Publications by authors named "Joseph C Manning"

35 Publications

Nursing interventions to reduce medication errors in paediatrics and neonates: Systematic review and meta-analysis.

J Pediatr Nurs 2021 Sep 7. Epub 2021 Sep 7.

Nottingham Childrens Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK; Children and Young People Health Research, School of Health Sciences, University of Nottingham, Nottingham, UK.

Background: Medication errors are a great concern to health care organisations as they are costly and pose a significant risk to patients. Children are three times more likely to be affected by medication errors than adults with medication administration error rates reported to be over 70%.

Objective: To identify nursing interventions to reduce medication administration errors and perform a meta-analysis.

Methods: Online databases; British Nursing Index (BNI), Cochrane Database of Systematic Reviews, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE and MEDLINE were searched for relevant studies published between January 2000 to 2020. Studies with clear primary or secondary aims focusing on interventions to reduce medication administration errors in paediatrics, children and or neonates were included in the review.

Results: 442 studies were screened and18 studies met the inclusion criteria. Seven interventions were identified from included studies; education programmes, medication information services, clinical pharmacist involvement, double checking, barriers to reduce interruptions during drug calculation and preparation, implementation of smart pumps and improvement strategies. Educational interventional aspects were the most common identified in 13 out of 18 included studies. Meta-analysis demonstrated an associated 64% reduction in medicine administration errors post intervention (pooled OR 0.36 (95% Confidence Interval (CI) 0.21-0.63) P = 0.0003).

Conclusion: Medication safety education is an important element of interventions to reduce administration errors. Medication errors are multifaceted that require a bundle interventional approach to address the complexities and dynamics relevant to the local context. It is imperative that causes of errors need to be identified prior to implementation of appropriate interventions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.pedn.2021.08.024DOI Listing
September 2021

Development of the CORE-Kids core set of outcome domains for studies of childhood limb fractures.

Bone Joint J 2021 Aug 19:1-10. Epub 2021 Aug 19.

Department of Trauma and Orthopaedics, University of Nottingham, Nottingham, UK.

Aims: The aim of this study is to develop a core set of outcome domains that should be considered and reported in all future trials of childhood limb fractures.

Methods: A four-phase study was conducted to agree a set of core outcome domains. Identification of candidate outcome domains were identified through systematic review of trials, and outcome domains relevant to families were identified through semi-structured interviews with 20 families (parent-child pairing or group). Outcome domains were prioritized using an international three-round Delphi survey with 205 panellists and then condensed into a core outcome set through a consensus workshop with 30 stakeholders.

Results: The systematic review and interviews identified 85 outcome domains as relevant to professionals or families. The Delphi survey prioritized 30 upper and 29 lower limb outcome domains at first round, an additional 17 upper and 18 lower limb outcomes at second round, and four additional outcomes for upper and lower limb at the third round as important domains. At the consensus workshop, the core outcome domains were agreed as: 1) pain and discomfort; 2) return to physical and recreational activities; 3) emotional and psychosocial wellbeing; 4) complications from the injury and treatment; 5) rturn to baseline activities daily living; 6) participation in learning; 7) appearance and deformity; and 8) time to union. In addition, 9a) recovery of mobility and 9b) recovery of manual dexterity was recommended as a core outcome for lower and upper limb fractures, respectively.

Conclusion: This set of core outcome domains is recommended as a minimum set of outcomes to be reported in all trials. It is not an exhaustive set and further work is required to identify what outcome tools should be used to measure each of these outcomes. Adoption of this outcome set will improve the consistency of research for these children that can be combined for more meaningful meta-analyses and policy development.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1302/0301-620X.103B.BJJ-2020-2321.R2DOI Listing
August 2021

Singapore's health outcomes after critical illness in kids: A study protocol exploring health outcomes of families 6 months after critical illness.

J Adv Nurs 2021 Aug 3;77(8):3531-3541. Epub 2021 Jun 3.

University of Plymouth, Plymouth, UK.

Aim: To explore and understand the impact of paediatric intensive care unit (PICU) admission on longitudinal health outcomes, experiences and support needs of children and their parents in the first 6 months after PICU discharge and to examine the role of ethnicity.

Design: This study uses a prospective, longitudinal design.

Methods: The sample will include children (N = 110) and at least one parent (N = 110) admitted to the PICU (KKH-AM start-up fund, October 2020). Quantitative study: Participants will be recruited at PICU admission. Data will be collected at five time points: during PICU admission (T0), at PICU discharge (T1), 1 month (T2), 3 months (T3) and 6 months (T4) after PICU discharge. Questionnaires will assess physical and cognitive outcomes of the child survivor. Emotional and social health outcomes will be assessed for both the child and the parents. Qualitative study: At least 12 parents will take part in a semi-structured interview conducted at both 1 and 6 months after PICU to explore their experiences and support needs after PICU discharge. All interviews will be audio-recorded with verbatim transcription. We will use framework analysis for qualitative data analysis.

Discussion: Understanding of Singapore health outcomes after critical illness in kids (SHACK) and their families is limited. There is an urgent need to comprehensively understand the health trajectory and consequences of the PICU child survivors and their families. This research will be the first to explore the health outcomes, needs and experiences after paediatric critical illness in Asia.

Impact: This study will provide an understanding of the health outcomes and trajectory of children and parents in the first 6 months after PICU discharge and examine the association between race and outcomes after PICU discharge. Identification of modifiable pre-disposing risk factors during the PICU admission will inform future interventions to improve long-term outcomes of children and parents following paediatric critical illness.

Trial Registration: Clinicaltrial.gov: ClinicalTrials.gov Identifier: NCT04637113.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jan.14911DOI Listing
August 2021

Assessing risk of self-harm in acute paediatric settings: a multicentre exploratory evaluation of the CYP-MH SAPhE instrument.

BMJ Open 2021 05 28;11(5):e043762. Epub 2021 May 28.

School of Health Sciences, University of Nottingham, Nottingham, UK.

