Journal of Child Health Care最新文献

Pain is frequently experienced by children in hospital, and international guidelines for appropriate pain assessment and management are available. Optimal management of paediatric pain has important long-term health, psychosocial, and economic benefits. However, evidence indicates that globally there are deficits in nurses' understanding of paediatric pain assessment and management. This study explored knowledge and attitudes regarding paediatric pain assessment and management among nurses at a tertiary children's hospital in Nepal. In this cross-sectional study all 140 nurses at a tertiary children's hospital in Nepal, were invited to complete the validated Paediatric Nurses Knowledge and Attitudes Survey. Findings revealed substantial deficits in nurse's knowledge and erroneous attitudes towards pain assessment and management in children. Test scores ranged from 14% to 56%, with mean scores of 38%, with no nurses achieving a recommended pass score of 80% regarding knowledge and attitudes in paediatric pain management. Consistent with previous research, nurses had insufficient knowledge and attitudes that did not reflect best practice regarding pain assessment and management in children. Education programmes targeting both trainees and registered nurses are essential to enable nurses to deliver evidence-based care and improve outcomes for children and their families.

This study aimed to explore motor trajectories of Brazilian pre-term and full-term infants from 3 to 12 months old whose parents participated in an educational program and had received guidance on gross motor development. Forty-eight Brazilian infants aged 3 months old were divided into Group 1 (full-term infants and their parents who received only verbal guidance, n = 14), Group 2 (full-term infants with parents who received an educative folder in addition to the same verbal guidance, n = 23), and Group 3 (preterm infants with parents who received the same verbal guidance and educative folder, n = 11). The folder had similar information to the verbal guidance; nonetheless, it helped to teach parents and allowed later consultation at home. We applied Alberta Infant Motor Scale, Affordances in Home Environment for Motor Development-Infant Scale, and a questionnaire about infants' information at 3-, 6-, 9-, and 12-months old. In longitudinal comparison, all groups showed a significant difference for AIMS variables on total score and subscales; all subitems of AHEMD-IS; and time spent in prone, supine, sitting, and standing positions. In general, no differences were found between groups. Motor trajectory, home opportunities, and parental positioning practices were similar between full-term and preterm infants with different guidance approaches.

Anxiety in children, as well as their parents, is common in high-tech environments such as an operating room. This study aimed to describe parents' experiences of being present when their child is being anaesthetised. Twenty-four parents were interviewed and data were analysed using a descriptive phenomenological approach. Findings show that being present at a child's anaesthesia and surgery is a long, continuous process that begins at home. Parents struggle to face strong emotions in a special and frightening environment, focussing on their child's well-being while trying to remain control in this situation. Security and trust are vital, but it's challenging to relinquish control in an uncertain situation. Professional caregivers can promote trust and participation, but an awareness that something can go wrong affects parents on a deep level. In conclusion, parental presence at induction of anaesthesia is important but can be overwhelming and anxiety-inducing for some parents. Parents should be seen as a resource rather than a disturbance. Overall, the healthcare system should prioritise parents' involvement and seek to create an environment where they feel supported and included.

The Congenital Heart Disease Standards for England indicate that parents and children should have access to a 24-h telephone advice service, however, little is known about existing services. This paper presents phase two of a mixed-methods service evaluation, which aimed to evaluate staff experiences of telephone communication with these parents. All nursing and support staff in a single specialist children's cardiac surgical centre were invited to participate in an online survey during July-November 2019. Data were descriptively and thematically analysed. Participants (N = 39) were predominantly nurses (n = 32, 82%) with 64.1% (n = 25) working in the speciality >10 years. Positive experiences included: signposting and preventing further deterioration; supporting families to get expert advice quickly; providing reassurance. Challenging experiences included: offering advice without being able to see the child, dealing with telephone calls alongside busy workload; and parents running out of medications and telephoning out of hours. In conclusion, taking telephone calls were perceived to be time consuming and are potentially high risk. A standardised approach to assessment, intervention and documentation was deemed necessary. Implementation of an updated parental early warning tool was recommended, along with staff and parental education.

Parents and youth across Alberta were engaged to identify specific research questions that are a priority to them. Two lists, containing 27 topics were developed with local parent and youth advisory groups, and sent to participants via online questionnaires. Topics were rated from one (least important) to five (most important) and ranked in order of priority. Initial questionnaires were completed by 263 (46%) parents and 308 (54%) youth. Parents rated five topics (behaviour, learning, and developmental disorders; mental health; food, environment and lifestyle; quality of health care; and vaccines) and youth rated four topics (brain and nerve health; mental health; quality of health care; and vaccines) as a high priority. Research questions stemming from 4 parent (12 [5%]) and 6 youth (21 [7%]) focus group discussions were then ranked in a second questionnaire, completed by 43 (43%) parents and 56 (56%) youth. Parents' highest ranked research question was 'What is the effect of screen time on cognition and neurodevelopment for children and adolescents?', while the highest ranked question from youth was 'What are the early signs of anxiety and depression and when should an individual seek help?'. These topics highlight areas that are important to parents and youth where funding, research, and knowledge mobilization efforts should be directed.

