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Effect of oral nutritional supplements on outcomes in children presenting with, or at risk of, faltering growth in clinical settings: A systematic review and meta-analysis. 口服营养补充剂对临床表现为生长迟缓或有生长迟缓风险的儿童预后的影响:一项系统综述和荟萃分析
IF 1.9 4区 医学 Q3 NURSING Pub Date : 2023-07-05 DOI: 10.1177/13674935231185181
A L Cawood, C Smith, F J Kinnear, L Upton, S Trace, G O'Connor, R J Stratton

This systematic review summarises evidence regarding oral nutritional supplement (ONS) use in children with, or at risk of, faltering growth (FG). Ten randomised controlled trials (RCTs), compared changes in outcomes amongst children receiving ONS versus control were included. Overall, 1116 children (weighted mean (WM) age 5 years; n658 (59%) male) were recruited, of which 585 (52%) received ONS (WM intake contribution 412 kcal, 16.3 g protein, 395 ml) for 116 days (WM). ONS use was associated with significantly greater gains in weight (mean difference (MD) 0.4 kg, 95% CI [0.36, 0.44]) and height (MD 0.3 cm, 95% CI [0.03, 0.57]), likely related to improvements in nutritional intake. Mean compliance to prescribed dose was 98%. Data suggested an association between ONS use and reduced infections. Further research is warranted to establish ONS dosage and effects upon other outcomes. This review provides evidence to support use of ONS in the management of children with, or at risk of, FG.

本系统综述总结了有关口服营养补充剂(ONS)用于生长迟缓(FG)或有生长迟缓风险的儿童的证据。纳入了10项随机对照试验(rct),比较了接受ONS治疗的儿童与对照组的结局变化。总体而言,1116名儿童(加权平均(WM) 5岁;招募了n658名(59%)男性,其中585名(52%)接受了为期116天的ONS (WM摄入贡献412 kcal, 16.3 g蛋白质,395 ml)。使用ONS与体重(平均差值(MD) 0.4 kg, 95% CI[0.36, 0.44])和身高(MD) 0.3 cm, 95% CI[0.03, 0.57])显著增加相关,可能与营养摄入的改善有关。处方剂量的平均依从性为98%。数据显示,使用ONS与减少感染之间存在关联。需要进一步的研究来确定ONS的剂量和对其他结果的影响。本综述提供证据支持在患有FG或有FG风险的儿童的管理中使用ONS。
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引用次数: 0
Effectiveness and safety of prophylactic phototherapy to prevent jaundice in premature newborns: Systematic review and meta-analysis. 预防性光疗预防早产儿黄疸的有效性和安全性:系统回顾和荟萃分析。
IF 1.9 4区 医学 Q3 NURSING Pub Date : 2023-07-04 DOI: 10.1177/13674935231187716
Luis A Lovera, Javier Torres, Herney A García-Perdomo

To determine the effectiveness and safety of prophylactic phototherapy compared with conventional phototherapy for the prevention of neonatal jaundice. We included clinical trials comparing prophylactic phototherapy to conventional phototherapy to prevent jaundice in premature newborns. We searched Embase, MEDLINE, LILACS, Central, and others. The statistical analysis was performed in RevMan (Review Manager 5.3). Outcomes were analyzed according to the type of variable: risk difference (RD) and mean difference (MD). A random effects model was used due to heterogeneity. We reported results in forest plots. Risk of bias was evaluated, and a sensitivity analysis was made. 1127 articles were found, and six studies (2332 patients) were included in the meta-analysis. Five studies evaluated the need for exchange transfusion as the primary outcome RD -0.01, 95% CI [-0.05 to 0.03]. One study evaluated bilirubin encephalopathy RD -0.04, 95% CI [-0.09 to 0.00]. Five studies evaluated the duration of phototherapy, MD 38.47, 95% CI [1.28 to 55.67]. Four studies evaluated levels of bilirubin (MD -1.23, 95% CI [-2.25 to -0.21]. Two studies evaluated mortality, RD 0.01, 95% CI [-0.03 to 0.04]. As a conclusion, compared to conventional phototherapy, prophylactic phototherapy decreases the last measured level of bilirubin, as well as the probability of neurodevelopmental disturbances. However, it increases phototherapy duration.

