Guest Editorial: Parents: Effective 'Medicine' for children’s pain
Linda Franck
The views of nurses on compliance in school-aged children with a chronic illness
Sandra Wales, Jackie Crisp
The proportion of children who develop a chronic illness, survive into adulthood and require ongoing treatment, is increasing worldwide. Health services are stretched to their limit and valuable resources for treating and managing chronic illness are becoming more expensive and in some cases scarce. The extent to which these resources are effective in achieving the best possible outcomes depends in large part on the level of adherence of the children and their families. The purpose of this study was to explore the views of paediatric nurses on the challenges of adherence, specifically in school-aged children, and their views on potential strategies for overcoming these challenges. Twenty-two registered nurses took part in focus groups and qualitative analysis of the data was undertaken. This paper discusses what the nurses considered to be the most challenging issues faced by school-aged children attempting to comply with treatment within the school environment. The most important of these issues was the need for an individualised, age-appropriate ‘self-managed’ approach to care. In addition, the need for basic facilities, education of school staff to support children, and better communication amongst those involved in the management of the child, were identified. In conclusion that successfully implementing a self-managed approach to care enables children with a chronic illness to attend school. The school health nurse is in the best position to act as the interface between the health and education systems to ensure children with chronic illnesses can maintain their health and receive an education.
The treatment of neonatal seizures: a critical review of the evidence
Mandie Foster, Peter Lewis
In a critical review of the literature to assess the efficacy of monotherapy and subsequent combinant anticonvulsant therapy in the treatment of neonatal seizures, four studies were examined; three randomised control trials and one retrospective cohort study. Each study used phenobarbital for monotherapy with doses reaching a maximum of 40mg/kg. Anticonvulsant drugs used in conjunction with phenobarbitone for combinant therapy included midazolam, clonazepam, lorazepam, phenytoin and lignocaine. Each study used an electroencephalograph for seizure diagnosis and neonatal monitoring when determining therapy efficacy and final outcome assessments. Collectively the studies suggest neither monotherapy nor combinant therapy are entirely effective in seizure control. Monotherapy demonstrated a 29% – 50% success rate for complete seizure control whereas combinant therapy administered after the failure of monotherapy demonstrated a success rate of 43% – 100%. When these trials were combined the overall success for monotherapy was 44% (n = 34/78) and for combinant therapy 72% ( n = 56/78). Though the evidence was inconclusive, it would appear that combinant therapy is of greater benefit to infants unresponsive to monotherapy. Further research such as multi-site randomised controlled trials using standardised criteria and data collection are required within this specialised area.
Support for stressed parents of young infants
Ritva Eronen, Jan Pincombe, Helen Calabretto
Research on the impact of the parent-child interaction on the child’s brain development and later wellbeing indicates that adequate support needs to be available for parents during the early weeks of parenthood. The aim of this study was to explore the definition of health and wellbeing for first-time parents and the issues parents face when they access information and support during the first months following the birth of a child. This study was the first stage of a larger action research project. The data were collected by focus group interviews conducted with members of established first-time parent groups. Data analysis used a thematic approach. The research found that parenting a young infant is stressful and the parents are not prepared for the complexities of caring for a newborn. Parents found support from their peer group extremely beneficial and looked to maternal and child health nurses for information and reassurance. Contradictory advice from health professionals added to parenting stress, with many parents preferring options rather than nurses directing possible solutions their problems. This study confirms that parents need support during the stressful early weeks of parenting a new baby. Maternal and child health services need to be structured in a way that provides parents with early access to both peer and professional support. The role of maternal and child health nurses is to facilitate access to peer groups, listen to the concerns of parents, affirm parenting skills and provide parenting information. This is best achieved when nurses are allowed continuity of care with the families they support.
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