Comparison of mother-father perceptions of their child's self-management of diabetes

"The logic of care" - parents' perceptions of the educational process when a child is newly diagnosed with type 1 diabetes

BACKGROUND

The number of new cases of type 1 diabetes mellitus (T1DM) has increased substantially in recent years and it is now one of the most common long-term endocrine disorders in childhood. In Sweden the child and family are hospitalised in accordance with the national guidelines for one to two weeks at diagnosis. The purpose of this study was to describe parents' perceptions of the educational process when their child is newly diagnosed with T1DM.

METHODS

Qualitative interviews were performed in the south western part of Sweden with ten mothers and eight fathers of children, diagnosed with T1DM, at three to six months after they had received the diagnosis. The interviews were analysed using deductive content analysis and Mol's philosophical theory.

RESULTS

The results show that almost all parents had experienced the educational process as being satisfactory. However, most parents felt that the teaching needed to be adapted to the individual families and to help them to learn to live with diabetes in their everyday lives. Rather than merely teaching according to a fixed schedule and cramming knowledge, the education should be parent-centered and provide time for grief and shock. There should also be a greater emphasis on why certain things should be done rather than on what should be done. The routines learned at the hospital made the efforts to be good parents managing the child's disease, and continuing to lead a normal family life, a difficult task.

CONCLUSIONS

In order to optimize the educational process for families with children newly diagnosed with T1DM an increased focus on the families' perceptions might be helpful in that this could lead to further revelations of the educational process thus making it more understandable for the family members involved.

Mother-father informant discrepancies regarding diabetes management: associations with diabetes-specific family conflict and glycemic control

OBJECTIVE

To examine the relationship of mother-father informant discrepancies regarding diabetes management to diabetes-specific family conflict and glycemic control.

METHODS

One hundred thirty-six mothers and fathers of youth with Type 1 diabetes reported on the youth's diabetes management, diabetes-specific family conflict, and amount of paternal involvement in diabetes care. Glycosylated hemoglobin A1c (HbA1c) was used to measure glycemic control.

RESULTS

As hypothesized, mother-father discrepancies regarding diabetes management were positively associated with frequency of diabetes-specific family conflict. Contrary to hypotheses, mother-father discrepancies regarding diabetes management predicted poorer glycemic control for youth with less involved fathers only.

CONCLUSIONS

Results highlight the importance of caregivers being consistent about pediatric illness management and support the idea that informant discrepancies represent an important window into the functioning of the family system.

A Review of Diabetes Mellitus–Specific Family Assessment Instruments

Family dynamics and attributes are increasingly recognized as affecting management of diabetes mellitus (DM); however, little research has been done on the validity and usefulness of family assessment instruments (FAIs). This article reviewed the literature that employs DM-specific FAIs and evaluates whether the instruments comprehensively captured family attributes/processes and were robust enough to be useful in understanding the relationship between family attributes/issues and DM-related health care. Studies using eight instruments were identified through a search of literature published from 1982 to 2010 and were analyzed with criteria derived from the measurement and family literatures. The findings of this study revealed that DM-specific FAIs yield useful data about family-related phenomenon; however, some domains of DM-specific care, such as family dynamics/functioning, were not overtly measured. Suggestions for improving DM-specific FAIs are provided and a rationale for why DM-specific and non-DM-specific FAIs is needed to fully measure family issues related to family dynamics/attributes on DM patient care.

A concept analysis: assuming responsibility for self-care among adolescents with type 1 diabetes

PURPOSE

This concept analysis clarifies "assuming responsibility for self-care" by adolescents with type 1 diabetes.

METHODS

Walker and Avant's (2005) methodology guided the analysis.

RESULTS

Assuming responsibility for self-care was defined as a process specific to diabetes within the context of development. It is daily, gradual, individualized to person, and unique to the task. The goal is ownership that involves autonomy in behaviors and decision-making.

PRACTICE IMPLICATIONS

Adolescents with type 1 diabetes need to be assessed for assuming responsibility for self-care. This achievement has implications for adolescents' diabetes management, short- and long-term health, and psychosocial quality of life.

Fathers of children and adolescents with diabetes: what do we know?

Knowing how fathers contribute to child outcomes is critical in the clinical management of children who have type 1 diabetes. The purposes of this review were to synthesize what is known about the role of fathers and to determine directions for future research. Research studies that reported findings that encompassed fathers' perceptions, knowledge, coping and adjustment, and behavior in relation to their children with type 1 diabetes were reviewed. Research suggests that, although fathers are usually not the primary caregiver or manager of the routine day-to-day care, their contribution to the family through perceptions, knowledge, adjustment, and behavior may be associated with important disease management outcomes.

Self-care of young adolescents with type 1 diabetes

The purpose of this study was to describe the universal and health deviation self-care of adolescents with Type 1 diabetes and the associations of basic conditioning factors with universal and health deviation self-care. Subjects for this study were 152 adolescents aged between 11 and 15 years with a diagnosis of Type 1 diabetes. Data were collected in the home setting of each adolescent and his or her family. The mean universal self-care scores ranged from 66.62% to 90%. The overall mean for this sample was 75.37, indicating that these adolescents took care of their self-care needs 75% of the time. Health deviation self-care was a mean of 27.26, indicating more positive self-care behaviors and treatment adherence. Health deviation and universal self-care were significantly and positively related (r = .36, p < .001). Ethnicity and adolescent sex were statistically significant in predicting universal self-care. Adolescent age was statistically significant in predicting health deviation self-care. Health deviation self-care decreases with age, suggesting that early adolescence or late school age is an appropriate time for interventions to strengthen self-care behaviors. Furthermore, the interrelationship of the two types of self-care supports the potential for a synergistic effect of intervention.

