Caring for the child with a tracheostomy through the eyes of their caregiver: A photovoice study.

PURPOSE: This qualitative descriptive study aimed to explore the daily experiences of caregivers of children with medical complexity with a tracheostomy at home. METHODS: This study used photovoice, a participatory action research methodology. Adult English-speaking caregivers of children with a tracheostomy, living in Texas, with access to a smartphone were recruited. Photographs taken by participants and an interview guide were used to guide semi-structured interviews with caregivers. RESULTS: Eight participants were recruited. After analyzing photographs and caregiver interviews, four main themes were identified: role transition, daily challenges, finding support, and thriving in the new normal. CONCLUSIONS: Caregivers take on multiple roles, including providing medical care, advocating for their children, and educating others. While facing emotional challenges such as guilt, fear, and exhaustion, caregivers rely on external support systems, emphasizing the need for nurses and healthcare providers to provide comprehensive support and improve the accessibility of home nursing services. PRACTICE IMPLICATIONS: The findings of this study can inform nurse-led interventions and advocacy efforts aimed at supporting marginalized children with medical complexity with a tracheostomy and their families. These efforts may include enhancing communication and collaboration between families, healthcare workers, and the public, providing comprehensive, proactive support for caregivers, and improving access to home nursing services.

Development and Validation of an Instrument to Measure Barriers to Surgical Conscience Action in Perioperative Nurses.

Background: Surgical conscience is a concept well known to perioperative nurses, yet it is rarely studied. The purpose of this study was to develop and psychometrically validate an original instrument called the Surgical Conscience Scale with perioperative nurses. Methods: The Surgical Conscience Scale was designed after a review of the literature, the creation of a concept analysis, content validity, and pilot testing. Validity was explored by an exploratory factor analysis (EFA) and a confirmatory factor analysis (CFA) with separate groups of participants. Results: EFA results explained 55% of the variance with three factors: Foundational Components, Barriers to Surgical Conscience Action, and Required Attributes. The CFA findings did not support goodness-of-fit indices in total; however, a valid and reliable subscale was discovered that measures barriers to using one's surgical conscience. This six-item scale, now referred to as the Barriers to Surgical Conscience Action Scale, had all six items of this factor (.734, .754, .806, .689, and .573) with strong loadings (>.5). Additionally, a good reliability coefficient of the subscale (α = .874) supports the recommendation to use this subscale on its own to measure barriers of surgical conscience. Conclusion: The use of the Barriers to Surgical Conscience Action Scale can promote awareness about the harmful consequences of failed action on behalf of perioperative nurses and help promote proficient surgical conscience usage.

Assessing Available Adolescent Self-Reported Measures for Asthma Management: A Systematic Literature Review.

Objective: Asthma is a common chronic disease and a substantial public health problem for children, adolescents, and adults. Adolescence, a period of increased independence and striving for autonomy, is an opportune time for youth transitioning to adulthood to assume more responsibility for their own asthma self-management. However, accurate measures of adolescent asthma outcomes are limited. The purpose of this systematic review is to identify self-reported asthma measures currently available in the empirical literature focused on adolescent populations. Methods: Search terms were based on the National Library of Medical Subject Headings and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Databases searched included CINAHL, Nursing Allied Health Prevention, Medline, ProQuest, and PubMed. Included studies were peer reviewed and published in English between 2010 and 2022. All studies reported on asthma measures for adolescents between 10 and 19 years old. Results: Nineteen studies were included, comprising 15 experimental and 4 quasi-experimental. This review revealed the following asthma measure domains: asthma knowledge, self-efficacy, attitudes, self-care, self-regulation, symptom prevention and management, medication adherence, asthma disease control, symptoms, and quality of life (QOL) for evaluating psychosocial, behavioral, clinical, and QOL outcomes. Conclusion: This review revealed the necessity of developing a comprehensive measure to assess the asthma self-management behaviors of adolescents. A comprehensive tool related to adolescent asthma self-management behavior would enhance the assessment and evaluation of adolescent asthma self-management behaviors and extend the science and clinical practice around adolescent self-management. Present measures for asthma self-management behavior for adolescents are limited; therefore, developing a valid and reliable measure is necessary not only to assess adolescents' asthma self-management behavior outcomes but also to identify and evaluate the essential components to include in educational interventions for adolescent self-management.

