"God gives me hope!": Hospitalized children's perception of the influence of religion in coping with chronic illness.

PURPOSE: The mechanism of the impact of religion on health is still unclear, especially in children and adolescents with chronic illness who live in religious contexts. This study aimed to understand the influence of religion on coping with chronic diseases from the perspective of hospitalized children and adolescents diagnosed with cancer, type 1 diabetes mellitus and cystic fibrosis. DESIGN AND METHODS: Qualitative descriptive research used photo-elicitation interviews with 35 Brazilian children and adolescents with cancer, type 1 diabetes mellitus and cystic fibrosis, aged between 7 and 17 years old. A thematic analysis approach was used to analyze qualitative data. RESULTS: Participants were diagnosed with cystic fibrosis (14.3%), cancer (57.1%), and type 1 diabetes mellitus (28.6%) and 82.9% had a religious affiliation. Three themes were constructed: finding strength and support in the relationship with the divine, religion as an important source of meaning, and religious practice as a promoter of well-being. These themes demonstrate that children and adolescents themselves perceived their illness as a journey through which their faith grew. CONCLUSIONS: This research shows the influence of religion on the positive coping of chronic illness, being a source of strength and support from the relationship with the divine, as well as offering a source of meaning, purpose and well-being based on religious practices. PRACTICE IMPLICATIONS: This study supports clinical practice, based on the recognition of the patient as a religious and spiritualized person who has spiritual beliefs and needs that are capable of influencing treatment.

Characterization of adopted suicidal behavior and its main influencing factors: A qualitative study with adolescents.

INTRODUCTION: A better understanding of the meanings that adolescents associate with suicide, contributes to the development of psychotherapeutic intervention programs to be implemented by nurse specialists in mental health and psychiatric nursing. Therefore, adolescents need to characterize their adopted suicidal behaviors and identify the personal characteristics that contribute to this same behavior. METHODOLOGY: A descriptive, exploratory, and qualitative study was conducted with 33 adolescents with suicidal behavior, hospitalized in a child psychiatry unit. Data were collected through a structured interview, and data treatment used the content analysis technique. RESULTS: Suicidal behaviors are characterized according to causality, meaning, and intent. Causality is mostly related to psychological factors (sadness, desperation, mental suffering, internal pain, emptiness, and rejection). As to the meaning, suicidal behavior is understood as an escape but also as a personal choice, sometimes regarded as rational. In what concerns intent, the intent to die is the most frequently reported. The most-reported personal characteristics which contributed to the suicidal behavior are feelings of exclusion, rejection, and humiliation, and also introversion. CONCLUSIONS: The results point to the need to reflect on the perceptions of adolescents with suicidal behavior. The current intervention strategies should be adjusted especially through the identification of the signs associated with mental distress in adolescents and the training of gatekeepers, contributing to productive and congruent suicide prevention in this vulnerable group.

Feasibility and Perceptions of PICU Diaries.

OBJECTIVES: To determine the feasibility of implementing an ICU diary in the pediatric critical care setting and to understand the perceptions held by family members who receive the diaries after PICU discharge. DESIGN: Observational pilot study. SETTING: PICU in a tertiary academic hospital in the United States. PARTICIPANTS: Critically ill pediatric patients admitted to the PICU and their families. INTERVENTIONS: The addition of a PICU diary to a patient's routine care. MEASUREMENTS AND MAIN RESULTS: Twenty families of critically ill children admitted to the PICU were enrolled in the PICU diary pilot study between May 2017 and March 2018. Patients who had an anticipated length of stay of at least 3 days and whose families were English-speaking were included. The median age of patients was 6 years, ranging from newborns to 18 years old, and the median length of stay was 11.5 days (interquartile range, 8.5-41 d). A total of 453 diary entries were written in 19 diaries over 433 PICU days, the majority of which were composed by bedsides nurses (63%). Follow-up surveys sent to parents 2 weeks after PICU discharge revealed that of the parents who had contributed to the diary, most enjoyed doing so (7/8). Nine of 12 parents had reviewed the diary at least once since discharge, and all parent respondents found the diary to be a beneficial aspect of their experience after PICU discharge. CONCLUSIONS: The use of ICU diaries in the PICU setting is feasible and perceived as beneficial by families of critically ill children. Future studies are needed to better understand if PICU diaries may objectively improve psychologic outcomes of patients and family members after PICU admission.

