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Agerskov H, Thiesson HC, Pedersen BD. Parenting a child with a kidney transplant-A study of everyday life experiences. J Ren Care 2022; 49:134-143. [PMID: 35106917 DOI: 10.1111/jorc.12410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/12/2022] [Accepted: 01/16/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Kidney transplantation in children shows excellent long-term outcomes. However, parents feel responsible for ensuring that their child adheres to complex medical interventions. The dual role - as both parent and medical caregiver - gives rise to fatigue, stress, and emotional pain. Parental and family functioning are critically important to a child's disease course, development and well-being. OBJECTIVE To explore the experiences and perspectives of mothers and fathers of children with a kidney transplant. DESIGN An explorative study using a qualitative method. PARTICIPANTS Twelve parents (seven mothers and five fathers) of seven children with a kidney transplant. APPROACH A qualitative exploratory study taking a phenomenological-hermeneutic approach. METHOD Semi-structured individual interviews were conducted. The data were analysed using Ricoeur's theory of narrative and interpretation on three levels: naïve reading, structural analysis, and critical interpretation and discussion. FINDINGS Four themes were generated: Kidney transplantation as a turning point, the importance of a close collaboration with health care professionals, being the child's voice, and managing the dual role as a parent, and medical caregiver in everyday life. CONCLUSION Child kidney transplantation led to a transformation in the child, on the physical, mental, and social levels; however, the child was still in need of special attention and support. Problems with the kidney graft functioning resulted in frustration and disappointment in parents. Teamwork between a child's parents became evident, in coping with the dual role as a parent and medical caregiver. Parents aimed to maintain a clear structure related to medication and disease-related treatment. A close and trustful relationship and collaboration with health care professionals were significant and included listening to the voice of the child.
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Affiliation(s)
- Hanne Agerskov
- Department of Nephrology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Family Focused Health Care Research Center, University of Southern Denmark, Odense, Denmark
| | - Helle C Thiesson
- Department of Nephrology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, University of Southern Denmark, Odense, Denmark
| | - Birthe D Pedersen
- Department of Clinical Research, University of Southern Denmark, University of Southern Denmark, Odense, Denmark
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Choe K, Kim Y, Yang Y. Pediatric nurses’ ethical difficulties in the bedside care of children. Nurs Ethics 2017; 26:541-552. [DOI: 10.1177/0969733017708330] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Pediatric nurses experience ethically difficult situations in their everyday work. Several studies have been conducted to reveal ethical issues among pediatric nurses; we do not think their ethical difficulties have been explored sufficiently from their own perspective. Objectives: This study aimed to explore the ethical difficulties faced by pediatric nurses during bedside care for hospitalized children. Methods: A phenomenological approach was used to collect and analyze interview data from 14 female pediatric nurses in South Korea. Ethical considerations: Ethical review was obtained from an ethics committee. The participants were informed about the aim of the study, and voluntary participation, anonymous response, and confidentiality were explained to them. Findings: Three themes emerged from the analysis: ethical numbness in a task-oriented context, negative feelings toward family caregivers, and difficulty in expressing oneself in an authoritative climate. Conclusion and implications: We need to develop strategies to manage ethical difficulties at an institutional level. Furthermore, it is important that pediatric nurses have the opportunity to communicate with fellow nurses and other medical staff regarding ethical difficulties. In addition, cultivation of pediatric nurses’ moral, ethical, and philosophical thinking patterns requires the immediate provision of continuous education in nursing ethics at the site of clinical nursing, time to discuss ethical difficulties, and other supportive measures. Findings indicated that, to provide high-quality patient-centered care, we should enhance nurses’ ethical sensitivity and autonomy and improve the ethical climate in hospitals.
