Maternal management behaviors for young children with type 1 diabetes

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.

'You have to do what is best': The lived reality of having a child who is repeatedly hospitalized because of acute lower respiratory infection

Introduction

Hospitalization of children is traumatic for children and their families. Little is known about the impact of repeated acute admissions on families, or of these experiences in Indigenous populations and ethnic minorities. This study explores the societal and health experiences for families who have a child under two years of age, admitted to hospitals more than twice for lower respiratory infections.

Methods

Underpinned by a reflective lifeworld research methodology, this article presents results from 14 in‐depth interviews in Aotearoa/New Zealand.

Results

Families learn to identify illness early and then navigate hospital systems. These families struggle to create safe spaces for their children at home or in society. Wider social and economic support are central to family resilience, without which they struggle.

Conclusion

This study reinforces the importance of bringing meaningful, culturally‐responsive care to the fore of treatment, particularly when managing vulnerable minorities. Formal referral and support processes are key to this responsiveness to lessen the burdens of acute admissions for families.

Patient or Public Contribution

Families chose to be involved in this study to highlight the importance of the topic and their experiences with accessing health care. The cultural advisors to the project provided feedback on the analysis and its applicability for the participant community.

A systematic review of parenting interventions for child chronic health conditions

This systematic review summarizes the parenting intervention literature for parents of children with chronic health conditions and evaluates intervention effects on parenting (parenting skills and parenting efficacy) and child (behaviour, illness severity/control and quality of life) outcomes. Systematic searches using seven electronic databases (including CINHAL, MEDLINE and PsycINFO) were used to identify relevant papers published in English between 1997 and 2017, and reference lists were searched for additional relevant articles. Ten papers reporting on eight separate studies met inclusion criteria: three studies evaluated stand-alone parenting interventions, while the remaining five studies included parenting components in broader interventions that also targeted medically oriented aspects of illness management. Results suggest that parenting interventions may lead to improved parent self-efficacy, parenting behaviour, illness severity/control, child quality of life and child behaviour; however, intervention effects were mixed and confined to parent-report outcome measures. A paucity of studies using rigorous randomized controlled trial study designs limits the conclusions that can be drawn regarding intervention efficacy. Achieving adequate enrolment and retention of families in parenting intervention trials appears to be problematic within these clinical groups. Larger samples and more diverse clinical populations will support the reliability of future evaluations of parenting interventions in this context and improve generalizability of results.

Parental levels of stress managing a child diagnosed with type 1 diabetes in Riyadh: a cross sectional study

BACKGROUND

Caring for a child with Type 1 Diabetes (T1D) pose a significant burden on parents especially when they struggle with their child's T1D management. The experience of not coping or struggling to cope increases the level of stress in parents, which may adversely affect their child's diabetic control (Al Dubayee et al, Horm Res Paediatr 88:2019). In this study, we assessed the level of stress parents experience in caring for a child diagnosed with T1D in four different domains.

METHODS

This was a cross-sectional study conducted in two specialized diabetic centers in Riyadh, Saudi Arabia, from February to May 2015 (Al Dubayee et al, Horm Res Paediatr 88:2019). We used an Arabic translation of the validated Pediatric Inventory for Parents (PIP) questionnaire. The frequency and perceived difficulty of stressful events were rated by interviewing parents caring for children with T1D using two 5-point Likert scales.

RESULTS

The sample realized as 390 parents. The level of stress increased in separated and unemployed parents. The frequency (mean 64.9/210, SD 7.529) and difficulty (mean 65.3/210, SD 9.448) indices of the parental level of stress were compared with variables possibly associated with stress. Both of the frequency difficulty indices correlated with the marital status, the father's level of education and occupation as well as HbA1c level (P-value < 0.05). In addition, the frequency index correlated with the frequency of hypoglycemia and the difficulty index correlated with the number of children in the family (P-value < 0.05).

CONCLUSION

Parents of children with T1D in Riyadh experience a significant level of stress that may affect the child's glycemic control (Al Dubayee et al, Horm Res Paediatr 88:2019). Assessing the level of stress and providing support for these families has the potential to improve the clinical outcome.

