Checklists for Assessing Skills of Children With Type 1 Diabetes on Insulin Injection Technique.

BACKGROUND: School-aged children often participate in type 1 diabetes (T1D) self-care tasks. Despite widespread discussion about the importance of developing self-care skills in childhood, few explain how the health care team should assess the skills of children with T1D when performing insulin injections. OBJECTIVE: We sought to assess content validity evidence in two checklists regarding injection technique performed by children. METHODS: Two checklists were designed based on a systematic review of the insulin injection technique. Experts in pediatric diabetes, health literacy, and diabetes education assessed the checklists regarding their clarity, objectivity, and relevance. Content validity was assessed using the content validity ratio (CVR). RESULTS: Eleven providers (72% nurses or physicians, professional experience 19.4 ± 10.1 years, 45% of specialists in endocrinology, and 18% in pediatrics) participated in the assessment. Experts considered items containing the word homogeneity inappropriate. Items related to the needle insertion angle and the skin fold did not reach the CVR critical value. The final version of the checklist for syringe injection comprised 22 items with CVR = 0.91, and the checklist for pen injection comprised 18 items with CVR = 0.87. CONCLUSIONS: The checklists presented clear, objective, and relevant content that assesses the skills of children with T1D for insulin injection. The checklists formally present the order of the technique and all the steps for insulin injection and allow a quantitative assessment of the operational skills of children. The developed instruments offer providers the possibility of continuous assessment of the progress of the pediatric clientele until they reach independence in diabetes self-care.

(Re)Establishment of fatherhood among fathers of children with mental disorders: A qualitative metasynthesis.

This metasynthesis synthesized and interpreted qualitative research results on the experience of fathers who care for children with mental disorders. It followed the guidelines from the Enhancing Transparency in Reporting the Synthesis of Qualitative Research statement. A search was conducted in five databases. The Critical Appraisal Skills Programme qualitative research checklist was used to evaluate the quality of the studies, and the Confidence in the Evidence from Reviews of Qualitative Research (Grade-CERQual) approach was used to assess review findings. Thematic analysis of 12 articles included yielded the theme (re)establishment of fatherhood and four subthemes: redefinition of expectations, redefinition of the fatherhood role, benefits achieved with increased father involvement, and strengths and challenges in fatherhood, all of which demonstrated how repercussions from diagnosis and redefinition of expectations of masculinity and fatherhood affected the way fathers exercise fatherhood. Fathers were participative and attentive to their child's needs, even in a challenging context demanding integration of care with work obligations. This metasynthesis highlights challenges faced by fathers in acquiring new skills and competencies while caring for their children. The findings identify a need for interventions to facilitate fathers' involvement in caring for their children.

Using Photo-Elicitation Interviews With Families of Children and Adolescents With Chronic Illness.

BACKGROUND: Despite the increasing number of studies using photo-elicitation for data collection in qualitative research, there is a need to further explore its use among families of children and adolescents living with chronic illness. OBJECTIVE: The aim of this study was to discuss methodological and pragmatic considerations about the use of photo-elicitation interviews (PEIs) for data collection with families of children and adolescents living with chronic illness. METHODS: We discussed methodological aspects of using PEIs as reported in publications. A search of the literature was carried out to identify articles presenting information on methodological aspects of the use of PEIs in qualitative data collection, regardless of age group. In pursuit of complementing the evidence with pragmatic considerations of using PEIs, we illustrate with an example of a recent qualitative study of our own that aimed to understand the narratives about hope of families of children and adolescents living with chronic illness. RESULTS: We synthesized common aspects that need to be considered when using PEIs with different populations: ethical issues, cameras, guidance, and interviews. We also presented our experience of using the PEI technique to collect data from families. Because of our experience, we denominate our method as the "family photo-elicitation interview" (FPEI). Our method goes beyond the PEI technique because it integrates aspects of family nursing theories when conducting interviews with families. FPEIs strengthen family interaction and allow family members to share their perspectives. DISCUSSION: We present a new perspective of PEIs-the FPEI-in the pediatric context. Previous studies have not addressed considerations about using PEIs for families. We hope our results assist novice researchers in planning and implementing FPEIs in qualitative research. We recommend that researchers explore the use of FPEIs in other contexts, such as geriatrics or palliative care.

Therapeutic play to teach children with type 1 diabetes insulin self-injection: A pilot trial in a developing country.

