Designing the future in wound care: the role of the nurse practitioner

The nurse practitioner is emerging as a new level and type of health care. Increasing specialisation and advanced educational opportunities in nursing and the inequality in access to health care for sectors of the community have established the conditions under which the nurse practitioner movement has strengthened both nationally and internationally. The boundaries of responsibility for nurses are changing, not only because of increased demands but also because nurses have demonstrated their competence in varied extended and expanded practice roles. The nurse practitioner role reflects the continuing development of the nursing profession and substantially extends the career path for clinical nurses.

This paper describes an aspect of a large-scale investigation into the feasibility of the role of the nurse practitioner in the Australian Capital Territory (ACT) health care system. The paper reports on the trial of practice for a wound care nurse practitioner model in a tertiary institution. In the trial the wound care nurse practitioner worked in an extended practice role for 10 months. The nurse practitioner practice was supported, monitored and mentored by a clinical support team. Data were collected relating to a range of outcomes including definition of the scope of practice for the model, description of patient demographics and outcomes and the efficacy of the nurse practitioner service.

The findings informed the development of clinical protocols that define the scope of practice and the parameters of the wound care nurse practitioner model and provided information on the efficacy of this model of health care for the tertiary care environment. The findings further suggest that this model brings expert wound care and case management to an at-risk patient population. Recommendations are made relating to ongoing research into the role of the wound care nurse practitioner model in the ACT health care system.

Pain assessment in critical care: what have we learnt from research

Despite an ongoing acknowledgement in the literature that pain is a significant problem within the critical care environment, this issue has not been adequately addressed by critical care nurses. This paper examines strategies for changing pain management practices in critical care, including reviewing documentation practices, the utilisation of guidelines and algorithms to augment clinical decision making, and increasing educational opportunities available to critical care nurses. It is recommended that pain assessment be given a higher priority within the clinical context, particularly as inadequate pain assessment and management has been linked to increased morbidity and mortality within critical care. Importantly, critical care nurses need to not only be aware of research-based pain management practices, but also lead the way in implementation and continuous evaluation as a measure of decreasing patient pain in the future.

Parent's views of the importance of making changes in settings where children spend time to prevent obesity

Aim : To examine the kinds of changes parents would like to see in those settings where children spend time (kindergartens and schools, child care centres and after-school care facilities, and the local neighbourhood) in policies and practices that impact on children’s risk of obesity, and to establish whether parents might be willing to advocate for changes in these settings.

Materials and Methods : 175 parents from five randomly selected primary schools and five randomly selected kindergartens located in suburbs of metropolitan Melbourne completed a questionnaire in which they rated the importance of a number of potential changes to promote healthy eating and increase physical activity in their children.

Results : Parents of children in kindergarten most commonly rated changes to the eating environment as important. In contrast, parents of primary school children believed changes related to both eating and physical activity in school were important. Ninety-five per cent of parents of kindergarten children and 89% of parents of primary school children believed it was possible for parents to bring about change to provide more opportunities for their child to eat more healthily and be more physically active. One in four parents reported that they had thought about or had tried to bring about changes in their community.

Conclusions : The findings suggest that mobilising parents to take an active role in advocating for change in those settings that have the potential to shape their children’s physical activity and eating behaviours may be feasible.

Separate spheres and public policy : the role of women in the development of children's services in Victorian local government, 1840-1992

The thesis is an explanation of the development of pre-school children's services (infant welfare, kindergartens and child care) at local government level in Victoria. The critical framework of analysis focuses on three dimensions of public policy: 1) the socio-historical environment; 2) the political processes involved in the development of the specific children's service; and 3) the major individuals and groups that exerted pressure for children's service, The argument is threefold. Firstly it is argued that the political environment of children's services has been dominated by the practice of separate spheres of public and private, in which the care of children is primarily the role of women. Secondly, it is argued that the political processes surrounding the development of local children's services have involved all levels of government in what is termed a local state. Thirdly, it is argued that the development of these children's services in local government has resulted mainly from the work of women both individually and collectively. Since the three services of infant welfare, kindergartens and child care all became a normal function of children's services at different times, the circumstances that surrounded each development exhibited different aspects of the three major arguments. The periodisation is broken into four phases: 1) the establishment of local government with no children's services in the nineteenth century; 2) the establishment of infant welfare services in local government in the early part of the twentieth century; 3) the incorporation of kindergartens into local government after the second world war; and 4) the incorporation of child care into local government in the 1970s and 1980s. The thesis concludes by arguing that the existence of children's services in local government in Victoria is testimony to the remarkable work of those women who have pursued the issue both individually and collectively. It has been the identification of children's services as a women's issue in Australian politics that has enabled women's groups at different times to influence the policy makers in diverse ways. However, while the establishment of children's services as a legitimate political concern brings the matter onto the public agenda, the separate spheres still remains a contested issue in the public policies of children's services.

