The relevance of family-centred medicine and the implications for doctor education

Validity and reliability of the Family Empowerment Scale for parents of children with cleft lip and/or palate

BACKGROUND

Empowerment is recognized as a crucial concept in strengthening the position of parents in healthcare services. This study aimed to evaluate the validity and reliability of the Turkish Family Empowerment Scale (FES).

METHODS

This methodological study was conducted between January and March 2021, with 348 family members actively caring for their children in the age group of 0-18 years with cleft lip and/or palate (CL/P). The English FES was translated into Turkish using back translation and modified so that it is generic and convenient for all families. The construct validity, internal validity, internal consistency, and split-half test reliability and responsiveness of the Turkish FES were examined.

RESULTS

The original FES structure with three factors (family, health services provided to the child and community participation) and 34 items was verified in Turkish culture. This obtained structure can explain 66% of the variance of the relevant concept. Scores of parents ranged between 34 and 170 points. Increasing scores indicated a positive significance regarding family empowerment. The Cronbach's α reliability coefficient of the scale was calculated as 0.976.

CONCLUSION

The study findings and the goodness-of-fit values indicated that the FES and its Turkish version are a valid and reliable measurement instrument to be used in Turkish culture.

'Challenges in experiential learning during transition to clinical practice: A comparative analysis of reflective writing assignments during general practice, paediatrics and psychiatry clerkships'

INTRODUCTION

This study explored the reflective writing (RW) of senior medical students across a co-ordinated reflection education programme in General Practice, Paediatrics and Psychiatry clerkships during their transition to clinical clerkships. The study compared RW themes from within and across three clerkships in order to understand the influence clerkships had on experiential learning and developing professional identity.

METHODS

All medical students in their penultimate year were invited to participate in the study. 135 reflection assignments were analysed. A qualitative thematic analysis of students' RW was performed. An inductive approach was used and data saturation was achieved.

RESULTS

Clerkship specific themes were the intimacy of the experience in General Practice, the powerlessness students felt and the challenge of delivering family centred care in Paediatrics and the sense of perceived risk in Psychiatry. Common themes across the three clerkships were of emotional struggles in developing a professional identity.

CONCLUSION

There is an educational need for developmental space for students during General Practice, greater focus on preparing students for relationship building during Paediatrics and addressing stigma and personal safety issues in students during the Psychiatry clerkships. Across clerkships there is a need for better use of evidence based pedagogies to support emotional development.

The impact of an eye drop booklet on distress in children when receiving eye drops

PURPOSE

Child- and family-centered care is an increasingly important area in healthcare. Up to now, little attention has been paid to the experience of children and their parents in ophthalmological healthcare. During their conversations at Bartiméus, children indicated that the administration of eye drops constituted the most stressful element that needed to be improved. This study describes the amount of distress experienced by children when receiving eye drops. Furthermore, it investigates the value and impact of the developed eye drop booklet, for children and parents.

METHODS

In this multicenter study on distress related to the administration of eye drops, 370 children participated with ocular disorders or Cerebral Visual Impairment CVI (4-12 years), from four ophthalmology outpatient clinics. Half of the children, randomly chosen, were presented with a booklet before receiving eye drops. A faces scale together with a numeric scale (0-10) was used to determine the level of distress before and after the eye drops were administered. Parents were asked how satisfied they were about using the booklet.

RESULTS

The average distress score of the children who did receive a booklet was 3.40 at T1 and 2.70 at T2, and, of the children who did not receive a booklet, this was 3.69 at T1 and 2.97 at T2. The largest levels of distress were found in children between the ages of 7 and 9. The majority of parents indicated to appreciate the booklet, scoring it at 7.6 on a scale of 1 to 10. Furthermore, 91% of them considered the booklet a good idea or good preparation, 69% found it to have a positive effect on their child, and 83% would use it again.

CONCLUSIONS

At T1 and T2, the differences in the children's distress scores were not statistically significant between the booklet group and the group who did not use the booklet. Children, generally, anticipated greater discomfort than what they actually experienced during the administration of eye drops. For most children, the booklet had a positive effect on their distress levels, but not for all. A large majority of parents noticed the added value of the booklet for their child. They were very positive and wanted to continue using the booklet in the future, as it appeared to give their child a sense of control during the administration of eye drops.

