 0-14 years in Queensland: an 11 year (1999-2009) retrospective analysis.

INTRODUCTION: The main objective of this study is to describe incidence rates of low-speed vehicle run-over (LSVRO) events among children aged 0-14 years residing in Queensland from 1999 to 2009. A second objective was to describe the associated patterns of injury, with respect to gender, age group, severity, characteristics (host, vehicle and environment), and trends over time in relation to geographical remoteness. Final results are hoped to inform prevention policies. METHODS: In this statewide, retrospective, population-based study, data were collected on LSVRO events that occurred among children aged 0-14 years in Queensland from 1999 to 2009 from all relevant data sources across the continuum of care, and manually linked to obtain the most comprehensive estimate possible of the magnitude and nature of LSVRO events to date. Crude incidence rates were calculated separately for males and females, for fatal events, non-fatal events (hospital admissions and non-admissions, respectively), and for all LSVRO events, for each area of geographical remoteness (major cities, inner regional, outer regional, remote/very remote). Relative risks and 95% confidence interval were calculated, and trends over time were examined. Data on host, injury and event characteristics were also obtained to investigate whether these characteristics varied between areas of remoteness. RESULTS: Incidence rates were lowest among children (0-14 years) living in major cities (13.8/100 000/annum, with the highest recorded incidence in outer regional areas (incidence rate =42.5/100 000/annum). Incidence rates were higher for children residing outside major cities for both males and females, for every age group, for each of the 11 years of the study, and consequences of LSVRO events were worse. Young children aged 0-4 years were identified as those most at risk for these events, regardless of geographical location. Differences were observed as a function of remoteness category in relation to injury characteristics (eg injury type), and host characteristics (eg sociodemographic status), but there were no observed differences in environmental characteristics (eg time of day, day of week). Heavy vehicles such as four-wheel drives, utilities, trucks and tractors were more frequently involved in LSVRO events that occurred outside major cities. CONCLUSION: The results confirmed that children of all ages and genders residing outside of major cities in Queensland are more at risk of being involved in an LSVRO incident, and experience more severe consequences compared to children in major cities. Future research should address the specific risk factors and focus on engaging rural communities to assist in the prevention of LSVRO incidents.

Attitudes to lesbian, gay, bisexual and transgender parents seeking health care for their children in two early parenting services in Australia.

AIMS AND OBJECTIVES: To examine the attitudes to and knowledge and beliefs about homosexuality of nurses and allied professionals in two early parenting services in Australia. BACKGROUND: Early parenting services employ nurses and allied professionals. Access and inclusion policies are important in community health and early childhood service settings. However, little is known about the perceptions of professionals who work within early parenting services in relation to lesbian, gay, bisexual and transgender families. DESIGN: This is the final in a series of studies and was undertaken in two early parenting services in two states in Australia using a cross-sectional design with quantitative and qualitative approaches. METHODS: Validated questionnaires were completed by 51 nurses and allied professionals and tested with chi-squared test of independence (or Fisher's exact test), Mann-Whitney U-test, Kruskal-Wallis one-way analysis of variance or Spearman's rank correlation. Thematic analysis examined qualitative data collected in a box for free comments. RESULTS: Of the constructs measured by the questionnaires, no significant relationships were found in knowledge, attitude and gay affirmative practice scores by sociodemographic variables or professional group. However, attitude scores towards lesbians and gay men were significantly negatively affected by conservative political affiliation (p = 0·038), held religious beliefs (p = 0·011) and frequency of praying (p = 0·018). Six overall themes were found as follows: respect, parenting role, implications for the child, management, disclosure, resources and training. CONCLUSIONS: The study provided an in-depth analysis of the attitudes, knowledge and beliefs of professionals in two early parenting services, showing that work is needed to promote acceptance of diversity and the inclusion of lesbian, gay, bisexual and transgender families in planning, developing, evaluating and accessing early parenting services. RELEVANCE TO CLINICAL PRACTICE: Access and inclusion plans for lesbian, gay, bisexual and transgender families are crucial in early parenting services in Australia and should be included in professional development programmes.

Tools to assess risk of bias in systematic reviews of nursing intervention in China: Global implications of the findings.

