An Innovative Educational Intervention for Pediatric Nurse Practitioner Faculty to Meet Social Justice Curriculum Standards

The association between adverse childhood experiences and negative health outcomes is a public health concern, particularly affecting disadvantaged groups and contributing to health disparities. Pediatric nurse practitioners are well-positioned to address this issue, emphasizing the importance of incorporating social justice concepts into nursing education to develop a pediatric workforce with the necessary skills to curb health disparities. However, evidence-based approaches to incorporating these concepts into pediatric nursing education are limited. To address this gap, we describe an innovative educational intervention that harnesses the power of narratives to empower future pediatric nurse practitioners as champions of social justice and health equity.

Development of the Tool to Empower Parental Telling and Talking (TELL Tool): A digital decision aid intervention about children's origins from donated gametes or embryos

Objective

This study aimed to create and develop a well-designed, theoretically driven, evidence-based, digital, decision Tool to Empower Parental Telling and Talking (TELL Tool) prototype.

Methods

This developmental study used an inclusive, systematic, and iterative process to formulate a prototype TELL Tool: the first digital decision aid for parents who have children 1 to 16 years of age and used donated gametes or embryos to establish their families. Recommendations from the International Patient Decision Aids Standards Collaboration and from experts in decision aid development, digital health interventions, design thinking, and instructional design guided the process.

Results

The extensive developmental process incorporated researchers, clinicians, parents, children, and other stakeholders, including donor-conceived adults. We determined the scope and target audience of the decision aid and formed a steering group. During design work, we used the decision-making process model as the guiding framework for selecting content. Parents' views and decisional needs were incorporated into the prototype through empirical research and review, appraisal, and synthesis of the literature. Clinicians' perspectives and insights were also incorporated. We used the experiential learning theory to guide the delivery of the content through a digital distribution plan. Following creation of initial content, including storyboards and scripts, an early prototype was redrafted and redesigned based on feedback from the steering group. A final TELL Tool prototype was then developed for alpha testing.

Conclusions

Detailing our early developmental processes provides transparency that can benefit the donor-conceived community as well as clinicians and researchers, especially those designing digital decision aids. Future research to evaluate the efficacy of the TELL Tool is planned.

Alpha Test of the Donor Conception Tool to Empower Parental Telling and Talking

OBJECTIVE

To conduct an alpha test of the prototype of a digital decision aid to help parents disclose donor conception to their children, the Donor Conception Tool to Empower Parental Telling and Talking (TELL Tool).

DESIGN

Convergent mixed-methods design.

SETTING

Virtual interviews in places convenient to the participants.

PARTICIPANTS

A purposeful sample (N = 16) of nine gamete-donor and embryo-recipient parents and eight clinicians, as one parent was also a clinician.

METHODS

We conducted cognitive interviews to explore participants' perceptions about the TELL Tool prototype and observe patterns of use. The International Patient Decision Aid Standards (i.e., usability, comprehensibility, and acceptability) guided the development of the qualitative interview guide and directed the qualitative analysis. We also collected data about participants' perceptions and ratings of the helpfulness of each of the prototype's webpages regarding parents' decision making about disclosure. Descriptive statistics were used to analyze the helpfulness ratings before we merged the two data sets to optimize understanding.

RESULTS

Participants reported that the TELL Tool was a helpful digital decision aid to help parents tell their children how they were conceived. Most (93.7%) webpage rating scores indicated that the content was very helpful or helpful. The participants identified content and technical areas that needed refinement and provided specific recommendations such as adding concise instructions (usability), tailoring adolescent language (comprehensibility), and softening verbiage (acceptability).

CONCLUSION

Alpha testing guided by the International Patient Decision Aid standards was an essential step in refining and improving the TELL Tool prototype before beta testing.

P-488 Perceptions of gamete and embryo donation recipient parents about the online experimental and control programs in the TELL Tool feasibility clinical trial at immediate post-test

Study question

What are parents’ initial perceptions about the online experimental and control programs at immediate post-test?

Summary answer

Parents reported overall acceptability of the online instructions, technological navigation, length, and quality of videos, as well as suggestions for further improvement.

What is known already

Multiple investigations have examined the reasons why parents who used donated gametes or embryos, decide to inform their children that they were conceived through third-party reproduction. A consistent theme in this research is parental calls for strategies and tools to aid parents with disclosure to their children. Despite these calls from parents, little research has focused on developing new methods of delivering parent-focused materials that aim to assist parents in their disclosure process. To address this concern, we developed an online experimental program called the Tool to Empower Parental TeLling and TaLking (TELL Tool) and completed alpha testing.

Study design, size, duration

A 3-month feasibility clinical trial.

Participants/materials, setting, methods

Donor sperm, egg, and embryo recipient parents were randomized to either an experimental TELL Tool program or a control program focused on good parenting practices. Both the TELL Tool and the control programs are administered online. To date 13 parents have completed the experimental or control program and each participant has answered an immediate post-test survey about the acceptability of the program. Descriptive statistics and qualitative content analysis guided the analysis.

Main results and the role of chance

The sample consists of 13 U.S. parents between 35 to 53 years (M = 41.3 years). The parents used donated sperm (n = 5), eggs (n = 2), sperm and eggs (n = 2) or embryos (n = 4) and their children were between 1 to 12 years (M = 5.7 years). Most parents were female (n = 11) and White (n = 10). Parents were asked to rate the level of truthfulness about the acceptability of the online programs (ratings: 1 to 5, with 1 being “not at all true” to 5 being “very true”). Responses about the: (1) instructions provided for accessing the program were easy, were: range 3 to 5, M = 3.9; (2) technological navigation within the program was problematic, were: range 1 to 5, M = 2.7; (3) length of the program was too long, were: range 1 to 5, M = 3; and (4) videos within the program were helpful, were: range 3 to 5, M = 3.69. Responses to the open-ended questions provided insights to the ratings, such as parents’ statements about specific technological issues (e.g., ability to print resources, ease of navigating in-and-out of the program).

