Journal articles on the topic 'Specialist Nurse in Child and Pediatric Health Nursing'

AimTo determine the impact of replacing a nurse with a ward-based pharmacy technician as the second checker, in the process of administering medicines to children in hospital by exploring the views and experiences of parents and staff involved in the change in practice.MethodHaving undertaken additional in-house training, a pharmacy technician replaced the second nurse on medication ward rounds (second checker) for 10 months over two wards. This took place on a neuro-medical ward and a medical specialty ward. The pharmacy technician undertook roles relating to medicines administration, including: attending day time medicine administration rounds; checking accuracy and appropriateness of prescriptions; preparing/administering prescribed medicines; independently undertaking dosage calculations; recording the administration of medicines. Using their specialist knowledge and skills, the role aimed to improve medicines optimisation for patients and their families during their inpatient stay.Research staff conducted semi-structured qualitative interviews with parents of patients who were administered medicines during the study period (n=12) and with staff involved with the change in practice, as well as an interview with the pharmacy technician themselves after leaving each ward. Families were recruited from the two wards. Semi-structured interviews with staff (n=14) gathered data on the perspectives and experiences of the contribution of the ward-based pharmacy technician across two wards. An exploratory approach was taken using Thematic Analysis.1 Interviews were transcribed verbatim and anonymised. The research team familiarised themselves with transcripts by reading in full and generating initial codes using text from the data. Themes were generated and discussed between the team to produce an overall story of the analysis. Interviews were conducted over a 4 month period.ResultsParents discussed the importance of communication about their child’s medicines in hospital. Some parents were aware of the pharmacy technician’s role as second checker. Parents recognised the benefits of the technician’s background and expertise, and their contribution to the ward team.Fourteen staff interviews were conducted including the ward based pharmacy technician (after leaving each ward), the Chief Pharmacist, the Director of Nursing, a Ward Manager, Nursing and Pharmacy staff. Staff commented how the pharmacy technician provided a link between the Pharmacy and Nursing teams, alleviating nurses of administration duties and allowing them to spend more time with patients. The role was also seen as educational allowing for nurses to refresh their knowledge on medication storage procedures and alternative methods of administration.ConclusionTo the research team’s knowledge, this is the first study of its kind to assess the potential benefits of introducing a ward-based pharmacy technician as a second checker. This novel role extension releases nursing staff time to undertake more patient-centred nursing duties. In addition, the specialist knowledge of the pharmacy technician at the point of medicine administration had a positive impact on medicines optimisation for children in hospital, providing more effective administration of medicines and contributing to wider patient safety in paediatric settings. Although further evaluation is required, our findings indicate that parental and staff support the future development of this service.ReferenceBraun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology 2006;3(2):77–101.

OBJECTIVE: To describe the epidemiological characteristics of all exogenic poisoning cases in children assisted in a pediatric emergency unit in Recife, State of Pernambuco, Brazil, from April to September 2006. METHODS: This is a descriptive study of exogenic poisoning in 0-12 aged children treated at Centro de Assistência Toxicológica de Pernambuco (Pernambuco Toxicological Assistance Center). The data were collected through interviews and by consulting patients' records. RESULTS: 26 cases of accidental exogenic poisoning were registered, mainly males (65.4%). Regarding age, children under five years old were the most affected (65.4%). Medication was involved in 50.0% of the cases. CONCLUSION: Accidental exogenic poisoning affecting children younger than five years of age stands out as a significant public health problem. As a member of a multiprofessional health team, the nurse plays an important role in health education and in the measures to prevent child poisoning.

AbstractProcedural sedation and analgesia outside the operating theater have become standard care in managing pain and anxiety in children undergoing diagnostic and therapeutic procedures. The objectives of this study are to describe the current pediatric procedural sedation and analgesia practice patterns in European emergency departments, to perform a needs assessment-like analysis, and to identify barriers to implementation. A survey study of European emergency departments treating children was conducted. Through a lead research coordinator identified through the Research in European Pediatric Emergency Medicine (REPEM) network for each of the participating countries, a 30-question questionnaire was sent, targeting senior physicians at each site. Descriptive statistics were performed. One hundred and seventy-one sites participated, treating approximately 5 million children/year and representing 19 countries, with a response rate of 89%. Of the procedural sedation and analgesia medications, midazolam (100%) and ketamine (91%) were available to most children, whereas propofol (67%), nitrous oxide (56%), intranasal fentanyl (47%), and chloral hydrate (42%) were less frequent. Children were sedated by general pediatricians in 82% of cases. Safety and monitoring guidelines were common (74%), but pre-procedural checklists (51%) and capnography (46%) less available. In 37% of the sites, the entire staff performing procedural sedation and analgesia were certified in pediatric advanced life support. Pediatric emergency medicine was a board-certified specialty in 3/19 countries. Physician (73%) and nursing (72%) shortages and lack of physical space (69%) were commonly reported as barriers to procedural sedation and analgesia. Nurse-directed triage protocols were in place in 52% of the sites, mostly for paracetamol (99%) and ibuprofen (91%). Tissue adhesive for laceration repair was available to 91% of children, while topical anesthetics for intravenous catheterization was available to 55%. Access to child life specialists (13%) and hypnosis (12%) was rare.Conclusion: Procedural sedation and analgesia are prevalent in European emergency departments, but some sedation agents and topical anesthetics are not widely available. Guidelines are common but further safety nets, nurse-directed triage analgesia, and nonpharmacologic support to procedural sedation and analgesia are lacking. Barriers to implementation include availability of sedation agents, staff shortage, and lack of space. What is Known:• Effective and prompt analgesia, anxiolysis, and sedation (PSA) outside the operating theatre have become standard in managing pain and anxiety in children undergoing painful or anxiogenic diagnostic and therapeutic procedures.• We searched PubMed up to September 15, 2020, without any date limits or language restrictions, using different combinations of the MeSH terms “pediatrics,” “hypnotics and sedatives,” “conscious sedation,” and “ambulatory surgical procedures” and the non-MeSH term “procedural sedation” and found no reports describing the current practice of pediatric PSA in Europe. What is New:• This study is, to the best of our knowledge, the first to shed light on the pediatric PSA practice in European EDs and uncovers important gaps in several domains, notably availability of sedation medications and topical anesthetics, safety aspects such as PSA provider training, availability of nonpharmacologic support to PSA, and high impact interventions such as nurse-directed triage analgesia.• Other identified barriers to PSA implementation include staff shortage, control of sedation medications by specialists outside the emergency department, and lack of space.

Abstract.NURSES SPECIALIST IN CHILD HEALTH AND PEDIATRICS AND PROMOTION OF BREASTFEEDING AFTER THE RETURN TO WORKBackground: In Portugal, breastfeeding rates are still below those recommended by the World Health Organization, despite the initiatives for its promotion. Most women choose and are favourable to breastfeeding. Working outside the home has become a reality for most women, and reconciling breastfeeding with the professional activity is often difficult. Thus, the return to work is one of the reasons mentioned by mothers for early breastfeeding cessation. The promotion of breastfeeding is a public health priority. Nurses’ attitudes and interventions influence the success of breastfeeding and help overcome some of the difficulties encountered. Objectives: To identify measures developed by primary care nurses specialized in Child Health and Pediatrics to promote breastfeeding and encourage working mothers to continue breastfeeding, as well as identify these nurses’ interventions toward the promotion of breastfeeding in the community, family, workplace, and day-care centers. Participants and Methods: Descriptive, cross-sectional study with a quantitative methodology using a sample of 13 nurses specialized in Child Health and Pediatrics working in Health Care Centers of a Cluster of Health Centers. Data were collected through semi-structured interviews between June and July 2015. Dara were analyzed using Bardin’s content analysis technique. Results: Aware of the need to promote breastfeeding after the mother’s return to work, nurses implement multiple interventions targeted at mothers, fathers, and grandparents (“breastfeeding corners”, phone support services, home visits, training sessions, celebration of the World Breastfeeding Week) in nursing consultations. Conclusions: Nurses only intervene in nursing consultations. However, there are other places where nurses should intervene, namely day-care centers, the workplace, and the community in general, with the purpose of reducing early breastfeeding cessation due to the mothers’ return to workKeywords: Breastfeeding; Women, Working; Pediatric Nursing; Primary Health Care.Resumo. Antecedentes: Em Portugal, apesar das iniciativas desenvolvidas para promover o aleitamento materno, as taxas e suas práticas continuam abaixo do recomendado pela OMS. A generalidade das mulheres decide e é favorável à amamentação. Trabalhar fora de casa tornou-se uma realidade para a maioria das mulheres. Por vezes torna-se difícil conciliar o aleitamento materno com a atividade laboral e o regresso ao trabalho encontra- se entre um dos motivos apontados pelas mães para o abandono precoce da amamentação. Promover a amamentação é uma prioridade de saúde pública. As atitudes e intervenções dos enfermeiros exercem influência no processo/sucesso da amamentação e no ultrapassar de dificuldades que surgem. Objetivos: Conhecer as medidas promotoras da amamentação que os enfermeiros dos cuidados de saúde primários, especialistas em Enfermagem de Saúde Infantil e Pediatria, desenvolvem no sentido de apoiar as mães que trabalham a continuar a amamentar e identificar as intervenções promotoras da amamentação desenvolvidas por estes enfermeiros junto das mães, a nível da comunidade, na família, nos locais de trabalho, nas creches e nos seus próprios locais de trabalho. Participantes e Métodos: Estudo descritivo, transversal, segundo a metodologia qualitativa, junto de 13 enfermeiros Especialistas em Enfermagem de Saúde Infantil e Pediatria que trabalham em Centros de Saúde de um Agrupamento de Centros de Saúde. Colheram-se dados por entrevista semiestruturada entre Junho e Julho de 2015. No tratamento da informação recorreu-se à análise de conteúdo de Laurence Bardin. Resultados: Os Enfermeiros embora despertos para a necessidade de promover a manutenção da amamentação após o regresso das mães ao trabalho desenvolvem, predominantemente no contexto das consultas de enfermagem, várias intervenções (cantinhos da amamentação, apoio telefónico, visita domiciliária, ensinos, comemoração da semana mundial do aleitamento materno) junto das mães, pais e avós. Conclusões: A atuação dos Enfermeiros resume-se ao contexto das consultas de enfermagem. Há contudo, outros locais onde as intervenções de enfermagem devem chegar, nomeadamente, creches, entidades patronais e sociedade em geral, com vista a reduzir o desmame precoce motivado pelo regresso das mães ao trabalho.Palavras-chave: Aleitamento Materno; Mulheres Trabalhadoras; Enfermagem Pediátrica; Cuidados de Saúde Primários.

