Family responses to children with diabetes and their influence on self-care

Transition from parents to caregivers of a child with type 1 Diabetes Mellitus: a scoping review

OBJECTIVES

to map and summarize the existing scientific evidence on parents' transition experience to exercise the caregiver role of a child with 1DM, identifying gaps in knowledge of this experience.

METHODS

a scoping review was carried out based on JBI methodology, in two databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist.

RESULTS

we included 31 articles. From the studies, constitutive elements of parents' transition experience to caregiver role of a child with 1DM were found, which focused on the nature of the experience, the feelings and emotions experienced, the hindering conditions, the facilitating conditions, the strategies used by parents and the results or effects obtained.

FINAL CONSIDERATIONS

the transition process' characterizing elements were identified, but not a theoretical explanation of it. Additional research should be carried out in order to allow a deeper understanding of this process.

Transição de pais para cuidadores de um filho com Diabetes Mellitus tipo 1: scoping review

RESUMO Objetivos: mapear e resumir a evidência científica existente sobre a experiência de transição dos pais para o exercício do papel de cuidador de um filho com DM1, identificando lacunas existentes no conhecimento dessa experiência. Métodos: efetuada revisão scoping baseada na metodologia do JBI, em duas bases de dados, seguindo a checklist Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Resultados: foram incluídos 31 artigos. A partir dos estudos, foram encontrados elementos constitutivos da experiência de transição dos pais para o papel de cuidador de um filho com DM1, que se centraram na natureza da experiência, nos sentimentos e emoções experimentadas, nas condições dificultadoras, nas condições facilitadoras, nas estratégias utilizadas pelos pais e nos resultados ou efeitos obtidos. Considerações finais: identificaram-se elementos caracterizadores do processo de transição, mas não uma explicação teórica do mesmo. Investigação adicional deverá ser realizada, a fim de permitir compreender aprofundadamente este processo.

Experiences and needs of children with siblings diagnosed with Type 1 diabetes: A mixed studies systematic review

PROBLEM

The lives of family members for children with Type 1 diabetes mellitus (T1DM) after often shaped around the diagnosis as long-term/life-long care is needed. The combination of illness symptoms, treatment cost, and caregiving demands for T1DM negatively affects family functioning. While the experiences and needs of both parents and children suffering from T1DM are well documented, literature on healthy siblings of children with T1DM remains scarce.

PURPOSE

This systematic review aims to consolidate and examine the experiences and needs of siblings of children with T1DM.

ELIGIBILITY CRITERIA

Qualitative and quantitative studies exploring the experiences and needs of children under 18 years old whose siblings are diagnosed with T1DM.

SAMPLE

Six electronic databases (PubMed, CINAHL, PsycINFO, EMBASE, Scopus and ProQuest) were searched from inception till July 2021. Thirteen studies met the inclusion criteria and were subjected to narrative synthesis.

RESULTS

Four themes were generated from the synthesis: (1) emotional responses to sibling's condition, (2) stepping out of comfort zone, (3) changes in family dynamics, and (4) takeaways and a way forward.

CONCLUSIONS

The impact of T1DM diagnosis on siblings of children with T1DM suggest a need for healthcare providers to provide them better emotional and informational support, and allow them more involvement in the care for their sibling with T1DM.

IMPLICATIONS

Findings from this review will be able to inform policymakers on the development of future support programmes for children with T1DM and their families and encourage clinicians to revise T1DM care plans to be more family-centered. PROSPERO number: CRD42020204985.

A concept analysis of psychological distress in parents related to diabetes management in children and adolescents

PURPOSE

To report a concept analysis of parents' psychological distress in the context of diabetes management among children and adolescents. A clear understanding of the possible impact of diabetes management on parents will help to inform how nurses can work with parents to support glycaemic control in children and adolescents.

DESIGN AND METHOD

Concept analysis using Walker and Avant's eight-stage approach was used as a guiding framework. PubMed, OVID (CINAHL, Medline, PsychInfo), the Cochrane library and the Joanna Briggs library were searched for the past 50 years.

