1
|
Santos ACPDO, de Camargo CL, Vargas MADO, Araújo CNVD, Whitaker MCO, Zilli F, Martins RD, Gomes NP. A critical perspective on institutional violence against hospitalized children: Testimonies by health professionals and family members. Nurs Inq 2024:e12665. [PMID: 39138913 DOI: 10.1111/nin.12665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 08/15/2024]
Abstract
The purpose of this study is to understand institutional violence (IV) in the relationships between health professionals, hospitalized children, and family members. This is a qualitative study developed at the pediatric inpatient unit of a university hospital in the city of Salvador, Bahia, Brazil. The research participants consisted of 39 health professionals who specialized in pediatrics and 10 family members of hospitalized children. Semi-structured interviews were the method used for data collection. Using discourse analysis as a basis and taking a Foucauldian perspective, the researchers observed that the expressions of IV could be traced to abusive power relations within the system. We found four discursive forms within the data set: communication problems as IV, violence through inattention and neglect, violence as an action and consequent materialization on the body, and psychological violence as a submission mechanism. Based on these findings, we argue that professionals, managers, the scientific community, and users might be able to better guarantee the safety of children by recognizing IV and effectively intervening in it.
Collapse
Affiliation(s)
| | | | | | | | | | - Francielly Zilli
- Federal University of Santa Catarina, R. Delfino Conti, S/N - Trindade, Florianópolis, SC, Brazil
| | | | | |
Collapse
|
2
|
Koller D, Espin S, Indar A, Oulton A, LeGrow K. Children's participation rights and the role of pediatric healthcare teams: A critical review. J Pediatr Nurs 2024; 77:1-12. [PMID: 38461775 DOI: 10.1016/j.pedn.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 02/16/2024] [Accepted: 02/26/2024] [Indexed: 03/12/2024]
Abstract
AIM A critical review examined how childrens participation rights as represented in the United Nations Convention on the Rights of the Child inform the work of pediatric teams in healthcare settings. METHODS We systematically searched peer-reviewed literature on the enactment of child participation rights, within the context of pediatric teams. Articles were evaluated using the LEGEND (Let Evidence Guide Every New Decision) tool. Data extraction and analysis highlighted themes and disparities between articles, as well as gaps. A total of 25 studies were selected. RESULTS We reviewed studies from around the globe, with the majority of papers from the UK. Qualitative and mixed methods approaches were administered. The following observations were made: (1) limited language of children's rights exists in the literature, (2) lack of information regarding the composition of pediatric healthcare teams and how they work with children, (3) children's perspectives on what constitutes good interactions with healthcare providers are replicated, (4) minimal references to theory or philosophical underpinnings that can guide practice. CONCLUSION Explicit references to children's participation rights are lacking in the literature which may reflect the absence of rights language that could inform pediatric practice. Descriptive understandings of the tenets of pediatric interprofessional team composition and collaboration are necessary if we are to imagine the child as part of the team along with their family. Despite these shortcomings, the literature alludes to children's ability to discern desirable interactions with healthcare providers.
Collapse
Affiliation(s)
- Donna Koller
- School of Early Childhood Studies, Toronto Metropolitan University, Toronto, Canada.
| | - Sherry Espin
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Canada
| | - Alyssa Indar
- Nova Scotia Health/Dalhousie University, Halifax, Canada
| | - Angie Oulton
- School of Early Childhood Studies, Toronto Metropolitan University, Toronto, Canada
| | - Karen LeGrow
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Canada
| |
Collapse
|
3
|
Oberg C. The Child Friendly Cities Initiative-Minneapolis Model. Matern Child Health J 2024; 28:990-997. [PMID: 38416333 DOI: 10.1007/s10995-024-03921-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE The Child Friendly Cities Initiative (CFCI) is a UNICEF framework based on the UN Convention on the Rights of the Child (CRC). CFCI was launched globally in 1996 to protect children's rights throughout the world. There are child friendly cities in over 44 countries around the globe, but none presently in the United States. The purpose was to establish a Child Friendly City in the United States. DESCRIPTION Child friendly cities are a child-rights and equity-based approach designed to ensure all children in a community reach their full potential for optimal health, development, and well-being. The paper discusses the development of the guiding principles of the CFCI-Minneapolis Model as well as a community needs assessment. ASSESSMENT The assessment consisted of a digital survey of 60 questions on the SurveyMonkey platform. The sample included 173 Minneapolis youth 10-18 years of age and 85 parents with children less than five years of age. The participants were drawn from four of the 83 Minneapolis neighborhoods that had the highest concentration of children and youth, communities of color, and immigrant families that have historically been under resourced. CONCLUSION The results of the community assessment guided the development of four programmatic initiatives. These included child rights learning & awareness, emergency preparedness & planning, community safety, and youth participation in decision making. The paper concludes with the lesson learned to date in the implementation of the CFCI-Minneapolis Model. These include partnership, dedication, leadership, community engagement, coalition building, and celebrating success. CFCI-Minneapolis received full designation from UNICEF USA as a child friendly city in February 2024.
