Nabeel Al-Yateem

Guidelines for the transition from child to adult cystic fibrosis care.

Aim To develop relevant and feasible guidelines for transition care, based on the perspectives of stakeholders. Methods A sequential exploratory mixed method design: the first, qualitative phase used focus group interviews with healthcare professionals. The second, quantitative phase used a questionnaire, based on the results of the interviews, to survey a larger sample of adolescent clients and healthcare professionals. Findings The group interviews recommended a systematic approach to transition care, in an environment appropriate to each individuals stage of development, and training of healthcare professionals in issues related to adolescence and the transition process. Survey participants agreed on the relevance and feasibility of 36 of the guidelines extracted from the interviews. Conclusion The proposed guidelines reflect the elements of care essential to a secure transition from child to adult health services. They go some way to meeting the diverse needs of young people living with a chronic life-limiting illness.

Unstructured play for anxiety in pediatric inpatient care

PURPOSE The purpose of this study was to examine the effects of unstructured play activities on the anxiety levels of hospitalized children. METHODS A nonequivalent control group pretest posttest design was employed for this study. The sample included children (N = 165) ages 4-7 years admitted to a large pediatric referral center in the United Arab Emirates. The control group (n = 84) received usual care, while the experimental group (n = 81) engaged in age-appropriate unstructured play activities using disposable games and toys. Parents and siblings, if present, were encouraged to participate. Research assistants conducted the play activities twice a day, with 30-min morning and evening sessions. Anxiety was measured at baseline and at the end of days 2 and 3 with a translated form of the Short-State-Trait Anxiety Inventory for Children. RESULTS Anxiety scores in both groups were similar at baseline and decreased significantly over the 3 days. Compared with the control group, anxiety scores in the intervention group were significantly lower on day 2 (12.7 ± 2.3 vs. 10.7 ± 2.5, p = .003) and day 3 (10.6 ± 2.2 vs. 9.47 ± 2.4, p < .001). The greatest decrease occurred in the percentage of children in the experimental group with medium-level anxiety scores: baseline (n = 61, 75%), day 2 (n = 24, 30%), and day 3 (n = 0, 0%). CONCLUSIONS This simple, low-cost play intervention implemented by nurses resulted in statistically and clinically significant decreases in the anxiety levels of children in an acute inpatient setting.

Determinants of Quality of Care for Adolescents and Young Adults With Chronic Illnesses: A Mixed Methods Study.

UNLABELLED Measuring the quality of service and user experience is an acknowledged priority for healthcare services; however it seems that healthcare systems have to work very hard to achieve this goal as evidenced by reports of gaps and disparities in the quality of care provided to clients, especially within pediatric and adolescent populations. OBJECTIVES To identify quality determinants for healthcare services for adolescents and young adults with chronic conditions based on the perceptions and the experiences of adolescents and young adults themselves. METHODOLOGY A sequential exploratory mixed method design guided this study. The initial qualitative phase employed semi-structured in-depth interviews to elicit the elements and determinants of quality of care as identified by adolescents and young adults living with chronic conditions. The second phase employed a questionnaire developed from the data gathered during the qualitative phase to survey the target population. This was distributed to a larger sample of adolescents and young adults with chronic conditions to determine and confirm the relevance of the identified care elements and quality determinants. RESULTS The study revealed 4 main determinants: the provision of adolescent friendly information relating to all aspects of living with chronic conditions, services that facilitate and encourage independence, services characterized by structure with the capacity to be both dynamic and responsive, and finally health care professionals knowledgeable and skilled in relation to adolescent specific issues.

