Search Results (258)

Flanders, the Dutch-speaking part of Belgium, was the first region in Europe to implement universal neonatal hearing screening (UNHS) in 1998. Early detection of hearing loss, in combination with advances in hearing technology, has provided new opportunities and different challenges especially for children with a severe to profound hearing loss. Both the population of students with hearing loss and their educational contexts and needs have undergone significant changes. The government of education and the government of health care in Flanders created several services to support students with a hearing loss and their families, which we describe in this chapter. Although the demand for specialized staff training to meet all these challenges increased, the availability of such training has declined. Historically, specialized training for professionals in deaf education was always organized by or with the special schools for the deaf. However, the expertise is diminishing as now most children are mainstreamed and the special schools have become much smaller. The specialized training supported by the government of education focuses on education of all types of children with special needs, with limited information about children with a hearing loss. Private organizations, such as ONICI (Independent Information and Research Centre on Cochlear Implants) have taken the initiative to start up training courses on different topics related to hearing loss, with great success. It is hoped that governmental support will expand to sustain these opportunities. Full article

Background/Objectives: Haematopoietic stem cell transplantation (HSCT) causes substantial morbidity in children and young people (CYP). Although prehabilitation benefits adults with cancer, its role in paediatric HSCT remains underexplored. This study aimed to describe current pre-transplant assessment and supportive care practices across paediatric HSCT centres, explore healthcare professional perspectives on prehabilitation implementation, and integrate patient and public involvement (PPI) to inform future intervention design. Methods: A cross-sectional survey was administered to healthcare professionals across 16 paediatric HSCT centres in the UK and the Republic of Ireland, alongside semi-structured PPI discussions conducted with eight children, young people, and caregivers with direct experience of paediatric HSCT. Survey data were analysed descriptively, free-text responses by qualitative content analysis, and PPI by reflexive thematic analysis. Results: Forty-nine eligible responses were received from healthcare professionals. Formal prehabilitation services were reported by 27 (55.1%) respondents, with substantial within-centre variation. Nutritional advice was the most consistently delivered component, 36 (72%), whilst physical activity interventions were the least consistently provided, 13 (26%). Workforce limitations were identified as the dominant barrier by 37 (95%) respondents. PPI findings described provision as reactive and inconsistent, with families expressing preference for flexible, hybrid, and family-centred delivery models. Conclusions: Prehabilitation provision in paediatric HSCT is variable, often informal, and limited by workforce capacity. CYP and caregivers expressed a desire for prehabilitation, particularly through flexible, hybrid (face-to-face and online), and family-centred approaches. Future research should prioritise co-design and feasibility testing of safe, individually tailored programmes that can be integrated into paediatric HSCT pathways. Full article

Background/Objectives: Despite its proven benefits, skin-to-skin contact (SSC) after caesarean section faces significant barriers to implementation. Complementing two previous randomised controlled trials conducted by our group, this descriptive qualitative study aimed to identify barriers and facilitators experienced by multidisciplinary healthcare teams, providing frontline insights into factors contributing to the inconsistent implementation of SSC. Methods: Following a phenomenological approach and the COREQ guidelines, 40 semi-structured interviews were conducted with healthcare professionals involved in caesarean care at a Spanish tertiary hospital, including anaesthetists, gynaecologists, neonatologists, midwives, nurses and nursing assistants. The data were thematically categorised at the semantic and pragmatic levels using MAXQDA software. Results: SSC implementation remains inconsistent in routine care. Despite the existence of an established institutional protocol, systematic adherence is hindered by high clinical workload, infrastructure constraints and inconsistent dissemination of guidelines. Professional barriers included gaps in training and entrenched routines, while attitudinal barriers stemmed from safety concerns following major abdominal surgery. Key facilitators included the absence of clinical complications and the positive emotional impact of SSC on family bonding. These findings provide critical diagnostic insights into implementation barriers, informing future strategies to enhance adherence to established institutional protocols. Conclusions: Although safe and feasible, post-caesarean SSC remains inconsistently implemented due to addressable barriers. Its routine adoption requires targeted multidisciplinary training, commitment from healthcare teams and infrastructural adaptations in post-anaesthesia care units (PACU). Full article

