Children's Perspectives on Living With a Sibling With a Chronic Illness

Anxiety in typically developing children with a sibling with a special healthcare need: A concept analysis

BACKGROUND

Anxiety levels among children have been rising. Currently, about 240 million children worldwide live with disabilities, affecting not only their well-being but also that of their siblings and families. Typically developing children aged 8 to 12 with a sibling who has special healthcare needs (SHCN) may experience increased anxiety. This topic requires further investigation to understand its unique factors.

PURPOSE

Examine the determinants of anxiety in children aged 8 to 12 years with a sibling who has SHCN.

METHODS

The concept analysis was carried out using the iterative eight-step method developed by Walker and Avant (2019).

DISCUSSION

Three key attributes of anxiety were identified: psychological, structural, and educational factors.

CONCLUSION

This research provides a foundational understanding of this emerging concept, anxiety in children 8 to 12 years with a sibling with a SHCN. This allows for developing targeted interventions and identifying potential areas for future research.

The psychosocial impact of childhood constipation on the children and family: A scoping review

BACKGROUND

Constipation is a common and complex health issue among children that negatively affects multiple domains of children's and families' lives. Emotional, psychological, and behavioural problems in children, as well as anxiety, distress and frustration in parents, are some of the reported effects.

AIM

This manuscript presents a systematic scoping review synthesising current evidence on the psychosocial impact of childhood constipation on children and their families.

METHODS

This review was guided by Arksey and O'Malley's five-stage framework, updated by Levac, Colquhoun and O'Brien and the Joanna Briggs Institute. Five databases were systematically searched: PUBMED, CINAHL, ASSIA, PsycINFO and Google Scholar, which yielded 2836 records. Following a systematic screening process, 32 articles met the inclusion criteria. Results were analysed, discussed and presented using the PAGER framework.

RESULTS

The four key patterns that emerged were the psychosocial impact of childhood constipation on children, their parents, and school and academic life, and parental factors associated with childhood constipation.

CONCLUSION

Childhood constipation significantly impacts the quality of life for both children and their parents, as well as the school life and academic performance. Various parental factors are linked to a higher prevalence of constipation in children.

IMPLICATIONS

Neglecting to assess and address psychosocial issues in children with constipation can prolong the condition and significantly reduce their overall quality of life, contributing to multimorbidity. Adopting a holistic approach to managing constipation in children and their families is essential for promoting overall well-being.

Disorder Type and Severity as Predictors of Mental Health in Siblings of Children with Chronic Disorders

Siblings of children with chronic disorders are at risk of developing mental health problems. Studies are inconclusive about whether sibling mental health is best predicted by the specific diagnoses of the child with disorder or by transdiagnostic factors. The aims of the present study were (1) to examine if specific diagnoses predicted sibling mental health, and (2) to examine if disorder severity in the child with the chronic disorder predicted sibling mental health. Baseline data from a randomized controlled trial were used. Siblings (aged 8 - 16 years) of children with chronic disorders and their parents were recruited from eight municipality and hospital clinics (N = 288). The children with chronic disorders were placed in ICD-10 diagnostic categories based on combined parent report and clinical records. Regression analyses with the most frequent primary diagnoses (ADHD, Asperger syndrome, autism, down syndrome, rare disorders) and a measure of disorder severity as predictors of sibling mental health were run. Father-reported disorder severity predicted sibling-reported internalizing problems and father-reported internalizing and externalizing problems in siblings. Mother-reported disorder severity predicted mother-reported sibling internalizing problems. No single primary diagnosis predicted sibling internalizing or externalizing problems. Disorder severity does to an extent predict sibling mental health, whereas single diagnostic categories do not. Disorder severity may be used to identify siblings at risk and/or in need of interventions. Fathers should be included in assessment and health care for siblings as their reports seem to predict sibling mental health better than the mothers.

Hospital to home transition of children with medical complexities in the Netherlands: current practice

Children with Medical Complexity (CMC) often require 24/7 expert care, which may impede discharge from hospital to home (H2H) resulting in prolonged admission. Limited research exists on pediatric patients with delayed discharges and the underlying reasons for such extended admissions. Therefore, our objectives were to (1) describe the demographics, clinical characteristics, and course of CMC who are in their H2H transition and (2) identify the reasons for postponement of H2H discharge. Prospective, multicenter, observational cohort study performed from February 2022 until November 2022 for 6 months in four Dutch University Medical Center children's hospitals. Clinically admitted patients (age 0-18 years) were eligible for inclusion if they were medically stable, yet required specialized nursing and/or paramedical care and were in the H2H transition process. In total, 44 participants were included, of whom 32 (72.7%) were younger than 1 year. Median stay in the hospital was 7.3 weeks (range 0.7-28.7). Upon entering the H2H phase, postponement of discharge was for 65.1% of the patients primarily due to a combination of medical reasons and organizational/family factors. For the remaining 34.9% of the patients, discharge was delayed solely due to organizational and/or family factors. CONCLUSION : Our study highlights several reasons contributing to the postponement of discharge for pediatric patients with medical complexity, including their medical fragility, the time-consuming process of parent training, and the challenges in organizing home care. Future steps should explore various transitional care programs aimed at improving the H2H transition. What is Known: • Hospital to home transition for Children with Medical Complexity is a multi-faceted process with many challenges and obstacles • Insight into the current practice of transitioning home in University Medical Centers remains unknown and is needed to develop a tailored yet standardized approach What is New: • Our findings reveal reasons for postponement of discharge home and show that patients are medically stable for more than half of their hospital stays. This indicates potential opportunities to reorganize care for better outcomes for the child, the family, and healthcare consumption.

"What about me?": lived experiences of siblings living with a brother or sister with a life-threatening or life-limiting condition

BACKGROUND

There is a lack of knowledge regarding siblings' experiences of being a brother or sister of a child with a life-threatening or life-limiting condition. Siblings' perspectives are often expressed through their parents and not by siblings themselves.

METHOD

This study has a qualitative design within hermeneutic phenomenology. Thirteen siblings (ages 3-29) of children with cancer or genetic conditions participated in semi-structured interviews. Analyses followed a thematic analysis guided by van Manen's lifeexistentials.

RESULTS

One overall theme, "What about me?", illustrates that siblings of children with LT/LL conditions are dealing with their own challenges and needs in the situation while also struggling to receive attention from their parents. The overall theme derives from three subthemes: living with heavy strains, feeling disregarded, and having needs of one's own.

CONCLUSION

The study revealed that siblings' own needs compete with the needs of the ill child, resulting in the risk of siblings taking a step back rather than expressing what they might actually need themselves. These findings can inform healthcare professionals on the importance of educating and supporting parents and the surrounding community close to the sibling, for example, by helping schoolteachers understand how to meet siblings' needs.

Experiences of siblings of children with chronic pediatric conditions: a qualitative systematic review

The needs of well siblings of children with chronic pediatric conditions (CPCs) are often overlooked as parents tend to direct their attention toward the child with CPC. This highlights the need to explore the experiences of these siblings to better inform the implementation of healthcare services. To consolidate the most up-to-date qualitative evidence regarding well siblings' perceptions and experiences of living with children with CPC. This qualitative systematic review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The search was conducted on eight electronic databases from their respective dates of inception to March 2024. Sandelowski and Barroso's (2007) two-step approach was used to synthesize findings. Review findings were assessed using the Grading of Recommendations Assessment, Development, and Evaluation-Confidence in the Evidence from Reviews of Qualitative research approach. In total, 23 studies (published between 2014 and 2023) were included. This review included 269 well siblings (aged between 7 and 23 years old) and 74 parents (mostly mothers). Four highly connected themes were identified: (1) A whirlpool of emotions, (2) Coping behaviors, (3) Growing up way too early, and (4) Doing and hoping for the best.