Measuring children’s involvement as an indicator of curriculum effectiveness : a curriculum evaluation of a selected child study centre in Singapore

This paper presents one aspect of a research project evaluating a curriculum model of a selected child study centre in Singapore. An issue of worldwide interest and concern is the ‘quality of learning’ debate as it relates to early childhood centres. In Singapore, the government is focusing on expansion in child care settings and increases in the amount of funded training. One of the issues surrounding prior-to-school education raises the question of how one measures the quality of teaching and learning, to describe the value of using, funding and promoting early education. The research reported in this study used a quasi experimental research paradigm to assess one aspect of the quality of a curriculum programme in a child study centre in Singapore. Children aged between 18 months and 6 years (N = 81) participated in the research. Using the observation scale of Laevers’ Child Involvement Scale, the active involvement of children in learning experiences was measured. The findings are presented and discussed.

Multilevel analysis of the Be Active Eat Well intervention : environmental and behavioural influences on reductions in child obesity risk

Background: The Be Active Eat Well (BAEW) community-based child obesity prevention intervention was successful in modestly reducing unhealthy weight gain in primary school children using a multi-strategy and multi-setting approach.

Objective: To (1) examine the relationship between changes in obesity-related individual, household and school factors and changes in standardised child body mass index (zBMI), and (2) determine if the BAEW intervention moderated these effects.

Methods: The longitudinal relationships between changes in individual, household and school variables and changes in zBMI were explored using multilevel modelling, with measurement time (baseline and follow-up) at level 1, individual (behaviours, n=1812) at level 2 and households (n=1318) and schools (n=18) as higher levels (environments). The effect of the intervention was tested while controlling for child age, gender and maternal education level.

Results: This study confirmed that the BAEW intervention lowered child zBMI compared with the comparison group (−0.085 units, P=0.03). The variation between household environments was found to be a large contributor to the percentage of unexplained change in child zBMI (59%), compared with contributions from the individual (23%) and school levels (1%). Across both groups, screen time (P=0.03), sweet drink consumption (P=0.03) and lack of household rules for television (TV) viewing (P=0.05) were associated with increased zBMI, whereas there was a non-significant association with the frequency the TV was on during evening meals (P=0.07). The moderating effect of the intervention was only evident for the relationship between the frequency of TV on during meals and zBMI, however, this effect was modest (P=0.04).

Conclusions: The development of childhood obesity involves multi-factorial and multi-level influences, some of which are amenable to change. Obesity prevention strategies should not only target individual behaviours but also the household environment and family practices. Although zBMI changes were modest, these findings are encouraging as small reductions can have population level impacts on childhood obesity levels.

Fair relationships and policies to support family day care educators’ mental health: a qualitative study

High quality child care is a population health investment that relies on the capacity of providers. The mental health and wellbeing of child care educators is fundamental to care quality and turnover, yet sector views on the relationship between working conditions and mental health and wellbeing are scarce. This paper examines child care educators' and sector key informants' perspectives on how working in family day care influences educator's mental health and wellbeing.

