A Systematic Review of Experimental Studies on the Impact of Empowerment-Based Interventions on Child and Parent Outcomes in the Pediatric Oncology Setting.

Background: Cancer has an impact not only on children but also on parents. Parents play the most crucial role in cancer's symptom control and management. However, as the primary caretakers, parents are frequently unprepared or engage in inappropriate behavior when caring for their children. Increasing parents' role through empowerment is critical in pediatric cancer care. Purpose: This systematic review aimed to identify the effect of empowerment interventions on parent and child outcomes in pediatric oncology. Methods: In this review, studies published between 2013 and 2023 in The Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Embase, Medline, and Scopus databases were identified using a search strategy to identify relevant studies that determined empowerment-based intervention for parents in the pediatric oncology. This study used the Joanna Briggs Institute (JBI) critical appraisal tools to assess the quality of the studies. This systematic review followed the recommended reporting items for systematic reviews and meta-analysis (PRISMA) standards. Results: Seven studies met the inclusion criteria: four randomized and three non-randomized experimental studies. Children range in age from 1-14 years. The intervention is mostly delivered through face-to-face learning using booklets or modules as a learning tool. The intervention is delivered in 2-6 sessions over 1-8 weeks, lasting 20-45 minutes each. In most studies, the interventions positively affect parents' outcomes (knowledge, caring behavior, distress, care burden, quality of life) and children's outcomes (oral mucositis, gastrointestinal complications, quality of life). The intervention, however, has no significant effect on the coping style. Barriers to implementation include parent-nurse commitment, the retention of parent-nurse participation, and more time spent to provide interventions. Conclusion: Our study highlights that empowerment-based interventions positively impact parents and children. These findings suggest that an empowerment-based intervention should be developed to provide better cancer care for a parent and their children. Systematic Review Registration: PROSPERO registration number was CRD42023422834.

Uncertainty of parents due to having children with cancer: A concept analysis.

Background: Parents of newly diagnosed cancer children often experience significant concerns about the implications of the diagnosis. They find themselves in challenging decision-making situations, navigating through uncertain conditions following the disclosure. Uncertainty is a prevailing issue in healthcare, yet its interpretation and application within the context of health and nursing practice exhibit multiple meanings and variations. Objective: This study aimed to clarify the concept of parental uncertainty arising from having children with cancer. Methods: The concept analysis followed the steps outlined by Walker and Avant. A thorough literature search was conducted using the Embase, CINAHL, and MEDLINE databases to identify articles published between 1980 and 2022. Results: The literature search yielded 147 articles from various disciplines, including health, nursing, medicine, psycho-oncology, and management. After analysis, 20 articles were selected for inclusion. This study identified four key attributes of parental uncertainty associated with having a child with cancer: (1) emotional disturbance, (2) unpredictability, (3) insufficient information, and (4) problems with decision-making. The antecedents of parental uncertainty encompassed the complexity of the disease, the diagnostic and treatment processes, the hospital environment, communication, and support from credible authorities. The consequences of parental uncertainty included the pursuit of new information, parental adaptability to their role, and parental distress. Conclusion: Understanding the four attributes of parental uncertainty, along with their antecedents and consequences, can facilitate the future development and operational translation of the concept of uncertainty in nursing practice. This concept is valuable in the evidence-based provision of nursing care to parents of children with cancer, enabling comprehensive recognition and assessment of parental uncertainty and the implementation of appropriate interventions that are sensitive to parental experiences. Ultimately, this approach promotes the adaptation of both the child and the parent.

The Experience of Uncertainty in Mothers Caring for Children at Home after Palliative Heart Surgery.

Objectives: Palliative heart surgery is a compelling option for some children with congenital heart disease for which corrective heart surgery is not yet possible due to its complexity. As primary caregivers, mothers have the challenge of providing optimal care to their children at home post-surgery. This study aims to explore the experiences of mothers who are caring for children recovering from palliative heart surgery at home. The research applied descriptive, qualitative and phenomenology design. Material and Methods: This study was conducted in Jakarta. The participants were 15 mothers of palliative heart surgery patients from seven provinces in Indonesia; Jakarta, Aceh, Bali, North Sumatra, West Java, Central Java and Banten. Data were collected using semi-structured interviews through the WhatsApp video call application and analysed using the Colaizzi method. Results: Mothers often felt uncertain about how to provide the best care and felt that their needs for hospital services to assist them went unmet. Conclusions: This study has implications for the development of nursing services related to discharge planning for palliative heart surgery patients.

Motivation of male adolescents to become perpetrators of violence: a study of phenomenology.

BACKGROUND: Violence committed by adolescents is a serious public health problem. More than ten percent of youth violence have been subjected to violence and more than fifty percent attacks and serious violence. DESIGN AND METHODS: A qualitative study with a phenomenological study design in which semi-structured interviews were conducted with participants who were once challenged by violence and are now kept in LPKA Class II Jakarta. RESULTS: This qualitative study explores adolescent motivation to become violent perpetrators. This study discusses four major themes, namely, i) Unsafe environmental conditions; ii) Unpleasant past experiences; iii) Childhood trauma; and iv) Peer group solidarity or friendship. CONCLUSIONS: Adolescent motivational advice provides protection for students in Indonesia to participate in discussions about children related to challenges or assistance that can be given to adolescents so as not to offend again.