Collapse
Affiliation(s)
- Charles Oberg
- Division of Epidemiology and Community Health, Maternal and Child Health Program, School of Public Health, University of Minnesota, 1300 South 2nd Street, Minneapolis, MN, 55454, USA.
| |
Collapse
|
4
|
Gramc M. Challenges in Transition of Care for People with Variations in Sex Characteristics in the European Context. Healthcare (Basel) 2024; 12:354. [PMID: 38338239 PMCID: PMC10855080 DOI: 10.3390/healthcare12030354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
OBJECTIVE People with variations in sex characteristics (VSCs) have been receiving inadequate care for many decades. The Chicago consensus statement in 2006 aimed to introduce improved comprehensive care, which would include the transition of care from pediatric to adult services organized by multidisciplinary teams. Yet, the evidence for transitional care is scarce. The aim of this paper is to outline the delivery of transition of care for adolescents and young adults with VSCs. METHOD Seven focus groups were conducted with health care professionals and peer support groups by care teams in Central, Northern, and Western Europe. The data from the focus groups were examined using reflexive thematic analysis. RESULTS Even though the transition of care has been implemented in the last two decades, it remains inadequate. There are differences among countries, as the quality of care depends on available resources and variations in sex characteristics. Moreover, there are significant hurdles to adequate transition of care, as there is lack of time and funding. The lack of adult care providers and psychosocial support often leaves young adults with VSCs to navigate the health care system alone. CONCLUSION The outcome of the study shows that the transition of care is organized through the department of pediatric endocrinology. The quality of care varies due to resources and variations in sex characteristics. A lack of adult specialists, and especially psychosocial support, represents the biggest obstacle for young adults and adults in navigating the health care system and for improvements in the provision of health care to adults. There is a risk of re-traumatization, as adolescents and young adults must often repeat their medical history and educate adult care providers who are insufficiently trained and knowledgeable.
Collapse
Affiliation(s)
- Martin Gramc
- Institute of Biomedical Ethics and the History of Medicine, University of Zürich, 8006 Zürich, Switzerland
| |
Collapse
|
5
|
Abbott P, Nixon G, Stanley I, D’Ambruoso L. A protocol for a critical realist synthesis of school mindfulness interventions designed to promote pupils' mental wellbeing. Front Public Health 2024; 11:1309649. [PMID: 38264247 PMCID: PMC10803664 DOI: 10.3389/fpubh.2023.1309649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 12/27/2023] [Indexed: 01/25/2024] Open
Abstract
Introduction The review described in this protocol will be the first critical realist review of the literature reporting on the impact of school-based mindfulness interventions on the mental wellbeing of pupils. Mindfulness interventions are increasingly being introduced into schools to promote children's (and teachers') wellbeing. Findings from impact evaluations, including systematic reviews and metanalysis, suggest that school-based mindfulness interventions promote pupils' wellbeing. However, there is a need for further evidence on the underlying causal mechanisms and contexts that explain program outcomes, to provide insight into how mindfulness programs can be successfully implemented in other contexts. Methods and analysis A critical realist review methodology will be used to provide a causal interdisciplinary understanding of how school-based mindfulness interventions promote the mental wellbeing of pupils. This will be done through a systematic literature review and extrapolating context, agency, intervention, mechanisms, and outcome configurations. This will enable an understanding of how, in certain contexts, pupils can use the resources offered by a mindfulness intervention knowingly or unknowingly to trigger mechanisms that promote their mental wellbeing and what mechanisms in the context support, restrict or prevent change. We will then use retrodiction and retroduction to develop the most plausible interdisciplinary middle-range theory to explain the findings. Discussion The review findings will inform a critical realist evaluation of a mindfulness intervention in schools. The findings from the review will also enable us to inform policymakers and other stakeholders about what conditions need to be in place for mindfulness interventions to promote pupils' mental wellbeing. We will publish the findings from the review in academic and professional publications, policy briefs, workshops, conferences, and social media.PROSPERO registration number: CRD42023410484.
