Pensar la práctica clínica con niñxs en tiempos de perplejidad / Thinking about the clinical practice with children in times of perplexity / Penser la pratique clinique avec les enfants en temps de perplexite / Pensando a prática clínica com crianças em tempos de perplexidade

En este trabajo comparto una experiencia clínica que me ha resultado conmovedora, difícil e inmensamente humanizante. La pandemia me llevó a replantearme tanto los encuadres como los marcos teóricos,entre otras cuestiones, para posibilitar la escucha sosteniendo la demora sin apresuramientos, dando tiempo al por decir de quien padece detrás de una pantalla. Asimismo,me situó de una manera impensada en una escena que puso a prueba los dispositivos que en otro tiempo hubiera considerado del terreno de la ciencia ficción. Despliego la idea de una clínica que demanda un entramado vincular en un espacio que fuimos construyendo "entre" paciente y analista en tiempos de perplejidad AU

In this work I share a clinical experience that has been moving, difficult and immensely humanizing for me. The pandemic led me to rethink both the framing and the theoretical frameworks, among other issues, to enable listening while maintaining the delay but without haste, giving time to the one who suffers behind a screen. Also placed me in an unexpected way in a scene that has put to test devices one would once have considered to be part of the realm of science fiction. I unfold the idea of a clinical practice that demands an interwined bond in a space that we've built "between" patient and analyst in times of perplexity AU

Dans ce travail, je partage une expérience clinique qui a été émouvante, difficile et immensément humanisant. La pandémie m'a amené à repenser à la fois les encadrementset les cadres théoriques, entre autres enjeux, pour rendre possible l'écoute tout en maintenant le retard sans hâte, en donnant le temps de dire à qui souffre derrière un écran. Aussim'a placé de manière inattendue dans une scène qui mettait des dispositifsà l'épreuve qu'il aurait autrefois considéré comme appartenant à la science-fiction. Je déploie l'idée d'une pratique clinique qui exige un réseau relationnel dans un espace que nous construisions "entre" patient et analyste en tempsde perplexité AU

Neste trabalho compartilho uma experiência clínica que tem sido comovente, difícil e imensamente humanizadora. A pandemia me levou a repensar tanto osenquadramentosassim como os referenciais teóricos, entre outras questões, para possibilitar a escuta mantendo oatraso sem pressa, dando tempo de dizer quem sofre atrás deuma telade computador. Da mesma maneira me colocou de forma inesperada em uma cena que chegou a por à prova os dispositivosque em outro tempo euteria considerado ficção cientifica. Desdobro a ideia de uma clínica que exige uma rede de vínculos em um espaço que estávamos construindo "entre" paciente e analista em tempo de perplexidade AU

A função constitutiva da voz e o poder da música no tratamento do autismo / La función constitutiva de la voz y el poder de la música en el tratamiento del autismo / The constitutive function of voice and the power of music in the treatment of autism

RESUMO. O artigo parte de uma experiência de pesquisa sobre o tratamento psicanalítico em grupo de crianças autistas, para refletir acerca da presença de mais de um analista no setting. A interação entre os analistas favorece uma abordagem não diretiva, permitindo à criança que ela se aproxime espontaneamente, sem ser forçada a um contato que pode ser sentido como extremamente angustiante pelo autista. Ademais, constatam-se os efeitos da voz como suporte para os próprios interventores, que dialogam, brincam e cantam entre eles, suscitando uma animação libidinal capaz de mobilizar a criança autista. A música que circula nas brincadeiras de roda veicula tanto aspectos simbólicos da cultura quanto o real do gozo de alíngua. Em um caso particular, a prosódia do canto mostrou-se uma forma imaginária específica de tratar a dimensão real da voz que invade o sujeito autista. Servindo-se de canções populares como objetos de mediação, foi possível orientar o tratamento a partir de uma solução que veio do próprio sujeito, que, antecipado neste ato, pode ouvir a invocação para advir. Evidencia-se assim, também no autismo, o papel do objeto pulsional voz para a constituição subjetiva.