目的:比较预防性光疗与常规光疗预防新生儿黄疸的有效性和安全性。我们纳入了比较预防性光疗和常规光疗预防早产儿黄疸的临床试验。我们搜索了Embase、MEDLINE、LILACS、Central等。在RevMan (Review Manager 5.3)软件中进行统计分析。结果根据变量类型进行分析:风险差异(RD)和平均差异(MD)。由于异质性,采用随机效应模型。我们报告了森林样地的结果。评估偏倚风险,并进行敏感性分析。共发现1127篇文章,6项研究(2332例患者)纳入meta分析。5项研究将换血需求评估为主要结局(RD -0.01, 95% CI[-0.05至0.03])。一项研究评估胆红素脑病RD为-0.04,95% CI[-0.09至0.00]。5项研究评估光疗持续时间,MD为38.47,95% CI[1.28 ~ 55.67]。四项研究评估了胆红素水平(MD -1.23, 95% CI[-2.25至-0.21])。两项研究评估死亡率,相对危险度为0.01,95% CI[-0.03 ~ 0.04]。综上所述,与常规光疗相比,预防性光疗降低了最后测量的胆红素水平,以及神经发育障碍的可能性。然而,它增加了光疗时间。
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引用次数: 1
Supportive use of digital technologies during transition to adult healthcare for young people with long-term conditions, focusing on Type 1 diabetes mellitus: A scoping review. 长期患有糖尿病的年轻人在向成人医疗保健过渡期间支持性使用数字技术,重点是1型糖尿病:范围审查
IF 1.9 4区 医学 Q3 NURSING Pub Date : 2023-06-30 DOI: 10.1177/13674935231184919
Joy Orpin, Alison Rodriguez, Deborah Harrop, Elizabeth Mills, Fiona Campbell, Jacqueline Martin-Kerry, James Turner, Janet Horsman, Jon Painter, Maddie Julian, Paul Dimitri, Philippa Howsley, Veronica Swallow

Type 1 diabetes mellitus (T1DM) is the second most common chronic or long-term condition (LTC) affecting young people (YP); when transitioning from paediatric to adult healthcare, young people with LTCs such as T1DM are expected to self-manage medication, diet and clinical appointments. This scoping review aimed to analyse research examining ways digital health technologies were used to support YP with LTCs during transition from paediatric to adult healthcare and to establish YP's needs, experiences and challenges when transitioning. We aimed to identify knowledge gaps and inform development of a novel chatbot with components such as avatars and linked videos to help YP with T1DM gain self-management confidence and competence during transition. Nineteen studies identified through searching five electronic databases were included in this review. A combination of digital health technologies was used to support transition of YP with LTCs to adult healthcare. Barriers to successful transition were reported and YP described the importance of social relationships and transition readiness and expressed the need for individualised interventions that acknowledge social factors such as work and college. No supportive chatbots with components to help YP with T1DM were identified. This contribution will inform future development and evaluation of such a chatbot.

1型糖尿病(T1DM)是影响年轻人(YP)的第二大常见慢性或长期疾病(LTC);当从儿科过渡到成人医疗保健时,患有LTCs(如T1DM)的年轻人预计将自我管理药物、饮食和临床预约。这项范围审查的目的是分析调查数字卫生技术在从儿科向成人医疗保健过渡期间用于支持YP和LTCs的方法的研究,并确定YP在过渡期间的需求、经验和挑战。我们的目标是确定知识差距,并为一种新型聊天机器人的开发提供信息,该机器人具有头像和链接视频等组件,以帮助患有T1DM的YP在过渡期间获得自我管理的信心和能力。通过检索5个电子数据库确定的19项研究纳入本综述。数字卫生技术的组合用于支持青少年健康计划与长期健康中心向成人医疗保健的过渡。报告了成功过渡的障碍,YP描述了社会关系和过渡准备的重要性,并表达了承认社会因素(如工作和大学)的个性化干预的必要性。没有支持性聊天机器人的组件来帮助YP与T1DM被确定。这一贡献将为这种聊天机器人的未来开发和评估提供信息。
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引用次数: 1
Elucidating children's understanding of brachial plexus birth injury. 阐明儿童对臂丛出生损伤的认识。
IF 1.9 4区 医学 Q3 NURSING Pub Date : 2023-06-28 DOI: 10.1177/13674935231183743
Michelle Goldsand, Kathleen Lai, Kristen Davidge, Emily S Ho

