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Translational Research - Pediatric Nursing Promoting the Health of Children Around the World
YJPDN-01550; No of Pages 3 Journal of Pediatric Nursing xxx (2017) xxx–xxx
Contents lists available at ScienceDirect
Journal of Pediatric Nursing
Research commentary column
Translational Research - Pediatric Nursing Promoting the Health of Children Around the World Becky J. Christian, PhD, RN, FNAP ⁎ School of Nursing, The University of Louisville, Louisville, KY
The primary goal of pediatric nursing is to promote the health of children. Promoting health is central to pediatric nursing practice. Pediatric nursing practice encompasses the health and development of children, preventing disease, managing illness, and integrating chronic illness into children's everyday lives around the world across different cultures and societies. Sociocultural contextual issues mediate how these health issues are addressed in different cultures and societies, yet the overall goal of healthy children is universal. Because the domain and scope of pediatric nursing is broad, research may focus on children, their parents, and families in an effort to better understand and to determine the most effective interventions with the ultimate goal of improving health outcomes of children. Exploring the interplay between the health of children and sociocultural contextual issues is essential to refining understanding of the impact of culture on children's health worldwide. Nursing research generates new evidence to improve the quality of practice (Polit & Beck, 2017), leading to improved health outcomes (Melnyk & Fineout-Overholt, 2014), for children and their families (Hockenberry & Wilson, 2015). Moreover, translating research evidence into pediatric nursing practice creates limitless possibilities for improving the health of children and their families worldwide (Christian, 2017). To improve the health of children, it is imperative to articulate the linkages between research and nursing practice through translation of research evidence into pediatric nursing practice (Christian, 2013a). To that end, translation of research evidence into practice leads to improvements in children's health and the quality of pediatric nursing practice (Christian, 2011, 2013a, 2013b, 2014a, 2014b). In this way, advances in pediatric nursing practice improve the health of children across different cultures and societies worldwide. In this issue of the Journal of Pediatric Nursing, nine articles present a broad range of topics focused on improving the health of children and their families around the world, highlighting the sociocultural influences on health. Six of the articles address health promotion issues worldwide, including: (a) Arab and Jewish parent perspectives about the intent to vaccinate against HPV for boys in Israel; (b) the importance of healthcare provider communication with parents to address immunization concerns to improve adherence; (c) a primary care office-based educational intervention program to maternal confidence in parenting skills with toddlers; (d) parents' perspectives of weight status and body type of preschool children in China; (e) perspectives of ⁎ Corresponding author: Becky J. Christian, PhD, RN, FNAP. E-mail address: [email protected].
adolescents and teachers about weight control in Korea; and (f) the safety of nasogastric tube placement and verification for children receiving care by parents and homecare providers. Another three articles highlight the importance of maintaining health among children with chronic conditions, including: (a) the social–emotional responses of school-age children with asthma in central Texas; (b) Palestinian children living in the West Bank with type 1 diabetes; and (c) the effects of children's chronic conditions on their siblings at school. The nine articles in this issue of the Journal of Pediatric Nursing provide evidence for translation into pediatric nursing practice for improving children's health, as well as the influence of culture on health around the world: • A systematic review was conducted to determine the most effective healthcare provider–parent communication approaches for discussing parental vaccination concerns for their children (Connors, Slotwinski, & Hodges, 2017). Forty abstracts were retrieved through searches of the published literature in PubMed and CINAHL databases from March 2011 to 2016. Of the 40 abstracts retrieved, 15 were rejected and full-text reviews were conducted on the remaining 25 articles, yielding nine articles that met inclusion criteria and were included in the systematic review. The study designs were predominantly descriptive (e.g., five descriptive quantitative, cross-sectional designs and three descriptive qualitative studies), and the level of evidence was low with only one randomized controlled trial (RCT). It is important to note that only two studies examined specific healthcare provider–parent interactions during discussion of vaccination concerns and parent hesitation. Key findings indicated that having trust in the healthcare provider was essential for parents in making decisions about vaccination. Findings from qualitative studies were categorized into provider communication practices and type of message preferred by parents. Communicating with vaccine-hesitant parents by healthcare providers using a more participatory engaging approach was more successful for discussing parental concerns about vaccination. • A quantitative, cross-sectional design was employed to determine the intention of mothers in Israel to vaccinate their sons against the Human Papilloma Virus (HPV) (Ben Natan, Midlej, Mitelman, & Vafiliev, 2017). A convenience sample (N = 200) of Jewish mothers (n = 100) and Arab mothers (n = 100) of boys aged 5 to 18 years completed a survey based on the health belief model.
http://dx.doi.org/10.1016/j.pedn.2017.02.007 0882-5963/© 2017 Elsevier Inc. All rights reserved.
