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Abstract
Seeking children's assent has been put forward as a way to foster children's involvement in the healthcare decision-making process. However, the functions of the concept of assent within clinical care are manifold, and methods used to recognize children's capacities and promote their involvement in their care remain debated. We performed an instrumentalist concept analysis of assent, with 58 included articles. Final themes were jointly identified through a deliberative process. Two distinct perspectives of assent were predominant: as an affirmative agreement for a specific decision and as part of a continuous, interactive process of care. Differing standards were provided as to how and when to apply the concept of assent. The concept of dissent was largely omitted from conceptions of assent, especially in situations for which children's refusal would lead to severe health consequences. Ethical implications included fostering autonomy, reducing physical/psychological harm to the child, respecting the child as a human being, and fulfilling the universal rights of the child. There remain important gaps in the theory of assent and its desirable and possible practical implications. Practical standards are largely missing, and evidence supporting the claims made in the literature requires further investigation.
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Affiliation(s)
| | - Justine Fortin
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Canada
| | - Eric Racine
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Canada
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Herrler A, Hoffmann DU, Görig T, Georg S, König J, Urschitz MS, De Bock F, Eichinger M. Assessing the extent of shared decision making in Pediatrics: Preliminary psychometric evaluation of the German CollaboRATE pediatric scales for patients aged 7-18 years, parents and parent-proxy reports. PATIENT EDUCATION AND COUNSELING 2022; 105:1642-1651. [PMID: 34865889 DOI: 10.1016/j.pec.2021.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 10/10/2021] [Accepted: 10/23/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To conduct a preliminary evaluation of psychometric properties of CollaboRATEpediatric, a set of three scales to assess shared decision making (SDM) with pediatric patients, parents and parents on behalf of their children (parent-proxy reports). As secondary objectives we examined the scales' distributional characteristics, acceptability, and agreement between scales. METHODS Patients aged ≥ 7 years and parents were recruited in two outpatient facilities providing healthcare services for children with neurological and behavioral health conditions. We collected 46, 169 and 227 pediatric patient, parent-proxy and parent reports, respectively. Convergent, divergent and discriminative validity were investigated. Acceptability of the scales and agreement between patient and parent-proxy reports were explored by assessing item nonresponse and Bland-Altman plots. RESULTS While convergent and divergent validity were established for the parent scale, discriminative validity was not demonstrated for any of the scales. The scales showed good to excellent acceptability. Parent-proxy reports agreed to a moderate extent with patients' self-reports of SDM. CONCLUSION CollaboRATEpediatric offers a starting point for parsimoniously assessing SDM in Pediatrics, however further psychometric testing is warranted. PRACTICE IMPLICATIONS Given limited psychometric support for the pediatric patient scale, we recommend using both the pediatric patient and parent-proxy report scales to assess SDM in pediatric patients until further psychometric testing is concluded.
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Affiliation(s)
- Angélique Herrler
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Faculty of Human Sciences and Faculty of Medicine, Graduate School GROW - Gerontological Research on Well-being, University of Cologne, Cologne, Germany
| | - Dorle U Hoffmann
- Division of Paediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Tatiana Görig
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sabine Georg
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jochem König
- Division of Paediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Michael S Urschitz
- Division of Paediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Freia De Bock
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Federal Centre of Health Education, Cologne, Germany
| | - Michael Eichinger
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Division of Paediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany; Department of Pediatrics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
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Murdoch J. A step too far or a step in the wrong direction? A critique of the 2014 Amendment to the Belgian Euthanasia Act. Monash Bioeth Rev 2021; 39:103-116. [PMID: 34971443 DOI: 10.1007/s40592-021-00147-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2021] [Indexed: 11/29/2022]
Abstract
In 2014, Article 3 of the the Belgian Euthanasia Act (2002) (the Euthanasia Act) was amended ('the Amendment') to include the 'capacity for discernment' requirement. This paper explores the implications of this highly controversial Amendment. I remain unconvinced of the benefits for children < 12 years old suffering chronic or terminal illnesses. In Part One, I argue that the phrase 'capacity for discernment' is problematic and vulnerable to abuse; neither a consistent, widely accepted definition of the phrase has been established nor a standardised method or procedure to adequately gauge a minor's capacity for discernment. In Part Two I advance the argument that specifically for children < 12 years, aggressive and sophisticated paediatric palliative care treatment, which risks, but does not intend death, is more ethically justified than Euthanasia treatment. A definition of a child's interests is best achieved through a care-based ethics framework; namely, the child's relationship with their parents and family members, their doctors and medical practitioners is held to be an interest of crucial importance for the child. I conclude that paediatric palliative care arguably better promotes and upholds this interest.
