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There is an urgent need for evidence-based internationally agreed guidelines for minimising readmissions after paediatric sepsis

Por: Paul · S. P. · Walsh · H. R.

Commentary on: Carlton E, Kohne J, Shankar-Hari, et al. Readmission diagnoses after paediatric severe sepsis hospitalisation. Crit Care Med 2019;47:583–90.

Implications for practice and research

  • Children with coexisting comorbidities when discharged following severe sepsis have a higher rate of readmission as compared with matched hospitalisations for other acute medical conditions.

  • There is a need for internationally agreed evidence-based guidelines/consensus paper to minimise post-sepsis readmissions through identification of potentially preventable factors, appropriate discharge criteria and parental education.

  • More research is required into strategies towards prevention of readmissions following discharge after an episode of severe sepsis in children.

  • Context

    Sepsis is a leading cause of avoidable death across all age groups.1 Attempts have been made to streamline the management pathways in the UK and elsewhere through publication of national guidelines.1 While robust guidelines exist for management of initial sepsis episodes, strategies...

    When a parent is dying: how we can do more to support families and children with a dying parent

    Por: Pinto · C. · Pinto · S.

    Commentary on: Hanna JR, McCaughan E, Semple CJ. Challenges and support needs of parents and children when a parent is at end of life: a systematic review. Palliat Med 2019;338:1017–1044. doi: 10.1177/0269216319857622.

    Implications for practice and research

  • When a parent is dying, an honest discussion should be made with the children to prepare them for an imminent bereavement. Community awareness is important for better support networks for grieving families.

  • Further research is needed to explore ways of supporting dying parents to have conversations with children of different ages, family settings and cultural backgrounds.

  • Context

    Dying parents of dependent children are faced with accepting their own impending death as well as supporting their children to understand what is happening and prepare them for when death occurs. Such a challenge needs support from healthcare professionals to facilitate a positive approach that prepares the children for loss...

    Moderate-to-vigorous exercise is beneficial and can improve symptoms of fatigue and depression in young people with paediatric-onset multiple sclerosis and other demyelinating conditions

    Por: McGuigan · K. · McGuigan · C. J.

    Commentary on: Stephens S, Shams S, Lee J, et al. Benefits of physical activity for depression and fatigue in multiple sclerosis: a longitudinal analysis. J Pediatr 2019;209:226–32. https://doi.org/10.1016/j.jpeds.2019.01.040

    Implications for practice and research

  • Young people with paediatric-onset multiple sclerosis (POMS) experience increased depression and fatigue across illness duration; healthcare professionals should be cognisant of the need to address these symptoms to ensure improved well-being and trajectory of these psychosocial aspects over time.

  • Additional longitudinal research among young people with MS is required to address symptomology and improve well-being among this grouping; and also to inform trends, potential interventions and treatment for the adult population.

  • Context

    Paediatric-onset multiple sclerosis presents in childhood or adolescence with fatigue and depression common among those living with POMS.1 Fatigue and depression are often comorbid conditions that have been consistently shown to affect cognitive function, social...

    Engaging teenagers with text-message services for glycaemic control

    Por: Waite · M.

    Commentary on: McGill DE, Volkening DA, Wasserman RM, et al. Text-message responsiveness is associated with HbA1c benefit in teenagers with type 1 diabetes. Diabet Med 2019;36:600–5.

    Implications for practice and research

  • Teenagers with type 1 diabetes (T1D) are at a transition phase in becoming independent for their blood glucose monitoring. Digital interventions may be a key component of behaviour change and management strategies for glycaemic control.

  • Involving the user at the centre of the technology design is critical for research that aims to support adherence with self-management for long-term conditions such as T1D.

  • Context

    There is a growing body of evidence associating the use and functions of mobile devices such as text-message services for people with T1D to promote glycaemic control.1 2 McGill et al3 addressed self-adherent behaviours of teenagers (13–17 years) with T1D through an 18-month text-message intervention...

    Nociceptor-stimulating devices can help reduce pain, anxiety and fear in children requiring regular injections

    Por: Waite · M. · Iness · E. J.

    Commentary on: Canbulat Sahiner N, Turkmen AS, Acikgoz A, et al. Effectiveness of two different methods for pain reduction during insulin injection in children with Type 1 Diabetes: Buzzy and ShotBlocker. Worldviews Evid Based Nurs [EPub ahead of print 11 Oct 2018].

    Implications for practice and research

  • Use of ShotBlocker or Buzzy during insulin administration was effective in reducing self-reported, parental and observer assessments of pain in comparison with no intervention.

