Issues in Comprehensive Pediatric Nursing

The Making Ethical Decisions about Surgical Intervention (MEDSI) tool is designed to guide health care professionals, patients, and families faced with ethically charged decisions regarding surgical interventions for pediatric patients. MEDSI is built on the principles of beneficence, nonmaleficence, and patient autonomy and created to promote truth-telling, compassion, respect for patient cultural and religious preferences, and appropriate follow up in the clinical setting. Following an overview of the 8 steps that compose MEDSI, the tool is applied to the management of intersex infants. The birth of a child with a disorder of sexual development (DSD) and ambiguous genitalia presents an ethically challenging situation for the family and health care team. The use of the MEDSI model is demonstrated in a case study involving the decision of surgical intervention in the management of an intersex child.

Breanna L. Lathrop

Teresa B. Cheney

Annette B. Hayman

Ethical Decision-Making in The Dilemma of the Intersex Infant

双性婴儿困境中的伦理决策

Edward Alan Glasper

Issues Compr Pediatr Nurs

Helping health care assistants develop skills in caring for sick children

帮助医疗助理发展照顾患病儿童的技能

Pediatric cancer diagnoses affect the entire family: parents, well siblings, the ill child, and others. The objective of this study was to review nursing studies on parental caregiving of children with cancer, family impact, and costs. The study used inclusion/exclusion criteria and family systems theory, self/dependent-care, and symptom management (monitoring, alleviation) concepts. Regarding "levels of evidence," 3 studies were Level II; 7 were Level IV; 7 were Level VI; 1 review was Level V and the second was Level I. Of 19 studies: 11 were qualitative; 4, quantitative; 2 were mixed methods. Content analysis themes were: Parental caregiving and family impact, economic burden. Conclusions were that (a) qualitative studies are predominant; findings supported quantitative findings; (b) quantitative nursing studies are less common: found one longitudinal, randomized controlled trial (RCT) focused on outcomes of an intervention for well siblings and parents, implemented by Clinical Nurse Specialists, CNSs; (c) few quantitative studies with large samples were found, especially ones with theoretical models of the family system and measures of illness impact on families; and (d) "mixed methods" longitudinal nursing research is illustrated. There is a need for "evidence-based" practice (EBP) nursing studies of interventions focused on parent education/support/assistance; respite care, and increasing family/well sibling knowledge/other information on the child's illness.

Phoebe D. Williams

Kirstin A. Williams

Arthur R. Williams

Parental caregiving of children with cancer and family impact, economic burden: nursing perspectives

儿童癌症的家长护理及家庭影响、经济负担：护理视角

Children with complex chronic conditions (CCC) have greater health care needs and use rates than children in general. Elevated health care use includes more frequent hospital admissions, longer hospital stays, and greater health care expenses. Prior studies have examined population characteristics associated with increased hospital admissions, emergency department (ED) use, and general healthcare use, yet few studies have investigated these events from the parents' or health care providers' point of view. The purpose of this study was to explore parents/caregivers' and health care providers' perceptions of the factors placing infants and young children with CCC at risk for or protecting them against hospital admissions and ED visits. Parents or primary caregivers participated in interviews, and health care providers in pediatric acute care, pediatric primary care, and emergency care participated in focus groups. Interview and focus group data were analyzed using directed content analysis and an ecological risk and protective factors model. The analysis revealed that parents/caregivers and health care providers described risk factors and protective factors on multiple ecological levels surrounding the child with CCC. This article presents these findings, which add to current knowledge of factors influencing hospital admissions and ED visits and may be used to inform interventions addressing high health care utilization in this population. This article concludes with the implications of the findings for future research and nursing practice.

Shannon M. Hudson

Susan D. Newman

William H. Hester

Gayenell S. Magwood

Martina Mueller

Marilyn A. Laken

Factors influencing hospital admissions and emergency department visits among children with complex chronic conditions: a qualitative study of parents’ and providers’ perspectives

复杂慢性疾病患儿住院和急诊就诊的影响因素：一项关于家长和医护人员观点的定性研究

The concept of transition is of fundamental concern to those seeking to prepare, recruit, and retain newly qualified staff. The pioneering work of researchers such as Kramer (1974) who explored the transition experiences of nurses has transcended international boundaries (Whitehead & Holmes, 2011) to influence the educational preparation of nurses worldwide. However, much of what we know about the transition experiences of newly qualified nurses is based on research with adult nurses and in the acute care settings. This article outlines the findings from a qualitative study about the experiences of a group of newly qualified children's nurses in England who had taken up first destination posts in community children's nursing teams at a time when such posts were novel, and had previously been met with some resistance. Data were collected using semi-structured interviews and fieldwork observation, and analyzed using a combination of thematic analysis (Braun & Clarke, 2006) and the framework approach (Ritchie & Lewis 2003; Smith & Firth 2011). The findings are outlined under the broad headings of "Shadowing," "The Visits," and "Emerging Identity" and support previous research that highlights how good formal support and the physical presence of a preceptor is valued by newly qualified nurses since it reduces occupational stress. However, the study also highlights the downside of such support which occurred because some accepted practices inadvertently reduced confidence and therefore inhibited a smooth transition. The ideal transition experience therefore necessitated a more individual approach, allowing for different rates of progression. The primary care environment allowed for such individuality which may account for the significant finding that the nurses in this study did not report feelings of reality shock (Kramer, 1974) as experienced by those in acute care settings. The study therefore highlights how the development of a new professional identity as a community children's nurse is not just dependent on the actions of the newly qualified nurse, but also of those with whom they work.