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Hornberger LL, Breuner CC, Alderman EM, Garofalo R, Grubb LK, Powers ME, Upadhya KK, Wallace SB. Diagnosis of Pregnancy and Providing Options Counseling for the Adolescent Patient. Pediatrics 2017; 140:peds.2017-2273. [PMID: 28827383 DOI: 10.1542/peds.2017-2273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The American Academy of Pediatrics policy statement "Options Counseling for the Pregnant Adolescent Patient" recommends the basic content of the pediatrician's counseling for an adolescent facing a new diagnosis of pregnancy. However, options counseling is just one aspect of what may be one of the more challenging scenarios in the pediatric office. Pediatricians must remain alert to the possibility of pregnancy among their adolescent female patients. When discovering symptoms suggestive of pregnancy, pediatricians must obtain a relevant history, perform diagnostic testing and properly interpret the results, and understand the significance of the results from the patient perspective and reveal them to the patient in a sensitive manner. If the patient is indeed pregnant, the pediatrician, in addition to providing comprehensive options counseling, may need to help recruit adult support for the patient and should offer continued assistance to the adolescent and her family after the office visit. All pediatricians should be aware of the legal aspects of adolescent reproductive care and the resources for pregnant adolescents in their communities. This clinical report presents a more comprehensive view of the evaluation and management of pregnancy in the adolescent patient and a context for options counseling.
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Affiliation(s)
| | - Cora C. Breuner
- Division of Adolescent Medicine, Children’s Mercy Hospital and Clinics, Kansas City, Missouri
| | - Elizabeth M. Alderman
- Division of Adolescent Medicine, Children’s Mercy Hospital and Clinics, Kansas City, Missouri
| | - Robert Garofalo
- Division of Adolescent Medicine, Children’s Mercy Hospital and Clinics, Kansas City, Missouri
| | - Laura K. Grubb
- Division of Adolescent Medicine, Children’s Mercy Hospital and Clinics, Kansas City, Missouri
| | - Makia E. Powers
- Division of Adolescent Medicine, Children’s Mercy Hospital and Clinics, Kansas City, Missouri
| | - Krishna Kumari Upadhya
- Division of Adolescent Medicine, Children’s Mercy Hospital and Clinics, Kansas City, Missouri
| | - Stephenie B. Wallace
- Division of Adolescent Medicine, Children’s Mercy Hospital and Clinics, Kansas City, Missouri
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Abstract
In this statement, the American Academy of Pediatrics reaffirms its position that the rights of adolescents to confidential care when considering abortion should be protected. Adolescents should be encouraged to involve their parents and other trusted adults in decisions regarding pregnancy termination, and most do so voluntarily. The majority of states require that minors have parental consent for an abortion. However, legislation mandating parental involvement does not achieve the intended benefit of promoting family communication, and it increases the risk of harm to the adolescent by delaying access to appropriate medical care. This statement presents a summary of pertinent current information related to the benefits and risks of legislation requiring mandatory parental involvement in an adolescent's decision to obtain an abortion.
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Kafaar Z, Swartz L, Kagee A, Lesch A, Jaspan H. Adolescent Participation in HIV Vaccine Trials: Cognitive Developmental Considerations. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2016. [DOI: 10.1177/008124630703700312] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Adolescents form an important target group for HIV vaccine trials for a number of reasons. These include the high HIVprevalence and incidence rates amongst adolescents, early sexual debut, multiple sexual partners, and other high-risk sexual behaviours. It has therefore been argued that the focus of HIV vaccination attempts should be on early adolescents younger than 15 years of age. Indeed, vaccination of adolescents prior to their sexual debut has been argued to have the potential to be one of the most effective ways to curb the HIV pandemic. While the biological and epidemiological arguments for vaccination of adolescents have been elucidated, this article offers some insight into the cognitive aspects of decision making in adolescence that may inform strategies vaccine trial sites might employ when dealing with adolescent participants. After a brief overview of the educational, biological, and relationship changes that occur during adolescence, this article explores some of the more pertinent cognitive changes that occur during adolescence. More specifically, this article explores the cognitive changes during adolescence that affect decision making, such as differences between younger and older adolescents in (a) choice, (b) comprehension, (c) creativity, (d) compromise, (e) consequentiality, (f) correctness, (g) credibility, (h) consistency, and (i) commitment. Research findings relating to the above changes are discussed, creating an argument for the exclusion of early adolescents in vaccine trials and the concomitant active engagement with middle adolescents.