Limitations, reasons for caution

Preliminary data are reported for the feasibility trial at the immediate post-test timepoint as recruitment is ongoing. As the 3-month study unfolds, additional data will be obtained to allow for more in-depth understanding of parents’ perceptions about the acceptability of the experimental TELL Tool and control programs.

Wider implications of the findings

The acceptability of the online research for donor gamete and embryo recipient parents may illuminate access issues to these often hidden and dispersed parents and their families across the lifespan. Parents’ responses can provide a window of understanding for other decision aids that target health promotion among parents and children.

Trial registration number

NCT04841967

Systematic Review of Self-Report Measures of Maternal Self-Efficacy

OBJECTIVE

To synthesize the literature to identify self-report measures used to assess maternal self-efficacy (MSE) among mothers of infants 0 to 1 year of age.

DATA SOURCES

OVID (MEDLINE), CINAHL, PsycINFO, Scopus, Google Scholar.

STUDY SELECTION

We searched for research articles that included self-report measurement of MSE and were published from January 2000 to September 2021. We selected this time frame to focus on a contemporary context and to build on an earlier systematic review of self-report measures of self-efficacy in parents that captured a subset of MSE measures across a broader time period (1970-2016).

DATA EXTRACTION

We extracted measures of MSE with descriptive details, including level of self-efficacy assessed (e.g., global, domain-specific, task-specific), concept(s) assessed, reliability, eligible age ranges, instrument origins, development, use, and translations.

DATA SYNTHESIS

In many studies of MSE, researchers used measures not specifically designed for self-efficacy and instead used measures for closely related concepts such as confidence or competence. We identified only four measures that were used to assess MSE among mothers of infants. Among these, we found variation in the level of self-efficacy being measured and the intended age range. Importantly, we also found that measures of MSE were primarily validated for use within Western and/or English-speaking cultures/countries.

CONCLUSION

We identified four instruments to measure MSE in mothers of infants, and each has strengths and weaknesses. Future researchers should focus on clear conceptual and operational alignment between MSE and its measurement; the development of an English, task-specific MSE measure; and further development and testing of measures of MSE outside of Western and/or English-speaking cultures/countries.

Parents' experiences telling children conceived by gamete and embryo donation about their genetic origins

Objective

To gain an in-depth understanding of parents' experiences telling children conceived by gamete and embryo donation about their genetic origins.

Design

Qualitative, descriptive.

Setting

Families' homes.

Patients

Gamete or embryo donation recipient parents living in the United States and who told their children, from birth to 16 years, about their genetic origins.

Interventions

Individual semistructured (n = 12) or dyadic (n = 2) parent interviews.

Main Outcome Measures

Directed qualitative content analysis.

Results

Fourteen families that comprised 16 gamete or embryo donation recipient parents and represented 24 donor-conceived children between the ages of 4 months and 16 years participated in the study. Single parents (n = 3) and both parents in most two-parent families (n = 9) led the initial telling conversations. Parents recounted personal short stories using language that was both developmentally and medically appropriate. Multiple strategies, including children's books, were used by parents to aid them in their telling. The oldest donor-conceived children in each family were first informed of their genetic origins at birth (n = 10 families) or at 6 months (n = 1 family; "practice runs") or from 3.5 to 12 years (n = 3 families). The telling conversations took place during routine family activities that naturally brought parents and children in close proximity, usually in the home.

Conclusions

Awareness of the nuances of parents' telling conversations with their children through the age of 16 years can help guide clinical counseling and the development of tools to aid parents in their telling conversations.

P–496 Alpha test results: Towards developing a digital prototype intervention to support parents’ disclosure about donor conception in the United States

Study question

The objective of the study was to determine the usability, comprehensibility, and acceptability of a digital, decision-support aid prototype supporting parental disclosure of donor conception. Summary answer: This mixed methods design maximized participant feedback about the digital, decision-support aid prototype yielding rich insight about the prototype while minimizing participant and investigator burden.

What is known already

Although a paradigm shift is underway to remove the secrecy that has historically shrouded the practice of gamete donation, little is known about best practices that can support parents in disclosing the conceptional origins to their children. To address this gap, we created a decision-support aid prototype to facilitate parental disclosure post-treatment. In doing so, we followed the International Patient Decision Aid Standards Collaboration for developing decision-support aids, which recommends that Alpha testing (i.e., usability, comprehensibility, and acceptability) be completed to improve the quality of newly created decision-support interventions prior to Beta (i.e., real world) testing.

Study design, size, duration

A mixed-methods, triangulation design was used.

Participants/materials, setting, methods

Sixteen participants were purposefully selected based on desired characteristics and the needs of the study. Participants were asked to: (1) follow investigator prepared instructions for accessing the digital, decision-support aid; (2) complete a quantitative rating form about each slide within the decision-support aid prototype; and (3) participate in a qualitative, cognitive interview or focus group. Descriptive statistics and qualitative content analysis guided the iterative analysis.

Main results and the role of chance

The sample was composed of 10 parents that used donated sperm (n = 3), oocytes (n = 4), or embryos (n = 2) to conceive children and 8 clinicians; 2 participants were both donor recipient parents and clinicians. The interviews (n = 14) and one focus group (2 participants) ranged in length from 25 to 70 minutes (M = 47 minutes).