RESULTS

Thirty-three studies provided data for the concept analysis. Attributes included difficulty coping, changes in emotional status and manifestations of mental health problems.

PRACTICE IMPLICATION

Based on the literature synthesis, we suggest all facets of distress related to diabetes can in principle be inferred through the proposed relationship between distress and other interactions of individual coping, caring burden and family relational functioning. The proposed conceptual model linking antecedents' factors and individual characteristics of parents to the concepts of psychological distress may assist researchers to design interventions for supporting diabetes management in children and adolescents.

Bringing Nursing Care to Patients Living With Diabetes Mellitus

The author in this article focuses on exploring a brief historical background of the diagnosis labeled diabetes mellitus and honoring persons who seek nursing care through incorporating Orem's self-care deficit theory. The author highlights utilizing a nursing theoretical framework as an important takeaway to enhance congruence among theory, research, practice, and education. This propels the discipline's meaning and interdisciplinary contributions to persons living with this diagnosis.

Factors Related to Behavioral Functioning in Mothers of Children with Type 1 Diabetes: Application of Transactional Model of Stress and Coping

BACKGROUND

Having a child with diabetes creates a great deal of stress for mothers. The transactional model of stress and coping is one of the best conceptual frameworks for stressors.

OBJECTIVES

This study aimed to investigate factors related to health promoting behaviors based on transactional model in mothers of children with type 1 diabetes.

METHODS

This study was conducted on 180 mothers of children with type 1 diabetes. The data was collected using a multi-sectional questionnaire including demographic characteristics and questions about the model constructs. Data were analyzed by SPSS software (version 19) and using statistical tests.

RESULTS

The highest mean score was related to interpersonal relationships (13.8 ± 4.5) and the lowest was related to stress management (10.8 ± 4.2). Linear regression model showed that mother's education, information seeking, and social support had a positive effect, and primary appraisal and emotion-focused coping had a negative effect on the mother's health promotion behaviors. In the regression model R-square accounts for 53.7% of the variance.

CONCLUSIONS

The transactional model was an appropriate framework for explaining the coping outcomes in mothers of children with type 1 diabetes. By mothers' attempts to improve attitude about diabetes and reduce their vulnerability, training to use coping strategies, increasing information and inter-sectoral interventions for attracting sufficient support from patients' families can be hopeful in improving mothers' behavioral Functioning.

Can having a sibling with type 1 diabetes cause disordered eating behaviors?

Background Adolescents with type 1 diabetes mellitus (T1DM) are at an increased risk of eating disturbances. The aim of this study was to evaluate whether the risk of a disordered eating behavior (DEB) also applies to the well sibling sharing the same environment. Methods Well siblings were included if they were 10-18 years old, had a sibling with a T1DM diagnosis for at least 6 months and lived with the sibling during the illness. The control group was comprised of healthy participants recruited from the outpatient clinic with no family history of T1DM. Participants completed a four-part questionnaire concerning their eating behaviors that was developed by the study team. This survey aimed to evaluate the dietary habits and eating patterns. All participants completed the Eating Attitudes Test-26 (EAT-26) and a 24-h food dietary recall. Any participant with a high EAT-26 score or that seemed to be at risk according to the questionnaire was re-evaluated. Results Eight cases (33.3%) in the well sibling group had either a total and/or subgroup pathological score. Three of them were found to have DEB and one case was diagnosed with anorexia nervosa (AN). In the control group, five cases (17.2%) had either a total and/or subgroup pathological score. Three of these cases were found to have DEB, no cases were diagnosed with an eating disorder. There were no statistically significant differences in the EAT-26 scores between the groups. Conclusions Although a direct relationship was not observed, the probability of having a pathologic EAT-26 score was higher in the group with a sibling with T1DM.

