Comprehensive child and adolescent nursing最新文献

Child- and family-centered care (C&FCC) is critical in pediatric nursing, but often difficult to implement consistently, particularly during high-stress procedures such as peripheral intravenous (IV) line placements. This two-arm quasi-experimental study evaluated the effectiveness of learning support materials developed to enhance nurse managers' knowledge of and attitudes toward promoting C&FCC and encouraging its implementation during peripheral IV line placements. It conducted a two-arm quasi-experimental study in Japan between October 2022 and April 2023. Nurse managers from pediatric departments were allocated to the intervention (n = 69) and control (n = 67) groups using an alternating assignment method stratified by facility. This study involved three surveys as follows: a pre-survey (T1), post-survey 1 (T2, within 2 days of T1), and post-survey 2 (T3, 1 month after T2). The intervention group received a comprehensive learning package, including management strategies and C&FCC promotion tools, while the control group was provided with a limited guide without management content. In this study, the primary outcome was the behavioral component of attitude - namely, nurse managers' motivation and confidence to promote C&FCC. The secondary outcomes were knowledge of department management in C&FCC and intention to create a C&FCC promotion core team. Adjusted T3 effects, controlled for baseline and prespecified covariates, were estimated using analysis of covariance. For the primary outcome, the intervention produced significant adjusted improvement at T3 (β = 10.04, standard error [SE] = 3.93, t = 2.56, p = .012). The adjusted effect was not significant for knowledge (β = ‒1.03, SE = 0.72, t = 1.44, p = .153). A greater proportion of nurse managers expressed an intention to establish a C&FCC promotion core team in the intervention group than in the control group. In the context of peripheral IV placement, management-integrated C&FCC learning materials appear effective in enhancing nurse managers' motivation and confidence to lead C&FCC implementation and may help cultivate a child- and family-centered organizational culture in pediatric care.

Adolescent pregnancy is a global phenomenon that increases the risk of maternal and neonatal morbidity and mortality. In addition, early parenthood has implications that foster intergenerational poverty and social exclusion. Hence, this study aimed to evaluate the association between self-esteem and family functioning with teenage pregnancy. We conducted a case-control study from April to November 2023 at two community health centers in Hidalgo, Mexico. Primiparous adolescents aged 10 to 19 whose gestational age was less than 21 weeks and who attended a prenatal checkup consultation were considered the case group. Conversely, the control group consisted of non-pregnant adolescents (aged 10-19 years) who visited the same community health centers for medical consultations. The APGAR family scale was used to assess the family functioning of the participants, and self-esteem was assessed using the Rosenberg Self-Esteem Scale. The associations between the variables of interest were evaluated using logistic regression models adjusted by confounders. After adjusting for confounders, adolescents with medium (adjusted odds ratio [aOR] = 1.81; 95% confidence interval [95% CI] = 0.91, 3.59; p-value = .086) and lo8w self-esteem (aOR = 4.04; 95% CI = 1.96, 8.31; p-value = .030) compared to those with high self-esteem were more likely to be mothers. Besides, we found that the lower the self-esteem, the greater the odds of being an adolescent mother (p-trend <0.014). On the other hand, adolescents with moderate (aOR = 2.31; 95% CI = 1.03, 5.21; p-value = .031) and severe family dysfunction (aOR = 4.00; 95% CI = 1.61, 9.97; p-value = .001) were more likely to be adolescent mothers compared to those with good family functioning. Furthermore, we found that the greater the family dysfunction degree, the higher the risk of being an adolescent mother (p-trend <0.001). Our findings suggest that self-esteem and family functioning are independently associated with adolescent pregnancy. This adds to the existing literature that emphasizes the relevance of promoting emotional well-being and family relationships to prevent risky behaviors among adolescents. Therefore, it is necessary to develop holistic intervention programs that promote healthy family relationships and consider strengthening sexual assertiveness and self-esteem from early adolescence.

Cannabis use among adolescents and young adults has become a significant public health concern in the United States (US), as it is associated with immediate and long-term effects on mental health, academic achievement, and social functioning. The purpose of this systematic review was to identify risk and protective factors contributing to cannabis use initiation and continuation among adolescents and young adults in the US. A search (January 2019 to September 2024) was conducted across CINAHL, Medline (OVID), and PubMed databases using PRISMA guidelines and relevant MeSH terms. Studies were included if they were peer-reviewed, quantitative, US-based, and involved youth ages 12-26. Fifteen studies met inclusion criteria and were critically appraised for quality. The Social Ecological Model guided analysis. Findings revealed that cannabis use is shaped by multi-level influences. At the individual level, older age, early initiation, lower perceived risk of harm, and polysubstance use were key risk factors. At the interpersonal level, peer influence, parental acceptance of cannabis use, and family structure played prominent roles, with peer disapproval and parental monitoring emerging as strong protective factors. At the community level, perceived neighborhood stress, social media exposure, and proximity to cannabis dispensaries contributed to increased use, while school connectedness and extracurricular involvement served as protective influences. At the societal level, cannabis legalization and lower socioeconomic status were associated with increased use and normalization of behavior. Gender disparities in use are narrowing, with similar rates reported among males and females. This review underscores the need for multi-level interventions that address peer and familial norms, promote public education to increase perceived harm, and account for environmental and policy contexts. Evidence-based strategies targeting individual, relational, community, and societal factors are essential to reduce cannabis use and mitigate its adverse effects among youth.

