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.     

Parent and teacher perceptions of the impact of school nurse interventions on children's self-management of diabetes

Diabetes is a common chronic illness among school-age children. The school nurse collaborates with the student, parents, and teachers to help the child manage their diabetes effectively. Very little is known about the relationship between school nurse interventions and parent/teacher perceptions of the child's self-management. We examined this relationship in a sample of 69 school-age children who received case management from school nurses. Our findings suggest that teachers and parents do not always agree on how well a child manages their illness. When school nurses provide more education and counseling, parents are more likely to perceive an improvement in their child's self-management. Teachers are more likely to perceive an improvement when the nurse provides more classroom visits and includes the physical education teacher and guidance counselor. These findings suggest that the roles of educator, counselor, and collaborator are important for school nurses who provide care to school-age children with diabetes.     

Nursing, food service, and the child with diabetes.

The safety and well-being of children while they are at school or day care is a major concern in our society. It is therefore important that the professionals who are entrusted with the care of young people possess the knowledge and skills necessary to provide a safe and caring environment for all children, including those with chronic disorders such as diabetes. Each day 35 children in the United States are diagnosed with diabetes mellitus. To make their school experiences positive, it is imperative that school employees be aware of the potential challenges associated with diabetes and how to meet these challenges successfully. This article discusses the role of the school nurse in forming an interdisciplinary team to work with a child with diabetes. It addresses the school nurse's role in diabetes education of food service personnel in the school. Confidentiality issues are also addressed.     

School nurse case management for children with chronic illness: health, academic, and quality of life outcomes

More children with chronic illnesses are attending school, and some of them struggle academically because of issues related to their health. School-based case management has been suggested as one strategy to improve the academic success of these children. This study tracked the academic, health, and quality of life outcomes for 114 children with asthma, diabetes, severe allergies, seizures, or sickle-cell anemia in 5 different school districts who were provided case management by school nurses. The children ranged in age from 5 to 19 years. At the end of the school year, children experienced an improvement in quality of life and gained skills and knowledge to manage their illness more effectively. Classroom participation, grades, and participation in extracurricular activities also increased for many children. The study provides evidence of the positive impact school nurses have on children with chronic illness and suggests ways they can measure the outcomes of their interventions.     

School nurses' perceived barriers to diabetes knowledge, communication and management in children with type 1 diabetes

Diabetes is a common chronic illness among children, with 13,000 new cases diagnosed each year. School nurses are in a unique position to facilitate the improvement of health for students with diabetes, but they face many challenges in acquiring diabetes knowledge, communicating with parents and healthcare providers, and managing children and adolescents with diabetes. To learn more about these challenges and the potential role of technology in alleviating them, we administered a survey to school nurses in the state of Maryland. Results indicated that lack of access to knowledge and time constraints were the biggest challenges in providing support and care to children with diabetes. The majority of the school nurses agreed that use of an electronic medium will significantly enhance care and improve knowledge and communication between parents, school nurses and providers.     

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.     

Addressing School Challenges for Children and Adolescents With Type 1 Diabetes: The Nurse Practitioner's Role

Children with type 1 diabetes need to monitor their blood glucose and food intake, administer insulin, and participate in physical activity during school hours. School concerns for this group include school personnel, the medical directive plan, classmates, school lunches, and physical education classes. Nurse practitioners should take an active role in advocating for improved T1DM management in schools by talking with patients and their parents about experiences in school, identifying challenges and discussing possible solutions for improving diabetes management during school hours, and accessing online resources to assist patients, parents, and school personnel.     

Children visiting parents in inpatient psychiatric facilities: perspectives of parents, carers, and children

A significant number of clients utilizing mental health services will also be parents. Being a child of a parent with mental illness increases health risks for the child, and hospitalization of the parent has been identified as one of the most difficult times for children. However, few proactive measures have been taken to understand or provide for the needs of children visiting psychiatric inpatient facilities. The aim of this exploratory study was to identify the perspectives children, their parents, nominated carers, and clinicians from their experience of children visiting. The study used qualitative data gathered from interviews to develop an understanding of the issues. The purpose of this paper was to present the findings from parents, carers, and children. Children indicated that they wanted to visit and to remain involved with their parent, but that there was little support from staff. Families indicated that children visiting psychiatric inpatient facilities were not well managed, and they received little support about decisions around children visiting. The issue of children visiting psychiatric facilities when they have a parent who is an inpatient appears not to have been addressed in models of inpatient mental health care.     

Information-seeking behaviours and decision-making process of parents of children with cancer

PurposeThis study aimed to explore the information-seeking behaviours, perceptions and decision-making experiences of parents of children with cancer by employing semi-structured interviews.Methods and sampleA qualitative research design was used to assess the information-seeking behaviours, perceptions and decision-making processes used by parents in Turkey whose children have cancer. Interviews were conducted with 15 parents of children with cancer using a semi-structured interview schedule. The interviews were recorded and transcribed verbatim.ResultsSix main issues emerged. Issues were related to parents' information needs, the sources of information, difficulties that the parents encountered when seeking information, the decision-making process, the factors affecting decision-making, and expectations from the health team. Information resources for parents included medical doctors and nurses, the internet, friends and the parents of other children who were staying in the hospital. The parents mostly sought information about their child's illness, prognoses, treatment, side-effects and care giving issues. The parents expressed that they were directed primarily by health care providers during their decision-making process.ConclusionsAdequate and systematic information pertaining to illness, treatment, prognosis and child care must be provided by health care professionals throughout the illness process. In addition, individual guidance and spare time are key components to helping parents make decisions about their children with cancer.     

