The role of motivation in the initiation and maintening mentoring relationships among nurses and midwives.

AIM: To understand clinicians' motivations to engage in mentoring to support newly graduated nurses and midwives working in hospital settings. BACKGROUND: Nursing and midwifery literature has established the benefits of mentoring and challenges that affect the effectiveness of formal mentoring programmes. No studies have explored hospital nurses' and midwives' motivations to mentor in the absence of the obligatory status and associated rewards of institutionalised mentoring. METHODS: A qualitative descriptive study with 35 nurses and midwives working in three public hospitals in the western, northern and northwestern parts of Uganda. Data were collected using semistructured interviews. Reflexive thematic analysis was applied to interpret the data. We have adhered to COREQ reporting guidelines. RESULTS: The study revealed three salient themes that capture nursing and midwifery professionals' mentoring perspectives. Participants expressed confidence in their inherent mentoring capacities and were often motivated by a desire to reciprocate prior mentoring experiences. Their mentoring approaches varied between self-focused and other-focused motivations, with some overlap in perspectives on hierarchical versus relational mentoring. Across the board, there was a strong consensus on the need of mentoring for individual clinicians, healthcare institutions and the broader profession. The study highlights five opportunities that can be harnessed to design future mentoring programmes. CONCLUSIONS: The findings delineate a complex interplay between self-centred and altruistic mentoring motivations, aligning with hierarchical or mutually beneficial mentoring paradigms. IMPLICATIONS FOR NURSING POLICY: Nurse managers should tailor mentoring programmes to align with these intrinsic motivations, affirm the enduring need for mentoring, and leverage existing institutional resources to create both acceptable and efficient mentoring frameworks.

Exploring the dark side of informal mentoring: Experiences of nurses and midwives working in hospital settings in Uganda.

Mentoring literature explores the dark side of mentoring as factors such as gender and race and how they affect the overall mentoring experience. The sociocultural context of the nursing and midwifery professions presents unique characteristics warranting a qualitative exploration of negative mentoring experiences. We aimed to characterise the dark side of mentoring based on informal mentoring relationships occurring among nurses and midwives working in hospitals. Utilising semistructured interviews in a qualitative descriptive design and reflexive thematic analysis, we examined the perceptions of 35 nurses and midwives from three public hospitals located in the Western, Northern and North-western regions of Uganda. Findings emerged in four overarching themes mentoring process deficits, mentoring relational problems, organisational challenges in mentoring and implications of negative mentoring experiences. Our study findings underscore that, while mentoring is frequently beneficial, it can also be interspersed with negative experiences arising from relational dynamics, particular mentoring processes and the overarching hospital environment. Notably, nurses and midwives actively transformed these challenges into opportunities for growth and self-improvement, while introspectively examining their roles in contributing to these negative experiences. Such a proactive approach highlights their resilience and steadfast commitment to professional development, even in the face of adversity.

'We aren't valued for who we are': Australian nurses' and midwives' perceptions of challenges and barriers to safeguarding children.

PURPOSE: Professionals working with children, including nurses and midwives, are foundational to effectively safeguarding children from maltreatment. However, little is known about the full nature and scope of nurses' and midwives' roles in safeguarding children in Australia presenting barriers to effective workforce preparation and support. DESIGN AND METHODS: This study reports an inductive analysis of qualitative responses (n = 51 Round 1, n = 17 Round 2) from a two-round Delphi study. The Delphi study aimed to build consensus on the nature and scope of nursing and midwifery practice in safeguarding children, and this manuscript presents findings of an inductive analysis of qualitative responses beyond the scope of the Delphi study. Participants were Australian nurses and midwives (n = 51, n = 17) from diverse child-focussed settings. RESULTS: Nurses and midwives experienced many factors outside of their control that restricted their capacity to safeguard children. Influences included high workloads, burnout, lack of support, poor collaboration, structural barriers and inaccessible services for children. CONCLUSIONS: Nurses and midwives are advocates for children but experienced many factors preventing them from effectively safeguarding children. Future approaches to reducing child maltreatment must be underpinned by support for frontline professionals to promote workforce capacity and sustainability. PRACTICE IMPLICATIONS: Despite nurses' and midwives' best intentions, their attempts to prevent and respond to child maltreatment were hampered by systemic factors beyond their control. This study highlighted the need to address broader influences on nursing and midwifery practice to reduce the impacts of child maltreatment and support children to thrive.