Angela Darvill

Debbie Fallon

Joan Livesley

A different world?: the transition experiences of newly qualified children’s nurses taking up first destination posts within children’s community nursing teams in England

不同的世界？：新晋儿童护士在英格兰儿童社区护理团队中担任首份岗位的过渡经历

Preschool is an important period for the development of healthy lifestyle behaviors. Parents have a great influence upon a child developing healthy lifestyle behaviors. The purpose of this study was to determine the self-efficacy perceptions of parents related to their preschool children’s healthy eating and physical activity behaviors. This study was conducted with a research population of 425 parents of 3- to 6-year-old children. The data collection tools included Demographic Information Form, and The Parental Self-efficacy Questionnaire (PSQ). Also, the weight and height of the children and their parents were measured. There was a positive correlation in parental self-efficacy score between parents’ educational status and economic status and there was a significant negative correlation between children’s body mass index and parental self-efficacy scores. The understanding of the effect of parental self-efficacy perception in the development of preschool children’s healthy eating and physical activity behaviors is one of the first important steps in effective health promotion interventions.

Ayfer Ekim

The Effect of Parents’ Self-Efficacy Perception on Healthy Eating and Physical Activity Behaviors of Turkish Preschool Children

土耳其学龄前儿童健康饮食和身体活动行为中父母自我效能感的影响

For many years pediatric healthcare experts have debated how much benefit was derived by host nations from the well intentioned efforts of Pediatric Short-Term Medical Missions (STMMs). Most of the literature on STMMs, while limited, has focused on frameworks for the delivery of care. Today the focus of these endeavors is on the ethical implications. The purpose of this article is to describe how the focus of STMMs has changed over the past 15 years from delivery of care frameworks to ethical considerations.

John S. Murray

Ethical considerations: pediatric short-term medical missions in developing countries

伦理考量：发展中国家的儿科短期医疗任务

In the literature, there is evidence about the importance of ensuring a Family-Centered approach for foreign patients to provide culturally competent care. The Italian context shows a lack of studies concerning nurses' perceptions regarding factors that influence foreign patients' daily care. In addition, the number of pediatric patients coming to Italian hospitals to be cured has increased dramatically in the last few years. This study aims to investigate the pediatric nurses' perception of the factors influencing nursing care for foreign pediatric patients who have undergone a stem cell transplant (SCT) and their families. A qualitative approach is used. Semi-structured interviews were recorded, transcribed verbatim, and analyzed using qualitative techniques for recurrent themes. Italian SCT pediatric nurses were interviewed until data saturation was achieved. Four themes emerged from the analysis: ''Respect for other cultural traditions,'' ''Different roles,'' ''Communication,'' ''Equal treatment and different opportunities.'' Communication was seen as a barrier in caring for foreign patients. Nurses perceived a lack in their training and knowledge when caring for foreign patients. The hospital supports nurses when caring for foreign patients. We found that pediatric nurses do not feel they are caring for foreign patients in the same way as they do for Italians, but adopt strategies to improve their relationships with them. Semi-structured interviews proved to be useful in highlighting the nurses' perceptions. These data were confirmed by the results of the audit conducted with the ''Children and Young People's Audit Policy Tool,'' The tool suggests specific interventions when foreign patients are admitted.

Simona Calza

Silvia Rossi

Annamaria Bagnasco

Loredana Sasso

Exploring Factors Influencing Transcultural Caring Relationships in the Pediatric Stem Cell Transplant Setting: An Explorative Study

探索儿科干细胞移植环境中影响跨文化护理关系因素的探索性研究

A new report published in 2015 by the global charity “Save the Children” aims to improve neonatal survival across the world. Entitled “Improving Newborn Survival: Saving the Lives of 3 Million” the...

E. A. Glasper

Editorial: Is There a Crisis in Neonatal Nursing?

编者按：新生儿护理是否面临危机？

Family caregivers play a critical role in caring for children living with HIV, however, there is little knowledge about their experiences. The aim of this study was to illuminate the family caregivers' lived experiences of caring for a child when he or she has been diagnosed with HIV and enrolled to antiretroviral treatment. Qualitative interviews with 21 family caregivers of 21 children diagnosed with HIV were analyzed using an inductive design with a hermeneutic phenomenological approach. The caregivers' experience were articulated in 5 subthemes under the main theme of "Surviving overwhelming challenges": "Committed care-giving," "Breaking the family life," "Caring burdens," "Confronting conflicts," and "Living with worry." Despite the difficult situation the family caregivers experienced with extensive worry, caring burdens, and disrupted family and social networks, they were committed caregivers. They were empowered by their belief in God but also by their strong belief in the child's treatment and support from healthcare workers. The healthcare system needs to consider possible ways to support the family caregivers during child's HIV diagnosis and treatment initiation as part of a continuum of care.

Mulatu Biru

Pia Lundqvist

Mitikie Molla

Degu Jerene

Inger Hallström

Surviving Overwhelming Challenges: Family Caregivers’ Lived Experience of Caring for a Child Diagnosed with HIV and Enrolled in Antiretroviral Treatment in Ethiopia

应对巨大挑战：埃塞俄比亚家庭护理者对照顾确诊艾滋病并接受抗逆转录病毒治疗的儿童的亲身体验

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Issues in Comprehensive Pediatric Nursing

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