Pediatric nursing in the United Kingdom.

Child health matters remain low on the government agenda, and present reforms of the NHS are overtly concerned with financial aspects rather than the quality of care. Pediatric nurses must therefore become more assertive and pro-active in their role as advocates for children and their families. However, pediatric nurses are extremely fortunate in the UK because they have (a) a nurse education system that has always recognized that the nursing needs of children are different to those of adults, (b) the opportunity to work with medical and voluntary organizations committed to improving children's health, and (c) a professional organization that is not only large and powerful, but since 1984 has been committed to advancing the art and science of pediatric nursing. It employs a full-time adviser to assist its members and publishes the only pediatric nursing journal. Pediatric nurses have assisted in advancing the art and science of pediatric nursing with caring for children and their families in a holistic fashion, with families supported and participating in their child's care. But there are still many opportunities to improve the quality of health care to children and their families. Quality caring is what children and their families want and deserve, but is not as easy to measure as quantity care. At a time when in so many countries, health service managers concentrate on quantity, pediatric nurses must use every opportunity to shape the health policy of their nation for the benefit of children. We all live in interesting times and it would be interesting to see what we make of them on behalf of children.     

Pediatric palliative care: a conceptual analysis for pediatric nursing practice

Although there have been significant advances in medical technology, thousands of children continue to die annually. Pediatric palliative care is a relatively new field and has not been well defined in the literature. Therefore, the purposes of this article were to provide a concept analysis of pediatric palliative care that presents pediatric nurses with fundamental information regarding this concept and to increase their ability to understand, identify, provide, and subsequently meet and enhance the needs of those children with a life-limiting illness and their families. With this enhanced understanding of pediatric palliative care, pediatric nurses will continue to improve and provide quality, safe nursing care for this vulnerable population of children with life-limiting illnesses.     

Application of Orem's Self-Care Deficit Theory to the pediatric chronically ill population

The conditions under which children with long-term chronic health problems are cared for have changed dramatically in the past decade. These children are more often living longer and being cared for at home by their families and nursing supports. An effective tool allowing nurses to systematically assess, plan, implement, and evaluate the care needs of these children is a nursing theory. Orem's (1985) self- or dependent-care deficit theory is a useful basis from which the care of the chronically ill pediatric population can be planned. Attention is given to a caring relationship in which there is a dependent person in need of care and an individual who serves as that dependent person's agent of care. This article discusses several of the major concepts of the self- or dependent-care deficit theory and how it can be applied to guide clinical nursing practice aimed at meeting the care demands of the pediatric chronically ill population and their families.     

End-of-life nursing education consortium for pediatric palliative care (ELNEC-PPC)

Pediatric nurses must often care for children with life-threatening illness. Although the child may be a neonate with multiple organ failure, a young adolescent diagnosed with HIV, or a 7-year-old child involved in a serious bicycle accident, pediatric nurses are an essential part of the interdisciplinary team that plans, organizes, implements, and manages the care of these children and their families. To date, more than 600 pediatric nurses have attended a national End-of-Life Nursing Education Consortium-Pediatric Palliative Care (ELNEC-PPC) training program. Many of these nurses have returned to their institutions dedicated to making a difference in the palliative care provided to children and their families. Because pediatric palliative care education is so important, many trainers have incorporated ELNEC-PPC into their nursing orientation, annual competencies, and undergraduate and graduate nursing education. They are developing standards of care and serve on key hospital/hospice committees, such as policy, education, clinical care, and ethics committees. This article showcases various activities of ELNEC-PPC trainers and demonstrates their commitment to improve pediatric palliative care not only in their institutions but also on local, state, national, and international levels.     

