PURPOSE:Tonsillectomy is one of the most common surgical procedures, with 289,000 ambulatory procedures performed annually in children <15 years of age, and pain is a major cause of post-tonsillectomy complications. We sought to evaluate the effect of parent participation in postoperative pain management programs on children's post-tonsillectomy pain score and other outcome measures. METHODS:Parent participation in postoperative pain management programs was based on the quality improvement model developed by the Evidence-Based Nursing Center of Fudan University and validated among child urological patients. This between-group experimental controlled study was conducted in the inpatient ENT ward of a tertiary children's hospital. The control group comprised 118 children randomly selected from April 1 to May 15, 2022, and the experimental group included 117 children randomly selected from June 1 to July 15, 2022. To evaluate the effectiveness of the model, the control group received routine postoperative pain management, and the intervention group received the program of parental involvement in postoperative pain management. Postoperative pain-related data were collected for the two groups of children. RESULTS:There was no significant difference in the demographic characteristics of the two groups of children (P > 0.05). The pain score of the children in the intervention group was significantly lower than that of the control group when returning to the ward on the day of surgery (Z = 3.185, P = 0.002), after 2 h (Z = 7.280, P<0.001), after 4 h (Z = 6.4000, P<0.001), after 24 h (Z = 2.698, P = 0.009), at discharge (Z = 3.397, P = 0.002), and at the postoperative hospital visit (Z = 3.349, P = 0.001). There were no significant differences in the pain score at 02:00 in the morning after the operation or effective sleep time after the operation between the two groups (P > 0.05). CONCLUSIONS:and Clinical Implications: Programs of parental participation in postoperative pain management applied to children undergoing tonsillectomy can improve the participation of parents in postoperative pain management of children, relieve postoperative pain in children undergoing tonsillectomy, and improve children's postoperative quality of life.

AIM:To construct an evidence ecosystem-based postoperative pain management programme for children with postoperative pain management. DESIGN:A mixed research design that combines qualitative and quantitative studies. METHODS:According to the literature search and analysis, the postoperative pain management programme for children was constructed from three aspects: assessment of pain intensity of children, management principles and management methods, and the preliminary draft of the programme was finally constructed to include three first-level entries and 11 second-level entries. In January-February 2023, the first draft of the postoperative pain management programme for children was developed based on a literature review using the ecosystem of evidence theory as the research framework; in March-April 2023, the postoperative pain management programme for children was revised and finalised through two rounds of Delphi expert consultation. RESULTS:In the second round of expert consultation, the return rate of valid questionnaires was 100%, the expert authority coefficient was 0.83, the importance scores and feasibility scores of each entry were > 3.5, the coefficients of variation were < 0.25, the Kendall's harmony coefficients of the importance scores of the entries were 0.650 (χ2 = 273.134, p < 0.001) and those of the feasibility scores were 0.649 (χ2 = 272.720, p < 0.001). The resulting postoperative pain management programme for the affected patients included three level 1, 11 level 2 and eight level 3 entries. PATIENT OR PUBLIC CONTRIBUTION:The postoperative pain management programme for children constructed based on the evidence ecosystem is practical and scientific, but its effectiveness in clinical practice needs to be further verified by a controlled study design. OBJECTIVES:Evidence ecosystem; paediatrics, surgery; pain; Delphi method.

Abstract Aim Postoperative pain has adverse effects on children with urological problems, including sleep disturbances, incision dehiscence, bleeding and delayed recovery. Accurate parental assessment of children's behaviours and responses could help to manage postoperative pain. We aimed to implement evidence‐based practice for parental involvement in a urology ward, to increase parents' participation in children's postoperative pain management. Design The project was conducted in a paediatric urology ward using the framework and methods of the Fudan University Evidence‐Based Nursing Center's Evidence‐based Continuous Quality Improvement Model. Methods Fifteen audit criteria were used to represent best practice recommendations for parental involvement in postoperative pain management. A pre‐implementation audit was conducted with 211 randomly sampled children and parents. Obstacles, promoting factors and key strategies were analysed, and evidence‐based interventions implemented to improve compliance. A follow‐up audit using the same audit criteria was conducted with 202 children and parents to assess the effect of targeted strategies on compliance with best practice. The SQUIRE guidelines were followed. Results At the baseline audit, compliance with the evidence‐based criteria was 0%–71.5%; only five audit criteria achieved a compliance rate > 60%. After best practice implementation, the follow‐up audit showed compliance improvements for all criteria; compliance for three criteria improved to 100%. Patient or Public Contribution This best practice implementation project improved parents' participation in children's postoperative pain management. The findings demonstrate how audits can promote best practice in postoperative pain management for children. Additional studies will be conducted to address children's postoperative life quality based on best practice.

