BACKGROUND:Adolescents with Type 1 diabetes face significant challenges in achieving effective self-management and maintaining psychosocial well-being. Peer-based and participatory health education approaches, grounded in Social Learning Theory, may strengthen adolescents' motivation, confidence, and experiential learning in diabetes care. AIM:This study aimed to evaluate the effectiveness of a peer-based participatory health education program on psychosocial adaptation outcomes - self-efficacy, illness attitudes, and diabetes knowledge - and to explore its short-term effects on glycemic control among adolescents with Type 1 diabetes. METHODS:A parallel-group randomized controlled trial was conducted with 46 adolescents aged 13-18 years with suboptimal glycemic control (HbA1c > 7.5%), recruited from a tertiary pediatric endocrinology clinic. Participants were randomly allocated to an intervention group (n = 23) or a control group (n = 23). The intervention group received a seven-week peer-based experiential education program including group discussions, exercise activities, and a kitchen workshop, while the control group received routine individual education. Data were analyzed using appropriate parametric and non-parametric tests with a significance level of p < .05. RESULTS:Adolescents in the intervention group showed significantly higher posttest scores for self-efficacy, illness attitudes, and diabetes knowledge compared with the control group (p < .01). Within-group analyses demonstrated significant improvements in psychosocial outcomes among intervention participants, whereas no meaningful change was observed in the control group. Although HbA1c levels decreased slightly in both groups over the three-month follow-up period, the between-group difference was not statistically significant. CONCLUSION:Peer-based participatory health education improved psychosocial outcomes among adolescents with Type 1 diabetes. Incorporating peer interaction and experiential learning into diabetes education programs may strengthen psychosocial adaptation and support the foundations of effective self-management.
BACKGROUND:To enhance the quality of life for individuals with type 1 diabetes and mitigate the risks of complications, new methods for insulin delivery and glucose monitoring are being developed. The ability to monitor a child's glucose levels via a mobile phone can provide parents with a feeling of security, potentially leading to improved sleep quality. However, constant monitoring could lead to increased stress both for youths and parents. AIM:The aim of the study was to explore how youths with type 1 diabetes and their parents experienced using insulin pumps and continuous glucose monitoring devices (CGM) and the support from the diabetes team. Further, to explore their opinions about the glucose target HbA1c ≤ 48 mmol/mol (6.5%) and other glucose metabolic measurements. METHOD:Sixteen individual interviews were performed with eight youths with type 1 diabetes and their parents. Qualitative content analysis was done according to Graneheim and Lundman. RESULTS:The participants described increased satisfaction, security, strengthened independence and increased freedom. The parents described improved sleep at night leading to increased quality of life. The participants had not reflected so much over the change when the glucose target was lowered in 2017, but they found time in tight range to be more useful. They had a positive experience of healthcare with easy accessibility and continuity, and they described technical support as important. CONCLUSION:Insulin pumps and CGM facilitate everyday life for both youths and their parents, and the opportunity to follow their youth's glucose values does not seem to be a problem to neither youths nor parents. The lowering of the glucose target is not something that parents and youth had much concern about, and they consider the gluco-metabolic measurement time in tight range to be more useful.
BACKGROUND:Social phobia is prevalent in adolescence and may be shaped by early adversity and family context; Southeast Asian evidence remains limited. OBJECTIVES/AIMS/HYPOTHESES:This study aimed to examine whether childhood trauma, bullying experiences, and parental bonding predict adolescent social phobia. Demographic variables (age and gender) were also examined descriptively. We hypothesized that higher levels of trauma and bullying, as well as non-optimal parental bonding, would be associated with greater social phobia. DESIGN:Quantitative Exploratory. METHODS (SETTING, INCLUSION/EXCLUSION):We surveyed 252 students (aged 15-18) from a public senior high school in Yogyakarta, Indonesia. Inclusion: active enrollment and assent; parental consent for minors. Exclusion: current clinician-diagnosed psychiatric disorder under treatment. Instruments included the Childhood trauma was assessed using the 28-item Childhood Trauma Questionnaire - Short Form (CTQ-SF), Parental Bonding Instrument, Bullying Experience Scale, and Liebowitz Social Anxiety Scale - Self Report. Data were analyzed in SPSS using descriptive statistics and multiple linear regression (α = 0.05). RESULTS:Participants were mostly aged 16 years (40.5%) and female (61.1%). Trauma was commonly mild to moderate; non-optimal bonding was present in a sizable minority; bullying ranged from low to moderate for many. Social phobia was predominantly mild to moderate. Regression showed the model was significant (R = 0.652; R2 = 0.425; Adjusted R2 = 0.416; F (3,248) = 61.820, p < .001). Childhood trauma (B = 0.285, p < .001) and bullying (B = 0.312, p = .001) positively predicted social phobia, while optimal parental bonding was protective (B = -0.204, p = .002). CONCLUSIONS:Future research could explore the effectiveness of nurse-led screening, school based anti-bullying, and family psychoeducation interventions to minimize social phobia among adolescents. IMPACT STATEMENT:Childhood trauma, bullying, and parental bonding predict adolescent social phobia, highlighting the importance of family and school-based mental health interventions.
