Editorial: evolution of a journal
Linda Shields

Implementing family health assessment: experiences of child health nurses
Catherine Marron and Catherine Maginnis

Holistic assessment of the health needs of the family is a complex and challenging task. Child health nurses need to be competent in interviewing families and facilitating a safe environment for caregivers to raise concerns . Nursing assessment of health needs has been widely researched; however, there are few published articles about child health nurses’ experiences.
This paper explores child health nurses’ lived experiences of family health assessment. The main objective of this study is to identify any barriers which may exist when implementing family health assessments in practice. Focus group interviews with seven child health nurses were undertaken. This method lends itself to a hermeneutic approach where the participants’ lived experience is the focus . The analysis revealed challenges related to the level of nurses’ knowledge, skills and experience, and barriers related to time. Findings showed that guidelines for conducting family assessment interviews are perceived as useful, relevant and contribute to improving practice. Child health nurses learn valuable skills through critical reflection on their experiences. Through exploring child health nurses’ experiences, they identify needs that need to be addressed. These may include knowledge and skill development, or critical reflection upon personal values and clinical practice. To address such needs, clinical support mechanisms identified from this study may include policies and guidelines, education and training, clinical supervision and peer support processes.

Food for thought: investigating parents' perspectives of the impact of their child's
Jennifer Fereday, Chris Thomas, Alison Forrest, Prof Phillip Darbyshire

Children with severe feeding problems present unique challenges as they may fail to thrive despite parents’ best efforts and require additional nutritional support. Comparatively few studies have examined the impact of tube-feeding on the lives of children and parents from the parents’ perspective. This study redresses this imbalance by providing a detailed interpretive account of parents’ experiences of their child’s home enteral nutrition (HEN). A sample of 34 parents in South Australia were interviewed individually or in focus groups. Data were analysed using a data-driven thematic analysis technique. Participants were parents of children in the HEN service at a tertiary paediatric hospital.
The impact of tube-feeding a child at home pervaded all areas of family life. This ranged from administering dietary formulas to their child often over 24 hours, constantly planning ahead to accommodate activities, being the child’s ‘case manager’ and primary communicator between health professionals, curtailing social activities due to lack of respite care, and coping with the negative, prejudiced attitudes of people when going out in public with their child. This study highlights the extensive physical and psychological demands that HEN places on families, and underscores support needed from health professionals to help ease the demands of caring for such a child at home. Parents’ accounts of their HEN experiences provide opportunities for all children’s services and professionals to improve services and approaches, for example by placing more emphasis on psychological support for parents and creating greater awareness of HEN among the general public.

A 'wee' problem: using action research to facilitate a change in urine collection methods
Sonia Smith, Peter Lewis, Dr Valerie Wilson

Collecting urine specimens from non-toilet trained children can be challenging, invasive and labour intensive, often resulting in distress for children and their families. Methods currently used to collect urine specimens include urine collection bags, in/out catheter or suprapubic aspiration (SPA), all of which are invasive. Several research studies undertaken in the UK suggest urine collection pads as an alternative method of collecting urine samples from non-toilet trained children.
A group of nurses undertook a project aimed at bringing about a change in clinical practice relevant to the collection of urine specimens in a paediatric hospital in Sydney, Australia. An action research methodology was chosen because it allowed for the participation of different stakeholder groups (nurses and parents) in the process of reflecting upon and changing clinical practice. The conduct of the project presented challenges associated with the translation of research evidence into practice and with the engagement of stakeholders. Ultimately, it was the success in meeting those challenges that brought about a change in practice which is becoming increasingly sustainable.
 
Cystic fibrosis diagnosis: impact on mothers of affected Australian children
Lynn Priddis, Alison Dougall, Elizabeth Balding, Andrea Barrett

The importance of early, secure attachment relationships for any child’s optimal development is well recognised. For parents faced with the diagnosis of cystic fibrosis (CF) in their baby following a routine newborn screening (NBS) test, this relationship can be initially challenged.
In order to better understand the impact on mothers of a CF diagnosis, a sample of 19 mothers of children diagnosed with CF under the NBS procedures participated in semi-structured interviews with an independent researcher. The transcribed interviews were analysed for common themes using qualitative content analysis, following established procedures for process and rigour. Mothers reported trauma at learning of the diagnosis, the nature and process of their grief, adjustment to the diagnosis, their stress in interaction with the healthcare system, and support and family systems issues. The findings are discussed with reference to clinical practice when working with mothers of children diagnosed with CF.