Facilitators and barriers to parent-child communication in pediatric palliative care:An integrative review

Objectives:This study aimed to identify facilitators and barriers to parent-child communication in pediatric palliative care,providing insights for medical professionals developing targeted interventions to enhance parent-child communication and improve its effectiveness.Methods:Whittemore and Knafl’s integrative review method was employed to guide a systematic search for literature in six databases(Medline,Embase,CINAHL Complete,PsycINFO,Web of Science,and Cochrane Library).Peer-reviewer articles published in the English language from inception to December 2023.All of the identified studies were screened,extracted,and analyzed independently by two researchers.Results:Twenty-four articles were included.Thefindings of the relevant studies were analyzed using thematic analysis.Four themes were identified as facilitators:legacy-making,resilience training programs,guidance from the healthcare team,and positive communication.Seven themes were identified as barriers:denial,being unprepared and evasive,mutual protection,being overwhelmed by painful emotions and overloaded with information,incorrect views of medical professionals and parents,negative communication,and cultural context.Conclusions:Parents and professionals should avoid myths about protecting the child and encourage open communication that respects the child’s wishes.The specialized pediatric palliative care team should carefully monitor parent-child communication,determine if any obstacles exist,and design more interventions to enhance it.

Expérience des parents faceàl’accompagnement pédiatrique en HAD:étude exploratoire qualitative Parents’Experience of Pediatric Home Care:A Qualitative Exploratory Study

Aim:To investigate parents’experience of home care for children in oncology in order to identify the benefits,expectations,and possible difficulties associated.Material and methods:A qualitative method was adopted,with non-directive interviews conducted with nine participants,then analyzed using thematic content analysis.Results:The main recurring themes in the discourse include:(1)relief,(2)positive representation of home,(3)positive representation of home care,and(4)negative representation of home care.For these parents,home care appears to be positive overall,even though the introduction of home care is often reported as a source of stress for them.Conclusion:These results must be interpreted with caution,but they do support previous research and highlight certain recommendations for further improving this experience,particularly for parents,but also for the sick child and the family.

Perspectives on non-emergent neonatal intensive care unit to pediatric intensive care unit care transfers in the United States

BACKGROUND There is a substantial population of long-stay patients who non-emergently transfer directly from the neonatal intensive care unit(NICU)to the pediatric intensive care unit(PICU)without an interim discharge home.These infants are often medically complex and have higher mortality relative to NICU or PICUonly admissions.Given an absence of data surrounding practice patterns for nonemergent NICU to PICU transfers,we hypothesized that we would encounter a broad spectrum of current practices and a high proportion of dissatisfaction with current processes.AIM To characterize non-emergent NICU to PICU transfer practices across the United States and query PICU providers’evaluations of their effectiveness.METHODS A cross-sectional survey was drafted,piloted,and sent to one physician representative from each of 115 PICUs across the United States based on membership in the PARK-PICU research consortium and membership in the Children’s Hospital Association.The survey was administered via internet(REDCap).Analysis was performed using STATA,primarily consisting of descriptive statistics,though logistic regressions were run examining the relationship between specific transfer steps,hospital characteristics,and effectiveness of transfer.RESULTS One PICU attending from each of 81 institutions in the United States completed the survey(overall 70%response rate).Over half(52%)indicated their hospital transfers patients without using set clinical criteria,and only 33%indicated that their hospital has a standardized protocol to facilitate non-emergent transfer.Fewer than half of respondents reported that their institution’s nonemergent NICU to PICU transfer practices were effective for clinicians(47%)or patient families(38%).Respondents evaluated their centers’transfers as less effective when they lacked any transfer criteria(P=0.027)or set transfer protocols(P=0.007).Respondents overwhelmingly agreed that having set clinical criteria and standardized protocols for non-emergent transfer were important to the patient-family experience and patient safety.CONCLUSION Most hospitals lacked any clinical criteria or protocols for non-emergent NICU to PICU transfers.More positive perceptions of transfer effectiveness were found among those with set criteria and/or transfer protocols.

Analysis of the Effect of Humanistic Care in the Process of Pre-Hospital Emergency Care

Objective:To explore the effectiveness of humanistic care in pre-hospital emergency care.Methods:From April 2020 to January 2021,80 pre-hospital emergency patients were studied.The patients were randomly divided into two groups:a control group(n=40),which received conventional care,and an experimental group(n=40),which received humanistic care.The effects of nursing care and psychological state were compared between the two groups.Results:The experimental group showed better nursing outcomes and a more positive psychological state compared to the control group(P<0.05).Conclusion:Humanistic care in pre-hospital emergency settings is more effective in reducing patients’anxiety and depression,enhancing the operational abilities and service attitudes of nursing staff,and increasing the emergency success rate.

