Sexuality in early childhood: pediatric nurses' attitudes,knowledge, and clinical practice

This exploratory study assessed pediatric nurses' attitudes, knowledge, and patient care practices related to the sexuality of hospitalized preschool and early school-age children. Sexuality was defined as the sum of the physical, emotional, and psychologic attributes that are expressed in gender identity and behavior. For this study, a questionnaire containing 24 attitude, 20 knowledge, and 29 nursing practice Likert-scale items was used to survey 45 pediatric nurses in a southeastern tertiary care teaching hospital. Results indicated that, in general, the nurses surveyed had positive attitudes, sound knowledge, and appropriate practice with regard to the sexuality-related needs of their patients. However, there appeared to be some attitudinal biases and knowledge gaps that could adversely affect nursing practice. These findings were used to alter the content in pediatric nursing education at the study institution.     

以家庭为中心儿科护理模式创建与评价

目的：探索以家庭为中心儿科护理模式,提升患儿及家长的满意度和患儿安全。方法：创建以家庭为中心儿科护理模式,包括制定以家庭为中心儿科护理政策,配备数量充足和资历合格的护理人员,明确总责护士和责任护士的具体职责,对临床护理人员进行以家庭为中心儿科护理理论和实践的培训与考核,研制工具以评价护理人员执行以家庭为中心护理措施的情况,评价以家庭为中心儿科护理模式的实施效果。结果：患儿家长对以家庭为中心儿科护理模式的总体满意度为93.5%,患儿安全指标如给药错误发生率、跌倒/坠床发生率明显下降。结论：把以家庭为中心儿科护理理念转化为行动,深入到儿科护理实践的方方面面是一个长期持久的过程。而在患儿危机时刻,让家长和孩子在一起更是一个巨大的挑战,需要医护人员和患儿家长共同努力。     

Nurses' attitudes toward continuing formal education: a comparison by level of education and geography

The education of nurses has an influence on patient safety and outcomes, the nursing shortage, the faculty shortage, and nurses' attitudes and actions. This article reports on a dissertation study designed to examine the attitudes of nurses, initially registered with an associate degree or diploma in nursing, toward continuing formal education. Actively licensed registered nurses in the eastern and western United States (n=535) participated. The main finding of this study was that, although nurses held positive attitudes overall, attitudes ranked barely above neutral. The findings suggest that work needs to be done to improve nurses' attitudes toward continuing formal education and research needs to be undertaken to understand what would entice nurses back to school. Implications for nursing practice and education are discussed along with suggestions for future research.     

A survey of pediatric nurses' knowledge about breastfeeding.

The purpose of this study was to obtain baseline data on pediatric nurses' knowledge about breastfeeding, to inform an education program being developed in a large Melbourne pediatric teaching hospital. A pediatric breastfeeding questionnaire was developed. A random sample of 278 nurses in a variety of clinical units was selected. The questionnaire return rate was 54%. Overall, the difference in the mean percentage knowledge scores between the most experienced and the least experienced nurses was small. The result indicate that an ongoing lactation education program and a Breastfeeding Day-Stay Unit would benefit nursing staff, mothers, and babies.     

Nurse characteristics and inferences about children's pain

The purpose of this study was to describe pediatric nurses' projected responses to children's pain as described in vignettes of hospitalized children and to explore nurse characteristics that might influence those responses. A survey was mailed to a national random sample of 700 RNs, and 334 nurses responded. The survey included case reports of three hospitalized school-aged children experiencing pain. Nurses were asked to rate their perceptions of the children's pain levels and to indicate how much analgesia they would recommend. Contrary to earlier studies, in response to the scenarios, nurses in this sample perceived high levels of pain, said they would administer doses of analgesia close to the maximum prescribed by physicians, and recommended an array of non-pharmacologic methods to treat pain. Variation in pain perceptions and decisions was not related to key personal and professional characteristics of the nurses, including their education level, race/ethnicity, age, years of clinical experience, and receipt of continuing education about pain. Findings from this large national study suggest that most nurses would make appropriate decisions relating to the treatment of children's pain, perhaps reflecting changes in the emphasis on pain management.     

