자연주의적 탐구조사(Naturalistic Inquiry)

A qualitative study on the psychological experience of caregivers of COVID-19 patients.

“North Star” goals toward an ideal integrated behavioral health and ambulatory care setting Tips, resources, and real-world examples of how others are doing it What not to do, or the pitfalls to avoid when integrating behavioral health An interactive integration self-assessment checklist with immediate feedback linked to guidance Access to the Academy Community, an online forum for peer-topeer networking and sharing

Agency for Healthcare Research and Quality (AHRQ)

CONTEXT: Numerous faces scales have been developed for the measurement of pain intensity in children. It remains unclear whether any one of the faces scales is better for a particular purpose with regard to validity, reliability, feasibility, and preference. OBJECTIVES: To summarize and systematically review faces pain scales most commonly used to obtain self-report of pain intensity in children for evaluation of reliability and validity and to compare the scales for preference and utility. METHODS: Five major electronic databases were systematically searched for studies that used a faces scale for the self-report measurement of pain intensity in children. Fourteen faces pain scales were identified, of which 4 have undergone extensive psychometric testing: Faces Pain Scale (FPS) (scored 0–6); Faces Pain Scale–Revised (FPS-R) (0–10); Oucher pain scale (0–10); and Wong-Baker Faces Pain Rating Scale (WBFPRS) (0–10). These 4 scales were included in the review. Studies were classified by using psychometric criteria, including construct validity, reliability, and responsiveness, that were established a priori. RESULTS: From a total of 276 articles retrieved, 182 were screened for psychometric evaluation, and 127 were included. All 4 faces pain scales were found to be adequately supported by psychometric data. When given a choice between faces scales, children preferred the WBFPRS. Confounding of pain intensity with affect caused by use of smiling and crying anchor faces is a disadvantage of the WBFPRS. CONCLUSIONS: For clinical use, we found no grounds to switch from 1 faces scale to another when 1 of the scales is in use. For research use, the FPS-R has been recommended on the basis of utility and psychometric features. Data are sparse for children below the age of 5 years, and future research should focus on simplified measures, instructions, and anchors for these younger children.

A Systematic Review of Faces Scales for the Self-report of Pain Intensity in Children

Background: This is an update of the Cochrane systematic review of family-centred care published in 2007 (Shields 2007). Family-centred care (FCC) is a widely used model in paediatrics, is thought to be the best way to provide care to children in hospital and is ubiquitous as a way of delivering care. When a child is admitted, the whole family is affected. In giving care, nurses, doctors and others must consider the impact of the child's admission on all family members. However, the effectiveness of family-centred care as a model of care has not been measured systematically.

Objectives: To assess the effects of family-centred models of care for hospitalised children aged from birth (unlike the previous version of the review, this update excludes premature neonates) to 12 years, when compared to standard models of care, on child, family and health service outcomes.

Search methods: In the original review, we searched up until 2004. For this update, we searched: the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 12 2011); MEDLINE (Ovid SP); EMBASE (Ovid SP); PsycINFO (Ovid SP); CINAHL (EBSCO Host); and Sociological Abstracts (CSA). We did not search three that were included in the original review: Social Work Abstracts, the Australian Medical Index and ERIC. We searched EMBASE in this update only and searched from 2004 onwards. There was no limitation by language. We performed literature searches in May and June 2009 and updated them again in December 2011.

Selection criteria: We searched for randomised controlled trials (RCTs) including cluster randomised trials in which family-centred care models are compared with standard models of care for hospitalised children (0 to 12 years, but excluding premature neonates). Studies had to meet criteria for family-centredness. In order to assess the degree of family-centredness, we used a modified rating scale based on a validated instrument, (same instrument used in the initial review), however, we decreased the family-centredness score for inclusion from 80% to 50% in this update. We also changed several other selection criteria in this update: eligible study designs are now limited to randomised controlled trials (RCTs) only; single interventions not reflecting a FCC model of care have been excluded; and the selection criterion whereby studies with inadequate or unclear blinding of outcome assessment were excluded from the review has been removed.

Data collection and analysis: Two review authors undertook searches, and four authors independently assessed studies against the review criteria, while two were assigned to extract data. We contacted study authors for additional information.

Main results: Six studies found since 2004 were originally viewed as possible inclusions, but when the family-centred score assessment was tested, only one met the minimum score of family-centredness and was included in this review. This was an unpublished RCT involving 288 children post-tonsillectomy in a care-by-parent unit (CBPU) compared with standard inpatient care. The study used a range of behavioural, economic and physical measures. It showed that children in the CBPU were significantly less likely to receive inadequate care compared with standard inpatient admission, and there were no significant differences for their behavioural outcomes or other physical outcomes. Parents were significantly more satisfied with CBPU care than standard care, assessed both before discharge and at 7 days after discharge. Costs were lower for CPBU care compared with standard inpatient care. No other outcomes were reported. The study was rated as being at low to unclear risk of bias.

