The cortisol response in parents staying with a sick child at hospital

AIM

To study the cortisol response in parents staying with their child in paediatric wards, to compare the parents' cortisol levels between the paediatric ward and at home 4 weeks after discharge and to compare the parents' cortisol levels with data of an adult reference population, reported by Wust et al., as there are few studies investigating parental cortisol.

DESIGN

This study has a descriptive and prospective comparative design.

METHOD

Thirty-one parents participated. Saliva samples were collected in the paediatric ward and 4 weeks later at home.

RESULTS

The parents had lower morning awakening cortisol levels in the paediatric ward than at home after discharge. There were no statistically significant differences in postawakening cortisol or cortisol awakening response (CAR). The child's age, diagnosis or previously diagnosed chronic condition did not affect the parents' cortisol levels. The morning and postawakening cortisol levels were lower than those of the reference population.

CONCLUSION

The hospital stay with a sick child affects parents' cortisol levels. Parental stress needs more attention to find interventions to prevent the risk of stress-related complications that subsequently can affect the care of the child.

The family house-A safe haven: A qualitative study of families' experiences staying in a hospital family house during their children's hospitalisation

AIMS

To gain knowledge about families' experiences while staying in a hospital family house during their child's hospitalisation.

BACKGROUND

When a child is hospitalised with a chronic, serious or life-threatening disease, the entire family is stressed as normal everyday life is disrupted. In Denmark, accompanying the ill child to the paediatric wards is often possible only for one of the parents.

DESIGN

This qualitative study takes a phenomenological-hermeneutical approach, exploring the lived experience of families' everyday life in a hospital family house.

METHOD

The study comprised semi-structured interviews with 33 family members from 15 families who stayed in a hospital family house. The interviews were made in the summer of 2017. The Consolidated Criteria for Reporting Qualitative Research checklist was used as a guideline "see Appendix S1."

RESULTS

The families experienced the house as a home or a haven where they could stay together as a family. The house provided a quiet and peaceful environment with space for family life and playing. Overall, this gave the families a feeling of togetherness.

CONCLUSION

The families who stayed in the hospital family house experienced the house as a place to breathe freely, that is, as a safe haven. A place with peace and quietness, without "activity efficiency." In the house, the volunteers offered a very caring and supportive environment including all families in the house and embracing everyday activities. Providing accommodation for the whole family at the hospital family house afforded the family a place where they could stay together and maintain everyday life even though everything around them was, at times, chaotic.

RELEVANCE TO CLINICAL PRACTICE

Healthcare professionals should use knowledge about the healing environment to help create havens for families to a hospitalised child. Hospitalised children need safe places where no treatment takes place-therefore, family houses should stay treatment free.

Cultural sensitivity in paediatric nursing care: a concept analysis using the Hybrid method

BACKGROUND

Cultural sensitivity is a core concept to establish awareness and knowledge about various ethnicities, cultures, genders and additional diversity characteristics to understand individual's requests and respond appropriately to them. A need for further development of the concept is warranted, especially in the context of paediatric nursing.

AIMS

The purpose of this paper was to determine the main elements of cultural sensitivity in the context of paediatric nursing in Iran.

METHODS

The Hybrid method was implemented consisting of three phases: theoretical, fieldwork and final analysis. In the theoretical phase, articles from 2007 to 2017 were reviewed for relevance. In the phase of fieldwork, 25 nurses and nine parents were interviewed to explore the aspects of cultural sensitivity in paediatric nursing. The interviews were transcribed, and content analysis was conducted. In the final phase, an overall analysis of the two previous phases was performed.

RESULTS

In the theoretical phase, the following attributes were determined: cultural encounter and awareness, acceptance of cultural diversity and designing programmes in accordance with family culture. The fieldwork phase explored three themes of intercultural encounters, intercultural communication and adapting the care plan with family culture. The final synthesis yielded that sensitivity to family requests and beliefs, effective intercultural communication and integration of family culture with the care plan are the main elements of cultural sensitivity in Iranian paediatric nursing.