Objective: To psychometrically assess the Children and Young People-Mental Health Self-harm Assessment in Paediatric healthcare Environments (CYP-MH SAPhE) instrument for the identification of immediate risk of self-harm in CYP, aged 10-19 years, in acute paediatric wards or emergency departments.

Design: The CYP-MH SAPhE Instrument was developed through a robust scoping review and Delphi consensus with 30 clinicians/topic experts. To evaluate the psychometric properties, a multicentre exploratory study was conducted.

Setting: Three acute hospitals in the UK.

Participants: 163 CYP presenting at acute hospital settings with primary mental health (cases) or physical health (non-cases) conditions.

Primary And Secondary Outcome Measures: Psychometric properties of the CYP-MH SAPhE instrument were evaluated through Principle Axis Factoring (PAF) with Oblimin (Kaiser normalisation) alongside measures of internal consistency (Cronbach's α), convergent, discriminant and face validity.

Results: PAF of the dichotomous items (n=9) loaded onto three factors (1) behaviours and intentions; (2) suicidality and (3) self-harm. Factors 1 (Cronbach's α=0.960) and 3 (Cronbach's α=1) had high internal consistency. There was: good level of agreement between raters (kappa=0.65); a moderately positive correlation between the CYP-MH SAPhE instrument and the Columbia-Suicide Severity Rating Scale; and discrimination between cases and non-cases across the three factors (factor 1: m=88 vs 70; factor 2: m=102 vs 70; factor 3: m=104 vs 68). Assessment of face validity resulted in six items being removed, culminating in an eight question, rapid assessment instrument.

Conclusions: The results support the CYP-MH SAPhE Tool as a potentially reliable and valid instrument to identify immediate risk of self-harm in CYP presenting to acute paediatric healthcare environments, which is a burgeoning and significant global health issue.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjopen-2020-043762DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8166599PMC
May 2021

Post intensive care syndrome across the life course: Looking to the future of paediatric and adult critical care survivorship.

Nurs Crit Care 2021 03;26(2):64-66

Children and Young People Health Research (CYPHR), School of Health Sciences, The University of Nottingham, Nottingham, UK.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/nicc.12605DOI Listing
March 2021

Outcomes for children with acquired brain injury (ABI) admitted to acute neurorehabilitation.

Dev Med Child Neurol 2021 07 10;63(7):824-830. Epub 2021 Mar 10.

Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK.

Aim: To evaluate an innovative paediatric neurorehabilitation model in relation to improving quality of neurorehabilitation and reducing length of stay (LOS) for children with acquired brain injury.

Method: A process evaluation approach was conducted in line with Medical Research Council evaluation of complex interventions guidance. Analysis was conducted on routinely collected patient data from 2017 to 2018, including LOS and family feedback. Descriptive and inferential statistics were used for quantitative analysis and qualitative data was analysed thematically.

Results: Outcomes for 70 children (0-16y, median age 5y, IQR 1-11y, 46 males, 24 females) referred to the service indicated improved function and reduced complexity of need. The mean LOS was 10.6 days compared to baseline mean LOS of 41 days (2011-2012). High satisfaction from the families was recorded; however, ongoing needs and service gaps regarding long-term support were identified.

Interpretation: This service model is effective in delivering quality paediatric neurorehabilitation, demonstrating a sustained impact on LOS, and positive patient outcome data and family feedback for this group of patients. What this paper adds Investment in early intensive neurorehabilitation and supported discharge impacts length of stay (LOS) for children with acquired brain injury. Early intensive neurorehabilitation and supported discharge is effective. This is demonstrated by a sustained reduction in LOS, positive patient outcomes, and family feedback.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/dmcn.14846DOI Listing
July 2021

Pressure injury and risk in the inpatient paediatric and neonatal populations: A single centre point-prevalence study.

J Tissue Viability 2021 May 9;30(2):231-236. Epub 2021 Feb 9.

Nottingham Childrens Hospital and Neonatal Services, Family Health Division, Nottingham University Hospitals NHS Trust, Nottingham, UK; Children and Young People Health Research, School of Health Sciences, University of Nottingham, Nottingham, UK.

Introduction: Prevention and management of pressure injury is a key nurse-sensitive quality indicator. From clinical insights, pressure injury effects hospitalised neonates and children, however it is unclear how prevalent this is. The aim of this study was to quantify prevalence of pressure injury, assess skin integrity risk level, and quantify preventive interventions in both neonatal and child inpatient populations at a large children's hospital in the UK.

Methods: A cross-sectional study was undertaken, assessing the skin integrity of all children allocated to a paediatric or neonatal bed in June/July 2020. A data collection tool was adapted from two established pressure ulcer point prevalence surveys (EUPAP and Medstrom pre-prevalence survey). Risk assessment was performed using the Braden QD scale.

Results: Eighty-eight participants were included, with median age of 0.85 years [range 0-17.5 years), with 32 (36%) of participants being preterm. Median length of hospital stay was 11 days [range 0-174 days]. Pressure ulcer prevalence was 3.4%. The majority of participants had at least two medical devices, with 16 (18.2%) having more than four. Having a medical device was associated with increased risk score of developing pressure injury (odds ratio [OR] 0.03, 95% Confidence Interval [CI] 0.01-0.05, p = 0.02). Most children (39 (44%)) were reported not having proposed preventive measures in place aligned to their risk assessment. However, for those that did, 2 to 4 hourly repositioning was associated with a risk reduction on pressure damage (OR 0.13, 95% CI 0.03-0.23, p = 0.01).

Conclusion: Overall, we found a low prevalence of pressure injury across preterm infants, children and young people at a tertiary children's hospital. Accurate risk assessment as well as availability and implementation of preventive interventions are a priority for healthcare institutes to avoid pressure injury.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jtv.2021.02.004DOI Listing
May 2021

Quality of patient-reported outcomes used for quality of life, physical function, and functional capacity in trials of childhood fractures.

