Barriers to Addressing Social Determinants of Health in Pediatric Nursing Practice: An Integrative Review

Family Self-Support in Managing Down Syndrome Children: A Qualitative Study

Background and Aim. Down syndrome (DS) is the most common reason for disabilities caused by genetic disorders. Due to the special nature of this disease and the special needs of children with Down syndrome, they are required to receive their families' support. Therefore, the recognition of their problems and needs and also the alternatives for resolving them and promoting their life quality are very useful. Also, since very limited qualitative studies have been conducted, it seems necessary to design a qualitative study. Method. This qualitative study was conducted by the content analysis method and through purposeful sampling method with the participation of 26 participants including 15 mothers, 6 fathers, 3 sisters, and 2 brothers of DS children in 2022-2023. The data were collected through semi-structured interviews. Findings. Using the content analysis method of Graneheim and Lundman (2004), the main theme was "Family self-supporting in protecting Down syndrome children." The subthemes were seven including "trying to find information-support resources," "Giving importance to child's health," "religious beliefs of the family," "child moral education, helping to child's relative self-support," "developing familial support," and "developing child's social interactions." Conclusion and Recommendations. The findings of this study showed that family is the main source of fulfilling the needs of children and their life challenges through using efficient self-support methods. This study introduced family self-support methods in terms of DS children in a way that other families can also manage the problems of their children more efficiently. The present study can be used by trustees of DS to support them and their families. Considering the existence of many problems in children with Down syndrome and the involvement of families, it is suggested that policymakers and community health managers provide the basis for receiving services and social support. For example, it is possible to strengthen the screening systems in the country to diagnose the disease on time and take quick action to solve this problem. Also, by increasing the health insurance coverage and fair distribution of the support resources needed by these people, it promoted the quality of life for them and their families. Also, health policymakers in Iran can take action to increase life expectancy and reduce deaths caused by DS by improving the equitable distribution of health resources and services. Also, public policies should enhance supportive intermediation for prevention and life quality promotion and also decrease health challenges. They are also supposed to lessen the costs of health care. Furthermore, to support social organizations, health service providers and researchers should consider the development of intermediations for the health enhancing and life quality promoting of DS children.

Nurse experiences of partnership nursing when caring for children with long-term conditions and their families: A qualitative systematic review

AIM

To explore the experiences of partnership nursing among nurses when caring for children and young people with long-term conditions, and their families.

BACKGROUND

Partnership nursing is promoted as a positive model of care among paediatric nurses, where shared roles and decision-making, parental participation, mutual trust and respect, communication and negotiation are valued to create positive care experiences and enhance patient outcomes. Little is known about how nurses use partnership with both the patient and the parents in this triad to deliver partnership nursing.

DESIGN

A qualitative systematic review followed Joanna Briggs Institute meta-aggregation approach and has been reported according to PRISMA guidelines.

METHODS

A comprehensive systematic search was conducted in seven electronic databases. Studies were assessed according to a pre-determined inclusion criteria. Qualitative findings with illustrative participant quotes were extracted from included studies and grouped into categories to inform overall synthesised findings. Methodological quality assessment was conducted.

FINDINGS

A total of 5837 publications were screened, and 41 qualitative studies were included. Three overarching synthesised findings were identified: (1) Using education to promote feelings of safety and support, (2) Partnering to develop a strong therapeutic relationship and (3) Optimising communication underpinned by shared decision-making principles to deliver individualised care.

CONCLUSION

Nurses demonstrated successful partnership in their practice, but focused on developing dyadic nurse-parent and dyadic nurse-child partnerships. Future practice development that creates a three-way triadic partnership may aid therapeutic relationships and shared decision-making.

IMPLICATIONS FOR CLINICAL PRACTICE

Clinicians can reflect on how dyadic partnerships (focusing on the child or the parent) may exclude opportunities for coherent care. Further exploration in practice, policy and research as to how nurses determine child competency and child and parent level of engagement in triadic partnership may improve the potential of meaningful shared decision-making.

Promoting health through nurse-led healthy conversations

Nurses in all settings have an important role in preventing non-communicable diseases such as cardiovascular disease, cancer, respiratory disease and diabetes mellitus. They have multiple daily opportunities in their practice to discuss health with people, with the aim of supporting behaviour changes that reduce the risk of non-communicable diseases and the associated health-related and economic challenges. Incorporating the principles of healthy conversations into all daily interactions provides opportunities for nurses collectively to promote health on an individual basis to millions of people. However, many nurses have not received training in such behaviour change interventions. This article explains the principles and potential benefits of healthy conversations, and emphasises the importance of training to promote nurses' knowledge, skills, confidence and motivation to engage in such conversations.