Children with complex medical care needs require extensive resources. Their families face significant challenges in coordinating care, managing insurance, and integrating various care plans, especially in areas without pediatric palliative care or complex care clinics. To address this gap, we developed a family-centered care coordination tool and evaluated stakeholder perceptions of its content and usability prior to electronic implementation. The tool was informed by a targeted literature review and iterative feedback from caregivers, primary care providers, and nurse coordinators. Stakeholders reviewed prototype templates and completed surveys with quantitative and qualitative items, analyzed using descriptive statistics and rapid thematic analysis. Caregivers and providers endorsed the tool's usefulness and anticipated benefits for care coordination. Key priorities included problem lists, medication details with doses, care-team contacts, and ease of updating. Feedback led to expanded medication and goal sections. Overall, stakeholders supported the tool's design and proposed electronic integration. A prospective pilot is planned to create an electronic prototype of the mobile application to assess usability, caregiver burden, and early clinical outcomes following implementation.
Holding children for procedures is often perceived as a routine, uncontested aspect of pediatric practice. There has been an increase in literature describing parents' experiences of holding their child and professionals reported practice. However, limited research has observed practice and explored what influences healthcare professionals' decisions to hold a child or to encourage parental holding. This study examined how and why healthcare professionals decide to initiate, continue, or stop holding a child during a procedure, and identified the factors that influence these decisions. A descriptive qualitative multi-method design was employed, incorporating semi-structured observations focused on verbal and nonverbal interactions, vignettes constructed from each observation, and semi-structured interviews with healthcare professionals. Purposeful sampling identified children under 10 years of age undergoing a procedure in a tertiary children's hospital in Northwest England. Data from the field notes and transcripts were analyzed thematically. Eight children (aged 1 month to 10 years) and their parents were observed, along with 12 healthcare professionals (doctors, nurses, healthcare assistants, and play specialists). Eleven professionals were interviewed in this study. The findings revealed a lack of explicit discussion or planning regarding the roles of professionals, parents, and children before the procedures. Two themes were identified which highlighted "healthcare professionals assumptions about parents' role" to comfort, distract, support and hold their child during a procedure, and "expectations about children's responses and behaviors during procedures," led professionals to expect that children who had been resistant previously and younger children would be distressed leading to holding being inevitable. This study provides the first in-depth exploration of healthcare professionals' decision-making about holding children based on observed practices. The findings demonstrate that unspoken assumptions and expectations influence procedural trajectories with implications for practice and training.
Adolescents with type 1 diabetes (T1D) report increased stress and anxiety in comparison to their peers, which may result in out-of-range glycemic outcomes. Complementary therapies such as mindfulness may improve stress and anxiety. However, mindfulness training is mostly delivered in-person for adolescents. As adolescents with T1D are high consumers of technology, with busy schedules that impede their ability to complete in-person training, we designed an mHealth application, Appricate©, to deliver mindfulness-training. The goal of this pilot study was to qualitatively describe the experience of participating in an 8-week mHealth mindfulness-training intervention based on the principles of MBSR, Appricate©, among adolescents with T1D. We conducted semi-structured interviews with 12 adolescents aged 12 to 19 years old who had T1D for >6 months and had completed our 8-week mHealth mindfulness-training intervention. We identified five themes based on participant interviews: (1) initial appeal and attractiveness, (2) usability, (3) engagement, (4) user outcomes, and (5) recommendations. Appricate© was reported as "well made" that was "very easy to use" with engaging lessons. Participants had improved sleep, stress and anxiety management and better ability to manage school and after-school activities after using Appricate©. Participants also recommended additional content and options for personalization.