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Perceptions of Pediatric Nurses on Ethical Decision Making Processes. SYSTEMIC PRACTICE AND ACTION RESEARCH 2017. [DOI: 10.1007/s11213-016-9386-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
BACKGROUND: There are no universally agreed rules of healthcare ethics. Ethical decisions and standards tend to be linked to professional codes of practice when dealing with complex issues. OBJECTIVES: This paper aims to explore the ethical complexities on who should decide to give infants born on the borderline of viability lifesaving treatment, parents or the healthcare professionals. METHOD: The paper is a discussion using the principles of ethics, professional codes of practice from the UK, Nursing Midwifery Council and UK legal case law and statute. Healthcare professionals' experiences that influence parental decision are also considered. FINDINGS & DISCUSSION: There are considerable barriers to an effective discussion taking place in an environment where clinical decisions have to be made quickly once the baby is born. This is compounded by the need and respect for parental autonomy and the difficulties they face when making a best interest's decision knowing that this could cause more harm than good for their infant child and balancing any decision they make with quality of life. CONCLUSION: On deciding whether to give lifesaving treatment born at the borderline of viability, it should be a joint decision between the parents and the neonatal team.
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Affiliation(s)
| | - Emma Welch
- Hull & East Yorkshire Women's and Children's Hospital, UK
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Coyne I, Hallström I, Söderbäck M. Reframing the focus from a family-centred to a child-centred care approach for children's healthcare. J Child Health Care 2016; 20:494-502. [PMID: 27141084 DOI: 10.1177/1367493516642744] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In this article, we argue for a conceptual move from family-centred care (FCC) to a child-centred care approach and the implications for clinical nursing practice. Firstly, we argue that the parents and professional dominance constructs an asymmetric relationship towards the child, which may take away the focus from the child; Secondly, we need to renew efforts to promote the fundamental principles of protection, promotion and participation rights for children and young people according to the United Nations Convention on the Rights of the Child declaration and thirdly, we need to strengthen the child's perspective and to view the child as an agent representing own experiences and wishes to be respected and negotiated.
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Affiliation(s)
- Imelda Coyne
- 1 School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, Ireland
| | - Inger Hallström
- 2 Department of Heath Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Maja Söderbäck
- 3 School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
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Nivel de autonomía de enfermeras en la práctica pediátrica. Una experiencia chilena. ENFERMERÍA UNIVERSITARIA 2016. [DOI: 10.1016/j.reu.2016.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Chen SL, Hsu HY, Chang CF, Lin ECL. An exploration of the correlates of nurse practitioners' clinical decision-making abilities. J Clin Nurs 2016; 25:1016-24. [PMID: 26879045 DOI: 10.1111/jocn.13136] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2015] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES This study investigated nurse practitioners' clinical decision-making abilities and the factors that affect these abilities. BACKGROUND Nurse practitioners play an important role in clinical care decision-making; however, studies exploring the factors that affect their decision-making abilities are lacking. DESIGN A cross-sectional descriptive survey was employed. METHODS A purposive sample of 197 nurse practitioners was recruited from a medical centre in central Taiwan. Structured questionnaires consisting of the Knowledge Readiness Scale, the Critical Thinking Disposition Inventory and the Clinical Decision-Making Model Inventory were used to collect data. RESULTS The intuitive-analytical type was the most commonly used decision-making model, and the intuitive type was the least frequently used model. The decision-making model used was significantly related to the nurse practitioners' work unit. Significant differences were noted between the nurse practitioners' clinical decision-making models and their critical thinking dispositions (openness and empathy). The nurse practitioners' years of work experience, work unit, professional knowledge and critical thinking disposition (openness and empathy as well as holistic and reflective dispositions) predicted the nurse practitioners' analytical decision-making scores. Age, years of nurse practitioner work experience, work unit and critical thinking disposition (holistic and reflective) predicted the nurse practitioners' intuitive decision-making scores. CONCLUSIONS This study contributes to the topic of clinical decision-making by describing various types of nurse practitioner decision-making. The factors associated with analytic and intuitive decision-making scores were identified. These findings might be beneficial when planning continuing education programmes to enhance the clinical decision-making abilities of nurse practitioners. RELEVANCE TO CLINICAL PRACTICE The study results showed that nurse practitioners demonstrated various clinical decision-making types across different work units. Consideration of nurse practitioners' knowledge readiness and their specific needs while planning on-duty education programmes is necessary.
