Challenges perceived by pediatric intensive care unit nurses in caring for maltreated children and adolescents: A qualitative phenomenological study.

This study explores the challenges and experiences faced by paediatric intensive care unit (PICU) nurses while caring for maltreated paediatric patients. A qualitative study was conducted using face-to-face semi-structured interviews from February to May 2022. The data were transcribed verbatim and a simple thematic analysis was used. Twenty PICU nurses from National Taiwan University Children's Hospital were recruited through purposive and snowball sampling. Ten sub-themes were identified and synthesised into three primary themes: 'unstable nurse-patient relationships', highlighting the tensions and communication challenges between nurses, and the families of maltreated children and adolescents; 'insufficient pertinent competencies in handling child maltreatment', pointing to nurses' lack of sensitivity, experience, and requisite skills for addressing child maltreatment; and 'challenges in multidisciplinary team collaboration', which underscores nurses' feelings of being overwhelmed and apprehensions regarding the continuity of care as various professional teams are involved. PICU nurses face considerable stress while caring for maltreated children and adolescents. This can be attributed to unstable nurse-patient relationships, insufficient care-related competencies of nurses, and the complexities introduced by multidisciplinary team interventions. Therefore, priority actions include continuous in-service education, sharing pertinent professional experiences, enhancing nurses' sensitivity toward maltreatment, establishing standard operating procedures, and developing comprehensive case management systems and multidisciplinary expertise tailored to the needs of PICU nurses. Understanding the stressors and challenges encountered by PICU nurses in caring for maltreated children and adolescents can guide the design and implementation of interventions by current hospital decision-making bodies or child protection medical centres to enhance the clinical working environment. These interventions can aim to bolster the competencies of nurses and promote joint efforts in delivering superior medical care.

Huang PL ，Lin CH ，Tseng WC ，Gau BS ... -  《-》

Exploring conceptual and theoretical frameworks for nurse practitioner education: a scoping review protocol.

Wilson R ，Godfrey CM ，Sears K ，Medves J ，Ross-White A ，Lambert N ... -  《-》

Factors that influence caregivers' and adolescents' views and practices regarding human papillomavirus (HPV) vaccination for adolescents: a qualitative evidence synthesis.

Human papillomavirus (HPV) vaccination in adolescents provides a powerful tool for preventing cervical cancer in women and other HPV-associated diseases in people of all genders. HPV vaccines have been progressively introduced in many countries. However, worldwide, many adolescents do not receive HPV vaccination, for various reasons. The HPV vaccine might be costly or unavailable, healthcare systems might lack capacity for its delivery, or adolescent health might not be prioritised. Some caregivers and adolescents may not accept available HPV vaccines and vaccination services. We currently lack a comprehensive understanding of the factors that influence HPV vaccination views and practices, and why some caregivers and adolescents may be less accepting of the vaccine. Qualitative research can contribute to this understanding and help inform policy and practice, including the development of more relevant, acceptable and effective interventions to promote public acceptance and uptake of HPV vaccination in adolescents. This qualitative evidence synthesis supplements a Cochrane review of the effectiveness of interventions to improve uptake of adolescent vaccination, including HPV vaccination. The objectives of the review are to identify, appraise, and synthesise qualitative studies that explore caregivers' or adolescents' views, experiences, practices, intentions, decision-making, acceptance, hesitancy, or nonacceptance of HPV vaccination; to gain an understanding of the factors that influence caregiver and adolescent views and practices regarding HPV vaccination for adolescents; and to explore how the findings of this review can enhance our understanding of the related Cochrane intervention review. We searched MEDLINE, Embase, CINAHL, PsycInfo, and Scopus for eligible studies (February 2023). We updated this search in October 2024, but these results have not yet been fully incorporated. We included studies that utilised qualitative methods for data collection and analysis; focused on caregivers' or adolescents' views, practices, acceptance, hesitancy, or refusal of HPV vaccination for adolescents aged 9 to 19 years of age; and were from any setting globally where HPV vaccination is provided. We used a prespecified sampling frame to capture a sample of eligible studies that were from a range of geographical and income-level settings, were conceptually rich in relation to the review's phenomenon of interest, and included HPV vaccination for diverse genders. We extracted contextual and methodological data from each sampled study. We used a thematic synthesis approach to analyse the evidence. We assessed methodological limitations using a list of criteria used in previous Cochrane reviews and originally based on the Critical Appraisal Skills Programme quality assessment tool for qualitative studies. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each review finding. We integrated the findings of this review with those from the related Cochrane review of intervention effectiveness (by Abdullahi and colleagues), by mapping whether the trial interventions reflected or targeted the factors identified by this review as influencing caregivers' or adolescents' views and practices regarding HPV vaccination. We included 206 studies in the review and sampled 71 of these for our synthesis. Of these, 35 studies were conducted in high-income countries, 26 studies in middle-income countries, 8 studies in low-income countries, and 2 studies in multiple-income settings. Studies came from all six World Health Organization (WHO) regions and included urban and rural settings. We downgraded our confidence in several findings, mainly due to concerns about how the studies were conducted (methodological limitations), concerns about perspectives lacking from some types of participants or in some settings (relevance), or because of variability in the data or insufficient evidence to support all aspects of a review finding (coherence). Many complex factors were found to influence caregivers' and adolescents' HPV vaccination views and practices, which we categorised into eight overarching themes: 1) A lack of biomedical knowledge; 2) Perceptions of a range of interrelated risks and benefits (or lack thereof) associated with HPV vaccination; 3) Routine responses to vaccination generally or more specific views or experiences of other vaccines and vaccination programmes; 4) Complex nuclear familial decision-making dynamics; 5) Extended familial and social relations and networks, particularly extended family members, peers, traditional or religious leaders, and the media; 6) Interrelated socio-cultural beliefs and practices regarding adolescence, sexuality, gender, parenting and health; 7) Trust or distrust in the institutions, systems or experts associated with vaccination, most particularly teachers and the school, the pharmaceutical industry, government, science and biomedicine, and healthcare professionals; and 8) Access to, and experiences of, HPV vaccination programmes and delivery services, such as the convenience (or lack thereof) of HPV vaccination services, the cost of the vaccine, language barriers, the feminisation of HPV vaccination programmes and procedural aspects of school-based vaccination delivery. We did not identify any major differences in the occurrence of these overarching themes between subgroups. However, for various subthemes certain differences emerged in relation to place, gender and socio-economic status, and between caregivers and adolescents. The interventions tested in the related Cochrane review of intervention effectiveness most commonly targeted caregivers' and adolescents' lack of biomedical knowledge and their perceptions of the risks and benefits of HPV vaccination, with the other influencing factors identified by our review being underrepresented. Our review reveals that caregivers' and adolescents' HPV vaccination views and practices are not only influenced by issues related to individual knowledge and perceptions of the vaccine, but also an array of more complex, contextual factors and meanings: social, political, economic, structural, and moral. Successful development of interventions to promote the acceptance and uptake of HPV vaccination for adolescents requires an understanding of the context-specific factors that influence HPV vaccination views and practices in the target setting. Through this, more tailored and in turn more relevant, acceptable, and effective responses could be developed. The eight overarching themes that emerged from our review could serve as a basis for gaining this understanding.

