Introduction: The numbers of children and young people living with chronic conditions are rising, with many experiencing significant functional limitations and complex healthcare needs. As life expectancy improves, there is a growing need to support families in managing care at home and promoting age-appropriate self-care behaviors. Existing frameworks provide evidence that self-care is essential for maintaining health, monitoring and managing changes, as it evolves with the child's development. Few instruments comprehensively assess self-care in pediatric populations or consider the role of parents. Objective(s): To develop and initially validate an instrument designed to assess self-care behaviors in children and young people with complex chronic conditions, and the contribution of their parents across different developmental stages. Methods: This initial validation study, conducted between 2022 and 2023, included four phases: 1) scale development based on theoretical evidence; 2) content and face validation through expert interviews; 3) calculation of Content Validity Indexes; and 4) cognitive interviews for face validity. Eleven variants of the instrument were developed to tailor it to five age groups and addressed three core dimensions of self-care: maintenance, monitoring, and management. Eighty-six expert participants (healthcare providers, parents, and patients) took part in phases 2 and 3, while cognitive interviews were conducted with 5 patients and 13 parents in phase 4. Statistical analyses included Item-Content Validity Indexes and Scale-Content Validity Indexes. Results: The final instrument, with an average of 37 items per variant, showed strong content validity, with Scale-Content Validity Indexes ranging from 0.91 to 0.98 and Item-Content Validity Indexes between 0.63 and 1. Minimal item revisions were made based on experts’ feedback. The instrument demonstrated good face validity and feasibility for online administration, with completion times between 6 and 14 min. Discussion: A new comprehensive instrument that measures self-care behaviors in children and young people with complex chronic conditions and the contribution of parents was developed, considering the various developmental stages. Initial evidence supports its content and face validity. Study registration: The study was ‘not registered’ in any public registry.

Background/Objectives: Worldwide, Type 1 diabetes mellitus (T1DM) in youth represents a growing public health concern, and Italy is among the countries with the highest incidence in the pediatric population. The transition from pediatric to adult care is a vulnerable period associated with increased risks of acute complications and long-term morbidity. This scoping review aimed to map the available Italian evidence on healthcare transition in adolescents and young adults (AYAs) with T1DM, addressing five key areas: characteristics of the transition process and involved populations, emotional and psychological experiences, the role of technology, existing transitional care models and related outcomes, and assessment criteria and tools for transition readiness. Methods: This review followed the JBI methodology and included studies focused on Italian AYAs (aged 10–24 years) with T1DM. Study selection was documented using the PRISMA flow chart. Results: Twenty studies were included. The evidence revealed a heterogeneous and inconsistently implemented transition landscape. Several structured transition projects were identified, differing in multidisciplinary team composition, organization, and outcome evaluation. Emotional distress, fear of separation from pediatric providers, and variable satisfaction with transition experiences were commonly reported. Adoption of technologies increased over time and was associated with improved clinical outcomes, although overall uptake remained suboptimal. Importantly, no Italian-validated tools for assessing transition readiness were identified. Conclusions: Transitional care for Italian AYAs with T1DM is increasingly recognized but remains insufficiently standardized and evaluated. Future research should prioritize multicenter studies, stratified analyses, and the development of culturally validated readiness assessment tools to support effective and individualized transitions.

