BACKGROUND:Clustered care is a core component of individualized developmental care (IDC) in neonatal intensive care units (NICUs). However, the absence of standardized, evidence-based guidance results in variability in nursing practices, potentially compromising developmental stability and care quality. This study aimed to develop, validate, and pilot an evidence-based Clustered Care Practice Guide to support standardized nursing care in NICUs. METHODS:This methodological study followed a de novo guideline development approach (April 2022-June 2025). Multiple data sources were integrated, including a PRISMA-guided and PROSPERO-registered systematic review, a descriptive survey with 122 NICU nurses, clinical observations in two university hospitals, and five focus group interviews with 35 nurses. Synthesized evidence was translated into structured recommendations. Content validity was evaluated by 33 multidisciplinary experts using the Davis technique, and methodological quality was assessed according to AGREE II criteria. A pilot implementation was conducted to evaluate feasibility and clinical applicability. RESULTS:The final guide comprised 55 items across five sections. All items demonstrated acceptable content validity (I-CVI ≥ 0.78), with excellent overall validity (S-CVI/Ave = 0.96). The guide met AGREE II standards. Pilot testing with five nurses and subsequent evaluation by 25 nurses indicated high acceptability, with 95.8% rating the guide as effective and useful. Thematic analysis revealed improved clinical decision-making, workflow organization, professional confidence, and standardization of care practices. CONCLUSION:The Clustered Care Practice Guide demonstrates strong methodological rigor and high clinical applicability. It offers a structured, evidence-based framework to standardize clustered care and enhance developmentally supportive practices in NICUs.
OBJECTIVES:This study mapped nursing-related pediatric medication safety research and examined publication trends, author, country, and source productivity, citation patterns, thematic structures, and comparatively less visible topics within the retrieved corpus. METHODS:This descriptive bibliometric analysis included Web of Science Core Collection records retrieved on April 3, 2026. Of 570 records identified, 292 original research articles met the eligibility criteria. Author keywords were audited and standardized before descriptive, thematic, trend-topic, multiple correspondence, and co-occurrence analyses using Bibliometrix and VOSviewer. RESULTS:The articles were published between 1976 and 2026; 2026 was a partial year through April 3. The compound annual growth rate for 1976-2025 was 6.19%. Mean citations per article and co-authors per document were 19.62 and 5.60, respectively. Publication output increased after 2020 and peaked at 28 articles in 2024. Pediatrics and Journal of Pediatric Nursing were the most productive sources. After cleaning, 577 author keywords were retained; 67 occurring in at least three articles were included in conceptual analyses. Medication errors, pediatrics, patient safety, nursing, and medication safety were the most prominent concepts. Medication preparation and administration safety, care transitions, home medication safety, and family education were comparatively less visible. CONCLUSION:Within the corpus retrieved through the nursing-related search strategy, publication output increased substantially but remained geographically and thematically uneven. Topic visibility may have been influenced by the search strategy and author-keyword practices. Future research should strengthen nursing- and family-centered approaches across the medication-use continuum, particularly in care transitions, home medication safety, and systems-based prevention.
OBJECTIVES:This study was conducted to determine the effect of the SENSE® program applied to preterm infants during their stay in the neonatal intensive care unit (NICU) on maternal stress, anxiety, and depressive symptoms among mothers. METHODS:This quasi-experimental pre-post study included 21 mother-infant pairs in the SENSE® group and 25 in the control group. The data collection instruments used were the Demographic Information Form, the Parental Stress Scale: Neonatal Intensive Care Unit (PSS: NICU), the State-Trait Anxiety Inventory (STAI), and the Edinburgh Postnatal Depression Scale (EPDS). RESULTS:The mean total PSS: NICU score of the experimental group in the post-test was found to be statistically significantly lower than that of the control group (p = 0.039; p < 0.05). The mean STAI score of the experimental group in the post-test was found to be statistically significantly lower than that of the control group (p = 0.020; p < 0.05). The mean EPDS score of the experimental group in the post-test was found to be statistically significantly lower than that of the control group (p = 0.019; p < 0.05). CONCLUSION:This study found lower levels of stress, anxiety, and depression in the experimental group. These findings suggest that participation in the SENSE® program may be associated with improved psychological well-being among mothers of preterm infants; however, given the quasi-experimental design and baseline differences between groups, a causal effect cannot be established. IMPLICATIONS FOR CLINICAL PRACTICE:Integrating the SENSE® program into NICU care may be associated with reduced maternal stress, anxiety, and depression. TRIAL REGISTRATION:www. CLINICALTRIALS:gov (Identifier: NCT06354517).