Sleep in Parental Caregivers and Children With Type 1 Diabetes

The purpose of this cross-sectional, descriptive, pilot study was to examine the correlations in sleep between caregivers (≥18 years) and young (6-12 years) children with type 1 diabetes. Sleep was measured in both parent and child over 7 days using actigraphy and a sleep diary. Parents completed questionnaires on sleep, stress, depressive symptoms, and demographics. Children completed pediatric anxiety and fatigue questionnaires, and A1C (Hemoglobin A1c) was documented at clinic. Descriptive statistics and Pearson correlations were used to analyze data. Parents (N = 18, mean age: 39.3 ± 5.4 years, 100% Caucasian, 83% mothers) and children (N = 18, mean age: 9.6 ± 2.4 years, diagnosed for mean 3.0 ± 2.4 years, 66% female, mean A1C: 7.5 ± 0.8%) were recruited. Strong to moderate correlations were found for several measures including sleep measures based on actigraphy: mean sleep duration (hours; 7.6 ± 0.7 for parents and 8.8 ± 0.8 for children; r = .638, p = .004), mean sleep efficiency (r = .823, p < .001), and mean daily wake after sleep onset (minutes; r = .530, p = .024).

Sleep in Caregivers of Children With Type 1 Diabetes

Purpose

The purpose of this study was to explore caregivers’ descriptions of their experience of nighttime sleep.

Design and Methods

Caregivers (N = 22) of children 10 to 18 years of age with type 1 diabetes (T1D) were recruited for this descriptive study. Anonymous questionnaires contained demographic information and both open- and closed-ended questions that focused on caregiving as it related to sleep. Open-ended questions were reviewed to help understand the effect of nocturnal caregiving activities on parental sleep.

Results

The sample of caregivers were all female and had a mean age of 43 years; 96% graduated high school, 68% were married or partnered, and 100% were white. Children had been diagnosed with T1D for a mean of 5 years, with a mean age of 12.2 years. Caregivers reported short sleep duration (mean, 5.8 hours). Over half of the participants reported they required ≥7 hours of sleep to feel their best, 64% indicated trouble sleeping at night, and 86% reported that caregiving interfered with their nighttime sleep, while 54% responded that sleep was “very important.” Content analysis of the open-ended questions revealed 2 themes: (1) anxiety about the child’s blood glucose levels and (2) nighttime disruptions.

Conclusions

Caregivers are frequently sleep deprived and worry about their child’s nighttime glucose. Caregiving duties, anxiety, and sleep fragmentation may contribute to their poor sleep.

Relationship of family management with sociodemographic aspects and children's physical dependence in neurological disorders

OBJECTIVE

To investigate the relationship of family management with sociodemographic and physical dependence aspects of children and adolescents with neurological impairment.

METHOD

Descriptive, cross-sectional study conducted at a child neurology center. A non-probabilistic sample was obtained from 141 family members who answered two instruments: a) Sociodemographic condition of families; b) Family Management Measure. In the statistical analysis, we used the Spearman Coefficient and the Mann Whitney Test.

RESULTS

the longer the specialized care time, the lower the identity score (rs = - 0.209, p = 0.01); the higher the effort score (rs = 0.181, p = 0.03), the family difficulty score (rs = 0.239, p = 0.001) and the impact of the disease on family life (rs = 0.213, p = 0.01). The families of children and adolescents with physical dependence for activities of daily living presented a higher score in the following dimensions: management effort (<0.001), family difficulty (p = 0.004) and perception of disease impact (p = 0.001).

CONCLUSION

There was evidence of a correlation between management with sociodemographic and child dependence aspects, with an association between management difficulty and longer time of child and adolescent care.

"Her Life Rests on Your Shoulders": Doing Worry as Emotion Work in the Care of Children With Diabetes

Research on parents' caregiving experiences in the context of diabetes management have consistently shown that parents experience high levels of pediatric parenting stress, anxiety, depression, and general worry. However, how parents understand their worry is largely unexplored and little attention is paid to the work parents are already actively doing to manage their worry. Adopting Arlie Hochschild's concept of "emotion work" and Dorothy Smith's concept of "work," this article examines how parents engage in the emotion work of doing worry. Drawing on the analysis of transcribed data from interviews with seven parents caring for children with diabetes, I show how parents expressed worry as an emotion they experience as well as an embodied way of knowing the presence of potential threats to their child's health. Thus, doing worry is an essential aspect of work done by parents to ensure the safety and well-being of their children with diabetes.