Abstract.NURSES SPECIALIST IN CHILD HEALTH AND PEDIATRICS AND PROMOTION OF BREASTFEEDING AFTER THE RETURN TO WORKBackground: In Portugal, breastfeeding rates are still below those recommended by the World Health Organization, despite the initiatives for its promotion. Most women choose and are favourable to breastfeeding. Working outside the home has become a reality for most women, and reconciling breastfeeding with the professional activity is often difficult. Thus, the return to work is one of the reasons mentioned by mothers for early breastfeeding cessation. The promotion of breastfeeding is a public health priority. Nurses’ attitudes and interventions influence the success of breastfeeding and help overcome some of the difficulties encountered. Objectives: To identify measures developed by primary care nurses specialized in Child Health and Pediatrics to promote breastfeeding and encourage working mothers to continue breastfeeding, as well as identify these nurses’ interventions toward the promotion of breastfeeding in the community, family, workplace, and day-care centers. Participants and Methods: Descriptive, cross-sectional study with a quantitative methodology using a sample of 13 nurses specialized in Child Health and Pediatrics working in Health Care Centers of a Cluster of Health Centers. Data were collected through semi-structured interviews between June and July 2015. Dara were analyzed using Bardin’s content analysis technique. Results: Aware of the need to promote breastfeeding after the mother’s return to work, nurses implement multiple interventions targeted at mothers, fathers, and grandparents (“breastfeeding corners”, phone support services, home visits, training sessions, celebration of the World Breastfeeding Week) in nursing consultations. Conclusions: Nurses only intervene in nursing consultations. However, there are other places where nurses should intervene, namely day-care centers, the workplace, and the community in general, with the purpose of reducing early breastfeeding cessation due to the mothers’ return to workKeywords: Breastfeeding; Women, Working; Pediatric Nursing; Primary Health Care.Resumo.Antecedentes: Em Portugal, apesar das iniciativas desenvolvidas para promover o aleitamento materno, as taxas e suas práticas continuam abaixo do recomendado pela OMS. A generalidade das mulheres decide e é favorável à amamentação. Trabalhar fora de casa tornou-se uma realidade para a maioria das mulheres. Por vezes torna-se difícil conciliar o aleitamento materno com a atividade laboral e o regresso ao trabalho encontra-se entre um dos motivos apontados pelas mães para o abandono precoce da amamentação. Promover a amamentação é uma prioridade de saúde pública. As atitudes e intervenções dos enfermeiros exercem influência no processo/sucesso da amamentação e no ultrapassar de dificuldades que surgem. Objetivos: Conhecer as medidas promotoras da amamentação que os enfermeiros dos cuidados de saúde primários, especialistas em Enfermagem de Saúde Infantil e Pediatria, desenvolvem no sentido de apoiar as mães que trabalham a continuar a amamentar e identificar as intervenções promotoras da amamentação desenvolvidas por estes enfermeiros junto das mães, a nível da comunidade, na família, nos locais de trabalho, nas creches e nos seus próprios locais de trabalho. Participantes e Métodos: Estudo descritivo, transversal, segundo a metodologia qualitativa, junto de 13 enfermeiros Especialistas em Enfermagem de Saúde Infantil e Pediatria que trabalham em Centros de Saúde de um Agrupamento de Centros de Saúde. Colheram-se dados por entrevista semiestruturada entre Junho e Julho de 2015. No tratamento da informação recorreu-se à análise de conteúdo de Laurence Bardin. Resultados: Os Enfermeiros embora despertos para a necessidade de promover a manutenção da amamentação após o regresso das mães ao trabalho desenvolvem, predominantemente no contexto das consultas de enfermagem, várias intervenções (cantinhos da amamentação, apoio telefónico, visita domiciliária, ensinos, comemoração da semana mundial do aleitamento materno) junto das mães, pais e avós. Conclusões: A atuação dos Enfermeiros resume-se ao contexto das consultas de enfermagem. Há contudo, outros locais onde as intervenções de enfermagem devem chegar, nomeadamente, creches, entidades patronais e sociedade em geral, com vista a reduzir o desmame precoce motivado pelo regresso das mães ao trabalho.Palavras-chave: Aleitamento Materno; Mulheres Trabalhadoras; Enfermagem Pediátrica; Cuidados de Saúde Primários.

BackgroundPressures to open pharmacy services 7 days a week, with no financial input for these extra resources, has knock on effects that may dilute accessibility to clinical pharmacists in specialist areas.AimsThe aim of this survey was to assess opinions of the users of the current pharmacy services to PICU and the planned extended hours provision.MethodAn e-survey was sent to PIC Consultants, Advanced Nurse Practitioners, and Senior Nursing Staff following a six month period of increased clinical pharmacists time allocation to PIC. Free-text area was added to each multiple choice question.ResultsTwenty-four staff responded, 14 prescribers and 10 senior nursesPresence of PICU trained clinical pharmacist on morning ward rounds was considered essential by 19 (79%) respondents and desirable by 4 (17%). Attendance on the afternoon round was deemed essential by 14 (59%) and desirable by 8 (33%) of respondents.Comments on the benefits of pharmacists on ward rounds included:“Enabling a second professional review of the patient overall—it prevents forced direction from the consultant and the pharmacists are empowered to ask us to reconsider. Very useful to have this safety and reality check.”“Essential for the guidance of drug usage and drug chart review which improves safety, benefit of advice for use with specialist patients, best cost approach, multiple benefits.”Roles expected as routine from the clinical pharmacist included patient safety (100%), managing parenteral nutrition (80%), advice on intravenous therapy e.g. compatibility (100%), education of the multidisciplinary team (96%), management of long term medicines e.g. sedation withdrawal (83%), and therapeutic drug monitoring control (83%).Only 6 respondents felt the PICU patient would benefit from extending access to dispensary only over weekends, 11 felt that there was no benefit, and 6 respondent unsure.Provision of the pharmacy on call service which involves both supply and clinical advice, was felt sufficient to the requirements of the PICU patient by less than a third of repondents,56% feeling the current service insufficient. Comments on the on call service included.“difficult to get experienced advice on weekends”“need access to pic pharmacists officially.”“we may direct queries to the on call pharmacy staff but 9 times out of 10 theses queries are redirected to our PICU pharmacists. Our questions are answered at any time of the weekend”Ninety one percent answered positively to the final question asked about extending the current clinical pharmacy service from 5 to 7 days per week. Comments included.“PICU is a 24 hr, 7 day a week service…how we can provide adequate care to children if this valuable service is only provided 5 days a week.”ConclusionPharmacy is a valued service on PICU, where the service users support increased access and attendance on certain ward rounds by specifically PICU trained pharmacist.

IntroductionDemand from local NHS stakeholders identified a gap for a taught education course tailored to the niche requirements of paediatric healthcare staff wishing to become non-medical prescribers. This was seen as an excellent opportunity to review and develop the pharmacology module within the Non-medical Prescribing (NMP) course by giving it a paediatric focus.AimTo develop a pharmacology module with an emphasis on paediatric prescribing that meets the professional requirements of the General Pharmaceutical Council (GPhC), the Nursing and Midwifery Council (NMC) and the Health Care Professions Council (HCPC).MethodKnowledge of curriculum design and structure was utilised in developing the paediatric pharmacology module. This ensured that the underpinning theory of prescribing medicines safely for children was delivered at the right academic level. The content, delivery and learning outcomes were dictated by the Prescribing Competency Framework for All Prescribers (RPS, 2016).1 But the cognitive teaching and learning methods arose from the rigid expectation to meet the regulatory requirements of each professional body. To ensure consistency across the whole NMP programme, the structure of the pharmacology module assessments (both formative and summative) was kept the same. The summative (final) assessments consisted of a multiple choice question (MCQ) paper requiring the students to answer a total of twenty MCQs, with the pass mark set by the regulatory bodies at 80%; a drug calculations paper consisting of five questions with a 100% pass mark; and a 5 minute information giving OSCE (objective structured clinical examination). The whole module was looked at a fresh from a paediatric perspective. The content and timetable were compiled and reviewed jointly by a paediatric pharmacist and a paediatric nurse. Both were experienced academics already teaching on the NMP course. While some of the lectures were delivered by in-house university academic staff, the majority of the sessions were delivered by specialist paediatric guest lecturers who were actively working in their respective clinical fields. This ensured that the knowledge imparted to students was practical, current and relevant to prescribing for children.ResultsAll students had to be practising in paediatrics for a minimum period of two years and have evidence of studying at level 6 (graduate level) or equivalent. The target audience consisted of allied healthcare professionals specialising in paediatrics, including nurses, pharmacists, optometrists, physiotherapists, podiatrists, dieticians and therapeutic radiographers. However, the first cohort of 51 students comprised entirely of paediatric nurses. The majority of students passed each assessment first time. All students passed the 5-minute information giving OSCE, but 25% of the students had to re-sit the pharmacology MCQ paper and 17% had to re-sit the drug calculations paper. Following the resits the remaining students all passed except for one student who failed the course.ConclusionOverall, the course was well received, with positive feedback from most students and stakeholders. Valuable suggestions were also received for further improvements to the course and pharmacology module. These are currently being implemented with intake of students.ReferenceRoyal Pharmaceutical Society ( 2016) A competency framework for all prescribers. Available from: http://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Professional%20standards/Prescribing%20competency%20framework/prescribing-competency-framework.pdf [Accessed 25/6/19]

