Comparison of health-related quality of life among 10- to 12-year-old children with chronic illnesses and healthy children: the parents' perspective.

The purpose of this study was to evaluate mothers' and fathers' perception of their child's health-related quality of life (HRQOL) among 10- to 12-year-old Icelandic children with or without chronic health condition or illness. A total of 912 Icelandic parents (510 mothers and 402 fathers) and 480 children (209 boys and 271 girls) participated in the study. The Icelandic fathers of children who visited the school nurse over a period of 1 week perceived HRQOL of their children to be significantly lower than the mothers. A gender difference was found between the parents; mothers perceived their children to have significantly higher school functioning than fathers. Both mothers and fathers of children with chronic health condition/illness perceived their children to have significantly lower HRQOL than did the parents of children without a chronic health condition. The findings underline the importance for school nurses to develop and test interventions for school-age children with chronic health conditions or illnesses.     

School re-entry for the child with chronic illness: parent and school personnel perceptions

PURPOSE: The number of children returning to school with chronic illnesses has increased during the past decade. Studies have suggested that school personnel are not well informed about chronic illness, receive little or no training, and feel unprepared to deal with these children in the classroom. Few studies address the concerns of parents when their children return to school. The purpose of the study was to identify and describe specific concerns and educational needs of parents and school personnel. METHOD: Telephone interviews were conducted with 21 parents. Twenty-four questionnaires were completed by school personnel, social workers, principals, psychologists, teachers, and school nurses. Content analysis was used to explore the data for recurrent themes. FINDINGS: Five areas of concern were evident in the survey responses of parents and school personnel: (a) how parents informed the school about the child's illness (breaking the news), (b) the processes related to the child's actual re-entry into the school (making the transition), (c) the ongoing monitoring of the child's health status both parents and teachers felt necessary (watching the child), (d) the need to teach school personnel about unexpected health problems (teaching the teachers), and (e) school personnel's expectations for the child (working with the child). Specific examples of positive and negative experiences related to these themes are provided.     

Parental perception and management of school-age children's fevers

Fever is a major childhood complaint. Parents have numerous means at their disposal to assess and manage childhood fevers. Previous studies of parents of infants and preschoolers have uncovered parental fears and misconceptions surrounding fever ("fever phobia"). A study of 84 parents of otherwise well school-age children revealed that these misconceptions remain, regardless of the child's age or parental level of education. The nurse practitioner must understand both parental fears and the body-temperature dynamics of children to successfully access and manage fever in the school-age child.     

Parents' support and satisfaction with their child's postoperative care

It is recognized that parents' presence during their child's hospitalization is of benefit to the parents and the child. However, the level of parental involvement in their child's care may be influenced by many factors, such as the amount of support nurses provide for parents. This article reports on two themes from the findings of a larger study on parental involvement in children's postoperative pain management - parental support and parents' satisfaction with their child's postoperative pain management. The aim of the larger study was to explore both nurses' and parents' perceptions of parental involvement in their child's postoperative pain management. The methods used were both qualitative and quantitative. The qualitative method of phenomenology was used to guide 20 nurse and 20 parent interviews. Quantitative methods involved surveying the nurses and parents on their perceptions of how supportive the nurses were towards the parents. The charts of 20 children were reviewed for pain-related data. This article reports on the issues of parent support from the results of the survey, and on satisfaction relating to their child's postoperative pain management from the parent interviews. The findings demonstrated that nurses perceived that parents were receiving more support from them than that which parents felt they were receiving. Parents were more satisfied with their child's pain management and children received more analgesia when they were cared for by a lower grade nurse.     

Parental perceptions of the schools' role in addressing childhood obesity.

As childhood obesity has increased, schools have struggled with their role in this epidemic. Parents with a school-age child in a suburban latchkey program were surveyed regarding their perceptions of childhood obesity, body mass index, and the school's role in prevention and treatment of obesity. More than 80% of participants identified inactivity, poor eating behavior, lack of parental control in what children eat, and eating too much as the main causes of childhood obesity. Parents preferred receiving information about their child's body mass index from the school via a letter from the school nurse. Participants agreed that physical education classes, as well as units on nutrition and weight control, should be present in schools. Parents also supported eliminating junk food machines and offering special low-calorie meals. By supporting these strategies, parents indicated that schools should have a role in childhood obesity. School nurses can advocate for parental preferences in their school district.     

Caring for a child with diabetes: the effect of specialist nurse care on parents'' needs and concerns

One hundred and sixty parents of 10- to 18-year-old children with diabetes were interviewed using Hymovich's Chronicity Impact and Coping Instrument (CICI: PQ). Eighty-two parents had access to a specialist nurse service; 72 parents did not. Regardless of the age of the child or the duration of diabetes, parents expressed a need for advice and support with child care. Parents with a specialist nurse needed information on more topics tending to focus on activities of daily living and child development rather than physical care and illness. They were also more likely to seek and receive help from nurses. Their level of concern was greater and, it is argued, may be the price parents pay for greater awareness. The findings of this study suggest that a systematic assessment of parent coping is necessary if specialist nurses are to help parents in their role as primary health carers.     

