Children should be more involved in healthcare decisions that affect them

Research at hospitals in Ireland revealed that children find it difficult to have their views heard | Imelda Coyne for The Conversation

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The children said that doctors and nurses were “nice” and “kind”, but some tended to carry out medical procedures without seeking their opinions or telling them beforehand. Some parents helped children to be included in talks about their care, but other parents answered questions on their behalf, told them to stay quiet and withheld information from them. Some parents also told their child to stay quiet and not annoy the doctor or nurse. Being excluded from discussions made some children feel sad, frustrated and angry. As one 14-year-old girl put it: “It made me feel like a piece of machinery; they weren’t actually talking to me.”

Read the full blog post here

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Parents’ experience of a follow-up meeting after a child’s death in the Paediatric Intensive Care Unit

Brink, H.L. et al. Intensive and Critical Care Nursing. Published online: 12 August 2016

Objective: ‘To identify parents’ experience of a follow up meeting and to explore whether the conversation was adequate to meet the needs of parents for a follow-up after their child’s death in the Paediatric Intensive Care Unit (PICU).

Design and setting: Qualitative method utilising semi-structured interviews with six pairs of parents 2–12 weeks after the follow-up conversation. The interviews were held in the parents’ homes at their request. Data were analysed using a qualitative, descriptive approach and thematic analysis.

Findings: Four main themes emerged: (i) the way back to the PICU; (ii) framework; (iii) relations and (iv) closure.

Conclusion: The parents expressed nervousness before the meeting, but were all pleased to have participated in these follow-up meetings. The parents found it meaningful that the follow-up meeting was interdisciplinary, since the parents could have answers to their questions both about treatment and care. It was important that the staff involved in the follow-up meeting were those who had been present through the hospitalisation and at the time of the child’s death. Parents experienced the follow-up meeting as being a closure of the course in the PICU, regardless the length of the hospitalisation.

Read the abstract here

‘I fell off and landed badly’: Children’s experiences of forearm fracture and injury prevention.

Sims-Gould, J. et al. Journal of child health care. Vol. 20, no. 1, p. 98-108, 1741-2889 (March 2016)

Forearm fractures are one of the most common injuries sustained by children. Our descriptive study addressed, from the perspective of a child, the following research objectives: (1) to describe their fracture experience and (2) to describe how fractures might be prevented.

Photovoice is a unique research strategy by which people create and discuss photographs. This technique has been used to elicit the perspectives of those whose voices are often ‘not heard’ in research, like children.

Participants were recruited from a larger three-year prospective trial and included 10 boys (12.3 ± 1.6 years) and 7 girls (11.3 ± 1.6 years). We asked participants to take pictures to explain where their injury occurred (place), what they were doing at the time (context) and how the fracture had happened (mechanism). We also used semi-structured interview techniques.

The following key themes emerged from our interviews: (1) the built environment as a key factor that ’caused’ their fracture, (2) the fracture experienced as a journey not an event and (3) strategies to prevent fractures.

A simple clinical step to potentially reduce subsequent fractures will be for clinicians to have a brief conversation with their young patients and to listen to the child’s personal preventive strategies.

Learning Motivational Interviewing: A Pathway to Caring and Mindful Patient Encounters

Kennedy, D. et al. Journal of Pediatric Nursing. Available online: 1 February 2016

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Abstract: We designed our project to explore the experience of learning motivational interviewing (MI). The project impetus came from a desire to improve our skill in communicating with patients. We created a curriculum led by an MI specialist that provided didactic sessions, discussions and individual feedback. In evaluating our audio-taped MI encounters, we approached beginner proficiency. Also, we recognized the need for formal MI education and practice to fully develop the interventionist skills needed for clinical work and our next research project about preparing patients for transition to adult health care. Lastly, we realized that MI strategies reflect aspects of caring theory and mindfulness, important components of patient-centered care.

Highlights: 

  • We conducted a professional development project to learn motivational interviewing (MI).
  • Project participants approached beginner MI competency.
  • Motivational interviewing reflects caring and mindful health care practice.
  • Self-evaluation and practice are important in developing MI skills.
  • The project learning activities were feasible for practicing health care professionals.

 

Read the abstract here

Consulting with young people’s about their health needs

Linda Milnes. BMJ Evidence-Based Nursing blog. Published: 25 January, 2016

As the 2015 update of Key Data for Adolescence (Association for Young People’s Health) was published, last September, once again we are alerted to the fact that one fifth of the UK’s population are 10-24 years old, which is 11.7 million young people.   One in seven of this population have a diagnosis of a long-term condition or disability. Many of these young people will be cared for by specialist services in paediatric centres but will also access primary care services. An example of this is young people with asthma, reported as 800,000 in the UK.  Young people talk of experiencing daily symptoms, restrictions on activities, having good days and bad days and feeling different to their peers (Callery et al., 2003). Health care for this group should be patient-centred and focus on skilling young people to self-care effectively as they move towards adulthood a transition we know can bring many challenges for them.

Consultations between health professionals and young people are an opportunity to develop and build therapeutic relationships, gain young people’s perspectives on their condition and understand their priorities for effective self-care. However, research tells us that young people’s participation in consultations can be limited (Lyte et al., 2007; Cahill and Papageorgiou, 2007). Using asthma as an exemplar, young people report a lack of confidence in asking questions (Dixon-Woods et al., 2002), feeling intimidated (Milnes et al., 2014) and uncomfortable about attending asthma appointments alone (Edgecombe et al., 2010).