Bone Joint J 2020 Dec;102-B(12):1599-1607

Trauma Outcomes Group, University of Nottingham, Queens' Medical Centre, Nottingham, UK.

Aims: This study evaluates the quality of patient-reported outcome measures (PROMs) reported in childhood fracture trials and recommends outcome measures to assess and report physical function, functional capacity, and quality of life using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) standards.

Methods: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant systematic review of OVID Medline, Embase, and Cochrane CENTRAL was performed to identify all PROMs reported in trials. A search of OVID Medline, Embase, and PsycINFO was performed to identify all PROMs with validation studies in childhood fractures. Development studies were identified through hand-searching. Data extraction was undertaken by two reviewers. Study quality and risk of bias was evaluated by COSMIN guidelines and recorded on standardized checklists.

Results: Searches yielded 13,672 studies, which were screened to identify 124 trials and two validation studies. Review of the 124 trials identified 16 reported PROMs, of which two had validation studies. The development papers were retrieved for all PROMs. The quality of the original development studies was adequate for Patient-Reported Outcomes Measurement Information System (PROMIS) Mobility and Upper Extremity and doubtful for the EuroQol Five Dimension Youth questionnaire (EQ-5D-Y). All other PROMs were found to have inadequate development studies. No content validity studies were identified. Reviewer-rated content validity was acceptable for six PROMs: Activity Scale for Kids (ASK), Childhood Health Assessment Questionnaire, PROMIS Upper Extremity, PROMIS Mobility, EQ-5D-Y, and Pediatric Quality of Life Inventory (PedsQL4.0). The Modified Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire was shown to have indeterminate reliability and convergence validity in one study and PROMIS Upper Extremity had insufficient convergence validity in one study.

Conclusion: There is insufficient evidence to recommend strongly the use of any single PROM to assess and report physical function or quality of life following childhood fractures. There is a need to conduct validation studies for PROMs. In the absence of these studies, we cautiously recommend the use of the PROMIS or ASK-P for physical function and the PedsQL4.0 or EQ-5D-Y for quality of life. Cite this article: 2020;102-B(12):1599-1607.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1302/0301-620X.102B12.BJJ-2020-0732.R2DOI Listing
December 2020

A regional evaluation of the health care utilization and outcomes of children and young people with long-term ventilation needs.

Child Care Health Dev 2021 01 26;47(1):70-76. Epub 2020 Oct 26.

Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK.

Background: Globally, the number of children and young people (CYP) with long-term ventilation (LTV) needs is increasing, with high associated health care costs, due to frequent hospital admissions and contact with community health care services. However, demographic, health care utilization and outcome details of the CYP cared for locally is unknown. This study aimed to examine health care utilization and outcomes for this patient population.

Methods: Routinely collected data from 2014 to 2018 were extracted from local LTV team records and from hospital electronic patient records. Descriptive and inferential statistical analysis was performed using SPSS 17.

Results: A total of 112 CYP aged 0-17 years old were included in the evaluation. Sixty per cent (n = 67) commenced ventilation in hospital, and 62% (n = 69) had at-least one hospitalization event whilst they were on LTV, with a median length of stay of 3 days. Most hospitalizations were unplanned and respiratory in nature. Ninety-five per cent (n = 106) of CYP accessed at least one clinic appointment whilst on LTV, with a median of 20 outpatient clinic appointments during the study period. The majority of CYP received time-intensive support from LTV nurses and physiotherapists during the period that they received LTV. Minimal seasonal variation existed in relation to hospital admissions. Year on year increasing trend of hospital admissions was noted. The observed mortality rate was 3.6% (n = 4), 72.3% (n = 81) remained active on LTV, 14% (n = 16) were liberated from their ventilation and 9% (n = 10) transitioned to adult care by the end of the study.

Conclusion: The study highlights the most common modes of health care utilization for CYP with LTV needs. To enable formalization of future resource planning and accurate assessment of health care utilization in evaluations, there is an urgent need to create a systematic approach for relevant LTV data collection.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/cch.12818DOI Listing
January 2021

A Core Outcome Set for Pediatric Critical Care.

Crit Care Med 2020 12;48(12):1819-1828

Children and Young People Health Research, School of Health Sciences, University of Nottingham and Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.

Objectives: More children are surviving critical illness but are at risk of residual or new health conditions. An evidence-informed and stakeholder-recommended core outcome set is lacking for pediatric critical care outcomes. Our objective was to create a multinational, multistakeholder-recommended pediatric critical care core outcome set for inclusion in clinical and research programs.

Design: A two-round modified Delphi electronic survey was conducted with 333 invited research, clinical, and family/advocate stakeholders. Stakeholders completing the first round were invited to participate in the second. Outcomes scoring greater than 69% "critical" and less than 15% "not important" advanced to round 2 with write-in outcomes considered. The Steering Committee held a virtual consensus conference to determine the final components.

Setting: Multinational survey.

Patients: Stakeholder participants from six continents representing clinicians, researchers, and family/advocates.

Measurements And Main Results: Overall response rates were 75% and 82% for each round. Participants voted on seven Global Domains and 45 Specific Outcomes in round 1, and six Global Domains and 30 Specific Outcomes in round 2. Using overall (three stakeholder groups combined) results, consensus was defined as outcomes scoring greater than 90% "critical" and less than 15% "not important" and were included in the final PICU core outcome set: four Global Domains (Cognitive, Emotional, Physical, and Overall Health) and four Specific Outcomes (Child Health-Related Quality of Life, Pain, Survival, and Communication). Families (n = 21) suggested additional critically important outcomes that did not meet consensus, which were included in the PICU core outcome set-extended.

Conclusions: The PICU core outcome set and PICU core outcome set-extended are multistakeholder-recommended resources for clinical and research programs that seek to improve outcomes for children with critical illness and their families.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/CCM.0000000000004660DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7785252PMC
December 2020

Mobilization practices in critically ill children: a European point prevalence study (EU PARK-PICU).

