The Need for Children's Advocacy Centres: Hearing the Voices of Children.

Children and young people (CYP) can be empowered to take on roles as agents of change in their own communities. CYP want to be heard and should be actively involved in the co-production, design and development of services aimed at them to ensure that the resulting services are acceptable and accessible. Little analysis of the framing and discourse of co-production in different contexts has been undertaken.Building on Children's Advocacy Center models from the United States of America (which are held in high esteem by local communities), there is perceived value of such a center in the UK. A service development initiative was designed to work with children from Greater Manchester (UK) to determine the potential for the establishment of a children's advocacy center in the North of England. This report presents the design and outcome of the initiative and contributes to the literature on the co-production of such service development projects with CYP, notably the means of achieving that outcome.Recommendations are made for the piloting of an Advocacy House model in the UK with collaborative efforts between CYP as well as health, education, law enforcement, social care providers, charities and voluntary groups. A community-inclusive partnership, underpinned by the principles of co-production and co-design, is integral to the further development of this pilot.

The Impact of a School-based, Nurse-delivered Asthma Health Education Program on Quality of Life, Knowledge, and Attitudes of Saudi Children with Asthma.

More than two million people have asthma in Saudi Arabia: 13% aged 6-10 years. Asthma is one of the most common childhood illnesses. Little has been explored about children's ability to learn more about their own asthma in Saudi Arabia. The study was designed to assess the impact of a school-based, nurse-delivered asthma health education program on asthmatic children's knowledge and attitude toward asthma, quality of life, anxiety level, and school absenteeism. A quasi-experimental, non-equivalent group, pretest-posttest design was used. The education program was developed from existing evidence. The Pediatric Asthma Quality of Life Questionnaire, Spence Anxiety Tool, Asthma Knowledge Questionnaire, and Asthma Attitude Questionnaire were employed for data collection. Intervention (n = 130) and control (n = 98) groups were drawn from 10 schools in Ha'il region, Saudi Arabia. Descriptive and inferential statistics were used to examine differences within and between groups. Knowledge of asthma increased significantly more in the intervention group than in the control group. Attitude toward asthma was not changed by the intervention. Anxiety scores reverted to pretest level by posttest II. The intervention group had significantly better total quality of life scores than the control group, and school absenteeism reduced significantly after the delivery of the program. It was concluded that the asthma education program impacted positively on students' knowledge, quality of life, and school attendance. However, asthma education did not change attitudes toward the condition, and the impact on anxiety was not persistent. The results emphasize the benefits of the provision of health education directly to children. Asthma education should be integrated into the Saudi national child health program.

Refining and testing the diagnostic accuracy of an assessment tool (PAT-POPS) to predict admission and discharge of children and young people who attend an emergency department: protocol for an observational study.

BACKGROUND: Increasing attendances by children (aged 0-16 years) to United Kingdom Emergency Departments (EDs) challenges patient safety within the National Health Service (NHS) with health professionals required to make complex judgements on whether children attending urgent and emergency care services can be sent home safely or require admission. Health regulation bodies have recommended that an early identification systems should be developed to recognise children developing critical illnesses. The Pennine Acute Hospitals NHS Trust Paediatric Observation Priority Score (PAT-POPS) was developed as an ED-specific tool for this purpose. This study aims to revise and improve the existing tool and determine its utility in determining safe admission and discharge decision making. METHODS/DESIGN: An observational study to improve diagnostic accuracy using data from children and young people attending the ED and Urgent Care Centre (UCC) at three hospitals over a 12 month period. The data being collected is part of routine practice; therefore opt-out methods of consent will be used. The reference standard is admission or discharge. A revised PAT-POPs scoring tool will be developed using clinically guided logistic regression models to explore which components best predict hospital admission and safe discharge. Suitable cut-points for safe admission and discharge will be established using sensitivity and specificity as judged by an expert consensus meeting. The diagnostic accuracy of the revised tool will be assessed, and it will be compared to the former version of PAT-POPS using ROC analysis. DISCUSSION: This new predictive tool will aid discharge and admission decision-making in relation to children and young people in hospital urgent and emergency care facilities. TRIAL REGISTRATION: NIHR RfPB Grant: PB-PG-0815-20034. ClinicalTrials.gov: 213469. Retrospectively registered on 11 April 2018.

A mixed-method systematic review of the effectiveness and acceptability of preoperative psychological preparation programmes to reduce paediatric preoperative anxiety in elective surgery.