Understanding Effective Delivery of Patient and Family Education in Pediatric OncologyA Systematic Review From the Children's Oncology Group [Formula: see text]

A diagnosis of childhood cancer is a life-changing event for the entire family. Parents must not only deal with the cancer diagnosis but also acquire new knowledge and skills to care safely for their child at home. Best practices for delivery of patient/family education after a new diagnosis of childhood cancer are currently unknown. The purpose of this systematic review was to evaluate the existing body of evidence to determine the current state of knowledge regarding the delivery of education to newly diagnosed pediatric oncology patients and families. Eighty-three articles regarding educational methods, content, influencing factors, and interventions for newly diagnosed pediatric patients with cancer or other chronic illnesses were systematically identified, summarized, and appraised according to the Grading of Recommendations Assessment, Development, and Evaluation criteria. Based on the evidence, 10 recommendations for practice were identified. These recommendations address delivery methods, content, influencing factors, and educational interventions for parents and siblings. Transferring these recommendations into practice may enhance the quality of education delivered by health care providers and received by patients and families following a new diagnosis of childhood cancer.

Parent Employment and School/Daycare Decisions among Parents of Young Children with Type 1 Diabetes

This study explored the employment and school/daycare experiences of parents of young children with type 1 diabetes (T1D). Parents (n=134) of young children with T1D (ages 1-6) responded to open-ended questions. Responses were systematically reviewed to identify themes. Four parent employment themes were identified: work cessation/reduction, employment flexibility, significant career impact, and financial pressure. Three school/daycare attendance themes were identified: school/daycare structure and setting, previous experience with T1D, and school/daycare importance. Insulin regimen, child age, and family income were related to parents' decisions. Parents may benefit from clinical programs that assist them with employment and school/daycare decisions.

Distinguishing Features and Similarities Between Descriptive Phenomenological and Qualitative Description Research

Scholars who research phenomena of concern to the discipline of nursing are challenged with making wise choices about different qualitative research approaches. Ultimately, they want to choose an approach that is best suited to answer their research questions. Such choices are predicated on having made distinctions between qualitative methodology, methods, and analytic frames. In this article, we distinguish two qualitative research approaches widely used for descriptive studies: descriptive phenomenological and qualitative description. Providing a clear basis that highlights the distinguishing features and similarities between descriptive phenomenological and qualitative description research will help students and researchers make more informed choices in deciding upon the most appropriate methodology in qualitative research. We orient the reader to distinguishing features and similarities associated with each approach and the kinds of research questions descriptive phenomenological and qualitative description research address.

Grandparent Education Through Simulation-Diabetes

Purpose

The purpose of this study was to explore the feasibility of using human patient simulation (HPS) to teach type 1 diabetes (T1DM) management to grandparents of grandchildren with T1DM.

Methods

Thirty grandparents (11 male, 19 female) of young grandchildren (aged 12 and under) with T1DM were recruited from an urban medical center. Experimental group (n = 14) grandparents received hands-on visual T1DM management education using an HPS intervention, and control group (n = 16) grandparents received similar education using a non-HPS intervention.

Findings

This study demonstrated the feasibility of recruiting and retaining grandparents into a clinical trial using HPS to teach T1DM management. Post intervention, all grandparent scores for T1DM knowledge, confidence, and fear showed significant improvement from time 1 to time 2, with HPS group grandparent scores showing consistently larger improvement.

Conclusions

The consistency of larger HPS-taught grandparent score improvement is suggestive of a benefit for the HPS teaching method. Early multimethod Certified Diabetes Educator (CDE)–provided T1DM education is an important point of entry for inducting grandparent members onto the grandchild’s diabetes care team.

Challenges of optimizing glycaemic control in children with Type 1 diabetes: a qualitative study of parents' experiences and views

AIMS

To explore the difficulties parents encounter in trying to achieve clinically recommended blood glucose levels and how they could be better supported to optimize their child's glycaemic control.

METHODS

In-depth interviews were conducted with 54 parents of children with Type 1 diabetes (≤ 12 years). Data were analysed thematically.

RESULTS

Parents described being reluctant and finding it difficult to keep their child's blood glucose levels consistently within clinically recommended ranges. As well as worrying about their child's ability to detect/report hypoglycaemia, parents highlighted a multitude of factors that had an impact on their child's blood glucose levels and over which they could exercise little control. These included: leaving their child with other caregivers who could not be trusted to detect hypoglycaemia; difficulties remotely monitoring and regulating their child's food consumption and activity; and physical and social changes accompanying childhood development. Most parents used two sets of blood glucose targets, with clinically recommended targets employed when their child was in their immediate care and higher targets when in the care of others. Parents described health professionals as lacking understanding of the difficulties they encountered keeping blood glucose within target ranges and needing more empathetic, tailored and realistic advice.

CONCLUSION

It is not parents' fear of hypoglycaemia in isolation that leads to decisions to raise their child's blood glucose but, rather, parental fear in conjunction with other factors and considerations. Hence, to improve diabetes management in children, these factors may need to be addressed; for instance, by training others in diabetes management and using new technologies. Changes to consultations are also recommended.

