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Abstract
BACKGROUND The concept of uncertainty in illness has been well described and applied to many different areas of nursing and other disciplines. Specifically, parental uncertainty in illness of an infant is a meaningful concept that has specific attributes and implications. A current concept analysis that considers the changing healthcare setting, historical conceptual inconsistencies, and a lack of information concerning parents of infants is needed. PURPOSE To identify essential antecedents, attributes, and consequences of parental uncertainty in illness using Rodgers' Evolutionary Concept Analysis method. METHODS A literature search was conducted using PubMed, CINAHL, and PsycInfo. The following keywords were used in combination using the Boolean terms "AND" and "OR": parental uncertainty; infants; parental uncertainty in illness; preterm infants; parent; uncertainty. INCLUSION CRITERIA articles published between 2000 and 2017 and published in English. The search included 38 articles published from 2000 to 2017 with a specific focus on parental uncertainty in illness. FINDINGS Parental uncertainty in illness of an infant is a paradoxical, cognitive, and emotional experience in which there is an inability to create meaning and may cause disruption in parental role development. IMPLICATIONS FOR PRACTICE Nursing care of parents with ill infants and children must include sensitivity to parents' experiences of uncertainty in illness. Nurses are uniquely positioned to normalize parental uncertainty and facilitate healthy coping.
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Hanson CS, Gutman T, Craig JC, Bernays S, Raman G, Zhang Y, James LJ, Ralph AF, Ju A, Manera KE, Teixeira-Pinto A, Viecelli AK, Alexander SI, Blydt-Hansen TD, Dionne J, McTaggart S, Michael M, Walker A, Carter S, Wenderfer SE, Winkelmayer WC, Bockenhauer D, Dart A, Eddy AA, Furth SL, Gipson DS, Goldstein SL, Groothoff J, Samuel S, Sinha A, Webb NJ, Yap HK, Zappitelli M, Currier H, Tong A. Identifying Important Outcomes for Young People With CKD and Their Caregivers: A Nominal Group Technique Study. Am J Kidney Dis 2019; 74:82-94. [DOI: 10.1053/j.ajkd.2018.12.040] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 12/23/2018] [Indexed: 11/11/2022]
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Clavé S, Tsimaratos M, Boucekine M, Ranchin B, Salomon R, Dunand O, Garnier A, Lahoche A, Fila M, Roussey G, Broux F, Harambat J, Cloarec S, Menouer S, Deschenes G, Vrillon I, Auquier P, Berbis J. Quality of life in adolescents with chronic kidney disease who initiate haemodialysis treatment. BMC Nephrol 2019; 20:163. [PMID: 31088395 PMCID: PMC6515621 DOI: 10.1186/s12882-019-1365-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 04/30/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND To describe the quality of life of adolescents initiating haemodialysis, to determine the factors associated with quality of life, and to assess coping strategies and their impact on quality of life. METHODS All adolescents initiating haemodialysis between September 2013 and July 2015 in French paediatric haemodialysis centres were included. Quality of life data were collected using the "Vécu et Santé Perçue de l'Adolescent et l'Enfant" questionnaire, and coping data were collected using the Kidcope questionnaire. Adolescent's quality of life was compared with age- and sex-matched French control. RESULTS Thirty-two adolescents were included. Their mean age was 13.9 ± 2.0 years. The quality of life score was lowest in leisure activities and highest in relationships with medical staff. Compared with the French control, index, energy-vitality, relationships with friends, leisure activities and physical well-being scores were significantly lower in haemodialysis population. In multivariate analyses, active coping was positively associated with quality of life and especially with energy-vitality, relationships with parents and teachers, and school performance. In contrast, avoidant and negative coping were negatively associated with energy-vitality, psychological well-being and body image for avoidant coping, and body image and relationships with medical staff for negative coping. CONCLUSIONS The quality of life of haemodialysis adolescents, and mainly the dimensions of leisure activities, physical well-being, relationships with friends and energy-vitality, were significantly altered compared to that of the French population. The impact of coping strategies on quality of life seems to be important. Given the importance of quality of life and coping strategies in adolescents with chronic disease, health care professionals should integrate these aspects into care management.
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Affiliation(s)
- Stéphanie Clavé
- Department of Multidisciplinary Pediatrics, Hôpital de la Timone Enfant, Assistance Publique des Hôpitaux de Marseille, Marseille, France. .,Aix-Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: - CEReSS Health Service Research and Quality of Life Center, Marseille, France.
| | - Michel Tsimaratos
- Department of Multidisciplinary Pediatrics, Hôpital de la Timone Enfant, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Mohamed Boucekine
- Aix-Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: - CEReSS Health Service Research and Quality of Life Center, Marseille, France
| | - Bruno Ranchin
- Department of Pediatric Nephrology, Hôpital Femme Mere Enfant, Hospices Civils de Lyon, Lyon, France
| | - Rémi Salomon
- Department of Pediatric Nephrology, Assistance Publique des Hôpitaux de Paris, University Hospital Necker-Enfants Malades, Paris, France
| | - Olivier Dunand
- Department of Pediatrics, Hôpital Félix Guyon, University Hospital La Réunion, Saint-Denis, La Réunion, France
| | - Arnaud Garnier
- Department of Pediatric Nephrology, Children Hospital Toulouse, Toulouse, France
| | - Annie Lahoche
- Department of Pediatric Nephrology, Jeanne de Flandre Hospital, University Hospital of Lille, Lille, France
| | - Marc Fila
- Department of Pediatric Nephrology, hôpital Arnaud-de-Villeneuve, University Hospital of Montpellier, Montpellier, France
| | - Gwenaelle Roussey
- Department of Pediatrics, University Hospital of Nantes, Nantes, France
| | - Francoise Broux
- Department of Pediatrics, Pediatric Nephrology and Hemodialysis Unit, University Hospital Charles Nicolle, Rouen, France
| | - Jérome Harambat
- Department of Pediatrics, Hôpital Pellegrin-Enfants, University Hospital of Bordeaux, Bordeaux, France
| | - Sylvie Cloarec
- Department of Pediatric Nephrology and Hemodialysis, Clocheville Hospital, University Hospital of Tours, Tours, France
| | - Soraya Menouer
- Department of Pediatrics 1, University Hospital of Strasbourg, Hôpital de Hautepierre, Strasbourg, France
| | - Georges Deschenes
- Department of Pediatric Nephrology, Assistance publique des Hôpitaux de Paris, University Hospital Robert Debré, Paris, France
| | - Isabelle Vrillon
- Department of Pediatric Nephrology, Hôpital d'Enfants Brabois, Nancy, France
| | - Pascal Auquier
- Aix-Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: - CEReSS Health Service Research and Quality of Life Center, Marseille, France
| | - Julie Berbis
- Aix-Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: - CEReSS Health Service Research and Quality of Life Center, Marseille, France
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54
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Mantulak A. "Best interest" and Pediatric End Stage Kidney Disease: The Case of Baby M. J Pediatr Nurs 2019; 46:e37-e43. [PMID: 30862429 DOI: 10.1016/j.pedn.2019.02.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 02/22/2019] [Accepted: 02/22/2019] [Indexed: 11/25/2022]
Abstract
In everyday clinical practice, health professionals and parents of chronically ill children often rely on the principle of 'best interest' in the development of medically oriented treatment plans. In most cases, such processes are done collaboratively; however, 'best interest' as a standard for decision-making becomes ambiguous in situations wherein parents and health professionals fail to agree on the course of treatment. This paper will explore the potential tensions that can exist in clinical practice when 'best interest' is used for making health care decisions. The discussion will be framed within the case of baby M, a newborn child of Mennonite descent diagnosed at birth with end-stage kidney disease (ESKD). M's parents refused medically-prescribed therapy on behalf of their child because of the uncertainty of the treatment and beliefs regarding quality of life. This case highlights that the application of the 'best interest' principle in the clinical domain can be ambiguously interpreted and subjectively operationalized along a narrowly defined medical understanding of what is in the patient's best interest. In addition, this case serves as an example of how power within the health care system can be used to operationalize a medically-sanctioned definition of 'best interest', often at the expense of the values, beliefs and interests of parental caregivers.
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Affiliation(s)
- Andrew Mantulak
- School of Social Work, King's University College at Western University, London, Ontario, Canada.
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55
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Petrongolo JL, Zelikovsky N, Keegan RM, Furth SL, Knight A. Examining Uncertainty in Illness in Parents and Children With Chronic Kidney Disease and Systemic Lupus Erythematosus: A Mediational Model of Internalizing Symptoms and Health-Related Quality of Life. J Clin Psychol Med Settings 2019; 27:31-40. [PMID: 30989366 DOI: 10.1007/s10880-019-09617-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To examine if parent illness uncertainty is indirectly associated with child depression, anxiety, and HRQOL in the CKD/SLE population. Parent-child dyads (N = 31) from outpatient rheumatology and nephrology clinics included children (ages 9-18) diagnosed with CKD (Stage 1, 2, or nephrotic syndrome) or SLE. Parents completed demographic and uncertainty measures and children completed uncertainty, depression, anxiety, and HRQOL measures. This cross-sectional study examined mediational models using the percentile bootstrapping method. Parent uncertainty had an indirect effect on child depression, anxiety, and HRQOL through the mediator, child uncertainty. In other words, parents' illness uncertainty regarding their child's condition correlates to the child's illness uncertainty, which then is associated with the child's mental health and wellbeing. Reverse mediations illustrated that parent uncertainty did not mediate child uncertainty and outcome variables. Results extend previous research by examining parent and child illness uncertainty in understudied conditions (CKD/SLE) and the relationship to outcome variables commonly related to depression (e.g., anxiety and HRQOL). Findings allow health psychologists and medical personnel to understand the impact of uncertainty on the child's wellbeing and HRQOL. Clinical implications, including using specialized interventions to address illness uncertainty, are discussed.
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Affiliation(s)
- Jennifer L Petrongolo
- Department of Psychology, La Salle University, 1900 West Olney Avenue, Philadelphia, PA, 19141, USA.
| | - Nataliya Zelikovsky
- Department of Psychology, La Salle University, 1900 West Olney Avenue, Philadelphia, PA, 19141, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania and the Children's Hospital of Philadelphia, 34th Street and Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Rachel M Keegan
- Department of Psychology, La Salle University, 1900 West Olney Avenue, Philadelphia, PA, 19141, USA
| | - Susan L Furth
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania and the Children's Hospital of Philadelphia, 34th Street and Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Andrea Knight
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania and the Children's Hospital of Philadelphia, 34th Street and Civic Center Blvd, Philadelphia, PA, 19104, USA
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56
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Lima AGT, Sales CCDS, Serafim WFDL. Burden, depression and anxiety in primary caregivers of children and adolescents in renal replacement therapy. ACTA ACUST UNITED AC 2019; 41:356-363. [PMID: 30806443 PMCID: PMC6788840 DOI: 10.1590/2175-8239-jbn-2018-0039] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 11/30/2018] [Indexed: 11/25/2022]
Abstract
Introduction: Chronic kidney disease (CKD) is rare in children, but it causes repercussions
in several aspects of life, because the disease and treatment cause great
changes in the daily lives of the child and his family, increasing the
burden on caregivers. Objective: To evaluate the burden of primary caregivers of children and adolescents who
undergo renal replacement therapy (RRT). Methods: Cross-sectional, observational study performed at the Pediatric Renal Unit of
a school hospital in the Northeast. Forty-nine primary caregivers of
pediatric patients with CKD in RRT followed up in our clinic participated in
the study. We used validated instruments to assess burden, depression and
anxiety. We ran some tests to analyze the findings of burden, depression and
anxiety in the sample. Results: Most of the caregivers are the mothers of these children (89.8%), aged
between 36 and 45 years (46.9%), have Elementary School education only
(55.1%) and reported feeling pain in the body (69.4%), but they did not have
chronic disease. The majority of the children have been in RRT from 1 to 3
years (40.8%), aged from 9 to 11 years (30.6%), are male (55.1%), and under
hemodialysis (38.8%). The caregivers had a moderate level of burden (2.10),
a high prevalence of moderate to severe depression (18.4%) and anxiety
(47%), and a strong correlation between burden, depression and anxiety. Conclusions: Caring for a child with CKD is an intense experience, with negative
consequences, due to uncertainties about the future and the very care these
children require. We need to do something to help these caregivers better
manage care, as well as cope with their own feelings.
