Decreasing the Risk of Complicated Bereavement and Future Psychiatric Disorders in Children

TOPIC: Decreasing the risk of complicated bereavement and future psychiatric disorders in children. PURPOSE: This literature will determine what major factors influence a child's response to death and to understand how children react to the death of a parent at different developmental stages. It will evaluate the following:

• a) What are children's emotional responses to the death of a parent?
• b) How can a surviving parent help the grieving child complete the tasks of grieving?
• c) What skills are important for a parent to learn in order to help the grieving child through the tasks of grieving and
• d) How can mental health providers help the grieving family and the grieving child?

SOURCES: Relevant literature from child psychiatry, child psychology, and nursing. CONCLUSIONS: The death of a parent is a major stressful event for children and their families. This traumatic event can bring serious psychological and social distress to bereaved children and their families. Children who are not supported in the early phases of grieving can develop serious emotional and behavioral problems that can lead to the development of some major psychiatric disorders. Providing early prevention support programs for surviving parents and bereaved children can help both the parents and the children adapt to their losses. These structured programs can decrease the risk of complicated grief in bereaved families. More research studies are needed to validate the effectiveness of these early prevention program interventions.     

The impact of care on family and health-related quality of life of parents with chronically ill and disabled children

Purpose: Parents of disabled and/or chronically ill children are more vulnerable regarding their health compared to parents of healthy children. This study examines how far the burden of care is associated with health-related quality of life (QoL) in parents, across different illnesses and disabilities. Moreover, it is unclear whether and to which extent familial resources can explain the association between parents’ care burden and health. Method: Data stem from a survey with the German Children’s Network, a self-help umbrella organization of parents and families of chronically ill and disabled children. Data collection was conducted nationwide with a standardized online questionnaire, which included children’s diagnoses and severity, burden of care, family and socioeconomic status, health-related QoL (SF-12) and family impact (Impact on Family Scale, IFS). 1567 parents participated. Results: A higher burden of care is associated with higher risks for poor health-related QoL. Especially, social impact and financial burden, which are both associated with care, can help to explain these associations. Conclusions: Future interventions should focus not only on the affected child but also on the whole family system and its social integration, as this seems likely to relief parents from burden of care. Therefore, a sustainable cooperation of health care institutions and professionals with self-help groups and parental initiatives is recommended.

• Implications for Rehabilitation

• Parents of disabled and chronically ill children are a vulnerable group regarding their health-related quality of life.

• A higher burden of care is associated with less social contacts, higher financial burden and higher help-needs in the household, which significantly contribute to higher health risks.

• Rehabilitation should take these constraints into account and put a stronger focus on the family of disabled and chronically ill children to support their inclusion.

• A sustainable and formally anchored collaboration with self-help and patient groups is recommended.

     

Powerlessness of caregivers in home care

• ? Patients are not the only ones who suffer when they have a chronic illness; significant others and family members can also suffer.
• ? Reaction to chronically ill family members and the problems in their care varies among significant others.
• ? As the number of elderly individuals is increasing the number of chronically ill people needing care is also increasing.
• ? Not only do patients feel powerless but personal factors, factors in the environment, and factors related to the illness itself can also provide a conceptual framework for organizing factors that affect feelings of powerlessness among family members and significant others.

     

The contribution of nurses to children's well-being in hospital: a selective review of the literature

• ? The literature demonstrating the effects of child hospitalization is reviewed prior to a review of selected aspects of a child's hospital experience.
• ? Despite the clearly demonstrated benefit of preparatory work with children and their parents, it appears that British nurses have not widely incorporated well-researched techniques into their practice.
• ? Hospitalization appears to be a lonely experience both for children and their parents.
• ? Pain management is also reviewed and it is clear that optimal pain relief has yet to be attained.