Non-urgent paediatric Emergency Department presentations contribute to overcrowding, poor patient health outcomes, and burden acute healthcare services. A study was conducted to explore motivations and factors that influence decision-making processes of parents who presented their child to ED for non-urgent conditions. An exploratory study using a qualitative descriptive design was undertaken to address research aims. Semi-structured interviews were conducted with a purposive sample of eight parents who presented their child (birth to 14 years of age), to ED for non-urgent conditions. Parental decision-making regarding ED presentations were influenced by a constellation of factors; however, three main themes emerged. These included Parental Anxiety, There is Only One Place, and Mitigating Perceived Delay or Inaccessibility. As such, centred on how parents addressed their anxiety when a child was ill, accessibility and capacity of EDs to provide immediate relief to parents and children, and parents' perception that accessing other healthcare services impacted crucial time for treatment. EDs remain a preferred healthcare service to address non-urgent paediatric needs, despite adequate health literacy among participants. When improving models of care within EDs, non-urgent presentations must be considered, including management of parental anxiety, along with establishing non-urgent care adjacent to or integrated within an ED.

This review aimed to analyze the effects of laughter-inducing therapy on anxiety, pain, and stress in children by synthesizing existing randomized controlled trials (RCTs). Researchers conducted a systematic literature review and meta-analysis, following the Cochrane Collaboration's methodology for systematic literature review and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We selected and evaluated 12 studies for quality using the Risk of Bias 2.0 tool. Seven studies were included in the meta-analysis, which showed that clown therapy produced a moderate effect on pain relief and a large effect on anxiety reduction in pediatric patients. In conclusion, this review highlights the potential of laughter-inducing therapies as an effective clinical intervention for reducing anxiety, pain, and stress in pediatric patients. These findings provide evidence supporting the use of laughter-based interventions as alternative or complementary approaches in medical settings. The review also underscores the need for further research across diverse clinical environments to validate the effectiveness of laughter-inducing therapies in broader pediatric populations. Overall, the incorporation of laughter-inducing therapy into clinical practice may play a valuable role in enhancing the overall well-being of pediatric patients.

There is limited literature on nurse leaders' perceptions of organisational policies, guidelines, and practices that enact children and young people's (CYP) involvement in hospitals. Nurse leaders within what were the four District Health Board providers of children's tertiary health services in New Zealand (Auckland, Counties Manukau, Wellington, and Canterbury) were invited to respond to an online survey during November 2022 through to January 2023. The survey was developed by the researchers in accordance with the literature and included 11 open-ended questions. The open-ended questions were analysed iteratively through inductive thematic analysis. Eight out of 24 invited nurse leaders responded to the survey. Thematic analysis of the findings resulted in four key themes that highlighted how nurse leaders perceived their organisations provided a platform for children and young people's involvement in hospital: Policy and Guidelines; Diversity, Equity, and Inclusion; Models of Care; and CYP's Voices. Nurse leaders described various means and methods utilised to enact CYP's participation within paediatric settings in New Zealand. A multi-tiered collaborative approach with government, industry, leaders, healthcare professionals, family and CYP is required to enhance CYP's agency/voice in New Zealand hospitals as in alignment with the United Nation Convention of the Rights of the Child.

Care leavers face adversity and poor psychological outcomes, despite being a significantly under researched population. Childhood maltreatment is associated with attachment insecurity and Early Maladaptive Schemas (EMS); however, there is little research into the relationships between these variables, and none exploring these variables in care leavers. The study aimed to investigate the relationship between childhood maltreatment, attachment, EMS and maladaptive coping in care leavers, hypothesising that higher levels of childhood maltreatment would be associated with increased attachment insecurity, EMS severity and maladaptive coping. Participants were 53 UK-based adults, with experience of living in care during childhood. An opportunity sample and a within-subjects, cross-sectional survey design was used with hierarchical multiple regression. High levels of childhood maltreatment, attachment insecurity (both anxious and avoidant), EMS and maladaptive coping were found within the sample of care leavers. Hierarchical regression indicated that both attachment anxiety and attachment avoidance, and EMS domain 'disconnection and rejection' were significant predictors in the relationship between childhood maltreatment and maladaptive coping. The study adds to the current knowledge about psychological vulnerabilities for care leavers. Results highlight the importance of targeted assessment, formulation and psychological interventions targeting attachment domains and EMS, with particular focus on the disconnection and rejection schema domain for this population.