Bronchopulmonary dysplasia (BPD) requires collaborative management in the pediatric health care setting. Because of the nature of the medical diagnoses, BPD can be viewed by nurses using selected nursing diagnoses. With the pediatric client, nursing diagnoses can assist the nurse to identify system alterations, and thereby address nursing interventions most appropriate for the child. Nursing interventions are based on collaborative decision making using both medical and nursing diagnoses. This case study will identify selected nursing diagnoses useful in the care of the child with BPD and nursing interventions used to treat frequently occurring health problems

This study evaluated the effects of Certified Child Life Specialist (CCLS) intervention on pediatric distress and pain and family satisfaction during routine peripheral intravenous (PIV) line placement in the emergency department (ED). A convenience sample of 78 children (3-13 years) requiring PIV placement for their treatment at a regional level 1 pediatric trauma center ED with 70 000 annual visits were selected to receive either standard nursing care or CCLS intervention for PIV placement. CCLS involvement was associated with fewer negative emotional behaviors as indicated by a lower score on the Children’s Emotional Manifestation Scale (−3.37 ± 1.49, P = .027), a reduction in self-reported pain on the Wong-Baker Faces pain rating scale (−1.107 ± 0.445, P = .017), an increase in parent-reported patient cooperation during PIV placement, and greater satisfaction with the ED visit. This study demonstrates that Child Life can have an impact on important outcomes in the pediatric ED such as distress, pain, and visit satisfaction.

Abstract BACKGROUND “…The field of paediatric pain medicine has demonstrated the benefits of interdisciplinary collaboration more than any other endeavour” (Law, Palermo, & Walco, 2013). Recently, the Ontario Ministry of Health and Long-term Care announced the funding of specialty paediatric chronic pain programs in several children’s hospitals across the province of Ontario, including McMaster Children’s Hospital. The Pediatric Chronic Pain Program includes Physicians (Pediatricians, Psychiatrist, Anesthesiologist), Psychologists, Child Life Specialist, Registered Nurse, Nurse Practitioner, Occupational Therapist, Physiotherapist, Social Workers, Pharmacist, and a Clinical Manager. OBJECTIVES The purpose of this poster is to highlight new initiatives within our clinic, including the development of a pain education session for families, group treatments (e.g., a 5 week Rise Above Pain Group; a 5-week Parenting Group), and a research database (to allow for program evaluation integrated within our clinical work). DESIGN/METHODS Challenges in developing a new clinic/new programs and providing care to complex families (e.g., professional roles and competencies, diagnostic discrepancies) will be discussed. CONCLUSION Implications for program development in new and established clinics will be highlighted.

Abstract INTRODUCTION Pediatric neuro-oncology requires attention to not only cancer biology and therapeutics, but also to the suffering of the patient. In addressing patient suffering, consensus guidelines direct attention to the spiritual distress and resources of patients and families. A lack of training has been a key barrier to integrating this aspect of health into patient care. METHODS A neuro-oncologist and a chaplain participated in a train the trainer for the Interprofessional Spiritual Care Education Curriculum (ISPEC) through the George Washington University’s Institute for Spirituality and Health. After the train the trainer, the online curriculum was offered to interdepartmental team members, combined with in-person discussion groups, which met weekly for six sessions. A survey was given before and after the training, and Likert scores were analyzed using the Wilcoxon rank-sum non-parametric test. OUTCOMES: 17 interdisciplinary members participated in the training. These members included neuro-oncologists, neuro-surgeons, rehabilitation physicians, nurse practitioners, nurses, physical therapists, music therapists, a child life specialist, a school liaison, and a patient experience specialist. The training resulted in multiple improvements, including increased ability to identify spiritual issues (p=.0278) and increased ability to respond to these issues (p=.0056). CONCLUSION ISPEC addressed a key barrier to providing generalist spiritual care to patients with pediatric brain tumors. Diverse disciplines were represented during the training. With implementation of interdisciplinary spiritual care, outcomes that may be measured in the future include improved quality of life, patient satisfaction, and the resilience of both patients and team members.

The Children's Hospital at Providence (TCHaP) is a hospital within a hospital, in the heart of Alaska's biggest city, Anchorage. TCHaP admits up to 60 extremely low birth weight (ELBW) neonates per year. The ELBW population, although small in number, contributes disproportionately to rates of death or serious morbidities. Nationally, ELBW is defined as a neonate born at a gestational age between 22 and 29 weeks. In 2014, only 38 percent of neonates born in Alaska <28 weeks survived without experiencing major morbidities. For those born <26 weeks, morbidity-free survival dropped to 25 percent. Discussions were held among NICU nursing leaders, clinical nurses, and physicians about current co-morbidities and potentially best practices to improve outcomes. Subsequently, the group decided to develop best practices for managing the care of the ELBW, which started by organizing a group of specialists. This group at TCHaP is called the Wee CARE team.

The purpose of this study was to evaluate the effrcacy of using a telecommunication system to assist in the outpatient management of pediatric patients with insulin- dependent diabetes. Metabolic control, patients' psychosocial status, family functioning, perceived quality of life, patterns of parental/child responsibility for daily diabetes maintenance, and nursing time-on-task were evaluated. One hundred six pediatric patients (mean age= 13.3 years) were randomly assigned to an experimental or control outpatient clinic for 1 year. Experimental subjects transmitted self-monitoring blood glucose data by modem to the hospital every 2 weeks. Transmitted data were reviewed by nurse practitioners who telephoned subjects to discuss regimen adjustments. Control subjects received standard care with regimen adjustments made by physicians. There were no significant between-group differences for metabolic control, rates of hospitalization or emergency-room visits, psychological status, general family functioning, quality of life, or parent-child responsibility. A significant decrease was noted in nursing time-on-task for experimental subjects.

Purpose: This study aimed to identify the factors affecting the quality of nursing care as perceived by mothers of hospitalized children and provide basic data for the development of nursing care quality improvement programs.Methods: The participants consisted of 167 mothers, each of whom had a child hospitalized at a specific children's hospital. Data were collected from June 22 to August 8, 2019.Results: The factors that affected how mothers perceived the quality of nursing care were the communication ability of nurses (β=.44, <i>p</i><.001) and the mother-nurse partnership (β=.33, <i>p</i>=.001). The total explanatory power of these factors was 54.1%.Conclusion: To improve the quality of pediatric nursing care, it is necessary to improve the communication abilities of nurses and to promote partnership between nurses and the mothers of hospitalized children.

AbstractIntroduction. Behaviour according to the ethical principles is meaningful for shaping of nurses’ ethical and professional attitude. Contact between the nurse and the sick child requires an ethical model and professional attitude, excellent politeness and sensitivity.Aim. Assessment of ethical attitudes in the opinion of pediatric nurses.Material and method. Research was conducted among 133 nurses working in two hospitals in Łodz: in the Clinical Hospital No. 4 of Medical University and in the Institute of Polish Mother’s Health Center. The study used questionnaire of own design. Pearson correlation index determination was used for statistical analysis of the results.Results and conclusions. More than half examined nurses (63.4%) was able to give a correct definition of professional ethics. The nursing profession was not connected only with earnings in the opinion of 86.4% nurses. Most respondents (56.8%) have admitted that nurses not always behave ethically. Too low salary was the most often mentioned reason (67%) for not ethical behaviour. High sense of responsibility and patience are the main features which mus distinguish the nurse. More than half of the respondents would choose this profession again. Participants claimed most often (95.5%) that nurses should deepen their knowledge permanently, but not everyone even in this group, does it.

Background: Childhood cancer affects the entire family. Siblings experience similar stress to that of the ill child, including anger, depression, jealousy, guilt, and social isolation. School reentry programs are shown to be positive interventions for patients, it is hypothesized that similar outcomes exist for siblings. Objective: To examine the feasibility of studying the impact of the Ontario Oncology Nurse School Visitation Program on the well-being and school adjustment of siblings of pediatric cancer patients. Methods: Fourteen sibling participants and parents completed a semistructured interview and the PedsQL® questionnaire before and after a nurse school visit. School attendance was also compared and data were collected for logistics of study procedures. Results: The mode of data collection was agreeable and easy to plan and execute. School attendance showed a reduction of days missed; there was no significant impact on PedsQL results but the interviews yielded positive feedback. Conclusions: The outlook for siblings improves with the support of family members and health care professionals. This pilot study provides hypotheses and design for future research.