Hospitalized adolescents' perception of dignity: A qualitative study.

BACKGROUND: Adolescents can be vulnerable to diminished dignity in the hospital because young people have significantly different healthcare needs than children and adults. They like to cooperate with caregivers only when they get respectful and dignified care. Care without considering dignity can adversely influence the adolescents' recovery. However, many studies have been conducted on exploring the concept of the patients' dignity from the adult patients and fewer studies still have explored the dignity of young people. OBJECTIVE: This study explores the hospitalized adolescents' perception about dignity. RESEARCH DESIGN: A conventional qualitative content analysis method was used to explore the meaning of hospitalized adolescents' dignity. PARTICIPANTS AND RESEARCH CONTEXT: Hospitalized adolescents in general medical and surgical pediatric units were eligible to participate. Data were obtained through unstructured interviews. Purposive sampling was used and adolescents were recruited until data saturation was reached (n = 13). ETHICAL CONSIDERATIONS: Ethical approval for the study was granted by the Ethics Committee of Shiraz University of Medical Sciences. Participants were provided with information about the purpose, reasons for recording interviews, voluntary participation, and confidentiality of data and interviewees. FINDINGS: Dignity was reflected in four themes: (1) protection of personal privacy, (2) protection of autonomy, (3) respect for identity, and (4) intimate communication. DISCUSSION AND CONCLUSION: Hospitalized adolescents stated that healthcare services should protect their personal privacy and autonomy. Also, they should respect the adolescent's identity and communicate intimately with them to provide the dignity. Adolescence is a discrete developmental stage, with specific healthcare needs which must be addressed effectively by healthcare providers especially nurses.

"LEARN"ing what is important to children and young people with intellectual disabilities when they are in hospital.

BACKGROUND: The need to review health service provision for children and young people (CYP) with disabilities and their families in the United Kingdom has been expressed in multiple reports: the most consistent message being that services need to be tailored to meet their individual needs. Our aim was to understand the hospital-related needs and experiences of CYP with intellectual disabilities. METHOD: An ethnographic study of a neurosciences ward and outpatient department was conducted within a paediatric tertiary hospital setting. RESULTS: Five themes, developed using the acronym LEARN, explained what is important to CYP with intellectual disabilities in hospital: (i) little things make the biggest difference, (ii) eliminate unnecessary waiting, (iii) avoid boredom, (iv) routine and home comforts are key and (v) never assume. CONCLUSIONS: It is imperative that the present authors continue to challenge the idea that it is acceptable to exclude CYP with intellectual disabilities from research because of their inability to participate.

[Support group for hospitalised adolescents: support for growing up]. / Groupe de parole pour adolescents hospitalisés : un appui pour grandir.

The theme of growing up is addressed through the presentation of the support group for around twenty hospitalised adolescents at the Maison de Solenn. In this weekly group, the subjects discussed are diverse in terms of their content and tone, depending on the atmosphere or changes: sharing daily life in hospital, the tastes and ideas of each participant, issues related to adolescence, to topics bordering on the philosophical or existential. The analysis of the themes discussed over the course of a year revealed that many provide the basis for thinking about the process of separation/individuation.

To Ask or Not to Ask? Opinions of Pediatric Medical Inpatients about Suicide Risk Screening in the Hospital.

OBJECTIVE: To describe opinions about suicide risk screening in a pediatric medical inpatient sample. STUDY DESIGN: As part of a larger instrument validation study, 200 pediatric medical inpatients (ages 10-21 years) were screened for suicide risk. Participants completed demographic self-report forms and were asked their opinions about suicide risk screening. Patient responses were recorded verbatim by trained research social workers. Qualitative data was analyzed using thematic analysis. RESULTS: The majority of adolescents who participated had not been previously asked about suicide (N = 101; 62.3%) and were supportive of suicide risk screening (81.0%). Five salient themes emerged from the qualitative analysis of patient opinions: prevention, elevated risk, emotional benefits, provider responsibility, and lack of harm in asking. CONCLUSIONS: The majority of youth screened for suicide risk on medical inpatient units were supportive of suicide risk screening. Opinion data have the potential to inform screening practices and assure clinicians that suicide risk screening will be acceptable to pediatric patients and their parents. Given the lack of screening in these patients' past experiences, the medical setting is a unique opportunity to capture youth at risk for suicide.