对儿童癌痛管理的护理研究进行综述,阐述儿童癌痛管理的现状及阻碍因素,介绍两种新的管理模式,并对管理所面临的机遇与挑战进行分析总结,提出有针对性的建议,旨在为儿童癌性疼痛管理及临床实践提供参考.

目的:探讨三级甲等医院全面托管模式提升区级儿童医院护理质量的效果.方法:2019年底苏州大学附属儿童医院,通过建立儿科护理帮扶团队、制定护理托管帮扶实践方案,在全面托管实施前、实施2年后对区级儿童医院5个病区进行护理质量评价,对65名护士进行护士综合能力考核、护士工作满意度调查和护士职业认同感调查,并对托管前后的数据进行统计学分析.结果:全面托管实施后护理质量评价得分、护士综合能力得分、护士工作满意度得分和护士职业认同感得分明显高于实施前,差异有统计学意义(P<0.05).结论:三级甲等医院全面托管模式可以有效提升区级儿童医院护理质量,提升护士综合能力、工作满意度和职业认同感,促进区级儿童医院的可持续发展.

目的:了解1岁内住院患儿父母参与照护的现状,探讨其影响因素.方法:采用一般资料问卷及住院患儿父母参与照护问卷对105名1岁内住院患儿父母进行调查.结果:1岁内住院患儿父母参与照护问卷总分为(87.00±12.19)分,基础护理维度得分为(22.90±3.33)分,信息支持维度得分为(26.85±4.54)分,情感支持维度得分为(37.25±4.97)分;与患儿的关系及是否为主要照顾者是影响患儿父母参与照护的主要因素.结论:1岁内住院患儿父母在基础护理的参与照护能力上较高,但在信息支持的参与照护能力上较低,与患儿的关系、是否为患儿主要照护者是影响父母参与照护能力的主要因素.儿科护理人员应加强与父母间的沟通,为父母与医护人员互相协作、共同完成患儿的护理工作提供机会.

BACKGROUND Postoperative pain has adverse effects on children after urology treatment, including sleep disturbance, incision dehiscence, bleeding, and delayed recovery. Parents, as the most direct caregivers of children, can make accurate assessments of children´s personal behaviors and responses, which is very important for the management of postoperative pain in children. PURPOSE The purpose of the current study was to develop a Parent Participation in Postoperative Pain Management Program for children in a urology ward and to evaluate its effects on children's postoperative pain scores and other outcome indicators. DESIGN This research comprised two phases. The first phase was the development of a Parent Participation in Postoperative Pain Management Program. The second phase was a randomized controlled trial between two groups, and was carried out in a 45-bed inpatient urology ward of a tertiary children's hospital in China. In the trial, 211 children and their parents were randomly selected as a control group between July 1 and August 15, 2019, and 202 children and their parents were randomly selected as an intervention group between August 16 and September 15, 2019. METHODS Following the framework and methods of the Evidence-based Continuous Quality Improvement Model developed at Fudan University Evidence-Based Nursing Center, we systematically gathered evidence regarding parental involvement in postoperative pain management in children to construct the program. To evaluate the program's effectiveness, the control group performed routine postoperative pain management, while the intervention group underwent the Parent Participation in Postoperative Pain Management Program. The management period was during hospitalization, and generally ranged 3-7 days. The Statistical Table of Pain Assessment for Children after Urology was employed by researchers. FINDINGS The results revealed no significant differences in demographic characteristics between the two groups of children and their parents. Children's pain scores during dressing removal (Z = -3.108, p = 0.002), at discharge (Z = -2.185, p = 0.029) and during catheter removal (Z = -6.553, p = 0.000) were significantly lower in the intervention group compared with the control group. CONCLUSIONS AND CLINICAL RELEVANCE The Parent Participation in Postoperative Pain Management Program was found to be effective for alleviating postoperative pain scores among children, and provided useful information regarding postoperative pain management in children involving four aspects of parental involvement: cognition, guidance, documentation and support.