Peripheral venous cannulation is a common invasive procedure with a high failure rate, particularly challenging in children and young patients due to their unique anatomical characteristics. This study evaluated the effectiveness of local heat and massage in facilitating venous access in hospitalized children with difficult access. A single-blind randomized controlled trial was conducted at Children's Hospital in Tabriz from December 20, 2023, to May 9, 2024. Ninety-six children aged 6 to 12 years were enrolled and randomly assigned to three groups: two intervention groups and one control group. In the first intervention group, an electric heating pad at 40 ± 2 degrees Celsius was applied to the venous access site for 5 minutes. In the second intervention group, a gentle circular massage from the wrist to the cubital fossa was performed for at least 2 minutes. Outcomes included pain scores using the Visual Analogue Scale (VAS), time spent, and number of attempts for venous access, along with vein assessment using the Vein Assessment Scale (VAS). Data were analyzed using SPSS version 23. No significant differences were found in demographic factors among the groups (p > .05). The vein assessment showed improved visibility and palpability with local heat and massage. Pain scores significantly decreased in both intervention groups (p ≤ .001), with the local heat group reporting lower mean pain scores and shorter cannulation duration compared to the massage group (p ≤ .001). No significant differences were observed in the frequency of cannulation attempts (p > .05). Applying local heat and massaging the venous cannulation site prior to venous cannulation significantly increases the ease of venous access. However, in a comparison of these two methods, local heat was more effective than massage in reducing perceived pain in children with difficult access. Therefore, using local heat can be recommended as a simple and cost-effective intervention.

Pediatric palliative care (PPC) places mothers in an extremely challenging situation, where they must confront not just the approaching death of their child, but also their own suffering. In this context, hospitalization at home (HaH) is often the preferred choice for children and parents alike since it offers the comfort of a familiar setting and the reassuring presence of family. Yet, there is limited research into how the home setting may impact the maternal experience of a dying child. This qualitative study aims to capture the intimate experience of mothers in PPC during the HaH of a child dying of cancer and to explore how they make sense of this specific experience. Non-directive interviews with three mothers were conducted and submitted to an interpretative phenomenological analysis. We identified one major theme made up of three sub-themes: waiting, uncertainty and life on hold. These three dimensions do not merely represent psychological states: they are part of a process in which the impending death is not just an imminent event, but a reality that is already active, progressive and psychologically invasive. This process may have an impact on the course of the mother's subsequent bereavement, which is an important consideration for professionals to integrate into their supportive interventions.

Children are vulnerable to hemodynamic instability due to their distinct physiological characteristics, including a higher circulating blood volume relative to body weight. This physiological difference reduces their ability to tolerate blood loss. The aim of this study was to assess the effect of blood component transfusions on vital signs among children. A descriptive cross-sectional study design was carried out. All children who received blood component transfusions (60 children). The study was conducted in Pediatric Intensive Care Unit, Pediatric Medical Unit, and Pediatric Surgical Unit at King Abdulaziz University Hospital in Jeddah City. During the blood component transfusions, all children were assessed for vital signs before, during, and after the transfusion. One tool was used to collect data. Tool I: A standardized blood component transfusions observational checklist, developed by the National Standards for Blood Transfusion Service (2013) and based on the first edition by the World Health Organization (WHO), was used to assess blood component transfusions and vital signs 15 minutes before, during, and one hour after blood component transfusion. The findings of this study revealed that blood component transfusions have no statistically significant effect on vital signs among children who received blood component transfusions before, during, and after transfusion. Blood component transfusions (packed red blood cells, fresh frozen plasma, and platelet concentrate) showed no statistically significant effect on vital signs (before, during, and after the transfusion). However, gender significantly impacted the mean temperature and blood pressure values during the transfusion. In contrast, other socio-demographic variables, such as blood group and blood component, did not influence the vital signs throughout the process.

Background: Children who complete brain tumor treatment encounter ongoing problems with functioning that fluctuate over time. Previous studies shows that health care and schools tend to focus more on the child's cancer-related body symptoms, rather than on existing problems to participate and manage everyday life activities, or moreover of environmental barriers they face. Few studies address how the child's problems to function on body, activity and participation levels co-occur and are presented over time. Therefore, this study´s purpose is to describe how documented problems with functioning, vary over time in children who have completed brain tumor treatment.