BACKGROUND: The number of systematic reviews (SRs) of nursing interventions is increasing in China. Authors of such studies are encouraged to use a risk of bias tool for assessing individual studies. Therefore, it is important to know how these tools have been applied in SRs in Chinese nursing. PURPOSE: The purpose of the study is to examine risk of bias tools used by Chinese nursing researchers to assess the quality of individual studies included in SRs of nursing interventions. METHODS: We searched the Chinese Biomedical Literature Database, Chinese Journal Full-Text Database, Chinese Academic Journal Full-Text Database, and Wanfang Database. Each relevant review found was subjected to quality assessment, data synthesis, and comprehensively described. DISCUSSION: Two hundred eight SRs were identified, most (94.7%) of which used the words "systematic review" or "meta-analysis" in their titles. Most used quality assessment rather than risk of bias as their major method to gauge quality; 7.6% reported on six domains of the Cochrane risk of bias tool. Only four provided a risk of bias graph/summary figure. CONCLUSIONS: Many SRs of nursing interventions are published in Chinese journals, and their assessment of risk of bias is usually either lacking or incomplete, potentially producing misleading results. This may also be the case in other countries. Assessment of risk of bias in SRs is a requisite. Authors who systematically review nursing literature should follow the latest Cochrane Collaboration Handbook.

Family-Centered Care As a Western-Centric Model in Developing Countries: Luxury Versus Necessity.

Family-centered care (FCC) is a model of care that emerged over many years and is broadly defined as promoting a partnership between the parents and health care professionals in the care of the child. Although recognized by many as the ideal way to care for children and families, previous reviews showed a lack of evidence for its efficacy. A recent Cochrane review recommended further rigorous research to assess the model's effect. Other reports emerged to ascertain FCC poor implementation. There is also a paucity of studies investigating the model outside the Western context. This article dissects the literature and provides a comprehensive summary on FCC in the context of limited resources versus best practice. Lessons learned from the literature for the reproducibility of the model in the developing world are provided. Considered a luxury, the autocratic health systems in most of these countries will not easily accept such a model of care except with a greater understanding and support for the model and high-quality research that can guide hospitals, health systems, and policy makers.

Losing the child's voice and 'the captive mother': an inevitable legacy of family-centred care?

EBN engages readers through a range of online social media activities to debate issues important to nurses and nursing. EBN Opinion papers highlight and expand on these debates.

Interventions for promoting participation in shared decision-making for children with cancer.

BACKGROUND: This is an update of the Cochrane systematic review of shared decision-making (SMD) making published in 2013. Children's rights to have their views heard in matters that affect their lives are now well established since the publication of the UN Convention treaty (1989). Children with cancer generally prefer to be involved in decision-making and consider it important that they have the opportunity to take part in decision-making concerning their health care, even in end-of-life decisions. There is considerable support for involving children in healthcare decision-making at a level commensurate with their experience, age and abilities. Thus, healthcare professionals and parents need to know how they should involve children in decision-making and what interventions are most effective in promoting SDM for children with cancer. OBJECTIVES: To examine the effects of SDM interventions on the process of SDM for children with cancer who are aged four to 18 years. SEARCH METHODS: We searched the following sources for the review: Cochrane Central Register of Controlled Studies (CENTRAL) (the Cochrane Library 2016, Issue 1); PubMed (NLM) (1946 to February 2016); Embase (Ovid) (1974 to February 2016); CINAHL (EBSCO) (1982 to February 2016); ERIC (ProQuest) (1966 to February 2016); PsycINFO (EBSCO) (1806 to February 2016); BIOSIS (Thomson Reuters) (1980 to December 2009 - subscription ceased at that date); ProQuest Dissertations and Theses (1637 to February 2016); and Sociological Abstracts (ProQuest) (1952 to February 2016). In addition we searched the reference lists of relevant articles and review articles and the following conference proceedings (2005 up to and including 2015): American Academy on Communication in Healthcare (AACH), European Society for Medical Oncology (ESMO), European CanCer Organisation (ECCO), European Association for Communication in Healthcare (EACH), International Conference on Communication in Healthcare (ICCH), International Shared Decision Making Conference (ISDM), Annual Conference of the International Society for Paediatric Oncology (SIOP) and Annual Scientific Meeting of the Society for Medical Decision Making (SMDM). We scanned the ISRCTN (International Standard Randomised Controlled Trial Number) register and the National Institutes of Health (NIH) Register for ongoing trials on 29 February 2016. SELECTION CRITERIA: For this update, we included randomised controlled trials (RCTs) and controlled clinical trials (CCTs) of SDM interventions for children with cancer aged four to 18 years. The types of decisions included were: treatment, health care and research participation decisions. The primary outcome was SDM as measured with any validated scale. DATA COLLECTION AND ANALYSIS: Two review authors undertook the searches, and three review authors independently assessed the studies obtained. We contacted study authors for additional information. MAIN RESULTS: No studies met the inclusion criteria, and hence no analysis could be undertaken. AUTHORS' CONCLUSIONS: No conclusions can be made on the effects of interventions to promote SDM for children with cancer aged four to 18 years. This review has highlighted the dearth of high-quality quantitative research on interventions to promote participation in SDM for children with cancer. There are many potential reasons for the lack of SDM intervention studies with children. Attitudes towards children's participation are slowly changing in society and such changes may take time to be translated or adopted in healthcare settings. The priority may be on developing interventions that promote children's participation in communication interactions since information-sharing is a prerequisite for SDM. Restricting this review to RCTs was a limitation and extending the review to non-randomised studies (NRS) may have produced more evidence. For this update, we included only RCTs and CCTs. Clearly more research is needed.

