Nursing Care of Families With Parents Who Are Lesbian, Gay, Bisexual, or Transgender

TOPIC:  Families in which parents are lesbian, gay, bisexual, or transgender are more diverse than they are similar. The numbers of parents and children in these families appear to be increasing with implications for nurses and other clinicians.
PURPOSE:  This paper reviews the current literature to determine the fundamental issues facing alternate families that include sexual minority parents and their children. It also explores the unique nursing needs of families with gay, lesbian, transgender, or bisexual parents in the field, which are critically examined for direct relevance to psychiatric nursing practice.
SOURCES USED:  Current theoretical and research literature in nursing, child development, family law, and healthcare professional journals.
CONCLUSIONS:  Despite a relative lack of pathology noted in the literature related to families with sexual minority parents, nurses, and other healthcare professionals can incorporate current knowledge of unique child developmental, parenting, and legal issues into their work with these families. Assessments and interventions that address the unique needs of these families may help parents and children to deal with social stress from being perceived as "different" by other children, or as "problematic and threatening" by other parents.     

Enabling overweight children to improve their food and exercise habits - school nurses' counselling in multilingual settings

Aims and objectives. The study aimed at analysing school nurses' counselling of overweight and obese children in settings with many immigrants, focusing on content concerning food and physical activity and how this was communicated. Background. For people with a predisposition for overweight, the weight control process requires cognitive skills. School nurses' counselling of overweight children has the potential to support this process by enabling personal resources in the children and their families. However, there is uncertainty among nurses about how to conduct supportive counselling. Design. An explorative design was used when collecting and analysing data. Method. Twenty-two counselling sessions between eight school nurses and 20 overweight children were audio-recorded and analysed using qualitative content analysis. Most of the participating schools represented areas with low socioeconomic status and a high proportion of immigrants and refugees. Results. Less adequate skills in enabling resources in the children and their parents were observed. Concurrently, school nurses provided inadequate explanations about food and physical activity. Topics related to general nutrition models were frequently communicated as general advice instead of individually tailored counselling. Counselling families with other languages and food cultures than the traditional Swedish created additional difficulties. Conclusions. Improved nutritional knowledge for nurses may enhance their skills in enabling children's and families' resources. School nurses should be provided with opportunities to cooperate with other professions in counteracting overweight. Relevance to clinical practice. Our findings demonstrate a relationship between content skills and person-centeredness in the counselling. This highlights the importance of inter-professional collaboration to ensure a high quality of lifestyle counselling. School health authorities should give high priority to facilitating school nurses' evidence-based continuing education.     

Social Implications of Overweight and Obesity in Children

PURPOSE.  To elucidate some of the social impacts that overweight and obesity in children has on families. Healthcare practitioners may be unaware of these impacts if not similarly affected.
DESIGN.  Qualitative semistructured, interview-based study.
METHODS.  A purposive sample of parents ( n  = 58) with overweight and obese children ( n  = 48) from three areas in the United Kingdom was used. Analysis was thematic and iterative , underpinned by Grounded Theory.
RESULTS.  There are many social situations that have an impact on the child directly (stigmatization), on parents (blame), and on the family in general (being ostracized).
PRACTICE IMPLICATIONS.  Seeing the child and his/her family in a broader context with improved understanding of the complexity of raising an overweight child.     

Ecological Differences in Weight, Length, and Weight for Length of Mexican American Children in the WIC Program

PURPOSE.  Examine factors common in the environments of children who obtain services from a WIC program to determine if differences in ecological/environmental factors can be found in the children who differ in weight , length , and weight for length.
DESIGN AND METHODS.  Cross-sectional study of 300 children , 100 each who were stunted , normal weight for length , or overweight. Instruments used were NCATS , ARSMA II , 24-hr diet recall , and Baecke Activity Questionnaire.
RESULTS.  Significant differences were present in children's diet , parents' BMI , parents' generation in United States , parents' activity levels , and maternal–child relationship.
PRACTICE IMPLICATIONS.  Encourage parents to adopt family approaches to encourage normal body size in children.     