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Affiliation(s)
- Zuhayr Kafaar
- Department of Psychology, Stellenbosch University and Sociobehavioural Group, South African AIDS Vaccine Initiative (SAAVI), South Africa
| | - Leslie Swartz
- Department of Psychology, Stellenbosch University and Sociobehavioural Group, South African AIDS Vaccine Initiative (SAAVI), South Africa
| | - Ashraf Kagee
- Department of Psychology, Stellenbosch University and Sociobehavioural Group, South African AIDS Vaccine Initiative (SAAVI), South Africa
| | - Anthea Lesch
- Department of Psychology, Stellenbosch University and Sociobehavioural Group, South African AIDS Vaccine Initiative (SAAVI), South Africa
| | - Heather Jaspan
- Department of Pediatrics and Child Health, Stellenbosch University, Tygerberg Hospital, South Africa
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Koshy AJ, Sisti DA. Assent as an ethical imperative in the treatment of ADHD. JOURNAL OF MEDICAL ETHICS 2015; 41:977-981. [PMID: 26112613 DOI: 10.1136/medethics-2014-102166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 06/10/2015] [Indexed: 06/04/2023]
Abstract
The American Academy of Paediatrics endorses obtaining assent when prescribing medications for attention-deficit/hyperactivity disorder (ADHD) in older children whenever possible. Studies indicate the concept of assent may not be well understood by clinicians, possibly effecting effective and widespread implementation. We argue that though the concept of assent continues to evolve, it is critical in the context of patient-centred care, shared decision-making and in supporting minors' transition to adulthood. Based on the principle of respect for young persons, we argue that obtaining assent is an ethical imperative when prescribing medication for ADHD. We highlight the instrumental benefits of obtaining assent in the paediatric clinical encounter when prescribing medications for treatment of ADHD.
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Affiliation(s)
- Anson J Koshy
- Department of Pediatrics, Children's Learning Institute, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Dominic A Sisti
- Department of Medical Ethics & Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Hein IM, Daams J, Troost P, Lindeboom R, Lindauer RJL. Accuracy of assessment instruments for patients' competence to consent to medical treatment or research. Hippokratia 2015. [DOI: 10.1002/14651858.cd011099.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Irma M Hein
- De Bascule and Academic Medical Center; Department of Child and Adolescent Psychiatry; Meibergdreef 5 Amsterdam Netherlands 1105 AZ
| | - Joost Daams
- Academic Medical Center; Amsterdam Netherlands
| | - Pieter Troost
- De Bascule and Academic Medical Center; Department of Child and Adolescent Psychiatry; Meibergdreef 5 Amsterdam Netherlands 1105 AZ
| | | | - Ramón JL Lindauer
- De Bascule and Academic Medical Center; Department of Child and Adolescent Psychiatry; Meibergdreef 5 Amsterdam Netherlands 1105 AZ
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Feenstra B, Lawson ML, Harrison D, Boland L, Stacey D. Decision coaching using the Ottawa family decision guide with parents and their children: a field testing study. BMC Med Inform Decis Mak 2015; 15:5. [PMID: 25889602 PMCID: PMC4326318 DOI: 10.1186/s12911-014-0126-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 12/19/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Although children can benefit from being included in health decisions, little is known about effective interventions to support their involvement. The objective of this study was to evaluate the feasibility and acceptability of decision coaching guided by the Ottawa Family Decision Guide with children and parents considering insulin delivery options for type 1 diabetes (insulin pump, multiple daily injections, or standard insulin injections). METHODS Pre-/post-test field testing design. Eligible participants were children (≤18 years) with type 1 diabetes and their parents attending an ambulatory diabetes clinic in a tertiary children's hospital. Parent-child dyads received decision coaching using the Ottawa Family Decision Guide that was pre-populated with evidence on insulin delivery options, benefits, and harms. Primary outcomes were feasibility of recruitment and data collection, and parent and child acceptability of the intervention. RESULTS Of 16 families invited to participate, 12 agreed and 7 attended the decision coaching session. For the five missed families, two families were unable to attend the session or the decision coach was not available (N=3). Baseline and immediately post-coaching questionnaires were all completed and follow-up questionnaires two weeks post-coaching were missing from one parent-child dyad. Missing questionnaire items were 5 of 340 items for children (1.5%) and 1 of 429 for parents (0.2%). Decision coaching was rated as acceptable with higher scores from parents and their children who were in earlier stages of decision making. CONCLUSION Decision coaching with children and their parents considering insulin options was feasible implement and evaluate in our diabetes clinic and was acceptable to participants. Recruitment was difficult due to scheduling restrictions related to the timing of the study. Coaching should target participants earlier in the decision making process and be scheduled at times that are convenient for families and coaches. Findings were used to inform a full-scale evaluation that is currently underway.