AbstractObjective:The study was designed to explore the subjective perspective on end-of-life practices in three different groups of pediatric onco-hematologic nurses.Method:In 2004–2005 each member of the nursing staff of the Pediatric Onco-Hematology Ward of the University of Padua, Italy, and the Oncology Ward and Home Assistance Module of the Giannetta Gaslini Hospital, Genoa, Italy was interviewed using a semistructured questionnaire with open questions on end-of-life procedures. The results were returned to the interviewees through group meetings. Here, we examine replies given regarding terminal sedation.Results:With regard to the nurses from Padua, common features came together in a consolidated practice. The amount of suffering and physical pain was considered an element in determining the use of sedation: “when there is atrocious suffering.” Another aspect was “painful awareness,” the difficulty in being able to bear the fact that the child is aware that death is imminent. The nurses from Genoa stated that the procedure was adopted mainly for three reasons: to sedate the pain, to calm the hunger for air, and to control the anguish caused by the realization that death was imminent or unavoidable. It was noted that the nursing staff of the Home Assistance Unit, Genoa found themselves in a privileged position regarding this procedure both because of the strong relationship established among child, parents, and nurse, and because of being able to take shared decisions after in-depth discussion.Significance of results:The results enlighten the critical role of the nursing staff with respect to this procedure, given the involvement with the families and their ability to understand the child's demands and intimate expectations.

Children with cancer require repeated hospitalizations and the family’s everyday life and routines undergo change. Concrete descriptions of how nurses act when caring for children with cancer throughout the various phases of care and treatment are sparsely highlighted in the literature. The aim of this study was to describe young children with cancer and their parents’ experiences of nurses’ caring practices over a 3-year period, from diagnosis to follow-up. This study is based on semistructured interviews with 25 children newly diagnosed with cancer, aged 1 to 6 years, and their parents, connected to a pediatric oncology unit in Sweden. Child and parent data were analyzed with a deductive content analysis using Swanson’s theory of caring. The result shows that nurse care practices directed toward young children with cancer and their parents are to some extent similar across a 3-year period from diagnosis to follow-up but also differ in some ways. Nurses’ caring practices aim to support children and parents in the transition to a “new normal.” Child- and family-friendly care processes include the following: creating hope and a trustful relationship, asking rather than assuming, providing knowledge and information, performing tasks skillfully, displaying an interest in the child’s and parents’ life outside the hospital, and helping the family to trust in the future and other health care providers. Based on these results, we recommend the development of a standardized and structured nursing care plan or clinical guideline with detailed information on how to carry out clinical nurse care practices in the different phases.

Objective: To know the barriers in the process of building family cultural care for the child in the hospital. Methodology: This is a qualitative study with a cross-cultural theoretical reference of Madeleine Leininger, called Theory of Diversity and Cultural Universality of Care, and with a methodological reference of the ethno-inference. It was developed in 2017 at the pediatric unit of a university hospital in the south of Brazil, through non-participant observation, participant observation and interview with 15 family caregivers of hospitalized children. The data was coded, classified and scrutinized to identify the saturation of ideas and similar or different patterns; also, it was re-coded and the theoretical formulations and recommendations were performed. Ethical aspects were followed, according to the Resolution of the National Research Ethics Council 466/2012. Results: The data showed as a barrier the need for hospitalization as a factor of family vulnerability, control of the unit’s health team members, hospital norms and routines, and the need to transgress as a manifestation of family care. Conclusion: Cultural care is a process that aggregates knowledge and can be considered a new paradigm for the accomplishment of nursing care by providing the mutual growth and construction of new knowledge, an affective, reflexive, human and empathic relationship between the nurse, the child and the family.

A promising practice for educating anti-trafficking stakeholders in healthcare emerged through an innovative train-the-trainer programme from a National Association of Pediatric Nurse Practitioner’s initiative called the Alliance for Children in Trafficking (ACT). The purpose of this training is to provide effective, high-quality education development with wide dissemination and reach. The obstacles to in-person education due to COVID-19 resulted in a pivot to a virtual platform to continue the ACT Advocate programme. This paper considers the engagement of the nursing profession in operationalising the ACT Advocate programme as a way to lead advocacy and education efforts, using a public health approach, for effective responses to child trafficking.

Family Centered Care is family care carried out on an approach to health care. Job satisfaction is the result of employees' perceptions of the extent to which their work can provide an emotional state. Nurse work stress caused by workload can lead to work dissatisfaction with nurses, if viewed from a work environment that makes nurses feel uncomfortable at work, because some of the patient's parents refuse to be invited to cooperate in caring for patients, their parents assume that it is not his job but the work of a nurse. The purpose of this study was to determine the relationship of the Family Centered Care approach in pediatric patients with nurse job satisfaction in the rose care room of RSUD. H. A. Sulthan Daeng Radja of Bulukumba Regency in 2019. The research design used a cross sectional design. The population in this study were all child patient nurses, amounting to 52 people in the rose hospital care room. H. A. Sulthan Daeng Radja of Bulukumba Regency with a sampling technique using purposive sampling, the number of samples in this study were 30 respondents. Data obtained through questionnaire sheets adopted from other researchers for respondents. Data analysis used Fisher's alternative Chi-square test with significance level p = 0.05. The results showed that the implementation of the Family Centered Care approach in pediatric patients was not good as many as 18 respondents (60.0%) and the job satisfaction of nurses was satisfied as many as 16 respondents (53.3%). The results of the analysis using the SPSS application obtained the value of ρ = 0.001. The conclusion is that there is a relationship between the Family Centered Care approach in pediatric patients with nurse job satisfaction in the rose care room of RSUD. H. A. Sulthan Daeng Radja of Bulukumba Regency in 2019. It is hoped that this research can be used as additional knowledge for students in nursing management courses.

Abstract BACKGROUND Pediatric central nervous system (CNS) tumors are the leading solid tumors in the United States, but vastly under-reported in the African population. There’s limited data on childhood brain tumors as well as the histopathological distribution in Kenya. This report surveys as an initial site visit to determine the feasibility of a comprehensive neuro-oncology program at Kenyatta National Hospital (KNH) in Nairobi, Kenya. DESIGN: This collaboration began with a visit from the director of neuropathology at KNH to our neuro-Oncology program at Riley Hospital for Children at Indiana University Health in May 2019. This report includes recommendations from the May 2019 trip, as well as a reciprocal site visit to Kenya in January 2020. RESULTS Building off the May 2019 trip, a brain tumor registry has been initiated and maintained. Additionally, the KNH program has many necessary components to forming a comprehensive neuro-oncology program, including capable neurosurgeons with a neurosurgical training program, radiology, intensive care unit, oncology ward, rehab, skilled nursing, and radiation oncology services. Currently, neurosurgery, radiology, and pathology meet weekly to review challenging cases. CONCLUSION Kenyatta National Hospital has the expertise to build a comprehensive neuro-oncology program. The program currently lacks a dedicated nurse coordinator and “specialist” in neuro-oncology. Ongoing discussions with local stakeholders are aimed to galvanize national support to improve awareness for children with brain tumors and to plan a multidisciplinary neuro-oncology symposium in 2021. In the meantime, telemedicine efforts can support nursing education and reiterate the multidisciplinary needs for children with brain tumors.

Abstract Although the vast majority of youths with an eating disorder (ED) are treated as outpatients, some require treatment in an inpatient unit. The purpose of this study was to determine the attitudes of nurses and pediatric residents towards adolescents and young adults with ED. Methods: Nursing questionnaires were distributed through a nurse manager and resident questionnaires were distributed in coordination with the chief residents. Results: A total of 82 individuals (32 nurses and 50 pediatric residents) completed the survey. Only two nurses and six residents had not worked with a patient with an ED in the previous year. The vast majority of nurses and residents recognized that fear of gaining weight, refusal to maintain body weight and, disturbed body image were frequent signs occurring in patients with an ED. Both nurses and residents believed that emotional problems, influence of friends and family, family pressure, influence of the media, and being self-induced were the most likely causes of EDs. Genetics and influence of other medical problems were deemed less likely causes. The majority of residents identified having different rules for different patients and poor communication as factors that make it difficult to take care of ED patients. More than half of all nurses and residents (58.2%) thought that ED patients were responsible for their disease “always” or “in most cases”. Residents (68.8%) were more likely than nurses (45.2%) to frequently feel frustrated with ED patients (χ2, p<0.0370). Conclusion: Adolescents with an ED provide a unique challenge to nurses and residents caring for them.

This study aimed to analyze parents’ perspectives of the health education practice provided by health professionals to children and parents. This is a descriptive research with a qualitative approach, based on the conceptual framework of health education provided by health professionals to children/young people and families. The selection took place by non-probabilistic sampling of convenience, and was developed with parents/users of health units for pediatric hospitalization and primary health care in northern Portugal. Data were collected using semi-structured interviews with 20 parents from March to April 2019, and were analyzed using the content analysis technique. Health education was understood to enhance health, and the evaluation was carried out according to planning and partnership. The most frequent topics were food, the national vaccination plan, and accident prevention. The evaluation shown is very positive, pointing to the nurse as the professional of choice for this practice and thus contributing to the visibility of nursing. We can state that the perspectives of parents about the health education carried out by health professionals show a practice that values health; is adaptable to the complexity of the binomial child and parents; is capable of influencing health determinants with sustainability, efficacy, and effectiveness; and gives visibility to nurses’ positions as health educators.