Please cite this article as: Christian, B.J., Translational Research - Pediatric Nursing Promoting the Health of Children Around the World, Journal of Pediatric Nursing (2017), http://dx.doi.org/10.1016/j.pedn.2017.02.007
2
B.J. Christian / Journal of Pediatric Nursing xxx (2017) xxx–xxx
Significant differences in health beliefs were found between Arab and Jewish mothers with respect to perceived susceptibility of their sons to HPV, with Arab mothers perceiving lower risk. Jewish mothers perceived greater severity of HPV than Arab mothers despite greater perceived susceptibility. However, only 14% (n = 28) of the mothers vaccinated their sons against HPV including twothirds of Arab mothers (n = 18) and one-third Jewish mothers (n = 10). The health belief model explained 68% of the variance of mothers' intention to vaccinate sons for HPV, with perceived benefits of vaccine most influencing intention. Although Arab and Jewish mothers had different motivations for their intention to vaccinate sons against HVP, both were influenced by cues to action by nurses. Indeed, nurses were the key factor in improving the mothers' intention to vaccinate their sons against HPV. Findings provide direction for increasing awareness of Arab and Jewish mothers about the benefits of vaccination of sons against HPV to improve vaccination rates. • A prospective, double-blind, randomized controlled trial (RCT) with pre-test/post-test design was used to determine the effectiveness of a primary care office-based educational intervention program to improve maternal confidence in parenting skills with respect to the social–emotional development of toddlers (Hallas, Koslap-Petraco, & Fletcher, 2017). Mother–Toddler dyads (N = 60) (mothers 17 to 62 years; toddlers 8 to 33 months) from five pediatric primary care clinics in New York were randomly assigned to intervention (n = 29) and control groups (n = 31). Of these, 51 mother–toddler dyads (intervention, n = 26, and control group, n = 25) completed the study with follow-up visit. Dropout analysis indicated that mothers who completed the baseline assessment but dropped out of the study had significantly lower levels of maternal confidence in parenting. Race/Ethnicity of the participants was identified as Latina (53.8%), Black (23.1%), White (7.7%) and Other (15.4%). The treatment intervention was comprised of a brief educational program about the joy of caring for the “Terrific Toddler” delivered through DVD presentation (English or Spanish versions), while the control group viewed a standardized DVD on toddler nutrition. Findings indicated that mother–toddler dyads in both intervention and control groups demonstrated improvement from in social–emotional development of toddlers, although these differences were not statistically significant. Mothers in the intervention group had statistically significant improvement in maternal confidence in caring for their toddler (p = 0.002), as compared to mothers in the control group. Findings suggest that the brief educational intervention program was effective in improving maternal confidence in parenting skills with respect to caring for their toddler, although no differences were found between groups with respect to the social–emotional development of toddlers. Thus, although the brief educational intervention had mixed results, it was effective in improving maternal confidence in parenting skills of toddlers in a pediatric primary care setting. • Parents of preschool-age children (N = 171) (49 to 71 months of age; 91 girls and 80 boys) in Shanghai, China were surveyed about their children's weight status and body type (Wang, Tan, & Cheah, 2017). Based on BMIs from physical assessment, children were classified by weight status into three groups using WHO guidelines: underweight (BMI≤ 15th percentile; n = 46), normal weight (BMI 16-85th percentile; n = 65), and overweight (BMI ≥86th percentile; n = 60). Mothers' BMIs demonstrated a weak association with children's BMIs (r = 0.25, p b 0.001), but fathers' BMIs were not significantly associated with children's BMIs (r = 0.11, p b 0.10). Parents accurately classified 91.1% of underweight children, 52.3% of normal weight children, and 61.7% of overweight children. Parents' ratings of children's actual and ideal weight status were significantly different (p b 0.001). Regarding body shape, 28.3% of parents of underweight children and 25% of
parents of overweight children wanted them to remain the same body shape. The authors noted that gender differences in parents' preferences for their children's weight status were consistent with the sociocultural influences in China, as reflected by parents' preferences for girls to be underweight and boys to be overweight. • A descriptive qualitative design was conducted using a socioecological framework to identify perceptions of Korean adolescents and their teachers about weight control (N = 34) (Chae et al., 2017). Focus groups using multiple-category design were employed to compare different views and different categories through four groups of adolescents (n = 20) and two groups of teachers (n = 14) from one high school in Seoul, South Korea. Thematic analysis was used for data analysis in conjunction with NVivo (v.11.0) qualitative analysis