Purpose To examine caregivers' perceived importance of topics regarding pediatric obesity management (POM) and explore their expectations and preferences regarding family navigation (FN). Design and methods In this cross-sectional, mixed-methods study, caregivers of 6-to-17-year-olds with a BMI ≥ 97th percentile completed a survey to assess their perceived importance of topics regarding POM, including knowledge and skill needs regarding healthier food/drinks, physical activity/exercise, family support/behaviour, and weight management goals. A sub-set completed individual interviews to explore their expectations and preferences regarding FN for POM. From 2022 to 2024, data collection occurred at two POM clinics in Calgary and Mississauga, Canada, within a randomized controlled trial. To examine differences between caregivers' knowledge and skill needs, the paired t-test or Wilcoxon test was used. Inductive/manifest content analysis was used to analyze interview data, with convergent mixed methods used to integrate quantitative and qualitative data. Results Overall, 108 caregivers completed the survey; data analysis included interviews with 52 caregivers. Survey data showed that caregivers' knowledge needs exceeded skill needs for healthier food/drinks, physical activity/exercise, and total knowledge/skills (all p < 0.01). Caregivers attended clinic appointments seeking support to change behaviours; however, competing commitments limited their ability to attend regularly. Participants preferred to meet navigators more often than monthly, both as a family and parent only, and expected navigators to serve as facilitators and supporters to identify available community resources. Conclusions Caregivers reported that FN could support families in accessing community resources and connect them with medical and healthcare providers to promote behaviour change and improve their children's mental health. Practice implications Caregivers expect to receive support to overcome barriers that reduce access to health services for managing pediatric obesity in clinics. Interventions that include family navigators as facilitators and supporters to help families in addressing barriers can enhance pediatric obesity management engagement in clinic appointments.
PURPOSE:This study investigated the short-term effects of a mobile game application developed for children with Chronic Kidney Disease (CKD) on knowledge, health-related beliefs, attitudes, and clinical parameters. DESIGN AND METHODS:This randomized controlled trial included 64 children with CKD (32 per group). A mobile game tailored for children aged 11-14 years was developed. Data were collected using a Data Collection Form, Clinical Parameters Follow-up Form, Information Form on Chronic Renal Failure, Healthy Lifestyle Belief Scale for Adolescents, and the Child's Attitude Toward His/Her Disease Scale. RESULTS:Mean ages were 12.78 ± 1.21 and 12.65 ± 1.31 years in the experimental and control groups, with no significant demographic differences (p > 0.05). Children using the mobile game showed significantly higher knowledge, healthy lifestyle belief, and disease attitude scores at 1 and 3 months than controls (p < 0.05). No significant between-group differences were found in blood pressure or pulse rate (p > 0.05). Initial differences in iron-binding capacity and potassium did not remain significant after correction. Usability was high (score: 276.18 ± 2.71/280). CONCLUSIONS:The intervention was associated with short-term improvements in knowledge, healthy lifestyle beliefs, and attitudes toward CKD; given the absence of an attention-matched control and confounding of modality with educational dosage, findings should be interpreted as association rather than established effectiveness. No significant effects were observed on clinical parameters. The internally developed knowledge instrument lacks formal factor-analytic or criterion validation. PRACTICE IMPLICATIONS:Pediatric nurses can support disease management in children with CKD by incorporating mobile game-based educational tools into routine care, recognizing that current evidence supports short-term educational benefit rather than established clinical effects.