Abstract Background A consistent and predictable discharge process is difficult to achieve, yet essential for good patient flow, appropriate resourcing, and safe patient care. At our institution, physicians predicted the estimated discharge date (EDD) for patients with bronchiolitis with 70.5% accuracy (January – March 2019). A key driver of this unpredictability is a lack of consensus on “medical discharge readiness” criteria across providers, which also has impacts on communication within the health care team and with patients and families. Objectives 1. To improve the ability to predict discharge date for patients with bronchiolitis by implementing a standardized medical discharge criteria checklist tool for one month (April 2019). 2. To more fully engage nurses in their patients’ care by improving transparency and accuracy of information about discharge. 3. To increase patient and family satisfaction with the discharge process. Design/Methods Meetings with key stakeholders determined drivers of discharge. Data on national practice variation in the management of patients with bronchiolitis was reviewed and informed the creation of a set of medical discharge criteria. Criteria were reviewed and accepted by the Division of Pediatric Medicine and presented to key stakeholders for feedback. Patient inclusion and exclusion criteria were developed. Feedback on the intervention was sought via surveys to physicians, nurses and patients/families. Results There was significant improvement (70.5% to 92.3%) in accuracy of predicting EDD with use of the medical discharge criteria checklist tool. There was also a reduction in length of stay. There were no patient bounce-backs to ED or patient readmissions. There was high satisfaction and support of the checklist tool from nursing and caregivers. Conclusion The development of standardized medical discharge criteria for patients with bronchiolitis is a safe and effective way to improve predictability, transparency, communication and patient flow, while enhancing engagement of the health care team and patient and family satisfaction. Its use is also associated with a reduced length of stay. Future directions include integrating the checklist tool into the electronic health record and moving towards a nurse-facilitated discharge process. Exploring and addressing non-medical barriers to discharge should also be a priority.

RESUMO Objetivo: conhecer a percepção do familiar acerca do cuidado de enfermagem numa unidade pediátrica. Método: trata-se de estudo qualitativo, descritivo, exploratório, com 21 familiares. Coletaram-se os dados por meio de entrevistas semiestruturadas, analisadas pela técnica de Análise de Conteúdo na modalidade Análise Temática. Resultados: considera-se, pela família, a equipe atenciosa e sempre disposta a dedicar auxílio e informações necessárias. Referiu-se, também, que é cuidadosa no momento de lidar com a família. Citou-se, nas reinternações, principalmente de crianças com doenças crônicas, a criação do vínculo como fator positivo. Relataram-se, também, o carinho e o bom acolhimento como demonstrações dos demais profissionais. Conclusão: entende-se que o enfermeiro se deve fazer presente e fornecer um cuidado humanizado à criança e à sua família, visto que se encontram em um período de fragilidade. Descritores: Criança Hospitalizada; Família; Saúde da Criança; Cuidado de Enfermagem; Enfermagem Pediátrica; Enfermagem.ABSTRACTObjective: to know the family's perception about nursing care in a pediatric unit. Method: This is a qualitative, descriptive, exploratory study with 21 relatives. The data were collected through semi-structured interviews, analyzed by the Content Analysis technique in the Thematic Analysis modality. Results: the family considers the staff attentive and always ready to dedicate the necessary help and information. She also mentioned that she is careful when dealing with the family. It was mentioned, in the readmissions, mainly of children with chronic diseases, the creation of the bond as a positive factor. The affection and the welcome were also reported as demonstrations of other professionals. Conclusion: it is understood that the nurse should be present and provide humanized care to the child and his family, as they are in a period of fragility.Descriptors: Hospitalized Child; Family; Child Health; Nursing Care; Pediatric Nursing; Nursing.RESUMEN Objetivo: conocer la percepción del familiar acerca del cuidado de enfermería en una unidad pediátrica. Método: se trata de un estudio cualitativo, descriptivo, exploratorio, con 21 familiares. Se recogen los datos por medio de entrevistas semiestructuradas, analizadas por la técnica de Análisis de Contenido en la modalidad Análisis Temático. Resultados: se considera, por la familia, el equipo atento y siempre dispuesto a dedicar ayuda e informaciones necesarias. Se refirió, también, que es cuidadosa en el momento de lidiar con la familia. Se ha citado, en las reinternaciones, principalmente de niños con enfermedades crónicas, la creación del vínculo como factor positivo. Se relataron, también, el cariño y la buena acogida como demostraciones de los demás profesionales. Conclusión: se entiende que el enfermero se debe hacer presente y proporcionar un cuidado humanizado al niño y a su familia, ya que se encuentran en un período de fragilidad. Descriptores: Niño hospitalizado; La Familia; Salud del Niño; Atención de Enfermería; Enfermería Pediátrica; Enfermería.

ABSTRACTObjectives: to discuss the main causes of diarrhea in infants and the major nursing care provided from preventive care to assistance, for these patients and their families, at different levels of health care. Methodology: this is about a literature review study, using the database of SciELO and REUOL, books and manuals of the Ministry of Health from April to May 1984 to 2010, with the descriptors diarrhea, dehydration, children, nursing care, treatment and hospitalization, found in 42 articles of which 13 discarded for not agreeing with the objective of the study. Results: the child is a being who needs protection, respect and care from his parents and a humanized health team, as this should provide an integrated and systematic assistance. Conclusion: the nurse, to act at all levels of health care, must know their role in promoting the health of pediatric patients with diarrhea, reviewing concepts in pursuit of excellence of care. Descriptors: diarrhea, dehydration; child; nursing care.RESUMOObjetivos: discutir as principais causas da diarréia em crianças e os principais cuidados de enfermagem, desde preventivos até assistenciais, a esses pacientes e suas famílias, nos diferentes níveis de atenção à saúde. Metodologia: artigo do tipo revisão de literatura, utilizando-se a base de dados da SciELO e da REUOL, livros e manuais do Ministério da Saúde, entre o ano de 1984 a 2010, no período de abril a maio de 2010. Com os descritores diarréia, desidratação, criança, assistência de enfermagem, tratamento e hospitalização, foram encontrados 42 artigos dos quais descartamos 13, por não condizerem com o objetivo do estudo. Resultados: a criança é um ser que necessita de proteção, respeito e cuidado dos seus pais e de um atendimento humanizado da equipe de saúde, visto que esta deve oferecer uma assistência integrada e sistematizada. Conclusão: o enfermeiro, por atuar em todos os níveis de atenção à saúde, deve conhecer bem a sua atuação na promoção à saúde dos pacientes pediátricos com diarréia, revisando conceitos em busca da excelência da assistência. Descritores: diarréia; desidratação; criança; assistência de enfermagem.RESUMENObjetivos: discutir las principales causas de la diarrea en niños y los principales cuidados de enfermería, desde preventivos hasta asistenciales, a esos pacientes y sus familias, en los diferentes niveles de atención a la salud. Metodología: artigo tipo revisión de literatura, utilizándose de la base de datos SciELO y REUOL, libros y manuales del Ministerio de Salud, entre los años de 1984 y 2010, en el periodo de abril a mayo de 2010. Con los descriptores diarrea, deshidratación, niño, asistencia de enfermería, tratamiento y hospitalización fueron encontrados 42 artículos de los cuales omitimos 13, por no se adecuaren al objetivo del estudio. Resultados: el niño es un ser que necesita protección, respeto y cuidado de sus padres y de una atención humanizada del equipo de salud, una vez que esta debe ofrecer una asistencia integrada y sistematizada. Conclusión: el enfermero, por actuar en todos los niveles de atención a la salud, debe reconocer bien su actuación en la promoción a la salud de los pacientes pediátricos con diarreas, revisando conceptos en busca de la excelencia en la asistencia. Descriptores: diarrea, deshidratación; niño; asistencia de enfermería.

Abstract Background Inadequate health human resources is a key challenge to advancing child survival in Ghana. Nurses are an essential human resource to target because they represent the largest portion of the health workforce. Building on lessons learned from our pilot pediatric nurse training project and World Health Organization guidelines for transforming and scaling up health professional education, this project aimed to; train 500 pediatric nurse specialists through a one-year training program; develop and integrate a critical mass of pediatric nursing faculty and establish a national standardized pediatric nursing curriculum. This study aimed to evaluate the effectiveness of a national pediatric nurse training program in Ghana at the end of 4 years, including eight cohorts with 330 graduates. Methods This was a mixed-method evaluation with surveys, focus groups and a pre-test/post-test design. Before and after surveys were used to measure knowledge and confidence at baseline and graduation. Objective Structured Clinical Examinations (OSCE) were used to measure clinical skills at baseline, graduation, and 14 months follow-up. At the end of every module, surveys were used to measure students’ satisfaction. Focus groups at graduation qualitatively measured program outcomes. Repeat focus groups and surveys at 14 months after graduation captured the graduates’ career progress, experiences reintegrating into the health system and long-term program outcomes. Results Overall, the graduates completed the program with significantly increased knowledge, confidence, and clinical skills. They also had increased job satisfaction and were able to apply what they learned to their jobs, including leadership skills and gender-sensitive care. Data from 14-month follow-up OSCEs showed that all graduates remained competent in communication, physical assessment, and emergency care, although some obtained a lower mark compared to their performance at graduation. This finding is linked with the observation that the amount of mentorship, support from leadership and equipment that the graduates accessed from their respective facilities varied. Conclusions Mixed-methods evaluations demonstrated significant increases in knowledge confidence and skills by completing the program and maintenance of skills more than 1 year after graduation. Findings have implications for those working on the design, implementation, and evaluation of nursing education interventions in low- and middle-income countries.

Specialist and advanced nursing roles have started to emerge in paediatrics and paediatricians may be asked to support nurses through their training. While there are specific training programmes for some areas of practice eg, neonatology, there are currently no programmes for others. Paediatricians may therefore find themselves being asked to train nurse specialists outside a formal training programme, or to provide the clinical specialty component linked to a generic MSc course, where the paediatrician may be required to devise a training curriculum specific to their area of practice. Using, neonatology, there are currently no programmes for others. Paediatricians may therefore find themselves being asked to train nurse specialists outside a formal training programme, or to provide the clinical specialty component linked to a generic MSc course, where the paediatrician may be required to devise a training curriculum specific to their area of practice. Using community child health as an example, this paper outlines how paediatricians might approach this, based on the experience of the author. However, the principles outlined can apply to any area of paediatrics.