Nursing practice to fulfill the information needs of parents of hospitalized children with cancer and related factors

PURPOSE

This study aimed to clarify the current status of nursing practice to fulfill the information needs of parents of hospitalized children with cancer and to determine the associated factors.

DESIGN AND METHODS

A cross-sectional survey using a questionnaire was administered to nurses working on wards admitting children with cancer in Japan. Data were analyzed using logistic regression analysis, after exploratory factor analysis.

RESULTS

Three factors were extracted as nursing practice: "provision of information that supports the child's future and other family members' daily lives" (factor 1), "provision of information regarding care for the child in the treatment process" (factor 2), "provision of information regarding the child's disease and treatment" (factor 3). Among these three factors, factor 1 achieved the lowest score for the level of practice. Logistic regression analysis indicated that interprofessional information sharing increased the scores of factors 1 and 3 (Odds ratio: 6.150, and 4.932, respectively); assessment of parental information needs increased the scores of factors 1, 2, and 3 (Odds ratio: 3.993, 3.654, and 3.671, respectively); and participation in training increased the score of factor 2 (Odds ratio: 3.078).

CONCLUSIONS

Nursing practice to fulfill the parents' information needs consisted of three factors. The degree of practice varied according to the information content and was primarily influenced by assessment of parental information needs, interprofessional information sharing, and participation in training.

PRACTICE IMPLICATIONS

It is necessary for nurses to accurately assess parents' needs, and interprofessional sharing of information is important to fulfill the information needs of parents.

Application of Nursing Intervention Based on Nel Noddings Care Theory for School-Aged Asthmatic Children

Objectives: The objective of this study was to examine the effect of nursing intervention based on Nel Noddings care theory on self-management behavior and symptomatic improvement in school-age asthmatic children in China. Methods: In this study, a sample of 100 school-aged children suffering from asthma was chosen, and divided into two groups: observation group and control group. Both groups received routine nursing but the observation group was combined with nursing intervention based on Nel Noddings theory.Results:The total scores of social psychologies, daily life, disease medicine and self-management in the observation group before intervention were similar to those in the control group. The self-management scores of the observation group after intervention were higher than those of the control group. The improvement time of wheezing and cough in the observation group was shorter than that in the control group. The total number of complete compliance and partial compliance in the observation group was higher than that in the control group. Conclusion: The application of nursing intervention based on Nel Noddings care theory to the nursing of school-age asthmatic children can improve the self-management ability of children, promote the recovery of cough, wheezing and other symptoms, and is of great significance to improve the compliance and nursing effect of children, with high popularization and application value.

Use of Social Determinants of Health Screening among Primary Health Care Nurses of Developed Countries: An Integrative Review

The aims of the study are to evaluate and synthesise research that has investigated social determinants of health screening by primary healthcare nurses; how and when primary health care nurses perform social determinants of health screening; and implications for advancing nursing practice. Systematic searches in electronic databases identified fifteen published studies which met the inclusion criteria. Studies were synthesised using reflexive thematic analysis. This review found little evidence of primary health care nurses using standardised social determinants of health screening tools. Eleven subthemes were identified and collapsed into three main themes: organisation and health system supports are required to enable primary health care nurses; primary health care nurses are often reluctant to perform social determinants of health screening; and the importance of interpersonal relationships for social determinants of health screening. The social determinants of health screening practices of primary health care nurses are poorly defined and understood. Evidence suggests that primary health care nurses are not routinely using standardised screening tools or other objective methods. Recommendations are made for valuing therapeutic relationships, social determinants of health education and the promotion of screening by health systems and professional bodies. Overall, further research examining the best social determinant of health screening method is required.

Nursing Education and Social Determinants of Health: A Content Analysis

BACKGROUND

By integrating a social determinants of health (SDOH) perspective into nursing programs, there is potential to reduce health disparities shaped by these forces. However, little is known about the extent to which nursing program curricula include SDOH education.

METHOD

This study used course descriptions from 32 nursing programs in the United States to perform a frequency and content analysis on required course offerings. Healthy People 2020 was referenced to determine coding categories.

