Ann W. Garwick

Uncertainty in Childhood Chronic Conditions and Family Distress in Families of Young Children

The objective of this study was to identify the relationship between the degree of uncertainty in the child’s chronic condition and family distress. Data were collected from parents (173 mothers, 150 fathers) of young children (12 to 30 months old) who had been diagnosed with a chronic physical health impairment within the past 12 months. Children were divided into separate groups, first based on the predictability of their symptoms and next based on the degree of certainty in their life expectancy. Using analysis of covariance, sex-stratified comparisons were made between the predictability groups and then between the life expectancy groups and five subscales of the Impact-on-Family Scale. Parents of young children with chronic conditions with intermittently unpredictable symptoms reported significantly more family distress than parents of children with more predictable symptoms. No significant differences were found for mothers or fathers between the degree of uncertainty in the child’s life expectancy and family distress.

Social Support in Families of Children with Chronic Conditions: Supportive and Nonsupportive Behaviors

We questioned parents of 182 young children with a variety of chronic health conditions concerning the amount of emotional, informational, and tangible social support they received from the family, community, and service providers. We also asked parents to describe nonsupportive or hurtful behaviors received from family or community members. Both mothers and fathers reported that family members provided the most emotional and tangible social support and service providers the most informational support. The amount of perceived support from all sources increased over time, but 78% of mothers and 60% of fathers reported at least one instance of nonsupport from these same sources, primarily from extended family members and health professionals. We encourage health professionals to show respect and to provide timely, accurate information in a sensitive manner to parents whose child has a chronic health condition and to assist parents in handling nonsupportive behaviors from family and friends.

Care Coordination for Children With Complex Special Health Care Needs: The Value of the Advanced Practice Nurse's Enhanced Scope of Knowledge and Practice

Efficiency and effectiveness of care coordination depends on a match between the needs of the population and the skills, scope of practice, and intensity of services provided by the care coordinator. Existing literature that addresses the relevance of the advanced practice nurse (APN) role as a fit for coordination of care for children with special health care needs (SHCN) is limited. The objective of this article is to describe the value of the APNs enhanced scope of knowledge and practice for relationship-based care coordination in health care homes that serve children with complex SHCN. The TeleFamilies project is provided as an example of the integration of an APN care coordinator in a health care home for children with SHCN.

HOME Plus: Program design and implementation of a family-focused, community-based intervention to promote the frequency and healthfulness of family meals, reduce children’s sedentary behavior, and prevent obesity

BackgroundInvolvement in meal preparation and eating meals with one’s family are associated with better dietary quality and healthy body weight for youth. Given the poor dietary quality of many youth, potential benefits of family meals for better nutritional intake and great variation in family meals, development and evaluation of interventions aimed at improving and increasing family meals are needed. This paper presents the design of key intervention components and process evaluation of a community-based program (Healthy Home Offerings via the Mealtime Environment (HOME) Plus) to prevent obesity.MethodsThe HOME Plus intervention was part of a two-arm (intervention versus attention-only control) randomized-controlled trial. Ten monthly, two-hour sessions and five motivational/goal-setting telephone calls to promote healthy eating and increasing family meals were delivered in community-based settings in the Minneapolis/St. Paul, MN metropolitan area. The present study included 81 families (8-12 year old children and their parents) in the intervention condition. Process surveys were administered at the end of each intervention session and at a home visit after the intervention period. Chi-squares and t-tests were used for process survey analysis.ResultsThe HOME Plus program was successfully implemented and families were highly satisfied. Parents and children reported that the most enjoyable component was cooking with their families, learning how to eat more healthfully, and trying new recipes/foods and cooking tips. Average session attendance across the ten months was high for families (68%) and more than half completed their home activities.ConclusionsFindings support the value of a community-based, family-focused intervention program to promote family meals, limit screen time, and prevent obesity.Trial registrationNCT01538615

Fatigue and Physical Performance in Children and Adolescents Receiving Chemotherapy

PURPOSE/OBJECTIVES To examine the relationship between physical performance and fatigue in child and adolescent cohorts during the first three cycles of chemotherapy. DESIGN Prospective, observational design. SETTING Two pediatric cancer centers in the upper Midwest region of the United States. SAMPLE 16 children and 14 adolescents newly diagnosed with cancer. METHODS Standardized instruments were administered during the first and third cycles of chemotherapy. Instruments included physical performance tests (Timed Up and Down Stairs [TUDS] and the 6-Minute Walk Test [6MWT]) and a self-report fatigue scale. MAIN RESEARCH VARIABLES Fatigue and physical performance. FINDINGS In the child cohort, physical performance appeared to improve and fatigue diminished from cycle 1 to 3 of chemotherapy. When time on TUDS decreased, fatigue tended to decrease; when 6MWT distance increased, fatigue decreased. In the adolescent cohort, fatigue seemed to decrease but physical performance measures evidenced little change. Correlations between changes in the physical performance variables and fatigue were not significant. CONCLUSIONS Fatigue may decrease early in treatment as disease symptoms resolve. Fatigue in the child cohort was related to physical performance, which is consistent with previous studies that defined fatigue in children as primarily a physical sensation. Findings in the adolescent cohort support research that defined adolescent fatigue as more complex with mental, emotional, and physical components. IMPLICATIONS FOR NURSING Knowing how fatigue relates to physical performance in children and adolescents informs the nurse in educating patients and families about symptom management.

Prime Time: 12-month sexual health outcomes of a clinic-based intervention to prevent pregnancy risk behaviors.