CONCLUSION

This review emphasizes the necessity for healthcare professionals to attend to the emotional and psychosocial needs of well siblings, and educate parents on how to better address well siblings' needs. Future research could look into the experiences of siblings of children with less common CPCs.

WHAT IS KNOWN

• The specific needs of well siblings of children with chronic pediatric conditions are unexplored. • Well siblings have difficulty comprehending and adapting to their sibling's chronic condition upon diagnosis.

WHAT IS NEW

• Interactions between family members and healthcare professionals play a crucial role in shaping how well siblings understand their siblings' chronic conditions. • Well siblings adopt various ways to help them cope with these challenging circumstances. • Well siblings are at risk for psychological distress upon learning about their sibling's chronic conditions.

Being a sibling of a child with intellectual disability from the perspective of mothers: A qualitative study

This qualitative study was conducted to identify how being a sibling of a child with intellectual disabilities is defined for the child, its implications from the perspective of mothers. Data were collected through in-depth individual interviews using a "Semi-structured interview form" between November 2023 and January 2024 with 14 mothers of children aged 12-18 who were studying in seven special education and rehabilitation centres in Türkiye. The semi-structured interview form included questions such as "Can you tell us about the relationship between your child with intellectual disability and his/her sibling?" Main themes and sub-themes were developed using thematic analysis. Four main themes were identified from the data through thematic analysis: (1) A special relationship (2) The need to be perfect (3) Guilt and shame (4) Restriction. The findings revealed both positive and negative aspects of being a sibling of children with intellectual disabilities from the mothers' perspective.

Challenges and coping strategies among caregivers of children with cancer receiving care at a national referral hospital in Kenya

BACKGROUND

The number of children diagnosed with cancer is expected to increase by 2050. The caring aspect of these children is usually left to members of the family, more so the mothers. Caregivers are usually faced with various challenges, such as financial issues, social stigma, and emotional and psychological issues. Caregivers use various coping strategies to manage the challenges they experience in the caring process, which can be positive or negative coping strategies.

OBJECTIVE

To explore the challenges and coping strategies of caregivers of children with cancer receiving care at a national referral hospital in Kenya.

METHODS

This study employed a descriptive phenomenological approach to explore the challenges and coping strategies of caregivers of children with cancer receiving treatment at a national referral hospital in Kenya. Purposive and snowball sampling techniques were used to select 44 participants for five focus group discussions (FGDs) conducted between October and December 2023. The data were analysed via inductive thematic analysis.

RESULTS

Four themes arose from the challenges experienced, which included psychological, financial, treatment-related, and social/family-related issues. These eleven subthemes included stress, depression, lack of transport, lack of food, loss of employment, treatment delays, and marital issues, among others. Two themes related to coping strategies were positive adaptation and denial, which were highlighted as negative coping strategies. Positive coping included praying, crying, talking to people, and seeking help.

CONCLUSION

Caregivers of children with cancer undergo various challenges and apply various coping strategies to try and adapt to their new normal. Reinforcing positive coping strategies and helping caregivers utilize other coping strategies, such as the use of support groups, could help them better care for their children.

Illness-related communication between siblings and parents of children with chronic illness and life-limiting conditions: A qualitative analysis

BACKGROUND

Having a brother or sister who has a chronic illness (lasting >6 months and requiring long-term care) or life-limiting condition (LLC; where cure is highly unlikely and the child is expected to die) has major impacts on siblings. Parent-sibling illness-related communication may contribute to siblings' capacity to cope.

OBJECTIVES

In this study, we aimed to explore parent-sibling illness-related communication, from the perspectives of parents and siblings. We also aimed to qualitatively compare participants' responses according to illness group (chronic illness vs. LLCs).

METHODS

We collected qualitative data from siblings (32 with a brother/sister with a chronic illness, 37 with a brother/sister with an LLC) and parents of a child with a chronic illness (n = 86) or LLC (n = 38) using purpose-designed, open-ended survey questions regarding illness-related communication. We used an inductive qualitative content analysis and matrix coding to explore themes and compare across illness groups.

RESULTS

Two-thirds of siblings expressed satisfaction with their family's illness-related communication. Siblings typically reported satisfaction with communication when it was open and age-appropriate, and reported dissatisfaction when information was withheld or they felt overwhelmed with more information than they could manage. Parents generally favored an open communication style with the siblings, though this was more common among parents of children with an LLC than chronic illness.

SIGNIFICANCE OF RESULTS

Our findings show that while many siblings shared that they felt satisfied with familial illness-related communication, parents should enquire with the siblings about their communication preferences in order to tailor illness-related information to the child's maturity level, distress, and age.

"I Don't Get to Play With My Mum Anymore": Experiences of Siblings Aged 8-12 of Children With Cancer: A Qualitative Study

Background: Siblings of children with cancer have been shown to experience disruption in multiple domains including family, school, and friendships. Existing literature on siblings' experiences focuses on older children or on a broad range of ages. Aim: To explore the experience of siblings aged 8-12 years when their brother or sister is diagnosed with cancer. Method: A qualitative design incorporating phenomenology as the theoretical framework was used. Participants were recruited from across Australia via notices on social media sites and by the distribution of flyers. We used thematic analysis to analyze the data. Data were collected via semistructured interviews conducted either in person or online. Findings: A total of 13 siblings (7 boys and 6 girls) aged between 8 and 12 years (M = 9.8, SD = 1.6) were interviewed. Seven main themes were identified. These were "It was really hard": Reactions to the cancer diagnosis; "I'm really angry": Emotional and Physical Responses to siblings' treatment; "I pretend teddy is real": Play as an outlet; "It was very lonely": Missing their siblings; "I missed out on a lot of fun": Disruption of activities: School, sports, playdates, and parties; Change and Transition and "Making a difficult situation worse": COVID-19 Pandemic. Discussion: Findings extend the current understanding showing that younger siblings' developmental and cognitive skills impact their experiences of childhood cancer. Younger siblings outlined the many losses they experienced which demonstrated a need for a comprehensive and tailored program to support young siblings aged under 12 of children with cancer.

The experiences and perceptions of healthy siblings of children with a long-term condition: Umbrella review

PROBLEM

The lives of healthy siblings living with a sibling with a long- term condition are often shaped by the family, type of illness, length of illness, age of the child, caregiver demands, and support provided to the family, ill sibling, and healthy sibling. While the experiences of healthy siblings are documented in the literature by parent proxy, literature on healthy siblings self-reported experiences of living with a sibling who has a long-term condition remains scarce.

PURPOSE

This umbrella review aims to synthesize reviews on the self-reported experiences of healthy siblings of children living with a sibling who has a long-term condition.

ELIGIBILITY CRITERIA

Published peer-reviewed reviews in English language exploring the self-reported experiences of healthy siblings under 24 years old, whose siblings are diagnosed with a long-term condition.

SAMPLE

Using a developed search strategy, seven electronic databases (CINAHLPlus, Scopus, PubMed, PsycINFO, Cochrane Database of Systematic Reviews, Clinical Key, and Google Scholar) were searched from 2018 till December 2023. Eleven reviews met the inclusion criteria and were subjected to narrative synthesis.

RESULTS

Four themes (adjusting to changes, wanting to help, living the ups and downs, living the changes), and eight subthemes were generated from the syntheses.

CONCLUSION

This is the first umbrella review undertaken on healthy siblings self-reported experiences of living with a sibling who has a long-term condition. The impact of a long-term condition on healthy siblings of children with a long-term condition suggests a need for healthcare providers and organisations to provide better emotional, psychological, and informational support to healthy siblings and their families.