PURPOSE:This phenomenological study explored mothers' caregiving experiences for children with special needs, focusing on stigmatization and how they make sense of these experiences in daily life. DESIGN AND METHODS:A descriptive phenomenological study was conducted with 15 mothers serving as primary caregivers of children with moderate to severe autism spectrum disorder and/or intellectual disability. Participants were recruited through purposive criterion sampling. Data were collected through semi-structured interviews and analyzed using Colaizzi's seven-step phenomenological method. RESULTS:Four themes emerged: motherhood experience and identity transformation, caregiving burden and continuous responsibility, stigmatization and social interaction, and future-related concerns and coping. Mothers described caregiving as a continuous responsibility extending beyond physical care and involving substantial invisible labor and mental load related to planning, monitoring, anticipating risks, and coordinating care. Their experiences were marked by physical and emotional exhaustion, social isolation, and stigma. Concerns about their children's future, particularly who would care for them after their death, emerged as a major source of anxiety. Spousal support, peer relationships, and rehabilitation services were identified as important coping resources. CONCLUSIONS:Caring for a child with special needs is a multidimensional experience characterized by invisible labor, constant vigilance, social challenges, and uncertainty about the future. Nursing care should address not only the child's needs but also mothers' psychosocial burden. RELEVANCE TO CLINICAL PRACTICE:Nurses should assess mothers' less visible cognitive and emotional caregiving demands, including constant vigilance, care coordination, social restrictions, and future uncertainty, to better understand their needs and provide appropriate support.
BACKGROUND:Adolescents with asthma often experience inadequate disease knowledge, limited social support, and poor self-management, which may adversely affect asthma control and quality of life. Online peer support programs offer a promising approach to complement conventional asthma education by addressing both educational and psychosocial needs. AIM:To examine changes in adolescents' asthma knowledge, social support-seeking behaviors, and asthma self-management following participation in an online peer support program. METHODS:A one-group quasi-experimental pretest-posttest study was conducted among 50 adolescents (12-16 years) with physician-diagnosed asthma attending two outpatient pulmonary clinics in Egypt. Participants completed validated questionnaires assessing asthma knowledge, social support-seeking behaviors, and asthma self-management before and after an 8-week nurse-supervised online peer support program delivered through WhatsApp and Microsoft Teams. RESULTS:Significant improvements were observed following the intervention. Mean asthma knowledge scores increased from 25.98 ± 4.19 to 39.40 ± 1.34 (p < .001), social support-seeking behavior scores increased from 13.90 ± 1.72 to 29.34 ± 1.69 (p < .001), and asthma self-management scores increased from 5.10 ± 2.19 to 15.10 ± 0.99 (p < .001). Significant positive correlations emerged between asthma knowledge and social support-seeking behaviors (r = 0.465, p < .001), asthma knowledge and self-management (r = 0.311, p = .02), and social support-seeking behaviors and self-management (r = 0.582, p < .001). CONCLUSIONS:Participation in the online peer support program was associated with significant improvements in asthma knowledge, social support-seeking behaviors, and asthma self-management.
Background Children with congenital gastrointestinal malformations often have complex conditions that require long-term treatment and care, which can negatively impact their physical and mental well-being as well as their families, who play a crucial role throughout their treatment and management. Purpose This study aimed to determine the current state of family disease management, the difficulties in managing disease in children with congenital gastrointestinal malformations, and the associated risk factors. Design and methods This was a cross-sectional descriptive study including 127 family members of children with congenital gastrointestinal malformations. Data were collected using a subscale of the Family Management Measure (FaMM), the Zarit Caregiver Burden Interview, the Feetham Family Functioning Survey (FFFS), and the Perceived Social Support Scale (PSSS). Result The family disease management and disease management difficulties for children with congenital gastrointestinal malformations were at a moderate level, and caregiver burden was also at a moderate level. Surgical history, family residence, family function, and caregiver burden were the main factors influencing family disease management in the children with Congenital Gastrointestinal Malformations. Conclusion The family management capacity for children with congenital gastrointestinal malformations needs to be improved. It is multi-influenced by surgical history, family residence, family function, and caregiver burden. Nursing staff should integrate caregiver burden assessment, family function support, and social resources to develop family-centered interventions. Through targeted education, personalized follow-up, and active caregiver engagement in the rehabilitation journey, family management can be facilitated, disease management difficulties reduced, and long-term health outcomes ultimately enhanced.
