Child healthcare nurses' experience of communication with 4-year-old children during their visit to the child health care center.

OBJECTIVE: To illuminate child healthcare nurses' experiences of communication with 4-year-old children during their visit to the child healthcare center. DESIGN: A qualitative method, using data collected from individual interviews. SAMPLE: Fifteen semistructured interviews with nurses working in a child healthcare center. MEASUREMENTS: The results were analyzed using reflexive thematic analysis. RESULTS: The analysis resulted in three themes and eight subthemes: Adapting to the child in the conversation, based on the subthemes Preparing for the visit, Listening in and observing, and Creating a welcoming environment; Combining strategies for the conversation, based on the subthemes Engaging the child, Using visual tools, and Parental involvement; and Challenges due to language barriers, based on the subthemes Using an interpreter and Parent acts as interpreter. CONCLUSION: Child healthcare nurses focus on the child when communicating and strive to create joy and a welcoming environment. The communication strategies employed during the visit include engaging the child directly, involving parents in the conversation, and balancing the parental involvement. Communication challenges related to language barriers are addressed, particularly during interpreter-assisted conversations. The study indicates a need for tailored strategies, collaboration, and sensitivity to ensure a child-centered approach.

Help overcoming pain early, a brief person-centred intervention for adolescents with chronic pain in a school setting, may improve symptoms of insomnia.

Introduction and aims: Chronic pain and symptoms of insomnia affect large numbers of adolescents and early interventions are prioritized. The aim of the current study was to evaluate potential secondary effects of the intervention, Help Overcoming Pain Early (HOPE), on symptoms of insomnia and self-rated health. Methods: The study included non-randomized aggregated data from the active and control conditions in a previously conducted randomized controlled trial evaluating the efficacy of HOPE, after the participants in the control condition also had received the intervention. Symptoms of insomnia were assessed with the Minimal Insomnia Symptom Scale and self-rated health was assessed with one item, at the start of the intervention, post intervention, and at a six-month follow-up. Baseline variables included age, gender, pain localization, pain impact, school absence and symptoms of depression (assessed with the Center for Epidemiological Studies Depression Scale for Children). Inferential analyzes were performed using Linear Mixed Models (LMM). Effect sizes were evaluated by calculating Cohen's d. Results: There were statistically significant improvements in symptoms of insomnia at the six-month follow-up, and statistically significant improvements in self-rated health at the end of the intervention and at the six-month follow-up. Effect sizes were small across outcomes and assessments. Discussion and conclusion: Results illustrated significant but small improvements in symptoms of insomnia and self-rated health in adolescents with chronic pain following the HOPE intervention. Although caution is needed when assessing the findings, results illustrate the potential utility of an accessible brief early intervention in a school context.

Need and benefit of communication training for NICU nurses.

Objectives: To assess the effects of a new communication course for neonatal intensive care unit (NICU) nurses on nurses' confidence in communicating with families, and to explore communication-related issues experienced by the nurses and their relationship to burnout. Study design: Twenty-nine nurses participated in an interactive course based on communication cases from the NICU. Participants' experience of communication with parents was assessed. They completed the Maslach Burnout Inventory. Self-reported communication skills were assessed before and after the course and at four-month follow-up. Results: Only one nurse reported previous nursing-related communication training. High burnout scores were associated with communication-related difficulties, especially lack of time for communication. The course improved participants' confidence in their communication skills in challenging situations, including those where parents express distress or ask questions the nurse cannot answer. Participants found the course highly interesting, useful and necessary for their work. Conclusion: Interactive, learner-centered training addressing issues specific to communication at the NICU was effective and highly appreciated. Innovation: The course centered on a unique variety of reality-based communication cases from the NICU, relevant to the nurses' work and stimulating their reflection. An innovative feature was the emphasis on nurses' perspective and the importance of communication for their coping.

Communication between parents and neonatal healthcare professionals using pictorial support when language barriers exist - parents' experiences.

PURPOSE: Families arriving in Sweden after being forced to flee their home need health care. Communication is a key component to establishing good care relations and becomes difficult when there are language barriers between families and healthcare professionals. In the context of neonatal care, communication is carried out with parents. The aim of the study was to describe parents' experiences of communication with neonatal healthcare professionals and using pictorial support when language barriers exist. METHOD: The study takes a qualitative approach based on seventeen interviews with parents who had experienced neonatal ward. Qualitative content analysis was used. RESULTS: The parents needed to communicate through supports, which caused distress and misunderstanding. The relationship between parents and the healthcare professionals affected the communication. Pictorial support was used to different degrees. Four categories were identified from the data analysis: Communicating through supports, Facing barriers in communication, Facing external influences and The need for a good healthcare relationship. CONCLUSION: The present study is the first to describe parents' experience with using the pictorial support developed in the project KomHIT Refugee and therefore fulfils the function of being a first evaluation of the pictures from parents' perspective.

