Anxiety and postoperative pain in children who undergo major orthopedic surgery.

Anxiety and pain are major concerns not only for children who undergo surgery, but also for their parents and health care professionals. A convenience sample of 74 adolescents who underwent major orthopedic surgery for repair of idiopathic scoliosis and their parents was used to investigate the relationships among children's and parents' preoperative and postoperative anxiety and children's postoperative pain. Age-appropriate versions of Spielberger's State-Anxiety scales measured children's and parents' anxiety, and a visual analog scale assessed children's pain intensities. Children's state anxiety increased from preoperative to postoperative levels, and their postoperative anxiety levels positively related to their pain intensities on days 2 and 4 following the operation. Parents' anxiety decreased from preoperative to postoperative levels, and their postoperative anxiety positively related to their children's postoperative anxiety. Studying both parents and children helped to explain the variance in children's self-reported anxiety. Parents' emotional states are important indicators of children's emotional states and, subsequently, their pain experience. The results of this study suggest that allowing children to assist in the assessment of their postoperative pain may help health care professionals better understand the subjective component of pain. The findings also emphasize the importance of including parents in future studies in which the aim is to understand children's behavioral responses and recovery outcomes.     

Detecting and addressing developmental and behavioral problems in primary care

Pediatric primary care clinicians usually offer a range of in-office services designed to detect and address developmental and behavioral problems. Research suggests that selecting among these services is difficult because fewer than 30% of children with disabilities are detected by their health care providers. Undetected children fail to receive early intervention, which has substantive benefits in improving high school graduation and employment rates, and reducing teen pregnancy and criminal activities. Fortunately, many recently published tools help detect the majority of children with problems. Measures relying on information from parents are flexible, brief, and accurate. One of the briefest tools. Parents' Evaluation of Developmental Status (PEDS), also offers an evidenced-based approach that helps clinicians decide when to refer, screen, advise, or reassure families or observe children more carefully over time.     

Parents call for concerned and collaborative care

Parents' perceptions and expectations of health care providers within the context of the pediatric lung transplant experience were investigated using a phenomenological approach. Fifteen parents of 12 children were interviewed. Two theme clusters, concerned care and collaborative care, were formulated. Themes that reflected parents' perceptions of concerned care included: being treated as an individual, seeing familiar faces, feeling that their children really mattered, and conversely, experiencing a feeling of abandonment. Parents' perceptions of collaborative care included: being part of the team, and conversely, feeling caught in the middle. The theme cluster, concerned care, reflected the value parents place on continuity of care. Humanistic nursing theory provided the link between study results and nursing practice.     

Parents' concerns about issues related to their children's genetic conditions.

PURPOSE: The purpose of this analysis was to examine parents' (N = 142) concerns about issues (i.e., privacy of information, insurance, healthcare costs, employment, school) related to their children's genetic conditions. DESIGN AND METHODS: Using a series of matrices, thematic analysis was conducted focusing on parents' concerns. RESULTS. Parents were less concerned with privacy and more concerned with insurance, healthcare costs, employment, and school issues. PRACTICE IMPLICATIONS: Nurses and other healthcare professionals need to give parents the opportunity to discuss their concerns and to assist parents with strategies and resources to meet the needs of their children and families.     

Parenting challenges in families of children with autism: a pilot study

A pilot study was conducted using a focus group interview with parents of children with autism to provide parents with the opportunity to express their concerns related to parenting a child with autism and to discuss strategies parents can use to manage these challenges. Parents' desire and need for information related to autism is evident. Parents' identified supports and resources in need of expansion and development to assist with their child's needs. These findings support previous research with families communicating a need for partnership with healthcare providers. Nurses are often the first contact with children with autism and their families; they can support the partnership between parents and healthcare professionals. Using the Double ABCX Model of family behavior as the conceptual framework, a study investigating the findings of this pilot study has been completed.     

The experience of stress in parents of children hospitalized with long-term disabilities

This paper discusses parents' perceptions of their stress when their children are hospitalized with long-term disabilities. The study used a qualitative method. Data were collected with 40 parents through in-hospital interviews, and were analysed using the method of constant, comparative analysis. Parents' own interpretation of their stress experience is considered in relation to their perception of their role. The data suggest that the hospitalization of a child requires parents to make changes in their usual parenting role. In describing the nature of the changes required, parents identified the need to understand the illness experience; become familiar with the hospital environment; adapt to their changing relationship with the child and other family members; and negotiate with health professionals about their child's care. Verbatim accounts are used in this paper to illustrate parents' interpretations of their hospital experience. Parents perceive their role in their hospitalized child's care differently than health professionals do, and it would appear that much parental stress is attributable to the 'space' between health care workers' understanding of parents' experience, and parents' own comprehension. If nurses understood parents' own perception of their hospital-related stress better, more effective nursing care could be developed. Further research is needed in this important area.     

