Autonomy and decision making for health promotion in adolescence

Autonomy in decision making regarding health issues is a set of skills that develops as part of self-care agency. Adolescence is an important time to begin fostering this autonomy. Providing health-promoting care to adolescents must occur in the context of developmental considerations, legal concerns, and ethical principles. Implications for health care providers include developing trust with the adolescent, teaching the family how to enable the adolescent's self-care, considering the use of advance directives, protecting the rights of minors and parents, implementing confidentiality guidelines concerning the adolescent's care, and formalizing the processes of consent/assent and dissent for health care.     

Encounters between children's nurses and culturally diverse parents in primary health care

The objective of this study was to analyze the healthcare encounters between nurses and parents of different cultural backgrounds in primary health care. An ethnographic study was carried out using participant observations in health centers and interviews with nurses. Data were analyzed using thematic content analysis and constant comparative method. Four main themes were identified when nurses met parents of other cultural backgrounds: lack of mutual understanding, electronic records hamper the interaction, lack of professionals' cultural awareness and skills, and nurses establish superficial or distant relationships. The concepts of ethnocentrism and cultural imposition are behind these findings, hampering the provision of culturally competent care in primary health services. There were difficulties in obtaining and registering culturally related aspects that influence children's health and development. This was due to e‐records, language barriers, and the lack of cultural awareness and skills in health professionals making the encounters difficult for both nurses and parents. These findings show that there is a clear threat for health equity and safety in primary care if encounters between nurses and parents do not improve to enable nursing care to be tailored to any individual family needs.     

Fostering health in the foster care maze

The fastest growing population of children in foster care today is quite young, and many of these children have significant health care needs. The General Accounting Office (GAO) reported that children in foster care "are among the most vulnerable individuals in the welfare population" (GAO, 1995, p. 1). Poverty, increased homelessness, substance abuse, and a rise in the incidence of persons with HIV all contribute to the problems faced by these children. The Caring Communities for Children in Foster Care Project, funded by the Maternal Child Health Bureau Integrated Services Medical Home Initiative with the American Academy of Pediatrics (AAP), investigated the availability of comprehensive health care services for children in foster care. The AAP recommends that pediatricians serve as the primary health care provider for children in foster care and also as consultants to child welfare agencies. Pediatric nurses play a crucial role in providing health care services to children in foster care. With an increased understanding of the potential physical and mental health care needs of children in foster care and the important role of foster parents, pediatric nurses can increase the likelihood of positive health outcomes for children in foster care.     

Parent-to-parent support: a critical component of health care services for families.

Families of children with chronic medical conditions or disabilities face many unique difficulties. It is often necessary for them to assimilate technical medical information and participate in important decisions regarding their children's care before they have had time to adjust to their children's condition. Health care providers are not always available to help parents learn how to function in their dramatically changed roles. To adjust to their new parenting roles and work through feelings of confusion, denial, anxiety, guilt, anger, and depression, parents of children with special health care needs need opportunities to fully vent feelings, and to experience the grieving processes in their own way and at their own pace, in a nonthreatening, nonjudgmental environment. An informal support network is a powerful tool for accomplishing these tasks, for teaching day-to-day coping skills, and for supporting the establishment of new value systems that incorporate families' unique needs. The literature on family support documents ways in which parents of children with special health care needs are particularly qualified to help each other. This article briefly describes the philosophy of parent-to-parent support, its unique contributions in the health care setting, and the ways that health care providers can assist in creating an environment in which parents and professionals can work together more effectively.     

School-age children with asthma and their parents: relationships with health care providers

Health care providers, including nurses, physicians, and other personnel, are key figures who design and implement plans of care to help families manage childhood asthma, yet families' perceptions of relationships with these professionals has received limited study. Child and parent perspectives about relationships with their health care providers emerged as themes in a study that explored responsibility sharing between school-age children with asthma and their parents (Buford, 2004). Fourteen school-age children with asthma and 14 of their parents from 11 families participated in the study. Parents and, to a lesser extent, children, described aspects of their relationships with their health care providers that were supports or barriers to asthma management. Implications for nurses and other health care providers stem from these data and include the importance for health care providers to educate themselves and their patients about state-of-the-art asthma care. Education should be directed to both parents and their children. In addition, parents need to receive education about how to coach their children because the children depend on them for information and direction. Finally, nurses and other health care providers need to listen to parents and value their input about their children's conditions.     

