Medically stable children in PICU: better at home

A number of medically stable children and young people with complex care needs, and in particular those requiring long-term ventilation, are spending inappropriately long periods of time in acute hospital settings waiting for discharge packages to be formulated. Apart from the impact this has on availability of inpatient beds for other children, specifically intensive care beds, the hospital environment can be detrimental to the well being of the child/young person and family. Discharging these children home requires complex multi-agency care packages to be established, with a high degree of co-ordinated multi-agency working, planning and commissioning that must be continued in the long term. UK governments need to set realistic standards for timely discharge of children with complex care needs once they are deemed medically fit. To achieve these standards there needs to be additional investment in community children's nursing and transitional care units, improved data collection and a UK-wide framework for commissioning of services for children and families with complex care needs.     

Multiprofessional education: improving care for acutely ill children

A three-year programme was established for practitioners who work with acutely ill and injured children and young people. Courses were held in urban and rural areas of Scotland and more than 2,000 NHS staff, including nurses, paramedics, doctors and allied health professionals, took part. Three-day training comprised clinical skills updates, scenario-based teaching and observed structural clinical examinations. As a result, NHS Scotland says care delivery to children, young people and their families has improved in community and hospital environments.     

Modernising nursing careers: implications for children's nurses

The future direction of pre-registration nursing education in the U.K. is once again under review with two consultation documents published by the Nursing and Midwifery Council (NMC). Pre-registration programmes need to prepare nurses who are able to provide holistic care to children, young people and families across all settings. In 2003 a position statement from the Royal College of Nursing proposed a model that encompassed: a foundation shared with other professionals involved in the care of children and young people, general nursing of children and young people, as well as theoretical and practical experience in public health, mental health and learning disability nursing of children and young people. This model is recommended as the way forward to ensure children's nursing is fit for the future     

Hypospadias repair: the nursing contribution

The role of the urology nurse in the care of 50 boys undergoing hypospadias surgery was prospectively evaluated using semi‐structured interviews and data retrieved from hospital notes. Four nursing‐related areas of interest were identified: Firstly, that nurses were instrumental in preparing the families for surgery by assessing the boys and providing information to the families. This enabled the early discharge of the children. Secondly, that nurses also dealt with any problems arising from pain or the wound as well as from the catheter or stent. Thirdly, that named nurses provided seamless care to the families enabling a development of familiarity and trust. Finally, nurses provided routine back‐up and a 24‐h emergency call facility for the families at home. These were valued by the parents for their reassuring and confidence giving effect as well as the quality of the advice given. Based on the results of this evaluation it was recommended to establish and introduce a care pathway for day‐case hypospadias repairs and to upgrade the urology nurses' role towards advanced nursing practice.     

Supportive and palliative care needs of families of children with life-threatening illnesses in Western Australia: evidence to guide the development of a palliative care service

OBJECTIVE: To obtain feedback from families of children receiving palliative and supportive care about their care needs in hospital and in community settings. DESIGN: A two-phase combined quantitative and qualitative study. SETTING: Western Australia. PARTICIPANTS: 134 parents and 20 service providers. RESULTS: Analysis indicated the concept of palliative care is poorly understood by health professionals and by parents. Many families are affected emotionally, financially and physically by the burden of caring for children with life threatening or chronic conditions requiring complex care at home. Parents indicated the need for clear and honest information about their child's condition and prognosis throughout the trajectory of illness and perceived this had been lacking. Families required financial and practical assistance with providing care from their children at home. Parents also wanted more practical resources and information to assist with the management of their child's nutrition and pain, as well as support for their other children. The level of respite (in home and residential) was perceived to be insufficient and inequitable. Parents also required access to, and advice from, multidisciplinary health professionals when caring for their child at home. There was a perceived lack of coordination between community services and the hospital. CONCLUSION: Education of health professionals and parents regarding the concepts and introduction of palliative and supportive care is required. Care for children and their families should be coordinated by a multidisciplinary team in consultation with children and their families, and linked and integrated with the treating hospital in collaboration with community services. More inclusive criteria are required for community services including practical aids and respite care.     

Discharge planning for children with heart disease

Almost all children with heart disease are successfully cared for at home by their parents. Pediatric cardiovascular nurses play a major role in preparing parents to meet their child's medical needs, in aiding families to cope with a chronic condition, and in encouraging normal growth and development for their young patients. Through assessment, collaboration with other members of the health care team, planning with the family, teaching, counseling and supportive interventions, and evaluating care, nurses assist in a smooth transition to home and appropriate use of community resources.     