Comparisons of parent cardiovascular knowledge, attitudes, and behaviors based on screening and perceived child risks

Questionnaire reports and universal screening procedures from 244 children (kindergarten, 5th grade, and 9th grade) were used to explore differences in parent health knowledge and attitudes of cardiovascular risks among children and parental involvement in promoting healthy lifestyles relative to whether their children were identified as being overweight or at risk of being overweight. The knowledge, attitudes, and behaviors of the parents of children who were identified as being at risk or overweight were further examined based on their perceptions of their children's level of risk. Parents' reports demonstrated significantly greater parent encouragement and knowledge of issues related to eating healthier foods and ways to cut calories among parents of children who were identified as being at risk or already overweight. A significant portion of parents underestimated their children's weight risks. Differences in parents' appraisals of their children's overweight risks were associated with differences in their knowledge, attitudes, and behaviors. These findings illustrate the need to address inaccuracies in parents' assessments of their children's overweight risks to improve parent investment and involvement in children's health modification programs.     

Concepts of pain in preschoolers and children of early school age and their parents after painful interventions during hospitalization

Subject of the present study are individual pain concepts of preschoolers and children of early school age. Their parents' concepts of pain were considered as well. In a qualitative study interviews were performed with 9 children and their parents in a children's hospital to investigate their individual concepts of pain, their methods of pain assessment, and self-initiated strategies of pain alleviation. Already 4-6 year old children are able to remember painful experiences and to communicate about pain. Strategies of pain alleviation used by children are distraction methods as well as methods of physical relief. The child's parents play an important role concerning pain assessment and coping. The parents' presence is also very important to communicate the child's needs to nurses. Parents want nurses to consider physiological as well as behavioral aspects in the assessment of the child's pain. Besides, they expect nurses to have competences concerning prevention, assessment and alleviation of pain. To perform a trustful relationship to children and parents, more intensified counselling by nurses seems necessary.     

Parent or nurse? The experience of being the parent of a technology‐dependent child

AIMS: This paper reports a study exploring parents' experiences of caring for a child who is dependent on medical technology, and in particular of performing clinical procedures on their own children. BACKGROUND: A group of children with a continuing need for the support of medical technology have emerged in community settings as a result of medical advances and government policies. Caring for these children has a significant social and emotional impact on parents, because of their specialized and intensive care needs. Obtaining appropriate and coordinated home support services is problematic. METHODS: Grounded theory techniques were used, and in-depth interviews were conducted with the parents of 24 children. FINDINGS: Parents' accounts revealed that their constructions of parenting were shaped by the nature of their role in caring for their child and by the transformation of their homes by medical equipment and personnel. They described themselves as having a role that had both parenting and nursing dimensions. Parents managed this tension and defined their role and relationship to their child to be primarily one of parenting by differentiating parental care-giving and its underpinning knowledge from that of professionals, particularly nurses. CONCLUSIONS: Parenting a technology-dependent child alters the meaning of parenting. Professionals need to recognize that providing care has a substantial emotional dimension for parents, and that they need opportunities to discuss their feelings about caregiving and what it means for their parenting identity and their relationship with their child. A key professional nursing role will be giving emotional support and supporting parents' coping strategies. Parents' perceptions of nurses raise questions about whether nurses' caregiving is individualized to the needs of the child and family, and whether parental expertise is recognized.     