Facilitating children's understanding of their medical condition can improve health outcomes and psychosocial well-being. To inform how medical information is delivered, an interpretive qualitative approach was used to explore children's understanding of their brachial plexus birth injury. In-depth interviews of children with brachial plexus birth injuries (n = 8) and their caregivers (n = 10) were conducted individually and as a child-caregiver dyad. Thematic analysis of interview data found that children primarily understood their injury through lived experiences of functional and psychosocial concerns related to movement and appearance of the affected limb, rather than medical information. Children's ability to learn about diagnostic and prognostic information was influenced by age, emotional readiness, and background knowledge. In receiving information about their medical condition, children needed greater support in understanding their prognosis and its implications on their future. These narratives indicate the importance of addressing the primary functional and psychosocial concerns to contextualize medical information and ascertain the emotional readiness of children with brachial plexus birth injuries in information delivery approaches.

促进儿童了解其医疗状况可以改善健康结果和社会心理健康。为了了解医学信息是如何传递的,我们采用了一种解释性质的方法来探讨儿童对臂丛出生损伤的理解。对臂丛出生损伤儿童(n = 8)及其照顾者(n = 10)进行了单独和作为儿童照顾者的深入访谈。对访谈数据的专题分析发现,儿童主要是通过与受影响肢体的运动和外观有关的功能和心理社会问题的生活经验,而不是通过医疗信息来了解他们的损伤。儿童学习诊断和预后信息的能力受年龄、情绪准备程度和背景知识的影响。在获得有关其医疗状况的信息时,儿童需要更多的支持,以了解其预后及其对其未来的影响。这些叙述表明,在信息传递方法中,解决主要功能和社会心理问题的重要性,以便将医疗信息置于背景中,并确定臂丛出生损伤儿童的情感准备情况。
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引用次数: 0
Exploring implementation processes of a parent-targeted educational video for improving newborn pain treatment: A sequential exploratory mixed-methods study. 探索实施过程的家长为目标的教育视频改善新生儿疼痛治疗:一个顺序的探索性混合方法研究。
IF 1.9 4区 医学 Q3 NURSING Pub Date : 2023-06-23 DOI: 10.1177/13674935231176888
Catherine Larocque, Carolina Lavin Venegas, Sandra Dunn, Marsha Campbell-Yeo, Lucy Gilmore, JoAnn Harrold, Jiale Hu, Leanne McArthur, Shokoufeh Modanloo, Stuart G Nicholls, Pat O'Flaherty, Shahirose Sadrudin Premji, Jessica Reszel, Sonia Semenic, Janet E Squires, Bonnie Stevens, Monica Taljaard, Marie-Josee Trepanier, Kathy Venter, Jodi Wilding, Denise Harrison

Despite known analgesic effects of breastfeeding (BF), skin-to-skin care (SSC), and sweet solutions (sucrose) for newborns, these interventions remain underutilized. Our team produced a five-minute parent-targeted video (BSweet2Babies) demonstrating BF, SSC, and sucrose during newborn blood sampling. We conducted a sequential exploratory mixed-methods study with eight maternal-newborn units across Ontario, Canada to identify barriers and facilitators to implementing the video and the three pain management strategies.Over a 6-month period, data collection included 15 telephone interviews, two email communications, and three community of practice teleconferences with the participating sites (n = 8). We used the Theoretical Domains Framework as the coding matrix. Participants discussed integrating the video in prenatal education and the importance of involving leadership when planning for practice change. Key barriers included lack of comfort with parental presence, perception of high complexity of the strategies, short postpartum stays, competing priorities, and interprofessional challenges. Key facilitators included alignment with the Baby-Friendly Hospital Initiative, modeling by Lactation Consultants, and frequent reminders.