Pathways to diagnosis: a qualitative study of the experiences and emotional reactions of parents of children diagnosed with type 1 diabetes

OBJECTIVE

The aim of this study was to explore from parents' perspectives the circumstances and events which led to their child being diagnosed with type 1 diabetes (T1D). The objective was to understand reasons for delays in seeking treatment and parents' emotional reactions to diagnosis so others can be better informed and supported in future.

METHODS

In-depth interviews with 54 parents of children (aged ≤12 yr) with T1D were conducted. Data analysis used an inductive, thematic approach.

RESULTS

Parents described a 'prompt' and a 'delayed' pathway to their child being diagnosed. Parents who considered the diagnosis to be 'prompt' reported how they, or other people, had recognized their child had developed symptoms of T1D which resulted in a rapid presentation to health care professionals. In contrast, parents who perceived their child's diagnosis to be 'delayed' did not recognize signs of T1D and attributed their child's deteriorating health to other conditions, being out of routines and/or their stage of development. These parents often only sought medical help when symptoms became extreme. All parents were distressed by their child's diagnosis; however, parents in the 'delayed' pathway expressed unresolved feelings of guilt, particularly when their child was diagnosed with diabetic ketoacidosis.

DISCUSSION

Parents' and other people's knowledge about T1D can affect the duration between onset of their child's symptoms and diagnosis. Campaigns to raise awareness should ensure that parents are made aware of symptoms and that T1D can develop during childhood. Health care professionals could discuss with parents the events preceding their child's diagnosis to better determine their emotional support needs.

Psychological experience of parents of children with type 1 diabetes: a systematic mixed-studies review

PURPOSE

The purpose of this review is to describe the prevalence of psychological distress in parents of children with type 1 diabetes (T1DM), the relationship between parental psychological distress and health outcomes, and parents' psychological experience of having a child with T1DM. Clinical and research implications are presented.

METHOD

A systematic mixed-studies review was undertaken to review the quantitative and qualitative research on the parental experience of having a child with T1DM. A total of 34 articles met the inclusion criteria and were included in the review.

RESULTS

The prevalence of parental psychological distress across all studies ranged from 10% to 74%, with an average of 33.5% of parents reporting distress at diagnosis and 19% of parents reporting distress 1 to 4 years after diagnosis. Parental psychological distress in parents of children with T1DM, regardless of how it was defined, was associated with higher child self-report of stress and depressive symptoms, more problematic child behavior, and lower child self-report of quality of life. Parental psychological distress also had negative effects on diabetes management. Themes of the qualitative synthesis indicated that parents perceived T1DM as a difficult diagnosis that contributed to significant family disruption. Adjustment occurred over time; however, ongoing stress was experienced.

CONCLUSIONS

Screening for psychological distress in parents of children with T1DM is indicated, and preventive interventions are needed.

Siblings' perceptions of the costs and rewards of diabetes and its treatment

This qualitative descriptive study explored the perceptions of siblings about the costs and rewards of diabetes and its management for the child with Type 1 diabetes, the sibling, and the family. Twenty children were interviewed using a semistructured interview guide. Children attending a day camp for children with diabetes and their siblings made up the sample. Iterative and thematic analysis yielded three cost themes and two reward themes. The perspectives of siblings about diabetes may aid in the development of family-focused teaching programs with the goal to assist family adaptation to Type 1 diabetes.

A concept analysis: assuming responsibility for self-care among adolescents with type 1 diabetes

PURPOSE

This concept analysis clarifies "assuming responsibility for self-care" by adolescents with type 1 diabetes.

METHODS

Walker and Avant's (2005) methodology guided the analysis.

RESULTS

Assuming responsibility for self-care was defined as a process specific to diabetes within the context of development. It is daily, gradual, individualized to person, and unique to the task. The goal is ownership that involves autonomy in behaviors and decision-making.

PRACTICE IMPLICATIONS

Adolescents with type 1 diabetes need to be assessed for assuming responsibility for self-care. This achievement has implications for adolescents' diabetes management, short- and long-term health, and psychosocial quality of life.