[Survey of adolescent perception of hospital admission. The importance of hospital humanisation]. / Percepción de los adolescentes sobre el ingreso hospitalario. Importancia de la humanización de los hospitales infantiles.

INTRODUCTION: The humanisation of health care involves considering the patient as an integral human being, providing assistance beyond medical care, and covering other fields such as social, emotional, spiritual, or relational areas. OBJECTIVE: To evaluate the requirements and concerns of the hospitalised children. SUBJECTS AND METHOD: A cross-sectional, descriptive study was conducted using an anonymous questionnaire on children aged 12-16. RESULTS: The study included 39 patients, with a median age of 14 years. The most unpleasant experience during the hospitalisation was the invasive procedures. Almost all (95%) of patients suffered from pain, and 17% of them felt at some point that a procedure was performed without them being fully aware. More than 75% of children asked for more entertainment, with the lack of Wi-Fi being the more demanded item. CONCLUSIONS: The needs of the population included in this survey, showed the importance to consider cognitive (necessity of obtaining clear and extensive information), social (maintaining everyday relationships), emotional (illness and its diagnostic and therapeutic procedures often generate mood disorders), and practical (environmental and architectural aspects can lead to either an improvement or a worsening of the hospitalisation perception) factors. All of these factors have shown a beneficial contribution, leading to an earlier recovery of health.

Negative cognitive style and perceived social support mediate the relationship between aggression and NSSI in hospitalized adolescents.

Despite the well-documented association between aggression and NSSI among adolescents, relatively little research has been conducted on the mechanisms underlying this relationship. The purpose of this study was to investigate potential socio-cognitive mechanisms through which aggression and NSSI are related. Participants were 186 adolescents (ages 13-18) recruited from a psychiatric inpatient facility in the northeastern United States. According to teen report, 57.5% of the sample endorsed NSSI in the previous year. Mediation was tested using the modern bootstrapping technique described by Hayes, using 5000 resamples with replacement, including sex and depression diagnosis as covariates. Results demonstrated that greater negative self-talk, a more negative cognitive style, and lower perceived family support were all significant mediators of the relationship between aggression and greater frequency of NSSI, whereas perceived social support from friends was not a significant mediator. Limitations, clinical implications, and future research directions of the current research are discussed.

Hospitalized Adolescents' Perspectives on Sexual and Reproductive Health Discussions.

OBJECTIVES: Experts recommend that providers discuss adolescent patients' sexual and reproductive health (SRH) at any health care encounter, including hospitalizations. The purpose of this qualitative study was to gain insight into hospitalized adolescents' experiences and perspectives on SRH discussions (SHDs) to better inform patient-centered care. METHODS: Private semistructured interviews were conducted with hospitalized adolescents aged 13 to 17 years. Interviews were coded and analyzed using thematic analysis. Themes were developed through an iterative process with focus on the primary research aim. RESULTS: Twenty participants were interviewed with a median age of 15.4 years. Adolescents expressed a range of preferences related to SHDs with providers. Themes included (1) experiences discussing SRH with providers, (2) SHDs during hospitalization, (3) communication preferences, and (4) perceptions of why providers initiate SHDs. Viewpoints about SHDs during hospitalizations varied, including that they addressed unmet needs, as well as that they seemed irrelevant to some participants. Aspects that facilitate SHDs include brevity with relevant depth, nonjudgmental provider demeanor, and reassurance of privacy. Some participants believed providers could judge the depth of discussion needed on the basis of the adolescent's age or personality. CONCLUSIONS: This study highlights variation in adolescents' preferences around SHDs with health care providers. Providers should initiate SHDs with statements of purpose and confidentiality. Given the variation in adolescents' perspectives, tools to privately collect self-reported behaviors before an SHD may help providers frame the conversation to the adolescent's specific SRH needs and communication style preferences.

Gender, age, and educational level attribute to blood alcohol concentration in hospitalized intoxicated adolescents; a cohort study.

