Nursing in critical careNana Wu, Xia Chen, Jie Fu, Liwen Ding, Hong Zhou, Tiantian Xiao
BACKGROUND: Point-of-care ultrasound (POCUS) is increasingly used in paediatric and neonatal critical care, but evidence on nurse-led bedside POCUS remains limited and fragmented. AIMS: This scoping review aimed to map the evidence on nurse-led bedside POCUS in paediatric and neonatal critical care nursing practice, examine implementation factors and identify evidence gaps relevant to nursing research, education and clinical practice. METHODS: Following JBI methodology and PRISMA-ScR guidance, we searched PubMed, Embase, CINAHL, Web of Science, Cochrane Library and CNKI from inception to October 2025. Eligibility followed the PCC framework. Two reviewers independently screened records and extracted data using a standardized form. Study characteristics were synthesized descriptively, and implementation factors were deductively analysed using the COM-B framework. RESULTS: Thirty-four studies were included, mainly from the United States and China. Nurse-led POCUS applications included vascular access, respiratory assessment, catheter localization, cardiac or hemodynamic evaluation, bladder assessment and education or competency development. Outcomes included clinical (procedural success and diagnostic accuracy), process (timeliness and workflow efficiency) and nurse-related (competency, confidence and role development). Safety-related outcomes were the least reported. Implementation was influenced by training, equipment, protected time, institutional support, collaboration and patient safety concerns. The automatic motivation domain, referring to unconscious drivers such as habits and emotional responses, was not addressed by any study. CONCLUSIONS: Nurse-led POCUS is an emerging but unevenly developed component of paediatric and neonatal critical care. Brief training may support initial competency, but sustained implementation is constrained by underdeveloped quality assurance, unclear career pathways and limited attention to motivational processes. RELEVANCE TO CLINICAL PRACTICE: Future nursing research and clinical programmes may look beyond short-term training outcomes to consider competency standards, longitudinal supervision, quality assurance, educational approaches combining foundational POCUS training with structured workplace supervision and sustainable integration into routine care delivery.
Nursing philosophy : an international journal for healthcare professionalsVasiliki Georgousopoulou, Georgios Manomenidis
Children's dignity in hospital care is often framed as a matter of privacy, etiquette, communication, or procedural compliance. A more demanding account is needed. Drawing on the philosophical framework of epistemic injustice, this conceptual article argues that dignity-related harms in paediatric nursing also arise when children are denied credibility, interpretive support, or meaningful authority over knowledge of their own embodied experiences. Children may not always describe pain, shame, embarrassment, fear, or boundary violation through adult-like verbal testimony. Their experiential knowledge may instead appear through silence, withdrawal, humour, bodily resistance, hesitation, gaze avoidance, or apparently compliant behaviour. When such expressions are dismissed as immaturity, difficulty, exaggeration, or non-compliance, the child is harmed not only as a vulnerable patient but also as a knower. This reframing connects paediatric dignity with children's rights to participation, privacy, and respect under the United Nations Convention on the Rights of the Child and the EACH Charter. It also positions paediatric nurses as central agents of epistemic repair because nursing work occurs at the intersection of intimate bodily care, sustained relational proximity, communication, documentation, and advocacy. The article proposes an epistemic justice practice bundle for paediatric nursing: credibility-oriented listening, embodied attunement, developmentally attuned communication, protected communicative spaces, minimal substitution by adult proxies, and voice-preserving documentation. The analysis extends nursing philosophy by showing that dignity is not only protected around the child but co-produced through relational practices that make children's experiences visible, credible, and actionable within clinical care.
For a family in the NICU, this is literally the worst time in their lives. Most new parents feel that they are protective of their newborn, but being a parent of a NICU baby is 20 times more challenging. NICU nurses have the power to make a difference by building resilience at the same time they are providing patient education. Celebrations, respectfulness, and supportiveness toward the family are key. For parents, the actions of nurses can profoundly affect the NICU stay and persist after discharge. Confidence and resilience go a long way toward creating advocates as they take their child out into the world.
AIMS: Newly graduated paediatric surgery nurses must be able to identify and handle potential risks to ensure patient safety. It is necessary to reinforce their understanding of their roles and responsibilities to achieve this goal. However, the limitations of traditional classroom-based teaching hinder the exploration of learners' potential. This study aimed to evaluate the effectiveness of the Jeffries simulation framework in improving the core competence of new graduate nurses in paediatric surgery. DESIGN: A quasi-experimental study, descriptive design following STROBE checklist. METHODS: A quasi-experimental methodology with a pretest/posttest design was used. The study involved 60 new graduate paediatric nurses who work in the paediatric surgery department of a level A tertiary hospital in Southwest China. Clinical scenario simulation cases, which were designed based on the Jeffries simulation framework, were used to improve clinical competence. Before and after the training, teachers assessed each nurse's core competency and clinical decision-making ability by the Chinese Registered Nurse Core Competency Scale (CIRN) and the Clinical Decision-Making in Nursing Scale (CDMNS). In addition, participants provided self-reported reflective feedback during the debriefing sessions following each simulation scenario. RESULTS: Across all 60 newly graduated paediatric surgical nurses, significant improvements in clinical competence were observed following the simulation-based training (p < 0.001). The total score of core competence increased significantly from 118.48 ± 8.84 pre-training to 142.56 ± 6.11 post-training, with a mean difference of 24.08 ± 9.51 points. Similarly, the total score of clinical decision-making ability showed a marked improvement, rising from 83.92 ± 2.43 to 91.15 ± 3.24, representing a mean increase of 7.23 ± 4.17 points. Moreover, the dimensions of 'clinical nursing', 'critical thinking/scientific' and 'clear goals and values' also showed significant improvements. CONCLUSION: Training new graduate paediatric nurses via the Jeffries simulation framework can enhance their clinical competence by helping them internalize knowledge and skills and improve their core competencies and clinical decision-making abilities. PATIENT OR PUBLIC CONTRIBUTION: The study analysed the core competency levels of newly graduated paediatric surgery nurses, providing a valuable reference for the management, training and evaluation of these nurses as well as establishing qualification criteria for paediatric specialist nurses. Identifying the factors that influence core competitiveness is crucial for developing standardized training programmes and enhancing the construction of nursing safety and paediatric nursing talent. TRIAL REGISTRATION: Clinical Trial Registry registration number: ChiCTR2400082003.