Developmental vulnerabilities in children of chronically ill parents: a population-based linked data study

Background

Currently, there is mixed evidence regarding the effects on children when a parent is chronically ill. Research has also primarily been conducted with adolescent samples. This study investigated developmental vulnerabilities in young children of parents with chronic illness.

Methods

This study used linked administrative data. The study population included children born in Western Australia during 2003–2004 (n=19 071; mean age 5.5 years). The outcome measure was a score in the bottom 25% on any of the five developmental domains (physical, social, emotional, communicative and cognitive) of the Australian Early Development Census (2009 collection). Parental chronic illnesses were identified from hospital and cancer registry records, during the period from 1 year prior to the child’s birth and until the end of 2009.

Results

Higher odds of developmental vulnerabilities in physical, social, emotional and communication domains were observed for daughters of chronically ill mothers. Sons of chronically ill mothers had increased odds of language and cognitive difficulties. Risk level increased with each additional year of exposure to maternal chronic illness. Results also indicated increased odds of developmental vulnerabilities for children of mothers experiencing multiple compared with single chronic conditions; however, results were not statistically significant (all p>0.05). No association between fathers’ chronic illness and children’s developmental outcomes was found.

Conclusions

Maternal chronic illness is associated with an increased risk of poor developmental outcomes for children, particularly daughters. Healthcare services have an important role to play in linking families into appropriate family-centred services to best support the needs of chronically ill mothers.

Perspectives of parents and nurses on the content validity of the Family Empowerment Scale for parents of children with a chronic condition: A mixed-methods study

BACKGROUND

Insight into parental empowerment is important to understanding the impact of health care policy and to supporting and strengthening parents in the care of their child. The Family Empowerment Scale (FES) is a valid 24-item instrument that measures parental empowerment. It was originally developed for parents of children with emotional disabilities. It has been translated from English into Dutch. Before using the translated FES in another context, the aim of this study was to assess the content validity of the Dutch FES in the context of children with a chronic condition in a children's hospital, according to parents and nurses.

METHOD

This content validity study has a convergent, mixed-methods design. The content validity index was used to examine the relevance, according to 22 parents and 12 nurses quantitatively, on a scale and item level. The qualitative part assessed the comprehensiveness and comprehension of the FES through cognitive interviewing with eight parents and four nurses. The results of both analyses were converged to determine content validity.

RESULTS

The scale-content validity index was 0.88; three items scored < 0.78 on the item level. For 10 (of 24) items, issues were noticed about the tone and clarity of wording. Participants considered the FES to be not only an instrument of research but also an instrument that could be used to give insight into the personal degree of parental empowerment.

CONCLUSION

The content validity of the Dutch FES for parents of children with a chronic condition can be considered sufficient. Resolving some minor translation issues in some of the items is advised. The FES can be used in further research to examine the value of the FES in health care services, aiming to support the needs of parents and to increase their empowerment.

Parent and staff perceptions of parental needs during a child's hospital admission to a paediatric high-dependency unit: A New Zealand study

AIM

This study aimed to identify parents' and staff's perceptions of parents' needs during a paediatric high-dependency unit admission and the relationships between needs, socio-demographic and clinical variables and explores if these perceptions have changed.

METHODS

This study uses a cross-sectional descriptive correlational design, and 104 parents whose children received care and 88 staff who worked within a paediatric high-dependency unit at a tertiary hospital in New Zealand completed the Needs of Parents' Questionnaire in 2011.

RESULTS

Parents' and staff's perceptions of the importance of needs were congruent, but differences arose between parents and staff on whether these needs were met. Parents were more likely to rate needs as having been met than staff members. Admission type, age and gender influenced parents' and staff's perceptions of parents' needs.

CONCLUSION

Synergy between parent and staff satisfaction scores will be enhanced when care delivery is more closely aligned to parents' priorities for care and staff receive feedback on positive health-care experiences.