BACKGROUND: The prevalence of adolescents hospitalized with acute alcohol intoxication, mainly because of severe reduced consciousness, is increasing. However, the characteristics of these adolescents are mainly unidentified. In this clinical research, we aimed to identify factors that attribute to higher ethanol concentration, on which targeted alcohol health interventions can be designed. METHODS: Since 2007, alcohol intoxication among adolescents has been one of the leading topics of the Dutch Pediatric Surveillance System. In the current study, we have analyzed which demographic characteristics, general alcohol use behaviors, and clinical intoxication data were related to the blood alcohol concentration (BAC) levels at hospital admittance. We included all adolescents aged <18 years, admitted with BAC >0.0 g/l, and reduced consciousness during the years 2007, 2008, 2009, and 2010. RESULTS: A total of 2,023 adolescents with alcohol intoxication were reported, and 1,618 questionnaires were returned, of which 1,350 met our inclusion criteria. In univariate analysis, age, gender, educational level, place of alcohol purchase, place of alcohol consumption, age of first drink, and regular alcohol use during the weekend correlated with higher BAC. After multivariate analysis, older adolescents, boys, and higher educational level significantly attributed to higher BAC at admittance. CONCLUSIONS: In alcohol-intoxicated adolescents with reduced consciousness, gender, age, and also educational level correlate with BAC at admittance. Explanatory factors could be found in sensitivity to alcohol, but also in socioeconomic factors, which influence availability. Intervention strategies could be targeted more specific now for the subgroups found in this study to decrease the growing burden of adolescent alcohol intoxication, both on the societal level and on the clinical level.

The contribution of children's temperamental fear and effortful control to restraint and seclusion during inpatient treatment in a psychiatric hospital.

The current study examined temperament characteristics as risk factors for restraint and seclusion (R/S) events in psychiatrically hospitalized youth, extending work that has sought to identify R/S risk factors and research examining temperament-behavior problem associations that has largely relied upon community samples. It was anticipated that children with poor effortful control (EC) and greater frustration would have more instances of R/S during psychiatric hospitalization. The contribution of children's fearfulness to R/S was also examined. A measure of temperament was completed by youths' clinicians and youths (n = 52) completed objective measures of EC. The frequency of R/S events for each participant was obtained from hospital records. After controlling for R/S risk factors, lower EC and higher fearfulness predicted increased R/S occurrences during the first 2 weeks of hospitalization and over the course of children's entire hospitalization. These findings indicate that temperament should potentially be considered in individualized treatment plans targeting the prevention and/or reduction of R/S. Additional implications of the findings are also discussed.

Croatian children's views towards importance of health care information.

The aim of research was to investigate: the need for health care information of Croatian adolescents aged from 13 to 18 years; the difference in evaluation of the frequency of receiving information between hospitalized and healthy children; if the hospitalized children expectations about the frequency of receiving health care information differed significantly from information they have actually received; whose information was most comprehensible to the hospitalized children (doctors, parents, other health care givers). The children were either hospitalized in the pediatrics departments or were high schools pupils (healthy children). The hospitalized children "Completely agreed" (92.7%) with the statement "When I am sick, I should receive information about my health" in comparison to the healthy children (85.1%). In comparison to healthy children, the hospitalized children assessed that doctors, other health care givers and parents should give them information more frequently. The experience of hospitalized children indicate that they received less information then they have actually excepted. The information received from doctors was mostly in correlation with the understanding of this information. We concluded that the children want to be informed about their health, especially hospitalized children. Health care professionals should offer understandable health care information according to the children's expectation.

Iranian nurses and hospitalized teenagers' views of dignity.

Respect for human dignity is a basic and crucial component of nursing care. Illness with restricted physical ability and being confined to bed can compromise the dignity of patients. The views of adolescents regarding dignity in care have not previously been researched. This article details a descriptive-analytic study in which survey data was collected from all nurses and compared with a convenience sample of 180 hospitalized adolescents in two hospitals in Iran. The data was analyzed with SPSS software. A significant difference between nurses and hospitalized ill adolescents' perceptions was identified in relation to: understanding the importance of privacy (p < 0.001); observance of privacy (p < 0.001); importance of interaction between nurses and patients (p = 0.019); and the observance of interaction between nurses and patients (p < 0.001). Attention to adolescents' views about dignity can help nurses to improve quality of care for this group.

How adolescent patients use ward space.