IMPLICATIONS

Findings from this review will inform healthcare providers, organisations, researchers, and policymakers on the development of future clinical practices and research for healthy siblings.

Children's behavioural and emotional reactions towards living with congenital heart disease in Saudi Arabia: A grounded theory study

BACKGROUND

A high incidence of children with congenital heart disease (CHD) was found in Saudi Arabia (SA). International literature reports that children with CHD exhibit behavioural and emotional issues due to experiencing hospitalisation and clinical treatments combined with a dearth of qualitative understanding of the experiences of younger children with CHD. Therefore, the aim was to explore the behaviour and emotions of 4-10-year-olds with CHD in SA through children's accounts of their own experiences and parental proxy reports of children's behaviour and emotions.

METHODS

Charmaz's constructivist grounded theory (GT) approach was used. Twenty single semi-structured interviews of 10 child/parent dyads were undertaken at a hospital clinic in SA. Children's interviews were combined with an arts-based approach using drawings, pictures and faces of emotions (emojis). Constant comparison analysis was undertaken. Consolidated Criteria for Reporting Qualitative Research guidelines was followed in reporting this study.

FINDINGS

A substantive GT: children's behavioural and emotional reactions towards stressors related to living with CHD was developed and provides new insights into children's and parents' perceptions of the children's behavioural and emotional reactions to living with CHD in SA. The theory proposes that children's reactions to living with CHD relate to medical treatment stressors, sociocultural stressors and physical change stressors. Several further factors influenced children's responses to these stressors.

CONCLUSION

Children and parents in SA contributed to a new understanding of the relationship between CHD and children's behavioural and emotional reactions. In addition, findings support the need for early assessment of behaviour and emotions among children with CHD and the application of preventative and supportive measures for the children and their families in SA.

PATIENT OR PUBLIC CONTRIBUTION

Before the research commenced, the developmental appropriateness of the proposed arts-based data collection tools was tested with three healthy children aged 6-9 years old; the tools were then revised accordingly before the interviews were undertaken.

Developing competencies for volunteer navigators to support caregivers of children living with medical complexity: a mixed-method e-Delphi study

Background

Providing specially trained volunteer navigators is one promising strategy for supporting the increasing number of family caregivers who are caring for children living with medical complexity.

Objective

The objective of this study was to develop consensus on the role and competencies required for volunteer navigators who support caregivers of children living with medical complexity.

Design

This was a mixed-method study using modified e-Delphi and focus group methods. In phase 1, a modified e-Delphi survey with 20 family caregivers and a focus group with 4 family caregivers were conducted to develop consensus on their unmet needs and the potential roles of a volunteer to meet those needs. In phase 2, a modified e-Delphi survey was conducted with experts to develop consensus on the volunteer competencies required to meet the roles identified by family caregivers in phase 1.

Results

Findings from phase 1 resulted in 36 need-related items over 8 domains: communication, daily life and chores, emotional support, information and knowledge, respite, support with decision-making, and sharing the caregiving experience. Concerns about the volunteer role included the potential lack of commitment in the absence of remuneration, the complexity of the child's condition that was beyond the role of a volunteer, and a preference for support from individuals they knew. Findings from the phase 2 Delphi survey with professionals resulted in 22 competencies, derived from the roles identified in phase 1, that would be required of volunteers who wished to support these family caregivers.

Conclusion

This study provides insight into a role for volunteers in meeting the needs of family caregivers of children living with medical complexity. A volunteer with lived experience and adequate preparation can assist with meeting some of these important needs. Further research is required to better understand the feasibility and acceptability of such a role.

Mental Health Conditions Among Children and Adolescents With Congenital Heart Disease: A Danish Population-Based Cohort Study

BACKGROUND

Despite the known mental health burden among children with congenital heart disease (CHD), the literature is constrained by a lack of comparison cohorts and population-based follow-up data. We examined the incidence of mental health conditions among children with CHD, relative to 3 comparison cohorts.

METHODS

This population-based cohort study identified all children with CHD (<18 years of age; n=16 473) in Denmark from 1996 to 2017, through linkage of individual-level data across national registries. This allowed for complete follow-up of the population. Comparison cohorts included children from the general population (n=162 204), siblings of children with CHD (n=20 079), and children with non-CHD major congenital anomalies (n=47 799). Mental health conditions were identified using inpatient and outpatient hospital discharge codes, prescription data, and data on use of community-based psychology, psychiatry, and psychotherapy services. We computed cumulative incidence by 18 years of age, incidence rates, and adjusted hazard ratios (aHRs) using Cox regression. aHRs accounted for sex, year of CHD diagnosis, parental mental health, and socioeconomic status. All estimates were stratified by age, sex, and CHD complexity.

RESULTS

The cumulative incidence of mental health conditions by 18 years of age in the CHD cohort was 35.1% (95% CI, 34.0%-36.1%), corresponding to aHRs of 1.64 (95% CI, 1.58-1.71), 1.41 (95% CI, 1.30-1.52), and 1.02 (95% CI, 0.98-1.07) compared with the general population, sibling, and major congenital anomaly cohorts, respectively. Mental health incidence rates showed prominent peaks in early childhood and adolescence. Males and children with severe or single-ventricle CHD demonstrated higher incidence rates of mental health conditions relative to females and children with mild or moderate CHD, respectively. Compared with the general population and sibling cohorts, incidence rates and aHRs in the CHD cohort were highest for severe stress reactions, attention deficit/hyperactivity disorder, intellectual disability, and autism spectrum disorder. Compared with children in the major congenital anomaly cohort, the aHRs were close to 1.

CONCLUSIONS

More than one-third of children with CHD were diagnosed or treated for a mental health condition by 18 years of age. Mental health conditions began early in life and were most prominent among males and children with severe or single-ventricle heart disease.

Siblings of children with type 1 diabetes mellitus: Psychosocial health, coping

PURPOSE

The literature widely reported the psychosocial toll of Type 1 diabetes mellitus (T1DM) on patients, though the family functioning of T1DM patients, particularly siblings, has traditionally obtained far less consideration. This study was framed to investigate the psychosocial adjustments of siblings of children with T1DM and to evaluate the frequencies and the perceived efficacy of coping strategies adopted by siblings.

DESIGN AND METHODS

This cross-sectional study included parents (n = 100) and siblings (n = 100) of children with T1DM. Parents completed the following questionnaires: Parenting Stress Index-Short Form, Pediatric Quality of Life Inventory™ Family Impact Module, and Strengths and Difficulties Questionnaire (SDQ), while siblings completed SDQ self-report and kidcope questionnaires.

RESULTS

Thirty-eight percent of siblings of children with T1DM reported significant emotional and behavioral problems related to HbA1c level, higher parenting stress, and worse family functioning (p < 0.05). Younger siblings considered social support and distraction the most effective coping strategies, while older siblings perceived adaptive coping as the most effective. Social support and problem-solving were found to be protective factors for better sibling adjustments; meanwhile, better family adjustments were related to social support and cognitive restructuring (p < 0.05).

CONCLUSIONS

Results demonstrate that siblings of children with T1DM experienced psychosocial maladjustment. Sibling adjustments are family interrelated. Adaptive coping strategies may play a buffer role for siblings and family adjustment.

PRACTICE IMPLICATIONS

The study highlights the need for comprehensive evaluations of family dynamics and sibling psychosocial functioning to provide appropriate family-centered care.