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Affiliation(s)
- Angélica Godoy Torres Lima
- Instituto Federal de Educação, Ciência e Tecnologia de Pernambuco, Belo Jardim, PE, Brasil.,Instituto de Medicina Integral Professor Fernando Figueira, Recife, PE, Brasil
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57
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Wightman A, Zimmerman CT, Neul S, Lepere K, Cedars K, Opel D. Caregiver Experience in Pediatric Dialysis. Pediatrics 2019; 143:peds.2018-2102. [PMID: 30696758 DOI: 10.1542/peds.2018-2102] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Pediatric dialysis is thought to be burdensome on caregivers given their need to assume dual responsibilities of parental and medical management of their child's chronic illness. In this study, we seek to describe the experience of parental caregivers of children receiving chronic dialysis for end-stage kidney disease. METHODS We performed semistructured interviews of primary caregivers of children with end-stage kidney disease receiving chronic peritoneal dialysis or hemodialysis for at least 8 weeks from March 2016 to April 2017 at 3 pediatric dialysis centers in the United States. We performed a thematic analysis to inductively derive and identify themes and subthemes related to positive and negative caregiver experiences. RESULTS Thirty-five caregivers completed interviews. Four major themes were identified, each with several subthemes: (1) caregiver medicalization (subthemes: diagnosis and initiation, disease management, and the future), (2) emotional adjustment (initial and/or acute phase, acceptance, personal growth, and medical stress and psychological burden), (3) pragmatic adaptation (disruption, adaptation of life goals and/or sense of self, and financial impact), and (4) social adjustment (relationship opportunity, relationship risk, advocacy, family functioning, and intimate relationships). These themes and subthemes reflected a broad range of experiences from positive to severely burdensome. CONCLUSIONS Caregivers of patients on dialysis report a broad range of positive and burdensome experiences. These results reveal a need for continued advocacy to support families with a child on dialysis and can be used to develop targeted measures to study and improve caregiver experience in this population.
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Affiliation(s)
- Aaron Wightman
- Divisions of Nephrology, .,Bioethics and Palliative Care, Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington.,Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington
| | - Cortney Taylor Zimmerman
- Section of Psychology, Nephrology Service, Department of Pediatrics, Texas Children's Hospital, Houston, Texas
| | - Shari Neul
- Division of Hematology and Oncology, Department of Pediatrics, Vanderbilt University, Nashville, Tennessee; and
| | - Katherine Lepere
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington
| | - KristiLynn Cedars
- Division of Psychology, Department of Psychiatry and Behavioral Medicine, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Douglas Opel
- Bioethics and Palliative Care, Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington.,Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington
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58
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Agerskov H, Thiesson H, Specht K, D Pedersen B. Parents' experiences of donation to their child before kidney transplantation: A qualitative study. J Clin Nurs 2019; 28:1482-1490. [PMID: 30552722 DOI: 10.1111/jocn.14734] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 11/27/2018] [Accepted: 12/04/2018] [Indexed: 11/29/2022]
Abstract
AIM AND OBJECTIVES To explore parents' experiences of donation to their child before kidney transplantation. BACKGROUND Transplantation is the treatment of choice for paediatric patients with end-stage renal disease. Living donor kidney transplantation has shown a higher long-term transplant survival compared to deceased donor transplantation and entails a more controllable process, with shorter waiting time. Besides complex care and treatment of their child, parents must reflect on the prospects of being a donor for their child. However, little is known about the parent donor and parent caregiver perspective. DESIGN A qualitative exploratory study taking a phenomenological-hermeneutic approach. METHOD The study was conducted in a Danish university hospital. Interviews were conducted with the parents of seven children, aged between 5-15 years, with end-stage renal disease in the period before kidney transplantation. Data were analysed with inspiration from Ricoeur's theory of interpretation on three levels: naïve reading, structural analysis and critical interpretation and discussion. RESULTS The decision about donation was experienced as a matter of course and commitment. There were preferences for a kidney from a living donor, including the hope of being accepted as a donor. Being refused as a donor revealed feelings of powerlessness. However, transformation was performed into having a new role providing care and comfort to the child during the transplant process. Asking family and friends about donation could feel like crossing a line. CONCLUSION The prospect of donating to one's child had an impact on the well-being of the entire family. Parents were in a vulnerable situation and in need of support, regarding both living and deceased donation. Waiting time included hopeful thoughts and reflections on a new caregiver role for the child during transplantation. RELEVANCE TO CLINICAL PRACTICE Health professionals' attention, engagement and dialogue are essential in order to gain extensive and varied knowledge about the individual parent's experiences and the well-being of the entire family to provide care and support before, during and after the donation and transplantation process.
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Affiliation(s)
- Hanne Agerskov
- Department of Nephrology, Odense University Hospital, Odense C, Denmark.,Department of Clinical Institute, University of Southern Denmark, Odense C, Denmark
| | - Helle Thiesson
- Department of Nephrology, Odense University Hospital, Odense C, Denmark.,Department of Clinical Institute, University of Southern Denmark, Odense C, Denmark
| | - Kirsten Specht
- Department of Orthopaedic Surgery, Zealand University Hospital, Køge, Denmark.,Faculty of Health Science, Department of Regional Health Research, University of Southern Denmark, Odense C, Denmark
| | - Birthe D Pedersen
- Department of Clinical Institute, University of Southern Denmark, Odense C, Denmark
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59
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Refinement of an Instrument to Measure the Needs of Parents of Sick Children in the Context of Family Centered Care. J Pediatr Nurs 2018; 43:77-87. [PMID: 30473160 DOI: 10.1016/j.pedn.2018.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 08/21/2018] [Accepted: 08/26/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to refine an instrument to capture the perceived needs of parents whose children are seriously ill. This article describes the psychometric properties of the Parents' Needs Scale (PNS), a translated, revised 22-item short form from an original instrument that was developed and tested on parents of children with cancer in Hong Kong. METHODS The study was done in three stages that included (a) factor analysis of two samples recruited from clinics in Northern Virginia of parents of children with cancer (n = 74) and end stage renal disease (ESRD) (n = 30); (b) known groups validity testing with two groups of parents recruited in a parallel study on children with special needs (n = 15) and a control group of well children (n = 23); and (c) concurrent validity testing on the subsample of parents of children with special needs using the known measure of Impact on the Family Scale (IFS). Data collection for the stages included mailed questionnaires and follow-up telephone interviews. RESULTS Exploratory factor analysis using the common factor approach identified two domains: (1) needs related to my child's illness and (2) needs unrelated to my child's illness. The factorial structure was followed by item scaling tests to determine item-level convergence and discriminative validity, as well as scale reliability for the two domains (Cronbach's alpha = 0.93 and 0.90). Domain-level discriminant validity tests yielded significant differences on several expected characteristics of the child and/or family based on the literature. The final 22-item scale was reworded and used to establish known groups validity by comparing the two groups of children with acute illnesses from the previous study with two control groups of parents of children who were well or children with special needs but not acutely ill, yielding significant results on both factors (p < 0.001). A final test of concurrent validity was performed on the parents of children with special needs measures of parent need with their reported impact on the family yielding significant correlations on predicted variables. CONCLUSIONS The PNS can measure parents' needs with demonstrated psychometric validity and reliability.
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60
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Green JA, Ephraim PL, Hill-Briggs FF, Browne T, Strigo TS, Hauer CL, Stametz RA, Darer JD, Patel UD, Lang-Lindsey K, Bankes BL, Bolden SA, Danielson P, Ruff S, Schmidt L, Swoboda A, Woods P, Vinson B, Littlewood D, Jackson G, Pendergast JF, St Clair Russell J, Collins K, Norfolk E, Bucaloiu ID, Kethireddy S, Collins C, Davis D, dePrisco J, Malloy D, Diamantidis CJ, Fulmer S, Martin J, Schatell D, Tangri N, Sees A, Siegrist C, Breed J, Medley A, Graboski E, Billet J, Hackenberg M, Singer D, Stewart S, Alkon A, Bhavsar NA, Lewis-Boyer L, Martz C, Yule C, Greer RC, Saunders M, Cameron B, Boulware LE. Putting patients at the center of kidney care transitions: PREPARE NOW, a cluster randomized controlled trial. Contemp Clin Trials 2018; 73:98-110. [PMID: 30218818 PMCID: PMC6679594 DOI: 10.1016/j.cct.2018.09.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/28/2018] [Accepted: 09/07/2018] [Indexed: 12/21/2022]
Abstract
Care for patients transitioning from chronic kidney disease to kidney failure often falls short of meeting patients' needs. The PREPARE NOW study is a cluster randomized controlled trial studying the effectiveness of a pragmatic health system intervention, 'Patient Centered Kidney Transition Care,' a multi-component health system intervention designed to improve patients' preparation for kidney failure treatment. Patient-Centered Kidney Transition Care provides a suite of new electronic health information tools (including a disease registry and risk prediction tools) to help providers recognize patients in need of Kidney Transitions Care and focus their attention on patients' values and treatment preferences. Patient-Centered Kidney Transition Care also adds a 'Kidney Transitions Specialist' to the nephrology health care team to facilitate patients' self-management empowerment, shared-decision making, psychosocial support, care navigation, and health care team communication. The PREPARE NOW study is conducted among eight [8] outpatient nephrology clinics at Geisinger, a large integrated health system in rural Pennsylvania. Four randomly selected nephrology clinics employ the Patient Centered Kidney Transitions Care intervention while four clinics employ usual nephrology care. To assess intervention effectiveness, patient reported, biomedical, and health system outcomes are collected annually over a period of 36 months via telephone questionnaires and electronic health records. The PREPARE NOW Study may provide needed evidence on the effectiveness of patient-centered health system interventions to improve nephrology patients' experiences, capabilities, and clinical outcomes, and it will guide the implementation of similar interventions elsewhere. TRIAL REGISTRATION NCT02722382.
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Affiliation(s)
- J A Green
- Department of Nephrology, Geisinger Commonwealth School of Medicine, Danville, PA, USA; Kidney Health Research Institute, Geisinger, Danville, PA, USA.
| | - P L Ephraim
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD, USA.
| | - F F Hill-Briggs
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - T Browne
- College of Social Work, University of South Carolina, Columbia, SC, USA.
| | - T S Strigo
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA.
| | - C L Hauer
- Center for Clinical Innovation, Institute for Advanced Application, Geisinger, Danville, PA, USA.
| | - R A Stametz
- Center for Clinical Innovation, Institute for Advanced Application, Geisinger, Danville, PA, USA.
| | - J D Darer
- Decision Support Siemens Healthineers Malvern, PA, USA.
| | - U D Patel
- Division of Nephrology, Duke University School of Medicine, Durham, NC, USA; Gilead Sciences, Inc., Foster City, CA, USA.
| | - K Lang-Lindsey
- Department of Social Work, Alabama State University, Montgomery, AL, USA.
| | - B L Bankes
- Patient stakeholder co-author, Bloomsburg, PA, USA
| | - S A Bolden
- Patient stakeholder co-author, Jacksonville, FL, USA
| | - P Danielson
- Patient stakeholder co-author, Portland, OR, USA
| | - S Ruff
- Patient stakeholder co-author, Mooresville, NC, USA
| | - L Schmidt
- Patient stakeholder co-author, Liberty, Illinois, USA
| | - A Swoboda
- Patient stakeholder co-author, Edgewater, MD, USA
| | - P Woods
- Patient stakeholder co-author, Hartsdale, New York, NY, USA
| | - B Vinson
- Quality Insights Renal Network 5, Richmond, VA, USA.
| | - D Littlewood
- The Care Centered Collaborative, Pennsylvania Medical Society, Harrisburg, PA, USA.
| | - G Jackson
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA.
| | - J F Pendergast
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, NC, USA.
| | - J St Clair Russell
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA.
| | - K Collins
- Patient Services, National Kidney Foundation, New York, NY, USA.
| | - E Norfolk
- Department of Nephrology, Geisinger Commonwealth School of Medicine, Danville, PA, USA.
| | - I D Bucaloiu
- Department of Nephrology, Geisinger Medical Center, Danville, PA, USA.