PURPOSE: Child participation in type 1 diabetes (T1D) self-care is needed in developing countries due to a lack of resources, especially during the school day. This pilot study evaluated the feasibility of a therapeutic play intervention (ITP) versus standard education (SE) on the ability of children with T1D to correctly perform insulin injection technique. DESIGN AND METHODS: Children with T1D (7-12 years) were recruited at two diabetes clinics in Brazil and randomized to ITP or SE. Registered nurses received protocol training to deliver the intervention and perform data collection. ITP group received an education that included a story about a child with T1D who self-injects insulin at school; SE group received routine clinic-based education. Preintervention, children were video-recorded giving insulin injections to a doll; postintervention, children were rerecorded giving the doll an injection. The research team reviewed the videos and assessed the injection technique using validated checklists. Parents reported children's self-injection practices at baseline and 30 days. RESULTS: Children (N = 20, 40% male) were 9.6 ± 1.3 years old and had T1D for 3.6 ± 2.3 years; HbA1c was 9.1 ± 2.0%; 20% of ITP and 50% of SE children used syringes (vs. pens) for injections. At baseline, 80% of both groups knew how to self-inject; most were taught by a parent/relative. Injection technique scores were low in both groups; ITP group increased their scores significantly postintervention. Practices of self-injection did not change in either group after 30 days. PRACTICE IMPLICATIONS: The play-based intervention appeared to improve the injection technique in the short-term. Pilot findings support the development of a larger trial to evaluate the effectiveness of ITP on educating children on insulin injections.

Clown Intervention on Psychological Stress and Fatigue in Pediatric Patients With Cancer Undergoing Chemotherapy.

BACKGROUND: Clown intervention has been shown to enhance emotional and behavioral processes, but few studies have comprehensively examined the effectiveness of this practice using biomarkers. OBJECTIVE: The aim of this study was to evaluate the effect of a clown intervention on the levels of psychological stress and cancer-related fatigue in pediatric patients with cancer undergoing chemotherapy. METHODS: Sixteen patients who met all criteria from a pediatric oncology inpatient unit in a Brazilian comprehensive cancer care hospital participated in this quasi-experimental study. Eight saliva samples were collected, comprising 4 at baseline and 4 after clown intervention (+1, +4, +9, and +13 hours after awakening). Salivary cortisol and α-amylase levels were determined using high-sensitivity enzyme-linked immunosorbent assay kits. Stress and fatigue were measured by the Child Stress Scale-ESI and the PedsQL Multidimensional Fatigue Scale, respectively. Relationships among stress, fatigue, and biomarker levels were investigated using nonparametric statistics. RESULTS: In comparison with baseline measurements, the total psychological stress and fatigue levels improved after the clown intervention at the collection time point +4 hours (P = .003 and P = .04, respectively). Salivary cortisol showed a significant decrease after clown intervention at the collection time points +1, +9, and +13 hours (P < .05); however, α-amylase levels remained unchanged. CONCLUSION: These findings provide preliminary evidence that clown intervention merits further study as a way to reduce stress and fatigue in pediatric cancer inpatients, and that self-report and biomarker measures are feasible to collect in this patient group. IMPLICATIONS FOR PRACTICE: Clown intervention as a nonpharmacological intervention may improve stress and fatigue levels in pediatric inpatients with cancer undergoing chemotherapy.

Determinants of Female Sexual Function in Breastfeeding Women.

Knowledge about the determinants of female sexual function in breastfeeding women is limited. A total of 355 breastfeeding women completed the Female Sexual Function Index (FSFI) and the Qol-8 quality of life questionnaire. FSFI scores decreased in the first six months of breast feeding. There was a positive relationship between FSFI scores and the importance of sex, level of communication, income, quality of life, and receiving brief sexual counseling.

Children With Type 1 Diabetes Mellitus: Self-Management Experiences in School.

BACKGROUND: Children with type 1 diabetes mellitus (T1DM) need to perform self-management activities at school and in other environments. Learning about their experiences at school is crucial to assist them in this challenging task. METHODS: Qualitative interviews were conducted with children with T1DM, aged between 7 and 12. A scenario was created and puppets were used during the interviews to help the participating children to communicate about school, daily routines, and experiences in diabetes management. Data were collected over a period of 1 year and analyzed according to content analysis procedures. RESULTS: Nineteen children, 13 boys and 6 girls, at the mean age of 9.8 ± 1.8 years and mean time since diagnosis of 3.3 years, participated in the study. Three themes were identified: lack of information on T1DM, diabetes self-care at school, and support received by the children. CONCLUSIONS: The study provides useful information to understand the children's experiences in managing the disease at school. The partnership between school staff, health teams, children with T1DM, and their families need to be enhanced to promote appropriate strategies that improve the management of diabetes in this setting.

Roles assessment in families of children with chronic renal failure on peritoneal dialysis.

Families with a child on chronic peritoneal dialysis have to assume a significant burden of care, intensifying the demands and the reorganization of roles in the families of children. The purpose of this study is to describe the implications of role changes in families of children with chronic renal disease on peritoneal dialysis. This is a case study of four families of children with chronic renal disease on peritoneal dialysis. Fourteen family members participate in the study. After the child's chronic kidney failure and the start of treatment, each relative's ways, acts and functions are changed, maintained or adapted to the new family dynamics, imposed by the child's treatment conditions. Appropriate role assessment provides the nurse and the families of children with chronic renal failure on peritoneal dialysis with insight regarding current and potential health problems and aids in identifying the needs of the families.