AIM:To evaluate the effectiveness of the Family Program "CARE" (Caring, Assisted, Redesign, Education) in maintaining nutritional status, environmental sanitation, and family function with stunted children, with the primary outcome focused on improving the child's linear growth. METHODS:This study used a quasi-experimental pre-post-test design with a control group among 56 children aged 12-60 months with stunting status (26 stunted children for intervention and 30 children in the control group). The research implemented the Family Program CARE (P-CARE) intervention for a period of 30 days. Parameters measured included environmental sanitation, family care function, oral health, and nutritional status. Data analysis was performed using a paired t-test to identify differences between the pre- and post-intervention periods. RESULTS:Children who received the P-CARE intervention showed a mean increase in height (H) of 1.43 cm. Within-group analyses demonstrated a significant improvement in HAZ-Height-for-Age z-score (0.563 ± 1.903, p = 0.003), while favorable changes were also observed in WAZ-Weight-for-Age z-score (0.104 ± 1.385). However, adjusted ANCOVA analyses showed that HAZ and WAZ did not remain statistically significant after controlling for covariates. In contrast, the between-group comparison showed a significant difference in WHZ (Weight-for-Height Z-score) between the control and intervention groups (p < 0.001). CONCLUSION:The Family Program CARE (P-CARE) demonstrated promising improvements in several child and family health indicators among children with stunting. Although improvements were observed in selected outcomes, not all anthropometric indicators remained statistically significant after adjusted analyses. These findings support the potential role of family-centered, community-based interventions as a comprehensive strategy for addressing stunting in children.
AIM:This study examines how children with a sibling who has a tracheostomy perceive family dynamics and express their emotional experiences through drawings. METHOD:A qualitative descriptive design using methodological triangulation was employed. Data were collected using an "Information About the Child and The Drawing Form", the Marmara Sibling Jealousy Scale-Short Form, and family drawings accompanied by narratives. Thematic analysis was conducted. RESULTS:Fourteen children (mean age = 11.5 years) participated, and the mean scale score was 31 ± 8.3. Five themes were identified: meaning of colors, expression of the sick sibling, expression of family members, self-expression, and communication. Jealousy-related expressions were identified in 8 of 14 drawings, including some children with low scale scores, suggesting differences between quantitative and qualitative findings. Drawings and narratives reflected perceived exclusion, unmet needs for parental attention, communication difficulties, emotional distance, and a desire for greater family support and interaction. Fathers were frequently depicted as important family figures. CONCLUSION:Self-report measures alone may not fully capture the emotional experiences of healthy siblings. Combining drawings with narrative provided a broader understanding of children's perceptions of family relationships, communication, and sibling experiences in families of children with tracheostomy. IMPLICATIONS FOR PRACTICE:Healthy siblings' emotional needs may be overlooked in families of children with tracheostomy. Drawings can serve as supportive communication tools to explore feelings of exclusion, need for attention, communication difficulties, and sibling jealousy. Pediatric nurses should include healthy siblings in family-centered care and provide opportunities for emotional expression and psychosocial support.