Immunization controversy: understanding and addressing public misconceptions and concerns.

School nurses often meet with parents who are reluctant to immunize their children. This reluctance is based on widely publicized stories about vaccine safety. Illnesses that are preventable by vaccines have become almost nonexistent, and consequently, vaccine safety concerns have increased in prominence. Often a negative report about the risk of a particular vaccine is released by the media and on the Internet before scientific evidence has been obtained. To adequately respond to parental concerns, school nurses should be aware of the historical impact of vaccine safety issues and the vaccine-related fears that are prevalent at the present time. Nurses also need to be provided with scientifically accurate information so that risk-benefit concerns regarding vaccine safety can be effectively communicated to parents. In this way, school nurses can play an important role in ensuring that the student population and the community are protected from vaccine-preventable diseases.     

The needs of children and adolescents with cancer for information and social support

Research has indicated that information and social support may have helped children and adolescents with cancer to cope with their illness and lead normal lives. However, recent researchers have reported that youths with cancer express a clear interest in receiving more information and social support. This study reviewed research on information and social support for children and adolescents with cancer to understand their needs. Young patients with cancer showed high uncertainty about cancer. Besides, adolescents with cancer were more in conflict with their parents than healthy youths. Discussions on future plans or death are difficult for young people with cancer. They also are frequently absent from school over time. Moreover, they want to make healthy friends. To fulfill the needs of these youths, nurses should be aware not only of individualized information and social support, but also of these factors from an ecologic perspective. Further qualitative research is required to identify the needs of youths with cancer and resolve these issues.     

Parents with psychosis and their children: experiences of Beardslee’s intervention

To meet children’s needs for information and support when a parent has a mental illness, Beardslee’s family intervention was implemented in Swedish psychosis care. The present study aimed to gain understanding of how parents’ with psychosis and their children experienced having taken part in Beardslee’s family intervention. The study followed COREQ guidelines. Semi‐structured interviews were conducted with 15 participants (8 parents with psychosis and 7 children) who had participated in the family intervention. Data were analysed with content analysis. Results showed that the parents perceived that the intervention had contributed to improved illness knowledge, communication, and understanding in the family. They also appreciated receiving support in finding an age‐adapted way of explaining their illness, but asked for structured follow‐ups in order to maintain communication. However, comparing parents’ and children’s interviews led to discrepancies in perceptions of the overall benefits of the intervention. In conclusion, parents with psychosis need continual support in talking to their children about their illness. Furthermore, discrepancies between parents’ and children’s interviews show the importance of multi‐perspective data collection when studying intervention effects.     

The experiences of school nurses caring for students receiving continuous subcutaneous insulin infusion therapy.

Diabetes mellitus is the most common metabolic disorder in childhood. Today, children with diabetes are receiving new technologically advanced treatment options, such as continuous subcutaneous insulin infusion (CSII) therapy. School nurses are the primary health caregivers of children with diabetes during school hours. Therefore, it is important to determine their perceptions, resources, and resource needs when caring for students with continuous subcutaneous insulin infusion or insulin pump therapy. This study uses a phenomenological approach to examine the experiences of school nurses caring for students receiving insulin pump therapy. Eleven school nurses were interviewed using semistructured taped interviews. The nurses' responses indicated that they were "scared" when first caring for students with continuous subcutaneous insulin infusion therapy. However, they were able to work through their fear by using their resources and gaining more knowledge and hands-on experience with insulin pumps. The data also revealed that school nurses who were able to learn the language of continuous subcutaneous insulin infusion therapy and successfully deal with pump problems developed trusting and knowing relationships with students, teachers, and parents.     

CLIENTS WITH MENTAL ILLNESS AND THEIR CHILDREN: IMPLICATIONS FOR CLINICAL PRACTICE

The problem of adults with severe mental illness parenting minor children is a growing concern. These clients suffer from concerns that negatively affect them and their children. This study showed many clients seeking services at public mental health agencies are parents of minor children and have had a history of family dysfunction. Prevalence rates, demographic characteristics, types of mental illness diagnoses, family background variables, and some current issues regarding these clients were examined. The study concludes with clinical implications for clients and their families and calls for a family focused approach.     

Clients with mental illness and their children: implications for clinical practice

The problem of adults with severe mental illness parenting minor children is a growing concern. These clients suffer from concerns that negatively affect them and their children. This study showed many clients seeking services at public mental health agencies are parents of minor children and have had a history of family dysfunction. Prevalence rates, demographic characteristics, types of mental illness diagnoses, family background variables, and some current issues regarding these clients were examined. The study concludes with clinical implications for clients and their families and calls for a family focused approach.     

Addressing the needs of children of parents with a mental illness: current approaches

Children of parents with a mental illness have been identified as vulnerable to experiencing a variety of psychosocial effects arising from the impact of parental mental illness. Many children do not however, experience difficulties as a result of their parent's mental illness and are able to thrive despite what may be an adverse situation. Until recently there has been a lack of adequate service provision in Australia for these children and their families. Recent government initiatives have led to greater awareness and recognition of the needs of children whose parents have a mental illness, and key principles and actions have been developed to assist health services to adequately care for them. The aim of this paper is to overview the risk and protective factors that may impact on the psychosocial health children of parents with a mental illness, and provide me strategies that nurses in a range of health settings may use to assist families where parents have a mental illness.