Effects of an Intervention Program for Promoting Ethical Practices Among Pediatric Nurses

The Japanese nursing education system only requires a general nursing qualification. After graduation, many Japanese nurses work within pediatric departments where they receive specialized training in pediatric care. An intervention program for promoting ethical nursing practices among patients and their families was implemented for pediatric nurses with 0-5 years pediatric nursing experience. The objective of this study was to clarify changes in nurses' recognition and behaviors, as well as the intervention's post-initiation durability. The pediatric nursing care model (PNCM), defining 24 nursing approaches, was developed to show simple examples of ethical nursing practices for pediatric patients and their families. An intervention program included an initial session that consisted of a 30-minute mini-lecture. Nurses also described details of approaches previously performed and conducted a peer-review. Concerning the PNCM, the frequency of implementing each approach was examined using a 4-point Likert scale both before and at 2-month post-intervention initiation. Recognition of intervention feasibility was evaluated using a 4-point Likert scale at the end of the first session. Furthermore, during the second month, reflection and outcome content was evaluated by examining approaches the nurses performed and described. During the third month, the nurses were asked to describe changes in their behavior in terms of ethical nursing practices, along with those observed by patient and family responses, and any recognition of future challenges. Regarding the care model items, feasible practices were recognized immediately post-intervention, and 18 of 24 items (75.0%) revealed significant improvement. Implementation frequency for 10 out of 18 items (55.6%) was higher than before the intervention, and there was a significant difference among four items. The intervention program led to improvements in highly feasible and basic ethical nursing practices, including an increase in greetings and self-introductions, verbal explanations for children, quantitative and qualitative alterations in order to improve children's coping behaviors, changes in nurses' active attitudes for reducing children's fear and attitudes for feasible future implementation. Changes in practices at 3-month post-initiation corresponded to the four components of "child assent" or the final three goals of our conceptual framework.