| | - S Kethireddy
- Critical Care Medicine, Northeast Georgia Health System, Gainesville, GA, USA
| | - C Collins
- Adult Psychology and Behavioral Medicine, Department of Psychiatry, Geisinger, Danville, PA, USA.
| | - D Davis
- Center for Translational Bioethics and Health Care Policy, Geisinger, Danville, PA, USA.
| | - J dePrisco
- Center for Clinical Innovation, Institute for Advanced Application, Geisinger, Danville, PA, USA.
| | - D Malloy
- Center for Clinical Innovation, Institute for Advanced Application, Geisinger, Danville, PA, USA.
| | - C J Diamantidis
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA; Division of Nephrology, Duke University School of Medicine, Durham, NC, USA.
| | - S Fulmer
- Geisinger Health Plan, Danville, PA, USA.
| | - J Martin
- Program Development, National Kidney Foundation, New York, NY, USA.
| | - D Schatell
- Medical Education Institute, Madison, WI, USA.
| | - N Tangri
- Department of Medicine, Section of Nephrology, University of Manitoba, 66 Chancellors Cir, Winnipeg, MB R3T 2N2, Canada; Chronic Disease Innovation Center, Seven Oaks General Hospital, 2300 Mcphillips St, Winnipeg, MB R2V 3M3, Canada.
| | - A Sees
- Anthem, Inc., Indianapolis, IN, USA
| | - C Siegrist
- Center for Clinical Innovation, Institute for Advanced Application, Geisinger, Danville, PA, USA.
| | - J Breed
- Center for Clinical Innovation, Institute for Advanced Application, Geisinger, Danville, PA, USA.
| | - A Medley
- Geisinger Health Plan, Danville, PA, USA.
| | - E Graboski
- Kidney Health Research Institute, Geisinger, Danville, PA, USA.
| | - J Billet
- Center for Clinical Innovation, Institute for Advanced Application, Geisinger, Danville, PA, USA.
| | - M Hackenberg
- Center for Clinical Innovation, Institute for Advanced Application, Geisinger, Danville, PA, USA.
| | - D Singer
- Renal Physicians Association, Rockville, MD, USA.
| | - S Stewart
- Council of Nephrology Social Workers, National Kidney Foundation, New York, NY, USA.
| | - A Alkon
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA.
| | - N A Bhavsar
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA.
| | - L Lewis-Boyer
- Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - C Martz
- Geisinger Health Plan, Danville, PA, USA.
| | - C Yule
- Kidney Health Research Institute, Geisinger, Danville, PA, USA.
| | - R C Greer
- Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - M Saunders
- Section of General Internal Medicine, Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA.
| | - B Cameron
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
| | - L E Boulware
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA.
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Ajarmeh S, Alnawaiseh N, Al Baramki J, Akl K. Jordanian Parents’ Knowledge and Attitudes Regarding Kidney Disease in Children. AMERICAN JOURNAL OF HEALTH EDUCATION 2018. [DOI: 10.1080/19325037.2018.1516169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Roberti J, Cummings A, Myall M, Harvey J, Lippiett K, Hunt K, Cicora F, Alonso JP, May CR. Work of being an adult patient with chronic kidney disease: a systematic review of qualitative studies. BMJ Open 2018; 8:e023507. [PMID: 30181188 PMCID: PMC6129107 DOI: 10.1136/bmjopen-2018-023507] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/28/2018] [Accepted: 08/08/2018] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) requires patients and caregivers to invest in self-care and self-management of their disease. We aimed to describe the work for adult patients that follows from these investments and develop an understanding of burden of treatment (BoT). METHODS Systematic review of qualitative primary studies that builds on EXPERTS1 Protocol, PROSPERO registration number: CRD42014014547. We included research published in English, Spanish and Portuguese, from 2000 to present, describing experience of illness and healthcare of people with CKD and caregivers. Searches were conducted in MEDLINE, Embase, CINAHL Plus, PsycINFO, Scopus, Scientific Electronic Library Online and Red de Revistas Científicas de América Latina y el Caribe, España y Portugal. Content was analysed with theoretical framework using middle-range theories. RESULTS Searches resulted in 260 studies from 30 countries (5115 patients and 1071 carers). Socioeconomic status was central to the experience of CKD, especially in its advanced stages when renal replacement treatment is necessary. Unfunded healthcare was fragmented and of indeterminate duration, with patients often depending on emergency care. Treatment could lead to unemployment, and in turn, to uninsurance or underinsurance. Patients feared catastrophic events because of diminished financial capacity and made strenuous efforts to prevent them. Transportation to and from haemodialysis centre, with variable availability and cost, was a common problem, aggravated for patients in non-urban areas, or with young children, and low resources. Additional work for those uninsured or underinsured included fund-raising. Transplanted patients needed to manage finances and responsibilities in an uncertain context. Information on the disease, treatment options and immunosuppressants side effects was a widespread problem. CONCLUSIONS Being a person with end-stage kidney disease always implied high burden, time-consuming, invasive and exhausting tasks, impacting on all aspects of patients' and caregivers' lives. Further research on BoT could inform healthcare professionals and policy makers about factors that shape patients' trajectories and contribute towards a better illness experience for those living with CKD. PROSPERO REGISTRATION NUMBER CRD42014014547.
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Affiliation(s)
- Javier Roberti
- FINAER, Foundation for Research and Assistance of Kidney Disease, Buenos Aires, Argentina
| | - Amanda Cummings
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Michelle Myall
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Jonathan Harvey
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Kate Lippiett
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Katherine Hunt
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Federico Cicora
- FINAER, Foundation for Research and Assistance of Kidney Disease, Buenos Aires, Argentina
| | - Juan Pedro Alonso
- Faculty of Social Sciences, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Carl R May
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, UK
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Iranian mothers' Experiences with Children Undergoing Hemodialysis: A Hermeneutic Phenomenological Study. J Pediatr Nurs 2018; 42:e19-e25. [PMID: 29958764 DOI: 10.1016/j.pedn.2018.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 06/16/2018] [Accepted: 06/17/2018] [Indexed: 11/23/2022]
Abstract
PURPOSE To describe Iranian mothers' perspectives regarding hemodialysis for their children. DESIGN AND METHODS This qualitative study was conducted using the hermeneutic phenomenological approach. The sample consisted of 11 mothers, among whom five were interviewed once and six were interviewed twice, for a total of 17 interviews. The data were then analyzed using van Manen's (1997) method. RESULTS Five themes emerged from the data: mothers enclosed by child care, emotional and psychological tension, acceptance and contrivance, the entire family being a victim of a sick child, and self-devotion. CONCLUSION The results indicated that the mothers of children undergoing hemodialysis experience multiple stresses in the physical, emotional-psychological, social, and economic dimensions. PRACTICAL IMPLICATIONS Nurses are the healthcare team members who most frequently interact with mothers of children undergoing hemodialysis. They are therefore positioned favorably to provide the information and emotional support needed by these mothers. Nurses are also among the frontline professionals who can provide services designed to assess the physical, psychological, and economic requirements of these mothers and their families.
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Geense WW, van Gaal BG, Knoll JL, Maas NM, Kok G, Cornelissen EA, Nijhuis-van der Sanden MW. Effect and Process Evaluation of e-Powered Parents, a Web-Based Support Program for Parents of Children With a Chronic Kidney Disease: Feasibility Randomized Controlled Trial. J Med Internet Res 2018; 20:e245. [PMID: 30068502 PMCID: PMC6094085 DOI: 10.2196/jmir.9547] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 04/30/2018] [Accepted: 05/08/2018] [Indexed: 11/30/2022] Open
Abstract
Background Parents of children with chronic kidney disease (CKD) experience high levels of stress in the daily management of their child’s illness. Parents need continuously available support and information, yet online support programs are lacking. e-Powered Parents was developed to fill this gap; it is an online program consisting of (1) medical information, (2) an interactive part, and (3) four training modules (stress management, setting limits, communication, and coping). Prior to a large-scale evaluation, we conducted a feasibility study that consisted of an effect study and a process evaluation. Objective The objectives of our study were to (1) identify the outcome measures that are most likely to capture the potential benefit, (2) evaluate the potential effectiveness and effect size, and (3) evaluate recruitment, reach, the dose received, and context. Methods We conducted a feasibility study with a two-armed, wait-list randomized controlled trial (RCT). Prior to baseline, parents (n=146) were randomly allocated to group 1 or group 2. After completing the baseline questionnaire, parents in group 1 were given access to e-Powered Parents, while those in group 2 received usual care. At the 6-month follow-up (T1), all parents received a questionnaire and parents in group 2 were given access to e-Powered Parents as well. After 1.5 years, through an extra measurement (T2), we evaluated the effect of long-term exposure. Outcomes were the child’s quality of life (Child Vulnerability Scale), parental stress (Pediatric Inventory for Parents) and fatigue (Multidimensional Fatigue Inventory), self-efficacy in communication with health care professionals (Perceived Efficacy in Patient-Physician Interactions, PEPPI-5), and parental perceptions of family management (Family Management Measure). Floor and ceiling effects and percentage of parents showing no change in scores were calculated. We used linear mixed models to evaluate the potential effectiveness and effect sizes using the intention-to-treat and per-protocol analyses. In the process evaluation, we evaluated recruitment, reach, the dose received, and context using a questionnaire sent to the parents, log-in data, and a focus group interview with health care professionals. Results At T1 (n=86) and T2 (n=51), no significant effects were found on any of the five outcomes. The PEPPI-5 showed ceiling effects and high percentages of parents showing no change between the measurement times. The information and interactive part of the intervention were used by 84% (57/68) of the parents in group 1 and 49% (32/65) of the parents in group 2. The information pages were visited most often. Overall, 64% (85/133) of the parents logged in to the training platform and 31% (26/85) actually used the training modules. Conclusions We did not observe any significant effect on any of the outcomes. This could possibly be explained by the minimal use of the intervention and by parents’ heterogeneity. For continued participation, we recommend a tailored intervention and further studies to find out whether and how online programs could be used to support parents in the management of their child’s CKD. Trial Registration Netherlands Trial Registry NTR4808; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4808 (Archived by WebCite at http://www.webcitation.org/719rCicvW)
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Affiliation(s)
- Wytske W Geense
- IQ Healthcare, Radboud Institute for Health Science, Radboud University Medical Center, Nijmegen, Netherlands
| | - Betsie Gi van Gaal
- IQ Healthcare, Radboud Institute for Health Science, Radboud University Medical Center, Nijmegen, Netherlands.,Institute of Nursing, HAN University of Applied Science, Nijmegen, Netherlands
| | - Jaqueline L Knoll
- Department of Pediatric Nephrology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
| | - Nienke M Maas
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Gerjo Kok
- Department of Work & Social Psychology, Maastricht University, Maastricht, Netherlands
| | - Elisabeth Am Cornelissen
- Department of Pediatric Nephrology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
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Pourghaznein T, Heydari A, Manzari Z, ValizadehZare N. "Immersion in an Ocean of Psychological Tension:" The Voices of Mothers with Children Undergoing Hemodialysis. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2018; 23:253-260. [PMID: 30034483 PMCID: PMC6034527 DOI: 10.4103/ijnmr.ijnmr_156_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Compared with other renal replacement therapies, hemodialysis treatment can impose restrictions on children with chronic renal failure and their mothers. Such pediatric illness can also lead to negative effects on mothers' physical and mental health. Knowledge about mothers' experiences can aid medical teams to support mothers in playing their roles as care managers. Providing supports to mothers can exert significant effects on mothers' health status and indirectly improve patient outcomes and whole family functioning. This study was aimed at understanding the meanings of care for children undergoing hemodialysis based on mothers' lived experiences. MATERIALS AND METHODS This study is a qualitative research using hermeneutic phenomenology. A total of 17 interviews were conducted with 11 mothers of children undergoing hemodialysis. The interview sessions were recorded and transcribed, after which the data were analyzed using van Manen's methodology. RESULTS The main themes identified in this study was "immersion in an ocean of psychological tension," which suggests that the mothers of the children undergoing hemodialysis are overwhelmed by the numerous psychological pressures that they encounter during their children's treatment. This theme was constituted by the subthemes "bewilderment between hope and despair," "endless concerns," "agony and sorrow," and "a sense of being ignored." CONCLUSIONS The findings indicated the need to implement multilateral support measures that align with the educational, emotional-psychological, and financial needs of mothers with children receiving hemodialysis treatment. Such measures should be taken with the participation of multidisciplinary teams.