Usability: Participants suggested refining the instructions for accessing the decision-support aid and upgrading the technology used to deliver the content. Common concerns were the inconsistent volume of the audio recordings and a need for higher quality images. Comprehensibility: Feedback obtained from the participants’ rating forms and in the interviews and focus group were consistently high about the ability to understand the content and the scope of the information presented. Acceptability: Participants noted the aid would resonate with parents. They recommended shortening the length of the aid, changing specific wording, modifying some of the video content, refining specific content for individual slides and the four modules. Unintended recommendations about how the aid might be used to provide clinician education or in international research were also reported.

Limitations, reasons for caution

Alpha testing is not designed to obtain all possible technological or content issues. Rather, it is a useful and recommended step in intervention development to mitigate existing technological bugs and key content issues prior to implementation of Beta testing of a decision-support aid.

Wider implications of the findings: Other investigators that develop digital decision-support aids may consider the use of both quantitative and qualitative data collection methods during Alpha testing to refine digital interventions efficiently. The use of mixed methods not only captures rich and insightful feedback but also minimizes the burden on participants and investigators.

Trial registration number

Not applicable

Using poetry as data to explore daily and formal care decision making within African American dementia dyads

There is limited research exploring how daily and formal care decision making occurs within African American dementia dyads as well as how these dyads navigate decision making across the dementia trajectory. Through semi-structured interviews, five African American dementia dyads shared their decision-making processes. We used a multimethod approach to the analysis of data, including qualitative and quantitative content analysis and the creation of I Poems. This novel use of I Poems provided a uniquely personal account of the lived experiences of the African American persons living with dementia, while other analyses revealed that within dyads, daily care decision making was led by African American persons living with dementia, whereas formal care decision making varied between dyads. There was intra-dyad congruence regarding who the final decision maker was in daily and formal care. Clinicians and researchers may be able to tailor interventions based on the dyad's involvement in these decision-making processes.

Health literacy as predictors of fluid management in people receiving hemodialysis in China: A structural equation modeling analysis

OBJECTIVES

To explore the impact of health literacy (HL) on perceived benefits of fluid restriction (PBFR), self-reported fluid restriction (SRFR) and relative-interdialytic weight gain (R-IDWG) in people receiving hemodialysis (HD).

METHODS

We conducted a cross-sectional study in two nephrology departments from two hospitals in Guangzhou, China (n = 226). The HL questionnaire, PBFR Subscale of Health Belief Model Constructs and Fluid Adherence Subscale of the HD Patients Therapy Adherence Scale were used. R-IDWG was calculated by the mean IDWG (from 3 consecutive HD), divided by the dry weight.

RESULTS

In structural equation modeling, three domains of the HL questionnaire, namely Actively Managing My Health, Social Support and Actively Engaging with Healthcare Providers (HCPs), were directly and positively associated with PBFR. Higher Actively Managing My Health predicted higher SRFR both directly and indirectly. Sufficient Social Support and adequate Actively Engaging with HCPs predicted higher SRFR indirectly. All three HL domains predicted R-IDWG indirectly.

CONCLUSION

Improving patients' HL could increase their understanding of PBFR and be more apt to follow fluid restrictions and reduce R-IDWG.

PRACTICE IMPLICATIONS

A better understanding of the relationships among HL, PBFR, SRFR and R-IDWG will allow for tailored interventions to decrease R-IDWG in people receiving HD.

A closer look at quality of life in the hepatocellular carcinoma literature

PURPOSE

Adults with hepatocellular carcinoma (HCC) have a high symptom burden. Their quality of life (QOL) has been shown to be significantly impacted by both the disease and its treatment, adding to the high symptom burden that these patients experience. The primary aims of this paper are as follows: (1) to identify how QOL is being defined in HCC literature and (2) to identify how QOL is being measured in the HCC literature using Ferrell's model of QOL.

METHODS

A systematic review was completed of relevant studies published after 2014, using PubMed, CINHAL, and PsycInfo. Relevant studies were reviewed by 2 reviewers using PRISMA guidelines.

RESULTS

From a total of 1312 papers obtained in the initial database search, 30 met inclusion criteria and are included in this review. From the included articles, 10% included a definition of QOL and 3% addressed the spiritual domain of QOL. Majority of study participants were in the early stage of HCC, though the majority of adults with HCC are diagnosed in the advanced stage. Only 3% of included studies included greater than 22% population of advanced stage of HCC.

CONCLUSION

The results of this systematic review demonstrate the need for future research into QOL in the advanced stage of QOL. It also identified gap in the literature concerning the definition of QOL in HCC and the spiritual domain of QOL in HCC.

Quality of life in "chronic" cancer survivors: a meta-analysis

PURPOSE

Cancer survivors are now living longer giving rise to a new concept-chronic cancer as survivors continue to face long-term consequences of cancer and its treatment. For these survivors, QOL becomes a vital consideration in understanding their survivorship and the long-term impact of cancer and its treatment. The primary aim of this review is to describe QOL in cancer survivors two or more years from diagnosis.

METHODS

A meta-analysis was completed of relevant studies assessing QOL in long-term cancer survivorship using PubMed, CINHAL, and PsycINFO. A total of 64 articles met inclusion criteria and included in the analysis. Standardized effect sizes and errors were calculated using previously published standard QOL pass rates to compare QOL across measurement tools and calculate cumulative effect sizes (CES). Fixed-effect or random-effects models were used based on the presence of significant heterogeneity of ≤ 0.10.