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Affiliation(s)
- Bryan Feenstra
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road (Rm 1118), Ottawa, ON, K1H 8 M5, Canada.
| | - Margaret L Lawson
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.
| | - Denise Harrison
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road (Rm 1118), Ottawa, ON, K1H 8 M5, Canada.
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.
| | - Laura Boland
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road (Rm 1118), Ottawa, ON, K1H 8 M5, Canada.
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.
| | - Dawn Stacey
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road (Rm 1118), Ottawa, ON, K1H 8 M5, Canada.
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
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Ngadimon IW, Islahudin F, Hatah E, Mohamed Shah N, Makmor-Bakry M. Antibiotic and shared decision-making preferences among adolescents in Malaysia. Patient Prefer Adherence 2015; 9:665-73. [PMID: 25999702 PMCID: PMC4437597 DOI: 10.2147/ppa.s82844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The purpose of this study was to establish baseline information on the current level of knowledge about, attitude toward, and experience with antibiotic usage, and preferences for shared decision making among adolescents in Malaysia. METHODS A cross-sectional survey, involving 1,105 respondents who were aged between 13 and 17 years and who lived in Malaysia, was conducted using a validated questionnaire. The survey assessed knowledge, attitude, and experience with regard to antibiotic usage, and adolescents' preferences for the style of shared decision-making process. RESULTS The majority (n=786 [71.13%]) of the respondents had a low level of knowledge, 296 (26.79%) had a moderate level of knowledge, and 23 (2.08%) had a high level of knowledge. Further, they demonstrated a slightly negative attitude mean score of 3.30±0.05 (range: 0-8 points) but a positive experience mean score of 2.90±0.029 (range: 0-4 points). There was a positive correlation between knowledge and attitude scores, with a higher knowledge level associated with a more positive attitude toward antibiotic usage (r=0.257, P<0.001). Higher knowledge scores were associated with a more negative experience with antibiotic usage (r=-0.83, P=0.006). When assessing preference in shared decision making, more adolescents preferred an active role (n=408 [37%]) compared with collaborative (n=360 [32.6%]) or passive (n=337 [30.5%]) (P=0.028) roles. CONCLUSION Current health care settings should involve adolescents in the decision-making process. Education packages can be introduced to improve adolescents' knowledge of and practice of taking antibiotics, as well as to encourage their participation in decision making, in an attempt to reduce misuse of antibiotics.
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Affiliation(s)
- Irma Wati Ngadimon
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Farida Islahudin
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Correspondence: Farida Islahudin, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia, Tel +603 9289 7689, Email
| | - Ernieda Hatah
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Mohd Makmor-Bakry
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Hein IM, Daams J, Troost P, Lindeboom R, Lindauer RJL. Accuracy of assessment instruments for patients' competence to consent to medical treatment or research. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014. [DOI: 10.1002/14651858.cd011099] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Vaknin O, Zisk-Rony RY. Including children in medical decisions and treatments: perceptions and practices of healthcare providers. Child Care Health Dev 2011; 37:533-9. [PMID: 20854447 DOI: 10.1111/j.1365-2214.2010.01153.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND With growing awareness of the need to involve children in their own health-related decisions, attention has primarily focused on the concept of assent, or a minor's participation in a research trial or experimental treatment. This study attempts to broaden that focus by examining the perceptions and practices of healthcare providers with respect to the role of children in more routine healthcare decisions and treatments. METHODS In total, 103 nurses and 40 physicians who work in a hospital in Israel completed self-administered perceptions and practices questionnaires. RESULTS Many participants agreed that children should be included in decision making. Factors that respondents felt would influence their approach to a particular child included child behaviour (80%), child communication (66%), experience of child, parent and healthcare provider (90%) and type of medical intervention (60%). Responses differed between physicians and nurses. In response to the question 'How often do you suggest the following methods to achieve child participation in treatment?' most respondents reported that they provide an explanation (98%) and recruit the parents (90%). The use of play was reported by only 63% of the professionals. CONCLUSION This study demonstrated that many healthcare providers recognize the need to include children in routine health-related practices and outlined factors healthcare providers use in deciding when to include children in medical decisions. Involving children in even the minute aspects of everyday decisions and treatments can allow children to feel part of the process, improve their co-operation, increase their sense of control and affect future healthcare encounters.