Characteristics of postintensive care syndrome in survivors of pediatric critical illness: A systematic review

AIM To synthesize the available evidence focusing on morbidities in pediatric survivors of critical illness that fall within the defined construct of postintensive care syndrome(PICS) in adults, including physical, neurocognitive and psychological morbidities.METHODS A comprehensive search was conducted in MEDLINE, EMBASE, the Cochrane Library, Psyc INFO, and CINAHL using controlled vocabulary and key word terms to identify studies reporting characteristics of PICS in pediatric intensive care unit(PICU) patients. Two reviewers independently screened all titles and abstracts and performed data extraction. From the 3176 articles identified in the search, 252 abstracts were identified for full text review and nineteen were identified for inclusion in the review. All studies reporting characteristics of PICS in PICU patients were included in the final synthesis. RESULTS Nineteen studies meeting inclusion criteria published between 1995 and 2016 were identified and categorized into studies reporting morbidities in each of three categories-physical, neurocognitive and psychological. The majority of included articles reported prospective cohort studies, and there was significant variability in the outcome measures utilized. A synthesis of the studies indicate that morbidities encompassing PICS are well-described in children who have survived critical illness, often resolving over time. Risk factors for development of these morbidities include younger age, lower socioeconomic status, increased number of invasive procedures or interventions, type of illness, and increased benzodiazepine andnarcotic administration.CONCLUSION PICS-related morbidities impact a significant proportion of children discharged from PICUs. In order to further define PICS in children, more research is needed using standardized tools to better understand the scope and natural history of morbidities after hospital discharge. Improving our understanding of physical, neurocognitive, and psychological morbidities after critical illness in the pediatric population is imperative for designing interventions to improve long-term outcomes in PICU patients.

Distribution and antibiotic resistance of pathogens isolated from ventilator-associated pneumonia patients in pediatric intensive care unit

BACKGROUND： With mechanical ventilation widely used in intensive care unit, the ventilator associated pneumonia （VAP） has become a common and serious complication in critically ill patients. Compared with adults, the incidence of VAP and the mortality are higher in children in pediatric intensive care unit （PICU） because of immune deficiency, severe basic diseases, and increased use of artificial airway or mechanical ventilation. Hence it is of significance to study the epidemiology and changes of antibacterial susceptibility in order to reduce the incidence and mortality of VAP in children.METHODS： From January 2008 to June 2010, 2758 children were treated in PICU of Wuhan Children＇s Hospital. Among them, 171 received mechanical ventilation over 48 hours in PICU, and 46 developed VAP. The distribution and drug-resistance pattern of the pathogenic bacteria isolated from lower respiratory tract aspirations were analyzed. RESULTS：A total of 119 pathogenic microbial strains were isolated. Gram-negative bacilli （G-） were the most （65.55%）, followed by fungi （21.01%） and gram-positive cocci （G~, 13.45%）. Among them, the most common pathogens were Acinetobacter baummannii, Escherichia coli, Klebsiella pneumoniae, candida albicans and coagulase-negative staphylococci. Antibiotic susceptibility tests indicated that the multiple drug-resistances of G- and G＋to antibiotics were serious. Most of G- was sensitive to ciprofloxacin, amikacin, imipenem, meropenem, cefoperazone-sulbactam and piperacillin-tazobactam. The susceptibility of G＋ to vancomycin, teicoplanin and linezolid were 100%. Fungi were almost sensitive to all the antifungal agents. The primary pathogens of VAP were G-, and their multiple drug-resistances were serious. CONCLUSION： In clinical practice we should choose the most sensitive drug for VAP according to pathogenic test.

