What is the concept of parental ‘emotional transference’ to children? A Walker and Avant concept analysis

Effect of play-based intervention on children's mental status and caregiver involvement during hospitalization: findings from Pakistan

BACKGROUND

The nurturing care framework (NCF) encompasses responsive caregiving, health, nutrition, safety and security by parents and other caregivers. It improves health, development and wellbeing of children. A hospital environment can be detrimental to the developmental and emotional needs of children hence NCF can be applied to hospitalized children.

OBJECTIVE

The objective was to determine if (i) play stimulation intervention mediated by non-specialist providers (caregivers) improves mental status of children who are hospitalized; (ii) to examine if difference varies between different providers and iii) if there is variation based on child age and criticalness of illness.

METHOD

A one-group pretest-posttest research was carried out using purposive sampling in a pediatric unit in Karachi, Pakistan, from November 2017 to December 2019. Children aged 3 months to 6 years were offered play stimulation by trainee psychologists. The outcome was measured through an observation tool, the Mental Status Examination Scale (MSE-S) developed for the study.

RESULTS

A total of 524 sessions were delivered to 351 children. Significant mean difference was observed on MSE-S before and after the intervention when it was provided by trainees (9.95, CI = 8.11, 11.7), mothers (mean difference = 5.86, CI = 5.30, 6.42), fathers (mean difference = 5.86, CI = 4.48, 7.24) and non-specialist providers [caregivers (mean difference = 5.40, CI = 3.91, 6.89). Significant differences in mean was observed on MSE-S across different age groups and criticalness of illness.

CONCLUSION

It was concluded that play stimulation not only affects the behaviour of children but also varies when delivered by caregivers and trainees. Hence, interventions that involve parents are feasible.

Introducing brief admissions by self-referral in child and adolescent psychiatry: an observational cohort study in Sweden

BACKGROUND

Brief admission by self-referral, a novel crisis intervention designed to reduce suicide and self-harm in adults, was adopted for adolescents in paediatric psychiatry in Malmö, Sweden, in 2018. We aimed to investigate changes in utilisation of emergency psychiatric care.

METHODS

We did an observational longitudinal cohort study in The University Hospital in Malmö, Sweden, which provides the only psychiatric emergency unit with 24 h psychiatric facilities in Region Skåne. Eligible patients were those aged 13-17 years who were admitted to the psychiatric facility, who had at least one emergency visit or admission during the 6 months before admission, and had prominent features of instability and self-harm, corresponding to at least three of the nine criteria for borderline personality disorder as per the DSM-5 as assessed by a paediatric psychiatrist during the admission. Patients with intellectual disabilities, psychosis, or language barriers were excluded. Patients who signed a brief admissions contract between April 1, 2018, and April 30, 2021, were eligible for inclusion in the study. A brief admissions contract allows patients to admit themselves to psychiatric emergency care for a transitory time. The primary outcome measures were the number of emergency visits, emergency admissions, inpatient days, and episodes of coercive (involuntary) care, compared at individual level before and after signing the brief admissions contract until end of follow-up. The number of visits and days were modelled using random-effects Poisson regression models, and the relative changes in the expected numbers of days per time unit were reported as rate ratios (RRs).

FINDINGS

Of the 928 patients admitted to the psychiatric facility between April 1, 2018, and April 30, 2021, 60 were excluded, and a further 801 did not meet the inclusion criteria for age, previous emergency visits, or having at least three of the nine criteria of borderline personality disorder. 67 patients were eligible for inclusion, but four patients did not sign a contract. 63 patients were included in the study, including 60 females (95%) and three (5%) males, with a mean age of 14·8 years (SD 1·7). Ethnicity data were not collected. Patients were followed up for a median of 13·5 months (IQR 9·2 -19·6). After signing the contract, there was a decrease in the number of emergency visits (RR 0·22 [95% CI 0·15-0·32]; p<0·0001), emergency admissions (RR 0·26 [0·19-0·35]; p<0·0001), inpatient days (RR 0·29 [0·26-0·32]; p<0·0001), and inpatient days including brief admissions (RR 0·44 [95% CI 0·40-0·48]; p<0·0001). Episodes of coercive care did not change significantly (RR 0·99 [95% CI 0·40-2·43]; p=0·98). Psychiatric evaluation due to persistent suicidal ideations immediately after discharge was required for five patients.

INTERPRETATION

Our findings suggest that brief admissions can be successfully implemented in paediatric psychiatry and appear to be an effective crisis management method for adolescents, associated with reduced demand for emergency care. Future randomised controlled trials are warranted.

FUNDING

Region Skåne Health Care Authority.

Microblog User Emotion Analysis Method Based on Improved Hierarchical Attention Mechanism and BiLSTM

The goal of Chinese fine-grained emotion analysis is to identify the target words corresponding to fine-grained elements from sentences and determine the corresponding emotional polarity for the target words. Aiming at the problem that the current Sina Microblog user emotion analysis methods have low accuracy and are difficult to effectively predict and manage, a Sina Microblog user emotion analysis method based on the Bidirectional Long Short-Term Memory algorithm (BiLSTM) and improved hierarchical attention mechanism is proposed. Firstly, an emotion analysis model is constructed based on text-level analysis and subjective and objective analysis, and the dimensionality curse problem of one-hot representation is solved by integrating the weighted word vector of TF-IDF. Then, by constructing a bidirectional long short-term memory neural network, the full acquisition of context information is realized, which increases the fine-grained elements of emotion analysis. Finally, by introducing an improved hierarchical attention mechanism, the network model can focus on different parts to achieve text classification and emotion analysis. Through simulation experiments, the proposed emotion analysis method and the other two methods are compared and analyzed under the condition of using the same database. The results show that the precision, recall, and F1 value of the method proposed in this paper are the best under 7 different emotion classifications, with the highest reaching 95.8%, 95.9%, and 96.1%, respectively, and the algorithm performance is better than the other two comparisons algorithm. It is proved that the proposed model has excellent performance.

Nonpharmacological Methods for Reducing Parental Concern for Infant Vaccine-Associated Pain

INTRODUCTION

Numerous studies demonstrate that parental concern for infant pain contributes to vaccine hesitancy. The purpose of this project was to alleviate parental concern for pain and facilitate infant immunization.

METHOD

Pediatric nurses at an urban ambulatory clinic implemented evidence-based nonpharmacological methods (breastfeeding or 24% sucrose solution) for managing vaccine pain in infants aged up to 6 months. A validated survey measured parental concern for vaccine-related pain before and after the implementation of pain relief interventions.

RESULTS

There was a statistically significant decrease in parental concern for vaccine pain from pre- to postintervention between both treatment groups (p = .035).

DISCUSSION

Nurses can effectively use nonpharmacological methods to alleviate the pain of infants undergoing routine vaccination while reducing the parental concern for vaccine-associated pain. Reducing infant pain and parental concern may increase vaccination rates.