Psychosocial characteristics and predictors of health-care use in families of young children with cystic fibrosis in Western Australia.

OBJECTIVE: Early childhood psychosocial experiences determine future health and health-care use. Identifying psychosocial predictors in cystic fibrosis may inform intervention strategies that can reduce health-care utilization. DESIGN: The study was designed as a prospective cohort study. SETTING: The study was set in the only cystic fibrosis clinic in Western Australia. PATIENTS: The patients were children up to 6 years diagnosed with cystic fibrosis in Western Australia between 2005 and 2011. MAIN OUTCOME MEASURES: Psychosocial data collected for each year of life were compared with Australian population data and analysed as predictors of annual hospital, emergency and outpatient visits. RESULTS: Compared with the Australian population, cystic fibrosis families demonstrated lower socio-economic status and labour supply (P < 0.001), increased residential mobility (P < 0.001) and trends towards increased rates of parental separation (P = 0.066). Marital discord and maternal and child psychological stress significantly predicted increased hospital admissions, emergency and outpatient visits. CONCLUSIONS: Social gradients may exist for families of young children with cystic fibrosis in Western Australia with potential implications for child health. Family psychological and relationship stress predicted increased child cystic fibrosis-related health-care use.

Family presence during resuscitation in a paediatric hospital: health professionals' confidence and perceptions.

AIMS AND OBJECTIVES: To investigate medical and nursing staff's perceptions of and self-confidence in facilitating family presence during resuscitation in a paediatric hospital setting. BACKGROUND: Family presence during resuscitation is the attendance of family members in a location that affords visual or physical contact with the patient during resuscitation. Providing the opportunity for families to be present during resuscitation embraces the family-centred care philosophy which underpins paediatric care. Having families present continues to spark much debate amongst health care professionals. DESIGN: A descriptive cross-sectional randomised survey using the 'Family Presence Risk/Benefit Scale' and the 'Family Presence Self-Confidence Scale 'to assess health care professionals' (doctors and nurses) perceptions and self-confidence in facilitating family presence during resuscitation of a child in a paediatric hospital. METHODS: Surveys were distributed to 300 randomly selected medical and nursing staff. Descriptive and inferential statistics were used to compare medical and nursing, and critical and noncritical care perceptions and self-confidence. RESULTS: Critical care staff had statistically significant higher risk/benefit scores and higher self-confidence scores than those working in noncritical care areas. Having experience in paediatric resuscitation, having invited families to be present previously and a greater number of years working in paediatrics significantly affected participants' perceptions and self-confidence. There was no difference between medical and nursing mean scores for either scale. CONCLUSION: Both medical and nursing staff working in the paediatric setting understood the needs of families and the philosophy of family-centred care is a model of care practised across disciplines. RELEVANCE TO CLINICAL PRACTICE: This has implications both for implementing guidelines to support family presence during resuscitation and for education strategies to shift the attitudes of staff who have limited or no experience.

Parental Experience of Information and Education Processes Following Diagnosis of Their Infant With Cystic Fibrosis Via Newborn Screening.

UNLABELLED: Following diagnosis with cystic fibrosis (CF), initial education powerfully influences parental adjustment and engagement with care teams. This study explored the education needs of ten parents following their infant's diagnosis with CF via newborn screening. DESIGN AND METHODS: Phenomenological study using van Manen's approach, with ten participant parents of children 1-8 years with CF. RESULTS: Parents recounted varying degrees of coping with information they acknowledged as overwhelming and difficult. For some it was too much too soon, while others sought such clarity to put CF into context. CONCLUSIONS: Participants delivered insight into their engagement with their education about CF. Their recommendations for appropriate context, content, format and timing of delivery enable development of education that is accurate and relevant.

How is Family Centered Care Perceived by Healthcare Providers from Different Countries? An International Comparison Study.

