A Systematic Review of the Experiences of Siblings of Children With Cancer.

BACKGROUND: When there is a child with cancer in the family, the entire family is affected. Childhood cancer is a highly stressful experience that affects the adaptation of family member to psychosocial tasks. Many of the family stresses and changes that accompany childhood cancer have a severe impact on siblings. An understanding of the experiences and needs of such siblings is vital. OBJECTIVE: The aim of this study was to understand the nature of the overall experiences of a child who has a brother or sister with cancer. METHODS: Searches of CINAHL, MEDLINE/PubMed, Science Direct, Scopus, Eric, and Chinese electronic periodical services identified 10 qualitative studies that were published between 1960 and 2013. An appraisal of the primary studies was carried out using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. RESULTS: Siblings of children with cancer were found to have experienced 4 themes: (1) the disintegration of life, (2) marginalization within their family relationships, (3) self-transcendence during the normalization of family relationships, and (4) maintenance of family integrity and family normality. CONCLUSIONS: Siblings of children with cancer experience a great deal of chaos in their family life, and this affects their self-esteem and family intimacy. Being with the sick child may help siblings understand the sick child's suffering and experiences. IMPLICATIONS FOR PRACTICE: The findings of this review provide evidence to help health professionals to assess the needs of the siblings to enhance their sense of self within the family. Providing the siblings with suitable resources should result in better adjustment.

The experiences of family members in the year following the diagnosis of a child or adolescent with cancer: a qualitative systematic review.

BACKGROUND: Research shows that it is stressful for family members when a child or an adolescent within the family unit is diagnosed with cancer and this stress continues over the course of the year after the diagnosis. Qualitative studies have been conducted aimed at exploring parental, siblings' and other family members' experiences when facing health-illness transition-related stress during the first year after the child is diagnosed with cancer. This study integrates the research findings of relevant existing qualitative studies on this topic in order to provide empirical evidence-based suggestions for clinical care. OBJECTIVES: This study intent is to obtain an understanding of the family members' experiences over the course of the following year after learning that a child or adolescent within their family unit has been diagnosed with cancer. TYPES OF PARTICIPANTS: The participants of interest are family members of a child or adolescent with cancer who verbally describe the whole experience and/or report on the impact of the diagnosis and disease on their lives. In this systematic review, there were no restrictions on the type, severity and prognosis of cancer. Studies investigating the experiences of the family of a child or adolescent with cancer that were reported verbally and the opinions of others external to the family (e.g. nurses) were excluded from the review. PHENOMENA OF INTEREST: The phenomena of interest were the self-reported experiences over the course of the following year of family members of a child or adolescent with cancer and the impact on the whole family of the child or adolescent receiving a cancer diagnosis. The settings included acute care, home and community settings with any cultural context. Research on other phenomena, such as experiences related to social support intervention for the family, the long-term coping experience of the family, the bereavement experiences of children with cancer, the experiences of a child or adolescent with cancer and experiences more than one year after the diagnosis was excluded from the review. Types of studies: This review considered studies that used qualitative methods to examine the experiences of families of a child or adolescent with newly diagnosed cancer; these included but were not limited to designs such as qualitative research, phenomenology, hermeneutic phenomenology, grounded theory, ethnography, action research, focus groups and narrative research. The search was limited to studies published in English or Chinese because the reviewers were fluent in both of these languages. SEARCH STRATEGY: The search strategy sought to find both published and unpublished studies. CINAHL, PUBMED, ProQuest Dissertations and Theses and Chinese electronic periodical services were used to search for articles. METHODOLOGICAL QUALITY: Each paper was assessed independently by two reviewers for methodological quality. The Joanna Briggs Institute Qualitative Assessment and Review Instrument was used to appraise the methodological quality of the articles. Any disagreements that arose between the reviewers were resolved through discussion, or via a third reviewer. DATA EXTRACTION: Qualitative data were extracted from papers for inclusion in the review using the standardized data extraction tool from JBI-QARI. DATA SYNTHESIS: Qualitative research findings were extracted and pooled using JBI-QARI. RESULTS: A total of eight qualitative papers were included in the review (two grounded theory, four phenomenology and two qualitative inquiries). Five syntheses were derived: (1) family loss and the turmoil that surrounds the diagnosis of cancer; (2) a sense of courage and hope for mutual responsibility inspired by the changes in circumstances; (3) family support enhancing family members' resilience; (4) health professional-patient communication that provide a deeper understanding of the illness and their own situations; and (5) a positive attitude towards the illness and planning for the future. CONCLUSIONS: The research findings should help health professionals understand the nature of the experiences of family members of a child or adolescent with cancer. It is critical to assess the family member's level of preparedness in the face of the psychological stress associated with the potential loss of their healthy child. Health professionals should enhance family coping strategies in order to promote normal family life. This can be done by inspiring positive attitudes and empowerment aimed at caring for the child and helping the family to build the necessary health-related communication capacities in order to clarify the child's condition. IMPLICATIONS FOR PRACTICE: Clinical guideline suggestions for health professionals working with families of children or adolescent diagnosed with cancer within the first year following the diagnosis were identified. Health professionals must listen to and accept the emotions of shock, anger and loss by the family members who are facing the potential loss of their healthy child together with the upheaval in their lives and disruptions to their plans for the future. Health professionals should be encouraged to provide clear information to the whole family in relation to the treatment plan and caring strategies for the child. Nurses should provide family members with strategies to help with the normalization of their life and a return to their previous pre-cancer lifestyle. The medical team should exhibit professionalism and skills when treating the cancer in order to enhance the child's and his/her family members' trust and sense of safety in the medical care environment. Encouraging the family members of children with cancer to develop positive thinking and to plan for their future life should be a priority of the nursing care plan.