RESUMEN. El artículo parte de una experiencia de investigación sobre el tratamiento psicoanalítico en grupo de niños autistas, para pensar se a propósito de la presencia de más de un analista en el setting. La interacción entre analistas favorece un abordaje no directivo, permitiendo que el niño se acerque espontáneamente, sin ser forzado a un contacto que puede ser extremadamente angustiante para el autista. Además, se constatan los efectos de la voz como soporte para los propios interventores, que dialogan, juegan y cantan entre sí, evocando una animación liminal capaz de movilizar el niño autista. La música que circula en las cirandas transmite tanto los aspectos simbólicos de la cultura cuanto el real del goce de la lengua. En un caso particular, la prosodia del canto se ha mostrado una forma imaginaria específica de tratar la dimensión real de la voz que invade el sujeto autista. Haciendo uso de canciones populares como objetos de mediación, fue posible guiar el tratamiento a partir de una solución proveniente del propio sujeto, que, anticipado en este acto, puede escuchar la invocación para venir a ser. Se evidencia así, también en el autismo, el papel del objeto pulsional voz para la constitución subjetiva.

ABSTRACT. Based on a research experience regarding the psychoanalytical group treatment of autistic children, the article reflects on the presence of more than one analyst in the setting. The interaction between analysts favors a non-directive approach, enabling the child to take action spontaneously, without being forced to a contact that can be extremely unsettling for the autist. Furthermore, one observes the effects of voice as a support for the caretakers, who talk, play and sing with each other, eliciting a libidinal excitement able to involve the autistic child. The music that reverberates through the circle games transmits both the symbolic aspects of culture and the real of la langue's jouissance. In a particular case, the singing prosody revealed itself to be a specific imaginary way to treat the real of voice which invades the autistic subject. Using folk songs as mediation objects, it was possible to conceive a treatment direction that took into account a solution that sprung from the subject, who, anticipated in this act, can hear the invocation to arise. Thus, one evidences, also in autism, the role of voice as pulsional object in the subjective constitution.

A service evaluation of parent adherence with dysphagia management therapy guidelines: reports from family carers supporting children with complex needs in Greece.

Purpose: Many children with complex needs exhibit eating, drinking, and/or swallowing disorders (dysphagia). These children often have associated learning needs, and require assistance from carers for daily tasks such as eating and drinking. The aim of this study was to identify which strategies to manage dysphagia were challenging for family carers, and reasons for any non-adherence.Method: In this service evaluation researchers observed carers during mealtimes, and investigated carer opinions of strategies used to minimise the risks of dysphagia. Eight children with complex needs aged 3.4-7.5 years and their primary family caregiver participated.Results: Adherence with speech and language pathologists' dysphagia recommendations overall was over 50% in all but one case. For specific strategies, the highest adherence was observed for diet modifications of foods (89%), communication during the mealtime (83%), amount of food to present (81%), and the pacing of fluids and foods (81%). Lower levels of adherence were identified in relation to postural management (58%), environmental changes (58%), utensils (56%), and preparatory strategies (49%).Conclusions: Adherence with use of strategies to support mealtimes was over 50% in all but one case. Findings suggest that support is essential to promote safe mealtimes, reduce family carers' stress and increase knowledge, confidence, and adherence in implementing dysphagia guidelines in the family home. Implications for rehabilitationDifficulties with eating, drinking and swallowing (dysphagia) can impact on the parent-child mealtime experience.Mealtime strategies as recommended by a speech-language pathologist can support children who have difficulties eating, drinking, and swallowing.Some strategies to support eating, drinking, and swallowing are easier for carers to adhere to than others.

Addressing the mental health needs of looked after children in foster care: the experiences of foster carers.