UNLABELLED: Family-centered care (FCC) is a healthcare delivery model in which planning care for a child incorporates the entire family. The purpose of this study was to describe and compare how healthcare providers from three countries with varied cultural and healthcare systems perceive the concept FCC by measuring attitudes, and to psychometrically identify a measure that would reflect "family-centeredness." DESIGN AND METHODS: The Working with Families questionnaire, translated when appropriate, was used to capture participants' perceptions of caring for hospitalized children and their parents from pediatric healthcare providers in the United States, Australia and Turkey (n=476). RESULTS: The results indicated significantly more positive attitudes reported for working with children than parents for all countries and individual score differences across countries: the U.S. and Turkey child scores were significantly higher than Australia, whereas the U.S. and Australia parent scores were both significantly higher than Turkey. CONCLUSIONS: Perceptions of working with families were different for nurses from the three countries that call for a clearer understanding about perceptions in relation to delivery systems. Further analyses revealed FCS scores to be significantly different between nurses and physicians and significantly correlated with age, number of children and education. PRACTICE IMPLICATIONS: The results of this study add to our understanding of influences on practice from different countries and healthcare systems. The FCS score may be useful to determine baseline beliefs and ascertain effectiveness of interventions designed to improve FCC implementation.

Protocol for a study of the psychosocial determinants of health in early childhood among children with cystic fibrosis.

AIMS: To investigate the causal associations between family relationships, family functioning, social circumstances and health outcomes in young children with cystic fibrosis. BACKGROUND: The anticipated health gains for patients with cystic fibrosis, promised by early diagnosis through newborn screening, have yet to be fully realized, despite advances in cystic fibrosis health care with aggressive management in multidisciplinary clinics and the development of specific medications. Adverse psychosocial functioning may underpin the current lack of progress as it is well recognized that compromised early parent-child attachment relationship experiences and adverse social circumstances have negative impacts on lifelong health status and health resource use, even in healthy children. DESIGN: A cross-sectional (initial) and longitudinal (progressive), multicentre study of children aged 3 months-6 years with cystic fibrosis, who have been diagnosed by newborn screening. METHODS: Questionnaire and observational measures of parent psychosocial functioning, parenting and parent-child attachment and social markers; and including clinical outcomes of regular health surveillance with clinical, lung imaging (computerized tomography) and bronchoalveolar lavage for airway microbiology and inflammation. CONCLUSION: This will be the first study to investigate the causal effect of psychosocial functioning, parenting and attachment on physical health outcome measures in children with cystic fibrosis.

Rainbows: a primary health care initiative for primary schools.

Within the current Australian health system is the understanding of a need to change from the predominate biomedical model to incorporate a comprehensive primary health care centred approach, embracing the social contexts of health and wellbeing. Recent research investigated the benefits of the primary health care philosophy and strategies in relation to the Rainbows programme which addresses grief and loss in primary school aged students in Western Australia. A multidisciplinary collaboration between the Western Australian Departments of Health and Education enabled community school health nurse coordinators to train teacher facilitators in the implementation of Rainbows, enabling support for students and their parents. The results of this qualitative study indicate that all participants regard Rainbows as effective, with many perceived benefits to students and their families.

Characteristics of low-speed vehicle run-over events in children: an 11-year review.

OBJECTIVES: The purpose of this study was to investigate the characteristics associated with fatal and non-fatal low-speed vehicle run-over (LSVRO) events in relation to person, incident and injury characteristics, in order to identify appropriate points for intervention and injury prevention. METHODS: Data on all known LSVRO events in Queensland, Australia, over 11 calendar years (1999-2009) were extracted from five different databases representing the continuum of care (prehospital to fatality) and manually linked. Descriptive and multivariate analyses were used to analyse the sample characteristics in relation to demographics, health service usage, outcomes, incident characteristics, and injury characteristics. RESULTS: Of the 1641 LSVRO incidents, 98.4% (n=1615) were non-fatal, and 1.6% were fatal (n=26). Over half the children required admission to hospital (56%, n=921); mean length of stay was 3.4 days. Younger children aged 0-4 years were more frequently injured, and experienced more serious injuries with worse outcomes. Patterns of injury (injury type and severity), injury characteristics (eg, time of injury, vehicle type, driver of vehicle, incident location), and demographic characteristics (such as socioeconomic status, indigenous status, remoteness), varied according to age group. Almost half (45.6%; n=737) the events occurred outside major cities, and approximately 10% of events involved indigenous children. Parents were most commonly the vehicle drivers in fatal incidents. While larger vehicles such as four-wheel drives (4WD) were most frequently involved in LSVRO events resulting in fatalities, cars were most frequently involved in non-fatal events. CONCLUSIONS: This is the first study, to the authors' knowledge, to analyse the characteristics of fatal and non-fatal LSVRO events in children aged 0-15 years on a state-wide basis. Characteristics of LSVRO events varied with age, thus age-specific interventions are required. Children living outside major cities, and indigenous children, were over-represented in these data. Further research is required to identify the burden of injury in these groups.