Background: Diabetes in youth, specifically type 1 diabetes (T1D), is an increasing global health concern. As prevalence rises, a growing number of adolescents are required to transition from pediatric to adult healthcare services. This phase is recognized as a particularly critical and high-risk period, during which emerging adults with T1D must exhibit advanced self-management skills to maintain optimal outcomes. When transition support is inadequate, the process is frequently associated with deterioration in glycemic control, higher rates of hospitalization, and significant psychological distress. Methods: A systematic review was conducted in accordance with PRISMA guidelines to identify and evaluate instruments that assess transition readiness in adolescents with diabetes, focusing on their psychometric properties. Five electronic databases (PubMed, CINAHL, Embase, APA PsycInfo, and Web of Science) were searched. Methodological quality and measurement properties were appraised using the updated 2024 COSMIN Guidelines. Results: Eleven studies were included, examining 10 distinct instruments. Overall, psychometric evidence was promising but limited. Only the "On TRAck" instrument demonstrated moderate-quality evidence with acceptable feasibility and reliability. Other tools showed partial support for validity, reliability, and responsiveness, but presented methodological limitations. Conclusions: Interest in diabetes-specific tools to assess transition readiness is growing, yet their psychometric robustness remains limited. Further research is needed to develop and validate instruments with stronger methodological rigor. Future efforts should focus on longitudinal performance and predictive validity to enhance their applicability in clinical practice and ultimately improve outcomes during transition.

BACKGROUND:Admission to the neonatal intensive care unit (NICU) is a challenging experience for parents. The use of narrative diaries could be a helpful support strategy to reduce psychological complications. AIM:To describe feasibility in terms of acceptability, demand and implementation of a narrative diary in the NICU and explore parents' and healthcare providers' (HCPs) perceptions and attitudes on its use. STUDY DESIGN:Prospective feasibility study using quantitative and qualitative approaches was conducted in a NICU at a tertiary care children's hospital in Italy. Participants are newborns admitted to the NICU, their families and HCPs. The narrative NICU diary intervention was assessed in terms of adherence, type of entries and perceptions on satisfaction, usability and usefulness. RESULTS:Twenty-three parents of critically ill newborns participated in this study between January 2024 and July 2025. The median length of NICU stay was 38 days (IQR: 27-48). Sixteen caregivers were mothers (84%). A total of 581, entries were collected in 21 diaries, with a median of 22 (IQR: 12-38) entries per diary and a median NICU diary duration of 30 (IQR: 20-51) days per family. Parents contributed at least once a day in 350/951 diary-days (37%), while HCPs contributed in 49/951 diary-days (5%). At 1-month follow-up after NICU discharge, 19 (83%) parents reported high levels of satisfaction and usefulness on a 1-10 Likert Scale (LS) with the diary for themselves and their newborn (LS = 9; IQR: 8-10). At the end of the study, 17 (24%) NICU HCPs reported greater usefulness of the diary for parents (LS = 9; IQR: 7-10) than for themselves (LS = 7; IQR: 5-9). CONCLUSIONS:The implementation of a narrative NICU diary was feasible and perceived as beneficial by both parents and HCPs. RELEVANCE TO CLINICAL PRACTICE:The use of a narrative NICU diary may support parents and prevent the family post-intensive care syndrome (PICS-f). Strategies are needed to promote diary writing by HCPs.

INTRODUZIONE: L’onco-ematologia pediatrica rappresenta un ambito clinico ad elevata complessità assistenziale, caratterizzato da bisogni avanzati sul piano clinico, relazionale ed etico. In Italia non esiste attualmente un riconoscimento formale né un Core Curriculum nazionale per l’infermiere con competenze avanzate in onco-ematologia pediatrica (Pediatric Hemato-Oncology Nurse, PHON), determinando eterogeneità formativa e organizzativa. OBIETTIVI: Definire, attraverso un processo strutturato e condiviso, un insieme di competenze avanzate finalizzato alla costruzione di un Core Curriculum nazionale e di una Job Description del PHON nel contesto italiano. METODI: Studio metodologico articolato in due fasi: revisione della letteratura nazionale e internazionale per l’identificazione preliminare delle competenze; successivo processo e-Delphi a due round con referenti infermieristici dei centri AIEOP. Le competenze sono state valutate per comprensione e pertinenza mediante scala Likert a 5 punti (0–4). Il consenso sul livello di esperienza necessario per l’autonomia professionale (principiante, intermedio, esperto) è stato definito con accordo ≥75%. RISULTATI: Hanno partecipato 19 infermieri (età media 45 anni; esperienza media in OEP 18 anni). Dopo il primo round sono state apportate modifiche testuali e strutturali; al termine del secondo round è stato definito un Core Curriculum composto da 126 competenze organizzate in nove macroaree. L’autonomia professionale è risultata prevista entro il primo anno per 58 competenze, dopo 1–3 anni per 46 e oltre tre anni per 22 competenze. CONCLUSIONI: Il processo Delphi ha consentito la definizione di un framework nazionale condiviso, fornendo una base metodologicamente solida per il riconoscimento e lo sviluppo del ruolo avanzato dell’infermiere in onco-ematologia pediatrica.