Abstract Background Eating disorders are life-threatening illnesses that commonly affect adolescents. The treatment of individuals with eating disorders can involve slow treatment progression and addressing comorbidities which can contribute to staff burnout. Dialectical behavior therapy (DBT) has emerged as a viable treatment option and has reduced staff burnout in several other settings. Our aim was to describe frontline staff burnout using mixed methodology on a DBT-trained combined inpatient/day hospital unit for pediatric eating disorders. Method Frontline staff were trained to provide DBT skills for adolescents with eating disorders. Twelve months following the training and implementation, they completed the Copenhagen Burnout Inventory (CBI) and a qualitative interview. Directed and summative content analyses were used. Results Eleven frontline staff including nurses, child life specialists and child and youth workers participated. The CBI revealed that only one staff member experienced high personal burnout, while another experienced high client-related burnout. Qualitative data indicated that all frontline staff felt DBT had the potential to reduce burnout. Conclusion Qualitative data indicate that staff believe that DBT may hold promise in reducing burnout for pediatric frontline staff who treat children and adolescents with eating disorders. Further study is needed. Plain English summary Understanding burnout is particularly important for nursing staff in inpatient and day hospital settings for eating disorders, as nursing staff generally have the most frequent patient contact; thought to be a risk factor for burnout. The reduction of burnout can prevent detrimental effects on job performance, personal well-being, and patient outcomes. Our exploratory study shows that frontline staff believe that DBT may have the potential to reduce burnout in staff treating children and adolescents with eating disorders in a combined inpatient/day hospital setting. Further study is needed in this area.

The survival rates of youth and young adults (YYAs) diagnosed with long-term conditions have improved considerably as 90% now enter adulthood; health care transition planning (HCTP) has emerged as a nursing practice priority. The aim of this national online survey was to investigate the extent to which nurses, recruited from two major United States pediatric nursing organizations are involved with HCTP including assessing YYA self-management abilities (SMA). Findings of a 9-item assessment of self-management abilities subscale of the nurses’ role in HTCP tool are reported. The nurse respondents ( n = 1269), identified the most frequently assessed SMA was the YYAs’ ability to understand and speak about their condition and its treatment ( M = 2.3, SD = .89). The least frequently assessed was the YYAs’ ability to identify community advocates to help them become more independent ( M =1.5, SD = .90). Regression analysis identified significant predictors of the frequency nurses assess YYA for SMA included nurses’ level of knowledge, perceived level of importance, HCTP and skills identified in job description, and caring for YYA. Findings indicate HCTP care advancements will necessitate HCTP training and development of nurse-led service efforts to facilitate optimal outcomes for YYA.

ABSTRACT Objectives: to understand the practice of the nurse in healthcare management of children with chronic condition in the hospital setting. Methods: analytical study of qualitative approach with theoretical and methodological reference of institutional ethnography. Developed in the pediatric unit of a university hospital, in a municipality in Northeastern Brazil. Data collections techniques were: participant observation, documentary analysis and semi-structured interview. Participants of the study totaled twenty professionals, including nurses, social workers, psychologists, pharmacists, nutritionists, physiotherapists, and doctors. For data analysis, it was used the Bardin's Content Analysis with interface of the Atlas.ti software. Results: categories of analysis were “Nurse as mediator of healthcare management”; “Nursing process as a mechanism of healthcare management”. Final considerations: the nurse proved to be essential for healthcare management of the child with chronic condition, acting as mediator of the relationship between the doctor, the members of the health team, the user and their family.

Abstract Tumor Size Reduction after Lu-177-DOTATATE (Lutathera®) Treatment in Patients with Inoperable Metastatic Pheochromocytoma and Paraganglioma: The Role of NursingAssumpta Ude, Frank I. Lin, Karel Pacak, Ejigayehu Demissie. Clinical Center Nursing Department, Molecular Imaging Program NCI, Endocrine Service Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development. Background: Nursing management of patients with metastatic pheochromocytoma (PCC) and paraganglioma (PGL) undergoing treatment trial with radiopharmaceutical medication has unpredictable clinical outcomes. Clinical Case: A 52-year old woman with inoperable metastatic PCC/PGL was admitted into protocol 17-C-0087 after poor response to various chemotherapies. Patient was treated in the endocrine nursing unit with 200 mCi of Lu-177-DOTATATE (Lutathera®) intravenous infusion given by a radionuclide specialist every eight weeks for a total of four doses. Prior to admission, various members of the endocrine clinical nursing leadership team reviewed protocol with the medical and radiation safety team and a clinical research nurse (CRN) to ensure CRNs understand their roles and expectations to ensure patient safety during procedures and treatment. The patient was admitted on the day preceding the treatment and monitored for 48 hours afterwards. The CRN obtained comprehensive diet and medication history to determine if there is anything that may falsely elevate plasma/urinary catecholamines/metanephrines. The CRN ensured correct placement of intravenous (IV) line and proper collection of blood from IV line to increase the reliability of results. The CRN ensured that IV amino acid (Clinisol 15 %) infusion was administered 30 minutes prior to dosing to diminish renal issues. This patient had minimal side effects and no adverse events to therapy. The research team followed up the patient in clinic every month while she was on treatment, then every 3 months in the follow-up period. Recent evaluation showed this patient had stable vital signs, impalpable supraclavicular lymph node, returned to baseline physical activity with significant decrease in the size of the PCC/PGL, and reduction in serum catecholamine/metanephrine levels. Conclusion: The endocrine CRN team is critical in the assessment, monitoring, observation and education of patients and families regarding expectations during therapy which played a significant role in minimizing the patient’s side effects to therapy. Working collaboratively with other members of the multidisciplinary research team also contributed to patient’s favorable outcome.