AIM: This paper is a report of a study of the use of ward space in a purpose-built adolescent ward and the influence of that space on both adolescent patients and nurses. BACKGROUND: A separate ward environment gives adolescent patients opportunities to be with peers, have privacy and independence and be nursed away from younger children. The aim of adolescent wards is to cater for these differences and to set routines around this age group. METHODS: Data were collected between 2002 and 2003 by participant observation and interview. In total 35 observations were undertaken of both adolescents and nursing staff, with associated interviews. A further 17 semi-structured individual nurse and 11 adolescent interviews were conducted, aimed at exploring the use of ward space. Patient demographics, ward policies and patient information sheets were also used. FINDINGS: Adolescent patients created their own spaces on the ward from personal effects that were of interest to them. These spaces show nurses who they are. Adolescent patients want to be identified as more than 'just' a patient when they are in hospital. What the creation of these spaces does is assist the adolescent patient in escaping the homogeneity of the ward by cutting across its activities. CONCLUSIONS: By understanding patients through their self-created spaces, nurses can improve the capacity of adolescents to contribute to their own care, whilst enhancing their care experiences through understanding and collaboration.

Clinical and Psychosocial Characteristics of Adolescent Pediatric Patients Hospitalized after Different Types of Suicidal Behaviors-A Preliminary Study.

The objective of this study was to examine the clinical characteristics of adolescents hospitalized after a suicide attempt or instrumental suicide-related behavior. Participants included thirty-six adolescents from the pediatric unit of a Polish hospital who made a nonfatal suicide attempt (SAA) or engaged in instrumental suicide-related behavior (IBA), as well as a general population sample (GPS). Psychosocial features were measured using the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS), the Social and Occupational Functioning Assessment Scale (SOFAS), the Suicide Behaviors Questionnaire-Revised (SBQ-R), the Psychache Scale (TPS), the State-Trait Anxiety Inventory (STAI), the Center of Epidemiological Studies Depression Scale for Children (CES-DC), and the Prodromal Questionnaire (PQ-16). The SAA group scored significantly higher than the IBA group and the GPS in modules related to irritability and anhedonia, voice hallucinations and delusions, suicidal acts, thoughts and ideation, and medical lethality. Additionally, the SAA scored higher on the SBQ-R and PQ-16 compared to the IBA group and the GPS. Although anxiety, mental pain, and depressive symptoms could not independently distinguish between the SAA and IBA groups, psychotic symptoms were more frequently present within the SAA group. The above symptoms may be important to consider when screening for suicide risk in the general population.

Using Animation to Self-Report Health: A Randomized Experiment with Children.

BACKGROUND: The Child Health Utility-9D (CHU-9D) is the only generic preference-based measure specifically developed to elicit health-related quality of life directly from children aged 7-11 years. The aim of this study was to investigate whether the use of animation on a touch screen device (tablet) is a better way of collecting health status information from children aged 4-14 years compared to a traditional paper questionnaire. The specific research questions were firstly, do young children (4-7 years) find an animated questionnaire easier to understand; secondly, independent of age, is completion of an animated questionnaire easier for sick children in hospital settings; and thirdly, do children's preferences for the different formats of the questionnaire vary by the age of the child. METHODS: Using a balanced cross-over trial, we administered different formats of the CHU-9D to 221 healthy children in a school setting and 217 children with health problems in a hospital setting. The study tested five versions of the CHU-9D questionnaire: paper text, tablet text, tablet still image, paper image and tablet animation. RESULTS: Our results indicated that the majority of the children aged 4-7 years found the CHU-9D questions easy to answer independent of the format of the questionnaire administered. Amongst children aged 7-14 with health problems, the format of questionnaire influenced understanding. Children aged 7-11 years found the tablet image and animation formats easier compared to text questionnaires, while the oldest children in hospital found text-based questionnaires easier compared to image and animation. CONCLUSION: Children in all three age groups preferred animation on a tablet to other methods of assessment. Our results highlight the potential for using an animated preference-based measure to assess the health of children as young as 4 years.

Youth Self Report Thought Problems and Sleep Difficulties Are Linked to Suicidal Ideation Among Psychiatrically Hospitalized Adolescents.

