Assent for children's participation in research: why it matters and making it meaningful

"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.

Research behind a webcam: an exploration of virtual interviewing with children and young people

BACKGROUND

Societal use of digital technology rapidly increased during the COVID-19 pandemic. Face-to-face services converted to online provision where possible. This affected many nurse researchers.

AIM

To explore conducting research interviews online with children and young people (CYP) about sensitive topics.

DISCUSSION

This article considers digital inclusion, as well as ethical issues surrounding safety, support and consent, along with choosing tools for collecting data. It also presents a discussion of physical proximity in qualitative interviews with this population and its role in data quality. The authors investigate benefits in the context of researchers' personal experiences. They acknowledge the disadvantages of conducting interviews online and discuss ways to mitigate these.

CONCLUSION

The advantages for researchers include cost-effectiveness, time-efficiency and greater geographical reach of participants. However, CYP's perspectives are unknown and the specific ethical issues of using this method with CYP need careful consideration.

IMPLICATIONS FOR PRACTICE

More research is needed to examine virtual interviews from the perspectives of CYP as participants. Virtual acquisition of consent and assent should be investigated to standardise good research practices.

The multilingual children’s library as physical and metaphorical ‘space’ within the community: Practical and emotional considerations

Following the establishment of a multilingual children’s library section in Sheffield, England, this paper explores logistical and emotional considerations concerning the set-up and running of the library, and its role within the community. Adopting a case study approach, data are derived from book stock and borrowing statistics, feedback from multiple events (including multilingual storytelling and story writing events, and a reading scheme), as well as a library staff and a parent focus group. Data were analysed thematically according to logistical and emotional concerns, with subthemes – such as borrowing patterns, identity, belonging and physical and metaphorical ‘space’ being identified within the data. The research highlights shortcomings in cataloguing facilities, and in the way in which ‘successes’ are measured in library management and research, while adding significantly to our understanding of the contribution multilingual resources and events in public libraries makes to a community’s sense of identity and belonging. The notion of real and metaphorical ‘space’ for multilingualism as part of library provision forms a vital addition to the way libraries might consider their roles in diverse societies.

Paediatric biobanking for health: The ethical, legal, and societal landscape

Biobanks play a central role in pediatric translational research, which deals primarily with genetic data from sample-based research. However, participation of children in biobanking has received only limited attention in the literature, even though research in general and in clinical trials in particular have a long history in involving minors. So, we resolved to explore specific challenging ethical, legal, and societal issues (ELSI) in the current pediatric biobanking landscape to propose a way forward for biobanking with children as partners in research. Methodologically, we first established the accessibility and utilization of pediatric biobanks, mainly in Europe. This was supported by a literature review related to children's participation, taking into account not only academic papers but also relevant guidelines and best-practices. Our findings are discussed under five themes: general vulnerability; ethical issues-balancing risks and benefits, right to an open future, return of results including secondary findings; legal issues-capacity and legal majority; societal issues-public awareness and empowerment; and responsible research with children. Ultimately, we observed an on-going shift from the parents'/guardians' consent being a sine-qua-non condition to the positive minor's agreement: confirming that the minor is the participant, not the parent(s)/guardian(s). This ethical rethinking is paving the way toward age-appropriate, dynamic and participatory models of involving minors in decision-making. However, we identified a requirement for dynamic tools to assess maturity, a lack of co-produced engagement tools and paucity of shared best practices. We highlight the need to provide empowerment and capability settings to support researchers and biobankers, and back this with practical examples. In conclusion, equipping children and adults with appropriate tools, and ensuring children's participation is at the forefront of responsible pediatric biobanking, is an ethical obligation, and a cornerstone for research integrity.

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.

From research 'on' to research 'with' children about their family lives: A scoping review of ethical and methodological challenges

BACKGROUND

Since the Convention on the Rights of the Child in 1989, interest in the ethical and methodological challenges involved in conducting research with children has increased considerably. Researchers who work with children have to take into account children's intrinsic physical, mental and emotional vulnerability as well as their interdependence with other family members, particularly their parents. This is especially challenging in research that seeks to explore children's lived experience in relation to aspects of their family lives.

OBJECTIVE

We aimed to identify specific ethical issues and ways of overcoming challenges in conducting research with children on some aspects of their family lives.

METHODS

We conducted a scoping review according to the PRISMA Extension for Scoping Reviews Checklist. Seventeen publications were selected for data extraction and synthesis, 4 of which were original studies and 13 reflexive papers.

RESULTS

Our results confirm that a research project that asks children about aspects of their family lives leads to a number of ethical tensions: While children depend on their parents and family to ensure that their safety and physical needs are met, they also greatly contribute to the development of family dynamics. We highlight methodological strategies that allow researchers to mitigate the ethical challenges that are inherent to this type of research.

DISCUSSION/CONCLUSION

A promising approach is to use participative methods at each stage of research, including developing a trusting and triadic partnership that includes parents, children, a multidisciplinary research team and professional gatekeepers. Benefits as well as possible risks for participants should also be considered when children and their parents are engaged in a study.

Children's exposure to trafficking, sexual exploitation and community-based violence in Canada: A narrative summary and policy perspective

BACKGROUND

Given the formidable health burdens associated with children's exposure to community-based violence (CBV) and trafficking and exploitation (TE), continued investments in determining their epidemiology constitute an important focus for Canada.

OBJECTIVE

The objective of the present study is to provide a narrative summary and policy perspective concerning the quantitative studies reporting on the risk and protective factors and prevalence of children's (<18 years) exposure to CBV and TE in Canada.