Parents' views about infant pain in neonatal intensive care

OBJECTIVE: The purpose of this study was to describe parents' perceptions and feelings about their infant's pain experience and pain care in the neonatal intensive care unit. METHOD: Thematic content analysis was used to encode the qualitative information contained in parents' written comments on a questionnaire about their views on infant pain and pain care. The questionnaire was completed by 257 parents from 9 neonatal units in the United Kingdom (n = 196) and 2 neonatal units in the United States (n = 61). RESULTS: Parents' comments indicated that they saw medical procedures as the major source of their infant's pain, wanted more information, and generally desired more involvement in this aspect of their infant's care. Parents' comments indicated that their infant's pain affected them emotionally and that they worried about their future relationship with their infant. Parents also articulated specific ways in which health care professionals could assist them and their infants in coping with neonatal intensive care unit-related pain. DISCUSSION: The findings from this study expand knowledge about how parents understand and respond to the difficult situation in which their newborn infant is subjected to essential but painful procedures. The findings provide direction for research and clinical practice interventions aimed at: 1) helping parents to gain knowledge and correct their misperceptions; 2) engaging parents in meaningful dialog about their concerns and preferences for involvement; and 3) helping parents to develop effective coping strategies to reduce psychologic distress related to their infant's pain.     

Parents in accident and emergency: roles and concerns

Attending Accident and Emergency (A&E) with a child who has sustained a minor injury is a common experience for parents. Little research has focused on parents' behaviour in these circumstances, but children in previous studies have identified parents as their primary source of support. This article reports findings from a qualitative study that reveals the responsibilities that parents adopt and the concerns they express. Data were collected through observation of the A&E experience of thirty-four children and the parents who accompanied them. Ten parents were interviewed at home a few days after the visit to A&E. Analysis revealed that parents adopted a number of roles: support, advocate, communicator, guide/enforcer and entertainer. Sources of concern included the child's injuries, but responsibilities such as work and the welfare of other siblings became more pressing once parents realised that the child's injuries were not serious. In addition parents' behaviour and comments indicated that they were anxious that practitioners should see them as responsible and caring parents. Anxieties could impair parents' ability to adopt the roles described suggesting that practitioners seeking to reduce the psychological impact of A&E encounters on the child must also recognise and manage parental concerns.     

Chronic sorrow in parents of children with type 1 diabetes

Title.  Chronic sorrow in parents of children with type 1 diabetes.
Aim.  This paper reports on a study exploring parents' longer-term experiences of having a child with type 1 diabetes.
Background.  Parents of children with type 1 diabetes may experience a grief reaction at diagnosis similar to that normally associated with bereavement, but little is known about their long-term emotional adaptation. Chronic sorrow, a sustained but intermittent grief reaction, is identified in adults with diabetes but has not previously been explored in relation to parents.
Methodology.  In-depth interviews were conducted in 2007 with a convenience sample of 17 parents of children with type 1 diabetes 7–10 years after diagnosis. Data were explored within a theoretical framework of grief, loss, adaptation, and change.
Findings.  Parents had adapted to the needs of diabetes management but most had not 'come to terms' with the diagnosis. They experienced a resurgence of grief at critical times during their child's development and some, particularly mothers, became upset during their interviews, even though these took place 7–10 years after their child's diagnosis. Mothers elaborated more on their emotions than fathers, but continuing feelings associated with grief, such as anger and guilt, were expressed by both fathers and mothers.
Conclusion.  Greater understanding of parents' long-term emotional responses and recognition that grief may never resolve in these parents may enable healthcare professionals to provide appropriate and timely support at critical times.     

Parental emotional responses to their child's pain: the role of dispositional empathy and catastrophizing about their child's pain.

Little is known about how a child's experience of pain affects his or her parents. Using a vignette methodology, this study investigated the emotional responses of parents who were asked to imagine different painful situations that their child might experience. A sample of 650 parents of school children (325 mothers; 325 fathers) read 8 short stories/vignettes about their child, which varied in terms of type of situation (pain vs other stressful situation), intensity (high vs low), and frequency of occurrence (high vs low). The role of individual differences in parental catastrophizing about their child's pain, catastrophizing about their own pain, dispositional empathy, and gender was also investigated. Parents' dispositional empathy was found to have an impact on parental distress and concern for their child. Catastrophizing about their child's pain had a unique contribution to parents' emotional responses to the vignettes describing their child in pain, beyond the influence of other variables. The impact of parental catastrophizing about their child's pain was most pronounced for parental distress, probably reflecting the high threat value that they attribute to their child's pain. The findings are discussed within recent models of empathy and pain, delineating possible relationships with parents' behavioral responses to their child's pain. PERSPECTIVE: This vignette study found preliminary evidence for the importance of parent characteristics, beyond situational characteristics, in parental emotional responses to their child's pain. The findings provide indications for the processes implied in parental helping behavior.     

Future life expectations and self-esteem of the adolescent survivor of childhood cancer.