Feasibility, acceptability and preliminary effectiveness of a mental health drop-in centre for the siblings of young people attending a paediatric hospital

Siblings of children with long-term conditions (LTCs) can have significantly elevated mental health needs, but these are often overlooked. A pragmatic single-arm feasibility pilot assessed feasibility, acceptability and preliminary effectiveness of a drop-in centre in a paediatric hospital addressing mental health needs of patients with LTCs, their carers and siblings. The drop-in centre accepted self-referral and supplemented existing provision offering a suite of interventions, including signposting, diagnostic assessments and/or guided self-help. This paper reports on feasibility, acceptability and preliminary outcomes of this centre for siblings. Eighteen siblings aged 2-17 used the centre. Sixteen of their parents completed the Strengths and Difficulties Questionnaires at baseline and 6 months post-baseline, and ten completed parent-reported PedsQL across two time points. Preliminary effectiveness results demonstrated a decrease in mental health symptoms with large effect size (score reduction of 3.44, 95% CI [1.25, 5.63], d = 0.84) and small effect on quality of life, with scores increasing from a median of 69.91, 95% CI [53.57, 91.67], to a median of 80.44, 95% CI [67.39, 89.13], r = 0.11 for these siblings. 88% of parents were satisfied with this provision for their sibling child. This study highlights the feasibility and value of assessing siblings for emotional and behavioural difficulties and providing them with an accessible, effective and acceptable intervention.

Growing up with a sibling with depression: A qualitative study in Israel

Depression has major consequences for the entire family, among them emotional distress, disrupted daily routine and social damage caused by negative stigmas. The aim of this study was to explore the retrospective experiences of young adults who lived with a sibling with depression while they were adolescents. The present study adopted a qualitative-phenomenological approach. The research participants were recruited via purposive sampling on social networks across Israel from May to September 2022. Semi-structured interviews were conducted with 21 participants aged 18-29 who lived with a sibling with depression during their adolescence. Data collection continued until saturation of concepts was reached. The results underwent thematic analysis. Three themes emerged from the qualitative analyses: 1) "I felt like I was living in a minefield": Adolescence while living with a sibling with depression; 2) "One step forward and two steps back": Siblings' coping strategies; 3) "My parents were not there for me when I needed them": Participants' experiences with their parents during their adolescence. The research findings indicate that adolescents who grew up with a sibling affected by depression had to cope with an acute family crisis, whose serious ramifications required emotional and social support. Mental health professionals and counselors working within educational institutions and the broader community should provide support and intervention for adolescents who have siblings struggling with depression. This intervention may take the form of individual or group therapy that aims to foster a sense of belonging and help affected individuals. Creating a supportive environment that meets the needs of the affected siblings is also crucial in addressing this issue effectively.

Experiences of siblings of children with chronic diseases revealed by the dramatic therapeutic play

OBJECTIVE

To understand, through dramatic therapeutic play, the experiences of siblings of children with chronic diseases.

METHOD

Phenomenological study, in the light of Heideggerian philosophical framework, conducted with 12 siblings of children with chronic diseases, aged between three and 11 years, accompanied in a public teaching hospital in the countryside of the state of São Paulo. The phenomenological interviews were audio-recorded and mediated by sessions of dramatic therapeutic play; later, interpreted from the Heideggerianphilosophical framework and thematic literature.

RESULTS

The siblings demonstrated that they are affectively touched in the mode of sadness, longing and affection towards the sick child and, by the daily occupations imposed by the disease.

CONCLUSION

The dramatic therapeutic play enabled the siblings of children with chronic diseases to expose their experiences permeated by the limitations of the child's chronic disease. Instituting actions for the inclusion of the sibling during the nursing care of the child with chronic disease is urgent to improve its quality.

Screening for psychosocial risk in caregivers of children with medical complexity during the COVID-19 pandemic: a cross-sectional study

OBJECTIVE

The primary objective was to quantify psychosocial risk in family caregivers (FCs) of children with medical complexity (CMC) during the COVID-19 pandemic using the Psychosocial Assessment Tool (PAT). The secondary objectives were to compare this finding with the average PAT score of this population before the COVID-19 pandemic and to examine potential clinical predictors of psychosocial risk in FCs of CMC.

DESIGN

Cross-sectional study.

PARTICIPANTS

FCs of CMC were recruited from the Long-Term Ventilation Clinic at The Hospital for Sick Children, Toronto, Ontario, Canada. A total of 91 completed the demographic and PAT questionnaires online from 10 June 2021 through 13 December 2021.

MAIN OUTCOME MEASURES

Mean PAT scores in FCs were categorised as 'Universal' low risk, 'Targeted' intermediate risk or 'Clinical' high risk. The effect of sociodemographic and clinical variables on overall PAT scores was assessed using multiple linear regression analysis. Comparisons with a previous study were made using Mann-Whitney tests and χ² analysis.

RESULTS

Mean (SD) PAT score was 1.34 (0.69). Thirty-one (34%) caregivers were classified as Universal, 43 (47%) as Targeted and 17 (19%) as Clinical. The mean PAT score (1.34) was significantly higher compared with the mean PAT score (1.17) found prior to the COVID-19 pandemic. Multiple linear regression analysis demonstrated an overall significant model, with the number of hospital admissions since the onset of COVID-19 being the only variable associated with the overall PAT score.

CONCLUSION

FCs of CMC are experiencing significant psychosocial stress during the COVID-19 pandemic. Timely and effective interventions are warranted to ensure these individuals receive the appropriate support.

Pediatric Critical Care Outcomes: State of the Science

Children who survive the pediatric intensive care unit (PICU) are at risk of developing post-intensive care syndrome in pediatrics (PICS-p). PICS-p, defined as new physical, cognitive, emotional, and/or social health dysfunction following critical illness, can affect the child and family. Historically, synthesizing PICU outcomes research has been challenging due to inconsistency in study design and in outcomes measurement. PICS-p risk may be mitigated by implementing intensive care unit best practices that limit iatrogenic injury and by supporting the resiliency of critically ill children and their families.

Interviews with children and adolescents with epilepsy or asthma about the situation of their healthy siblings

AIM

Chronic conditions can influence the situation of healthy siblings of affected children. We investigated the opinion of the affected child about the situation of their healthy sibling and the sibling relationship.

METHODS

We performed a semi-structured interview with epilepsy or asthma patients aged 6-18 years and asked them to draw a picture: "Epilepsy/Asthma, my siblings and me."

RESULTS

Of the 58 children with epilepsy, 67%, and of the 40 children with asthma, 60% thought that their siblings were worried about the condition. Among other aspects, they addressed helplessness during a seizure. Of the children with epilepsy, 83% and of those with asthma, 95% assumed that their siblings were not disadvantaged because of the participant's condition. Of the patients with epilepsy, 91% and of those with asthma, 93% thought that the sibling relationship would not be different without the condition. Of the participants with epilepsy, 86% and of those with asthma, 93% drew a picture; 30% with epilepsy and 14% with asthma visualised an interaction with their siblings in context of a seizure or episode of dyspnoea.

CONCLUSION

According to the affected children, the condition worries their siblings but does not affect the siblings' lives or the sibling relationship.

Sibling Relationship Dynamics in Families with a Child Diagnosed with a Chronic Mental Disorder versus a Somatic Condition

BACKGROUND

Recent research still focuses on the psychological impact on siblings and the problematic relationships in families with children with chronic illnesses. Our study evaluates the dynamics in sibling relationships in families with a child diagnosed with a chronic disease.

METHODS

We comparatively evaluated the degree of empathy, involvement, friendship, and rivalry in sibling relationships in two groups of families who have a child with a chronic pediatric disorder versus a chronic mental disorder.