Análise do custo-aluno das creches municipais diretas do município de Santo André

O presente estudo tem como foco o levantamento e análise do custo-aluno das creches, primeira etapa da Educação Infantil, que compreende as crianças de 0 a 3 anos de idade. Ele responde à situação problema apresentada pela Secretaria de Educação do Município de Santo André (SP), caracterizada pela necessidade do aprimoramento da gestão dos recursos financeiros em um cenário de dificuldades orçamentárias e aumento de demanda. Foram selecionadas 12 unidades municipais da rede direta, com atendimento exclusivo a crianças nesta faixa etária. A metodologia utilizada teve como base a utilização do Sistema de Informações do Orçamento Público municipal, a partir do qual foram realizadas as consultas e definições dos componentes do custo do objeto em estudo, sendo que a metodologia de acumulação de custos utilizada foi o custeio por absorção. Adicionalmente, os autores analisaram os processos administrativos relacionados aos itens de custeio e realizaram entrevistas com os diversos atores envolvidos nos processos de gestão daquela e de outras secretarias, bem como acadêmicos dedicados ao estudo de custos no setor público, cujas experiências relatadas subsidiaram a pesquisa e as avaliações realizadas. O estudo apontou um custo-aluno médio de R$ 11.970,72 sendo que, para melhor análise dos resultados, as unidades escolares foram agrupadas em três categorias de acordo com o número de alunos: i) pequeno porte: com até 149 alunos (três unidades); ii) médio porte: entre 150 e 190 alunos (cinco unidades); e, iii) grande porte: com mais de 190 alunos (quatro unidades). A partir dessa divisão foi possível concluir que as creches de grande porte apresentaram vantagem comparativa em relação às demais, com custo-aluno médio de R$ 11.684,03, seguidas das creches de médio porte, R$ 11.751,46 e pelas unidades de pequeno porte, que apresentaram o custo-aluno de R$ 13.235,88, ou seja, 13,23% acima das escolas de grande porte. Esses resultados indicam a existência de ganhos de escalas de acordo com o porte da creche e pode subsidiar a tomada de decisão dos gestores para futuros projetos de expansão da rede pública de creches.

Vivendo e aprendendo no ambiente hospitalar: Percepções de crianças sobre a doença

This study focuses on the child within the hospital environment. Its purpose is to describe children s perceptions of their illness and time in hospital and to identify their main hardships during treatment. This study has a qualitative nature and is theoretically and methodologically supported by the creative and sensitive method developed by Cabral (1998), studies by Piaget, Vygotsky and Wallon on child development, and studies conducted by Pinto (2005), Collet (2004), Chiattone (2003), Silva (2002), Lima et.al (1999) on in-patient children. For this study, 13 children between the ages of 7 and 12 at a public hospital institution specialized in child care in the city of Natal, Rio Grande do Norte, were interviewed. As a criterion for taking part in this study the children would have to have been in hospital for over three days and be fully capable of physically and emotionally interacting with the researcher at the time the interview took place. Analysis drew on the study of the empirical material made up of interviews and a field diary where notes had been entered for the children s reactions, expressions and gestures. Results show that there is some understanding, on the part of these children, of their illness, with their parents as the main informants. They accept being in hospital because they need treatment, but they realize that life becomes different especially on account of the constraints resulting from the illness and the hospital itself. The main hardships during treatment are: lack of recreational activities in the evenings and on the weekends within the hospital environment; absence of family members, especially brothers and sisters; and lack of explanation on the part of health professionals regarding some procedures as these are being carried out. Our conclusion is that children perceive illness and the hospital environment as something that changes the rhythm of their lives bringing on them perturbations, fears and anxieties. Hence, we suggest that professionals working with in-patient children should be especially prepared to deal with these children and their parents, aiming at bringing down fears and anguishes, clear their doubts and, in addition, advise the parents in respect of their children s treatment while in hospital and after hospital discharge. The hospital environment should also be cheerful and colorful and have a toy room under the coordination of persons especially prepared for that purpose