Maximizing services along the continuum of care from inpatient to home

The nurse managers of the inpatient pediatric units and home care division of Robert Wood Johnson University Hospital met to restructure and optimize the quality of care delivered to children and their families in the home setting. A program was developed using inpatient pediatric staff nurses to perform home visits to children requiring follow-up after an inpatient hospital stay. The nurse managers found home visits could comfortably be delivered by pediatric inpatient nurses if they were appropriately oriented and precepted by experienced home care nurses. When home visits were performed by the nurses who cared for the patient in the hospital, both the child and the family appeared to have an increase in comfort and self-confidence in caring for their child. The program also was successful in reducing the costs associated with pediatric home care. This was achieved by facilitating the downsizing of the inpatient units in periods of low census, as well as in cost avoidance associated with not paying benefits to additional employees that otherwise would have been hired by the home care department. This program could be implemented successfully in institutions that support communication, coordination, and continuous improvement of the programs provided to children and families.     

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.     

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.     

Rural hospital generalist and emergency medicine training in Papua New Guinea

The present paper describes the role of the hospital generalist in rural Papua New Guinea (PNG) and the contribution of emergency medicine training to that practice. Generalist practice in Tinsley District Hospital in Western Highlands Province is described, with emphasis on emergency surgery and anaesthesia. The potential of the PNG emergency medicine training programme for preparing generalists is discussed. Tinsley Hospital served a population of 40,000 people, with 4000 admissions and 300-400 operations performed annually. Two doctors and 50 nurses and community health workers provided care with minimal resources. The doctors provided supervision and teaching for nurses, community health workers, hospital administrators and primary health carers, including on long range medical patrols. Over 16 months, doctors performed 243 emergency surgical procedures including orthopaedics, general surgery, obstetrics and gynaecology. The generalist in rural hospitals is required to perform a wide variety of medical tasks in isolated settings yet there is no active postgraduate training programme. The Master of Medicine, Emergency Medicine programme includes rotations through the major disciplines of surgery, anaesthesia, internal medicine, paediatrics, obstetrics and gynaecology. It has the potential to train doctors in PNG for a generalist role as graduates will learn the foundations of the required skills.     

“A stressful and frightening experience”? Children's nurses' perceived readiness to care for children with cancer following pre-registration nurse education: A qualitative study

BackgroundIn the UK children with cancer are cared for by children's nurses in a variety of settings, specialist and non-specialist. Whilst post-registration specialist education is available to some nurses, many nurses rely solely on pre-registration education to competently care for these children. This study explores whether nurses perceive that this adequately prepares them.ObjectivesTo explore the extent to which qualified nurses perceive that pre-registration nurse education prepares them to care for children with cancer; to consider the implications for children's nursing pre-registration curricula.DesignA small-scale qualitative study was undertaken using an interpretivist approach.MethodsSemi-structured interviews were conducted with six qualified children's nurses in two clinical areas - a specialist children's cancer inpatient ward, and a general children's ward where inpatients included children with cancer.ResultsFindings are discussed in relation to three emergent themes: Learning in Theory and Practice, Care of the Child and Family, and Resilience. Participants attached significance to the quantity and quality of practice experience. They reflected on barriers to specific and transferable theoretical learning and stressed the importance of integrating theory and practice. Understanding of family-centred care formed a significant part of their preparation. Preconceptions, communication with families and the emotional impact of this speciality were stressful. Improved pre-registration preparation may have developed participants' resilience.ConclusionThe complexities of caring for children with cancer and their families require well-prepared nurses. Participants' perceptions of preparedness were influenced by aspects of pre-registration education. Their experiences suggest that curricula should be practice-focused and include a range of placements. Specialist theoretical content must be integrated with practice and transferability of knowledge and skills made explicit. Reflection and problem-based learning may foster coping mechanisms and resilience that will equip them to care for children with cancer.     

Nurse prescribing by children’s nurses: views of doctors and clinical leads in one specialist children’s hospital

Aim. To explore the views of doctors and clinical leads (CLs), who care for children and young people, on nurse prescribing in one specialist children’s hospital. Background. Nearly 14,000 nurses in the UK have virtually the same prescribing rights as doctors. Benefits of nurses adopting this role have been reported, but doctors do have some concerns. Increasing numbers of specialist nurses involved in the care of children in the hospital setting are undertaking prescribing training. No research has explored the views of health care professionals on nurse prescribing in this setting. Design. A subset of qualitative data taken from a larger study that adopted an intrinsic case study design. Method. Interviews were conducted between October 2006–July 2007 with 11 doctors and three clinical leads in one specialist children’s hospital. A thematic analysis was conducted on the interview data. Results. Nurse prescribing improved access to medicines and continuity of care. Concerns included the need for doctors to have confidence in the ability of the nurse who wanted to become a prescriber, the selection of nurses for prescribing training, the effects of nurse prescribing on the individual roles and responsibilities of doctors and nurses’ clinical skills. Conclusion. Doctors and clinical leads working in a specialist children’s hospital in the UK recognise that nurse prescribing makes a positive contribution to the delivery of services. However, it is important that nurses have the appropriate clinical skills and doctors understand nurse prescribing. This will only take place if there is good communication across professional boundaries. Relevance to clinical practice. Selection processes for the prescribing programmes must ensure that students have the necessary course prerequisites. Communication across professional boundaries is crucial to the successful implementation of nurse prescribing in the care of children and young people in the hospital setting.     