RESULTS

The levels of involvement/friendship, empathy/care/concern, and education/learning were significantly higher in the pediatric group. Where there were siblings under the age of 10, rivalry scores tended to be higher in both groups.

CONCLUSIONS

Coping strategies, emphatic interactions, and implications in common activities are difficult to identify in the relationship between siblings when one of them has a chronic mental disorder. All of these negative aspects entail poor quality sibling relationships and draw alarm signals regarding the need for monitoring and intervention familial programs.

The experiences of siblings of children with chronic illness of health-related communication directed at them: a systematic review protocol and thematic synthesis of qualitative studies

The psychological, social and financial impact that chronic illness can have on a family and in particular the siblings of children with chronic illness (SCWCI) is well documented. Siblings are at risk of a variety of psychosocial and physical problems such as suffering from anxiety, experiencing headaches, appetite loss. However, the experiences with health-related communication of SCWCI is not well known. This may leave them with suboptimal information. The aim of this systematic review described in this protocol is to understand SCWCI experience of targeted health-related communication; detailing the communication strategies utilised, how helpful the information was and what they wish would be different. The Preferred Reporting Items for Systematic reviews and Meta-analysis for Protocols (PRISMA-P) checklist will be used to frame this protocol. Registration: PROSPERO (393998, 03 February 2023).

Siblings of children with chronic disorders: Family and relational factors as predictors of mental health

Siblings of children with chronic disorders are at increased risk of mental health problems. Predictors of siblings' mental health require further study to identify children in need of interventions and to design effective intervention programs. Siblings of children with chronic disorders (n = 107; M age = 11.5 years; SD = 2.1, 54.6% girls) and their parents (n = 199; 50.3% mothers) were included in a survey study. Siblings and parents completed questionnaires on mental health. Siblings completed questionnaires on parent-child communication, relationships with parents, and an adjustment measure on the sibling situation. Multiple linear regression analyses were applied to identify predictors of siblings' mental health. Sibling-reported relationship with parents was a significant predictor of sibling mental health reported by siblings, fathers, and mothers (R² = 0.26 - R² = 0.46). Siblings' adjustment was significantly associated with fathers' report of siblings' mental health (r = .36), but not mothers' report (r = .17). Siblings' relationships (d = 0.26) and communication (d = 0.33) with mothers were significantly better than with fathers. We conclude that the sibling-parent relationship is a significant factor in identifying siblings at risk and that family-based intervention programs should be developed.

Parent-Reported Caregiving Roles of Siblings of Children with Inborn Errors of Metabolism

OBJECTIVES

Research examining sibling caregiving contributions to medically complex pediatric patients, including those with inborn errors of metabolism (IEMs), is limited. We assess caregiving roles and attributes of siblings and hypothesize that there will be differences in parent-reported contributions among siblings of children with IEMs and siblings of typically developing (TD) children.

STUDY DESIGN

A convergent parallel mixed-methods study design guided analysis of data from parental surveys and semistructured interviews. Interviews were conducted with parents (n = 49) of children with IEMs and parents (n = 28) of exclusively TD children. We used inductive thematic analysis to identify themes related to sibling caregiving. The caregiving and support roles for siblings (n = 55) of children with IEMs and siblings (n = 42) of TD children were coded to assess each sibling's caregiving contributions and personal attributes.

RESULTS

Logistic regressions, using generalized estimating equations, were fitted. Results showed that siblings of children with IEMs were significantly more likely to provide monitoring (odds ratio [OR]: 3.62, confidence interval [CI]: 1.30-10.07) and emotional/social support (OR: 4.02, CI: 1.67-9.67) than siblings of TD children. Themes arising from interviews with parents of children with IEMs focused on sibling attributes, parental expectations regarding sibling caregiving, and challenges to the sibling-sibling and parent-sibling relationships. Themes revealed nuances in the sibling caregiving experience.

CONCLUSION

Siblings of children with IEMs make meaningful caregiving contributions and may provide care differently than siblings of TD children. Understanding childhood caregiving roles may inform how health care providers and parents encourage sibling caregiving contributions into adulthood.

Behavior Problems, Self-Esteem, and Prosocial Behavior in Siblings of Children With Chronic Physical Health Conditions: An Updated Meta-Analysis

OBJECTIVE

Chronic physical health conditions (CPHC) of children affect the whole family. The aim of the present meta-analysis was to compare levels of internalizing, externalizing, and total problems as well as self-esteem/positive self-concept and prosocial behavior of the healthy siblings with children from families not affected by CPHC and test norms, respectively.

METHODS

A systematic search for literature was conducted using the electronic data bases CINAHL, PsycInfo, PubMed, PSYNDEX, and Web of Science. In total, results from 216 studies were included in random-effects meta-analyses that had been published or made available online before February 15, 2022.

RESULTS

Healthy siblings of children with CPHC had elevated levels of internalizing (g = .18 standard deviation units), externalizing (g = .13), and total behavior problems (g = .22), and effect sizes were found to be small to very small. While levels of self-esteem did, on average, not vary between healthy children with and without a sibling with CPHC or test norms (g = .08), higher levels of prosocial behavior were found in the healthy siblings of children with CPHC (g = .18). In addition, some moderating effects of kind of CPHC and its intrusiveness as well as mortality risk, country, sociodemographic equivalence of the compared groups, and year of publication were identified.

CONCLUSIONS

It is concluded that CPHC of a child can have negative as well as positive effects on psychosocial outcomes of healthy siblings. Psychosocial interventions are recommended for healthy siblings at elevated risk for psychological problems.

Siblings of young people with chronic illness: Caring responsibilities and psychosocial functioning

Siblings of young people with chronic illness commonly undertake caring responsibilities for their affected brother/sister, which may encourage maturation, yet may also be perceived as a burden. Our study determined (1) siblings' caring responsibilities, (2) siblings' current emotional distress and psychosocial functioning, and (3) how siblings' caring responsibilities and psychosocial functioning related to familial relationships and coping strategies. Siblings completed questionnaires which contained Sibling Inventory of Behavior, Sibling Inventory of Differential Experiences, PedsQL, emotion thermometers, Brief COPE, and a checklist of caregiving responsibilities. We analyzed the data with t-tests and multi-level models. Forty-five siblings (mean age = 15.40 years, SD = 3.31 years; 60.0% female) participated. Siblings who had caring responsibilities (n = 26, 57.8%) reported lower anxiety symptoms, lower need for help, greater use of problem-focused coping, and more companionship and teaching/directiveness with their affected brother/sister than siblings without caring responsibilities. Siblings reported lower psychosocial and physical functioning when they perceived their parents provided them with less affection than their affected brother/sister. Family-based psychosocial interventions may aim to improve the sibling-parent relationship (including expressing affection) and the sibling-sibling relationship. Future interventions may also focus on increasing siblings' use of problem-focused coping strategies.

Clinical Health Outcomes of Siblings of Children with Chronic Conditions: A Systematic Review and Meta-Analysis

OBJECTIVE

The objective of the study was to assess clinical mental and physical health outcomes of siblings of children with chronic health condition(s) compared with siblings of healthy children or normative data.

STUDY DESIGN

We searched Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, and CINAHL through August 9, 2021. We included English-language studies that reported clinically diagnosable mental or physical health outcomes among siblings of children (<18 years old) with a chronic health condition, included a comparison group, and used an experimental or observational study design. Two reviewers extracted data and independently assessed risk of bias using the Newcastle Ottawa Scale.