Parent Physical and Mental Health Comorbidity and Adolescent Behavior

The objectives of this study were to ascertain behavioral outcomes 10-11 years after 9/11 in adolescents ages 11-18 years (0-8 years old at the time of 9/11) enrolled in the World Trade Center Health Registry (Registry), and relate these outcomes to their 9/11-exposures and to parent health. Behavioral difficulties among adolescents were assessed using the adolescent-reported Strengths and Difficulties Questionnaire (SDQ). Parental post-traumatic stress disorder (PTSD) was assessed using a 9/11-specific PTSD Checklist-Civilian Version, a cut-off score of 44 or greater was considered probable PTSD. Multivariable logistic regression was used to estimate associations of 9/11-exposure and parental health with abnormal/borderline SDQ scores, adjusting for demographic variables that were significantly associated with the SDQ score in bivariate analyses. Of the 449 adolescents, 12.5% (n=56) had abnormal/borderline SDQ scores. In the multivariable model, adolescents with severe/ moderate 9/11-exposures were 2.4 times more likely to have abnormal/borderline SDQ scores compared to adolescents with mild 9/11-exposures (95% Confidence Interval (CI): 1.1-6.4). Adolescents who had a parent with 9/11-related PTSD and at least one comorbid chronic condition were 4.2 times more likely to have abnormal/borderline SDQ scores compared to adolescents with a parent who had no reported chronic health conditions. Adolescents whose parent reported 14 or more poor mental health days in the preceding 30 days were 3.4 times more likely to have abnormal/borderline SDQ scores (95% CI: 1.2-9.5) The finding that parents' health appears to influence adolescent behavior problems 10-11 years following a disaster may have implications for healthcare practitioners and disaster response planners.

Parents' experiences and needs regarding physical and occupational therapy for their young children with cerebral palsy

OBJECTIVE

To explore the experiences and needs of parents of young children (aged 2-4 years) with cerebral palsy (CP) regarding their child's physical and occupational therapy process in a rehabilitation setting.

METHODS

A qualitative design was used involving semi-structured interviews with 21 parents of young children with CP. Interviews were conducted until informational redundancy was achieved.

RESULTS

Three major themes were identified: Information, communication and partnership. A fourth, overarching theme emerged: The process of parent empowerment. Experiences and needs differed between parents and changed over time.

CONCLUSION

This study suggests that various themes play a key role in the experiences and needs of parents of young children with CP. The identified themes provide important insights into how and why service providers might change their approach.

PRACTICE IMPLICATIONS

Becoming empowered is a dynamic process for parents, in which both parents and service providers play a role. Service providers should continually adapt their role to parents' needs of information, communication and partnership, and they should support and facilitate parents in becoming empowered. For that, service providers should be educated on the process of parent empowerment, on ways to facilitate this process and on the importance of involving and interacting with parents. This allows families of young children with CP to be provided with services that best suit their needs.

Family presence during resuscitation in a paediatric hospital: health professionals' confidence and perceptions

AIMS AND OBJECTIVES

To investigate medical and nursing staff's perceptions of and self-confidence in facilitating family presence during resuscitation in a paediatric hospital setting.

BACKGROUND

Family presence during resuscitation is the attendance of family members in a location that affords visual or physical contact with the patient during resuscitation. Providing the opportunity for families to be present during resuscitation embraces the family-centred care philosophy which underpins paediatric care. Having families present continues to spark much debate amongst health care professionals.

DESIGN

A descriptive cross-sectional randomised survey using the 'Family Presence Risk/Benefit Scale' and the 'Family Presence Self-Confidence Scale 'to assess health care professionals' (doctors and nurses) perceptions and self-confidence in facilitating family presence during resuscitation of a child in a paediatric hospital.

METHODS

Surveys were distributed to 300 randomly selected medical and nursing staff. Descriptive and inferential statistics were used to compare medical and nursing, and critical and noncritical care perceptions and self-confidence.