  • ShotBlocker or Buzzy was effective in lowering self-reported, parental and observer assessments of fear and anxiety prior to and during insulin administration in comparison with no intervention.

  • Further research is needed to examine the effectiveness of the devices over a longer time period for children who need regular injections.

  • Context

    The negative impact of needle-related procedures has been widely reported with evidence of distress, anxiety and non-compliant behaviours.1 This is...

    Exploratory analysis of single 15 min videotaped structured play session of children aged 1 year reveals no differences between fathers parenting behaviours whether infants are born prematurely or at term

    Por: Lee · A. J.

    Commentary on: McMahon GE, Spencer-Smith MM, Pace CC, et al. Influence of fathers’ early parenting and development of children born very preterm and full term. Journal of Pediatrics 2019:205; 195–201.

    Implications for practice and research

  • Fathers’ parenting behaviours are important to subsequent child development.

  • Further research is needed to review parental interactions and child development for infants born prematurely.

  • Context

    Parenting behaviours impact on child development.1 Children are influenced by a range of factors, including social, cultural, psychological, financial and intellectual standing. Child factors also influence parenting behaviours (such as prematurity, neurodevelopmental disability and gender). Fathers’ parenting styles differ to mothers’, and this can also impact on child behaviour.2

    There are many ways to measure behaviours associated with ‘positive and negative’ parenting.1 There are also a number of ways to measure social, emotional and developmental status of children.

    Poor communication hinders the role of the school nurse as a key professional in protecting children and young people from maltreatment

    Por: Wilkinson · Y.

    Commentary on: Harding L, Davison-Fischer J, Bekaert S, Appleton JV. The role of the school nurse in protecting children and young people from maltreatment: An integrative review of the literature. Int J Nurs Stud. 2019 Jan 2;92:60–72.

    Implications for practice and research

  • Interagency communication can be problematic; adopting an interagency approach to education and training in this area may be beneficial.

  • There is a need for research exploring the impact of school nurse interventions in relation to child maltreatment from the perspective of children and young people.

  • Context

    Child maltreatment is a global public health issue with one in four adults experiencing physical violence in their childhood.1 Effects are far reaching and long standing for children and young people; these include behavioural, physical and mental health consequences. Internationally, in a global overview of school health services, it was found that at least 102...

    Supporting rural nurses to develop and implement a contextualised, systematic approach to paediatric pain management is vital to improve pain care for children

    Por: Noakes · A.

    Commentary on: Marshall C, Forgeron P, Harrison D, et al. Exploration of nurses’ pediatric pain management experience in rural hospitals: a qualitative descriptive study. Appl Nurs Res 2018;42: 89–97.

    Implication for practice and research

  • Considering the context within which nurses deliver paediatric pain management provides implication for practice via ensuring that there are systematic procedures rather than pain care based on individual beliefs.

  • Further research is required to consider rural contextual specific pain management interventions that could enable long-term improvements to care.

  • Context

    Poor pain management for children can have long-term negative impact.1 Yet it has been recognised that globally hospitalised children continue to experience pain despite the availability of effective management strategies.2 Nurses possess a key role in pain assessment, treatment and escalation of concerns to clinicians. This study by Marshall et al1 considers the interplay between the context within...

    Using draw-and-tell methods to inform clinical nursing assessments with children aged 6-12 years

    Por: Neilson · S.

    Commentary on: Linder LA, Bratton H, Nguyen A, et al. Symptoms and self-management strategies identified by children with cancer using draw-and-tell interviews. Oncol Nurs Forum 2018;45:290–300.

    Implications for practice and research

  • Nurses should consider using arts-based approaches when assessing symptoms experienced by children with cancer and identifying and exploring the self-management strategies employed.

  • Further research exploring the use of draw-and-tell methods to inform clinical nursing assessments could inform practice.

  • Context

    The importance and complexity of effective communication in informing children’s knowledge and understanding of their cancer and care, is recognised1 2 Challenges can arise from the acknowledged need for communication to be appropriate for, and tailored to, each individual child.2 School-aged children aged 6–12 years with cancer should be supported, according to their ability, to describe their symptoms and self-identified strategies for their management: this study demonstrates that arts-based...

    Childhood obesity is associated with higher incidence of paediatric onset asthma

    Por: Williams · V. · Nunan · D.

    Commentary on: Lang JE, Bunnell HT, Hossain MJ, et al. Being overweight or obese and the development of asthma. Pediatrics 2018;142. pii: e20182119. doi: 10.1542/peds.2018-2119.