BACKGROUND:An infant's admission into the Neonatal Intensive Care Unit (NICU) disrupts the normal transition to parenthood due to the separation. Non-narrative diaries are structured tools that record predefined information and activities. Their use could facilitate parent-infant closeness, while also serving as a data collection tool for clinical research. AIM:To explore the use of non-narrative diaries in NICU in terms of definitions, formats, recorded variables and the identity of the diarist. STUDY DESIGN:A scoping review was conducted following the Joanna Briggs Institute (JBI) methodology. The search strategy was conducted consulting PubMed, Embase, Scopus, PsycInfo, CINAHL and Grey Literature up to March 2025. Studies reporting on the use of non-narrative diaries in the NICU were included. Descriptive and thematic analyses were performed. RESULTS:Of the initial 538 initial records, 18 were included. Most studies had an observational design (88%); one included a validation process of a diary. Parents (50%) were the most common diarists, in particular mothers (33%). Parental presence (72.2%) was the most documented variable in the diary, followed by skin-to-skin contact (66.6%) and holding (33.3%). Only seven studies used a validated tool called 'the parent-infant closeness diary'. Non-narrative diaries were adaptable for collecting diverse quantitative and semi-structured data, including behavioural, emotional, organisational, well-being and breastfeeding outcomes. CONCLUSIONS:Non-narrative diaries show promise as versatile, user-friendly tools both for research and family-centred care in NICU settings. Future studies should aim for greater methodological rigor and broader stakeholder involvement. RELEVANCE TO CLINICAL PRACTICE:Non-narrative diaries offer a practical and low-cost method for documenting parent-infant interactions in the NICU.

AIM:To describe and categorize the thematic content emerging from narrative diaries in Neonatal Intensive Care Unit (NICU) written by parents and healthcare providers. METHODS:A qualitative study of NICU diary writings, provided for a feasibility study, was conducted at a tertiary-care hospital in Central Italy. Parents of neonates admitted to a 22-bed NICU, who underwent intubation and sedation for at least 48 h, were enrolled. Parents, relatives, visitors, and healthcare professionals were invited to write about their experiences, emotions, reflections, along with drawings, or photographs in the NICU narrative diary during the hospitalization. Narrative data were analyzed using thematic analysis following Braun and Clarke's approach. FINDINGS:Twenty-one NICU narrative diaries were collected between January 2024 and January 2025. Each diary contained a median of 22 entries (IQR = 12-28), and the majority of which were written by mothers (91%). Thematic analysis of diaries revealed 15 subthemes, which were then categorized into three overarching themes: 1) the NICU journey, reporting the newborn's clinical course and development, the first-time experience, the NICU environment, and parents' involvement in care; 2) parenthood, encompassing emotions, parental identity, bonding and separation, partner mutual support, and relationships with siblings; and 3) resilience and coping, highlighting narratives of communicating with the newborn, gratitude, support from relatives and peers, spirituality and the role of the narrative diary. CONCLUSIONS:NICU narrative diaries provide valuable insight into the clinical, emotional, and relational dimensions of the NICU experience. Clear communication, recognition of meaningful moments, and structured opportunities for parental participation and narrative expression may foster bonding, resilience, and overall quality of care. IMPLICATIONS FOR CLINICAL PRACTICE:NICU narrative diaries promote a more humane and participatory care environment by supporting parental involvement, caregiver emotional well-being, and a relationship-oriented care culture.

