Editorial
Professor Linda Johnston

Palliative care in the neonatal nursery: Guidelines for neonatal nurses in Australia
Shelley Reid, Sandie Bredemeyer, Cathy van den Berg, Trevor Cresp, Terri Martin and Nathalia Miara

Development of a transition readiness scale for young adults with cystic fibrosis: face and content validity
Lauren Dudman, Pat Rapley and Sally Wilson 

Background: The process of moving from a paediatric to adult health care setting is known as health care transition (HCT). The current lack of transition planning to determine and ensure readiness means patients with chronic conditions experience less than ideal outcomes. There is a lack of a widely used, validated instrument to assess readiness to transition in adolescents with cystic fibrosis (CF). Objective To develop the Cystic Fibrosis Health Care Transition Readiness Scale and assess this instrument for face and content validity.
Design: The study used both qualitative and quantitative methods in the design and testing of the Cystic Fibrosis Health Care Transition Readiness Scale. Participants Two adolescents with CF and four parents of adolescents with CF participated voluntarily in this study.
Method: Interviews were conducted in a semi-structured manner to explore the meaning of health care transition for study participants. Qualitative data were analysed using a thematic content method. These results were combined with those of a literature review of existing published measures of transition readiness for other chronic illness groups to formulate a draft Cystic Fibrosis Health Care Transition Readiness Scale. Expert opinion was used to assess content analysis using the content validity index. Results: Sixty-six readiness items were developed from the integration of interview findings and items from other scales. A confidence rating scale was used. After testing for face and content validity, it is proposed the 57-item Cystic Fibrosis Health Care Transition Readiness Scale undergo further testing.
Conclusion: The Cystic Fibrosis Health Care Transition Readiness Scale includes views of experts and participants undergoing the experience to strengthen its content validity. However, this study also highlighted the more general concern of adolescents’ disengagement with health care found in other studies. A condition-specific readiness measure should facilitate a smooth transition to adult health care by targeting areas needing more preparation.
Keywords: adolescents, cystic fibrosis, health care transition, readiness scale.

The effect of incubator humidity on the body temperature of infants born at 28 weeks' gestation or less: a randomised controlled trial.
Yuk-Shan Kong, Alison Medhurst, Jeanie Ling Yoong Cheong, Despina Kotsanas and Damien Jolley

Background: Nursing very low birthweight, preterm infants during the first weeks of life in a humidified incubator is beneficial in maintaining body temperature and decreasing transepidermal water loss. However, the optimal level of relative humidity is unclear. At incubator humidity levels of >80%, there is potential for increased condensation inside the incubator, decreased visibility and increased risk of infection.
Objective: The primary objective of this single-centre, randomised, controlled trial was to compare the effect of 80% and 70% incubator humidity on the body temperature of infants born at ≤28 weeks' gestation during the first two weeks after birth. Secondary objectives included examining: daily fluid requirement, serum sodium levels, significant medical conditions, skin integrity and incubator microbial contamination.
Method: Fifty infants were randomised to either 80% or 70% incubator humidity. Data on a range of variables were collected. Means of measures both groups were compared using t-test.
Results: There was no significant difference in the mean body temperature between groups (mean difference of area outside targeted temperature range was 0.059 degree-days, 95% CI [-0.06 to 0.18], p=0.33). There were no significant differences in total daily fluid requirement and serum sodium levels. Similarly, there were no significant differences in the rates of sepsis, patent ductus arteriosus, intraventricular haemorrhage, chronic lung disease and skin integrity. There was little difference in the number and type of microbes grown from cultures taken from the internal surface of the incubator walls.
Conclusions: For infants ≤28 weeks' gestation, nursed in either 80% or 70% incubator humidity, there was little evidence of a difference in maintenance of body temperature and other clinical outcomes.
Keywords: incubator humidity, temperature, preterm infant.

Management of chronic functional constipation in children: a review of the literature.
Helen Jurgens, Candice Oster and Jennifer Fereday

Background: Constipation in childhood is relatively common. For some children, constipation can become a chronic problem, with a significant psychosocial impact on children and their families. It has been estimated that chronic constipation accounts for around 3% of out-patient visits with a paediatrician and approximately 25% of visits to a paediatric gastroenterologist. The prevalence appears to be rising.
Aim: To review the literature with respect to assessment and management of chronic functional constipation in children.
Design: Literature review.
Methods: A search of medical, nursing and allied health electronic databases for literature published between 1980 and 2009 in order to provide a current definition, causes, assessment, management and treatment outcomes for chronic functional constipation in children.
Results: No studies were found that identified a definitive solution to management; however, there is documented consensus on definitions and terminology and the most effective approaches to manage chronic functional constipation in childhood.
Conclusion: Initial assessment is essential to ascertain the child and family’s understanding of constipation and any previous history of treatment. The main foci for management include disimpaction of faeces with lavage solutions and/or enemas; maintenance therapy with laxatives to keep the rectum empty; education and behavioural therapy; and regular follow-up to support the child and family to maintain regular bowel habits and toileting.
Implications for clinical practice: This review will help guide and inform clinical practice in relation to assessment and management of chronic functional constipation in children and enable the development of tools and care plan.