Parents voice their experiences of caring for children with special healthcare needs amid the COVID-19 pandemic.

PURPOSE: The purpose of this study was to understand the experiences of parents and caregivers of children with special healthcare needs during the COVID-19 pandemic. DESIGN AND METHODS: In this descriptive phenomenological study, the researchers used purposive and snowball sampling to recruit nineteen participants, ranging in age from 21 to 55 years of age until saturation was established. Colaizzi's method guided data analysis. Iterative examination of the interview transcripts, an audit trail, bracketing, and validation of findings with a subset of participants established trustworthiness. RESULTS: Navigating the COVID-19 Pandemic was the overarching theme. Four major themes emerged under Navigating the COVID-19 Pandemic as follows: Disruptions in Daily Life, Shifts in Daily Life, Innovations in Daily Life, and Surprising Silver Linings. CONCLUSION: This study elucidated an in-depth understanding of the positive and negative impacts of the pandemic on the lives of families living with a child with special needs. The COVID-19 pandemic profoundly affected families and parenting approaches. Parents of children with special healthcare needs in this study found day-to-day living especially difficult in similar and unique ways. For virtually all parents the pandemic added new challenges in meeting their child's physical, mental, social, and educational needs. Parents and caregivers revealed innovative ways of maintaining a sense of normalcy during the height of the pandemic. PRACTICE IMPLICATIONS: These findings demonstrate the importance of developing interventions and creating public health policies as we move beyond the current pandemic and plan for potential outbreaks in the future.

Orem's Self-Care Deficit Nursing Theory to Improve Children's Self-Care: An Integrative Review.

Often school-age children are thought of as dependent on their parents and not necessarily involved in behaviors related to their own self-care. It is important to implement and advance self-care performance early in life to promote healthy lifestyles. This review examined the use of Orem's Self Care Deficit Nursing Theory in relation to children's self-care behaviors. This integrative review followed the Whittemore and Knafl guidelines. A systematic search was conducted using the nursing databases. The sixteen study articles were identified for the review, and five themes were identified. Children can develop skills and actively participate in maintaining health and wellbeing. Self-care programs based on Orem's theory are well suited to assist individuals including children to improve self-care skills that lead better self-care practices. Nurses guided by Orem's SCDNT will be well equipped to promote children's knowledge and self-care skills for maintaining health and preventing negative health outcomes.

A School Nurse-Led Asthma Intervention for School-Age Children: A Randomized Control Trial to Improve Self-Management.

Asthma is a common disease in children, and obtaining basic knowledge and skills to manage asthma symptoms is critically important. This study examined the effectiveness of a theoretically based school nurse-led asthma intervention on asthma symptoms, self-management, peak flow meter usage, daily activities, and school absences in children 7-12 years old. A randomized controlled, two-group, repeated measures design was conducted in eight public schools. Data collection occurred at three time points. The treatment group had statistically significant differences in reported symptoms (p < .001), asthma control with a peak flow meter usage (p < .001), and daily activities (p < .001) at 6 weeks and at 12 weeks. Although difference in school absences was not statistically significant, the treatment group missed fewer school days than the control group. Self-management is a complex process, and school nurses can provide essential learning steps and continuity of care for school-age children living with asthma.

The Use of Theoretical Frameworks Guiding Interprofessional Simulation: An Integrative Review.