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Affiliation(s)
- Tayebeh Pourghaznein
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Heydari
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - ZahraSadat Manzari
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Najmeh ValizadehZare
- Department of Operating Room, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
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Francis A, Johnson DW, Craig JC, Wong G. Moving on: transitioning young people with chronic kidney disease to adult care. Pediatr Nephrol 2018; 33:973-983. [PMID: 28707039 DOI: 10.1007/s00467-017-3728-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 06/03/2017] [Accepted: 06/13/2017] [Indexed: 10/19/2022]
Abstract
Advances in the care of children mean that adolescents with chronic kidney disease (CKD) are surviving to adulthood and requiring transition to adult care. The transition phase is well-recognised to be associated with considerable excess morbidity and graft loss, but these outcomes may be avoidable through a structured transition programme. This review will discuss the (1) challenges encountered by patients with CKD, caregivers and clinicians during transition; (2) predictors and outcomes of transition; (3) current guidelines on transition from paediatric to adult renal services; (4) interventions and research directions that may help to improve the care and outcomes for young people with CKD in transition. In spite of the substantial improvement in health gains required for this disadvantaged population, there is to date only limited evidence on the effects of current transition programmes.
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Affiliation(s)
- Anna Francis
- Sydney School of Public Health, University of Sydney, Camperdown, NSW, Australia.
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,Australasian Kidney Trials Network, Diamantina Institute, University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - Jonathan C Craig
- Sydney School of Public Health, University of Sydney, Camperdown, NSW, Australia
| | - Germaine Wong
- Sydney School of Public Health, University of Sydney, Camperdown, NSW, Australia
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Health-related quality of life of the parents of children hospitalized due to acute rotavirus infection: a cross-sectional study in Latvia. BMC Pediatr 2018; 18:114. [PMID: 29544465 PMCID: PMC5856199 DOI: 10.1186/s12887-018-1086-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 03/07/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Rotavirus is the leading cause of severe diarrhea in young children and infants worldwide, representing a heavy public health burden. Limited information is available regarding the impact of rotavirus gastroenteritis on the quality of life of affected children and their families. The objectives of study were to estimate the impact of rotavirus infection on health-related quality of life (HRQL), to assess the social and emotional effects on the families of affected children. METHODS This study enrolled all (n = 527) RotaStrip®-positive (with further PCR detection) cases (0-18 years of age) hospitalized from April 2013 to December 2015 and their caregivers. A questionnaire comprising clinical (filled-in by the medical staff) and social (filled by the caregivers) sections was completed per child. RESULTS Main indicators of emotional burden reported by caregivers were compassion (reported as severe/very severe by 91.1% of parents), worry (85.2%), stress/anxiety (68.0%). Regarding social burden, 79.3% of caregivers reported the need to introduce changes into their daily routine due to rotavirus infection of their child. Regarding economic burden, 55.1% of parents needed to take days off work because of their child's sickness, and 76.1% of parents reported additional expenditures in the family's budget. Objective measures of their child's health status were not associated with HRQL of the family, as were the parent's subjective evaluation of their child's health and some sociodemographic factors. Parents were significantly more worried if their child was tearful (p = 0.006) or irritable (p < 0.001). Parents were more stressful/anxious if their child had a fever (p = 0.003), was tearful (p < 0.001), or was irritable (p < 0.001). Changes in parents' daily routines were more often reported if the child had a fever (p = 0.02) or insufficient fluid intake (p = 0.04). CONCLUSION Objective health status of the child did not influence the emotional, social or economic burden, whereas the parents' subjective perception of the child's health status and sociodemographic characteristics, were influential. A better understanding of how acute episodes affect the child and family, will help to ease parental fears and advise parents on the characteristics of rotavirus infection and the optimal care of an infected child.
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Sari D, Allenidekania, Afiyanti Y. Family Experience in Treating Children with Chronic Renal Failure Undergoing Hemodialysis Therapy. ENFERMERIA CLINICA 2018. [DOI: 10.1016/s1130-8621(18)30178-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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69
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Pugh P, Hemingway P, Christian M, Higginbottom G. Children's, parents' and other stakeholders' perspectives on early dietary self-management to delay disease progression of chronic disease in children: a protocol for a mixed studies systematic review with a narrative synthesis. Syst Rev 2018; 7:20. [PMID: 29370832 PMCID: PMC5785819 DOI: 10.1186/s13643-017-0671-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 12/29/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic disease of childhood may be delayed by early dietary intervention. The purpose of this systematic review is to provide decision-makers with a perspective on the role of early dietary intervention, as a form of self-management, to delay disease progression in children with early chronic disease, as described by children, parents and other stakeholders. METHODS The study will systematically review empirical research (qualitative, quantitative and mixed method designs), including grey literature, using a narrative synthesis. A four-stage search process will be conducted involving a scoping search, the Scottish Intercollegiate Guidelines Network (SIGN) Patient Issues search filter on MEDLINE, the search of seven databases using a chronic disease and chronic kidney disease (CKD) search strategy, and hand searching the reference lists of identified papers for additional studies. All studies retrieved during the search process will undergo a screening and selection process against the inclusion/exclusion criteria. Methodological quality of relevant studies will be assessed using a validated Mixed Studies Review scoring system, before inclusion in the review. Relevant grey literature will be assessed for methodological quality and relative importance using McGrath et al.'s framework and the Academy Health advisory committee categories, respectively. Data extraction will be guided by the Centre for Review and Dissemination guidance and Popay et al.'s work. The narrative synthesis of the findings will use elements of Popay et al.'s methodology of narrative synthesis, applying recognised tools for each of the four elements: (1) developing a theory of how the intervention works, why and for whom; (2) developing a preliminary synthesis of findings of included studies; (3) exploring relationships in the data; and (4) assessing the robustness of the synthesis. DISCUSSION This mixed studies systematic review with a narrative synthesis seeks to elucidate the gaps in current knowledge and generate a fresh explanation of research findings on early dietary self-management in chronic disease, with particular application to CKD, from the stakeholders' perspective. The review will provide an important platform to inform future research, identifying the facilitators and barriers to implementing early dietary interventions. Ultimately, the review will contribute vital information to inform future improvements in chronic disease. The lead author has a particular interest in CKD paediatric service delivery. SYSTEMATIC REVIEW REGISTRATION The review has been registered with PROSPERO (CRD42017078130).
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Affiliation(s)
- Pearl Pugh
- School of Health Sciences, University of Nottingham, Nottingham, UK.
| | - Pippa Hemingway
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Martin Christian
- Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Mantulak A, Cadell S. Mothers' Experience of Post-Traumatic Growth in Pediatric Kidney Transplantation. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2018; 14:110-123. [PMID: 29482461 DOI: 10.1080/15524256.2018.1437587] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Parenting a child with chronic kidney disease has a profound impact on the parental caregivers across social, emotional, and physical functioning. As the survival rates for children with chronic kidney disease increase, the demands on parents caring for these children intensify. The aim of this study was to understand the lived experience of being a mother of a child who has undergone kidney transplantation. Seven mothers caring for children with chronic kidney disease in Ontario, Canada participated in in-depth interviews that were analyzed according to the principles of hermeneutic phenomenology. The present study presents the findings concerning post-traumatic growth: personal strength, new possibilities, enhanced relationships, appreciation of life and spiritual change. Recognizing positive aspects of stressful situations and the potential for growth can impact the practice of social workers and other health-care professionals. Ultimately the assistance that is provided to parent caregivers can be improved with a better understanding of the whole experience.
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Affiliation(s)
- Andrew Mantulak
- a School of Social Work , King's University College , London , Ontario , Canada
| | - Susan Cadell
- b School of Social Work , Renison University College - University of Waterloo , Waterloo , Ontario , Canada
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Sou'ub RM, Masa'Deh R, AbuRuz ME, Alhalaiqa F. Parental psychological stress: Children on hemodialysis. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2018. [DOI: https://doi.org/10.1016/j.ijans.2018.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Sou'ub RM, Masa'Deh R, AbuRuz ME, Alhalaiqa F. Parental psychological stress: Children on hemodialysis. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2018. [DOI: 10.1016/j.ijans.2018.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Sou'ub RM, Masa'Deh R, AbuRuz ME, Alhalaiqa F. Parental psychological stress: Children on hemodialysis. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2018. [DOI: https:/doi.org/10.1016/j.ijans.2018.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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Geense WW, van Gaal BGI, Knoll JL, Cornelissen EAM, van Achterberg T. The support needs of parents having a child with a chronic kidney disease: a focus group study. Child Care Health Dev 2017; 43:831-838. [PMID: 28547746 DOI: 10.1111/cch.12476] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 08/02/2016] [Accepted: 04/17/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Parents of children with a chronic kidney disease (CKD) have a crucial role in the management of their child's disease. The burden on parents is high: they are often exhausted, depressed and experience high levels of stress and a low quality of life, which could have a negative impact on their child's health outcomes. Support aiming at preventing and reducing parental stress is essential. Therefore, it is necessary to have insight in the problems and support needs among these parents. OBJECTIVE Our aim is to describe parents' support needs regarding the problems they experience in having a child with CKD. METHODS Five focus group interviews were conducted with parents of children: (i) with hereditary kidney disease, (ii) with nephrotic syndrome, (iii) with chronic kidney failure, (iv) using dialysis and (v) after renal transplantation. The children were treated at a paediatric nephrology unit in one university hospital in the Netherlands. The data were thematically analysed. RESULTS Twenty-one parents participated in the focus groups. Parents need more information about their child's CKD and treatment options, and managing their own hobbies and work. Furthermore, parents need emotional support from their partner, family, friends, peers and healthcare professionals to help them cope with the disease of their child. Additionally, parents need practical support to hand over their care and support in transport, financial management and regarding their child at school. CONCLUSION Needs regarding balancing their personal life are seldom prioritized by parents as the child's needs are considered more important. Therefore, it is important that healthcare professionals should not only attend to the abilities of parents concerning their child's disease management, but also focus on the parents' abilities in balancing their responsibilities as a caregiver with their own personal life.
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Affiliation(s)
- W W Geense
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - B G I van Gaal
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - J L Knoll
- Department of Pediatric Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - E A M Cornelissen
- Department of Pediatric Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - T van Achterberg
- Centre for Health Services and Nursing Research, KU Leuven, Leuven, Belgium
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75
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Die Kölner Nephro-Krabbelgruppe. Monatsschr Kinderheilkd 2017. [DOI: 10.1007/s00112-017-0387-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pinsk M, Nicholas D. Changing Needs for Information and Support in an Online System for Parents of Children With Kidney Disease. Can J Kidney Health Dis 2017; 4:2054358117714999. [PMID: 28717515 PMCID: PMC5502939 DOI: 10.1177/2054358117714999] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 05/12/2017] [Indexed: 11/17/2022] Open
Abstract
Background: Pediatric chronic kidney disease is psychologically, financially, and physically demanding on parents providing care. Parents often feel isolated because of the rarity of the condition, and geographic isolation often compounds this perception in Canada. Many parents seek assistance online for both information and social support. Objective: This study examines an online portal, titled “Ability Online,” which was designed to provide support and information to a diverse group of parents using chat facilities, bulletin boards, and e-mail. Specifically, we sought to identify how the technologies offered in this system related to the support and information seeking needs for parents. Secondary aims of determining possible reasons for attrition over time were explored as well. Design: Mixed methodology sequential exploratory design using the qualitative methodology of descriptive interpretation. Setting: Telephone interviews. Patients: Twenty parents of pediatric patients with chronic kidney disease from four Canadian centers who engaged in an online social support system “Ability Online.” Measurements: Interview transcripts generated from 20 taped phone conversations were reviewed from parents who engaged in the online system, and the themes derived from these transcripts served to generate semistructured interview questions that focused on their use of, and perceived benefit from, this technology for social support. Follow-up telephone interviews were then conducted with a 6-person subset of the original group in an effort to further define the impact of technology on their experience. This same smaller cohort provided data on social supports, caregiver satisfaction, and caregiver stress. Results: Many parents experience a progression through which their needs for knowledge and support change over time. Specifically, parents describe a transition from pure information seeking, to seeking parental interaction, mutual support and collaboration, and ultimately to advocacy. Parents described how technology could be used to address those needs. Limitations: Our cohort was slightly more educated and representative of more urban populations than published data reflecting the population of North American pediatric patients living with kidney disease. Conclusions: Our data suggest themes of technology use influencing the goals of online support seeking. While our findings are preliminary, further study may inform Web designers to identify the changing needs of participants in designing such online support networks, and minimize the reasons that participants fail to adopt, or terminate their online experiences.
