Journal for Specialists in Pediatric Nursing最新文献

Purpose

Parents of children with medical complexity (CMC) frequently experience challenges with family management and depression. The purpose of the study was to provide preliminary feasibility, usage, acceptability, and efficacy data following a trial of mindfulness app use in parents of a CMC.

Design and Methods

In this single-arm intervention pilot study, parents were asked to use a mindfulness mobile application (app) for 10–15 min, 4 days a week. Depression severity and family management were measured using the Patient Health Questionnaire-9 and Family Management Measure, respectively, at baseline and 4 weeks later.

Results

A total of 32 parents consented to participate; 28 parents completed all surveys. Self-reported usage data indicate that 8 parents (32%) used the app 4 days a week and 12 parents (50%) used it for at least 10 min/session. The majority rated the app easy to use and would recommend it (n = 26; 92.8%). There was a statistically significant improvement in depression severity and family management scores following app use. Time spent using the app had a strong negative correlation with depression severity scores (p <0.01), however, the number of days used per week of use was not statistically significant.

Practice Implications

Parents of a CMC are at risk for depression and family management issues. Timely identification of parental mental health is important so interventions can be provided. This pilot study provides promising, preliminary information regarding the feasibility, acceptability, and efficacy of a mindfulness app intervention.

Purpose

Sleep disturbances are common in adolescents diagnosed with neurodevelopmental disorders (NDDs), such as autism spectrum disorder (ASD) and/or attention-deficit hyperactivity disorder (ADHD). Sleep-related impairment can include worsening of underlying symptoms such as stereotypic and repetitive behavior, inattention, hyperactivity, and impaired learning. Exogenous melatonin has shown promise in improving sleep onset latency and total sleep time in adolescents with NDDs. The purpose of this study was to describe parents' experiences with sleep disturbance, sleep-related impairment, and exogenous melatonin use in their adolescent child diagnosed with an NDD.

Design and Methods

We conducted semi-structured interviews with twenty-six parents of adolescents (11–18 years of age) diagnosed with ASD and/or ADHD. Data were analyzed using qualitative conventional content analysis.

Results

Before the initiation of melatonin, all parents stated their child had experienced difficulties falling asleep. Parents described sleep-related impairments in both child and family functioning, such as behavioral issues, cognitive difficulty, and parental lack of sleep. Most parents had attempted sleep hygiene-related interventions before initiating melatonin. Over half of the parents reported initiating melatonin at their healthcare provider's recommendation. All parents believed melatonin was natural, without major health or safety issues. All parents described subjective improvements in their child's sleep latency with the use of exogenous melatonin. Parents of adolescents diagnosed with ASD and/or ADHD reported that melatonin is a safe and effective intervention for the management of their child's sleep disturbances. Parents also reported switching melatonin brands, changing melatonin dosages, and discontinuing and restarting melatonin.

Practice Implications

Due to the known reported inconsistencies in purity and dosage between over-the-counter melatonin brands, frequent switching of brands and dosages should be a consideration for patient education and the potential impact of efficacy and safety. Practice would benefit from future studies targeting validation and standardization of age-appropriate adolescent sleep-related intervention, including the everyday usage and long-term safety of exogenous melatonin.

Purpose

To describe the views of a group of nurses about the competencies needed by registered nurses working in neonatal intensive care units.

Design and Methods

A descriptive study design with a qualitative approach. A total of six focus group interviews involving 21 registered nurses were conducted between October and November of 2023. The participants had work experience (average 14 years, range 3–36 years) of neonatal nursing in university hospitals and central hospitals in Finland. The data were analysed using inductive content analysis.

Results

The competence of registered nurses working in the neonatal intensive care units comprise of (1) competence in family-oriented care, (2) clinical competence, (3) advanced competence in nursing preterm infants, (4) competence in communication and health technology, and (5) professional growth in competence and collaboration.

Practice Implications

These findings highlight the complexity of nursing preterm and sick infants. They can be used to improve the education and orientation of neonatal nurses and therefore ensure safe and high-quality neonatal nursing.