AIM: The aim of the review was to describe and summarize the use of theoretical premises noted in published studies on the implementation of interprofessional simulation (IPE-Sim). BACKGROUND: IPE-Sim is an educational methodology being used throughout nursing, allied health, and health science programs of study. Understanding frameworks currently used in IPE-Sim is essential in advancing the knowledge of this type of educational methodology. METHOD: An integrative literature review on the use of theories and models guiding IPE-Sim was performed. RESULTS: Ten studies meeting the inclusion criteria were categorized into theoretical frameworks (n = 4) or competency frameworks (n = 6) guiding the development and implementation of IPE-Sim and were included in the review. The literature review revealed a lack of consistent theoretical and competency-based frameworks guiding the development, implementation, assessment, and research of IPE-Sim. CONCLUSION: The integrative literature review describes specific theoretical and competency frameworks currently used in the literature on IPE-Sim.

Evaluating an Intergenerational Model to Explain the Path From Violence Against Mothers to Child Behavior and Academic Outcomes.

An intergenerational model to explain the long-term effect of partner violence against mothers on child behavior was evaluated 48 months after 278 mothers first sought safe shelter or justice services. Twelve percent reported recent abuse, and six mothers reported severe or extreme danger. Self-efficacy (-.58, p < .05), social support (-28, p < .05), and financial support (-.25) were inversely associated with mental health concerns. Higher maternal mental health concerns (.55, p < .05) and child witnessing abuse (.70, p < .05) were associated with child behavioral problems. Child behavioral problems were inversely associated with child academic functioning (-.22, p < .05). To improve child outcomes, interventions that establish safety for mothers and children and promote maternal mental health are needed.

Battle weary/battle ready: A phenomenological study of parents' lived experiences caring for children with autism and their safety concerns.

AIM: The first aim of this study was to explore the lived experiences of parents caring for their autistic children and their experiences with safety for these children. The second aim was to elicit safety recommendations from the parents of autistic children. DESIGN: Hermeneutic phenomenology. METHODS: Fifteen participants who self-reported they were parents of children with autism were recruited via snowball sampling. Data were collected from September 2017-December 2018 in audiotaped interviews using semi-structured questions. Interviews were held with four participants to determine if the findings represented their experiences and concerns accurately. RESULTS: Two underlying structures which demonstrated the trajectory of the experience caring for autistic children were lost/finding our way and battle ready/battle weary. The phenomenological themes within battle weary included living with fear, living with uncertainty and living with disappointment. Resilience was a fourth phenomenological theme which supported the experience of being battle ready. The participants provided recommendations for other parents and healthcare professionals to help keep autistic children safe. CONCLUSION: This study illustrates the unique perspective of parents of autistic children concerning autism and safety. IMPACT: Most parents in this sample reported they faced substantial issues with safety for their child. Study results demonstrated that parents received little to no information about safety from healthcare professionals. Parents of autistic children and healthcare professionals need to be educated about safety issues to prevent injuries and death.

School and Community-based Nurse-led Asthma Interventions for School-aged Children and Their Parents: A Systematic Literature Review.

PROBLEM: Asthma is one of the most prevalent chronic diseases in the world. Lack of asthma knowledge can lead to asthma exacerbations, more emergency room visits, school absences, and decreased quality of life. This systematic review examines the effectiveness of educational intervention programs on asthma management for school-aged children and their parents beyond inpatient clinic settings. ELIGIBILITY CRITERIA: Educational asthma interventions for school-aged children and their parents with comparison with usual asthma care and the outcome related to asthma management. Studies included were peer-reviewed and published in English within the last five years. SAMPLE: The eight study articles were identified in ProQuest, Medline, CINAHL, and PubMed databases. RESULTS: The review demonstrated that educational asthma interventions for children and their parents significantly improved knowledge and skills related to asthma self-management. CONCLUSIONS: School and community-based asthma educational intervention programs are key components for good management of asthma condition. Well-planned asthma education programs are valuable and should go beyond inpatient clinic settings for promoting and maintaining health for children with asthma and their parents. IMPLICATIONS: School nurses are well-positioned to assume a more prominent role in asthma care to improve child health and academic outcomes. School nurses have an opportunity to establish a trusting relationship that is foundational for collaborating with parents and students for better asthma management.