AIM: To explore the effectiveness of preoperative psychological preparation programmes aimed to reduce paediatric preoperative anxiety and the potential factors that could have an impact on parent and children's acceptance of such interventions. BACKGROUND: Various preoperative psychological preparation programmes are available to address paediatric preoperative anxiety. No mixed-method review has been conducted to explore the effectiveness and acceptability of these programmes. DESIGN: A mixed-method systematic review. DATA SOURCES: Seven bibliographic databases were searched from inception to September 2016, complemented by hand searching of key journals, the reference lists of relevant reviews, search for grey literature and the contacting of associated experts. REVIEW METHODS: The review process was conducted based on the framework developed by the Evidence for Policy and Practice Information and Co-ordinating Centre. A narrative summary and a thematic synthesis were developed to synthesize the quantitative and qualitative data respectively, followed by a third synthesis to combine the previous syntheses. RESULTS: Nineteen controlled trials and eleven qualitative studies were included for data synthesis. The controlled trials reveal that educational multimedia applications and web-based programmes may reduce paediatric preoperative anxiety, while the effectiveness of therapeutic play and books remains uncertain. Qualitative studies showed parent-child dyads seek different levels of information. CONCLUSIONS: Providing matched information provision to each parent and child, actively involving children and their parents and teaching them coping skills, may be the essential hallmarks of a successful preoperative psychological preparation. Further research is necessary to confirm the effectiveness of therapeutic play and books.

Evaluating a community-led project for improving fathers' and children's wellbeing in England.

Although under-researched and under-theorized compared to other settings, there is potential for the family setting to be harnessed to support the development of healthy children and societies and to reduce health inequalities. Within this setting, the role of fathers as health facilitators has yet to be fully understood and considered within health promotion. This paper draws on a two year evaluation of a community embedded intervention for fathers and children in an area of multiple deprivation in North West England. The evaluation integrated a variety of qualitative methods within a participatory evaluation framework to help understand the development and impact of a programme of work co-created by a social enterprise and fathers from within the community. Findings suggest that allowing fathers to define their own concerns, discover solutions to these and design locally appropriate ways to share these solutions can result in significant change for them, their children and the wider community. The key to this process is the provision of alternative spaces where fathers feel safe to share the substantial difficulties they are experiencing. This improved their confidence and had a positive impact on their relationships with their children and with significant others around them. However, this process required patience, and a commitment to trusting that communities of men can co-create their own solutions and generate sustainable success. We suggest that commissioning of services delivered 'to' people could be replaced, or supplemented, by commissioning appropriate organisations to work with communities to co-create solutions to the needs they themselves have recognized.

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.

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.

Four-year longitudinal impact evaluation of the Action for Children UK Neglect Project: outcomes for the children, families, Action for Children, and the UK.

Neglect has a devastating impact on children and is the most pervasive form of child maltreatment in the United Kingdom. The study purpose was to establish outcomes for neglected children following structured assessment and intervention to ascertain what worked and why it worked. This prospective cohort study included 85 cases of neglected children under 8 years of age from 7 centers across the United Kingdom. Data were collected between 2008 and 2012 through serial quantitative recording of the level of concern about neglect. Serial review of qualitative case-file data was undertaken for detail of assessment, interventions, and evidence of outcomes for the child. Data analysis was undertaken by paired t-test, Chi Square, descriptive statics for categorical data, and, for narrative data, identification of recurring factors and patterns, with correlation of presenting factors, interventions, and outcomes. Paired t-test demonstrated significant decrease in overall Action for Children Assessment Tool scores between assessment (M=43.77, SD=11.09) and closing the case (M=35.47, SD=9.6, t(84)=6.77, p<0.01). Improvement in the level of concern about neglect was shown in 79% of cases, with only 21% showing no improvement. In 59% of cases, concern about neglect was removed completely. Use of the assessment tool fostered engagement by parents. The relationship between lack of parental engagement and children being taken into care was statistically significant, with a large effect size (χ(2) 10.66, df1, p=0.0001, OR=17.24). When parents refused or were unable to respond positively to the intervention, children benefited from an expedited move into care.

Children's experiences as hospital in-patients: voice, competence and work. Messages for nursing from a critical ethnographic study.

BACKGROUND: There is growing evidence that children's subjective interpretations of events may differ significantly from those of adults; yet children's and young people's voices and children's knowledge regarding hospital care remain relatively unexplored. OBJECTIVE: To develop insight into children's subjective interpretations and knowledge of being hospital in-patients. DESIGN: Critical ethnography. SETTING: A nephro-urology ward in a tertiary referral children's hospital in the north of England. PARTICIPANTS: A purposive sample was employed of 15 children over 2 phases: six (9-15 years) at home in a reconnaissance first phase, and nine (5-14 years) in hospital in phase 2. METHODS: A raft of child-friendly, age-appropriate strategies was used to engage children in phase 1. Phase 2 involved over 100 h of field-work with hospitalised children over 6 months, with observation, interview, play and craft activities as prominent methods. Data were analysed using constant comparative methods. RESULTS: The study ward was a place in which children struggled to find a space for their competence to be recognised and their voice heard. Children's voice became manifest in what they said but also through the non-verbal mechanisms of resisting, turning away and being silent. While all the children shared the experience of being in trouble, recognition of their competence was fluid and contingent on their relationships with the nurses alongside other structural and material factors. The children worked hard to maintain their position as knowledgeable individuals. When they could not do so they relied on supportive adults, and in the absence of supportive adults they became marooned and received bare minimum care. CONCLUSION: The hospital ward was a place for children in which there was little space for children's voices. When their voices were heard, they were often seen as a challenge. Quiet, sick and shy children who were alone were the most likely to have their needs overlooked and become subject to standardised nursing care. A more inclusive and participatory model of nursing practice with children is urgently needed.

