Sølvi Helseth

Having a parent with cancer: coping and quality of life of children during serious illness in the family.

Little research has addressed how a parents cancer affects young children. The purpose of this study was to explore the well-being and coping of young children during a period of cancer illness in the family. An explorative design was chosen, and data were collected through qualitative in-depth interviews with children (ages, 7-12 years) and their parents. Data were analyzed and interpreted within a phenomenologic-hermeneutic frame of understanding. Four major themes emerged in the findings: illness ruling in the family, reactions over and under the surface, many efforts to manage the situation, and feeling good most of the time. This report discusses how childrens reactions and their management of such a difficult life event affect their quality of life. By going “in and out” of the situation, both literally and emotionally, the children cope with the situation and maintain a balance in life. In general, the children reported “feeling good,” but they put a lot of effort into it, and their quality of life appeared to be fragile. Their well-being was especially vulnerable at the time of the diagnosis and when the illness situation changed.

Predictors of health-related quality of life in a sample of children and adolescents: a school survey

AIM The aim is to study the health-related quality of life in a school sample of children and adolescents aged 8-18 years and to examine the relationship between health-related quality of life and the following variables; age, gender, perceived pain, body image, body mass index and bullying. BACKGROUND The study of health-related quality of life in children and adolescents have received little attention compared with adults in health care research and still little is known about the associations between health-related quality of life and other variables. DESIGN A cross-sectional design was chosen. METHOD We measured the health-related quality of life using the generic questionnaire KIDSCREEN-10. We administered the KIDSCREEN 52-item, and the 10 items were selected from this according to the KIDSCREEN manual. Multilevel regression models were used to evaluate the associations between health-related quality of life and the independent variables. RESULTS The sample included 1066 children and adolescents, 576 girls and 490 boys, with a response rate of 74%. The results show that body mass index was not significant associated with health-related quality of life in full model. However, in addition to age, being bullied, pain and body image were significant associated with health-related quality of life. Of these predictors, body image has the strongest impact in terms of explained variance in health-related quality of life. CONCLUSION The subjective sense of satisfaction or dissatisfaction with ones body, perceived body image, is a powerful predictor of health-related quality of life. RELEVANCE TO CLINICAL PRACTICE Knowledge about predictors of health-related quality of life is especially important for public health nurses. Health promotion and intervention programmes that aim to strengthen psychosocial well-being, especially those that strengthen body image, should be developed for both genders.

Nurses as Moral Practitioners Encountering Parents in Neonatal Intensive Care Units

Historically, the care of hospitalized children has evolved from being performed in isolation from parents to a situation where the parents and the child are regarded as a unit, and parents and nurses as equal partners in the child’s care. Parents are totally dependent on professionals’ knowledge and expertise, while nurses are dependent on the children’s emotional connection with their parents in order to provide optimal care. Even when interdependency exists, nurses as professionals hold the power to decide whether and to what extent parents should be involved in their child’s care. This article focuses on nurses’ responsibility to act ethically and reflectively in a collaborative partnership with parents. To illuminate the issue of nurses as moral practitioners, we present an observation of contemporary child care, and discuss it from the perspective of the Danish moral philosopher KE Løgstrup and his book The ethical demand.

Research Involving Children: some ethical issues:

In a Norwegian study on how children aged 7-12 years cope during a period of serious illness within the family and on their quality of life at this time, several ethical questions became apparent. These were mainly concerned with the vulnerability of children during research, with their ability to make autonomous decisions, and with considerations regarding how to respect their right to confidentiality during the research process. In this article we approach these questions using our experience from this previous study, discussing them within the framework of theories of ethics and relevant research ethical guidelines. Finally, we discuss our experience in the light of the overall purpose of this article: how to deal with the ethical dilemmas that may appear during research involving young children.