software. A total of 52 codes were extracted from the data, reduced and categorized into three primary themes and 12 sub-themes. The three primary themes were: (a) adolescent perceptions about weight control; (b) status of adolescent weight control; and (c) needs of adolescents regarding weight control. The predominant sub-theme within adolescents' perceived meaning of weight control focused on managing one's appearance rather than health. Females were more sensitive to losing weight, while males were focused on building muscles. For the status of adolescent weight control theme, the lack of physical activity was most frequently identified and attributed to the Korean culture of an academic-oriented society. Both adolescents and teachers noted that the lack of time for physical activity and increased sedentary activity were related to the heavy focus of the high school curriculum on college admission. Unhealthy eating habits were related to study stress and overeating. Adolescents and teachers supported the implementation of a school-based weight control program and highlighted the importance of homeroom teachers in encouraging student participation. Thus, the use of a socioecological framework to guide this study captured the social influences on weight control and management among Korean adolescents within a society focused on academic success with implications for a school-based weight control program. • An exploratory, descriptive correlational study was conducted in central Texas to explore factors identified in the literature that influence school-age children's (52 boys, 33 girls) emotional responses to asthma (Walker, 2017). School-age children (N = 85; 6 to 12 years) with asthma with identified race/ethnicity as 52.9% Hispanic, 32.9% Non-Hispanic White, 7.1% African American, and 7.1% other participated in the study, as well as their parents or caregivers [N = 85; 84.7% mothers (n = 72), 14.1% fathers (n = 12), grandmother (n = 1)]. Multiple regression analysis revealed that asthma severity and child externalizing problems accounted for 26% of the explained variance in asthmarelated emotional functioning quality of life in school-age children. Moderator analysis indicated that there was no moderating effect of SES or race/ethnicity when predicting asthma severity and asthma-related emotional functioning quality of life. Parent/Caregiver emotional functioning quality of life was a non-significant predictor of child asthma-related emotional functioning quality of life. Thus, school-age children with asthma may use externalizing problem behaviors that indicate negative emotional functioning quality of life. • A descriptive, qualitative design was used to explore daily life experiences of children and adolescents with type I diabetes (n = 10; 8 to 18 years) and their parents (n = 10) living in the West Bank in Palestine (Elissa, Bratt, Axelsson, Khatib, & Sparud-Lundin, 2017). Individual face-to-face interviews were conducted with children and their parents in their homes or a private room in the diabetes clinic. Content analysis was performed and augmented with NVivo (v.10) qualitative analysis software. The overarching theme was identified as Facing the
Please cite this article as: Christian, B.J., Translational Research - Pediatric Nursing Promoting the Health of Children Around the World, Journal of Pediatric Nursing (2017), http://dx.doi.org/10.1016/j.pedn.2017.02.007
B.J. Christian / Journal of Pediatric Nursing xxx (2017) xxx–xxx
Social Reality of Diabetes, with two themes and sub-themes: (a) stigmatization (e.g., feeling different, concealing signs of the disease, keeping illness as a secret); and (b) social constraints (e.g., restricting social events, gender implications, excluded from school activities, imposing economic burden), describing the everyday experiences of children and their parents attempting to place themselves within the context of disease and their social context. These findings highlight the impact of socio-cultural factors within the context of Arabic Palestinian society that stigmatize children and adolescents with type 1 diabetes, as well as the gender stereotyping that prevents female adolescents from adopting healthy lifestyle behaviors for managing their chronic illness. Additionally, these findings have implications for healthcare providers to address the lack of knowledge and understanding about type 1 diabetes within the Palestinian culture and society. • A systematic review of the published literature was conducted to examine the school experiences of siblings of children with chronic illness (Gan, Lum, Wakefield, Nandakumar, & Fardell, 2017). A search of six databases (e.g., Medline, PsycINFO, CINAHL, ERIC, EMBASE, Cochrane Library) and references of eligible papers in Web of Science and Scopus published from January 2000 to March 2016, yielded 2137 peer-reviewed published studies. Of these, 28 studies focused on school experiences of siblings of children with chronic illness that met the inclusion criteria. Cancer was the primary focus for 23 studies, with single studies of other chronic illnesses, including: cancer and cystic fibrosis, type 1 diabetes, chronic renal failure, hemophilia and thalassemia blood disorders, functional abdominal pain, and