Mealtime behavior and diabetes-specific parent functioning in young children with type 1 diabetes

OBJECTIVE

Management of meals and mealtime behavior is often challenging for parents of young children with Type 1 diabetes. Parent functioning related to diabetes care may directly affect mealtime behaviors and glycemic control. This study evaluated associations among diabetes-specific parent functioning, parent and child mealtime behaviors, and glycemic control.

METHOD

Parents of young children with Type 1 diabetes (n = 134) completed self-report measures assessing diabetes-specific functioning (hypoglycemia fear, diabetes self-efficacy, diabetes-related quality of life) and child and parent mealtime behaviors. Hemoglobin A1c and percentage of blood glucose values out of range (<70 mg/dL or >200 mg/dL) over a 30-day period were abstracted from medical charts as indicators of glycemic control. Structural equation modeling was utilized to evaluate predictors and related outcomes of child and parent mealtime behavior.

RESULTS

The proposed model fit the data very well. More frequent problematic child mealtime behaviors were associated with poorer glycemic control; however, more frequent problematic parent mealtime behaviors were marginally associated with better glycemic control. Poorer diabetes-specific parent functioning was associated with more frequent problematic child and parent mealtime behaviors.

CONCLUSIONS

Problematic child mealtime behaviors, such as disruptive behavior, present a significant risk for poorer glycemic control. Parents may engage in ineffective mealtime management strategies in an effort to meet glycemic recommendations and avoid hyperglycemia and hypoglycemia. Future research will help to determine whether parents may benefit from specific, developmentally appropriate behavioral strategies to manage meals and snacks and promote optimal diabetes management.

Parenting interventions for childhood chronic illness: a review and recommendations for intervention design and delivery

Every day, thousands of children suffer the effects of chronic health conditions and families struggle with illness management and children's behavioural and emotional adjustment. Many parents experience difficulties with their caregiving role and lack confidence in their ability to manage their child's illness and ensure the child's well-being. While there is consistent evidence as to the extent and impact of childhood chronic illness, there is a paucity of evidence-based parenting approaches to help children with chronic health conditions and their families. This paper provides a narrative review of the current literature to examine relationships between chronic childhood illness, emotional and behavioural disorders and parenting. Key guidelines and recommendations for the development of evidence-based parenting programs for parents of children affected by chronic health conditions are provided.

Tried and true: self-regulation theory as a guiding framework for teaching parents diabetes education using human patient simulation

Parents become emotionally upset when learning that their child has type 1 diabetes, yet they are expected to quickly learn functional diabetes management. The purpose of this article is to describe the application of self-regulation theory to guide a family-focused education intervention using human patient simulation to enhance the initial education of parents in diabetes management. A brief description is provided of the intervention framed by self-regulation theory. On the basis of the literature, we describe the educational vignettes used based on self-regulation in the randomized controlled trial entitled "Parent Education Through Simulation-Diabetes." Examples of theory-in-practice will be illustrated by parental learning responses to this alternative educational innovation.

Parents' information and support needs when their child is diagnosed with type 1 diabetes: a qualitative study

AIM AND OBJECTIVE

The aim of this study was to describe and explore parents' information and support needs when their child is diagnosed with type 1 diabetes, including their views about the timing and chronology of current support provision. Our objective was to identify ways in which parents could be better supported in the future.

DESIGN AND PARTICIPANTS

Semi-structured interviews were conducted with 54 parents of children with type 1 diabetes in four paediatric diabetes clinics in Scotland. Data were analysed using an inductive, thematic approach.

FINDINGS

Parents described needing more reassurance after their child was diagnosed before being given complex information about diabetes management, so they would be better placed psychologically and emotionally to absorb this information. Parents also highlighted a need for more emotional and practical support from health professionals when they first began to implement diabetes regimens at home, tailored to their personal and domestic circumstances. However, some felt unable to ask for help or believed that health professionals were unable to offer empathetic support. Whilst some parents highlighted a need for support delivered by peer parents, others who had received peer support conveyed ambivalent views about the input and advice they had received.

CONCLUSIONS

Our findings suggest that professionals should consider the timing and chronology of support provision to ensure that parents' emotional and informational needs are addressed when their child is diagnosed and that practical advice and further emotional support are provided thereafter, which takes account of their day-to-day experiences of caring for their child.