Crit Care 2020 06 24;24(1):368. Epub 2020 Jun 24.

Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Background: Early mobilization of adults receiving intensive care improves health outcomes, yet little is known about mobilization practices in paediatric intensive care units (PICUs). We aimed to determine the prevalence of and factors associated with physical rehabilitation in PICUs across Europe.

Methods: A 2-day, cross-sectional, multicentre point prevalence study was conducted in May and November 2018. The primary outcome was the prevalence of physical therapy (PT)- or occupational therapy (OT)-provided mobility. Clinical data and data on patient mobility, potential mobility safety events, and mobilization barriers were prospectively collected in patients admitted for ≥72 h.

Results: Data of 456 children admitted to one of 38 participating PICUs from 15 European countries were collected (456 patient days); 70% were under 3 years of age. The point prevalence of PT- and/or OT-provided mobility activities was 39% (179/456) (95% CI 34.7-43.9%) during the patient days, with significant differences between European regions. Nurses were involved in 72% (924/1283) of the mobility events; in the remaining 28%, PT/OT, physicians, family members, or other professionals were involved. Of the factors studied, family presence was most strongly positively associated with out-of-bed mobilization (aOR 7.83, 95% CI 3.09-19.79). Invasive mechanical ventilation with an endotracheal tube was negatively associated with out-of-bed mobility (aOR 0.28, 95% CI 0.12-0.68). Patients were completely immobile on 25% (115/456) of patient days. Barriers to mobilization were reported on 38% of patient days. The most common reported patient-related barriers were cardiovascular instability (n = 47, 10%), oversedation (n = 39, 9%), and medical contraindication (n = 37, 8%). Potential safety events occurred in 6% of all documented mobilization events.

Conclusion: Therapists are infrequently consulted for mobilization of critically ill children in European PICUs. This study highlights the need for a systematic and interdisciplinary mobilization approach for critically ill children.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13054-020-02988-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7311184PMC
June 2020

Post-intensive care syndrome in paediatrics: setting our sights on survivorship.

Lancet Child Adolesc Health 2020 07;4(7):486-488

Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, and Department of Physical Medicine & Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/S2352-4642(20)30170-XDOI Listing
July 2020

Study protocol for a multicentre longitudinal mixed methods study to explore the Outcomes of ChildrEn and fAmilies in the first year after paediatric Intensive Care: the OCEANIC study.

BMJ Open 2020 05 17;10(5):e038974. Epub 2020 May 17.

Children and Young People Health Research, School of Health Sciences, University of Nottingham, Nottingham, Nottinghamshire, UK.

Introduction: Annually in the UK, 20 000 children become very ill or injured and need specialist care within a paediatric intensive care unit (PICU). Most children survive. However, some children and their families may experience problems after they have left the PICU including physical, functional and/or emotional problems. It is unknown which children and families experience such problems, when these occur or what causes them. The aim of this mixed-method longitudinal cohort study is to understand the physical, functional, emotional and social impact of children surviving PICU (aged: 1 month-17 years), their parents and siblings, during the first year after a PICU admission.

Methods And Analysis: A quantitative study involving 300 child survivors of PICU; 300 parents; and 150-300 siblings will collect data (using self-completion questionnaires) at baseline, PICU discharge, 1, 3, 6 and 12 months post-PICU discharge. Questionnaires will comprise validated and reliable instruments. Demographic data, PICU admission and treatment data, health-related quality of life, functional status, strengths and difficulties behaviour and post-traumatic stress symptoms will be collected from the child. Parent and sibling data will be collected on the impact of paediatric health conditions on the family's functioning capabilities, levels of anxiety and social impact of the child's PICU admission. Data will be analysed using descriptive and inferential statistics. Concurrently, an embedded qualitative study involving semistructured interviews with 24 enrolled families at 3 months and 9 months post-PICU discharge will be undertaken. Framework analysis will be used to analyse the qualitative data.

Ethics And Dissemination: The study has received ethical approval from the National Health Services Research Ethics Committee (Ref: 19/WM/0290) and full governance clearance. This will be the first UK study to comprehensively investigate physical, functional, emotional and social consequences of PICU survival in the first-year postdischarge.Clinical Trials Registration Number: ISRCTN28072812 [Pre-results].
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjopen-2020-038974DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7239532PMC
May 2020

Paediatric intensive care follow-up provision in the United Kingdom and Republic of Ireland.

Nurs Crit Care 2021 03 23;26(2):128-134. Epub 2020 Apr 23.

School of Nursing and Midwifery, Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK.

The objective of this study was to examine the characteristic, content, and role of Paediatric Intensive Care Units (PICUs) in the provision of follow-up for children and their families' post-intensive care discharge in the United Kingdom (UK) and Republic of Ireland (RoI). The study followed a descriptive self-reported, web-based survey design. "In-hospital PICU follow-up" was defined as follow-up delivered by the PICU team following PICU discharge but before hospital discharge and "post-discharge PICU follow-up" was defined as follow-up delivered by the PICU team following hospital discharge. The survey was administered to all 28 PICUs in the UK and RoI. Paediatric intensive care medical directors or delegated individuals participated. Data were collected between September 2017 and January 2018 with a response rate of 79% (n = 22/28). Twelve units provided either in-hospital and/or post-discharge PICU follow-up. Ten (45%) PICUs reported providing in-hospital follow-up, with half (n = 5) using an eligibility criteria for in-hospital follow-up, which related to disease groups. The most frequently reported form of in-hospital PICU follow-up consisted of face-to-face patient consultation (n = 8) by a PICU doctor (n = 5) and/or nurse (n = 4). The time at which initial contact was made was usually not predetermined (n = 4) and the assessment of care needs included are tracheostomy care (n = 4), respiratory care (n = 4), and sedative medication weaning plan (n = 5). Four PICUs reported to provide post-discharge follow-up. This involved telephone (n = 2), follow-up clinic consultations (n = 1) or home visits (n = 1), provided predominantly by PICU doctors (n = 2), with their activity directed by patient needs (n = 3). Despite increasing evidence to suggest PICU survivors and their families experience negative sequalae post-PICU discharge, less than half of PICUs surveyed provide in-hospital follow-up and only a minority provide post-discharge follow-up. There is variation in the delivery, content, and format of in-hospital and post-discharge PICU follow-up in the UK and RoI.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/nicc.12510DOI Listing
March 2021

CORE-Kids: a protocol for the development of a core outcome set for childhood fractures.

