Mothers typically act as gatekeepers to health care for their children, yet many Indigenous mothers report poor access to health services. Inadequate access to health services may contribute to the poor health outcomes experienced by Indigenous infants. Understanding how urban-dwelling Indigenous mothers experience selecting and using health services to meet the health needs of their infants is important to informing how health services can best support the needs of these families. This study employs qualitative interpretive description methodology guided by the Two-Eyed Seeing framework and Andersen’s Behavioural Model of Health Services Use. Interviews facilitated by ecomaps and a discussion group were conducted with 19 Indigenous mothers living in Hamilton with infants under the age of 2 years. Additional interviews with 12 health providers added further context to the mothers’ experiences. Results relate to three domains of health service use: primary care, acute care and early childhood health promotion services. Findings suggest that health providers can improve the access and use of health services by Indigenous mothers and infants through integrating three approaches to care: culturally safe care, trauma and violence-informed care and family centred care. While Indigenous-led supports may be better suited to meet the needs of Indigenous families, mainstream services can improve access and promote health service use through integrating these approaches to care. The findings have numerous implications for nursing education, practice and research as well as for health policy. Application of this evidence may result in equitable access to care, improved use of health services and better health outcomes for Indigenous infants and their families. / Thesis / Doctor of Philosophy (PhD) / Access and use of health care are important to health and wellness. Indigenous infants are known to have poorer health outcomes than non-Indigenous infants in Canada, yet little is understood of how their parents access health care to meet their health needs. This thesis uses qualitative methods, including interviews and a discussion group, to ask Indigenous mothers living in a city about their experiences selecting and using health services to meet their infant’s health needs. Interviews with health providers assist with understanding how health care is delivered to these families. The results provide important strategies for nurses and other health providers to improve how they provide care. This may then improve access to health services for Indigenous parents and ultimately lead to improved health outcomes for Indigenous infants and their families.

No / This paper is ed from an action research project on promoting family-centred care in Nigeria through the practice of Nigerian Primary Nursing (NMPN). This article will present results of comparative evaluation of the impact of primary nursing on the quality of care received by patients in a 37-bedded acute medical-surgical, mixed sex ward in a specialist hospital in eastern Nigeria. A total of 44 nurses' interactions with 10 patients in the pre-NMPN period and 58 nurses' interactions with eight patients in the post-NMPN period were assessed using QUALPACS (Quality Patient Care Scale.). Results showed a significant improvement in the quality of nursing care with primary nursing practice. The greatest improvement in quality of nursing appeared to be in the elements that address the individual needs of the patient, while the smallest improvements were in the area of physical care--elements of routine, technical nursing care. Implications of the study and recommendations for further studies are made.

Yes / Children’s hospices provide a range of family-centred care services, including bereavement support. Not all hospices provide specific services for grandparents. To explore how a hospice-based bereavement support group supported grandparents in their grief following the death of a grandchild. Methods: Grandparents attending a group were invited to complete an anonymous questionnaire. Questionnaires from eight groups, run between 2015 and 2019 were collated and interpreted to identify themes. Findings: 121 grandparents attended the groups; 113 returned the questionnaires (93% response). Three central themes were identified: environment and space, being with people who understand, and the opportunity to hear the stories of others. Grandparents valued hearing the stories of others, providing an opportunity to reflect on the experience of others. Conclusion: Grandparents felt supported and validated by the group. The facilitated sessions increased coping and resilience of participants, enabling grandparents to support their partner, adult children and surviving grandchildren more effectively.