Early childhood education and care (ECEC) systems in equitable welfare states are designed to provide comparatively standardised institutional inputs, yet substantial developmental gaps among children persist. This study examined this configuration—descriptively labelled the “Flemish Paradox”—using data from the OECD’s International Early Learning and Child Well-being Study (IELS 2025) for the Flemish Community of Belgium (2363 five year olds in 200 ECEC centres; parent-questionnaire data were available for a subset of the sample, and missing parent-report data were addressed through multiple imputation). Children’s cognitive and executive skills were measured with standardised direct tablet-based assessments, while home environments were reported by parents, separating measurement sources. Two-level hierarchical linear models with design-based weighting (child weight and 92 BRR replicate weights), pooled across five plausible values and 20 multiply imputed datasets, showed comparatively limited between-centre outcome variation (ICC ≈ 23% for foundational learning, ≈11% for executive function). Within centres, family socioeconomic status (B = 25.11, p < 0.001) and a print-focused home literacy index (PHLI; B = 16.60, p < 0.001) were positively associated with foundational learning, and centre-mean PHLI showed an independent contextual association (B = 24.11, p < 0.001). A positive within-centre indirect association through children’s executive function skills was estimated (3.60, 95% Monte Carlo CI [1.83, 5.40]); a secondary exploratory analysis indicated a parallel between-centre pattern (8.40, 95% CI [1.16, 15.65]). Centre socioeconomic composition was strongly associated with outcomes (B = 36.38, p < 0.001); the analysis did not provide evidence that it modified the within-centre PHLI–learning association (p = 0.219). The findings are consistent with cultural-capital perspectives and indicate that family resources, print-focused home literacy, and EFs are jointly associated with early learning within a multilevel ECEC context. However, the cross-sectional design does not establish temporal or causal mediation, and the results should not be interpreted as evidence regarding the effectiveness of particular family- or centre-based interventions. Full article

Background/Objectives: Older adults may experience healthcare encounters in which their voices are discounted, redirected through family members, or interpreted through age-related assumptions about cognitive decline. Although such problems are often discussed through dignity, communication, ageism, person-centred care, or shared decision-making, this conceptual review argues that they also involve epistemic harms: harms that occur when older adults are not recognized as credible knowers of their own bodies, needs, values, histories, and care priorities. Methods: This article develops a conceptual and critical analysis of Fricker’s account of testimonial and hermeneutical injustice, later critiques of epistemic injustice, and the nursing and gerontological literature on dignity, person-centred nursing, documentation, dementia care, and shared decision-making. Results: The analysis distinguishes ordinary communication failure, institutional restriction of interpretive space, testimonial injustice, and hermeneutical injustice. It identifies interacting interpersonal and institutional mechanisms through which older adults’ knowledge may be discounted or rendered invisible and develops five theoretically derived principles: credibility-oriented listening, narrative recognition, supported participation, relational decision-making, and epistemic documentation. For each principle, the framework identifies the epistemic failure addressed, its added value beyond general person-centred practice, and responsibilities at both individual and organizational levels. Conclusions: An epistemic-justice lens does not replace dignity, person-centred care, shared decision-making, or professional judgement. It adds a focused analysis of credibility, interpretive authority, knowledge visibility, and whose account shapes care. The proposed framework is a conceptual and normative contribution that requires empirical evaluation before its effects can be established. Full article