RESULTS

Physical health (CES = - 0.894; CI, - 1.472, - 0.316), role-physical health (CES = - 2.039; CI, - 2.643, - 1.435), and mental health (CES = - 0.870; CI, - 1.447, - 0.292) had large, negative cumulative effect sizes signifying worse QOL compared with acceptable QOL rates. Tested moderators, cancer type, average age, country of origin, time since diagnosis, or decade of diagnosis, were not significant to explain heterogeneity between included studies.

CONCLUSION

QOL is significantly impacted 2 to 26 years after cancer diagnosis. More research is needed to determine possible moderators of QOL in long-term cancer survivors.

IMPLICATIONS FOR CANCER SURVIVORS

QOL continues to be significantly impacted in long-term cancer survivorship. More research is needed to understand the impact of these findings on care needs for survivors with chronic cancer.

FORMAL AND DAILY CARE DECISION-MAKING INVOLVEMENT IN AFRICAN-AMERICAN DEMENTIA DYADS

Decision-making involvement (e.g., verbal and/or nonverbal communication) of persons with dementia (PWD) has been associated with quality of life of PWDs and their caregivers, underscores personhood, and reduces ethical dilemmas for caregivers regarding the PWD’s care. Yet, no study has explored the decision-making involvement in formal and daily care of both members of African-American dementia dyads (i.e., African-American PWDs and their African-American caregivers), limiting our understanding of how these dyads navigate decision-making during the dementia trajectory. This study took a closer look through in-depth, semi-structured interviews with African-American dementia dyads as they reflected on their decision-making surrounding formal and daily care. A pilot study of five dyadic interviews, each averaging 45 minutes, was completed. We used a combination of quantitative content analysis, decision-making matrices and I-poems created from I-statements of the dyad regarding their decision-making involvement. Decision-making matrices (i.e., diagrams of the degree of sharing, the balance of power within the dyad, and the final decision maker in formal and daily care) were constructed across interviews. The pairing of traditional analyses with the novel use of I-poems traces participants’ sense of self, ensuring their voice is retained. There was agreement within all five dyads regarding the final decision maker(s) in formal and daily care. Between dyads, daily decision-making involvement was led by African American PWDs; whereas, formal care decision-making involvement of African American PWDs varied. Findings highlight the importance of a deeper understanding of formal and daily care decision-making involvement within and between African-American dementia dyads and potential clinical implications.

Oocyte donation disclosure decisions: a longitudinal follow-up at middle childhood

Few studies have captured oocyte donation (OD) parents' decision processes about intended and actual disclosure over time. Likewise, OD children's perceptions about their family composition during middle childhood are underexplored. To address these gaps, a longitudinally followed cohort of OD recipient families was invited to participate in a qualitative, follow-up study. With an 86% response rate after 12 years, families were composed of oocyte recipient mothers (n = 6) and biological fathers (n = 6) representing 12 donor-oocyte conceived children (10.33 ± 1.23 years; mean ± SD). Of the 12 children, two that were aware and two that were unaware of their conceptual origins completed conversational interviews. Only one family in the initial cohort had disclosed OD to their children by the 12-year follow-up, despite 43% of parents intending to disclose and another 43% undecided about disclosure during pregnancy. Four parental disclosure patterns emerged at 12 years: (i) wanting to disclose; (ii) conflicted about disclosure; (iii) not planning to disclose; and (iv) having disclosed. Children that were unaware of their conceptual origins displayed no knowledge of their method of conception. There is a need for family-centric interventions to assist 'wanting to disclose' parents in their disclosure process and 'conflicted about disclosure' parents in their decision-making process post-OD treatment.

Psychometric testing of the healthy eating and physical activity self-efficacy questionnaire and the healthy eating and physical activity behavior recall questionnaire for children

PURPOSE

The purpose of this study was to develop and assess the psychometric properties for two related questionnaires: the Healthy Eating and Physical Activity Self-Efficacy Questionnaire for Children (HEPASEQ-C) and the Healthy Eating and Physical Activity Behavior Recall Questionnaire for Children (HEPABRQ-C).

DESIGN AND METHODS

HEPASEQ-C and HEPABRQ-C were administered to 517 participating children with 492 completing. Data were analyzed to evaluate for reliability and validity of the questionnaires.

RESULTS

Content validity was established through a 10-person expert panel. For the HEPASEQ-C, item content validity index (CVI) ranged from 0.80 to 1.00. The CVI for the total questionnaire was 1.0. All HEPASEQ-C items loaded on a single factor. Cronbach's alpha was deemed acceptable (.749). For the HEPABRQ-C, item CVI ranged from 0.88 to 1.00. CVI for the total questionnaire was 1.0. Pearson product moment correlation between HEPASEQ-C and HEPABRQ-C scores was significant (r = .501, p = .000).

PRACTICE IMPLICATIONS

The HEPASEQ-C and HEPABRQ-C are easily administered and provide helpful insights into children's self-efficacy and behavior recall. They are easy to use and applicable for upper elementary school settings, in clinical settings for individual patients, and in health promotion settings.

Children with ADHD draw-and-tell about what makes their life really good

PURPOSE

The purpose of this study was to engage children with attention deficit hyperactivity disorder (ADHD) in a developmentally sensitive way to explore the children's subjective well-being. Explicitly, their life satisfaction, or what makes their life "really good." To date, little is known about the subjective life experience of children with ADHD or how incorporating children's views separate from the purview of adults and pathology might enhance our understanding or change our approach to evaluation and/or intervention.