RESULTS

Although 18.5% of courses implicitly referenced SDOH, only 1% made explicit references to SDOH. Implicit references were likely to include themes such as cultural sensitivity and diversity, or social, cultural, economic, and political factors influencing health.

CONCLUSION

Although several required nursing course descriptions made implicit references to SDOH, explicit use of the term SDOH is still limited. Faculty, administrators, and program accrediting bodies must push to incorporate SDOH more thoroughly into nursing education. [J Nurs Educ. 2022;61(9):516-523.].

Evaluation of the communication of nursing students in the simulated teleconsultation: A cross-sectional study

INTRODUCTION

The COVID-19 pandemic presented universities with the challenge of virtualizing the teaching-learning process. Simulated teleconsultation has been used in undergraduate training, which allows nursing students to interact with simulated patients remotely. Studies have identified that distance imposes communication barriers on all elements-sender, receiver and message-and in both forms of transmission: verbal and nonverbal.

OBJECTIVE

To describe the communication of nursing students in teleconsultation with simulated patients in the context of primary health care.

METHODS

This was a descriptive, cross-sectional study of 92 fifth-year nursing students. The communication variable was measured with the Connect Identify Understand Agree Help scale. In the data analysis, the mean and standard deviation of the scores on the 29 items of the scale were determined, as were the mean values for the total scale and for the 3 domains of the scale.

RESULTS

The items that presented an average of less than 1 were primarily those related to the Agree and Help to Act domain. The total mean was 1.15, and the means for the domains Connect, Identify and Understand Problems and Agree and Help to Act were 1.53, 0.90 and 1.28, respectively. A weakness in the exploration of the psychosocial context of the simulated patients was observed.

CONCLUSIONS

The results of this study, which evaluated communication in the context of distance care, corroborate the evidence regarding communication in real or simulated face-to-face situations. Studies that compare communication in various teaching-learning contexts, whether real or virtual, face-to-face or at a distance, are recommended.

Inequality and child health: dynamic population health interventions

PURPOSE OF REVIEW

Established social gradients across a wide range of child health issues including obesity, anxiety, infectious diseases, injuries, prematurity and low birth weight suggest that much illness is avoidable and there is an imperative to intervene in this whole of society issue. This review examines recent advances in understanding of the pathways to health and health inequalities and their application to interventions to improve health equity.

RECENT FINDINGS

Children's health develops over the life course in ways that are profoundly influenced by their entire developmental ecosystem including individual, family, community and system-level factors. Interventions to address child health inequalities must include action on the structural determinants of health, a greater focus on family and community health development, and attention to the acquisition of developmental capabilities. Nascent dynamic population health initiatives that address whole developmental ecosystems such as All Children Thrive, Better Start Bradford and Generation V, hold real promise for achieving child health equity.

SUMMARY

Pathways to health inequalities are driven by social and structural determinants of health. Interventions to address inequalities need to be driven less by older biomedical models, and more by prevailing ecological and complex systems models incorporating a life course health development approach.

The effect of violence in childhood on school success factors in US children

BACKGROUND

A robust literature-base on adverse childhood experiences (ACEs) provides strong evidence on the relationships between social adversity in childhood and the health and well-being of individuals across the lifespan. One form of social adversity, exposure to violence in childhood, is not only harmful to a child's health and well-being, but detrimental to their performance in school. Poor performance in school may affect educational attainment later in life and hinder a child's upward social mobility. We focus on the impact of violence-related ACEs on school success factors to add new evidence on how violence in childhood affects a child's educational progress.

OBJECTIVE

To examine the impact of violence-related ACEs on school success factors, including grade repetition, school absence, and school-home contact.

PARTICIPANTS AND SETTINGS

This study uses secondary data analysis of a nationally representative survey, the National Survey of Children's Health (NSCH), to study a sample of non-institutionalized children aged 6-17 in the US (n = 35,122).

METHODS

We employed binary logistic regression and multinomial logistic regression using 95% confidence intervals to analyze the effect of violence in childhood on three school success factors, controlling for socio-demographic and health status characteristics.

RESULTS

We found that violence in childhood increases the likelihood of grade repetition (OR = 1.47, 95% CI, 1.12-1.92), school-home contact (OR = 2.20, 95% CI, 1.86-2.60), and school absence greater than one week (OR=1.4, 95%CI,1.08-2.00; OR=1.86, 95%CI, 1.36-2.60), controlling for socio-demographic and health status characteristics.