Determination of the Relationship between Empathy and Compassion Fatigue in Pediatric Clinic Nurses

Background:This study aimed to determine the relationship between compassion fatigue and empathic disposition and skill levels of pediatric clinic nurses.Methods:This research was carried out as a descriptive and cross-sectional study.The research was carried out with 233 nurses determined by using a stratified sampling method from 648 nurses working in two University Hospital and two City Hospital children’s clinics.Data were collected using the“Personal Information Form”,“Compassion Scale(CS)”,“Empathic Tendency Scale(ETS)”and“Empathic Skill Scale(ESS)”.Pearson Correlation test,Student’s t-test,ANOVA test,and Scheffe test were used in the analysis of the data.Results:The mean age of the nurses participating in the study was 30.93±6.23 years,81.1%were women and 54.9%were married.Pediatric clinic nurses’mean compassion score was 96.29±11.64,empathic tendency mean score was 69.30±8.39,and empathic skill mean score was 140.82±23.15.According to the findings obtained,the mean compassion score of the male,married,and nurses who were not satisfied with working in the pediatric clinics and working in the pediatric emergency clinics was found to be the lowest(p<0.05,p<0.01,p<0.001).The empathic disposition mean scores of the nurses working in the pediatric inpatient clinics,who were satisfied with working in the pediatric clinic,and who did not have the thought of moving to another clinic,were found to be significantly higher(p<0.01,p<0.001).The mean scores of empathic skills of nurses working only during the daytime were found to be significantly higher(p<0.001).Conclusion:This study confirms that pediatric clinic nurses are experiencing compassion fatigue at the end of COVID-19 and how this situation negatively affects their empathic tendencies and skills.The study highlights the need for both clinical and management-based planning to prevent compassion fatigue and increase empathic tendencies and skills in Pediatric clinic nurses.

Processus pour le développement d’une stratégie d’évaluation de la qualitéde vie en cancer avancépédiatrique Process for Developing a Quality of Life Assessment Strategy in Advanced Pediatric Cancer

In pediatric advanced cancer,i.e.,when cancer-targeted treatments are not effective,care provided to patients is of palliative nature.It aims at limiting symptoms and optimizing quality of life(QoL).To orient care,it is necessary to know and measure what is really important for young people.Unfortunately,tools are still scarce in this context.The aim of this paper is to describe the development process of a new QoL assessment method,the Advance QoL program.This is specifically designed for the clinical context of pediatric advanced cancer.Three previous studies carried out by our team identified seven important QoL domains for this population.We developed a tool named Advance QoL—parent/caregiver version.A current study aims to develop self-reported versions of the Advance QoL for children(8-12 years)and adolescents(13-18 years)with advanced cancer.In the very near future,the Advance QoL tool will be available in three versions(parents/caregivers,children,and adolescents)ready to be tested in validation studies.Regular assessment of the QoL of young people with cancer is a central process in defining targets for care and should be carried out throughout the trajectory,including when cancer is at an advanced stage,i.e.,when no standard treatment options are available.

Risk factors and antibiotic resistance of pneumonia caused by multidrug resistant Acinetobacter baumannii in pediatric intensive care unit

With beta-lactam drugs and immunosuppressants widely used, the infection caused by Acinetobacter baumannfi （Ab） has become more and more serious with multidrug resistant Acinetobacter baumannfi （MDRAb） emerging and worsening rapidly. Compared with other patients, the incidence and multidrug resistance of MDRAb are higher in children in pediatric intensive care unit （PICU） because of immune deficiency, severe basic diseases, prolonged hospitalization and invasive operations. Hence it is significant to study the epidemiology and changes of antibacterial susceptibility in order to reduce the incidence of MDRAb in children. A total 115 patients with MDRAb pneumonia and 45 patients with negative MDRAb （NMDRAb） pneumonia who had been treated from January 2009 to August 2011 were studied retrospectively at the PICU of Wuhan Children＇s Hospital. Clinical data were analyzed with univariate and multivariate Logistic regression. In 176 clinical strains of Acinetobacter baumannfi isolated, there were 128 strains of MDRAb, accounting for 72.73%. Drug susceptibility tests showed that the resistance rates of 13-1actam antibiotics were more than 70% except for cefoperazone sulbactam. The rates to carbapenems were higher than 90%. They were significantly higher than those of NMDRAb. Amikacin, levofloxacin, ciprofloxacin and minocycline had the lowest drug-resistance rates （〈20%）. Multivariate Logistic regression revealed that ICU stay, the time of mechanical ventilation, anemia, hypoproteinemia and the use of carbapenems were independent risk factors for MDRAb pneumonia. MDRAb is an important opportunistic pathogen to pneumonia in PICU, and its drug-resistance is severe. It increases significantly the mortality of patients. It is important to take the effective prevention measures for controlling it.

