Role of nursing professionals for parenting development in early childhood: a systematic review of scope

Objective: map available evidence regarding the role of nursing professionals in early childhood care through the development of parenting. Method: systematic review of scope, with selection of studies about the role of nursing professionals for the development of parenting in the context of early childhood care, using a standardized data extraction tool and qualitative thematic analysis. Results: nineteen studies were included, showing the role of nursing professionals covers nine dimensions: promoter of parental role construction; guidance and support for the implementation of physical health care; guidance for promoting safe environment; application of theories, principles and methods of maternal and child programs; development of therapeutic relationships; implementation of maternal and child care management; promotion of access to support network; guidance for the life course of parental figures; and use of scientific evidence to guide practice. Conclusion: nursing professionals offer important knowledge and significant practices for the development of parenting in early childhood care. These findings provide the basis for improving the clinical practice of these professionals, showing relevant areas of action and interventions to early childhood.


Introduction
Parental care during childhood can affect a child's development and life, with possible impact on health and economic and social consequences due to influences in the early period of human development (1) .
Individual and social circumstances experienced by vulnerable families can be a challenge to a successful start for children and disrupt long-term socioeconomic stability (2) .
Besides, studies show positive correlations between poor family structure and development of emotional, behavioral and cognitive problems in children (3) .
Parenting is described as activities aiming to promote the survival and full development of children performed by their reference adults (4) , who are responsible for caring, stimulating, providing information, loving, imposing limits, ensure autonomy and preparing the child for the challenges and opportunities of present and adult life (4) .
Interventions during pregnancy and childhood to help reference adults acquire positive parenting skills and create safe and healthy environments are the goals of several nurse home visiting programs (5)(6) .
These nurse home visits promote strong connections with visited families, so nursing professionals become reliable for them (7) , with the possibility to exchange knowledge from different fields, establish effective communication channels with various social sectors and promote effective health care strategies.
Nursing is recognized for its ability to understand and take care of human beings in general, assisting them in their health issues (8) . However, according to a primary study found in the literature, nursing professionals are not prepared to meet the demands of their role in child health care (9) .
Despite presenting validated instruments for the diagnosis of support to parental figures and target of nursing interventions (10)  In addition, based on international experience, maternal and child health programs focused on building positive parenting skills have more successful results when developed by nursing professionals (11)(12)(13) .
A search conducted in the systematic review database of the Joanna Briggs Institute, the Cochrane Library and the online medical literature search and analysis system (PubMed/MEDLINE) in November 2017 did not identify any systematic review or published review protocols related to this topic.
In case of absence of clear evidence of the role of nursing professionals in parenting development in early childhood care, these professionals miss the opportunity to intervene based on evidence in child development. Therefore, a scope review is needed to map studies on this topic.
Then, the following review question was developed: What is the nursing professional role in parenting development in early childhood care? Therefore, the objective of this scope review was to map available evidence about the role of nursing professionals in early childhood care through parenting development.

Method
This review used the P-C-C strategy to formulate the review question, as proposed by the Joanna Briggs Institute, where "P" refers to the population/participants, "C" is the concept to be investigated, and "C" refers to the context. Therefore, this review considered the studies conducted with the population of nursing professionals that addressed their performance in early childhood care through parenting development.
For the purposes of this study, the source of information included existing literature, such as published or unpublished quantitative or qualitative primary research studies, systematic reviews, and research reports.

Results
In total, 477 studies were identified in databases and 10 additional records were obtained from other sources.
After excluding repeated articles, titles of 299 documents were read to check them against the inclusion criteria.
Of these, 188 studies were selected for abstract reading and later 49 were fully read. Of these, 30 were excluded because they did not meet the inclusion criteria and the objectives, so 19 were included in this review.  The studies included in this review (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33) were produced from 1998 to 2016, most of them (14) in the last 10 years. Seven studies were conducted in Portugal, five in the United States, two in Australia, one in England, one in Sweden, one in Scotland, one in Canada and one in Jamaica, Antigua and Saint Lucia. Figure 2 details the characteristics of these studies: All documents included in this review address the context of early childhood care. Figure 3 shows the role of nursing professionals for the development of parenting, described in nine dimensions:  -Provide health education about different topics: breastfeeding, feeding, prevention of infectious diseases, prevention of accidents, recreational and leisure activities, hygiene and comfort care, bowel elimination pattern.
-Emphasize the importance of observing the national immunization schedule and regular child/youth health visits.
-Conduct nutritional assessment and provide guidance.
-Guide postpartum mothers about newborn feeding and care.

DIMENSION 3
Guidance for promoting safe environment -Conduct environmental education (housing hygiene and health promoting environment).
-Provide guidance for the implementation of safe family environment (smoke detector, tap water temperature, protection on windows and stairs, safe place for children to sleep).
-Instruct and encourage the family for home management (definition of monthly resources for food, transportation and items of basic needs).
-Provide guidance to promote a place with an area where children can play, for their meals, promoting a daily routine.
-Plan interventions in partnership with parents, creating an environment that contributes to development and well-being.   (2) guidance and support for the implementation of Regarding the dimension of promoter of parental role construction, positive parenting covers several attributions of reference adults in child care, which are critical for child health and development. In the first years of life, a child's brain presents high learning potential (10,34) , which is an opportunity for parental figures to optimize child development (10) ; however, in some cases, they need support and guidance to play their role properly (34) . In the meantime, nursing professionals can provide support, articulated with other professionals and facilitate their implementation, such as home visits.
A study shows home visits by nursing professionals during the prenatal period and first years of the child help reduce all-cause mortality among mothers and avoidable mortality among children (35) .
Besides home visits, other strategies are used in the application of theories, principles and methods of maternal and child programs, such as telephone support, discussion groups and use of videos. Then, actions should be developed by nursing professionals to achieve the goals of specific programs. The literature demonstrates the role of nursing professionals should be planned in detail before its practical implementation (36) .  (7) .
To explain all these dimensions of action, scientific evidence is used to guide their practice, as professionals need support to develop and maintain their skills and a knowledge base for high-quality evidence-based practice (9) in order to perform their role effectively.
Ideally, early childhood development services should be offered holistically and integrally across all relevant sectors, without fragmentation, to enable young children to thrive (34,37) . Policies to reduce poverty and strengthen family resources can create a favorable environment to promote, protect and support early childhood development (38) .