OBJECTIVE:To examine the associations between symptom clusters and quality of life (QoL) in pediatric liver transplant recipients. DESIGN AND METHODS:From June 2022 to June 2023, a cross-sectional study was conducted with 129 pediatric liver transplant recipients (mean age: 4.1 years old) at 3 tertiary hospitals in Guizhou Province, China. QoL and symptom clusters were measured using the validated Chinese version of Pediatric Quality of Life Inventory Measurement Models and the Modified Transplant Symptom Occurrence and Symptom Distress Scale, respectively. The data were analyzed using the Pearson correlation and linear regression. RESULTS:The mean QoL score was 70.05 ± 19.37. Pearson correlation revealed that neurological system-related (r = -0.560 to -0.282, p < 0.05), digestive system-related (r = -0.522 to -0.160, p < 0.05), and medication-related (r = -0.648 to -0.344, p < 0.05) symptom clusters were negatively correlated with the overall QoL scores and all dimensions. Linear regression showed that the child's primary disease diagnosis (β = -0.157, p = 0.038) and neurological- (β = -0.436, p < 0.001), digestive- (β = -0.326, p < 0.001), and medication-related symptom clusters (β = -0.161, p = 0.025) were significant predictors of QoL (adjusted R2 = 0.385, p < 0.001). CONCLUSIONS:The QoL of pediatric liver transplant recipients was sub-optimal and warranted clinical attention. The neurological-, digestive-, and medication-related symptom clusters are significant predictors of QoL. Nursing care including assessment and management of these key symptom clusters may be considered to improve the well-being of children after liver transplantation. IMPLICATIONS TO PRACTICE:These findings highlight the need for routine screening of symptom clusters in pediatric liver transplant recipients and for developing targeted nursing interventions to manage co-occurring symptoms, thereby improving health-related quality of life in this population.
BACKGROUND:Children with medical complexity (CMC) often require highly individualized care environments in everyday living settings. Nurses play key roles in coordinating care and optimizing these environments; however, their specific practices have not been fully elucidated. PURPOSE:This study aimed to clarify nursing practices for optimizing care environments for CMC in everyday living settings. DESIGN AND METHODS:A qualitative interpretive description study was conducted with nurses from hospitals, home-visit nursing agencies, and community-based services in Japan. Participants were recruited using purposive and snowball sampling between July 2023 and February 2024. Semi-structured interviews explored nurses' experiences of optimizing care environments for CMC. Data were analyzed using reflexive thematic analysis. RESULTS:Seventeen female nurses with a mean of 16 years (SD = 5.4) of CMC-related care experience participated. Five themes were identified: (1) supporting autonomous decision-making by CMC and their families; (2) organizing daily living environments for safety, comfort, and holistic well-being; (3) fostering family empowerment; (4) preparing service environments to improve service quality and support; and (5) organizing community environments for safe and sustainable living. PRACTICE IMPLICATIONS:Nurses play key coordinating roles in optimizing multidimensional care environments through collaboration with families and multidisciplinary teams. These practices may inform community-based nursing interventions, strengthen family empowerment and decision-making, and support integrated care systems that promote safe and sustainable living for CMC and their families.
OBJECTIVE:This study determined the effect of the Family Empowerment in Pediatric Thalassemia Care (FE-PTC) Module on anxiety, problem-solving skills and psychological resilience in parents of children with thalassemia major. METHOD:In this randomized controlled study, 76 parents of children with thalassemia major followed in a thalassemia unit were randomly assigned to an intervention (n = 36) or control (n = 40) group between December 2025 and April 2026. The intervention group received the FE-PTC Module, structured on the Family-Centered Empowerment Model; the control group received routine care. Data were collected at pre-test and post-test using an Information Form, the Generalized Anxiety Disorder-7, the Problem-Solving Inventory and the Brief Resilience Scale, and analysed using mixed ANOVA and one-way ANCOVA adjusted for baseline scores. FINDINGS:The groups were comparable at baseline (p > 0.05). Relative to controls, the intervention group showed lower post-test anxiety (adjusted mean difference = -5.62; 95% CI: -7.78 to -3.46; p < 0.001; ηp2 = 0.190), lower, that is more favourable, problem-solving scores (-2.77; 95% CI: -4.52 to -1.02; p = 0.002; ηp2 = 0.130) and higher psychological resilience (+2.44; 95% CI: 1.08 to 3.80; p = 0.001; ηp2 = 0.150). CONCLUSION:FE-PTC is an effective, evidence-based and implementable nursing intervention for reducing anxiety and improving problem-solving skills and psychological resilience in parents of children with thalassemia. IMPLICATIONS FOR PRACTICE:FE-PTC gives pediatric nurses a structured, low-cost protocol deliverable within existing transfusion and outpatient visits, without additional staffing or technology. Routine psychosocial screening of parents early after diagnosis, with referral to structured empowerment programmes, is warranted in thalassemia units.