Methods: Medical and school records from seven children were reviewed for up to 5 years after treatment completion, to identify problems and link these to International Classification of Functioning, Disability and Health (ICF) code domains. The coded data were divided into six-month blocks over a 4-year time period, analyzed statistically and illustrated graphically. Code variations on group-levels and patterns of body, activity and environmental codes that tentatively co-occurred with participation were exemplified in a child-case, using a collaborative problem-solving (CPS) approach.

Results: Based on median (Md) number of codes within participation, activity, body and environment, the children exhibited ongoing problems with body function over time (Md 11-18). Activity-related problems were most noticeable about 1-year post-treatment completion (Md 6), and participation problems (Md 1-2) persisted throughout the follow-up period. Documentation of environmental problems was limited but increased after 3 years (Md 3). In the child-case example, participation problems with self-care, schooling and peer-relations continued across the years, with plausible explanations related to problems with communication and fine-hand function (activity), fatigue (body function) and with surrounding supportive systems (environment).

Conclusion: Over time, professionals' documentation predominantly focused on problems with the child's body function, while functioning in everyday life and environmental barriers affecting participation, was often neglected. By using the ICF and CPS, service professionals, including nurses, are provided with guidance for comprehensive and systematic approach of addressing patterns of co-occurring problems with functioning, which could lead to improved support to optimize the child's participation in everyday life.

Across the globe, the COVID-19 pandemic and the resulting public health measures significantly impacted the lives of families with young children. The emerging tensions surrounding the loss of social interactions for young children, 0-8 years, during the pandemic, as evident in recent literature, have sparked our interest. To explore this from a Canada-wide perspective, we delved into a subset of data from a national mixed methods survey conducted in 2021, examining the impact and projected psychological and social concerns of the COVID-19 pandemic. This subset included responses from 688 participants who identified as primary daily caregivers of children aged 0-8 years. The study employed descriptive statistics and thematic analysis to fill an evidence gap around the possible effects of the pandemic on caregivers' concerns for their child's social and emotional development. Findings revealed that parents/caregivers ranked their child's social and emotional development as their highest concern during and after the pandemic; connecting it to the loss or lack of socialization, increases in screen time, and the lack of participation in early years education and community programs. Moving forward from the pandemic, this study's results help us understand where focused attention may be needed to support young children's development and consider areas where parents stress may remain high post-pandemic, to inform service design and policy direction.

The use of traditional and complementary medicine is increasing in the population with developmental disabilities, including children diagnosed with autistic spectrum conditions (ASC). Despite the growing use of T&CM, limited research exists on its use in ASC populations. This study aims to explore the attitudes and behaviors of mothers with children diagnosed with ASC regarding of traditional and complementary medicine (T&CM) use and identify the factors influencing their decisions. This descriptive study was conducted with a total of 149 mothers of children diagnosed with ASC under the age of 18 who were receiving education in seven special education and rehabilitation centers. Data were collected using the Socio-Demographic Characteristics Questionnaire, the Diagnostic Form for the Use of Traditional and Complementary Treatment Practices, and the Attitude toward the Holistic Complementary and Alternative Medicine Questionnaire. Descriptive and inferential statistics were used to analyze the data. The findings revealed that 27.5% of mothers used T&CM for their children, with vitamins and minerals being the most commonly used forms (65.9%). Higher maternal education and paternal self-employment were significantly associated with T&CM use (p < .05). The study suggests that healthcare professionals should be aware of the widespread use of T&CM and provide parents with accurate information regarding these practices. These findings underscore the importance of healthcare professionals being informed about the prevalence of T&CM use in children with ASC and proactively guiding families with evidence-based information. Further research is warranted to assess the safety and effectiveness of these practices in this vulnerable population.

Communication is a right of children, a pillar of the philosophy of Child-Centered Care and health advocacy, and a priority for research. Despite the widespread recognition that developmentally appropriate information has a positive effect on children's healthcare experience, their information needs remain unmet. Giving voice to the child's experience is vital for transforming this scenario. In our study, we aimed to understand the perspective of hospitalized children regarding the sharing of information by healthcare professionals. A descriptive, qualitative study was developed, grounded in the philosophy of Child-Centered Care. Thirty school-aged children, hospitalized in a pediatric inpatient unit at an university hospital in São Paulo, Brazil, participated in the study. Data collection occurred between July 2023 and May 2024 through semi-structured individual interviews, analyzed using Inductive Thematic Analysis and Lexical Analysis. Four themes emerged: 1) Family members: source of information, support, and comfort; 2) Individual information needs; 3) Barriers to understanding information; and 4) Identifying encouraging information. In summary, for children, the sharing of information by healthcare professionals is permeated by barriers that hinder their understanding, requiring them to turn to family members to decode messages, as they often feel shy about directing questions to the healthcare professionals. During hospitalization, children identify information shared by the team, such as the possibility of attending the playroom and the pedagogy room, as powerful in alleviating boredom, promoting cheerfulness, and supporting learning.