Subjective experience of parent-child relationship in adolescents with congenital heart disease: A qualitative study.

PURPOSE: To explore the parent-child relationship through the subjective experience of adolescents with congenital heart disease (CHD). DESIGN AND METHODS: A descriptive phenomenology approach was adopted. Twelve adolescents aged from 12 to 18 years with CHD were recruited from the pediatric cardiology clinics at two medical centers in Taiwan. Data were collected through in-depth interviews. Data were analyzed using Colaizzi's phenomenological analysis method, and results were reported in accordance with the Consolidated Criteria for Reporting Qualitative Research guidelines. RESULTS: The experiences of the adolescents with CHD revealed five themes: 1. the enhancement of self-worth through parents' love; 2. the importance of parental support in desperate situations; 3. the development of a sense of security through mutual understanding; 4. growth under parental expectations; and 5. parental overcontrol disguised as love. CONCLUSIONS: The parent-child relationship encompasses both positive and negative experiences. Adolescents prioritize their relationship with parents over that with peers. PRACTICE IMPLICATIONS: Nurses caring for adolescents with CHD can improve care by recognizing the influence of parental love, support in challenges, mutual understanding, parental expectations, and potential negative consequences of overcontrol. This insight guides effective guidance for adolescents, enhancing parent-child interactions and overall well-being.

Birth environment interventions and outcomes: A scoping review.

BACKGROUND: The physical environments in which women give birth can contribute positively to meeting both physiologic and psychosocial needs during labor. Most studies on the labor and delivery processes have focused on mitigating pain and providing psychological support. Fewer have explored the influence of the physical birth environment. In this study, we performed a scoping review to compile and examine qualitative and quantitative studies related to the characteristics of physical birth environments and their effects on labor outcomes. METHODS: We searched the PubMed, CINHAL, Cochrane, Web of Science, and MEDLINE databases from inception to May 2022. A total of 13 studies met the criteria for inclusion in our review. Two reviewers screened the titles and full-text articles and extracted data from the included studies. We used summary statistics and narrative summaries to describe the study characteristics, intervention implementation guidelines, intervention selection and tailoring rationale, and intervention effects. RESULTS: In previous research, several elements of birth environments have been shown to provide physical and psychological support to birthing people and to improve outcomes related to the experience of care and pain management. We identified five main themes in the included studies: (1) "hominess;" (2) whether spaces are comfortable for activity; (3) demedicalization of the birth environment; (4) accommodations for birth partners; and (5) providing women with a sense of control over their birth environment. CONCLUSIONS: Birth environments should be designed to promote positive birthing experiences, both physiologically and psychologically. Facilities and those who manage them can improve the experiences and outcomes of service users by modifying or designing spaces that are "homey," comfortable for activity, demedicalized, and include natural elements. In addition, policies that allow the birthing person to control her own environment are key to promoting positive outcomes and satisfaction with the birth experience.

Salvage boron neutron capture therapy for pediatric patients with recurrent diffuse midline glioma.

PURPOSE: Pediatric diffuse malignant glioma located in the brainstem was officially named "diffuse midline glioma" (DMG) by the World Health Organization in 2016. For this disease, radical surgery is not beneficial, and the only major treatment strategy is radiotherapy. However, the dose limitations to brainstem tissue mean that treatment by radiotherapy can only control and not eradicate the tumors, and there is no effective treatment for recurrence, resulting in short overall survival of 6-12 months. This paper reports our experience with boron neutron capture therapy (BNCT), a new treatment process, and its efficacy in treating children with recurrent DMG. METHODS: From September 2019 to July 2022, we treated 6 children affected by recurrent DMG. With the collaboration of Taipei Veteran General Hospital (TVGH) and National Tsing-Hua University (NTHU), each patient received two sessions of BNCT within 1 month. RESULTS: Among the six patients, three showed partial response and the rest had stable disease after the treatment. The overall survival and recurrence-free survival duration after treatment were 6.39 and 4.35 months, respectively. None of the patients developed severe side effects, and only one patient developed brain necrosis, which was most likely resulted from previous hypofractionated radiotherapy received. CONCLUSION: BNCT elicited sufficient tumor response with low normal tissue toxicity; it may benefit vulnerable pediatric patients with DMG.