The UP Manila Health Policy Development Hub recognizes the invaluable contribution of the participants in theseries of roundtable discussions listed below: RTD: Beyond Hospital Beds: Equity,quality, and service1. Ma. Esmeralda C. Silva, MPAf, MSPPM, PhD,Faculty, College of Public Health, UP Manila2. Leonardo R. Estacio, Jr., MCD, MPH, PhD, Dean,College of Arts and Sciences, UP Manila3. Michael Antonio F. Mendoza, DDM, MM, Faculty,College of Dentistry, UP Manila4. Hilton Y. Lam, MHA, PhD, Chair, UP Manila HealthPolicy Development Hub; Director, Institute of HealthPolicy and Development Studies, University of thePhilippines Manila5. Irma L. Asuncion, MHA, CESO III, Director IV,Bureau of Local Health Systems Development,Department of Health6. Renely Pangilinan-Tungol, MD, CFP, MPM-HSD,Municipal Health Officer, San Fernando, Pampanga7. Salome F. Arinduque, MD, Galing-Pook AwardeeRepresentative, Municipal Health Officer, San Felipe,Zambales8. Carmelita C. Canila, MD, MPH, Faculty, College ofPublic Health, University of the Philippines Manila9. Lester M. Tan, MD, MPH, Division Chief, Bureau ofLocal Health System Development, Department ofHealth10. Anthony Rosendo G. Faraon, MD, Vice President,Zuellig Family Foundation (ZFF)11. Albert Francis E. Domingo, MD, Consultant, HealthSystem strengthening through Public Policy andRegulation, World Health Organization12. Jesus Randy O. Cañal, MD, FPSO-HNS, AssociateDirector, Medical and Regulatory Affairs, AsianHospital and Medical Center13. Christian Edward L. Nuevo, Health Policy and SystemsResearch Fellow, Health Policy Development andPlanning Bureau, Department of Health14. Paolo Victor N. Medina, MD, Assistant Professor 4,College of Medicine, University of the PhilippinesManila15. Jose Rafael A. Marfori, MD, Special Assistant to theDirector, Philippine General Hospital16. Maria Teresa U. Bagaman, Committee Chair, PhilippineSociety for Quality, Inc.17. Maria Theresa G. Vera, MSc, MHA, CESO III, DirectorIV, Health Facility Development Bureau, Departmentof Health18. Ana Melissa F. Hilvano-Cabungcal, MD, AssistantAssociate Dean for Planning & Development, Collegeof Medicine, University of the Philippines Manila19. Fevi Rose C. Paro, Faculty, Department of Communityand Environmental Resource Planning, University ofthe Philippines Los Baños20. Maria Rosa C. Abad, MD, Medical Specialist III,Standard Development Division, Health Facilities andServices Regulation21. Yolanda R. Robles, RPh, PhD, Faculty, College ofPharmacy, University of the Philippines Manila22. Jaya P. Ebuen, RN, Development Manager Officer,CHDMM, Department of Health23. Josephine E. Cariaso, MA, RN, Assistant Professor,College of Nursing, University of the Philippines Manila24. Diana Van Daele, Programme Manager, CooperationSection, European Union25. Maria Paz de Sagun, Project Management Specialist,USAID26. Christopher Muñoz, Member, Yellow Warriors SocietyPhilippinesRTD: Health services and financingroles: Population based- andindividual-based1. Hilton Y. Lam, MHA, PhD, Chair, University of thePhilippines Manila Health Policy Development Hub;Director, Institute of Health Policy and DevelopmentStudies, University of the Philippines Manila2. Ma. Esmeralda C. Silva, MPAf, MSPPM, PhD,Faculty, College of Public Health, University of thePhilippines Manila3. Leonardo R. Estacio, Jr., MCD, MPH, PhD, Dean,College of Arts and Sciences, University of thePhilippines Manila4. Michael Antonio F. Mendoza, DDM, MM, Faculty,College of Dentistry, University of the PhilippinesManila5. Mario C. Villaverde, Undersecretary, Health Policyand Development Systems and Development Team,Department of Health6. Jaime Z. Galvez Tan, MD, Former Secretary, Department of Health7. Marvin C. Galvez, MD, OIC Division Chief, BenefitsDevelopment and Research Department, PhilippineHealth Insurance Corporation8. Alvin B. Caballes, MD, MPE, MPP, Faculty, Collegeof Medicine, University of the Philippines Manila9. Carlos D. Da Silva, Executive Director, Association ofMunicipal Health Maintenance Organization of thePhilippines, Inc.10. Anthony Rosendo G. Faraon, MD, Vice President,Zuellig Family Foundation (ZFF) 11. Albert Francis E. Domingo, MD, Consultant, HealthSystem strengthening through Public Policy andRegulation, World Health Organization12. Salome F. Arinduque, MD, Galing-Pook AwardeeRepresentative, Municipal Health Officer, San Felipe,Zambales13. Michael Ralph M. Abrigo, PhD, Research Fellow,Philippine Institute for Developmental Studies14. Oscar D. Tinio, MD, Committee Chair, Legislation,Philippine Medical Association15. Rogelio V. Dazo, Jr., MD, FPCOM, Legislation,Philippine Medical Association16. Ligaya V. Catadman, MM, Officer-in-charge, HealthPolicy Development and Planning Bureau, Department of Health17. Maria Fatima Garcia-Lorenzo, President, PhilippineAlliance of Patients Organization18. Tomasito P. Javate, Jr, Supervising Economic DevelopmentSpecialist, Health Nutrition and Population Division,National Economic and Development Authority19. Josefina Isidro-Lapena, MD, National Board ofDirector, Philippine Academy of Family Physicians20. Maria Eliza Ruiz-Aguila, MPhty, PhD, Dean, Collegeof Allied Medical Professions, University of thePhilippines Manila21. Ana Melissa F. Hilvano-Cabungcal, MD, AssistantAssociate Dean for Planning & Development, College ofMedicine, University of the Philippines Manila22. Maria Paz P. Corrales, MD, MHA, MPA, Director III,Department of Health-National Capital Region23. Karin Estepa Garcia, MD, Executive Secretary, PhilippineAcademy of Family Physicians24. Adeline A. Mesina, MD, Medical Specialist III,Philippine Health Insurance Corporation25. Glorey Ann P. Alde, RN, MPH, Research Fellow,Department of HealthRTD: Moving towards provincelevel integration throughUniversal Health Care Act1. Hilton Y. Lam, MHA, PhD, Chair, University of thePhilippines Manila Health Policy Development Hub;Director, Institute of Health Policy and DevelopmentStudies, University of the Philippines Manila2. Ma. Esmeralda C. Silva, MPAf, MSPPM, PhD,Faculty, College of Public Health, University of thePhilippines Manila3. Leonardo R. Estacio, Jr., MCD, MPH, PhD, Dean,College of Arts and Sciences, University of thePhilippines Manila4. Michael Antonio F. Mendoza, DDM, MM, Faculty,College of Dentistry, University of the PhilippinesManila5. Mario C. Villaverde, Undersecretary of Health, HealthPolicy and Development Systems and DevelopmentTeam, Department of Health6. Ferdinand A. Pecson, Undersecretary and ExecutiveDirector, Public Private Partnership Center7. Rosanna M. Buccahan, MD, Provincial Health Officer,Bataan Provincial Office8. Lester M. Tan, MD, Division Chief, Bureau of LocalHealth System Development, Department of Health9. Ernesto O. Domingo, MD, FPCP, FPSF, FormerChancellor, University of the Philippines Manila10. Albert Francis E. Domingo, MD, Consultant, HealthSystem strengthening through Public Policy andRegulation, World Health Organization11. Leslie Ann L. Luces, MD, Provincial Health Officer,Aklan12. Rene C. Catan, MD, Provincial Health Officer, Cebu13. Anthony Rosendo G. Faraon, MD, Vice President,Zuellig Family Foundation14. Jose Rafael A. Marfori, MD, Special Assistant to theDirector, Philippine General Hospital15. Jesus Randy O. Cañal, MD, FPSO-HNS, Consultant,Asian Hospital and Medical Center16. Ramon Paterno, MD, Member, Universal Health CareStudy Group, University of the Philippines Manila17. Mayor Eunice U. Babalcon, Mayor, Paranas, Samar18. Zorayda E. Leopando, MD, Former President,Philippine Academy of Family Physicians19. Madeleine de Rosas-Valera, MD, MScIH, SeniorTechnical Consultant, World Bank20. Arlene C. Sebastian, MD, Municipal Health Officer,Sta. Monica, Siargao Island, Mindanao21. Rizza Majella L. Herrera, MD, Acting Senior Manager,Accreditation Department, Philippine Health InsuranceCorporation22. Alvin B. Caballes, MD, MPE, MPP, Faculty, Collegeof Medicine, University of the Philippines Manila23. Pres. Policarpio B. Joves, MD, MPH, MOH, FPAFP,President, Philippine Academy of Family Physicians24. Leilanie A. Nicodemus, MD, Board of Director,Philippine Academy of Family Physicians25. Maria Paz P. Corrales, MD, MHA, MPA, Director III,National Capital Region Office, Department of Health26. Dir. Irma L. Asuncion, MD, MHA, CESO III, DirectorIV, Bureau of Local Health Systems Development,Department of Health27. Bernard B. Argamosa, MD, Mental Health Representative, National Center for Mental Health28. Flerida Chan, Chief, Poverty Reduction Section, JapanInternational Cooperation Agency29. Raul R. Alamis, Chief Health Program Officer, ServiceDelivery Network, Department of Health30. Mary Anne Milliscent B. Castro, Supervising HealthProgram Officer, Department of Health 31. Marikris Florenz N. Garcia, Project Manager, PublicPrivate Partnership Center32. Mary Grace G. Darunday, Supervising Budget andManagement Specialist, Budget and Management Bureaufor the Human Development Sector, Department ofBudget and Management33. Belinda Cater, Senior Budget and Management Specialist,Department of Budget and Management34. Sheryl N. Macalipay, LGU Officer IV, Bureau of LocalGovernment and Development, Department of Interiorand Local Government35. Kristel Faye M. Roderos, OTRP, Representative,College of Allied Medical Professions, University ofthe Philippines Manila36. Jeffrey I. Manalo, Director III, Policy Formulation,Project Evaluation and Monitoring Service, PublicPrivate Partnership Center37. Atty. Phebean Belle A. Ramos-Lacuna, Division Chief,Policy Formulation Division, Public Private PartnershipCenter38. Ricardo Benjamin D. Osorio, Planning Officer, PolicyFormulation, Project Evaluation and MonitoringService, Public Private Partnership Center39. Gladys Rabacal, Program Officer, Japan InternationalCooperation Agency40. Michael Angelo Baluyot, Nurse, Bataan Provincial Office41. Jonna Jane Javier Austria, Nurse, Bataan Provincial Office42. Heidee Buenaventura, MD, Associate Director, ZuelligFamily Foundation43. Dominique L. Monido, Policy Associate, Zuellig FamilyFoundation44. Rosa Nene De Lima-Estellana, RN, MD, Medical OfficerIII, Department of Interior and Local Government45. Ma Lourdes Sangalang-Yap, MD, FPCR, Medical OfficerIV, Department of Interior and Local Government46. Ana Melissa F. Hilvano-Cabungcal, MD, AssistantAssociate Dean for Planning & Development, College ofMedicine, University of the Philippines Manila47. Colleen T. Francisco, Representative, Department