DESIGN AND METHODS

A parallel convergent mixed-methods design was used to collect data from a convenience sample of children with ADHD (N = 20) ages 7 to 11 years old. This article focuses solely on the qualitative data obtained through semi-structured interviews using the art-based approach draw-and-tell conversation (DTC). The DTC data were analyzed using qualitative content analysis. In addition, each parent (N = 20) independently completed demographic and health-related forms to provide descriptive and contextual variables.

RESULTS

Three themes were discerned in the DTC analysis-activity, nature, and connections. Most children (90%) described engaging in some form of activity, often outdoors, and with others; though the focus of activity was varied. Nature was evidenced directly and indirectly in many of the children's (85%) stories. Over half (65%) of the children described some variation in relational connection across a continuum that contributed to, or detracted from, their sense of well-being/life satisfaction.

PRACTICE IMPLICATIONS

Children shared that doing things, outdoors, with others, [emphasis added] made their life "really good". Children's stories yielded insightful and actionable information that is relevant to each individual child/family, and to nursing assessment, intervention, and advocacy. These child-granted insights also extend our attention beyond pharmacological and behavioral focused interventions, to include the children's own innate health promoting interests that help to make their life really good.

"Who Are You From?": The Importance of Family Stories

This article emphasizes the importance of family stories, or intergenerational narratives, and their health benefits across the lifespan. Knowing and sharing the story of who you are from complements the current focus on knowing and sharing one's geographic heritage, or where you are from. Knowing one's family stories creates meaning that goes beyond the individual to provide a sense of self, through time, and in relation to family. This expanded sense of self is referred to as our intergenerational self, which not only grounds an individual but also provides a larger context for understanding and dealing with life's experience(s) and challenges. This connection across generations appears to contribute to resilience at all stages of life. This shift in focus challenges family nurses to rethink and/or prioritize the use of family stories as a key health-promoting intervention for not only children but also their parents, and their parents' parents.

The Impact of a Video-Mediated Communication on Separated Perinatal Couples in Japan

Japanese communication relies heavily on nonverbal cues and context. The purpose of this study was to examine the impact of video-mediated communication (VMC) on communication satisfaction and marital relationships in young couples separated during the perinatal period as they honor the Japanese tradition of Satogaeri Bunben. Couples were assigned to the VMC treatment group ( n = 14) or control group ( n = 13). A mixed-methods approach to data collection and analysis was used. Longitudinal quantitative analysis from the Primary Communication Inventory and Intimate Bond Measure revealed significant differences between the Husband groups. Primary Communication Inventory and Intimate Bond Measure were strongly correlated regardless of group. Qualitative analysis of participant diaries revealed the addition of visual cues helped create a sense of "virtual co-presence," which was both positive and negative. In conclusion, VMC appears to improve communication in the separated Japanese perinatal couples, especially through the addition of visual cues provided with VMC.

Testing the committee approach to translating measures across cultures: Translating primary communication inventory from English to Japanese

This paper presents the initial translation process and follow-up psychometric evaluation of the Japanese version of the Primary Communication Inventory (J-PCI). The J-PCI was developed using the committee approach to translation and then used in a study exploring Japanese couples' communication satisfaction while separated during Satogaeri Bunben - a Japanese perinatal tradition. The committee approach attends to cultural nuance and context and is especially useful when languages have dissimilar linguistic roots and cultures, such as Japanese and English. The translation process and evaluation included five steps; (i) selection of the original PCI for research; (ii) selection of translators; (iii) development of the J-PCI using a committee approach; (iv) an initial small pilot study; and (v) a larger follow-up study. The J-PCI has good initial validity and reliability, although some nuances were observed in scoring.

Consulting with children in the development of self-efficacy and recall tools related to nutrition and physical activity

PURPOSE

This article chronicles our efforts to develop an instrument with and for children-complete with insights, multiple iterations, and missteps along the way. The instruments we developed assess children's self-efficacy and recall related to healthy eating and physical activity.

DESIGN AND METHODS

Five focus groups were held with 39 children to discuss the evolving instrument.

RESULTS

A nine-item self-efficacy instrument and a 10-item recall instrument were developed with Flesch-Kincaid grade levels of 1.8 and 4.0, respectively, which fifth graders can complete in less than 5 min.

PRACTICE IMPLICATIONS

When assessing children in clinical practice or research, we should use instruments that have been developed with children's feedback and are child-centered. Without that assurance, assessment results can be questionable.

Using the "Newest Vital Sign" to assess health literacy in children

INTRODUCTION

The purpose of this study was to explore the feasibility, utility, and validity of using the Newest Vital Sign (NVS) tool to assess health literacy in children.

METHOD

Forty-seven parent-child dyads individually completed the NVS and a Home Literacy Environment single-item screening question (No. of children's books in the home).

RESULTS

The majority (72%; n = 34) of parent-child dyads had adequate health literacy (NVS scores ≥4), with no significant differences (p = .95) between children's NVS scores (M = 4.8, SD = 1.5) and parents (M = 4.8, SD = 1.6). A moderate, positive correlation was found between children's and parents' NVS scores (rs = .35, p = .017). Of note was that all of the parents (n = 4) and children (n = 6) who reported having only 10 or fewer children's books in their homes had NVS scores less than 4, indicating inadequate health literacy.

DISCUSSION

The NVS is a quick screening mechanism for identifying households that have adequate health literacy levels. Asking children the Home Literacy Environment single-question screening item (No. of children's books) provided additional insight that confirmed and extended findings from the NVS.