This narrative review investigates the influence of child-specific content within pre-registration nursing programs on newly qualified nurses' perceptions of preparedness to care for children, young people, and their families. Despite international recognition of the specialised competencies required for pediatric nursing, the proportion and quality of child-focused education across Higher Education Institutions is not clear. The Population, Exposure, Outcome framework provided a comprehensive search strategy applied across eight databases to identify relevant studies that met the inclusion and exclusion criteria. Of 663 records identified, 451 were screened and 25 full texts were assessed for eligibility by two reviewers. No studies met the eligibility criteria, resulting in an empty review. Although no empirical evidence could be synthesized, the absence of eligible studies is itself a notable finding. Empty reviews are becoming increasingly recognized within structured review methodology as scientifically meaningful contributions. An empty review can highlight areas where assumptions are made without evidence and where systematic research is urgently needed. In our review, the lack of studies reveals a critical and previously uncharted gap in the literature. Although authors acknowledge that a strict inclusion criteria may narrow the field for capturing relevant studies. Rather than representing a failure of the review process, the empty review demonstrates that the research question has not been empirically investigated despite longstanding concerns about adequacy of children's nursing education. Empty reviews aid researchers to identify gaps in the evidence base and to identify where research is needed. They can ensure that policy or curriculum reform is not based upon untested beliefs. Empty reviews offer guidance for researchers, educators and healthcare providers on future research. By confirming through a robust and comprehensive search strategy that no eligible evidence exists, this empty review strengthens the case for dedicated studies exploring the relationship between curriculum content and preparedness outcomes. It highlights the need for empirical work before evidence‑based recommendations on child‑specific content can be made. In this sense, the empty review is not a negative result but an important and constructive contribution, drawing attention to a neglected but vital area of nursing education research.
Osteosarcoma is the most common type of bone malignancy among adolescents and is known for its rapid progression, high invasiveness, and poor prognosis. It poses a serious threat to adolescents' survival and well-being. Moreover, as research on adolescent osteosarcoma patients in China is limited, studies exploring their disease experience are even rarer. In this descriptive-phenomenological study, 10 adolescent patients with osteosarcoma underwent semi structured interviews to explore their disease experience. Data were analyzed using Colaizzi's seven-step method, yielding five core themes: physiological symptom distress, negative psychological experiences, changes in social functioning, individual coping strategies, and experiences of self-growth. Adolescents with osteosarcoma face multiple challenges during diagnosis and treatment, including physical and psychological distress, impaired social functioning, and difficulties in self-management, but they also demonstrate the potential for positive personal growth. It is recommended that health care professionals develop and implement personalized, multidimensional support strategies covering physiological, psychological, and social aspects to facilitate recovery and enhance the quality of life of these adolescents.
Children continue to be held still within pediatric practice for clinical tests, treatments and examinations. Existing literature has focussed on health professionals' and parent's views and experiences of the use of holding and restraint, and children's views and experiences remain largely absent. This study aimed to explore the experiences and perceptions of children with long-term conditions of being held for clinical procedures in hospital environments. A qualitative descriptive design used interviews and participatory arts-based approaches to hear the experiences of children aged 4-12 years. Recruitment occurred through a children's hospital. Data were analyzed using thematic and content analysis processes. Twenty-two children aged 4-12 years were interviewed. Children gave detailed accounts of how they had been held, with many describing experiences of distress and forceful holding. Children shared their understanding of why they had been held and talked of difficult communication during the "horrible moment" because adults were either "not saying anything" or "being angry." They talked of preferring to be held by their parents or given a choice over who holds them. Children discussed that being informed, listened to, and able to rehearse events helped them during a procedure and led to less forceful holding. This study adds important knowledge of children's perspectives of being held for clinical procedures, demonstrating that even young children have complex emotions and understandings of what happened when they were held. Adopting a trauma-informed approach and providing supportive debriefs is key to avoiding the accumulation of fear, distress and harm.