Blow pinwheels improve oxygen saturation of preschool children with post pneumonia in outpatient pediatric departement.

This study aimed to recognize the Pursed Lips Breathing (PLB) modification effect by blowing pinwheel to the oxygen saturation of preschool children with post pneumonia. Also, to analyze the oxygen saturation value of the preschool children with pneumonia on the intervention group and the control group and to recognize the differences. This study design was quasi experimental pre-posttest with control group design. The participants were 30 preschool children with post pneumonia (15 children were in the intervention group, 15 were in the control group) and were chosen by consecutive sampling. This study showed significant differences on oxygen saturation between the intervention group and control group (p=0.018<0.05). Blowing pinwheel affected the oxygen saturation of the preschool age with pneumonia on the intervention group but none on the control group. The results of this study can be used as the basis and reference for the hospital in making policies, as founded that blowing pinwheel affected the oxygen saturation escalation of the preschool children with pneumonia after several exercises. This activity was recommended to be implemented at the hospital as the treatment for the outpatient children with pneumonia and to be carried on at home for the preschool children who were able to perform independently. The recommendation for the further study was to use a true experiment with a larger sample and was not limited to PLB but also to measure the ability to blow.

Effectiveness of a conservation energy model for febrile neutropenia in children with cancer.

Febrile neutropenia is a complication of chemotherapy that occurs in children with cancer. This paper aimed to provide an overview of the application of the Levine Energy Conservation Model for treating fever neutropenia in children with cancer. The method involved a case study of five children with cancer treated for febrile neutropenia using the nursing process approach. The nursing process, according to the Levine Energy Conservation Model, focuses on increasing the body's adaptability through four forms of conservation, namely, the conservation of energy, personal integrity, structural integrity, and social integrity. Trophicognosis in the five cases under management identified hyperthermia and the risk of infection transmission. Other nursing problems were nutritional imbalances that were less than the body's needs and the risk of bleeding. These problems can hinder the process of adapting children with cancer to the challenges of disease and the treatment of side effects in achieving self-integrity.

Appreciation family support and the abilities of children with special needs to maintain personal hygiene: an Indonesian case study.

Family support is needed to empower children with special needs to maintain personal hygiene, includes information, instrumental, emotional, and appreciation support. The study design was cross-sectional, involving 84 parents of children with special needs. The study was conducted via the respondents filling out a questionnaire consisting of three sub-questionnaires. The results showed no relationship between the characteristics of children with special needs and personal hygiene; there was also no relationship between parental characteristics and personal hygiene (P>0.05). There was, however, a relationship between information, instrumental, emotional, and appreciation support and personal hygiene (P<0.005), the most influential support being appreciation support. In conclusion, there was a significant relationship between information, instrumental, emotional, and appreciation support and the ability of children with special needs to maintain their personal hygiene. The recommendations for future studies are different research methods to explore more about the types of family support.

Correlation between parents' self-efficacy and quality of life of children with cancer aged 8-12 years.

This study aims to determine the correlation between parents' self-efficacy and the quality of life of children with cancer aged 8-12 years. Quantitative research using a crosssectional design was carried out on 39 parents and 39 children with cancer. The participants were selected using a consecutive sampling method. The measurement instruments used were the Self-Efficacy for Parenting Task Index (SEPTI), the Pediatric Quality of Life InventoryTM (PedsQLTM) 4.0 Generic Core Scale, and the PedsQLTM 3.0 Cancer Module in the Indonesian version. Data analysis was performed using Pearson's correlation coefficient. The results showed that parents' self-efficacy and the quality of life of children were strongly correlated and that the direction of the correlation was positive (r= 0.680). Parents' self-efficacy and quality of life children with cancer were also strongly correlated, and the direction of the correlation was positive (r = 0.715). It is recommended that parents and children with cancer ensure the adequate management of cancer treatment.

The Relationship between Activity Level and Fatigue in Indonesian Children with Acute Lymphocytic Leukemia in the Home Setting.

Previous studies have examined physical exercise as a way to lower the fatigue of children with cancer in a hospital setting, but there have been no such studies in a home setting. Therefore, this study identifies the relationship between physical activity and fatigue in children undergoing chemotherapy at home. The design of this study is a cross-sectional correlation analysis. Forty-five children aged 3-16 years with acute lymphocytic leukemia residing in the greater Jakarta area in Indonesia were recruited using consecutive and snowball sampling methods. The relationship between physical activity and level of fatigue was assessed using the Spearman test. A statistically significant relationship was found between physical activity and fatigue in the children studied (p < 0.001). The active children had lower fatigue than the less active children. This study finds that higher physical activity is associated with lower fatigue in children with leukemia in a home setting. Nurses should educate children and their parents to promote physical activities at home in-between chemotherapy cycles.

