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Gardener L, Bourke-Taylor H, Desha L, Gardener M, Turpin M. Developing Self-Management in Type 1 Diabetes at Secondary Schools: Who Is Responsible? A Qualitative Study. Am J Occup Ther 2024; 78:7805205110. [PMID: 39137007 DOI: 10.5014/ajot.2024.050662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024] Open
Abstract
IMPORTANCE Occupational therapists have the proven capacity to improve outcomes for young adults who are self-managing Type 1 diabetes (T1D). There is insufficient understanding of adolescents' experiences of developing responsibility for diabetes self-management (DSM). OBJECTIVE To investigate adolescents' perceptions of sharing responsibility for T1D management at school. DESIGN This study had a descriptive qualitative design and used semistructured interviews and thematic analysis. It is the second phase of a mixed-methods study with a sequential explanatory design that investigated mechanisms of responsibility-sharing at school. SETTING Secondary school in Australia. PARTICIPANTS Purposive sample of adolescents (age 15-16 yr) with T1D (N = 11). RESULTS Adolescents approached the complex occupation of school-based DSM primarily in partnership with their parents, with each adolescent having unique responsibilities while sharing others. Health care professionals and teachers reportedly had minimal involvement. Adolescents described owning most DSM tasks, with their perceptions of building independence limiting the sharing of this responsibility. A heightened sense of risk meant that adolescents were likely to communicate with others in cases of errant blood glucose readings. Current processes commonly resulted in reduced school participation. CONCLUSIONS AND RELEVANCE Adolescents valued working responsively and interdependently with their parents to manage T1D at school, which aligns with the occupational therapy model of co-occupation. Effective responsibility-sharing depends on clear, frequent, autonomy-supportive, team-based communications. Our results showed that patterns of communication for determining school-based DSM processes were fragmented and risk focused, with limited adolescent involvement, resulting in strategies that led to students at times being excluded from school activities. Plain-Language Summary: This is the first study to use an occupational lens to examine the way in which adolescents share their responsibility for diabetes care at school. Diabetes self-management in secondary schools occurs more often when adolescents work interdependently with their parents to manage their diabetes. Adolescent involvement in formal school processes and a clearer allocation of team roles and responsibilities would better support health-promoting habits and school participation.
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Affiliation(s)
- Lisa Gardener
- Lisa Gardener, BOccThy, is PhD Candidate, School of Health and Rehabilitation, The University of Queensland, St. Lucia, Queensland, Australia;
| | - Helen Bourke-Taylor
- Helen Bourke-Taylor, BAppSc OT, MS, PhD, is Professor, Department of Occupational Therapy, Monash University, Frankston, Victoria, Australia
| | - Laura Desha
- Laura Desha, BOcc Thy (Hons), PhD, is Adjunct Research Fellow, Department of Occupational Therapy, University of Otago, Wellington, New Zealand
| | - Madeline Gardener
- Madeline Gardener, BOccThy (Hons), MTeach, is Research Assistant, School of Education and Professional Studies, Griffith University, Mt. Gravatt, Queensland, Australia
| | - Merrill Turpin
- Merrill Turpin, BOccThy, GradDipCounsel, PhD, is Senior Lecturer, School of Health and Rehabilitation, The University of Queensland, St. Lucia, Queensland, Australia
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Cui C, Li S, Zhou H, Chen W, Xiao C, Fan M, Zheng X. Barriers and facilitators of nurse-led self-management support for adolescents with epilepsy: A mixed-methods study in transition preparation. Heliyon 2024; 10:e33774. [PMID: 39071638 PMCID: PMC11283166 DOI: 10.1016/j.heliyon.2024.e33774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 06/26/2024] [Accepted: 06/26/2024] [Indexed: 07/30/2024] Open
Abstract
Aims To gain insight into the readiness for evidence-based practice of self-management support during transition for adolescents with epilepsy among pediatric nurses, and to explore the promoting and hindering factors. Design A mixed-methods design with an explanatory sequential approach was employed. Setting Three specialty children's hospitals in southwest regions of China. Methods In phase 1, a total of 126 participants were included in the Survey of Clinical Readiness of Evidence-Based Nursing Assessment (CREBNA) from Dec 2022 to Feb 2023. Total scale and subscale scores were calculated. In phase 2, we developed the interview outline based on the analysis of the quantitative results. In-depth interviews (n = 15) were conducted from Feb 2023 to Apr 2023 to explain and