Nursing in critical careMeng Huang, Meng Lv, Jiayu Huang, Yan Lin
BACKGROUND: Existing research has focused mainly on high-risk medication errors, contributory factors and process-based interventions; less is known about nurses' everyday safety work in paediatric intensive care. AIM: To explore how nurses maintain high-risk medication safety in paediatric intensive care. STUDY DESIGN: A descriptive qualitative study using purposive sampling, critical incident interviews and inductive content analysis at a tertiary children's hospital in China. RESULTS: Ten nurses participated. Four themes were generated: anomaly recognition and proactive verification; team communication and continued follow-up after risk identification; safety checks and bedside adaptations in medication practice; and learning from near misses and adjusting future practice. Together, these practices spanned order review, preparation, administration, pump and compatibility management, monitoring and team learning. CONCLUSIONS: Experienced nurses in paediatric intensive care maintained high-risk medication safety through linked practices of anomaly recognition, proactive verification, team communication, continued follow-up, safety checks, bedside adaptation and near-miss learning. RELEVANCE TO CLINICAL PRACTICE: Training and workflow support should strengthen anomaly recognition, dose and infusion-rate recalculation, communication, active double checking, compatibility checking, infusion-pump management, follow-up monitoring and near-miss learning.
Neonatal network : NNDigamber Chaubey, Sathya Bama G
Surgical neonates represent one of the most vulnerable populations in the NICU due to physiologic immaturity, limited compensatory reserves, and exposure to perioperative stress. Although advances in neonatal surgery, anesthesia, and intensive care have improved survival, outcomes remain closely linked to the quality and consistency of nursing care. Nurses play a critical role in physiologic stabilization, prevention of complications, early recognition of deterioration, and delivery of family-centered care throughout the perioperative course. This narrative review synthesizes current evidence on the nursing care of surgical neonates, focusing on essential domains including monitoring and documentation, thermoregulation, respiratory and nutritional support, infection prevention, pain assessment, parental counseling, nurse-led education, and nursing leadership. The review also examines the influence of nurse-to-bed ratios on patient safety, particularly in low- and middle-income countries where workforce shortages remain common. Strengthening nursing capacity, leadership, and structured communication with families is essential to improving safety and outcomes for surgical neonates.
Neonatal network : NNMeredith L Farmer, Krystal Echavarria, Macy Saito, William L Hull
Neonatal conjunctivitis is a common condition that can develop and progress at any stage of infancy, depending on the causative agent, including in otherwise healthy term infants outside of the NICU. Despite its frequency, there is no single, readily accessible reference that concisely integrates causative pathogens, presentation timing, and evidence-based treatment strategies. Given the multiple etiologies, each with distinct pathophysiology and management considerations, accurate identification is essential to prevent complications. This article highlights the most common causes of neonatal conjunctivitis, reviews the pathophysiology and clinical presentation, and provides recommendations for both pharmacologic and nonpharmacologic treatments. In addition, nursing implications for prevention, early recognition, and bedside management are discussed. A case study is included to enable readers to apply these concepts in a real-world context.
Nursing in critical careDerya Kılınç, Eylem Hallaç Kaygusuz
BACKGROUND: Family Presence During Resuscitation (FPDR) is a key component of family-centred care in paediatric settings, supported by international guidelines. However, limited evidence exists regarding how nurses' perceptions of FPDR relate to self-confidence during paediatric resuscitation. AIM: This study investigated the relationship between FPDR perceptions and self-confidence levels among paediatric nurses in critical care units. STUDY DESIGN: A descriptive, cross-sectional study was conducted between April 10 and June 20, 2025, with nurses working in paediatric critical care units of a tertiary city hospital. Data were collected through face-to-face survey administration using a Personal Information Form and the Family Presence Risk-Benefit Scale, and analysed using descriptive statistics, correlation analyses, and multiple linear regression. RESULTS: A total of 194 eligible nurses were approached, of whom 138 completed the survey, yielding a response rate of 71.1%. The majority of nurses opposed FPDR, citing concerns related to team communication, increased stress, interruption of medical interventions and risk of violence. Mean total self-confidence and risk perception scores were 47.24 ± 18.06 and 32.75 ± 10.37, respectively. Age, professional experience and certificate status did not significantly predict risk perception or self-confidence. Postgraduate education significantly increased risk perception, while working in paediatric haematology units significantly decreased self-confidence levels. A weak but statistically significant positive correlation was found between risk perception and self-confidence (rs = 0.25, 95% CI [0.09, 0.40], p = 0.013). CONCLUSION: The findings indicate that paediatric nurses' perceptions of family presence during resuscitation are influenced more by clinical and organisational context than by individual experience or certification. These results highlight the need for clear institutional policies and structured paediatric-specific training to support the safe implementation of family-centred resuscitation practices. RELEVANCE TO CLINICAL PRACTICE: The findings may inform the development of context-sensitive institutional policies and structured educational programs to support safer implementation of family-centred resuscitation practices.
Perinatal mood and anxiety disorders (PMADs) are the most common complications of pregnancy and the postpartum period, affecting approximately one in five women in the United States. Perinatal mood and anxiety disorders encompass postpartum depression, perinatal anxiety, obsessive-compulsive disorder, posttraumatic stress disorder, bipolar spectrum disorder, and perinatal psychosis. Despite their prevalence, PMADs remain significantly underdiagnosed and undertreated, with up to 75% of affected women not receiving adequate care. Untreated PMADs carry substantial consequences for maternal health, infant development, and family well-being, with an estimated annual economic burden of $14.2 billion. NICU admission compounds parental risk due to heightened stress, trauma, and uncertainty. Fathers and nonbirthing parents are also affected but remain largely unscreened. This article reviews the epidemiology, pathophysiology, key symptoms, screening, and treatment considerations for each PMAD, with case studies illustrating clinical implications for neonatal nursing practice.
The Textbook of Neonatal Resuscitation is the leading educational resource on neonatal resuscitation, and the ninth edition was released in October 2025, updating the standard of care for newborn resuscitation. The changes in this new edition of NRP are sweeping, with twice as many changes as the previous edition, and include two new highly requested chapters on resuscitation of infants with congenital heart disease and resuscitation of postnatal infants convalescing in the NICU. This narrative review provides in-depth coverage of the changes and discusses the evidence supporting them, enabling clinicians to incorporate them into their everyday practice. With such sweeping changes, individual centers must adapt their approach to resuscitation to their unique circumstances, given their available resources.