AIM:To explore the phenomenon of nurse-patient's illness experience. DESIGN:A multicentre phenomenological qualitative study was conducted in Italy. METHODS:A convenience sample of nurses with an acute illness experience, requiring at least one hospitalisation of ≥ 3 days, was enrolled. Semi-structured interviews were conducted. Data were transcribed verbatim and analysed according to Giorgi's descriptive method. Ethics committee approval was obtained for this study. The COnsolidated criteria for REporting Qualitative research checklist guided the study reporting. RESULTS:Eleven interviews were conducted from August 2022 to July 2023. The essential structure 'being on the other side of the fence' and six common themes, 'role reversal', 'expanded awareness', 'professional identity', 'emotional swing', 'having experienced it on their own skin' and 'reframing the healthcare context', were identified. Nurses' awareness of the healthcare system and pathways related to their professional background at the onset of their illness experience turns into an expanded awareness of the illness experience in itself, having it 'lived on their own skin'. When nurses return from the 'other side of the fence' to their professional role this new awareness triggers a more compassionate and cognizant relationship with patients and colleagues. CONCLUSION:This study highlights the lived experience of nurses who became patients, showing characterising elements of 'being on the other side of the fence' and the potential of this experience for expanding nurses' awareness of other patients' experiences under their care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE:Nurse-patients' illness experience may be instrumental to reinforce nurses' awareness, empathy and any positive attitude or practice devised to improve patient's illness experiences and patient centred care in hospitals. PATIENT OR PUBLIC CONTRIBUTION:Nurses participated as interview respondents.

OBJECTIVES:1) to evaluate the feasibility of a pilot trial on the effectiveness of a pediatric intensive care unit (PICU) diary intervention; 2) to explore group differences in parent's and child's psychological outcomes and children's behaviors after discharge from PICU. METHODS:A non-blinded, single-centered, pilot randomized controlled trial (RCT) was performed in two PICUs at a tertiary care children's hospital in Italy. Children admitted to the PICU, <18 years old, sedated and intubated for ≥ 48 h were eligible. The exclusion criteria included severe disability (Pediatric Overall Performance Category > 3), low Italian communication proficiency, and no life expectancy. The intervention was the PICU narrative diary. RESULTS:A total of 119 patients were prospectively enrolled from June 2021 to June 2024, of which 60 received a PICU diary, and 59 did not. The composite feasibility outcomes, including eligibility, recruitment, retention, attrition, and protocol adherence met 6 of the 8 criteria. At 1 and 3 months after PICU discharge Post Traumatic Stress Disease (PTSD), anxiety, depression in parents and children, and children's behaviors were measured with validated scales. At the one-month follow-up, parents in the control group had a higher PTSD (21 % vs 11 % p = 0.1) and depression (28 % vs 25 % p = 0.7) and lower anxiety (54 % vs 60 % p = 0.5) compared to the intervention group. At 3 months, lower levels were observed across all outcomes. Parent satisfaction with the intervention was high. The small sample size and lack of blinding were the main study limitations. CONCLUSIONS:The trial was feasible and acceptable. No significant differences in parents' and children' psychological outcomes were found among the study groups. IMPLICATIONS FOR CLINICAL PRACTICE:PICU diaries could be a valuable support tool for parents and children admitted to PICU. Further evidence through larger RCTs is needed to understand the effect of post-PICU discharge psychological outcomes on children and their parents.