Organizational climate and interpersonal interactions among registered nurses in a neonatal intensive care unit: A qualitative study.

AIM: The aim of this work is to describe the organizational climate and interpersonal interactions experienced by registered nurses in a level III neonatal intensive care unit. BACKGROUND: Neonatal nurses have a demanding task in caring for a varied, highly vulnerable patient population and supporting patients' families. Nurses' psychosocial work environment affects quality of care as well as nurses' job satisfaction and organizational commitment. METHOD: Semistructured interviews with 13 nurses, covering numerous aspects of their psychosocial work environment, were analyzed using thematic analysis. RESULTS: High staff turnover and a preponderance of inexperienced nurses were described as stressful and detrimental to group cohesion. Work at the unit was considered overly demanding for newly qualified nurses, while senior nurses expressed frustration at the work of training new nurses who might not stay. While some were very satisfied with the group climate, others complained of a negative climate and incivilities from some experienced nurses toward new recruits. CONCLUSIONS: High turnover and variable competence among staff present challenges for maintaining a positive organizational climate. IMPLICATIONS FOR NURSING MANAGEMENT: Management should communicate a clear sense of the nature of neonatal intensive care when recruiting, foster group cohesion (e.g., by creating stable work teams) and reward commitment to working at the unit.

Child health care nurses' experiences of language barriers during home visits.

OBJECTIVE: The aim of the study was to explore the communication tools that child healthcare nurses can use during home visits to families when language barriers exist. DESIGN: Qualitative study using data collected from focus group sessions. SAMPLE: Six semi-structured focus group interviews with twenty nurses in child healthcare services. MEASUREMENTS: The results were analyzed with a thematic content analysis. RESULTS: The analysis resulted in two themes: Using pictures as support in the conversation, with subthemes Not using pictures as support, Wanting to know how to use pictures as support, Pictures as support for invitations, Different types of pictures as support, and Alternative means of communication with the subthemes Possibilities of using an interpreter, Obstacles to using an interpreter, Mixed communication. CONCLUSION: If language barriers are present during home visits, decision-making nurses in Child Health Care (CHC) put families in an unequal position when communicating with them. These results point to a need for more education, guidelines and support regarding alternative and augmentative communication (AAC) tools and structures to assist in overcoming language barriers.

Assessment of health status in adolescents with spina bifida in the West Bank, Palestine: sense of coherence and self-perceived health.

PURPOSE: To assess self-perceived health and sense of coherence (SOC) in adolescents with spina bifida (SB) in the West Bank, Palestine, compared to a healthy reference group. Further, to assess the association between impairment levels in the adolescents with SB and their self-perceived health and SOC. METHODS: Fifty adolescents with SB and 150 healthy adolescents completed measures of self-perceived health - the Pediatric Quality of Life Inventory (PedsQLTM 4.0) - and SOC. The rehabilitation center nurses identified the physical impairments of the adolescents with SB from their medical records, and classified them by impairment severity. RESULTS: Adolescents with SB reported lower self-perceived health (PedsQL median 55, IQR 42-67), than the reference group (median 85, IQR 74-90), p < 0.001, and lower SOC (median 47, IQR 44-50) than the reference group (median 55, IQR 44-61), p < 0.001. Impairment level was inversely associated with both self-perceived health and SOC. CONCLUSIONS: The low self-perceived health and SOC among adolescents with SB in Palestine indicate the need for collaboration between policy makers and providers to improve these adolescents' physical and social environment and to promote the rehabilitation services provided for them.Implications for rehabilitationThe low self-perceived health and SOC among adolescents with SB in Palestine highlight the need to develop appropriate interventions to promote their health, independency, and self-care management.Collaboration of the caregivers and health care providers is required to develop, implement, and evaluate intervention programs that might promote coping abilities of the adolescents with SB.A multidisciplinary approach is needed to set goals that have a meaningful impact on social, emotional, behavioral, and educational conditions of the adolescents with SB and in different settings, for example, home, school, and community.The environment in Palestine presents barriers to the social engagement of adolescents with SB, and new ways are needed to enhance their participation in the society to promote their self-concept and wellbeing.