Revista gaucha de enfermagemÉrika Maria Siqueira Lima, Cristianne Teixeira Carneiro, Maria Augusta Rocha Bezerra, Ruth Cardoso Rocha, José Cláudio Garcia Lira Neto, Mychelangela de Assis …
OBJECTIVE: To evaluate patient safety in the neonatal intensive care unit, according to the Donabedian model, considering the performance of the nursing team. METHOD: Cross-sectional study. The sample consisted of 28 nursing professionals. Data collection was carried out through systematic observation, performed by two independent evaluators, using two instruments: the Patient Safety Assessment Checklist in the Neonatal Intensive Care Unit, which includes the dimensions of Structure, Processes, and Outcomes; and the Graphic Protocol. Descriptive statistics were applied for analysis, and the Kappa coefficient was calculated. RESULTS: The Kappa coefficient indicated a perfect degree of agreement between the evaluators (k=1). The overall assessment showed a conformity rate of 86.48%. The Structure category obtained 88.46%; Process reached 82.69%; and Outcome, 85.71%. The main deficiencies are concentrated in the dimensions of the care process, such as patient identification, communication with the family, and prevention of infections and falls. CONCLUSION: The Neonatal Intensive Care Unit was classified as a provider of partially safe care, with greater compliance in the Structure category, followed by the Outcome category, and lower performance in the Process category, highlighting weaknesses in the execution of care practices.
Anales del sistema sanitario de NavarraBirsen Mutlu, Zeynem Yildirim Balkan, Esra Cumur Baskir
BACKGROUND: This study examined the association between empathy and compassion fatigue among nurses working in neonatal and pediatric intensive care units. METHODS: A cross-sectional study was conducted among nurses employed in neonatal and pediatric intensive care units at three hospitals in Turkey. Sociodemographic and occupational data were collected, and participants completed the Jefferson Scale of Empathy and the Compassion Fatigue Short Scale. Pearson´s correlation and linear regression analyses were performed to examine the association between empathy, compassion fatigue, and other study variables. RESULTS: Sixty-five nurses participated in the study, representing 90.3% of the target population. Mean empathy and compassion fatigue scores were 79.77 ± 8.69 and 52.09 ± 20.44, respectively. A moderate positive correlation was observed between empathy and compassion fatigue (r = 0.484). Empathy explained 22.2% of the variance in compassion fatigue (R² = 0.222; B = 1.139; 95% CI: 0.621 - 1.657; p < 0.001). Nurses who had voluntarily chosen nursing reported significantly lower compassion fatigue scores than those who had not (49.14 ± 19.39 vs 61.93 ± 21.42; p = 0.032). Working more than 50 hours per week was associated with higher empathy scores (84.06 ± 11.58 vs 78.82 ± 6.46; p = 0.046), but not with compassion fatigue. CONCLUSIONS: Higher empathy associates with greater compassion fatigue among nurses working in neonatal and pediatric intensive care units. Voluntarily choosing nursing associates with lower compassion fatigue, whereas longer working hours associate with higher empathy.
BMC medical educationFatma Alm Eldeen Goda, Amal Gharib Sabaq, Reda Mohamed Abdullah
BACKGROUND: High-quality pediatric care depends on well-prepared nursing students. Innovative educational strategies, such as problem-based learning (PBL), have gained recognition for their potential to enhance students' self-efficacy and self-directed learning, which are essential for providing safe and effective care to children. OBJECTIVE: This study aims to compare the effects of traditional PBL versus video-assisted PBL on pediatric nursing students' academic self-efficacy and self-directed learning in order to explore their implications for pediatric patient care. METHODS: An experimental research study was conducted at the Faculty of Nursing, Benha University. A systematic random sample of 150 pediatric nursing students was utilized. Participants were evaluated using a structured interviewing questionnaire for knowledge, the Academic Self-Efficacy Scale, and the Self-Directed Learning Readiness Scale. The study compared experimental groups (Traditional PBL and Video-assisted PBL) against a control group. RESULTS: Following the intervention, significant improvements were observed in total knowledge, academic self-efficacy, and self-directed learning readiness among both experimental groups compared with the control group (P < 0.001). The video-assisted PBL group achieved the highest post-intervention mean scores in total knowledge (77.30 ± 4.42), academic self-efficacy (72.16 ± 6.18), and self-directed learning readiness (118.38 ± 3.76), followed by the traditional PBL group (72.22 ± 6.96, 67.70 ± 7.78, and 113.84 ± 11.72, respectively), whereas the control group demonstrated the lowest scores (59.98 ± 12.89, 45.74 ± 5.88, and 84.86 ± 10.28, respectively). Post hoc analyses further confirmed that video-assisted PBL significantly outperformed traditional PBL and conventional teaching across all measured outcomes (P ≤ 0.001). CONCLUSION: This study provides evidence that both traditional and video-assisted PBL are effective in improving students' learning outcomes. However, Video-assisted PBL is superior in enhancing knowledge, academic self-efficacy, and self-directed learning readiness, offering a more effective strategy for nursing education. TRIAL REGISTRATION: Not applicable.
BACKGROUND: Culturally sensitive nursing care is vital in paediatric settings, where children's health experiences and responses to care are influenced by their cultural beliefs, family practices and developmental needs. OBJECTIVES: This study aimed to develop, describe and evaluate a model to guide professional nurses in providing culturally sensitive care for hospitalised children. METHOD: A theory-generative, qualitative, exploratory, descriptive and contextual design was employed. The model was created through four systematic steps: concept analysis, formulation of relationship statements, model construction and expert evaluation. RESULTS: The resulting model helps professional nurses to recognise and clarify their own values, incorporate institutional cultural guidelines and utilise relevant resources to facilitate culturally sensitive care. CONCLUSION: At the core of the model is the active involvement of mothers or primary caregivers throughout the child's hospitalisation, ensuring holistic, culturally responsive and developmentally appropriate care.Contribution: The model provides a practical framework to improve cultural competence and enhance paediatric nursing care across diverse clinical settings.