BMJ Open 2020 02 28;10(2):e036224. Epub 2020 Feb 28.

Trauma Outcomes Group, University of Nottingham, Nottingham, UK.

Introduction: Limb fractures in children are common yet there are few trials that compare treatments for these injuries. There is significant heterogeneity in the outcomes reported in the paediatric orthopaedic literature, which limits the ability to compare study results and draw firm conclusions. The aim of the CORE-Kids Study is to develop a core outcome set for use in research studies of childhood limb fractures. A core outcome set will provide a minimum set of outcomes to be measured in all trials to minimise the heterogeneity of outcomes reported and minimise reporting bias. A core outcome set ensures that outcomes are reported that are relevant to families as well as clinicians. The core outcome set will include additional upper and lower limb modules.

Methods: The development of the core outcome set will require four phases to evaluate:What are the outcomes that are relevant to professionals?What are the outcomes that are relevant to families?What are the most important of these outcomes?Which outcomes should be included in the core outcome set?This will be completed through a systematic review of trials to identify the outcomes domains that are relevant to trialists. A series of semi-structured interviews will be completed with families to identify the outcome domains that are relevant to families. These outcome domains will be used in a three-round Delphi Study to analyse the importance of these outcome domains to a range of stakeholders including parents, clinicians and researchers. Following this, the core outcome set will be decided at a consensus meeting.

Ethics And Dissemination: Ethical approval has been awarded HRA/REC IRAS number 262503. Date of approval 06/08/2019. Dissemination will be through scientific literature and international societies.

Trial Registration: Core Outcome Measures in Effectiveness Trials Initiative, registration number: 1274. Date of registration 13/12/2018.

Prospero Registration Number: CRD42018106605.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjopen-2019-036224DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7050303PMC
February 2020

Exploring participation after paediatric acquired brain injury.

J Child Health Care 2021 03 18;25(1):81-92. Epub 2020 Feb 18.

Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK.

This study aimed to explore the levels of participation in a UK sample of children and young people (CYP) with an acquired brain injury (ABI) at home, school and in the community through a cross-sectional study. The Child and Family Follow-Up Survey was distributed to parents/carers of 134 CYP with ABI (CYP-ABI) who received neuro-rehabilitation from 2014 to 2016. Access and recruitment were problematic resulting in a low response rate (4%). Widespread restrictions in participation were reported by four of the five respondents with community-structured events/activities and educational activities being the most restricted. Factors impacting on participation were cognitive-based and movement skills, family stress and lack of support/encouragement in the community. Study results provide information pertaining to the feasibility of undertaking research with this population while also highlighting the restrictions to participation experienced by CYP-ABI more than two years after injury.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1367493520905673DOI Listing
March 2021

A scoping review of the needs of children and young people with acquired brain injuries and their families.

Brain Inj 2019 7;33(9):1117-1128. Epub 2019 Jul 7.

a Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust , Nottingham , UK.

Understanding the needs of children and young people (CYP) with acquired brain injuries (ABI) is essential in delivering pathways of care and providing effective rehabilitation. : To identify relevant literature and key themes relating to the nature and extent of needs (met, unmet or unrecognized) of CYP with ABI and their families. : Scoping review. Sixteen electronic bibliographic databases were searched using terms relating to children, brain injury and need. Papers were screened against eligibility criteria by two independent reviewers. No date limits were applied. Data were extracted by the lead author regarding the needs of CYP with ABI and their families and thematic analysis conducted to identify the key themes. Methodological quality was not assessed. : A total of 28 articles were identified including three systematic reviews, one scoping review, two practice recommendation articles, and 22 original research studies. Participants included CYP with ABI, parents, siblings, and professionals. Four key themes were identified; CYP-related impairment needs, support needs, return to school and long-term aftercare. : CYP with ABI and their families report extensive needs, many of which are often unmet or unrecognized by those supporting the CYP. Needs transcend the health, social care, and education domains.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/02699052.2019.1637542DOI Listing
June 2020

Engaging and developing front-line clinical nurses to drive care excellence: Evaluating the Chief Nurse Excellence in Care Junior Fellowship initiative.

J Res Nurs 2018 Dec 7;23(8):678-689. Epub 2018 Dec 7.

Assistant Director of Nursing (Research, Innovation and Professional Regulation), Institute for Nursing and Midwifery Care Excellence, Nottingham University Hospitals NHS Trust, Nottingham, UK.

Background: Global challenges in the development of a highly skilled and motivated nursing workforce jeopardise the delivery of high-quality care. Flexible and innovative workforce solutions are required to overcome these challenges.

Aims: To describe the implementation and present the preliminary evaluation of the 'Chief Nurse Excellence in Care Junior' bespoke Fellowship initiative designed to develop the foundational clinical and academic skills of front-line junior clinical staff.

Methods: This initiative was developed and piloted at a large, inner-city, acute NHS trust. The initiative involved two main components: a bespoke development programme and an improvement project that was supported by clinical and academic mentors. The initiative was evaluated using structured feedback, case studies and data on dissemination activities.

Results: Six front-line nurses completed the first cohort of the initiative that commenced in spring 2016. Results showed a positive impact on professional development relating to the acquisition of new knowledge and skills. Case studies of projects had a demonstrable impact on patient experiences, outcomes and cost savings. Wider organisational and NHS impact was demonstrated through multiple dissemination activities.