Managing conflict situations nursing students encounter during their clinical practice, narrated and performed through Forum Play.

AIM: To describe and illuminate conflict situations nursing students encounter during their clinical practice, narrated and performed through Forum Play. BACKGROUND: Conflicts are common in healthcare settings and affect patient care and the wellbeing of nurses. To be able to manage complex practice situations, conflict management is an essential competence for nurses and should be highlighted during education. The aim of the study was to describe and illuminate conflict situations nursing students encounter during their clinical practice, narrated and performed through Forum Play. DESIGN: The study was designed as a summative qualitative analysis of written group assignments related to nursing students' participation in a drama workshop. METHOD: A summative qualitative content analysis of written group assignments related to nursing students' participation in a drama workshop, focusing on conflict management. During the workshop the students explored conflict situations they had encountered during clinical practice, through Forum Play. After the workshop, the students handed in a mandatory written group assignment where they described one of the conflict situations. RESULTS: The findings are presented in three categories; Parties; Arenas; Situations, one main theme; "Who knows best" and two subthemes; Difficulties to adapt to the new and Difficulties reaching a mutual understanding. CONCLUSION: Conflict situations that nursing students encounter during their clinical practice often stem from the health care staff's difficulties in adapting to the new and difficulty reaching a mutual understanding. Conflict management can be implemented as a powerful learning strategy in nursing education.

Self-perceived health among children with spina bifida in the West Bank: a cross-sectional study.

BACKGROUND: Children born with spina bifida endure constant physical disability, which is challenging for themselves and their families. To date, the impact of spina bifida on the health-related quality of life (HRQOL; eg, physical, psychological, and social wellbeing) of these children has been assessed mainly through parent proxy reports, and self-perceived health among these children is rarely measured. This study aimed to measure self-perceived health in children with spina bifida in the West Bank, to compare this with that in a healthy reference group also from the West Bank, and to assess the potential association between self-perceived health and the level of disability in children with spina bifida. METHODS: A cross-sectional study was conducted in the West Bank. The Paediatric Quality of Life Inventory (PedsQL) was administered to a convenience sample of 200 children aged 8-12 years, of whom 50 have spina bifida and 150 are healthy. For the children with spina bifida, their disability was categorised and ranked according to four aspects of impairment (mobility, bowel function, bladder function, and hydrocephaly). Data were analysed with SPSS version 24. Difference in PedsQL scores between the two groups of children was tested with the Mann-Whitney U-test. The Spearman's rank correlation coefficient was used to evaluate the association between the level of physical impairment in children with spina bifida and their self-perceived health. Written informed consent was obtained from the children's parents. The children's verbal assent was also obtained, and their right to withdraw from the study at any time was emphasised. FINDINGS: Children with spina bifida had lower overall PedsQL scores (mean 45·5, SD 14.5) than those reported by the reference group of healthy children (mean 80·0, SD 12·8). For children with spina bifida, social functioning had the lowest mean score (30·5, SD 20·8), followed by physical functioning (37·5, SD 16.6), emotional functioning (56·0, SD 17·2), and school functioning (62·6, SD 17.8), whereas the range for all of the PedsQL scores in the reference group was 71·7-84·5. The results demonstrate significant inverse associations between self-perceived health (overall PedsQL score) in children with spina bifida and both the level of mobility impairment (rs=-0·65, p<0·0001) and the presence of hydrocephalus (rs=-0·53, p<0·0001). A weak inverse association was found between self-perceived health and both bladder and bowel dysfunction. For both groups, no associations were found between demographic characteristics (age, gender, type of settlement of residence [city, village, camp]) and self-perceived health. INTERPRETATION: The findings provide insights into the importance of social support and rehabilitation services for children with spina bifida in the occupied Palestinian territory. In particular, community awareness, and education of health care providers and family members, may be important. FUNDING: None.

A Person-Centred Approach When Encountering Students With Recurrent Pain: School Nurses' Experiences.