Background: Population ageing, increasing care demands, and rapid advances in artificial intelligence and robotics have intensified interest in care robots as potential tools to support independent living and complement human caregiving. However, the successful implementation of robotic technologies depends largely on public acceptance, which is influenced by functional, psychological, ethical, cultural, and generational factors. Objective: This study examined generational differences in the acceptance of care robots among Portuguese adults by integrating the Almere Model of technology acceptance with the Katz Index of Activities of Daily Living (ADL) and the Lawton–Brody Instrumental Activities of Daily Living (IADL) Scale. The research sought to determine whether acceptance varies according to generation and the type of caregiving activity performed by the robot. Methods: A cross-sectional quantitative study was conducted using an online questionnaire administered to a purposive sample of 235 adults residing primarily in the Lisbon Metropolitan Area, Portugal. The questionnaire combined constructs from the Almere Model with perceptions of robotic assistance for ADLs and IADLs. Principal Component Analysis, reliability analysis, descriptive statistics, and inferential analyses were performed to examine differences across generational groups. Results: Acceptance of care robots was strongly task-dependent. Participants expressed significantly greater acceptance of robots assisting with instrumental activities, including housekeeping, shopping, transportation, meal preparation, and medication management, than with intimate personal care activities such as bathing, dressing, toileting, feeding, and continence care. Contrary to common assumptions regarding digital natives, Generation Z reported higher levels of fear, discomfort, and perceived intimidation than Generation X and Baby Boomers. Older generations generally demonstrated more pragmatic acceptance of robotic assistance, particularly regarding future support needs associated with ageing. Across generations, respondents preferred robots with more human-like appearances; however, emotional trust remained substantially lower than perceived functional usefulness. Conclusions: The findings suggest that acceptance of care robots is conditional rather than universal and is shaped by the nature of the caregiving task, generational differences, and broader emotional and cultural perceptions of care. Integrating the Almere Model with established ADL and IADL frameworks provides a novel perspective by linking technology acceptance to specific functional domains of caregiving. The results support the view that care robots are more likely to be accepted as complementary tools that enhance human-centred care rather than as substitutes for professional or family caregivers. Given the purposive and geographically limited sample, the findings should be interpreted cautiously and not generalised to the wider Portuguese population. They nevertheless provide valuable implications for the design of socially assistive robots, healthcare practice, and public policy in ageing societies. Full article

Collective intergenerational trauma is a complex phenomenon affecting descendants and families exposed to the enduring effects of collective traumatic events, such as forced displacement, genocide and war. This systematic review aimed to explore the mechanisms through which collective trauma is transmitted across generations, examine its consequences for children and families, and critically analyse interventions employed by health professionals and social workers. A systematic review was conducted using ScienceDirect, Wiley Online Library and PubMed. Studies published between 2016 and 2026 were screened for eligibility, resulting in the inclusion of 22 studies. The indexing terms “collective intergenerational trauma”, “collective transgenerational trauma”, “trauma transmission”, “transmission mechanisms”, “consequences”, “intergenerational trauma interventions”, “Social Care”, and “Health Professionals”, were used, along with the Boolean operators AND and OR. The included studies were synthesised using thematic analysis. The findings indicate that collective intergenerational trauma is transmitted through interacting family, communicative, sociocultural and biological mechanisms. Its consequences include psychological and psychosocial difficulties among descendants, disruptions in family relationships and adverse effects on family functioning. Existing interventions primarily focus on individual trauma, with limited attention to its collective and intergenerational dimensions. The findings highlight the need for culturally responsive, trauma-informed and family-centred interventions addressing collective intergenerational trauma within a systemic framework. Health professionals and social workers can play an important role in promoting mental health, strengthening resilience, mitigating the long-term effects of trauma and supporting affected children, families and communities. Full article

Effective motor neurone disease (MND) management depends on patient and carer involvement in decisions about interventions and future care. Communication and cognitive impairments are common in MND and have under-recognised consequences for shared decision making and autonomy. This narrative conceptual review draws on empirical qualitative research with people living with MND and unpaid family carers and the literature specifically concerning shared decision making and communication in MND. Themes relating to communication, information use, and decision making styles were mapped onto an ALS/MND multidisciplinary decision making model. Enhancements to the model include expanding the decision making context beyond in clinical activity, embedding communication and cognitive skills and accommodations across stages, and acknowledging risks to collaborative decision making. Practical strategies for clinicians, healthcare services, people living with MND, and family carers are proposed to ensure that communication is foregrounded in-person-centred MND care. Observational and implementation research is required to evaluate and refine the proposed approaches. Full article

Background/Objectives: Communication about illness severity in the neonatal intensive care unit (NICU) occurs in settings of uncertainty and changing clinical status. Reviewing how the literature describes this communication may clarify current practices and identify gaps in how parents receive severity-related information. This scoping review aimed to describe how illness severity is communicated to parents in the NICU, including parental engagement, communication goals, informational content, framing, and communication across periods of clinical stability and deterioration. Methods: We conducted a scoping review using the Joanna Briggs Institute method and reported it according to PRISMA-ScR guidelines. MEDLINE (Ovid) was searched from 2010 to 2025. We included studies that reported empirical data on communication about infant clinical status or illness severity and included parental perspectives. A framework, informed by parental information behaviour and prognostic communication models, guided the data extraction. Results: We included 25 studies. Communication was most often clinician-led and often combined active and passive approaches. Communication primarily focused on information sharing rather than decision-making. Discussions were largely biomedical; however, several studies also included treatment- and care-related information. Studies inconsistently described prognostic communication and did not emphasize optimistic or pessimistic framing. Few studies examined communication across distinct phases of illness trajectory, such as clinical stability or deterioration. Conclusions: Illness severity communication in the NICU remains largely clinician-led, with limited attention to parental engagement and changes across the infant’s clinical course. Greater consideration of parental information needs, prognostic communication, and illness trajectory may support more responsive communication practices in NICU care. Full article