An evaluation of a supervised playground service for children and families who live in an area of disadvantage was undertaken to assess its impact on children, families, and the wider community. The playground is located in the suburbs of a city in the southeast of Ireland, and it is operated by Barnardos. A central objective of the study was to explore children's experiences of their involvement in the playground, what it means to them, and how it has influenced their lives. The evaluation adopted a qualitative design using art-based participatory methods and semi-structured interviews to ensure that the voice of the child was prioritized. A total of 33 participants, including children, parents, Barnardos staff, volunteers, and community stakeholders took part in the study. Data generated from creative activities and interviews provided rich insights into the value and outcomes of the service. Findings indicate that the playground contributes positively to children's social, emotional, cognitive, and physical development. It also fosters inclusion, friendship, and community connection, while supporting children's confidence, wellbeing, and sense of belonging. The evaluation highlights the significance of supervised, community-based play initiatives in promoting holistic child development and strengthening community ties.
Oral mucositis (OM) is significant clinical problem for children receiving chemotherapy. This study was conducted to evaluate the effect of basic oral care (BOC) education given to children receiving chemotherapy and their mothers on the prevention and severity of oral mucositis. This study was a quasi-experimental, single-arm, pre-post intervention design conducted to evaluate the effect of basic oral care (BOC) education on the prevention and severity of oral mucositis in children undergoing chemotherapy. The study was carried out at the pediatric hematology and oncology unit of a university hospital in Trabzon, Türkiye, between January and December 2019. A total of 30 children aged 3-17 years who met the inclusion criteria and their parents were enrolled in the study. Data were collected using three instruments: the Information Form, the Basic Oral Care Follow-up Chart (BOCFC), and the World Health Organization Mucositis Assessment Scale (WHOMAS). Oral mucositis was assessed on days 1, 3, 5, 7, 14, and 21, while adherence to BOC practices was recorded daily using the follow-up chart. BOC education was delivered face-to-face by the same researcher to both children and their parents in two 25-minute sessions. The training included tooth brushing with the Bass technique, the use of oral care sponges, and sodium bicarbonate rinses. Data were analyzed using SPSS 24.0. Normality was tested with the Shapiro-Wilk test. For nonparametric data, the Wilcoxon Signed Rank Test was applied. A p-value < 0.05 was considered statistically significant. Data were analyzed for 30 children. In the post-training period, there was a significant increase in BOC practices, especially in the evening and at bedtime, compared to the pre-education group (p<0.05). The results showed that there was a significant difference in the degree of oral mucositis after BOC education planned for children receiving chemotherapy compared to the group before BOC education (p<0.05). In the pre-training period, the number of children who developed severe OM increased until day 14, improvement started after day 14, but severe OM was still detected in 3.3% of the children on day 21. After BOC training, children did not develop severe OM and mild mucositis decreased from 23.3% on day 14 to 3.3% on day 21. BOC education given to children receiving chemotherapy and their parents prevents the development of severe oral mucositis by increasing tooth brushing and mouth rinsing rates. BOC may be the best option to prevent OM and reduce the severity of OM in children receiving chemotherapy.
Child- and family-centered care (C&FCC) is critical in pediatric nursing, but often difficult to implement consistently, particularly during high-stress procedures such as peripheral intravenous (IV) line placements. This two-arm quasi-experimental study evaluated the effectiveness of learning support materials developed to enhance nurse managers' knowledge of and attitudes toward promoting C&FCC and encouraging its implementation during peripheral IV line placements. It conducted a two-arm quasi-experimental study in Japan between October 2022 and April 2023. Nurse managers from pediatric departments were allocated to the intervention (n = 69) and control (n = 67) groups using an alternating assignment method stratified by facility. This study involved three surveys as follows: a pre-survey (T1), post-survey 1 (T2, within 2 days of T1), and post-survey 2 (T3, 1 month after T2). The intervention group received a comprehensive learning package, including management strategies and C&FCC promotion tools, while the control group was provided with a limited guide without management content. In this study, the primary outcome was the behavioral component of attitude - namely, nurse managers' motivation and confidence to promote C&FCC. The secondary outcomes were knowledge of department management in C&FCC and intention to create a C&FCC promotion core team. Adjusted T3 effects, controlled for baseline and prespecified covariates, were estimated using analysis of covariance. For the primary outcome, the intervention produced significant adjusted improvement at T3 (β = 10.04, standard error [SE] = 3.93, t = 2.56, p = .012). The adjusted effect was not significant for knowledge (β = ‒1.03, SE = 0.72, t = 1.44, p = .153). A greater proportion of nurse managers expressed an intention to establish a C&FCC promotion core team in the intervention group than in the control group. In the context of peripheral IV placement, management-integrated C&FCC learning materials appear effective in enhancing nurse managers' motivation and confidence to lead C&FCC implementation and may help cultivate a child- and family-centered organizational culture in pediatric care.
