Background: Type 1 diabetes is a life-long metabolic illness. Typically diagnosed in childhood, adolescence, and young adulthood, this diagnosis is often associated with increased psychological vulnerability. Diabetes distress is associated with the daily demands of managing complicated medication and dietary regimes that are emotionally, psychologically, and physically taxing. Emotional labour may be required to manage or negotiate the demands of diabetes distress. Emotional labour is the process of managing feelings and expressions that come with fulfilling the emotional demands of necessary tasks or roles. However, the meaning of emotional labour has not been explored for young people living with Type 1 diabetes. Methods: Using Interpretive Phenomenological Analysis, we conducted this study to explore the lived experience of emotional labour for young adults living with Type 1 diabetes in adulthood. Results: Themes were identified that constituted sources of emotional labour inherent to participants’ experiences of diabetes management. The over-expenditure of emotional labour suggests profound implications for mental health outcomes and diabetes distress levels, and participant experiences revealed institutionally imbedded ableism that elicited further expenditure of emotional labour. Conclusion: The findings suggest that reconsideration of educational frameworks and praxis within diabetes healthcare may alleviate emotional labour and diabetes distress.

The Circle of Security® Parenting™ (COSP™) program is a relationship-based intervention that targets attachment security and caregiver internal working models. Effectiveness and efficacy research utilizing observational measurement of parent-child interaction remains limited in the Circle of Security® literature and few studies have examined changes in parent-child/dyadic mutuality as a construct of interest. The aims of this exploratory study were to evaluate the efficacy of COSP™ by examining changes in dyadic mutuality and parent positivity/negativity using the Parent Child Interaction System (PARCHISY), a validated observational measurement tool, in 16 parent-child dyads. A quasi-experimental repeated measures design was employed to investigate changes in observed parent-child interaction before and after the 8-week COSP™ intervention and across two tasks, structured play and clean-up. Analyses revealed theoretically predicted positive changes in dyadic mutuality and parent positivity and no significant change in parent negativity. These results support the utility of PARCHISY in the assessment of attachment-focused parenting interventions.

AimTo synthesise qualitative research on pulmonary sequelae of COVID-19 and identify patient needs and experiences to develop nursing care strategies. BackgroundQualitative research on long COVID by subtype has not yet occurred. As pulmonary sequelae constitute a serious long COVID subtype, exploring patient experience and needs can generate knowledge to guide nursing practice. DesignSystematised review methodology utilised on a purposive sample of published articles and reported using the PRISMA guidelines and checklists. Searched MEDLINE, Cumulative Index to Nursing and Allied Health, and Google Scholar, for English or French articles published from February 2020 to June 2022; qualitative research with adults recovering from COVID-19 with evidence of pulmonary sequelae. MethodsEstablished principles for data extraction followed related to data reduction, data presentation, data comparison, and conclusion formulation and verification. Analysis was informed by Thorne's Interpretive Description and extended with Meleis' transitions theory, Mishel's uncertainty in illness theory and Moore et al.'s holistic theory of unpleasant symptoms. The quality of included studies was assessed Joanna Briggs Institute critical appraisal tool for qualitative research. ResultsFour articles with six pooled participants provided data to yield three main themes: (1) a novel health-illness transition, (2) lung injury and pulmonary fibrosis as antecedent to illness uncertainty, (3) and pulmonary symptoms that are compounded by fatigue and weakness. ConclusionPulmonary sequelae of COVID-19 confers a unique health-illness transition, uncertainties and symptoms that can be addressed by theory informed nursing practice. Relevance to Clinical PracticeAdvocacy, optimising the nurse-patient relationship, offering up-to-date information and addressing uncertainty may help patients cope with pulmonary sequelae, a complex subtype of long COVID with important considerations for clinical nursing care. Despite a lack of evidence-informed clinical pathways, nurses can support patients to understand novel treatments, support discharge planning and acknowledge the synergistic nature of pulmonary symptoms and fatigue to support health-illness transitions. No Patient or Public ContributionThis article involved analysis of previously published works.

Background:Fontan surgery is performed at 2-4 years of age and is the third planned surgical intervention for children with a univentricular heart. Major challenges for children and parents after Fontan include (a) psychological distress, (b) prolonged pleural drainage, and (c) the need for postoperative anticoagulation. The aim of this study was to evaluate a pre-Fontan video-based intervention for parents to address these challenges.Methods:This study is a single-centre mixed-methods cluster randomized controlled trial. The intervention consisted of 3 brief whiteboard videos offered online from preadmission clinic to 1 month postoperatively. The parent's State Trait Anxiety Inventory score and the child's Post Hospital Behaviour Questionnaire score were measured 1 week and 1 month postoperatively. Semistructured interviews were conducted to obtain parental feedback on the videos.Results:We enrolled 26 children (13 female patients; 16 intervention group) and 1 parent per child. Mean State Trait Anxiety Inventory scores were similar between groups at both 1 week (52.8 vs 55.5, P = 0.25) and 1 month postoperatively (50.9 vs 53.9, P = 0.25). Post Hospital Behaviour Questionnaire scores were in the maladaptive range but did not differ between groups. Parents agreed or strongly agreed that the videos were helpful but should be provided earlier in the preoperative process. The main value of the videos was recognized as being a method for standardizing information provided to parents.Conclusions:A video-based education intervention did not impact State Trait Anxiety Inventory or Post Hospital Behaviour Questionnaire scores. However, the majority of parents agreed that the videos were helpful.