     

Partnership in care: parents' views of participation in their hospitalized child's care

• ? This paper describes parents' experiences of participation in their hospitalized child's care on a general surgical paediatric ward.
• ? The findings indicate that parents chose to participate because of concern for the child's emotional welfare. Influencing- factors included sense of parental duty, past experiences with hospitals, and concern for consistency of care.
• ? Parents' readiness to care was encouraged by a supportive family network, support from other parents, familiarity and experience with care.
• ? Parents were willing to adapt their parenting skills in order to be able to care for their child at home and were willing to perform more care provided it did not cause pain for the child, had the nurses' approval and increased their confidence and competence as carers.
• ? Lack of information, non-negotiation of roles, inadequate facilities, feelings of anxiety and loneliness were the difficulties parents experienced.

     

Burdened parents sharing their concerns for their children with the doctor. The impact of trust in general practice: a qualitative study

Abstract

Objective: The aim of this study was to recognise the preconditions experienced by general practitioners (GPs) in addressing the children’s needs when ill and substance abusing parents consult for their own health problems.

Design: Qualitative analysis of 38 case stories told by GPs in focus group interviews.

Setting: Focus group interviews of four continuing medical education groups for GPs in western Norway.

Subjects: 27 GPs (nine females) with at least 5 years’ experiences in general practice.

Results: Different aspects of the GPs’ perceived mandate of trust from the parents was a precondition for the children’s situation to be addressed. In some case stories the participants took an open mandate from the parent for granted, while in others they assumed that the parent did not want to discuss their family situation. Sometimes the participants had faith that by continuing with their ordinary GP tasks, they might obtain a more open mandate of trust. Their evaluation of the mandate of trust seemed to impact on how the GP could adopt a mediating role between the parents and various support agencies, thus supporting children who were at risk.

Discussion/conclusion: The children most at risk may remain invisible in GPs’ encounters with their parents, possibly because their parent’s health problems and overall situation overshadow the children’s situation. The mandate of trust from burdened parents to GPs can be a fruitful concept in understanding the interaction regarding the welfare of the parent’s children. Negotiating the mandate of trust with parents by explicitly addressing trust and having an ongoing discussion about the mandate and its limits might be an option to secure the children support if necessary.

• KEY POINTS

• Offering children of burdened parents information and support can be crucial for health promotion and illness prevention.

• A general practitioner’s (GP’s) evaluation of the trust parents have in them can determine the extent of support children receive.

• Depending on the parents’ level of trust, GPs may take a mediating role between support services and parents for the benefit of the children.

• A negotiation concerning the trust parents have in the GP may open up possibilities for GPs to offer children necessary support.

     

Partnership caring

• ? ‘Partnership caring’ emphasizes the current paediatric practices and their importance in paediatric nursing Today.
• ? The importance in not compromising care in a rapidly changing health scene is described when shrinking resources and increasing constraints put pressure on the health services.
• ? Important concepts such as pre-admission programmes, creating the right environment for the child, family-centred care, parent participation, family accommodation and supporting services, nursing documentation, the rights of the child and family, specialist and community nursing services as well as children's out-patient services providing the vital link in the continuum of care are all emphasized. They show how these became ideas 5–6 years ago but are now firmly established in the philosophy of family-centred care.
• ? In the new health service today, paediatric nurses face new challenges which emanate from the children and parents served, but also from within new clinical directorate structures. ‘However, within our new world of clinical directorates and when the clinical director has the executive authority to make and influence decisions, and when segmentalization of paediatric services becomes a real threat (and in some places this is happening now!) paediatric nurses must remember the children. We must stand firm in our values and beliefs and above all we must not allow these changes to compromise the care we give to children and their families.’

     

Awareness of parental illness: a grounded theory of upholding family equilibrium in parents on long-term sick-leave in primary health care

ObjectiveTo understand the main concern of chronically ill parents and how they resolve this concern in relation to their children.DesignGrounded theory.SettingThree primary health care clinics in Sweden.SubjectsThirty-two interviewed parents and their children.Main outcome measuresProcesses and typologies of upholding family relationships.ResultsA concern of chronically ill parents is sustaining family equilibrium, achieved through a process of upholding family relationships. How a parent upholds depends upon his/her comprehension of the illness and of their child’s need for parenting. In response to the parent’s upholding behaviours, children mirror the effect of the illness to the parent, the child’s specific behaviour depending on his/her level of comprehension regarding the parent’s illness. Their combined behaviours create an awareness context that may be closed, concealed, suspicious, conflicted, mutual pretence or open.When the parent drives and facilitates the evolution of comprehension, the context quickly evolves from closed to open. When the parent hinders the process by masking and resisting the child responds by probing and proving and they become locked into a suspicious or conflicted awareness context with high relational tension. To create family equilibrium the parent needs to reveal and facilitate the awareness process.ConclusionParents on long-term sick leave in primary health care can need assistance to facilitate the awareness context of themselves and their child.Implications: Clinicians can identify the current awareness context of their patient and help their patient towards increased understanding of their illness; their child’s needs and the parental capacities needed to reveal the illness and its impacts.