Interprofessional education within a nurse practitioner led paediatric service: A multi-methods study.

AIM: This project explored whether a nurse practitioner led mobile paediatric screening service in early learning centres could incorporate allied health and nursing students and develop their confidence in interprofessional collaboration. BACKGROUND: Interprofessional collaboration is essential for health professionals across all contexts of care, including early childhood screening and intervention that enables children to thrive. METHODS: This multi-methods study (pre-test/post-test design) was conducted with nursing, physiotherapy, occupational therapy and nutrition and dietetics students attending clinical placement within the nurse practitioner led mobile paediatric service. Data were collected via pre and post placement surveys (ISVS-21) and post placement semi-structured interviews. RESULTS: Twelve students participated from July to December 2022. Survey findings demonstrated students improved inter-professional socialisation and readiness, supported by qualitative findings that uncovered unique mechanisms for how positive experiences were achieved. Unique pedagogical elements included 1) the nurse practitioner's professional attributes and 2) the mobile nature of the service leveraging learning opportunities within the shared commute. CONCLUSIONS: This study provides proof-of-concept of a placement model that facilitates interprofessional collaboration in nursing and allied health students. Further research should explore longer-term outcomes and scalability.

Interprofessional Education in Child Protection for Preservice Health and Allied Health Professionals: A Scoping Review.

Health and allied health professionals are uniquely positioned to collaborate in prevention, early intervention and responses to child maltreatment. Effective collaboration requires comprehensive interprofessional education (IPE), and inadequate collaboration across sectors and professions continually contributes to poor outcomes for children. Little is known about what interprofessional preparation health and allied health professionals receive before initial qualification (preservice) that equips them for interprofessional collaboration and provision of culturally safe care in child protection. This scoping review aimed to identify what is known internationally about IPE in child protection for preservice health and allied health professionals. Thirteen manuscripts reporting 12 studies met the inclusion criteria and were included in the synthesis. Key characteristics of the educational interventions are presented, including target disciplines, core content and their learning objectives and activities. Findings demonstrated primarily low-quality methodologies and educational interventions that had not been replicated beyond their initial context. Many educational interventions did not provide comprehensive content covering the spectrum of prevention, early intervention and responses for all types of child maltreatment, and/or did not clearly indicate how IPE was achieved. Key challenges to delivering comprehensive interprofessional child protection include lack of institutional support and competing priorities across disciplines who must meet requirements of separate regulatory bodies. Consequently, there is a need for further development and robust evaluation of educational interventions to explore how interprofessional collaborative skills for child protection can be developed and delivered in preservice health and allied health professional education.

Multidisciplinary atopic dermatitis program: A novel approach to managing difficult-to-control atopic dermatitis patients.

BACKGROUND/OBJECTIVES: Disease improvement for difficult-to-control pediatric atopic dermatitis may be more challenging to achieve when directed by single specialties due to disjointed and conflicting dialogue with patients. METHODS: The Multidisciplinary Atopic Dermatitis Program (MADP) was developed through collaborations with the Rady Children's Hospital and UC San Diego Health Divisions of Dermatology, Allergy & Immunology and Clinical Pharmacy, to create team-based evaluation and management of children and adolescents with atopic dermatitis (AD). The MADP allows concurrent, comprehensive evaluations by multiple specialists to develop treatment plans. The program includes extensive patient education to support shared decision making, incorporating patient and family's perspectives along with those of clinical experts into their care. Objective severity measures and patient reported outcome data were collected, along with assessment of patient and family satisfaction with the MADP. RESULTS: Data showed significant improvement in AD severity as assessed by providers, patients and families by the first follow-up visit. BSA mean percentage decreased by up to 56% by the 7th visit, and pruritus (NRS), CLDQI and POEM mean scores decreased by more than 4 points, 12 points, and over 11 points, respectively. After management was initiated in the MADP, 72.73% of patients achieved an EASI 50 and 47.73% achieved an EASI 75 from a baseline mean of 21.7. Patients who continued in clinic beyond the second visit showed further clinically significant decreases in disease measures. CONCLUSIONS: The multidisciplinary approach shows success in the treatment of difficult-to-control AD patients with improvements in clinician and patient reported outcome measures.

