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Betsy Sleath,1,2 Delesha M Carpenter,1 Imelda Coyne,3 Scott A Davis,1 Claire Hayes Watson,1 Ceila E Loughlin,4 Nacire Garcia,1 Daniel S Reuland,5 Gail E Tudor6 1Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; 2Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; 3School of Nursing and Midwifery, Trinity College, Dublin, Ireland; 4Department of Pediatric Pulmonology, School of Medicine University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; 5Division of General Internal Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; 6Department of Science and Mathematics, Husson University, Bangor, ME, USA Background: We conducted a randomized controlled trial to test the effectiveness of an asthma question prompt list with video intervention to engage the youth during clinic visits. We examined whether the intervention was associated with 1) providers including youth and caregiver inputs more into asthma treatment regimens, 2) youth and caregivers rating providers as using more of a participatory decision-making style, and 3) youth and caregivers being more satisfied with visits.Methods: English- or Spanish-speaking youth aged 11–17 years with persistent asthma and their caregivers were recruited from four pediatric clinics and randomized to the intervention or usual care groups. The youth in the intervention group watched the video with their caregivers on an iPad and completed a one-page asthma question prompt list before their clinic visits. All visits were audiotaped. Generalized estimating equations were used to analyze the data.Results: Forty providers and their patients (n=359) participated in this study. Providers included youth input into the asthma management treatment regimens during 2.5% of visits and caregiver input during 3.3% of visits. The youth in the intervention group were significantly more likely to rate their providers as using more of a participatory decision-making style (odds ratio=1.7, 95% confidence interval=1.1, 2.5). White caregivers were significantly more likely to rate the providers as more participatory (odds ratio=2.3, 95% confidence interval=1.2, 4.4). Youth (beta=4.9, 95% confidence interval=3.3, 6.5) and caregivers (beta=7.5, 95% confidence interval=3.1, 12.0) who rated their providers as being more participatory were significantly more satisfied with their visits. Youth (beta=–1.9, 95% confidence interval=–3.4, –0.4) and caregivers (beta=–8.8, 95% confidence interval=–16.2, –1.3) who spoke Spanish at home were less satisfied with visits. Conclusion: The intervention did not increase the inclusion of youth and caregiver inputs into asthma treatment regimens. However, it did increase the youth’s perception of participatory decision-making style of the providers, and this in turn was associated with greater satisfaction. Keywords: shared decision-making, patient–provider, question prompt list, video intervention, communication, intervention

To conduct a pilot randomized trial of an intervention to improve adolescent question-asking and provider education during paediatric diabetes visits. Adolescents aged 11 to 17 with type 1 diabetes and their parents were enrolled from two urban tertiary paediatric clinics. Adolescents were randomised to the intervention group or control group. Adolescent consultations were audio-recorded, their HbA1c level was recorded, and they completed surveys after three clinic appointments. The intervention group completed a question prompt list and watched a video on a tablet with their parents before meeting their doctor and completed a short evaluation after each visit. Six consultant endocrinologists and ninety-nine adolescents and their parents participated. The intervention increased adolescents' question asking and provider education in diabetes encounters. Total patient question-asking across the 3 consultations and a higher baseline HbA1c at time one was significantly associated with HbA1c at time three. Question prompt lists and an educational video are useful tools to increase adolescents' question-asking and communication between adolescents and their providers. Interventions that encourage adolescents' question-asking in healthcare encounters may lead to more meaningful providers-adolescents' communication and tailored education. Interventions to improve professionals' listening, communication and educational skills are also required. • Positive or negative attitudes and behaviours developed during adolescence influence health behaviours into adulthood. • A co-designed question prompt list and video intervention statistically improved adolescent question-asking and provider education. • Promoting adolescent–provider communication may contribute to positive diabetes self-management behaviours. [ABSTRACT FROM AUTHOR]

This paper describes the development of a national assessment guide to assist the Irish Pre-School Inspectorate in evaluating support for child development in early childhood care and education settings. The development arose as a direct result of changes to the regulations governing pre-school childcare provision in Ireland. Revised regulations, published in 2006, built on prevoius regulations and made explicit the whole-child perspective within them. This places an important and overt focus on support for children's development within the inspection process, and is based on a socio-ecological understanding of children's lives. Using a collaborative approach with the Pre-School Inspectorate, an assessment guide was developed to enhance practitioners' understanding of the whole-child perspective element of the revised regulations, and to ensure consistency in the inspection process. [ABSTRACT FROM AUTHOR]