尽管已知母乳喂养(BF)、皮肤对皮肤护理(SSC)和新生儿甜溶液(蔗糖)具有镇痛作用,但这些干预措施仍未得到充分利用。我们的团队制作了一个5分钟的针对家长的视频(BSweet2Babies),展示了新生儿血液采样过程中BF、SSC和蔗糖的含量。我们在加拿大安大略省的8个母婴单位进行了一项连续的探索性混合方法研究,以确定实施视频和三种疼痛管理策略的障碍和促进因素。在6个月的时间里,数据收集包括15次电话访谈、2次电子邮件通信和3次与参与站点的实践社区电话会议(n = 8)。我们使用理论领域框架作为编码矩阵。与会者讨论了将视频整合到产前教育中,以及在规划实践变化时领导参与的重要性。主要障碍包括缺乏对父母存在的舒适感,对策略高度复杂性的认识,产后停留时间短,竞争优先事项和跨专业挑战。主要的促进因素包括与爱婴医院倡议保持一致,由哺乳顾问建模,以及经常提醒。
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引用次数: 0
The relationship between children's food allergies and family mealtimes: A systematic review. 儿童食物过敏与家庭用餐时间的关系:一项系统综述。
IF 1.9 4区 医学 Q3 NURSING Pub Date : 2023-06-14 DOI: 10.1177/13674935231183491
Ritu Sampige, Leslie Ann Frankel

Food allergy prevalence is increasing among children; however, it is not clear how children's food allergy status impacts family mealtimes. This study's purpose was to systematically synthesize research regarding the relationship between children's food allergies, parental meal-centered stress, and family mealtime dynamics. Data sources for this study include peer-reviewed, English language sources from CINAHL, MEDLINE, APA PsycInfo, Web of Science, and Google Scholar. Five keyword categories (child, food allergies, meal preparation, stress, and family) were utilized to identify sources regarding how food allergies of children (from birth-12 years) relate to family mealtime dynamics or parental meal-centered stress. All 13 identified studies determined that pediatric food allergies relate to either increased parental stress, meal preparation issues, mealtime problems, or changes to family meals. Studies also indicate that meal preparation takes longer, requires more vigilance, and is more stressful due to children's food allergies. Limitations include that most studies were cross-sectional and based on maternal self-report. Children's food allergies are associated with parental meal-centered stress and mealtime issues. However, there is a need for research to account for specific changes to family mealtime dynamics and parent feeding behaviors so that pediatric health care professionals can alleviate parental meal-centered stress and provide guidance towards optimal feeding behaviors.

儿童食物过敏患病率正在上升;然而,目前尚不清楚儿童食物过敏状况如何影响家庭用餐时间。本研究的目的是系统地综合有关儿童食物过敏、父母以用餐为中心的压力和家庭用餐时间动态之间关系的研究。本研究的数据来源包括来自CINAHL、MEDLINE、APA PsycInfo、Web of Science和Google Scholar的同行评审的英文来源。五个关键词类别(儿童、食物过敏、膳食准备、压力和家庭)被用来确定儿童(从出生到12岁)的食物过敏与家庭用餐时间动态或父母以用餐为中心的压力之间的关系。所有13项确定的研究都确定,儿童食物过敏与父母压力增加、饭菜准备问题、用餐时间问题或家庭膳食改变有关。研究还表明,准备饭菜需要更长的时间,需要更多的警惕,并且由于儿童食物过敏,压力更大。局限性包括大多数研究是横断面的,并且基于母亲的自我报告。儿童食物过敏与父母以吃饭为中心的压力和吃饭时间问题有关。然而,有必要对家庭用餐时间动态和父母喂养行为的具体变化进行研究,以便儿科卫生保健专业人员可以减轻父母以用餐为中心的压力,并为最佳喂养行为提供指导。
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引用次数: 1
Post-traumatic growth of Afghan adolescents after traumatic loss of father. 阿富汗青少年在痛失父亲后的创伤后成长。
IF 1.9 4区 医学 Q3 NURSING Pub Date : 2023-06-08 DOI: 10.1177/13674935231183020
Benazir Poya, Maryam Esmaeili, Azam Naghavi

Adolescents' mental health may be influenced either negatively or positively through loss of a parent, especially bereavement due to a traumatic death. This descriptive phenomenological study aimed to investigate Afghan adolescents' post-traumatic growth after traumatic loss of father. The participants were 14 female and male Afghan adolescents who met the inclusion criteria. Post-traumatic growth was substantiated by virtue of post-traumatic growth questionnaire. Data was collected through a semi-structured interview, and Colaizzi analysis method was used for data analysis. Two main themes were extracted: (a) moving forward with hope and (b) factors associated with enhancement of hope. Findings showed that Afghan traumatized adolescents achieved post-traumatic growth over time. The most important factors in enhancement of hopefulness were social support, psychological, and cognitive factors, as well as spiritual well-being. Our findings suggested that both schools and non-governmental organization in Afghanistan may be benefitted from more accessible opportunities to enhance post-traumatic growth for bereaved adolescents.

