Down's syndrome: experiences of mothers from different cultures

A different type of appointment: the experiences of parents who have children with intellectual disabilities referred for genetic investigation

Current research endeavours in genetics largely concentrate on developing more effective approaches to genetic investigation and treatment for individuals. By contrast, less attention has been paid to the impact of genetic referral on the parents of children undergoing investigation, in particular which aspects of the referral process that contribute to increased anxiety reported by parents attending a genetics appointment. The overall aim of this project was to gain an understanding of the experience of parents who have a child referred for genetic investigation. This paper reports how parents perceived an appointment with a geneticist as being `different' from appointments with other doctors they had attended. Using an Interpretative Phenomenological Analysis (IPA) design information was obtained using preappointment self-completion questionnaires with 19 parents that they completed in the two weeks prior to their appointment. After the appointment semi-structured interviews with 17 of these parents within three months of the appointment with the geneticist. In addition, a second interview with 10 parents (of the above 17 parents) for whom genetic investigation were continuing was completed approximately nine months following their initial appointment with the geneticist. All parents who agreed to participate in this study were parents of children with intellectual disabilities. Overall, four superordinate themes were identified, these were: seeking information — the wider context; a different type of appointment; interpreting information and experiences and parents' changing perspectives. The findings reinforce the findings of previous studies that have highlighted the desire of parents to receive an explanation of their child's condition, the wider impact of being referred to and attending an appointment with a geneticist and the role that receiving a diagnosis can play in parents' process of adaptation to their child's condition. However, this study provided a new insight into how parents perceive their appointment with a geneticist as being different from other doctors they have attended. The findings of this study highlight the need to recognise the different manner in which parents perceive an appointment with a geneticist in comparison with appointments with other doctors. The illumination of the perceived `differentness' that parents have prior to and during an appointment with a geneticist appointment provides a new insight into why parents may be anxious as a result of the processes involved. In seeking to support the parents of children referred to a geneticist, health professionals should identify parents' understanding and expectations of the appointment and provide timely information and support in order to assist parents prepare for the appointment and make maximum use of this opportunity to raise and understand new information.

Establishing components of cultural competence healthcare models to better cater for the needs of migrants with disability: a systematic review

This study examined the challenges of providing services to migrants with disability (MWD), including healthcare providers’ (HCP) level of cultural competence, and documented components of the cultural competence framework required to reduce disability-related health inequalities. This systematic review was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Six databases were searched from January 2000 to August 2013: Ovid Medline, Ovid PsychINFO, EMBASE, CINHAL plus, Informit health databases and Scopus. The search focused on MWD, carers of MWD and HCP working with MWD in industrialised countries. The search yielded 271 articles of which 11 met the inclusion criteria (10 qualitative and 1 quantitative). While HCP perceived themselves as being culturally competent, carers of MWD felt that HCP needed to be more culturally competent as MWD’s needs were not being adequately addressed due to cultural misunderstandings and disrespect of cultural values, beliefs and traditions. The review found one existing healthcare model intended for use with MWD; however, the lack of specific attention to cultural competency limits its clinical utility. The findings of this review led to the development of suggested components to be included in a cultural competence model for HCP working with MWD.

Quality of life among Malaysian mothers with a child with Down syndrome

The purpose of this paper is to examine the quality of life (QOL) among mothers with a child with Down syndrome using The World Health Organization Quality of Life scale instrument. A convenience sample of 161 mothers was accessed through the various institutions which provide interventional or educational programmes to children with disabilities within two of the regions of the Borneo State of Malaysia (Sarawak). Nearly half of the group of mothers perceived their QOL as neither poor nor good (n = 73). An overall QOL score of 14.0 ± 1.84 was obtained. The highest and lowest domain scores were found for social relationship domain (Mean = 14.9 ± 2.1) and environmental support domain (Mean = 13.3 ± 2.1) respectively. Correlation analysis of selected background variables (i.e. locality, education, income and marital status) and overall QOL indicated rho (161) = 0.22-0.28 (P < 0.01). Inverse correlation between maternal age and overall QOL score was indicated, with rho (161) = -0.17 (P < 0.05). Linear regression analysis indicated that the combination of these few variables together accounted for 14.5% of the QOL variability in the sample. Findings point to implications for priorities of care provisions by policy-makers and care professionals in their practice.

Health inequity in children and youth with chronic health conditions

BACKGROUND

Over the last decades, there have been great advances in health care delivered to children with chronic conditions, but not all children have benefitted equally from them.

OBJECTIVES

To describe health inequities experienced by children with chronic health conditions.

METHODS

We performed a literature review of English-language studies identified from the Medline, Centers for Disease Control and Prevention, National Cancer Institute, and Cystic Fibrosis Foundation Web sites that were published between January 1985 and May 2009, included children aged 0 to 18 years, and contained the key words "incidence," "prevalence," "survival," "mortality," or "disparity" in the title or abstract for the following health conditions: acute leukemia, asthma, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorders, cerebral palsy, cystic fibrosis, diabetes mellitus, Down syndrome, HIV/AIDS, major congenital heart defects, major depressive disorder, sickle cell anemia, spina bifida, and traumatic brain injury.

RESULTS

Black children had higher rates of cerebral palsy and HIV/AIDS, were less likely to be diagnosed with ADHD, had more emergency department visits, hospitalizations, and had higher mortality rates associated with asthma; and survived less often with Down syndrome, type 1 diabetes, and traumatic brain injury when compared with white children. Hispanic children had higher rates of spina bifida from Mexico-born mothers, had higher rates of HIV/AIDS and depression, were less likely to be diagnosed with ADHD, had poorer glycemic control with type 1 diabetes, and survived less often with acute leukemia compared with white children.

CONCLUSIONS

Serious racial and ethnic health and health care inequities persist for children with chronic health conditions.

The size, extent and nature of the learning disability nursing research base: a systematic scoping review

BACKGROUND

A research base should be of sufficient quality and quantity to inform nursing practice. It must allow nurses to access information about clients' needs and to identify effective strategies for meeting those needs. This paper presents the findings of a scoping review of 'learning disability nursing research'. The review aimed to determine whether there is a research base sufficient to support learning disability nursing practice.

METHOD

We undertook searches of the Cochrane Library and electronic databases (Medline, Psychinfo, Embase, CINAHL and British Nursing Index) for the years 1996-2006. Full references and abstracts were downloaded for papers returned. Papers considered relevant to the topic of the review were organised into three categories according to whether the main focus of the research was people with learning disabilities, carers or family members, or nurses. For each paper, information about the locality of the research, the topic of the research, design/method and sample size was extracted.

FINDINGS

We identified 180 relevant research studies, most of which made use of convenience samples of less than one hundred people. Very few studies evaluated the clinical impact of nursing interventions or the delivery of care by learning disability nurses. A small number of studies examined the impact or patient experiences of nurse-led interventions. These tend to small-scale evaluations of new service initiatives, such as the management of behavioural problems. Overall there was an absence of strong evidence about the effectiveness of specific nursing interventions.

CONCLUSIONS

The extent of learning disability nursing research is limited in quantity and it is difficult to draw comparisons across research studies. Much of the available evidence is drawn from small-scale evaluations; which may provide useful guidance and inspiration for service development but do not, in themselves, constitute a sufficient body of research evidence to support learning disability nursing practice.