Annette Dickinson

Managing it: a mother's perspective of managing a pre-school child's acute asthma episode.

Over the last decade asthma management strategies have required families to take increased responsibility for the assessment and treatment of their child’s asthma. This exploratory descriptive study informed by grounded theory examines the experience of mothers in managing their pre-school child’s acute asthma attack at home. The study reveals that mothers perceive that they are responsible for the management of their pre-school child during an acute asthma episode, a process they described as ‘managing it’. This process involves mother in ‘working on treatment’, ‘making the call’, ‘watching’ and ‘calming’, while the husband/partner, family, friends and health professionals are ‘supporting treatment’. This study suggests that nurses and doctors need to move away from the current paternalistic view of health care delivery in acute settings and embrace the concepts of support and partnership in the care of the pre-school child with asthma and their family.

The perceptions and preferences of parents of children with tracheostomies in a study of humidification therapy.

This article reports a grounded theory study which was the qualitative phase of a randomized-controlled trial in children with tracheostomies comparing two techniques for providing humidified inspired gases. Semi-structured interviews were conducted with eight mothers of children with tracheostomies recruited from the trial, one mother who was not involved in the trial and four experienced nurses. Data were analysed using open, selective and theoretical coding. A core category was identified of parents managing the child’s care in response to a set of problematic and constraining states. Parents were seen to utilize strategies of constant checking, becoming the expert, the family pulling together and electing to use preferred technology. The findings of this study mirror those of previous studies and reinforce the primacy of caregivers as managers of their child’s health care. Mothers elected to use or not use a given technology within this context, utilizing a process of balancing.

Children’s perspectives in family-centred hospital care

Background: Children’s nursing has developed into its current forms in large part as a result of broader sociopolitical and organisational influences. Family-centred, patient-centred and collaborative approaches are now well established within the lexicon of child healthcare. Children are central to this yet their role within the family-centred care approach is not clear. Aim: To ask children to share the narratives of their experience of hospitals and hospitalisation in New Zealand, in order to consider multiple factors influencing their experience in hospital. Methods: A qualitative narrative study involving face-to-face interviews with families (adults and children) who have had the experience of a child in hospital in New Zealand. The family narratives have been explored elsewhere. In this study, the stories told by children were examined in context of the family interview and the broader sociocultural narratives influencing them. Findings: The research findings offer insights into how children make meaning of hospital experience and how their roles are influenced by adults. Themes evident are that parent and child experience may be different; children’s stories may not be consistent with family narratives; and, children’s agency in hospital is variable. Conclusion: Children’s stories provide insights to the interconnectedness of personal, familial and societal narratives and their influence on experience of hospitalisation. Nurses and families are able to both constrain and enable children’s participation in hospital care.

Auto-driven Photo Elicitation Interviews in Research with Children: Ethical and Practical Considerations

ABSTRACT Children can sometimes find it difficult to articulate their experiences if they have to rely solely on words. Giving children the opportunity to use arts-based research approaches can support their participation in research and create a bridge that enables them to express their perspectives and feelings. This paper focuses on the ethical and practical considerations when using photo elicitation interviews (PEI) in research with children. The discussion and examples provided are drawn from an international study that used auto-driven PEI, where photographs are taken by children themselves, to explore children’s experiences of living with a chronic condition and the impact condition management may have on their everyday lives. In this paper we critically explore the issues arising from our use of PEI including children’s participation and engagement, balancing power and control, and keeping children safe. The main areas of focus for the paper are how PEI provided a means of shifting control; how setting photographic boundaries influenced our PEI study with children; and how we addressed risks associated with the method. Our experience shows that PEI is an engaging and valuable research method, providing a powerful medium for obtaining rich data with children. However, PEI is challenging and it requires researchers to conscientiously address ethical and practical aspects that extend beyond those inherent to standard (words-alone) interviews.

The implementation and evaluation of an oral healthcare best practice guideline in a paediatric hospital

The oral health of the New Zealand population now compares unfavourably with other countries. A number of strategies have been introduced at a government and health provider level to improve the oral health status of children. One such strategy was the introduction of a recommended best practice (RBP) within Starship Childrens Hospital. Nursing practice was evaluated 2 weeks prior and 6 months post-implementation of the RBP using a survey technique. While there was no significant change in practice post-introduction of the RBP, awareness regarding the oral health care needs of children while in hospital has been improved. This study provides increased understanding in regard to the oral healthcare practices of paediatric nurses, the influences on evidence-based practice change and health education and promotion within an acute paediatric hospital.