life-limiting conditions. These studies represented N1470 siblings of children with chronic illness ranging from 7 to 38 years of age, as well as N260 parents. Research designs for the studies included 11 quantitative, 12 qualitative, and 5 mixed-methods designs, with satisfactory quality assessments: 95.3% (average) quantitative studies, 89.6% (average) qualitative studies, and mixed-methods studies included 94% (average) quantitative and 85% (average) qualitative criteria. Three key themes were identified that reflected the school experiences of siblings: (a) impact of psychological well-being on sibling school functioning; (b) decreased school attendance and academic functioning; and (c) differences in interaction with peers and teachers. Thus, siblings of children diagnosed with chronic illnesses experienced negative effects on psychological, social, academic and peer-related difficulties at school, although they were generally socially resilient. • Online surveys of parent caregivers (n = 144) and homecare providers (n = 66) were employed to determine current practice in home management of nasogastric tube (NGT) placement in children requiring feeding tubes (Northington, Lyman, Guenter, Irving, & Duesing, 2017). The majority of children were younger than 12 months of age. Parents reported that they were provided education about NGT placement prior to discharge of the child from the hospital. Parents (81%, n = 97) reported that the predominant method of NGT placement and verification that they had been taught was to determine the tube depth for placement by measuring from the child's nose to earlobe, to xiphoid process, to umbilicus, followed by verification of NGT location through auscultation (44%), assessment gastric pH (25%), or inspection of stomach contents via syringe (18%). The majority (74%) of parents reported no known NGT placement complications. Homecare providers from 21 states in the U.S. reported that NGT placement was confirmed through auscultation (39%), assessment of gastric pH (28%), or inspection of stomach contents via syringe (25%) to verify NGT placement location. Routine replacement of NGTs was performed monthly (48%), weekly (35%), every two
3
weeks (11%), or more than once per day (4%). In summary, findings revealed wide variability in NGT placement and verification with potentially unsafe practices by parents and homecare providers. Although the gold standard for verification is the abdominal x-ray, the use of gastric pH assessment has been identified as a reliable option. These findings have identified potential safety problems with respect to NGT placement and verification in children and the need for evidence-based guidelines for best practice. With the ultimate goal of improving children's health, it is essential to consider the sociocultural contextual issues that influence the health of children worldwide. As highlighted by these articles, translation of research evidence into pediatric nursing practice leads to better health outcomes for children and their families and advances in pediatric care. Research evidence generates new knowledge and provides insights about health and illness within the context of children's lives across different cultures and societies. Through nursing research, the most effective interventions are determined to improve health outcomes for children and their families. To that end, identifying new strategies for promoting children's health and examining the influence of sociocultural contextual issues on children's health promotes better health outcomes for children and their families worldwide.
References Ben Natan, M., Midlej, K., Mitelman, O., & Vafiliev, K. (2017). Intention of mothers in Israel to vaccinate their sons against the human papilloma virus. Journal of Pediatric Nursing, 32(2) (XXX). Chae, S. M., Yeo, J. Y., Hwang, J. H., Lee, J. H., Lim, J., & Kwon, I. (2017). Weight control in adolescents: Focus groups with Korean adolescents and their teachers. Journal of Pediatric Nursing, 32(2) (XXX). Christian, B. J. (2011). Hallmark of excellence: Research and evidence-based practice as the foundation for quality pediatric nursing. Journal of Pediatric Nursing, 26(2), 170–171. Christian, B. J. (2013a). Translational research – The imperative for integrating evidence into pediatric nursing practice to improve health outcomes. Journal of Pediatric Nursing, 28(5), 508–510. Christian, B. J. (2013b). Rebirth and renewal through research – New evidence and strategies for improving the quality of pediatric nursing care. Journal of Pediatric Nursing, 28(3), 305–308. Christian, B. J. (2014a). Translational research – The multidimensional scope of pediatric nursing. Journal of Pediatric Nursing, 29(6), 508–510. Christian, B. J. (2014b). Translational research – Transforming the quality of pediatric nursing practice. Journal of Pediatric Nursing, 29(3), 268–271. Christian, B. J. (2017). Translational research – The panoramic scope of pediatric nursing and new horizons for improving the health of children, adolescents, and their families. Journal of Pediatric Nursing, 32(1), 80–82. Connors, J. T., Slotwinski, K. L., & Hodges, E. A. (2017). Provider-parent communication when discussing vaccines: A systematic review. Journal of