Key Points

• Children are affected when parents are ill; they wish for information on their parent’s illness. Effective interventions are available in settings other than primary health care and possibilities seen by GPs and families in Scandinavian primary health care have been previously described. There is a knowledge gap in how parents view themselves and their parenting when ill in primary health care. An analysis grounded in interviews was needed to generate a hypothesis (theory) of parental concerns and behaviours.
• This theory proposes that an important concern of chronically ill parents is to sustain family equilibrium, which they attempt to do by upholding family relationships.
• Specific upholding behaviours include masking, resisting, colluding, and revealing. In response, children will engage in mirroring behaviours. Which paired behaviours are enacted will depend upon the respective levels of comprehension of parent and child regarding the illness and on the child’s need for parenting. In their interactions, parent and child create one of six awareness contexts.
• Identifying the current awareness context in the family about chronic parental illness provides clinicians with a conceptual tool to better support those families locked in suspicious or conflicted awareness contexts.

     

Managing capacity issues in clinical placements for pre‐registration nurses

Aims and objectives. To explore influences on decision‐making concerning placement capacity planning for supporting nursing students in clinical placements. The research questions were:

• ? How are decisions relating to capacity planning and management of the learning environment made within the practice areas?
• ? What factors were or are perceived as important to take into consideration when making these decisions?

Background. It is already known that clinical placements are pivotal to pre‐registration nurse education. The recent large expansion of nurse education places means that more students require clinical placements than previously. This study explored decision‐making about placement capacity amongst mentors in one central English county. Design. A qualitative design using focus groups. Study and methods. Collecting data allowed researchers to engage mentors in discussions concerning their decisions about how many students they could support in practice and the learning environment they could provide. Twenty‐nine active nursing student mentors participated, representing three branches (Adult, Mental Health and Child Health Nursing) from various acute and community settings and professional roles. Results. Three themes emerged relating to capacity management issues in clinical placements:

• ? Capacity issues: how decisions are made in relation to capacity planning, by whom they are made and what influences them?
• ? Supporting learners and enhancing support in practice.
• ? Issues impacting on learning in practice.

Conclusions. This study adds further understanding of the need for robust information to support allocation decisions, coupled with greater clinical staff and mentors’ involvement in decisions about student support. The forthcoming Skills for Health Ensuring Quality in Partnership requirements may add authority and structure to student support activities. Relevance to clinical practice. Strategic practice and placement development links and joint appointments between UK NHS trusts and higher education institutions should be considered if placement capacity issues are to be addressed successfully and the quality of students’ placements are to be safeguarded.     

A review of lay health beliefs research: insights for nursing practice in health promotion

• ? Recent sociological research in the field of lay health and illness beliefs is reviewed and discussed in the light of nursing practice in health promotion.
• ? How the findings might deepen nurses' understanding of difficulties in adhering to desired health behaviours is outlined.
• ? The distinctions between ‘public’ and ‘private’ accounts of health, the ‘taken-for-grantedness’ of health, the emotive nature of health and the difficulty of accessing ‘unpolluted’ lay views of health is considered. The implications for nurses working in health promotion are discussed.
• ? There is a need for further research into the relationship between health beliefs and behaviour, the health beliefs of various groups within society and a need to examine how health beliefs arise and change.