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Affiliation(s)
- Shiah-Lian Chen
- Department of Nursing, National Taichung University of Science and Technology, Taichung, Taiwan
| | - Hsiu-Ying Hsu
- Department of Emergency Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Chin-Fu Chang
- Department of Emergency Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Esther Ching-Lan Lin
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Greenberg RA, Weingarten K. When health care professionals say "more" and parents say "enough". Paediatr Child Health 2015; 20:131-4. [PMID: 25914570 DOI: 10.1093/pch/20.3.131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- R A Greenberg
- The Hospital for Sick Children, Toronto, Ontario; ; Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - K Weingarten
- The Hospital for Sick Children, Toronto, Ontario; ; Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario
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Abstract
The provision of information is an individual entitlement and a prerequisite to enabling children to understand their illness, make choices about their health care and be involved in decision-making processes around these choices. However, limited evidence exists on children's perspectives of information provision while an inpatient in hospital. The aim of this paper is to describe the process of information exchange between health professionals and children in hospital. Informed by an ethnographic design, data were collected using multiple methods, including semi-participant observations, interviews and participatory activities. Forty-nine children aged six to 16 years, with a variety of medical and surgical conditions, admitted to one children's ward at one children's hospital participated in the research. Findings revealed that children encountered a variety of information management experiences. The key message for health professionals is that there is a need to develop child- and family-focussed strategies for assessing children's information needs in order to determine their preferences for information (amount, format, from whom, etc.), to develop a method for gaining an appreciation of parents' and health professionals' beliefs about the optimal amount and type of information to relay to children, and to achieve consensus about who is best placed to transmit this information to children.
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Affiliation(s)
- Veronica Lambert
- School of Nursing and Human Sciences, Dublin City University, Ireland
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Mitchell WA. Making choices about medical interventions: the experience of disabled young people with degenerative conditions. Health Expect 2012; 17:254-66. [PMID: 22296527 DOI: 10.1111/j.1369-7625.2011.00752.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Current western policy, including the UK, advocates choice for service users and their families, taking greater control and being more involved in decision making. However, children's role in health decision making, especially from their own perspective, has received less research attention compared to doctors and parents' perspectives. OBJECTIVE To explore the perspective and experiences of disabled young people with degenerative conditions as they face significant medical interventions and engage in decision-making processes. DESIGN AND METHODS Findings from a longitudinal qualitative study of 10 young people (13-22 years) with degenerative conditions are reported. Individual semi-structured interviews were conducted with participants over 3 years (2007-2010); the paper reports data from all three interview rounds. Interviews focused on medical intervention choices the young people identified as significant. RESULTS Although the young people in this study felt involved in the medical intervention choices discussed, findings demonstrate a complex and diverse picture of decision making. Results highlighted different decisional roles adopted by the young people, the importance of information heuristics and working with other people whilst engaging in complex processes weighing up different decisional factors. DISCUSSION Young people's experiences demonstrate the importance of moving beyond viewing health choices as technical or rational decisions. How each young person framed their decision was important. Recognizing this diversity and the importance of emerging themes, such as living a normal life, independence, fear of decisions viewed as 'irreversible' and the role of parents and peers in decision making highlights that, there are clear practice implications including, active practitioner listening, sensitivity and continued holistic family working.