Advances in Boron Neutron Capture Therapy (BNCT) for Recurrent Intracranial Meningioma.

Meningiomas are the most frequently diagnosed primary intracranial tumors in adults. Surgical resection is preferred if the meningioma is accessible; for those that are not suitable for surgical resection, radiotherapy should be considered to improve local tumor control. However, recurrent meningiomas are challenging to treat, as the recurrent tumor might be located in the previously irradiated area. Boron Neutron Capture Therapy (BNCT) is a highly selective radiotherapy modality in which the cytotoxic effect focuses mainly on cells with increased uptake of boron-containing drugs. In this article, we describe four patients with recurrent meningiomas treated with BNCT in Taiwan. The mean boron-containing drug tumor-to-normal tissue uptake ratio was 4.125, and the tumor mean dose was 29.414 GyE, received via BNCT. The treatment response showed two stable diseases, one partial response, and one complete response. We also introduce and support the effectiveness and safety of BNCT as an alternative salvage treatment for recurrent meningiomas.

Cognitive behaviour therapy in adults with spinal cord injury: A scoping review.

AIM: The aim of this study is to report on the extent and range of the research evaluating cognitive behaviour therapy (CBT) in adults with spinal cord injury. BACKGROUND: Spinal cord injury is a devastating event that can lead to permanent neurologic deficit. Compared with the average person, spinal cord injury (SCI) patients are at twice the risk of developing mood disorders, highlighting vulnerability of SCI patients' mental states which can be easily hurt. CBT is the most commonly used psychosocial intervention. DESIGN: This was a scoping review. REVIEW METHOD: Five electronic databases (MEDLINE, CINAHL, EMBASE, PsycINFO and Airiti Library) were searched for articles published between 1990 and 2021. Google Scholar was utilized to search additional articles listed in the reference lists of included articles. RESULTS: Overall, 16 articles met the inclusion criteria, with the majority reporting on CBT, that focused on psychological distress and neuropathic pain. The core concept of intervention included disease identification, cognitive distortion/modification and coping strategies. CONCLUSIONS: There were significant knowledge gaps on the interventions' content and effectiveness for psychological distress of persons with SCI. Development of multifaceted cognitive behaviour interventions, especially to strengthen self-identity and to inspire patients' hope, is needed. Further research is required to investigate the long-term effectiveness of CBT.

[The Unknown Journey: Uncertain Experiences in Mothers of Infants With Congenital Heart Disease Before Undergoing Open Heart Surgery].

BACKGROUND: Most children with complex congenital heart disease (CHD) require open-heart surgery within one year of birth to survive. Thus, new mothers of infants with CHD are faced with making unexpected and difficult decisions. PURPOSE: This study was designed to explore the essence of the maternal uncertain experience prior to infants with CHD undergoing open-heart surgery. METHODS: In this study, a phenomenological approach was used and data were collected using open-ended interview guidelines structured around the Uncertainty in Illness Theory. Nine mothers of infants with CHD who had received open-heart surgery were interviewed in a hospital interview room within two weeks the operation. Colaizzi's (1978) data processing procedure was applied in the post-interview analysis. RESULTS: Five themes emerged: (1) Hit bottom and felt helpless; (2) Hit the road - An overwhelming sense of emergency; (3) The crunch - Do your best to accept destiny (4) Disease brought the unknown; (5) Hope in uncertainty. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The high-risk nature of and their unfamiliarity with the surgery made the participants experience illness uncertainty. The medical system should develop more-structured CHD information and provide emotional support in a timely manner to alleviate illness uncertainty in mothers of infants with CHD.

Experiences of parents providing kangaroo care to a premature infant: A qualitative systematic review.

Parents who give birth to an unexpected preterm infant not only suffer a psychological impact, but, in addition, their roles as parent are full of uncertainty. As part of family-centered care, kangaroo care is an important way to support premature infants and their family. This review synthesizes qualitative studies on the experiences of parents who have used kangaroo care for preterm infants in neonatal intensive care units. English and Chinese databases were searched for relevant studies from 1970 to July 2018. The findings of qualitative studies were extracted and pooled using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. A total of 731 studies were screened, and 9 were included. Five synthesized findings were identified: sense of emptiness of the parent's role, barriers in the translation of parental roles in kangaroo care, preparation enhances parental role expectations, kangaroo care enhances parental competency, and encouragement and support from family and friends. Through the implementation of kangaroo care, nurses are able to help prepare and guide parents, fit parents' needs, and help improve their ability and self-confidence in their parental roles.