Working while undertaking graduate education in nursing is challenging at any time. During the COVID-19 pandemic, many nurses continued to work on the frontline while completing their graduate studies. Healthcare workers, including nurses, were routinely exposed to several types of psychological trauma during the COVID-19 pandemic. In this study, we seek to generate an understanding of the psychological influence of COVID-19 on registered nurses’ (RNs’) self-efficacy and job satisfaction while commencing graduate studies in nursing and working in clinical practice during the pandemic. A qualitative descriptive design was used to explore written reflections from 72 RNs enrolled in their first Master of Nursing graduate course at an online university. The RNs’ online discussion postings related to the impact of the pandemic on nursing. Data were analysed using content and thematic analysis. Analysis revealed five overriding themes around job satisfaction and self-efficacy: level of professional involvement and guilt, communication of information and leadership, psychological and physical wellbeing, the safety of self and others, and relationships to and within the nursing profession. Overall, a strong sense of kinship contributed to job satisfaction and self-efficacy. Findings confirmed the need for so-called “aftercare” for nurses by leadership and administrators. The impact of the COVID-19 pandemic has been considerable on the individual nurse’s sense of self-efficacy and job satisfaction, and this is particularly noted in nurses who commenced graduate studies during the pandemic.

Objective To evaluate the impact of a novel nurse-led transition intervention program designed for young adolescents (age 13-14 years) with congenital heart disease (CHD). We hypothesized that the intervention would result in improved self-management skills and CHD knowledge. Study design Single-center cluster randomized controlled trial of a nurse-led transition intervention vs usual care. The intervention group received a 1-hour individualized session with a cardiology nurse, focusing on CHD education and self-management. The primary end point was change in TRANSITION-Q (transition readiness) score between baseline and 6 months. The secondary end point was change in MyHeart score (CHD knowledge). Results We randomized 60 participants to intervention (n = 30) or usual care (n = 30). TRANSITION-Q score (range 0-100) increased from 49 +/- 10 at baseline to 54 +/- 9.0 at 6 months (intervention) vs 47 +/- 14 to 44 +/- 14 (usual care). Adjusted for baseline score, TRANSITION-Q scores at 1 and 6 months were greater in the intervention group (mean difference 5.9, 95% CI 1.3-10.5, P =.01). MyHeart score (range 0-100) increased from 48 +/- 24 at baseline to 71 +/- 16 at 6 months (intervention) vs 54 +/- 24 to 57 +/- 22 (usual care). Adjusted for baseline score, MyHeart scores at 1 and 6 months were greater in the intervention group (mean difference 19, 95% CI 12-26, P <.0001). Participants aged 14 years had a greater increase in TRANSITION-Q score at 6 months compared with 13-year-old participants (P <.05). Conclusions A nurse-led program improved transition readiness and CHD knowledge among young adolescents. This simple intervention can be readily adopted in other healthcare settings.

Interview Data There is ample evidence that childhood adversity correlates negatively with physical and mental health outcomes across the lifespan. Resilience results when internal and external protective factors in childhood mitigate the effects of adversity and mental and physical health outcomes are improved. However, the phenomena of childhood adversity and resilience among autistic children are understudied and not well understood. In this study, we engaged members of the autism community to advise on the research question, research design, and analysis. Following the engagement phase, three autistic young women and one nonbinary young adult, aged 19-27, participated in semi-structured interviews via phone, video conference, and online chat;. credibility checking interviews followed data analysis. Through interpretative phenomenological analysis we identified themes related to negative effects of adversity, including social disconnection, mental and emotional well-being, sense of self, and development into young adulthood. Resilience was developed in places of refuge and identity, and was evident in their transitions into young adulthood. These findings provide direction for fostering resilience in children and adolescents on the autism spectrum and planning and implementing mental health supports to autistic individuals across the lifespan.