BACKGROUND:Media reports of fatal violent incidents involving children and adolescents may evoke secondary trauma in parents who have not directly experienced such trauma. PURPOSE:This study explored the secondary trauma experiences and protective parenting responses of parents of adolescent children following exposure to media reports of child deaths. METHODS:This study employed a qualitative phenomenological approach. Semi-structured individual interviews were conducted with 15 parents from different regions of Türkiye. Data were analyzed using Colaizzi's seven-stage phenomenological analysis method. RESULTS:Five main themes were identified: "Secondary Trauma Responses," "Overprotective and Controlling Parenting Behaviors," "Protective Parent-Child Communication and Behavioral Guidance," "Loss of Societal Trust and Institutional Expectations," and "Coping Strategies." Parents described fear, anxiety, hypervigilance, and emotional distress after exposure to media reports of fatal violence involving children and adolescents. Media exposure also increased parental control, restrictions on adolescents' activities, and changes in parent-child communication. CONCLUSIONS:Parents described secondary trauma responses, overprotective parenting behaviors, and loss of societal trust after being exposed to media reports of child deaths. Their coping strategies included avoidance, spirituality, and behavioral approach. PRACTICAL IMPLICATIONS:Pediatric nurses should recognize secondary trauma responses in parents within the context of family centered and trauma-informed care and support adaptive coping and healthy parent-adolescent communication.
OBJECTIVE:To examine the associations among postoperative fall risk, pain, and psychosocial symptoms, including anxiety, hopelessness, anger/aggression, developmental regression, and communication difficulties, in hospitalized children. METHODS:This cross-sectional correlational study included 115 children aged 6-12 years who were hospitalized in the pediatric surgery unit of a tertiary-level training and research hospital between January 1 and June 1, 2025. Data were collected through structured face-to-face interviews using the Personal Information Form, the Humpty Dumpty Fall Scale, the Wong-Baker FACES Pain Rating Scale, and the Psychosocial Symptoms Identification Scale for Hospitalized Children. RESULTS:Postoperative fall risk differed significantly by gender, educational status, and previous surgical history. Boys and children not yet attending primary school had higher fall risk scores. Children receiving routine postoperative information had higher fall risk and pain scores, whereas those undergoing neurosurgery had the highest fall risk and psychosocial symptom scores (p < 0.01). Higher fall risk was associated with higher psychosocial symptom scores, particularly anxiety, anger/aggression, and developmental regression, although not all psychosocial subdimensions differed significantly between fall risk groups. In an unadjusted regression model, postoperative pain was significantly associated with psychosocial symptom scores and explained approximately 20% of the variance. CONCLUSION:Postoperative fall risk, pain, and psychosocial symptoms were significantly associated during the early postoperative period in hospitalized children. These findings support a holistic approach to pediatric postoperative care integrating fall risk assessment, pain management, psychosocial assessment, and family-centered support. Because of the cross-sectional design, causal relationships cannot be established. Further multicenter longitudinal studies are needed to support evidence-based pediatric nursing interventions. IMPLICATIONS FOR PRACTICE:Pediatric nurses should integrate fall risk, pain, and psychosocial assessment into routine postoperative care. Identifying co-occurring risks can guide individualized safety precautions, pain management, and psychosocial and family-centered support, particularly for children with higher fall risk.