Family-centred approaches are being increasingly recognized as integral to inclusive mental health care. Although substantial evidence-based exists for specific interventions particularly family intervention for psychosis, there is no synthesis that maps how family-centred approaches are conceptualized, implemented, and linked to inclusivity across diagnoses, service contexts, and levels of evidence. Existing reviews are largely disorder-specific or outcome-focused and do not examine family-centred care as a system-level strategy for inclusive practice. This scoping review aimed to map and synthesize the existing literature on family-centred approaches used to promote inclusive mental health care for individuals with psychiatric disorders. This review followed the Joanna Briggs Institute (JBI) methodology for scoping reviews and the PRISMA-ScR reporting guidelines. Searches were conducted in PubMed, PsycINFO, CINAHL, Scopus, Embase, and Web of Science for English-language empirical studies published between 2000 and 2025. Studies involving individuals with psychiatric disorders and any form of family-centred, family-focused, or family-inclusive approach were eligible. Data were charted and analyzed thematically to map intervention types, reported outcomes, and implementation influences; the review did not evaluate intervention effectiveness. Twenty-four studies met the inclusion criteria. Only five themes emerged from this study. Across the literature, family involvement was associated with improved engagement, enhanced communication, and increased caregiver competence. Psychoeducation featured prominently in evidence-based interventions, while newer models emphasized shared decision-making and service co-production. Family-centred approaches are conceptualized in diverse ways across mental health services and are commonly linked to more inclusive and collaborative care. However, the strength of evidence varies substantially between intervention types. This review clarified how family-centred practices are situated across levels of evidence and service contexts, highlighting the need for greater precision in distinguishing established interventions from emerging practices and for system-level strategies to support consistent, culturally responsive family inclusion. Full article

Background/Objectives: Evacuation policies for childbirth in Nunavut, Canada, continue to profoundly shape the lives of Inuit women, their families, and communities. The evacuation policy is known to disrupt kinship networks and contribute to the erosion of Inuit birthing knowledge. Addressing a gap in Inuit-led understandings of sexual and reproductive health priorities, this paper presents findings from research conducted in 2024 with Kivallirmiut women (‘People of’ in Inuktitut is miut; Kivallirmiut means people of the Kivalliq Region. Nunavummiut means people of Nunavut, and Arviarmiut means people of Arviat, Nunavut, Canada). The study took place in two communities in the Kivalliq Region of Nunavut. Methods: Employing a highly participatory, community-based Indigenous methodology, this study was underpinned by Inuit Qaujimajatuqangit, Indigenous feminist and postcolonial and decolonial theories, and principles of health equity. Data from a survey were generated to identify needs and priorities related to perinatal health and care. Results: Findings identify that Inuit women in these communities hold an interest in accessing perinatal information and support, with a strong desire for learning from Inuit Elders, as well as support via peer networks. Participants also emphasized a desire for more information concerning travelling for birth (medical evacuation), breastfeeding, and healing after birth. Different models for delivery of this information and perinatal support were also identified. Conclusions: Collectively, the priorities of Inuit women in this survey offer insights concerning a structural misalignment between existing perinatal care supports and services that rely on evacuation-based perinatal care and the needs and priorities within Kivalliq communities. This disconnection reveals enduring colonial assumptions embedded within current healthcare systems. The findings suggest a need for perinatal supports that centre culture, kinship, and relational forms of support. Full article

