The power of words: examining the linguistic landscape of pediatric nursing

The purposes of this article are to increase pediatric nurses' awareness of language use and to suggest strategies that foster therapeutic communication for the benefit of children and parents. The use of jargon, labels, metaphors, and parental expressions of stress are examined from the context of therapeutic communication in nursing practice. Evidence of language use is substantiated by theory, submissions to a Web site that features narratives from youngsters coping with disease and disability, and interactions with children in hospitals. Practice recommendations are made for the integration of language that protects children's self-esteem.     

Preserving dignity in the young hospitalized child

TOPIC: Bodily intrusion and exposure are common experiences for hospitalized children. Placing children in such compromising situations can have a significant impact on their self-perception. PURPOSE: To recognize pediatric patients' inherent powerlessness in the hospital setting and suggest strategies to overcome it. SOURCES: Published literature and author's clinical experiences. CONCLUSIONS: Nurses have a key role in ensuring that the psychosocial issues of privacy, modesty, and self-esteem are recognized, respected, and incorporated appropriately into their clinical practice when caring for hospitalized children.     

Adoption law: a district nurse's guide

The Government wants to see a large rise in the use of adoption as a means of giving children a secure, loving and permanent home. Guidance coming into effect from April calls for a more pragmatic approach to adoption placements, and calls for the active promotion of the adoption process by health and social care professionals. District nurses will encounter people interested in becoming prospective adopters, but who are unsure if their background or lifestyle makes them eligible. It is essential that district nurses have a working understanding of the guidance and provisions of the Adoption and Children Act 2002 to confidently advise others about adoption and clarify any issues raised.     

African Americans and obesity: implications for clinical nurse specialist practice

PURPOSE/OBJECTIVE: The purpose of this article is to examine the connection between genes, culture, and environment in the development of obesity and its impact on the health of African Americans. This information will be utilized to facilitate the design of weight management programs for African Americans. RATIONALE: Literature review of the connection between the above variables revealed a disproportionate amount of health risks associated with excess weight in African Americans. Several nonfatal consequences of obesity were noted to impact quality of life but improved significantly with small reductions in body weight. However, factors that affect weight in a culturally relevant context were seldom addressed and few intervention programs were specifically designed to treat minorities with obesity issues. DESCRIPTION: This article describes the role that genetic, cultural, and environmental factors play in energy regulation. Factors that impact lifestyle changes, self-esteem, public awareness, participation, and community involvement are highlighted. OUTCOME: Providing healing environments that are culturally acceptable can empower individuals to commit to goals as well as influence others who are resistant to change. Public awareness tools designed by clinical nurse specialists (CNSs) that appeal to ethnic values can facilitate cooperation and enhance successful outcomes. CONCLUSION: Despite genetic susceptibility to obesity, research on the African diaspora emphasized that obesity tends to be expressed in environmental conditions that are markedly different from ancestral origin. (Kruger A, Kruger HS, MacIntyre U, et al. S Afr J Sci. 2000;96:505-513. Available at: www.nrf.ac.za/sajs/absepooj.stm. Accessed April 11, 2004.) Black adults therefore have much to gain from weight management strategies that address the complexity of the disorder and are sensitive to cultural issues. IMPLICATIONS FOR NURSING PRACTICE: CNSs with advanced knowledge of the impact of obesity on health and wellness are in a unique position to utilize research-based data in the design of weight management programs for diverse populations. In practice, cultural variables that significantly impact the complex issues of weight control should be addressed in the study and treatment of obesity in black populations. By researching what is available to the community, CNSs can evaluate programs that may require adaptation to encourage greater participation.     

Why pediatric health care providers are not using homeopathic antidiarrheal agents

OBJECTIVES: Several randomized, controlled trials have demonstrated the efficacy of homeopathic agents for use in childhood diarrhea. However, this therapeutic innovation is not being routinely adopted. We chose to study the degree of adoption as well as the perceived reasons for failure to adopt homeopathic antidiarrheal agents by pediatric health care providers. Additionally, we sought to determine if these agents are likely to be adopted in the future. DESIGN: This study was a self-administered survey, including a standardized scale of innovativeness. SUBJECTS: Subjects for this study were pediatric health care providers, and interventions consisted of abstracted results of two randomized, controlled, double-blinded studies reporting on the efficacy of homeopathic antidiarrheal agents. OUTCOME MEASURES: Outcome measures consisted of reports of the current treatment approach to childhood diarrhea, innovativeness, perceptions homeopathic antidiarrheal agent efficacy, and barriers to use, before and after reading the abstracts. RESULTS: We obtained a 61% response rate. Only 3% of surveyed respondents use homeopathic antidiarrheal agents. Lack of experiential knowledge, awareness, concerns of effectiveness, and safety were the greatest barriers to adoption. More respondents felt that homeopathic antidiarrheal agents were efficacious after reading supportive abstracts, but this did not increase their willingness to use these agents. Adoption did not correlate with individual innovativeness. CONCLUSIONS: The use of homeopathic antidiarrheal agents for childhood diarrhea is a minimally adopted innovation. Lack of correlation between adoption and individual innovativeness may suggest that this innovation is unlikely to be adopted in the future without intervention. Current barriers to adoption reveal that a stronger evidence base, and efforts to increase awareness and experiential knowledge, would be necessary to increase adoption. The results reported in this paper are discussed in the context of current theories on knowledge translation in medicine.     