Bakgrund: Barnhälsovården (BHV) genomför universella insatser till alla barn och deras föräldrar och riktade insatser till de familjer som har särskilda behov. Hembesök är en arbetsmetod som används av BHV-sjuksköterskan och kan göras av olika orsaker. Dels som en del av de universella insatserna, dels som en riktad insats till familjer i behov av extra stöd.   Syfte: Beskriva sjuksköterskors erfarenheter av att arbeta med universella och riktade hembesök inom barnhälsovården. Metod: En kvalitativ studie. Femton specialistsjuksköterskor inom BHV intervjuades. Innehållsanalys med induktiv ansats har använts som analysmetod. Resultat: BHV-sjuksköterskorna har positiva erfarenheter av hembesök som en användbar arbetsmetod både universellt och riktat, men att det är tidskrävande med hembesök. BHV-sjuksköterskornas erfarenheter visar att hembesök ger goda förutsättningar för att kunna etablera en god vårdrelation med familjen. BHV-sjuksköterskorna upplever att både barnen och föräldrarna är tryggare i hemmiljön.  Föräldrarna vågar öppna sig mer och det underlättar för BHV-sjuksköterskan att bedöma barnets hälsa när barnet är tryggare. Samarbete med andra professioner vid hembesök upplevs i vissa situationer som ett bra stöd. Slutsats: Barnet och föräldrarna upplevs tryggare i hemmet än på mottagningen och hembesök ger därför goda förutsättningar för att bygga upp en förtroendefull vårdrelation med familjen. Universella hembesök ger BHV-sjuksköterskorna möjlighet att identifiera familjer med behov av riktat stöd och riktade hembesök kan vidare bidra till att alla familjer får en ökad möjlighet till likvärdig hälsa. / Background: The Child Health Care (CHC) offer universal interventions to all children and their parents, as well as targeted intervention for families with specific needs. One method used by the CHC-nurse is home visits and they can be performed for different reasons. Partly as a component of the universal support, partly as a targeted intervention to families in need of extra support. Purpose: To describe nurses experiences working with universal as well as targeted home visits in Child Health Care. Method: A qualitative study. Fifteen specialist nurses were interviewed, and content analysis has been used to analyse the interviews. Results: The CHC-nurses find home visits as a positive and useful method, both for universal and targeted purpose. However, it is a time-consuming method. Their experiences show that the method facilitate caring relation with the family. The nurses experience that both children and their parents are much safer in their home environment. The parents dare to open up more and it makes it easier for the Child Health Care Nurses to assess the child’s health and development. Cooperation with other professions when making home visits can be supportive in certain situations. Conclusion: The child and the parents are seemingly more at ease at home than at the clinic. As a consequence, home visits lead to good opportunities to establish a caring and trustful relation with the family. Universal home visits offer the possibility to identify families in need of more targeted support. Targeted home visits can contribute to promote every families the opportunity to access equal health.

Bakgrund: Barnhälsovården finns till för att främja alla barns hälsa, allsidiga utveckling och välbefinnande. Sjuksköterskans uppdrag inom barnhälsovården är att tidigt grundlägga god kontakt med båda föräldrarna till det nyfödda barnet samt främja båda föräldrarnas delaktighet i omvårdnaden av barnet. Som stöd för främjande av en jämställd vård infördes år 2018 ett enskilt samtal även med den ickefödande föräldern i det nationella barnhälsovårdsprogrammet. Syfte: Att undersöka hur sjuksköterskor inom barnhälsovården upplever det enskilda samtalet med den icke-födande föräldern. Metod: Studien genomfördes med kvalitativa intervjuer med stöd av semistrukturerad intervjuguide. Data analyserades med hjälp av kvalitativ innehållsanalys. Resultat: Fyra kategorier och tio underkategorier framkom i analysen. Följande kategorier presenteras: (i) Bättre kontakt med den icke-födande föräldern, (ii) Stort intresse för samtalet, (iii) Att kunna stärka föräldern i sin nya roll, och (iv) Att bekräfta betydelsen av att båda föräldrarna är lika viktiga. Konklusion: Införandet av det enskilda samtalet för den icke-födande föräldern har gjort att BVCsköterskan får möjlighet att grundlägga en bättre relation till den icke-födande föräldern och på så sätt utforma ett stöd som innebär en jämställd vård till hela familjen. / Background: The Child Health Care’s (CHC) aim is to enable all children's right to health, versatile development and wellbeing. It is important that the CHC-nurse early in the care of the newborn child develops a good relationship with both parents to create better possibilities for good health for the entire family. As a support for the CHC-nurses to be able to present an equal care for both parents a one on one conversation with the father/non-birth parent is offered when the newborn is about 3- 5 months old. Aim: The aim was to study the CHC-nurse’s experiences of the one on one conversation with the non-birth parent. Method: The study was conducted with a qualitative descriptive method including semi-structured interviews and qualitative content analysis. Result: The result is presented in the following categories: Better contact with the non-birth parent, Great interest for the conversation, To be able to support the parent in their new situation, To confirm the relevance of both parents being equally important. Conclusion: The introduction of the one on one conversation with the non-birth parent has increased the possibilities for the CHCnurse to found a better relationship with the non-birth parent. This increases the chances to offer equal care for the entire family.

