Oligoanalgesia in Adult Colles Fracture Patients Admitted to the Emergency Department.

Pain is a complex symptom to assess properly and it is often poorly managed in the Emergency Department. The majority of research has focused on exploring oligoanalgesia in samples of patients with heterogeneous injuries. The occurrence of oligoanalgesia in a homogeneous injury, such as Colles fracture, has yet to be explored. A retrospective chart review was conducted to determine the incidence of oligoanalgesia in adults with Colles fractures admitted to two urban Emergency Departments in Western Canada. Data were collected from one hundred fifty charts from a 5-year period (2009-2014). Age and gender predicted of pain assessment (p = .019), but were not significantly associated with receipt of an opioid or pain reassessment. Pain reassessment was only completed in 47% of patients who received an initial pain assessment; this was significantly different from current best practice standards (p = .0002).

Parental Vigilance in Caring for Their Children with Hypoplastic Left Heart Syndrome.

Hypoplastic left heart syndrome (HLHS) is a complex heart malformation that requires life-saving treatments. Parents experience numerous challenges as they learn to parent a child with complex care requirements. The following research question guided this qualitative study: Is the parenting process among parents of a child with HLHS characterized by exaggerated vigilant parental action, and if so, how does this influence parental response? Situated within a larger program of pediatric cardiology research, this study included data from two grounded theory studies with parents of children with HLHS. This secondary analysis involved a thematic content analysis using sensitizing concepts of uncertainty, protectiveness, support, and mastery of complex care. Transcribed data from 55 interviews with 24 mothers and 17 fathers of young children with HLHS were analyzed for relevant and recurring themes. In mastering skills required to care for their child with HLHS, parents contrasted what was in their hands with what was out of their hands. Vigilant parental actions were evident as parents became skilled at providing complex care. Parents said they were sometimes excessive in their vigilant actions. In retrospect they viewed this vigilance as appropriate in some situations but exaggerated in other situations. Understanding parents' vigilant actions in response to their child's complex care can guide health care providers' interactions with families. Long-term follow up, both clinically and through research, is needed to assess the long-term consequences of exaggerated vigilant parental action on the child, parent, and family, and to determine and evaluate appropriate and timely intervention.

Pediatric migraine teaching for families.

PURPOSE: Child and family education regarding management of pediatric migraine is essential to reduce acute pain, prevent chronic daily migraine, and minimize the total number of headache attacks. This paper summarizes current evidence and provides a foundation for family teaching. CONCLUSIONS: Effective management of pediatric migraine can be achieved with a combination of individually tailored biobehavioral strategies, lifestyle modifications, and optimal scheduling of rescue and preventative pharmacologic treatment. PRACTICE IMPLICATIONS: Included are goal setting recommendations, common triggers, key comorbidities, lifestyle modifications, principles of pharmacologic management, commonly used naturopathic compounds, and a link to an online downloadable teaching handout.

Information sharing during diagnostic assessments: what is relevant for parents?

ABSTRACT This descriptive qualitative study facilitates the application of family-centered care within a tertiary care interdisciplinary neurodevelopmental diagnostic assessment clinic by furthering an understanding of parent perceptions of the relevance of diagnostic information provision. An interdisciplinary assessment team completed an open-ended questionnaire to describe parent information provision. Parents from 9 families completed in-depth parent interviews following clinic attendance to discuss perceptions of information received. Interviews were audiotaped, transcribed, and coded by related themes. Parents did not perceive the information in the way professionals expected. Parents acknowledged receipt of comprehensive information relevant to the diagnosis but indicated that not all their needs were met. During the interviews, parents described the assessment process, preassessment information, and "steps in their journey." They noted that a strength-based approach and a focus on parental competency would support their coping efforts. Results underscore the need for professionals to be attentive to parents' individualized needs.

Brief report: an online support intervention: perceptions of adolescents with physical disabilities.

Adolescents with cerebral palsy and spina bifida report restricted interactions with peers and gaps in social support. A pilot online support intervention offered interactions with peers. Five mentors with cerebral palsy or spina bifida and 22 adolescents with the same disabilities met weekly online for 25 group sessions over six months. Participants completed quantitative measures of loneliness, sense of community, self-perceptions, coping, and social support prior to intervention, post-intervention, and delayed post-intervention. Semi-structured qualitative interviews elicited perceptions of the intervention's impacts. Participants reported more contact with teens with disabilities, decreased loneliness, and increased social acceptance and confidence. A significant increase in sense of community was reported from post-intervention to delayed post-intervention. Encouraging qualitative findings were supported by trends in the quantitative measures. This pilot study can guide a future community-based intervention trial.

Computer-mediated support for adolescents with cerebral palsy or spina bifida.

Social support plays a key role in improving health outcomes for children with chronic conditions. Internet connections are an important component of adolescents' social networks and may overcome geographic and environmental barriers for those with disabilities. This article focuses on the processes associated with a 6-month online support intervention for adolescents with cerebral palsy or spina bifida. Specifically, the purpose was to determine the extent to which adolescents used an online peer support intervention, the processes used, and the perceived benefits and satisfaction with the intervention. Five peer mentors with the same disabilities provided information, affirmation, and emotional support. The online environment created a safe space to foster reciprocal interpersonal connections and appropriate social comparison. Two-thirds of the participants viewed the computer-mediated support intervention as fun. Factors influencing the perceived utility of the intervention included typing speed, cognitive skills, and perceived need for additional support. Girls were significantly more likely to contribute messages than were boys. Peer mentors wished that this type of support program had been available when they were teens, appreciated the supportive elements, and reported learning from the teen participants. Health professionals wanting to implement online support need to consider the age and ability levels of participants and the optimal length and format of the support program.