RESULTS

Of 9899 screened studies, 34 were included; 28 studies reported on mental health, 3 reported on physical health, and 3 reported on mortality. Siblings of children with chronic conditions had greater depression rating scale scores than their comparison groups (standardized mean difference = 0.53; 95% CI = 0.38-0.68; P < .001 [6 studies]), whereas anxiety scores were not substantially increased (standardized mean difference = 0.21; 95% CI = -0.02 to 0.43; P = .07 [7 studies]). The effects for confirmed psychiatric diagnoses (7 studies), mortality (3 studies), or physical health outcomes (3 studies) could not be meta-analyzed given the limited number of studies and between-study heterogeneity.

CONCLUSION

Siblings of children with chronic health conditions may be at an increased risk of depression. Our findings suggest the need for targeted interventions to support the psychological well-being of siblings of children with chronic health conditions.

Being a parent of a child with Down's arthritis: an interpretative phenomenological analysis

PURPOSE

To explore the parental impact and experiences of caring for a child with Down's arthritis (DA), an aggressive, erosive form of arthritis affecting children with Down syndrome.

MATERIALS AND METHODS

Ten mothers of children with DA were interviewed via telephone. Interviews were guided using a semi-structured non-directive topic guide and ranged from 17 to 242 minutes in duration. Interpretative phenomenological analysis was the method of analysis.

RESULTS

Three superordinate themes were identified: "Struggle for Help," "Mothers Know Best," and "Daily Impacts." Common challenges included issues around child pain, communication, and challenges in accessing diagnoses and relevant healthcare services. Parents portrayed a reality characterised by ongoing struggles, particularly parents of nonverbal children and those living further from paediatric rheumatology services. Connecting with other parents of children with DA provided a vital source of emotional and informational support.

CONCLUSIONS

Findings provide novel insight into the experience of being mother of a child with DA, highlighting regional healthcare disparities, the need for upskilling of healthcare professionals, and for increased public awareness. Further research is needed to better understand the impact of DA on fathers and siblings. Findings can contribute to development and provision of supports to children with DA and their families.Implications for RehabilitationHealthcare professionals need to be upskilled in the treatment of, and communication with, children with Down syndrome with chronic illnesses and their families.A specialised stream of care for children with Down's arthritis (DA) within paediatric rheumatology services may facilitate timely diagnosis and treatment and minimise risk of future complications.Formalised support services for children with DA and their families are needed to minimise emotional distress.

Parenting a child with a chronic illness during a pandemic

BACKGROUND

Nearly 20% of children in the United States experience one or more chronic health conditions. Parents of a child with a special healthcare need (CSHCN) experience increased stress caring for a child with chronic illness.

PURPOSE

The purpose of this descriptive study is to describe stress in parents of a child with chronic illness during the COVID-19 pandemic.

METHODS

Parents of CSHCN (n = 34) were asked to fill out the Pediatric Inventory for Parents (PIP) and answer two questions related to caring for their child during the COVID-19 pandemic.

CONCLUSIONS

The means of the PIP-F (M = 146.6, SD = 20.5) and PIP-D (M = 141.9, SD = 23.9) were significantly higher than in previous studies. There is statistically significant positive correlation between parent stress and variables of age of the child and the length of time since diagnosis. In response to the questions about the impact of COVID, nearly all parents reported COVID increased their stress and reported their stress was related to isolation, lack of resources, and concern for the mental health of other children in the household.

PRACTICE IMPLICATIONS

COVID-19 likely exacerbated feelings of stress for parents of children with chronic health conditions. Although unprecedented, COVID-19 shed light on the existing fragility and high stress of parents of CSHCN. Pediatric nurses not only care for children, but must be advocates for the mental health of their patient's parents.

El hermano del niño con cáncer merece ser visible

El hermano sano en situaciones de cáncer infantil es con frecuencia un sujeto invisible para su familia, los profesionales de la salud y las instituciones. El objetivo de este trabajo fue mapear e integrar la literatura científica acerca de la experiencia del hermano del niño diagnosticado con cáncer. Se desarrolló una Scoping Review de 28 artículos publicados entre 2016 y 2020, en los idiomas español, inglés y portugués. Se incluyeron 12 estudios cualitativos, 15 cuantitativos y un estudio mixto. Frente a los hallazgos, se identificó que hay cambios en las relaciones entre hermanos, parentales y sociales, además de cambios personales y una oferta limitada de apoyo a los hermanos del niño con cáncer. Se concluye que el cáncer infantil afecta directamente a los miembros de la familia, incluido al hermano sano, quien enfrenta cambios drásticos en su vida que implican nuevas necesidades, sentimientos y conductas de riesgo. Se requiere una mayor investigación y abordaje acerca del impacto del cáncer infantil en hermanos sanos, así como el diseño de intervenciones que pongan de manifiesto la necesidad de hacer visible a este sujeto que sufre el daño colateral del cáncer infantil y que ha sido descuidado por su familia y por los profesionales en salud.

Psychosocial Considerations for the Child with Rare Disease: A Review with Recommendations and Calls to Action

Rare diseases (RD) affect children, adolescents, and their families infrequently, but with a significant impact. The diagnostic odyssey undertaken as part of having a child with RD is immense and carries with it practical, emotional, relational, and contextual issues that are not well understood. Children with RD often have chronic and complex medical conditions requiring a complicated milieu of care by numerous clinical caregivers. They may feel isolated and may feel stigmas in settings of education, employment, and the workplace, or a lack a social support or understanding. Some parents report facing similar loneliness amidst a veritable medicalization of their homes and family lives. We searched the literature on psychosocial considerations for children with rare diseases in PubMed and Google Scholar in English until 15 April 2022, excluding publications unavailable in full text. The results examine RD and their psychosocial ramifications for children, families, and the healthcare system. The domains of the home, school, community, and medical care are addressed, as are the implications of RD management as children transition to adulthood. Matters of relevant healthcare, public policies, and more sophisticated translational research that addresses the intersectionality of identities among RD are proposed. Recommendations for interventions and supportive care in the aforementioned domains are provided while emphasizing calls to action for families, clinicians, investigators, and advocacy agents as we work toward establishing evidence-based care for children with RD.

Siblings of children with a complex chronic disorder treated by non-invasive ventilation

AIM

The aim of the study was to assess the emotional and behavioural functioning of siblings of children treated with long term non-invasive ventilation (NIV).

METHODS

Parents of children treated with NIV completed the Child Behaviour Checklist and a qualitative questionnaire for each sibling, aged 1.5-18 years old.

RESULTS

The parents of 49 ventilated children were questioned about 79 siblings. For the siblings aged 1.5-5, mean total T score was 57 ± 22 (range 28-92), and five siblings (31%) were in the clinical range. For the siblings aged 6-18, mean total T score was 49 ± 12 (range 26-71), and six siblings (10%) were in the clinical range. Siblings felt responsible for their affected sibling (31%) and involved with his/her illness (52%), with 31% being worried about him/her. A change in behaviour was observed in 19% of the siblings since the initiation of NIV; 26% were impacted by the use of the NIV device.

CONCLUSIONS

The majority of siblings of children treated with NIV do not present significant emotional and behavioural problems. They feel deeply responsible for their affected sibling and involved in his/her illness and treatment, highlighting the importance to involve the siblings in the care of the affected child.

Siblings' experience during pediatric intensive care hospitalization

PURPOSE

The impact on children who visit an ill sibling in the pediatric intensive care unit (PICU) is unknown. The aim of this study was to describe the experiences of siblings of acutely critically ill or injured children hospitalized in the PICU.

DESIGN AND METHODS

A qualitative approach using one-to-one interviews was conducted to gain an understanding of the experience of 9- to 17-year-old children who visited their siblings in the PICU. Thematic analysis was used to develop a description of the experiences of the siblings.