supplement the quantitative phase results. Results The total score of CREBNA indicated that teams have good readiness and capacity for implementation of evidence-based nursing practice Compared with the norm. The scores of the three subscales of evidence factors, organizational environment, and promoting factors were normal. In subsequent interviews and integration, we extracted four themes based on the Knowledge-To-Action (KTA) framework: 1. organization barriers (incentive mechanism, interdisciplinary cooperation process, information aids); 2. operational barriers (Exemplary evidence-based practice, time pressure, gaps in patient and family understanding of evidence); 3. individual-level barriers (evidence-based and professional knowledge reserve, professional autonomy, shared decision-making roles, dependence on habitual clinical behaviors); and 4. facilitating factors (leadership commitment, self-management identity, transition service needs, patient- and family-centered care culture). A conceptual model was constructed based on the KTA. Conclusion It is feasible to carry out evidence-based practice of nurse-led self-management support in transition preparation. Nursing researchers and managers should carry out knowledge selection and tailoring based on barriers at the organizational, operational, and individual levels to promote favorable factors and improve the smooth transition of adolescents with chronic diseases.
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Affiliation(s)
- Cui Cui
- Department of Nursing, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Shuangzi Li
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child, Chongqing, 400014, China
- Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Hengyu Zhou
- School of Nursing, Chongqing Medical University, Chongqing, 400014, China
| | - Wenjin Chen
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child, Chongqing, 400014, China
- Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Changmin Xiao
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child, Chongqing, 400014, China
- Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Mingping Fan
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child, Chongqing, 400014, China
- Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Xianlan Zheng
- Department of Nursing, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
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Wong Chung R, Willemen A, Bakker A, Maaskant J, Voorman J, Becher J, Schuengel C, Alsem M. The development and validation of the S-scan-parental self-management support (S-scan - PS): A self-reflection tool for child healthcare professionals. Child Care Health Dev 2024; 50:e13223. [PMID: 38265134 DOI: 10.1111/cch.13223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 11/18/2023] [Accepted: 12/07/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Professionals providing self-management support to parents regarding the care for their child with a chronic condition nowadays is an important aspect of child healthcare. This requires professionals to orient themselves towards partnership and collaboration with parents. The aims of the current study were the development and validation of the S-Scan-Parental self-management Support (S-scan - PS) as a tool for healthcare professionals to reflect on their attitude and practices regarding the support for parental self-management. METHODS An existing instrument was adapted together with field experts for professionals to self-evaluate their support for self-management of parents. The resulting 36-item self-report questionnaire was filled in by healthcare professionals in the Netherlands working with children and their parents. Cognitive interviews, exploratory and confirmatory factor analysis (CFA), and test-retest reliability analysis were part of the development and validation process. RESULTS In total, 434 professionals, including physicians, physiotherapists, occupational therapists, and nurses, from 13 rehabilitation institutes and 5 medical centres participated. The cognitive interviews with child healthcare professionals indicated adequate face and content validity. The S-scan - PS scale had acceptable internal consistency (0.71 ≤ α ≤ 0.91) for the total score as well as the domain scores. CFA showed acceptable root mean square error of approximation (RMSEA) model fit (0.066), though not on other tested goodness-of-fit indices. Test-retest reliability of the instrument was moderate with an average intraclass correlation coefficient (ICC) = 0.61. CONCLUSIONS The S-scan - PS fulfils important psychometric criteria for use by child healthcare professionals to reflect on parental self-management support. Such self-reflection might help to improve their approach towards supporting self-management of parents in the care for their child with a chronic condition. Further research is needed into the construct validity and test-retest reliability of the instrument.