Promoting positive parenting: an annotated bibliography

Positive parenting is built on respect for children and helps develop self-esteem, inner discipline, self-confidence, responsibility, and resourcefulness. Positive parenting is also good for parents: parents feel good about parenting well. It builds a sense of dignity. Positive parenting can be learned. Understanding normal development is a first step, so that parents can distinguish common behaviors in a stage of development from "problems." Central to positive parenting is developing thoughtful approaches to child guidance that can be used in place of anger, manipulation, punishment, and rewards. Support for developing creative and loving approaches to meet special parenting challenges, such as temperament, disabilities, separation and loss, and adoption, is sometimes necessary as well. This annotated bibliography offers resources to professionals helping parents and to parents wishing to develop positive parenting skills.     

Adoption of a sedation scoring system and sedation guideline in an intensive care unit

AIM: The paper presents a study assessing the rate of adoption of a sedation scoring system and sedation guideline. BACKGROUND: Clinical practice guidelines including sedation guidelines have been shown to improve patient outcomes by standardizing care. In particular sedation guidelines have been shown to be beneficial for intensive care patients by reducing the duration of ventilation. Despite the acceptance that clinical practice guidelines are beneficial, adoption rates are rarely measured. Adoption data may reveal other factors which contribute to improved outcomes. Therefore, the usefulness of the guideline may be more appropriately assessed by collecting adoption data. METHOD: A quasi-experimental pre-intervention and postintervention quality improvement design was used. Adoption was operationalized as documentation of sedation score every 4 hours and use of the sedation and analgesic medications suggested in the guideline. Adoption data were collected from patients' charts on a random day of the month; all patients in the intensive care unit on that day were assigned an adoption category. Sedation scoring system adoption data were collected before implementation of a sedation guideline, which was implemented using an intensive information-giving strategy, and guideline adoption data were fed back to bedside nurses. After implementation of the guideline, adoption data were collected for both the sedation scoring system and the guideline. The data were collected in the years 2002-2004. FINDINGS: The sedation scoring system was not used extensively in the pre-intervention phase of the study; however, this improved in the postintervention phase. The findings suggest that the sedation guideline was gradually adopted following implementation in the postintervention phase of the study. Field notes taken during the implementation of the sedation scoring system and the guideline reveal widespread acceptance of both. CONCLUSION: Measurement of adoption is a complex process. Appropriate operationalization contributes to greater accuracy. Further investigation is warranted to establish the intensity and extent of implementation required to positively affect patient outcomes.     

Future life expectations and self-esteem of the adolescent survivor of childhood cancer.

The number of adolescent cancer survivors has increased dramatically over the past decade as the result of improved treatment and diagnostic techniques. This population brings with them unique characteristics and concerns. The present study consisted of interviews with 10 adolescent survivors of childhood cancer and their parents. It investigated the adolescent's present self-esteem, the future life expectations held by both the teenagers and parents, and the relationship between the variables. Results indicated that the adolescents felt moderately competent in their lives (measures of self-esteem) and the parents felt more certain than their children that the teenagers would accomplish the tasks deemed appropriate for entry into a healthy adulthood. Pearson correlations showed a strong relationship between parents' future life expectations and adolescents' self-esteem (r = .82; P = .002), but not between parents' and adolescents' future life expectations or between the adolescents' future life expectations and self-esteem. The results are significant in addressing the impact parents can have on their child's self-esteem.     

Research and organizational issues for the implementation of family work in community psychiatric services

BACKGROUND: The need for evidence-based practice (EBP) to guide and develop mental health services remains fundamental for modern services. Aim. To discuss issues that impact upon implementation of EBP and practice development using family work (FW) as an example. METHODS: A selection of the FW literature was reviewed drawing on sources including the Cochrane Library, Cinahl and Medline. Keywords used were FW, community mental health team and research design. FINDINGS: Centralized policy initiatives and guidelines that are themselves guided by evidence of randomized controlled trials predominantly risk alienating practitioners and clients/carers. Family work has some demonstrable clinical benefits although models differ and the active therapeutic agent remains unclear. Its adoption into routine care is also hindered by a productivity management outlook that seeks to maximize stretched resources and whose values are likely to be internalized by practitioners. The dichotomous position of previous research and practice development make implementation of EBP difficult and highlights the need for strategic planning that embraces both factors. CONCLUSION: The current drive to increase EBP requires a bi-directional process of influence that allows individual practitioners and clients/carers to become producers of evidence and not simply recipients. The authors support wider adoption of case study research designs to reflect the unpredictable nature of mental health care. Adoption of assertive community treatment models within community services is most likely to promote the excellence management model and accommodate EBP such as FW.     