WHAT IS KNOWN ON THE SUBJECT?: In the UK and internationally, the number of looked after children is increasing year on year. Mental health problems among looked after children are significantly higher than in the general population, and the uptake of mental health services for these children is low. There is a poor prognosis for children with untreated mental health problems; this is further compounded if the child is within the care system. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: This study adds to our understanding of foster carers' experiences of the mental health needs of looked after children and demonstrates some of the challenges associated with accessing appropriate and timely mental health services. New knowledge derived from this research is that the barriers to accessing Child and Adolescent Mental Health Services (CAMHS) are not at the time of initial referral as previously reported, but later, once within the mental health system with long waiting times experienced particularly for specialist services. This study provides new insights into the experience of being a foster carer and the levels of support and resources needed that directly relate to the viability of the placement. The majority of the foster carers interviewed were from a Black and Minority Ethnic (BME) background, previously under-represented in this research area. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: A number of areas in current CAMHS provision need addressing with a focus on accessibility, consultation and support for foster carers. Waiting times need to be addressed, and improved communication with other agencies is also highlighted. CAMHS nurses are well placed to develop and deliver a comprehensive care package to foster carers, offering more tailored support to them whilst enabling the children and young people in their care to access and engage more effectively with mental health services. ABSTRACT: Introduction Despite well-documented vulnerabilities to mental health problems among the increasing population of looked after children, there continues to be poor uptake and utilization of Child and Adolescent Mental Health Services (CAMHS). Aim To elicit views of foster carers regarding the mental health needs of children and adolescents in their care and their experiences of accessing mental health services. Methods A grounded theory approach and semistructured interviews with ten foster carers. Results The experience of being a foster carer was the core category, with three major themes: (1) foster carers' psychological understanding of challenging behaviour; (2) barriers to accessing CAMHS; (3) the importance of support. Discussion A key finding of this research is that barriers to accessing CAMHS were not experienced at the point of referral, but once within the mental health system. The foster carers demonstrated a proactive approach to accessing services but expressed a need for more support structures related directly to the viability of the placement. Implications for practice Mental health nurses have a pivotal role in providing a more responsive and needs-led service for this population; professional support to foster carers to include facilitating peer support; and clinical interventions for the looked after children.

Trauma and diverse child populations.

It has been estimated that as many as two-thirds of American youth experience a potentially life-threatening event before 18 years of age and that half have experienced multiple potentially traumatic events. Race, ethnicity, and culture influence the frequency and nature of these traumas and also the ways in which children react to traumatic events. The authors discuss the varied influences of cultural background on these reactions to trauma, the varying presentations of diverse children experiencing troubling reactions, and the need to provide treatment to children and their families in a fashion that is culturally sensitive and acceptable to diverse families.

Asthma knowledge and behaviours among mothers of asthmatic children in Aseer, south-west Saudi Arabia.

Mothers of children with bronchial asthma consecutively admitted to Aseer central hospital, Saudi Arabia (n = 171), were interviewed using a questionnaire based on the Chicago Community Asthma Survey to study their knowledge and behaviours concerning bronchial asthma. The least known information among mothers was the complications of bronchial asthma. Breathing exercises during asthma attacks were the least practised behaviour. In a multivariate analysis, significant risk factors for poor knowledge and behaviours among mothers were female sex of the child, illiterate mother and young age of mother (< 30 years). More education is needed to help the mothers of asthmatic children to acquire the necessary knowledge and practices to care for their children.

Medicine vs. prayer: the case of Kara Neumann.

Religious beliefs and the use of complementary and alternative medicine can help or hinder health care and the well being of children, who are often unable to make informed decisions for themselves, but instead, depend on their parents or caregivers to make health care decisions for them. Tragically, this can sometimes result in prolonged suffering and death when parents or caregivers refuse treatment due to their own personal beliefs. This two-part article explores the case of Kara Neumann, an 11-year-old girl who died after her parents denied her medical care in lieu of prayer to cure her "spiritual attack," and the role pediatric nurses can play in educating patients and their families.

Construção e validação da Escala de Lócus de Controle Parental na Saúde / Construction and validation of Parental Health Locus of Control Scale

O propósito da pesquisa foi adaptar para o contexto brasileiro uma escala de avaliação do lócus de controle parental na saúde. Inicialmente, foram realizadas as traduções direta e reversa da escala desenvolvida por Tinsley e Holtgrave (1989). Ao longo do processo de investigação (análise de juízes, semântica e psicométrica) verificou-se a necessidade de criação de novos itens, gerando uma nova escala, intitulada Escala de Lócus de Controle Parental na Saúde (LOCPS). Cada uma das etapas investigativas contou com uma determinada amostra. A amostra principal ficou constituída de 266 cuidadores (idade média=35,17 anos). Os 18 itens finais da LOCPS se mostraram discriminativos. Os índices de precisão (alfa de Cronbach) para as três dimensões da LOCPS ficaram entre 0,67 e 0,80. A validade fatorial indicou que a escala não é unidimensional. Estatísticas descritivas das pontuações são apresentadas para fins de referência para os profissionais que venham a utilizá-la.(AU)

The purpose of this research was to adapt an assessment scale of the parental health locus of control to the brazilian context. Initially, direct and back translations of the scales developed by Tinsley and Holtgrave (1989) were done. Throughout the investigative process (judge, semantic and psychometric analyses) the need to create new items showed up leading to a new scale called Parental Health Locus of Control Scale (PHLCS). Each of the investigative stages had a particular sample. The main sample was constituted of 266 carers (average age=35.17 years old) .The last 18 items of the PHLSC were discriminative. The accuracy ratings (Cronbach's alpha) for the three dimensions of the PHLCS were between 0.67 and 0.80. The factor validity indicated that the scale is not unidimentional. Descriptive statistics of the ratings are depicted as a reference to those professionals who might want to use them.(AU)

Child health promotion and protection among Mexican mothers.