CONCLUSION

With a deeper understanding of the term cultural sensitivity, nurses will have a foundation to improve paediatric nursing care and align the care plan with the patient's culture to provide trust, child/parent participation, secure care, effective communication and satisfaction. Since the concepts are the building blocks that underpin theory, the present concepts identified can help to serve as the foundation for the development of a theoretical model.

Parent and staff perceptions of parental needs during a child's hospital admission to a paediatric high-dependency unit: A New Zealand study

AIM

This study aimed to identify parents' and staff's perceptions of parents' needs during a paediatric high-dependency unit admission and the relationships between needs, socio-demographic and clinical variables and explores if these perceptions have changed.

METHODS

This study uses a cross-sectional descriptive correlational design, and 104 parents whose children received care and 88 staff who worked within a paediatric high-dependency unit at a tertiary hospital in New Zealand completed the Needs of Parents' Questionnaire in 2011.

RESULTS

Parents' and staff's perceptions of the importance of needs were congruent, but differences arose between parents and staff on whether these needs were met. Parents were more likely to rate needs as having been met than staff members. Admission type, age and gender influenced parents' and staff's perceptions of parents' needs.

CONCLUSION

Synergy between parent and staff satisfaction scores will be enhanced when care delivery is more closely aligned to parents' priorities for care and staff receive feedback on positive health-care experiences.

Developing a website to demonstrate clinical holding techniques

Healthcare staff routinely use clinical holding to help infants, children or young people stay still when treatment is being administered, to prevent children or young people from interfering with the treatment, or when invasive examinations are being carried out. However, healthcare staff rarely have any formal discussion with children and young people, or their parents, on the techniques used for clinical holding. Visual tools are important when talking to children or young people about their healthcare, and a website with images of clinical holds would allow staff to discuss relevant holds with their patients. In this article, we describe a collaboration between Birmingham City University and Birmingham Children's Hospital to develop a website that presents 3D images of clinical holds, outlining how we introduced it to staff in the clinical areas that would benefit from it and how we have been evaluating its effectiveness. We hope this website will formalise the professional discussion of clinical hold techniques. This will allow information on the appropriate holds for different situations to be documented, which will enhance best practice. In addition, the website should provide information needed to allow children, young people and their parents to give true, informed consent for any procedures they need.

Engagement and effective information provision to promote recovery from depression

Mental illness is the number one health issue facing 14-25 year olds in England, which contributes to almost half the burden of disease in this age group ( Kessler et al 2005 , Kim-Cohen et al 2003 ). A total of 75% of all mental health disorders are established by the age of 18 which is a critical point of emotional, educational and social development. All nurses working with children and young people (CYP) across all health and social care settings should be familiar with national guidelines and the services available to treat CYP with mental health conditions such as depression.

Developing an information leaflet for children having planned procedures in hospital

We have developed an information leaflet with advice on how to support children before, during and after a planned clinical procedure, using ideas from consultations with parents and professionals. Children worry about these procedures and children who are prepared and supported through procedures have better experiences. The project developing the leaflet had five phases: a scoping review of existing information, a parent consultation group, readability and parent feedback, professional input and feedback, and a final review by the patient information officer. In total, we consulted with 50 parents and 134 professionals during this project. We report on how the consultation process used group work and structured feedback to influence the content and format of the leaflet.

Picture book support for preparing children ahead of and during day surgery

Aim To develop and evaluate the use of a specific picture book aiming to prepare children for anaesthesia and surgery. Methods An intervention comparing two different information methods before ear, nose and throat day surgery was performed. The intervention involved using a specific information sheet and a specific picture book. Parents (n=104) of children aged 2-12 years completed open-ended questions that were analysed with qualitative content analysis. They were divided into two groups: one group received routine information and one received routine information and the intervention. Findings The picture sheet and picture book were valuable aids to prepare small children for anaesthesia and surgery by explaining the procedures that would take place. The parents expressed that knowledge of the procedures made them and the child feel secure. Conclusion Peri-operative information through pictures supports children and their parents during day surgery and may be helpful in future healthcare visits.