METHODS

To identify literature, we searched eight electronic databases. English and French citations from database inception to December 2018 were included; this was supplemented with citation chaining for peer-reviewed publications and grey literature up to December 2019. Evidence is synthesized via a narrative summary.

RESULTS

There are few studies that have investigated children's exposure to TE and CBV in Canada. Self-reported exposure to these forms of violence varies according to the type investigated, with estimates ranging from 2 % - to - 23 % and 5 % - to - 53 % for TE and CBV, respectively. Literature focused on risk and protective factors for these forms of victimization are also limited.

CONCLUSIONS

Canada has the infrastructure in place to make significant gains in their data collection and monitoring of children's exposure to TE and CBV via five national-level studies. To help realize the goal of ending all forms of violence against children by 2030, incorporation of reliable measures of these forms of exposure in new and ongoing national-level data collection systems is urgently needed.

The experience of school-aged children with hospitalisation

AIMS AND OBJECTIVES

This study intended to contribute to the improvement of nursing care for both children and their parents and aimed to identify the best and worst experiences of school-aged children during hospitalisation.

BACKGROUND

Child hospitalisation has traditionally been studied from the parent's perspective, but studies in which the child is the subject are scarce and mainly focus on to the hospitalisation experiences.

DESIGN

A cross-sectional, observational and descriptive exploratory design was used, and STROBE reporting guidelines were followed.

METHODS

A paper survey was applied by the primary researcher within a 3 months period to 252 children. It presented two open-ended statements: 'In my opinion the best thing about the hospital is …' and 'In my opinion the worst thing about the hospital is…'. The study was submitted and approved by the national data protection commission and also by the ethics committees of each of the six institutions where the study was undertaken. Informed consent was also obtained from children and parents.

RESULTS

Answers were analysed through content analysis. Five categories were identified for each of the open-ended statements. Children identified 'people', 'physical environment', 'activities', 'outcomes' and 'food' as best experiences. The worst experiences included: 'feelings', 'activities', 'food', 'environment' and 'outcomes'.

CONCLUSIONS

The results allowed the identification of the children's most valued aspects of hospitalisation.

RELEVANCE TO CLINICAL PRACTICE

The results should be considered by healthcare professionals in order to make the hospitalisation experience more positive from the perspective of the school-aged children.

Ethical considerations when conducting research with children and young people with disabilities in health and social care

Background Rights-based approaches for conducting research with children and young people are now widely accepted by those working in the field. Such approaches focus on the voice of the child and are underpinned by a firm recognition that children are experts on their own lives. However, children and young people with disabilities are less likely to take part in research. Aim To draw on doctoral research conducted with children and young people with disabilities to explore the ethical issues that arose concerning access, recruitment, consent, anonymity, confidentiality and sensitive issues, as well as what mitigated these issues. Discussion Research with children and young people with disabilities can pose additional ethical challenges. There is a growing body of literature about this area, but it needs further development. Conclusion Additional planning and preparation are vital in ensuring that children and young people with disabilities can participate in research in a meaningful way and that researchers conduct studies ethically. Implications for practice This paper has clear implications for research and nursing practice in terms of communicating with children and young people with disabilities, enabling them to express their views and participate in decisions about their lives.

Helping Them Decide: A Scoping Review of Interventions Used to Help Minors Understand the Concept and Process of Assent

For adults, understanding research protocols prior to consenting to participate can be demanding. For children, that challenge is likely amplified. Yet, the participation of minors as research subjects is necessary. Otherwise, the likelihood of improving healthcare for minors now and in the future is hampered. The risk that minors could be harmed by procedures and medicines that are ill-adapted to their age-group or lack adequate scientific basis is real. It is therefore necessary to identify age-appropriate models to help minors understand the concept and process of assent. For this scoping review the concepts of assent and dissent, tools to evaluate the capacity of minors to assent, and six empirically based methods that have been used to help minors understand the process of assent were reviewed. Helping minors become better decision-makers in a manner that is commensurate with their development, supports children's prerogative to participate as human subjects in research.

Adaptation and Validation of the Instrument ‘Children Care Quality at Hospital’ for Portuguese

Objective: adapt and validate the instrument Children Care Quality at Hospital (CCQH) to assess the quality of nursing care of hospitalized children for the Portuguese language of Portugal. Materials and Methods: content, language, and conceptual validity methodological study, with translation, feedback, and reflection. A non-probabilistic simple was used of 252 children between 7 and 11 years of age, hospitalized due to acute disease in nine services of six Portuguese hospitals. The reliability and validity of the results were determined to measure the psychometric properties of the instrument. Construct validity was calculated through exploratory factor analysis of main components with Varimax rotation and the internal consistency by determining the Cronbach’s alpha coefficient. Results: the internal consistency has adequate psychometric characteristics suitable for the Portuguese population (Cronbach’s alpha values between 0.66 and 0.82). The instrument maintained 49 items grouped into three categories: characteristics, activities, and environment. The psychometric characteristics of the CCQH, adapted and validated for Portuguese, guarantees its reliability and validity to measure satisfaction with the quality of nursing care from the perspective of school-aged children. Conclusions: the instrument could be used to assess children’s satisfaction with the quality of nursing care during their hospitalization.

Invitation to grief in the family context

Grief is a family affair, yet it is commonly viewed as an individual phenomenon. As an international, interdisciplinary team, we explore grief within a family context across theoretical, research, practice, and educational domains. Families are complex and working with this complexity is challenging but necessary for a holistic view of grief. We therefore encourage an increased focus on theorizing, researching, practicing, and educating using innovative approaches to address the complexities of grief within the context of families. Learnings from within each domain will affirm and enhance the development of family-level thinking and approaches.