Nursing children and young people最新文献

Children and young people with diabetes mellitus and their families often develop expertise in managing their condition independently, but their autonomy to manage it is often removed during hospital admissions. Insulin is a high-risk medicine and insulin errors can lead to serious or life-threatening events. Allowing children and their parents or carers to self-manage their diabetes and self-administer insulin while in hospital is likely to improve patient safety. In 2022-2023, the paediatric diabetes team at Southampton Children's Hospital, England, developed and implemented a diabetes self-management policy for children and young people on insulin therapy who are admitted as inpatients. The new policy provides a robust decision-making tool for healthcare professionals and gives children and young people and their parents the opportunity to self-manage during hospital stays, if they are deemed competent and it is considered safe to do so. It is anticipated that the policy will facilitate communication between families and staff, improve patient experience and promote safe and effective diabetes management on the wards.

Sepsis in children has been defined as a clinical syndrome resulting from a dysregulated immune response to infection. Several publications have highlighted the need for education for healthcare professionals on the recognition and management of sepsis to improve patient care and reduce the risk of morbidity and mortality. This article offers information, tools and resources for children's nurses to promote a multidisciplinary team approach to assessing children and young people with suspected sepsis and escalating care where appropriate. It uses a case study to illustrate the challenges that may be encountered in diagnosing sepsis and providing effective care.

Background: Nasogastric tube (NGT) feeding under physical restraint is a clinical intervention that may be required when a child or young person is medically unstable secondary to restrictive eating.

Aim: To explore the experiences of parents when their child receives NGT feeding under physical restraint and understand the effects of this on them.

Method: This is a secondary analysis of data from two previous studies on NGT feeding under physical restraint - one in mental health wards and one in children's wards - in which semi-structured interviews had been conducted with patients, staff and parents. For this secondary analysis, the authors thematically analysed 31 transcripts of interviews with parents.

Findings: Parents reported a range of emotions which could be conflicting in nature, notably relief and shame. In both studies, parents understood the necessity of NGT feeding under physical restraint but experienced the intervention as traumatic. They expressed empathy for staff facilitating the restraint. In the children's wards study, some parents described conflict and damaged relationships with staff, and three parents had participated in physically restraining their child for NGT feeding.

Conclusion: Nursing staff should be aware that NGT feeding under physical restraint is distressing for parents. Adopting a trauma-informed framework may help to mitigate the traumatic effects on parents and, in turn, on their child.

Medical procedure-induced anxiety in children can have short- and long-term negative effects. Research shows that children's anxiety can be affected by non-pharmacological interventions and adults' behaviours in a complex manner. This article presents a scoping review of the literature on non-pharmacological interventions to manage medical procedure-induced anxiety in children. Based on this review, the authors propose a framework comprising six strategies for effective non-pharmacological management of medical procedure-induced anxiety in children. A real-life, and anonymised, example is used to illustrate this framework in practice.

Adolescent idiopathic scoliosis (AIS) is the most common spinal disorder among children and adolescents, with most cases being diagnosed around puberty. While the majority of people with AIS do not undergo treatment, a small but significant number are treated, depending on the extent of their spinal curvature. Treatment typically involves bracing, which requires substantial adherence, and/or surgery, which is invasive and permanent. Furthermore, decisions about treatment often need to be made at a critical stage of the person's development. This article examines the evidence on AIS and its treatment, synthesising the current literature and drawing from the authors' empirical work to explore the clinical outcomes of bracing and surgery, as well as the longer-term effects on people's quality of life. Drawing from this evidence, the authors provide guidance for nurses and healthcare professionals who care for people with AIS.

Children and young people's (CYP) nursing leaders have experienced considerable challenges in the context of a complex health and social care system with rapidly changing organisational structures, including the establishment of integrated care systems in England on 1 July 2022. The CYP nursing lead at NHS England commissioned a review of CYP organisational structures in emerging integrated care systems across England. The review encompassed a vision for CYP services, leadership, governance structures and opportunities for progression. A proforma was used to collate data from CYP trusts, CYP standalone hospitals and children's wards in district general hospitals. Qualitative interviews were also undertaken with senior children's nurses. At the same time, the first author of this article interviewed senior children's nurses as part of a Florence Nightingale Foundation leadership scholarship. The aim was to explore how they navigated their leadership journey and understand what advice they may give to future leaders in CYP nursing. The findings in this article identify 'what good looks like' in terms of CYP nursing leadership. Six recommendations for future development and enhancement of CYP nursing leadership are outlined.

Children with overweight or obesity are at risk of experiencing perioperative complications during general anaesthesia (GA). At Guy's and St Thomas' NHS Foundation Trust in London, children who require dental surgery under GA are placed on a waiting list for the Dental Day Surgery Unit (DDSU) or the Evelina London Children's Hospital (ELCH), which has inpatient beds and a paediatric intensive care unit, depending on their body mass index (BMI) and centile thresholds. The waiting list for the ELCH is longer than for the DDSU. This article discusses the results of a retrospective audit which involved analysis of the BMI of 300 children (aged ≤16 years) on the waiting lists for both sites (DDSU n =250; ELCH n =50). The aims were to identify those who were overweight or very overweight, calculate how much weight loss would be required for some of those allocated to the ELCH to be treated instead at the DDSU and to achieve a healthy weight, and to compare obesity prevalence with national data. The results identified 57 (19%) of the 300 patients as very overweight or overweight. A total of 24 (48%) patients on the ELCH waiting list ( n =50) were identified as very overweight or overweight. For seven (29%) of these 24 patients, the amount of weight loss required to be treated at the DDSU ranged between 19.5kg and 0.9kg and the amount of weight loss required to attain a healthy weight ranged between 28.5kg and 11.5 kg. The prevalence of obesity among the audit cohort was lower than national obesity prevalence rates for children.

Inherited cardiac conditions (ICCs) encompass a range of rare genetic heart diseases and require the expert care of a skilled multidisciplinary team. Increased awareness of these conditions and advances in genetic testing have led to a rise in demand for specialist ICC services. The Centre for Inherited Cardiovascular Diseases at Great Ormond Street Hospital in London, England, is a tertiary centre for the diagnosis and management of ICCs in children and young people. Specialist nursing roles have developed at the centre in recent years in parallel with the growth of ICC nursing. There are also increasing opportunities for advanced and autonomous nursing practice to support the provision of high-quality care for children and young people affected by ICCs and their families.

Pain management in children is often more complex than in adults, since pain in children can be more challenging to assess and therefore more challenging to treat. It is essential that children's nurses have knowledge and understanding of the physiology of pain and the analgesics available to treat different types of pain. This article describes nociception and provides an overview of the three main groups of analgesics - non-opioids, opioids and adjuvants - that can be used in the pharmacological management of pain in children and young people.

A lumbar puncture may be performed for various reasons, but is commonly used to facilitate the diagnosis of central nervous system infections in infants and children. It involves inserting a needle into the lower spine to obtain cerebrospinal fluid, which is then sent for testing in a laboratory. The results of the tests, together with a clinical assessment of a patient, can guide the effective treatment of infections and reduce the risk of neurological conditions. This article outlines some of the reasons why lumbar punctures are performed, discusses the practical aspects of the procedure and explains how nurses can effectively support the child and their family, while also assisting the practitioner undertaking the procedure.