Roberta S. Rehm

Mental health of undocumented Mexican immigrants: a review of the literature.

The Latino population in the United States, the majority of whom are Mexican, is one of the fastest growing. Similarly, the number of undocumented Mexican immigrants (UMIs) continues to swell. However, little is known about UMIs living in the United States, and much less is known about their mental health status. This interdisciplinary review of the literature aims to outline the current state of knowledge regarding the mental health of UMIs in the United States. Themes isolated from the literature include failure to succeed in the country of origin; dangerous border crossings; limited resources; restricted mobility; marginalization/isolation; blame/stigmatization and guilt/shame; vulnerability/exploitability; fear/fear-based behaviors; and stress, depression, and health implications.

Normalization in Families Raising a Child Who Is Medically Fragile/Technology Dependent and Developmentally Delayed

The authors combined and analyzed parent data from two field studies examining family experiences in raising children who were both medically fragile and developmentally delayed or disabled to compare these families’ experiences to published attributes of normalization. Normalization is usually considered a useful conceptual and coping strategy for families of children with chronic conditions, but it has not been examined in families whose children have both complex physical and developmental disabilities. Developmental delays compounded the effects of the children’s physical chronic conditions, severely affecting how families organized and managed their daily lives, with the result that families did not fit currently established attributes of normalization. Instead, parents recognized normal and positive aspects of their lives while acknowledging the profound challenges that their families faced. Parents concluded that it was possible to have a good life that was not necessarily normal by usual standards.

Chronic conditions among children admitted to U.S. pediatric intensive care units: Their prevalence and impact on risk for mortality and prolonged length of stay*

Objective:To estimate the prevalence of chronic conditions among children admitted to U.S. pediatric intensive care units and to assess whether patients with complex chronic conditions experience pediatric intensive care unit mortality and prolonged length of stay risk beyond that predicted by commonly used severity-of-illness risk-adjustment models. Design, Setting, and Patients:Retrospective cohort analysis of 52,791 pediatric admissions to 54 U.S. pediatric intensive care units that participated in the Virtual Pediatric Intensive Care Unit Systems database in 2008. Measurements:Hierarchical logistic regression models, clustered by pediatric intensive care unit site, for pediatric intensive care unit mortality and length of stay >15 days. Standardized mortality ratios adjusted for severity-of-illness score alone and with complex chronic conditions. Main Results:Fifty-three percent of pediatric intensive care unit admissions had complex chronic conditions, and 18.5% had noncomplex chronic conditions. The prevalence of these conditions and their organ system subcategories varied considerably across sites. The majority of complex chronic condition subcategories were associated with significantly greater odds of pediatric intensive care unit mortality (odds ratios 1.25–2.9, all p values < .02) compared to having a noncomplex chronic condition or no chronic condition, after controlling for age, gender, trauma, and severity-of-illness. Only respiratory, gastrointestinal, and rheumatologic/orthopedic/psychiatric complex chronic conditions were not associated with increased odds of pediatric intensive care unit mortality. All subcategories were significantly associated with prolonged length of stay. All noncomplex chronic condition subcategories were either not associated or were negatively associated with pediatric intensive care unit mortality, and most were not associated with prolonged length of stay, compared to having no chronic conditions. Among this group of pediatric intensive care units, adding complex chronic conditions to risk-adjustment models led to greater model accuracy but did not substantially change unit-level standardized mortality ratios. Conclusions:Children with complex chronic conditions were at greater risk for pediatric intensive care unit mortality and prolonged length of stay than those with no chronic conditions, but the magnitude of risk varied across subcategories. Inclusion of complex chronic conditions into models of pediatric intensive care unit mortality improved model accuracy but had little impact on standardized mortality ratios.

What we know (and do not know) about raising children with complex continuing care needs.

ventilators and nutrition systems allow many children to survive diseases and injuries previously considered fatal. Most are cared for in their homes, where they are cherished members of their families. These children have complex continuing care needs that stem from multi-organ system involvement and cognitive and/or developmental problems. Incidence and prevalence rates are unknown because different terms are used to classify this small but growing pediatric population. Each of us has conducted research with these families in Canada, the US and UK respectively. Although these countries have different models of health and social service provision, our findings are similar. Our combined findings corroborate those of other researchers, indicating that radically new forms of childhood, parenthood and family life have been created, but are poorly understood. We know that these children commonly receive sub-optimal long-term care because they ‘fall between the cracks’ due to ambiguous categories, exclusionary criteria or service gaps. Nevertheless, most parents emphasize the important benefits that they derive from raising them and the enhancements they make to family life. However, daily life is extremely constrained also by extraordinary physical, psychological, social and financial challenges. EDITORIAL

Profiling Health and Health-Related Services for Children With Special Health Care Needs With and Without Disabilities