Comforting measures described by staff working in paediatric units

Aim Children with cancer identify staff members, who work with them in paediatric units, as their most important comforters. This study aimed to shed light on how those staff members deliver this comfort. Methods Semi-structured interviews were performed and the content then analysed. Nine families (n=9) and eight staff members (n=8) participated in the study. Findings The staff described caring for the children and the whole family. They implemented certain comforting measures with the child, and described how they provided support to parents. Staff described how they felt comforted by relating to the children they were caring for. Conclusion Staff working in paediatric units develop good relationships with children and parents and comfort them using methods described in the literature. The quality of the staff's positive relationships with the children marked all their actions.

How professionals should communicate with children who have mental healthcare needs

Young people with mental health needs are often cared for on children's wards by generalist children's healthcare professionals (CHCPs). Generalist CHCPs find these encounters challenging and difficult but they are viewed as an opportunity to improve the healthcare offered to these young people. The authors secured funding from Health Education South London to design and deliver interactive workshops to improve the communication skills of CHCPs with adolescents in challenging circumstances. In this article, the authors outline the design and content of the workshops and discuss how the workshops explore and challenge the attitudes the participants have that could prevent a young person from seeking support or engaging with professionals. They also describe how the workshops have improved generalist CHCPs' confidence and communication skills when talking with young people and how participants now use these encounters as an opportunity to improve healthcare for children and young people.

Improving children's nurses' knowledge of caring for people with mental health problems

[Figure: see text] The aim of this project was to provide training to nursing staff to improve their confidence and knowledge when caring for children and young people with mental health problems. A one-day bespoke training course was given to a purposeful sample of eight children's nurses. The nurses completed questionnaires before and after the training day and a third questionnaire three months after the course. All nurses reported an increase in knowledge and confidence when caring for young people with mental health problems.

Recognition and management of foreign body ingestion and aspiration

Foreign body ingestion and foreign body aspiration commonly affect children. The most vulnerable age is between six months and four years, when children tend to explore new objects with their mouths. Many of these events remain asymptomatic, with the swallowed object passing through the gastrointestinal tract without causing harm. However, the frequency of serious complications as a result of the ingestion of hazardous objects has increased in recent years, in particular button batteries and magnets. To increase the likelihood of identifying foreign body ingestion and aspiration, healthcare professionals should maintain a high index of suspicion, be aware of the variation in presentations and include it as a differential diagnosis in children presenting with non-specific symptoms, such as fever, cough, drooling, dysphagia and abdominal pain. Management of most foreign body ingestions is conservative, using a 'watch-and-wait' approach. Children should be triaged as an emergency if they have signs or symptoms of airway obstruction or a history that indicates dangerous foreign body ingestion. Early recognition and management leads to improved outcomes for patients. Nurses have a vital role in providing education and practical advice to parents, which reduces the occurrence of these events. Stronger legislation is required to ensure manufacturers emphasise the potential dangers of certain products and design child-safe devices.

Recognition and management of febrile convulsion in children

Febrile convulsion is characterised by convulsion associated with fever in an infant or child aged between six months and six years. The febrile illness causing the convulsion should not be secondary to an intracranial infection (meningitis or encephalitis) or acute electrolyte imbalance. Most cases of febrile convulsion are short lived and self-terminating. However, a few cases of prolonged febrile convulsion may need anticonvulsant medication to stop the seizure. Management is mainly symptomatic, although anticonvulsants may have a role in a small number of children with complex or recurrent febrile convulsion. Referral to paediatric neurologists may be necessary in cases of complex or recurrent febrile convulsion, or in those where a pre-existing neurological disorder exists. One third of children will develop a further febrile convulsion during subsequent febrile illness. Nurses have a vital role in managing children with febrile convulsion, educating parents about the condition and dispelling myths. This article outlines the presentation, management, investigations and prognosis for febrile convulsion, indicating how nurses working in different clinical areas can help to manage this common childhood condition.