Health literacy and child health outcomes: a systematic review of the literature

OBJECTIVES

To review the relationship between parent and child literacy and child health outcomes and interventions designed to improve child health outcomes for children or parents with low literacy skills.

METHODS

We searched Medline and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) for articles published from 1980 through 2008 and included studies that reported original data, measured literacy and >or=1 health outcome, and assessed the relationship between literacy and health outcomes. Health outcomes included health knowledge, health behaviors, use of health care resources, intermediate markers of disease status, and measures of morbidity. Two abstractors reviewed each study for inclusion. Included studies were abstracted into evidence tables and were assessed by using an 11-item quality scale.

RESULTS

We reviewed 4182 new titles and abstracts published since 2003. Fifty-eight articles were retained for full review, and 13 met the inclusion criteria. Eleven articles from the systematic review from 1980 to 2003 met the inclusion criteria, giving us a total of 24 articles. Children with low literacy generally had worse health behaviors. Parents with low literacy had less health knowledge and had behaviors that were less advantageous for their children's health compared with parents with higher literacy. Children whose parents had low literacy often had worse health outcomes, but we found mixed results for the relationship of literacy to the use of health care services. Interventions found that improving written materials can increase health knowledge, and combining good written materials with brief counseling can improve behaviors including adherence. The average quality of the studies was fair to good.

CONCLUSIONS

Child and parent literacy seems associated with important health outcomes. Future research can help us understand under what circumstances this relationship is causal, how literacy and health outcomes are related in noncausal pathways, the relative importance of parent and child literacy, and what interventions effectively reduce health literacy-related disparities.

SELF-CARE IN CHILDREN WITH TYPE 1 DIABETES

PURPOSE

To provide insight into mothers' perceptions of their children's development of diabetes-related capabilities and identify factors that influence these capabilities.

STUDY DESIGN AND METHOD

Mothers' perceptions of children's self-care practices were solicited using an 84-item fixed choice instrument authored by this investigator. Items that were based on the literature and results of a preliminary qualitative study solicited information regarding self-care practices, independence in management, parental involvement, dietary adherence, precision in skills, attitude about diabetes, and ability to manage abnormal blood glucose levels. Descriptive statistics were used to analyze the data.

RESULTS

Forty-six boys and 42 girls aged 6 to 18 years were represented by the 88 mothers in this study. According to the mothers, children demonstrated higher levels of self-care abilities, independence, precision, and ability to manage blood glucose levels as they aged. The mothers believed, however, that older children had more negative attitudes about diabetes than did younger children. Girls learned skills earlier and were more independent in diabetes-related self-care, yet they had more difficulty than boys in adhering to dietary requirements. Some findings indicated the children engaged in behaviors that were potentially life-threatening or at least deleterious to their future health.

CLINICAL IMPLICATIONS

Nurses can use this study to help encourage parents to stay involved with their children's self-care practices into the adolescent years. Providing opportunities for communication with others who have type 1 diabetes should be encouraged. Knowledge of age and gender differences can help establish realistic expectations for self-care.

Family influence on self-care, quality of life, and metabolic control in school-age children and adolescents with type 1 diabetes

This study explored the influence of family behaviors on self-care, quality of life (QoL), and metabolic control in school-age children and adolescents with type 1 diabetes. Ninety-nine participants were recruited in the midsouth from a health science center and an affiliated diabetes camp. Warm and caring family behaviors predicted self-care behaviors and aspects of QoL for the participants. African American school-age children and adolescents had more worries related to diabetes and had poorer metabolic control than Caucasians. Nursing implications included emphasizing open family communication and providing emotional support for diabetes management to promote developmentally appropriate levels of self-care and QoL.