Primary care management of childhood and adolescent hypertension

Purpose: To educate advance practice nurses on the diagnosis, pharmacologic, and nonpharmacologic management of hypertension in children and adolescents.
Data sources: Information was collected through a search of published literature and clinical practice guidelines.
Conclusions: Increasing rates of hypertension in children and adolescents are correlated to risk for coronary artery disease in adulthood. Nonpharmacologic management includes lifestyle modifications addressing weight reduction, physical activity, and dietary modification. Pharmacologic management is typically reserved for patients with severe hypertension or those who do not respond to lifestyle modifications. Early intervention is critical for preventing target-organ damage and complications of long-term hypertension.
Implications for practice: Nurse practitioners must identify and address elevated blood pressure levels in children and adolescents. Many children and adolescents can successfully lower blood pressure readings through nonpharmacologic lifestyle changes. Education about lifestyle modification strategies should focus on family-based changes in order to increase likelihood of successful implementation.     

Bridging Cultures for Latino Children: School Nurse and Advanced Practice Nurse Partnerships

TOPIC:  Barriers to use of mental health services by Latino families include stigma, service costs, and disparity of services with cultural values and traditions. School nurses are in key positions to recognize mental health needs of Latino children and form relationships that facilitate family connections with mental health services. Advanced practice psychiatric nurses may be contracted by school districts to provide consultation to school nurses or may be available to school nurses through connections with school-based health centers. Case examples are provided to illustrate the value of school nurse consultation with an advanced practice psychiatric nurse in promoting awareness of cultural influences on children's symptoms and behaviors and developing culturally sensitive approaches to engage Latino children and families in school and health services.
PURPOSE:  This paper aims to review literature on Latino mental health and present rationale for school nurse and advanced practice nurse partnerships to promote culturally sensitive approaches that facilitate Latino family access and utilization of health services.
SOURCES:  Published literature and case scenarios.
CONCLUSIONS:  With advanced practice nurse consultation, school nurses identify mental health needs of Latino children and develop culturally sensitive approaches that bridge Latino families' access to and utilization of health services.     

Sleep Deprivation Is an Additional Stress for Parents Staying in Hospital

PURPOSE.  This study aims to describe the sleep experience of parents staying overnight with their children in hospital.
DESIGN AND METHODS.  Parents ( n  = 102) completed the Verran and Snyder-Halpern Sleep Scale following a night spent with their children in an Australian tertiary pediatric hospital .
RESULTS.  Parents experienced sleep deprivation and poor quality of sleep, reporting a mean sleep period of 4.6 hr ( SD  = 2.1). Having only one child in the room was the only variable that significantly influenced the quality or amount of parental sleep .
PRACTICE IMPLICATIONS.  Parental sleep deprivation needs to be acknowledged and accommodated when nurses and parents negotiate the care of children in hospital .     

Parent's involvement in decisions when their child is admitted to hospital with suspected shunt malfunction: study protocol

Title.  Parent's involvement in decisions when their child is admitted to hospital with suspected shunt malfunction: study protocol.
Aim.  This paper outlines the protocol for a study aimed at exploring parent's involvement during professional–parent interactions and decisions about their child's care in the context of suspected shunt malfunction.
Background.  Hydrocephalus is a long-term condition treated primarily by the insertion of a shunt that diverts fluid from the brain to another body compartment. Shunts frequently malfunction, and parents of children with shunted hydrocephalus are responsible for recognizing and responding to shunt complications. Parents feel that interactions with professionals when they seek healthcare advice for their child do always not encourage active participation in care decisions.
Methods.  The study design is based on qualitative methodologies: a combination of conversation analysis applied to consultation recordings of professional–parent interactions when a child is admitted to hospital with suspected shunt malfunction, and semi-structured follow-up interviews with the same participants within 2 weeks of the consultation.
Participants.  This is a prospective study and participants will be purposefully selected. Parents of children who have been admitted to hospital with suspected shunt malfunction and healthcare professionals responsible for the initial assessment of the child will be invited to participate.
Discussion.  The study will identify how decisions about a child's care are negotiated between parents and healthcare professionals at key stages of the care pathway. In addition, examining interactions between healthcare professionals and parents may identify approaches that support or hinder parents in contributing to the decision-making processes when they seek advice from healthcare professionals.     