OBJECTIVE The aims of this study were to profile and compare the health and health services characteristics for children with special health care needs (CSHCN), with and without disabilities, and to determine factors associated with unmet need. METHODS Secondary data analysis of the 2005-2006 National Survey of Children with Special Health Care Needs was conducted. The sociodemographics, health, and health services of CSHCN with and without disabilities were compared. Multivariable logistic regression was employed to examine factors associated with unmet need for health services. RESULTS Children from minority racial and ethnic groups and children living in or near poverty were over-represented among CSHCN with disabilities, compared with other CSHCN. Statistically higher percentages of CSHCN with disabilities had behavioral problems (39.6% vs 25.2%), anxiety/depressed mood (46.1% vs 24.0%), and trouble making/keeping friends (38.1% vs 15.6%) compared with other CSHCN. Thirty-two percent of CSHCN with disabilities received care in a medical home compared with 51% of other CSHCN. CSHCN with disabilities had higher rates of need and unmet need than other CSHCN for specialty care, therapy services, mental health services, home health, assistive devices, medical supplies, and durable medical equipment. The adjusted odds of unmet need for CSHCN with disabilities were 71% higher than for other CSHCN. CONCLUSION CSHCN with disabilities had more severe health conditions and more health services need, but they less commonly received care within a medical home and had more unmet need. These health care inequities should be amenable to policy and health service delivery interventions to improve outcomes for CSHCN with disabilities.

The Search for Social Safety and Comfort in Families Raising Children With Complex Chronic Conditions

Social consequences of raising children who were medically fragile and developmentally delayed (MF/DD) were explored in an ethnographic study of 20 families with school-age children. The overarching theme was the families’ search for safety and comfort in social situations. Major categories comprising this theme included the need to anticipate and plan for the child’s care; overcoming environmental, child-related, and attitudinal barriers; and finding social activities that were comfortable for all members of the family. When this search was successful, families could relax, and all members could participate in a variety of social encounters and activities; but when safety and comfort could not be achieved, families were likely to limit social activities or split the family so that the child who was MF/DD could be cared for while other family members participated in social events.

Parent and youth priorities during the transition to adulthood for youth with special health care needs and developmental disability.

Families undertake extensive planning during transition to adulthood so youth with concomitant special health care needs and developmental disabilities will have a long-term high quality of life. Findings from an interpretive field study involving 64 youth and their parents indicated that the meaning of adulthood was functioning as independently as possible with appropriate supports. Parental priorities included protecting health, assuring safety and security in multiple realms, finding meaningful activities after high school, and establishing supportive social relationships. These priorities demonstrated the need to broaden usual health care transition goals that focus on finding adult providers and optimizing self-management.

Creating a context of safety and achievement at school for children who are medically fragile/technology dependent.

Parents, nurses, and educators collaborate closely to create school environments that are safe and productive for children who are medically fragile/technology dependent. This article reports the results of a field study conducted in schools and family homes with the significant adults who care for and facilitate school participation for children who are medically fragile/technology dependent. Key steps in this process included learning about rights and responsibilities, planning for childrens individual needs, being persistent in the face of systemic barriers, and taking actions to protect both children and professionals from perceived threats.

Relationships and Betrayal among Young Women: Theoretical Perspectives on Adolescent Dating Abuse

AIMS Adolescent dating abuse is not specifically described by any current nursing theory, and this article presents discussion of some existing theories that could inform a nursing theory of adolescent dating abuse. To account for the effects of gender, this discussion is limited to young women. BACKGROUND Adolescent dating abuse is an important and understudied international issue for nursing. Theoretical frameworks can support development of nursing scholarship for such issues. No single theory yet exists in nursing to explain the experiences and health ramifications of dating abuse among young women. DATA SOURCES A summary table of theories is provided. Literature was gathered via database search and bibliographic snowballing from reference lists of relevant articles. Included literature dates from 1982 through 2010. DISCUSSION Theories of relationship formation and function are discussed, including attachment, investment, feminist and gender role conflict theories. Betrayal trauma theory is considered as a mechanism of injury following an abusive dating experience. IMPLICATIONS FOR NURSING Gender, relationship and adolescence combine in a complex developmental moment for young women. To improve nursing care for those at risk for or in the throes of abusive relationships, it is critical to develop specific nursing approaches to understanding these relationships. CONCLUSION Existing theories related to relationship and traumatic experiences can be combined in the development of a nursing theory of adolescent dating abuse among young women.

It's Just a Fact of Life: Family Members' Perceptions of Parental Chronic Illness

Both parents and children constructfamily meanings when chronic illness or disability affects a parent. In this analysis, using a symbolic interaction framework, family members described implications for parenting that occurred when one of the parents experienced multiple sclerosis. This study is a secondary analysis of longitudinal data from 23 families each year for a period of 4 years. Findings indicated that both parents and children mostly thought of their families as functioning well, despite the many changes brought about by the chronic illness of one parent. Both spouses were considered good parents by children and parents, although specific changes in parenting, including increased irritability and yelling by parents, increased work and stress of the parent without multiple sclerosis, and changes in family activities away from more active pursuits were acknowledged. Knowledge of family perceptions will provide context and guidance for nurses planning intervention and counseling.