Health expectations : an international journal of public participation in health care and health policyMartin Blanc, Marie-Pierre Gagnon, Daphney St-Germain, Boutheina Mejri, Marie Gagné, Isabel Bean, Gratianne Vaisson
INTRODUCTION: HOPtimise is an organisational innovation in paediatric oncology in the province of Québec (Canada) destined to improve and reinforce best nursing practices through digital training using a serious game and create dashboards focused on indicators sensitive to the quality of care. This complex intervention is led by a quality improvement committee, a joint committee of user partners (former patients and family members) and healthcare providers. The present study aims to demonstrate how innovation and training are co-created with multiple stakeholders. The involvement of patients and their families is at the core of the innovation's design. The aim of this study was to create and elaborate on the components of the logic model of the innovation in order to make it easily understandable for any stakeholder, to set the central roles and activities of the innovative process and to be able to verify the progress of the elaboration and the implementation of the innovation afterwards. The study also intended to generate guidance for future complex interventions in nursing practice improvement. DESIGN: This study has a qualitative, descriptive and participatory design with a mixed data collection destined to create the logic model of the innovation. The qualitative methods used are organised through a three-step timeline: the elaboration of the logic model, the verification phase and validation. Data collection methods involved two focus groups, each one at a different phase of the process (n = 9 and n = 6), semi-structured interviews (n = 4) and verification checklists (n = 9) conducted from June 2022 to June 2024. Data collection guides are based on the Porteus (2009) method for the elaboration of a logic model. Through the process, n = 15 participants took part in at least one data collection (either focus group or interviews). RESULTS: With a 2-year and n = 15 multistakeholder study, the team obtained a logic model of organisational innovation. The HOPtimise logic model is a necessary tool to communicate with all stakeholders from various backgrounds. The study shows that the logic model was clear enough to all the participants (n = 15). As a result, this logic model is a strong base to stabilise the roles and activities of those stakeholders in the elaboration and implementation of the innovation. Indeed, it allowed the building of a stable quality improvement committee. Finally, the logic model became a baseline for the process of identifying barriers and implementation strategies. CONCLUSIONS: The HOPtimise logic model is representative of the complexity of the organisational innovation and the organisational challenges that the project will encounter, and is a necessary tool for evaluation of its implementation in terms of its co-constructive nature. PATIENT AND PUBLIC CONTRIBUTION: This study is a co-creation and is family-centred. It involved the engagement and participation of user partners and organisational members. The research team interacted with them during the three steps of the elaboration of the logic model. They provided opinion and expertise on the content of the innovation, its components, the activities needed to reach the outcomes and implementation strategies.
Hu li za zhi The journal of nursingChun-Chi Huang, Chung-Ying Lin, Mei-Chih Huang
BACKGROUND: The primary purpose of developmental care, the core requirement of premature infant care, is to provide a demand-central care model that reduces pressure in the environment to assist preterm infants in neonatal intensive care units (NICUs). While developmental care is the care aim of NICUs, no validated measures are currently available in Taiwan to evaluate the developmental care ability of nurses. To improve the quality of care provided to preterm infants and strengthen the on-the-job education received by nurses, the current status of relevant competencies in NICU nurses must be elucidated. PURPOSE: In this study, the original English version of the Developmental Support Competency Scale for Nurses (DSCS-N) developed by the Korean scholars Kim and Shin was translated into a Traditional Chinese version (DSCSN-TC) and evaluated for reliability and validity. METHODS: The DSCS-N was translated using the Brislin translation model and cross-cultural equivalence was reviewed using the Jones process. Content validity (including content relevance and item clarity) was subsequently verified. Reliability and validity were assessed using descriptive statistics, confirmatory factor analysis, item analysis, and internal consistency reliability. RESULTS: Convenience sampling was used to enroll 153 nurses (N = 153) as participants, all of whom had worked for more than one year in a NICU at one of three medical centers. The 19-item DSCSN-TC has a total possible score range of 19 to 76. Content Validity Index, evaluated by eight experts, was .92. The mean total score was 64.91 (SD = 7.61). CFA confirmed a good fit for the six-factor structure: CFI = .935, TLI = .919, RMSEA = .063, and SRMR = .05. The Cronbach's alpha values for the six factors were: interaction (.717), critical thinking (.833), parental support (.676), professional development (.762), partnership (.784), and environmental support (.688). The overall Cronbach's alpha for the scale was .935. CONCLUSIONS: The findings show the DSCSN-TC to be a reliable and valid measure when applied in either research or clinical settings to evaluate developmental care competency in nurses. Based on the preliminary testing results, the original instrument was further refined and evolved into a DSCSN-TC 2.0 version with the aim of providing an even more precise assessment of the developmental supportive care competence of nursing staff.
Nursing openAbera Mersha, Asresash Demissie, Susan Anand, Konstantinos Antypas
AIM: To report study protocol on the effectiveness of a nurse-led, touch-based intervention grounding in caring theory in improving informal caregivers' engagement and perceptions of nurse support during neonatal nursing care. DESIGN: A two-arm parallel cluster randomized controlled trial. METHODS: This study will involve 228 informal caregiver-neonate dyads recruited from neonatal intensive care units. A multi-level block stratification randomization will be used to assign both neonatal intensive care units (by level) and participants (by neonate's health status category) to either the experimental or control group. The primary outcome for this study is informal caregivers' levels of engagement, and their perceptions of nurses' support are considered a secondary outcome. Data will be collected in two surveys: the baseline (cohort one survey) and the impact assessment (cohort two survey). IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: This study will evaluate potentially effective intervention to promote bonding between informal caregivers and neonates. The approach will improve informal caregivers' engagement and perceptions of nursing support, which will lead to the optimization of high-acuity neonatal nursing care and, ultimately, the improvement of clinical outcomes for both informal caregivers and neonates. Overall, this study is highly relevant to neonatal intensive care unit nurses. It improves the quality of care and delivers valuable practical and theoretical insights. IMPACT: No previous studies have reported interventions specifically designed to address informal caregiver engagement in neonatal nursing or their perceptions of support. This study serves as the first cluster randomized controlled trial to evaluate a nurse-led, theory-driven intervention aimed at improving both caregiver engagement and perceptions of nursing support. These findings will generate new knowledge regarding nurse-led, touch-based care grounded in established caring theories, effectively bridging the gap between theoretical models and clinical practice in resource-limited settings. REPORTING METHOD: This protocol is adhered to the EQUATOR Network's SPIRIT 2025 statement. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. TRIAL REGISTRATION: PACTR202512767733948.