AIM:To examine the associations between social appearance anxiety (SAA), fear of missing out (FoMO), and social media addiction (SMA) in adolescents, and investigate whether FoMO mediated the association between SAA and SMA. MATERIALS AND METHODS:This cross-sectional study collected data using the Social Appearance Anxiety Scale for Adolescents, the Fear of Missing Out Scale, and the Social Media Disorder Scale. Pearson correlation analysis was used to examine associations between the study variables. Hierarchical multiple linear regression identified factors associated with SMA. The indirect association through FoMO was evaluated using path analysis with 5000 bootstrap samples and 95% confidence intervals. Statistical significance was set at p < 0.05. RESULTS:A total of 646 adolescents aged 13-18 years participated. SAA and FoMO were positively correlated with SMA (r = 0.360 and r = 0.524, respectively), and SAA was positively correlated with FoMO (r = 0.416). Path analysis showed a significant indirect association between SAA and SMA through FoMO. The direct association remained significant after including FoMO, indicating partial statistical mediation. CONCLUSION:Higher levels of SAA and FoMO were associated with greater SMA among adolescents. FoMO statistically explained part of the association between SAA and SMA. Because of the cross-sectional design, the findings indicate statistical associations rather than temporal or causal relationships. IMPLICATIONS FOR PRACTICE:These findings may inform school- and family-based interventions promoting healthy social media use and addressing SAA and FoMO. Pediatric and school nurses may use these findings to develop awareness programs for adolescents and their parents.
PURPOSE:To explore the lived experiences of family caregivers caring for children at home after the Fontan procedure, using chronic sorrow theory as a sensitizing framework. To our knowledge, this is the first descriptive phenomenological study of post-Fontan home caregiving and the first application of chronic sorrow theory to this population. METHODS:A transcendental (descriptive) phenomenological design (Moustakas, 1994) was used. Ten mothers serving as primary caregivers were recruited through purposive and snowball sampling from a transit shelter for families of children with congenital heart disease in Jakarta, Indonesia. In-depth semi-structured interviews (30-60 min) were conducted in Bahasa Indonesia, transcribed verbatim, and analyzed in the original language using the modified Stevick-Colaizzi-Keen method, yielding 116 significant statements. Trustworthiness was established through member checking, analyst triangulation, an audit trail, and reflexive journaling, with reporting guided by COREQ. RESULTS:Three themes emerged: (1) being the primary caregiver, spanning fluid balance, nutrition, wound care, and anticoagulation management; (2) oscillating between sorrow and strength, encompassing emotional responses, spiritual coping, caregiving instinct, and support systems; and (3) still restricting the child's activities, alongside cautious, gradual reintegration. CONCLUSIONS:Post-Fontan home caregiving in Indonesia is characterized by recurring sorrow, adaptive growth, and protective vigilance consistent with chronic sorrow theory. In the absence of formal home nursing, mothers function as informal clinical co-providers. PRACTICE IMPLICATIONS:Competency-based discharge education, telenursing follow-up, peer-support integration, and culturally responsive activity guidance are needed to support families managing post-Fontan home care, particularly in low- and middle-income countries.
PURPOSE:This study examined the associations among nurse-perceived staffing adequacy, the psychosocial work environment, and nursing care left undone in pediatric wards. DESIGN AND METHODS:A cross-sectional study was conducted in seven pediatric wards of a tertiary children's hospital in South Korea in 2024. Nurse-perceived staffing adequacy was measured using a 4-point scale (very insufficient to very sufficient). The psychosocial work environment was assessed using the third version of the Copenhagen Psychosocial Questionnaire (COPSOQ III). Care left undone was measured by asking nurses whether they had left each of 13 nursing activities undone because of insufficient time during their most recent shift. Data were collected through a survey of 121 nurses. Regression analyses were conducted to examine associations among the study variables. RESULTS:Most nurses perceived staffing as very insufficient (20.7%) or insufficient (70.2%). Nurses reported an average of 5.8 nursing activities left undone because of time constraints, with patient repositioning being the most frequently omitted activity. Seventeen of the 28 COPSOQ III dimensions differed significantly by staffing adequacy, with more favorable work environments observed as perceived staffing adequacy improved. Perceiving staffing as very insufficient and higher quantitative demands were significantly associated with greater numbers of care activities left undone. CONCLUSIONS:Nurse staffing adequacy and quantitative work demands appear to be key factors associated with care left undone in pediatric inpatient settings. IMPLICATIONS FOR CLINICAL PRACTICE:Ensuring adequate staffing and reducing excessive quantitative work demands may minimize care left undone and improve the quality of pediatric nursing care.
