"What If?": Caregivers' Experiences Following Early Childhood Concussion.

OBJECTIVE: Little is known about the symptoms, signs, and management guidelines for children under the age of 6 years after they sustain a concussion. Caregivers of such young children may have unique concerns and encounter different challenges from those of school-age children given the distinctive developmental characteristics of the early childhood period. This study aimed to explore the experience of caregivers through semistructured interviews to inform clinical practice. METHODS: Fifty caregivers of children aged 6 months to 5.99 years were interviewed 3 months postinjury for this qualitative study to document their experience in relation to their child's accident, recovery, and healthcare provisions. RESULTS: Four main themes were identified: (1) visible changes associated with caregiver concerns, (2) a roller-coaster of emotions after the injury, (3) healthcare providers' role in addressing the need for reassurance, and (4) the need for better information after the injury. CONCLUSION: The findings provide critical insight into the unique experiences and information needs of caregivers of young children who sustain concussion. The challenges identified can inform healthcare professionals regarding the needs of caregivers after early concussion and contribute to building a knowledge base for the development of age-appropriate anticipatory guidance for caregiver mental health and child recovery.

Children's perspectives on friendships and socialization during the COVID-19 pandemic: A qualitative approach.

BACKGROUND: Good quality friendships and relationships are critical to the development of social competence and are associated with quality of life and mental health in childhood and adolescence. Through social distancing and isolation restrictions, the COVID-19 pandemic has had an impact on the way in which youth socialize and communicate with friends, peers, teachers and family on a daily basis. In order to understand children's social functioning during the pandemic, it is essential to gather information on their experiences and perceptions concerning the social changes unique to this period. The objective of this study was to document children and adolescents' perspectives regarding their social life and friendships during the COVID-19 pandemic, through qualitative interviews. METHODS: Participants (N = 67, 5-14 years) were recruited in May and June 2020. Semi-structured interviews were conducted via a videoconferencing platform. A thematic qualitative analysis was conducted based on the transcribed and coded interviews (NVivo). RESULTS: The upheavals related to the pandemic provoked reflection among the participants according to three main themes, each of which included sub-themes: (1) the irreplaceable nature of friendship, (2) the unsuspected benefits of school for socialization and (3) the limits and possibilities of virtual socialization. CONCLUSIONS: The collection of rich, qualitative information on the perspectives of children and adolescents provides a deeper understanding of the consequences of the pandemic on their socialization and psychological health and contributes to our fundamental understanding of social competence in childhood.

Assessing the impacts of an interdisciplinary programme supporting father involvement on professionals' practices with fathers: A qualitative study.

AIMS AND OBJECTIVES: The study aimed to assess the impacts of the Father-Friendly Initiative within Families (FFIF) programme, an interdisciplinary programme supporting father involvement, on health professionals' practices with fathers. BACKGROUND: It is increasingly recognised that father involvement benefits children's cognitive and social development and contributes to both parents' well-being. Recent research has shown health professionals' support to be a protective factor in father involvement. Research results were translated into practice through the implementation of a programme, the FFIF, aimed at empowering health professionals to support father involvement. DESIGN: The study employed a qualitative impact assessment approach based on semi-structured interviews with 36 health professionals to assess the impacts of the FFIF on professionals' practices with fathers. METHODS: A total of 36 health professionals were interviewed (13 nurses, 10 social workers, six community workers, three educators, two psychoeducators, one health manager, and one special education teacher). Interviews were transcribed, and a qualitative thematic analysis was carried out. This study is presented in line with COREQ's checklist. RESULTS: Impacts of the FFIF on health professionals were seen in changes on three fronts: (a1) their beliefs; (b) their conception of their role; and (c) their interventions. These changes related to three themes: (a) difficulties experienced by fathers; (b) importance of father involvement; and (c) differences between fathers and mothers. The professionals, having realised the importance of their own role in improving the services offered to fathers, made concrete changes in their interventions, such as reaching out to fathers more effectively, encouraging their participation and treating them fairly and equitably. CONCLUSIONS: After attending this interdisciplinary programme supporting father involvement, participating professionals adopted father-friendly beliefs, redefined their conception of their role and modified their interventions. RELEVANCE TO CLINICAL PRACTICE: To provide family-centred care, nurses and other health professionals need to adopt father-inclusive practices.

Women's Experiences of Miscarriage in the Emergency Department.