Self-concept of Children of Alcoholics: Part I. Family Influences

This paper focuses on the processes by which alcoholic parents affect their children's self-esteem. The impact of families on children's self-concept and self-esteem is examined within the framework of a transactional model of self-concept development. Next, a model of self-esteem for children of alcoholics, including risk factors and protective factors for self-esteem, is proposed. It is suggested that alcoholic parents influence their children's self-concepts so that their children judge themselves on unique dimensions, and use atypical standards to interpret their behaviors. The result is that the children do not learn to realistically assess their strengths and abilities. Finally, the role of social support, within families and from other persons, is explored in relation to self-esteem.     

The hidden challenges in role transitions and how leadership coaching can help new leaders find solid ground

Leadership coaching is becoming an increasingly important intervention that helps individual nurse executives and managers develop and use the best of their strengths, gifts, and talents. As the need for leadership in nursing becomes urgent and brave souls move into the positions of greater authority and potential impact, they will face challenges as they move up in rank. This article identifies the hidden and often-overlooked challenges that are faced by new leaders as they transition into roles of increased responsibility, and it demonstrates how leadership coaching can help new leaders make successful transitions. As the current health care crisis creates opportunity for new leaders, those who opt for promotions and lateral shifts encounter both expected and surprising challenges. The expected challenges include mastering new content skills, learning new organizational structures, and getting to know new teams. The less obvious stressors include issues of self-esteem, assertiveness, self-consciousness, self-criticism, perfectionism, new boundaries, changing identities, and finding one's own leadership style. These important issues are often kept out of conscious awareness and overlooked at great cost to the individual leader and her institution. Leadership coaching can provide support and practical strategies for managing and overcoming these hidden challenges.     

Current state of information technologies for the clinical research enterprise across academic medical centers

Information technology (IT) to support clinical research has steadily grown over the past 10 years. Many new applications at the enterprise level are available to assist with the numerous tasks necessary in performing clinical research. However, it is not clear how rapidly this technology is being adopted or whether it is making an impact upon how clinical research is being performed. The Clinical Research Forum's IT Roundtable performed a survey of 17 representative academic medical centers (AMCs) to understand the adoption rate and implementation strategies within this field. The results were compared with similar surveys from 4 and 6 years ago. We found the adoption rate for four prominent areas of IT-supported clinical research had increased remarkably, specifically regulatory compliance, electronic data capture for clinical trials, data repositories for secondary use of clinical data, and infrastructure for supporting collaboration. Adoption of other areas of clinical research IT was more irregular with wider differences between AMCs. These differences appeared to be partially due to a set of openly available applications that have emerged to occupy an important place in the landscape of clinical research enterprise-level support at AMC's.     

The loss of self: The effect of miscarriage,stillbirth, and child death on maternal self-esteem

A child’s death augments how grieving parents view the world, the family, and the self. Using a representative sample of women ages 25–45 who have ever given birth, we assessed whether miscarriage, stillbirth, and child death impact self-esteem and whether this loss is moderated by maternal identity. We found that stillbirth and child death, but not miscarriage, negatively impacted self-esteem. For those who experienced a loss, the impact on self-esteem was moderated by maternal identity. Women who experienced a stillbirth were the only group who had significantly lower self-esteem after controlling for background characteristics and maternal identity variables.     

Parent–Child Communication Processes: Preventing Children''s Health-Risk Behavior

PURPOSE: Review individual, family, and environmental factors that predict health-risk behavior among children and to propose parent-child communication processes as a mechanism to mediate them. CONCLUSIONS: Improving parent-child communication processes may: reduce individual risk factors, such as poor academic achievement or self-esteem; modify parenting practices such as providing regulation and structure and acting as models of health behavior; and facilitate discussion about factors that lead to involvement in health-risk behaviors. PRACTICE IMPLICATIONS: Assessment strategies to identify youth at risk for health-risk behavior are recommended and community-based strategies to improve communication among parents and children need development.     