     

Helping ‘new carers' of the frail elderly patient: the challenge for nurses in acute care settings

• ? The present policy of community care for frail elderly individuals relies primarily on the provision of support by informal carers. Such carers are usually close family members, most often spouses or children.
• ? Whilst most carers take on their role willingly they often do so at a time of crisis, such as following a period of hospitalization. As a consequence many individuals are ill-prepared for their new responsibilities. For a minority of others the role of carer is adopted reluctantly.
• ? This paper argues that nurses in acute care settings are in the best position to try and ensure that individuals become carers following an informed decision-making process.
• ? Suggestions are provided as to how current nursing practice can be improved in order better to achieve this aim.

     

Nurses caring for families – issues in a multiracial society

• ? Social, racial and ethnic factors are examined as key issues which affect nurses caring for families.
• ? A co-ordinated approach to caring for all families means that diverse clinical or therapeutic nursing may result.
• ? Quality caring for all families requires improved education, at pre- and post-registration levels, about the relationship between race and ethnicity and families' health, and the treatment regimens undertaken by families.
• ? Effective caring for families from different social, racial and ethnic groups is still at a rudimentary level.
• ? Orem's (1989) self-care nursing model is explored to show how ethnic differences and similarities among families are incorporated into caring.

     

Juggling identities of rheumatoid arthritis,motherhood and paid work – a grounded theory study

Purpose: To explore how women with rheumatoid arthritis manage their illness, motherhood, and work life.

Methods: A constructivist, grounded theory approach based on individual interviews and participant observations with 20 women with rheumatoid arthritis who participated in work life and had children living at home or were pregnant. After initial and focused coding Goffman’s concepts of social identity were applied.

Results: A core category: “Juggling meaningful identities” and three conceptual categories were developed: (1) Work life as the strongest identity marker; (2) Motherhood: a two-sided act; (3) Living with rheumatoid arthritis as an identity? Paid work, motherhood, and illness are linked to the women’s social identities. The women construct and change their identities in interactions with children, partners, other parents, colleagues, and employers.

Conclusion: The women attribute the highest priority to their professional identity, spending the majority of their time and energy in an effort to appear as “good stable workers”. The disease is seen as a hindrance in this regard, and the illness identity is almost completely rejected. In motherhood, the women prioritize close interaction with their children, and deprioritize external activities. Extended outbreaks of the disease and issues regarding the children force the women to deprioritize working life.

• Implications for rehabilitation

• Juggling meaningful identities of rheumatoid arthritis, motherhood, and paid work challenge women in managing their everyday lives. Therefore, rehabilitation professionals should support individuals to develop new strategies to manage the challenges they experience regarding juggling motherhood and work ability.

• Work is a dominant identity marker for women with rheumatoid arthritis therefore, rehabilitation professionals have an important role to play in investigating possible ways for the individual to maintain employment or return to work.

• Living with rheumatoid arthritis and being a paid worker challenge women’s role performance and thereby their identification as mothers. Therefore, rehabilitation professionals have to support the women and their families.

     

‘A thorny problem for feminism’: an analysis of the subjective work experiences of enrolled nurses

• ? Feminist methodology has been used in this study to investigate the subjective work experiences of 19 enrolled nurses.
• ? Reflexive conversational techniques enabled participants to relate autobiographical narratives examining their experiences of working in a nursing hierarchy.
• ? Two themes are reported: ‘nursing identity’ and ‘exploitation’. Through an analysis of these themes insight has been gained into the manner in which nurses inter-relate.
• ? The study demonstrates how the correlation between rank, status and expertise within the nursing hierarchy may have negative consequences for patient care.

     

To give the invisible child priority: Children as next of kin in general practice