The developing role of children's nurses in community palliative care

This article addresses some of the contemporary issues in relation to providing palliative care for children in Ireland, particularly focusing on the creation of the specialist palliative care nursing outreach posts. The recent publication of an Irish national policy on palliative care for children with life-limiting illness is welcome news for paediatric nurses in Ireland. Children are valued members of society and have a right to receive quality health care and support appropriate to meet both children and the families' precise needs. However, community services for children with life-limiting illnesses remain inadequate, with many parents and families struggling to provide palliative care for children in the home. Currently, community nurses, who are not always registered children's nurses, are providing palliative care for children at the end of life. These nurses may not fully understand the specific needs of critically or chronically ill children and their families. In addition, there are no specific palliative care educational programmes in Ireland with regard to end-of-life care for children. The challenges of providing palliative care to children and their families in relation to symptom control, controversial ethical and legal issues, and emotional and practical support, mean that advanced knowledge is required in order to progress the agenda and thus provide excellence in children's palliative care in Ireland. It is important that the agenda is moved forward so that children and their families requiring palliative care and nursing support do not suffer from a lack of professional provision for their needs.     

Are nurses respecting and upholding the human rights of children and young people in their care?

Children's nurses may assume that the care they provide for children and their families is family centred and meets their holistic needs. However, very little objective evaluation has been undertaken with children and young people regarding the health services and nursing care they receive. In this study, data were collected from 18 young ventilator-dependent people and their families in order to evaluate their experiences of health and social care. The UN Convention and other policy documents advocating client-focused services were used as benchmarks for analysis, demonstrating that the needs and aspirations of the young people are not being addressed and raising questions for nurses and other professionals.     

Understanding the child with special health care needs: a developmental perspective

Children with special health care needs and their families are becoming a greater part of pediatric nursing practice, and often present with major health and psychosocial needs that interfere with their ability to function. Optimal intervention with these children requires an understanding of their chronic conditions as well as their unique developmental needs. This paper reviews the characteristics of children with special health care needs and introduces some of the most salient theories of child development in order to provide a perspective from which to view this population. A case example that illustrates some of the features discussed is presented. Because a knowledge of theories of child development can improve the care provided to children with special health care needs, it should be included as part of nursing curricula.     

Illuminating the clinical nurse specialist role of advanced practice nursing: a qualitative study

As the advanced practice nursing initiative in Canada gains momentum, effort is being directed towards clarifying and defining advanced practice roles. A qualitative study was undertaken to increase understanding of the clinical nurse specialist role of advanced practice. Sixteen nurses who worked in advanced practice roles, organizing and providing healthcare for children with complex health needs and their families across the continuum of care, participated in in-depth conversations about the nature of their practice, the knowledge that informs it and the factors that influence it. Findings suggest that clinical nurse specialists have a unique role in the organization and delivery of healthcare for specialized populations with complex health needs in their dual focus on the system level of healthcare and on population health needs. Initiatives directed to children and families within the study participants' specialties included program development, consultation and educational outreach and the development of clinical guidelines and policies. Although the nurses described their practice as focusing both on individual children and families and on the population of children and families within their specialty, it is at the population level that they see their greatest potential for contributing to the delivery of high-quality, cost-effective healthcare.     

Developing resilient children and families when parents have mental illness: a family-focused approach

There is substantial evidence supporting the need for effective intervention for children and families living with parental mental illness. However, translation of this knowledge into mental health workforce practice remains variable, with a range of clinical practices and models of care evident. Nurses, who constitute the majority of the mental health workforce, are in prime positions to support children and families and provide preventative measures, identify those at risk, and intervene early. In this paper, we provide a framework for practice for nurses working with consumer parents. We contend that traditional models of nursing practice concentrating on the consumer are insufficient in meeting the needs of children and families living with parental mental illness. A focus on families needs to be core business for mental health nurses. A family-focused approach can be used to prevent problems for children and their families, and identify their strengths as well as vulnerabilities. Family-focused care is a useful framework from which to support families and address the challenges that might arise from parental mental illness, and to build individual and family resilience.     