The Relationship of Oral Care Practice at Home with Mucositis Incidence in Children with Acute Lymphoblastic Leukemia.

Mucositis is a common and devastating side effect of chemotherapeutic agents in children undergoing chemotherapy. The prevention and management of mucositis are necessary to improve these children's quality of life. Oral care is a recommended strategy for preventing and managing oral mucositis. Thus, the objective of this study was to identify the relationship between oral care practice and mucositis incidence. A cross-sectional analytical design was used in this study. A total of 34 children from 3 to 12 years of age with acute lymphoblastic leukemia who were in the last cycle of chemotherapy were recruited through a snowball sampling method. The Oral Assessment Guide (OAG) was administered to assess the severity of mucositis. A majority of the participants (51.5%) had mucositis after completing the last cycle of chemotherapy. Furthermore, there was a statistically significant relationship between their oral care practice at home and mucositis incidence. These results show that oral care at home is linked with the incidence and severity of mucositis. Nurses should educate children with leukemia and their parents regarding good oral hygiene practice.

Still Hoping for a Miracle: Parents' Experiences in Caring for their Child with Cancer Under Palliative Care.

CONTEXT: Parents' despair and feelings of grief, as well as communication and coordination that is less than adequate between the parents and the palliative team, can affect the provision of a qualified palliative care plan for children and their families. AIMS: This study aims to explore the parents' experience in caring for children with cancer under palliative care condition. SETTING AND DESIGN: The research applied descriptive qualitative phenomenology design. SUBJECTS AND METHODS: The study was conducted at Jakarta, Bogor, and Bekasi. Parents who caring their child with cancer under palliative care were in-depth interviewed with open-ended question. Data were then analyzed using the Colaizzi method. RESULTS: This study resulted in two themes, still hoping for a miracle of God and always being surrendered while under palliative care. Parents still hope for a miracle of God to keep having their children during palliative care. The forms of surrendering exhibited by the parents in this study are believing in God, praying to God, saying thanks to God, relying on God, and preparing to face the deaths of their children. CONCLUSION: This study shows that during palliative care, parents cannot be separated from their relationship with God. Therefore, nurses are vital to the continuous assessment of parents' spiritual needs and to the facilitation of need fulfillment involving family and religious figures.

Parents' Voice in Managing the Pain of Children with Cancer during Palliative Care.

CONTEXT: Pain experienced by children can adversely affect their growth and development. Pain is a major health problem for cancer patients and remains an unresolved problem. AIM: To know how the experiences of mothers managing their children's pain during palliative care following cancer diagnosis. BACKGROUND: Pain experienced by children can adversely affect their growth and development. SUBJECT AND METHODS: Using qualitative methods within a descriptive phenomenological approach, in-depth interviews were conducted with parents (mostly mothers) of eight children diagnosed with cancer. The data were collected using the snowball sampling method. RESULTS: Participants experienced in managing the pain of children with cancer. Analysis of the results identified 8 themes: the dimensions of pain experienced by children undergoing palliative care; mothers' physical and psychological responses; mothers' emotional responses; barriers encountered by mothers when taking care of their child at home; mothers' interventions to reduce their child's pain; mothers' efforts to distract their child from pain; giving encouragement when the child is in pain; and mothers' efforts and prayers to make their child comfort. CONCLUSION: It can be concluded that the child's pain is the main cause of mothers' stress and pressure and also affects the daily lives of mothers and children. Along with the most effective intervention, nurses need to provide mothers and children with adequate information about cancer pain.

Phenomenology Study on Nurses' Experiences in Understanding the Comfort of Children at the End-of-Life.

CONTEXT: Patients' need for comfort at the end of their lives is rarely fulfilled. The comfort of patients at the end of their lives, especially children, is affected by nurses' understanding of what comfort means. AIMS: This research aims to explore and to understand the meaning of children's comfort at the end of their life for nurses. SETTING AND DESIGN: The research applied descriptive qualitative phenomenology design. SUBJECT AND METHODS: The study was conducted at Jakarta. Nurses who have experience in caring the child at the end of their life were in-depth interview with an open-ended question. Data were then analyzed using the Colaizzi method. RESULTS: This research identified six themes: striving to reduce children's suffering, realizing what children wanted, observing the children felt comfortable in their family's acceptance of their condition, facing internal and external conflict, experiencing mixed feelings knowing the children's condition, and requiring support from all parties. CONCLUSION: Nurses should provide information regarding children's end of life conditions to the family, to achieve family acceptances. Eventhough it was hard situation and rose internal conflict to nurses. It was found that children also felt comfortable at the end-of-life when they did not experience any suffering, and their wishes were granted. Subsequently, the nurses did not have mixed feelings when the children died. Therefore, evaluation of the training effectiveness that has been given to the nurses should be done to fulfill the need of the child's comfort at the end-of-life.