AIM:Explore the care escalation process initiated by parents concerned about their hospitalised child's deterioration and healthcare providers' response to parental concerns. DESIGN:A qualitative study using Charmaz's constructivist grounded theory. METHODS:Participants included healthcare providers, cultural mediators and parents of children hospitalized for ≥ 3 days, who had experienced previous urgent intensive care admission or parental concern during hospitalization, in a tertiary pediatric hospital. Data were collected through focus groups, and analyzed using a grounded theory methodology with NVivo Software. RESULTS:A total of 13 parents, 7 cultural mediators and 68 healthcare providers participated in 16 focus groups. Two main categories were identified: (1) Parents navigating the uncertainty of the escalation system to get a response; (2) Healthcare providers balancing parents' concerns, their own situation awareness, escalation processes and team relations. We developed a Grounded theory called 'Parents Supporting Timely Escalation Processes' (P-STEP). By monitoring their children, parents identify early signs of deterioration and advocate for escalation. Reasons for concern are their child's behaviour, communication failure and admission on an off-service ward. Parents escalate by contacting ward providers, their child's specialist or the most trusted staff and, only selected parents, the Rapid Response Team. Staff escalate parents' concern according to their own situation awareness, parent evaluation and ward escalation practices. Parent's emotions and trust are influenced by the timeliness and type of staff response. CONCLUSION:While some parents effectively advocate for their child, others face obstacles due to unclear and lack of formal care escalation systems. Understanding how parents escalate care and healthcare providers respond is essential to identify facilitators, barriers, key stakeholders, and implement a formal system for parent-initiated escalation of care. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE:Integrating parents into processes of escalation and rapid response systems could optimise early recognition and improve responsiveness in paediatric deterioration. REPORTING METHOD:The study adheres to the COnsolidated criteria for REporting Qualitative research (COREQ) guidelines. PATIENT OR PUBLIC CONTRIBUTION:Parents and HCPs participated as interview respondents.

PURPOSE:To describe numbers and activities carried out by clinical trial nurses (CTNs) present in the centers of the Italian Association of Pediatric Hematology and Oncology (AIEOP). MATERIALS AND METHODS:Descriptive observational multicenter study based on data collected via electronic questionnaire. RESULTS:Thirteen of the 28 responding AIEOP centers declared having a CTN within their team. In 85% of centers, the number of CTNs ranges from 1 to 3; in 15%, all nursing staff fill this role. The top required minimum requirements to be able to fill the role of a CTN include possessing the good clinical practice certificate, having certification in training for immediate support of vital functions, and work experience of variable duration. Seventy percent of CTNs have post-basic training, but only 31% in clinical research. Ninety-two percent of CTNs deal with the nursing care of the patient enrolled in the studies, including the management of adverse events and therapeutic education. In a smaller percentage, depending on the activity, the CTNs are also actively involved in the more specific aspects of the trial such as management of the experimental drug, reporting non-compliance, data entry in the data collection forms, trial approval process, and participation in the site initiation visit. CONCLUSIONS:The study highlights the lack of homogeneity of CTNs in AIEOP centers and lays the foundations for the creation of a consensus document for a uniform development of this role. IMPLICATIONS FOR PRACTICE:Standardize the activities of CTNs with the drafting of a common "job description."

BACKGROUND:Premature birth and the Neonatal Intensive Care Unit (NICU) experience can be challenging for parents, affecting their psychological and emotional well-being. NICU diaries could help to reduce the separation gap and strengthen the bonding process with their infant. AIM:To review the literature on narrative diaries, definitions and use in the NICU. STUDY DESIGN:We conducted a scoping review following the Joanna Briggs Institute (JBI) methodology. We searched PubMed, Embase, Scopus, PsycINFO, Cinahl, and Grey Literature up to September 2024. Studies reporting on the use or effect of narrative diaries in the NICU were included. A descriptive and thematic analysis was conducted. RESULTS:Of a total of 526 records, 21 were included. Most studies had a quasi-experimental or qualitative design, including a framework conceptualization. Editorials were common. Mothers (33%), nurses (9%) and fathers (5%) were the most common diarists. Seven studies evaluated the effect of NICU diaries on family post-intensive care syndrome (PICS-F), satisfaction, and family separation. The benefits of NICU diaries for parents included improved communication, empowerment, personal emotional awareness and parental closeness with their newborn, while for staff, they reduced burnout and fostered the humanization of care. Acceptability was high. CONCLUSIONS:Acceptability and perceived benefits of NICU diaries were widely reported. Heterogeneity in aims, use, and follow-up was high. Well-designed effective multicentre studies providing evidence of impact on PICS-F and a position statement framing the intervention in NICU are recommended. RELEVANCE TO CLINICAL PRACTICE:This study has shown that NICU diaries have the potential to improve humanization, communication between NICU staff and parents, parents' coping, and closeness to their newborn.