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Affiliation(s)
- Wendy A Mitchell
- Research Fellow, Department of Social Policy and Social Work, Social Policy Research Unit, University of York, York, UK
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Andersson N, Klang B, Petersson G. Differences in clinical reasoning among nurses working in highly specialised paediatric care. J Clin Nurs 2012; 21:870-9. [DOI: 10.1111/j.1365-2702.2011.03935.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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12
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Lipstein EA, Brinkman WB, Britto MT. What is known about parents' treatment decisions? A narrative review of pediatric decision making. Med Decis Making 2011; 32:246-58. [PMID: 21969136 DOI: 10.1177/0272989x11421528] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND With the increasing complexity of decisions in pediatric medicine, there is a growing need to understand the pediatric decision-making process. OBJECTIVE To conduct a narrative review of the current research on parent decision making about pediatric treatments and identify areas in need of further investigation. METHODS Articles presenting original research on parent decision making were identified from MEDLINE (1966-6/2011), using the terms "decision making," "parent," and "child." We included papers focused on treatment decisions but excluded those focused on information disclosure to children, vaccination, and research participation decisions. RESULTS We found 55 papers describing 52 distinct studies, the majority being descriptive, qualitative studies of the decision-making process, with very limited assessment of decision outcomes. Although parents' preferences for degree of participation in pediatric decision making vary, most are interested in sharing the decision with the provider. In addition to the provider, parents are influenced in their decision making by changes in their child's health status, other community members, prior knowledge, and personal factors, such as emotions and faith. Parents struggle to balance these influences as well as to know when to include their child in decision making. CONCLUSIONS Current research demonstrates a diversity of influences on parent decision making and parent decision preferences; however, little is known about decision outcomes or interventions to improve outcomes. Further investigation, using prospective methods, is needed in order to understand how to support parents through the difficult treatment decisions.
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Affiliation(s)
- Ellen A Lipstein
- Division of Adolescent Medicine (EAL, MTB) Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,Center for Innovation in Chronic Disease Care (EAL, WBB, MTB) Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,University of Cincinnati College of Medicine, Cincinnati, OH (EAL, WBB, MTB)
| | - William B Brinkman
- Center for Innovation in Chronic Disease Care (EAL, WBB, MTB) Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,Division of General and Community Pediatrics (WBB) Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,University of Cincinnati College of Medicine, Cincinnati, OH (EAL, WBB, MTB)
| | - Maria T Britto
- Division of Adolescent Medicine (EAL, MTB) Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,Center for Innovation in Chronic Disease Care (EAL, WBB, MTB) Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,Anderson Center for Health Systems Excellence (MTB) Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,University of Cincinnati College of Medicine, Cincinnati, OH (EAL, WBB, MTB)
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Knopf JM, Hornung RW, Slap GB, DeVellis RF, Britto MT. Views of treatment decision making from adolescents with chronic illnesses and their parents: a pilot study. Health Expect 2009; 11:343-54. [PMID: 19076663 DOI: 10.1111/j.1369-7625.2008.00508.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Shared decision making may increase satisfaction with health care and improve outcomes, but little is known about adolescents' decision-making preferences. The primary purpose of this study is to describe the decision-making preferences of adolescents with chronic illnesses and their parents, and the extent to which they agree. DESIGN Survey. SETTING AND PARTICIPANTS Participants were 82 adolescents seen at one of four paediatric chronic illness subspecialty clinics and 62 of their parents. MAIN VARIABLES Predictor variables include sociodemographics, health parameters, risk behaviour, and physical and cognitive development. The main outcome variable is preferences for decision-making style. RESULTS AND CONCLUSIONS When collapsed into three response categories, nearly equal percentages of adolescents (37%) and parents (36%) preferred shared decision making. Overall, the largest proportion of adolescents (46%) and parents (53%) preferred passive decision making compared to active or shared decision making. Across five response choices, 33% of pairs agreed. Agreement was slight and not significant. Improved general health perceptions (OR=0.76, 95% CI=0.59-0.99) and improved behaviour (OR=0.75, 95% CI=0.56-0.99) were significantly associated with parents' preferences for less active decision making. Older age was significantly associated with agreement (OR 1.58, 95% CI=1.09-2.30) between parents and adolescents. The paucity of significant predictor variables may indicate physicians need to inquire directly about patient and parent preferences.
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Affiliation(s)
- Jennifer M Knopf
- Division of Adolescent Medicine, Center for Innovation in Chronic Disease Care, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.
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Mårtenson EK, Fägerskiöld AM. A review of children’s decision-making competence in health care. J Clin Nurs 2008; 17:3131-41. [DOI: 10.1111/j.1365-2702.2006.01920.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Hallström I. Commentary on Wong MY-F & Chan SW-C (2006) The qualitative experience of Chinese parents with children diagnosed of cancer. Journal of Clinical Nursing 15, 710-717. J Clin Nurs 2007; 17:282-3; author reply 283. [DOI: 10.1111/j.1365-2702.2006.01678.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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