目的:探讨儿科护士传染病突发事件应对能力现状及其影响因素,为儿科护士传染病突发事件应对能力的培训提供依据.方法:2020年2月15日—25日期间通过问卷星的形式,采用《传染病突发事件应对能力问卷》对851名儿科护士进行调查,并分析其现状及影响因素.结果:儿科护士传染病突发事件应对能力总分为(134.87±24.61)分,预防能力、准备能力和救援能力3个维度的得分分别为(12.02±2.17)分、(14.44±3.24)分、(108.42±20.18)分.多元回归分析显示,儿科护士传染病突发事件应对能力的影响因素包括:如果开展传染病突发事件培训您是否愿意参加、参加培训数分组,2个因素的可解释度为20.9％.结论:儿科护士传染病突发事件应对能力有待进一步提高,医疗卫生管理者和教育者应加强培训力度,从培训内容、培训频次等方面着手,进一步提升儿科护士对传染病突发事件的应对能力.

Aim: To develop a nursing early warning system in children’s hospital during the outbreak of the novel coronavirus pneumonia, and to accomplish the construction and application of this system, so as to provide decision-support of the prevention and control for COVID-19 in children’s medical institutions. Method: Children’s hospital nursing early warning system was divided into three modules: hospital nursing early warning platform includes internal and external early warning platform, nursing staff early warning program includes protection, human resources early warning plan and patient early warning program includes outpatient, emergency and ward early warning plan. The data of epidemic training, assessment, prevention and control screening from January to June 2020 were collected from the nursing early warning system to evaluate the application effect of the system. Results: A total of 18 procedures and specifications were formulated, nine hospital-level trainings and about 1000 department-level trainings were organized, two hospital-level assessments (pass rate 95.6% and 98.2%), and 78 nurses were reserved, and 10 popular science articles, five popular science videos were published during the application of the nursing early warning system. A total of 583,435 children and 139,308 caregivers were screened in outpatient, emergency and wards during pre-checks, 2385 suspected cases of novel coronavirus pneumonia were confirmed (0.41%) after the screening and 1 case (0.0002%) was finally confirmed. Conclusion: The nursing early warning system of children’s hospital can prevent and control the novel coronavirus pneumonia epidemic from each module, ensure early warning and triage of suspected infected patients, reduce the risk of cross-infection in hospital and improve the safety of the children’s hospital medical environment.

Purpose: To develop a Chinese version of the State Behavioral Scale (SBS-C) and to evaluate its reliability and validity for sedation assessment in mechanically ventilated children in China. Design and methods: Cross-sectional survey design was used in a two-part study of mechanically ventilated children, aged 6 weeks to 6 years. A total 172 children and 145 children were recruited from Jan-Dec 2017 and Jan-Dec 2018, respectively, at a tertiary care pediatric hospital in southeast China. Following translation of the scale, the content validity was established by the content validity index, internal consistency was established using Cronbach's a, and construct validity was confirmed by correlation with a similar well-recognized scale, the COMFORT Scale-Chinese version (CS-C). Results: The content validity index for the seven scale dimensions ranged from 0.83 to 1.0 and for the full scale was 0.932. In the first study, Cronbach's a for the full SBS-C was 0.986 and for the seven scale dimensions ranged from 0.973 to 0.983; similarly, in the second study, Cronbach's a for the full scale was 0.983 and for the seven dimensions ranged from 0.977 to 0.987. The correlation coefficient between scores of the SBS-C and the CS-C was 0.919 (P <.01). Conclusions: The SBS-C is valid, reliable, and responsive and is suitable for assessing sedation inmechanically ventilated children in China. Implications for practice: The SBS-C can be used for sedation assessment in mechanically ventilated children in China, guiding decision making and the provision of care, and optimizing patient safety. (C) 2020 Elsevier Inc. All rights reserved.