Obesity in the pediatric headache population: a multicenter study

Objective.— To examine the prevalence of obesity, the relationship between weight compared with headache frequency and disability, and effect of weight change on headache outcomes within a pediatric headache population.
Background.— Headache and obesity are both common conditions in children and adults. Research in adults has suggested a relationship between the 2 conditions. This relationship has not yet been explored within a pediatric population. The effect of obesity and weight change on headache outcomes may have important implications for clinical care.
Method.— Data on height, weight, age, and gender, as well as headache frequency and disability, were collected on 913 consecutive patients at 7 pediatric headache centers, the body mass index (BMI) calculated and the BMI percentile determined. The same data were collected on patients seen at 3- (n = 213) and 6-month (n = 174) follow-up for comparative analysis.
Results.— The prevalence of overweight patients at initial visit did not significantly differ from the general pediatric population. BMI percentile was significantly correlated with headache frequency and disability at initial visit, although the correlations were relatively small. For children who were obese or at risk for overweight as initial visit, change in BMI was significantly positively correlated with change in headache frequency at 3- and 6-month follow-up.
Conclusions.— Obesity is associated with headache frequency and disability in the pediatric headache population. For children who are overweight, weight loss can contribute to a reduction in headaches over time. Clinicians should consider child weight status in providing care for pediatric headache.     

Turkish nurses' perspectives on a programme to reduce burnout

Background:  Burnout is a serious problem among nurses. Programmes to prevent and reduce burnout have been described, but nurses report that they have difficulty attending such programmes and the dropout rate is substantial.
Aim:  To investigate the perspectives of nurses on burnout and the barriers and facilitators affecting attendance at a burnout reduction programme offered in their institution.
Methods:  A qualitative study using semi-structured interviews was conducted with 18 nurses who had volunteered to attend a burnout intervention programme at a University Hospital in Izmir, Turkey. Six of the nurses had not attended any sessions, six attended four or less of the seven and six attended all sessions. Data were analysed using thematic analysis.
Results:  Nurses attributed burnout to their heavy workload and a lack of recognition for their work. Most stated that they need work-directed rather than person-directed interventions to reduce stress and burnout. Attendance at the intervention programme was impeded by such issues as a perceived lack of institution support and the possibility of being seen by other nurses as unable to cope with stress.
Conclusion:  Researchers planning burnout intervention programmes should consider ways of increasing cooperation between the administration and the staff that facilitate attendance at such programmes. A holistic approach involving work-directed and person-directed interventions is recommended.     

Barriers to and facilitators of nurse-parent interaction intended to promote healthy weight gain and prevent childhood obesity at Swedish child health centers

Background

Overweight and obesity in preschool children have increased worldwide in the past two to three decades. Child Health Centers provide a key setting for monitoring growth in preschool children and preventing childhood obesity.

Methods

We conducted semi-structured interviews with 15 nurses working at Child Health Centers in southwest Sweden in 2011 and 2012. All interviews were tape recorded and transcribed verbatim and imported to QSR N’Vivo 9 software. Data were analyzed deductively according to predefined themes using content analysis.

Results

Findings resulted in 332 codes, 16 subthemes and six main themes. The subthemes identified and described barriers and facilitators for the prevention of childhood obesity at Child Health Centers. Main themes included assessment of child’s weight status, the initiative, a sensitive topic, parental responses, actions and lifestyle patterns. Although a body mass index (BMI) chart facilitated greater recognition of a child’s deviant weight status than the traditional weight-for-height chart, nurses used it inconsistently. Obesity was a sensitive topic. For the most part, nurses initiated discussions of a child’s overweight or obesity.

Conclusion

CHCs in Sweden provide a favorable opportunity to prevent childhood obesity because of a systematic organization, which by default conducts growth measurements at all health visits. The BMI chart yields greater recognition of overweight and obesity in children and facilitates prevention of obesity. In addition, visualization and explanation of the BMI chart helps nurses as they communicate with parents about a child’s weight status. On the other hand, inconsistent use and lack of quality assurance regarding the recommended BMI chart was a barrier to prevention, possibly delaying identification of overweight or obesity. Other barriers included emotional difficulties in raising the issue of obesity because it was perceived as a sensitive topic. Some parents deliberately wanted overweight children, which was another specific barrier. Concerned parents who took the initiative or responded positively to the information about obesity facilitated prevention activities.

     

Lifestyle behaviours and weight among hospital-based nurses

Aims  The purpose of this study was to (i) describe the weight, weight-related perceptions and lifestyle behaviours of hospital-based nurses, and (ii) explore the relationship of demographic, health, weight and job characteristics with lifestyle behaviours.
Background  The obesity epidemic is widely documented. Worksite initiatives have been advocated. Nurses represent an important part of the hospital workforce and serve as role models when caring for patients.
Methods  A sample of 194 nurses from six hospitals participated in anthropometric measurements and self-administered surveys.
Results  The majority of nurses were overweight and obese, and some were not actively involved in weight management behaviours. Self-reported health, diet and physical activity behaviours were low, although variable by gender, age and shift. Reports of co-worker norms supported low levels of healthy behaviours.
Conclusions  Findings reinforce the need to address the hospital environment and culture as well as individual behaviours for obesity control.
Implications for nursing management  Nurse managers have an opportunity to consider interventions that promote a climate favourable to improved health habits by facilitating and supporting healthy lifestyle choices (nutrition and physical activity) and environmental changes. Such efforts have the potential to increase productivity and morale and decrease work-related disabilities and improve quality of life.     

