Life satisfaction in children with attention deficit hyperactivity disorder: Looking beyond proxy reports.

PROBLEM: A common clinical approach to children with attention deficit hyperactivity disorder (ADHD) is to view them through an adult-proxy report of problems. There is little evidence on how children with ADHD evaluate their life satisfaction, how their evaluations compare with unaffected children, or how their perspectives might inform clinical practice. METHODS: A parallel convergent mixed-methods design was used to interview 20 children (aged, 7-11 years) with ADHD. This report presents the children's responses to the 40-item Multidimensional Student Life Satisfaction Scale. Parents/guardians ( N = 20) provided contextual data consisting of demographics, ADHD-related items, and health literacy. FINDINGS: Total life satisfaction (M = 3.08, SD = 0.35) fell within the 95% CI [2.91, 3.25] of comparative data. Overall subscale ratings (high to low) included: friends (M = 3.24, SD = 0.60), living environment (M = 3.14, SD = 0.51), family (M = 3.08, SD = 0.51), school (M = 3.0, SD = 0.65), and self (M = 2.93, SD = 0.60). Positive and negative associations are reported. CONCLUSIONS: Including a measure of life satisfaction adds a child-centered approach to understanding children with ADHD beyond an adult-proxy report of problems that is contextually and clinically relevant.

Children with ADHD draw-and-tell about what makes their life really good.

PURPOSE: The purpose of this study was to engage children with attention deficit hyperactivity disorder (ADHD) in a developmentally sensitive way to explore the children's subjective well-being. Explicitly, their life satisfaction, or what makes their life "really good." To date, little is known about the subjective life experience of children with ADHD or how incorporating children's views separate from the purview of adults and pathology might enhance our understanding or change our approach to evaluation and/or intervention. DESIGN AND METHODS: A parallel convergent mixed-methods design was used to collect data from a convenience sample of children with ADHD (N = 20) ages 7 to 11 years old. This article focuses solely on the qualitative data obtained through semi-structured interviews using the art-based approach draw-and-tell conversation (DTC). The DTC data were analyzed using qualitative content analysis. In addition, each parent (N = 20) independently completed demographic and health-related forms to provide descriptive and contextual variables. RESULTS: Three themes were discerned in the DTC analysis-activity, nature, and connections. Most children (90%) described engaging in some form of activity, often outdoors, and with others; though the focus of activity was varied. Nature was evidenced directly and indirectly in many of the children's (85%) stories. Over half (65%) of the children described some variation in relational connection across a continuum that contributed to, or detracted from, their sense of well-being/life satisfaction. PRACTICE IMPLICATIONS: Children shared that doing things, outdoors, with others, [emphasis added] made their life "really good". Children's stories yielded insightful and actionable information that is relevant to each individual child/family, and to nursing assessment, intervention, and advocacy. These child-granted insights also extend our attention beyond pharmacological and behavioral focused interventions, to include the children's own innate health promoting interests that help to make their life really good.

Care coordination: Identifying and connecting the most appropriate care to the patients.

Although nurses are increasingly expected to fulfill the role of care coordinator, the knowledge and skills required to be an effective care coordinator are not well understood. The purpose of this study was to describe the knowledge and skills required in care coordination practice using an interpretive phenomenological approach. Fifteen care coordinators from 10 programs were interviewed over a 6-month period. Semi-structured face-to-face interviews were audio recorded, transcribed, and analyzed using interpretive phenomenology. The central theme of care coordination practice was bridging the patient and the healthcare systems. To bridge, care coordinators needed to have knowledge of the patient and healthcare system as well as the skills to identify and negotiate treatments appropriate for the patient. The most salient finding and new to this literature was that care coordinators who used their medical knowledge about available treatment options to discern and negotiate for the most appropriate care to the patient made differences in patient outcomes. Nurses with medical and healthcare system knowledge, combined with the skills to navigate and negotiate with others in an increasingly complex healthcare system, are well situated to be care coordinators and generate optimal outcomes. Further investigations of critical care coordinator competencies are needed to support nurses currently enacting the role of care coordinator and to prepare future nurses to fulfill the role.