Pediatric Nursing, 32 (XXX). Elissa, K., Bratt, E. L., Axelsson, A. B., Khatib, S., & Sparud-Lundin, C. (2017). Societal norms and conditions and their influence on daily life in children with type I diabetes in the West Bank in Palestine. Journal of Pediatric Nursing, 32(2) (XXX). Gan, L. L., Lum, A., Wakefield, C. E., Nandakumar, B., & Fardell, J. E. (2017). School experiences of siblings of children with chronic illness: A systematic literature review. Journal of Pediatric Nursing, 32(2) (XXX). Hallas, D., Koslap-Petraco, M., & Fletcher, J. (2017). Social–Emotional development of toddlers: Randomized controlled trial of an office-based intervention. Journal of Pediatric Nursing, 32(2) (XXX). Hockenberry, M. J., & Wilson, D. (2015). Wong's nursing care of infants and children (10th ed.). St. Louis: Mosby. Melnyk, B. M., & Fineout-Overholt, E. (2014). Making the case for evidence-based practice and cultivating a spirit of inquiry (pp. 3–24). In B. M. Melnyk, & E. Fineout-Overholt (Eds.), Evidence-based practice in nursing and healthcare: a guide to best practice (3rd ed.). Philadelphia: Wolters Kluwer/Lippincott, Williams & Wilkins. Northington, L., Lyman, B., Guenter, P., Irving, S. Y., & Duesing, L. (2017). Current practice in home management of nasogastric tube placement in pediatric patients: A survey of parents and homecare providers. Journal of Pediatric Nursing, 32 (XXX). Polit, D. F., & Beck, C. T. (2017). Nursing research: generating and assessing evidence for nursing practice (10th Ed.) ). Philadelphia: Lippincott Williams & Wilkins. Walker, V. G. (2017). Exploration of the influence of factors identified in the literature on school-age children's emotional responses to asthma. Journal Of Pediatric Nursing, 32 (XXX). Wang, G. H., Tan, T. X., & Cheah, C. S. L. (2017). Preschool-age Chinese children's weight status: WHO classification, parent ratings, child/family characteristics. Journal of Pediatric Nursing, 32(2) (XXX).
Please cite this article as: Christian, B.J., Translational Research - Pediatric Nursing Promoting the Health of Children Around the World, Journal of Pediatric Nursing (2017), http://dx.doi.org/10.1016/j.pedn.2017.02.007
Contents lists available at ScienceDirect
Journal of Pediatric Nursing
Research commentary column
Translational Research - Pediatric Nursing Promoting the Health of Children Around the World Becky J. Christian, PhD, RN, FNAP ⁎ School of Nursing, The University of Louisville, Louisville, KY
The primary goal of pediatric nursing is to promote the health of children. Promoting health is central to pediatric nursing practice. Pediatric nursing practice encompasses the health and development of children, preventing disease, managing illness, and integrating chronic illness into children's everyday lives around the world across different cultures and societies. Sociocultural contextual issues mediate how these health issues are addressed in different cultures and societies, yet the overall goal of healthy children is universal. Because the domain and scope of pediatric nursing is broad, research may focus on children, their parents, and families in an effort to better understand and to determine the most effective interventions with the ultimate goal of improving health outcomes of children. Exploring the interplay between the health of children and sociocultural contextual issues is essential to refining understanding of the impact of culture on children's health worldwide. Nursing research generates new evidence to improve the quality of practice (Polit & Beck, 2017), leading to improved health outcomes (Melnyk & Fineout-Overholt, 2014), for children and their families (Hockenberry & Wilson, 2015). Moreover, translating research evidence into pediatric nursing practice creates limitless possibilities for improving the health of children and their families worldwide (Christian, 2017). To improve the health of children, it is imperative to articulate the linkages between research and nursing practice through translation of research evidence into pediatric nursing practice (Christian, 2013a). To that end, translation of research evidence into practice leads to improvements in children's health and the quality of pediatric nursing practice (Christian, 2011, 2013a, 2013b, 2014a, 2014b). In this way, advances in pediatric nursing practice improve the health of children across different cultures and societies worldwide. In this issue of the Journal of Pediatric Nursing, nine articles present a broad range of topics focused on improving the health of children and their families around the world, highlighting the sociocultural influences on health. Six of the articles address health promotion issues worldwide, including: (a) Arab and Jewish parent perspectives about the intent to vaccinate against HPV for boys in Israel; (b) the importance of healthcare provider communication with parents to address immunization concerns to improve adherence; (c) a primary care office-based educational intervention program to maternal confidence in parenting skills with toddlers; (d) parents' perspectives of weight status and body type of preschool children in China; (e) perspectives of ⁎ Corresponding author: Becky J. Christian, PhD, RN, FNAP. E-mail address: [email protected].