[The Readiness and Mental Construction of Nurses Caring for Patients With COVID-19: An Example From a Medical Center in Northern Taiwan].

The COVID-19 epidemic continues to spread, and frontline health professionals have unfortunately contracted this virus because of exposure while providing clinical care. Based on the painful experience of the previous SARS epidemic in Taiwan, nurses have adopted a standard of care for infection protection that incorporates early prevention and detection. However, international public health experts remain unable to control the infectivity and variability of the COVID19 virus, which increases the mental stress on frontline nurses when performing care. In this paper, which uses a medical center in the north of Taiwan as an example, JBI clinical guidelines, infection control experience, and nurses' awareness, perceived support, and self-efficacy are applied to suggest ways to improve epidemic prevention and mental construction, enhance nurses' psychological empowerment and refection, promote role identity in nursing and self-value, establish health team awareness, strengthen infection protection concepts, and integrate infection control concepts into the nursing models to develop effective standard operating procedures for epidemic prevention management and effectively prevent the spread of the virus and maintain public health.

The experiences of families living with the anticipatory loss of a school-age child with spinal muscular atrophy - the parents' perspectives.

AIMS AND OBJECTIVES: To probe into parents' anticipatory loss of school-age children with Type I or II spinal muscular atrophy. BACKGROUND: Spinal muscular atrophy is a rare disorder that causes death. Children die early due to either gradual atrophy or an infection of the lungs. Therefore, family members experience anticipatory loss, which causes grief before the actual loss. Family members feel physically and mentally exhausted, which results in a family crisis. Therefore, it is important to explore their experiences related to anticipatory loss to assist with the adjustment of the families to their circumstances. DESIGN: This study applied a phenomenology method and purposive sampling. PARTICIPANTS: The 19 parents who participated in this study were referred to us by two medical centers in Taiwan. Their average age was 32-49 years. METHODS: Using in-depth interviews, this study explored parents' anticipatory loss. The interviews were recorded and transcribed. Meanings were extracted using Giorgi analysis, and precision was assessed according to Guba and Lincoln, which was treated as the evaluation standard. RESULTS: Four themes were identified from the parents' interviews. The themes included enduring the helplessness and pressure of care, suffering due to the child's rare and unknown condition, loss of hope and a reinforcement of the parent-child attachment, and avoiding the pressure of death and enriching the child's life. CONCLUSIONS: The research findings help nurses identify anticipatory loss among parents of school-age children with type I or II spinal muscular atrophy. They enhance health professionals' understanding of the panic that occurs in the society surrounding the families, family members' dynamic relationships, and the families' demands for care. RELEVANCE TO CLINICAL PRACTICE: In an attempt to providing intersubjective empathy and support with family having a child with type I and II SMA, nurses may recognize relevant family reactions and enhancing their hope and parent-child attachment. Encourage family members and child go beyond the pressure of death and create customized care plans meeting families' emotional and medical needs.

'Living with tics': self-experience of adolescents with Tourette syndrome during peer interaction.

AIMS AND OBJECTIVES: To describe the essence of the self-experience of adolescents with Tourette syndrome in the context of peer interaction. BACKGROUND: Tourette syndrome has an adverse impact on adolescents' physical, psychological and interpersonal interactions. Peers provide adolescents with social interactions that are crucial to the formation of self-identity. Studies exploring the self-experience of adolescents with Tourette syndrome in the context of peer relationships are lacking. DESIGN: A qualitative, phenomenological research design was used. METHODS: A total of 12 adolescents with Tourette syndrome from the Taiwan Tourette Family Association were selected by purposive sampling. Data were collected using open-ended questions in one-on-one in-depth interviews that lasted 60-90 minutes. Giorgi's phenomenological methods were applied to analyse the data obtained. Four criteria were employed to evaluate methodological rigour. RESULTS: The findings showed that the self-experience of adolescents with Tourette syndrome during peer interaction reflected their lived experiences of peer identity, social identity and self-identity. Themes included: (1) the inexplicable onset of tics during encounters with other people, (2) sources inspiring the courage for self-acceptance and (3) strategies of self-protection in response to changes in situation. CONCLUSIONS: The self-experience of peer interaction among adolescents with Tourette syndrome is a dynamic and interactive process characterised by the symbolic meanings conferred on the tics by the interacting adolescents. The adolescents with Tourette syndrome obtain self-identity through peer responses and recognition, while the tolerance, respect and support of parents and teachers spark the adolescents' courage for self-acceptance. RELEVANCE TO CLINICAL PRACTICE: Healthcare providers who assist adolescents with Tourette syndrome must understand that tics occur in the context of peer interaction and how this affects the adolescents' relationships with their peers in various life situations. Furthermore, healthcare providers should provide support, respect and offer coping strategies regarding peer interaction based on an understanding of the social dynamics of such peer interactions.