青少年的心理健康可能因失去父母而受到消极或积极的影响,特别是因创伤性死亡而造成的丧失。本描述性现象学研究旨在探讨阿富汗青少年创伤性失去父亲后的创伤后成长。参与者是14名符合纳入标准的阿富汗男女青少年。通过创伤后成长问卷对创伤后成长进行证实。采用半结构化访谈法收集数据,采用Colaizzi分析法进行数据分析。提炼出两个主要主题:(a)带着希望向前迈进和(b)与增强希望有关的因素。研究结果表明,阿富汗受创伤的青少年随着时间的推移实现了创伤后成长。增强希望的最重要因素是社会支持、心理和认知因素以及精神健康。我们的研究结果表明,阿富汗的学校和非政府组织都可以从更多的机会中受益,以促进失去亲人的青少年的创伤后成长。
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引用次数: 0
Clinician and carer moral concerns when caring for children who tube-feed. 临床医生和护理人员在照顾管饲儿童时的道德问题。
IF 1.9 4区 医学 Q3 NURSING Pub Date : 2023-06-01 DOI: 10.1177/13674935211052842
Ann Dadich, Kaitlyn Hockey, Cathy Kaplun, Catharine Fleming, Nick Hopwood, Khadeejah Moraby, Chris Elliot

Child healthcare can be vexed by moral concerns - this extends to the care of children who tube-feed. Children who tube-feed often receive care from family members and clinicians of various disciplines. Each brings expertise, experiences, values, and views to a situation, prioritising the child's needs while attending to those they deem important in potentially disparate ways. Their understanding of a situation is shaped by beliefs, feelings, and perceptions. How then are key decisions made about the care of a child who tube-feeds? This article explores clinicians' and carers' moral concerns when caring for children who tube-feed. Interviews with clinicians (n = 9) and carers (n = 9) clarified three findings: first, there are often disparate beliefs about the need for tube-feeding; second, tube-feeding can evoke strong emotions; and third, it can be difficult to normalise tube-feeding. This article demonstrates how challenges can emerge when relationships between clinicians and carers diverge. Furthermore, it establishes how an ethic of care can bring different interests together to bolster the relationships required to optimise feeding care and promote health outcomes among children who tube-feed and their carers. This requires improved dialogue between and among clinicians and carers to create shared understandings of what is, what should be, and how to benefit children who tube-feed.

儿童保健可能会受到道德问题的困扰——这延伸到管饲儿童的护理。管饲的儿童经常得到家庭成员和不同学科的临床医生的照顾。每个人都把专业知识、经验、价值观和观点带到一个情境中,优先考虑孩子的需求,同时以可能不同的方式关注他们认为重要的事情。他们对一种情况的理解是由信仰、感觉和感知形成的。那么,对于管饲儿童的护理,如何做出关键的决定呢?这篇文章探讨了临床医生和护理人员在照顾管饲儿童时的道德问题。对临床医生(n = 9)和护理人员(n = 9)的访谈澄清了三个发现:首先,人们对管饲的必要性往往有不同的看法;第二,管饲可以唤起强烈的情绪;第三,管饲可能难以正常进行。这篇文章展示了当临床医生和护理人员之间的关系出现分歧时,挑战是如何出现的。此外,它还确定了护理伦理如何将不同的利益结合在一起,以加强优化喂养护理和促进管饲儿童及其照顾者的健康结果所需的关系。这需要临床医生和护理人员之间加强对话,就什么是、什么应该是以及如何使管饲儿童受益达成共识。
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引用次数: 4
The imperative to develop health literacy: An ethical evaluation of HealthLit4Kids. 发展健康素养的必要性:对儿童健康的伦理评价。
IF 1.9 4区 医学 Q3 NURSING Pub Date : 2023-06-01 DOI: 10.1177/13674935221143883
Claire Emma Otten, David Moltow, Nenagh Kemp, Rose Enid Nash