Strategies used by teens growing up in families with Huntington disease

The purpose of this study was to identify helpfulness of strategies used by teens growing up in families with Huntington disease (HD). Forty-four participants responded to a mailed HD Family Survey-Teens Strategies. Strategies were those with strong positive correlation between use and perceived helpfulness, and those with negative or inverse relationships. Obtaining information, thinking about or doing something else, and actions on behalf of the parent with HD were rated as highest use and perceived helpfulness. Emotional suppression had high use but low helpfulness. Participants reported using numerous helpful strategies. Social support was often unavailable to help manage teen concerns.

Children 'draw-and-tell' their knowledge of genetics

The purpose of this study was to explore children's early understanding of basic genetic/genomic concepts using an innovative, child-sensitive approach to data collection. Exploratory, qualitative study using art-based "Draw-and-Tell Conversation" interviews with children were used. Each conversational interview was guided by two drawing completion tasks and a semi-structured interview guide. Data were analyzed using qualitative content analysis. In this study, 27 children 7 to 10 years of age shared their understanding of basic genetic/genomic concepts in their drawings and conversations. Data were organized into four categories: 1) Inside the Body, 2) Under the Microscope, 3) It's Genetic, and 4) In Our World. Using a child-sensitive approach to data collection, children revealed a range of understanding about basic genetic concepts, including DNA, disease causation, risk, and inheritance. Data suggest informal family conversations and media exposure inform children's early understanding, highlighting the need to be aware of the sources and content of information available to children. Nurses play a central role in assessing children's genetic/genomic knowledge. The Draw-and-Tell Conversation is a novel approach that can be used to support parents as they approach and discuss genetic concepts with their children.

'Information is information': a public perspective on incidental findings in clinical and research genome-based testing

The potential for genomic incidental findings is increasing with the use of genome-based testing. At the same time approaches to clinical decision making are shifting to shared decision-making models involving both the healthcare community and the public. The public's voice has been nearly absent in discussions on managing incidental findings. We conducted nine focus groups and nine interviews (n = 63) with a broad cross-section of lay public groups to elucidate public viewpoints on incidental findings that could occur as a result of genome-based testing in clinical and research situations. Data were analyzed using qualitative content analysis. Participants wanted incidental findings disclosed to them whether or not these were clinical or research findings. Participants used different terms to define and describe incidental findings; they wanted to know that incidental findings are possible and be given a choice to learn about them. Personal utility was an important reason for disclosure, and participants believed that managing information is a shared responsibility between professionals and themselves. Broad public input is needed in order to understand and incorporate the public's perspective on management of incidental findings as disclosure guidelines, and policies are developed in clinical and research settings.

The disclosure of incidental genomic findings: an "ethically important moment" in pediatric research and practice

Although there are numerous position papers on the issues and challenges surrounding disclosure of incidental genomic findings involving children, there is very little research. To fill this gap, the purpose of this study was to explore the perspectives of multiple professional (N = 103) and public (N = 63) stakeholders using both interviews and focus groups. Using qualitative analysis, we identified one overarching theme, "It's hard for us; it's hard for them," and three subthemes/questions: "What to disclose?," "Who gets the information?," and "What happens later?" Perspectives differed between professional (Institutional Review Board chairs, clinicians, and researchers) and public stakeholders. While professionals focused on the complexities of what to disclose, the lay public stated that parents should have all information laid out for them. Professionals pondered multiple parent and child situations, while the public identified parents as informational gatekeepers who know their children best. Professionals described the potential requirement for follow-up over time as a logistical "nightmare," while the public believed that parents have the responsibility for managing their children's health information over time. However, the parent role as gatekeeper was seen as time limited and in need of professional support and backup. Our findings present a case for needed dialogue around what we propose as an "ethically important moment," with the goal of protecting and respecting the viewpoints of all stakeholders when policies regarding children are developed.

A closer look at the recommended criteria for disclosing genetic results: perspectives of medical genetic specialists, genomic researchers, and institutional review board chairs

Next generation sequencing offers benefit of improved health through knowledge, but comes with challenges, such as inevitable incidental findings (IFs). The applicability of recommended criteria for disclosure of individual results when applied to disclosure of IFs is not well known. The purpose of this study was to examine how medical genetic specialists, genomic researchers, and Institutional Review Board (IRB) chairs perceive the importance of recommended criteria when applied to genetic/genomic IFs. We conducted telephone interviews with medical genetic specialists (genetic counselors, genetic nurses, medical geneticists, laboratory professionals), genomic researchers, and IRB chairs (N = 103). Respondents rated and discussed the importance of nine recommended criteria regarding disclosure of genetic/genomic IFs. Stakeholders agreed the most important criteria for disclosure were: (1) the IF points to a life-threatening condition; (2) there is a treatment; (3) individuals indicate in writing they wanted to be informed of IFs. Criteria rated less important were: analytic validity, high penetrance, association with a young age of onset and relative risk more than 2.0. Respondents indicated that some technical criteria were confusing, and in need of context. Our findings suggest that development of guidelines regarding management of IF include multiple stakeholders' perspectives and be based on a common language.

Genetics specialists' perspectives on disclosure of genomic incidental findings in the clinical setting

OBJECTIVE

Evidence documenting management of incidental findings (IFs) from clinical genomic testing is limited. The aim of this study was to examine genetics specialists' perspectives regarding current and preferred disclosure of clinical genomic IFs.

METHODS

50 genetics specialists, including medical geneticists, laboratory professionals, genetic counselors, and nurses participated in structured telephone interviews. Data were analyzed using qualitative content analysis and descriptive statistics.