BACKGROUND: Fever is one of the most common symptoms in children and a leading cause of their hospitalisation. Nurses, as primary caregivers in paediatric wards, play a pivotal role in the assessment and management of children with fever. However, nurses' perceptions and experiences of fever management are influenced by cultural contexts, psychological and social factors, as well as prevailing health system policies. AIM: The aim of the study was to explore nurses' perceptions influencing their management of childhood fever, including barriers and facilitators to evidence-based practice. DESIGN: A qualitative descriptive design using a conventional content analysis approach. METHODS: Nineteen nurses working in paediatric wards participated in individual semi-structured interviews conducted between March 20, 2024 and May 20, 2025. Purposive sampling was used to recruit participants with direct experience in managing fever in children. Data were audio-recorded, transcribed verbatim and analysed inductively using qualitative content analysis as described by Graneheim and Lundman. The study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. RESULTS: Data analysis resulted in the extraction of one main theme titled 'Navigating Uncertainty and Psychological Strain in Pediatric Fever Management' and five main categories. Nurses described challenges related to the absence of locally adapted clinical guidelines, lack of continuous education, hierarchical dependence on physicians, fever phobia and misconceptions, which led to non-evidence-based decision-making and unnecessary interventions. CONCLUSION: The findings underscore the need for developing culturally appropriate local clinical guidelines, implementing evidence-based continuous educational programmes, enhancing nurses' professional autonomy and providing effective family education. These interventions can improve care quality, reduce nurses' occupational anxiety and ultimately enhance child health outcomes. IMPLICATIONS FOR PROFESSION AND/OR PATIENT CARE: Understanding nurses' experiences and challenges may inform the development of educational interventions, localised clinical guidelines and organisational strategies to improve the quality and consistency of fever management in children. IMPACT: What problem did the study address? ◦The study addressed the gap between evidence-based fever management guidelines and actual nursing practice in paediatric settings. What were the main findings? ◦Nurses' clinical decision-making was influenced by fear of complications, parental expectations, organisational factors and contextual factors. Where and on whom will the research have an impact on? ◦The findings may impact paediatric nurses, healthcare administrators and policymakers by informing strategies to support evidence-based fever management in hospital settings. REPORTING METHOD: This study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution: Patients or members of the public were not involved in the design, conduct, reporting or dissemination plans of this research, as the study focused on nurses' professional experiences.
BACKGROUND: As direct and continuous providers of patient care, nurses are more susceptible to various forms of psychological stress within the healthcare environment compared to other healthcare professionals. Nurses in paediatric wards, who maintain constant contact with children and their families, are particularly vulnerable to moral distress. This study aimed to explore the perceptions and experiences of Iranian nurses regarding moral distress in paediatric settings. METHODS: This qualitative study employed inductive content analysis, conducted between 2023 and 2024. Data were collected through semi-structured individual interviews and analysed following Graneheim and Lundman's approach. Twelve participants experiencing moral distress were selected via purposive sampling from the Babol and Tehran Universities of Medical Sciences. RESULTS: The findings identified four primary categories and eight subcategories: moral distress related to colleagues (doctors and nursing colleagues); moral distress related to parents (conflict with children's rights and distrust of nurses); moral distress related to organizational factors (understaffing and workload undermining holistic care and professional ethics; and inadequate equipment and resources compromising care and fostering dishonesty); and psychological tensions following moral distress (mental conflict involving the cognitive and emotional burden of moral compromise; and helplessness and despair in the face of systemic failure). Rather than representing isolated individual experiences, these findings illustrate that moral distress in paediatric nursing is deeply rooted in the structural and relational conditions of healthcare settings. The results highlight that repeated exposure to ethical conflicts can erode professional values, impede the delivery of holistic care, and intensify emotional suffering. Consequently, this study contributes to a deeper understanding of moral distress as a systemic phenomenon requiring organizational intervention rather than merely an individual coping response. CONCLUSION: The findings underscore the necessity for healthcare managers and policymakers to implement systemic mechanisms, such as specialized educational programmes and workshops, to mitigate moral distress among nurses. Furthermore, identifying the inherent stressors in paediatric nursing and reducing nurses' exposure to moral dilemmas are essential steps toward safeguarding ethical practice and enhancing care quality. This study contributes by shifting the focus from merely describing moral distress as a set of themes toward understanding it as a critical indicator of organizational strain and ethical vulnerability in paediatric nursing.
International journal of nursing practiceZeynep Yurdakul, Figen Işık Esenay
AIMS: This study aimed to describe specific missed nursing care (MNC) practices among paediatric surgical unit nurses in Türkiye and to explore descriptive differences and bivariate associations according to nurses' demographic and work-related characteristics. BACKGROUND: MNC adversely affects patient safety and care quality. Although widely studied in various clinical settings, evidence from paediatric surgical units, where care is complex and specialized, remains limited. DESIGN: A descriptive cross-sectional survey was conducted. METHODS: Data were collected from a nonprobability voluntary-response sample of 242 nurses working in paediatric surgical units between April and August 2024 using a structured questionnaire consisting of a demographic form and the adapted MISSCARE Survey. Participants were recruited through a professional association's social media network. Descriptive and exploratory bivariate statistical analyses were performed. RESULTS: Most frequently missed practices included promoting neurodevelopment (82.2%), nonpharmacological anxiety management (79%) and oral care (73.6%). Primary reported reasons for MNC were nurse shortages (42.1%) and increased patient load (40.5%). The primary reported reasons for MNC were nurse shortages (42.1%) and increased patient load (40.5%). Exploratory bivariate analyses showed statistically significant differences in MNC scores according to age, professional experience (p < 0.001), overtime work and job satisfaction (p < 0.05). CONCLUSION: Organizational challenges-chiefly staffing shortages, increased workload and communication gaps-were the most prominent reported reasons for MNC; targeted organizational interventions and confirmatory research using representative samples are warranted.