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Affiliation(s)
- Ruud Wong Chung
- Merem Medical Rehabilitation, Almere, The Netherlands
- Amsterdam Public Health Research Institute and Department of Educational and Family Studies, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Agnes Willemen
- Amsterdam Public Health Research Institute and Department of Educational and Family Studies, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Amber Bakker
- Amsterdam Public Health Research Institute and Department of Educational and Family Studies, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jolanda Maaskant
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, the Netherlands
| | - Jeanine Voorman
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht and De Hoogstraat Rehabilitation Utrecht, Utrecht, The Netherlands
- Department of Rehabilitation, Physical Therapy Science & Sports, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Jules Becher
- Amsterdam Movement Sciences and Department of Rehabilitation Medicine, Amsterdam UMC - VU Medical Centre, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Carlo Schuengel
- Amsterdam Public Health Research Institute and Department of Educational and Family Studies, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- LEARN! Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mattijs Alsem
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Nightingale R, Kirk S, Swallow V, McHugh GA. Supporting the parent-to-child transfer of self-management responsibility for chronic kidney disease: A qualitative study. Health Expect 2023; 26:683-692. [PMID: 36562551 PMCID: PMC10010075 DOI: 10.1111/hex.13693] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/09/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION As children with long-term conditions (LTCs) mature, they are usually expected to assume responsibility from their parents for self-management of their condition. Little is known about what supports families with this handover of responsibility, including the role of healthcare professionals (HCPs). This study aimed to explore what supports young people with chronic kidney disease (CKD) to assume self-management responsibility and parents to relinquish control. METHODS A qualitative study, using a grounded theory approach was conducted. Individual and dyadic interviews and focus groups were carried out with 16 young people aged 13-17 years old with CKD, 13 parents, and 20 HCPs. Participants were recruited from two UK children's renal units. FINDINGS Building and maintaining trust, fostering positivity, learning from mistakes, forming partnerships and individualized support, facilitated the transfer of self-management responsibility. However, HCPs' focus on developing partnerships with young people meant some parents felt excluded, highlighting uncertainty around whether support should be child- or family-centred. Although tailored support was identified as critical, aspects of local service provision appeared to impact on HCPs' capacity to implement individualized approaches. CONCLUSION This study has identified what supports the handover of responsibility, and, importantly, HCPs' current, and potential role in helping young people to assume responsibility for managing their LTC. Further research is needed to explore how HCPs' involvement balances child- and family-centred care, and how HCPs can adopt personalized, strengths-based approaches to help ensure the support that families receive is tailored to their individual needs. PATIENT OR PUBLIC CONTRIBUTION Patient and public involvement was integrated throughout the study, with young adults with CKD and parents who had a child with CKD actively involved in the study's design and delivery.
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Affiliation(s)
- Ruth Nightingale
- Language and Cognition Department, UCL Division of Psychology and Language Science, University College London, London, UK
| | - Sue Kirk
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Veronica Swallow
- Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, UK
| | - Gretl A McHugh
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK
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Health Care Transition Planning: Educational Needs of Pediatric Nurses and Pediatric Nurse Practitioners. J Pediatr Health Care 2022; 36:e6-e16. [PMID: 35501202 DOI: 10.1016/j.pedhc.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/24/2022] [Accepted: 04/02/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The purpose was to identify the educational needs of pediatric nurses and pediatric nurse practitioners providing direct care to transition-aged youth with chronic illness and disability and to identify strategies to develop health care transition planning (HCTP) expertise. METHOD Mixed-methods descriptive analyses were performed on survey data extracted from a larger national study exploring the provision of HCTP activities performed by nurses of two pediatric nursing professional organizations. RESULTS Items querying educational needs were completed by 1,162 pediatric nurses serving in advanced practice and staff roles. Twenty percent reported having specialized HCTP education. Of which more than half received it outside of the workplace. Factor analysis revealed two constructs explaining 73.4% of the variance in nurses' reported level of knowledge. DISCUSSION HCTP education and the development of nurse-led services to facilitate optimal health care transitions outcomes are necessitated. Academia and service have a shared responsibility in educating nurses.