An imperative exists to promote health literacy (HL) development in today's young people. Included in curricula worldwide, health literacy has been recognised as a social determinant in its own right, which has the potential to redress inequity and positively impact health and educational outcomes. While it has been shown that schools provide an ideal setting to support HL development, available evidence suggests that health may be undertaught in primary schools, and further resources are required to support educators' inclusion of HL in their lessons. The aims of this paper were to (1) highlight the ethical imperative to promote HL through schools and (2) provide an ethical evaluation of an existing HL intervention. Spike's (2018) four principles for public health ethics were employed as a framework for evaluating a program's ethical status and suitability in the school setting. In this paper, one program, HealthLit4Kids, is evaluated according to Spike's framework, and shown to be an ethically acceptable approach to foster HL in young people. These results model how other HL programs may be evaluated and offer critical insights concerning how HL could be promoted in an ethically acceptable manner in the classroom.

促进当今年轻人的健康素养发展是当务之急。卫生知识普及已被列入世界各地的课程,其本身已被视为一种社会决定因素,有可能纠正不平等现象,并对卫生和教育成果产生积极影响。虽然已有证据表明,学校为支持HL的发展提供了理想的环境,但现有证据表明,小学的健康教育可能不足,需要进一步的资源来支持教育工作者将HL纳入其课程。本文的目的是:(1)强调通过学校推广HL的伦理必要性;(2)对现有HL干预措施进行伦理评估。斯派克(2018)公共卫生伦理的四项原则被用作评估项目在学校环境中的道德地位和适用性的框架。在这篇论文中,一个名为HealthLit4Kids的项目根据斯派克的框架进行了评估,并被证明是一种道德上可接受的培养年轻人HL的方法。这些结果为如何评估其他HL项目提供了模型,并提供了关于如何在课堂上以道德上可接受的方式推广HL的关键见解。
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引用次数: 2
Children's assent within clinical care: A concept analysis. 临床护理中的儿童同意:概念分析。
IF 1.3 4区 医学 Q3 NURSING Pub Date : 2023-06-01 Epub Date: 2020-12-21 DOI: 10.1177/1367493520976300
Marjorie Montreuil, Justine Fortin, Eric Racine

Seeking children's assent has been put forward as a way to foster children's involvement in the healthcare decision-making process. However, the functions of the concept of assent within clinical care are manifold, and methods used to recognize children's capacities and promote their involvement in their care remain debated. We performed an instrumentalist concept analysis of assent, with 58 included articles. Final themes were jointly identified through a deliberative process. Two distinct perspectives of assent were predominant: as an affirmative agreement for a specific decision and as part of a continuous, interactive process of care. Differing standards were provided as to how and when to apply the concept of assent. The concept of dissent was largely omitted from conceptions of assent, especially in situations for which children's refusal would lead to severe health consequences. Ethical implications included fostering autonomy, reducing physical/psychological harm to the child, respecting the child as a human being, and fulfilling the universal rights of the child. There remain important gaps in the theory of assent and its desirable and possible practical implications. Practical standards are largely missing, and evidence supporting the claims made in the literature requires further investigation.

征求儿童同意被认为是促进儿童参与医疗决策过程的一种方式。然而,"同意 "这一概念在临床护理中的功能是多方面的,而用于确认儿童能力和促进儿童参与护理的方法仍存在争议。我们对 58 篇文章中的 "同意 "概念进行了工具主义分析。最终的主题是通过审议过程共同确定的。对同意的理解主要有两种不同的视角:一种是对特定决定的肯定性同意,另一种是持续、互动的护理过程的一部分。对于如何以及何时应用 "同意 "的概念,提出了不同的标准。在同意的概念中,特别是在儿童拒绝会导致严重健康后果的情况下,异议的概念在很大程度上被忽略了。伦理方面的影响包括培养自主性、减少对儿童身体/心理的伤害、尊重儿童的人格以及实现儿童的普遍权利。在同意理论及其理想和可能的实际影响方面仍存在重大差距。实际标准在很大程度上是缺失的,而支持文献中所提主张的证据也需要进一步调查。
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引用次数: 0
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Journal of Child Health Care
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