Respecting children's rights to be heard in matters that directly affect their everyday lives has become an established principle in Ireland and internationally. Accessing children's voices raises a number of important issues for researchers across a wide range of disciplines. This article reflects on the organizational, practical and ethical challenges that arose from a study that investigated hospitalized children's experiences of consultation and decision-making. The data collection process was hampered by practical and organizational factors, which consequently led to carrying out more individual interviews than focus groups as planned. Some obstacles associated with the hospital environment were practical issues that could be resolved, in contrast to ethical issues such as consent, privacy, access and the role of gatekeepers. The function of gatekeepers generally and in the healthcare setting in relation to accessing children needs to be debated and challenged because children may be silenced and excluded from the opportunity to have their voices heard. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: To investigate parent participation in the hospitalized child's care from the perspectives of children, parents and nurses. BACKGROUND: Parent participation in the hospitalized child's care has been increasingly promoted in paediatric nursing for many years because it ameliorates the adverse aspects of hospitalization, avoids parental separation and contributes to quality care for sick children. Parent participation is assumed to be unproblematic but evidence exists that nurses often have difficulty caring for parents. DESIGN: Using grounded method, data were collected through in-depth interviews, questionnaires and observation with 12 nurses from four paediatric wards in two hospitals in England. RESULTS: The dominant process appeared to be the socialization of parents to their role on the ward through inclusionary and exclusionary tactics. Nurses controlled the nature of parents' participation and parents had to 'toe the line'. Although participation was presented as optional, parents were presented with no course other than acceptance. Parents were expected to stay with their child, behave properly and be involved in care. When parents did not adhere to these norms, they caused disruption to the order and routine of the ward. Compliance or non-compliance to the set of norms and rules was followed by reward or punishment. CONCLUSION: The nurses' dependence on parents' active participation in the organization and delivery of the work suggests that parent participation as it is practised is clearly about administrative efficiency, not consumer empowerment. RELEVANCE TO CLINICAL PRACTICE: Organizational and managerial issues must be examined to ensure that nurses are adequately prepared and resourced to support parents on the ward. Continuing assessment of parents' expectations though a structured assessment tool would help reduce misunderstandings and conflict. Nurses should assess the situational context before relying on subjective impressions and assumptions about parents' participation in care. [ABSTRACT FROM AUTHOR]

There are many interpretations and applications of the grounded theory method which have contributed to different understandings of grounded theory and different versions of how the key components (theoretical sampling, constant comparative analysis and theoretical saturation) should be implemented. The esoteric terminology coupled with the matrix style of the analysis process can be challenging for new researchers. This paper uses data from a study on parent participation to illustrate the application of the key components of grounded theory. Grounded theory provides clear guidelines on how to analyse qualitative data and so is a rigorous method that provides structure and direction to the researcher. However, theoretical sampling with vulnerable groups can be problematic and requires further discussion and debate from other users of grounded theory. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: To explore children's, parents' and nurses' views on participation in care in the healthcare setting. BACKGROUND: Children have a right to be consulted and involved in their care. DESIGN: The grounded theory method was used and data were collected through in-depth interviews, questionnaires and observation. Sample consisted of 11 children, 10 parents and 12 nurses from four paediatric wards in two hospitals in England. RESULTS: Parents felt that children should be involved in the decision-making process thereby enhancing and promoting children's self-esteem and positive self-regard, which would consequently enhance their overall welfare. Likewise, children expressed the need for consultation and information so that they could understand their illness; be involved in their care, and prepare themselves for procedures. However, children's own opinions and views were underused and they had varying experiences of being consulted about their care and treatment. Nurses appeared to hold varying and discrepant views on the involvement of children in decisions and for some nurses, the child's involvement seemed to be dependent on the child's cognitive maturity and being defined as a rational subject. CONCLUSION: Health professionals' communication behaviour may reflect recognition of children's cognitive abilities rather than their competence to understand. The fact that children's nurses appeared to make decisions about involving children in decision making in the absence of a reliable framework was a significant finding and highlights a real problem in the current climate. RELEVANCE TO CLINICAL PRACTICE: Nurses faced with workforce pressures may encounter considerable challenges to facilitating children's involvement in decisions about their care. Hence it is imperative that nurses' examine the basis of their decisions and use more explicit criteria for determining children's involvement. [ABSTRACT FROM AUTHOR]

Despite the increase in prevalence of asthma among children and the importance of appropriate professional training in asthma management, no programme of study in children's asthma care was available to nurses in Ireland. A professional development module was designed to meet the education needs of nurses caring for children with asthma and their families. The module has theoretical and practical elements that are reflected in both module delivery and assessment. It was evaluated using a Likert scale questionnaire and focus group interviews with 15 students. The results indicate a high degree of student satisfaction with the module. Students reported changes in practice as a result of greater confidence, increased knowledge and improved skills. Future evaluation should include the ongoing impact on practice as well as the perspectives of service users and managers. [ABSTRACT FROM AUTHOR]