[Translating Evidence Into Practice in the Field of Nursing].

Evidence-based healthcare, the organized translation of knowledge into practice, and the implementation of evidence in practice have become vital in nursing care and health policy. Evidence translation is an essential concept that relates to the knowledge development and core competence of advanced practice nurses (APNs). The present article introduces the development and definitions of nursing evidence translation. The evidence-based nursing perspectives of Techne and Phronesis are used to illustrate the characteristics and nature of knowledge translation. The evidence translation models are introduced and the barriers that are often encountered during the three stages of evidence translation are explained. The final section discusses the future development of evidence translation.

Pain prediction model based on machine learning and SHAP values for elders with dementia in Taiwan.

INTRODUCTION: Pain conditions are common in elderly individuals, including those with dementia. However, symptoms associated with dementia may lead to poor recognition, assessment and management of pain. In this study, we incorporated the variables based on questionnaires into a machine learning algorithm to build a prediction model for the pain index of elderly individuals with dementia. MATERIALS AND METHODS: In this study, 113 cases were collected through questionnaires and used to build prediction models for the patient's pain index. Three machine learning algorithms were incorporated for comparison in this study. To interpret the prediction model, SHapley additive explanations values were used to depict the ranking importance of variables and the relationship between features and pain index. RESULTS: In the comparison of models, random forests with feature selection outperformed in terms of root mean square error and mean absolute error. A total of 11 features were selected based on embedded method. The results showed that the Karnofsky scale played a key role in predicting pain index for elderly individuals with dementia and was positively associated with pain index. Arthritis is the most important disease to predicting the pain index. CONCLUSIONS: Our findings provided the key insights to predict the pain index of elderly patients with dementia. In the future, it can be used to develop an application system or webpage, which can reduce the use of labour and improve the efficiency.

Efficacy of therapeutic play for pediatric brain tumor patients during external beam radiotherapy.

OBJECTIVE: External beam radiotherapy (EBRT) is frequently used to improve disease control for pediatric brain tumor patients. However, to facilitate the radiotherapy (RT) procedure, "forced" type interventions including conscious sedation or general anesthesia are frequently used to manage patients' fear and anxiety. The aim of this study was to investigate the effects of therapeutic play (TP) in reducing anxiety for pediatric brain tumor patients treated by EBRT. METHODS: Between April 1st and September 30th, 2009, 19 young brain tumor patients, aged 3-15 years and recommended for RT, were recruited: ten to a control group and nine to the study intervention group. The study group was introduced with TP during EBRT. The Beck Youth Anxiety Inventory and the Faces Anxiety Scale were used to evaluate patients' psychological levels of anxiety. The heart rate variability and salivary cortisol concentrations were used to indicate the patients' physical levels of anxiety. Both the psychological and physiological tests were administered to all subjects before and after the RT procedure. RESULTS: The study group had significantly lower anxiety scores and expressed fewer negative emotions than did the control group before EBRT. CONCLUSIONS: TP can not only improve the quality of medical services but can also reduce costs and staffing demands. In addition, it can help lower young patients' anxiety and fear during medical procedures. As a result, it further decreases the potential negative impacts of hospitalization on these young patients.

The experiences of adult ventilator-dependent patients: a meta-synthesis review.