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Affiliation(s)
- Maury Pinsk
- Section of Pediatric Nephrology, University of Manitoba, Winnipeg, Canada
| | - David Nicholas
- Department of Social Work, University of Calgary, Alberta, Canada
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77
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Chong LSH, Sautenet B, Tong A, Hanson CS, Samuel S, Zappitelli M, Dart A, Furth S, Eddy AA, Groothoff J, Webb NJA, Yap HK, Bockenhauer D, Sinha A, Alexander SI, Goldstein SL, Gipson DS, Raman G, Craig JC. Range and Heterogeneity of Outcomes in Randomized Trials of Pediatric Chronic Kidney Disease. J Pediatr 2017; 186:110-117.e11. [PMID: 28449820 DOI: 10.1016/j.jpeds.2017.03.034] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/07/2017] [Accepted: 03/10/2017] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To determine the range and heterogeneity of outcomes reported in randomized controlled trials of interventions for children with chronic kidney disease (CKD). STUDY DESIGN The Cochrane Kidney and Transplant Specialized Register was searched to March 2016. Randomized trials involving children across all stages of CKD were selected. All outcome domains and measurements were extracted from included trials. The frequency and characteristics of the outcome domains and measures were evaluated. RESULTS From 205 trials included, 6158 different measurements of 100 different outcome domains were reported, with a median of 22 domains per trial (IQR 13-41). Overall, 52 domains (52%) were surrogate, 38 (38%) were clinical, and 10 (10%) were patient-reported. The 5 most commonly reported domains were blood pressure (76 [37%] trials), relapse/remission (70 [34%]), kidney function (66 [32%]), infection (61 [30%]), and height/pubertal development (51 [25%]). Mortality (14%), cardiovascular disease (4%), and quality of life (1%) were reported infrequently. The 2 most frequently reported outcomes, blood pressure and relapse/remission, had 56 and 81 different outcome measures, respectively. CONCLUSIONS The outcomes reported in clinical trials involving children with CKD are extremely heterogeneous and are most often surrogate outcomes, rather than clinical and patient-centered outcomes such as cardiovascular disease and quality of life. Efforts to ensure consistent reporting of outcomes that are important to patients and clinicians will improve the value of trials to guide clinical decision-making. In our study, non-English articles were excluded.
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Affiliation(s)
- Lauren S H Chong
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Benedicte Sautenet
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; University Francois Rabelais, Tours, France; Department of Nephrology and Clinical Immunology, Tours Hospital, Tours, France; INSERM (U1153), Paris, France
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia.
| | - Camilla S Hanson
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Susan Samuel
- Department of Pediatrics, Section of Nephrology, University of Calgary, Calgary, Canada
| | - Michael Zappitelli
- Department of Pediatrics, Division of Pediatric Nephrology, Montreal Children's Hospital, McGill University Health Centre, McGill University, Montreal, Canada
| | - Allison Dart
- Department of Pediatrics and Child Health, The Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Canada
| | - Susan Furth
- Departments of Pediatrics and Epidemiology, Perelman School of Medicine, Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Allison A Eddy
- Department of Pediatrics, University of British Columbia and the British Columbia Children's Hospital, Vancouver, Canada
| | - Jaap Groothoff
- Department of Pediatric Nephrology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Nicholas J A Webb
- Department of Pediatric Nephrology and National Institute for Health Research/Wellcome Trust Clinical Research Facility, University of Manchester, Manchester Academic Health Science Centre, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Hui-Kim Yap
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Detlef Bockenhauer
- University College London Centre for Nephrology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, United Kingdom
| | - Aditi Sinha
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, India
| | - Stephen I Alexander
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Stuart L Goldstein
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Debbie S Gipson
- Department of Pediatrics, School of Medicine, University of Michigan, Ann Arbor, MI
| | - Gayathri Raman
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Jonathan C Craig
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
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78
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Al-Gamal E, Long T. Psychometric properties of the Arabic version of the PedsQL Family Impact Scale. J Res Nurs 2016. [DOI: 10.1177/1744987116670204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Treatment of childhood cancer and its side effects can exert a negative impact on patients’ parents. A valid and reliable instrument to measure family functioning in Arabic families was considered to be a vital resource. The Pediatric Quality of Life Inventory (PedsQL) Family Impact Scale and the PedsQL Healthcare Satisfaction Hematology/Oncology Scale – Parent Report were completed by 113 Jordanian parents of children with cancer. Cronbach’s alpha coefficient was found to be excellent at 0.93 for the total PedsQL Family Impact Scale, which correlated significantly with the PedsQL Healthcare Satisfaction Hematology/Oncology Scale – Parent Report demonstrating good construct validity. The Arabic version of the PedsQL Family Impact Scale is both valid and reliable for use with parents of children with cancer.
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Affiliation(s)
- Ekhlas Al-Gamal
- Associate Professor, Faculty of Nursing, The University of Jordan, Jordan
- Associate Professor, College of Nursing, King Saud bin Abdulaziz University for Health Sciences, Saudi Arabia
| | - Tony Long
- Professor of Child and Family Health, School of Nursing, Midwifery and Social Work, University of Salford, UK
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79
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Sodi T, Kgopa B. Coping strategies of mother carers of children living with chronic illness and disease in a rural South African community. JOURNAL OF PSYCHOLOGY IN AFRICA 2016. [DOI: 10.1080/14330237.2016.1219546] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Tholene Sodi
- Department of Psychology, University of Limpopo, South Africa
| | - Bontle Kgopa
- Department of Psychology, University of Limpopo, South Africa
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80
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Tjaden LA, Grootenhuis MA, Noordzij M, Groothoff JW. Health-related quality of life in patients with pediatric onset of end-stage renal disease: state of the art and recommendations for clinical practice. Pediatr Nephrol 2016; 31:1579-91. [PMID: 26310616 PMCID: PMC4995226 DOI: 10.1007/s00467-015-3186-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 07/21/2015] [Accepted: 07/27/2015] [Indexed: 11/14/2022]
Abstract
Health-related quality of life (HRQoL) is increasingly recognized as a key outcome in both clinical and research settings in the pediatric population with end-stage renal disease (ESRD). This review aims to: (1) summarize the current knowledge on HRQoL and socioprofessional outcomes and (2) provide strategies for incorporation of HRQoL assessment into clinical practice. Studies report that pediatric patients with ESRD have significantly lower HRQoL scores compared with children with other chronic diseases. Patients treated by dialysis are at particularly high risk for impaired HRQoL. Furthermore, patients more often have impaired neurocognitive functioning and lower academic achievement. Important determinants of impaired HRQoL include medical factors (i.e., receiving dialysis, disabling comorbidities, cosmetic side effects, stunted growth), sociodemographic factors (i.e., female gender, non-Western background) and psychosocial factors (i.e., noneffective coping strategies). Contrary to the situation in childhood, adult survivors of pediatric ESRD report a normal mental HRQoL. Despite this subjective feeling of well-being, these patients have on average experienced significantly more difficulties in completing their education, developing intimate relationships, and securing employment. Several medical and psychosocial strategies may potentially improve HRQoL in children with ESRD. Regular assessment of HRQoL and neurocognitive functioning in order to identify areas in which therapies and interventions may be required should be part of standard clinical care.
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Affiliation(s)
- Lidwien A Tjaden
- Department of Pediatric Nephrology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
- Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands
| | - Martha A Grootenhuis
- Psychosocial Department, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Marlies Noordzij
- Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands
| | - Jaap W Groothoff
- Department of Pediatric Nephrology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
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81
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Rosselló MR, De la Iglesia B, Paz-Lourido B, Verger S. [Needs of psychopedagogical training for the care of children with chronic disease: perceptions of hospital nursing]. Rev Esc Enferm USP 2016; 49:37-43. [PMID: 25789640 DOI: 10.1590/s0080-623420150000100005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 10/22/2014] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To identify the psychopedagogical training needs of the pediatric nurses in the largest public hospital of the Balearic Islands, Spain. METHOD This study was developed with a quantitative and qualitative design, where 78 nurses (97.5% of the service) answered a questionnaire, and 15 participated in interviews that were analyzed via content analysis. RESULTS The quantitative results show gaps in the knowledge and psychopedagogical skills of the staff. These aspects could facilitate the development of tasks tailored to the personality and the psychoevolutional time of children with chronic diseases, as well as to the emotional state of families. The qualitative data was organized into four categories: family support; hospital and education; psychopedagogical training and difficulties in practice. The little communication between nurses and teachers is evident. CONCLUSION The data reinforces the need to implement training strategies and interdisciplinary work among health professionals, educators and families.
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Affiliation(s)
- Maria Rosa Rosselló
- Department of Applied Pedagogy and Educational Psychology, University of the Balearic Islands, Balearic Islands, Spain
| | - Begoña De la Iglesia
- Department of Applied Pedagogy and Educational Psychology, University of the Balearic Islands, Balearic Islands, Spain
| | - Berta Paz-Lourido
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Balearic Islands, Spain
| | - Sebastià Verger
- Department of Applied Pedagogy and Educational Psychology, University of the Balearic Islands, Balearic Islands, Spain
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Mantulak A, Nicholas DB. "We're not going to say it's suffering; we're going to say it's an experience": The lived experience of maternal caregivers in pediatric kidney transplantation. SOCIAL WORK IN HEALTH CARE 2016; 55:580-594. [PMID: 27586427 DOI: 10.1080/00981389.2016.1208712] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 06/29/2016] [Indexed: 06/06/2023]
Abstract
Advances in the surgical and immunological aspects of pediatric kidney transplantation have resulted in significant improvements in long-term outcome and survival rates. However, there continues to be a negative impact reported on overall family functioning despite the reported good health and quality of life for the transplanted child. This research utilizes a phenomenological approach to examine the lived experiences of seven mothers of children who had undergone kidney transplantation. Findings of the study illuminate that the experience of mothering in the context of pediatric kidney transplantation is reflected in (1) the significance of relationships to the experience of self; (2) the lived experience of time; and (3) opportunities for growth and personal development. This research identifies that, while maternal caregiving in this context is fraught with challenges, there are opportunities for the development of skills and personal growth within the experience. By embracing a strength-based perspective, social work is well positioned to offer support for maternal meaning-making and adjustment during times of stress and uncertainty.
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Affiliation(s)
- Andrew Mantulak
- a School of Social Work , King's University College at Western University , London , Ontario , Canada
| | - David B Nicholas
- b Faculty of Social Work , University of Calgary, Central and Northern Alberta Region , Calgary , Alberta , Canada
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83
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Tong A, Samuel S, Zappitelli M, Dart A, Furth S, Eddy A, Groothoff J, Webb NJA, Yap HK, Bockenhauer D, Sinha A, Alexander SI, Goldstein SL, Gipson DS, Hanson CS, Evangelidis N, Crowe S, Harris T, Hemmelgarn BR, Manns B, Gill J, Tugwell P, Van Biesen W, Wheeler DC, Winkelmayer WC, Craig JC. Standardised Outcomes in Nephrology-Children and Adolescents (SONG-Kids): a protocol for establishing a core outcome set for children with chronic kidney disease. Trials 2016; 17:401. [PMID: 27519274 PMCID: PMC4982996 DOI: 10.1186/s13063-016-1528-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 07/26/2016] [Indexed: 01/03/2023] Open
Abstract
Background Children with chronic kidney disease (CKD), requiring dialysis or kidney transplantation, have a mortality rate of up to 30-fold higher than the general aged-matched population, and severely impaired quality of life. Symptoms such as fatigue and pain are prevalent and debilitating. Children with CKD are at risk of cognitive impairment, and poorer educational, vocational, and psychosocial outcomes compared with their well peers, which have consequences through to adulthood. Treatment regimens for children with CKD are long-term, complex, and highly intrusive. While many trials have been conducted to improve outcomes in children with CKD, the outcomes measured and reported are often not relevant to patients and clinicians, and are highly variable. These problems can diminish the value of trials as a means to improve the lives of children with CKD. The Standardised Outcomes in Nephrology—Children and Adolescents (SONG-Kids) study aims to develop a core outcome set for trials in children and adolescents with any stage of CKD that is based on the shared priorities of all stakeholders. Methods/Design SONG-Kids involves five phases: a systematic review to identify outcomes (both domains and measures) that have been reported in randomised controlled trials involving children aged up to 21 years with CKD; focus groups (using nominal group technique) with adolescent patients and caregivers of paediatric patients (all ages) to identify outcomes that are relevant and important to patients and their family and the reasons for their choices; semistructured key informant interviews with health professionals involved in the care of children with CKD to ascertain their views on establishing core outcomes in paediatric nephrology; an international three-round online Delphi survey with patients, caregivers, clinicians, researchers, policy-makers, and members from industry to develop consensus on important outcome domains; and a stakeholder workshop to review and finalise the set of core outcome domains for trials in children with CKD (including nondialysis-dependent, dialysis, and kidney transplantation). Discussion Establishing a core outcome set to be reported in all trials conducted in children with any stage of CKD will enhance the relevance, transparency, and impact of research to improve the lives of children and adolescents with CKD.