Treatment non-adherence in pediatric long-term medical conditions: systematic review and synthesis of qualitative studies of caregivers' views

Background

Non-adherence to prescribed treatments is the primary cause of treatment failure in pediatric long-term conditions. Greater understanding of parents and caregivers’ reasons for non-adherence can help to address this problem and improve outcomes for children with long-term conditions.

Methods

We carried out a systematic review and thematic synthesis of qualitative studies. Medline, Embase, Cinahl and PsycInfo were searched for relevant studies published in English and German between 1996 and 2011. Papers were included if they contained qualitative data, for example from interviews or focus groups, reporting the views of parents and caregivers of children with a range of long-term conditions on their treatment adherence. Papers were quality assessed and analysed using thematic synthesis.

Results

Nineteen papers were included reporting 17 studies with caregivers from 423 households in five countries. Long-term conditions included; asthma, cystic fibrosis, HIV, diabetes and juvenile arthritis. Across all conditions caregivers were making on-going attempts to balance competing concerns about the treatment (such as perceived effectiveness or fear of side effects) with the condition itself (for instance perceived long-term threat to child). Although the barriers to implementing treatment regimens varied across the different conditions (including complexity and time-consuming nature of treatments, un-palatability and side-effects of medications), it was clear that caregivers worked hard to overcome these day-to-day challenges and to deal with child resistance to treatments. Yet, carers reported that strict treatment adherence, which is expected by health professionals, could threaten their priorities around preserving family relationships and providing a ‘normal life’ for their child and any siblings.

Conclusions

Treatment adherence in long-term pediatric conditions is a complex issue which needs to be seen in the context of caregivers balancing the everyday needs of the child within everyday family life. Health professionals may be able to help caregivers respond positively to the challenge of treatment adherence for long-term conditions by simplifying treatment regimens to minimise impact on family life and being aware of difficulties around child resistance and supportive of strategies to attempt to overcome this. Caregivers would also welcome help with communicating with children about treatment goals.

Revisiting a non-significant findings study: a parent mentor intervention trial as exemplar

The purpose of this paper is to describe an interactive process for revising a parent social support intervention study with non-significant quantitative findings but strong clinical significance. We will present the methodological challenges that were problematic in the original intervention that potentially contributed to the non-significant findings, and a revised plan of action for conducting a future parent social support intervention. Of note, we have reconsidered the theory used to frame the original study, the randomization process, the intervention clarity and fidelity plan, what measures would better capture the effect, and the development of a more robust analysis plan that considers intra-family correlation, mediation and moderation (mixed model analysis). We will present the revision for each of these methods supported by recent empirical literature. Although this process may not be appropriate for all non-significant interventions, it should be considered with any study that has clinical significance.

Parallel vigilance: parents' dual focus following diagnosis of Type 1 diabetes mellitus in their young child

There is consensus that enabling patient self-care and expertise leads to better management of chronic illness. Clinicians are being encouraged to manage clinical encounters in ways that promote these outcomes rather than perpetuate hierarchical relationships. This article describes one part of a larger study of 55 outpatient consultations conducted within 14 months of the diagnosis of Type 1 diabetes mellitus in young children. Participants were parents and the specialist doctors, nurses, dieticians and social workers who oversee the child's secondary care. Consultations were audio-recorded and transcribed. Our analysis draws on aspects of conversation analysis (CA) to investigate how parents' talk enacts a growing confidence in the management of their child's disease in the face of questioning from professionals. Analysis reveals how this talk distinguishes a duality of focus that combines the normal watchfulness exhibited by all parents as they protect their children, with an additional intense, parallel watchfulness for signs of potentially serious manifestations of diabetes. We term this phenomenon parallel vigilance and illustrate its development using five representative extracts from consultations. The concept of parallel vigilance extends the chronic illness literature and informs our understanding of a process that contributes to parents' developing expertise and provides new and important insights into the way in which parents conceptualize and implement their evolving role in the care of their child. Moreover, parallel vigilance serves as an enabler of parental contributions to the specialist consultation.

Parental expectations in the care of their children and adolescents with diabetes

There is little research about what parents of children with diabetes want and need from their health-care providers as they negotiate life with diabetes. Sixty-three parents of children with type 1 diabetes were interviewed. Interviews were tape-recorded and transcribed verbatim, and a content analysis of text data was conducted. Three themes emerged describing what they wanted in their relationships with diabetes providers: laying the foundation, providing clinical care, and engaging families as partners. Collectively, these data provide vivid insights into the parent's perspective regarding their needs from diabetes providers as well as their perceptions of interactions that were unhelpful or worse, hurtful or undermining.