Evaluation of a gerontological nursing continuing education programme: effect on nurses'' knowledge and attitudes and on patients'' perceptions and satisfaction

The purpose of this study was to evaluate the effects of a four-session (8-hour) gerontological nursing continuing education (CE) programme on nurses' knowlege of and attitudes towards the elderly. The study also sought to ascertain the effects of the CE programme on patient satisfaction with and perceptions of nursing care. Seventy-six nurses completed the Miller-Dodder Revision of the Palmore Facts on Ageing Quiz and the Kogan Attitudes Towards Old People Scale before and after participating in the CE programme. Post-test scores on both measures were slightly but significantly higher than pretest scores. Thirty hospitalized elderly patients were interviewed before and 33 were interviewed after the CE programme was offered to the nurses on their hospital units, using the LaMonica-Oberst Patient Satisfaction Scale and the Harrison-Novak Patient Perception Scale. Post-test measures of patient satisfaction and perception were not significantly different from pretest scores. Patients were generally satisfied with their nursing care, but perceived that nurses did not focus on health promotion activities. In addition, 59% of the patients indicated that they were unable to distinguish nurses from other health care providers. The article identifies implications of the study for nursing education, practice and research.     

Nurse-patient relationship: a dichotomy of expectations

The nurse-patient relationship has traditionally been viewed as the essence of nursing practice. This paper disputes that the ideals of such a relationship occur effortlessly in nursing practice. Findings from a phenomenological study of individuals hospitalized with a depressive illness found that a therapeutic relationship did not come instinctively to the mental health nurses, and that there was a dichotomy between the close relationship expected by patients and the distant relationship provided by nurses. It is unclear whether nurses' distancing behaviour was as a result of the participant's depressive illness, a normal part of nursing practice, or whether other features such as nurses' workloads were an influencing factor. Further research is required to explore this issue.     

Use of toys in hospitals: what are Brazilian nurses studying?

Care for the emotional needs of hospitalized children has had the attention of nursing professionals in Brazil, although not as a general rule. The chance to play is known as a relief from suffering, especially in childhood, which justifies the importance of this theme. This study had the objective of analyzing Brazilian nurses' academic production on the use of toys during the attention to children in hospitals in strictu sensu Graduate programs. Data were taken from Portal CAPES, CEPEn, IBICT and papers' references. Of the 15 theses/dissertations found in the literature only 14 are available; they were analyzed and comprise the corpus of this study. It was found that toys have been used mostly in pre and postsurgery, by Nursing professors, with preschool and school age children, parents and nurses. All of the works reinforce the positive results of toys' use. We recommend to pediatric nurses the use of toys in all institutions where children need care.     

Nurses' beliefs about their abilities to delegate within changing models of care

Changing models of nursing care have resulted in a more diverse work force composition. Nurses (RNs and licensed practical and vocational nurses) have greater responsibilities for delegation and supervision of unlicensed assistive personnel providing direct nursing care. This study describes nurses' beliefs about their abilities to delegate and supervise direct nursing activities and explores differences based on professional and job-related factors. A national sample of 148 licensed nurses working in three practice settings was surveyed. In general, nurses reported a high level of comfort, frequency, preparedness, confidence, competence, and control. Differences found in nurses' beliefs were based on education, practice setting, and type of work responsibilities.     

Bringing magic to the nursing workforce of the future

How can nursing education respond to the ominous signs of a serious shortage of nurses in the future? One answer to this question is a focus on reclaiming nurses' stories of the "real-world" of nursing practice. In the process of creating a childrens book, The Magic Stethoscope, a group of nurse authors found a new appreciation for the stories of their practice and the need to share these stories with children. The authors hope that these stories will inspire children to consider the exciting career opportunities for the nursing workforce of the future.     

