Linda Shields

The evolution of family-centered care

AIM The aim of this study is to explore the history of family-centered care (FCC). BACKGROUND FCC was developed after Word War II, when nursing, then deeply paternalistic, had become asynchronous with changing social expectations for the care of hospitalized children. METHODS This is a historical review of literature reflecting development of pediatric models of care using publications of classic theorists and others. RESULTS Development of FCC resulted from work by U.S. and UK researchers, theorists, and advocates. Their research was right for its time, and its acceptance was the result of social readiness for change resulting from peoples experience of Word War II. CONCLUSION Word War II brought about changes enabling emergence of lobby groups concerned with children in hospital, awakening of pediatric health professionals to family-oriented practice, and development of models of care that allowed widescale adoption of FCC.

Breastfeeding and obesity at 14 years: A cohort study

Aim:  To determine the influence of breastfeeding on overweight and obesity in early adolescence.

The needs of parents of hospitalized children in Australia

The aim of this study was to compare the perceptions of needs held by parents of hospitalized children with those held by the staff caring for them. Family-centred care is a central tenet of paediatrics and should encompass all aspects of the child and familys experience of hospitalization. Important to this are the needs of parents when their children are hospitalized. A widely used and validated tool was used with a convenience sample in paediatric facilities in a childrens hospital in Australia. Some differences were found between parents and staff for scores for perceived importance of the 51 needs included in the questionnaire, and whether or not they were being met satisfactorily during childrens hospital admission, although there were no consistent patterns. Parents declared themselves more independent than the staff perceived them to be. These findings facilitate improvements in communication between parents and staff and can be included in education programmes for both.

Parents' and staff's perceptions of parental needs during a child's admission to hospital: an English perspective

The aim of this research was to compare perceptions of parental needs held by parents of hospitalized children and the staff caring for them, so that potential communication breakdown could be avoided. A well-trialled tool was used with a convenience sample in paediatric facilities in a National Health Service trust in north-east England. Some differences were found between parents and staff for scores for perceived importance of the 51 needs that were included in the questionnaire, and whether or not they were being satisfactorily met during the child’s hospital admission, but there were no consistent patterns, so it is difficult to draw conclusions. Parents declared themselves more independent than the staff perceived them to be. Such findings facilitate improvements in communication between parents and staff and can be included in education programmes for both.

Breastfeeding and obesity at 21 years: a cohort study

AIMS To determine the influence of breastfeeding on overweight and obesity, as determined by body mass index in early adulthood. BACKGROUND Obesity is a contemporary epidemic and linked to increased risk of later cardiovascular disease and type 2 diabetes. The success of long-term treatment is modest. Protective factors, such as potentially, and breastfeeding, are few and very important. There are uncertainties as to whether breastfeeding has a protective effect, especially in adults, or whether it is a reflection of other markers of obesity that are more linked to cardiovascular disease and diabetes risk. Some studies suggest that breastfeeding is protective in later life for cardiovascular disease and atherosclerosis. DESIGN Epidemiological analysis of longitudinal data set. METHODS We collected data about breastfeeding duration, body mass index of children at 21 years and confounding variables from an ongoing longitudinal study of a singleton birth cohort of 7223 children in Brisbane. We assessed the duration of breastfeeding at six months and prevalence of overweight and obesity at 21 years by body mass index. Adjustment for potential confounders was by multivariable multinomial logistic regression. RESULTS Data were available for 2553 young adults. In neither the unadjusted or adjusted analysis was longer duration of breastfeeding associated with reduction in obesity at 21 years. CONCLUSIONS Findings of this investigation are consistent with breastfeeding not independently affecting body mass index in young adults. RELEVANCE TO CLINICAL PRACTICE Breastfeeding has a range of important benefits for infants, mothers and families, although duration of breastfeeding may not play a substantial role in preventing adult onset obesity.

Paediatric low speed vehicle run-over fatalities in Queensland

Introduction Child pedestrian fatalities associated with motor vehicles reversing or moving at low speed are difficult to identify in surveillance data. This study aims to determine the incidence of fatalities associated with what is thought to be an under-reported and preventable fatal injury mechanism. Methods The term low speed vehicle run-over (LSVRO) incidents encompasses pedestrian fatalities where vehicles run-over a child at low speed. Data were obtained for children aged 0–15 years in the Australian state of Queensland (January 2004–December 2008). Results There were 15 deaths (12 boys and 3 girls) during 2004–2008 (rate:1.67/100 000). Over half were aged 0 and 1 years of age (n=8; 53.3%, rate: 14.67/100 000), and one quarter were 2 and 3 years of age (n=4, 27%, rate 7.46/100 000). There were no LSVRO deaths recorded among 10–15 year olds. Most (13/15) of the incidents occurred on private property, and only two occurred on a street/road. Almost half of the fatalities were caused by a four wheel drive (4WD) vehicle; large family sedans were involved in four fatalities, and heavy vehicles were involved in three deaths. In 11 of the fatalities, parents were the drivers of the vehicle involved (mothers 5; fathers 6). In nine, the vehicle involved was reversing before it came in contact with the child. Fatalities occurred in each of the Socio-Economic Indexes For Areas (SEIFA) levels. Conclusion The unique data provided by the child death review team has signalled that LSVRO fatalities are a significant problem in Queensland. The Commission for Children and Young People and Child Guardian (CCYPCG) continue to collect data, which, when combined, will provide outcomes that will act as an impetus for promoting intervention and child advocacy.