Mothers' posttraumatic stress and child adjustment problems in families seeking services for intimate partner violence.

OBJECTIVE: This study examines whether fluctuation in mothers' posttraumatic stress symptoms (PTSSs) predicts fluctuation in child adjustment problems in families seeking services for intimate partner violence (IPV). METHOD: Participants were 300 mothers (mean age = 30.65 years) of children (mean age = 6.88 years; 49% female) who were seeking shelter or legal services because of IPV. Most mothers identified as Hispanic (57%), followed by Black/African American (26%). Mothers reported PTSSs on a 7-item screening measure and reported child externalizing and internalizing problems on the Child Behavior Checklist. Mother and child functioning were assessed shortly after the mothers' requested services and then every 4 months for a 5-year period. RESULTS: Eighty-one percent of mothers reported clinical levels of PTSSs at the initial assessment. As hypothesized, fluctuation in mothers' PTSSs predicted fluctuation in child externalizing and internalizing problems during the ensuing 4-month period. These relations, however, occurred within subjects but not between subjects. The within-subject associations emerged after accounting for IPV and mothers' depressive symptoms and were stronger for older children than younger children. The strength of the associations decreased over time. CONCLUSIONS: Addressing women's trauma symptoms at the point of seeking services for IPV has possible implications for child mental health. Attempting to reduce mothers' PTSSs may have positive effects for women as well as their children. (PsycINFO Database Record

Using Baseline Data to Predict Chronic PTSD 48-months After Mothers Report Intimate Partner Violence: Outcomes for Mothers and the Intergenerational Impact on Child Behavioral Functioning.

Worldwide one in three women report intimate partner violence. Many of these women report long term mental health problems, especially PTSD, which is associated with negative problem solving, isolation, somatization, depression, and anxiety. Children are impacted by their exposure to domestic violence and experience internal (i.e., depression, anxiety) and external (i.e., hostility, delinquency) behavioral clinical problems. To predict which women will experience chronic PTSD symptoms, a PTSD predictor tool was developed and applied to PTSD symptom scores four years after 300 mothers with children (age 18 months to 16 years) received assistance for the violence. At four years, 266 (89%) of the 300 mother child dyads were retained. Of those, 245 met inclusion criteria for this study and 53% had scores above the clinical threshold for PTSD. The predictor tool performed well. There was a significant association, χ2 (4) = 11.83, p = .019, Cramer's V = 0.229, between mothers predicted at low/some risk for chronic PTSD and scoring below the cut-off score for diagnostic PTSD symptoms at four years. Mothers predicted to be at extreme risk for chronic PTSD reported PTSD symptoms at or above the diagnostic level at 48 months. Children whose mothers had PTSD were at greater risk for Borderline/Clinical range behavioral problems compared to children whose mothers did not have PTSD. Relative risk values ranged from 2.07 (Externalizing) to 2.30 (Internalizing). When appropriate interventions are available, the PTSD predictor tool can assist with triage and guided referral of women at risk for chronic PTSD.

Exploring the Association of Maternal Adverse Childhood Experiences with Maternal Health and Child Behavior Following Intimate Partner Violence.