Associations between general self-efficacy and health-related quality of life among 12-13-year-old school children: a cross-sectional survey

BackgroundWhile research on school childrens health has mainly focused on risk factors and illness, few studies have examined aspects of health promotion. Thus, this study focuses on health promotional factors including general self-efficacy (GSE) and health-related quality of life (HRQOL). GSE refers to a global confidence in coping ability across a wide range of demanding situations, and is related to health. The purpose of this study was to examine associations between GSE and HRQOL, and associations between HRQOL and socio-demographic characteristics. Knowledge of these associations in healthy school children is currently lacking.MethodsDuring 2006 and 2007, 279 school children in the seventh grade across eastern Norway completed a survey assessing their GSE and HRQOL. The children were from schools that had been randomly selected using cluster sampling. T-tests were computed to compare mean subscale values between HRQOL and socio-demographic variables. Single and multiple regression analyses were performed to explore associations among GSE, HRQOL and socio-demographic variables.ResultsRegression analyses showed a significant relationship between increasing degrees of GSE and increasing degrees of HRQOL. In analyses adjusted for socio-demographic variables, boys scored higher than girls on self-esteem. School children from single-parent families had lower scores on HRQOL than those from two-parent families, and children who had relocated within the last five years had lower scores on HRQOL than those who had not relocated.ConclusionThe strong relationship between GSE and HRQOL indicates that GSE might be a resource for increasing the HRQOL for school children.

Parents’ experiences of a Family Support Program when a parent has incurable cancer

AIMS AND OBJECTIVES The Family Support Program was created to support children and parenting when one of the parents has incurable cancer. We chose a family-based approach to support parents coping and to help families pull together, identify strengths in the family and learn how to seek help. BACKGROUND Cancer is usually a new experience for young families. In most cases, parents do not have the necessary knowledge about their childrens need for information and support about their parents serious illness and impending death. DESIGN A qualitative evaluation study based on data collected through in-depth interviews focusing on parents experiences with the Family Support Program. METHODS Participants were patients with incurable cancer and their partners and ex-partners with children aged between 5-18 years. Thirteen parents were in-depth interviewed. RESULTS Parents described how the Family Support Program helped them gain greater insight into their childrens thoughts and reactions and into how the situation affected their daily living. Parents reported that conflicts were reduced, they could talk more openly about the situation in the family and that they were shown how to support their childrens coping. CONCLUSION The Family Support Program met the parents in the studys needs for more information and support about how to cope with their children during the patients terminal illness. RELEVANCE TO CLINICAL PRACTICE The Family Support Program is described in detail in a manual that makes it easy for other health workers to use the same programme. The Family Support program was in use in outpatient clinics, oncology wards and palliative care units and was provided both from nurses and social workers trained in cancer care. Parents in the study would like the Family Support Program to be available to all patients who receive the poor prognosis that their cancer cannot be cured.

The effect of a solution-focused approach to improve self-efficacy in socially withdrawn school children: A non-randomized controlled trial

BACKGROUND Socially withdrawn children can improve their social skills through increased self-efficacy. Previous studies have shown that socially withdrawn children are prone to low self-efficacy and problems at school. Therefore, we investigated the effects of an intervention on the self-efficacy of these school children. A solution-focused approach may be an appropriate tool in such interventions. OBJECTIVES To explore the effects of a group intervention based on a solution-focused approach on the self-efficacy of a group of socially withdrawn children and to explore possible sex-based differences. DESIGN This interventional study was a non-randomized controlled trial, with experimental and control groups. SETTING The study was performed within the school health services of 14 primary schools in eastern Norway from 2006 to 2008. PARTICIPANTS School children who were aged 12-13 years and identified as socially withdrawn participated: 156 at baseline, but 6 dropped out before the first measurement and an additional 6 did not complete the second measurement. METHODS The participants completed questionnaires assessing general self-efficacy, social self-efficacy, and assertive self-efficacy at three different times. The first time was at baseline, the second was immediately after the 6-week intervention period, and the third was 3 months after the intervention. RESULTS The general self-efficacy scores increased significantly among girls in the experimental group immediately after the intervention compared with those of the control group. The effect size was 0.60. No significant change was observed among the boys at the same time. From baseline to 3 months after the intervention, the general self-efficacy scores increased for both sexes in the experimental group and also in the control group. The assertive self-efficacy of the boys in the experimental group also increased (effect size, 0.29). CONCLUSION This study demonstrates that socially withdrawn children can benefit from a solution-focused approach group intervention and reach their goals, probably because they learn from each other and share their feelings, experiences, and support. These results indicate that a solution-focused approach may be suitable for school nurses in their work with children with special needs. Solution-focused groups are also recommended for use in school health services.