Mommy first

Parents of children with special health care needs are often required to assume responsibility for the complex care of their children. It is important for pediatric nurses to remember these parents are, first and foremost, the child's parents and primarily responsible for loving their child, providing a safe and secure home, and fostering their child's development as a person. Pediatric nurses should support the parents in the medical/nursing care of their child in whatever way possible so the parents have more time to parent. This account from a mother of a child with developmental delay helps remind us of our need to help support parents in being "parents first."     

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.     

Nursing students' first-time experiences in pediatric clinical practice in Taiwan: A qualitative study

BackgroundA pediatric nursing practicum is essential in equipping students with basic knowledge of theory, professional attitudes, and skills for the clinical setting. However, students often face multiple challenges in the practicum due to gaps between theory and practice.PurposeTo describe nursing students' first-time experiences in pediatric clinical practice in Taiwan.MethodsA phenomenological approach with purposive sampling was used. Twenty participants were interviewed individually, in person, within a month of completion of a pediatric nursing practicum. Interviews were semi-structured and digitally recorded. Data analysis followed Colaizzi's methods; epochs (bracketing) focused analysis on students' experiences and maintained objectivity.FindingsThree themes and related subthemes emerged: (a) orienting to the pediatric unit (becoming familiar with common treatments and surroundings in the pediatric unit; recognizing people in the unit); (b) encountering challenges in pediatric and family-centered care (navigating communication between child and families; student nurse-patient relationships: maintaining a good rapport with children and their families; being prepared for quick role changes); (c) translating knowledge into clinical practice thoughtfully (providing desirable and correct responses for children and their families; providing a safe and friendly environment for children and their families).ConclusionsStudent nurses engaged in a variety of care practices necessitated by patients' differing ages, developmental levels, and family needs. Ensuring students' successful completion of the demanding pediatric practicum, including innovative communication, technical skills, and role transitions, is challenging yet achievable.Clinical relevanceGaining a fuller understanding of nursing students' experiences in the pediatric nursing practicum can assist nursing professionals in preparing students to provide competent care for children and their families.     

Parents' report of children's hospital care: what it means for your practice

PURPOSE: To determine the aspects of nursing practice that are predictive of parent satisfaction with their child's hospitalization. METHOD: A sample of 3,299 families whose children were hospitalized in a tertiary pediatric teaching hospital between 1995 and 1998 were surveyed. The survey covered their experiences during the child's hospitalization and their overall satisfaction with care. FINDINGS: Survey questions that were most strongly associated with overall satisfaction were questions about caring practices that are collaborations between nurses and parents. Satisfied parents reported nursing care that was tailored to their needs and preferences. CONCLUSIONS: These findings are consistent with Curley's model for nursing practice, which predicts better patient outcomes when nursing care is synergistic with patient characteristics.     

Using the resiliency model to deliver culturally sensitive care to Chinese families

In 1998, 4% of U.S. children were Asian/Pacific Islander; of these, 23% were Chinese. The incidence of infants with congenital heart defects (CHD) in Chinese children approximates that of Caucasian children in the United States. Parents of children with CHD are faced with caring for the children at home after surgery. Parents' roles and responsibilities expand significantly as their children return home with complex care needs. In pediatric nursing, we not only take care of the individual child but also the family as a whole. The family is the primary institution in society that preserves and transmits culture. Understanding Chinese culture and its association with health care practice helps nurses to establish culturally sensitive nursing interventions; develop appropriate discharge plans; decrease family stress; reduce future medical hospitalization costs; increase positive coping, adaptation, and family function; and improve health outcomes of the child and the family. The Resiliency Model was used to examine its applicability in caring for Chinese families in this paper.     

Challenges and Choices in Child and Adolescent Mental Health-Psychiatric Nursing

Challenges to the profession of child and adolescent mental health-psychiatric nursing, and choices available to address these challenges, are examined. The challenges stem from the large numbers of children in need of mental health services, the many risk factors to which children and families are exposed, and society's inadequate responses. Research evidence demonstrates that the gap between mental health needs and services for children results not from ignorance, but rather from a lack of commitment to providing a coordinated system of mental health services. Nurses are among the most appropriate professionals to address these needs for a coordinated system of care, but are not viewed as child mental health experts by the public or by policymakers. Nurses can demonstrate that child mental health nursing programs are effective by choosing to support programs that work, by conducting research projects that test nursing interventions, and by educating students to meet the needs of children and families for coordinated and cost-effective care. Finally, nurses must publicize their successes so that the public recognizes nursing's role in promoting children's mental health.     