Psychological needs of parents of children with complicated congenital heart disease after admitting to pediatric intensive care unit: A questionnaire study

BACKGROUND Parents of children with complicated congenital heart disease(CHD)have different needs after surgery.Little literature reports the impact factors for psychological needs of parents of children with complicated CHD.AIM To investigate the status quo of the needs of parents of children after surgery for complex CHD,and analyze the influencing factors,in order to provide a theoretical basis for formulating corresponding nursing countermeasures.METHODS A modified Chinese version of the Critical Care Family Needs Inventory(MCCFNI)was used to select 200 parents of children with complex CHD after surgery within 72 h after admission to the intensive care unit in our hospital to conduct an online questionnaire survey.The aim was to understand the needs of parents in relation to the following five aspects:The support from medical staff,comfort of the parents themselves,the acquisition of information,their closeness to the children,and assurance of the child’s condition.RESULTS Parents of children with complex CHD had a higher degree of demand,especially in terms of condition assurance,acquisition of information,and closeness to the children.The age,education level,and residence of the parents were related to the five dimensions of the needs of parents of children with complex CHD who had undergone surgery.CONCLUSION In practice,nurses should formulate corresponding nursing strategies based on the different cultural and social backgrounds of parents of children after complex CHD surgery to meet their different needs,and improve satisfaction.These findings provide a theoretical basis for constructing a family participatory nursing model for children in the intensive care unit in the future.

Computer-based simulative training system--a new approach to teaching pre-hospital trauma care

Objective:A computer-based STS(simulative training system) in providing pre-hospital trauma care at a disaster site was applied to teaching nursing students in the Second Military Medical University,China.This article reports on the teaching effectiveness of this system.Methods:Among 92 participants,46 were in the study group and 46 were in the 'control' group. Each student completed a multiple-choice quiz after completing 18 hours(six three-hour sessions) of the study module,and a score was recorded.The simulative training module was completed only by the study group;the 'control' group was assigned in-class discussions for the same amount of time covering the same content as the study group.The final course scores,which included both comprehensive and group task-based tests were compared between these two groups.The study used a descriptive and comparative approach for quantitative data analysis.Tests of independency between the multiple choice scores and the simulation scores were also performed.Finally,anonymous surveys were conducted.Results:The study group performed better than the 'control' group with a significantly higher average score for the group scenario task-based test score,and consequently the study group's final course score was significantly higher than the 'control' group.As per chi-square tests,no significant associations were found between the multiple choice scores and the simulated training scores.The final surveys showed students overwhelmingly agreed that STS training improved their knowledge and skills,their ability to recognize a potential critical event, and their initial response for trauma care at pre-hospital settings.The survey responses of the study group were noteworthy as they indicated that students recognized the importance of simulative training,appreciated the realism of the simulation,and were able to fight/adjust to the stressful feelings in order to focus on the task.Conclusion:Computer-based STS may be an effective teaching model to help students improve their capability in providing pre-hospital trauma care,and in their effectiveness in disaster response.

Comment on review article:Chronic hepatitis C virus infection cascade of care in pediatric patients

An enhanced cascade of care should include a younger population,helping to achieve the goal of the World Health Organization with a focus on elimination in the pediatric population.Furthermore,enhanced screening and awareness efforts and continued education of health care providers will improve the outcomes of chronic hepatitis C virus(HCV)infection in the pediatric population.The present work discusses and comments on the topic"cascade of care in HCV chronic pediatric patients".

Nursing Care of the Laryngeal Mask Airway in Pediatric Cataract Surgery

Purpose:.To investigate the important experience of nursing care of the laryngeal mask airway(LMA) in children undergoing cataract surgery.Methods: Fifty-five children undergoing cataract surgery were anesthetized by inhaling sevoflurane through a LMA and received perioperative nursing care. The safety of perioperative nursing for these children was also evaluated.Results: Through perioperative nursing care and psychological counseling for children with LMA,.all patients were anesthetized without complications and underwent successful surgeries..No severe postoperative complications were observed.Conclusion: Nursing care specific for LMA is a vital part of the success of anesthesia and pediatric cataract surgery.

The Application of Psychological Nursing in Pediatric Clinical Nursing

Objective:To study the application effect of psychological nursing in pediatric clinical nursing.Method:100 pediatric patients who underwent treatment in our hospital from January 2019 to December 2020 were selected as the research subjects.They were randomly divided into a control group and an observation group,with 50 cases in each group.The control group received routine nursing care,while the observation group received psychological care based on routine nursing care.The nursing compliance,incidence of adverse events,and parental satisfaction of the two groups of pediatric patients were compared and analyzed.Result:Through psychological nursing intervention,it was found that the observation group had better nursing compliance,incidence of adverse events,and parental satisfaction than the control group,P<0.05,the differences are statistically significant.Conclusion:The application of psychological nursing in pediatric clinical nursing can improve the compliance of pediatric care,reduce the incidence of adverse events,enhance parental satisfaction,and have clinical promotion and application value.