RESULTS

Most specialists had encountered IFs, but definitions of IFs varied. They discussed challenges with informing patients about the prospect of IFs and disclosing IFs to patients. Causing psychological harm to patients was a concern. Participants were divided on whether IFs needed to be clinically significant and/or actionable in order to be disclosed to patients. Creating formal disclosure guidelines was considered useful, but only if they were flexible. Additional counseling, more interdisciplinary communication, maintaining contact with patients, and a centralized database to interpret IFs were also proposed.

CONCLUSION

Genetics specialists offer insights into the challenges of defining IFs, knowing when and how to disclose them, and the potential need for flexible disclosure guidelines.

PRACTICE IMPLICATIONS

Further discussion between practicing genetics specialists is needed to develop consensus on the development of best-practice guidelines for IF management.

Stop, look, and listen: revisiting the involvement of children and adolescents in genomic research

The intersection of the genomic era and information age has created novel ethical, legal, and social issues that may be beyond the reach of existing guidelines for children and adolescents in research. By taking the opportunity to stop, to look, and to listen, nurses are in an ideal situation to help children, adolescents, and families understand these emerging and important issues. This chapter thus reviews and highlights the issues and challenges that arise when children and adolescents are involved in genomic research. First, we stop and review existing guidelines for the protection of individual children and adolescents in research and existing gaps and inconsistencies in their implementation. Then we take a closer look at the unique features of genetic and genomic research that create particular ethical challenges for completing the informed consent process when the research participant is a child or adolescent. Finally, we challenge nurses to listen more intently to what children and their families need to know before they are included in genetic and genomic research. We emphasize the changing context of children's lives today and the emergence of their decision-making skills.

Informed consent and genomic incidental findings: IRB chair perspectives

It is unclear how genomic incidental finding (GIF) prospects should be addressed in informed consent processes. An exploratory study on this topic was conducted with 34 purposively sampled Chairs of institutional review boards (IRBs) at centers conducting genome-wide association studies. Most Chairs (96%) reported no knowledge of local IRB requirements regarding GIFs and informed consent. Chairs suggested consent processes should address the prospect of, and study disclosure policy on, GIFs; GIF management and follow-up; potential clinical significance of GIFs; potential risks of GIF disclosure; an opportunity for participants to opt out of GIF disclosure; and duration of the researcher's duty to disclose GIFs. Chairs were concerned about participant disclosure preferences changing over time; inherent limitations in determining the scope and accuracy of claims about GIFs; and making consent processes longer and more complex. IRB Chair and other stakeholder perspectives can help advance informed consent efforts to accommodate GIF prospects.

Video-Mediated Communication to Support Distant Family Connectedness

It can be difficult to maintain family connections with geographically distant members. However, advances in computer–human interaction (CHI) systems, including video-mediated communication (VMC) are emerging. While VMC does not completely substitute for physical face-to-face communication, it appears to provide a sense of virtual copresence through the addition of visual and contextual cues to verbal communication between family members. The purpose of this study was to explore current patterns of VMC use, experiences, and family functioning among self-identified VMC users separated geographically from their families. A total of 341 participants (ages 18 to above 70) completed an online survey and Family APGAR. Ninty-six percent of the participants reported that VMC was the most common communication method used and 60% used VMC at least once/week. The most common reason cited for using VMC over other methods of communication was the addition of visual cues. A significant difference between the Family APGAR scores and the number of positive comments about VMC experience was also found. This exploratory study provides insight into the acceptance of VMC and its usefulness in maintaining connections with distant family members.

A practical first step to integrating genetics into the curriculum

We conducted a systematic literature review to identify tools that could be used to measure faculty and undergraduate nursing students' genetic literacy, and we assessed the utility of one of those tools, the Genetic Literacy Assessment Instrument (GLAI), with faculty and students at a college of nursing in a large public university. No significant differences were noted between faculty and students in terms of their overall scores on the GLAI. On average, faculty answered 76% of the questions correctly and students answered 73% of the questions correctly. Both groups scored highest in the genetics and society domain (93% and 85% correct answers for faculty and students, respectively) and lowest in the evolution domain (52% correct for both groups). The GLAI may be used to evaluate curricula for strengths and deficiencies, as well as to identify students and faculty in need of additional instruction.

Researcher and institutional review board chair perspectives on incidental findings in genomic research

AIMS

Genomic research can produce findings unrelated to a study's aims. The purpose of this study was to examine researcher and Institutional Review Board (IRB) chair perspectives on genomic incidental findings (GIFs).

METHODS

Nineteen genomic researchers and 34 IRB chairs from 42 institutions participated in semi-structured telephone interviews. Researchers and chairs described GIFs within their respective roles. Few had direct experience with disclosure of GIFs. Researchers favored policies where a case by case determination regarding whether GIF disclosure would be offered after discovery, whereas IRB chairs preferred policies where procedures for disclosure would be determined prior to approval of the research.

CONCLUSIONS

Researcher and IRB chair perspectives on management of GIFs overlap, but each group provides a unique perspective on decisions regarding disclosure of GIFs in research. Engagement of both groups is essential in efforts to provide guidance for researchers and IRBs regarding disclosure of GIFs in research.

Arts-based data collection techniques used in child research

PURPOSE

The purpose of this study was to identify the different arts-based techniques being used in health-related research with children.

DESIGN AND METHODS

A systematic survey of literature was conducted.

RESULTS

Two hundred and ten articles were initially identified and reviewed. Of these, 116 met inclusion criteria of arts-based techniques in research with children 7-12 years of age. The different categories of techniques identified included (a) drawings, (b) photographs, (c) graphics, and (d) artifacts. Only 19% of the studies were health related. Further, 79% were conducted outside the United States, revealing that arts-based techniques appear to be underused by nurses and other healthcare researchers, especially in the United States.