Predictors of adopting therapeutic hypothermia for post-cardiac arrest patients among Canadian emergency and critical care physicians

Therapeutic hypothermia improves outcomes in resuscitated cardiac arrest patients, but prior application rates are less than 30%. We sought to evaluate self-reported physician adoption, predictors of adoption, and barriers to use among Canadian emergency and critical care physicians.A web-based modified Dillman questionnaire asked all physicians on the membership lists of the Canadian Association of Emergency Physicians and the Canadian Critical Care Forum physicians to report their experience with therapeutic hypothermia using the Pathman framework of changing physician behaviour. We used logistic regression to explore the association between physician and practice variables and the adoption of therapeutic hypothermia.We surveyed 1264 physicians; 39% responded. Most (78%) were emergency physicians, 54% worked at tertiary care hospitals, 62% treated >10 arrests annually and 50% had standardized cooling protocols. Most respondents were aware of therapeutic hypothermia (99%) and agreed that it is beneficial (91%), but only two-thirds (68%) had used it in clinical practice. Predictors for adopting therapeutic hypothermia included critical care field of practice (OR 6.3, 95% CI 2.5-16.0), availability of a cooling protocol (OR 5.6, CI 3.1-10.0), being <10 years post-residency (OR 2.0, CI 1.2-3.3), and treating >10 cardiac arrests annually (OR 2.6, CI 1.6-4.1). Common barriers included: lack of awareness of recommended practice (31%), perceptions of poor prognosis (25%), too much work required to cool (20%) and staffing shortages (20%).Therapeutic hypothermia after cardiac arrest has not been universally adopted. Adoption might be improved through protocol implementation, education about benefits and prognosis, and strategies to make administration easier.     

Adoption of NCLEX-RN for licensure in Canada: Faculty concerns and implications for nursing education

This paper highlights questions about Canadian nurse regulators' adoption of the U.S.-based NCLEX-RN examination, effective 2015, as the only route to initial registered nurse licensure in all jurisdictions, excluding Quebec. The decision for this change was made by the Canadian Council of Registered Nurses Regulators (CCRNR), an umbrella association of CEO's of provincial regulatory bodies in collaboration with the National Council of State Boards of Nursing (NCSBN). Adoption and implementation of this new policy was accomplished by the Council of each provincial regulatory body. This change, representing the first international adoption of NCLEX-RN, was deemed successful by CCRNR and NCSBN. However, the Canadian Association of Schools of Nursing (CASN) described the decision as unilateral and unwise, questioning the applicability of NCLEX-RN in the Canadian context, citing significant French language translation issues and unacceptable pass rates. Both authors have had extensive academic nursing experience in U.S. and Canada. Both had many conversations with Canadian colleagues who described the impact on nursing education as disastrous. Most of our American colleagues knew nothing about this change, but once informed, expressed some concerns similar to those of their Canadian counterparts. We suggest that international adoption of a US-based examination for initial licensure merits wider discussion by nursing faculty here and abroad.     

Addressing the needs of children of parents with a mental illness: current approaches

Children of parents with a mental illness have been identified as vulnerable to experiencing a variety of psychosocial effects arising from the impact of parental mental illness. Many children do not however, experience difficulties as a result of their parent's mental illness and are able to thrive despite what may be an adverse situation. Until recently there has been a lack of adequate service provision in Australia for these children and their families. Recent government initiatives have led to greater awareness and recognition of the needs of children whose parents have a mental illness, and key principles and actions have been developed to assist health services to adequately care for them. The aim of this paper is to overview the risk and protective factors that may impact on the psychosocial health children of parents with a mental illness, and provide me strategies that nurses in a range of health settings may use to assist families where parents have a mental illness.     

Attitudes of parents,teachers, and health professionals toward child disabilities

Attitudes toward 20 different handicaps in children were investigated by requesting groups of psychologists, parents of children with handicaps, parents of children without handicaps, special education teachers, and regular classroom teachers to respond to three different attitudinal measures. The measures consisted of an Adoption Scale, calling for degree of acceptance of each condition for adoption; a version of the Semantic Differential Scale, involving ratings of each condition on seven bipolar scales; and a Social Distance scale, measuring the acceptability of children having these handicapping conditions within the community, school, social group, and home. The findings indicated major differences in attitudes attributable to disparate rating groups, handicapping conditions, and measures employed.     

家长营养知识—态度—行为对肥胖儿童的影响

目的:了解肥胖儿童家长营养知识-态度-行为水平及其影响因素,为制订有针对性的营养教育干预策略提供基础资料。方法:对深圳市宝安区10家社区健康服务中心790名儿童家长进行有关儿童肥胖知识-态度-行为调查。结果:儿童家长营养知识水平普遍偏低,影响营养知识知晓率的因素主要是家长的文化程度。结论:父母的生活方式、饮食习惯及对肥胖症危害的认知态度是影响儿童肥胖发生的重要因素。