Voiding school as a treatment of daytime incontinence or enuresis : Children's experiences of the intervention

Background Daytime incontinence and enuresis are common problems in otherwise healthy children, and negatively influence their social lives and self-esteem. Motivation for treatment is often a real clinical problem. Children's experiences of their incontinence treatments have not been previously described. Objective The aim of this study was to describe children's experiences of the Voiding School intervention as a treatment for their incontinence. Study design A qualitative, descriptive focus-group study with a purposive sample was conducted at a Finish university hospital in 2014. Children aged 6-12 years participated in the Voiding School at an outpatient clinic. The intervention included two 1-day group visits 2 months apart. The educational content was based on the International Children Continence Society's standards for urotherapy. The education was delivered with child-oriented teaching methods. At the end of the second visit, 19 children were interviewed in five groups. Data were analysed with inductive content analysis. Results The children described incontinence as an embarrassing problem, which they had to hide at any cost. They had experienced bullying and social isolation because of it. Normal outpatient visits emphasized adult-to-adult communication, which made the children feel like outsiders. The children perceived the Voiding School as a nice and child-oriented experience. Making new friends was especially important to younger boys who felt that the Voiding School day was too long and issue-oriented. In the Voiding School, videos and 'learning by doing' helped the children to understand the basis of given advice, and they were able to learn new habits, which gave them control over the incontinence; this helped them to become 'the boss of the bladder'. Sharing experiences and improvements in their incontinence with their peers supported the children's self-esteem and encouraged them to do new things, such as staying overnight with friends. These experiences helped them to acquire control over the problem (Summary Figure). Discussion According to the children's experiences, normal outpatient visits were only appointments for adults, and not very useful for children. In the Voiding School, they were respected as being the main person, and their views were listened to. The results underlined the importance of a child-oriented approach to patient education with regard to children, and provided encouragement to further develop the intervention. Conclusion Child orientation, peer support, learning by doing, and understanding the cause and effect helped children to gain control over their bladders. Based on the children's experiences, this could be achieved by a voiding school.Peer reviewe

Health and medical device development for fundamental care: Scoping review

BackgroundThe use of technology and health and medical devices as a part of fundamental nursing care is increasing. Although involving users in the device development process is essential, the role of nurses in the process has not yet been discussed.ObjectivesTo examine and map what kind of health and medical devices have been developed specifically for fundamental nursing care and to examine the design and development of the devices, particularly focusing on the role of nurses in the process.DesignScoping review.Data sourcesThe Medline, Cinahl, Web of Science, IEEE Explore and ACM DL databasesReview methodsThe databases were searched to identify studies describing health and medical devices developed for fundamental nursing care published between the years 2008–2018 in English language. References of included articles were reviewed for additional eligible studies. Two research team members screened the abstracts and full articles against the predefined inclusion and exclusion criteria. The PRISMA‐ScR checklist was used.ResultsOf the 7223 reports identified, a total of 19 were chosen for the scoping review. Of these, five were further analysed regarding the development process. Main focus areas of the included reports were patient monitoring, pressure ulcer prevention and patient transfer and mobility. Device development process, divided into three phases, was mainly driven by technological expertise and healthcare personnel were mainly involved in the evaluation phases.ConclusionsHealth and medical devices are a crucial part of the healthcare today and nurses are increasingly involved with their use. Most of the devices have been developed mainly by using technological expertise although they are directly aimed at fundamental aspects of nursing care. The results of our review suggest that the expertise of the nurses as the end‐users of the devices could be much more exploited.</p

Validation of Finnish Neecham Confusion Scale and Nursing Delirium Screening Scale using Confusion Assessment Method algorithm as a comparison scale