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Affiliation(s)
- O Vaknin
- Hadassah University Hospital, Mt Scopus, Israel
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Abstract
UNLABELLED THE STUDY RATIONALE: In earlier research on paediatric nursing care, children's views have received only scant attention. As a rule, it is the parents' opinions that are solicited, but these are not necessarily accurate representations of what children think. AIM To describe school-age children's best and worst experiences during hospitalisation. METHODOLOGICAL DESIGN AND JUSTIFICATION Data were collected by using sentence completion. Using the method of content analysis, the answers were coded and main and subcategories identified. A total of 388 Finnish children aged 7-11 years from all Finnish university hospitals (n = 5) who stayed at least overnight at paediatric or surgical wards (n = 23) were included in the study. RESULTS Children's best experiences were related to people, their characteristics, activities, environment and outcomes. Especially entertainment activities and objects were mentioned among best experiences. The worst experiences were related to people, feelings, activities and environment. As patients, children felt symptoms of illness and separation in an environment where someone conducted physical care and treatment activities, especially procedures perceived as unpleasant. CONCLUSIONS Paediatric care should be improved especially by taking into account children's best experiences and by utilising them to minimise or eliminate worst experiences. Children's own views should be used in strategic planning, purchasing, space design and other key initiatives. Children are more likely to be less stressed if their views are taken into consideration and they are allowed to take part in their health care in accordance with their rights.
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Affiliation(s)
- Tiina Pelander
- Department of Nursing Science, University of Turku, Turku, Finland.
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Moore L, Kirk S. A literature review of children's and young people's participation in decisions relating to health care. J Clin Nurs 2010; 19:2215-25. [PMID: 20659201 DOI: 10.1111/j.1365-2702.2009.03161.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To review and critique the research literature on children's and young people's participation in health care decision-making, to highlight gaps in the research and to identify implications for nursing practice. BACKGROUND Children have a right to participate in decisions about their lives. The recognition of this, along with greater acknowledgement of children's capabilities, has led to an increasing awareness that children's views must be given value in both national policy and individual decisions. Health professionals have also been given explicit direction to ensure that children are actively involved in decision-making. DESIGN Literature review. METHOD Search of electronic databases and manual searching of journals and reference lists between 1990-2009. RESULTS Children want to be involved in discussions about their care but it is unclear to what extent this happens in practice. The research conducted has interpreted participation in different ways. Studies have compared decisions of differing importance in terms of risk and many have a wide age range in their samples, including children who are arguably too young for meaningful participation. However, this heterogeneity is often overlooked in the reporting of studies. Aspects of practice which can help or hinder participation are identified but there is little evidence on the outcome benefits of participation. In addition, there has been an over-reliance on interviews as the method of data collection. CONCLUSIONS Research using a combination of observation and interviewing would provide more in-depth knowledge about participation in practice. In addition, studies should consider decisions of similar consequence and children at an age when participation is appropriate. RELEVANCE TO CLINICAL PRACTICE The need for health professionals to ensure children are protected is undisputed but should not prevent children's rights to participate from being enacted. Practitioners, therefore, need further guidance on how to facilitate the participation of children.
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Affiliation(s)
- Lucie Moore
- The School of Nursing, Midwifery and Social Work, The University of Manchester, University Place, Oxford Road, Manchester M13 9PL, UK.