Reporting Method

The COREQ-guidelines were adhered to in reporting the study.

Purpose

The benefits of maintaining glycemic control for persons with diabetes include delaying the onset and slowing the progression of macro- and microvascular complications. However, many children and adolescents with diabetes do not regularly meet target hemoglobin A1c levels.

Our pilot project aimed to improve glycemic control among children and adolescents, 8 to 17 years, with insulin-dependent diabetes at greatest risk for complications and enrolled in North Carolina Medicaid at least 1 month during the study period.

Design and Methods

We used a pre-intervention post-intervention design. We implemented an intensive care management intervention, led by a nurse practitioner. The nursing intervention consisted of tele-health visits, emails, and MyChart messages with patients and caregivers to supplement in-clinic visits. Therapeutic communication skills were applied, including motivational interviewing techniques and unconditional positive regard. We measured glycosylated hemoglobin (HbA1c) at 6-month intervals before, during, and after the intervention period.

Results

Mean participant (n = 12) HbA1c levels dropped by 1.5 percentage points from baseline (12.8%) to the 6-month study end point (11.3%). Seventy-five percent of participants experienced some decrease in HbA1c during the study period.

Practice Implications

This pilot project demonstrated short-term success of care management and therapeutic communication interventions in reducing HbA1c levels among a sample of children and adolescents with complicated case histories. Our findings are consistent with other studies that found telephonic nursing support, care management, and motivational interviewing to be effective interventions among pediatric populations. These studies suggest that nurses can implement relatively low-resource interventions that add value to health services delivery for children and adolescents with insulin-dependent diabetes. However, more studies are needed to understand which combinations of interventions may be most effective.

Purpose

Knowledge deficiencies among family caregivers of children with asthma impede optimal disease management. Current research has shown that texting caregivers is an effective method for delivering family-centered health education. The aim of this quality improvement project was to implement a short message service (SMS)-based intervention to educate family caregivers of children with asthma and evaluate its effect on caregiver knowledge and confidence in asthma management.

Design and Methods

This project employed a pre-posttest design with questionnaires completed at the beginning and conclusion of the intervention. Nineteen caregivers received daily educational messages over a 3-week period.

Results

The intervention resulted in a significant increase in the caregiver asthma knowledge (p = 0.037), but not their confidence (p = 0.604). Caregivers indicated high satisfaction with the length and content of the messages.

Conclusions

This project suggests that the SMS-based education intervention holds potential to assist family caregivers in better managing their child's asthma.

Practice Implications

This quality improvement project seeks to fill the existing gap of inadequate family caregiver education, strengthen caregiver confidence in asthma management, and ultimately, enhance the care experience of asthmatic children. As chronically ill children have the best care experience when their parents are well-informed about the disease and able to formulate solutions to manage emerging symptoms, family caregivers benefit as well. The educational messages enrich their asthma knowledge, enabling them to administer medicine promptly and appropriately when their child exhibits symptoms. Early medical attention minimizes the incidence of asthma attacks as well as the demand for emergency room visits, easing the burden on the healthcare providers. Therefore, using text messaging to educate family caregivers of children with asthma may positively affect child, parent, and provider outcomes.

Purpose

This study aimed to develop a virtual reality (VR) intervention for reducing exposure to endocrine disruptors (EDs) and examined the effect of the intervention among Korean adolescent girls.

Design and Methods

A methodological design was employed involving five phases for developing the VR tool and its evaluation of validity testing. The five development phases were conducted through (1) a literature review and surveys to select appropriate VR content for adolescents’ snack shopping, (2) a VR scenario composition based on the information-motivation-behavioral (IMB) skills model, (3) implementation of the VR tool using Oculus Quest 2, (4) heuristic and usability evaluations of the VR tool, and (5) the confirmation of final maintenance. For the evaluation, a one-group pre- and post-test design was utilized with a convenience sample of 19 adolescent girls who were recruited from a high school located in W city. Knowledge about EDs and sensitivity to women's reproductive health problems were measured using a self-administered questionnaire.