Development and implementation of an adolescent epilepsy transition clinic.

This article describes the collaborative development of a nurse-led transition clinic within the Comprehensive Epilepsy Program at the Stollery Children's Hospital and at the University of Alberta Hospital. Developed in 2005, our program has been instrumental in assisting 97 teens and their parents' transition from pediatric to adult epilepsy care. Through our Adolescent Epilepsy Transition Clinic, we address concerns expressed by teens and their parents when shifting from pediatric to adult healthcare services, including fear of the unknown, change in appointment location, loss of established relationships, and anticipated decrease in the quality of care posttransition. We also address concerns of adult and pediatric healthcare providers related to the adolescents' working knowledge of how their particular type of epilepsy and its management interact with typical adolescent developmental challenges and future career and lifestyle choices. The results from a process evaluation are presented and offer new insights for improving adolescent transition.

Cross-ministerial collaboration related to paediatric rehabilitation for children with disabilities and their families in one Canadian province.

The delivery of paediatric rehabilitation services is complex due to the involvement of different service sectors and diverse models of care. Parents of children with disabilities find it challenging to navigate successfully through complicated service delivery systems. Cross-sectoral collaboration to improve continuity of care for children with disabilities and their families is viewed as ideal in public policies. The purpose of this research was to explore how ministerial cultures, processes and structures influence inter-ministerial collaboration for the purpose of enhancing continuity of care for children with disabilities and their families in a Western Canadian province. Six key informants from three government Ministries that funded paediatric rehabilitation services participated in individual, semi-structured interviews between January and May of 2007. Nineteen provincial public policy documents were reviewed. Hall's framework guided the analysis of the key informant interviews and policy documents. Influences of organisational culture, processes and structures on cross-ministerial collaboration were classified into the categories of ideas-values and beliefs that underlie policy development, interests-influence of various policy actors and institutions-structures and processes used to deliver public policy. Fundamental ideological and structural differences were apparent across the three ministries that affected the ease of inter-ministerial collaboration towards ensuring continuity of care for children with disabilities. Variations in ideas (philosophy and values) and institutions (geography and service delivery structure, relationships with regional governance, mission and function, choice of policy instruments and financial processes) are presented and implications for service delivery are explored.

Parents' perspectives on occupational therapy and physical therapy goals for children with cerebral palsy.

UNLABELLED: Contemporary rehabilitation literature emphasises functional goals for children with disabilities and use of a collaborative goal-setting process grounded in principles of family centred service delivery. PURPOSE: To explore parents' experiences with goals and goal setting. METHOD: We conducted a qualitative study with 11 focus groups and two individual interviews with 39 parents of children with cerebral palsy living in western Canada. We used an inductive, thematic analysis to identify prominent themes. RESULTS: The analysis revealed five themes representing goals that were meaningful to parents and provided insight into parents' experiences with goal-setting processes in occupational and physical therapy: (1) movement as the means to functional success; (2) physical health and fitness are important therapy goals; (3) the importance of leading happy, fulfilling lives and being accepted by others; (4) 'We can't do it all': balancing therapy with the demands of everyday life; and (5) shifting roles and responsibilities in goal setting. CONCLUSIONS: The variability noted both in parents' desired role in goal setting and in goals important to parents highlights the importance of establishing trusting relationships with families so that family goals, values, individual circumstances, and desired level of participation in goal setting can be openly discussed.

Categorical service allocation and barriers to care for children with chronic conditions.

Parents raising children with chronic conditions face the challenge of locating and coordinating appropriate community-based resources and services for their child. The purpose of this secondary analysis was to determine parents' view of the mechanisms used to allocate health, education, and social services to children with chronic illness and disability and their caregiving families. A thematic analysis was conducted on data from interviews with 30 mothers and 13 fathers. These parents described 11 mechanisms that were used to determine eligibility and/or to ration services: diagnosis, age, technology dependence, severity, functional ability, guardianship status, geographic location, financial resources, judged parental coping, failure to inform parents about available services, and cyclical funding. These mechanisms were complex, inconsistent, and subject to change. Mechanisms that are integrated, proactive, flexible, and fair are needed to reduce parents' workload and to ensure more equitable allocation of services.

Children with chronic continence problems: the challenges for families.

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.

Parenting and Childhood Chronicity: making visible the invisible work.

The work required to raise a child with a chronic illness or disability is above and beyond that of raising a typical child. This article presents a model, Parenting and Childhood Chronicity (PACC), that was developed during an interpretive study with 43 parents of 34 children (aged 15 months to 16 years) with various chronic conditions, is presented. "Special needs parenting" describes the additional care that a child needs and includes medical care, parenting plus, and working the systems. "Minimizing consequences" reflects the struggle to balance the rest of family life and includes parenting siblings, maintaining relationships, and keeping yourself going.