Objective To describe the associations between patient-to-nurse staffing ratios and rates of mortality, process of care events and vital sign documentation.Design Secondary analysis of data from the evaluating processes of care and outcomes of children in hospital (EPOCH) cluster-randomised trial.Setting 22 hospitals caring for children in Canada, Europe and New Zealand.Participants Eligible hospitalised patients were aged>37 weeks and <18 years.Primary and secondary outcome measures The primary outcome was all-cause hospital mortality. Secondary outcomes included five events reflecting the process of care, collected for all EPOCH patients; the frequency of documentation for each of eight vital signs on a random sample of patients; four measures describing nursing perceptions of care.Results A total of 217 714 patient admissions accounting for 849 798 patient days over the course of the study were analysed. The overall mortality rate was 1.65/1000 patient discharges. The median (IQR) number of patients cared for by an individual nurse was 3.0 (2.8–3.6). Univariate Bayesian models estimating the rate ratio (RR) for the patient-to-nurse ratio and the probability that the RR was less than one found that a higher patient-to-nurse ratio was associated with fewer clinical deterioration events (RR=0.88, 95% credible interval (CrI) 0.77–1.03; P (RR<1)=95%) and late intensive care unit admissions (RR=0.76, 95% CrI 0.53–1.06; P (RR<1)=95%). In adjusted models, a higher patient-to-nurse ratio was associated with lower hospital mortality (OR=0.77, 95% CrI=0.57–1.00; P (OR<1)=98%). Nurses from hospitals with a higher patient-to-nurse ratio had lower ratings for their ability to influence care and reduced documentation of most individual vital signs and of the complete set of vital signs.Conclusions The data from this study challenge the assumption that lower patient-to-nurse ratios will improve the safety of paediatric care in contexts where ratios are low. The mechanism of these effects warrants further evaluation including factors, such as nursing skill mix, experience, education, work environment and physician staffing ratios.Trial registration number EPOCH clinical trial registered on clinical trial.gov NCT01260831; post-results.

Background: Internationally, there is an increasing trend in using Rapid Response Systems (RRS) to stabilize in-patient deterioration. Despite a growing evidence base, there remains limited understanding of the processes in place to aid the early recognition and response to deteriorating children in hospitals across Europe. Aim/s: To describe the processes in place for early recognition and response to in-patient deterioration in children in European hospitals. Study Design: A cross-sectional opportunistic multi-centre European study, of hospitals with paediatric in-patients, using a descriptive self-reported, web-based survey, was conducted between September 2021 and March 2022. The sampling method used chain referral through members of European and national societies, led by country leads. The survey instrument was an adaptation to the survey of Recognition and Response Systems in Australia. The study received ethics approval. Descriptive analysis and Chi-squared tests were performed to compare results in European regions. Results: A total of 185 questionnaires from 21 European countries were received. The majority of respondents (n = 153, 83%) reported having written policies, protocols, or guidelines, regarding the measurement of physiological observations. Over half (n = 120, 65%) reported that their hospital uses a Paediatric Early Warning System (PEWS) and 75 (41%) reported having a Rapid Response Team (RRT). Approximately one-third (38%) reported that their hospital collects specific data about the effectiveness of their RRS, while 100 (54%) reported providing regular training and education to support it. European regional differences existed in PEWS utilization (North = 98%, Centre = 25%, South = 44%, p < .001) and process evaluation (North = 49%, Centre = 6%, South = 36%, p < .001). Conclusions: RRS practices in European hospitals are heterogeneous. Differences in the uptake of PEWS and RRS process evaluation emerged across Europe. Relevance to Clinical PracticeIt is important to scope practices for the safe monitoring and management of deteriorating children in hospital across Europe. To reduce variance in practice, a consensus statement endorsed by paediatric and intensive care societies could provide guidance and resources to support PEWS implementation and for the operational governance required for continuous quality improvement.