Children undergoing cancer treatment face repeated, prolonged hospitalisations carrying substantial risks of psychological distress, social isolation, and impaired development. Volunteers offering structured non-medical activities are widely employed to complement professional psychosocial care in paediatric oncology settings, yet empirical evidence examining their role specifically—as distinct from professionally delivered psychosocial interventions—remains sparse. This narrative review, conducted in accordance with SANRA criteria and drawing on a structured search of PubMed, PsycINFO, and Google Scholar (2000–2025), supplemented by a targeted verification search in July 2026, synthesises the theoretical and preliminary empirical basis for volunteer involvement, critically evaluates associated clinical risks, and proposes evidence-informed recommendations for paediatric oncology clinical practice. Three theoretical frameworks provide the conceptual grounding for volunteer activities: developmental psychological models (Piaget; Erikson), stress and coping theory (Lazarus and Folkman), and the biopsychosocial model (Engel). Indirect empirical evidence—derived predominantly from professionally delivered interventions—supports short-term benefits of structured distraction, play, and social activities on procedural anxiety, pain experience, and sense of social inclusion; the sole study examining volunteer-facilitated activities specifically in paediatric oncology reported meaningful reductions in distress and high family satisfaction. Eight categories of clinical risk are identified, including physical and psychological overload, erosion of child autonomy, suppression of authentic emotional expression, and inadequate coordination with healthcare staff. Six practice recommendations are proposed, centred on a working definition of the volunteer role, mandatory pre-access training, genuine individualisation including cultural adaptation, multidisciplinary-team-led coordination, and structured programme evaluation. Volunteer involvement can meaningfully complement professional psychosocial care when delivered within a structured, supervised, and multidisciplinary-team-coordinated framework. The paediatric oncology team occupies a pivotal role in realising the potential benefits while safeguarding children from associated risks. Prospective research employing standardised volunteer programme definitions and validated child-reported outcome measures is urgently needed to build an evidence base commensurate with the clinical importance of this practice. Full article

Background/Objectives: Spiritual care is a core component of holistic paediatric palliative care, yet nurses often feel insufficiently prepared to address the spiritual and existential needs of seriously ill children and their families. This systematic review aimed to explore nurses’ experiences of providing spiritual care to seriously ill and dying children in paediatric palliative care settings and to identify the factors that facilitate or hinder its provision. Methods: A systematic review was conducted in accordance with PRISMA 2020. CINAHL, PubMed, Web of Science and SAGE were searched for English-language qualitative, quantitative and mixed-methods studies published up to November 2025. Study quality was assessed using JBI critical appraisal checklists, and the findings were synthesised thematically following Thomas and Harden. Results: A total of 228 records were identified, of which ten studies met the predefined inclusion criteria. The thematic synthesis identified one overarching theme—nurses’ engagement with spirituality while caring for seriously ill and dying children—supported by two sub-themes: managing emotional responses and maintaining professional, family-centred support. Conclusions: Nurses recognise spiritual care as essential in paediatric palliative care but often lack the competence and institutional support to provide it consistently. Education should prioritise spiritual assessment, developmentally appropriate communication, ethical boundaries, reflective practice and structured debriefing. Full article