The provision of nurse-led school based health services

Background: Internationally, nurses have been in the forefront of delivering health care services in the school environment and whilst health care delivery in secondary and high schools is evaluated, this is not the case for services delivered in primary/elementary schools. In countries such as New Zealand there is no significant inter-service collaboration between health and education; therefore, the delivery of health services remains fragmented and underdeveloped. Objectives: This discussion paper reviews the history and development of nurse-led school-based health services internationally and provides an insight into the current provision of primary school-based health services in New Zealand. Design: The initial approach to this paper was to gain an understanding of the history of school-based health services internationally and to explore the relationship between health and education in relation to this. This assisted in providing some context and comparison with the current provision of school-based health services in New Zealand. Discussion outcome: Internationally, it is acknowledged that schools provide not only a location to deliver health services to children but also the opportunity to reach entire families and communities yet surprisingly, the development of school-based health services within the primary/elementary school sector has received minimal attention in New Zealand and worldwide. Conclusions:This paper supports the need for further research concerning the feasibility, provision and effectiveness of school-based health services in primary/elementary schools. In order to be effective, this should incorporate the shared needs and values of all stakeholders. The authors argue the need to develop an inter-service, collaborative, national framework for the delivery of school nursing services within the primary school sector in New Zealand. Impact statement: A collaborative framework for health service delivery into primary schools can enable early establishment of supportive health relationships with families.

Holding children for procedures; an international survey of health professionals

Children undergoing clinical procedures can experience pain and/or anxiety. This may result in them being unwilling to cooperate and being held still by parents or health professionals. This study aimed to capture an international perspective of health professionals’ reported practices of holding children still for clinical procedures. An online questionnaire was distributed through network sampling to health professionals working with children aged under 16 years of age. A total of 872 responses were obtained from Australia (n = 477), New Zealand (n = 237) and the United Kingdom (n = 158). Responses were from nurses (n = 651), doctors (n = 159) and other professionals (n = 53). Health professionals reported children as held still for clinical procedures quite often (48%) or very often (33%). Levels of holding varied significantly according to country of practice, profession, student status, length of time working within a clinical setting, training received and the availability of resources in the workplace. Health professionals who gained permissions (assent from children and/or consent from parents) before procedures were less likely to hold children still for a clinical procedure than those who did not. Holding children still for procedures is an international practice, which is influenced by training, access to guidance, country of practice and profession. Childrens permission and parental consent is often not sought before a child is held for a procedure to be completed.

Facilitating open family communication when a parent has chronic pain: A scoping review

Abstract Background: When a parent has chronic pain, family communication can become strained. Clinicians are encouraged to identify and support families struggling with open communication. Occupational therapists are commonly involved in the provision of pain management services but their role in facilitating open communication in families affected by this condition has not been clearly articulated. Objective: To develop a comprehensive understanding of what is being done and/or thought to be helpful for facilitating open communication in families affected by chronic pain, in order to articulate the role of occupational therapy in this area of care. Methods: A scoping review was conducted and 24 items analyzed using qualitative content analysis. Results: The facilitation of open communication in families affected by parental chronic pain is dependent on a variety of factors, including the skills that members possess and occupations which they perform individually and together. It can also be prompted by relationship tension or a family accessing professional support. Occupational therapy literature on the matter is currently limited and focused on assertiveness training. Conclusion and significance: There is scope for occupational therapist to extend their role beyond assertiveness training and use occupation-centered interventions to facilitate communication within families affected by parental chronic pain.

Child Centred Care: Challenging Assumptions and Repositioning Children and Young People

Theoretical Principles: Against a backdrop of increasing debate regarding childrens voice and position within health care and the struggle to effectively implement Family‐Centred Care (FCC) in practice, the concept of Child‐Centred Care (CCC) has emerged. Phenomena Addressed: The purpose of this paper is to explore the concept of CCC and its potential theoretical alignment with an ecological approach to health care. Research Linkages: The paper will draw on practice‐based research, highlighting the differences and similarities of CC against the more established FCC. Arguments will be presented to show that rather than competing with FCC, CCC has the potential to complement or extend traditional FCC, by placing children in a more prominent and central position than that which they currently hold within health care. HIGHLIGHTSChallenges and continues the debate in regard to the provision of family‐centred care.Child‐centred orientates children to a more central position in health care.An ecological model allows exploration of relational, contextual and environmental influences on the delivery of care.

A qualitative study of health professionals’ views on the holding of children for clinical procedures: Constructing a balanced approach:

Children undergoing clinical procedures can experience fear, uncertainty, and anxiety which can cause them to become upset and resist procedures. This study aimed to capture an international perspective of how health professionals report they would act if a child was upset and resisted a procedure. An online questionnaire, distributed through network sampling, used three vignettes to elicit qualitative open text responses from health professionals. Seven hundred and twelve professionals participated, resulting in 2072 pieces of text across the three vignettes. Many professionals reported that they would use distraction and spend time to inform and engage children in making choices about their procedure. However, most professionals indicated that if a child became uncooperative they would hold or instruct the holding of the child in order to get the procedure done ‘as quickly as possible’. The findings demonstrate that professionals experience difficulty in balancing the different agendas, rights and priorities within the momentum which can build during a clinical procedure, often resulting in the child’s voice and rights being undermined. A more balanced approach could be facilitated by a ‘clinical pause’ that would equip professionals with the time to consider children’s expressed wishes and explore alternative approaches to holding.