Guest editorial: Learning is a two-way process
Jane Salvage

Making the wait easier: evaluating the role of supervised play in a surgical admission area
Jennifer Fereday & Philip Darbyshire

A child’s admission to hospital for surgery is often a time of anxiety for children and parents, regardless of how ‘minor’ the surgery is purported to be. Although the benefits of play for hospitalised children and particularly in-patients are well known, less is known regarding the benefits of organised play within a more ‘short-term’ waiting area. As the popularity of day surgery increases, this becomes a more pressing research and practice concern. This paper describes a practice evaluation project that addressed this question by exploring the perceived advantages and/or disadvantages of the play coordinator role within a day of surgery admission suite (DOSA) in a tertiary paediatric hospital. A primarily qualitative approach was used to ascertain the perspectives of children, parents and staff regarding the provision of play opportunities whilst waiting for day surgery. This project’s findings support the importance of organised play opportunities and activities that enhance the quality of care and create a more ‘child-friendly’ environment within a day of surgery setting.

Caring for children with a tracheostomy:a national survey of Australian and New Zealand nurses
Samantha Keogh, Marie Chitakis & Karen Watson

Caring for a child with a tracheostomy in the ward or home environment places additional responsibility on nurses’ knowledge and competency to meet the unique needs of the paediatric patient and to fulfil the obligations of education and support to families and carers. This study set out to gain an overview of the care and management of children with tracheostomies through surveying facilities that provided dedicated support to children requiring long-term tracheostomy care in Australia and New Zealand. No recent review of nursing practice and management of the paediatric tracheostomy patient existed. Fifteen units throughout Australia and New Zealand were identified as the sample population. A nurse specialist from each area was asked to comment on their unit practice by completing a survey based on variables identified in the literature regarding tracheostomy care in adult and paediatric populations.
Many areas of practice were consistent throughout the units surveyed and, for the most part, practice was based on evidence. Two areas of practice were identified as deviating significantly from the evidence and were therefore highlighted for modification. Those practices were the use of saline instillation as a method of loosening secretions, and the depth to which suction catheters were inserted during tracheal suctioning. These identified areas of concern were highlighted to participating units for modification in practice. Within the research facility immediate changes to practice were implemented, with saline installation being withdrawn from practice standard guidelines. Ongoing quality activities have resulted from these findings.

Nurses’ contribution to child protection
Marie Land & Lesley Barclay

This qualitative study used interviews to explore nurses’ perceptions of their role in protecting children and to identify any barriers to implementing the role. Participants in this study were recruited through purposive sampling. Ten nurses whose work brings them into regular contact with children and their families were interviewed; the sample included nurses from acute care and community-based nursing services in the Northern Territory (NT). Results from semi-structured, open-ended questions were analysed using a process of coding and thematic analysis.
Three major themes, derived from aggregating related sub-themes, were identified and names as Drawing a line in the sand; Mushrooms in the dark and Fear factor. Three broad areas that influence nurses’ effectiveness in the protection of children were identified – organisational structures, institutional practices and legislative frameworks. Recommendations from this study include a need for collaborative interdisciplinary practices, development of departmental protocols to support such practice, and nurse-led models of care that aim for early identification of risk factors for child abuse and early intervention to support families and improve family functioning. This exploratory research has provided baseline data for an action research study in progress on the role of nurses in protecting children.

Discussion paper: The great pram cover-up – a cautionary tale
Leigh Wilson

In the early 20th century, infant care recommendations were vastly different from those of today, with practices such as a daily sunbath for a new baby commonly used by mothers 1, 2. More recently, research evidence suggests the practice of deliberately exposing the skin of babies and young children to the sun is dangerous, and may increase the risk of skin cancer in later life 3. To reduce the chances of sun damage to infant skin, the Cancer Council of Australia recommends parents cover strollers and prams with a light cloth to reduce infant sun exposure when outdoors 3. Observations of parents indicate that these recommendations are being taken seriously, with parents covering prams and strollers; however, it has been noted that parents often use a drape when sunlight exposure is not an issue, such as in shopping centres and public places. A particular concern is the practice of ‘pegging’ heavy blankets around both the front and back of the pram or stroller, reducing adequate ventilation.
Much has been written about the quality of air in, and around an infant and the importance of adequate ventilation to help minimise the risk of sudden infant death syndrome (SIDS) 4-7. To date, no detailed studies have been undertaken to establish the quality of air a baby breathes when enclosed in a pram covered by a heavy blanket. Until further evidence is available, it is suggested that health professionals advise parents not to use fabric to drape prams or strollers unless their infants are in direct sunlight, and then to only use light sheets, muslin wraps or commercially available net covers designed to fit strollers and prams.

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