Teacher time spent on student health issues and school nurse presence

Elementary school teacher time spent on student health issues and the relationship to school nurse services was the focus of this 2-year study. A cross-sectional design was used to survey traditional and exceptional (special needs) classroom teachers about the time they spent on health issues and their perception of school nurse presence. The school nurses were surveyed regarding the impact of their presence on early releases due to illness. Study findings related to teacher perceptions indicate with school nurse presence there are fewer early releases, increased communication, less time spent on health issues, students with chronic illnesses are safer, and there is a resource available for health information. The data provide the groundwork for discussions to improve the communication of the nurses' schedules, increase teacher confidence in consistent nurse hours at their school and aid the nurse in protecting valuable on-site school hours from other interferences or commitments.     

Nursing care of a school-age child with asthma: an ecological system theory approach

This research applied the Ecological System Theory of Dr. Bronfenbrenner (1979) to evaluate and analyze the impact of a school-age asthmatic child's ecological environment on the child's development. This project ran from March 16th to April 16th, 2010. A full range of data was collected during clinical care, outpatient follow-up services, telephone interviews, home visits, and school visits and then identified and analyzed. Results indicated that the family, household environment, campus, teachers, classmates, physical education program, and medical staffs comprised the most immediate microsystem and that parents, school nurses, teachers, and classmates formed the child's mesosystem. Researchers found a lack of understanding and appreciation in the mesosystem regarding asthmatic patient care needs. Hidden factors in the environment induced asthma, which eventually caused the child to be unable to obtain necessary medical care assistance. The exosystem reflected adequacy of the family social economy. The father's flexible working hours allowed him to allocate more time to childcare responsibilities. The government Asthma Medical Payment program also facilitated effective care. The macrosystem demonstrated parental cognition related to asthma treatment and caring to be deeply influenced by local customs. Thus, rather than using advanced medical treatments, parents preferred to follow traditional Chinese medicinal practices. Evaluation using the Ecological of Human Development Theory showed the subject's ecology environment relationships as based upon a foundation of family and school. Therefore, active family and school support for an asthma management plan appropriate to the subject's needs was critical. Asthma symptoms were better controlled after the child and his parents invested greater effort in mastering asthma management protocols.     

School nurses and sex education: surveillance and disciplinary practices in primary schools

Title. School nurses and sex education: surveillance and disciplinary practices in primary schools Aim. This paper is a report of a study to explore how school nurses perceive the influence of schools on their role in delivering sex and relationship education in primary schools. Background. School nurses play a key role in sex education in English schools. However, sex education is a contentious issue meaning the sex education of children is often an area of tension within the curriculum. However, the impact of these tensions upon school nursing practice is poorly described. Method. Three focus groups with a convenience sample of 16 nurses experienced in conducting sex and relationship education were conducted during 2006. Focus groups were audio‐taped, transcribed verbatim and subjected to a thematic analysis. Findings. Four themes were identified in the data: ‘covert surveillance’ refers to school staff conducting clandestine surveillance of the classroom actions of the nurse; ‘overt surveillance’ reflects how nurses felt they were being openly monitored by teachers in the classroom; ‘Teacher attitude’ refers to the interventions of the supervising teacher in the classroom during the sex education session and ‘resistance practices’ detailed how nurses attempted to manage the disciplinary practices of the school. Conclusion. School nurses need to be pragmatic about the fact that there will be some attempts by the school to regulate sex education. Developing an early dialogue with the school can mediate this. Closer working practices and the involvement of school nurses in the development of sex education policy and practice is vital to ensure that they continue to make a valuable contribution to sex education in schools.     

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.     

Death education: knowledge, attitudes, and perspectives of Irish parents and teachers

This article reports on a cross-sectional survey of the knowledge, attitudes and perspectives of Irish parents and school teachers concerning children's grief and the concept of death education. The sample comprised 119 parents and 142 teachers of Irish Primary-school children (5-12 years of age) who completed a self administered questionnaire. Both parents and teachers reported high levels of understanding of the nature of children's grief and strongly supported the view that death should be discussed with children before they encounter it. Although discussions of death were reported in the classroom and in the home, both teachers and parents, particularly men, reported being uncomfortable talking to children about death. There was general support for the inclusion of death education in the school curriculum, with both teachers and parents supporting the need for further teacher training to undertake its delivery. There were few significant differences between the expressed attitudes of parents and teachers. However, teachers were more likely than parents to agree that death education would take away from parental responsibility. The implications of the findings for further work in this area are considered.     

