The ethical demand in nursing: a scandinavian perspective.

In this column the authors discuss the ethics of information exchange in nursing practice with children. Five concepts identified in three Swedish grounded theory studies and a content analysis that used the theoretical framework of ethical demand were analyzed. A simultaneous concept analysis found five related concepts: being interconnected, acting according to accepted procedure, completeness, interdependence, and social intercourse. These concepts are synthesized in the concept of intergrade, which emphasizes the value of maintaining the integrity of all involved in information exchange.

Observations of health-care professionals sharing and contributing responsibility in paediatric caring situations.

This study aimed to identify, describe and generate concepts regarding health care professionals' information exchanges with minors and/or their parents/guardians in paediatric caring situations. The study took place at three paediatric outpatient units at a university hospital and there were 15 health care professionals involved. Using the grounded theory and the constant comparative analysis methods, the data collection and analysis was undertaken simultaneously, using participant observation, review of medical records and follow-up interviews. The main concern of the health care professionals that emerged as the core category was: sharing and contributing responsibility, interrelated with the six categories; interchanging of knowledge, relationship-creating chat, calculated confirming, encouraging, dichotomous talking and of situation related effects. This research has explored the elements of information exchange in caring situations and highlighted the interaction between the involved persons. These findings could be valuable to health care professionals in order to develop and improve their caring skills.

A change in life as experienced by first-time fathers.

Research suggests that the attitude of men towards pregnancy, childbirth and child-caring is different from that of women. Up to now, research has focused mainly on motherhood. The aim of this study was to explore first-time fathers' experiences during early infancy of their children. Grounded theory and constant comparative method were used and 20 fathers aged 20-48 participated. Interviews were carried out in 2002-2003. 'Changing life' emerged as the core category consisting of the categories: becoming a father, alternating between work and home, changing relationship towards partner and developing relationship with their child. Changing life implied that they have left bachelor life and become responsible for a child. Becoming a father was much more fantastic than they could have imagined and they suggested that they performed childcare to the same extent as the mother when both parents were at home. Still fathers viewed the mother as the main parent, partly because of their alternating between work and home and because the mothers breast-feed the infants. Fathers' attitude towards breast-feeding seemed to be ambiguous; it was a matter of necessity, but made them feel insignificant. Changing relationship towards partner was common but it was not necessarily for the worst and often resulted in a more closely united relationship. However, tiredness because of lack of sleep could result in increased irritability towards problems. Developing relationship with their child implied increasing possibilities to learn to know the infant's signals. Fathers are one of two parents, and hence are important for their child's growth and development, emotional health and cognitive development. Knowledge about first-time fathers' experiences during the early infancy of their children may bring about increased support from midwives and child health nurses.

A review of children's decision-making competence in health care.

AIMS AND OBJECTIVES: The purpose of this literature review was to search for and review, systematically, children's decision-making competence in health care in the scientific literature. Findings of both quantitative and qualitative studies were analysed thematically. BACKGROUND: Most previous research in children's decision-making competence in health care concerns adults' care in the best interests of the child. It is important to consider decision-making competence from the child's perspective because of children's own human rights. METHODS: Systematic review including database search, manual selection, supplementary searching, management and acquisition of relevant literature, quality appraisal, literature review saturation and thematic review. RESULTS: Six themes emerged: measurable issues, values and beliefs, power, parent-related communication, trust and self-determination. Measurable issues were age, reading ability and memory. Values and beliefs as well as power and parent-related communication were associated with healthcare professionals. Children showed trust and expressed a wish to use self-determination. CONCLUSIONS: Age appropriate information and participation were prerequisites for allowing children to have possibilities of making competent decisions about their own care. Children's decision-making competence is dependent on others, such as parents and healthcare professionals, attitudes and not only on their own capacity. Lack of competence, however, does not exclude children from the human right to have a say. It should be noted that it is a decision to leave the determination to a parent or healthcare professional. RELEVANCE TO CLINICAL PRACTICE: Future research from the viewpoint of children is important to reach optimal levels of participation, through respecting their integrity and to develop them into potential competent decision makers.

Information exchange in paediatric settings: an observational study.