Continued development of the family management style framework

Based on a review of 64 published reports, this article addresses the implications of current research for the further development of the Family Management Style Framework (FMSF). Articles are published in 46 different journals, including 13 in nursing and 12 in interdisciplinary outlets. Most studies are based on samples of less than 50 individuals. The review provides continuing support for the 8 dimensions of the framework, with between 8 and 16 reports supporting the relevance of each. Changes to the sociocultural component of the framework are proposed as well as wording changes to reflect the broader applicability of the framework. The family's social network, health care and education professionals, and resources predominate as key influences on family management.

Family management style framework and its use with families who have a child undergoing palliative care at home

Palliative care settings in many countries acknowledge families as their prime focus of care, but in Brazil, to date, researchers have devoted scant attention to that practice setting. In this article, we report the findings of a study that explored how families define and manage their lives when they have a child or adolescent undergoing palliative care at home. Data included individual semistructured interviews with 14 family members of 11 different families. Interviews were transcribed and the coding procedure featured qualitative content analysis methods. The deductive coding was based on the major components of the Family Management Style Framework and the eight dimensions comprising these components. The analysis provides insight into families' daily practices and problems inherent in managing their everyday lives that are encountered when they have a child in palliative care. The article features discussion of implications for the palliative care related development of family nursing practice.

A longitudinal study of families with technology-dependent children

Few researchers have longitudinally examined families caring for technology-dependent children at home. We tested a theoretically and empirically based conceptual model by examining family functioning and normalization in 82 mothers (female primary caregivers) twice over 12 months. Time 1 and Time 2 cross-sectional findings were consistent; the only predictor of family functioning was mothers' depressive symptoms. Contrary to the proposed model, normalization, caregiving duration, and home nursing hours were not directly related to family functioning. Baseline family functioning significantly predicted future family functioning. Also, mothers whose children were no longer technology-dependent at Time 2 reported significant improvements in family functioning and normalization. An intervention to address high levels of depressive symptoms of these mothers is essential to optimizing family functioning.

Social Support to Empower Parents (STEP): an intervention for parents of young children newly diagnosed with type 1 diabetes

PURPOSE

The purpose of this study was to test the efficacy of a social support intervention with parents of children <13 years old newly diagnosed with type 1 diabetes mellitus (T1DM).

METHODS

For this randomized, controlled clinical trial, 10 parent mentors of children diagnosed with T1DM >or=1 year and 60 parent participants were recruited from 2 pediatric diabetes centers. Mentors were trained to provide social support (home visits and phone calls) for 12 months to families in the experimental arm (32 mothers). Control group parents (28 mothers) received the phone number of an experienced parent (not trained to give social support) to call as needed. Findings Mothers in the experimental and control arms differed at baseline only in birth order of the child with T1DM. The 2 groups did not differ significantly at 3, 6, or 12 months in parent concern, confidence, worry, impact on the family, or perceived social support. Mothers in the experimental arm identified the parent mentor as someone they would seek for advice and issues regarding growth and development, sleep, eating habits, and identification of community agencies. Parent mentors consistently referred mothers to health care providers for advice on medications and treatments but helped them incorporate this advice into day-to-day management.

CONCLUSION

Mothers in the experimental arm valued the mentors' help in adjusting to the diagnosis, but this value was not measured by the study instruments. Focus group research is under way to clarify the concept of parent mentor social support and to develop a social support measurement tool.

Responsive parenting is associated with improved type 1 diabetes-related quality of life

BACKGROUND

Improved quality of life is an important treatment goal for children and adolescents with type 1 diabetes. While previous research supports a relationship between family environment and quality of life, little research has addressed the relationship of parenting style constructs to quality of life in children with chronic disease. The present investigation assesses the relationship of parent responsiveness and demandingness with diabetes-related quality of life among children and adolescents with type 1 diabetes.

METHODS

Baseline and 12-month follow-up self-report assessments were collected on a sample of 81 children with type 1 diabetes participating in an efficacy trial of a behavioural intervention to enhance adherence. The sample had a mean age of 13.3 years (SD=1.7) and duration of diabetes of 7.7 years (SD=3.7). Multiple regression analyses were conducted to determine the relationship of parent responsiveness and demandingness to diabetes-related quality of life at each time point.

RESULTS

After adjusting for demographic and diabetes characteristics, as well as diabetes-specific parent-child behaviours, parent responsiveness was significantly associated with baseline diabetes-related quality of life (beta=0.23; P=0.04). This relationship was sustained at 12-month follow-up (beta=0.22; P=0.04) after adjusting for baseline quality of life and treatment group assignment, suggesting that parent responsiveness is associated with improved quality of life.