Conclusion: This preliminary evaluation provides evidence that this initiative is a sustainable, clinically driven career development opportunity at a foundational level that has a demonstrable positive impact on care and staff development. Further work is underway to carry out a longitudinal structure, process and outcome evaluation with particular focus on impact.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1744987118808843DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7932417PMC
December 2018

Parents' and carers' experiences of transition and aftercare following a child's discharge from a paediatric intensive care unit to an in-patient ward setting: A qualitative systematic review.

Intensive Crit Care Nurs 2019 Apr 16;51:35-44. Epub 2018 Nov 16.

School of Health Sciences, The University of Nottingham, Nottingham, UK; The University of Nottingham Centre of Evidence Based Health Care: A Collaborating Centre of The Joanna Briggs Institute, The University of Nottingham, Nottingham, UK; Nottingham Children's Hospital and Neonatology, Nottingham University Hospitals NHS Trust, Nottingham, UK; Children and Families Research, Centre for Innovative Research Across a Life Course, Coventry University, UK. Electronic address:

Objectives: To explore parents' experiences of transition and aftercare following their child's discharge from a paediatric intensive care unit to an in-patient ward.

Methods: A qualitative systematic review was conducted. Electronic databases CINAHL, MEDLINE, EMBASE, Psych INFO, and ASSIA were searched for qualitative studies with no date limits imposed. Methodological quality was assessed using the JBI QARI standardised critical appraisal instrument. Data were extracted into a standardised data extraction tool. Findings were pooled using a meta-aggregative approach.

Results: Four studies were included in the final review that included a total of 95 participants. Forty-nine findings were extracted and through an iterative process resulting in four synthesised findings being developed. These included: (1) Dynamic emotional response pre, peri and post-transfer; (2) Involvement in care absent but fundamental to functioning; (3) Changes in care delivery and environment provoking adverse emotions and (4) Transition as a physical, emotional and social balancing act.

Conclusion: Transitioning from the paediatric intensive care unit to an in-patient ward can be a challenging time for parents, exposing them to a turbulent emotional and social status, and depleting their personal resources. Parents are aware of differences in the organisation and delivery of care between clinical areas which can compound the adversity experienced. Health professionals need to provide targeted support in order to mitigate these negative emotional, physical and social effects experienced.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.iccn.2018.10.003DOI Listing
April 2019

Parents' and carers' experiences of transition and aftercare following a child's discharge from a paediatric intensive care unit to an in-patient ward setting: A qualitative systematic review.

Intensive Crit Care Nurs 2019 Apr 16;51:35-44. Epub 2018 Nov 16.

School of Health Sciences, The University of Nottingham, Nottingham, UK; The University of Nottingham Centre of Evidence Based Health Care: A Collaborating Centre of The Joanna Briggs Institute, The University of Nottingham, Nottingham, UK; Nottingham Children's Hospital and Neonatology, Nottingham University Hospitals NHS Trust, Nottingham, UK; Children and Families Research, Centre for Innovative Research Across a Life Course, Coventry University, UK. Electronic address:

Objectives: To explore parents' experiences of transition and aftercare following their child's discharge from a paediatric intensive care unit to an in-patient ward.

Methods: A qualitative systematic review was conducted. Electronic databases CINAHL, MEDLINE, EMBASE, Psych INFO, and ASSIA were searched for qualitative studies with no date limits imposed. Methodological quality was assessed using the JBI QARI standardised critical appraisal instrument. Data were extracted into a standardised data extraction tool. Findings were pooled using a meta-aggregative approach.

Results: Four studies were included in the final review that included a total of 95 participants. Forty-nine findings were extracted and through an iterative process resulting in four synthesised findings being developed. These included: (1) Dynamic emotional response pre, peri and post-transfer; (2) Involvement in care absent but fundamental to functioning; (3) Changes in care delivery and environment provoking adverse emotions and (4) Transition as a physical, emotional and social balancing act.

Conclusion: Transitioning from the paediatric intensive care unit to an in-patient ward can be a challenging time for parents, exposing them to a turbulent emotional and social status, and depleting their personal resources. Parents are aware of differences in the organisation and delivery of care between clinical areas which can compound the adversity experienced. Health professionals need to provide targeted support in order to mitigate these negative emotional, physical and social effects experienced.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.iccn.2018.10.003DOI Listing
April 2019

Parents' and carers' experiences of transition and aftercare following a child's discharge from a paediatric intensive care unit to an in-patient ward setting: A qualitative systematic review.

Intensive Crit Care Nurs 2019 Apr 16;51:35-44. Epub 2018 Nov 16.

School of Health Sciences, The University of Nottingham, Nottingham, UK; The University of Nottingham Centre of Evidence Based Health Care: A Collaborating Centre of The Joanna Briggs Institute, The University of Nottingham, Nottingham, UK; Nottingham Children's Hospital and Neonatology, Nottingham University Hospitals NHS Trust, Nottingham, UK; Children and Families Research, Centre for Innovative Research Across a Life Course, Coventry University, UK. Electronic address:

Objectives: To explore parents' experiences of transition and aftercare following their child's discharge from a paediatric intensive care unit to an in-patient ward.

Methods: A qualitative systematic review was conducted. Electronic databases CINAHL, MEDLINE, EMBASE, Psych INFO, and ASSIA were searched for qualitative studies with no date limits imposed. Methodological quality was assessed using the JBI QARI standardised critical appraisal instrument. Data were extracted into a standardised data extraction tool. Findings were pooled using a meta-aggregative approach.

Results: Four studies were included in the final review that included a total of 95 participants. Forty-nine findings were extracted and through an iterative process resulting in four synthesised findings being developed. These included: (1) Dynamic emotional response pre, peri and post-transfer; (2) Involvement in care absent but fundamental to functioning; (3) Changes in care delivery and environment provoking adverse emotions and (4) Transition as a physical, emotional and social balancing act.