"Living with risk": mothering a child with food-induced anaphylaxis

Food-induced anaphylaxis (FIA) affects an increasing number of children and families encountered in a variety of nursing environments. Sensitive nursing care requires consideration of the psychosocial impact of the condition. The purpose of this phenomenological study was to arrive at an understanding of the mother's lived experience of parenting a child with FIA. Semistructured interviews were conducted with six mothers of children 6 to 12 years old considered at risk for FIA. Data analysis was carried out concurrently with data collection, revealing "Living with Risk" as the essence of the experience, supported by five themes: "Living with Fear," "Worrying About Well-Being," "Looking for Control," "Relying on Resources," and "It Is Hard But It Is Not." These findings should assist nurses in meeting families' education and support needs related to FIA.

Changing patterns of self-management in youth with type I diabetes

Self-management of type I diabetes is key to good physical and psychosocial outcomes of the disease, yet little is known about how youth and their parents share responsibility for illness management. This study describes the division of labor between youth and their parents, self-management conflict, and three patterns of self-management in youth across four developmental stages: preadolescence, early adolescence, mid-adolescence, and late adolescence. Twenty-two youth (8-19 years) with type I diabetes and one of their parents were interviewed using semistructured interviews. Data were analyzed using qualitative content analysis. Results indicated that parents of preadolescents (8-11 years) performed much of their children's diabetes care. Dyads reported some conflicts, particularly over food, amount of bolus, and blood glucose testing. The dyads demonstrated a self-management pattern that we identified as parent-dominant. Most early adolescents (11-15 years) performed much of their own daily care, but parents actively participated in their self-management and oversaw it. The majority of dyads reported conflict over food and blood glucose testing. Most early adolescents demonstrated a transitional self-management pattern whereby they managed their own daily care, with varying amounts of parental oversight. In mid-adolescence (15-17 years), youth managed nearly all of their diabetes care; however, some dyads reported that parental oversight of illness care was still considerable. Exercise was conflictual for the majority of these dyads. Over half of the youth and, by late adolescence (17-19 years), all youth demonstrated a pattern of adolescent-dominant self-management. In adolescent-dominant self-management, youth independently managed their diabetes. Half of the dyads reported that there were sometimes conflicts over food and blood glucose testing. Understanding the nature of sharing self-management responsibilities, the nature of conflict in carrying out such responsibilities, and the pattern of self-management may help nurses provide more targeted assistance to youth with diabetes and to their parents.

Children's and young adolescents' voices: perceptions of the costs and rewards of diabetes and its treatment

Young peoples' perceptions of the costs and rewards related to diabetes may influence their understanding of, attitude toward, and adherence to positive diabetes-related behaviors. This qualitative descriptive research explores children's beliefs about the costs and rewards of Type 1 diabetes and its treatment via semistructured interviews. Children with diabetes attending a day camp comprised a purposive sample. These children were questioned using a researcher-developed interview guide. The results provide important insights into the perceptions of children and young adolescents with diabetes that may inform initiatives designed to foster positive diabetes-related behaviors.

Self-care of young adolescents with type 1 diabetes

The purpose of this study was to describe the universal and health deviation self-care of adolescents with Type 1 diabetes and the associations of basic conditioning factors with universal and health deviation self-care. Subjects for this study were 152 adolescents aged between 11 and 15 years with a diagnosis of Type 1 diabetes. Data were collected in the home setting of each adolescent and his or her family. The mean universal self-care scores ranged from 66.62% to 90%. The overall mean for this sample was 75.37, indicating that these adolescents took care of their self-care needs 75% of the time. Health deviation self-care was a mean of 27.26, indicating more positive self-care behaviors and treatment adherence. Health deviation and universal self-care were significantly and positively related (r = .36, p < .001). Ethnicity and adolescent sex were statistically significant in predicting universal self-care. Adolescent age was statistically significant in predicting health deviation self-care. Health deviation self-care decreases with age, suggesting that early adolescence or late school age is an appropriate time for interventions to strengthen self-care behaviors. Furthermore, the interrelationship of the two types of self-care supports the potential for a synergistic effect of intervention.