A Scale of Parental Anxiety about Pediatric Emergency Medical Care Services of Japan: Development, Reliability, Validity, Generalizability and Usefulness

Aim: The purpose of this study was to develop a scale, “parental anxiety about pediatric emergency medical care services” (PAPEMCS), and to evaluate its psychometric properties. Methods: Participants were 14,510 parents with children 6 years old or younger in Kagawa Prefecture. Using each half of the participants, exploratory factor analysis was performed to generate items and factors for the PAPEMCS, and confirmatory factor analysis (CFA) was used to establish the construct validity. The generalizability of the PAPEMCS was evaluated by congruence tests and multigroup CFA. The usefulness of the PAPEMCS was established by the relationship between the PAPEMCS and non-urgent usage of pediatric emergency medical care services (PEMCS). Results: The PAPEMCS compromised 4 factors: “anxiety about quality of PEMCS”, “anxiety about PEMCS system”, “anxiety about public support”, and “anxiety about private support”. All reliability estimates (polychoric ordinal alpha coefficients, item-rest correlations), the item discrimination, 5 fit indices for CFA, the convergent validity (indicator reliabilities, composite reliabilities, average variance extracteds), and the discriminant validity fulfilled the acceptability thresholds. All generalizability estimates fulfilled the predetermined levels of acceptability (Tucker’s congruence coefficients, congruence tests, strict factorial invariance). The usefulness of the PAPEMCS was established by the higher scores of the PAPEMCS being related to non-urgent usage of PEMCS. Conclusions: The PAPEMCS demonstrated satisfactory reliability, validity, generalizability and usefulness. The PAPEMCS is useful to quantify the contents and extent of parental anxiety about PEMCS, and to clarify the mechanisms of non-urgent PEMCS usage.

Asthma in Children at the Pediatric Intensive Care Unit of University Hospital of Brazzaville (Congo)

Objectives: To describe the epidemiological, clinical and therapeutic aspects of asthma in children at the Pediatric Intensive Care Unit of University Hospital of Brazzaville. Patients and methods: We reviewed the records of children hospitalized in the Pediatric Intensive Care Unit of University Hospital of Brazzaville from January 1 to December 31, 2015, and retained those from two months to 17 years hospitalized for asthma. The study variables were: age, sex, influence of seasons, history of atopy;the factors triggering the crisis, the type of follow-up, the degree of severity of asthma exacerbation, the type of treatment instituted and the course of the disease. In total, out of 2012 hospitalized children, 65 children met the inclusion criteria. Results: The hospital prevalence of asthma was 3.5%. Among 65 children of study, 42 (59.2%) were male and 29 (40.8%) female. The mean age was 3.9 ± 2.9 years (range from 2 months to 14 years). Children aged 30 months to 5 years were the most represented (40%). They were known as asthmatics, n = 18 (27.7%). Family atopy was found, n = 11 (16.9%). Acute Otorhinolaryngologic infections were in all cases the factors triggering the crisis. The peak frequency of hospitalizations for asthma occurred during the short rainy season. The crisis was moderate n = 46 (70%) and severe n = 19 (29%). Beta 2 mimetics were administered in all cases, by subcutaneous in 18 cases (27.7%) and inhaled in 47 cases (72.3%). The outcome was favorable in all cases with a mean hospital stay of 1.46 ± 0.92 days. Conclusion: Childhood asthma remains a public health challenge and severe asthma is the paradigm of uncontrolled and costly asthma. This first work suggests that a large-scale study be carried out for a better knowledge of it.

Adaptation and validation of pediatric peripheral intravenous catheter insertion and care practices audit tools