Authors' conclusions: This update of a review has found limited, moderate-quality evidence that suggests some benefit of a family-centred care intervention for children's clinical care, parental satisfaction, and costs, but this is based on a small dataset and needs confirmation in larger RCTs. There is no evidence of harms. Overall, there continues to be little high-quality quantitative research available about the effects of family-centred care. Further rigorous research on the use of family-centred care as a model for care delivery to children and families in hospitals is needed. This research should implement well-developed family-centred care interventions, ideally in randomised trials. It should investigate diverse participant groups and clinical settings, and should assess a wide range of outcomes for children, parents, staff and health services.

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Family‐centred care for hospitalised children aged 0‐12 years

The effects of two non-pharmacologic pain management methods for intramuscular injection pain in children

The purpose of this study was to explore parents' and nurses' experiences of parental participation in child care in hospitals in Iran. Using thematic analysis, the data were collected through interviewing 14 parents and 11 nurses from two pediatric hospitals. The results showed that four major themes emerged, including the necessity of a parent's presence, the unplanned and informal delegation of care to the parents (which itself had five subthemes: the parents as nurses, the delegation of care without sufficient and planned parental training, informal parent-to-parent support, the continuum of parents' willingness to participate, and the neglect of parents' needs), the inconsistency of care, and the parents as informal evaluators of care. Based on the study's findings, effective communication by nurses with parents is required. Nurses need to make an ongoing assessment of parents' wishes for involvement and negotiate care accordingly, with enough support and supervision to warrant quality of care.

Parental participation and mismanagement: a qualitative study of child care in Iran.

Background In disaster situations, nurses may face new and unfamiliar ethical and legal challenges not common in their everyday practice Research question/objectives/hypothesis The aim of this study was to explore Iranian nurses' experience of disaster response and their perception of the competencies required by nurses in this environment Research design This article discusses the findings of a descriptive study conducted in Iran in 2012 Participants and research context This research was conducted in Iran in 2012 Participants included 35 nurses who had experience in healthcare delivery following a disaster event in the past 10 years, either in a hospital or out-of-hospital context Ethical considerations This research study was approved by the Ethics Committee of the Isfahan University of Medical Sciences Findings From this study, five themes emerged as areas that nurses require competence in to work effectively in the disaster setting This article focusses on one theme, the ethical and legal issues that arise during disaster response Within the theme of ethical and legal issues, two sub-themes emerged (1) Professional ethics explores professional responsibility of nurses as well as sense of ethical obligation (2) Adherence to law refers to nurses' familiarity with and observation of legal requirements Discussion This article adds to a growing pool of literature which explores the role of nurses in disasters The findings of this study emphasize the need for nurses working in the disaster setting to be aware of professional responsibilities and familiar with legal requirements and the challenges related to observing ethical responsibilities Conclusion In highlighting these issues, this article may provide a useful starting point for the development of an educational framework for preparing nurses and other health professionals to work in the disaster setting

Ethical and legal challenges associated with disaster nursing

Background: Today disasters, natural and man-made, are a part of many people's lives. Iran has a long history of disaster events. Nurses are one of the most significant groups within Iranian disaster relief operations, providing immediate and longer term care for those affected by the disaster. However, the competence of Iranian nurses and their training for this work has received little attention. This paper presented the results of a study aimed to explore the context. Materials and Methods: A qualitative study was performed in 2012 in Iran. Interviews were conducted with 35 nurses. The sampling of participants was purposeful and continued until data saturation was achieved. Themes were identified using inductive qualitative content analysis. Trustworthiness of the study was supported considering auditability, neutrality, consistency, and transferability. Findings: Data analysis undertaken for the qualitative study resulted in the identification of five main themes included 1-management competences, 2- ethical and legal competences, 3-team working, 4-personal competences, and specific technical competences that presented in this report. Conclusions: This report presents an overview of nursing competences required for Iranian nurses in disaster relief. It is argued that additional competencies are required for nurses who care in high-risk situations, including disaster. Nurses need to prepare themselves more effectively to be responsible and effective in the nursing care.

Iranian nurses' perception of essential competences in disaster response: A qualitative study

Background:: The manner in which healthcare professionals deliver bad news affects the way it is received, interpreted, understood, and dealt with. Despite the fact that clinicians are responsible for breaking bad news, it has been shown that they lack skills necessary to perform this task. Objectives:: The purpose of this study was to explore Iranian mothers’ experiences to receive bad news about their children cancer and to summarize suggestions for improving delivering bad news by healthcare providers. Materials and Methods:: A qualitative approach using content analysis was adopted. Semi-structured interviews were conducted with 14 mothers from two pediatric hospitals in Iran. Results:: Five major categories emerged from the data analysis, including dumping information, shock and upset, emotional work, burden of delivering bad news to the family members, and a room for multidisciplinary approach. Conclusions:: Effective communication of healthcare team with mothers is required during breaking bad news. Using multidisciplinary approaches to prevent harmful reactions and providing appropriate support are recommended.

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Fereshteh Aein

Papers

The effects of two non-pharmacologic pain management methods for intramuscular injection pain in children

Parental participation and mismanagement: a qualitative study of child care in Iran.

Ethical and legal challenges associated with disaster nursing

Iranian nurses' perception of essential competences in disaster response: A qualitative study

Giving bad news: a qualitative research exploration.