Objectives: Thought problems, such as hallucinations and delusional or disorganized ideas, have been associated with increased sleep problems and risk for suicidal ideation (SI). Sleep problems have also been linked directly to suicidality in adolescence. The nature of the relationship between these symptoms among adolescents with acute suicidality is not well understood. This study aims to examine the interrelationships between thought problems, sleep difficulties, and SI in adolescents psychiatrically hospitalized for safety concerns, with the goal of informing suicide risk screening and intervention for this population. Methods: Participants included adolescents (n = 690) aged 11-18. A retrospective chart review was used to obtain scores on study measures, including the Suicidal Ideation Questionnaire Junior (SIQ-Jr), the thought problems and sleep disturbance scales on the Youth Self Report (YSR), and mental health diagnoses using the Children's Interview for Psychiatric Syndromes (ChIPS). Results: Findings indicate that SIQ-Jr scores are moderately correlated with both YSR thought problems (r = 0.51, p < 0.001) and YSR sleep disturbance (r = 0.47, p < 0.001). Further, linear regression analyses support the hypotheses that thought problems (ß = 0.28) and sleep difficulties (ß = 0.11) are uniquely associated with SI, beyond the significant effects of depression (ß = 0.36) and female sex (ß = -0.07); R2 = 0.43, F (8, 673) = 62.49, p < 0.001). Conclusions: These results suggest that sleep interventions and treatment of thought problems may be important for reducing SI, within and outside the context of depression. Furthermore, the adolescent version of the YSR may be a useful tool to evaluate these risk factors alongside other psychiatric concerns.

Characteristics of a First Suicide Attempt that Distinguish Between Adolescents Who Make Single Versus Multiple Attempts.

Although a history of a suicide attempt is the strongest predictor of future suicide attempts, not all adolescents who make an attempt engage in repetitive suicidal behavior. The present study sought to determine whether certain characteristics of a first suicide attempt (e.g., age of first attempt, method of attempt used, intent seriousness, medical lethality, and receipt of treatment after attempt) can distinguish between adolescents who make single versus multiple suicide attempts. Adolescents (N = 95) who were psychiatrically hospitalized and their guardian completed a diagnostic interview to gather information on all lifetime suicide attempts. A multivariate hierarchical logistic regression was conducted, predicting single attempt versus multiple attempt status. Of the first-attempt characteristics examined, only age of first attempt, OR = 0.33, 95% CI [0.17-0.63], p = .001, and receipt of treatment following attempt, OR = 0.28, 95% CI [0.09-0.88], p = .028, significantly distinguished SA vs. MA status, even after controlling for current age and depression at the time of first attempt. Female and White participants were overrepresented in this sample, which limits generalization to more heterogenous and diverse samples. The cross-sectional nature of data introduces the potential for retrospective recall bias. Younger age of first attempt and lack of receipt of mental health treatment following a first attempt were associated with multiple attempt status. These findings highlight the importance of early mental health screening, parental psychoeducation, and linkage to mental health care after a suicide attempt.

Suicidal behavior in children and adolescents: does a history of trauma predict less severe suicidal attempts?

OBJECTIVES: The aim of this study was to identify risk factors and possible predictors of severity of suicidal behavior of children and adolescents. METHODS: Seventy-seven patients (15 boys and 62 girls) aged 15.5+/-1.6 years on average, hospitalized due to a suicidal attempt in the department of pediatric psychiatry, were examined. Structured interviews with patients and their parents were used to clinically assess circumstances of suicidal behavior, relevant risk factors and severity of suicidal behavior. RESULTS: The results indicated that patients with any previous traumatic experience tended to have somatically less severe suicidal attempts (p=0.050). Intensity of suicidal intent was associated with a history of depression (p=0.014) and anxiety disorders (p=0.004), and the current stress from a mental disorder (p=0.014). Somatic severity of suicidal behavior was significantly associated with intensity of suicidal intent (p=0.014). A history of any trauma (previous traumatic experience predicted less severe suicidal behavior, p=0.053) and the current stress from sexual problems (p=0.067) were identified as predictors of somatic severity of suicidality. These two predictors showed only a trend level of significance. The only significant predictor of intensity of suicidal intent was the current stress from a mental illness (p=0.017). CONCLUSIONS: Several risk factors of somatic severity of suicidal behavior and intensity of suicidal intent were described. The most important finding of the study was the association between a history of psychological trauma and a tendency to have less somatically severe suicidal behavior.