Transfer of asthma management responsibility from parents to their school-age children

This study used grounded theory to explore the process of transfer of responsibility for asthma management from parents to their school-age children. Interviews were conducted with 11 mothers, 2 fathers, 1 grandmother, and their 14 children who were between 8 and 13 years old. Responses revealed that transfer of responsibility within families is a complex, uneven process that occurs over years and involves identifiable stages and transitions. The Theoretical Model for Parent-Child Transfer of Asthma Responsibility emerged from the data. The central concept underlying the process was controlling the situation. Specific cues stimulated changes in parent-child responsibility.

Mothers’ Perceptions of Self-Care in School-Age Children With Diabetes

PURPOSE

To describe mothers' perceptions of the diabetes-related self-care abilities and practices of their school-age children with Type 1 diabetes.

STUDY DESIGN AND METHOD

Qualitative study using the naturalistic inquiry method. Mothers of school-age children with diabetes were interviewed by means of a semi-structured interview guide. The children were between the ages of 11 and 12 and had been diagnosed with diabetes for a minimum of 2 years. Twelve mothers were interviewed, generating 20 hours of qualitative data.

RESULTS

Mothers reported that their children with diabetes had learned skills in a predictable sequence, were usually motivated by events in the here and now, and did not consistently perform all diabetes-related skills of which they were capable. Most of the children were becoming embarrassed about having diabetes. There were considerable gender differences in the children's self-care development.

CLINICAL IMPLICATIONS

Nurses can use this study to help with anticipatory guidance for parents. It may be helpful for parents to know the sequence in which many children learn diabetes-related skills, and to learn that even though a child is capable of task performance, he or she may not necessarily be ready for the independent practice or daily execution of the skill. Encouraging parents to stay involved with their children's self-care practices past the early adolescent years may be effective in improving self-care practices, and helping children to identify reasons to meet the self-care demands associated with diabetes can be beneficial.

Eating disorders and type 1 diabetes mellitus in adolescence

One of the main difficulties in managing type 1 diabetes mellitus (T1DM) in the young is nutritional treatment. Studies have shown that adolescents (particularly adolescent girls and young women) have an increased risk for clinical and sub-clinical eating disorders. Adjustment to the nutritional regimen and, consequently, to the management of the disease in adolescence seems to involve a complex interplay of various psychosocial and biological aspects. The aim of this review is to consider the relationship between T1DM and eating disorders in adolescence in the light of some important biological psychological and familial factors. Further research is required in order to detect the degree of the interactions between these factors in adolescents with T1DM.

Role of family in the management of Type-I diabetes: an Indian experience

The role of the family in the management of Type-I diabetes is gaining recognition. In countries where the adolescent is dependent on the family for medical needs, the family's role is all the more important. At times, when the family is uncooperative, the care of the adolescent is hampered, making psychosocial intervention even more difficult. The following case study illustrates the difficulty encountered while working with a young diabetic belonging to an Indian family. The issues related to parental role and management of diabetes-related problems are discussed.

Maternal management behaviors for young children with type 1 diabetes

PURPOSE

To describe the process that mothers raising young (0-4 years old) children who are newly diagnosed with type 1 diabetes move through to attain the necessary skills to care for their children.

STUDY DESIGN AND METHODS

A mixed methods design was used, including qualitative interviews with 28 mothers of young children with type 1 diabetes. Principles of naturalistic inquiry were used to guide the data collection process, management, and analysis of the qualitative findings.

RESULTS

The process paralleled two of three management approaches and associated behaviors previously described by Gallo and Knafl. Strict adherence behaviors included rigidly following the team recommendations and avoiding strange environments outside the home. Flexible adherence behaviors strove to bring spontaneity back into family life. Selective adherence was not used by this population.

CLINICAL IMPLICATIONS

Nurses working with these mothers can provide information and support to help them transition from using strict adherence to the more user-friendly flexible adherence, while avoiding the pitfalls of the possibly harmful third approach of selective adherence. Nurses need to remember to praise the parents' efforts at managing their children's diabetes, for our acknowledgment of their work is empowering and affirming.