目的 探讨儿童医疗辅助服务对学龄期哮喘患儿自我管理能力的影响.方法 选取我院2018年3—8月哮喘专病门诊就诊的患儿为研究对象,2018年3—5月纳入50例患儿为对照组,2018年6—8月纳入50例患儿为观察组.对照组给予常规护理,观察组在对照组基础上实施儿童医疗辅助服务.观察比较2组学龄期哮喘患儿于干预前和干预6个月末自我管理能力、哮喘复发率和哮喘急性发作就诊率.结果 观察组哮喘患儿干预6个月末自我管理能力各维度及总分均高于对照组,差异有统计学意义(P<0.05);观察组哮喘患儿哮喘复发率低于对照组(字2=4.320,P=0.038);2组患儿哮喘急性发作就诊率的比较差异无统计学意义(字2=1.895,P=0.169).结论 儿童医疗辅助服务能提升学龄期哮喘患儿自我管理能力,降低患儿哮喘复发率,促进患儿疾病控制.

目的:通过分析三级医院医务人员对建立医院-社区-家庭儿童哮喘服务链的认知和感受,为构建哮喘儿童连续性照护模式提供参考.方法:于2021年2月选取江苏省苏州市苏州大学附属儿童医院、南京医科大学附属苏州市立医院和南京医科大学附属苏州科技城医院儿童呼吸科和哮喘中心的医务人员为访谈对象进行半结构式深度访谈,共有15名医务人员参与本次访谈.结果:访谈结果显示,医院-社区-家庭儿童哮喘服务链的构建和完善需要较长过渡期,政府相关政策推动了服务链的发展,但服务链的构建面临诸如上下级医院联系不够紧密、社区卫生服务中心哮喘诊疗技术有待提升、欠缺危重症哮喘急救能力和设备、哮喘评估相关技术支持有待完善等问题.结论:医院-社区-家庭儿童哮喘服务链的构建还存在诸多困难,应加强政策引导和宣传力度,完善社区哮喘相关硬件设施配备,强化医务人员哮喘专业技能培训.

[目的]了解3～18月龄婴幼儿神经心理发育现状,分析不同出生季节对其神经心理发育状况的影响.[方法]采用方便抽样法,选取2018年1月—2018年12月某三级甲等儿童医院儿童保健科门诊就诊的3～18月龄婴幼儿1613例,采用首都儿科研究所编制的0～6岁小儿神经心理发育量表进行测试,比较不同季节出生儿童的总发育商(DQ)以及神经发育大运动、精细动作、适应性、语言、社交各方面发育情况.[结果]4月龄、5月龄、6月龄、16月龄婴幼儿的神经心理发育DQ值与出生季节间的相关性有统计学意义(P<0.05);4月龄婴幼儿的神经心理发育迟缓率与出生季节间的相关性有统计学意义(P<0.05).[结论]出生季节与婴幼儿神经心理发育有关,临床儿童保健工作者应指导家长根据季节差异给予婴幼儿动作、语言、适应力、社交等多方面的均衡训练.

目的 检索并获取父母参与患儿术后疼痛管理的相关证据,并进行最佳证据总结.方法 计算机检索2009年1月至2019年5月BMJ、NICE、美国指南网、JBI、Cochrane Library、Pubmed、美国麻醉医师协会、美国儿科学会、美国疼痛协会、加拿大医学会临床实践指南网、苏格兰学院间指南网络、新西兰指南协作组网、国际指南协作组网、中国生物医学文献数据库中有关父母参与患儿术后疼痛管理的证据,包括计算机决策支持系统、临床实践指南、证据总结和系统评价.由研究者对纳入文献进行质量评价,并对符合质量标准的文献进行证据提取.结果 共纳入文献6篇,包括1篇指南、2篇证据总结、2篇系统评价和1篇Meta分析,最终总结出10条最佳证据.结论 父母参与患儿术后疼痛管理的最佳证据包括父母参与认知、指导、文件和支持,可为临床疼痛管理提供循证依据,护理人员可根据证据进行临床护理实践.