adolescents and teachers about weight control in Korea; and (f) the safety of nasogastric tube placement and verification for children receiving care by parents and homecare providers. Another three articles highlight the importance of maintaining health among children with chronic conditions, including: (a) the social–emotional responses of school-age children with asthma in central Texas; (b) Palestinian children living in the West Bank with type 1 diabetes; and (c) the effects of children's chronic conditions on their siblings at school. The nine articles in this issue of the Journal of Pediatric Nursing provide evidence for translation into pediatric nursing practice for improving children's health, as well as the influence of culture on health around the world: • A systematic review was conducted to determine the most effective healthcare provider–parent communication approaches for discussing parental vaccination concerns for their children (Connors, Slotwinski, & Hodges, 2017). Forty abstracts were retrieved through searches of the published literature in PubMed and CINAHL databases from March 2011 to 2016. Of the 40 abstracts retrieved, 15 were rejected and full-text reviews were conducted on the remaining 25 articles, yielding nine articles that met inclusion criteria and were included in the systematic review. The study designs were predominantly descriptive (e.g., five descriptive quantitative, cross-sectional designs and three descriptive qualitative studies), and the level of evidence was low with only one randomized controlled trial (RCT). It is important to note that only two studies examined specific healthcare provider–parent interactions during discussion of vaccination concerns and parent hesitation. Key findings indicated that having trust in the healthcare provider was essential for parents in making decisions about vaccination. Findings from qualitative studies were categorized into provider communication practices and type of message preferred by parents. Communicating with vaccine-hesitant parents by healthcare providers using a more participatory engaging approach was more successful for discussing parental concerns about vaccination. • A quantitative, cross-sectional design was employed to determine the intention of mothers in Israel to vaccinate their sons against the Human Papilloma Virus (HPV) (Ben Natan, Midlej, Mitelman, & Vafiliev, 2017). A convenience sample (N = 200) of Jewish mothers (n = 100) and Arab mothers (n = 100) of boys aged 5 to 18 years completed a survey based on the health belief model.
http://dx.doi.org/10.1016/j.pedn.2017.02.007 0882-5963/© 2017 Elsevier Inc. All rights reserved.
Please cite this article as: Christian, B.J., Translational Research - Pediatric Nursing Promoting the Health of Children Around the World, Journal of Pediatric Nursing (2017), http://dx.doi.org/10.1016/j.pedn.2017.02.007
2
B.J. Christian / Journal of Pediatric Nursing xxx (2017) xxx–xxx
Significant differences in health beliefs were found between Arab and Jewish mothers with respect to perceived susceptibility of their sons to HPV, with Arab mothers perceiving lower risk. Jewish mothers perceived greater severity of HPV than Arab mothers despite greater perceived susceptibility. However, only 14% (n = 28) of the mothers vaccinated their sons against HPV including twothirds of Arab mothers (n = 18) and one-third Jewish mothers (n = 10). The health belief model explained 68% of the variance of mothers' intention to vaccinate sons for HPV, with perceived benefits of vaccine most influencing intention. Although Arab and Jewish mothers had different motivations for their intention to vaccinate sons against HVP, both were influenced by cues to action by nurses. Indeed, nurses were the key factor in improving the mothers' intention to vaccinate their sons against HPV. Findings provide direction for increasing awareness of Arab and Jewish mothers about the benefits of vaccination of sons against HPV to improve vaccination rates. • A prospective, double-blind, randomized controlled trial (RCT) with pre-test/post-test design was used to determine the effectiveness of a primary care office-based educational intervention program to improve maternal confidence in parenting skills with respect to the social–emotional development of toddlers (Hallas, Koslap-Petraco, & Fletcher, 2017). Mother–Toddler dyads (N = 60) (mothers 17 to 62 years; toddlers 8 to 33 months) from five pediatric primary care clinics in New York were randomly assigned to intervention (n = 29) and control groups (n = 31). Of these, 51 mother–toddler dyads (intervention, n = 26, and control group, n = 25) completed the study with follow-up visit. Dropout analysis indicated that mothers who completed the baseline assessment but dropped out of the study had significantly lower levels of maternal confidence in parenting. Race/Ethnicity of the participants was identified as Latina (53.8%), Black (23.1%), White (7.7%) and Other (15.4%). The treatment intervention was comprised of a brief educational program about the joy of caring for the “Terrific Toddler” delivered through DVD presentation (English or Spanish versions), while the control group viewed a standardized DVD on toddler nutrition. Findings indicated that mother–toddler dyads in both intervention and control groups demonstrated improvement from in social–emotional development of toddlers, although these differences were not statistically significant. Mothers in the intervention group had statistically significant improvement in maternal confidence in caring for their toddler (p = 0.002), as compared to mothers in the control group. Findings suggest that the brief educational