Genograma e ecomapa: possibilidades de utilização na estratégia de saúde da família / Genogram and ecomap: possibility to use in the family health strategy

Conhecer a estrutura da família, sua composição, como os membros se organizam e interagem entre si e com o ambiente, os problemas de saúde, as situações de risco, os padrões de vulnerabilidade, é vital para o planejamento do cuidado à saúde da família. Este estudo objetiva descrever a aplicação dos instrumentos genograma e ecomapa em duas famílias cadastradas no Núcleo de Saúde da Família IV do Centro de Saúde Escola de Ribeirão Preto da Universidade de São Paulo, com vistas à reflexão sobre sua utilização no PSF. É um estudo descritivo-exploratório, fundamentado na literatura e na experiência das autoras quanto à utilização do genograma e ecomapa como um instrumento de coleta de dados em entrevistas com famílias. A aplicação destes instrumentos possibilitou informações sobre as famílias e suas relações entre si e com a comunidade, constituindo-se em uma ferramenta para ordenar as informações sobre a família, de forma prática, para o cuidado da saúde centrado na família. Concluiu-se que esses instrumentos podem ser adotados pela equipe de saúde da família como uma forma de abordar a família, de modo que esta se sinta participante do processo de coleta de informações, bem como possibilita conhecer a família no que tange à estrutura familiar, cultura, ciclo de vida, relações e inter-relações.

Genograma e ecomapa: possibilidades de utilização na estratégia de saúde da família / Genogram and ecomap: possibility to use in the family health strategy

Conhecer a estrutura da família, sua composição, como os membros se organizam e interagem entre si e com o ambiente, os problemas de saúde, as situações de risco, os padrões de vulnerabilidade, é vital para o planejamento do cuidado à saúde da família. Este estudo objetiva descrever a aplicação dos instrumentos genograma e ecomapa em duas famílias cadastradas no Núcleo de Saúde da Família IV do Centro de Saúde Escola de Ribeirão Preto da Universidade de São Paulo, com vistas à reflexão sobre sua utilização no PSF. É um estudo descritivo-exploratório, fundamentado na literatura e na experiência das autoras quanto à utilização do genograma e ecomapa como um instrumento de coleta de dados em entrevistas com famílias. A aplicação destes instrumentos possibilitou informações sobre a família e suas relações entre si e com a comunidade, constituindo-se em uma ferramenta para ordenar as informações sobre a família, de forma prática, para o cuidado da saúde centrado na família. Conclui-se que esses instrumentos podem ser adotados pela equipe de saúde da família como uma forma de abordar a família, de modo que esta se sinta participante do processo de coleta de informações, bem como possibilita conhecer a família no que tange à estrutura familiar, cultura, ciclo de vida, relações e inter-relações.(AU)

The family structure, its composition, how its members are organized and interact among themselves and with the environment, its health problems, the risk situations, the vulnerability patterns are fundamental facts to plan the family health care. The main in this study is to describe the genogram and ecomap application by families' subscript in the IV Health Family Nucleus of Ribeirão Preto School of São Paulo University, for a reflection about its use in Health Family Program. It is a descriptive and exploratory study that is supported by the literature and authors' experience about the genogram and ecomap use. The instruments application made some information available about the families and their relationships and the relation with the community. Then these instruments are possible tools to acquire and put in order the families' information for the Family Health care. It can be used by the health family team as a way to approach the family, in this way the family is active in the assessment process. These instruments can show the family structure, the culture, the health cycle, relations and interrelations.(AU)

Genograma e ecomapa: possibilidades de utilização na estratégia de saúde da família / Genogram and ecomap: possibility to use in the family health strategy

Conhecer a estrutura da família, sua composição, como os membros se organizam e interagem entre si e com o ambiente, os problemas de saúde, as situações de risco, os padrões de vulnerabilidade, é vital para o planejamento do cuidado à saúde da família. Este estudo objetiva descrever a aplicação dos instrumentos genograma e ecomapa em duas famílias cadastradas no Núcleo de Saúde da Família IV do Centro de Saúde Escola de Ribeirão Preto da Universidade de São Paulo, com vistas à reflexão sobre sua utilização no PSF. É um estudo descritivo-exploratório, fundamentado na literatura e na experiência das autoras quanto à utilização do genograma e ecomapa como um instrumento de coleta de dados em entrevistas com famílias. A aplicação destes instrumentos possibilitou informações sobre as famílias e suas relações entre si e com a comunidade, constituindo-se em uma ferramenta para ordenar as informações sobre a família, de forma prática, para o cuidado da saúde centrado na família. Concluiu-se que esses instrumentos podem ser adotados pela equipe de saúde da família como uma forma de abordar a família, de modo que esta se sinta participante do processo de coleta de informações, bem como possibilita conhecer a família no que tange à estrutura familiar, cultura, ciclo de vida, relações e inter-relações.(AU)