Studies exploring the perceptions of patients whose lives are maintained by mechanical ventilation highlight the stressful nature of this type of experience. The objective of this meta-synthesis study was to describe the nature of the experience of adult ventilator-dependent patients. A systematic literature search of English and Chinese databases was undertaken, covering the period between 1970 and 2012. Qualitative research findings were extracted and pooled using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. A total of 1004 papers were identified from various database and hand searches. Nineteen papers were critically appraised and 16 met inclusion criteria. Five meta-synthesis themes emerged from the analysis: (1) the feelings of fear due to being dependent on a ventilator and the loss of control of life; (2) disconnection with reality; (3) impaired embodiment; (4) construction of coping patterns; (5) trust and caring relationship. Suggested implications for practice include enhancing the trust relationship with health professionals, as well as nursing actions throughout the suction procedure relating to release of patient's psychological distress and empowering their resilience factors.

[Qualitative translational science in clinical practice].

Qualitative translational research refers to the "bench-to-bedside" enterprise of harnessing knowledge from the basic sciences to produce new treatment options or nursing interventions for patients. Three evidence-based translational problems related to qualitative translational research discussed this year address the interfaces among the nursing paradigm, the basic sciences, and clinical nursing work. This article illustrates the definition of translational science and translational blocks of evidence-based practice; discusses the qualitative research perspective in evidence synthesis, evidence translation and evidence utilization; and discusses the research questions that must be answered to solve the problems of the three translational gaps from the qualitative research perspective. Qualitative inquiry has an essential role to play in efforts to improve current healthcare-provider nursing interventions, experiences, and contexts. Thus, it is vital to introduce qualitative perspectives into evidence-based practice from the knowledge discovery through to the knowledge implementation process.

Systematic review and meta-analysis of nonpharmacological interventions for fatigue in children and adolescents with cancer.

BACKGROUND: Fatigue is one of the most distressing and prevalent symptoms reported by pediatric oncology patients. With the increase in cancer survival rates, medical teams have focused on methods that control cancer-related fatigue in children during the disease and its treatment in order to increase the quality of life for these patients. AIM: The objective of this systematic review was to synthesize the best available evidence concerning the effectiveness of nonpharmacological interventions for fatigue in children and adolescents with cancer. METHODS: The search strategy was designed to retrieve studies published between 1960 and 2010 in either English or Chinese. This review included randomized controlled trials and quasi-experimental studies. The studies that were selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical-appraisal instruments. RESULTS: The review included six studies, and the meta-analysis revealed a statistically significant effect of exercise interventions in reducing general fatigue (effect size = -0.76; 95% CI [-1.35, -0.17]) in children and adolescents with cancer. CONCLUSIONS AND IMPLICATIONS: The review provides an evidence-based guide to future priorities for clinical practice. Exercise interventions could reduce the levels of general fatigue in children aged 6-18 years. In particular, exercise interventions for fatigue are feasible and safe.

Severity of Binge Eating Behavior among Overweight College Students in Taiwan and Associated Factors.

BACKGROUND: Binge eating (BE) is considered a marker of obesity and overweight and a significant characteristic of feeding and eating disorders. Despite the high prevalence of obesity on college campuses, the issue of BE among college students in Taiwan has received little attention. The aim of this study was to investigate BE behavior among overweight college students in Taiwan and associated factors. METHODS: This study utilized a cross-sectional survey. A total of 300 overweight college students were recruited through convenience sampling. Data were collected using a self-administered Binge Eating Scale (BES) and a body weight composition monitor (Model No. OMRON, HBF-126) and analyzed using descriptive statistics, correlation analysis, and regression analysis. RESULTS: The average BES score was 10.67 (SD = 6.66, 0-34). With a BES score of 17 as the cut-off point, 17.3% (n = 52) of the participants were found to have moderate or severe BE behavior. Analysis of the demographic and psychosocial data using Spearman's rho rank correlation coefficient revealed that sex, body mass index (BMI), uncontrolled eating, weight loss diets, academic stress, peer competition, interpersonal distress, and unpleasant or major life events were significantly correlated with BE behavior and its probability (rs = -0.14-0.15, p < 0.05). Furthermore, logistic regression analysis indicated that the odds ratio of the BES scores of female participants and those who stated to have experienced uncontrolled eating, weight loss diets, peer competition, and interpersonal distress was 1.05-6.04 times those of male participants and those without such experiences (p < 0.05). CONCLUSION: The study found that nearly one-fifth of participants presented moderate to severe levels of BE behaviors, and these were significantly correlated with sex and external environmental stress. This study suggests early intervention from campus psychological health personnel to provide proper therapy.