INTRODUCTION: Miscarriage is a common event, usually managed in the emergency department. Although studies have examined the impact of miscarriage on women's mental health and the effects of their dissatisfaction with health care received, little is known about the characteristics of the miscarriage experience in the emergency department. The objective of this study was to identify characteristics of care management that may have contributed to the difficulties experienced by women presenting with miscarriage in the emergency department. METHODS: Forty-eight women treated at 4 emergency departments in different regions of Quebec, Canada, were interviewed for 60 to 90 minutes. A thematic qualitative analysis of these interviews was performed. RESULTS: Analyses revealed that participants' experiences were characterized particularly by a lack of information at 3 critical junctures of the miscarriage experience: the announcement of the miscarriage, the course of the miscarriage, and the ED discharge. The topics on which the women lacked information were categorized into 7 subthemes within these junctures. DISCUSSION: Lack of information throughout the care management of miscarriage exacerbated the already-difficult nature of this event for the participants. Training emergency nurses to give adequate and complete information enables the delivery of compassionate care, potentially making a difficult situation less traumatic.

The role of fathers during breastfeeding.

OBJECTIVE: identify fathers' perceptions of their role in a breastfeeding context. SETTING: three different geographic areas (urban, semi-urban, and rural) of Quebec, a francophone province in Canada. PARTICIPANTS: 43 fathers whose children had been exclusively breastfed for a minimum of six months. METHODS: a qualitative study using semi-structured interviews was undertaken. Thematic analysis of the interviews was carried out with NVivo 11. FINDINGS: variations were identified in the role of father during breastfeeding, namely, 1) acting as partners in decision-making; 2) being responsible for the family functioning, and 3) providing emotional support to the mother. These different variants each entail challenges and tasks. KEY CONCLUSIONS: participating fathers perceived their role as much more complex than the limited role of breastfeeding facilitator that is usually attributed to them. Fathers saw themselves as stakeholders in decision-making relating to how their child was fed and they reacted to the imbalance created by breastfeeding. Their involvement occurred at several levels: that of their child, their spouse, and their family. IMPLICATIONS FOR PRACTICE: these results suggest that more attention should be given to fathers' roles in a breastfeeding context and more investigation is required into the extent to which health professionals, such as midwives and nurses, support fathers in managing these various roles and the challenges they entail.

Perspectives of young adults with cerebral palsy on transitioning from pediatric to adult healthcare systems.

Transition from pediatric to adult healthcare is a well-established challenge for individuals with neurodevelopmental disorders like cerebral palsy. With regard to ethics, some of the key aspects to explore include the following: if and how individuals feel respected during the transition process; if and how their values and preferences are developed and integrated within transition; and if and how young patients are prepared to participate in decision making (to be autonomous) within the transition. We carried out a qualitative study on 14 young adults with cerebral palsy. Some participants reported positive experiences. However, several tension points were identified, including before the transition (eg, transition envisaged with fear and apprehension); during the transition (eg, lack of cooperation or communication between providers in the pediatric and adult healthcare systems); and after the transition (eg, feelings of abandonment). We discuss the clinical influence and ethical significance of better capturing ethical values within the transition process and preparing young individuals to engage in discussions about their health and disease management.

Ethics in health care services for young persons with neurodevelopmental disabilities: a focus on cerebral palsy.

In this article we review and discuss some of the key ethical and social challenges that young persons with cerebral palsy face in health care delivery. We identify and explain these challenges, some of which are rarely discussed in contemporary medicine and biomedical ethics, partly because they are not considered genuine "ethical" challenges per se. Most of these challenges are heavily shaped by broader social context and institutional practices, which highlights the importance of nonbiological aspects of the care of young persons with cerebral palsy from an ethics standpoint.

Perspectives of adolescents and young adults with cerebral palsy on the ethical and social challenges encountered in healthcare services.

Healthcare is a context where individuals with disability confront important ethical and social challenges. Adolescents and young adults with cerebral palsy (CP) seem to face additional challenges but we have little insight into their perspectives. This qualitative study aimed to identify and better understand such challenges. We interviewed 14 participants with CP aged 18 to 25. Participants described a range of challenges experienced when using health services, including: lack of long-term follow-up, shortcomings in physical access to infrastructures, and situations of injustice. Challenges specific to medical consultations were reported (e.g., rude attitudes, belittlement, inadequate communication, lack of consideration). We discuss and explain further that: (1) the ethical principle of respect for persons needs to be concretely specified to improve current practices; (2) respect for autonomy calls for further direct empowerment of individuals with CP and, (3) gaps in dedicated healthcare resources for CP and the long-term needs associated should be addressed.