Communication issues for the interdisciplinary community palliative care team

This paper discusses the findings of a critical study that examined the communication patterns between nurses and general practitioners (GPs) providing palliative care in Australia. Interviews and focus groups involved 40 palliative care nurses who worked in the three settings of care: community, hospice and hospital. Issues that impeded effective communication strategies between palliative care nurses and GPs were networking, case management, multiple service providers, lack of standardized documentation and formal tracking of clients, along with difficulties in transmission of relevant practice knowledge. Supporting strategies for effective formal modes of communicating and reporting are described.     

Israeli nurses' knowledge of health care reforms

Israeli nurses’ knowledge of health care reforms Objectives. This study examines health care reforms’ implementation processes from the perspective of nurses’ knowledge regarding the reforms. The research has been carried out in the Israeli context, where health care reforms were initiated in 1995. Three specific research questions were formulated: (a) What is the level of nurses’ knowledge regarding the recommendations of the Netanyahu committee? (b) What is the level of nurses’ knowledge concerning the basic principals of the National Insurance Law? and (c) Are there knowledge differences relating to employment setting (hospital, community, and educational settings), nurses’ roles (managerial vs. staff nurses), years of experience, and level and type of education? Method. The stratified nonproportional random sample consisted of a total of 468 nurses. Of these nurses, 206 were employed in community settings (136 in curative care, and 70 in preventive care), 137 were employed in hospital settings, and 125 worked in schools and departments of nursing. Research tools, developed for the purpose of this study, included the nurses’ knowledge questionnaire comprised of five subscales, and the knowledge relevancy questionnaire. Results. Overall, data demonstrated a low to moderate level of knowledge on all knowledge scales. Knowledge level on the criteria questions was particularly low. Contrary to the low level of knowledge, nurses regarded health care reforms’ knowledge as highly relevant to their work life. Curative setting, an extensive work experience, managerial position, and non‐nursing academic degree were all positively related to higher levels of reforms’ knowledge. Conclusion. These findings should encourage both policy makers and managers in various health care organizations to develop programs for informing health care providers on central aspects of health care reforms considered most relevant to the practice setting.     

Communicating with families of patients in an acute hospital with advanced cancer: problems and strategies identified by nurses

After pain management, poor communication with health professionals creates the most distress for families of patients with cancer. Difficulties communicating with families also have been identified as potentially stressful for nurses. This is particularly the case for nurses working in acute care settings. However, little research has been undertaken to examine the specific problems and challenges confronting nurses who endeavor to communicate with families of patients with cancer in a hospital setting. The purpose of this study was to describe nurses' perceptions of communication issues, potential barriers, and strategies associated with nurse-family interactions in an acute cancer hospital setting. Focus groups were conducted with nurses from two cancer wards at an Australia hospital. Four distinct themes emerged. First, all nurses described communication difficulties they encountered when interacting with families. Second, team factors appeared to be a central determinant of the quality of nurse-family communication. Third, nurses described difficulties associated with the delivery of bad news and treatment plans that are not clearly defined for the patient. Finally, the effects of poor communication on nurses were notably and vividly described. In this report, recommendations for clinical practice and subsequent research are offered.     

CAMHS liaison: supporting care in general paediatric settings

Increasing numbers of children and young people with mental health problems are being cared for in general paediatric settings, presenting a challenge to nurses who do not have mental health nursing qualification and experience. A survey of nurses in a children's hospital identified their concerns and attitudes to caring for this client group. On-call nursing support was felt by almost all nurses (87 per cent, n=90) to be the most beneficial aspect of a liaison service, followed by teaching (84 per cent) and individual support with the young person/family (84 per cent). Based on the findings, a project was initiated to improve nursing liaison with CAMHS nurses providing support and advice to general children's nurses. Effective liaison between general paediatric wards and child and adolescent mental health services (CAMHS) can improve care for children and young people with diagnosed mental health problems. However, there is still a gap in addressing the need of the significant numbers of children with physical illness who also have mental health needs.     

Who should nurse children requiring emergency care?

There are constant challenges in developing a workforce fit to deliver care to children and young people requiring emergency or urgent care. These challenges are often compounded when the care setting for children and young people is within a general Emergency Department. This paper will review contemporary issues around who should deliver emergency care to children in these settings; reasoned debate is required to ensure that we have a workforce fit for purpose.