PRACTICE IMPLICATIONS

To ensure that children actively engage in research involving them, nurses can familiarize themselves with and advocate for the use of arts-based techniques.

Development of the HD-Teen Inventory

Adolescents, who have a parent with Huntington Disease (HD), not only are at genetic risk for HD but also are witness to its onset and devastating clinical progression as their parent declines. To date, no mechanism has been developed to direct health care providers to the atypical adolescent experiences of these teens. The purpose of this report is to describe the process of developing the HD-Teen Inventory clinical assessment tool. Forty-eight teens and young adults from 19 U.S. states participated in the evaluation of the HD-Teen Inventory tool. Following item analysis, the number of items was reduced and item frequency and reaction scales were combined, based on the strong correlation (r = .94). The resultant tool contains 15 inventory and 2 open-ended response items. The HD-Teen Inventory emerged as a more compact and efficient tool for identifying the most salient concerns of at-risk teens in HD families in research and/or clinical practice.

Factorial structure of the perception of risk factors for type 2 diabetes scale: exploratory and confirmatory factor analyses

RATIONALE, AIMS AND OBJECTIVES

The extent to which individuals' perceptions of risk for type 2 diabetes are related to their actual risks and health-promoting behaviours is not well known. Yet perception of risk for type 2 diabetes may influence the likelihood that individual would engage in preventive behaviours. The purpose of this study was to evaluate the psychometric properties of the perception of risk factors for type 2 diabetes (PRF-T2DM).

METHODS

A descriptive, correlational, methodological design was used to conduct this study. The sample consisted of 629 adults from 42 states of the United States. A demographic questionnaire, the PRF-T2DM, the health-promoting lifestyle profile II and the depressive cognition scale were used to collect the data. Data analyses consisted of descriptive statistics, scale and item analyses, Pearson's correlation analysis, and exploratory and confirmatory factor analyses.

RESULTS

The PRF-T2DM has a Cronbach's alpha of 0.81. Both extracted factors had Cronbach's alphas of 0.74 and 0.80, respectively. Most inter-item and item-to-total correlation coefficients for factor 1 and factor 2 met the recommended criteria of r=0.30 to r=0.70. The PRF-T2DM achieved all minimum recommended criteria for model fit (χ(2) /d.f.=2.33, goodness of fit index=0.95, adjusted goodness of fit index=0.93, comparative fit index=0.94, root mean square error of approximation=0.05, root mean residual=0.05 and the P value for test of close fit=0.33).

CONCLUSIONS

All statistical estimates and measures of model fit were above the standard recommended criteria. The scale has potential uses in research and clinical practice. Further development and psychometric evaluation of the PRF-T2DM is warranted.

Am I sure I want to go down this road? Hesitations in the reporting of child maltreatment by nurses

PURPOSE

The purpose of this study was to explore the process of mandated reporting of child maltreatment by pediatric nurses.

DESIGN & METHODS

Qualitative description using a grounded theory lens was used with a cross-section of pediatric nurses.

RESULTS

A point of divergence in the reporting process appears to occur at the first of three moderating points. When nurses hesitate at this first point, decision-making becomes complex and delays the reporting process, giving rise to two themes: "It's the law" and "The ones that haunt you."

PRACTICE IMPLICATIONS

Increasing educational efforts focused on the recognition of child maltreatment may impact nurses' low rate of reporting.

Experiences of teens living in the shadow of Huntington Disease

Research on families with Huntington Disease (HD) has primarily focused on adult decision-making surrounding predictive genetic testing and caregiver stress. Little is known about the experiences of teens living in these families. This qualitative study explored the experiences of 32 teens living in families with HD. Six focus groups were conducted across the U.S. and Canada. Data were analyzed using descriptive qualitative analysis. Huntington disease appeared to cast a shadow over the experiences described by teens. Four themes were identified: watching and waiting; alone in the midst of others; family life is kind of hard; and having to be like an adult. These experiences highlight the need for genetic counselors, health care providers, and school personnel to be aware of issues facing teens living in families with HD. Recognizing patterns of teen experiences may help health care providers develop strategies to support coping by teens in HD families.

An overview of research designs relevant to nursing: part 2: qualitative research designs

This second article of the series An Overview of Research Designs Relevant to Nursing presents qualitative research designs. Phenomenological, ground theory, ethnography, narrative inquiry, and other related qualitative-related research methodologies are described. In addition, the importance of qualitative research as groundwork for quantitative studies is discussed. This link between qualitative and quantitative research is fundamental to promote evidence-based nursing practice.

An overview of research designs relevant to nursing: Part 1: quantitative research designs

This three part series of articles provides a brief overview of relevant research designs in nursing. The first article in the series presents the most frequently used quantitative research designs. Strategies for non-experimental and experimental research designs used to generate and refine nursing knowledge are described. In addition, the importance of quantitative designs and the role they play in developing evidence-based practice are discussed. Nursing care needs to be determined by the results of sound research rather than by clinical preferences or tradition.

Draw-and-tell conversations with children about fear

As the demand to include children in research increases, researchers are discovering that few methods exist that are specifically designed with children in mind. In this article, the author introduces the draw-and-tell conversation as a child-centered and child-directed approach to data collection and illustrates its use in a qualitative study of children's fear experiences. Twenty-two children, ages 7 and 8 years, participated. Sequential mixed qualitative analyses suggest that children's draw-and-tell conversations provide new insight into how children describe and experience fear and highlight the unique nature of information accessed when using this approach.