Professional nurses' perceptions of the skills required to render comprehensive primary health care services

As multidisciplinary health team members, professional nurses play a vital role in the delivery of primary health care services. They require specific knowledge and skills to function effectively in the primary health care settings. In South Africa, however, professional nurses followed various training programmes. This has made it difficult for the professional nurses to be competent in rendering the full spectrum of comprehensive primary health care services, focussing on preventive, promotive, curative as well as rehabilitative care. In a setting where professional nurses have different qualifications it is possible that they do not recognise their own limitations. The research aimed to explore and describe the perceptions of professional nurses about the skills required and their own level of skills to render comprehensive primary health care services. A further aim of the research was to formulate guidelines for the facilitation of trained professional nurses to truly render quality comprehensive primary health care services, based on the findings. A qualitative design was followed. Participants were identified by means of purposive voluntary sampling and data was collected by utilising a semi-structured interview schedule. Twenty two participants were interviewed. After each interview field notes were written. Ethical aspects and confidentiality were taken into consideration. The researcher and a co-coder analysed the transcribed interviews by means of open coding. The findings indicated that the more comprehensively the professional nurses were trained, the more competent they felt. The less comprehensively trained, the more negative they experienced their work. They viewed their skills as ranging from adequate to inadequate, depending on their training. The conclusion was drawn that professional nurses' perceptions were congruent with the skills they possessed. Recommendations for nursing research, education and practice, including guidelines to facilitate trained professional nurses to truly render comprehensive primary health care, were formulated.     

Educational and behavioral issues in transitioning from pediatric cardiology to adult-centered health care

It is assumed that when they begin growing up, a child with congenital heart disease will take personal responsibility for his or her care. For this purpose, patients need sufficient knowledge on the heart defect, treatment,and measures to prevent complications. However, empirical studies indicated that the levels of knowledge and understanding of both parents and children with congenital heart disease are poor. Therefore, sound patient education is imperative, particularly when patients are transitioned from pediatric cardiology to adult congenital cardiology. In this respect, the focus of communication shifts from the parent to the young patient; moreover, education should be tailored according to the developmental level of the patient. Issues that should typically be covered by educational programs for adolescents with congenital heart disease are information on the heart defect, treatment, endocarditis, sexuality and reproduction, sports, employability and insurability, and cardiovascular risk factor. International guidelines indicate that advanced practice nurses are key in developing and implementing patient education programs during the transition from pediatric cardiology to adult-centered health care.     

A service-learning project to eliminate barriers to oral care for children with special health care needs

Children with special health care needs face many barriers to oral care and are at high risk for oral disease. School nurses are in a unique position to promote oral wellness in this vulnerable population. Collaboration between school nurses and dental hygiene faculty resulted in the formation of a partnership between a university-based dental hygiene program and two special education districts in rural southern Illinois. Senior dental hygiene students participated in a school-based service-learning project that provided dental examinations, preventive services, and education to children with special health care needs. Evidence-based behavioral interventions were used to teach children to comply with oral procedures. School nurses mentored dental hygiene students in behavior management of children. Dental exams were provided to 234 children from four special education schools with the majority receiving cleanings and fluoride.     

Foster child health and development: implications for primary care

Children in foster care are the most vulnerable to experiencing poor health compared with any other group of children in the United States. Children enter foster care due to experiences that have been detrimental to their health and well-being, including child abuse and neglect. They have significantly higher rates of all health problems than the general population of children, including acute and chronic illnesses, growth and developmental problems, serious mental health problems, and difficulties accessing health services. Additionally, they often experience multiple foster care placement transitions, involvement in multiple systems of care (e.g., mental health, juvenile justice, special education), and aging-out of foster care at age 18 before they are developmentally ready for independent living. While management of the complex health and developmental needs of these children is challenging, nurses in primary care have the expertise and obligation to serve these vulnerable children. Priorities for clinical practice include care coordination and interdisciplinary collaboration; maintenance of adequate, up-to-date health records; vigorous follow-up; and health-targeted advocacy.     

Parent/professional partnerships in caring for children with special health care needs.