Collapse
Affiliation(s)
- Pamela Abbott
- Centre for Global Development, University of Aberdeen, Aberdeen, United Kingdom
- School of Education, University of Aberdeen, Aberdeen, United Kingdom
| | - Graeme Nixon
- Centre for Global Development, University of Aberdeen, Aberdeen, United Kingdom
- School of Education, University of Aberdeen, Aberdeen, United Kingdom
| | - Isabel Stanley
- Centre for Global Development, University of Aberdeen, Aberdeen, United Kingdom
- School of Education, University of Aberdeen, Aberdeen, United Kingdom
| | - Lucia D’Ambruoso
- Centre for Global Development, University of Aberdeen, Aberdeen, United Kingdom
- Aberdeen Centre for Health Data Science, University of Aberdeen, Aberdeen, United Kingdom
| |
Collapse
|
6
|
Chapman AR, Brunelli L, Forman L, Kaempf J. Promoting children's rights to health and well-being in the United States. LANCET REGIONAL HEALTH. AMERICAS 2023; 25:100577. [PMID: 37650073 PMCID: PMC10462822 DOI: 10.1016/j.lana.2023.100577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/28/2023] [Accepted: 08/03/2023] [Indexed: 09/01/2023]
Abstract
The United States has a highly sophisticated pediatric healthcare system and spends more than any other country per capita on children's healthcare. However, not all children have access to needed and affordable health care and the life expectancy and health outcomes of children in the country are worse than in any other industrialized nation. These nations typically offer universal healthcare for children as part of a robust recognition of a children's rights framework. In 1989 the United Nations adopted the Convention on the Rights of the Child that recognizes the right of the child to the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. Currently the United States is the only United Nations member country that has not ratified the Convention on the Rights of the Child. This paper outlines the potential benefits of adopting a child rights approach based on the principles and provisions of the Convention on the Rights of the Child. The fact that countries who invest much less in healthcare compared to the United States can achieve better health outcomes provides the certainty that a solution is possible and within reach.
Collapse
Affiliation(s)
- Audrey R. Chapman
- Department of Public Health Sciences, UConn Health, Farmington, CT, USA
| | - Luca Brunelli
- Department of Pediatrics/Neonatology, University of Utah Health/Primary Children’s Hospital, Salt Lake City, UT, USA
| | - Lisa Forman
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Joseph Kaempf
- Providence Health System, Women and Children’s Services, Portland, OR, USA
| |
Collapse
|
7
|
Barnert E, Wright J, Choi C, Todres J, Halfon N, Adedokun LA, Akl A, Alexander DT, Alvarez ME, Aron LY, Auerswald CL, Barbosa G, Battle GC, Bunnett DM, Chow G, Christakis DA, Counts NZ, El-Amin Champion TS, Engman MG, Ewing TJ, Gentile-Montgomery CR, Godoy B, Goldhagen JL, Gran B, Hernandez G, Iyer P, Jones-Taylor M, Kemp JM, Kirsch KA, Lansdown G, Lazarus W, Lesley B, Lombardi J, López Hernández G, Mejia-Garzaro BN, Michael Brown K, Morales X, Moulton MK, Peiffer MB, Peńa AR, Pitre N, Porayouw WF, Poterek LA, Santana S, Sayed RS, Schotland MS, Thomas III BL, Togi D(DL, Woodhouse B, Zhang A. Reimagining Children's Rights in the US. JAMA Pediatr 2022; 176:1242-1247. [PMID: 36279125 DOI: 10.1001/jamapediatrics.2022.3822] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
IMPORTANCE The US faces a pivotal moment of opportunity and risk regarding issues affecting children (aged 0-17 years). Although the US remains the only United Nations member state to not have ratified the Convention on the Rights of the Child (CRC), a child rights framework is essential for child health professionals seeking to advance many issues affecting children in the US. The Reimagining Children's Rights project (2020-2021) conducted an in-depth environmental scan of relevant literature and policy analysis using the Three Horizons design process to assess strategies that could advance the rights and well-being of children in the US. The project was overseen by a steering committee and informed by an advisory committee composed of youth leaders and experts in children's rights, advocacy, health, law, and a range of child-specific issues (eg, youth justice, early childhood development), who provided expert input on strategic considerations for advancing children's rights. OBSERVATIONS Seven findings about advancing children's rights in the US are notable, all reflecting current gaps and opportunities for using a whole-child rights