Background: Delirium is a common clinical problem with acute and fluctuating onset. Early notification of its symptoms can lead to earlier detection and management of this state. Valid and reliable instruments are required for successful nursing practice. The purpose of the study was to psychometrically test the Finnish versions of the Neecham Confusion Scale (NEECHAM) and the Nursing Delirium Screening Scale (Nu-DESC) in surgical nursing care, utilizing the Confusion Assessment Method (CAM) algorithm as a comparison scale. Methods: This randomized, blinded, instrument testing study was conducted at one university hospital in one surgical unit. Study patients (n = 112) meeting the pre-set criteria were assessed by the principal investigator (PI) and a registered nurse (RN, n = 18). Internal consistency, inter-rater reliability, and concurrent validity of the scales were calculated and face validity and usability evaluated. Results: Internal consistency was from .76 to .86 for all three scales. Inter-rater reliability between PI and RNs was .87 with NEECHAM, .60 with CAM and .47 with Nu-DESC. Concurrent validity was .56 and .59 between CAM and NEECHAM, and .68 and .72 between NEECHAM and Nu-DESC. In the PI group, the correlation between CAM and Nu-DESC was .91, in the RN’s group .42. Nu-DESC was evaluated as the most usable scale. Conclusion: The findings strengthen the earlier research on the scales and indicate that the Finnish NEECHAM and Nu-DESC correlates with CAM algorithm and with each other. They seem to be clinically viable in assessing patients’ delirium in surgical wards but more validity testing is needed. Keywords: Confusion, Confusion Assessment Method, Delirium, Instrument testing, Neecham Confusion Scale, Nursing Delirium Screening Scale</p

Associations Between Daytime Sleepiness, Psychological Symptoms, Headache, and Abdominal Pain in Schoolchildren

Daytime sleepiness and different symptoms are common problems affecting health and well-being of schoolchildren. This population-based cohort study included 568 children who were followed from ages 10 to 15 years. Daytime sleepiness, headache, abdominal pain, and psychological symptoms (depression, irritability or bad temper, nervousness, anxiety, and dejection) were assessed by self-administered questionnaires. The prevalence of frequent daytime sleepiness was 13% at the ages of 10 and 12 years and increased significantly up to 24% at the age of 15 (p </p

A Typology of Breastfeeding Mothers of Preterm Infants: A Qualitative Analysis

Breastfeeding is an important element of motherhood with a preterm infant, but the role of maternal emotions in relation to breastfeeding is vague.\nTo describe maternal emotions regarding and insights into breastfeeding during the first year after a preterm birth.\nIn total, 80 mothers of preterm infants (<35 gestational weeks) participated in this secondary analysis of a larger study. The data were collected with an open question at discharge and 3, 6, and 12 months after the expected birth date and analyzed using thematic analysis.\nA typology of breastfeeding mothers of preterm infants was created. The group of survivors wished to be breastfeeding mothers, but after some unexpected difficulties, they had to give up their dream. The disappointment alleviated with time, but some of the mothers still harbored self-accusations after a year. The highfliers were mothers who succeeded in breastfeeding because of their own persistence. They described breastfeeding as enjoyable for both the mother and the infant. The pragmatist mothers breastfed because it was the general norm and a practical way to feed the infant; breastfeeding caused neither passion nor discomfort. The group of bottle-feeding-oriented mothers expressed that breastfeeding did not interest them at any point.\nBeing aware of the typology could help nurses and midwives carefully observe mothers' individual counselling needs. Mothers' wishes and decisions regarding breastfeeding need to be respected and supported without any judgment.\nThe possibilities to tailor breastfeeding interventions based on the typology should be investigated.\nBACKGROUND\nPURPOSE\nMETHODS\nFINDINGS\nIMPLICATIONS FOR PRACTICE\nIMPLICATIONS FOR RESEARC

Adaptation of pain scales for parent observation: are pain scales and symptoms useful in detecting pain of young children with the suspicion of acute otitis media?