FINDINGS

Sixteen siblings (mean age, 12.5 years) indicated that visiting their critically ill sister or brother in the PICU can cause negative reactions. The data revealed two major themes within the overall sibling experience-stressors, coping-and nine subthemes. Predominant sibling stressors included pre-illness stressors, the PICU environment, the appearance of the ill child, uncertainty, and parental stress. Siblings coped mainly via distractions, social support, and spirituality and by reflecting on the sibling relationship. Support from friends, family members, and the community was reported to be helpful.

CONCLUSIONS

Siblings visiting the PICU may experience a broad range of physical, emotional, and social responses.

PRACTICE IMPLICATIONS

Future research should fully incorporate the sibling perspective when designing interventions to mitigate the potentially distressing effects of PICU visitation on the family.

Experiences of siblings of children with congenital heart disease during Coronavirus disease 2019; A qualitative interview study

PURPOSE

To explore siblings' perceptions of having a brother or sister with congenital heart disease in the UK during the COVID-19 pandemic.

DESIGN AND METHODS

Siblings of children with congenital heart disease aged 8-17 years old were interviewed via video call technology between September 2020 and February 2021. We conducted reflexive thematic analysis of these interviews to generate themes.

FINDINGS

Interviews took place with 17 siblings, predominantly of white ethnicity n = 15 (86%). Most siblings interviewed were first born in the family n = 15 (88%), and most children with CHD were the youngest n = 15(88%). Four themes were generated; My sibling is vulnerable, what does this mean for my family, I have a responsibility to protect my brother or sister, our family time during the pandemic and adjustment and adaptations to pandemic life.

CONCLUSIONS

Siblings identified difficult aspects of the pandemic and these related to concerns about their brother's or sister's vulnerability, family impact, and keeping their sibling safe. They also identified adjustments they made to keep their family functioning throughout the COVID-19 pandemic. Despite the worry and uncertainty siblings experienced, they valued increased family cohesion which helped to mitigate some challenges of the restrictions imposed in the UK.

PRACTICE IMPLICATIONS

Honest and open communication is valued by siblings. It is vital to ensure siblings receive the support they need to ensure they keep up with their schooling and social commitments as pandemic related restrictions ease.

Psychosocial functioning in adolescents growing up with chronic disease: The Dutch HBSC study

Many adolescents worldwide (indirectly) grow up with a chronic disease, which may impact their functioning and wellbeing. The objective of this study is to assess whether adolescents with a (family member with a) chronic disease differ from their healthy counterparts in terms of psychosocial functioning. Data from the Dutch 2013 HBSC-survey were used, including 7168 adolescents (Mean_age = 13.7, SD = 1.57, 50.5% female). Participants indicated whether they or one of their family members had a long-term (> 3 months) disease or disability (mental/physical) and were categorized into four groups based on disease presence (none, other, self, both). Psychosocial functioning was assessed in terms of life satisfaction, self-rated health, psychosomatic health, mental health problems, support, substance use, physical exercise, screen time, and school liking. Chronically diseased adolescents (n = 162) reported lower life satisfaction, self-rated and psychosomatic health, more mental health problems, lower peer support, more substance use, and less physical exercise compared to healthy peers. Chronically diseased adolescents who also had a family member with a chronic disease (n = 74) showed comparable outcomes on these life domains, although they did not differ from their healthy peers regarding peer support, substance use, and physical activity. Healthy adolescents with a chronically diseased family member (n = 737) reported significantly lower life satisfaction, self-rated and psychosomatic health, more mental health problems, and less family support compared to healthy peers who grew up in healthy families; however, they reported more positive outcomes than adolescents who had a chronic disease themselves.Conclusion: Having a (family member with a) chronic disease is associated with impaired psychosocial functioning on various life domains. Our findings aid in understanding the psychosocial associates of chronic disease and imply that caregivers should be observant of psychosocial problems among vulnerable adolescents to provide appropriate guidance. What is Known: • Adolescents who grow up with a (family member with a) chronic disease encounter numerous challenges that may be related to poorer developmental outcomes on the long term. What is New: • This study adds a comprehensive overview of the psychosocial functioning of adolescents with a (family member with a) chronic disease, as compared to healthy counterparts that grow up in a healthy family.

Coping with cystic fibrosis: An analysis from the sibling's point of view

BACKGROUND

Cystic fibrosis (CF) is a chronic, life-threatening condition that results in life-long morbidity and premature mortality. CF has a significant impact on healthy siblings' adaptation and well-being. Siblings of patients with a chronic disease may experience psychological difficulties, such as anxiety, depression symptoms and troubles in adaptation. This study aimed to explore the participants' experiences of growing up with a CF patient diagnosed at a paediatric age and their adaptation strategies.

METHODS

We enrolled eight CF siblings (adolescents and young adults) in a 6-month focus group sessions programme. Each session had two phases (psychoeducational and experiential). Transcripts were analysed and grouped through grounded theory analysis to elaborate on data-driven theory.

RESULTS

We identified 14 subthemes by which the raw data could be organized. All the subthemes were gathered together according to the axial coding process into six themes (illness, changes, communication, avoidance, normalization, and protection and care). We then grouped the six themes into two main themes ('Growing up with a CF brother or sister' and 'Finding the right distance') and conceptualized the grounded theory 'Keeping the right distance'. The participants described the evolving process of maintaining a balance between the illness of their brother or sister, family organization and their own needs.

CONCLUSIONS

Knowing siblings' experiences and their common strategies to deal with the experience of having a brother or sister with a chronic health condition may be useful to ensure more tailored and specific interventions.

Occupational injuries and psychological support in Chinese nurses: a cross-sectional study

OBJECTIVE

To assess the occupational injuries and psychological support received by nurses and to investigate the relationship between the two.

METHOD

This was a nation-wide cross-sectional study of nurses working across 1858 hospitals in China. Data were collected using an online structured, self-administered questionnaire between 2016 and 2017.

RESULTS

Nearly half of respondents had experienced aggressive behavior from patients or their attendants; 13.4% respondents had experienced aggressive behavior on more than three occasions. 78.96% respondents had experienced needle-stick injuries and 51.22% had experienced psychological trauma. 20.5% respondents believed that hospitals do not pay any attention to occupational safety. 86.1% respondents expressed the need for little or moderate psychological support. Nurses who had experienced aggressive behavior expressed a greater need for psychological support. Nurses working at hospitals that adequately addressed the occupational safety issues expressed the lowest need for psychological support.

CONCLUSION

We found a high prevalence of psychological stress and occupational injuries among nurses. Nursing managers need to address this issue and implement interventions to prevent and reduce injuries.

A Child with Home Mechanical Ventilation Affects the Family: A Danish Study shows that well Siblings may become Shadow Children

BACKGROUND

Having a child with chronic respiratory illness and home mechanical ventilation (HMV) may not only affect the ill child, but also the family, including well siblings' everyday life and physical and mental well-being.

PURPOSE

To explore the perspectives of parents to a child with HMV on well siblings' lives.

DESIGN AND METHODS

A qualitative phenomenological-hermeneutic approach using semistructured interviews with eight families, that included a child on HMV and well siblings. Data were collected from March to June 2019 at a Danish University Hospital.

RESULTS

Three main themes emerged: Tying emotional bonds with both children, Protection of everyday life for well siblings and A different family life - sharing attentiveness. The findings showed that being a parent to an HMV child and well siblings is complex to manage, and may make parents feel inadequate towards their children.

CONCLUSIONS

Parents feel inadequate in being parents to both the HMV child and well siblings, often transferring adult responsibilities to the well sibling, and sometimes leaving the well siblings in the shadow.