Práticas populares de cuidado à criança: o saber/fazer de cuidadoras

Popular practices correspond to the resources used by households, lay people and popular therapists, whose perception of knowledge is constructed in the everyday. In this context, the sick child can become vulnerable to be dependent on a family caregiver, who often decide to employ popular practices. Thus, the child care should be shared between carer and health professional. However, they know little about the resources that the family uses to detect a grievance in infant. Therefore, the present research aimed to analyse the use of popular practices by caregivers of children with zero to five years old. We conducted an exploratory and descriptive study with a qualitative approach, together with 15 caregivers of children who were treated at the Joint Unit Felipe Shrimp, located in Natal, Rio Grande do Norte, Brazil. To select the participants, they should be age and above 18 years; be caregivers of children up to five years of age; and reside in the area ascribed the Joint Unit Felipe Shrimp. The data collection took place between September and October 2013, through in depth interview. This step was preceded by the approval of the Health Department of the city of Natal; the direction of the Joint Unit Felipe Shrimp; as well as, the Committee on Ethics in Research from the Federal University of Rio Grande do Norte with Certificate of Presentation and Consideration Ethics, No 15467013.8.0000.5537. Furthermore, the interviewees formally authorized their participation in the research by signing the consent form. The data were treated according to the technique of content analysis in the form of thematic analysis according to Bardin. This process, four categories emerged: "Types of popular practices used in the care of the child"; "Source of information of popular practices"; "Results obtained with popular practices"; "Factors that hinder the adoption of common practices." The results showed the use of popular practices by caregivers in the case of illness to children such as the homemade preparations with medicinal plants and folk healers. The family environment was referenced as the main learning space and spread of popular practices, which are influenced by cultural relations present in this context. As to the results obtained with popular features, the caregivers said to be satisfactory, and this triggers a feeling of confidence and acceptability of such measures. It is concluded that the use of popular practices in child care persists in everyday most of the participants, despite the hegemony of allopathic therapy. The caregivers stated that such practices are effective and easy to obtain, being secured in context by popular culture. In addition, health professionals, especially nurses, were seldom mentioned by the caregivers as to the information concerning popular resources used by them, which suggests the weakness in dialogic process of negotiating practices between both of them

Contando histórias de cuidado à infância em unidade de terapia intensiva pediátrica

The tales of children's literature, in their plots, mark existential dilemmas belonging in human‟s lives, such as death, situations of separation, loss, abandonment, fear, challenges, achievements and other elements that make them suitable material to assist children in their developmental process. Such elements, present in children‟s storybooks, are close to the experiences lived by the children in the context of hospitalization in a special manner. With that said this study focus on the understanding of the therapeutic possibilities of the tales of children's literature in the care of hospitalized children in Pediatric Intensive Care Units (UTIPED) based on the Heidegger's concept of Care and adopting the Phenomenology as the method. The UTIPED of a state public hospital located in the municipality of Natal/RN was elected as the study site and four hospitalized children aged between six and nine years, all males, presenting different clinical conditions were selected to participate in the study following age and clinical conditions as the selective criteria. The procedure of corpus construction included eight individual sessions of storytelling accompanied by the use of ludic resources. The phenomenological understanding about the therapeutic possibilities of tales was structured under three main elements: (1) the ludic axis; (2) the reflective axis; and (3) the affective axis. The appropriateness of the proposed therapy in the context of the UTIPED and the potential of the tales as a protection factor to the child was evident. The storytelling activity framed a scenario of care unusual in the context of intensive care units, establishing a symbolic space for children‟s expression. Therefore, this study indicates this therapeutic proposal for children‟s care in the UTIPED that considers their evolutionary stage, their clinical conditions at the time and especially their emotional needs during their immersion in a diverse and foreign environment which is filled with potentially harmful elements to their full development.

Malnutrition in the second year of life and psychosocial care: a case-control study in an urban area of Southeast Brazil

O objetivo do estudo foi identificar e medir a presença de associação entre cuidado psicossocial e desnutrição. Realizou-se estudo caso-controle incluindo 101 crianças desnutridas (peso/idade < percentil 5 do padrão NCHS/OMS), com idades entre 12 e 23 meses, que foram comparadas a 200 controles eutróficos (peso/ idade > percentil 25) em termos de sua exposição a uma série de comportamentos maternos indicadores da qualidade de seu cuidado psicossocial. Criou-se um escore de cuidado psicossocial, variando de 0 a 14, de acordo com o número de comportamentos maternos desejáveis não observados: quanto maior o escore, pior a qualidade do cuidado psicossocial. Mediante análise de regressão logística verificou-se maior risco de desnutrição para as crianças no 2º e 3º tercis do escore de cuidado psicossocial. Esta associação foi modificada pela renda per capita. Após ajustes para possíveis confundidores, nas crianças dos estratos superiores de renda não houve associação entre cuidado psicossocial e desnutrição. Para as crianças com nível mais baixo de renda, pior cuidado psicossocial dobrou o risco de desnutrição (OR = 7,26; IC95%: 2,42-21,82) em relação àquele associado apenas à baixa renda (OR = 3,08; IC95%: 1,28-7,42).