Student nurses' knowledge, attitudes, and self-efficacy of children's pain management: evaluation of an education program in Taiwan

The purpose of this study was to examine the effectiveness of a pediatric pain education program (PPEP) for student nurses. The sample consisted of 181 licensed student nurses who were enrolled in a nursing school in Taiwan. Student nurses attended a 4-hour PPEP that involved case scenario discussion, video, and lecture. Data were collected by an extensive questionnaire that assessed student nurses' knowledge of, attitudes toward, and self-efficacy in pediatric pain assessment and pharmacological and nonpharmacological pain management. The results demonstrated that student nurses gained significant knowledge of pediatric pain, expressed more appropriate attitudes, and reported greater self-efficacy in children's pain management after attending PPEP. Their knowledge of analgesic pharmacotherapy did not significantly improve. These results suggest that PPEP should be integrated into pediatric nursing curricula to enhance knowledge and skills regarding children's pain management during the early stage of a nursing career.     

Self-reports of recovery-oriented practices of mental health nurses in state mental health institutes: development of a measure

The focus of this study was to modify a measure of recovery practice for mental health nurses and explore nurses' self reports of recovery practices. Findings support the soundness of the Recovery Self Assessment-Registered Nurse Version (RSA-RN) as a self-assessment instrument designed to evaluate recovery-oriented nursing practice. More favorable perceptions of recovery practices were noted amongst older and more experienced nurses, those who had previous formal training or education in mental health recovery or psychiatric rehabilitation, and those who considered their facilities to be recovery-oriented. The RSA-RN can be use to identify nurses' and nursing departments' strengths in the provision of recovery-oriented interventions and lead to focused performance improvement.     

A comparative study of nurses' and elderly patients' ratings of pain and pain tolerance

The purpose of this study was to compare elderly patients' and nurses' ratings of pain and pain tolerance. Data were collected through structured interviews with the patients. The attending nurses completed a questionnaire after conducting a pain assessment. Independent of each other, patients and nurses were asked to rate on a VAS when pain should be treated (pain tolerance) and pain intensity. The VAS has been used both by patients and nurses. The initial selection consisted of 43 patients; however, 9% (n = 4) were unable to complete the VAS. These patients were not significantly older than those who completed the study (n = 39). The results shows that nurses tend to overestimate mild pain and underestimate severe pain. Nurses rated pain tolerance significantly lower than patients. The results also suggest that nurses with training beyond basic nursing education tend to assess patients' pain more accurately than those without additional training. For patients who reported that they had pain prior to hospitalization, the nurses' pain ratings showed a higher agreement than for those who reported that they did not have pain before being hospitalized. At the time of the interviews, 21% (n = 8) of patients felt that their pain was so great they needed treatment. Those patients also were recognized by the attending nurses as being in pain. To improve elderly patients' pain management, practicing nurses must collaborate with researchers to develop specific empirical research nursing knowledge within geriatric pain management. This research-based knowledge should be incorporated into nurses' clinical practice regarding pain management. Specific guidelines must be developed for the assessment, treatment, and documentation of elderly patients' pain.     

Registered nurses' expectations and experiences of first year students' clinical skills and knowledge

BACKGROUND: Clinical education is a fundamental component of nurse education. In theory, this aspect involves integrated input from registered nurses, clinical educators and university lecturers. Registered nurses are important contributors to this process and play a major role in influencing and shaping undergraduate nursing students' early clinical experiences. Despite this important function, their voice has been somewhat neglected. Little is known about registered nurses' expectations and experiences of first year aduate nursing students undertaking their first clinical placement. AIM: The aim of this study was to explore registered nurses' expectations and experiences of first year undergraduate students' levels of knowledge and clinical skills. METHOD: Three consecutive focus groups were conducted with a purposive sample of 16 registered nurses. Interviews were audiotaped and transcribed and thematic analysis applied to the data to identfy themes imbedded in the data sets. FINDINGS: Three main themes emerged: (1) Clinical nursing skills (2) Knowledge requirements and (3) Experiences of reality shock. The findings highlight that registered nurses' expectations of first year students' clinical skills and knowledge were not consistently met. Registered nurses placed significant emphasis upon a range of basic skills, but acknowledged that some aspects of nursing knowledge can only be learned through experience. Furthermore, they demonstrated a considerable degree of empathy surrounding the reality shock that students might experience during early clinical placement. CONCLUSION: Findings from this study suggest that registered nurses and academics differ in their perceptions surrounding the level of clinical skills first year students should have during their first clinical placement. There appears to be a two way theory practice gap between registered nurses in clinical practice and academics in tertiary institutions. Improved communication between registered nurses and providers of nurse education may assist in addressing some of the issues raised by this study and reduce the theory practice gap, which remains 'alive and well'.     