BackgroundThe assessment of ear pain is challenging in young, mostly preverbal children. Our aim was to investigate whether pain scales are useful tools for parents to detect pain in their young children with the suspicion of acute otitis media (AOM), and to assess associations between 16 symptoms and the severity of pain.MethodsThis cross-sectional study included 426 children (6-35months) with symptoms suggestive of AOM. We surveyed symptoms and pain via parental interview. As part of the interview, parents assessed their child's pain by using two pain scales: The Faces Pain Scale-Revised (FPS-R) and the Face, Legs, Activity, Cry, Consolability (FLACC) Scale. The outcome of interest was moderate/severe pain. We used the (2) test or Fisher's test as applicable to compare the severity of pain between three parental pain assessment methods (the parental interview, the FPS-R and the FLACC Scale). We also used multivariable logistic regression models to study the association between the severity of pain and AOM and to study the association between symptoms and the severity of pain.ResultsIn children with AOM (n=201), pain was assessed by parents as moderate/severe in 65% via interview; 90% with the FPS-R; and 91% with the FLACC Scale (P<0.001). In children without AOM (n=225), the percentages were 56, 83 and 88%, respectively (P<0.001). Between children with and without AOM, the occurrence of moderate/severe pain did not differ with any of the pain evaluation methods. Of symptoms, ear pain reported by child and restless sleep were significantly associated with moderate/severe pain, regardless of the pain evaluation method.ConclusionsIt seems that nearly all the children with respiratory tract infection, either with or without AOM, might suffer from moderate/severe pain. Without pain scales, parents may underestimate their child's pain. Of symptoms, ear pain reported by child and restless sleep might indicate pain in children with respiratory tract infection. We suggest that the adaptation of pain scales for parent observation is a possibility in children with respiratory tract infection which, however, requires further studies.Trial registrationwww.clinicaltrials.gov, identifier NCT00299455. Date of registration: March 3, 2006

Supporting LGBTQ+ students: a focus group study with Junior High School nurses

LBGTQ+ students often miss the support and information they need in the school nursing, but little is known about junior high school (JHS) nurses’ work with LGBTQ+ students. 15 JHS nurses were interviewed in focus groups about their perceptions of supporting LGBTQ+ students. Four interconnected themes were identified with inductive thematic analysis: (1) JHS nurses’ professional identity and practice; (2) Recognition of sexual and gender diversity in school; (3) Family acceptance process; and (4) LGBTQ+ students as school nursing clients. JHS nurses self-identified as accepting professionals, but having limited skills, knowledge, and education needed in supporting LGBTQ+ students. Supporting LGBTQ+ students is a complex phenomenon, and to enhance JHS nurses’ competence in providing care for these students, sexual and gender diversity needs to be included in evidence-based nursing information sources, covered in nursing education, and the school needs to be secured as LGBTQ+ safe place

The effect of an active video game intervention on physical activity, motor performance, and fatigue in children with cancer: a randomized controlled trial

ObjectiveTo evaluate the effect of active video games in promoting physical activity and motor performance, and reducing fatigue in children with cancer. A randomized controlled trial was conducted. The intervention included playing Nintendo Wii™Fit (Nintendo Co., Ltd., Kyoto, Japan) for 30 min/day for 8 weeks. Physical activity was estimated with accelerometers, physical activity diaries and questionnaires. Movement-ABC2 and PedsQL™ were used to examine motor performance and fatigue. Intervention experiences and fidelity were examined with an interview.ResultsParticipants (n = 36 children with cancer, 3–16 years-old) were randomly assigned to the intervention and control groups. The median [min–max] accelerometer counts/h (500 [131–1130] vs 385 [116–1012], p = 0.63) and physical activity min/day (34 [0–150] vs 23 [0–260], p = 0.95) did not differ between the groups. Change between the pre-test and post-test regarding motor performance and fatigue was similar in both groups (motor performance p = 0.77; fatigue p = 1.00). Participants experienced playing active video games meaningful, but the intervention was not followed completely as instructed. Overall, the physical activity levels were low and one fourth of the children had or were at risk of having movement difficulties.</p