framework in the US, even without formal adoption of the CRC. Actionable strategies, tactics, and tools to leverage sustainable change in the multitude of issue areas can advance the current state of children's rights. High-potential strategies for catalyzing advancement of children's rights include youth activism, innovations in governance and accountability, legislative action, impact litigation, place-based initiatives, education and public awareness, alignment with other children's movements, and research. The child rights framework is unifying and adaptive to future unforeseen challenges. CONCLUSIONS AND RELEVANCE Children's rights provide a powerful, synergistic framework for child health professionals-in partnership with youth and other leaders-to increase equity and protect the rights and well-being of all children in the US.
Collapse
Affiliation(s)
- Elizabeth Barnert
- Department of Pediatrics, David Geffen School of Medicine at UCLA, University of California, Los Angeles.,UCLA Center for Healthier Children, Families, and Communities, University of California, Los Angeles.,Children's Discovery & Innovation Institute, Mattel Children's Hospital, University of California, Los Angeles
| | - Joseph Wright
- UCLA Center for Healthier Children, Families, and Communities, University of California, Los Angeles.,Department of Education, School of Education and Information Sciences, University of California, Los Angeles.,Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles
| | - Charlene Choi
- Department of Pediatrics, David Geffen School of Medicine at UCLA, University of California, Los Angeles.,UCLA Center for Healthier Children, Families, and Communities, University of California, Los Angeles.,Department of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | | | - Neal Halfon
- Department of Pediatrics, David Geffen School of Medicine at UCLA, University of California, Los Angeles.,UCLA Center for Healthier Children, Families, and Communities, University of California, Los Angeles.,Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles.,Department of Public Policy, Luskin School of Public Affairs, University of California, Los Angeles
| | | | - Lola A Adedokun
- for the Reimagining Children’s Rights Steering Committee, Advisory Committee, and Project Team
| | - Abdullah Akl
- for the Reimagining Children’s Rights Steering Committee, Advisory Committee, and Project Team
| | - David T Alexander
- for the Reimagining Children’s Rights Steering Committee, Advisory Committee, and Project Team
| | - Mayra E Alvarez
- for the Reimagining Children’s Rights Steering Committee, Advisory Committee, and Project Team
| | - Laudan Y Aron
- for the Reimagining Children’s Rights Steering Committee, Advisory Committee, and Project Team
| | - Colette L Auerswald
- for the Reimagining Children’s Rights Steering Committee, Advisory Committee, and Project Team
| | - Gabriella Barbosa
- for the Reimagining Children’s Rights Steering Committee, Advisory Committee, and Project Team
| | - Gabrielle C Battle
- for the Reimagining Children’s Rights Steering Committee, Advisory Committee, and Project Team
| | - Dana M Bunnett
- for the Reimagining Children’s Rights Steering Committee, Advisory Committee, and Project Team
| | - Giselle Chow
- for the Reimagining Children’s Rights Steering Committee, Advisory Committee, and Project Team
| | - Dimitri A Christakis
- for the Reimagining Children’s Rights Steering Committee, Advisory Committee, and Project Team
| | - Nathaniel Z Counts
- for the Reimagining Children’s Rights Steering Committee, Advisory Committee, and Project Team
| | | | - Mark G Engman
- for the Reimagining Children’s Rights Steering Committee, Advisory Committee, and Project Team
| | - Toby J Ewing
- for the Reimagining Children’s Rights Steering Committee, Advisory Committee, and Project Team
| | | | - Blanca Godoy
- for the Reimagining Children’s Rights Steering Committee, Advisory Committee, and Project Team
| | - Jeffrey L Goldhagen
- for the Reimagining Children’s Rights Steering Committee, Advisory Committee, and Project Team
| | - Brian Gran
- for the Reimagining Children’s Rights Steering Committee, Advisory Committee, and Project Team
| | - Giovanni Hernandez
- for the Reimagining Children’s Rights Steering Committee, Advisory Committee, and Project Team
| | - Puja Iyer
- for the Reimagining Children’s Rights Steering Committee, Advisory Committee, and Project Team
| | - Myra Jones-Taylor
- for the Reimagining Children’s Rights Steering Committee, Advisory Committee, and Project Team
| | - Jasmin M Kemp