Cooper S ，Schmidt BM ，Jama NA ，Ryan J ，Leon N ，Mavundza EJ ，Burnett RJ ，Tanywe AC ，Wiysonge CS ... -  《Cochrane Database of Systematic Reviews》

The impact of redeployment during COVID-19 on nurse well-being, performance and retention: a mixed-methods study (REDEPLOY).

Hartley H ，Dunning A ，Murray J ，Simms-Ellis R ，Unsworth K ，Grange A ，Dunn M ，Marran J ，Joseph O ，Essler P ，Archibong U ，Johnson J ，Lawton R ... -  《-》

Understanding the impact of natural disasters on children within fist hours and days after an event: A phenomenological study through the experience of nurses.

Children are a particularly vulnerable group in natural disasters such as earthquakes, and although they represent a difficult group to research in such situations, there appears to be a lack of literature investigating children's experiences in the immediate post-earthquake period. Experienced nurses can shed light on children's experiences. This study was conducted to examine the experiences of nurses caring for children affected by the earthquake in Kahramanmaraş, Turkey. This phenomenological study was conducted with nurses who provided care to children during the Kahramanmaraş earthquake between May and August 2023. The study sample consisted of 14 nurses selected using a purposive sampling technique. Data were collected through in-depth interviews by using the "Introductory Information Form" and "Semi-structured Interview Form" developed by the researchers. The interviews were subsequently analyzed using Colaizzi's method. The results revealed five themes under two main themes. Under the main theme of nurse, there are subthemes of chaos, helplessness-incompetence, while under the main theme of child, there are subthemes of unresponsiveness, intertwined needs, empathy, and care. The study also highlights the chaotic environment in the immediate aftermath of the earthquake, characterized by a high number of pediatric casualties and psychological trauma, and the nurses' feelings of helplessness as a result of being separated from their families. This study found that nurses caring for children in the earthquake had difficulties in managing children's hospital processes and they demonstrated an empathic approach by trying to communicate with the children in their care. The nurses stated that children should be supported psychologically as well as having their basic needs such as water, food, and shelter met. Health policymakers should be aware that in the early stages of major disasters such as earthquakes, children are not only physically injured but also have basic needs such as water, shelter, and food, and are emotionally affected. It is recommended that disaster management plans be developed to address all children's needs and nurses be provided with psychological support and training to improve their knowledge and skills.

Dağ YS ，Zengin M ，Yayan EH ，Dağ S ... -  《-》