Fathers??? Reflections on Parenting Young Children With Type 1 Diabetes

PURPOSE

To describe fathers' experiences in parenting and managing the care of their young children with type 1 diabetes.

DESIGN AND METHODS

This qualitative descriptive study used 16 open-ended, in-depth interviews with 14 purposively selected, involved, educated, stably employed fathers of 15 children younger than 10 years old. The fathers were asked to describe their perspective of the initial diagnosis, how they learned diabetes care, their day-to-day care and parenting experiences, and what strategies they used in the day-to-day management. Data were managed using NVivo software and analyzed using principles of naturalistic inquiry and qualitative content analysis.

RESULTS

The overarching theme was "From sadness to action," with six categories emerging: (1) "shock and awe" (after diagnosis), (2) quick response to the diagnosis and learning diabetes care: "suck it up and do it," (3) "staying in the loop" (practicing the skills, tasks, and responsibilities of diabetes management), (4) "partnerships in care" (tag teaming or co-parenting), (5) active participation (being actively involved in their children's day-to-day care and benefiting from participating in this care), and (6) mantra for living with diabetes: child first, diabetes second.

CLINICAL IMPLICATIONS

Nurses working with children with diabetes can use the results of this study to better understand the role of fathers in the care of these children. Fathers underscored the importance of practicing diabetes care-related tasks to improve their confidence when caring for children alone. Their practical and philosophical strategies for managing their children's chronic illness have recently been incorporated into a parent mentor intervention for children newly diagnosed with type 1 diabetes.

Paternal reactions to a child with epilepsy: uncertainty, coping strategies, and depression

AIM

This paper reports a study examining the stress that fathers experience when caring for a child with epilepsy.

BACKGROUND

A seizure, which is frightening and potentially damaging, creates uncertainty about its possible effects and threatens the integrity of family systems. In the Chinese social context, epilepsy is stereotyped 'sudden craziness' of people and affected family feel shamed by the diagnosis. When a child has epilepsy, the stereotype of epilepsy affects the family experience in terms of stress and their coping process. Few studies have focused on how a father with an ill child adapts to family stress.

METHODS

This study was based on the resiliency model of family stress, adjustment, and adaptation, and was designed to examine the relationships among fathers' uncertainty, coping strategies, and depression. From three teaching hospitals in Taiwan, 210 fathers were recruited. A pilot study was conducted to establish the reliability and face validity of the Chinese language version of the Coping Health Inventory for Parents.

FINDINGS

Results showed that paternal uncertainty was negatively associated with the total Coping Health Inventory for Parents score for family coping patterns for factors I, II, and III. Uncertainty and coping strategies for factors II and III were indicators of paternal depression and accounted for 10.3% of the total variance.

CONCLUSIONS

The results give insight into the unique family stress that fathers experience as a result of the interaction between the social context of a child with epilepsy and the family's coping patterns. They also suggest ways to improve family-centred nursing interventions to help parents establish effective caring patterns to manage the family stress.

The concept of self-management of type 1 diabetes in children and adolescents: an evolutionary concept analysis

AIM

An evolutionary concept analysis was undertaken to clarify the concept of self-management of type 1 diabetes in children and adolescents.

BACKGROUND

Several problems exist in the literature on self-management of type 1 diabetes in children and adolescents. There is no uniform terminology and there is no uniform definition of the concept. Also, there is no differentiation in the literature between self-management of diabetes in children and adults.

METHODS

Ninety-nine references were reviewed and analysed in the disciplines of nursing, medicine, and psychology. After separate analyses revealed no significant differences across disciplines, the analyses were combined to describe the attributes, antecedents, consequences, and surrogate and related concepts.

RESULTS

The three essential attributes of the concept were identified as process, activities, and goals. Self-management of type 1 diabetes in children and adolescents is an active and proactive process; it is daily, lifelong, and flexible, and it involves shifting and shared responsibility for diabetes care tasks and decision-making between child and parent. It is a process that involves collaboration with health care providers. Self-management of type 1 diabetes in children and adolescents also consists of varied and many activities related to giving insulin, monitoring metabolic control, regulating diet and exercise, to name just a few. The concept also involves goals, which may differ from one parent/child dyad to another. A working definition of the concept is suggested.

CONCLUSIONS

It is hoped that a more uniform definition of the concept will enable researchers to continue investigating antecedents and consequences of the concept in a way that allows for aggregating results.

The paediatric diabetes specialist nurse and diabetes education in childhood

AIMS OF THE STUDY

The aim of this study was to identify the job title, work setting, qualifications and training of the paediatric diabetes specialist nurse (PDSN) as well as to examine the composition of the multidisciplinary diabetes team. It also aimed to determine who is involved in diabetes education and to explore the teaching methods, approaches, tools and materials that the PDSN uses in the educational process.

DESIGN AND METHODS

A survey design was used. Questionnaires, which combined quantitative and qualitative approaches, were sent to 80 participants from eight opportunistically selected regions of the United Kingdom (UK). Access to names and addresses was gained through the directory of diabetes specialist nurses (DSNs). The selection criteria were nurses working full-time with children with diabetes or having children with diabetes on their caseloads. The overall response rate was 66 (82.5%).

FINDINGS

The study findings showed that the majority of the respondents were based in both hospital and community, held paediatric qualifications and had undertaken further training to prepare as diabetes specialists. Respondents used a wide range of teaching methods and materials in the educational process. A substantial number of individuals and voluntary organizations were also involved in diabetes education.

CONCLUSIONS

The findings of this study support the belief that the PDSN, as a member of the multidisciplinary paediatric diabetes team, has a key role in the education of children with diabetes and their parents/carers. However, the importance of the team approach as a whole should not be underestimated.