Results

The prototype of a 15-min VR intervention was developed based on the waterfall model and evaluation criteria yielded acceptable results through content validity, heuristic evaluation, and usability test. The Wilcoxon signed-rank test showed significant differences in knowledge about EDs (U = 3.57, p < 0.001) and sensitivity to women's reproductive health problems (U = 4.36, p < 0.001) between pre- and post-intervention.

Practice Implications

The VR intervention was found to be applicable and effective for reducing exposure to EDs in female adolescents. School and community health centers need to expand the application of VR-based health education to provide adolescents with a conducive environment for engaging in health behaviors and enhancing learning experiences.

Purpose

Although insufficient sleep influences cognitive function and physical and mental health in adolescents, many still get less sleep than the recommended duration. Adolescent substance use, including alcohol and tobacco, influences sleep disturbance. However, sex differences in the relationship between substance use and sleep health have not been extensively studied. This study aimed to examine the effect of substance use on sleep duration among South Korean adolescents by sex.

Design and Methods

This secondary data analysis used the 4th Wave of the Korean Children and Youth Panel Survey 2018 and applied a multiple regression analysis. Tobacco use and alcohol consumption were assessed by asking whether the participants had ever smoked or drunk alcohol during the previous year. Sleep duration was calculated based on the participants' reports related to sleep and awake times on weekdays and weekends.

Results

For male adolescents, substance use, either tobacco use or alcohol consumption, did not significantly affect sleep duration, whereas for female adolescents, alcohol consumption was found to influence sleep duration. Age and subjective health were additional influential factors for adolescents' sleep duration, regardless of sex.

Practice Implications

Interventions for alcohol consumption should be considered to enhance sleep health in female South Korean adolescents. Further studies are needed to understand the underlying mechanisms of sleep health, particularly the effects of substance use, among male adolescents.

Purpose

This research aims to uncover the life experiences of fathers of children with Cerebral Palsy (CP) in Indonesia.

Design and Methods

This study utilized a descriptive phenomenological approach. Nine fathers of young children and adolescents with CP were purposively recruited and were interviewed in-depth between June and August 2023. Data were analysed by using Giorgi's descriptive phenomenological approach.

Results

Our study identified three main themes: uncovering the meaning of being a father, expectations and hope for children's growing up, and the challenges of being a father. These themes were further divided into 10 sub-themes. Our research suggests that fathers consider having a disabled child as a gift and a test from God, and they hold specific meanings about being a father that gives them strength. Fathers are responsible for taking care of their children and not neglecting them. They have expectations and hopes for their children to become independent and successful, with the skills needed to make a living. Fathers face many challenges, such as dividing their time between work and family and figuring out how to stimulate their children's motor skills.

Practice Implications

The research indicates that involving fathers in caring for children, particularly those with CP, has significant implications for program planning and service delivery. Therefore, professionals should integrate fathers' role in planning and delivering services for childcare.

Purpose

Virtual reality is used as a distraction tool during medical procedures that can cause anxiety and pain. We assessed the usefulness, engagement, value and feasibility of virtual reality to help children cope with routine clinical procedures.

Design and Methods

Quality improvement study. Children, 4–16 years old, were given the option to use virtual reality during their procedure in oncology, immunology or diabetes clinics, or during an induction of general anesthesia. The emotional state of the child was documented using the children's emotional manifestation scale. We assessed feedback from patients, parents, and clinicians.

Results

Across all clinics, children responded positively to the virtual reality and 80% would choose to use virtual reality again for health-related procedures. Parents and clinicians, respectively, reported that virtual reality helped children tolerate the procedure (82% and 87%), engaged children well (82% and 89%) and was a valuable tool (85% and 98%). Clinicians (90%) endorsed the feasibility of using virtual reality during procedures.

Practice Implications

This project demonstrated that virtual reality can be implemented as a useful, engaging and feasible tool to help children tolerate a variety of routine medical procedures. However, ensuring comfortable fit of virtual reality devices and diversifying the visual content is necessary.