For numerous reasons, children of Mexican descent experience many health disparities. One strategy for addressing these disparities is to increase health promotion and protection behaviors that mothers use with their preschool children. Limited literature is available on such practices used by mothers of Mexican descent with their healthy preschool children. This study explored child health promotion and protection practices used by mothers of Mexican descent. A naturalistic design, guided by Spradley's ethnographic interview techniques, was selected for this study. The sample included 9 Mexican-descent mothers from an urban U.S. community with healthy preschool children. Despite significant challenges, participants promoted and protected the health of their preschool children by al cuidado (taking care) and by being al pendiente (being mindful) of balancing the health of their children's bodies, minds, and souls. Understanding these mothers' approaches allows the creation of culturally sensitive health programs that can build on existing maternal strengths.

Symptom monitoring and dependent care during cancer treatment in children: pilot study.

Symptom monitoring by parents/caregivers of children with cancer and what the caregiver and child did to help alleviate symptoms during chemotherapy were studied. The Therapy-Related Symptom Checklist (TRSC) child version was administered to parents/caregivers of 11 children and adolescents (mean age, 10.4 years; SD, 6.1 years; range, 2-18 years; 45% were boys). The Karnofsky scale was completed by clinicians to rate the child's functional status. The TRSC child version and functional status scores were inversely related. All children experienced nausea; the most frequent symptoms reported were in TRSC subscales: fatigue, nausea, eating, fever, oropharynx, pain, and hair loss. Care strategies that helped were distraction, massage, mouth rinses, and vitamins; some reported that their child received medications for pain, nausea, and vomiting. Using complementary medicine categories, the care strategies were diet/nutrition/lifestyle change (eg, more high-fat, high-calorie foods; new foods; any food the child likes; and much sleep and rest); mind/body control (eg, play, video games, television, reading, activity puzzle, breathing exercises, relaxation methods, and prayer); manual healing method (massage and skin-to-skin contact); and biologic treatments (vitamins). The first 2 categories were the most used. Systematic assessment with a self-report checklist enables the provider to identify and prioritize (according to reported severity) those symptoms needing intervention.

Psychological aspects of HIV infection in children.

Despite advances in the pharmaceutical treatment of HIV disease, there are still an increasing number of people living with the disease, and an increasing number of children and adolescents are personally affected by the epidemic. The psychological effects on these children are significant and relate not only to a parent's degree of illness and the threat of death but also to the association of the disease with substance abuse and the pervasive effects of the stigma that surround it. To intervene optimally on behalf of these children, programs must be multidisciplinary and take a holistic approach to address specific social and psychological issues and ensure stability in a child's care giving.

The use of complementary and alternative health care practices among children.

INTRODUCTION: The purposes of this descriptive study were to: (a) describe the use of complementary and alternative medicine (CAM) practices for children as reported by their parents, and (b) to develop a CAM screening tool. METHOD: A convenience sample of 191 parents was obtained from 3 primary care settings within a midwestern, metropolitan area. The questionnaire consisted of: (a) seven screening questions, (b) a list of specific CAM therapies used by children and by parents, (c) six open-ended questions about sick child care, and (d) a demographic section. RESULTS: Thirty-three percent of parents reported using CAM for their child within the past year, most commonly citing infant massage, massage therapy, vitamin therapy, and botanical products. Analysis revealed that White parents who used CAM for themselves and had children school-age and older were significantly more likely to provide CAM for their child. Chi-square analyses between the responses to selected screening questions and use of CAM were statistically (P =.001) significant but identified only 24% of the parents who used CAM for their children. DISCUSSION: Pediatric nurses should ask parents and children about CAM use in an open manner that promotes discussion. Further refinement of the screening tool is needed.