In order for children with special health care needs to be adequately cared for, a variety of integrated, coordinated services are needed to support the children and their families. To facilitate optimal coordination of care for these children, it is imperative that the professionals who serve them engage in a partnership of care with parents or other family members. To that end, the Division of Children's Special Health Care Services (DCSHCS), Michigan Department of Public Health has carried out a variety of efforts to foster such partnerships. This article describes the efforts that have been carried out over the last few years in Michigan to develop parent/professional partnerships. It is not intended to be a scholarly review of the literature, but rather an explanation of strategies that have been used successfully to develop this important interface. Particular emphasis is given to describing the establishment of partnerships between parents of children with special health care needs and nurses and physicians. It is hoped that the sharing of such information will assist others who are just beginning such efforts.     

Compiling, costing and funding complex packages of home-based health care

Nurses play a central role in putting together complex packages of care to support children with complex healthcare needs and their families in the community. However, there is little evidence or guidance to support this area of practice. At present, the process of compiling a care package and obtaining funding takes too long, causing significant delays in discharge and great frustration for parents, children and professionals. This article presents a combination of best practice guidance and, where possible, evidence-based principles that can be adapted and applied to an individual case irrespective of the child's diagnosis. The aim is to assist nurses and other healthcare professionals in organising funding for packages of care, bringing about the desired outcomes of successful discharge and appropriate community support. To work effectively as keyworkers for these children and families nurses need knowledge and skills in relation to: multidisciplinary assessment frameworks and processes, identifying appropriate models of service provision, costing care packages and approaches to obtaining funding. A further article next month will address risk management and clinical governance issues in delivering complex home-based care.     

Iatrogenic developmental effects of pediatric intensive care.

Critically ill children in the pediatric intensive care environment are at particular risk for experiencing health care interventions that hinder them from progressing through their normal developmental milestones. Knowledge of the factors that influence iatrogenic developmental insults can help the nurse develop the skills and sensitivity to meet the complex needs of these children and their families.     

Mental health issues within the general health care system: the challenge for nursing education in Australia

The mental health content of undergraduate nursing programs has consistently been identified as inadequate in preparing graduate nurses with the knowledge and skills for, and interest in, a career in mental health nursing. Since the introduction of generic nursing education, undergraduate programs have become primarily focused on the development of generalist skills, with specialisation occurring at postgraduate level. The integration of mental health services within the broader health care system in Australia has led to a significant increase in the prevalence of mental health problems within the general health care setting. The relevant literature suggests that nurses are not well prepared to meet the mental health care needs of this population. The aim of this paper is to briefly outline the incidence of mental health problems within the general health care system, the implications for nursing, and the potential role which nursing could play in recognising, and providing appropriate care for the treatment of mental health problems. The implications for nursing education, and the need for mental health nursing skills to be considered essential for all nurses will be discussed.     

Health issues of children in foster care

Community health nurses provide care to children in foster care. Nurses who understand the health needs of the foster care population are better prepared to assess health status, provide appropriate services and evaluate the care. The health needs of these children are related to the reason for their placement in foster care, the lack of continuity of caregivers, and the health care systems available. The health issues are especially acute in the United States where the number of children in foster care has reached over 500,000. (Leslie et al., 2000) The health issues include chronic physical problems, developmental delays, and especially, mental health issues.     

Characteristics of child health care practitioners in overweight prevention of children

ObjectivesTo identify behavioral and personal characteristics of child health care (CHC) practitioners that influences the effect of early overweight prevention in children.MethodsIn total 216 questionnaires were filled out by CHC practitioners from four organizations in the Netherlands.ResultsThere is a gap between awareness of the problem overweight in early childhood and actually discussing this with parents, as well as a gap between the existing recommendations and the perceived importance of early overweight prevention. Despite the fact that nurses have a more central task in life-style support than physicians, they reported to have less knowledge and skills than physicians.ConclusionsWhile both CHC physicians and nurses need support in improving their knowledge and skills, it is the nurses who need more support. A more structured and tailored implementation strategy with more emphasis on the needs of the nurses and physicians may improve early overweight management.     

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."     

Negotiation of care by children's nurses: lessons from research

Parental participation and role negotiation are central elements in family-centred care, but research suggests that such negotiation tends to be ad hoc, depending on the relationships developing between the family and health professionals. Lack of effective communication, professional expectations and issues of power and control often prevent open and mutual negotiation between families and health professionals, especially nurses. This article summarises key lessons from a critical review of relevant research literature (Corlett and Twycross 2006) which suggests that nursing staff often control parental participation leaving parents feeling disempowered and deskilled. Poor communication and lack of information sharing exacerbate the situation. Where parents do not comply with nurses' expectations conflict can arise, resulting in more anxiety for already stressed parents. Current health policy requires that health workers listen to children and their families, to actively involve them in the decision-making process and to plan care around their needs and wishes. Nurses need to be aware of the way they interact with parents and the control they may unwittingly exert. A greater emphasis on communication, interpersonal and negotiation skills within nurse education is also needed.     