An approach to mentoring healthcare play specialist students

Healthcare play specialists (HPSs) provide therapeutic play programmes for children in healthcare settings. Each HPS student must have a mentor in practice, but most HPSs have received no formal training for their role. This article explores mentoring in the HPS service at Guy's and St Thomas' NHS Foundation Trust. A study day for HPSs was arranged to share best practice and discuss the challenges of mentoring students. Stronger links were built between the higher education institute that delivers the training to HPS students and the trust, and the HPSs were provided with a deeper understanding of what was required of them in their mentoring role. HPSs highlighted the importance of a yearly update on mentoring students.

Play distraction versus pharmacological treatment to reduce anxiety levels in children undergoing day surgery: a randomized controlled non-inferiority trial

BACKGROUND

Perioperative experience can be one of the most distressful experiences in a child's life if not managed properly by healthcare professionals. Its consequences can extend well beyond surgery and recovery into the child's future life. Healthcare professionals have a responsibility to decrease the anxiety associated with this experience, improve the child's and the parent's experience and prevent negative consequences. This has traditionally been performed through pharmacological treatment which might have negative side effects. More developmentally appropriate distraction methods are currently being trialled globally to augment the evidence that supports their use as a similarly efficient alternative.

OBJECTIVES

The aim of this study was to explore the efficiency of storytelling, pictures and colouring activities as an anxiolytic intervention in comparison to the traditional pharmacological premedication technique in a non-inferiority study.

STUDY DESIGN

A randomized non-inferiority controlled trial was carried out in 168 children scheduled for day surgery. Children's perioperative anxiety was assessed by a trained anaesthetist using the modified Yale Preoperative Assessment Scale and by parents using the State-Trait Anxiety Inventory for Children. Children's vital signs were also collected preoperatively during the induction period and during the recovery period.

RESULTS

The primary endpoint, which is non-inferiority in terms of anxiety as per Yale Preoperative Assessment Scale survey between play distraction and preoperative medication, was met [average score 10.95 vs. 10.94, respectively, 95% confidence interval (-0.35; 0.37); P = 0.941]. Moreover, anxiety scores of both the intervention and the control group were quite comparable as per STAIC survey [20.90 vs. 20.73, respectively, 95% confidence interval (-0.52; 0.88); P = 0.708] and in terms of vital signs.

CONCLUSION

The results indicate that the distraction technique employed can be considered as an efficient alternative to traditional pharmacological premedication for children undergoing day surgery.

How a short stay unit can reduce children's waiting times

Admitting children to emergency departments (EDs) often places them in an environment better suited to the treatment of adult patients. These children are often triaged and treated as adults, resulting in children being given the wrong triage categories and having their treatment delayed. EDs have problems giving drugs to children, staff are unfamiliar with children's emergency care, and children find EDs frightening. A paediatric emergency short stay unit (PESSU) was opened at Caboolture Hospital, Queensland, Australia, in January 2014. Admission to the PESSU has significantly reduced waiting times for children arriving at the ED and enabled specialist nursing and medical care to be provided quickly. This has been supported by the development of the paediatric flow nurse role ( Gray et al 2016 ).

