New developments in treating children with insulin-dependent diabetes mellitus

Developing parent expertise: A framework to guide parental care following diagnosis of Type 1 Diabetes in a young child

OBJECTIVES: This article examines how health professionals guide parental acquisition of knowledge and development of expertise following diagnosis of Type 1 diabetes in a young child. METHODS: Fifty-five consultations from two outpatient paediatric diabetes clinics, one in the UK and one in the US, were audio recorded, transcribed and analysed; eight exemplar extracts are presented here. Participants were parents, whose child younger than 6 years of age had been diagnosed with diabetes within the previous 14 months, and health professionals, who were experienced doctors, nurses, dieticians and social workers. RESULTS: Over the first year following diagnosis, experienced health professionals use four strategies to enable parental self-management of their child's diabetes. Clinicians begin by setting expectations to define the shared responsibilities for the management of the child's disease. Next, they introduce two concepts, trial and error, to help parents respond to variations in blood glucose values and pattern recognition, to help parents refine therapy. As parents gain confidence, clinicians encourage independent pro-active management. Together, these four strategies form a framework to enable development of parental expertise. CONCLUSIONS: This framework addresses the needs of parents and guides their socialization as they assume the role of an expert health care provider for their child. If incorporated into clinical guidelines and health professional training programmes, the framework could facilitate improved self-management of diabetes and perhaps of other chronic diseases.

Perceptions of parenting children with type 1 diabetes diagnosed in early childhood

INTRODUCTION

The purpose of this study was to explore perceptions of psychosocial adaptations in parenting young children with type 1 diabetes (T1DM) from diagnosis through childhood.

METHOD

Fourteen parents of 11 children with T1DM who were diagnosed at age five years or younger participated in semi-structured interviews. Data were analyzed using content analysis.

RESULTS

Three significant themes were identified. In the theme "Diagnostic Experiences: Frustrations, Fears, and Doubts," parents described inadequate diagnostic experiences with pediatricians where concerns were minimized and diagnosis was sometimes delayed. Although hospitalization occurred abruptly, communication with specialists was more satisfactory. In the theme "Adapting to Diabetes," parents described isolation in caring for their child's T1DM. Family and friends had minimal understanding of T1DM care. Support groups lessened mothers' isolation, but fathers were less positive about this experience. Parental adaptation was more effective when responsibility for diabetes decision making was shared. All parents reported never mastering diabetes management. The theme "Negotiating Developmental Transitions" revealed that normative childhood events were stressful, requiring that parents balance concerns to foster their child's participation.

CONCLUSIONS

Pediatric providers can improve diagnostic and treatment experiences for parents of children with T1DM by recognizing feelings of isolation and lack of mastery, providing attentive communication, encouraging parental teamwork, and offering ongoing anticipatory guidance.

A multi-disciplinary education process related to the discharging of children from hospital when the child has been diagnosed with type 1 diabetes--a qualitative study

Background

Worldwide, insulin-dependent type 1 diabetes is one of the most frequently diagnosed long-term endocrine disorders found in children and the incidences of this diseased is still increasing. In Sweden the routines are, according to national guidelines, when the child is diagnosed with type 1 diabetes, the child and its family remains at the hospital for about two weeks. There is limited knowledge about how a diabetes team handles a child and its family from admission to discharge, therefore the purpose of this study was to seek a deeper understanding of how the diabetes team's parent/child education process works, from admission to discharge, among families with a child newly diagnosed with type 1 diabetes.

Methods

Qualitative data collection was used. Four focus-group interviews, with a sample of three diabetes teams from different paediatric hospitals in the south western part of Sweden, were conducted and the data recorded on tape and then analysed using qualitative content analysis.

Results

The results indicate that achieving a status of self-care on the part of the patient is the goal of the diabetes education programme. Part of the programme is aimed at guiding the child and its parents towards self-help through the means of providing them with knowledge of the disease and its treatment to enable the whole family to understand the need for cooperation in the process. To do this requires an understanding, by the diabetes team, of the individualities of the family in order to gain an overall picture.

Conclusion

The results of this study show that the diabetes education programme is specifically designed for each family using the internationally recommended clinical practice guidelines with its specific aims and objectives. Achieving the families' willingness to assist in the self-care of the child care is the goal of the parent education process. To achieve this, the paediatric diabetes specialist nurse and the diabetes specialist paediatrician immediately and deliberately start the process of educating the family using a programme designed to give them the necessary knowledge and skills they will need to manage their child's type 1 diabetes at home.

Parental anxiety and depression associated with caring for a child newly diagnosed with type 1 diabetes: opportunities for education and counseling

OBJECTIVE

To examine demographic and clinical characteristics, such as pediatric parenting stress and self-efficacy for diabetes care, of parents of children newly diagnosed with type 1 diabetes that are associated with parental anxiety and depression.

METHODS

102 parents reported on their levels of depression (CESD), state anxiety (STAI), pediatric parenting stress (PIP), and self-efficacy for diabetes care (SED) within 4 weeks of their child's diagnosis with type 1 diabetes. Data were analyzed using hierarchical multiple regression.

RESULTS

Parents' scores in the clinical range for depression and anxiety were associated with increased frequency and difficulty of pediatric parenting stress, and there was a trend for depression to be related to lower self-efficacy for diabetes care. The association of female gender with anxiety and depression was partially mediated by more frequent pediatric parenting stress.

CONCLUSION

Parents of children newly diagnosed with type 1 diabetes are at risk for experiencing anxiety and depression, related, in part, to their experiences of pediatric parenting stress.

PRACTICE IMPLICATIONS

Providers and educators should be aware of the risk for depression and anxiety in parents and should work to decrease pediatric parenting stress, increase self-efficacy, and refer parents who are experiencing significant anxiety or depression following their child's diagnosis to a mental health specialist.

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.

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.

Management of children with diabetes in the school setting. American Association of Diabetes Educators

The AADE recognizes the special needs of children with diabetes in the school setting. This position statement has been developed to provide basic guidelines to assist these children, their parents, school personnel, and healthcare workers in promoting a safe school environment and successful learning experience for the child with diabetes. Diabetes educators are encouraged to support this endeavor by sharing their knowledge and resources with school personnel whenever possible.