CONCLUSIONS

Violence in childhood has a statistically significant negative impact on each of the school success factors included in this study.

Knowledge of the Human Papillomavirus by Social Stratification Factors

BACKGROUND

Social determinants of health explain most health inequities. Intermediate determinants dictate differences in the exposure and vulnerability of people based on social stratification. Vulnerable women (lower education level, older age, uninsured, etc.) have lower adherence to recommended Pap smear screening guidelines. However, a gap remains concerning the effect of social determinants on human papillomavirus (HPV) infection.

OBJECTIVES

The aim of this study was to analyze the association between the level of knowledge about HPV infection and HPV vaccines with education level and residential setting among a sample of Spanish women.

METHODS

A cross-sectional study at six primary care centers (Cantabria, Spain) was performed. All women >21 years consecutively attended by midwives for routine follow-up were invited to participate during the study period (2015-2016) until a convenience sample was recruited. Participants completed an anonymous questionnaire addressing sociodemographic variables (age, education level, and residential setting) and the level of knowledge regarding HPV infection, including general knowledge about infection and knowledge about the HPV vaccine. Associations between education level (primary, secondary, and university) and residential setting (urban, semiurban, and rural) with the level of knowledge of HPV infection and HPV vaccine were calculated using adjusted logistic regressions. Dose-response associations were estimated based on p-trend.

RESULTS

Compared to university women, a lower education level was associated with limited or no knowledge of either HPV infection or the HPV vaccine. Women living in rural areas poorly identified "promiscuity" as a risk factor of HPV infection and "the use of condoms" as a protective factor. Moreover, living in rural areas was associated with limited or no knowledge of HPV infection and HPV vaccine. There were significant dose-response trends; those who were more educated and living in more urban areas had more knowledge about either HPV infection or the vaccine.

DISCUSSION

In our sample, the level of knowledge of HPV infection and HPV vaccine was high. However, vulnerable women, defined by a lower education level and living in rural areas, presented a greater lack of knowledge regarding HPV infection and the HPV vaccine.

Iranian Cancer Patients Perceptions of Barriers to Participation in Decision-Making: Potential Impact on Patient-Centered Care

Objective:

The purpose of this study was to explore perceptions about barriers to decision-making in Iranian patients with cancer about their care.

Methods:

Utilizing a qualitative approach, semi-structured interviews were conducted with 15 cancer patients.

Results:

Data analysis revealed four central categories reflecting patient perceptions about barriers that included medical dominance (uninformed decision-making, perceived inability to disagree secondary to despair, and patient objectification), healthcare system mistrust (physician, nurse, and medical center facility and equipment), healthcare system characteristics (services and facilities’ limitations, poor communication, healthcare setting compulsion), and cultural barriers (feeling unfamiliar, insecurity in an unfamiliar environment, language barriers, limited attention to religious beliefs).

Conclusions:

Barriers may impact the perceived ability of Iranian patients’ with cancer ability to participate in decision-making regarding their care. Such barriers contain the potential to disrupt patient-centered care. Perceptions about barriers articulated by patients are modifiable. While some Iranian healthcare systems may have problematic challenges, targeted allocation of resources and education of healthcare providers convey strong possibilities to enhance patient-centered care.

Childhood Disability and Educational Outcomes: A Systematic Review

PROBLEM

Graduation from high school is an important milestone for all adolescents and affects future health in adulthood. Children with chronic illnesses have additional challenges that affect school attendance, grade retention and graduation. If children with chronic conditions are not able to participate fully in education, this may limit their opportunities for future health. The aim of this study was to integrate the evidence in the past 28 years about educational outcomes of children and adolescents with chronic conditions causing disability.

ELIGIBILITY CRITERIA

Quantitative studies reporting on a chronic condition and attendance, grade retention, or high school graduation, from a peer-reviewed journal in the English language, data collection since 1990, and research conducted with a population in the United States were eligible for review.

SAMPLE

Forty-three studies from a literature search of CINAHL, MEDLINE, ERIC, Teacher Reference Center, Psychology & Behavioral Science Collection, and Academic Search Elite databases, followed by ancestry searches, were included in this review.

RESULTS

In general, chronic conditions are significantly associated with increased absenteeism, grade repetition and not completing high school within four years, although hemophilia does not follow this pattern. Additionally, increased severity of the condition is associated with poorer educational outcomes.