Conclusion: Transitioning from the paediatric intensive care unit to an in-patient ward can be a challenging time for parents, exposing them to a turbulent emotional and social status, and depleting their personal resources. Parents are aware of differences in the organisation and delivery of care between clinical areas which can compound the adversity experienced. Health professionals need to provide targeted support in order to mitigate these negative emotional, physical and social effects experienced.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.iccn.2018.10.003DOI Listing
April 2019

An exploration of predictors of children's nurses' attitudes, knowledge, confidence and clinical behavioural intentions towards children and young people who self-harm.

J Clin Nurs 2018 Jul 19;27(13-14):2836-2846. Epub 2018 Apr 19.

Faculty of Medicine and Health Sciences, School of Health Sciences, University of Nottingham, Nottingham, UK.

Aims And Objectives: To explore the potential predictors of children's nurses' attitudes, knowledge and confidence towards caring for children and young people admitted to hospital with self-harm.

Background: Admissions to paediatric inpatient settings for individuals who have self-harmed are growing. Limited previous research suggests that nurses have mixed attitudes towards people who have self-harmed and potentially lack the confidence to provide effective care. There is a specific paucity of research in this area for children's nurses.

Design: A cross-sectional descriptive survey was used to gather data for exploration of variables associated with attitudes, confidence, knowledge and clinical behavioural intentions of 98 registered children's nurses in a single tertiary children's hospital, colocated in a large acute NHS Trust in the UK.

Methods: Data were collected over a 4 weeks in 2015, using an online survey tool. The predictive effect of several demographic variables was tested on the outcomes of attitudes, knowledge, confidence and behavioural intentions, which were collected using relevant, previously used outcome measures.

Results: Increased experience was found to be associated with improved attitudes relating to negativity. Previous training in caring for children who had self-harmed was found to be associated with improved attitudes around perceived effectiveness of their care. Higher academic qualifications and having undertaken previous training on self-harm were each found to be associated with increased knowledge of self-harm, and increased age was associated with reduced knowledge of self-harm.

Conclusions: This study provides an initial exploration of variables associated with attitudes, knowledge, confidence and behaviour intentions of registered children's nurses in relation to caring for CYP who have self-harmed.

Relevance To Clinical Practice: Targeted training on caring for CYP who have self-harmed should be considered as a component of continuing education for registered children's nurses in the UK to improve the experience and outcomes for this patient group.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jocn.14361DOI Listing
July 2018

Conceptualizing Post Intensive Care Syndrome in Children-The PICS-p Framework.

Pediatr Crit Care Med 2018 04;19(4):298-300

Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA.

Context: Over the past several decades, advances in pediatric critical care have saved many lives. As such, contemporary care has broadened its focus to also include minimizing morbidity. Post Intensive Care Syndrome, also known as "PICS," is a group of cognitive, physical, and mental health impairments that commonly occur in patients after ICU discharge. Post Intensive Care Syndrome has been well-conceptualized in the adult population but not in children.

Objective: To develop a conceptual framework describing Post Intensive Care Syndrome in pediatrics that includes aspects of the experience that are unique to children and their families.

Data Synthesis: The Post Intensive Care Syndrome in pediatrics (PICS-p) framework highlights the importance of baseline status, organ system maturation, psychosocial development, the interdependence of family, and trajectories of health recovery that can potentially impact a child's life for decades.

Conclusion: Post Intensive Care Syndrome in pediatrics will help illuminate the phenomena of surviving childhood critical illness and guide outcomes measurement in the field. Empirical studies are now required to validate and refine this framework, and to subsequently develop a set of core outcomes for this population. With explication of Post Intensive Care Syndrome in pediatrics, the discipline of pediatric critical care will then be in a stronger position to map out recovery after pediatric critical illness and to evaluate interventions designed to mitigate risk for poor outcomes with the goal of optimizing child and family health.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/PCC.0000000000001476DOI Listing
April 2018

Stories of survival: Children's narratives of psychosocial well-being following paediatric critical illness or injury.

J Child Health Care 2017 Sep 30;21(3):236-252. Epub 2017 Jun 30.

4 Faculty of Health, Social Care and Education, Anglia Ruskin University, Cambridge, UK.

Survival from critical illness can expose children to an array of negative physical and psychological problems. While the perspective of parents and professionals have been well documented, there is limited understanding of how childhood critical care survivors make sense of their experiences in relation to psychosocial well-being. We aimed to explore long-term psychosocial well-being of childhood survivors of critical illness through their stories. A qualitative, exploratory study using serial in-depth interviews was employed. Nine children (aged 6-15 years) were recruited to the study, 6-14 months post-discharge from a paediatric intensive care unit. Qualitative art-based methods were used with a responsive interviewing technique and data were analysed using narrative psychological analysis. Four themes emerged: disrupted lives and stories; survivors revealed uncertainties in their stories as they recalled their critical care event, exposure to death and dying; talking about extreme physical vulnerability provoked anxieties, mediating between different social worlds and identities; revealed the dynamic nature of survival and getting on with life; the prospective outlook survivors had on their existence despite newly manifesting adversities. Childhood survivors' stories identify challenges and adversities that are faced when attempting to readjust to life following critical illness that both enhance and impair psychosocial well-being.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1367493517717078DOI Listing
September 2017

A qualitative, exploratory study of nurses' decision-making when interrupted during medication administration within the Paediatric Intensive Care Unit.

Intensive Crit Care Nurs 2018 Feb 23;44:11-17. Epub 2017 May 23.

Faculty of Health and Life Sciences, Coventry University, Coventry, CV1 5FB, United Kingdom.

Objective: In the paediatric intensive care unit (PICU), medication administration is challenging. Empirical studies demonstrate that interruptions occur frequently and that nurses are fundamental in the delivery of medication. However, little is known about nurse's decision making when interrupted during medication administration. Therefore, the objective is to understand decision making when interrupted during medication administration within the PICU.

Research Design: A qualitative study incorporating non-participant observation and audio recorded semi-structured interviews. A convenience sample of ten PICU nurses were interviewed. Each interview schedule was informed by two hours of observation which involved a further 29 PICU nurses. Data was analysed using Framework Analysis.

