Background

Information exchange is fundamental in the paediatric care encounter. Health care professionals need further background knowledge to encounter the parents/guardians from their perspective in their minors’ paediatric care. The parents’/guardians’ ability to manage the situation is dependent on their receiving optimal information, which is why it is important to study how information is exchanged.

Aim

The aim of this study was to identify, describe and conceptualize how parents/guardians resolved their main concern in information exchange with health care professionals in paediatric care situations involving their minors.

Methodology

Glaser’s grounded theory method was used and all data were analysed using constant comparative analysis. The observational study took place at three paediatric outpatient units at a university hospital and 24 parents/guardians participated. Data sources were field notes from 37 observations of paediatric care situations and five adherent excerpts from the minors’ medical records. Grounded theory is a method of conceptualising behaviour, which is why an observational study of parents’/guardians’ information exchange and social interaction in the context of nursing care is relevant as research design.

Results

Firm handling was revealed as the way the parents/guardians resolved their main concerns when they were exchanging information about their minors’ paediatric care. Firm handling is built on five inter-related categories: representative advocating, collaborating, aim sharing, supportive resourcing and minor bypassing.

Conclusions

This knowledge suggests possible ways for health care professionals to design paediatric care that supports, facilitates, strengthens and improves the parents’/guardians’ firm handling. The key issue is to find ways to support parents/guardians and minors so they can participate in health care encounters according to their preferences. Firm handling gives an opportunity to both reinforce parenthood in paediatric care and invite minors to participate.

Background: Most children with neurogenic bladder and bowel dysfunctions suffer from myelomeningocele and shunted hydrocephalus. Fewer such births and better treatment have led to more children reaching adulthood. Increased knowledge about their lived experiences can direct support to help them. Aim: The study aims to investigate how children and adolescents aged between 10 and 18 years old with neurogenic bladder and bowel dysfunction live their everyday life. Methods: Hermeneutic phenomenology was appropriate to investigate the participants experiences in depth. Thirteen qualitative interviews were analysed by coding line-by-line in order to find the essence and themes that underpin their responses. Findings: The major theme being an outsider in the community, was built upon the themes, constraint and togetherness. Constraint was caused by their need for regular clean intermittent catheterization, bowel movement, aids and assistance from others, which identified a participant as being an outsider. They were only partially outsiders because they were inside the community and they enjoyed togetherness in their everyday life from their families, peers and other significant people. They appeared to be rather unaware of their problems. Limitations: The wide range of participants ages was a limitation, as these young people develop a great deal between these ages; in order to guarantee confidentiality, the participants were too few to divide into groups. Conclusions: These young people would be helped if supported more towards independence by people inside their circle. Today, support is usually given by personal assistants and by the use of advanced techniques. Less support is given for development towards independence. Competent health-care professionals working together with the parents should have the opportunity to provide such valuable support.

This study aimed to identify, describe and generate concepts regarding health care professionals’ information exchanges with minors and/or their parents/guardians in paediatric caring situations. The study took place at three paediatric outpatient units at a university hospital and there were 15 health care professionals involved. Using the grounded theory and the constant comparative analysis methods, the data collection and analysis was undertaken simultaneously, using participant observation, review of medical records and follow-up interviews. The main concern of the health care professionals that emerged as the core category was: sharing and contributing responsibility, interrelated with the six categories; interchanging of knowledge, relationship-creating chat, calculated confirming, encouraging, dichotomous talking and of situation related effects. This research has explored the elements of information exchange in caring situations and highlighted the interaction between the involved persons. These findings could be valuable to health care professionals in order to develop and improve their caring skills.

In this column the authors discuss the ethics of information exchange in nursing practice with children. Five concepts identified in three Swedish grounded theory studies and a content analysis that used the theoretical framework of ethical demand were analyzed. A simultaneous concept analysis found five related concepts: being interconnected, acting according to accepted procedure, completeness, interdependence, and social intercourse. These concepts are synthesized in the concept of intergrade, which emphasizes the value of maintaining the integrity of all involved in information exchange.