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Affiliation(s)
- Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia. .,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, 2145, Australia.
| | - Susan Samuel
- Department of Pediatrics, Section of Nephrology, University of Calgary, Calgary, AB, Canada
| | - Michael Zappitelli
- Department of Pediatrics, Division of Pediatric Nephrology, Montreal Children's Hospital, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Allison Dart
- Department of Pediatrics and Child Health, The Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Susan Furth
- Departments of Pediatrics and Epidemiology, Perelman School of Medicine and Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Allison Eddy
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Jaap Groothoff
- Department of Pediatric Nephrology, Emma Children's Hospital AMC Academic Medical Center, Amsterdam, The Netherlands
| | - Nicholas J A Webb
- Department of Paediatric Nephrology and NIHR/Wellcome Trust Clinical Research Facility, University of Manchester, Manchester Academic Health Science Centre, Royal Manchester Children's Hospital, Manchester, UK
| | - Hui-Kim Yap
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Detlef Bockenhauer
- UCL Centre for Nephrology and Great Ormond Street Hospital for Children NHS Foundation Trus, London, UK
| | - Aditi Sinha
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Stephen I Alexander
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, 2145, Australia
| | - Stuart L Goldstein
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Debbie S Gipson
- Department of Pediatrics, School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Camilla S Hanson
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, 2145, Australia
| | - Nicole Evangelidis
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, 2145, Australia
| | | | | | - Brenda R Hemmelgarn
- Departments of Medicine and Community Health Sciences, Libin Cardiovascular Institute and O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada
| | - Braden Manns
- Departments of Medicine and Community Health Sciences, Libin Cardiovascular Institute and O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada
| | - John Gill
- Division of Nephrology, University of British Columbia, Vancouver, BC, Canada
| | - Peter Tugwell
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Wim Van Biesen
- Renal Division, Ghent University Hospital, Ghent, Belgium
| | - David C Wheeler
- Centre for Nephrology, University College London, London, UK
| | - Wolfgang C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Baylor College of Medicine, Houston, TX, USA
| | - Jonathan C Craig
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, 2145, Australia
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84
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Al Maghaireh DF, Abdullah KL, Chan CM, Piaw CY, Al Kawafha MM. Systematic review of qualitative studies exploring parental experiences in the Neonatal Intensive Care Unit. J Clin Nurs 2016; 25:2745-56. [PMID: 27256250 DOI: 10.1111/jocn.13259] [Citation(s) in RCA: 164] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2016] [Indexed: 12/21/2022]
Abstract
AIMS AND OBJECTIVES To determine the feasibility and utility of a thematic analysis approach to synthesising qualitative evidence about parental experiences in the neonatal intensive care unit. BACKGROUND Admission of infants to the neonatal intensive care unit is usually an unexpected event for parents who can cause them to experience psychosocial difficulties. A qualitative systematic review is the best method for exploring these parents' experiences regarding this type of admission. DESIGN Systematic review. METHODS Qualitative studies in peer-reviewed journals aimed at understanding parental experiences regarding infant neonatal intensive care unit admission were identified in six electronic databases. Three reviewers selected relevant articles and assessed the quality of the methodological studies using the Critical Appraisal Skills Programme. A thematic analysis approach was used to identify the most common themes in the studies describing parental experiences in the neonatal intensive care unit. RESULTS A total of eighty articles were identified; nine studies were included in this review. Four studies used semistructured interviews, three used interviews, one used self-reporting and one used both focus group and interview methodologies. Common themes across parents' experiences were the stress of hospitalisation, alteration in parenting roles and the impact of infant hospitalisation on psychological health. CONCLUSION Having an infant hospitalised in the neonatal intensive care unit is a stressful experience for parents. This experience is the result of exposure to different stressors related to the infant's condition, an alteration in parenting roles or the neonatal intensive care unit environment and staffing. These parents suffered negative psychological effects, experienced an interrupted development of a healthy parent-infant attachment and/or felt parental role alteration. RELEVANCE TO CLINICAL PRACTICE The study's findings are crucial for neonatal intensive care unit nurses to develop intervention strategies and programmes that help parents to decrease the stress of their experience and to support them in facing this stressful situation.
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Affiliation(s)
- Dua'a Fayiz Al Maghaireh
- Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Khatijah Lim Abdullah
- Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chong Mei Chan
- Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chua Yan Piaw
- Institute of Educational Leadership & Unit for the Enhancement of Academic Performance, University of Malaya, Kuala Lumpur, Malaysia
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85
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Chausset A, Gominon AL, Montmaneix N, Echaubard S, Guillaume-Czitrom S, Cambon B, Miele C, Rochette E, Merlin E. Why we need a process on breaking news of Juvenile Idiopathic Arthritis: a mixed methods study. Pediatr Rheumatol Online J 2016; 14:31. [PMID: 27209342 PMCID: PMC4875712 DOI: 10.1186/s12969-016-0092-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 05/11/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Juvenile Idiopathic Arthritis is the most common chronic pediatric rheumatic disease. The announcement of Juvenile Idiopathic Arthritis poses for parents a number of challenges that make it hard to accept a diagnosis of the disease for their child; yet to our knowledge, no study to date has focused on the time period immediately surrounding the diagnosis. This study sets out to describe parents' experiences in engaging with their child's diagnosis of Juvenile Idiopathic Arthritis. METHODS This is a mixed methods study. Semi-structured interviews of families with a Juvenile Idiopathic Arthritis child were conducted. A grounded-theory thematic analysis was performed. Items that emerged in the interviews were compiled into a self-administered questionnaire. RESULTS Eleven families participated in the qualitative study. Sixty families responded to the questionnaire. The path of parents was characterized by doubt (before, during and after diagnosis) while the disease tended to take center stage. Doubt was generated through mismatches in perspectives between the parents' circle of acquaintances, physicians, and the parents' own subjective experiences of symptoms. This study also found that social support and parent associations occupied an ambiguous position between help and stigmatization. CONCLUSIONS Doubt fuels self-energizing spirals that take root as parents learn the news that their child has Juvenile Idiopathic Arthritis. These spirals of doubt may influence parents' experiences at every stage throughout the course of disease. Our data support the implementation of a specific process dedicated to breaking the news of Juvenile Idiopathic Arthritis to parents.
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Affiliation(s)
- Aurélie Chausset
- Pédiatrie, CHU Estaing, Clermont-Ferrand, France. .,Pédiatrie, INSERM-CIC1405, CHU Estaing, 1, place Lucie & Raymond Aubrac, 63003, Clermont-Ferrand, cedex 1, France.
| | | | - Nathalie Montmaneix
- Pédiatrie, CHU Estaing, Clermont-Ferrand, France ,Pédiatrie, INSERM-CIC1405, CHU Estaing, 1, place Lucie & Raymond Aubrac, 63003 Clermont-Ferrand, cedex 1 France
| | | | | | - Benoit Cambon
- Département de médecine générale, Faculté de Médecine, Clermont-Ferrand, France
| | - Cécile Miele
- CRIAVS, Pôle Santé Publique, CHU Gabriel Montpied, Clermont-Ferrand, France
| | - Emmanuelle Rochette
- Pédiatrie, CHU Estaing, Clermont-Ferrand, France ,Pédiatrie, INSERM-CIC1405, CHU Estaing, 1, place Lucie & Raymond Aubrac, 63003 Clermont-Ferrand, cedex 1 France
| | - Etienne Merlin
- Pédiatrie, CHU Estaing, Clermont-Ferrand, France ,Pédiatrie, INSERM-CIC1405, CHU Estaing, 1, place Lucie & Raymond Aubrac, 63003 Clermont-Ferrand, cedex 1 France
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86
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Avşar U, Avşar UZ, Cansever Z, Yucel A, Cankaya E, Certez H, Keles M, Aydınlı B, Yucelf N. Caregiver Burden, Anxiety, Depression, and Sleep Quality Differences in Caregivers of Hemodialysis Patients Compared With Renal Transplant Patients. Transplant Proc 2016; 47:1388-91. [PMID: 26093725 DOI: 10.1016/j.transproceed.2015.04.054] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND We compared the caregivers of hemodialysis (HD) patients and caregivers of patients with renal transplantation (Tx) in terms of anxiety, depression, sleep quality, and caregiver burden. We believe that caregivers of HD have more difficult conditions than caregivers of the patients with Tx. METHODS This cross-sectional study analyzed the psychological status of caregivers of Tx patients compared with those of HD patients with using the Hospital Anxiety and Depression Scale, Zarit Burden Interview, and Pittsburg Sleep Quality Indexes. We recruited 133 caregivers-65 caregivers in the Tx group and 68 in the HD group. RESULTS Mean age was 43.1 ± 8.5 years. The age, sex, income level, and education level were similar between the 2 groups. Caregivers in the HD group had significantly higher rates of anxiety and depression compared with the Tx group (P = .007 and P < .001, respectively). Good sleep quality rates for caregivers in the Tx group and caregivers in the HD group were 92% (n = 60) and 63% (n = 43), respectively. Poor sleep quality was significantly higher in caregivers in the HD group compared with caregivers in the Tx group (P < .001). Caregiver burden scores were significantly higher for caregivers in the HD group compared with caregivers in the Tx group (P < .001). CONCLUSIONS We suggest that Tx is the more appropriate renal replacement therapy for caregivers who undertake the care of patients with end-stage renal disease and chronic kidney disease.
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Affiliation(s)
- U Avşar
- Department of Family Medicine, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - U Z Avşar
- Department of Medical Education, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Z Cansever
- Department of Medical Education, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - A Yucel
- Department of Psychiatry, Faculty of Medicine, Ataturk University, Erzurum, Turkey.
| | - E Cankaya
- Department of Nephrology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - H Certez
- Department of Nephrology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - M Keles
- Department of Nephrology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - B Aydınlı
- Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - N Yucelf
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Ataturk University, Erzurum, Turkey
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Brown M, Hoyle L, Karatzias T. The experiences of family carers in the delivery of invasive clinical interventions for young people with complex intellectual disabilities: policy disconnect or policy opportunity? J Clin Nurs 2016; 25:534-42. [PMID: 26818378 DOI: 10.1111/jocn.13090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2015] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To explore the experiences of family carers in the delivery of invasive clinical interventions within community settings. BACKGROUND Many young people with intellectual disabilities present with complex health needs and require clinical interventions to sustain life. As the population lives into older age there is growing demand for the delivery of these interventions within the community setting. DESIGN An interpretivist qualitative design. METHODS Ten family carers of children with intellectual disabilities and complex care needs requiring invasive clinical interventions participated in semi-structured interviews. RESULTS There are barriers identified regarding the delivery of invasive clinical interventions in the home setting by social care support workers. These include a reluctance to carry out invasive clinical interventions both for family carers and staff, anxiety, a lack of knowledge and training and difficulties in recruiting appropriate staff. CONCLUSIONS There needs to be strategic policy developments focusing on this population who are cared for in the community and require invasive clinical interventions. RELEVANCE TO CLINICAL PRACTICE Registered Nurses have a key role in educating and preparing families and social care support workers to safely deliver invasive clinical interventions in community settings for both children and adults with intellectual disabilities.