Evaluating psychometric properties of three mentoring scales among nurses and midwives in hospital settings: A methodological study.

BACKGROUND: Scales used to evaluate nurses' perspectives of mentoring programmes are mainly designed in developed countries, making them unsuitable for nurses and midwives working in resource-poor developing countries. AIM: To explore the psychometric properties of the perceived cost of mentoring (PCM) scale, negative mentoring experiences (NME) scale and relational mentoring index (RMI) for adaptation in hospital settings in Uganda. METHODS: A cross-sectional study design was used. In total, 303 hospital nurses/midwives in Ugandan participated in the study to evaluate the psychometric properties of the three mentoring scales. RESULTS: Revisions based on word choice were made in adapting the scales to the Ugandan context. The PCM showed three factors (risk to reputation, mentoring effort and nepotism) and had an intra-class correlation (ICC) of 0.609 (95% CI, 0.324-0.793) and Cronbach's alpha of 0.705. The NME scale had two factors (lack of mentor expertise and mismatch between the dyad) consistent with the original scale with an ICC of 0.568 (95% CI, 0.271-0.767) and Cronbach's alpha of 0.841. The RMI showed two factors (individual influence and relational quality) with an ICC of 0.664 (95% CI, 0.410-0.824) and Cronbach's alpha of 0.933. CONCLUSIONS: The initial psychometric assessment indicates satisfactory validity and reliability of the scales for implementation among nurses and midwives within Ugandan hospital contexts. Subsequent research is warranted to validate the factor structures of the scales on a different sample. IMPLICATIONS FOR NURSING AND HEALTH POLICY: In using mentoring programmes to develop the hospital workforce, nurse and midwifery policymakers need to use culturally adapted and validated PCM, NME, and RMI scales to evaluate the quality of these mentoring programmes to maximise the benefits while avoiding unintended consequences.

The Application of Dupilumab to Pediatric Patients Aged 6-11yrs with Moderate-to-Severe Atopic Dermatitis Whose Disease is Not Adequately Controlled: The Clinical Data so Far.

Background: While dupilumab has shown efficacy in improving atopic dermatitis, few studies have assessed the long-term clinical data of dupilumab use in pediatric patients. Objective: In the present study, we reviewed the current literature to assess reported efficacies, side effects, and risks of using dupilumab to treat atopic dermatitis in pediatric populations. Methods: Using PRISMA guidelines, the authors searched PubMed/MEDLINE and Embase for studies related to dupilumab treatment for atopic dermatitis in pediatric patients aged 6-11 years old. Results: A total of 512 pediatric patients (ages 6-11) were included. Outcome measures assessed by EASI, SCORAD, P-NRS, IGA and C-DLQI showed significant improvements in scores from those observed at baseline to the last treatment of dupilumab. Most reported adverse effects on dupilumab were conjunctivitis and infection site reactions. All studies reported that dupilumab was well-tolerated. Limitations: Limitations include the low number of studies available and observation periods of up to 16 weeks, which may be too short to evaluate the drug's effectiveness and occurrence of adverse effects. This also limits our knowledge on whether there are sustained benefits and/or diminished efficacy as well as long-term side effects. Conclusion: Thus far, the data demonstrates dupilumab to be safe and effective in the management of moderate-to-severe atopic dermatitis in children aged 6-11 years. Future studies should evaluate long-term dupilumab use and sustained effects.

Benefits and challenges for hospital nurses engaged in formal mentoring programs: A systematic integrated review.