Retaining older nurses in primary care and the community

Title.  Retaining older nurses in primary care and the community.
Aim.  This paper is a report of a study conducted to examine issues associated with the impact of age on the retention of female primary and community care nurses in the National Health Service in England.
Background.  Little is known about why older nurses in the primary and community care workforce leave and what might encourage them to stay.
Methods.  A cross-sectional survey using a semi-structured postal questionnaire was carried out during 2005. Responses were received from 485 (61%) district nurses, health visitors, school nurses and practice nurses in five primary care trusts in England. Data were analysed to test for associations.
Results.  Older nurses were more likely than younger ones to report that their role had lived up to expectations ( P  = 0·001). Issues important for older nurses were feeling valued and being consulted when change was implemented. Important factors encouraging nurses to stay were pension considerations, reduced working hours near retirement, and reduced workload. For those with degree-level qualifications, enhanced pay was a factor encouraging retention ( P  = 0·044). Nurses might leave in response to high administrative workloads, problems in combining work and family commitments ( P ≤  0·001), and lack of workplace support ( P  = 0·029). Retirement and pensions advice was not widely available.
Conclusion.  Since two-thirds of nurses were generally happy in their role, it is important that the conditions necessary to maintain this level of satisfaction are continued throughout a nurse's working life. Nurses may all too easily consider leaving prematurely unless policy makers and managers ensure that their working environment reflects the issues nurses consider to be conducive to retention.     

The aspects school health nurses find important for successful health promotion

Scand J Caring Sci; 2010; 24; 156–163
The aspects school health nurses find important for successful health promotion
Background:  The work of school health nurses has changed over time; today they focus on health promotion, i.e. encouraging and protecting pupils' health.
Aim:  The aim of this study was to explore school health nurses' conditions for health promotion work with pupils aged 13–15 years.
Methods:  Eight school health nurses from eight different municipalities in Sweden were interviewed. Since the focus was on describing school health nurses' own experiences of their conditions for health promotion work, the research method used was based on Graneheim and Lundman's qualitative content analysis.
Results:  The results showed that conditions for school health nurses' work with health promotion varied between the different municipalities. This had an influence on what they did and the extent to which they worked in this way. The school health nurses described three important aspects that were essential in order to enable successful health promotion work in schools: organisation, support and knowledge. Organisation : It was important to understand the role of school health nurses and the conditions for health promotion work. Without this, they could only work on an individual level. Support : A network of other professions, working in close collaboration for the health of the pupils, created an understanding of ill health and what could be done to promote health. Knowledge : Most school health nurses recognized a lack of general theories and methods, leading to different empirical working methods in the municipalities.
Conclusion:  In an organisation where the need for health promotion work was understood, and school health nurses had support and knowledge, health promotion could be performed not only on an individual- but also on a general level.     

Effects of pro-/synbiotic supplementation on anthropometric and metabolic indices in overweight or obese children and adolescents: A systematic review and meta-analysis

Background & aimsExisting evidence on the possible effects of pro-/synbiotics on overweight or obese children and adolescents has not been fully established. Therefore, the present review was undertaken to evaluate the overall effects of pro-/synbiotics supplementation on anthropometric indices and metabolic indices in overweight or obese children and adolescents.MethodsA systematic computerized literature search of PubMed, Scopus, ISI Web of science and Google Scholar databases was conducted up to November 2018. All RCTs using pro-/synbiotics supplements in overweight or obese children and adolescents included in this systematic review and meta-analysis.ResultsOverall 9 randomized trials including 410 subjects were identified for the present meta-analysis. Pooled analysis did not illustrate any significant changes in BMI z-score, waist circumference, weight, body fat, fasting blood sugar and lipid profiles (triglyceride, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol) after supplementation with pro-/synbiotics for 4–16 weeks. However, subgroup analysis by intervention type revealed a significant reduction of BMI z-score in synbiotic subgroups.ConclusionBased on our findings, modulation of gut microbiota composition through pro-/ synbiotic supplements did not have favorable effects to manage overweight or obese children and adolescents. Further large-scale studies are warranted to confirm present findings.