Joan Livesley

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 childrens subjective interpretations of events may differ significantly from those of adults; yet childrens and young peoples voices and childrens knowledge regarding hospital care remain relatively unexplored. OBJECTIVE To develop insight into childrens subjective interpretations and knowledge of being hospital in-patients. DESIGN Critical ethnography. SETTING A nephro-urology ward in a tertiary referral childrens 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. Childrens 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 childrens 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 Masters level advanced practice programme in the context of the radical reform and remodelling of the UKs 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 Masters 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 students work and intended advanced practice role remains at the centre of their learning. Analysis of each students knowledge and skill deficits alongside an analysis of the organizations 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 α coefficient for the total instrument was .95, and Cronbach α 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.

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.

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.

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 childrens 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.

Repaying the trust

In a world dominated by risk and uncertainty, theability to predict the outcome of any intervention is essential. Yet few nurses develop appropriate outcome measures, preferring to hide behind the notion that nursing is a process that transcends the need to consider outcomes. Indeed, the process of nursing is understood by some to be an end rather than the means to an end.