CONCLUSIONS

Nurses and other healthcare providers should include an educational assessment as part of psychosocial assessment of children and adolescents to identify risk, intervene early and limit risk.

Determinants of Health-related Quality of Life Among Mothers of Children With Cerebral Palsy

PURPOSE

Caring for a child with cerebral palsy (CP) can impact both the physical and mental health of parents. However, determinants associated with health-related quality of life (HRQOL) in these parents have yet to be adequately examined. The study aims were to identify the determinants affecting HRQOL among mothers of children with CP.

DESIGN AND METHODS

Participants in this cross-sectional study (N = 180) were mothers of children with CP recruited from clinical and school-based settings in Korea. Variables examined were characteristics of child (demographic factors and disability parameter), mother (demographic factors, number of chronic conditions, health-promoting behaviors (HPB), and parenting stress), and environmental factors (use of personal assistant care, leisure time and social support). Multivariate regression analysis was performed to examine the child, mother, and environmental factors associated with HRQOL.

RESULTS

The HRQOL results revealed that the physical HRQOL was higher than mental HRQOL in the sample. Longer length of disability of children and lower number of chronic conditions of mothers were significant factors of higher physical HRQOL. Lower parenting stress, more leisure time, engagement in HPB, and greater social support were significantly associated with higher mental HRQOL.

CONCLUSIONS

The levels of HRQOL of mothers of children with CP were very low and our findings suggest modifiable factors. Decreasing parenting stress, engaging in HPB, and providing social support should be considered when developing psychosocial intervention for this population.

PRACTICE IMPLICATIONS

Study results may inform programs aimed at health promotion, stress reduction, and QOL improvement among parents of children with disabilities.

Provider Perspectives on the Collection of Social Determinants of Health

Social determinants of health (SDH) impact health outcomes. Medical centers have begun to collect SDH data, urged by government and scientific entities. Provider perspectives on collecting SDH are unknown. The aim is to understand differences in views and preferences according to provider characteristics. A cross-sectional survey of University of Miami clinical faculty was conducted in late 2016. The survey contained 11 questions: 8 demographic and departmental responsibilities questions and 3 Likert scale questions to capture collection and use of SDH perspectives. The main outcome was whether providers thought the benefit of collecting SDH outweighs the burden and risks. In all, 240 faculty members were included. The majority were men (64%), with a mean age of 51 years. Among participants, 53.5% were non-Hispanic white, 32% were Hispanic, 5% were Black/African American, and 5% were Asian. The majority agreed that SDH are important predictors of health outcomes and quality of care (83%). When comparing minority to nonminority faculty, 25% believed that SDH should only be available to PCPs, compared to 8% of nonminorities (P < 0.01). In a multivariate model, belonging to a racial ethnic minority was the only characteristic associated with believing that benefits of collecting SDH outweigh the risks (odds ratio 1.87, 95% confidence interval 1.02- 3.5) after adjusting for age, sex, minority status, health care provider type, type of responsibilities, and department. This study reveals that although most providers of a health system believe social risks impact health outcomes and quality metrics, the buy-in to collect SDH varies according to the racial/ethnic composition of the faculty.

"The child is our focus": On couple issues in child oncology treatment

OBJECTIVE

This study explored the perspectives of child oncology professionals and parents about the attention professionals should give to the parent couple relationship during treatment of the child.

METHODS

We employed a qualitative research design, framed within the approach of consensual qualitative research (CQR), gathering data from four focus groups with 20 professionals and from nine in-depth interviews with 16 parents. Thematic analysis of the focus group and interview data was done with MaxQda software, using two coders and member checks to strengthen confidence in the analysis.

FINDINGS

Both professionals and parents talked about an elevated tension in the partner relationship during oncology treatment of the child. However, explicit attention to the partner relationship in this context felt inappropriate to professionals and parents. All emphasized the importance of the professional helpers' openness to conversation and an attuned response to the parental couple relationship.

CONCLUSION

During treatment, the child is the primary focus for parents and professionals. The parents' focus on supporting their child makes talking about their own emotions or about issues in the partner relationship potentially disruptive and unhelpful. Therefore, it is crucial for professionals to support the parents in their parents' role, but with an openness to converse about issues in the partner relationship at the moments when these issues might threaten their focus on the child.