- for the Reimagining Children’s Rights Steering Committee, Advisory Committee, and Project Team
| | - Kayla A Kirsch
- for the Reimagining Children’s Rights Steering Committee, Advisory Committee, and Project Team
| | - Gerison Lansdown
- for the Reimagining Children’s Rights Steering Committee, Advisory Committee, and Project Team
| | - Wendy Lazarus
- for the Reimagining Children’s Rights Steering Committee, Advisory Committee, and Project Team
| | - Bruce Lesley
- for the Reimagining Children’s Rights Steering Committee, Advisory Committee, and Project Team
| | - Joan Lombardi
- for the Reimagining Children’s Rights Steering Committee, Advisory Committee, and Project Team
| | | | - Brianna N Mejia-Garzaro
- for the Reimagining Children’s Rights Steering Committee, Advisory Committee, and Project Team
| | - Keaun Michael Brown
- for the Reimagining Children’s Rights Steering Committee, Advisory Committee, and Project Team
| | - Xavier Morales
- for the Reimagining Children’s Rights Steering Committee, Advisory Committee, and Project Team
| | - Melissa K Moulton
- for the Reimagining Children’s Rights Steering Committee, Advisory Committee, and Project Team
| | - Matthew B Peiffer
- for the Reimagining Children’s Rights Steering Committee, Advisory Committee, and Project Team
| | - Andrea R Peńa
- for the Reimagining Children’s Rights Steering Committee, Advisory Committee, and Project Team
| | - Nikki Pitre
- for the Reimagining Children’s Rights Steering Committee, Advisory Committee, and Project Team
| | - William F Porayouw
- for the Reimagining Children’s Rights Steering Committee, Advisory Committee, and Project Team
| | - Lauren A Poterek
- for the Reimagining Children’s Rights Steering Committee, Advisory Committee, and Project Team
| | - Sandy Santana
- for the Reimagining Children’s Rights Steering Committee, Advisory Committee, and Project Team
| | - Rimsha S Sayed
- for the Reimagining Children’s Rights Steering Committee, Advisory Committee, and Project Team
| | - Marieka S Schotland
- for the Reimagining Children’s Rights Steering Committee, Advisory Committee, and Project Team
| | - Bernard L Thomas III
- for the Reimagining Children’s Rights Steering Committee, Advisory Committee, and Project Team
| | - Dashuri (Dash) L Togi
- for the Reimagining Children’s Rights Steering Committee, Advisory Committee, and Project Team
| | - Barbara Woodhouse
- for the Reimagining Children’s Rights Steering Committee, Advisory Committee, and Project Team
| | - Adrianna Zhang
- for the Reimagining Children’s Rights Steering Committee, Advisory Committee, and Project Team
| | | |
Collapse
|
8
|
Navein A, McTaggart J, Hodgson X, Shaw J, Hargreaves D, Gonzalez-Viana E, Mehmeti A. Effective healthcare communication with children and young people: a systematic review of barriers and facilitators. Arch Dis Child 2022; 107:1111-1116. [PMID: 36008089 DOI: 10.1136/archdischild-2022-324132] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/10/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To identify children and young people's preferences for effective healthcare communication. DESIGN A systematic review of qualitative studies was conducted to identify evidence from children and young people on effective healthcare communication. Electronic databases and reference lists of relevant articles were searched to July 2020. RESULTS A total of 13 studies were included. Five major themes were identified: medical information (timing, amount, coordination and futures), person not patient (creating relationships, time, nurse involvement, sensitivity), type of communication (creative and interactive, behavioural, talking and listening, written communication), consultations (first impressions, with and without parents, actively promoting involvement, open and honest, age appropriate) and communication with parents (using parental knowledge, support). CONCLUSIONS Research in this area remains sparse and consistent implementation is debateable. Children and young people articulate a preference for two-way healthcare communication. General principles for effective communication are identified as well as the need to avoid making assumptions and to tailor approaches to individuals. Establishing and maintaining relationships is essential and requires time and resources. Parents and carers have a positive role in healthcare communication which needs to be balanced with the needs and rights of children. All these factors also apply to children with communication difficulties or from marginalised groups, but additional extra support may be required. PROSPERO REGISTRATION NUMBER CRD42019145539.