Objectives:This study aimed to describe the translation process and establish the validity of the three instruments in Indonesian to assess pediatric peripheral intravenous catheter(PIVC)insertion and care practices.Methods:The six-step forward and backward translation method was used to translate the adapted questionnaires.The English version questionnaires included the point prevalence audit checklist,the nurse survey consisting of the nurse PIVC knowledge questionnaire and the nurse PIVC confidence questionnaire,plus a Patient/parent Experience Survey.Data collection was conducted in Indonesia between October 2019 and February 2020.In total,there were six translators(two for each instrument),nine-panel vascular access experts(three for each instrument),and 30 participants(ten for each in-strument)of the target population involved in the translation and validation of the three instruments.Three-panel experts rated the content relevance of each instrument using a four-point rating scale.Item level and scale level content validity index and kappa index were calculated.Ten-panel members of the target population evaluated each questionnaire regarding feasibility,clarity,logical sequence,and formatting.Qualitative comments from the panel were also reviewed.Results:The translation process indicated relatively low discrepancies between translators except for semantic equivalence.There were nine,eight,and one semantic discrepancies found in the forward translation of the point prevalence audit checklist,nurse survey,and patient/parent experience survey.The semantic discrepancies were less prevalent in the backward translation,with only one,three,and two items reported during the process.The item validity index for all of the three instruments showed relatively high agreement between experts(I-CVI>0.78,S-CVI/Ave>0.90,S-CVI/UA>0.70,and kappa index>0.74).The face validity was established with the panel reporting that the three instruments were easy to understand and presented logically.However,some re-formatting of the nurse survey and pa-tient/parent experience survey were needed to avoid ambiguity and confusion for the participants.Conclusions:The results indicate that the translated three survey instruments that had been widely used in other developed countries show good content validity in the Indonesian context.They can be used as a reference for further testing in different countries and contribute to understanding the pediatric PIVC audit tools used in future clinical research.

The Evaluation of Pediatric HIV Care in Congo

Pediatric AIDS is still a public health issue. In order to improve the care of children living with HIV, a study was carried out between January and December 2014, that is in 12 months at University Center Hospital (UCH) of Brazzaville, in the two Ambulant Treatment Centers (ATCs) of Brazzaville and Pointe-Noire, In three general hospitals and seven base hospitals. Heads of centers and follow-up files of children aged 0 to 15 constituted the target population. The study variables concern the provision of care, the organization of structures and personnel, and data management. Thirteen health facilities, 13 heads of centers and 520 medical files were selected. HIV care was effective in nine out of eleven departments, only the two CTAs offered the entire package of activities. The diagnosis was made in WHO stage 3 in 433 cases (83.3%), the pre-therapeutic assessment in 246 cases (47.2%);Psychological care in 84 cases (16.1%) whose 80 (95.2%) in the ACT, nutritional management in 4 cases (0.7%). Nine out of 13 centers did not have computer tools or materials for patient information and education;No center had sufficient staff. The dispensation of Anti-retroviral drugs (ARDs) is not based on any standard and the safety conditions of the laboratory providers are not guaranteed. The importance of the observed dysfunction makes it necessary to improve the general conditions of care.

Focuses and trends of the studies on pediatric palliative care:A bibliometric analysis from 2004 to 2018

Objectives:To investigate the focuses and trends of the studies on pediatric palliative care(PPC)and provide directions for future research.Methods:Relevant papers about PPC published from 2004 to 2018 were analyzed using bibliometric analysis methods,including co-word analysis,biclustering analysis,and strategic diagram analysis.The included papers were divided into three groups based on the publication time,including 2004-2008,2009-2013,and 2014-2018.Results:A total of 1132 papers were published between 2004 and 2018,and there were 293 papers published between 2004 and 2008,396 between 2009 and 2013,and 443 between 2014 and 2018.There were 42 high-frequency MeSH terms/MeSH subheadings in papers published between 2004 and 2018,including 12 between 2004 and 2008,13 between 2009 and 2013,and 17 between 2014 and 2018.Conclusion:Studies on PPC were making progress,with the increasing number,expanding scope,and uneven global distribution.Integration palliative care into pediatrics,cancer treatments in pediatric oncology,education methods on PPC,and establishment of professional teams were the major themes during 2004e2008,then the themes changed into establishing interventions to enhance the quality of life of the patients and parents,building professional-family relationship,and investigating attitude of health personnel in PPC during 2009-2013 and subsequently turned into communication skills,end-oflife decision making,and guidelines making on PPC during 2014-2018.Underdeveloped and protential themes including effective approaches to deal with the ethical dilemmas,training programs on communication skills,family support and guideline making are worth studying in the future.

Changes in Nurses after Online Workshops Using the Pediatric Nursing Care Model

This study aimed to clarify the changes in nurses’ cognition about the rate and likelihood of implementation of daily ethical nursing items used in pediatric care before and after attending online workshops using the Pediatric Nursing Care Model (PNCM). A 1.5-hour online workshop was held twice over two weeks. A total of nine nurses participated in the program. These online workshops using PNCM helped achieve the original goals and the results revealed a positive outcome of the workshops. We should devise an educational program to arouse participants’ interest and comprehension to make the most of online competency.