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Affiliation(s)
- Michael Brown
- Faculty of Health, Life & Social Sciences, Edinburgh Napier University, Edinburgh, UK.,NHS Lothian, Edinburgh, UK
| | - Louise Hoyle
- Faculty of Health, Life & Social Sciences, Edinburgh Napier University, Edinburgh, UK
| | - Thanos Karatzias
- Faculty of Health, Life & Social Sciences, Edinburgh Napier University, Edinburgh, UK.,NHS Lothian, Edinburgh, UK
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88
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Geense WW, van Gaal BG, Knoll JL, Cornelissen EA, Schoonhoven L, Kok G. Online Support Program for Parents of Children With a Chronic Kidney Disease Using Intervention Mapping: A Development and Evaluation Protocol. JMIR Res Protoc 2016; 5:e1. [PMID: 26764218 PMCID: PMC4730104 DOI: 10.2196/resprot.4837] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 08/27/2015] [Accepted: 09/20/2015] [Indexed: 12/26/2022] Open
Abstract
Background The care for children with a chronic kidney disease (CKD) is complex. Parents of these children may experience high levels of stress in managing their child’s disease, potentially leading to negative effects on their child’s health outcomes. Although the experienced problems are well known, adequate (online) support for these parents is lacking. Objective The objective of the study is to describe the systematic development of an online support program for parents of children with CKD, and how this program will be evaluated. Methods Intervention Mapping (IM) was used for the development of the program. After conducting a needs assessment, defining program objectives, searching for theories, and selecting practical applications, the online program e-Powered Parents was developed. e-Powered Parents consist of three parts: (1) an informative part with information about CKD and treatments, (2) an interactive part where parents can communicate with other parents and health care professionals by chat, private messages, and a forum, and (3) a training platform consisting of four modules: Managing stress, Setting limits, Communication, and Coping with emotions. In a feasibility study, the potential effectiveness and effect size of e-Powered Parents will be evaluated using an explorative randomized controlled trial with parents of 120 families. The outcomes will be the child’s quality of life, parental stress and fatigue, self-efficacy in the communication with health care professionals, and family management. A process evaluation will provide insight in parents’ experiences, including their experienced level of support. Results Study results are expected to be published in the summer of 2016. Conclusions Although the development of e-Powered Parents using IM was time-consuming, IM has been a useful protocol. IM provided us with a systematic framework for structuring the development process. The participatory planning group was valuable as well; knowledge, experiences, and visions were shared, ensuring us that parents and health care professionals support the program. Trial Registration Dutch Trial Registration: NTR4808; www.trialregister.nl (Archived by WebCite at http://www.webcitation.org/6cfAYHcYb)
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Affiliation(s)
- Wytske W Geense
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands.
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89
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Khanna AK, Prabhakaran A, Patel P, Ganjiwale JD, Nimbalkar SM. Social, Psychological and Financial Burden on Caregivers of Children with Chronic Illness: A Cross-sectional Study. Indian J Pediatr 2015; 82:1006-11. [PMID: 25976615 DOI: 10.1007/s12098-015-1762-y] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 04/01/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To explore social, psychological and financial burden on caregivers of chronically diseased children. METHODS Participants were recruited from ambulatory and hospital areas in pediatrics department following informed consent. Parents who were caregivers of children 18 y or below in age with chronic illness were included. Socio-demographic details were collected using a semi structured questionnaire, adapted from Family Burden Interview Schedule (FBIS). The psychological well-being of caregivers was assessed using Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7). Descriptive analysis and ANOVA was done for comparing mean scores of responses to analyze financial, psychological and social burden across different diagnosis. RESULTS A total of 204 (89 females:115 males) participated. Only 27% were receiving some benefits from government or hospital side. No depressive symptoms were reported by 25% caregivers, while 37% reported mild and 38% moderate to severe depressive symptoms. No anxiety symptoms were reported by 33%, while 50% reported mild and 17% moderate to severe anxiety symptoms. No association was seen between gender of the caregiver and depressive or anxiety symptoms. Significantly higher financial and social burden was seen in cerebral palsy and cancer groups vis-a-vis other diseases, being least in thalassemia. Disruption of routine life was highest in cancer group caregivers followed by those in cerebral palsy group. CONCLUSIONS Most caregivers reported moderate depressive symptoms and mild to moderate anxiety symptoms. Cerebral palsy caused more social and financial burden on family vis-a-vis thalassemia. Social and financial burden on families of remaining diseases was comparable.
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Affiliation(s)
- Ankush K Khanna
- Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat, 388325, India
| | - Anusha Prabhakaran
- Department of Psychiatry, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Priyanka Patel
- Department of Psychiatry, Pramukhswami Medical College, Karamsad, Gujarat, India
| | | | - Somashekhar M Nimbalkar
- Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat, 388325, India. .,Central Research Services, Charutar Arogya Mandal, Karamsad, Gujarat, India.
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90
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Medway M, Tong A, Craig JC, Kim S, Mackie F, McTaggart S, Walker A, Wong G. Parental Perspectives on the Financial Impact of Caring for a Child With CKD. Am J Kidney Dis 2015; 65:384-93. [DOI: 10.1053/j.ajkd.2014.07.019] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 07/28/2014] [Indexed: 11/11/2022]
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91
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Swallow V, Smith T, Webb NJA, Wirz L, Qizalbash L, Brennan E, Birch A, Sinha MD, Krischock L, van der Voort J, King D, Lambert H, Milford DV, Crowther L, Saleem M, Lunn A, Williams J. Distributed expertise: qualitative study of a British network of multidisciplinary teams supporting parents of children with chronic kidney disease. Child Care Health Dev 2015; 41:67-75. [PMID: 24827413 PMCID: PMC4368419 DOI: 10.1111/cch.12141] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Long-term childhood conditions are often managed by hospital-based multidisciplinary teams (MDTs) of professionals with discipline specific expertise of a condition, in partnership with parents. However, little evidence exists on professional-parent interactions in this context. An exploration of professionals' accounts of the way they individually and collectively teach parents to manage their child's clinical care at home is, therefore, important for meeting parents' needs, informing policy and educating novice professionals. Using chronic kidney disease as an exemplar this paper reports on one aspect of a study of interactions between professionals and parents in a network of 12 children's kidney units in Britain. METHODS We conducted semi-structured, qualitative interviews with a convenience sample of 112 professionals (clinical-psychologists, dietitians, doctors, nurses, pharmacists, play-workers, therapists and social workers), exploring accounts of their parent-educative activity. We analysed data using framework and the concept of distributed expertise. RESULTS Four themes emerged that related to the way expertise was distributed within and across teams: (i) recognizing each other's' expertise, (ii) sharing expertise within the MDT, (iii) language interpretation, and (iv) acting as brokers. Two different professional identifications were also seen to co-exist within MDTs, with participants using the term 'we' both as the intra-professional 'we' (relating to the professional identity) when describing expertise within a disciplinary group (for example: 'As dietitians we aim to give tailored advice to optimize children's growth'), and the inter-professional 'we' (a 'team-identification'), when discussing expertise within the team (for example: 'We work as a team and make sure we're all happy with every aspect of their training before they go home'). CONCLUSIONS This study highlights the dual identifications implicit in 'being professional' in this context (to the team and to one's profession) as well as the unique role that each member of a team contributes to children's care. Our methodology and results have the potential to be transferred to teams managing other conditions.
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Affiliation(s)
- V Swallow
- School of Nursing, Midwifery and Social Work, Faculty of Medical and Human Sciences, Manchester Academic Health Sciences Centre, University of ManchesterManchester, UK,
Correspondence:, Veronica Swallow, School of Nursing, Midwifery and Social Work, Faculty of Medical and Human Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Oxford Road, Manchester M13 9PT, UK, E-mail:
| | - T Smith
- Royal Manchester Children's HospitalManchester, UK
| | - N J A Webb
- Royal Manchester Children's HospitalManchester, UK
| | - L Wirz
- Health Psychology (Old Ward 1 Offices), Royal Victoria InfirmaryNewcastle, UK
| | - L Qizalbash
- The Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle, UK
| | - E Brennan
- Great Ormond Street Children's HospitalLondon, UK
| | - A Birch
- Nephrology, Alder Hey Children's NHS Foundation TrustLiverpool, UK
| | - M D Sinha
- Department of Pediatric Nephrology, Evelina Children's Hospital, Guy's & St Thomas' NHS Foundation TrustLondon, UK
| | - L Krischock
- Sydney Children's HospitalRandwick, NSW, Australia
| | | | - D King
- Yorkhill Children's HospitalGlasgow, UK
| | - H Lambert
- The Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle, UK
| | - D V Milford
- Birmingham Children's HospitalBirmingham, UK
| | - L Crowther
- Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation TrustManchester, UK
| | - M Saleem
- University of Bristol Children's Renal Unit, Bristol Royal Hospital for ChildrenBristol, UK
| | - A Lunn
- Children's Renal and Urology Unit, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, QMC CampusNottingham, UK
| | - J Williams
- School of Environment, Education and Development, University of ManchesterUK
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92
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Tallon MM, Kendall GE, Snider PD. Development of a measure for maternal confidence in knowledge and understanding and examination of psychosocial influences at the time of a child's heart surgery. J SPEC PEDIATR NURS 2015; 20:36-48. [PMID: 25378118 DOI: 10.1111/jspn.12096] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 09/30/2014] [Accepted: 10/01/2014] [Indexed: 01/16/2023]
Abstract
PURPOSE The purpose was to develop a maternal confidence in knowledge and understanding scale (Maternal Knowledge and Understanding Scale [MKUS]) and examine the effect of psychosocial factors at the time of a child's heart surgery. DESIGN AND METHODS Using cross-sectional design, the MKUS was developed and tested. Validated instruments were used to examine the impact of psychosocial factors. RESULTS The MKUS showed acceptable internal consistency (Cronbach's alpha .78). Higher levels of maternal anxiety and lower levels of social support were associated with lower MKUS scores (p < .05). PRACTICE IMPLICATIONS A measure of maternal confidence in knowledge and understanding could draw attention to psychosocial factors and opportunities to enhance nursing support.
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Affiliation(s)
- Mary M Tallon
- Curtin University, Perth, Western Australia, Australia
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93
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Luijk MPCM, Sonnenschein-van der Voort AMM, Mileva-Seitz VR, Jansen PW, Verhulst FC, Hofman A, Jaddoe VWV, de Jongste JC, van IJzendoorn MH, Duijts L, Tiemeier H. Is parent-child bed-sharing a risk for wheezing and asthma in early childhood? Eur Respir J 2014; 45:661-9. [PMID: 25504998 DOI: 10.1183/09031936.00041714] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Household crowding can place young children at risk for respiratory infections which subsequently provoke asthma symptoms. However, crowding might also protect against asthma, in accordance with the hygiene hypothesis. We tested if parent-infant bed-sharing, an important dimension of household crowding, increases or decreases the risk for asthma. In a population-based prospective cohort (N = 6160) we assessed bed-sharing at 2 and 24 months; wheezing between 1 and 6 years of age; and asthma at 6 years of age. Generalised estimating equation models were used to assess repeated measures of wheezing and asthma. We found no association between bed-sharing in early infancy and wheezing or diagnosis of asthma. By contrast, we found a positive association between bed-sharing in toddlerhood and both wheezing (OR 1.42, 95% CI 1.15-1.74) and asthma (OR 1.57, 95% CI 1.03-2.38). Wheezing was not associated with bed-sharing when using cross-lagged modelling. This study suggests that bed-sharing in toddlerhood is associated with an increased risk of asthma at later ages, and not vice versa. Further studies are needed to explore the underlying causal mechanisms.