International journal of qualitative studies on health and well-beingLaura Ortju, Ari Haaranen, Päivi Kankkunen, Liisa Karlsson
PURPOSE: The aim of this qualitative descriptive study was to explore young children's perspectives on participation and care experiences in child health clinic nursing encounters. Knowledge of children's experiences and views can help professionals support children's right to participation. METHODS: Data were generated using a multi-method approach that included researcher-initiated role-play, stimulated recall interviews, Storycrafting, painting and drawing. Eleven children aged 5-7 years and 12 parents participated. Children were involved in selecting methods and settings. Thematic and semiotic analyzes were conducted, supported by researcher triangulation. The Consolidated Criteria for Reporting Qualitative Research checklist guided reporting. RESULTS: Clinic visits emerged as shared and meaningful experiences for children. Children's narratives highlighted their wish to act as active agents, the importance of play, toys and rewards, the need for psychosocial support and proximity to a support person, and the significance of the clinic's physical appearance. Vaccinations, physical measurements and adults' restrictive actions were described as memorable aspects that shaped children's care experiences. CONCLUSIONS: Clinic visits emerged as shared and meaningful experiences for children. Children's narratives highlighted their wish to act as active agents, the importance of play, the need for psychosocial support, and the significance of the clinic's environment. Vaccinations, physical measurements and adults' restrictive actions were described as memorable aspects that shaped children's care experiences.
International journal of environmental research and public healthTeresa Galanti, Morena Santoriello, Michela Cortini, Elisa Di Tullio, Angelica Di Febbo, Stefania Fantinelli, Gabriella Mincione
Pediatric oncology nursing is among the highest-intensity care specialties, exposing nurses to repeated child death and sustained emotional investment in family relationships. This occupational burden is a recognized psychosocial risk factor and a driver of compassion fatigue, burnout, and reported intention to leave, yet the organizational and educational determinants of this risk remain poorly captured by existing assessment approaches. This study investigated the lived experiences of nurses caring for terminally ill children in a pediatric onco-hematology unit and hospice ward in central Italy (N = 15), using a qualitative descriptive design, informed by a phenomenological sensibility to lived experience, supported by computer-assisted textual analysis. Structured face-to-face interviews were analyzed through thematic content analysis with stepwise replication, while quantitative textual analysis was performed using T-Lab software to map co-occurrence patterns among key lemmas, providing a frequency-based, semantically grounded picture of nurses' representations of occupational risk. Seven themes emerged, including quality of nursing care, parental relationships, coping with a child's death, and impact on personal and professional life. Findings showed that reported intention to leave was associated, in participants' accounts, with absent psychological debriefing, cumulative emotional burden, inadequate end-of-life training, and a near-total absence of organizational vocabulary for peer-level support-a gap directly visible in the co-occurrence structure of nurses' language. As a secondary aim, by combining qualitative depth with complementary lexical analysis of thematic patterns, this study also offers a methodological example of how psychosocial risk in high-intensity care settings can be assessed and translated into actionable indicators for organizational climate and workforce well-being. The findings inform concrete prevention strategies and policy recommendations for nursing education and occupational health, consistent with this Special Issue's focus on methodological innovation for psychosocial risk assessment and public health policy design.
Revista gaucha de enfermagemViviane Layse Silva Rosado, Tarcísio Tércio das Neves Júnior, Hellen Anaídh de Oliveira, Bruna Ruselly Dantas Silveira, Ana Teresa Leiros de Azevedo, Erika Sim…
OBJECTIVE: To map characteristics of bad news communication by nurses in pediatrics. METHOD: Scoping review according to JBI and PRISMA-ScR recommendations. Searches were conducted between March and May 2024 in six databases, one virtual library, and seven thesis/dissertation repositories, without temporal or language restrictions. Two independent/blinded reviewers performed the selection, and a third resolved disagreements. Data collection used an instrument adapted from the Cochrane Data Collection form, with descriptive synthesis and analysis according to scientific literature. RESULTS: 31 studies comprised the sample, 13 addressing the communication of bad news to the child/adolescent, 10 to their families, and eight encompassing both audiences. Breaking bad news in pediatrics has specific characteristics, considering the child's developmental stages, family context, and cultural factors. Facilitating factors include the collaboration of the multiprofessional team and the bond established through the nurse's longer contact time with the child/adolescent. Among the difficulties, the lack of preparation, knowledge, self-confidence, experience, and security stand out. The nurse's actions include supporting, welcoming, and encouraging the family and child/adolescent. CONCLUSION: Breaking bad news communication is a complex practice that requires adaptation to the cognitive and emotional aspects of the child/adolescent and family, and is hindered by limitations in professional preparation.
The American journal of nursingCassi Crouse, Margaret Gettis, Regena Spratling
BACKGROUND: Premature neonates may require hospitalization in the neonatal intensive care unit (NICU), where they receive life-sustaining medical treatment. Care often involves the need for painful, invasive medical procedures. Music therapists working with nurses in pediatric health care settings can provide procedural support to patients via therapeutic music interventions. PURPOSE: The purpose of this evidence-based practice pilot initiative was to examine the impact of a pacifier activated lullaby (PAL) device intervention, facilitated by a NICU music therapist (NICU-MT) in collaboration with bedside nurses, on neonates undergoing retinopathy of prematurity (ROP) exams in the NICU. METHODS: The NICU-MT facilitated the PAL device intervention for neonates (N = 25) following ROP exams. Data were collected before the procedure; at the end of the procedure; and at one, three, and five minutes of PAL device use. Measurements to assess infant pain and stress before, during, and after the procedure included vital signs and pain scores. RESULTS: Findings reflected improvements in vital signs and pain scores following the five-minute PAL intervention, with measurements nearing preprocedure baseline averages, despite noteworthy end-of-procedure averages (including increased heart rate, decreased arterial oxygen saturation, and elevated pain scores). Outcomes from the pilot suggest that the PAL device may encourage a return to preprocedure baseline levels following ROP exams. CONCLUSION: NICU-MTs and nurses can collaboratively provide procedural support using a therapeutic music intervention such as the PAL device to comfort neonates during painful, invasive procedures.