The management of advanced practitioner preparation: a work-based challenge.

AIMS: This paper explores the collaborative development of a Master's level advanced practice programme in the context of the radical reform and remodelling of the UK's National Health Service. Some of the educational, managerial and practice challenges are discussed. BACKGROUND: Changes to education and training in response to key strategic reviews undertaken by the Greater Manchester Strategic Health Authority (North West of England) established a need to develop nurses and allied health care practitioners to advanced practitioner level. This paper considers how employers, commissioners and educationalists worked together to produce a Master's level programme to prepare nurses and other health care practitioners for sustainable advanced practice roles. KEY ISSUES: Developing innovative and effective curricula to meet the needs of post graduate students from varied backgrounds preparing to practice in different contexts with different client groups is challenging. However, the development of individual learning pathways and work-based learning ensures that the student's work and intended advanced practice role remains at the centre of their learning. Analysis of each student's knowledge and skill deficits alongside an analysis of the organization's readiness to support them as qualified advanced practitioners (APs) is instrumental in ensuring that organizations are ready to support practitioners in new roles. CONCLUSION: Work-based learning and collaboration between students, employers and higher education institutions can be used to enable managers and students to unravel the network of factors which affect advanced practice in health and social care. Additionally, collaborative working can help to create opportunities to develop strategies that will facilitate change. Implications for nursing management Sustainable change concerned with the introduction of advanced practitioner roles present a real challenge for managers at a strategic and operational level. Commissioning flexible, collaborative and service-led educational programmes can assist in ensuring that change is sustainable and produce practitioners who are fit for practice, purpose and award.

Development of a modified instrument to measure anticipatory grieving in Jordanian parents of children diagnosed with cancer: the Marwit and Meuser Caregiver Inventory Childhood Cancer.

The purpose of this article is to report on the development and field testing for validity and reliability of a modified version of the Marwit and Meuser Caregiver Inventory (MM-CGI) for the assessment of anticipatory grief among Jordanian parents of children with cancer (the MM-CGI Childhood Cancer). In 2006, a 50-item MM-CGI Childhood Cancer was administered to 140 Jordanian parents living with a child with cancer. The Cronbach alpha coefficient for the total instrument was .95, and Cronbach alpha coefficients for each of the 3 subscales was .91 for personal sacrifice burden, .90 for heartfelt sadness and longing, and .86 for worry and felt isolation. The construct validity of this instrument was supported by demonstrating a significant and positive correlation with the Anticipatory Grief Scale. The MM-CGI Childhood Cancer demonstrated strong convergent validity and excellent internal consistency reliability. However, further testing with a larger sample to facilitate factor analysis is needed to complete the validation process.

Telling tales: a qualitative exploration of how children's nurses interpret work with unaccompanied hospitalized children.

AIMS AND OBJECTIVES: To explore how qualified children's nurses define, interpret and give meaning to their work with unaccompanied children in hospital. BACKGROUND: Unaccompanied children are amongst the most vulnerable of the hospital population yet there is little insight into the strategies nurses use to work with them. DESIGN: A qualitative study. METHODS: Tape recorded unstructured interviews with four qualified children's nurses. The interviews focused on stories from the participants' experiences of working with unaccompanied hospitalized children. Transcribed interviews were analyzed for narrative structure to expose how the participants interpreted and gave meaning to their experiences. FINDINGS: The participants' interpretations of the child 'alone' advance previous understandings. The stories unfold into interpreted meanings that shed light on the participant's experiences of sadness and distress. RELEVANCE TO CLINICAL PRACTICE: The strategy of differentiating between being a nurse and being a parent emerges as an important strategy in interpreting professional boundaries. The conventional meaning of 'emotional distancing' is further advanced by the participants' resiliency at remaining emotionally available to the children and parents in their stories. Further research into the emotional aspects of working with children in hospital is warranted.

How a personal account contributes to nurse knowledge: Rachel's story.

This personal account concerns a mother whose sick baby was treated in hospital for a congenital heart anomaly. This mother was inspired by her own experience to train as a children's nurse. Her co-author begins by describing how such personal stories and insights can help raise awareness of parents' feelings and improve nursing practice.