Adolescent pregnancy is a global phenomenon that increases the risk of maternal and neonatal morbidity and mortality. In addition, early parenthood has implications that foster intergenerational poverty and social exclusion. Hence, this study aimed to evaluate the association between self-esteem and family functioning with teenage pregnancy. We conducted a case-control study from April to November 2023 at two community health centers in Hidalgo, Mexico. Primiparous adolescents aged 10 to 19 whose gestational age was less than 21 weeks and who attended a prenatal checkup consultation were considered the case group. Conversely, the control group consisted of non-pregnant adolescents (aged 10-19 years) who visited the same community health centers for medical consultations. The APGAR family scale was used to assess the family functioning of the participants, and self-esteem was assessed using the Rosenberg Self-Esteem Scale. The associations between the variables of interest were evaluated using logistic regression models adjusted by confounders. After adjusting for confounders, adolescents with medium (adjusted odds ratio [aOR] = 1.81; 95% confidence interval [95% CI] = 0.91, 3.59; p-value = .086) and lo8w self-esteem (aOR = 4.04; 95% CI = 1.96, 8.31; p-value = .030) compared to those with high self-esteem were more likely to be mothers. Besides, we found that the lower the self-esteem, the greater the odds of being an adolescent mother (p-trend <0.014). On the other hand, adolescents with moderate (aOR = 2.31; 95% CI = 1.03, 5.21; p-value = .031) and severe family dysfunction (aOR = 4.00; 95% CI = 1.61, 9.97; p-value = .001) were more likely to be adolescent mothers compared to those with good family functioning. Furthermore, we found that the greater the family dysfunction degree, the higher the risk of being an adolescent mother (p-trend <0.001). Our findings suggest that self-esteem and family functioning are independently associated with adolescent pregnancy. This adds to the existing literature that emphasizes the relevance of promoting emotional well-being and family relationships to prevent risky behaviors among adolescents. Therefore, it is necessary to develop holistic intervention programs that promote healthy family relationships and consider strengthening sexual assertiveness and self-esteem from early adolescence.
Across the globe, the COVID-19 pandemic and the resulting public health measures significantly impacted the lives of families with young children. The emerging tensions surrounding the loss of social interactions for young children, 0-8 years, during the pandemic, as evident in recent literature, have sparked our interest. To explore this from a Canada-wide perspective, we delved into a subset of data from a national mixed methods survey conducted in 2021, examining the impact and projected psychological and social concerns of the COVID-19 pandemic. This subset included responses from 688 participants who identified as primary daily caregivers of children aged 0-8 years. The study employed descriptive statistics and thematic analysis to fill an evidence gap around the possible effects of the pandemic on caregivers' concerns for their child's social and emotional development. Findings revealed that parents/caregivers ranked their child's social and emotional development as their highest concern during and after the pandemic; connecting it to the loss or lack of socialization, increases in screen time, and the lack of participation in early years education and community programs. Moving forward from the pandemic, this study's results help us understand where focused attention may be needed to support young children's development and consider areas where parents stress may remain high post-pandemic, to inform service design and policy direction.
Pediatric palliative care (PPC) places mothers in an extremely challenging situation, where they must confront not just the approaching death of their child, but also their own suffering. In this context, hospitalization at home (HaH) is often the preferred choice for children and parents alike since it offers the comfort of a familiar setting and the reassuring presence of family. Yet, there is limited research into how the home setting may impact the maternal experience of a dying child. This qualitative study aims to capture the intimate experience of mothers in PPC during the HaH of a child dying of cancer and to explore how they make sense of this specific experience. Non-directive interviews with three mothers were conducted and submitted to an interpretative phenomenological analysis. We identified one major theme made up of three sub-themes: waiting, uncertainty and life on hold. These three dimensions do not merely represent psychological states: they are part of a process in which the impending death is not just an imminent event, but a reality that is already active, progressive and psychologically invasive. This process may have an impact on the course of the mother's subsequent bereavement, which is an important consideration for professionals to integrate into their supportive interventions.
