Lucy Bray

Developing an activity to aid informed assent when interviewing children and young people

It is now recognised that children as social actors, are competent witnesses to speak for themselves about their experiences of, and perspectives on, the social worlds in which they live (James et al., 1998). Consulting with children and young people directly is vital to gain an understanding of their experiences and it is important for their involvement in research to be appropriate and ethically sound. They should be guaranteed a clear explanation of the purpose of the research and a clear choice about whether they want to get involved based on a full knowledge and understanding of what is involved (Cohen and Emanuel, 1998). There is limited literature which addresses the practical process of obtaining assent from children and young people in social research. This article discusses the factors influencing the assent process and the development of an activity to aid obtaining assent from children and young people.

Child-centred nursing : promoting critical thinking

Child-Centred Nursing presents a unique approach by bringing children to the fore of the discussion about their health and health care. It encourages you to think critically about children, their families and contemporary practice issues. It promotes reflection on how you can develop innovative practice so as to improve children’s health outcomes and their experiences of health care. Clinical case studies and critical thinking exercises are included in each chapter, creating and sustaining a clear link between professional practice, research and theory. The book is essential reading for all pre-registration and post-graduate students studying children’s and young people’s health care.

Home-Based Care for Special Healthcare Needs: Community Children’s Nursing Services

Background:Community children’s nursing services (CCNS) provides nursing and supportive care, ranging from relatively simple to highly technological interventions, to children and young people (0–18 years) within the family home. Objectives:The aim of this study was to elicit the perspectives on and experiences about CCNS in England in relation to things that are working well or that could be improved and the vision for services. Methods:Using a qualitative approach, underpinned by an Appreciative Inquiry philosophy, researchers worked closely with advisory groups (six children and young people, four parents, and five professionals) to design and implement the study. Arts-based participatory appreciative workshops were held in nine regional locations in England; shared activities were undertaken to elicit participants’ experiences. Participants unable to attend the workshops were able to contribute via semistructured interview (face to face or by telephone) or by a dedicated blog or e-mail. Results:Thematic analysis was used, and 214 people participated: families (n = 82), children (n = 27), and professionals or stakeholders (n = 105). Things that were working well were effective communication, robust leadership, actively enabling the child’s care to be sustained at home, and partnerships based on mutual trust. Problems relating to feelings of marginalization, ineffective commissioning, under provision of services and hours of service availability, lack of equipmentor resources, and poor communication between services and settings were areas of concern. The vision for CCNS was for a flexible, equitable, and accessible service that supported children’s and families’ needs and choices and which enabled parents to be parents first rather than caregivers. Discussion:Care at home reduces the disruption to children’s and families’ lives and can empower them to make decisions and control routines and practices. Having CCNS situated within larger teams with strong interdisciplinary and transdisciplinary practices seems to offer the best benefits for children and families. Findings from this study have directly influenced government policy and practice. Further research is needed to determine efficacy of particular models and practices.

Developing biographies: the experiences of children, young people and their parents of living with a long-term condition

This article reports on data from a qualitative interview study that sought to understand the experiences, choices and actions of children and young people undergoing surgery for a long-term condition and that of their parents. Using the concept of biography the article examines how the biographies of children, young people and their parents can be influenced by surgery and the ongoing management of a long-term continence condition. This article challenges previous work that characterises the presence of a condition from birth as a continuous and normal part of the illness experiences of these patients. Although this may be the case in some instances, children, young people and their parents can experience diverse and changing experiences associated with ongoing condition management as well as surgery. Biographical continuity, enrichment and disruption are all relevant concepts for such patients living with a long-term continence condition. These can be influenced by their previous experiences of their condition, their expectations, and dynamics with parents, including changes associated with development and the increasing independence of young people.

Holding and restraining children for clinical procedures within an acute care setting: an ethical consideration of the evidence

This critical reflection on the ethical concerns of current practice is underpinned by a systematic synthesis of current evidence focusing on why and how children are held or restrained for clinical procedures within acute care and the experiences of those present when a child is held against their wishes. Empirical evidence from a range of clinical settings internationally demonstrates that frequently children are held for procedures to be completed; younger children and those requiring procedures perceived as urgent are more likely to be held. Parents and health professionals express how holding children for procedures can cause feelings of moral distress expressed as uncertainty, guilt and upset and that this act breaches the trusting and protective relationship established with children. Despite this, childrens rights and alternatives to holding are not always respected or explored. Childrens experiences and perceptions are absent from current literature. Children and young people have a moral right to have their voice and protests heard and respected and for these to inform judgements of their best interests and the actions of health professionals. Without robust evidence, debate and recognition that children are frequently held against their wishes in clinical practice for procedures which may not be urgent, childrens rights will continue to be compromised.

The knowledge and attitudes of student nurses towards patients with sexually transmitted infections: Exploring changes to the curriculum

Evidence suggests that nurses can struggle to care for patients with sexually transmitted infections in a non-judgemental way. It is unknown how targeted education can influence the knowledge and attitudes of student nurses towards caring for patients with sexually transmitted infections. This study aimed to investigate how a change in curriculum influenced the reported sexual health knowledge and attitudes of pre-registration adult student nurses in a University in the UK. A two phase mixed methods study, using a sequential explanatory strategy, collected quantitative questionnaire data (n = 117) followed by qualitative group data (n = 12). Data were collected from one cohort of students before a curriculum change and then from a subsequent cohort of students. Those students who had increased educational input in relation to sexual health reported higher degrees of knowledge and demonstrated a more positive attitude towards patients with a sexually transmitted infection. Both cohorts of students identified that education in this subject area was essential to challenge negative attitudes and positively influence patient care. Active learning approaches in the curriculum such as small group debates and service user involvement have the ability to allow students to express and challenge their beliefs in a safe and supportive environment.