The educational needs of neonatal nurses regarding neonatal palliative care.

BACKGROUND: Studies have shown that education can improve the knowledge, attitudes, and beliefs of neonatal nurses regarding neonatal palliative care. However, no study has investigated the need for neonatal nurse education in neonatal palliative care in Taiwan. OBJECTIVE: The purpose of this study was to explore neonatal nurses' experiences in caring for dying neonates and their educational backgrounds regarding palliative care, as well as to assess their educational needs. METHODS: A cross-sectional survey was used for this research. A research structural questionnaire was used to investigate the research goals. RESULTS: One hundred fifteen nurses participated in this survey. Few participants indicated having received neonatal palliative care education (13%), but most responded that palliative care is necessary in neonatal nursing education (97.4%). Participants also responded that they were often or always exposed to death in NICU (62.6%), but few reported providing pain management to dying neonates (8.7%) and few had experience providing symptomatic care for dying neonates (19.1%). Fifty percent ranked "pain control" as the area in which they most required training. Another high-ranked need was in discussing with parents and families the outcomes of CPR and their neonate's progress. CONCLUSION: Research indicates that the education currently provided to neonatal nurses does not meet their distinctive needs. Neonatal nurses in Taiwan expressed an urgent desire for training in pain control and communication. Research suggests that the most important topics to trainees are pain management and end-of-life communication. Additionally, non-pharmacological pain control interventions are valuable and should be included in an educational program.

Development of serum IgA and IgM levels in breast-fed and formula-fed infants during the first week of life.

BACKGROUND: IgA and IgM antibodies play important roles to protect infants in early life AIM: To study the effects of breast milk feeding versus formula feeding in early infancy on the development of serum IgA and IgM. METHODS: A group of 220 healthy infants born after uncomplicated pregnancies and deliveries were enrolled. The infants were divided into three groups according to feeding type: breast-fed (BF), formula-fed (FF), and mixed-fed (MF). Capillary blood was collected for serum IgA and IgM detection at the first week of life. RESULTS: The average concentrations of serum IgA and IgM in all infants were 1.171±1.079 and 256.2±165.8 µg/ml, respectively. There were significantly higher concentrations of serum IgA in the FF group than MF group at 3, 4 and 6 days of age and BF group at 5 and 6 days old. Paired serum IgA concentrations revealed that IgA significantly decreased in the BF group, but not in the FF and MF groups. Meanwhile, paired serum IgM concentrations revealed that IgM increased significantly during early infancy in all groups. However, the IgM levels had no difference among the 3 groups within 7 days of age. CONCLUSIONS: Our study demonstrated the development of serum IgA and IgM in early life. Formula feeding induced higher serum IgA concentrations than breast-feeding within 7 days of age. However, serum IgM concentration was significantly increased in early life in all groups but had no differences between the different feeding types. Breast-feeding may protect antigen loading in early life.