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Kostenius C, Öhrling K. Schoolchildren from the north sharing their lived experience of health and well-being. Int J Qual Stud Health Well-being 2009. [DOI: 10.1080/17482620600747485] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Mårtenson EK, Fägerskiöld AM. A review of children’s decision-making competence in health care. J Clin Nurs 2008; 17:3131-41. [DOI: 10.1111/j.1365-2702.2006.01920.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Proczkowska-Björklund M, Runeson I, Gustafsson PA, Svedin CG. Decision making about pre-medication to children. Child Care Health Dev 2008; 34:713-20. [PMID: 18959568 DOI: 10.1111/j.1365-2214.2008.00853.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Inviting the child to participate in medical decisions regarding common medical procedures might influence the child's behaviour during the procedures. We wanted to study nurse decision-making communication regarding pre-medication before ear, nose and throat (ENT) surgery. METHOD In total, 102 children (3-6 years) signed for ENT surgery were video-filmed during the pre-medication process. The nurse decision-making communication was identified, transcribed and grouped in six main categories dependent on the level of participation (self-determination, compromise, negotiation, questioning, information, lack of communication). Associations between child factors (age, gender, verbal communication and non-verbal communication) and different nurse decision-making communication were studied. Associations between the decision-making communication and verbal hesitation and/or the child's compliance in taking pre-medication were also studied. RESULTS Totally, information was the most frequently used category of decision making communication followed by negotiation and questioning. To the children showing signs of shyness, the nurse used more negotiation, questions and self-determination communication and less information. The nurse used more compromise, negotiation and gave less information to children with less compliance. No specific type of nurse decision-making communication was associated with verbal hesitation. The most important predictors for verbal hesitation were none or hesitant eye contact with nurse (OR = 4.5) and placement nearby or in parent's lap (OR = 4.7). Predictors for less compliance in taking pre-medication were verbal hesitation from the child (OR = 22.7) and children who did not give any verbal answer to nurse initial questions (OR = 5.5). CONCLUSION Decision-making communication could not predict the child's compliance during pre-medication. Although negotiation, questioning and self-determination communication were associated with more unwillingness to take pre-medication. More knowledge is needed about communication to children in medical settings and how it influences the child's behaviours.
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Affiliation(s)
- M Proczkowska-Björklund
- Division of Child and Adolescent Psychiatry, IMK, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
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Tabari-Khomeiran R, Kiger A, Parsa-Yekta Z, Ahmadi F. Competence Development Among Nurses: The Process of Constant Interaction. J Contin Educ Nurs 2007; 38:211-8. [PMID: 17907665 DOI: 10.3928/00220124-20070901-01] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The importance of competence to nursing practice was the motivation for this study, which explored nurses' experience in developing their competence as they progress through their careers. METHODS In accordance with grounded theory method, data collection and data analysis were performed simultaneously using the constant comparative method. RESULTS Data revealed that nurses developed competence through an iterative process called "the process of constant interaction." This five-stage process was found to be a complex, ongoing interpersonal dynamic between the nurse and the surrounding world. CONCLUSIONS Although the nurse is the key player in the process of his or her own competence development, employers have a pivotal responsibility in facilitating the nurse's progress toward ongoing professional competence, which is a key element of the quality of care.
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Affiliation(s)
- Rasoul Tabari-Khomeiran
- Nursing & Midwifery School, Guilan University of Medical Science, Bandaranzali, Guilan, Iran
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19
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Pelander T, Leino-Kilpi H, Katajisto J. Quality of pediatric nursing care in Finland: children's perspective. J Nurs Care Qual 2007; 22:185-94. [PMID: 17353757 DOI: 10.1097/01.ncq.0000263110.38591.9a] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study assessed the quality of pediatric nursing care as perceived by children (N = 388) aged 7 to 11 in Finland. The children rated as excellent the nursing environment, the nurses' humanity and trustworthiness, and caring and communication. They were most critical about the nurses' entertainment activities such as playing with them. Children's age and type of admission were both related to the amount of information they received. The instrument used in the study needs to be developed and tested further.
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Affiliation(s)
- Tiina Pelander
- Departments of Nursing Science, University of Turku, Turku, Finland.