Background/Objectives: Prognostication in ICU patients with documented coma or unresponsiveness is a high-stakes task that informs escalation of care, goals-of-care discussions, and family counselling. Conventional scores are often based on static snapshots and may not reflect early physiological evolution in heterogeneous real-world ICU populations. Routine arterial blood gases (ABG) and SpO₂ are repeatedly measured during early ICU care and may capture clinically meaningful trajectories that can be leveraged by explainable machine learning. To develop and internally validate exploratory, time-updated explainable machine-learning models for ICU outcome in ICU patients with clinically documented coma or unresponsiveness using routine ABG/SpO₂ measurements and physiological trajectories available at admission, 24 h, and 72 h, and to evaluate whether trajectory information adds prognostic information within a staged internal-validation framework. Methods: We conducted a retrospective single-centre study of 108 adult ICU patients with clinically documented coma or unresponsiveness. Predictors included demographics, comorbidity burden, COVID-19 status, baseline ABG/SpO₂ at ICU admission, inflammatory and coagulation biomarkers, and derived ABG/SpO₂ trajectory variables at 24 h and 72 h. Trajectory variables were defined as changes from admission to 24 h and to 72 h and were retained as missing when follow-up measurements were unavailable. The primary ICU-course outcome was ICU death versus transfer to ward. Three staged models were evaluated: Model A using baseline variables, Model B adding 24 h trajectory features, and Model C adding 72 h trajectory features. For each stage, models were analyzed with and without the derived respiratory_support index; models excluding respiratory_support were treated as the main interpretive analyses. Logistic regression, random forest, and gradient boosting (XGBoost) classifiers were assessed using repeated stratified 5-fold cross-validation with 20 repeats and aligned out-of-fold predictions. Performance was reported using AUC-ROC, precision–recall AUC, Brier score, and operating-point metrics; clinical utility was examined with decision-curve analysis. Model interpretation used SHAP and partial dependence plots. Robustness analyses included feature-exclusion sensitivity analysis for respiratory_support and a label-permutation sanity check. Results: ICU mortality was 65.7% (71/108). Follow-up ABG completeness was 75.9% at 24 h and 61.1% at 72 h. Because respiratory_support summarized the highest support level during the first 72 h and strongly separated outcome groups, models excluding respiratory_support were treated as the primary interpretive analyses. In the primary NoRS logistic-regression models, discrimination was moderate-to-strong, with AUC-ROC 0.822 for Model A_noRS, 0.848 for Model B_noRS, and 0.895 for Model C_noRS; bootstrap 95% confidence intervals were 0.739–0.897, 0.766–0.919, and 0.830–0.951, respectively. Measurement-availability sensitivity analyses and simple benchmark models were added to contextualize trajectory-related performance. Respiratory_support-enriched models were retained only as secondary severity-aware analyses, not as admission-only prediction models. Label permutation reduced discrimination toward chance (AUC ≈ 0.55). SHAP and partial-dependence analyses identified oxygenation variables, inflammatory burden, acid–base status, and ΔPaO₂ at 72 h as clinically coherent contributors to predicted risk; when included, respiratory_support dominated feature attribution, consistent with its role as an organ-support intensity marker. Conclusions: In ICU patients with clinically documented coma or unresponsiveness, explainable machine-learning models using routine ABG/SpO₂ trajectories within the first 72 h are feasible and may provide time-updated prognostic information, but the incremental value of trajectory-enriched models over simpler admission-only benchmarks remains unproven. Trajectory-enriched NoRS models retained meaningful discrimination after removing organ-support severity, suggesting a possible physiologically meaningful signal beyond support intensity alone, although definitive incremental value over parsimonious admission-only benchmarks was not established. These findings should be interpreted as exploratory and internally validated only; they do not establish a deployable ICU mortality score, do not demonstrate superiority over established ICU severity scores, and require external validation in larger multicentre cohorts before clinical deployment. Full article

Background: Virtual reality (VR) is a promising technology for the relief of physical and psychosocial burdens. We found that individualised VR videos were well tolerated and accepted and seemed to have a stronger effect on well-being and emotional connection than standardised VR in cancer inpatients under palliative care. For implementation, it is important to actively involve patients, as their input helps to ensure that the VR intervention meets their needs, thus making it more likely to be accepted and effective in practice, while balancing the needs of healthcare professionals. Aim: Exploration of patients’ and healthcare professionals’ perspectives on best practice VR intervention implementation. Design: Workshop-based 360° focus group using a strengths–weaknesses–opportunities–threats (SWOT) model and deductive/inductive qualitative analysis with a ‘framework’ approach. Setting/participants: The focus group took place at the National Centre for Tumour Therapy of a German university hospital. Participants were a local doctor (1) and nurses (3) with VR experience, the cooperating patient advisory board of the study (2), and members of a regional self-help group (3). Results: Eighteen subthemes were identified in the SWOT model. While there was agreement on the ‘strength of distraction’ and ‘opportunities of individualised VR’, concerns remained regarding data protection when using private VR content. There was an argument about gatekeeping by relatives worried about mental distress in patients immersing in home or family VR scenes. In contrast, many ideas were discussed regarding how to overcome rejectionist staff attitudes. However, the high organisational time and staff deployment were addressed as major weaknesses. Conclusions: Involving patient stakeholders and healthcare professionals in the planning of the implementation strategy revealed several issues that require attention. In particular, information needs to be provided not only to patients but also to relatives and hospital staff, alongside ensuring data protection and adequate staffing. Trial registration: Registered at German Clinical Trials Register (Deutsches Register Klinischer Studien; DRKS); registration number: DRKS00032172; registration date: 11 July 2023. Full article