School children’s experience of being bullied – and how they envisage their dream day

Bullying may have a number of negative health impacts on children. Previous studies have mainly explored negative health consequences related to being bullied. A different approach is to explore how these phenomena are related to the school childs quality of life (QOL). The role of the school nurse is to promote health and prevent sickness, and school nurses therefore need knowledge of what promotes or threatens QOL in children. No previous research has explored how bullied children envisage their dream day or a day with good QOL. There is a need for more qualitative research on how school children experience being bullied and the kind of help they need from their school, and school nurse, to realize their dream day. The aim of this study was to explore how school children experience bullying in their everyday lives, what constitutes their dream day and what kind of help they need. An explorative qualitative design was chosen, and data were collected through focus group interviews. Data collection was conducted throughout 2007 and during the spring of 2008. The sample consisted of 17 school children, aged 12-13 years, in four different groups. An interview guide was used, and the group responses were audio-taped, transcribed and coded into themes. The data were analysed according to Kvales three contexts of interpretation within a phenomenological and hermeneutic framework. Four main themes were identified: teasing and fighting, emotional reactions to being left alone or excluded, the need for friends to achieve the dream day and stopping the bullying immediately. The participants said that being bullied made them feel helpless, lonely and excluded. They wanted the bullying to be recognized, assistance from the school staff to stop the bullying, and to be included by their peers.

Important periods of weight development in childhood: a population-based longitudinal study

BackgroundIdentifying important ages for the development of overweight is essential for optimizing preventive efforts. The purpose of the study was to explore early growth characteristics in children who become overweight or obese at the age of 8 years to identify important ages for the onset of overweight and obesity.MethodsData from the Norwegian Child Growth Study in 2010 (N = 3172) were linked with repeated measurements from health records beginning at birth. Weight and height were used to derive the body mass index (BMI) in kg/m2. The BMI standard deviation score (SDS) for each participant was estimated at specific target ages, using a piecewise linear mixed effect model.ResultsAt 8 years of age, 20.4% of the children were overweight or obese. Already at birth, overweight children had a significantly higher mean BMI SDS than normal weight 8-year-olds (p < .001) and this difference increased in consecutive age groups in infancy and childhood. A relatively large increase in BMI during the first 9 months was identified as important for being overweight at 8 years. BMI SDS at birth was associated with overweight at 8 years of age (OR, 1.8; 1.6–2.0), and with obesity (OR, 1.8; 1.4–2.3). The Odds Ratios for the BMI SDS and change in BMI SDS further increased up to 1 year of age became very high from 2 years of age onwards.ConclusionsA high birth weight and an increasing BMI SDS during the first 9 months and high BMI from 2 years of age proved important landmarks for the onset of being overweight at 8 years of age. The risks of being overweight at 8 years appear to start very early. Interventions to prevent children becoming overweight should not only start at a very early age but also include the prenatal stage.

Health related quality of life in children and adolescents: Reliability and validity of the Norwegian version of KIDSCREEN-52 questionnaire, a cross sectional study

BACKGROUND A number of health-related quality of life instruments for children and adolescents have been developed and used in European countries during recent years. However, few well-validated instruments have been translated into Norwegian. As part of a larger investigation about pain and health-related quality of life, the KIDSCREEN-52, a cross-cultural 10-scale questionnaire, was translated into Norwegian. The aim of this study was to examine psychometric properties of the first Norwegian version of KIDSCREEN, particularly reliability and construct validity. METHODS A cross-sectional study was carried out, and a cluster sample of 20 randomly selected schools was drawn. The final study sample encompassed 1123 children and adolescents, aged 8-18 years. Internal consistency reliability was assessed using Cronbachs alpha. Construct validity was examined by confirmatory factor analysis, and by analysing whether the KIDSCREEN scales correlated with comparable KINDL scales, another health-related quality of life instrument. The analyses were conducted using SPSS (16.0) and Lisrel (8.7). RESULTS The Cronbachs alpha value was above 0.80 for all KIDSCREEN scales, suggesting good internal consistency reliability for the instrument. Confirmatory factor analysis shows that most of the KIDSCREEN scales fit the data well. Fit statistics for the 10-factor model were satisfactory, although some scales displayed residual covariance. Several confirmatory factor analysis models were fitted to the data, and the model specified according to the 10-dimensional KIDSCREEN-52 measurement model with correlated first-order factors fitted the data well (RMSEA=0.04; CFI=0.99). The KIDSCREEN scales correlated sufficiently highly with comparable KINDL scales. CONCLUSIONS The results of the present study indicate that the Norwegian version of the KIDSCREEN-52 seems to work well in a Norwegian context, and is a valid and reliable generic health-related quality of life instrument. It is considered appropriate for screening in the public health area, for example, in school health care.