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Nightingale R, McHugh GA, Swallow V, Kirk S. Shifting responsibilities: A qualitative study of how young people assume responsibility from their parents for self-management of their chronic kidney disease. Health Expect 2022; 25:1919-1929. [PMID: 35770677 PMCID: PMC9327865 DOI: 10.1111/hex.13549] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/20/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The responsibility for managing a long-term condition (LTC) such as chronic kidney disease (CKD) typically transfers from parent to child, as children become older. However, children can find it challenging to become independent at managing their LTC, and evidence for how healthcare professionals (HCPs) support transfer of responsibility is limited. This study aimed to explore how young people with CKD assume responsibility for managing their condition and the HCP's role during this process. METHODS Sampling, qualitative data collection and analysis were guided by a constructivist grounded theory approach. Individual and dyadic interviews, and focus groups, were conducted with 16 young people aged 13-17 years with CKD, 13 parents and 20 HCPs. FINDINGS A grounded theory, shifting responsibilities, was developed that provides new insights into how young people's, parents' and HCPs' constructions of the transfer of responsibility differed. These diverse constructions contributed to multiple uncertainties around the role of HCPs, when the process started and was completed and whether the endpoint of the process was young people's self-management or young person-parent shared management. CONCLUSION Families would benefit from HCP support over a longer timeframe that integrates assuming self-management responsibility with gaining independence in other areas of their lives and focuses on young people 'doing' self-management. PATIENT OR PUBLIC CONTRIBUTION Patient and public involvement was integrated throughout the study, with young adults with CKD and parents who had a child with CKD actively involved in the study's design and delivery.
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Affiliation(s)
- Ruth Nightingale
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Gretl A McHugh
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Veronica Swallow
- Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, UK
| | - Sue Kirk
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
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Catarino M, Charepe Z, Festas C. Promotion of Self-Management of Chronic Disease in Children and Teenagers: Scoping Review. Healthcare (Basel) 2021; 9:healthcare9121642. [PMID: 34946368 PMCID: PMC8701924 DOI: 10.3390/healthcare9121642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/09/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The scientific literature describes that self-management of chronic illness leads to improved health outcomes. Knowledge about interventions that promote self-management behaviors in children and teenagers has been poorly clarified. This study aims to map, in the scientific literature, the nature and extent of interventions that promote self-management of chronic disease, implemented and evaluated in contexts of health care provided to children and teenagers. METHODS The guidelines proposed by the Joanna Briggs Institute were followed. The survey was conducted in June 2021, with access to international databases and gray literature, in Portuguese, English, French, and Spanish. RESULTS Interventions that promote self-management of children and teenagers can be developed through a local contact or through technological means of support for health care. The use of online supports, such as applications or communication platforms, should be parameterized with health professionals, according to the needs of users. CONCLUSIONS The acquisition of self-management skills in pediatrics is a process supported by the family, health professionals and the community, in which the nurse, in partnership, can promote communication and health education through cognitive strategies, behavioral programs included in physical or online programs, adjusted to the patients' needs.
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Affiliation(s)
- Marta Catarino
- Health Department, Polytechnic Institute of Beja, 7800-111 Beja, Portugal
- Institute of Health Sciences (ICS), Universidade Católica Portuguesa, 1649-023 Lisboa, Portugal;
- Center for Interdisciplinary Research in Health (CIIS), Institute of Health Sciences (ICS), Universidade Católica Portuguesa, 1649-023 Lisboa, Portugal;
- Correspondence:
| | - Zaida Charepe
- Institute of Health Sciences (ICS), Universidade Católica Portuguesa, 1649-023 Lisboa, Portugal;
- Center for Interdisciplinary Research in Health (CIIS), Institute of Health Sciences (ICS), Universidade Católica Portuguesa, 1649-023 Lisboa, Portugal;
| | - Constança Festas
- Center for Interdisciplinary Research in Health (CIIS), Institute of Health Sciences (ICS), Universidade Católica Portuguesa, 1649-023 Lisboa, Portugal;
- Institute of Health Sciences (ICS), Universidade Católica Portuguesa, 4169-005 Porto, Portugal
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