Functional Independence of Children With Myelomeningocele: Is It Associated With the Informal Caregivers' Burden?

PURPOSE

This study aims to evaluate the association between the functional independence of children after postnatal spinal dysraphism correction and informal caregivers' burden.

DESIGN AND METHODS

This is a cross-sectional study conducted in a child neurosurgery clinic at a University hospital. We included informal caregivers of children between six months and seven-and-a-half years old who were operated on for spinal dysraphism correction due to myelomeningocele. Functional independence was assessed using the Pediatric Evaluation of Disability Inventory (PEDI). Caregivers' burden was assessed through the Caregiver Burden Scale (CBS).

RESULTS

Twenty-six caregivers were assessed, all mothers, aged 18-42years. Five provided child care and engaged in paid work. Regarding functional independence, 23.1% of the children were classified as needing supervision, 23.1% moderate assistance, 42.3% maximal assistance, and 11.5% total assistance. Median value for the overall CBS was 27.0 (22.0-53.0). The mean global CBS score was 1.42 and the mean PEDI score was 1.95. Correlations between PEDI and CBS scores were very close to zero.

CONCLUSIONS

We found no association between the functional independence of children with myelomeningocele from 0 to 7years old and the burden of informal caregivers.

PRACTICE IMPLICATIONS

The effect of functional independence of children with myelomeningocele may be balanced by the caregivers' resilience so that caregivers' burden is not dependent upon the child's independence.

Myelomeningocele, avocados, and rubber tree plants

Infants with myelomeningocele and the nurses who care for them have something in common. Both are at higher risk than the general population for developing latex allergies. This article provides a review of the literature regarding latex production, latex allergic responses in children and adults, types of latex allergic reactions, and prevention of latex allergies.

Children With Chronic Continence Problems

For families who are raising children with myelomeningocele, bowel and bladder incontinence presents unique challenges for everyday life. The Parenting and Childhood Chronicity model is used to describe the work of raising a child with a chronic condition in 6 areas, including medical care, adapted parenting, dealing with the systems, caring for siblings, maintaining relationships, and personal coping (keeping yourself going). This article provides an overview of the physiologic and developmental challenges inherent in this neural tube defect and illustrates the work that is involved in the child's care and the challenges of maintaining a balance in family life. Clinical implications are discussed, including the setting of appropriate expectations, providing parents with accurate information, ensuring that a focus on continence is not at the expense of other important aspects of the child's functioning, and supporting parents in their interaction with the school system. The medical team, consisting of nursing, urology, nephrology, and psychology working together, can be a strong support for families.

[Nursing care for myelomeningocele in infancy]

After studying the factors which most often lead to the hospitalization, recuperation and treatment facilitating release from hospitalization of newborns affected by myelomeningocele, we present this treatment plan. One commences with an evaluation, after which various problems are detected. Once identified, establish priorities setting objectives to meet and their corresponding dates; continue by drawing up an action plan which lists those activities that help achieve one's objectives. The purpose of this plan is to provide individualized quality treatments as well as to create a relaxed, confidential atmosphere in which parents express their fears while becoming secure in their practice of those treatments their child needs in their home.

Perceptual accuracy and gender-related differences in parents of children with myelomeningocele

The ability to perceive accurately is central to efficient and optimal use of health care resources. Many factors may affect parental ability to achieve this accuracy including concepts pertinent to perception theory and gender of the parent. Facets of person perception theory, gender-related differences between parents and suggestions for nursing care are discussed in the context of caring for a child with myelomeningocele.

The determinants of successful self-catheterization programs in children with myelomeningoceles

Myelomeningocele is a birth defect that results in lifelong consequences for the child and family. One of the abnormalities that results from the defect is a neurogenic bladder. Most children with myelomeningoceles will require a clean intermittent catheterization (CIC) program for continence. Yet, many children do not have success with these programs. The purpose of this report is to identify in the literature components of a successful self-catheterization program. The importance of proper urinary management in children with myelomeningoceles will be discussed. Physiological, developmental, and motivational qualities that are present in successful self-catheterization programs will be identified. The importance of knowing when the child is ready to learn, how to know when the child is ready to learn, and different styles of teaching self-catheterization will be discussed. Finally, nursing implications for children on CIC programs will be described.