BACKGROUND: Adverse childhood experiences (ACEs) have been empirically linked to a host of negative health outcomes, both physical and psychosocial. Exposures to ACEs make individuals more susceptible to conditions such as cardiovascular disease, diabetes, cancers, and depression. Many of these conditions do not appear until sometime in adolescence or adulthood and have been linked to premature death. OBJECTIVE: This study explores the association between the number and type of exposure to ACEs in women (mothers) who experienced intimate partner violence and health outcomes. Specifically, it explores the association between maternal ACEs and maternal perceived health and maternal mental and behavioral health. This study also explores the association between ACEs and child behavior. METHODS: This analysis is part of a 7-year prospective study. A cohort of 300 mother-child pairs was assessed at baseline and every 4 months after reaching out for shelter or justice services for the very first time after being in an abusive intimate relationship. RESULTS: Data document individual mothers' ACE scores and show a trend at 12 months, 24 months, and is most significant at 36 months. Additionally, at 36 months, higher ACE scores were significantly associated with all child behavioral subscales (anxiety, depression, aggressive behavior, attention problems, internalizing, externalizing). CONCLUSION: The women in this study reported ACE scores consistently higher than national rates. Our data highlight the added benefit of using ACE criteria as a global prevention strategy to identify those most at risk for delayed mental and behavioral health issues and to intervene with supportive strategies and guided referrals as indicated.

The lived experience of nurse practitioners practicing within the Transformational Advanced Professional Practice Model: A phenomenological study.

PURPOSE: The purpose of this study was to describe the lived experiences of nurse practitioners (NPs) practicing within the Transformational Advanced Professional Practice (TAPP) Model, a professional practice model (PPM). DATA SOURCES: A descriptive phenomenological analysis using semistructured interviews of 11 NPs across multiple inpatient and outpatient clinical areas at Texas Children's Hospital. Member checking and theming data occurred using Colaizzi's Method concurrently with Mind Mapping technique. CONCLUSIONS: Main themes included: (a) transforming professional practice, (b) cultivating the inner self, and (c) mentoring professional transitions. IMPLICATIONS FOR PRACTICE: The findings of this study provide qualitative evidence that the TAPP Model influences role transition and professional development. Transforming NP practice within organizations and within the nursing profession itself will take mindfulness with an intentional approach to design PPMs specifically for NPs.

Parenting in the Wake of Abuse: Exploring the Mediating Role of PTSD Symptoms on the Relationship Between Parenting and Child Functioning.

BACKGROUND: Children whose mothers report partner violence and symptoms of posttraumatic stress disorder (PTSD) are at risk for behavior dysfunctions. AIM: To examine the mediating effects of maternal PTSD symptoms on the relationship of parenting behaviors to child internalizing and externalizing behavior dysfunctions. FINDINGS: Maternal PTSD symptoms have a partial mediating effect on the relationship between inconsistent discipline and child internalizing and externalizing behaviors. Maternal PTSD symptoms have a fully mediating effect on the relationship between poor supervision and child internalizing behaviors. CONCLUSIONS: There is a need to identify women who report partner violence and are at high risk for PTSD and intervene early to prevent problematic parenting and resulting child behavior problems.

Modeling the intergenerational impact of partner abuse on maternal and child function at 24 months post outreach: Implications for practice and policy.

OBJECTIVE: Many women are exposed to partner violence during their lifetime which affects mental health and child development. This study revalidates an intergenerational model connecting partner violence to poor functioning for mothers and children using structural equation techniques. METHOD: A longitudinal design collected data on 300 mother-child pairs. Comparisons between the model, tested at study entry and again at 24 months, are reported. Maternal measures included childhood experiences of abuse, partner abuse, chronic pain, and mental health. The Child Behavior Checklist measured child function. RESULTS: Comparison of both models revealed that maternal chronic pain, maternal mental health, and child witnessing of mother's abuse remain strong predictors of child dysfunction. Maternal social support and self-efficacy are significant predictors of more positive maternal mental health with a conduit effect on child behavior. CONCLUSION: Intimate partner violence directly impacts the victim and also has a secondary impact on the children of abuse victims.

Partner Abuse of Mothers Compromises Children's Behavioral Functioning Through Maternal Mental Health Dysfunction: Analysis of 300 Mother-Child Pairs.