The 'gender gap' in authorship in nursing literature

Objectives Gender bias has been found in medical literature, with more men than women as first or senior authors of papers, despite about half of doctors being women. Nursing is about 90% female, so we aimed to determine if similar biases exist in nursing literature. Design Taking the eight non-specialist nursing journals with the highest impact factors for that profession, we counted the numbers of men and women first authors over 30 years. Setting We used nursing journals from around the world which attract the highest impact factors for nursing publication. Participants Eight journals qualified for entry, three from the United Kingdom, four from the United States of America, and one from Australia. Main outcome measures Using Chi-square and Fisher exact tests, we determined differences between the numbers of men and women across all the journals, between countries (USA, UK and Australia), changes over the 30 years, and changes within journals over time. Results Despite the small proportion of men in the nursing workforce, up to 30% of first authors were men. UK journals were more likely to have male authors than USA journals, and this increased over time. USA journals had proportions of male first authors consistent with the male proportion of its nursing workforce. Conclusions In the UK (though not in the USA) gender bias in nursing publishing exists, even though the nursing workforce is strongly feminized. This warrants further research, but is likely to be due to the same reasons for the gender gap in medical publishing; that is, female nurses take time out to have families, and social and family responsibilities prevent them taking opportunities for career progression, whereas mens careers often are not affected in such ways.

Cruel Britannia: A personal critique of nursing in the United Kingdom

Abstract The United Kingdom (UK) once led the world in nursing but because of the exigencies of the funding mechanisms of the National Health Service (NHS), it has fallen a long way behind other countries. We aim to raise awareness inside and outside the UK about the decline in nursing as a profession there. We are purposely contentious, in an attempt to raise questions, both for the UK and for countries which are recruiting British nurses who are leaving because of job losses caused by the funding crisis in the NHS. This paper discusses where the problems that have led to the decline have come from, where nursing is going and poses questions for the future. We hope that the UK government and those who influence the development of nursing will bring it back to the standard it once had.

In whose interest?: Comment on "Toward a sociology of conflict of interest in medical research" by Sarah Winch and Michael Sinnott

Winch and Sinnott’s (2011) case scenario presents a not uncommon dilemma faced by many researchers. As one who studies the medical experiment crimes at Ravensbrück (Shields 2008), I hold a deep understanding of the necessity for research ethics committees, and I have written about how these can be subverted to satisfy personal agendas (Shields 2002). However, Winch and Sinnott have raised the spectre of research governance—nowadays associated with research ethics, and probably important—but I contend that this side of ethics administration is becoming as cumbersome as the ethics process itself, and I ask: Who gains from this? If protection of the subjects/ participants is the raison d’être of research ethics committees, who are the beneficiaries of research governance committees? The whole process has taken on a “Yes, Minister” flavour, with the processes satisfying the bureaucrats, but leaving the participants largely unaware of research governance and certainly the researchers at risk (and I use the word advisedly, consistent withWinch and Sinnott’s narrative) of hours, weeks, months of extra work and delay of their projects. In fact, the delay illustrated in Winch and Sinnott’s scenario should be a major concern for the research ethics committee, as one of the requirements of ethical research is that it is completed efficiently and within a reasonable time frame. Ideas about what constitutes conflict of interest have, as the scenario demonstrates, become so problematic as to deter researchers from either being particularly pedantic about what to declare (or not) or abandoning projects. While we all wish to protect our organizations, our potential participants, and ourselves, we may put ourselves more at risk by declaring possible conflicts of interest because of the varied, inconsistent, and sometimes downright silly perceptions surrounding them, as occurred with Dr. B. But conflict of interest can be something from which human research ethics committees (HREC) and research governance committee members themselves suffer, and while hardworking and honest committee members declare them, there can be hidden conflicts that subtly affect the outcomes of decisions. In fact, if one delved deeply enough into the lives of those who sit on these committees, it would always be possible to Bioethical Inquiry (2012) 9:219–220 DOI 10.1007/s11673-012-9357-z

Children's social/emotional characteristics at entry to school: implications for school nurses.

Children entering school need to build healthy peer relationships; school, however, is the central place for bullying. School nurses have a growing focus on providing care for students with social, emotional and behavioural problems. We examined the relational development of children at school entry in regard to aggression and empathy, showing that teacher-reported aggression decreased between Pre-primary and Year One, while empathy increased between Year One and Year Two classes. No gender difference was found in teacher-reported total, or covert aggression. Understanding how development of empathy can be supported in children at school entry is important, thereby supporting development of pro-social behaviour and decreasing bullying. School nurses must understand the importance of surrounding children with safety in relationships as they begin school.