Childhood Stress in Healthcare Settings: Awareness and Suggested Interventions

Pivotal to healthy adulthood is a supportive and nurturing environment that enables successful progression through the developmental tasks of childhood and adolescence. For many children there are events that disrupt this development. Illness, injury, painful medical interventions, and hospitalization have been reported by children and families as causing medical trauma and psychological stress. Frequently pediatric health professionals focus primarily on achieving positive physical treatment outcomes. Creating an environment that will support the developmental tasks of childhood and limit the trauma and distress associated with illness and treatment is also required. Strategies and practices to deliver holistic and comprehensive pediatric care are well established in many Western settings. Opportunity exists to broaden the focus of pediatric care in developing healthcare systems such as the United Arab Emirates (UAE) to encompass psychological well-being. The study focused on two key objectives, firstly to assess healthcare professionals’ awareness of the stressful and potentially traumatic nature of healthcare settings and treatment for children. Second the study explored the views of healthcare participants regarding possible strategies to minimize medically induced stress and trauma for children and adolescents in UAE healthcare settings. The study utilized a mixed methods design in which participants views were examined through administration of a survey comprised of close-ended questions that were analyzed quantitatively and open-ended questions analyzed qualitatively. One hundred and seventeen healthcare professionals from a range of disciplines in two government hospitals completed the survey. Data revealed that one third of the participating healthcare professionals were unaware of or did not think that their healthcare settings could provoke stress for pediatric patients. Respondents suggested three main strategies to minimize stress for children and parents while receiving treatments, specifically; providing focused information for both children and healthcare providers, adapting the environment and systems to fit children’s needs, and, improving the interpersonal skills and attitudes of healthcare professionals. The findings from this study could inform the development of standards for pediatric services and policy directions in regard to post-graduate training for health professionals working in pediatric healthcare settings.

Research Priorities for School Nursing in the United Arab Emirates (UAE)

School nurses are challenged with more children having complex conditions, who are now surviving into school age. This is paralleled by a shift in focus of health systems toward primary care, and national efforts to develop the health-care services, especially those offered to vulnerable populations. Being at the forefront of this change, school nurses in United Arab Emirates (UAE) are finding themselves under pressure to adapt to and facilitate these changes both by improving their practice and by contributing to its underpinning evidence. A cross-sectional design was used in this study in which 370 school nurses participated, identifying 11 research priorities. The three most important, as ranked by participants, were management of children with complex health-care needs; nutrition, obesity, and lifestyle issues of schoolchildren; and managing illnesses, injuries, and emergencies in schools and provision of medical support. These priorities should direct future research activities in the field.

Play distraction versus pharmacological treatment to reduce anxiety levels in children undergoing day surgery: a randomized controlled non‐inferiority trial

BACKGROUND Perioperative experience can be one of the most distressful experiences in a childs life if not managed properly by healthcare professionals. Its consequences can extend well beyond surgery and recovery into the childs future life. Healthcare professionals have a responsibility to decrease the anxiety associated with this experience, improve the childs and the parents experience and prevent negative consequences. This has traditionally been performed through pharmacological treatment which might have negative side effects. More developmentally appropriate distraction methods are currently being trialled globally to augment the evidence that supports their use as a similarly efficient alternative. OBJECTIVES The aim of this study was to explore the efficiency of storytelling, pictures and colouring activities as an anxiolytic intervention in comparison to the traditional pharmacological premedication technique in a non-inferiority study. STUDY DESIGN A randomized non-inferiority controlled trial was carried out in 168 children scheduled for day surgery. Childrens perioperative anxiety was assessed by a trained anaesthetist using the modified Yale Preoperative Assessment Scale and by parents using the State-Trait Anxiety Inventory for Children. Childrens vital signs were also collected preoperatively during the induction period and during the recovery period. RESULTS The primary endpoint, which is non-inferiority in terms of anxiety as per Yale Preoperative Assessment Scale survey between play distraction and preoperative medication, was met [average score 10.95 vs. 10.94, respectively, 95% confidence interval (-0.35; 0.37); P = 0.941]. Moreover, anxiety scores of both the intervention and the control group were quite comparable as per STAIC survey [20.90 vs. 20.73, respectively, 95% confidence interval (-0.52; 0.88); P = 0.708] and in terms of vital signs. CONCLUSION The results indicate that the distraction technique employed can be considered as an efficient alternative to traditional pharmacological premedication for children undergoing day surgery.

Mental health literacy of school nurses in the United Arab Emirates

BackgroundTo support promotion, prevention and early intervention for mental illness school nurses need to be mental health literate.MethodsThree hundred and thirty-nine school nurses employed in government and private schools from three Emirates in the UAE were surveyed. A culturally adapted Mental Health Literacy questionnaire comprising three vignettes of fictional characters meeting diagnostic criteria for the target conditions along with the Kessler Psychological Distress Scale (K10) was administered to ascertain school nurses’ ability to correctly identify the conditions and to elicit beliefs about helpfulness of treatment interventions and of health care providers for these conditions.ResultsLess than 50% of the respondents correctly identified the disorders presented, while accurate identification of evidence-based interventions was also limited. Correlations between level of psychological distress and level of inaccurate survey responses was also revealed, respondents who correctly identified the correct diagnosis of the vignette and the most appropriate interventions were those who had a significantly lower K10 score.ConclusionsLow levels of mental health literacy amongst respondents in combination with potential religious and cultural factors as reported in the literature, highlight the need for curriculum enhancements for future health professionals and a targeted program of culturally appropriate professional development focused on mental health promotion for those in clinical practice. The level of psychological distress noted in this cohort also signals a need to ensure that appropriate supports are available for clinical staff employed in schools.