Children are vulnerable to hemodynamic instability due to their distinct physiological characteristics, including a higher circulating blood volume relative to body weight. This physiological difference reduces their ability to tolerate blood loss. The aim of this study was to assess the effect of blood component transfusions on vital signs among children. A descriptive cross-sectional study design was carried out. All children who received blood component transfusions (60 children). The study was conducted in Pediatric Intensive Care Unit, Pediatric Medical Unit, and Pediatric Surgical Unit at King Abdulaziz University Hospital in Jeddah City. During the blood component transfusions, all children were assessed for vital signs before, during, and after the transfusion. One tool was used to collect data. Tool I: A standardized blood component transfusions observational checklist, developed by the National Standards for Blood Transfusion Service (2013) and based on the first edition by the World Health Organization (WHO), was used to assess blood component transfusions and vital signs 15 minutes before, during, and one hour after blood component transfusion. The findings of this study revealed that blood component transfusions have no statistically significant effect on vital signs among children who received blood component transfusions before, during, and after transfusion. Blood component transfusions (packed red blood cells, fresh frozen plasma, and platelet concentrate) showed no statistically significant effect on vital signs (before, during, and after the transfusion). However, gender significantly impacted the mean temperature and blood pressure values during the transfusion. In contrast, other socio-demographic variables, such as blood group and blood component, did not influence the vital signs throughout the process.
Cannabis use among adolescents and young adults has become a significant public health concern in the United States (US), as it is associated with immediate and long-term effects on mental health, academic achievement, and social functioning. The purpose of this systematic review was to identify risk and protective factors contributing to cannabis use initiation and continuation among adolescents and young adults in the US. A search (January 2019 to September 2024) was conducted across CINAHL, Medline (OVID), and PubMed databases using PRISMA guidelines and relevant MeSH terms. Studies were included if they were peer-reviewed, quantitative, US-based, and involved youth ages 12-26. Fifteen studies met inclusion criteria and were critically appraised for quality. The Social Ecological Model guided analysis. Findings revealed that cannabis use is shaped by multi-level influences. At the individual level, older age, early initiation, lower perceived risk of harm, and polysubstance use were key risk factors. At the interpersonal level, peer influence, parental acceptance of cannabis use, and family structure played prominent roles, with peer disapproval and parental monitoring emerging as strong protective factors. At the community level, perceived neighborhood stress, social media exposure, and proximity to cannabis dispensaries contributed to increased use, while school connectedness and extracurricular involvement served as protective influences. At the societal level, cannabis legalization and lower socioeconomic status were associated with increased use and normalization of behavior. Gender disparities in use are narrowing, with similar rates reported among males and females. This review underscores the need for multi-level interventions that address peer and familial norms, promote public education to increase perceived harm, and account for environmental and policy contexts. Evidence-based strategies targeting individual, relational, community, and societal factors are essential to reduce cannabis use and mitigate its adverse effects among youth.
Peripheral venous cannulation is a common invasive procedure with a high failure rate, particularly challenging in children and young patients due to their unique anatomical characteristics. This study evaluated the effectiveness of local heat and massage in facilitating venous access in hospitalized children with difficult access. A single-blind randomized controlled trial was conducted at Children's Hospital in Tabriz from December 20, 2023, to May 9, 2024. Ninety-six children aged 6 to 12 years were enrolled and randomly assigned to three groups: two intervention groups and one control group. In the first intervention group, an electric heating pad at 40 ± 2 degrees Celsius was applied to the venous access site for 5 minutes. In the second intervention group, a gentle circular massage from the wrist to the cubital fossa was performed for at least 2 minutes. Outcomes included pain scores using the Visual Analogue Scale (VAS), time spent, and number of attempts for venous access, along with vein assessment using the Vein Assessment Scale (VAS). Data were analyzed using SPSS version 23. No significant differences were found in demographic factors among the groups (p > .05). The vein assessment showed improved visibility and palpability with local heat and massage. Pain scores significantly decreased in both intervention groups (p ≤ .001), with the local heat group reporting lower mean pain scores and shorter cannulation duration compared to the massage group (p ≤ .001). No significant differences were observed in the frequency of cannulation attempts (p > .05). Applying local heat and massaging the venous cannulation site prior to venous cannulation significantly increases the ease of venous access. However, in a comparison of these two methods, local heat was more effective than massage in reducing perceived pain in children with difficult access. Therefore, using local heat can be recommended as a simple and cost-effective intervention.