Stress has a negative impact on students' daily lives and can be associated with recurrent pain. School nurses play a key role in supporting young people with stress-related pain. The purpose of this qualitative interview study was to elucidate school nurses' experiences of encountering students with recurrent pain when practicing person-centred care. The school nurses were based at public and private schools and worked with students aged 12-19. Data were collected through interviews with 18 school nurses and analyzed with deductive content analysis. The school nurses felt that actively listening to the students' narratives about daily life with recurrent pain, and co-creation of a health plan, encouraged the students to participate as partners in their own care and strengthened their relation with the students. The application of a person-centred approach in school health care meant that traditional knowledge transfer was replaced with a dialogue that reflects both the student's and school nurse's perspective.

Effects of a person-centred approach in a school setting for adolescents with chronic pain-The HOPE randomized controlled trial.

BACKGROUND: Chronic pain among adolescents is common but effective interventions applicable in a school setting are rare. Person-centred care (PCC) is a key factor in improving health by engaging persons as partners in their own care. METHODS: In this randomized controlled trial, a total of 98 adolescents in secondary school or upper secondary school (aged 14 - 21 years) with chronic pain were randomly assigned to a PCC intervention or standard school healthcare. In the intervention group a pain management programme, based on a PCC approach, comprising four face-to-face sessions with a school nurse over a period of 5 weeks was added to standard school healthcare. The main outcome measure was self-efficacy in daily activities (SEDA scale) and rating scales for pain intensity and pain impact were used as secondary outcome measures. RESULTS: At the follow-up, no significant differences were found between the groups in the SEDA scale (p = .608) or in the rating scales for pain intensity (p = .261) and pain impact (p = .836). In the sub-group analysis, a significant improvement in the SEDA scale was detected at the secondary school in favour of the PCC intervention group (p = .021). CONCLUSION: In this pain management programme based on a PCC approach, we found no effect in the total sample, but the programme showed promising results to improve self-efficacy in daily activities among adolescents at secondary school. SIGNIFICANCE: This study evaluates the effects of a pain management programme based on a PCC approach in a school setting addressing adolescents at upper secondary and secondary schools with chronic pain. No overall effects were shown, but results illustrate that the intervention improved self-efficacy in adolescents at secondary school. Implementation of a PCC approach in a school setting may have the potential to improve self-efficacy in daily activities for adolescents with chronic pain at secondary school.

Women's experiences of fear of childbirth: a metasynthesis of qualitative studies.

Purpose: Women's experiences of pregnancy, labour and birth are for some pregnant women negative and they develop a fear of childbirth, which can have consequences for their wellbeing and health. The aim was to synthesize qualitative literature to deepen the understanding of women's experiences of fear of childbirth.Methods: A systematic literature search and a meta-synthesis that included 14 qualitative papers.Results: The main results demonstrate a deepened understanding of women's experiences of fear of childbirth interpreted through the metaphor "being at a point of no return". Being at this point meant that the women thought there was no turning back from their situation, further described in the three themes: To suffer consequences from traumatic births, To lack warranty and understanding, and To face the fear.Conclusions: Women with fear of childbirth are need of support that can meet their existential issues about being at this point of no return, allowing them to express and integrate their feelings, experiences and expectations during pregnancy, childbirth and after birth.Women with fear after birth, i.e., after an earlier negative birth experience, need support that enables them to regain trust in maternity care professionals and their willingness to provide them with good care that offers the support that individual women require. Women pregnant for the first time require similar support to reassure them that other's experiences will not happen to them.

Psychosocial support for parents of extremely preterm infants in neonatal intensive care: a qualitative interview study.

BACKGROUND: Extremely premature infants (those born before 28 weeks' gestational age) are highly immature, requiring months of care at a neonatal intensive care unit (NICU). For parents, their child's grave medical condition and prolonged hospitalization are stressful and psychologically disruptive. This study aimed at exploring the needs of psychosocial support of parents of extremely premature infants, and how the NICU as an organization and its staff meets or fails to meet these needs. METHOD: Sixteen open-ended interviews were conducted with 27 parents after their infant's discharge from the NICU. Inductive content analysis was performed. RESULTS: Four themes were identified: Emotional support (with subthemes Empathic treatment by staff, Other parents as a unique source of support, Unclear roles of the various professions); Feeling able to trust the health care provider; Support in balancing time spent with the infant and other responsibilities; Privacy. Parents of extremely premature infants needed various forms of emotional support at the NICU, including support from staff, professional psychological help and/or companionship with other patients' parents. Parents were highly variable in their desire to discuss their emotional state with staff. The respective roles of nursing staff, social workers and psychologists in supporting parents emotionally and identifying particularly vulnerable parents appeared unclear. Parents also needed to be able to maintain a solid sense of trust in the NICU and its staff. Poor communication with and among staff, partly due to staff discontinuity, damaged trust. Parents struggled with perceived pressure from staff to be at the hospital more than they could manage and with the limited privacy of the NICU. CONCLUSIONS: The complex and individual psychosocial needs of parents of extremely preterm infants present many challenges for the NICU and its staff. Increasing staffing and improving nurses' competence in addressing psychosocial aspects of neonatal care would help both nurses and families. Clarifying the roles of different professions in supporting parents and developing their teamwork would lessen the burden on nurses. Communicating with parents about their needs and informing them early in their NICU stay about available support would be essential in helping them cope with their infant's hospitalization.