IntroductionParents often take their children to the Paediatric Accident and Emergency Department (A&E) for non-urgent consultations rather than using community-based primary care services. This study describes the use of primary care services in parents taking their children to the A&E for non-urgent consultations.MethodsA cross-sectional study was conducted from July 2018 to June 2019, in a second-level Italian paediatric A&E of a tertiary-level children’s academic research and hub hospital. Parents of children aged between 3 months and 6 years assigned with a white code at the triage were asked to complete a paper-and-pencil 40-item questionnaire after accessing the A&E for a non-urgent consultation.ResultsThe questionnaire was completed by the parents of 237 children (males 58 %; median age = 2.3 years). Overall, 48.1 % (n = 114) of the parents reported consulting ‘often/always’ the primary care paediatrician, mainly when their child was sick and for check-ups (n = 182, 76.8 %). However, only 7.2 % (n = 17) of the parents ‘often/always’ used any other health service in the community. Most of them (n = 191, 82 %) did not even know where the community health centre was located.ConclusionParents accessing the A&E for non-urgent consultations should be better informed/educated on how to use community health services.

The aim of this scoping review is to describe the role, education, policies/regulation, skills and competencies required for advanced practice in paediatric haematology-oncology nursing in Europe, highlighting the differences in development between the different European countries. A scoping review was conducted following the methodological framework of guidelines by Arksey and O'Malley and the recommendations for advancing the methodology by Levac et al. We searched MEDLINE/PubMed, EMBASE, CINAHL, Cochrane Library, Scopus, grey literature, webpages, reference lists and performed a manual search, without any restrictions on language or time. The intersection between databases, grey literature and evidence documents traced from the sites of the most authoritative European organisations in the field made it possible to identify the regulatory and training differences between the various countries that were examined. This scoping review highlights how advanced knowledge and competences are used in the care of paediatric haematology-oncology patients, which are strictly necessary for implementing quality care. At present these competences are not recognised in policies and regulation in most of the countries that were examined. It is desirable that all EU member states work to implement a radical change and allow these more competent figures to assist patients in the best possible way.

AIM:To develop a trigger tool for parents and lay caregivers of children with medical complexity (CMC) at home and to validate its content. DESIGN:This was a multi-method study, using qualitative data, a Delphi method and a concept mapping approach. METHODS:A three-round electronic Delphi was performed from December 2021 to April 2022 with a panel of 23 expert parents and 30 healthcare providers, supplemented by a preliminary qualitative exploration of children's signs of deterioration and three consensus meetings to develop the PArents' Trigger Tool for Children with Medical Complexity (PAT-CMC). Cognitive interviews with parents were performed to assess the comprehensiveness and comprehensibility of the tool. The COREQ checklist, the COSMIN guidelines and the CREDES guidelines guided the reporting respectively of the qualitative study, the development and content validity of the trigger tool and the Delphi study. RESULTS:The PAT-CMC was developed and its content validated to recognize clinical deterioration at home. The tool consists of 7 main clusters of items: Breathing, Heart, Devices, Behaviour, Neuro-Muscular, Nutrition/Hydration and Other Concerns. A total of 23 triggers of deterioration were included and related to two recommendations for escalation of care, using a traffic light coding system. CONCLUSION:Priority indicators of clinical deterioration of CMC were identified and integrated into a validated trigger tool designed for parents or other lay caregivers at home, to recognize signs of acute severe illness and initiate healthcare interventions. IMPACT:The PAT-CMC was developed to guide families in recognizing signs of deterioration in CMC and has potential for initiating an early escalation of care. This tool may also be useful to support education provided by healthcare providers to families before hospital discharge. PATIENT OR PUBLIC CONTRIBUTION:Parents of CMC were directly involved in the selection of relevant indicators of children's clinical deterioration and the development of the trigger tool. They were not involved in the design, conducting, reporting or dissemination plans of this research.