PloS oneRebecca Silvers, Maly Chittaphai, Matt Evans, Jessica Van Meter
BACKGROUND: In 2015, the child mortality rate in Laos was 53.6 per 1,000 live births. The Lao Friends Hospital for Children (LFHC) in Luang Prabang was established to enhance access to specialized pediatric care. To support workforce development, a Pediatric Nursing Training Program was implemented. However, the program has not undergone a formal evaluation since its inception. This study aims to evaluate the program's first five years. STUDY DESIGN: The evaluation included a review of curriculum documents via an online platform and feedback collection through an online survey administered to former expatriate nurse volunteers who provided clinical mentorship. Additionally, semi-structured interviews were conducted with former nurse leaders who designed and implemented the program. Qualitative data were analyzed thematically and validated through triangulation. RESULTS: The curriculum review revealed system-based and course-specific plans, including clear objectives, teaching methods, and evaluation tools. Of the 148 clinical mentors surveyed, a 45% response rate was achieved. Survey responses indicated improvements in nurses' clinical skills since the program's inception, with mentors emphasizing the importance of cultural attunement to Lao staff. Six out of seven former nurse leaders participated in interviews. Key themes emerged, highlighting the value of culturally relevant educational materials, multimodal teaching strategies, a train-the-trainer approach, and clinical mentorship as integral components of the program. CONCLUSION: The development of pediatric nursing specialization at LFHC was facilitated by structured curriculum plans, cultural sensitivity, diverse teaching methodologies, and robust clinical mentorship. These findings provide valuable insights for designing culturally competent and sustainable training programs in Laos and similar contexts.
Experimental and clinical transplantation : official journal of the Middle East Society for Organ TransplantationHalil Ibrahim Tasdemir, Deniz Tasdemir
OBJECTIVES: We aimed to explore the experiences, challenges, and coping strategies of nurses working in pediatric organ transplant clinics in Türkiye. We investigated emotional stressors, ethical dilemmas, communication challenges, and the effectiveness of institutional support to address these challenges. MATERIALS AND METHODS: A qualitative descriptive study design was employed. Data were collected through semi -structured face -to -face interviews with 20 organ transplant nurses from various hospitals in Türkiye. We used a purposive sampling method to select the participants. We used qualitative data analysis software (NVivo; version 12 ) to identify recurring themes related to emotional distress, ethical concerns, communication issues, and coping strategies. Ethical approval was obtained from the relevant institutional review board, and informed consent was secured from all participants. RESULTS: Thematic analysis revealed 4 main categories: emotional challenges, ethical dilemmas, communication challenges, and coping strategies. Nurses reported experiencing high levels of stress and burnout due to prolonged exposure to critically ill children. Ethical dilemmas related to organ allocation decisions created additional moral distress. Communication challenges were primarily linked to breaking bad news to patients' families and managing unrealistic expectations from families. Coping mechanisms included reliance on peer support, use of previously established personal resilience strategies, and access to institutional psychological support. CONCLUSIONS: Pediatric organ transplant nurses encounter important emotional, ethical, and communication challenges. Enhancing institutional support structures, providing targeted psychological counseling, and improving communication training programs could alleviate these concerns and thereby improve both nurse well -being and patient care outcomes. Future multicenter studies would expand the generalizability of these findings and identify best practices for institutional support of transplant nurses.
Neonatal network : NNWilliam L Hull, Meredith L Farmer, Tracey Bell, Jessica M Jones, Curry Bordelon
Multiple imaging modalities are used to diagnose, care for, and manage infants in the NICU. Each modality provides unique benefits; however, radiography remains the most common. This article aims to highlight the use of x-rays by reviewing indications, applications, and a systematic interpretation-guiding process. Evaluation, common pathologies, and considerations are discussed to bridge the gap between fundamental concepts and clinical practice, thereby enhancing neonatal care. This article is designed as an educational resource for all neonatal providers and trainees. Finally, a case study allows readers to practice applying concepts in a real-world, clinically relevant context.
Neonatal network : NNLenora Marcellus, Miranda May Marie Amundsen
Social and community context, the final domain in the Centers for Disease Control and Prevention's determinants of health framework, influences the health and well-being of neonates and their families in many ways that may not always have been considered in neonatal intensive care settings. Building on previous columns, here the impacts of social and community context are described, focusing on community cohesion, justice-related issues, and discrimination and stigma. In this column, we encourage neonatal nurses to consider how the social environment impacts neonates and families during their NICU stay and after discharge. Actions that nurses can take within the NICU setting and externally are described and resources are provided.
INTRODUCTION: Paediatric clinical education presents unique challenges for nursing students owing to the clinical complexity and emotional sensitivity of caring for ill children and their families. This high-stakes period profoundly influences students' professional identity. This study aims to explore the lived experiences of nursing students during their paediatric practicum through a descriptive phenomenological lens. METHODS AND ANALYSIS: This study will be conducted using a qualitative design with a descriptive phenomenological approach. Data will be collected through in-depth, semi-structured interviews with undergraduate nursing students who have completed their paediatric clinical rotation. Purposive sampling will be employed, continuing until data saturation is achieved. Interviews will be recorded in a quiet confidential setting and subsequently transcribed verbatim. Data analysis will follow Colaizzi's seven-step method, involving independent analysis by three researchers followed by group consensus. To ensure rigour and trustworthiness, strategies such as researcher triangulation, member checking and maintaining an audit trail will be utilised. ETHICS AND DISSEMINATION: The Ethics Committee of Qazvin University of Medical Sciences has granted ethical approval for this study. The findings will be published in a peer-reviewed journal and presented at relevant conferences. Furthermore, the results will be shared with nursing faculties and paediatric nursing departments to inform educational practices.
Recherche en soins infirmiersSandra Bonilla, Assumpta Ndengeyingoma, Lucie Lemelin
INTRODUCTION: The perinatal period involves complex care and requires collaboration among multiple healthcare professionals. Nurses play a central role; however, the literature often describes their activities in a fragmented manner. OBJECTIVE: To map the nursing roles and competencies involved in perinatal care. METHODS: A scoping review was conducted following Peters et al. (2020). Five databases and the grey literature were searched for relevant publications (2015-2025; in French and English). Thirty-seven documents were included and analyzed using an inductive thematic approach. RESULTS: Seven roles were identified: direct clinical care, education and support, coordination and collaboration, organization and management, leadership and mentorship, research, and sociopolitical advocacy. These roles are supported by competencies in clinical reasoning, therapeutic communication, educational intervention, humanistic support, interprofessional collaboration, quality and safety, clinical influence, ethical reflection, cultural safety and equity, and the mobilization of best available evidence. DISCUSSION: Roles and competencies vary according to job titles, training, regulatory and organizational frameworks, and families&#8217; needs. Interprofessional role overlap and structural barriers limit the full enactment of nursing roles, particularly in advanced practice settings. CONCLUSION: Greater recognition of nursing competencies and updated training may strengthen the quality and equity of perinatal care.