目的 将基于循证的父母参与在泌尿外科患儿术后疼痛管理的最佳证据应用于临床实践,提高父母基于证据对患儿术后疼痛管理的参与度,从而进一步缓解患儿术后疼痛情况.方法 遵循JBI循证护理中心的临床证据实践应用系统的标准程序进行证据的临床应用.通过检索父母参与患儿术后疼痛管理的相关证据并制定15条审查指标.采用问卷调查法、现场观察法、访谈、查阅护理记录收集数据;分析每条证据应用存在的障碍因素和促进因素,并制定行动策略;通过审查指标执行情况、患儿术后疼痛评分、患儿术后其他指标来评价证据应用效果.结果 3项审查指标在证据应用后的执行率由0提升至100％;患儿术后拆敷料时疼痛评分、拔导尿管时疼痛评分和出院时疼痛评分均在证据应用后显著降低(P<0.05).结论 在临床护理中应用基于循证的父母参与在泌尿外科患儿术后疼痛管理的最佳证据,可提高父母基于证据对患儿术后疼痛管理的参与度,并缓解泌尿外科患儿术后疼痛程度,提升患儿术后生活质量.

目的 了解江苏省儿童专科医院护士的满意度情况,探讨儿科护士群体满意度影响因素,为提高护理质量、发展护理学科提供数据支持.方法 采用方便抽样法选择2017年10-11月江苏省儿童专科医院院529名护士进行满意度体验的测评.结果 护士满意度总体均分为(2.377±0.899)分,各维度评分分别为:团队协作(1.852±0.756)分、本职工作(2.152±0.893)分、护理管理(2.598±1.084)分、执业环境(2.427±1.001)分、工作回报(2.830±1.217)分、职业生涯(2.648±1.239)分.多因素线性回归结果显示,年龄、学历、工作岗位是护士体验满意度的影响因素,可解释29.2％的变异量.结论 儿科护士的整体满意度呈较低水平,其影响因素也是多方面的,如何合理管理护理人力资源,实现儿科护士对护理职业的价值观、认同感,以提升护理质量是值得深入研究的重要课题.

Objective To test the reliability and validity of the Chinese version of State Behavioral Scale for Mechanically Ventilated Children (SBS). Methods The English version of SBS was revised and translated into Chinese version. The reliability and validity of the Chinese version of SBS was tested in 172 mechanically ventilated children. Results The Cronbach α coefficient of the Chinese SBS was 0.986. The item-level content validity index of Chinese SBS were 0.83-0.10, and the scale- level content validity index of Chinese SBS was 0.932. The correlation coefficient between the score of Chinese SBS and the Comfort Scale (CS) was 0.919 (P<0.01). Conclusions The Chinese version of SBS has been proved to be reliable and valid.It can be used to sedation assessment for mechanically ventilated children.

[目的]调查江苏省三级儿童医院护士疼痛管理的知识及态度并探讨其影响因素,为针对性制订儿科护士疼痛管理培训方案提供科学依据.[方法]采用问卷星电子问卷填写方式,采用一般资料调查表、中文版儿科护士疼痛知识与态度调查量表对江苏省三级儿童医院的649名在职护士进行问卷调查.描述一般人口学及疼痛管理现状、疼痛知识与态度得分及正确率,分析其影响因素.[结果]江苏省三级儿童医院护士疼痛知识与态度总分为17.10分±3.95分.多因素线性回归结果显示:是否正在或曾经担任护士长、学历、科室是影响护士疼痛管理知识及态度的因素,可解释28.4％的变异量.[结论]儿童专科医院护士疼痛管理知识及态度存在缺陷,建议构建与临床实践密切相关的儿童疼痛管理培训项目,以提高护士疼痛管理知识.

Objective To develop the questionnaire which was used in clinical practice and could measure inpatient children's parent participation in care,so as to provide the reference for clinical research.Methods To formulate the initial entry of questionnaire on the basis of searching literature and revise it through two rounds of expert consultation,then used the questionnaire to survey 103 parents and tested its reliability and validity.Results The questionnaire included three dimensions and 19 items,which overall Cronbach's α was 0.961 and each objective Cronbach's α was 0.949~0.955.Factor analysis extracted three common factors,which were emotional support,information support and basic nursing,with a cumulative contribution rate of 76.05%.Conclusion The questionnaire had well reliability and validity,which can effectively and objectively measure the actual statue of parents'participating in nursing care.