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Affiliation(s)
- Maartje P C M Luijk
- School of Pedagogical and Educational Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Agnes M M Sonnenschein-van der Voort
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands Dept of Pediatrics, Division of Respiratory Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Viara R Mileva-Seitz
- School of Pedagogical and Educational Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Pauline W Jansen
- Dept of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands Institute of Psychology, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Frank C Verhulst
- Dept of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Albert Hofman
- Dept of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands Dept of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands Dept of Pediatrics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Johan C de Jongste
- Dept of Pediatrics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marinus H van IJzendoorn
- School of Pedagogical and Educational Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands Center for Child and Family Studies, Leiden University, Leiden, The Netherlands
| | - Liesbeth Duijts
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands Dept of Pediatrics, Division of Respiratory Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands Dept of Pediatrics, Division of Neonatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Henning Tiemeier
- Dept of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands Dept of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands Dept of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
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94
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Swallow VM, Knafl K, Santacroce S, Campbell M, Hall AG, Smith T, Carolan I. An interactive health communication application for supporting parents managing childhood long-term conditions: outcomes of a randomized controlled feasibility trial. JMIR Res Protoc 2014; 3:e69. [PMID: 25472567 PMCID: PMC4275487 DOI: 10.2196/resprot.3716] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 10/17/2014] [Accepted: 11/01/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Families living with chronic or long-term conditions such as chronic kidney disease (CKD), stages 3-5, face multiple challenges and respond to these challenges in various ways. Some families adapt well while others struggle, and family response to a condition is closely related to outcome. With families and professionals, we developed a novel condition-specific interactive health communication app to improve parents' management ability-the online parent information and support (OPIS) program. OPIS consists of a comprehensive mix of clinical caregiving and psychosocial information and support. OBJECTIVE The purpose of this study was to (1) assess feasibility of a future full-scale randomized controlled trial (RCT) of OPIS in terms of recruitment and retention, data collection procedures, and psychometric performance of the study measures in the target population, and (2) investigate trends in change in outcome measures in a small-scale RCT in parents of children with CKD stages 3-5. METHODS Parents were recruited from a pediatric nephrology clinic and randomly assigned to one of two treatment groups: usual support for home-based clinical caregiving (control) or usual support plus password-protected access to OPIS for 20 weeks (intervention). Both groups completed study measures at study entry and exit. We assessed feasibility descriptively in terms of recruitment and retention rates overall; assessed recruitment, retention, and uptake of the intervention between groups; and compared family condition management, empowerment to deliver care, and fathers' involvement between groups. RESULTS We recruited 55 parents of 39 children (42% of eligible families). Of those, about three-quarters of intervention group parents (19/26, 73%) and control group parents (22/29, 76%) were retained through completion of 20-week data collection. The overall retention rate was 41/55 (75%). The 41 parents completing the trial were asked to respond to the same 10 questionnaire scales at both baseline and 20 weeks later; 10 scores were missing at baseline and nine were missing at 20 weeks. Site user statistics provided evidence that all intervention group parents accessed OPIS. Analysis found that intervention group parents showed a greater improvement in perceived competence to manage their child's condition compared to control group parents: adjusted mean Family Management Measure (FaMM) Condition Management Ability Scale intervention group 44.5 versus control group 41.9, difference 2.6, 95% CI -1.6 to 6.7. Differences between the groups in the FaMM Family Life Difficulty Scale (39.9 vs 36.3, difference 3.7, 95% CI -4.9 to 12.2) appeared to agree with a qualitative observation that OPIS helped parents achieve understanding and maintain awareness of the impact of their child's condition. CONCLUSIONS A full-scale RCT of the effectiveness of OPIS is feasible. OPIS has the potential to beneficially affect self-reported outcomes, including parents' perceived competence to manage home-based clinical care for children with CKD stage 3-5. Our design and methodology can be transferred to the management of other childhood conditions. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number (ISRCTN): 84283190; http://www.controlled-trials.com/ISRCTN84283190 (Archived by WebCite at http://www.webcitation.org/6TuPdrXTF).
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Affiliation(s)
- Veronica M Swallow
- School of Nursing, Midwifery and Social Work, Faculty of Medical and Human Sciences, University of Manchester, Manchester, United Kingdom.
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95
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Tong A, Palmer S, Craig JC, Strippoli GFM. A guide to reading and using systematic reviews of qualitative research. Nephrol Dial Transplant 2014; 31:897-903. [PMID: 25414375 DOI: 10.1093/ndt/gfu354] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 10/11/2014] [Indexed: 11/12/2022] Open
Abstract
There is an increasingly widespread policy momentum to increase patient-centred care and to improve quality of life outcomes within health services. Qualitative research methods are used to elicit in-depth and detailed insights into people's attitudes, beliefs, emotions and experiences-much of which may remain unspoken during clinical encounters. Questions about patients' beliefs and preferences for treatment can be addressed by qualitative research and inform evidence-based strategies for delivering patient-centred care. Systematic reviews of multiple primary qualitative studies bring together findings from different studies to offer new and more comprehensive understandings of social phenomena across various healthcare contexts and populations and are an emerging methodology in the literature including for care in chronic kidney disease. This article will provide a framework for the systematic review of qualitative research so readers can make sense of these study types and use them in clinical care and policy.
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Affiliation(s)
- Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW 2145, Australia
| | - Suetonia Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Jonathan C Craig
- Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW 2145, Australia
| | - Giovanni F M Strippoli
- Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, S. Maria Imbaro, Italy Diaverum Scientific Office, Lund, Sweden Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
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Kari JA, Alzahrany M, El-Deek B, Maimani M, El-Desoky S. Social impact of dialysis on children and their families. Indian J Pediatr 2014; 81:1020-6. [PMID: 24122420 DOI: 10.1007/s12098-013-1236-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 08/26/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To evaluate the social consequences of dialysis on children and their parents. METHODS From January through June 2012 short structured interviews with parents or caregivers of children on peritoneal dialysis (PD) or hemodialysis (HD) who were followed up at King Abdulaziz University Hospital, King Faisal Specialty Hospital and Research Center, or the Kidney Center at King Fahad Hospital were conducted. Data were analyzed using the Statistical Package for the Social Sciences. RESULTS Thirty six children (20 boys and 16 girls [corrected] ) and their families were included. The mean (SD) age of the children was 11.5±6.87 y, and the mean (SD) duration of dialysis was 28±11.32 mo. Only one third of the families had the opportunity to choose the modality of dialysis. Both modalities of dialysis had a negative effect on fathers' jobs in over 50% of the cases. Similarly, both modalities of treatment had a considerable impact on the quality of care provided by the mothers to other family members. There was no difference between the two modalities on the frequency of admissions. CONCLUSIONS Both PD and HD had a negative impact on fathers' jobs and on the level of care provided by mothers to the rest of the family.
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97
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Nightingale R, Sinha MD, Swallow V. Using focused ethnography in paediatric settings to explore professionals' and parents' attitudes towards expertise in managing chronic kidney disease stage 3-5. BMC Health Serv Res 2014; 14:403. [PMID: 25234741 PMCID: PMC4176584 DOI: 10.1186/1472-6963-14-403] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 09/15/2014] [Indexed: 11/26/2022] Open
Abstract
Background Interactions between parents and healthcare professionals are essential when parents of children with chronic conditions are learning to share expertise about clinical care, but limited evidence exists on how they actually interact. This paper discusses the use of focused ethnography in paediatric settings as an effective means of exploring attitudes towards expertise. Methods The paper draws on repeated observations, interviews and field-notes involving the parents of six children with chronic kidney disease, and 28 healthcare professionals at two, tertiary, children’s hospital-based units. Data were analysed using the Framework approach and the concepts of expertise and self-management. Results Our study highlighted rewards and challenges associated with focused ethnography in this context. Rewards included the ability to gain a richer understanding of the complex phenomena of mutual acknowledgement of expertise that occurs during parent/ healthcare professional interactions. Challenges related to gaining informed consent and ensuring potential participants had an adequate understanding of the purpose of the study. Two dimensions of parental expertise around their child (personal and clinical) were evident in our data. Parents’ and professionals’ expertise about the child and their condition was acknowledged and exchanged as parents learnt to share clinical-care with the multi-disciplinary team. Healthcare professionals acknowledged parents’ need to understand aspects of each of the eight disciplinary knowledge bases relating to their child’s management and recognised parents’ expert knowledge of their child, found ways to mobilise this knowledge, and wove parents’ expertise into the management plan. Parents spoke of the degree to which their own expert knowledge of their child complemented healthcare professionals’ clinical knowledge. However, ambivalence around expertise was evident as both parents and healthcare professionals questioned what the expertise was, and who the expert was. Our discussion focuses on the ways healthcare professionals and parents share expertise around the child’s condition as parents take on responsibility for home-based clinical care. Conclusions Our findings point to focused ethnography being an effective way of capturing new insights into parent and professional interactions in a paediatric setting and mutual acknowledgement of expertise; these insights may help redress the reported limitations of previous, retrospective studies.
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Affiliation(s)
- Ruth Nightingale
- NIHR Clinical Research Network: North Thames, c/o Somers Clinical Research Facility, Frontage Building, Level 1, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK.
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98
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McNeill T, Nicholas D, Beaton J, Montgomery G, MacCulloch R, Gearing R, Selkirk E. The Coconstruction of Couples' Roles in Parenting Children With a Chronic Health Condition. QUALITATIVE HEALTH RESEARCH 2014; 24:1114-1125. [PMID: 24963081 DOI: 10.1177/1049732314540339] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In this study we explored the ways that mothers and fathers of children who have a chronic health condition coconstructed their parenting roles. We wanted to move beyond the standard focus on individual parenting behaviors and use a grounded theory approach to better capture the dyadic and interpersonal gestalt of how parents worked out their roles. We explored multiple factors that influenced their decision making and the unique models that each couple developed. We held conjoint qualitative interviews with 20 couples from the Toronto area, as well as follow-up interviews with individual partners in five of these couples. Our findings introduce several concepts (such as role negotiation, complementarity and symmetry of roles, and "good enough" role performance) that form an explanatory model. A key finding is the diversity of ways in which couples adapted to the parenting challenges they faced. Implications in conceptual, clinical, and research areas are presented.
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Affiliation(s)
- Ted McNeill
- University of Toronto, Toronto, Ontario, Canada
| | | | - John Beaton
- University of Guelph, Guelph, Ontario, Canada
| | - Gert Montgomery
- Holland Bloorview Kid's Rehabilitation Hospital, Toronto, Ontario, Canada
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Watson AR. Psychosocial support for children and families requiring renal replacement therapy. Pediatr Nephrol 2014; 29:1169-74. [PMID: 23963710 DOI: 10.1007/s00467-013-2582-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 07/04/2013] [Accepted: 07/16/2013] [Indexed: 10/26/2022]
Abstract
Chronic kidney disease (CKD) and the need for renal replacement therapy (RRT) can place a great strain on the child and family. As well as the medical and nutritional prescription, each child and family requires an individual psychosocial prescription that requires input from multiprofessional team members. The information needs of each child and family need to be constantly evaluated as well as the choice of therapy in relation to social, psychological and economic factors. Many tertiary units lack adequate "time" to deliver such assessments and coordinate the support and respite care for those on long-term dialysis, especially when significant numbers of children are now accepted onto RRT programmes with co-morbidities. National and international standards are needed for the staffing of comprehensive tertiary paediatric renal units as well as studies evaluating supportive care to families.
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Affiliation(s)
- Alan R Watson
- Children's Renal and Urology Unit, Nottingham Children's Hospital, Queen's Medical Centre, Derby Road, Nottingham, NG7 2UH, UK,
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Apostolou A, Karagiozoglou-Lampoudi T. Dietary adherence in children with chronic kidney disease: a review of the evidence. J Ren Care 2014; 40:125-30. [PMID: 24814533 DOI: 10.1111/jorc.12069] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND In children with chronic kidney disease (CKD), a nutrition support plan is important to ensure optimal macro- and micro-nutrient intake in order to avoid malnutrition, disease-related complications and growth rate reduction. Children with CKD and their families encounter many difficulties in adjusting to the renal diet. Even though adherence to the recommended dietary plan is important in CKD, it is rarely measured partly due to the lack of robust, unbiased assessment methods. METHODS In this review of 22 papers, the techniques used to assess adherence in children with CKD are reviewed, alongside their advantages and disadvantages. FINDINGS Although dietary surveys, biochemical index assessment and clinician ratings have been found not to be efficient when used as a single tool, they should be used in combination in order to give the opportunity to the health providers to perceive adherence from as many angles as possible.
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Affiliation(s)
- Aggeliki Apostolou
- Clinical Nutrition Laboratory, Department of Nutrition and Dietetics, Alexander Technological Education Institute, Thessaloniki, Greece
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