AIMS: To explore the overall benefits and challenges for the mentee, the mentor, and the hospital (stakeholders) in hospital-sponsored mentoring programs. BACKGROUND: Formal mentoring programs are widely used to assist nurses to adapt to clinical practice, facilitate their career development, and improve workforce retention. However, the overall benefits and challenges for stakeholders involved in formal mentoring programs remain largely unknown due to a lack of systematic reviews to synthesize relevant studies in this important area. DESIGN: A systematic integrated review. DATA SOURCES: A systematic search of six databases including CINAHL, Web of Science, MEDLINE, Scopus, Science Direct, and ProQuest was undertaken. REVIEW METHODS: Studies that met the inclusion criteria were assessed for methodological quality using the Joanna Briggs Institute critical appraisal tools. Findings from qualitative, quantitative, and mixed-methods studies were extracted and synthesized thematically using a convergent synthesis method. RESULTS: Twenty-two original studies were included in the review. Findings are presented under five themes: the benefits for mentees, the benefits for mentors, the benefits for the hospital, challenges perceived by mentees and mentors, and mismatched mentor-mentee pairs. CONCLUSION: Mentoring programs that build on reciprocal relationships among mentees and mentors generate substantial benefits for all if mentees are able to navigate the challenges of the complex and dynamic nature of the clinical practice environment. Organizational support is important in overcoming these challenges.

Cost-Effectiveness Analyses on Various Models of The Red Light, Purple Light Self-Regulation Intervention for Young Children.

Early childhood interventions can improve self-regulation, but there are few economic evaluations of such interventions. This study analyzed the cost-effectiveness of an early childhood self-regulation intervention (Red Light Purple Light!; RLPL), comparing three different models of implementation across stages of intervention development: (Model 1) trained research assistants (RAs; graduate students) directly delivered the RLPL intervention to children; (Model 2) RAs trained trainers (e.g., program coaches), who then trained teachers to implement RLPL with children (e.g., train-the-trainer); and (Model 3) program faculty trained teachers to deliver the RLPL intervention to children. We implemented a cost-effectiveness analysis by calculating the incremental cost-effectiveness ratio. We also conducted a series of sensitivity analyses to adjust for parameter uncertainty. Our base-case analysis suggests that Model 2 was the most cost-effective strategy, in that a cost of $23 per child was associated with a one-unit increase of effect size on self-regulation scores. The "train-the-trainer" model remained the optimal strategy across scenarios in our sensitivity analysis. This study fills an important gap in cost-effectiveness analyses on early childhood self-regulation interventions. Our process and results can serve as a model for future cost-effectiveness analyses of early childhood intervention programs and may ultimately inform decisions related to intervention adoption that optimize resource allocation and improve program design.

The Head-Toes-Knees-Shoulders Revised: Links to Academic Outcomes and Measures of EF in Young Children.

The measurement of self-regulation in young children has been a topic of great interest as researchers and practitioners work to help ensure that children have the skills they need to succeed as they start school. The present study examined how a revised version of a commonly used measure of behavioral self-regulation, the Head-Toes-Knees-Shoulders task (HTKS) called the HTKS-R, and measures of executive function (EF) was related to academic outcomes between preschool and kindergarten (ages 4-6years) in a diverse sample of children from families with low income participating in Head Start in the United States. Participants included 318 children (53% female; 76% White; and 20% Latino/Hispanic) from 64 classrooms in 18 Head Start preschools who were followed over four time points between the fall of preschool and the spring of kindergarten. Results indicated that children with higher HTKS-R scores had significantly higher math and literacy scores at all-time points between preschool and kindergarten. The HTKS-R was also a more consistent predictor of math and literacy than individual EF measures assessing inhibitory control, working memory, and task shifting. Parallel process growth models indicated that children who had high initial scores on the HTKS-R also had relatively higher initial scores on math and literacy. In addition, growth in children's scores on the HTKS-R across the preschool and kindergarten years was related to growth in both children's math and literacy scores over the same period independent of their starting points on either measure. For the HTKS-R and math, children's initial scores were negatively associated with growth over the preschool and kindergarten years indicating that lower skilled children at the start of preschool started to catch up to their more skilled peers by the end of kindergarten.

Breastfeeding, Early Self-Regulation, and Academic Achievement in Kindergarten Among Disadvantaged Children.