Constant vigilance: mothers' work parenting young children with type 1 diabetes

Little is known about the experiences of mothers raising young children with type 1 diabetes. The purpose of this study was to describe the day-to-day experiences of mothers (N = 28) raising young children under 4 years of age with type 1 diabetes. Descriptive, naturalistic inquiry principles were used to interview subjects, as well as to manage and analyze the data. The mothers reported using the management behavior of constant vigilance. Their concerns about hypoglycemia and providing competent care reflected the interplay between their fears and profound sense of responsibility for managing the disease. Mothers reported having to learn the management behaviors and to occasionally adjust the day-to-day management when either severe hypoglycemia or developmental milestones occurred. Although mothers initially had feelings of incompetence with the care they provided, with time, they became very skilled. There were also reports of limited access to babysitting, child care, or respite services. The intensity of their constant vigilance associated with their concerns, responsibility, and lack of supports resulted in some mothers having physical and/or emotional problems. The findings of the study highlight the importance of identifying family and/or community resources that may provide mothers with support that could reduce some of the tremendous stress and burden of responsibility experienced after diagnosis of diabetes.

Parenting and Childhood Chronicity: making visible the invisible work

The work required to raise a child with a chronic illness or disability is above and beyond that of raising a typical child. This article presents a model, Parenting and Childhood Chronicity (PACC), that was developed during an interpretive study with 43 parents of 34 children (aged 15 months to 16 years) with various chronic conditions, is presented. "Special needs parenting" describes the additional care that a child needs and includes medical care, parenting plus, and working the systems. "Minimizing consequences" reflects the struggle to balance the rest of family life and includes parenting siblings, maintaining relationships, and keeping yourself going.

Mothers' experiences raising young children with type 1 diabetes

ISSUES AND PURPOSE

To examine the day-to-day experiences of mothers raising children 4 years of age and younger with type 1 diabetes.

DESIGN AND METHODS

The descriptive design compared mothers of children with (n = 25) and without diabetes (n = 25). Mother-child observations were completed for children with diabetes.

RESULTS

Mothers of children with diabetes are very skilled in reading their children's behavioral cues. Mothers' concerns included the fear of hypoglycemia and seizure activity, access to daycare centers, and babysitting services capable of caring for their children's condition. These responses significantly differed from the control group mothers.

PRACTICE IMPLICATIONS

Nurses can affirm that hypoglycemia-related fears are normal and help mothers identify community resources that might ease the burden of care required, especially during the early postdiagnosis period.

The concept of self-management of type 1 diabetes in children and adolescents: an evolutionary concept analysis

AIM

An evolutionary concept analysis was undertaken to clarify the concept of self-management of type 1 diabetes in children and adolescents.

BACKGROUND

Several problems exist in the literature on self-management of type 1 diabetes in children and adolescents. There is no uniform terminology and there is no uniform definition of the concept. Also, there is no differentiation in the literature between self-management of diabetes in children and adults.

METHODS

Ninety-nine references were reviewed and analysed in the disciplines of nursing, medicine, and psychology. After separate analyses revealed no significant differences across disciplines, the analyses were combined to describe the attributes, antecedents, consequences, and surrogate and related concepts.

RESULTS

The three essential attributes of the concept were identified as process, activities, and goals. Self-management of type 1 diabetes in children and adolescents is an active and proactive process; it is daily, lifelong, and flexible, and it involves shifting and shared responsibility for diabetes care tasks and decision-making between child and parent. It is a process that involves collaboration with health care providers. Self-management of type 1 diabetes in children and adolescents also consists of varied and many activities related to giving insulin, monitoring metabolic control, regulating diet and exercise, to name just a few. The concept also involves goals, which may differ from one parent/child dyad to another. A working definition of the concept is suggested.

CONCLUSIONS

It is hoped that a more uniform definition of the concept will enable researchers to continue investigating antecedents and consequences of the concept in a way that allows for aggregating results.