AIM: The aim of this observational study was to identify, describe and generate concepts regarding the exchange of information between children/young people and healthcare professionals in paediatric outpatient settings. METHOD: The grounded theory methodology was used. Field notes from observations and excerpts from medical records were analysed using constant comparative analysis. Twenty eight children and young people were observed in three separate paediatric outpatient units; 76 observations were conducted of interactions between children/young people, parents and staff (paediatric nurses, paediatric enrolled nurses and paediatricians). FINDINGS: 'Balancing the circumstances' was identified as the core category during information exchange, based on six categories: taking part, trust, being in touch, mutuality, getting facts and family influence. The six categories relate to one another and balance the circumstances in the information exchange to varying degrees. These children and young people seemed to be trying to enhance their situation as much as possible by finding out as much as they were able to, sharing their own knowledge with the staff and participating in social interaction with them. CONCLUSION: With this understanding of information exchange, nurses can enable and support children and young people to balance their circumstances and improve information exchanges, thereby promoting their partnership in care.

Support of fathers of infants by the child health nurse.

The child health nurse is considered to be able to support fathers in the transition to parenthood, through utilizing the fathers' inherent resources for the best development of the child. The aim of present study was to identify what expectations fathers of infants have of the child health care, including the nurse: whether they feel that they have received support in this role and how they think the nurse can support new fathers. A qualitative descriptive design was used with an inductive approach using grounded theory, which was suitable to obtain knowledge and understanding of how fathers perceived and interpreted their interaction with their child health nurse. Twenty fathers of infants gave their informed consent to participate. They were interviewed and data were systematically analysed on three levels by constant comparative method. From the analysis, the core category trustful relationship was discovered, comprising the categories involvement, faith and support. Nurses ought to reflect on that a father of an infant may feel slighted at the child health clinic if, as traditionally, the nurse turns only to the mother. Many fathers of today want to share the infant care and they want more communication with the nurse. It is suggested that in the long run, support in early fatherhood may be of benefit for the child and for the family. If the father has a trustful relationship with the nurse, his involvement in child health care is presumed to increase, as is the possibility of having faith in the nurse, as well as receiving support in his role as father. The findings are discussed in relation to literature in the field.

The willingness to eat. An investigation of appetite among elderly people.

The aim of this study was to identify and describe factors of importance with regard to appetite among elderly people. A qualitative approach was used and the method was grounded theory. Fifteen elderly people were interviewed using a method with two overall questions. The results show that the willingness to eat plays a central role in appetite among elderly people. The appetite is a state on a sliding scale, from good to poor appetite. Factors affecting the appetite include six categories: mood, personal values, wholesomeness, food, eating environment and meal fellowship. When planning and realizing nursing actions concerning eating, the willingness to eat has to be observed. The desire within every individual has to be given consideration, including all factors as well as how they affect each other. The willingness to eat contains internal factors dependent on mood and personal values, as well as external factors dependent on wholesomeness, food, eating environment and meal fellowship. These factors contain qualitative dimensions, which affect elderly people's appetites as well as their quality of life to a varying extent. Through this, it can be seen that there is a connection between their desire or willingness to eat and their will to live.

Nursing and the child's rights in Sweden

The aim of this paper is to reflect about nursing and the child's rights in Sweden from the nursing perspective, using parts of the United Nations Convention on the rights of the child and scientific studies. A short introduction about Swedish families is included. Every child has a complete integrity, which can be violated or respected. It is unclear at what age a child is a competent to contribute in a decision that regards the child him/herself. Sometimes the child can be seen as competent to give consent to an examination, but not to refuse such an examination. Nurses in Sweden, work to develop the childs rights to be involved in decisions regarding his/her own care and the parents' involvement in the health care. Nurses can get inspitation in caring for children and in involving parents via exchange experiences. Exchanges between Brazil and Sweden are especially interesting as both have a lot of different cultures whithin the country.

The view of the child health nurse among mothers.

The aim of this exploratory study was to investigate mothers' experiences of their encounters with the child health (CH) nurse. A cross-sectional design was used for the study, based on data from 140 mothers gathered by the critical incident technique. The analysis was accomplished by a thematic content analysis, using inductive reasoning in three steps. Symbolic interactionism was used as a frame of reference. The results suggest that the central factor in the encounter between mother and nurse is that they are able to share the realm of motherhood, meaning that the nurse is open and willing to share all types of emotions, experiences and attitudes related to being a mother. Given this basis, other important factors are the supply of sound advice and practical interventions, and that the nurse is reassuring and accessible. The majority of the participating mothers had experienced CH nurses who had provided them with valuable support during troublesome incidents. However, there were also several dissatisfied mothers who had expected support but thought they received insulting treatment instead. The mothers and the nurses have varying experiences and background and therefore different perspectives, which may lead to difficulties in understanding each other. Knowledge about the important factors, that affect the mother-nurse encounter, can be used to strengthen the nurses' positive behaviours and facilitate understanding of how disappointed mothers have experienced their health care encounters.