The ethical demand in nursing: a scandinavian perspective.

In this column the authors discuss the ethics of information exchange in nursing practice with children. Five concepts identified in three Swedish grounded theory studies and a content analysis that used the theoretical framework of ethical demand were analyzed. A simultaneous concept analysis found five related concepts: being interconnected, acting according to accepted procedure, completeness, interdependence, and social intercourse. These concepts are synthesized in the concept of intergrade, which emphasizes the value of maintaining the integrity of all involved in information exchange.

Observations of health-care professionals sharing and contributing responsibility in paediatric caring situations.

This study aimed to identify, describe and generate concepts regarding health care professionals' information exchanges with minors and/or their parents/guardians in paediatric caring situations. The study took place at three paediatric outpatient units at a university hospital and there were 15 health care professionals involved. Using the grounded theory and the constant comparative analysis methods, the data collection and analysis was undertaken simultaneously, using participant observation, review of medical records and follow-up interviews. The main concern of the health care professionals that emerged as the core category was: sharing and contributing responsibility, interrelated with the six categories; interchanging of knowledge, relationship-creating chat, calculated confirming, encouraging, dichotomous talking and of situation related effects. This research has explored the elements of information exchange in caring situations and highlighted the interaction between the involved persons. These findings could be valuable to health care professionals in order to develop and improve their caring skills.

A review of children's decision-making competence in health care.

AIMS AND OBJECTIVES: The purpose of this literature review was to search for and review, systematically, children's decision-making competence in health care in the scientific literature. Findings of both quantitative and qualitative studies were analysed thematically. BACKGROUND: Most previous research in children's decision-making competence in health care concerns adults' care in the best interests of the child. It is important to consider decision-making competence from the child's perspective because of children's own human rights. METHODS: Systematic review including database search, manual selection, supplementary searching, management and acquisition of relevant literature, quality appraisal, literature review saturation and thematic review. RESULTS: Six themes emerged: measurable issues, values and beliefs, power, parent-related communication, trust and self-determination. Measurable issues were age, reading ability and memory. Values and beliefs as well as power and parent-related communication were associated with healthcare professionals. Children showed trust and expressed a wish to use self-determination. CONCLUSIONS: Age appropriate information and participation were prerequisites for allowing children to have possibilities of making competent decisions about their own care. Children's decision-making competence is dependent on others, such as parents and healthcare professionals, attitudes and not only on their own capacity. Lack of competence, however, does not exclude children from the human right to have a say. It should be noted that it is a decision to leave the determination to a parent or healthcare professional. RELEVANCE TO CLINICAL PRACTICE: Future research from the viewpoint of children is important to reach optimal levels of participation, through respecting their integrity and to develop them into potential competent decision makers.

Information exchange in paediatric settings: an observational study.

AIM: The aim of this observational study was to identify, describe and generate concepts regarding the exchange of information between children/young people and healthcare professionals in paediatric outpatient settings. METHOD: The grounded theory methodology was used. Field notes from observations and excerpts from medical records were analysed using constant comparative analysis. Twenty eight children and young people were observed in three separate paediatric outpatient units; 76 observations were conducted of interactions between children/young people, parents and staff (paediatric nurses, paediatric enrolled nurses and paediatricians). FINDINGS: 'Balancing the circumstances' was identified as the core category during information exchange, based on six categories: taking part, trust, being in touch, mutuality, getting facts and family influence. The six categories relate to one another and balance the circumstances in the information exchange to varying degrees. These children and young people seemed to be trying to enhance their situation as much as possible by finding out as much as they were able to, sharing their own knowledge with the staff and participating in social interaction with them. CONCLUSION: With this understanding of information exchange, nurses can enable and support children and young people to balance their circumstances and improve information exchanges, thereby promoting their partnership in care.