CONCLUSIONS

Findings indicate the importance of a supportive and emotionally warm parenting style in promoting improved quality of life for children with type 1 diabetes. Appropriate parenting skills should be an element of diabetes family management health care.

Fear of hypoglycemia in parents of young children with type 1 diabetes mellitus

The current study examined fear of hypoglycemia in 81 mothers and 64 fathers of young children with type 1 diabetes (T1DM) using the Hypoglycemia Fear Survey-Parents of Young Children (HFS-P-YC possible range = 26-130). Mothers and fathers completed the HFS-P-YC at enrollment and mothers completed it 2 weeks later. Families recorded daily blood glucose on a standardized meter for 2 weeks. Mothers' mean total HFS-P-YC score was 75.0 (SD = 17.2) and fathers' mean score was 66.5 (SD = 18.0). Mothers reported greater HFS-P-YC total and behavior subscale scores than fathers. Mothers' HFS-P-YC scores were comparable to published HFS scores for mothers of preadolescents with T1DM and higher than adult patients with T1DM. The HFS-P-YC had good internal consistency and test-retest reliability in this sample. These findings suggest parents of young children with T1DM report a high level of fear of hypoglycemia. Additionally, the HFS-P-YC appears to be a reliable measure in this population.

Fathers of children and adolescents with diabetes: what do we know?

Knowing how fathers contribute to child outcomes is critical in the clinical management of children who have type 1 diabetes. The purposes of this review were to synthesize what is known about the role of fathers and to determine directions for future research. Research studies that reported findings that encompassed fathers' perceptions, knowledge, coping and adjustment, and behavior in relation to their children with type 1 diabetes were reviewed. Research suggests that, although fathers are usually not the primary caregiver or manager of the routine day-to-day care, their contribution to the family through perceptions, knowledge, adjustment, and behavior may be associated with important disease management outcomes.

Interventions for the family with diabetes

This article demonstrates that families can make a difference in diabetes outcomes and nurses can make a difference in how families organize and interact around the person with diabetes. Highlighted are key findings from the research on families and diabetes across different phases of the lifespan. Recommendations for general practice with families that might be adapted by nurses to different settings in which they care for families with diabetes are included.

Adherence, behavior change, and visualization: a qualitative study of the experiences of taking an obesity medication

OBJECTIVE

Our objective was to examine patients' experiences of taking orlistat as a means to explore adherence and behavior change.

METHOD

We performed qualitative interviews with 12 participants who had taken orlistat in the past 2 years.

RESULTS

Their experiences were described in terms of beliefs about the causes of their obesity, their motivations for taking orlistat, and highly visual side effects. These themes have implications for understanding adherence and behavior change. For some, the side effects led to nonadherence and absence of behavior change. These individuals seemed to be motivated by routine effects of being overweight, such as lowered self-esteem. In contrast, those who were motivated by a life crisis seemed to tolerate the side effects of the drug, leading to adherence. In turn, these highly visual side effects enabled them to make an explicit link between food consumed and weight, creating a shift in their beliefs about the causes of obesity and making behavior change more likely.

CONCLUSION

Orlistat use illustrates how treatment and illness beliefs interact to create both adherence and behavior change, particularly in the context of a life crisis and particularly when symptoms can be visualized.

Parenting children with diabetes and Belsky's Determinants of Parenting Model: literature review

AIM

This paper provides a critical appraisal of the parenting literature as related to children with diabetes and proposes an adapted model of Belsky's Determinants of Parenting.

BACKGROUND

Diabetes is the leading endocrine disease in school-aged children. As primary healthcare providers, parents assume responsibility for the daily management of their children's diabetes. It is therefore inevitable that parenting becomes a crucial variable in determining diabetes control. However, the literature examining parenting children with a chronic illness such as diabetes is limited.

METHOD

A literature search was conducted using the CINAHL, EMBASE, PsychINFO, and Social Science Index databases and the terms 'parenting', 'determinants of parenting', 'Belsky's Determinants of Parenting' and combined with 'children' and 'type 1 diabetes'. Parenting and nursing literature from 1984 to 2004 was included if it was related to parenting determinants and diabetes control in children. The literature retrieved was critically appraised and synthesized in relation to Belsky's Determinants of Parenting Model.