Objective. To explore general practitioners’ (GPs’) experiences in helping children as next of kin of drug-addicted, mentally ill, or severely somatic ill adults. These children are at risk of long-term mental and somatic health problems. Design. Qualitative focus-group study. Setting. Focus-group interviews were conducted in western Norway with a total of 27 GPs. Participants were encouraged to share stories from clinical encounters with parents who had one of the above-mentioned problems and to discuss the GP''s role in relation to helping the patients’ children. Results. The GPs brought up many examples of how they could aid children as next of kin, including identifying children at risk, counselling the parents, and taking part in collaboration with other healthcare professionals and social workers. They also experienced some barriers in fulfilling their potential. There were time constraints, the GPs had their main focus on the patient present in a consultation, and the child was often outside the attention of the doctors, or the GPs could be afraid of hurting or losing their vulnerable patients, thus avoiding bringing up the patients’ children as a subject for discussion. Conclusions. Norwegian GPs are in a good position to help children as next of kin and doctors make a great effort to support many of them. Still, support of these children by GPs often seems to depend not on careful consideration of what is best for the patient and the child in the long run, but more on short-term convenience reasons.Key Words: Child of impaired parent, children as next of kin, disease prevention, family health, focus group, general practice, general practitioner, health promotion, Norway, qualitative researchChildren whose parents are suffering from mental health illness, substance abuse, or severe somatic disease are at risk of developing poor health and psychosocial problems. Meeting their special needs is important for health promotion and disease prevention.

• GPs are in a good position to identify children as next of kin, support parents in their parenting role, and take part in the multidisciplinary network.
• Lack of time and capacity problems are barriers for GPs in fulfilling this potential.
• GPs’ fear of jeopardizing the relationship with their patients represents an important barrier to introducing the children''s situation in consultations with the parents.

     

An exploratory study from the patients' perspective of living with allergies

• ? Allergic disease is one of the most prevalent chronic medical conditions in the world.
• ? Allergen avoidance has been accepted as a form of treatment for allergic disease; however, the success of treatment is often dependent on how patients choose to manage their condition.
• ? The purpose of this study was to explore how allergic conditions affect the lives of allergy sufferers and what information they believe would be useful to other allergy sufferers in the management of their allergic condition.
• ? Patients suffering from non-life-threatening allergies stated that their allergy affected many aspects of their life, such as their work, their social life, their emotional state, their physical appearance and, hence, their interactions with others. The chronic symptoms of their condition caused the greatest concern to patients. Many of these participants ‘accepted their condition’ and undertook controlling measures as part of their daily life.
• ? In contrast, patients suffering from life-threatening allergies stated that their allergy did not affect their life. Knowledge of their allergic condition was more important than acceptance.
• ? The findings elicited from allergy sufferers identified how nurses can educate patients about their condition and assist them in learning to live with their condition.

     

Socially disadvantaged parents of children treated with allogeneic haematopoietic stem cell transplantation (HSCT): Report from a supportive intervention study,Denmark

PurposeThis study was undertaken to test a daily Family Navigator Nurse (FNN) conducted intervention program, to support parents during the distressful experience of their child's Allogeneic Haematopoietic Stem Cell Transplantation (HSCT).MethodsA qualitative analysis of the supportive intervention program for parents whose child is under HSCT treatment while hospitalized. Parents to 25 children were included in the intervention group. Twenty-five parents were included in a participant observational study and 21 of these completed a semi-structured interview 100 days following HSCT.ResultsThree main problems faced by all parents included 1) the emotional strain of the child's HSCT; 2) re-organizing of the family's daily life to include hospitalization with the child; and 3) the financial strain of manoeuvring within the Danish welfare system.The FNN performed daily intervention rounds to ease each of these problems during the study period. Having the following pre-existing risk factors, negatively influenced the parents' ability to address these problems: 1) being a single parents; 2) low-level income; 3) low-level education; 4) low-level network support: 5) being a student or unemployed; 6) physical/psychiatric illness; and 7) ethnicity. Six families with 4 or more risk factors had complex emotional, social and financial problems that required extensive intervention by the FNN and that impacted their ability to provide care for the child.ConclusionThe parents' pre-existing risk factors were further complicated by their children's HSCT. A recommendation for clinical practice is to identify families with multiple interrelated problems and allocate resources to support these families.     

What do elderly people do in hospital?

• ? Current health-care reforms have sharpened the focus on efficiency of bed usage; one useful method of exploring this concept is to determine how patients spend their time in hospital.
• ? This small study explored how 23 elderly patients spent their time on two elderly care wards.
• ? A time-sampling, patient-focused, structured observation method was employed to observe the patients. The most commonly observed activity was eating and drinking.
• ? The findings, in keeping with previous work, suggest that therapeutic activities occupy a minimal proportion of the patient's day.
• ? Reasons for inactivity are explored and recommendations made for further research.