ofBudget and Management48. Kristine Galamgam, Representative, Department ofHealth49. Fides S. Basco, Officer-in-charge, Chief Budget andManagement Specialist, Development of Budget andManagementRTD: Health financing: Co-paymentsand Personnel1. Hilton Y. Lam, MHA, PhD, Chair, University of thePhilippines Manila Health Policy Development Hub;Director, Institute of Health Policy and DevelopmentStudies, University of the Philippines Manila2. Ma. Esmeralda C. Silva, MPAf, MSPPM, PhD,Faculty, College of Public Health, University of thePhilippines Manila3. Leonardo R. Estacio, Jr., MCD, MPH, PhD, Dean,College of Arts and Sciences, University of thePhilippines Manila4. Michael Antonio F. Mendoza, DDM, MM, Faculty,College of Dentistry, University of the Philippines Manila5. Ernesto O. Domingo, MD, Professor Emeritus,University of the Philippines Manila6. Irma L. Asuncion, MHA, CESO III, Director IV,Bureau of Local Health Systems Development,Department of Health7. Lester M. Tan, MD, MPH, Division Chief, Bureau ofLocal Health System Development, Department ofHealth8. Marvin C. Galvez, MD, OIC Division Chief, BenefitsDevelopment and Research Department, PhilippineHealth Insurance Corporation9. Adeline A. Mesina, MD, Medical Specialist III, BenefitsDepartment and Research Department, PhilippineHealth Insurance Corporation10. Carlos D. Da Silva, Executive Director, Association ofHealth Maintenance Organization of the Philippines,Inc.11. Ma. Margarita Lat-Luna, MD, Deputy Director, FiscalServices, Philippine General Hospital12. Waldemar V. Galindo, MD, Chief of Clinics, Ospital ngMaynila13. Albert Francis E. Domingo, MD, Consultant, HealthSystem strengthening through Public Policy andRegulation, World Health Organization14. Rogelio V. Dazo, Jr., MD, Member, Commission onLegislation, Philippine Medical Association15. Aileen R. Espina, MD, Board Member, PhilippineAcademy of Family Physicians16. Anthony R. Faraon, MD, Vice President, Zuellig FamilyFoundation17. Jesus Randy O. Cañal, Associate Director, Medical andRegulatory Affairs, Asian Hospital and Medical Center18. Jared Martin Clarianes, Technical Officer, Union of LocalAuthorities of the Philippines19. Leslie Ann L. Luces, MD, Provincial Health Officer,Aklan20. Rosa Nene De Lima-Estellana, MD, Medical OfficerIII, Department of the Interior and Local Government21. Ma. Lourdes Sangalang-Yap, MD, Medical Officer V,Department of the Interior and Local Government 22. Dominique L. Monido, Policy Associate, Zuellig FamilyFoundation23. Krisch Trine D. Ramos, MD, Medical Officer, PhilippineCharity Sweepstakes Office24. Larry R. Cedro, MD, Assistant General Manager, CharitySector, Philippine Charity Sweepstakes Office25. Margarita V. Hing, Officer in Charge, ManagementDivision, Financial Management Service Sector,Department of Health26. Dr. Carlo Irwin Panelo, Associate Professor, College ofMedicine, University of the Philippines Manila27. Dr. Angelita V. Larin, Faculty, College of Public Health,University of the Philippines Manila28. Dr. Abdel Jeffri A. Abdulla, Chair, RegionalizationProgram, University of the Philippines Manila29. Christopher S. Muñoz, Member, Philippine Alliance ofPatients Organization30. Gemma R. Macatangay, LGOO V, Department ofInterior and Local Government – Bureau of LocalGovernment Development31. Dr. Narisa Portia J. Sugay, Acting Vice President, QualityAssurance Group, Philippine Health InsuranceCorporation32. Maria Eliza R. Aguila, Dean, College of Allied MedicalProfessions, University of the Philippines Manila33. Angeli A. Comia, Manager, Zuellig Family Foundation34. Leo Alcantara, Union of Local Authorities of thePhilippines35. Dr. Zorayda E. Leopando, Former President, PhilippineAcademy of Family Physicians36. Dr. Emerito Jose Faraon, Faculty, College of PublicHealth, University of the Philippines Manila37. Dr. Carmelita C. Canila, Faculty, College of PublicHealth, University of the Philippines ManilaRTD: Moving towards third partyaccreditation for health facilities1. Hilton Y. Lam, MHA, PhD, Chair, University of thePhilippines Manila Health Policy Development Hub;Director, Institute of Health Policy and DevelopmentStudies, University of the Philippines Manila2. Ma. Esmeralda C. Silva, MPAf, MSPPM, PhD,Faculty, College of Public Health, University of thePhilippines Manila3. Leonardo R. Estacio, Jr., MCD, MPH, PhD, Dean,College of Arts and Sciences, University of thePhilippines Manila4. Michael Antonio F. Mendoza, DDM, MM, Faculty,College of Dentistry, University of the PhilippinesManila5. Rizza Majella L. Herrera, MD, Acting SeniorManager, Accreditation Department, Philippine HealthInsurance Corporation6. Bernadette C. Hogar-Manlapat, MD, FPBA, FPSA,FPSQua, MMPA, President and Board of Trustee,Philippine Society for Quality in Healthcare, Inc.7. Waldemar V. Galindo, MD, Chief of Clinics, Ospital ngMaynila8. Amor. F. Lahoz, Division Chief, Promotion andDocumentation Division, Department of Trade andIndustry – Philippine Accreditation Bureau9. Jenebert P. Opinion, Development Specialist, Department of Trade and Industry – Philippine AccreditationBureau10. Maria Linda G. Buhat, President, Association ofNursing Service Administrators of the Philippines, Inc.11. Bernardino A. Vicente, MD, FPPA, MHA, CESOIV, President, Philippine Tripartite Accreditation forHealth Facilities, Inc.12. Atty. Bu C. Castro, MD, Board Member, PhilippineHospital Association13. Cristina Lagao-Caalim, RN, MAN, MHA, ImmediatePast President and Board of Trustee, Philippine Societyfor Quality in Healthcare, Inc.14. Manuel E. Villegas Jr., MD, Vice Treasurer and Board ofTrustee, Philippine Society for Quality in Healthcare,Inc.15. Michelle A. Arban, Treasurer and Board of Trustee,Philippine Society for Quality in Healthcare, Inc.16. Joselito R. Chavez, MD, FPCP, FPCCP, FACCP,CESE, Deputy Executive Director, Medical Services,National Kidney and Transplant Institute17. Blesilda A. Gutierrez, CPA, MBA, Deputy ExecutiveDirector, Administrative Services, National Kidney andTransplant Institute18. Eulalia C. Magpusao, MD, Associate Director, Qualityand Patient Safety, St. Luke’s Medical Centre GlobalCity19. Clemencia D. Bondoc, MD, Auditor, Association ofMunicipal Health Officers of the Philippines20. Jesus Randy O. Cañal, MD, FPSO-HNS, AssociateDirector, Medical and Regulatory Affairs, Asian Hospitaland Medical Center21. Maria Fatima Garcia-Lorenzo, President, PhilippineAlliance of Patient Organizations22. Leilanie A. Nicodemus, MD, Board of Directors,Philippine Academy of Family Physicians23. Policarpio B. Joves Jr., MD, President, PhilippineAcademy of Family Physicians24. Kristel Faye Roderos, Faculty, College of Allied MedicalProfessions, University of the Philippines Manila25. Ana Melissa Hilvano-Cabungcal, MD, AssistantAssociate Dean, College of Medicine, University of thePhilippines Manila26. Christopher Malorre Calaquian, MD, Faculty, Collegeof Medicine, University of the Philippines Manila27. Emerito Jose C. Faraon, MD, Faculty, College ofPublic Health, University of the Philippines Manila 28. Carmelita Canila, Faculty, College of Public Health,University of the Philippines Manila29. Oscar D. Tinio, MD, Representative, Philippine MedicalAssociation30. Farrah Rocamora, Member, Philippine Society forQuality in Healthcare, IncRTD: RA 11036 (Mental Health Act):Addressing Mental Health Needs ofOverseas Filipino Workers1. Hilton Y. Lam, MHA, PhD, Chair, University of thePhilippines Manila Health Policy Development Hub;Director, Institute of Health Policy and DevelopmentStudies, University of the Philippines Manila2. Leonardo R. Estacio, Jr., MCD, MPH, PhD, UPManila Health Policy Development Hub; College ofArts and Sciences, UP Manila3. Ma. Esmeralda C. Silva, MPAf, MSPPM, PhD, UPManila Health Policy Development Hub; College ofPublic Health, UP Manila4. Michael Antonio F. Mendoza, DDM, UP ManilaHealth Policy Development Hub; College of Dentistry,UP Manila5. Frances Prescilla L. Cuevas, RN, MAN, Director,Essential Non-Communicable Diseases Division,Department of Health6. Maria Teresa D. De los Santos, Workers Education andMonitoring Division, Philippine Overseas EmploymentAdministration7. Andrelyn R. Gregorio, Policy Program and Development Office,Overseas Workers Welfare Administration8. Sally D. Bongalonta, MA, Institute of Family Life &Children Studies, Philippine Women’s University9. Consul Ferdinand P. Flores, Department of ForeignAffairs10. Jerome Alcantara, BLAS OPLE Policy Center andTraining Institute11. Andrea Luisa C. Anolin, Commission on FilipinoOverseas12. Bernard B. Argamosa, MD, DSBPP, National Centerfor Mental Health13. Agnes Joy L. Casino, MD, DSBPP, National Centerfor Mental Health14. Ryan Roberto E. Delos Reyes, Employment Promotionand Workers Welfare Division, Department of Laborand Employment15. Sheralee Bondad, Legal and International AffairsCluster, Department of Labor and Employment16. Rhodora A. Abano, Center for Migrant Advocacy17. Nina Evita Q. Guzman, Ugnayan at Tulong para saMaralitang Pamilya (UGAT) Foundation, Inc.18. Katrina S. Ching, Ugnayan at Tulong para sa MaralitangPamilya (UGAT) Foundation, Inc.RTD: (Bitter) Sweet Smile of Filipinos1. Dr. Hilton Y. Lam, Institute of Health Policy andDevelopment Studies, NIH2. Dr. Leonardo R. Estacio, Jr., College of Arts andSciences, UP Manila3. Dr. Ma. Esmeralda C. Silva, College of Public Health,UP Manila4. Dr. Michael Antonio F. Mendoza, College of Dentistry,UP Manila5. Dr. Ma. Susan T. Yanga-Mabunga, Department ofHealth Policy & Administration, UP Manila6. Dr. Danilo L. Magtanong, College of Dentistry, UPManila7. Dr. Alvin Munoz Laxamana, Philippine DentalAssociation8. Dr. Fina Lopez, Philippine Pediatric Dental Society, Inc9. Dr. Artemio Licos, Jr.,Department of Health NationalAssociation of Dentists10. Dr. Maria Jona D. Godoy, Professional RegulationCommission11. Ms. Anna Liza De Leon, Philippine Health InsuranceCorporation12. Ms. Nicole Sigmuend, GIZ Fit for School13. Ms. Lita Orbillo, Disease Prevention and Control Bureau14. Mr. Raymond Oxcena Akap sa Bata Philippines15. Dr. Jessica Rebueno-Santos, Department of CommunityDentistry, UP Manila16. Ms. Maria Olivine M. Contreras, Bureau of LocalGovernment Supervision, DILG17. Ms. Janel Christine Mendoza, Philippine DentalStudents Association18. Mr. Eric Raymund Yu, UP College of DentistryStudent Council19. Dr. Joy Memorando, Philippine Pediatric Society20. Dr. Sharon Alvarez, Philippine Association of DentalColleges