FINDINGS

By incorporating new knowledge, an adapted Determinants of Parenting Model is proposed. The adapted model reflects a bi-directional relationship between parenting and child characteristics. Specifically, suggestions for future research on the adapted model and the bi-directional relationship between parenting and child characteristics are also discussed.

CONCLUSION

Recommendations are presented for use of the adapted Determinants of Parenting Model for future nursing research. Future research will need to focus on establishing causal links between the determinants, identifying the extent to which each determinant influences parenting, and parenting determinants questionnaire development.

Adherence in young children with asthma

PURPOSE OF REVIEW

To discuss the unique challenges of managing asthma in young children and to review the literature over the past year with regard to regimen adherence in this relatively understudied population.

RECENT FINDINGS

Young children and their families face unique challenges in dealing with asthma and these have the potential to affect regimen adherence. They include the time and effort required by asthma-management activities (e.g. nebulizer use), dependency on parents for asthma care, and the limited ability of children to communicate about their symptoms. Five published studies were found for the past year. They covered three areas: adherence assessment (e.g. electronic monitoring versus diary cards), device impact on adherence (e.g. influence of the novelty of medication-delivery device), and adherence interventions (e.g. parental education regarding symptoms).

SUMMARY

Research suggests that several components need to be considered when designing interventions to improve adherence for young children with asthma: to consider the strain in the caregiver role when developing the treatment regimen, to provide devices that parents and children can use, to monitor adherence with electronic monitoring, and to address parents' concerns and perceptions about treating prodromal symptoms of an asthma exacerbation. Because many parents are hesitant to treat cough symptoms, an additional training component may need to be added to address this concern.

Parents' perceptions of factors that affect successful diabetes management for their children

OBJECTIVE

To learn which factors parents perceive to be most influential in determining successful type 1 diabetes management.

METHODS

A 4-stage mixed qualitative-quantitative method that consists of a series of focus groups, a survey, and in-depth interviews was used to ensure that parents generated, prioritized, and explained their own ideas. In each stage, parents offered a new level of insight into their perception of how children achieve good metabolic control while living as normal a life as possible. The survey responses were divided into statistically different ranks, and the Kruskal-Wallis test was used to compare the results between subgroups.

RESULTS

A total of 149 parents participated in the formative qualitative phases, 799 families (66%) responded to the parent-generated survey, and 67 explanatory interviews were conducted. The families who responded to the survey had children of varied ages (mean: 11.9 years; SD: 4.44) and diabetes control (mean hemoglobin A1c: 8.22%; SD: 1.65); 84.1% of respondents were white, 12.3% were black, and 89% were privately insured. The 30 survey items were statistically discriminated into 8 ranks. The items cover a wide range of categories, including concrete ways of achieving better control, families' or children's traits that affect coping ability, actions of the health care team that support versus undermine families' efforts, and the availability of community supports. No clear pattern emerged regarding 1 category that parents perceived to matter most.

CONCLUSIONS

Clinicians can affect many of the factors that parents perceive to make a difference in whether they can successfully raise a resilient child in good diabetes control. Future research needs to determine whether health care teams that address the concerns that parents raised in this study are more effective in guiding children to cope well with diabetes, to incorporate healthier lifestyles, and ultimately to achieve better metabolic control.

Child in hospital: family experiences and expectations of how nurses can promote family health

AIMS AND OBJECTIVES

This study set out to explore, from the family's point of view, ways in which nursing staff can promote family health during the child's hospital stay.

BACKGROUND

Having a child in hospital is a major source of stress and anxiety for the whole family. Earlier studies have described parental coping strategies, ways to strengthen those strategies and to support parental participation in child care, but no one has studied the promotion of family health during the child's hospitalization from the family's point of view.

DESIGN

Interviews were conducted in 2002 with 29 families who had a child with a chronic illness which were receiving or had received treatment on the paediatric wards of two Finnish hospitals.

METHODS

Data analysis was based on the grounded theory method, proceeding to the stage of axial coding. Data collection and analysis phases proceeded simultaneously.

RESULTS

Five domains were distinguished in the promotion of family health: (1) reinforcing parenthood, (2) looking after the child's welfare, (3) sharing the emotional burden, (4) supporting everyday coping and (5) creating a confidential care relationship.

CONCLUSIONS

The results strengthen the knowledge base of family nursing by showing how nursing staff can promote family health during the child's hospital stay.

RELEVANCE TO CLINICAL PRACTICE

The results have a number of practical applications for nursing, both for clinical practice and research. The results can be used in paediatric hospital wards caring for chronically ill children and their families. The five domains of family health promotion described here should be tested in other paediatric wards and in other geographical locations.