PURPOSE Prime Time, a youth development intervention, aims to reduce pregnancy risk among adolescent girls seeking clinic service who are at high risk for pregnancy. This article examines sexual risk behaviors and hypothesized psychosocial mediators after 12 months of the Prime Time intervention. METHODS This study was a randomized controlled trial with 253 girls aged 13-17 years meeting specified risk criteria. Intervention participants were involved in Prime Time programming plus usual clinic services for 18 months, control participants received usual clinic services. The intervention used a combination of case management and peer leadership programs. Participants in this interim outcomes study completed self-report surveys at baseline and 12 months after enrollment. Surveys assessed sexual risk behaviors and psychosocial factors targeted for change by Prime Time. RESULTS At the 12-month interim, the intervention group reported more consistent use of condoms, hormonal contraception, and dual contraceptive methods with their most recent partner as compared with the control group. The intervention group also reported greater stress management skills with trends toward higher levels of prosocial connectedness at school and with family. No between-group differences were noted in psychosocial measures specific to sex and contraceptive use. CONCLUSION Preventing early pregnancy among high-risk adolescents requires multifaceted, sustained approaches. An important research focus involves testing youth development interventions offered through clinic settings, where access to high-risk adolescents is plentiful and few efforts have emphasized a dual approach of building protective factors while addressing risk. Findings suggest that youth development interventions through clinic settings hold promise in reducing pregnancy risk among high-risk youth.

A clinic-based, youth development approach to teen pregnancy prevention

OBJECTIVE To provide a description of Prime Time, an intervention to reduce pregnancy risk behaviors among high-risk adolescent girls. METHODS Prime Time, a clinic-based, multicomponent youth development intervention aims to reduce sexual risk behaviors, violence involvement, and school disconnection. RESULTS We highlight key considerations in conceptualization, design, and methods for a Prime Time randomized trial. CONCLUSIONS Prime Time comes at a time of great interest in restructuring adolescent health services. This study represents an important effort to expand preventive and youth development services among young people most vulnerable to early pregnancy, for whom services must go beyond traditional problem-oriented approaches.

Family Identity: Black-White Interracial Family Health Experience

The purpose of this interpretive descriptive study was to describe how eight Black-White couples with school-aged children constructed their interracial family identity through developmental transitions and interpreted race to their children. Within and across-case data analytic strategies were used to identify commonalities and variations in how Black men and White women in couple relationships formed their family identities over time. Coming together was the core theme described by the Black-White couples as they negotiated the process of forming a family identity. Four major tasks in the construction of interracial family identity emerged: (a) understanding and resolving family of origin chaos and turmoil, (b) transcending Black-White racial history, (c) articulating the interracial familys racial standpoint, and (d) explaining race to biracial children across the developmental stages. The findings guide family nurses in promoting family identity formation as a component of family health within the nurse-family partnership with Black-White mixed-race families.

Prime Time: Sexual Health Outcomes at 24 Months for a Clinic-Linked Intervention to Prevent Pregnancy Risk Behaviors

IMPORTANCE Preventing early pregnancy among vulnerable adolescents requires innovative and sustained approaches. Prime Time, a youth development intervention, aims to reduce pregnancy risk among adolescent girls seeking clinic services who are at high risk for pregnancy. OBJECTIVE To evaluate sexual risk behaviors and related outcomes with a 24-month postbaseline survey, 6 months after the conclusion of the Prime Time intervention. DESIGN Randomized controlled trial. SETTING Community and school-based primary care clinics. PARTICIPANTS Of 253 sexually active 13- to 17-year-old girls meeting specified risk criteria, 236 (93.3%) completed the 24-month follow-up survey. INTERVENTION Offered during an 18-month period, Prime Time includes case management and youth leadership programs. MAIN OUTCOME MEASURES Self-reported consistency of condom, hormonal, and dual-method contraceptive use with most recent male sex partner and number of male sex partners in the past 6 months. RESULTS At 24-month follow-up, the intervention group reported significantly more consistent use of condoms, hormonal contraception, and dual-method contraception than the control group. Intervention participants also reported improvements in family connectedness and self-efficacy to refuse unwanted sex, and reductions in the perceived importance of having sex. No between-group differences were found in the number of recent male sex partners. CONCLUSIONS AND RELEVANCE This study contributes to what has been a dearth of evidence regarding youth development interventions offered through clinic settings, where access to high-risk adolescents is plentiful but few efforts have emphasized a dual approach of strengthening sexual and nonsexual protective factors while addressing risk. Findings suggest that health services grounded in a youth development framework can lead to long-term reductions in sexual risk among vulnerable youth.

The Uncertainty of Preadolescents’ Chronic Health Conditions and Family Distress

This study aims to identify the relationship between the degree of uncertainty in the preadolescent’s chronic condition and family distress. In-home interviews were conducted with 99 mothers and 86 fathers of 99 preadolescents with chronic physical health impairments. Preadolescents were divided into separate groups, first based on the predictability of their symptoms and next, based on the degree of certainty in their life expectancy. Using analysis of covariance, sex-stratified comparisons were made between the predictability groups and then between the life expectancy groups and four subscales of the Impact on Family Scale. Fathers and mothers of preadolescents with uncertain life expectancies reported significantly greater family/social disruption, emotional strain, and financial burden than parents of preadolescents with normal life expectancies. Unpredictability of symptoms was significantly associated with greater emotional strain for mothers and greater family/social disruption for fathers. Uncertain life expectancy and unpredictable symptoms were associated with significantly more family distress.