BACKGROUND:Caregiver burden is a major concern for those caring for children with special needs, who face more health issues. This study aimed to evaluate the impact of compassion and psychological well-being on perceived caregiver burden among family caregivers of children with special needs. METHODS:A descriptive, cross-sectional, single-center study was carried out at the Afyonkarahisar Private Special Education and Rehabilitation Center from September 12, 2024, to February 25, 2025. The sample consisted of 260 family caregivers. The study utilized the Sociodemographic Information Form, Caregiver Burden Scale, Compassion Scale, Psychological Well-being Scale for Married Women and Men as data collection tools. Normality of the data was assessed using Skewness-Kurtosis, Pearson correlation, ANOVA, hierarchical regression analyses were conducted. A p-value less than 0.05 was considered statistically significant. FINDINGS:A significant weak negative correlation was found between caregiving burden and compassion (p < 0.01), a significant positive correlation was observed between caregiving burden and psychological well-being (p < 0.01). Psychological well-being is a variable that significantly predicts caregiving burden (p = 0.002). While compassion was not found to be significant in one dimension (p = 0.522), its sub-dimensions, indifference (p = 0.021), and conscious awareness (p < 0.029) were significant. DISCUSSION:The care burden varied depending on the child's disability, remained constant despite the burden of affectionate care, and psychological well-being was significantly affected. PRACTICE IMPLICATIONS:Family caregivers need to be clearly informed about care funding, leave policies, and support services. Peer support groups should be established for caregivers, and cognitive-behavioural interventions should be implemented. In primary healthcare settings, psychosocial support should be integrated into care processes to facilitate early identification of caregivers at risk.
PURPOSE:This study aimed to compare the Reverse Kangaroo Care position with the ROP position in terms of pain and related physiological responses during retinopathy examination in premature infants. METHODS:The research was carried out at the Premature Retinopathy Outpatient Clinic of a university-affiliated medical institution during the period spanning from February 2024 to July 2025. Data were obtained from 25 in the Reverse Kangaroo Care position group and 25 in the ROP position group. For each infant, heart rate, SpO₂, PIPP-R score, and crying duration were recorded around the ROP examination at three procedural moments: before, during, and after the examination. Generalized estimating equations were used because the same infants contributed repeated measurements over time. RESULTS:PIPP-R pain scores differed significantly between groups and at the time of measurement (p < 0.001). One minute after examination, mean pain scores were lower in both the Reverse Kangaroo Care and ROP position groups (0.08 ± 0.40 and 1.04 ± 1.77, respectively; p < 0.01 for within-group variation). Heart rate was lower in the Reverse Kangaroo Care position group one minute after examination (p < 0.05). Crying duration increased during examination and then decreased afterward; however, the Group × Time interaction was not statistically significant. CONCLUSION:Both positions resulted in lower pain scores after ROP examination. Changes in pain score and crying duration over time were not statistically different between groups, whereas heart rate recovery one minute after examination was more positive in the Reverse Kangaroo Care position group. IMPLICATIONS TO PRACTICE:The Reverse Kangaroo Care position and the ROP position are two practical and effective, non-pharmacological methods that enable parental involvement in pain management during ROP examinations. The Reverse Kangaroo Care position is more effective at improving physiological parameters. The Reverse Kangaroo Care position, which also promotes parental involvement through skin-to-skin contact, is recommended to be preferred whenever feasible. CLINICAL TRIALS NUMBER:NCT06694103.