BACKGROUND:Children who complete brain tumor treatment encounter ongoing problems with functioning that fluctuate over time. Previous studies shows that health care and schools tend to focus more on the child's cancer-related body symptoms, rather than on existing problems to participate and manage everyday life activities, or moreover of environmental barriers they face. Few studies address how the child's problems to function on body, activity and participation levels co-occur and are presented over time. Therefore, this study´s purpose is to describe how documented problems with functioning, vary over time in children who have completed brain tumor treatment. METHODS:Medical and school records from seven children were reviewed for up to 5 years after treatment completion, to identify problems and link these to International Classification of Functioning, Disability and Health (ICF) code domains. The coded data were divided into six-month blocks over a 4-year time period, analyzed statistically and illustrated graphically. Code variations on group-levels and patterns of body, activity and environmental codes that tentatively co-occurred with participation were exemplified in a child-case, using a collaborative problem-solving (CPS) approach. RESULTS:Based on median (Md) number of codes within participation, activity, body and environment, the children exhibited ongoing problems with body function over time (Md 11-18). Activity-related problems were most noticeable about 1-year post-treatment completion (Md 6), and participation problems (Md 1-2) persisted throughout the follow-up period. Documentation of environmental problems was limited but increased after 3 years (Md 3). In the child-case example, participation problems with self-care, schooling and peer-relations continued across the years, with plausible explanations related to problems with communication and fine-hand function (activity), fatigue (body function) and with surrounding supportive systems (environment). CONCLUSION:Over time, professionals' documentation predominantly focused on problems with the child's body function, while functioning in everyday life and environmental barriers affecting participation, was often neglected. By using the ICF and CPS, service professionals, including nurses, are provided with guidance for comprehensive and systematic approach of addressing patterns of co-occurring problems with functioning, which could lead to improved support to optimize the child's participation in everyday life.
BACKGROUND:Spina bifida (SB), a congenital defect affecting neural tube closure, results in physical, neuropsychological, and social challenges. Adolescents with SB may experience impaired social functioning due to mobility limitations, pain, and cognitive issues, which can affect their overall well-being. However, little is known about factors facilitating social functioning in these adolescents. OBJECTIVE:This study aimed to explore the perceptions and expectations of adolescents with SB and their parents regarding social functioning, identifying facilitators and challenges that could inform interventions. METHODS:A qualitative descriptive design and interactive interviews were used with adolescent-parent dyads. Adolescents recruited were diagnosed with myelomeningocele (the most severe form of SB), spoke English, and had cognitive ability to participate in an interview. Adolescents' English-speaking parents were also recruited. Data were analyzed using direct content analysis to identify key themes related to social functioning. RESULTS:Participants were 10 primarily African American adolescent-parent dyads where the adolescents were aged 12-14. The interviews revealed four key themes: (1) facilitators of social functioning, primarily family relationships and family/peer support, helped adolescents navigate social interactions despite their physical limitations; (2) challenges to social functioning, including mobility limitations, stigma, and difficulty developing friendships, often led to social isolation; (3) the impact of social participation on physical and mental health was evident, with both adolescents and parents recognizing that social involvement contributed positively to well-being; and (4) the impact of parents' expectations on social functioning significantly shaped adolescents' social involvement, with some parents promoting active participation while others limited social activities to protect their children from negative influences. CONCLUSION:Minority adolescents with SB face significant barriers to social functioning, particularly due to pain, mobility limitations, and stigma/bullying. However, strong family support and peer relationships played a critical role in fostering social engagement and promoting overall well-being. The study highlights the importance of early interventions and inclusive programs that reduce stigma/bullying and promote social participation for adolescents with SB. Findings provide a voice for underrepresented African American adolescents and insight into the complex interplay of physical, social, and psychological factors affecting adolescents with SB, offering guidance for future interventions aimed at enhancing social functioning.