Father-to-father support: fathers of children with cancer share their experience.

Fathers are important to the stability of the family and to the coping of mothers and their children when there is a child in treatment with cancer. The vulnerability they experience is stupefying and causes self-doubt, general worry, and frustration with the medical care they receive. Fathers' experiences are relatively unreported in the literature, and even less so, the experiences of fathers with children who have cancer. This research is based on two focus groups of five men each who spoke unabashedly for more than 2 hours about their grief, their struggle to come to terms with the diagnosis and the role strain, and role confusion they experienced as fathers and husbands. The findings could be described as reflecting the following themes: (1) impact on the provider role, (2) the emotional impact: I cry privately, (3) it's the fight of our lives, (4) tag-team parenting, (5) hypervigilance, (6) that place is scary!, and (7) what happens next--coping and moving on. The group format was powerful in terms of what these men were willing to share of themselves and their experience. These groups could be characterized as the coming together of strangers, bound by the common experience of "cancer," who actively supported each other and each other's process. Implications for holistic nursing practice are provided.

Medically fragile children: an integrative review of the literature and recommendations for future research.

The literature related to medically fragile children (MFC) is analyzed, and a model is generated to improve quality of care and cost effectiveness. The sources of stress for families include home care professionals, respite care, financial concerns, and limited community resources. Children cared for in hospitals often experience less than desirable quality outcomes. Community-based pediatric extended care facilities may be a means of reducing family stress, improving physiologic and developmental outcomes, and reducing cost. Case management may significantly reduce parental stress and improve the quality of life for these children. Additional systematic study of care options for MFC is essential.

Knowledge and home management of malaria fever by mothers and care givers of under five children.

This study documents the knowledge and home management practices of 376 mothers and care givers of under five children on malaria fever. Results revealed that both the knowledge and case management practices were poor as only 179 (46.8%) knew how malaria was transmitted. Of those who knew malaria could be prevented, clearing of bushes and gutters was the commonly stated method (78 or 21.8%), followed by the use of traditional herbs. 'Agbo' by 75(20.9%) mothers. The elders and friends were stated to be the major source of knowledge about malaria by 141(37.5%) mothers. Knowledge scores was significantly higher in older mothers, among the educated, and skilled mothers (P<0.05). As regards practices, self-medication with modern drugs was common, these drugs had been given in the home by 265(70.5%) mothers while "Agbo", had been used by 95(25.5%) mothers before presenting at the clinic. Paracetamol was the modern drug often used (217 or 81.8%). Followed by chloroquine (57 or 21.5%). However, drug treatment practice were often incorrect. Chloroquine was prescribed correctly by 15(26.3%) mothers, while 109(50.2%) gave the correct dose of paracetamol. Only 16(4.3%) of the children received anti-malarial on the day the illness began. There is the need for education programmes on malaria for mothers, especially for young, illiterate and unskilled mothers, including the family elders.

Child care beliefs and practices of Hispanic mothers.

Even though Hispanics are the fastest growing minority in the United States, they face difficulties in accessing the health care system because of perceived health care needs, culture, income, language and lack of health insurance benefits. As a result, children of Hispanic parents suffering from such ailments as viral and bacterial infections, upper respiratory infections and gastroenteritis may not be treated at all or may be treated in the home. It is unclear as to how much a role traditional, cultural practices continue to play in their health care and how long medical treatment may be delayed. The purposes of this exploratory pilot study were to examine the types of cultural health care provided by Mexican-American mothers to their ill children at home, the extent of the child's illness and the time frame involved that determined the mother's need to seek medical attention. The mothers' use of lay healers and/or folk remedies prior to seeking medical attention for their child was also investigated. Implications and recommendations for culturally-relevant and culturally-competent care, and sensitive health education are presented.

Role play. Providing care to children and their families in the emergency center.

The collaborative model has many benefits for children and families, physicians, nurses, staff, and NPs. The model of care can be structured to charge lower fees for nonacute problems, thereby saving money. Various studies have reported savings of 20% to 38% in the cost of visits when patients were seen by NPs instead of physicians (Salkever, Skinner, Steinwach, & Katz, 1982). With appropriate triaging, waiting time may be reduced for children and families with nonacute problems. Perhaps the most important benefit is the teaching that the NP is able to provide for families in terms of managing particular health problems, safety needs, and preventive interventions and maintenance of wellness for children.