Evaluating the Reliability and Validity of the Arabic Version of the Parents Perceptions of Uncertainty Scale (A-PPUS)

Background Uncertainty often accompanies illness and may be a major aversive component of the patients’ treatment process. There is evidence that parental uncertainty has a negative impact on their own and on their childs coping strategies and may affect family functioning. Key to the provision of competent care, to address uncertainty, is the use of an appropriate validated assessment tool to understand key parental concerns. The ‘Parent Perception of Uncertainty Scale’ (PPUS) has been widely used for this purpose. Aim This study reports on the validity and reliability testing of the Arabic version of the Parents Perception of Uncertainty Scale (A‐PPUS). Methods The scale was translated to Arabic using the translation‐back‐translation method. Appropriate statistical tests were performed including measurements of internal consistency, item to total scale correlation, and univariate and multivariate analyses. Results The study included 240 parents of children with chronic illnesses. Cronbachs alpha coefficient of the whole scale was 0.93. All the items were positively correlated to the total score. The univariate and multivariate analysis supported the previous tests and the assertion that the Arabic version of the PPUS provided a relevant measure of the uncertainty level. Conclusion This study has identified that the A‐PPUS is a reliable tool for parent report of their uncertainty, in the UAE and Arabic population. HighlightsParental uncertainty has a negative impact on their own and their child’s coping strategies and possibly the family unit functioning.Key to the provision of competent care that eliminate uncertainty is an appropriate validated assessment tool in the first instance.This study reports the validity and reliability testing of the Arabic version of the Parents Perception of Uncertainty Scale (A‐PPUS).The Cronbach’s &agr; coefficient of the scale was 0.93. The A‐PPUS is thus a reliable tool for parent uncertainty in the Arabic population.

Nutritional knowledge and habits of adolescents aged 9 to 13 years in Sharjah, United Arab Emirates: a crosssectional study

Good nutritional knowledge and behaviour among adolescents is important to avoid health problems that can continue into adulthood. This cross-sectional study aimed to provide baseline data on nutritional knowledge and eating habits of adolescents in Sharjah. Data were collected from 300 adolescents aged 9-13 years attending 4 private schools using a validated self-administered questionnaire. Most students (86%) had poor nutritional knowledge, especially in key areas: nutritional terms, what constitutes healthy snacks and foods, daily nutritional requirements and components of food (e.g. fibre, fat, sugar). Only 34% of the students had healthy eating behaviour: 33% had eaten none or 1 vegetable only in the previous week, 25% had eaten unhealthy snacks 3 or more times, 19% had eaten frequently or daily at fast food outlets, and 36% had skipped breakfast frequently or daily. Culturally-specific, school-based educational interventions are warranted to build sound nutritional knowledge among adolescents and motivate the diet and behaviour changes needed to promote health throughout the lifespan.

Validation of the Short State Trait Anxiety Inventory (Short STAI) Completed by Parents to Explore Anxiety Levels in Children

ABSTRACT While the healthcare setting is commonly associated with some level of anxiety, this can extend to toxic harmful anxiety that has the potential to have a negative long-term effect on a child’s anxiety and coping mechanisms, if not addressed adequately by healthcare professionals. For healthcare professionals to intervene in a timely basis and address anxiety in children in hospital, it is important that they have valid and reliable tools that enable them to measure anxiety in the first place. The purpose of this study is to present the findings of the reliability tests of the Short-STAI to measure anxiety levels in children, comparing the results with the measurements derived from the other two reliable methods utilized in the same study which are the vital signs and the MYPAS (the Modified Yale Perioperative Anxiety Survey). The validity testing was carried out in an RCT that used the S-STAI, in which 88 surveys were completed by parents of children who had a tonsillectomy and adenoidectomy. All of the children were between 4 and 7 years of age. The relationships between variables were investigated and 25 showed a positive correlation between all items. Cronbach’s α for the entire scale was 0.79. This study has identified that the S-STAI is a reliable tool for parent report of a child’s anxiety in the peri-operative period.