ABSTR A C T Purpose: To understand the effectiveness of a nurse-led transition intervention by analyzing qualitative data gen-erated in the context of a clinical trial. Design & methods: Qualitative study of a two-session transition intervention conducted by registered nurses at two sites. Adolescents aged 16-17 years with moderate or complex congenital heart disease (CHD) had been ran-domized to a two-session transition intervention or usual care. Session 1 emphasized patient education including creation of a health passport and goal setting. Session 2, two months later, emphasized self-management. Qual-itative data extracted from intervention logs, field notes and audio recordings of the sessions were analyzed for content and themes. Results: Data from 111 transition intervention sessions with 57 adolescents were analyzed. Creating a health passport, goal setting, and role-plays were the elements of the intervention most valued by participants. A typol-ogy of transition readiness was identified: 1) the independent adolescent (5%), already managing their own care; 2) the ready adolescent who was prepared for transition after completing the intervention (46%); 3) the follow-up needed adolescent who was still in need of extra coaching (26%), and 4) the at-risk adolescent who warranted immediate follow-up (14%). Baseline knowledge and transition surveys scores validated the typology. Conclusions: A two-session nursing intervention met the transition needs of approximately half of adolescents with CHD. However, additional transition-focused care was needed by 40% of participants (groups 3 and 4). Practice implications: These findings will guide pediatric nurses and other healthcare professionals to optimize an individualized approach for ensuring transition readiness for adolescents with CHD. (c) 2021 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).

Children and adolescents who live with chronic conditions are rarely participants in research specifically focused on meeting their needs, nor in intervention planning research. There are, however, special considerations required when conducting research with children and adolescents. This article offers Interview Guidelines designed to ensure children and adolescents’ control of and comfort with interviewing and to maximize the caliber of ethically co-constructed data. We developed, tested, and revised these guidelines with 80 children and adolescents aged 5 to 17 years: 27 with complex Congenital Heart Disease (CCHD) (5–17 years) and 13 with Early Onset Scoliosis (5–12 years) and 28 siblings (7–17 years). The guidelines were further tested with 12 adolescents with Adolescent Idiopathic Scoliosis (10–16 years) and 10 children and adolescents with CCHD (8–12 years). The children and adolescents recounted stories about their everyday life and activities through digitally recorded face-to-face interviews that were transcribed. Detailed field notes were recorded before and after the interview. Our Interview Guidelines address ethics, informed assent and consent, pre-interview planning, establishing trust, and engaging children and adolescents in research. Special attention is given to involving parents in pre-interview planning and disclosing sensitive information post interview. Involving children and adolescents as research participants to gain information from them, not only about them, will assist those in planning appropriate intervention research to meet the needs of children and adolescents living with chronic conditions and their siblings.

Explanatory style is based on how one explains good and bad events according to three dimensions: personalization, permanence, and pervasiveness. With an optimistic explanatory style, good events are explained as personal, permanent, and pervasive, whereas bad events are explained as external, temporary, and specific. For counsellors, an optimistic explanatory style creates positive expectancy judgments about the possibilities and opportunities for successful client outcomes. In this research study, we explored the explanatory styles expressed in 400 events (200 good events and 200 bad events) extracted from 38,013 writing samples of first year and final year graduate level counsellors in training. Across the three optimism dimensions and within good and bad events, there was one occurrence of a positive relationship between counsellor training time and the amount of expressed optimism. The implications of this study include the need to cultivate optimistic explanatory styles of counsellors in training and practicing counsellors.

Nursing in interventional radiology is diverse and multifaceted. This area of specialty nursing has not yet been acknowledged as such or embraced in Canada. Professional development for interventional radiology nurses is lacking with even fewer educational opportunities for non-radiology nurses who care for interventional radiology patients throughout the hospital to develop needed interventional radiology knowledge and related skills. This qualitative descriptive study explored the experiences non-radiology nurses have caring for interventional radiology patients. Interviews with ten non-radiology nurses in a Canadian hospital provided rich data for analysis. Thematic analysis revealed that these nurses did not receive formal IR education in their nursing curriculum, acquired their knowledge through self-teaching, lacked knowledge about imaging modalities and IR procedures, were impeded to build trusting nurse-patient relationships, and felt ineffective communication disrupted the continuity of care they provided. Addressing professional development needs related to creating interventional radiology education, increasing awareness of the specialty of interventional radiology nursing, and enhancing clinical collaboration is a key recommendation.

Members of the autistic community have long advocated for more input into and participation with autism-related research. Currently, the power to determine the direction of autism-related research and knowledge production related to autism lies with non-autistic researchers, while the wishes and perspectives of the autistic community are largely ignored. There is a growing trend toward ethical autism-related research, however, in which the perspectives of all stakeholders, particularly those of autistic individuals, are sought and their expertise on autism is foregrounded. In a study exploring the experiences of childhood adversity and resilience among autistic adults, we strove to conduct our research in an inclusive and ethical way, by integrating participatory methods, such as community engagement to inform research design, and credibility checking with participants to confirm that the analysis resonated with their experiences. Five stakeholders, representing parents of children on the autism spectrum, professionals, and autistic community members were recruited to provide input into the research design and provide insight into autistic ways of communicating, interacting, and being. The recommendations generated through this community engagement were then integrated into an interpretative phenomenological analysis (IPA) framework and implemented with four adult autistic participants. Through reflection on the process of community engagement, development of research design, implementation of the study, and credibility checking, it is clear that incorporating participatory methods into IPA increases rigor and ensures that autistic perspectives are represented through research.

Five sources of methodological data: the interview recordings, transcribedinterviews, interviewer’s pre and post field notes, interviewer reflectivejournals, and team meeting notes.