Cooperation between parents and school nurses in primary schools: parents' perceptions

Introduction: Cooperation between pupils’ parents and school nurses is an important part of health promotion in primary schools. Developing frank and trusting relationships contributes to easy and uninhibited cooperation. Cooperation between parents and school nurses has not been widely researched internationally. Aims: This article reports on parents’ views on cooperation with school nurses in primary schools. The study aims at contributing to school nurses’ work so that instead of focusing only on the children, family nursing approaches could be improved. Methods: Nineteen parents from 13 families from southern Finland were interviewed for the study in 2004. The data were analysed by grounded theory and the constant comparative method was utilized. Findings: Six concepts describing parents’ views on cooperation were generated on the basis of the data. Cooperation consists of supporting the child’s well‐being. School nurses take children’s and parents’ concerns seriously and intervene effectively if the child’s health is threatened. School nurses’ expertise is not very visible within school communities. Hoping to receive information and desiring parental involvement are important concepts of cooperation with the school nurse. The child’s family is not sufficiently known or taken holistically into consideration when the child’s health is promoted. Parents are the initiators of cooperation within school health care and parents describe this by the concept of one‐sided communication. Conclusions: Parents do not know about school nurses’ work and school health services. They would like to be more involved in school nursing activities. When developing children’s health services, parents’ expertise in their children’s well‐being should be paid more attention. This study enhances the knowledge of family nursing by describing Finnish parents’ perceptions of cooperation with school nurses. The findings facilitate the understanding of cooperation in school health services.     

DEATH EDUCATION: KNOWLEDGE,ATTITUDES, AND PERSPECTIVES OF IRISH PARENTS AND TEACHERS

This article reports on a cross-sectional survey of the knowledge, attitudes and perspectives of Irish parents and school teachers concerning children's grief and the concept of death education. The sample comprised 119 parents and 142 teachers of Irish Primary-school children (5-12 years of age) who completed a self administered questionnaire. Both parents and teachers reported high levels of understanding of the nature of children's grief and strongly supported the view that death should be discussed with children before they encounter it. Although discussions of death were reported in the classroom and in the home, both teachers and parents, particularly men, reported being uncomfortable talking to children about death. There was general support for the inclusion of death education in the school curriculum, with both teachers and parents supporting the need for further teacher training to undertake its delivery. There were few significant differences between the expressed attitudes of parents and teachers. However, teachers were more likely than parents to agree that death education would take away from parental responsibility. The implications of the findings for further work in this area are considered.     

The child and family facing death

When children are diagnosed with life threatening illnesses such as cancer, their lives and their families' lives are changed forever. The nurse has valuable roles as advocate, facilitator, teacher, and support throughout the child's illness and death. The purpose of this article is to provide practical and applicable information to nurses regarding their clinical practice with children and families facing death.     

Mommy first

Parents of children with special health care needs are often required to assume responsibility for the complex care of their children. It is important for pediatric nurses to remember these parents are, first and foremost, the child's parents and primarily responsible for loving their child, providing a safe and secure home, and fostering their child's development as a person. Pediatric nurses should support the parents in the medical/nursing care of their child in whatever way possible so the parents have more time to parent. This account from a mother of a child with developmental delay helps remind us of our need to help support parents in being "parents first."     

Parents' experience of coming to know the care of a chronically ill child

The family is the primary source of care for a chronically ill child, and it is the parents who must manage the child's illness on a daily basis. This qualitative study was undertaken to investigate the ways in which 10 two-parent families of children with juvenile arthritis experience their child's illness. In this paper the theme of coming to terms with the management of the illness and what it entails for the parents is examined. The data provide evidence of how the parents learn, and their efforts and experience of learning to care for the child on a daily basis. This is a complex process and includes the different phases the parents experience as they move through the learning process. The findings suggest that the parents learn the child's care and make adjustments to the demands of managing the child's illness in a way that works best for them.     

Making chicken pox prevention a priority

School nurses are the IDEAL professionals to catch those kids without a history of chicken pox (varicella illness) who have not been immunized, thereby falling into the susceptible range. We handle charts daily. We have both illness history (if it was provided) and immunization dates. We can call parents. We can talk to kids. Wouldn't it be easy if we could do that and then call (or email) the primary care provider? But there is no longer an "easy" way to communicate health information. Doing things the easy way could be perceived by some as "tattling" and by others as "reporting without permission." Instead, the school nurse must take the time-consuming (and better long range) path of education ... of the student, and the parent. And the priority can slip down below other school nurse requirements such as getting kids their required immunizations, first aid and illness care, individualized health care plans for students with medical problems, parent and teacher phone calls, and endless conversations. It takes a village to raise a child though, and the school nurse is a village resident. The following information is vital to the knowledge base of today's school nurse. Please read it, store it and consider it when planning and intervening with your students in the day-to-day interaction that promotes optimal health and wellness.     

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.