Tineke Water

Critical Moments in Preschool Obesity: The Call for Nurses and Communities to Assess and Intervene

Abstract Thirty years ago obesity was rarely seen in children but is now described as a world wide pandemic. Previous research has focused on school age children; however, researchers have now identified critical moments of development during uterine life and early infancy where negative factors or insults could cause permanent changes in the structure and function of tissues and lead to epigenetic changes. Obesity in preschool children can cause premature and long term chronic health problems; has been associated with academic and social difficulties in kindergarten children; difficulty with social relationships; increased feelings of sadness, loneliness and anxiety; and negative self image in children as young as 5 years of age. The importance of identifying children under the age of five with obesity and associated risks is important yet less than half of health professionals intervene in cases of preschool obesity. This paper explores the concerns around antenatal and preschool obesity and the challenges for nurses and midwives in assessing and providing appropriate interventions for children and families in community settings.

Children’s perspectives in family-centred hospital care

Background: Children’s nursing has developed into its current forms in large part as a result of broader sociopolitical and organisational influences. Family-centred, patient-centred and collaborative approaches are now well established within the lexicon of child healthcare. Children are central to this yet their role within the family-centred care approach is not clear. Aim: To ask children to share the narratives of their experience of hospitals and hospitalisation in New Zealand, in order to consider multiple factors influencing their experience in hospital. Methods: A qualitative narrative study involving face-to-face interviews with families (adults and children) who have had the experience of a child in hospital in New Zealand. The family narratives have been explored elsewhere. In this study, the stories told by children were examined in context of the family interview and the broader sociocultural narratives influencing them. Findings: The research findings offer insights into how children make meaning of hospital experience and how their roles are influenced by adults. Themes evident are that parent and child experience may be different; children’s stories may not be consistent with family narratives; and, children’s agency in hospital is variable. Conclusion: Children’s stories provide insights to the interconnectedness of personal, familial and societal narratives and their influence on experience of hospitalisation. Nurses and families are able to both constrain and enable children’s participation in hospital care.

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.

Patient advocacy by nurses – past, present and future

Background: Patient advocacy is central to the nursing profession yet a sense of certainty about the concept, its meaning and its implications for nursing practice remains elusive. Aim: This scholarly paper examines the concept of patient advocacy and its relevance to the nursing profession in Aotearoa/New Zealand. Design: A broad historical overview of the evolution of the role of advocacy in nursing practice is provided including factors that encourage or discourage nurses to practice patient advocacy. Conclusions: This paper highlights the gap between the ideal of patient advocacy and the realities of everyday nursing practice. The responsibility for enacting advocacy sits with both individual practitioners and the organizations nurses work within.

Holding children for procedures; an international survey of health professionals

Children undergoing clinical procedures can experience pain and/or anxiety. This may result in them being unwilling to cooperate and being held still by parents or health professionals. This study aimed to capture an international perspective of health professionals’ reported practices of holding children still for clinical procedures. An online questionnaire was distributed through network sampling to health professionals working with children aged under 16 years of age. A total of 872 responses were obtained from Australia (n = 477), New Zealand (n = 237) and the United Kingdom (n = 158). Responses were from nurses (n = 651), doctors (n = 159) and other professionals (n = 53). Health professionals reported children as held still for clinical procedures quite often (48%) or very often (33%). Levels of holding varied significantly according to country of practice, profession, student status, length of time working within a clinical setting, training received and the availability of resources in the workplace. Health professionals who gained permissions (assent from children and/or consent from parents) before procedures were less likely to hold children still for a clinical procedure than those who did not. Holding children still for procedures is an international practice, which is influenced by training, access to guidance, country of practice and profession. Childrens permission and parental consent is often not sought before a child is held for a procedure to be completed.