Setting: A regional PICU located in a university teaching hospital in the United Kingdom.

Findings: Analysis resulted in four overarching themes: (1) Guiding the medication process, (2) Concentration, focus and awareness, (3) Influences on interruptions (4) Impact and recovery CONCLUSION: Medication administration within the PICU is an essential but complex activity. Interruptions can impact on focus and concentration which can contribute to patient harm. Decision making by PICU nurses is influenced by interruption awareness, fluctuating levels of concentration, and responding to critically ill patient and families' needs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.iccn.2017.04.012DOI Listing
February 2018

Survived so what? Identifying priorities for research with children and families post-paediatric intensive care unit.

Nurs Crit Care 2018 03 17;23(2):68-74. Epub 2017 May 17.

Faculty of Health, Social Care and Education, Anglia Ruskin University, Cambridge, UK.

The involvement of patients and the public in the development, implementation and evaluation of health care services and research is recognized to have tangible benefits in relation to effectiveness and credibility. However, despite >96% of children and young people surviving critical illness or injury, there is a paucity of published reports demonstrating their contribution to informing the priorities for aftercare services and outcomes research. We aimed to identify the service and research priorities for Paediatric Intensive Care Unit survivors with children and young people, their families and other stakeholders. We conducted a face-to-face, multiple-stakeholder consultation event, held in the Midlands (UK), to provide opportunities for experiences, views and priorities to be elicited. Data were gathered using write/draw and tell and focus group approaches. An inductive content analytical approach was used to categorize and conceptualize feedback. A total of 26 individuals attended the consultation exercise, including children and young people who were critical care survivors; their siblings; parents and carers; health professionals; academics; commissioners; and service managers. Consultation findings indicated that future services, interventions and research must be holistic and family-centred. Children and young people advisors reported priorities that focused on longer-term outcomes, whereas adult advisors identified priorities that mapped against the pathways of care. Specific priorities included developing and testing interventions that address unmet communication and information needs. Furthermore, initiatives to optimize the lives and longer-term functional and psycho-social outcomes of Paediatric Intensive Care Unit survivors were identified. This consultation exercise provides further evidence of the value of meaningful patient and public involvement in identifying the priorities for research and services for Paediatric Intensive Care Unit survivors and illuminates differences in proposed priorities between children, young people and adult advisors.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/nicc.12298DOI Listing
March 2018

'Our Care through Our Eyes'. Impact of a co-produced digital educational programme on nurses' knowledge, confidence and attitudes in providing care for children and young people who have self-harmed: a mixed-methods study in the UK.

BMJ Open 2017 05 4;7(4):e014750. Epub 2017 May 4.

School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK.

Objectives: (1) To determine the impact of a digital educational intervention on the knowledge, attitudes, confidence and behavioural intention of registered children's nurses working with children and young people (CYP) admitted with self-harm.(2) To explore the perceived impact, suitability and usefulness of the intervention.

Intervention: A digital educational intervention that had been co-produced with CYP service users, registered children's nurses and academics.

Setting: A prospective, uncontrolled, intervention study with preintervention and postintervention measurement, conducted at a large acute NHS Trust in the UK.

Participants: From a pool of 251 registered children's nurses and 98 participants were recruited to complete the intervention (response rate=39%). At follow-up, 52% of participants completed the postintervention questionnaire, with 65% (n=33) of those reporting to have completed the digital educational intervention.

Primary Outcome Measures: Attitude towards self-harm in CYP was measured using a 13-item questionnaire; knowledge of self-harm in CYP was measured through an adapted 12-item questionnaire; confidence in different areas of practice was measured through Likert Scale responses; self-efficacy for working with CYP who have self-harmed was measured through an adapted version of the Self-efficacy Towards Helping Scale; clinical behavioural intention was measured by the Continuing Professional Development Reaction Questionnaire. Semistructured interviews were undertaken with a purposive sample of participants.

Results: For those who completed the intervention (n=33), improvements were observed in knowledge (effect size, ES: 0.69), confidence, and in some domains relating to attitudes (effectiveness domain-ES: 0.49), and clinical behavioural intention (belief about consequences-ES:0.49; moral norm-ES: 0.43; beliefs about capability-ES: 0.42). Qualitative findings suggest participants experienced skill development, feelings of empowerment and reflection on own practice.

Conclusions: The effect of the intervention is promising and demonstrates the potential it has in improving registered children's nurse's knowledge, confidence and attitudes. However, further testing is required to confirm this.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjopen-2016-014750DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5623397PMC
May 2017

Should out of sight mean out of mind? Challenging the role of paediatric intensive care in understanding and supporting children and families following childhood critical illness.

Nurs Crit Care 2016 Sep;21(5):262-4

Faculty of Health and Human Sciences, School of Nursing and Midwifery, Plymouth University, Plymouth, UK.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/nicc.12253DOI Listing
September 2016

Family-Clinician Communication Within Critical Care Settings: Unraveling the Complex and Valuing the Hidden.

Pediatr Crit Care Med 2016 Mar;17(3):264-5

Faculty of Medicine and Health Sciences, School of Health Sciences, The University of Nottingham; and Nottingham Children's Hospital and Neonatal Services, Family Health Division, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom Faculty of Health and Human Sciences, School of Nursing and Midwifery, Plymouth University, Plymouth, United Kingdom; and Faculty of Health Sciences, School of Nursing and Midwifery, Curtin University, Perth, Western Australia, Australia.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/PCC.0000000000000646DOI Listing
March 2016

Parents' and carers' experiences of transitions and aftercare following a child's discharge from a pediatric intensive care unit to an inpatient ward setting: a qualitative systematic review protocol.

JBI Database System Rev Implement Rep 2016 Jan;14(1):89-98

1. School of Health Sciences, The University of Nottingham; The University Of Nottingham Center of Evidence Based Health Care: a Collaborating Center of The Joanna Briggs Institute.2. Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.11124/jbisrir-2016-2557DOI Listing
January 2016
-->