Dealing with adolescents' recurrent pain problems in school health care-Swedish school nurses' view.

AIM: To explore school nurses' strategies for supporting adolescents with recurrent pain. DESIGN: An explorative inductive qualitative design. METHOD: Twenty-one Swedish school nurses were interviewed, and the interviews were subjected to content analysis. RESULTS: The findings show that the nurses are aware that recurrent pain problems are common among the adolescents. In their attempt to support these adolescents, the nurses describe how they are striving in attempts to acquire an understanding of the adolescents' situation, to understand the cause of the pain problem and to devise strategies that can be used to help the adolescents handle the situation.

Development of the Help Overcoming Pain Early (HOPE) Programme Built on a Person-Centred Approach to Support School Nurses in the Care of Adolescents with Chronic Pain-A Feasibility Study.

Chronic pain and its consequences are major global health challenges, and the prevalence is increasing worldwide among adolescents. Adolescents spend most of their waking hours in school; however, there is limited research available on how school nurses can address chronic pain among adolescents in the Swedish school context. Therefore, we designed a person-centred intervention, known as Help Overcoming Pain Early (HOPE), to enable school nurses to offer adolescents strategies to manage their stress and pain. We used the Medical Research Council (MRC) framework for developing and designing this new complex intervention. For this study, we describe two of the four phases: (a) development and (b) feasibility and piloting. The final version of the HOPE programme consists of (i) an educational package for school nurses in the areas person-centred care, stress and pain education/management and gender perspective; and (ii) an intervention package for adolescents with chronic pain. The programme consists of four sessions during which adolescents with chronic pain have person-centred dialogues with a school nurse. The HOPE programme is based on the existing evidence of managing chronic pain and on the assumption that school nurses can support adolescents with chronic pain by using person-centred care.

Conditions for communication between health care professionals and parents on a neonatal ward in the presence of language barriers.

Purpose: Family-centred neonatal care views parents and child as a unit, and aims to support each family on the basis of its specific needs. Good communication can increase parents' satisfaction and reduce tension, and is necessary to create a mutual trustful relation, but is influenced by language barriers. We aimed to describe communication between neonatal health care professionals and parents in the presence of language barriers. Methods: A field study using a hermeneutic lifeworld approach, participative observation, and interviews with parents and health care professionals. Results: The main theme, endeavouring to understand the meaning behind the words, comprised three themes. Wanting to speak for oneself meant that parents wanted to speak for themselves or call on a friend or multilingual health care professionals, in contrast to the health care professionals wish to use an interpreter. Being aware of cultural keys meant that some wards had access to a "cultural broker" to assist health care professionals and parents with both language translation and understanding of the Swedish health care environment. Understanding one another in the employees' arena reflected varying language skills among health care professionals. The health care professionals had the power to decide the level of access to communication, and decided both the intensity and the frequency of the conversations. Conclusions: Health care professionals preferred to use an interpreter when communicating with parents, while parents wished to be independent and speak for themselves. If an interpreter was used, parents preferred this to be a friend or health care professionals; this option was less popular among health care professionals.

Health care professional's communication through an interpreter where language barriers exist in neonatal care: a national study.