Nurses' perceptions of unaccompanied hospitalized children

The purpose of this study was to acknowledge and interpret the stories and perceptions of pediatric nurses who care for children left unaccompanied during their hospitalization. This was a phenomenological qualitative study conducted via interviews using open-ended questions. The study was conducted in a large Midwestern pediatric hospital that has both urban and suburban settings. Twelve nurses voluntarily completed the interviews. Recruitment was accomplished though a group e-mail that was sent to all registered nurses at the hospital complex. Nurses made assumptions about families particularly when the family did not communicate the reason for their absence. Unaccompanied children received equal nursing care but often received more attention than children whose families were present. Care for unaccompanied hospitalized children presents more challenges to nurses and may not be optimal for children. Nurses should examine their feelings and judgments about non-attendant families. Staffing levels should take into account whether the child has a guardian at the bedside.     

Advanced practice nurses as faculty.

This article details a program through which two child health faculty members who are advanced practice nurses (APNs) combined practice with teaching undergraduate students in a community-based clinical experience on nursing case management. A collaborative agreement between a university-based Children's Special Services Team (CSST) and school of nursing faculty was developed to extend services into the home communities of children with special healthcare needs. Senior students made visits to the homes of the team's clients, conducted assessments, interacted with families, and provided additional care. The team, which included physicians, nurses, a social worker, and therapists (occupational and physical) identified children and families who would benefit from home visits by students nurses who were directed by APNs. Both service and educational goals were accomplished by this community-based case-management experience. The children and their families received additional care from multiple healthcare providers. Students practiced components of community-based case management, and the CSST obtained vital information about their clients' living environments.     

Nurses of NESB working in a multicultural community

Ensuring that the cultural composition of the nursing population reflects the multicultural mix of the general population assumes that culturally appropriate care will occur when people of non-English background (NESB) are encountered in nursing practice. In a feminist praxis study involving twenty-six nurse participants, seven of whom were of NESB, the nurses discovered that the structure of the health care institution not only overlooked the cultural and linguistic needs of children and NESB families, but also created a dominant Anglo-Australian health culture that taught NESB nurses to ignore the traditions and practices of their NESB culture. This paper will explore the nurses' discovery of their own collusion in sustaining an Anglo-Australian health care culture.     

Nursing Research Priorities in the Pediatric Emergency Care Applied Research Network (PECARN): Reaching Consensus Through the Delphi Method

IntroductionPediatric emergency nurses who are directly involved in clinical care are in key positions to identify the needs and concerns of patients and their families. The 2010 Institute of Medicine report on the future of nursing supports the active participation of nurses in the design and implementation of solutions to improve health outcomes. Although prior efforts have assessed the need for research education within the Pediatric Emergency Care Applied Research Network (PECARN), no systematic efforts have assessed nursing priorities for research in the pediatric ED setting.MethodsThe Delphi technique was used to reach consensus among emergency nurses in the PECARN network regarding research priorities for pediatric emergency care. The Delphi technique uses an iterative process by offering multiple rounds of data collection. Participants had the opportunity to provide feedback during each round of data collection with the goal of reaching consensus about clinical and workforce priorities.ResultsA total of 131 nurses participated in all 3 rounds of the survey. The participants represented the majority of the PECARN sites and all 4 regions of the United States. Through consensus 10 clinical and 8 workforce priorities were identified.DiscussionThe PECARN network provided an infrastructure to gain expert consensus from nurses on the most current priories that researchers should focus their efforts and resources. The results of the study will help inform further nursing research studies (for PECARN and otherwise) that address patient care and nursing practice issues for pediatric ED patients.