RESULTS

Critical care staff had statistically significant higher risk/benefit scores and higher self-confidence scores than those working in noncritical care areas. Having experience in paediatric resuscitation, having invited families to be present previously and a greater number of years working in paediatrics significantly affected participants' perceptions and self-confidence. There was no difference between medical and nursing mean scores for either scale.

CONCLUSION

Both medical and nursing staff working in the paediatric setting understood the needs of families and the philosophy of family-centred care is a model of care practised across disciplines.

RELEVANCE TO CLINICAL PRACTICE

This has implications both for implementing guidelines to support family presence during resuscitation and for education strategies to shift the attitudes of staff who have limited or no experience.

Factors associated with family-centered involvement in family practice--a cross-sectional multivariate analysis

The importance of a family-centered approach in family practice has been emphasized. Knowledge about factors associated with higher family-centered involvement seems beneficial to stimulate its realization. German office-based family physicians completed a questionnaire addressing several aspects of family-centered care. Logistic regression was used to identify associations with the involvement overall and in different domains: routine inquiry and documentation of family-related information, family orientation regarding diagnosis and treatment, family-oriented dialogues, family conferences, and case-related collaboration with marriage and family therapists. We found significant associations between physicians' family-centered involvement and expected patient receptiveness, perceived impact of the family's influence on health, self-perceived psychosocial family-care competences (overall and concerning concepts for family orientation, psychosocial intervention in family conferences, and the communication of the idea of family counseling), advanced training in psychosocial primary care (PPC), personal acquaintance with family therapists (regarding case-related collaboration), and rural office environment. Increased emphasis on the family's influence on health in medical education and training, the provision of concepts for a family-centered perspective, and versatile skills for psychosocial intervention and inquiry of patient preferences, as well as the strengthening of networking between family physicians and family therapists, might promote the family-centered approach in family practice.

Differential Outcomes of Adolescents with Chronically Ill and Healthy Parents

Approximately 10% of children grow up with a parent who has been diagnosed with a chronic medical condition (CMC) and seem to be at risk for adjustment difficulties. We examined differences in behavioral, psychosocial and academic outcomes between 161 adolescents from 101 families with a chronically ill parent and 112 adolescents from 68 families with healthy parents, accounting for statistical dependence within siblings. Children between 10 and 20 years and their parents were visited at home and filled in questionnaires. Multilevel analyses showed that 20-60% of the variance in most adolescent outcomes was due to the family cluster effect, especially in internalizing problem behavior, caregiving variables and quality of parent attachment. Conversely, the variance in stress and coping variables and grade point average (GPA) was mainly due to individual characteristics. Adolescents with parents affected by CMC displayed more internalizing problems than the comparison group and scored higher on frequency of household chores, caregiving responsibilities, activity restrictions, isolation, daily hassles and stress. In addition, their grade point average was comparatively worse. No group differences in externalizing problems, coping skills and quality of parent attachment were found. In conclusion, the family cluster effect largely explains adolescent outcomes and should be accounted for. Adolescents with parents affected by CMC are subject to an increased risk for internalizing problems, adverse caregiving characteristics, daily hassles, stress and a low GPA. According to a family-centered approach, school counselors and health care practitioners should be alert to adjustment difficulties of children with a chronically ill parent.

Problem behavior in children of chronically ill parents: a meta-analysis

The aim of this meta-analysis is to examine whether children of chronically ill parents differ from norm groups in problem behavior. We report moderator effects and overall effect sizes for internalizing, externalizing and total problem behavior assessed by children and parents. In fixed effect models, we found a significant overall effect size for internalizing problem behavior (number of studies k = 19, total sample size N = 1,858, Cohen’s d = .23, p < .01) and externalizing problem behavior (k = 13, N = 1,525, d = .09, p < .01) but not for total problem behavior (k = 7; N = 896). Effects for internalizing and externalizing problem behavior were larger in non-cancer studies, in samples including younger children and younger ill parents, in samples defined by low average SES and in studies including parents with longer illness duration. In addition, effects for externalizing problem behavior were larger in studies characterized by a higher percentage of ill mothers and single parents. With exclusive self-report, effect sizes were significant for all problem behaviors. Based on these results, a family-centered approach in health care is recommended.