Sante publique (Vandoeuvre-les-Nancy, France)Madeleine Collombier, Emmanuelle du Plessis
INTRODUCTION: The private practice of children&#8217;s nurses in France remains poorly documented, although it could contribute to early prevention and parental support during the first years of life. This study aims to describe their professional practices and their role within child healthcare pathways. METHODS: A national descriptive survey was conducted in 2024 among children&#8217;s nurses working in private practice, using an online questionnaire disseminated through professional networks. Data were analyzed using descriptive and thematic approaches. RESULTS: Most children&#8217;s nurses in private practice are highly experienced professionals, focusing their activities on prevention and health education for children aged 0&#8211;6 years and their families. They provide individual consultations, but also implement innovative approaches such as group workshops and &#8220;parent circles,&#8221; which promote experience sharing and parental empowerment. Their interventions complement those of general practitioners, midwives, and maternal and child health services. Technical care is marginal, whereas psychosocial support and parental guidance are central. Motivations for private practice include professional autonomy and the desire to address unmet needs. However, the lack of public funding through national health insurance remains a major obstacle to the development and accessibility of this practice. CONCLUSION: Private practice of children&#8217;s nurses represents an emerging resource to strengthen early prevention and complement the work of other primary care professionals. Better integration into coordinated care pathways, inspired by international models, could help consolidate public health policies in favor of early childhood and, potentially, adolescence.
Journal of nursing managementBrenda Van Delft, Melissa Lauwerens, Manuela Bastanie, Ann Berghs, Ingrid Deroover, Dorien Evens, Geert Lingier, Anne Malcort, Marianne Peelman, Agna Preudhomm…
BACKGROUND: Continuous advancements in neonatal intensive care (NICU) have increased the complexity of care and the workload of nurses. Existing workload measurement instruments, such as the Winnipeg Assessment of Neonatal Nurses Needs Tool (WANNNT), are valuable but require adaptation to local healthcare settings. OBJECTIVE: This study aimed to adapt and validate the WANNNT for the Belgian NICU context, resulting in the BE-WANNNT. METHODS: A 2-year observational mixed-methods study was conducted. First, the original WANNNT and WANNNT-SC were translated and adapted to the Belgian context, incorporating corrected gestational age, updated respiratory modalities, and restructuring of indicators by physiological systems. Using the Policy Delphi method, an expert panel of NICU head nurses (n = 8) reviewed and refined 49 indicators across six consensus rounds. Subsequently, an online survey was distributed to NICU nurses and midwives (n = 76) to evaluate indicator clarity, relevance, and care intensity using a four-point Likert scale. Qualitative data were analyzed thematically, while quantitative data were assessed with descriptive and inferential statistics. RESULTS: The preliminary BE-WANNNT was modified to reflect current Belgian NICU practices. Consensus was reached on the majority of indicators, with 45 of 49 achieving ≥ 75% agreement for clarity and relevance. Four indicators (e.g., low-flow nasal cannula, neonatal abstinence syndrome < 8, cardiorespiratory monitoring, and saturation measurement) did not reach consensus but were retained after expert evaluation. Care intensity levels were confirmed for 38 indicators, while 11 required reconsideration, resulting in minor adjustments. The final BE-WANNNT consists of six care levels and a contextually adapted and content validated set of indicators, enabling structured assessment of nursing workload in Belgian NICUs. CONCLUSION: The BE-WANNNT is the first workload assessment tool specifically adapted for the Belgian NICU context. It provides a structured and contextually adapted framework to support workload assessment and evidence-informed staffing discussions in neonatal intensive care. Future research is needed to evaluate inter-rater reliability, additional psychometric properties, and the long-term impact on workforce planning, nurse well-being, and patient outcomes.
Medical journal (Fort Sam Houston, Tex.)Christopher H Stucky, Mashandra D Elam-Canty
This case study details a U.S. Army perinatal clinical nurse specialist's (66G7T) experience providing advanced obstetric care, including an unexpected twin delivery, in a resource-constrained environment at Kamenge Military Hospital in Bujumbura, Burundi, during a Medical Readiness Exercise (MEDREX). It illustrates the practical application of the U.S. Army Medical Department's dual mission of military readiness and global humanitarian engagement. The narrative highlights the critical need for adaptability, resourcefulness, and cultural humility when working in austere settings. This experience goes beyond standard combat-focused medical training, emphasizing that nurses must be prepared to deliver specialized care, such as perinatal nursing, in environments with severe resource limitations and differing cultural norms. It suggests that future military medical education should explicitly integrate training for these complex scenarios, fostering the skills necessary for effective global health engagement and humanitarian missions. The case study also underscores the mutual learning and strengthened partnerships fostered by international medical collaboration for impactful global health outcomes.
Journal of nursing managementLeah Rosengarten, Laura Jillian Park, Marco Tomietto
AIM: To explore paediatric nurses' experiences and perceptions of personal and professional development (PPD). BACKGROUND: PPD is a crucial factor in enhancing nurses' job satisfaction and retention. Whilst this topic has been widely explored in general nursing, limited research exists on how paediatric nurses perceive and experience PPD. Registered nurses at the standard clinical grade (Band 5) comprise the majority of the children's nursing workforce, but are rarely the focus of PPD. DESIGN: This UK-based qualitative study used interpretative phenomenological analysis (IPA) following COREQ guidelines. Trustworthiness was ensured through researcher reflexivity, PhD supervision and member checking. METHODS: A purposeful sample of 15 nurses working in acute paediatric services across four organisations were interviewed, with a range of ages, experiences and work qualifications. Each participant was interviewed twice, and data were analysed using a seven-step IPA framework. RESULTS: Four overarching themes emerged: Individual impact, work location, employing organisation and external factors. PPD was experienced as a dynamic, non-linear process shaped by intrinsic motivation, personal circumstance, workplace culture and managerial gatekeeping, staffing constraints, organisational funding and geographic inequity. Paediatric nurses felt undervalued when compared to other nursing fields, experiencing limited field-specific development. CONCLUSIONS: This study suggests the implementation of organisational strategies at the unit and hospital level to support PPD. To shape the most effective approaches, it is also necessary to consider individual and extra-organisational levels, which might affect the human resource management in this area. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers must act as enablers rather than gatekeepers of PPD. It is key to ensure equitable access to opportunities, with adequate staffing and field-specific pathways of development. National minimum standards for paediatric nursing PPD are needed to address systemic inequity.