Collapse
Affiliation(s)
- Alice Navein
- Royal College of Obstetricians and Gynaecologists, London, UK
| | - James McTaggart
- Highland Council, Inverness, UK .,School of Humanities, Social Sciences and Law, University of Dundee, Dundee, UK
| | | | - Joanna Shaw
- London Ambulance Service NHS Trust, London, UK
| | - Dougal Hargreaves
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Eva Gonzalez-Viana
- Department of Clinical, Educational and Health Psychology, University College London, London, UK.,National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London, UK
| | - Agnesa Mehmeti
- National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London, UK
| |
Collapse
|
9
|
Wood MD, Correa K, Ding P, Sreepada R, Loftsgard KC, Jordan I, West NC, Whyte SD, Portales-Casamar E, Görges M. Identification of Requirements for a Postoperative Pediatric Pain Risk Communication Tool: Focus Group Study With Clinicians and Family Members. JMIR Pediatr Parent 2022; 5:e37353. [PMID: 35838823 PMCID: PMC9338417 DOI: 10.2196/37353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Pediatric surgery is associated with a risk of postoperative pain that can impact the family's quality of life. Although some risk factors for postoperative pain are known, these are often not consistently communicated to families. In addition, although tools for risk communication exist in other domains, none are tailored to pediatric surgery. OBJECTIVE As part of a larger project to develop pain risk prediction tools, we aimed to design an easy-to-use tool to effectively communicate a child's risk of postoperative pain to both clinicians and family members. METHODS With research ethics board approval, we conducted virtual focus groups (~1 hour each) comprising clinicians and family members (people with lived surgical experience and parents of children who had recently undergone surgery/medical procedures) at a tertiary pediatric hospital to understand and evaluate potential design approaches and strategies for effectively communicating and visualizing postoperative pain risk. Data were analyzed thematically to generate design requirements and to inform iterative prototype development. RESULTS In total, 19 participants (clinicians: n=10, 53%; family members: n=9, 47%) attended 6 focus group sessions. Participants indicated that risk was typically communicated verbally by clinicians to patients and their families, with severity indicated using a descriptive or a numerical representation or both, which would only occasionally be contextualized. Participants indicated that risk communication tools were seldom used but that families would benefit from risk information, time to reflect on the information, and follow-up with questions. In addition, 9 key design requirements and feature considerations for effective risk communication were identified: (1) present risk information clearly and with contextualization, (2) quantify the risk and contextualize it, (3) include checklists for preoperative family preparation, (4) provide risk information digitally to facilitate recall and sharing, (5) query the family's understanding to ensure comprehension of risk, (6) present the risk score using multimodal formats, (7) use color coding that is nonthreatening and avoids limitations with color blindness, (8) present the most significant factors contributing to the risk prediction, and (9) provide risk mitigation strategies to potentially decrease the patient's level of risk. CONCLUSIONS Key design requirements for a pediatric postoperative pain risk visualization tool were established and guided the development of an initial prototype. Implementing a risk communication tool into clinical practice has the potential to bridge existing gaps in the accessibility, utilization, and comprehension of personalized risk information between health care professionals and family members. Future iterative codesign and clinical evaluation of this risk communication tool are needed to confirm its utility in practice.