Patient education needs as reported by congestive heart failure patients and their nurses

Patients with congestive heart failure (CHF) need considerable education to enable them to provide effective self-care for their chronic illness. No information has been published about the learning needs of this population. The purpose of this study was to examine hospitalized CHF patients and their nurses' perceptions regarding the importance and realism of typical patient education content. An instrument to assess learning needs was developed and piloted for use in this study. Thirty hospitalized patients and 26 nurses were surveyed. Both nurses and patients rated all information as important to learn and realistic to learn during the patients' hospitalizations. Patients and nurses agreed that medication information was the most important to learn. Generally, patients rated information as more important than nurses rated the same information areas. Suggested nursing interventions and future research endeavours are addressed.     

Effect of a geriatric nurse education program on the knowledge, attitudes, and certification of hospital nurses

Although nurses are the primary care providers for hospitalized and vulnerable older adults living in the community, they are generally not prepared in geriatric care. This study examined the effect of a 21-hour nursing education program on nurses' knowledge and attitudes regarding care of older adults and the geriatric nursing certification of the participants. The program was offered to 92 nurses in three cohorts over a 1-year period. Participants completed pre- and posttest measures of geriatric knowledge and attitudes. Significant differences were found between pretest and posttest knowledge and attitudes. Program evaluation and success in achieving certification in gerontological nursing also indicated a positive effect of the program.     

Pediatric nurses' attitudes toward hospice and pediatric palliative care

Several studies have investigated nurses' attitudes toward hospice and palliative care for adults, yet little information exists about pediatrics. Assessing pediatric nurses' attitudes is especially important in Florida, where a publicly funded pediatric palliative care program operates in eight cities across the State. The aims of this study were 1) to assess the attitudes toward hospice and palliative care, and 2) to examine the associations between sociodemographic and nursing care factors and nurses' attitudes toward hospice and palliative care. A cross-sectional research design using online and mail-in survey data was used to address the study aims. Surveys were conducted with 279 pediatric nurses across Florida. Bivariate results showed there were significant differences between the attitudes of pediatric nurses employed in a city with a pediatric palliative care program versus those not employed in a program site (p = 0.05). Multivariate analyses also showed that being employed in a program site increased attitudinal scores toward hospice and pediatric palliative care by 0.6 points. Beyond being employed in an area city where a pediatric palliative care program operates, results also suggest that having prior training in palliative care could alter nurses' attitudes, which might subsequently lead to increased referrals and improved outcomes for children and families.     

Therapeutic play

Atraumatic care is one of the important principles in pediatric nursing. Immature cognitive development, however, and limited coping ability exacerbate tension when children are ill and require hospitalization. Therapeutic play has been demonstrated as an effective nursing intervention. Through therapeutic play, children can acquire opportunities to express themselves and deal with stress related to health experiences. Also, nurses can gain insights into children's cognition, perception, and needs. This paper introduces concepts of therapeutic play. We hope that nurses will be able to incorporate it into pediatric nursing practice and provide care as atraumatically as possible.     

'Something always comes up': nurse-patient interaction in an acute psychiatric setting

In this study, 10 nurses and 10 patients were interviewed to explore factors influencing nurse-patient interactions in an acute psychiatric inpatient facility. The six themes that emerged from the nursing interviews were; environment, something always comes up, nurses' attributes, patient factors, instrumental support and focus of nursing. The four themes from the patient interviews were; nurses' attributes, role perceptions, clinical care, and time. These findings have implications for clinical practice, the nurses' role and nursing education.