Enhancing bladder management for intrapartum/postpartum women at a maternity hospital in Taiwan: a best practice implementation project.

INTRODUCTION AND AIMS: Voiding dysfunction is a common perinatal condition. Appropriate bladder management and monitoring during labor and postpartum improves bladder function and reduces the incidence of infections and complications. This project aimed to promote evidence-based bladder management strategies for perinatal women at a maternity hospital in Taiwan. METHODS: The project was implemented using the JBI framework and the JBI Practical Application of Clinical Evidence System. Implementation audits were conducted by examining nurses and intrapartum and postpartum women. Ten criteria were applied in the baseline audit, and two follow-up audits were conducted to assess actual compliance with best-practice recommendations. Through a Getting Research into Practice analysis, we identified three barriers to changing practice. RESULTS: A comparison of the audit outcomes revealed that all criteria had improved by the second follow-up audit cycle. Specifically, the compliance rate increased from 37% and 50% to 100% for criteria 1 and 2, respectively; from 0% to 100% for criteria 3, 5, and 10; and from 7%, 28%, 50%, and 17% to 100%, 100%, 97%, and 100% for criteria 4, 6, 8, and 9, respectively. Following implementation, the frequency of intrapartum intermittent catheterization (53.44-38.30%) and the postpartum incidence of urinary retention (9.09-8.51%) decreased. The time to first voiding after vaginal delivery and between the first and the second voiding decreased from 5.51 and 4.01 h to 2.32 and 2.29 h, respectively. CONCLUSIONS: This evidence-based implementation project achieved substantial improvements in bladder management. Relational leadership theory, which integrates empowerment, purposefulness, ethical behaviors, and process orientation, underpinned the project.

Decreasing the incidence of central line-associated bloodstream infection in a medical intensive care unit: a best practice implementation project.

INTRODUCTION AND OBJECTIVES: Bloodstream infections are common in critically ill patients using central venous access devices (CVAD) in intensive care units (ICU). This project aimed to decrease the incidence of central line-associated bloodstream infections (CLABSI) by using evidence-based strategies. METHODS: The project applied the JBI audit and feedback methods. Thirty-two nurses and five resident physicians from the medical ICU of a medical center participated in the project. Preintervention compliance was measured for the 11 key evidence-based criteria (six audit criteria of central venous catheter insertion and five audit criteria of dressing and catheter securement). Strategies were implemented to overcome the barriers identified in the baseline assessment. Impact evaluation and sustainability were conducted to change the CLABSI rate and the competence of healthcare professionals in providing CVAD care. The JBI Practical Application of Clinical Evidence System and Getting Research into Practice audit tools were used for the data collection, analysis, and implementation planning. RESULTS: Barriers included insufficient knowledge among nurses and physicians, poor compliance with the standard CVAD insertion procedure by physicians, inadequate cooperation among the CVAD care team members, and lack of CVAD-related equipment. The strategies included education and training in CVAD care, the establishment of a team resource management program, and the provision of appropriate equipment. Following project implementation, the CLABSI rate decreased from 8.38 to 3.9 BSIs/1000 CVAD-days. CONCLUSIONS: The project successfully decreased the CLABSI rate and increased the competence of healthcare professionals. Implementation of best practices in clinical care should focus on leadership, team resource management, education, monitoring, and innovation.

Relationship among asthma knowledge, behavior management and social adaptation in school-age children with asthma in Taiwan.

This study examined the relationships between asthma knowledge, behavior management, and social adaptation among school-age children with asthma. A total of 210 school-age asthmatic children and their parents were recruited from a medical hospital in Taiwan. The children completed asthma knowledge and behavior management questionnaires, and their parents completed the Child and Adolescent Adjustment Profile. There was a statistically significant positive correlation between behavior management and social adaptation among asthmatic children. Asthma knowledge and behavior management were positively associated but did not correlate with children's social adaptation. The behavior management of the children acted as a predictor of their social adaptation. These findings suggest that efforts to raise children's asthma knowledge will benefit these individuals in terms of behavior management. The introduction of asthma behavior management plans could facilitate the social adaptation of asthmatic children and, in particular, increase their independence and reduce their withdrawal as well as enhance their self-confidence and self-esteem.