It is estimated that between 58% and 82% of children and young people who present to paediatric emergency department (PEDs) have a non-urgent condition. This systematic review of the literature explores why parents of children with non-urgent conditions present to the PED rather than to community healthcare services. Five databases were searched for studies on children and young people's presentations to the PED for the treatment of a non-urgent condition, as identified by a low priority triage code. This article describes and discusses the findings of the 18 included studies.

Aims: To describe: 1) systems in place for recognition and response to deteriorating children in Italy, 2) attitudes and practices of registered nurses (RN) towards vital signs (VS) monitoring in pediatric wards, 3) the associations of nurses attitudes and pratices with nurses' and organizational characteristics. Design and methods: A multicentre cross-sectional correlational study. Data were collected between January-May 2020 using: an adapted version of the 'Survey on Recognition and Response Systems in Australia', and the 'Ped-V Scale'. Descriptive and adjusted linear regression analysis was performed, accounting for clustering. Results: Ten Italian hospitals participated, 432 RNs responded to the Ped-V scale (response rate = 52%). Five (50%) hospitals had a VS policy in place, three hospitals (30%) had a Pediatric Early Warning System (PEWS), almost all hospitals had a system in place to respond to deteriorating children. Following multivariate regression analysis, having a PEWS was significantly associated with Ped-V scale 'Workload', 'Clinical competence', 'Standardization' dimensions; gender was associated with 'key indicators' and pediatric surgical ward with 'Clinical competence'. Conclusions: The use of VS policies and PEWS was not consistent across hospitals caring for children in Italy. Nurses' attitudes and practices (i.e., perception of workload, and clinical competence) were significantly lower in hospitals with increased complexity of care/PEWS. Gender was significantly associated with knowledge scores. Practice implications: System strategies to improve nurses' attitudes and practices towards VS monitoring and education are warranted to support effective behaviors towards VS monitoring, their interpretation, and appropriate communication to activate the efferent limb of the rapid response system. (c) 2023 Elsevier Inc. All rights reserved.

Objectives: To explore how the multi-professional pediatric intensive care unit staff experienced the imple-mentation of the diary.Research Methodology/Design: Qualitative study using the implementation research approach. Setting: a six-bed pediatric intensive care unit at a large Italian tertiary care pediatric hospital, treating patients with acute conditions from the Emergency Department or hospital wards.Main outcome measures: Healthcare providers' experiences of the implementation of the diaries. Data was collected by focus groups and interviews and thematic analysis was performed.Findings: Three focus groups and four interviews with staff were conducted after the implementation of thediaries from August 2020 to June 2021. Staff describe an initial disbelief towards the effectiveness of diaries followed by an increasing perception of their relevance for parents' emotional expression through shared narration. Diaries are reported as a beneficial communication tool between the family, the child, and health care providers, increasing staff understanding of parents' experiences of their child's admission and parents' sense of the care received by their child. For staff, barriers for diary writing were logistics, lack of time, limited sense of ownership, fear of legal retaliation and fear of emotional labor.Conclusion: Health care providers perceived diaries as beneficial for parents and the healthcare team, potentially supporting their partnership as recommended by Family Centered Care models. The enablers and barriers that emerged for diary writing can support the development of implementation strategies to prevent the reported challenges to diary writing in the healthcare team, enhancing their uptake in the pediatric intensive care unit setting.