An experience-based treatment model for children unwilling to eat

Background Guidance during Meals is a two-week inpatient intervention undertaken at the Folke Bernadotte Regional Habilitation Centre, Sweden, to help parents deal with children's eating problems. Parents are given advice about medical and/or behavioural reasons for food selectivity and possible treatment strategies. Aims To identify the way parents handle mealtimes and associated difficulties and investigate parents' opinion on children's progress using Guidance during Meals. Method A questionnaire, consisting of 30 statements and answered by 41 parents, was used to investigate parents' opinions regarding the success of the intervention in altering their child's eating habits at home. Findings Most parents thought that the intervention had helped them and their child, by teaching them how to guide their child during mealtimes, what made it easier for their child to eat, and how to communicate with their child in an encouraging way. Most children retained their increased interest in eating once back at home. These results were not dependent on time of onset of eating problems, number of intervention periods, length of time since the intervention, or gastrostomy. Conclusion The Guidance during Meals intervention helps parents develop knowledge about factors that hinder or facilitate eating in their child and tools that can help their child finish meals, and gives them a sense of hope that positive change can occur.

Children's nurses' post-operative pain assessment practices

Pain assessment is crucial to achieving optimal pain management in children. Pain that is insufficiently controlled can have extensive short- and long-term repercussions. Many studies continue to report that children experience unnecessary post-operative pain when they are in hospital. The purpose of this literature review was to explore post-operative pain assessment practices used by children's nurses. A literature search of databases was undertaken and inclusion criteria identified. Four themes emerged: pain assessment tools; behavioural cues; documentation; and communication between child, parent/carer and nurse. The findings showed that pain assessment tools were inadequately used, that children's behavioural cues were misinterpreted, and that there was inconsistency in the documentation of pain scores and in communication about pain scores between children, parent/carer and nurse. Addressing the key issues identified from the articles reviewed can help improve nursing practice and care.

OC27 - How to manage teenagers' emotions? Proposal of an algorithm for nursing intervention

Theme: Complex health care and chronic disease management.

Staff perspectives on two rare mental health disorders

Pervasive refusal syndrome (PRS)/pervasive arousal withdrawal syndrome (PAWS) and conversion disorder (CD) are two rare mental health disorders that commonly affect children and young people. In the most extreme cases of PRS/PAWS, young people may be unable to perform activities of daily living and rely on adults for physical and emotional support. CD can present as loss of sensation in vision and touch, pain in certain areas and an inability to walk. It is important that children's nurses are aware of these disorders and have some insight into the most helpful approaches. Young people need to feel that their experiences are validated, which can elicit feelings in staff from an urge to help to intense frustration. It is essential for staff to be able to talk and reflect to allow such feelings to be understood. Although these are rare conditions, this article outlines what to do if young people present with features of PRS/PAWS or CD in a general healthcare setting.

Ethical dimensions of paediatric nursing: A rapid evidence assessment

BACKGROUND

Paediatric nurses often face complex situations requiring decisions that sometimes clash with their own values and beliefs, or with the needs of the children they care for and their families. Paediatric nurses often use new technology that changes the way they provide care, but also reduces their direct interaction with the child. This may generate ethical issues, which nurses should be able to address in the full respect of the child. Research question and objectives: The purpose of this review is to describe the main ethical dimensions of paediatric nursing. Our research question was, 'What are the most common ethical dimensions and competences related to paediatric nursing?'

RESEARCH DESIGN

A rapid evidence assessment.

METHOD

According to the principles of the rapid evidence assessment, we searched the PubMed, SCOPUS and CINAHL databases for papers published between January 2001 and March 2015. These papers were then independently read by two researchers and analysed according to the inclusion criteria. Ethical considerations: Since this was a rapid evidence assessment, no approval from the ethics committee was required.

FINDINGS

Ten papers met our inclusion criteria. Ethical issues in paediatric nursing were grouped into three areas: (a) ethical issues in paediatric care, (b) social responsibility and (c) decision-making process.

CONCLUSION

Few studies investigate the ethical dimensions and aspects of paediatric nursing, and they are mainly qualitative studies conducted in critical care settings based on nurses' perceptions and experiences. Paediatric nurses require specific educational interventions to help them resolve ethical issues, contribute to the decision-making process and fulfil their role as advocates of a vulnerable population (i.e. sick children and their families). Further research is needed to investigate how paediatric nurses can improve the involvement of children and their families in decision-making processes related to their care plan.