IMPLICATIONS

Clinical practice needs to expand interventions to support parents and well siblings by using a more family-centred care approach, not only during admission, but also in a long-term perspective.

Siblings of children with chronic kidney disease: A qualitative study of everyday life experiences

BACKGROUND

Chronic kidney disease in children has an impact on all family members. Healthy siblings, in particular, may experience negative psychological and emotional symptoms. Little attention has been paid to how they experience everyday family life and the impact of their sibling's disease.

OBJECTIVES

To explore perspectives on and experiences of everyday life among siblings of children with chronic kidney disease.

DESIGN

An explorative study with a qualitative method.

PARTICIPANTS

Seven siblings (7-13 years) of children with chronic kidney disease (5-16 years) were included.

APPROACH

The study took a phenomenological-hermeneutical approach. Semistructured 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

Three themes emerged: The illness is in the background or comes to the fore, being concerned for and taking care of the sick sibling and the importance of bonds with relatives or other significant adults.

CONCLUSION

In everyday life, participants experienced that their sick sibling's illness was either in the background or came to the fore. They needed to adapt to periods of hospitalisation. They felt a need to be attentive to, take care of and have concern for the sick brother or sister. Conflicts caused feelings of loneliness; however, having knowledge about the disease provided security and meaning. Being introduced to the healthcare professionals was significant. It was important to have close relationships with friends and other adults, which gave rise to feelings of self-confidence and being supported.

Resilience in adolescents with thalassemia

Adolescents with thalassemia often manifest with an increased risk of emotional and behavioral problems, as well as poor quality of life. However, some can be well-adapted and demonstrate evidence of resilience. This study aimed to explore resilience among those with thalassemia and determine the protective factors for their resilience. Sixty adolescents with thalassemia and 60 healthy adolescents as a comparison group participated in the study. Most adolescents with thalassemia demonstrated resilience. Eighty percent of them scored in the low-risk range of the SDQ total difficulties scale, and 91.7% scored in the low-risk range of the SDQ prosocial scale. The mean total difficulties scores of the thalassemia patients and the healthy controls were 11.38 and 11.27 respectively, whereas the mean prosocial scores were 7.28 and 6.65, without statistical significance. Despite the extensive demands of the illness, most adolescents with thalassemia appear to be adapted well, demonstrating evidence of resilience. Factors promoting resilience are lower BMI, less severe type of thalassemia, and younger age at the start of an iron chelator. Health care professionals who take care of adolescents with thalassemia should collaborate to improve their resilience.

A delicate balance between control and flexibility: Experiences of care and support among pre-teenage children with type 1 diabetes and their families

For children with type 1 diabetes, the period of adolescence is associated with higher blood glucose levels and increased psychological distress compared to other age groups. Focusing on pre-teens (9-12 years) with type 1 diabetes and their families has been suggested as key to understanding and reducing these challenges. The aim of this study was to explore: 1, how diabetes affects family life, 2, experiences of and needs for support and 3, how care responsibilities are negotiated among pre-teens with type 1 diabetes and their families. Data were obtained from four interactive workshops with pre-teens (n = 17), their parents (n = 26) and their siblings (n = 14). Dialogue tools, for example quotes and picture cards, were used to facilitate discussion and reflection concerning family life with type 1 diabetes. Data analysis resulted in three themes: 1, diabetes takes up 'a lot of space', 2, giving and receiving support and 3, balancing control and flexibility. While diabetes took up significant space in the families, family members protected each other from their respective frustrations. The findings point to the significance of considering all key family members and their interactions in diabetes interventions. This includes balancing control and flexibility, negotiating responsibilities and building trust.

Martial Arts-Based Therapy Reduces Pain and Distress Among Children with Chronic Health Conditions and Their Siblings

Objective

Test whether a martial arts-based therapy, Kids Kicking Cancer (KKC), can reduce pain and emotional distress in children with cancer, other chronic health conditions (e.g., sickle cell), and healthy siblings.

Methods

This study surveyed children’s pain and distress levels immediately before and after a 1-hr in-person KKC class. Eligible participants were enrolled in standard KKC classes, were diagnosed with a chronic health condition (e.g., cancer, sickle cell) or were the sibling of a child diagnosed and were between the ages of 5–17 years (inclusive). Children reported on their pain and distress using Likert-style scales (Coloured Analog Scale and modified FACES scale, respectively). Friedman test was used to test for overall changes in pain and distress, and within subgroups. Age and sex effects were evaluated using Spearman’s rank-order correlation. Additional Yes/No questions were administered regarding KKC satisfaction and use of techniques.

Results

Fifty-nine youth (19 cancer patients, 17 non-cancer patients, 23 siblings; 5–17 yrs, 26 females) completed this study. Overall, there was a significant reduction in pain (p = 0.033) and emotional distress (p < 0.001) after a 1-hr class, with 50% and 89% of youth reporting a reduction in pain and distress, respectively. On average, pain levels remained within the mild/moderate range on average (i.e., pre vs. post levels; pre: M = 1.67, post: M = 1.33) and emotional distress went from mild/moderate to none/mild distress, on average (pre: M = 1.92, post: M = 1.08). Youth with higher pre-class pain and distress reported greater reductions (p = 0.001 and p < 0.001, respectively). The reduction in pain appeared to be most pronounced with cancer and non-cancer patients. In contrast, the reduction in distress appeared to be most pronounced among healthy siblings. However, overall, reductions in pain and distress did not significantly differ among subgroups (i.e., cancer patients, non-cancer patients, siblings), and change in pain and distress was not associated with age or sex. Ninety-six percent of youth would recommend KKC to others and 81% reported using KKC techniques (e.g., the Breath Brake^TM or other martial arts techniques) outside of class, such as at home.

Conclusion

Results support the more widespread application of KKC as a psychosocial intervention for reducing pain and distress in various pediatric populations.

Disruption, worries and autonomy in the everyday lives of adolescents with type 1 diabetes and their family members: A qualitative study of intrafamilial challenges

AIM

To explore daily life with type 1 diabetes in families with an adolescent with type 1 diabetes.

BACKGROUND

Management of adolescent type 1 diabetes is carried out in the context of everyday life, thus involving and affecting the entire family. Type 1 diabetes causes disruption of family life, but the specific experiences and challenges of adolescents with type 1 diabetes, siblings and parents are not well-explored. Specifically, research is lacking on the siblings' experience of adolescents with type 1 diabetes.

DESIGN

A qualitative design using participatory workshops.

METHODS

A sample of 21 families comprising adolescents with type 1 diabetes (aged 8-18) (N = 20), their parents (N = 29) and siblings (N = 10) participated in four workshops exploring everyday life in families with adolescent diabetes from the perspective of all family members. Data were analysed using systematic text condensation. The COREQ checklist was used preparing the manuscript.

RESULTS

Family life with type 1 diabetes was characterised by three overarching themes: (a) the perpetual challenges and disruptive nature of life with diabetes, (b) different ways of worrying about diabetes and (c) diabetes autonomy and emancipation from parents. All family members' lives were marked by these aspects, however in different ways and to varying degrees.

CONCLUSIONS

Our findings emphasise that type 1 diabetes is indeed a family illness affecting all family members. The study provides insight into the unique experiences of adolescents with diabetes, their parents and siblings, all of whom encounter diabetes-related challenges in their daily lives.

RELEVANCE TO CLINICAL PRACTICE

The findings call for the inclusion of all family members of adolescents with type 1 diabetes in both research and healthcare practice. Family-oriented approaches targeting adolescents with diabetes as well as their parents and siblings will enable provision of nursing care that can meet the needs of the entire family.