OBJECTIVES: The importance of breastfeeding exposure and children's development of self-regulation, independently, are well established. Each of these domains also has been linked to better cognitive development and academic achievement in children. However, little is known about how breastfeeding affects development of early self-regulation skills or whether self-regulation mediates the relationship between breastfeeding and academic achievement, particularly for disadvantaged children. This study examined breastfeeding exposure, self-regulation, and academic achievement in kindergarten among a population of children who previously attended Head Start. METHODS: Children were recruited from Head Start classrooms in the Pacific Northwest. Breastfeeding exposure was assessed via parent report. Children's self-regulation (Day Night Stroop, Dimensional Change Card Sort, Head-Knees-Toes-Shoulders-Revised) and academic achievement [Letter-Word Identification and Applied Problems subtests of Woodcock Johnson Tests of Achievement (English) or the Batería III Woodcock-Muñoz (Spanish)] were directly assessed in fall and spring of kindergarten. Regressions were performed using Stata v14.1 and included breastfeeding exposure as the primary independent variable, controlling for child age, sex, and language spoken. RESULTS: Of the 246 children, 56% were reported as White, 34% Latino/a, 4% African American, and 6% other; 83% were ever exposed to breastfeeding. Breastfeeding exposure was predictive of both fall kindergarten academic achievement (emergent math/literacy scores) and self-regulation (p < 0.05) and related to higher math performance in the spring of kindergarten, which was associated with stronger self-regulation in the fall (p = 0.04). CONCLUSIONS: These findings extend our understanding of the positive effects of breastfeeding exposure on children's development and support breastfeeding promotion, particularly for children at risk of academic difficulty.

Not COVID Toes: Pool Palms and Feet in Pediatric Patients.

So-called COVID toes is probably the most publicized cutaneous manifestation of COVID-19. The parents of 4 patients pursued dermatology evaluation with concerns about COVID-19 infection in their children who presented with symmetric, focal, erythematous lesions of the hands or feet, or both. We elicited a history of extended time in swimming pools for the 4 patients that was associated with COVID-19 restrictions during summer months of the pandemic and recognized findings of frictional and pressure-induced erythema and scaling, leading to a diagnosis of pool palms and feet-an extension of pool palms. It is important to recognize this diagnosis and provide reassurance to the patients and caregivers because the condition warrants no notable workup or therapeutic intervention.

Update on pediatric atopic dermatitis.

Recent studies have led to new insights into atopic dermatitis (AD) pathogenesis and epidemiology as well as its impact on the quality of life of affected children and adolescents. In addition, there are several novel topical and systemic agents recently approved and in late-stage clinical development programs. Epidemiologic insights include relative prevalence rates in different countries and studies of subsets of pediatric patients with different disease longevity and persistence. Studies on quality of life have shown tremendous impact on sleep, not only in affected individuals but in their parents/guardians. The impact of bathing regimens is discussed. Newer topical therapies are reviewed, including topical crisaborole, with a new indication for infants as young as 3 months of age. Topical Janus kinase (JAK) inhibitors are being developed, with some studies including adolescents and children. Other novel therapies include the topical aryl hydrocarbon receptor agonist tapinarof and oral JAK inhibitors; adolescents are being included in the initial clinical trials for several of these therapies. Dupilumab, the first biologic agent approved for AD, has now been well studied in patients aged 6 years and older, with expanded indication down to 6 years of age.

Red Light, Purple Light! Results of an Intervention to Promote School Readiness for Children From Low-Income Backgrounds.