Collapse
Affiliation(s)
- Michael D Wood
- Department of Anesthesiology Pharmacology and Therapeutics, The University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Kim Correa
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,School of Information, The University of British Columbia, Vancouver, BC, Canada
| | - Peijia Ding
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Rama Sreepada
- Department of Anesthesiology Pharmacology and Therapeutics, The University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | | | | | - Nicholas C West
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Simon D Whyte
- Department of Anesthesiology Pharmacology and Therapeutics, The University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Elodie Portales-Casamar
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Pediatrics, The University of British Columbia, Vancouver, BC, Canada
| | - Matthias Görges
- Department of Anesthesiology Pharmacology and Therapeutics, The University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| |
Collapse
|
10
|
Gugglberger L, Flaschberger E, Degelsegger-Márquez A. [Children's rights in Austrian hospitals: implementation factors for children's participation]. Monatsschr Kinderheilkd 2022; 172:1-7. [PMID: 35578683 PMCID: PMC9097564 DOI: 10.1007/s00112-022-01505-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 03/24/2022] [Indexed: 11/28/2022]
Abstract
Background Various studies show that it is important for children and adolescents (as well as their parents) to be involved and have a say in decisions regarding treatment. Nevertheless, it seems that participation processes are not necessarily implemented into hospital routines everywhere. So far, no study has been conducted on the implementation of children's rights or participation in Austrian hospitals. Objective Our study aimed at investigating the extent to which children's rights (especially the right to participation) and the European Association of Children in Hospital (EACH) Charter are known in Austrian hospitals, how they are implemented, and which facilitating and hindering factors can be identified. Methods A questionnaire survey was conducted among the chief medical and nursing staff on wards where children and adolescents are treated (n = 133), and qualitative interviews were conducted with experts on children's rights, medical and nursing staff, parents and one adolescent girl (n = 15). The results and recommendations for action that were derived from the data were discussed and validated in an expert workshop. Results The medical and nursing staff in Austrian children's and adolescents' wards are already doing a lot to implement and uphold children's rights. There is awareness of the need for child-centered treatment and the need to allow children and adolescents to participate during their hospital stay. Nevertheless, the interviews with parents show that there are large differences between hospitals and that there is still a lot to be done. Conclusion Based on the results, three areas for recommendations for action were identified: 1) anchoring children's rights, both legally and in the training of medical and nursing staff, 2) strengthening the team and feedback culture, e.g., through more staff resources for good teamwork and 3) good health information and good conversation quality. This means that health information for children and adolescents should be quality assured, comprehensible, evidence-based and on aspects relevant to them. Conversations between health professionals and patients and their relatives, should be patient-centered, which can be promoted through training, introduction of quality standards and guidelines.
Collapse
|
11
|
O’Connor D, Lynch H, Boyle B. A qualitative study of child participation in decision-making: Exploring rights-based approaches in pediatric occupational therapy. PLoS One 2021; 16:e0260975. [PMID: 34914778 PMCID: PMC8675724 DOI: 10.1371/journal.pone.0260975] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/19/2021] [Indexed: 11/24/2022] Open
Abstract
Background According to Article 12 of the United Nations Convention on the Rights of the Child, therapists are duty-bound to include children in decisions that impact them. Although occupational therapists champion client-centred, collaborative practice, there remains a paucity of studies detailing children’s rights and experiences of decision-making in pediatric occupational therapy. Purpose This qualitative study described the decision-making experiences of children, parents and therapists in occupational therapy. Methods Semi-structured interviews were conducted with 17 participants (six children, five parents and six occupational therapists), and data analysed using thematic analysis. Findings Three themes emerged: 1) Goal-setting experiences; 2) Adults: child-rights gatekeepers or defenders? and 3) Decision-making in context. Findings suggest that decision-making is mostly adult directed, and children’s voices are subsumed by adult-led services, priorities, and agendas. Implications Children’s rights need to be embedded as an aspect of best practice in providing services that are child-centred in occupational therapy practices and education.
Collapse
Affiliation(s)
- Deirdre O’Connor
- Department of Occupational Science and Occupational Therapy, University College Cork, Cork, Ireland
- * E-mail:
| | - Helen Lynch
- Department of Occupational Science and Occupational Therapy, University College Cork, Cork, Ireland
| | - Bryan Boyle
- Department of Occupational Science and Occupational Therapy, University College Cork, Cork, Ireland
| |
Collapse
|