Research suggests that the attitude of men towards pregnancy, childbirth and child-caring is different from that of women. Up to now, research has focused mainly on motherhood. The aim of this study was to explore first-time fathers’ experiences during early infancy of their children. Grounded theory and constant comparative method were used and 20 fathers aged 20–48 participated. Interviews were carried out in 2002–2003. ‘Changing life’ emerged as the core category consisting of the categories: becoming a father, alternating between work and home, changing relationship towards partner and developing relationship with their child. Changing life implied that they have left bachelor life and become responsible for a child. Becoming a father was much more fantastic than they could have imagined and they suggested that they performed childcare to the same extent as the mother when both parents were at home. Still fathers viewed the mother as the main parent, partly because of their alternating between work and home and because the mothers breast-feed the infants. Fathers’ attitude towards breast-feeding seemed to be ambiguous; it was a matter of necessity, but made them feel insignificant. Changing relationship towards partner was common but it was not necessarily for the worst and often resulted in a more closely united relationship. However, tiredness because of lack of sleep could result in increased irritability towards problems. Developing relationship with their child implied increasing possibilities to learn to know the infant’s signals. Fathers are one of two parents, and hence are important for their child’s growth and development, emotional health and cognitive development. Knowledge about first-time fathers’ experiences during the early infancy of their children may bring about increased support from midwives and child health nurses.

Aims and objectives: The purpose of this literature review was to search for and review, systematically, childrens decision-making competence in health care in the scientific literature. Findings of both quantitative and qualitative studies were analysed thematically.

Background: Most previous research in childrens decision-making competence in health care concerns adults care in the best interests of the child. It is important to consider decision-making competence from the childs perspective because of childrens own human rights.

Methods: Systematic review including database search, manual selection, supplementary searching, management and acquisition of relevant literature, quality appraisal, literature review saturation and thematic review.

Results: Six themes emerged: measurable issues, values and beliefs, power, parent-related communication, trust and self-determination. Measurable issues were age, reading ability and memory. Values and beliefs as well as power and parent-related communication were associated with healthcare professionals. Children showed trust and expressed a wish to use self-determination.

Conclusions: Age appropriate information and participation were prerequisites for allowing children to have possibilities of making competent decisions about their own care. Childrens decision-making competence is dependent on others, such as parents and healthcare professionals, attitudes and not only on their own capacity. Lack of competence, however, does not exclude children from the human right to have a say. It should be noted that it is a decision to leave the determination to a parent or healthcare professional.

Relevance to clinical practice: Future research from the viewpoint of children is important to reach optimal levels of participation, through respecting their integrity and to develop them into potential competent decision makers.

Objective: The purpose of study was to identify, describe and generate concepts in parents/guardians information exchange with health care professional in nursing care situations for their minors in paediatric outpatients units.

Materials & Methods: In this observational study a grounded theory methodology was used. The study started with a descriptive observation of the units in a period of two weeks. After that, the 18 female and six male parents/guardians to minors, aged 10-16 years, were observed during their visit in three separate paediatric outpatients units; the paediatric day care unit, the paediatric neuro- urology and bowel disorders unit and the paediatric diabetic clinic. Data collection was made by using field notes from the observations and also notes from patient records were data sources. Totally 37 observations were conducted, all together in about a time of 10 hours. All data was analysed according to constant comparative analysis, the basis for grounded theory.

Results: The data analysis gave the meaning of parents/guardians information exchange, generating the core category steadfast handle and containing of six categories: substitute manners, cooperation, shared aims, and resource, involvement and adult relations. Steadfast handle is manoeuvrings with the minor in exchanging information in paediatric nursing care situations, handling the situation as an adult in charge. Substitute manners are when acting instead of the minor and cooperation is acting together with the minor. Shared aims are when being active together with the minor in a focused way and resource is when supporting the minor in the situation. Involvement is when being concerned and curios about the minor in the situation. Adult relations are separated from the minor and are about the present adults’ particular communication. The categories relieved one another in priority and intensity and was to be seen all or just some of them in every single observation.

Conclusion: This knowledge have relevance to health care professional to design paediatric nursing care situations and support and facilitate the parents/guardians handling in their minors nursing care.