The number of adolescent cancer survivors has increased dramatically over the past decade as the result of improved treatment and diagnostic techniques. This population brings with them unique characteristics and concerns. The present study consisted of interviews with 10 adolescent survivors of childhood cancer and their parents. It investigated the adolescent's present self-esteem, the future life expectations held by both the teenagers and parents, and the relationship between the variables. Results indicated that the adolescents felt moderately competent in their lives (measures of self-esteem) and the parents felt more certain than their children that the teenagers would accomplish the tasks deemed appropriate for entry into a healthy adulthood. Pearson correlations showed a strong relationship between parents' future life expectations and adolescents' self-esteem (r = .82; P = .002), but not between parents' and adolescents' future life expectations or between the adolescents' future life expectations and self-esteem. The results are significant in addressing the impact parents can have on their child's self-esteem.     

Parents' use of nonpharmacological methods to alleviate children's postoperative pain at home

STUDY BACKGROUND: Nonpharmacological methods are stated to be effective in alleviating children's postoperative pain when used as an adjuvant to analgesics. However, little is known about how these methods are used by parents at home. PURPOSE OF THE STUDY: The purpose of this study was to describe parents' use of nonpharmacological methods at home in 1-6-year-old children's pain alleviation after minor day surgery. METHODS: Mothers (n = 201) and fathers (n = 114) whose child had undergone day surgery in 10 Finnish hospitals between October 2000 and September 2001 filled in a questionnaire including a Visual Analogue Scale, Parents' Postoperative Pain Measure and a subscale consisting of 25 items measuring parents' use of several nonpharmacological pain alleviation methods with their children at home after day surgery. RESULTS: The most frequently used nonpharmacological pain alleviation methods were holding the child on the parent's lap, comforting the child and spending more time with them. Differences were found in mothers' and fathers' use of these methods. In addition, several methods were used more with girls than with boys. Significant relationships were found between parents' use of nonpharmacological pain alleviation methods and children's pain intensity and pain behaviour. CONCLUSIONS: Parents used several nonpharmacological pain alleviation methods with their children. However, their implementation seemed to be gender-related and limited to methods that were familiar to the parents from everyday life. The findings can be used in advising parents to use nonpharmacological pain alleviation methods at home after surgical procedures. Further research using experimental designs is needed into the effectiveness of these methods.     

Understanding emotional and psychological considerations of children with diabetes: tips for school nurses

Any chronic illness in children is worrisome to parents who must transfer the care and safety of their children to others while the children are at school. Children, too, may have many concerns, including fear of failure, not wanting to be different from peers and needing to navigate the normal developmental issues of childhood and adolescence. When the illness is diabetes with its unrelenting regimen, it is critical that school personnel have an understanding of the issues involved so that they are in a position to help the child attain optimal health. This article is designed to foster understanding of the emotional and psychological issues children with diabetes and their parents face, so that school nurses and other personnel can better assist these students in the school setting.     

Insights on Immunizations From Caregivers of Children Receiving Medicaid-Funded Services

ISSUES AND PURPOSE. Despite numerous programs aimed at improving immunization rates among American children, under-immunization remains a significant problem. This study was conducted to gain insight into parents' /guardians' knowledge and attitudes regarding childhood immunizations.
DESIGN AND METHODS. Thirteen African-American mothers and grandmothers participated in semistructured, audiotaped focus-group interviews.
RESULTS. Four major themes emerged: health knowledge and beliefs about immunizations, system barriers that impede obtaining immunizations, facilitators that enhance obtaining immunizations, and suggestions for change.
PRACTICE IMPLICATIONS. Immunizations are one of the most important health advantages available to children. Therefore, nurses must become aware of the problem of underimmunization and work to address some of the concerns caregivers have identified in this study. The health and lives of the nation's children depend on it.     

Anxiety in children having elective surgery

One hundred and twenty children aged 5-12 years and their parents were interviewed preoperatively about anxiety and fear. Needles, postoperative pain, the unknown, and many unrecognizable people in the induction room were all reported as increasing anxiety for children. Effective modes of reducing children's anxiety were considered to be the prospect of eating after surgery, staff speaking directly to children in a friendly way, and having a television to watch. Parents' suggestions for reducing children's anxiety included giving better explanations, ensuring that children who have had their operations do not return to the same ward where other children are still waiting, and providing more distractions.