Parents' experiences of care decisions about children with life-limiting illnesses

AIM

To understand the 'lived experience' of parents throughout the process of making and revising end of life care decisions for their child.

METHOD

Three mothers who had been bereaved participated in semi-structured interviews. These were recorded, transcribed and analysed using interpretative phenomenological analysis.

FINDINGS

Two overarching themes were identified: making decisions and revising and implementing end of life care plans. Sub-themes included: who should be the decision maker; when discussions should be initiated; the values underpinning the plans; revisiting the plans; and barriers and facilitators to their implementation.

CONCLUSION

Parents understand the importance of planning for the end of their child's life but find the process difficult. They also find it a challenge to verbalise their decisions at the end of their child's life and value having the decision partly taken away from them. Professionals can assist parents by using a non-dissent model of decision making. The parents' values are important in these decisions and should be elicited by professionals during the initial stages of decision making.

Prenatal maternal risk factors for infantile colic

AIM

To examine maternal prenatal risk factors for infantile colic (IC).

METHODS

Mothers were asked to complete a standard pre-coded questionnaire form. Inclusion in the study consisted of four criteria. The case group comprised healthy children with infantile colic according to Wessel's definition. The control group comprised healthy children with no history of IC. Prenatal period characteristics of mothers were examined to determine associations with IC.

RESULTS

Children with mothers who had prophylactic iron supplementation therapy during pregnancy suffered more from IC. Postpartum depression was found to be more frequent in the case group than in the control group. Gynaecological history, including suffering from migraine, presence of any premenstrual symptoms, dysmenorrhea and high pre-pregnancy body mass index, was associated with development of IC.

CONCLUSION

Pre-gestational gynaecological complaints and pregnancy characteristics may point to IC. These characteristics should be investigated and families should be informed.

Parent-healthcare provider interaction during peripheral vein cannulation with resistive preschool children

AIM

The aim of this study was to increase understanding of parent-healthcare provider interaction in situations where newly admitted preschool children resist peripheral vein cannulation.

BACKGROUND

Parent-healthcare provider interaction represents an important context for understanding children's resistance to medical procedures. Knowledge about this interaction can provide a better understanding of how restraint is used and talked about. Symbolic interactionism informed the understanding of interaction.

DESIGN

An exploratory, qualitative study was chosen because little is known about these interactions.

METHODS

During 2012-2013, 14 naturalistic peripheral vein cannulation -attempts with six newly hospitalized preschool children were video recorded. Eight parents/relatives, seven physicians and eight nurses participated in this study. The analytical foci of turn-taking and participant structure were used.

RESULTS

The results comprised three patterns of interactions. The first pattern, 'parents supported the interaction initiated by healthcare providers', was a response to the children's expressed resistance and they performed firm restraint together. The second pattern, 'parents create distance in interaction with healthcare providers', appeared after failed attempts and had a short time span. Parents stopped following up on the healthcare providers' interaction and their restraint became less firm. In the third pattern, 'healthcare providers reorient in interaction', healthcare providers took over more of the restraint and either helped each other to continue the interaction or they stopped it.

CONCLUSION

Knowledge about the identified patterns of interactions can help healthcare providers to better understand and thereby prepare both parents and themselves for situations with potential use of restraint.

Views of children, young people and families: the 15 steps challenge

There is a growing emphasis on involving service users in improving service delivery, accelerated by the inquiry into care failings at Mid Staffordshire NHS Foundation Trust. The 15 Steps Challenge was originally developed by the NHS Institute for Innovation and Improvement as a tool to help healthcare professionals, service users and others to work together to improve the patient experience. The 15 Steps Challenge involves a ward 'walkaround' to see the ward through the eyes of a child or young person and a parent or carer. This article explores the emphasis that is placed on user involvement in the context of children's nursing, and shares the experience of planning and evaluating the introduction of the 15 Steps Challenge in an acute children's ward in a busy district general hospital.