The frequency of pharmacological pain relief in university neonatal intensive care units

Objective: To evaluate the use of drugs to relieve the pain of invasive procedures newborn infants cared for at a university hospital NICU. Methods: A prospective cohort study of all newborn infants hospitalized in four NICU during October 2001. The following data were collected: demographic data of the hospitalized newborn infants; clinical morbidity; number of potentially painful procedures and frequency of analgesic administration. Factors associated with the use of analgesia in this cohort of patients were studied by multiple linear regression using SPSS 8.0. Results: Ninety-one newborn infants were admitted to the NICU during the study period (1,025 patient-days). Only 25% of the 1,025 patient-days received systemic analgesia. No specific drugs were administered to relieve acute pain during any of the following painful events: arterial punctures, venous, capillary and lumbar punctures or intubations. For chest tube insertion, 100% of newborn infants received specific analgesia. For the insertion of central catheters 8% of the newborn infants received painkillers. Only nine of the 17 newborn infants that underwent surgical procedures received any analgesic dosage during the postoperative period. For 93% of patients under analgesia the drug of choice was fentanyl. The presence of mechanical ventilation increased the chance of newborn infants receiving painkillers by 6.9 times and the presence of chest tube increased this chance by five times. Conclusion: It is necessary to train health professionals in order to bridge the gap between scientific knowledge regarding newborn infant pain and clinical practice. Copyright © 2005 by Sociedade Brasileira de Pediatria.

Juvenile localized scleroderma: Clinical and epidemiological features in 750 children. An international study

Objective. Juvenile localized scleroderma (JLS) includes a number of conditions often grouped together. With the long-term goal of developing uniform classification criteria, we studied the epidemiological, clinical and immunological features of children with JLS followed by paediatric rheumatology and dermatology centres. Methods. A large, multicentre, multinational study was conducted by collecting information on the demographics, family history, triggering environmental factors, clinical and laboratory features, and treatment of patients with JLS. Results. Seven hundred and fifty patients with JLS from 70 centres were enrolled into the study. The disease duration at diagnosis was 18 months. Linear scleroderma (LS) was the most frequent subtype (65%), followed by plaque morphea (PM) (26%), generalized morphea (GM) (7%) and deep morphea (DM) (2%). As many as 15% of patients had a mixed subtype. Ninety-one patients (12%) had a positive family history for rheumatic or autoimmune diseases; 100 (13.3%) reported environmental events as possible trigger. ANA was positive in 42.3% of the patients, with a higher prevalence in the LS-DM subtype than in the PM-GM subtype. Scl70 was detected in the sera of 3% of the patients, anticentromere antibody in 2%, anti-double-stranded DNA in 4%, anti-cardiolipin antibody in 13% and rheumatoid factor in 16%. Methotrexate was the drug most frequently used, especially during the last 5 yr. Conclusion. This study represents the largest collection of patients with JLS ever reported. The insidious onset of the disease, the delay in diagnosis, the recognition of mixed subtype and the better definition of the other subtypes should influence our efforts in educating trainees and practitioners and help in developing a comprehensive classification system for this syndrome. © 2006 Oxford University Press.

Policies and care provision in Latin America: A view of regional experiences

This study identifies the key challenges facing the region in the domain of care provision. To that end it describes, analyses and discusses the concept of care, the rights approach and the public policies implemented in Latin America and the Caribbean on the social organization of care. The document describes care policies in the region generally, and it specifically analyses experiences of the social organization of care provision in four countries. In Chile, it studies the Chile Crece Contigo national child-care programme; in Costa Rica it reviews the National Care Network; in Ecuador, it analyses the recognition of unpaid reproductive work in the 2008 Constitution and the National Plan for Good Living; and in Uruguay it considers the National Care System.