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20
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Coa TF, Pettengill MAM. Autonomia da criança hospitalizada frente aos procedimentos: crenças da enfermeira pediatra. ACTA PAUL ENFERM 2006. [DOI: 10.1590/s0103-21002006000400011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: conhecer as crenças e ações da enfermeira pediatra em relação à autonomia da criança hospitalizada durante a realização de procedimentos terapêuticos. MÉTODOS: estudo de abordagem qualitativa, em que foram realizadas observações e entrevistas com sete enfermeiras de um hospital público de São Paulo. RESULTADOS: foram evidenciados dois temas que revelam as crenças de enfermeira e que fundamentam suas ações em relação à autonomia da criança hospitalizada: acreditando no potencial da criança para exercer a autonomia e considerando a criança incapaz de exercer a autonomia. CONSIDERAÇÕES FINAIS: tem sido dada pouca oportunidade à criança para desenvolver sua autonomia. Como regra, em situações de conflito, o profissional não permite a participação da criança, permanecendo uma distância entre seu discurso e a prática.
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21
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Borry P, Stultiens L, Nys H, Cassiman JJ, Dierickx K. Presymptomatic and predictive genetic testing in minors: a systematic review of guidelines and position papers. Clin Genet 2006; 70:374-81. [PMID: 17026616 DOI: 10.1111/j.1399-0004.2006.00692.x] [Citation(s) in RCA: 154] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The objective of this study is to review ethical and clinical guidelines and position papers concerning the presymptomatic and predictive genetic testing of minors. The databases Medline, Philosopher's Index, Biological Abstracts, Web of Science and Google Scholar were searched using keywords relating to the presymptomatic and predictive testing of children. We also searched the websites of the national bioethics committees indexed on the websites of World Health Organization (WHO) and the German Reference Centre for Ethics in the Life Sciences, the websites of the Human Genetics Societies of various nations indexed on the website of the International Federation of Human Genetics Societies and related links and the national medical associations indexed on the website of the World Medical Association. We retrieved 27 different papers dealing with guidelines or position papers that fulfilled our search criteria. They encompassed the period 1991-2005 and originated from 31 different organizations. The main justification for presymptomatic and predictive genetic testing was the direct benefit to the minor through either medical intervention or preventive measures. If there were no urgent medical reasons, all guidelines recommend postponing testing until the child could consent to testing as a competent adolescent or as an adult. Ambiguity existed for childhood-onset disorders for which preventive or therapeutic measures are not available and for the timing of testing for childhood-onset disorders. Although the guidelines covering presymptomatic and predictive genetic testing of minors agree strongly that medical benefit is the main justification for testing, a lack of consensus remains in the case of childhood-onset disorders for which preventive or therapeutic measures are not available.
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Affiliation(s)
- P Borry
- Centre for Biomedical Ethics and Law, Universiteit Leuven, Leuven, Belgium.
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22
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Abstract
The right of adolescents to consent to various types of healthcare vary widely from state to state. Nurses have a responsibility to be aware of the issues surrounding adolescent consent and to know what state statutes guide the healthcare provider. This article describes the issues surrounding adolescent consents, including contraception, abortion, prenatal care, sexually transmitted disease testing and treatment, confidentiality, and paternity among other topics.
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Affiliation(s)
- Jackie Tillett
- Department of Obstetrics and Gynecology, University of Wisconsin Medical School, Milwaukee Clinical Campus, and Aurora UW Midwifery Center, Aurora Sinai Medical Center, Milwaukee, Wisconsin, USA
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23
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Dickey SB, Kiefner J, Beidler SM. Consent and confidentiality issues among school-age children and adolescents. J Sch Nurs 2002; 18:179-86. [PMID: 12079183 DOI: 10.1177/10598405020180031001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This article supports the moral viewpoint that minors with decision-making capacity, regardless of their age, should be involved in their health care decisions. When clinical care proceeds without attention to a child's emotional and developmental potential, the needs of a young person to be socialized to take care of his or her health care from an early age are not met. This is ethically irresponsible. Developing competence for informed consent decisions is associated with cognitive capacity. Explicit federal guidelines and laws exist for the inclusion of minors in research. By contrast, minors are often left out of participating in the health care decisions that may affect them for a lifetime in illness and wellness preservation. For day-to-day care, respect for children as increasingly autonomous individuals, members of families, and society is derived from the ethical principle of autonomy. The school nurse is often in a unique position to promote this professional behavior because most interactions are directly with the minor and without parental presence. In addition, the health office is a "safe" place where students can go for a variety of concerns. The school nurse must be concerned about ethical practice while staying within the limits of state and federal laws regarding minors' consent to treatment and confidentiality.
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Affiliation(s)
- Susan B Dickey
- Department of Nursing, Temple University, College of Allied Health Professions, Philadelphia, PA, USA
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