The paediatric diabetes specialist nurse and diabetes education in childhood

AIMS OF THE STUDY

The aim of this study was to identify the job title, work setting, qualifications and training of the paediatric diabetes specialist nurse (PDSN) as well as to examine the composition of the multidisciplinary diabetes team. It also aimed to determine who is involved in diabetes education and to explore the teaching methods, approaches, tools and materials that the PDSN uses in the educational process.

DESIGN AND METHODS

A survey design was used. Questionnaires, which combined quantitative and qualitative approaches, were sent to 80 participants from eight opportunistically selected regions of the United Kingdom (UK). Access to names and addresses was gained through the directory of diabetes specialist nurses (DSNs). The selection criteria were nurses working full-time with children with diabetes or having children with diabetes on their caseloads. The overall response rate was 66 (82.5%).

FINDINGS

The study findings showed that the majority of the respondents were based in both hospital and community, held paediatric qualifications and had undertaken further training to prepare as diabetes specialists. Respondents used a wide range of teaching methods and materials in the educational process. A substantial number of individuals and voluntary organizations were also involved in diabetes education.

CONCLUSIONS

The findings of this study support the belief that the PDSN, as a member of the multidisciplinary paediatric diabetes team, has a key role in the education of children with diabetes and their parents/carers. However, the importance of the team approach as a whole should not be underestimated.

Chronic sorrow in parents of children with newly diagnosed diabetes: a review of the literature and discussion of the implications for nursing practice

Childhood (type 1) diabetes is a chronic, life-long condition, the diagnosis of which may represent multiple losses for parents. Their emotional responses to the diagnosis have been likened to the grief reactions experienced as a result of bereavement through death. The practice of health professionals who work with these families is informed by two contrasting theoretical views of the progress of grief reactions; the time bound and the chronic sorrow perspectives. This paper provides a critical appraisal of the evidence concerning grief reactions in parents of children with diabetes and evaluates the extent to which this supports the expectations of the time bound theorists, that parents normally reach an end stage of the grieving process, or those of the proponents of chronic sorrow, who anticipate lifelong, recurring sadness. It concludes with a discussion of the implications of the debate for nursing practice.

'Self-care' and its relevance to developing demand management strategies: a review of qualitative research

The promotion of self-care has been recognized as an important aspect of managing demand for health care more effectively. Self-care is increasingly being seen by policy makers as a hidden health care resource to be viewed in the context of health care provided by the formal health care sector. Quantitative studies are important for understanding the effectiveness of interventions in terms of the impact they may have on health service utilization. However, questions remain about the reasons people may or may not adopt self-care, the mechanisms for change and the way in which social context may affect the way in which people respond to self-care interventions. Qualitative research that has focused on people's self-care practices provide insights into these aspects. The qualitative studies reviewed here suggest that a number of factors need to be considered when devising health care interventions for managing demand better. These include an assessment of the meaning of the disease to the person so that self-care information can be designed in a way that fits people's prior beliefs and lifestyles. Timing and the stage in a person's illness career are also important factors to consider when designing effective self-care interventions. Social interaction and the impact of significant others may affect whether or not a self-care regime is followed, and autonomy and control are also relevant to designing acceptable self-care strategies. Incorporating these aspects of self-care as a dynamic and interactive process is important for both devising and assessing the impact of interventions aimed at the better management of demand.

A normal lifestyle: parental stress and coping in childhood diabetes

This article forms part of an extensive literature review informing a study exploring the parental experience of home management of children with newly diagnosed diabetes. As a diagnosis of childhood diabetes may represent a major stressor event for parents, selected theories and models of stress and coping are discussed. These suggest that, influenced by a variety of interpersonal and environmental factors, parents may approach the process of coping in different ways. Coping strategies employed by parents of children with diabetes elicited from the literature are categorized according to a psychological theory of stress and coping. Normalization, a coping strategy used by parents of chronically ill children, is discussed in relation to childhood diabetes. To conclude, implications for nursing practice are outlined and suggestions made about how parents may be assisted to cope with the demands of having a child with diabetes.