Considerable research has examined interventions that facilitate school readiness skills in young children. One intervention, Red Light, Purple Light Circle Time Games (RLPL; Tominey and McClelland, 2011; Schmitt et al., 2015), includes music and movement games that aim to foster self-regulation skills. The present study (N = 157) focused on children from families with low-income and compared the RLPL intervention (SR) to a revised version of RLPL that included literacy and math content (SR+) and a Business-As-Usual (BAU) control group. In both versions of the intervention, teachers were trained to administer the self-regulation intervention in preschool classrooms with coaching support. Although not statistically significant, children receiving either version of the intervention gained more in self-regulation on the Head-Toes-Knees-Shoulders (HTKS) over the preschool year compared to the BAU group (ß = 0.09, p = 0.082, Cohen's d = 0.31). Effect sizes were similar to previous studies (Schmitt et al., 2015; Duncan et al., 2018) and translated to a 21% difference in self-regulation over and above the BAU group at post-test. Furthermore, children participating in either version of the intervention gained significantly more in math across the school year compared to children in the BAU group (ß = 0.14; p = 0.003, Cohen's d = 0.38), which translated to a 24% difference in math over and above the BAU group at post-test. Results were somewhat stronger for the SR+ version, although effect sizes across intervention conditions were comparable. There were no statistically significant differences across groups for literacy skills. Results extend previous research and suggest that the RLPL intervention, which includes an explicit focus on self-regulation through music and movement games, may improve children's self-regulation and math scores over the preschool year.

Diffuse erythematous rash resistant to treatment.

A 39-year-old woman presented to the emergency department for evaluation of diffuse redness, itching, and tenderness of her skin. The patient said the eruption began 4 months earlier as localized plaques on her scalp, elbows, and beneath both breasts. Over the course of a few days, the redness became more diffuse, affecting most of her body. She also noticed swelling and skin desquamation on her lower extremities. WHAT IS YOUR DIAGNOSIS? HOW WOULD YOU TREAT THIS PATIENT?

Nurse managers' experiences in continuous quality improvement in resource-poor healthcare settings.

Ensuring safe and quality care for patients in hospitals is an important part of a nurse manager's role. Continuous quality improvement has been identified as one approach that leads to the delivery of quality care services to patients and is widely used by nurse managers to improve patient care. Nurse managers' experiences in initiating continuous quality improvement activities in resource-poor healthcare settings remain largely unknown. Research evidence is highly demanded in these settings to address disease burden and evidence-based practice. This interpretive qualitative study was conducted to gain an understanding of nurse managers' Continuous Quality Improvement experiences in rural hospitals in Uganda. Nurse managers in rural healthcare settings used their role to prioritize quality improvement activities, monitor the Continuous Quality Improvement process, and utilize in-service education to support continuous quality improvement. The nurse managers in our sample encountered a number of barriers during the implementation of Continuous Quality Improvement, including: limited patient participation, lack of materials, and limited human resources. Efforts to address the challenges faced through good governance and leadership development require more attention.

Factors associated with depressive symptoms among postpartum mothers in a rural district in Uganda.

OBJECTIVE: across Africa the prevalence of postpartum depression is a major health problem affecting mothers, their infants and families. The purpose of this study was to explore the factors associated with postpartum depressive symptoms (PDS) among women living in a rural Ugandan district. DESIGN: descriptive correlation design. SETTING: Young-Child's Clinic of a public hospital, providing postpartum care services to approximately 450 women and their babies per month in a rural district of Uganda. PARTICIPANTS: 202 postpartum women who have lived in the rural district both during pregnancy and postpartum period following birth of the current infant of age ≤12 weeks. MEASUREMENTS: PDS were measured using the Edinburgh Postnatal Depression Scale (EPDS). FINDINGS: participants' mean age and number of children were 24±4.33 years and 2.85±1.26 children, respectively. Majority of participants were married (61%), delivered the current infant by normal vaginal delivery (91%) at a health facility (86%) and experienced no complications (80%). The mean EPDS score for the sample was 9.5±0.18 and 43% of the participants were found to have PDS (scores ≥10). Statistically significant relationships were found between PDS and factors such as number of female sexual partners the husband has (r=0. 28, p≤0.01); current problems in marriage (r=0.22, p≤0.01), participant's parity (r=-0.24, p≤0.05), infant's ability to breast feed (r=0.28, p≤0.05) and husband support during the postpartum period (r=0. 20, p≤0.05). CONCLUSION: male partners of postpartum women are a major source of factors associated with PDS in rural areas. IMPLICATION FOR PRACTICE: midwifery practitioners in rural settings should emphasise psychosocial assessment and male involvement in postpartum care to increase opportunities of identifying mothers at risk of PDS and implementation of interventions targeting men.