Auto-driven Photo Elicitation Interviews in Research with Children: Ethical and Practical Considerations

ABSTRACT Children can sometimes find it difficult to articulate their experiences if they have to rely solely on words. Giving children the opportunity to use arts-based research approaches can support their participation in research and create a bridge that enables them to express their perspectives and feelings. This paper focuses on the ethical and practical considerations when using photo elicitation interviews (PEI) in research with children. The discussion and examples provided are drawn from an international study that used auto-driven PEI, where photographs are taken by children themselves, to explore children’s experiences of living with a chronic condition and the impact condition management may have on their everyday lives. In this paper we critically explore the issues arising from our use of PEI including children’s participation and engagement, balancing power and control, and keeping children safe. The main areas of focus for the paper are how PEI provided a means of shifting control; how setting photographic boundaries influenced our PEI study with children; and how we addressed risks associated with the method. Our experience shows that PEI is an engaging and valuable research method, providing a powerful medium for obtaining rich data with children. However, PEI is challenging and it requires researchers to conscientiously address ethical and practical aspects that extend beyond those inherent to standard (words-alone) interviews.

Exploring young people's expectations and experiences of discussing sexual and relationship health with professionals in a children's hospital.

AIM AND OBJECTIVE The purpose of this study was to explore young peoples expectations and experiences of discussing sexual and relationship health with healthcare professionals whilst attending or having been admitted to an acute childrens hospital. BACKGROUND Sexual health and teenage pregnancy are topics of debate in the context of public health. Programmes that provide sexual and relationship education to young people are often delivered in education and/or community health settings. However, a significant proportion of young people access acute health services, yet the literature on acute service providers opportunistically providing sexual and relationship advice to young people is limited. DESIGN Survey. METHODS One hundred young people attending either an outpatient appointment or being discharged following an in-patient episode on a hospital ward were approached to complete a questionnaire. Discussion of the questionnaire findings was undertaken with a group of eight young people, which enriched the interpretation and provided clarity of the findings. RESULTS The topic of sexual and relationship health was important to young people. Although young people infrequently sought advice when in acute settings, they wanted to know there was a choice to discuss these issues with healthcare professionals in the hospital. Young people suggested that professionals needed to have a level of sensitivity and confidence to be able to initiate sexual and relationship discussions with young people. CONCLUSION The information from the questionnaires and the discussion group highlighted that young people feel they need to know there is an option to discuss sexual and relationship health whilst attending or being admitted to an acute childrens hospital. By giving young people a choice to participate or decline in dialogues about sexual and relationship health, a degree of empowerment and level of respect can be encouraged between young people and healthcare professionals. RELEVANCE TO CLINICAL PRACTICE Healthcare professionals need to be mindful of opportunities to engage young people in maximising their health and well-being, this includes providing them with a choice to discuss sexual and relationship health issues in any health setting.

Paediatric catheterisation: exploring and understanding children’s nurses’ perceptions and practice in an acute setting

AIMS AND OBJECTIVES This research study explored the factors which influenced the ability of childrens nurses to urethrally catheterise children in their care. BACKGROUND There is currently limited evidence to inform the clinical skills training of childrens nurses and the impact of competencies and other educational documents on practice. The project aimed to use data to inform local service provision and the design and development of future training programmes in an acute paediatric hospital. DESIGN A mixed method study using questionnaires and focus groups. METHODS Data were obtained through two focus groups (n = 10) and questionnaires (n = 34, response rate 88%) with trained childrens nurses to explore the influencing factors on their ability to conduct this clinical skill. RESULTS The childrens nurses discussed that barriers to being competent and confident to catheterise included a lack of exposure to the clinical skill, increasing awareness of the role of competencies and litigation and the presence of specialist roles. Current catheterisation training was evaluated positively with most nurses stating their knowledge and clinical skills had increased; despite this only 55% (n = 18) identified that would feel able to catheterise a child in their care. CONCLUSIONS Comprehensive training of all childrens nurses in an acute care setting may not provide a workforce, which is competent and confident in urethrally catheterising children, and resources for training may be more appropriately deployed to ensure the optimum care of children and families. RELEVANCE TO CLINICAL PRACTICE This study highlights the difficulties encountered for clinical nurses to remain competent in infrequently used clinical skills. This has relevance to the challenges of providing a multi-skilled workforce in childrens nursing.

Navigating Uncertainty: Health Professionals’ Knowledge, Skill, and Confidence in Assessing and Managing Pain in Children with Profound Cognitive Impairment

There is limited evidence to underpin the assessment and management of pain in children with profound cognitive impairment and these children are vulnerable to poor pain assessment and management. Health professionals working with children with profound cognitive impairment from a single paediatric tertiary referral centre in England were interviewed to explore how they develop and acquire knowledge and skills to assess and manage pain in children with cognitive impairment. The interviews were transcribed and subjected to thematic analysis. Nineteen health professionals representing different professional groups and different levels of experience participated in the study. A metatheme “navigating uncertainty; deficits in knowledge and skills” and two core themes “framing as different and teasing things out” and “the settling and unsettling presence of parents” were identified. Uncertainty about aspects of assessing and managing the pain of children with cognitive impairment tended to erode professional confidence and many discussed deficits in their skill and knowledge set. Uncertainty was managed through engaging with other health professionals and the childs parents. Most health professionals stated they would welcome more education and training although many felt that this input should be clinical and not classroom oriented.