    Implications for practice and research

  • The findings of this study further support the importance of reducing childhood obesity levels to reduce the risk for comorbidities, including asthma.

  • This study also found a more modest increase in the risk of childhood asthma in overweight children, highlighting the importance of interventions focusing on preventing further weight gain for overweight children.

  • Future research can focus on understanding causal pathways and developing effective interventions to manage and prevent childhood obesity and associated comorbidities.

  • Context

    There is clear evidence that obesity and asthma both place a significant burden on children, their families and healthcare systems.1 We also know that obesity in adults and adult-onset asthma are linked2; however, we are...

    Developmentally appropriate social and mental health support could improve quality of life for children receiving cancer treatment

    Por: Neilson · S.

    Commentary on: Jibb LA, Croal L, Wang J, et al. Children’s experiences of cancer care: A systematic review and thematic synthesis of qualitative studies. Oncology Nursing Forum 2018;45:527–44.

    Implications for practice and research

  • Developmentally appropriate conversations with children receiving cancer treatment can ensure timely referrals to the wider team through early identification and understanding of impact and needs.

  • The benefits of ongoing social support during cancer treatment while wide ranging may not be optimally facilitated or utilised in care settings and therefore is an area for future research.

  • Context

    As the overall long-term survival rate for children’s cancer increases,1 recognition of the wide-ranging (physical, psychological, emotional and social) impacts on the quality of life for these children and young people is important.2 3 The systematic review undertaken by Jibb et al4 focuses on the experiences of children receiving cancer treatment...

    Maternal dominance and reliance on over-the-counter analgesia can hinder development of healthy coping strategies for adolescents in pain

    Por: Swift · A.

    Commentary on: Skarstein S, Lagerløv P, Kvarme LG, et al. Pain and development of identity in adolescents who frequently use over-the-counter analgesics: a qualitative study. J Clin Nurs 2018;27:3583–91. doi:10.1111/jocn.14513

    Implications for practice and research

  • A mother’s pain beliefs are influential in shaping an adolescents beliefs, behaviours and coping strategies.

  • There is a historical pattern of pain beliefs and behaviour within families.

  • Further qualitative exploration is needed using co-design, a more diverse group and involvement of fathers.

  • Context

    Chronic pain affects more than 15% of able-bodied adolescents and 27% of those with disabilities.1 Adolescents frequently use over-the-counter analgesics (OTCA): this paper contends that reliance on analgesia limits the opportunity for development of healthier coping strategies.2 A child’s development shapes the way he or she understands and expresses pain. Koslowska3 explains this in terms of attachment theory where...

    Adolescent girls are susceptible to sexual pressure, coercion and victimisation and strategies need to be developed and aimed at males and females to prevent this

    Por: Wilkinson · Y.

    Commentary on: Morrison-Beedy D, Grove L. Adolescent girls’ experiences with sexual pressure, coercion, and victimization: #MeToo. Worldviews Evid Based Nurs 2018;15:225–229.

    Implications for practice and research

  • The power imbalance within sexual relationships needs to be addressed; sex and relationship education should focus around consent, issues of respect and gender harassment.

  • Research exploring the attitudes of young males towards sexual relationships, including sexual pressure and coercion, may provide valuable insight in order to develop appropriate sexual health promotion programmes.

  • Context

    The #MeToo campaign and the use of social media have highlighted and brought to the forefront of society the sexual pressure, coercion and victimisation of women that has been an experience of women across time.1 Tarana Burke began using the phrase ‘me too’ more than 10 years ago when as an activist she supported women of colour surviving sexual abuse. More recently high-profile cases...

    Effectiveness of therapeutic clowning on handwashing habits remains unknown

    Por: Lee · P. H.

    Commentary on: Arıkan D, Gürarslan Bas N, Kurudirek F, Bastopcu A, Uslu H. The effect of therapeutic clowning on handwashing technique and microbial colonization in preschool children. J Nurs Scholarsh; article in press.

    Implications for practice and research

  • Further interventions targeting preschool children can consider delivery methods involving clowns and other entertaining methods.

  • The effectiveness of the therapeutic clowning approach should be compared with existing teaching methods.

  • Context

    Handwashing is an effective and convenient practice to prevent many infectious diseases.1 Children, especially preschoolers, will benefit the most from proper handwashing as they are vulnerable to infectious diseases. Traditional educations on handwashing may not effectively engage preschool children. Arıkan and colleagues proposed an entertaining method, that is, using therapeutic clowning, to teach handwashing technique among preschool children.2 They evaluated their proposed therapeutic clowning by their subjects’ handwashing habit and hand cleanliness.

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