intervention program was effective in improving maternal confidence in parenting skills with respect to caring for their toddler, although no differences were found between groups with respect to the social–emotional development of toddlers. Thus, although the brief educational intervention had mixed results, it was effective in improving maternal confidence in parenting skills of toddlers in a pediatric primary care setting. • Parents of preschool-age children (N = 171) (49 to 71 months of age; 91 girls and 80 boys) in Shanghai, China were surveyed about their children's weight status and body type (Wang, Tan, & Cheah, 2017). Based on BMIs from physical assessment, children were classified by weight status into three groups using WHO guidelines: underweight (BMI≤ 15th percentile; n = 46), normal weight (BMI 16-85th percentile; n = 65), and overweight (BMI ≥86th percentile; n = 60). Mothers' BMIs demonstrated a weak association with children's BMIs (r = 0.25, p b 0.001), but fathers' BMIs were not significantly associated with children's BMIs (r = 0.11, p b 0.10). Parents accurately classified 91.1% of underweight children, 52.3% of normal weight children, and 61.7% of overweight children. Parents' ratings of children's actual and ideal weight status were significantly different (p b 0.001). Regarding body shape, 28.3% of parents of underweight children and 25% of
parents of overweight children wanted them to remain the same body shape. The authors noted that gender differences in parents' preferences for their children's weight status were consistent with the sociocultural influences in China, as reflected by parents' preferences for girls to be underweight and boys to be overweight. • A descriptive qualitative design was conducted using a socioecological framework to identify perceptions of Korean adolescents and their teachers about weight control (N = 34) (Chae et al., 2017). Focus groups using multiple-category design were employed to compare different views and different categories through four groups of adolescents (n = 20) and two groups of teachers (n = 14) from one high school in Seoul, South Korea. Thematic analysis was used for data analysis in conjunction with NVivo (v.11.0) qualitative analysis software. A total of 52 codes were extracted from the data, reduced and categorized into three primary themes and 12 sub-themes. The three primary themes were: (a) adolescent perceptions about weight control; (b) status of adolescent weight control; and (c) needs of adolescents regarding weight control. The predominant sub-theme within adolescents' perceived meaning of weight control focused on managing one's appearance rather than health. Females were more sensitive to losing weight, while males were focused on building muscles. For the status of adolescent weight control theme, the lack of physical activity was most frequently identified and attributed to the Korean culture of an academic-oriented society. Both adolescents and teachers noted that the lack of time for physical activity and increased sedentary activity were related to the heavy focus of the high school curriculum on college admission. Unhealthy eating habits were related to study stress and overeating. Adolescents and teachers supported the implementation of a school-based weight control program and highlighted the importance of homeroom teachers in encouraging student participation. Thus, the use of a socioecological framework to guide this study captured the social influences on weight control and management among Korean adolescents within a society focused on academic success with implications for a school-based weight control program. • An exploratory, descriptive correlational study was conducted in central Texas to explore factors identified in the literature that influence school-age children's (52 boys, 33 girls) emotional responses to asthma (Walker, 2017). School-age children (N = 85; 6 to 12 years) with asthma with identified race/ethnicity as 52.9% Hispanic, 32.9% Non-Hispanic White, 7.1% African American, and 7.1% other participated in the study, as well as their parents or caregivers [N = 85; 84.7% mothers (n = 72), 14.1% fathers (n = 12), grandmother (n = 1)]. Multiple regression analysis revealed that asthma severity and child externalizing problems accounted for 26% of the explained variance in asthmarelated emotional functioning quality of life in school-age children. Moderator analysis indicated that there was no moderating effect of SES or race/ethnicity when predicting asthma severity and asthma-related emotional functioning quality of life. Parent/Caregiver emotional functioning quality of life was a non-significant predictor of child asthma-related emotional functioning quality of life. Thus, school-age children with asthma may use externalizing problem behaviors that indicate negative emotional functioning quality of life. • A descriptive, qualitative design was used to explore daily life experiences of children and adolescents with type I diabetes (n = 10; 8 to 18 years) and their parents (n = 10) living in the West Bank in Palestine (Elissa, Bratt, Axelsson, Khatib, & Sparud-Lundin, 2017). Individual face-to-face interviews were conducted with children and their parents in their homes or a private room in the diabetes clinic. Content analysis was performed and augmented with NVivo (v.10) qualitative analysis software. The overarching theme was identified as Facing the
Please cite this article as: Christian, B.J., Translational Research - Pediatric Nursing Promoting the Health of Children Around the World, Journal of Pediatric Nursing (2017), http://dx.doi.org/10.1016/j.pedn.2017.02.007