Parents' perceptions of quality health care

PURPOSE: To examine differences in definitions of health care quality and the importance of indicators of quality between consumers with dependent children and consumers with no dependents. STUDY DESIGN AND METHODS: This was an exploratory study using a convenience sample of 229 consumers--96 with one or more dependent children and 133 with no dependent children. Consumers were asked four open-ended questions as to their definitions of health care and nursing care quality. Consumers then rated the importance of 27 indicators of quality care. RESULTS: There were no differences between parents with dependent children and other consumers in how quality care was defined. Important indicators of quality nursing care to parents with children were: Being cared for by nurses who are up to date, well informed, and certified in their specialty; being able to communicate with the nurse; spending enough time with the nurse; and teaching by the nurse. Although having access to midwives was of lowest importance to consumers overall, it was significantly more important to subjects with children (p < 0.05). Getting care and services when needed was also more important to parents than to consumers without children (p = 0.05). Parents gave more importance to their interactions with the nurse than did subjects without children (t = 1.93, df = 229, p = 0.05). CLINICAL IMPLICATIONS: Parents and consumers without children have similar views of what constitutes quality nursing care--having nurses who are concerned about them and their children, demonstrating caring behaviors and staying attentive to their needs, being competent and skilled, communicating effectively, and providing the teaching needed for managing their own and their family's health problems.     

Exploring the role of partnership in the home care of children with special health needs: qualitative findings from two service evaluations

BACKGROUND: Advances in therapeutics and the increasing survival rate among premature infants means that more parents now have to adapt to caring at home for children with special health needs. Community paediatric nurses require a wide range of specialist skills and the concept of partnership appears to be foundational to their care of parents and children. OBJECTIVES: Drawing on data gathered during the course of two service evaluations of community paediatric nursing care of children with special health needs, this paper explores the extent to which a concept analysis of partnership can be verified empirically. EVALUATION METHODS: In-depth interviews were carried out with parents, a range of professionals and members of different agencies who received training from the nursing team. The sample comprised 17 parents and 20 professionals. FINDINGS: Respect for parental routine was strongly evidenced in both areas, was highly valued in the training of carers and contributed to mothers' confidence. Parents acknowledged that nurses' interactional strategies engendered trust, demonstrated respect for them and empathy for their child. These features of care resonate strongly with partnership attributes identified in the conceptual analysis. Nursing support of parents demonstrated a deep understanding of different styles of adult learning, of how to alleviate psychological and emotional stress and of parental vulnerability. In addition, there was evidence of extensive partnership working across health and social care boundaries. The findings demonstrated the wide range of such collaboration, the time necessary to make it work and the benefit that accrues to the families. CONCLUSIONS: It was possible to make empirical links with the partnership attributes identified in the concept analysis although the data highlight the complexity of some of the individual attributes. While there may be overlap between professional-parent partnership and partnership at the level of service co-ordination, there may also be important differences which merit further enquiry. In terms of policy and practice, findings suggest that partnership in the community setting is central to effective service delivery but is knowledge, skill and resource intensive.     

Do women want women health workers? Women's views of the primary health care service

This paper sets out to explore key aspects of women's views of women GPs and practice nurses within primary health care settings The extent to which women actively seek female health workers for the provision of their primary health care needs, including preventive health care, is examined The findings presented m this paper are from a 3-year research project employing both quantitative and qualitative methods, which aimed to develop an understanding of the role women primary health care workers play in the construction and provision of primary health care services for women The findings indicate that for specific 'women's health issues' the gender of the worker is clearly important for women However, for other health needs factors such as the personal approach of the provider become paramount Consideration of the role of the practice nurse suggests that there is considerable potential for practice nurses to further develop a specific role with women Although lack of awareness among women of nursing skills and expertise raises issues for the presentation of the role of the practice nurse within the primary health care service In conclusion the paper highlights that women's views should be understood in terms of a complex range of preferences and needs