Participatory Methods to Improve and Develop Pediatric Nursing Practice: A Scoping Review.

Children's nurses in African pediatric settings are often responsible for leading practice improvements. There is a shortage of contextually relevant guidance to inform the design of practice improvement projects in African care settings. Distinctive features of children's nursing practice in Africa include high levels of family caregiver involvement, and organizational and professional cultures which value participation. While established practice improvement methods offer many strengths, methods developed in other geographies should not be adopted uncritically. Our purpose in undertaking this review was to inform selection of methods for a multi-center practice improvement project in Africa. Our aim was to identify types of participatory methods used to improve and develop pediatric nursing practice. We used the PRISMA-ScR method to conduct a scoping review to identify published reports of participatory methods used to improve and develop pediatric nursing practice. We undertook structured searches of five bibliographic databases to identify articles. Only articles written in the English language were included and no limitation was applied to publication date. We identified 7,406 titles and abstracts. After screening, 76 articles met the inclusion criteria. A wide range of participatory methodologies were identified; just under half (n = 34) reported on methods that were not recognized or named methodologies but can be described as collaborative in nature. Plan-do-study-act cycles were reported in 22 articles. There was considerable heterogeneity in frameworks, practical tools and/or nursing models on which the participatory methods were based and there was no apparent relationship between these and the choice of participatory methods. The outcomes identified were also heterogenous in nature and were grouped according to whether they improved structure and/or processes and patient outcomes. Most of the included articles stem from high-income countries with little evidence from low-middle-income countries and none in African settings. Less than half of the included articles involved family caregivers in their practice improvement methodologies. This review highlights the need for greater application of formalized methods for practice improvement and improved rigor and consistency in reporting outcomes. There is also a need to formalize participatory practice improvement methodologies specifically suited to Africa's context of children's nursing.

Engaging nurses in research awareness using a new style of hospital journal club - a descriptive evaluation.

BACKGROUND: Nurses, especially nurses in Africa, face barriers when trying to access and apply literature. These challenges include paywalls; complex academic language; and journal content which is hard to translate to local realities. OBJECTIVES: To investigate nurses' self-reported experiences of participating in a monthly hospital wide journal club at the Red Cross War Memorial Children's Hospital (RCWMCH). DESIGN: This descriptive study used a researcher-designed quantitative questionnaire design. The Revised Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) guideline were used. SETTING: Red Cross War Memorial Children's Hospital (RCWMCH) in Cape Town, South Africa. PARTICIPANTS: All cadres of nurses working at the Red Cross War Memorial Children's Hospital (RCWMCH) who had attended six or more hospital journal club sessions at RCWMCH over the previous two years. METHODS: A descriptive study using a researcher-designed quantitative questionnaire. RESULTS: 155 participants completed the survey (96.87% response rate). Participants self-reported an improved knowledge of the main sections of a journal article (p < 0.001) and a significant increase in talking to colleagues about evidence-based nursing practice after attending journal club (p < 0.001). CONCLUSIONS: Attendance at a journal club appears to contribute to increased access to scientific literature, personal and organisational habits of reading, and collaborative exploration of clinical practice for nurses of all cadres. Innovative facilitation methods (including large-scale graphic facilitation) may contribute to efficacy and popularity of sessions.

A scoping review of mother-child separation in clinical paediatric settings.

There is increasing evidence to suggest that autonomic regulation of hospitalised infants is affected by separation from their mother. This review explored the extent of the evidence relating to the impact of separation on infants and children and aimed to identify suitable measures of the impact of mother-child separation. We conducted a scoping review of seven databases using the main search terms 'physiological', 'psychological', 'infant/child', 'maternal separation' and 'hospital'. Thirty-four articles containing data relevant to the effects of mother-child separation on either member of the pair were included. Findings highlight the central importance of the mother's presence in mediating the stressful effects of hospitalisation on her child. The majority of articles reported on psychological effects of separation on mothers of infants or on younger children. We identified no articles reporting on physiological effects on the older child or mothers of older children or psychological effects on mothers of older children. Only nine articles used validated tools to measure the effects of separation. There is a need for more evidence, based on validated measurement, about the psychological effects of separation on the child, particularly the older child, and on the physiological effects of separation on the mother-child pair during hospitalisation.

Developing children's nursing care outcome statements in Africa using World Café methods.

Nursing metrics use indicators to make the outcomes of nursing care visible through measurement. Metrics must be sensitive to the context-specific nature of nursing and should reflect the work that nurses really do. A workshop at the Building Children's Nursing conference (2019) was convened to develop statements of nursing care outcomes and actions specific to the work of children's nurses in African care settings, using the World Café method and the Nightingale Metrics approach. The process resulted in the development of statements as intended. Appropriate nursing metrics can guide data-driven practice improvements and decision-making about supporting the nursing workforce.

Pain and behaviour changes in children following surgery.

OBJECTIVES: To quantify postoperative pain and problematic behaviour (PB) in children at home following day-case (same day admission and discharge) or inpatient (≥1 night in hospital) surgery, to identify factors associated with PB at 2 and 4 weeks after discharge and to determine whether pain is associated with PB after adjustment for other factors. PATIENTS AND METHODS: Children scheduled for elective surgery were recruited to a descriptive study involving direct observation and self-report questionnaires. The principal outcomes were pain and PB on the 2nd post-discharge day and after the 1st, 2nd and 4th weeks. RESULTS: 131 parents and their children (aged 2-12years) participated in the study. 93% of children had pain and 73% exhibited PB on day 2 after discharge. The incidence of pain and PB decreased over time, but 25% of children still had pain and 32% PB at week 4. Factors associated with PB were child's previous pain experience, parent and child anxiety and parent's level of education. CONCLUSIONS: There was a high incidence of pain and PB persisting for several weeks after surgery in this cohort of children. Previous painful medical experiences and anxiety were important modifiable factors that require further attention from healthcare providers and researchers to potentially improve health and social outcomes for children after surgery.

Parent participation in the care of hospitalized children: a systematic review.

AIM: This paper is a report of a systematic literature review of research on parent participation in the care of hospitalized children. BACKGROUND: Research prior to 1994 found that parents want to participate in basic child care activities normally performed at home. Nurses expected parents to participate in these activities but were reluctant for parents to take on technical roles. Further research has been conducted over the last decade, but has not been systematically reviewed. DATA SOURCES: A search of biomedical research, published between January 1994 and June 2006, was conducted using the databases CINAHL, PsychInfo, Embase and Medline. The search terms related to parents, participation and hospitalized children. METHODS: A systematic review was conducted and study findings were extracted, summarized and critiqued in relation to their contribution to knowledge about parent participation. RESULTS: Twenty-one descriptive studies were found which investigated the following dimensions of parent participation: parents' and healthcare professionals' needs, desires and expectations; parent and healthcare professionals' attitudes; parent roles and healthcare professional facilitation activities. Ways in which nurses gave parents instruction and guidance to participate effectively in the care of their hospitalized child were examined in five intervention studies. CONCLUSION: Recent research has confirmed parents' desire and expectations to participate in their child's care and shown how the nature of their participation has evolved. The attitudes and activities of healthcare professionals are both barriers and facilitators to parent participation. Further research is needed to examine how parents' expectations differ between specialties and acute and chronic care and ways of facilitating parent participation.