B.J. Christian / Journal of Pediatric Nursing xxx (2017) xxx–xxx
Social Reality of Diabetes, with two themes and sub-themes: (a) stigmatization (e.g., feeling different, concealing signs of the disease, keeping illness as a secret); and (b) social constraints (e.g., restricting social events, gender implications, excluded from school activities, imposing economic burden), describing the everyday experiences of children and their parents attempting to place themselves within the context of disease and their social context. These findings highlight the impact of socio-cultural factors within the context of Arabic Palestinian society that stigmatize children and adolescents with type 1 diabetes, as well as the gender stereotyping that prevents female adolescents from adopting healthy lifestyle behaviors for managing their chronic illness. Additionally, these findings have implications for healthcare providers to address the lack of knowledge and understanding about type 1 diabetes within the Palestinian culture and society. • A systematic review of the published literature was conducted to examine the school experiences of siblings of children with chronic illness (Gan, Lum, Wakefield, Nandakumar, & Fardell, 2017). A search of six databases (e.g., Medline, PsycINFO, CINAHL, ERIC, EMBASE, Cochrane Library) and references of eligible papers in Web of Science and Scopus published from January 2000 to March 2016, yielded 2137 peer-reviewed published studies. Of these, 28 studies focused on school experiences of siblings of children with chronic illness that met the inclusion criteria. Cancer was the primary focus for 23 studies, with single studies of other chronic illnesses, including: cancer and cystic fibrosis, type 1 diabetes, chronic renal failure, hemophilia and thalassemia blood disorders, functional abdominal pain, and life-limiting conditions. These studies represented N1470 siblings of children with chronic illness ranging from 7 to 38 years of age, as well as N260 parents. Research designs for the studies included 11 quantitative, 12 qualitative, and 5 mixed-methods designs, with satisfactory quality assessments: 95.3% (average) quantitative studies, 89.6% (average) qualitative studies, and mixed-methods studies included 94% (average) quantitative and 85% (average) qualitative criteria. Three key themes were identified that reflected the school experiences of siblings: (a) impact of psychological well-being on sibling school functioning; (b) decreased school attendance and academic functioning; and (c) differences in interaction with peers and teachers. Thus, siblings of children diagnosed with chronic illnesses experienced negative effects on psychological, social, academic and peer-related difficulties at school, although they were generally socially resilient. • Online surveys of parent caregivers (n = 144) and homecare providers (n = 66) were employed to determine current practice in home management of nasogastric tube (NGT) placement in children requiring feeding tubes (Northington, Lyman, Guenter, Irving, & Duesing, 2017). The majority of children were younger than 12 months of age. Parents reported that they were provided education about NGT placement prior to discharge of the child from the hospital. Parents (81%, n = 97) reported that the predominant method of NGT placement and verification that they had been taught was to determine the tube depth for placement by measuring from the child's nose to earlobe, to xiphoid process, to umbilicus, followed by verification of NGT location through auscultation (44%), assessment gastric pH (25%), or inspection of stomach contents via syringe (18%). The majority (74%) of parents reported no known NGT placement complications. Homecare providers from 21 states in the U.S. reported that NGT placement was confirmed through auscultation (39%), assessment of gastric pH (28%), or inspection of stomach contents via syringe (25%) to verify NGT placement location. Routine replacement of NGTs was performed monthly (48%), weekly (35%), every two
3
weeks (11%), or more than once per day (4%). In summary, findings revealed wide variability in NGT placement and verification with potentially unsafe practices by parents and homecare providers. Although the gold standard for verification is the abdominal x-ray, the use of gastric pH assessment has been identified as a reliable option. These findings have identified potential safety problems with respect to NGT placement and verification in children and the need for evidence-based guidelines for best practice. With the ultimate goal of improving children's health, it is essential to consider the sociocultural contextual issues that influence the health of children worldwide. As highlighted by these articles, translation of research evidence into pediatric nursing practice leads to better health outcomes for children and their families and advances in pediatric care. Research evidence generates new knowledge and provides insights about health and illness within the context of children's lives across different cultures and societies. Through nursing research, the most effective interventions are determined to improve health outcomes for children and their families. To that end, identifying new strategies for promoting children's health and examining the influence of sociocultural contextual issues on children's health promotes better health outcomes for children and their families worldwide.
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Please cite this article as: Christian, B.J., Translational Research - Pediatric Nursing Promoting the Health of Children Around the World, Journal of Pediatric Nursing (2017), http://dx.doi.org/10.1016/j.pedn.2017.02.007