BACKGROUND: A number of parents in neonatal care are foreign-born and do not speak the local language, which makes communication between healthcare professionals and parents more difficult. Interpreters can be used when language barriers exist - parent interactions, medical communication and communication about the care of the child. The aim in this study was to examine healthcare professionals' use of interpreters and awareness of local guidelines for interpreted communication in neonatal care. METHOD: A survey was distributed to all 2109 employees at all 38 neonatal units in Sweden, thus to all physicians, registered nurses and nurse assistants in active service. Data were analysed with descriptive statistics and dichotomized so the professionals were compared in groups of two using the Mantel-Haenszel Chi Square test and Fisher's Non Parametric Permutation test. RESULTS: The survey was answered by 41% (n = 858) representing all neonatal units. The study showed a difference between the professional groups in awareness of guidelines, availability of interpreters, and individual resources to communicate through an interpreter. Nurse assistants significantly lesser than registered nurses (p < .0001) were aware of guidelines concerning the use of interpreters. In emergency communications nurse assistants used authorized interpreters to a significantly lesser extent than physicians (p < .0001) and registered nurses (p < .0001). Physicians used authorized interpreters to a significantly higher extent than registered nurses (p 0.006) and non-authorized interpreters to a significantly lesser extent than registered nurses (p 0.013). In planned communications, nurse assistants used authorized interpreters to a significantly lesser extent than physicians (p < .0001) and registered nurses (p < .0001). Nurse assistants rated their ability to communicate with parents through an interpreter to a significantly lesser extent than physicians (p 0.0058) and registered nurses (p 0.0026). No other significant differences were found. CONCLUSION: The results of the study show insufficient awareness of guidelines in all neonatal units in Sweden. Clinical implications might be to provide healthcare professionals with guidelines and training clinical skills in using interpreters and increasing the availability of interpreters by having interpreters employed by the hospital.

Causes and outcomes in studies of fear of childbirth: A systematic review.

PROBLEM: Fear of childbirth negatively affects women during pregnancy and after birth. AIM: To summarise the findings of published studies regarding possible causes/predisposing factors and outcomes of fear of childbirth for childbearing women. DESIGN: A systematic review, searching five databases in March 2015 for studies on causes/predisposing factors and outcomes of fear of childbirth, as measured during pregnancy and postpartum. Quality of included studies was assessed independently by pairs of authors. Data were extracted independently by reviewer pairs and described in a narrative analysis. FINDINGS: Cross-sectional, register-based and case-control studies were included (n=21). Causes were grouped into population characteristics, mood-related aspects, and pregnancy and birth-related aspects. Outcomes were defined as mood-related or pregnancy and birth-related aspects. Differing definitions of fear of childbirth were found and meta-analysis could only be performed on parity, in a few studies. CONCLUSIONS: Stress, anxiety, depression and lack of social support are associated with fear during pregnancy. Need for psychiatric care and presence of traumatic stress symptoms are reported outcomes together with prolonged labour, longer labours, use of epidural and obstetric complications. Nulliparous and parous women have similar levels of fear but for different reasons. Since the strongest predictor for fear in parous women is a previous negative birth experience or operative birth, we suggest it is important to distinguish between fear of childbirth and fear after birth. Findings demonstrate the need for creating woman-centred birthing environments where women can feel free and secure with low risk of negative or traumatic birth experiences and consequent fear.

Palestinian children's narratives about living with spina bifida: Stigma, vulnerability, and social exclusion.

BACKGROUND: Living with spina bifida in Palestine is a critical issue that might influence various aspects of the individual's life. It is a challenge for children, their families, and health care providers because it requires lifelong treatment and follow-up of care provision. However, little focus has been placed on these children's perceptions about their daily life experiences with spina bifida. PURPOSE: To illuminate the lived experience of children with spina bifida in the West Bank, Palestine. METHODS: A qualitative study was conducted using the phenomenological hermeneutical method to interpret the meaning of being a child with spina bifida in Palestine. Ten children with spina bifida, aged 7-18 years, were interviewed. The two local authors independently analyzed the Arabic transcriptions, whereas the two Swedish authors analyzed the transcriptions after translation to English. Finally, the four authors discussed their analysis and reached agreement about the themes. RESULTS: Studying the children's experience with spina bifida helped us highlight their feelings, needs, and challenges. The findings were formulated into one main theme, Vulnerability and suffering due to social exclusion and stigma, which was grounded in three themes: Experiencing negative self-concept, Experiencing vulnerability, and Obtaining a sense of security. These three themes were in turn derived from subthemes. CONCLUSION: The Palestinian children in this study faced physical, emotional, and psychosocial challenges, which negatively influenced their health and development. They were vulnerable and stigmatized, and they lived with a negative self-concept. The findings could help health professionals, families, and caregivers to achieve a deeper understanding of what being a child with disabilities entails, and the findings may also serve as a platform for interventions that seek to promote these children's development and to enable them to experience childhood as a meaningful and positive process.