Partner violence is associated with numerous negative consequences for victims, especially poor mental health. Children who are exposed to partner violence are more likely to have behavior problems. Nevertheless, research on the relationship between severity of abuse, maternal mental health functioning following partner violence, and child behavior problems is limited. We explored the direct and indirect effects on the child's behavioral functioning of severity of maternal abuse and maternal mental health functioning following abuse. A sample of 300 mothers was recruited when they sought assistance for abuse for the first time at shelters for abused women or at the district attorney's office. Severity of abuse, mothers' mental health functioning, and child behavioral functioning were measured by maternal self-report at entry into the study and 4 months later. In SEM analysis, at both entry and 4 months, severity of abuse had a direct effect on maternal mental health functioning, which in turn had a direct effect on child behavioral functioning. The path from severity of abuse to child behavioral functioning also was significant but became non- significant once maternal mental health functioning was added to the equation, indicating that the path from severity of abuse to child behavioral functioning was indirect and occurred as a result of the mother's mental health functioning, which remained directly linked to child behavioral problems. Intergenerational interventions are needed to address both maternal mental health and child behavioral functioning when a mother reports partner violence and is experiencing mental health problems.

The Intersection of Partner Violence and Adverse Childhood Experiences: Implications for Research and Clinical Practice.

Violence against women continues to be a serious public health issue afflicting women worldwide. The intersection of Adverse Childhood Experiences (ACEs) and intimate partner violence is detrimental to a woman's well-being. This review aims to identify the types of ACEs reported by women who also report partner violence and the subsequent negative impact of this combination of experiences on the women's health. The evidence supports the cumulative effects of Adverse Childhood Experiences on women, particularly when coupled with experiences of intimate partner violence. Early interventions by providers have the potential to mitigate negative health outcomes of abused women and interrupt the intergenerational transmission of violence to their children.

Predictors and outcomes of community agency use in abused mothers.

OBJECTIVE: To identify characteristics of abused mothers that predict use and difficulty of use of community agencies for intimate partner violence (IPV) and to describe the outcomes of community agency use. DESIGN AND SAMPLE: A prospective study design was used. Three hundred mothers who had experienced physical or sexual IPV and were seeking services for the first time at either a safe shelter for abused women or applying for a protection order. MEASURES: Data were collected and analyzed by the research team. Predictors were tested using binary logistic regression and outcomes were tested using a series of Mann-Whitney U nonparametric test of difference on change scores between baseline and 24-month scores. RESULTS: No individual predictors were statistically significant and/or meaningful for use or difficulty using community agencies. There were significant differences in change scores for severity of violence after women used counseling, the police, or legal services. There were also significant change scores for anxiety after women used legal services and social services. CONCLUSIONS: Abused women need individualized attention to assure that they can access the services they need to recover from IPV. Evidence-based practice is needed for community agencies to treat abused women to facilitate safety and health.

Problem-solving and mental health outcomes of women and children in the wake of intimate partner violence.

The environmental stress of intimate partner violence is common and often results in mental health problems of depression, anxiety, and PTSD for women and behavioral dysfunctions for their children. Problem-solving skills can serve to mitigate or accentuate the environmental stress of violence and associated impact on mental health. To better understand the relationship between problem-solving skills and mental health of abused women with children, a cross-sectional predictive analysis of 285 abused women who used justice or shelter services was completed. The women were asked about social problem-solving, and mental health symptoms of depression, anxiety, and PTSD as well as behavioral functioning of their children. Higher negative problem-solving scores were associated with significantly (P < 0.001) greater odds of having clinically significant levels of PTSD, anxiety, depression, and somatization for the woman and significantly (P < 0.001) greater odds of her child having borderline or clinically significant levels of both internalizing and externalizing behaviors. A predominately negative problem-solving approach was strongly associated with poorer outcomes for both mothers and children in the aftermath of the environmental stress of abuse. Interventions addressing problem-solving ability may be beneficial in increasing abused women's abilities to navigate the daily stressors of life following abuse.