Working in the dark: a hermeneutic inquiry into health professionals’ stories of ketamine sedation with children

Background: Physiological risks of ketamine have been well researched, yet for health professionals (HPs) undertaking paediatric ketamine sedation, questions of benefit and harm remain. Research question: What are health care professionals’ experiences of undertaking ketamine sedation with children? Methodology: Hermeneutic narrative. Methods: The study comprised hermeneutic narrative analysis of stories from seven HPs in nursing, medicine, paramedicine, and play therapy. Findings: The theme, “seeking to control and protect” reveals the chaotic nature of paediatric emergency work and how ketamine can deliver control. The second theme “working in the dark” acknowledges that HPs try to balance perceived benefit and harm, adopting “dream-seeding” in an attempt to mitigate potentially negative psychotropic events. Conclusion: The study recommends further research into childrens experiences of ketamine sedation and the use of dream-seeding to mitigate negative emergence phenomena. It also recommends education for clinicians to increase awareness of the potential for non-physiological risk and harm.

Ethical Issues in Participatory Research with Children and Young People

Research ethics is primarily concerned with the protection of human participants: that the research will benefit and not harm participants and that it is conducted in a way that is ethically sound. Undertaking research with children and young people often brings with it ethical concerns around the power dynamics between adult researchers and children and young people, children’s and young people’s potential vulnerability and competency and capacity to consent to participating in the research and questions around appropriate methodological approaches and methods to facilitate children’s and young people’s engagement and participation in research. Participatory research is offered as a way of increasing children’s agency and decreasing issues of power. However researchers are still called on to be reflexive to ensure ethical participatory research with children and young people.

Child Centred Care: Challenging Assumptions and Repositioning Children and Young People

Theoretical Principles: Against a backdrop of increasing debate regarding childrens voice and position within health care and the struggle to effectively implement Family‐Centred Care (FCC) in practice, the concept of Child‐Centred Care (CCC) has emerged. Phenomena Addressed: The purpose of this paper is to explore the concept of CCC and its potential theoretical alignment with an ecological approach to health care. Research Linkages: The paper will draw on practice‐based research, highlighting the differences and similarities of CC against the more established FCC. Arguments will be presented to show that rather than competing with FCC, CCC has the potential to complement or extend traditional FCC, by placing children in a more prominent and central position than that which they currently hold within health care. HIGHLIGHTSChallenges and continues the debate in regard to the provision of family‐centred care.Child‐centred orientates children to a more central position in health care.An ecological model allows exploration of relational, contextual and environmental influences on the delivery of care.

A qualitative study of health professionals’ views on the holding of children for clinical procedures: Constructing a balanced approach:

Children undergoing clinical procedures can experience fear, uncertainty, and anxiety which can cause them to become upset and resist procedures. This study aimed to capture an international perspective of how health professionals report they would act if a child was upset and resisted a procedure. An online questionnaire, distributed through network sampling, used three vignettes to elicit qualitative open text responses from health professionals. Seven hundred and twelve professionals participated, resulting in 2072 pieces of text across the three vignettes. Many professionals reported that they would use distraction and spend time to inform and engage children in making choices about their procedure. However, most professionals indicated that if a child became uncooperative they would hold or instruct the holding of the child in order to get the procedure done ‘as quickly as possible’. The findings demonstrate that professionals experience difficulty in balancing the different agendas, rights and priorities within the momentum which can build during a clinical procedure, often resulting in the child’s voice and rights being undermined. A more balanced approach could be facilitated by a ‘clinical pause’ that would equip professionals with the time to consider children’s expressed wishes and explore alternative approaches to holding.

Looking towards the horizon: changing landscapes and a shift to a more equitable future for children, young people and their families

Since the turn of this century, there has been a noticeable positive international change by governments towards recognising children and young people as integral to the future of our communities. Many countries have legislation and policies that promote, support and protect the wellbeing of children and their families. The International Council of Nurses (ICN) identifies nurses, as the largest health professional group, as having a pivotal role in ensuring the health and well-being of children and families. This special issue brings attention to actions taken by nurses to influence the health experiences of children/young people and their families.