The sociocultural context of families with a child with myelomeningocele

The purpose of this article is to describe in greater detail the sociocultural context of, and its level of supportiveness for, families with a child with myelomeningocele. Using the Family Management Style framework and a semistructured interview guide, the authors interviewed 30 mothers and fathers in this qualitative study. Families were stratified by age of the child with myelomeningocele. Fifteen categories reflecting components of the sociocultural context were identified. Across the fifteen categories, three major themes emerged: (a) Sharing Information, (b) Interpersonal Interactions, and (c) Supports/Hindrances. Levels of supportiveness across the three themes were described as supportive, moderately supportive, moderately nonsupportive, and nonsupportive. An exemplar case is presented for each. To assist families better, nurses need to assess each family's sociocultural context and its perceived level of supportiveness in the course of managing the child's chronic condition. Families require developmentally appropriate and current information specific to their situations. Interpersonal interactions should be individualized with a goal of empowering the family. Nurses should also determine supports or hindrances that may be modified through the plan of care.

Perceptions and concerns of the school-age siblings of children with myelomeningocele

Chronic illness affects all members of the family, including siblings. Siblings of children with myelomeningocele have been studied infrequently. This descriptive study examined the perceptions and concerns of the school-age siblings of children with myelomeningocele and compared sibling responses with maternal perceptions of the sibling relationship. The effects of age, birth order, and gender were also examined. Fifteen children and their mothers participated in the study. Data were collected through a sibling interview and maternal survey. Qualitative analysis of the sibling responses revealed a high level of empathy and concern for their brothers and sisters with myelomeningocele. Maternal responses yielded similar findings. No statement could be made regarding the effects of age, birth order, or gender upon the sibling relationship. Nurses are in a unique position to assess the perceptions and concerns of siblings, and to intervene to ensure that their needs are met and their contributions to family life recognized.

Continuity of care through nursing case management of the chronically ill child

In the care of the chronically ill or disabled child, continuity of care between hospital and home must be prompt and continuous. In our myelomeningocele clinic, continuity of care is maintained through a nursing case management system. Our definition of case management is derived from the definition of service coordination made by the Ohio State Bureau for Children with Medical Handicaps. The service coordinator is a CNS who works for health care coordination by bringing together all health care services that are needed for a child with a disabling condition. We describe the aspects of that care coordination, including a thorough definition of our nursing case management process.

Community nursing needs of newborns with myelomeningocele and their families

The needs of newborns with myelomeningocele are a special challenge to the community health nurse. An in-depth knowledge of the pathophysiology of myelomeningocele, the ability to act as a communication channel between agencies, and the provision of ongoing advocacy, supportive counseling, and education to individual families and the community are necessary in addition to standard nursing care. Community health nurses provide this vital link in the holistic care of children with myelomeningocele and their families.

Stress and coping in families of children with myelomeningocele

This pilot study examined differences in and relationships between parent health-related stressors (child care needs and parental concerns), daily hassles, and coping strategies of 17 mothers and 17 fathers of preschool and school-age children with myelomeningocele (MMC). Help related to play was the most frequent need among mothers; fathers needed the most help with school activities. Among the greatest concerns of both parents were their child's future and sufficient income. Too many things to do was a frequently mentioned hassle by both parents. Having faith in God was the coping strategy mentioned most often by both parents.

A brighter future for adults who have myelomeningocele--one form of spina bifida

Recently a new population of adults with myelomeningocele, the most severe form of spina bifida, has emerged. Because of the complex issues challenging these adults, specialized health care services provided by a multispecialty team are recommended. With the hope that similar services will be developed, the establishment of one specific teen/adult spina bifida multispecialty team is discussed in this article. An overview of myelomeningocele is presented, which includes adult focused physical/cognitive/social-emotional challenges and goals, potential medical problems, and opportunities for nurse leadership.

[Problems in managing the newborn infant with lumbosacral meningomyelocele: basis for comprehensive care]

Newborns affected by spina bifida with myelomeningocele has been managed in Bologna by a team of neurosurgeons and neonatologists, whose experience is described here. Among the main problems faced during a ten years period are: selection of infants for surgical correction, treatment schedule and follow up program, nursing protocol in an intensive care unit. Basing on their personal work and an exhaustive literature's revision, the authors emphasize the opportunity of delaying surgery until local and general conditions are improved and a careful evaluation of the patient has been achieved. An appropriate pre and post operative nursing is mandatory. But the whole therapeutic program and furthermore any rehabilitation chance has their cornerstone in a full cooperation among the several specialists involved. The neonatologist first, the family pediatrician later can act as the pivot for the team, in order to achieve a comprehensive approach and an "overall" management for the individual affected child.

Peter: an infant with a myelomeningocele

Caring for a child with a myelomeningocele is not a task that one person can accomplish on his own. An interdisciplinary team approach, early parental involvement in the baby's care, a thorough knowledge of community resources, and parental understanding of the long range implications will greatly influence and affect Peter's early years. With support from both professionals and relatives and friends, it is hoped that they will develop a positive attitude to this challenge and continue to demonstrate their love and concern for Peter.