Bakgrund: Övervikt hos barn är ett växande folkhälsoproblem som hotar barns psykiska och fysiska hälsa. Distriktssköterskan har i uppdrag att främja barns hälsa i sitt arbete på barnavårdscentralen och kan med hjälp av familjefokuserad omvårdnad se till barnets helhet. Föräldrarna har ett stort inflytande över sina barns levnadsvanor och det är därmed av stor vikt att undersöka upplevelsen av det hälsofrämjande arbetet utifrån deras perspektiv. Syfte: Syftet med studien är att belysa hur föräldrar till barn med övervikt upplever distriktssköterskans hälsofrämjande arbete på barnavårdscentralen. Metod: Kvalitativ intervjustudie med induktiv ansats. Semistrukturerade intervjuer med 9 föräldrar som erhåller eller har erhållit stöd och behandling via barnavårdscentralen när barnet var i åldern 2 – 5 år. Data analyserades utifrån kvalitativ latent innehållsanalys. Resultat: Resultatet redovisas i 2 huvudkategorier: ”Baksidan av tillväxtkontroller” och ”Skiftande uppfattningar om det hälsofrämjande arbetet”. I “Baksidan av tillväxtkontroller” identifierades 2 underkategorier: “Olika syn på barnets övervikt” och “Känslan av att vara övervakad utan nytta”. I “Skiftande uppfattningar om det hälsofrämjande arbetet” identifierades fyra underkategorier: “Konkret rådgivning”,“Användbar rådgivning och positiva effekter”, “Brister i rådgivning och kompetens” och“Kampen mellan att följa råden och göra det bästa för sitt barn”. Slutsats: Behandlingen på barnavårdscentralen väckte mycket känslor hos föräldrarna och de hade sitt barns bästa i fokus huruvida de valde att följa behandlingen eller inte. Föräldrarna beskrev både positiva och negativa upplevelser av distriktssköterskans rådgivning och bemötande, vilket till stor del påverkade om familjen förändrade sina levnadsvanor. / Background: Obesity in children is a growing public health problem that threatens children's mental and physical health. The district nurse is tasked with promoting children's health through her work at the childcare centre and, with the help of family-centred care, can taken care of the child as a whole. Parents have a great influence over their children's lifestyle and it is therefore of great importance to examine the experience of the health promotion work from their perspective. Aim: The purpose of the study is to shed light on how parents to overweight children experience the district nurse's health promotion work at the childcare centre. Method: Qualitative interview study with an inductive approach. Semi-structured interviews with 9 parents who receive or have received support and treatment via the childcare centre when the child was aged 2 -5 years. The data was analysed based on qualitative latent content analysis. Results: The results are reported in 2 main categories: “The back side of growth controls” and “Changing perceptions of health promotion work". In "The back side of Growth controls" could 2 subcategories be identified: "Different views on the child's obesity" and "The feeling of being observes without benefit". In "Changing perceptions of health promotion work" 4 subcategories could be identified: "Concrete advice", "Useful advice and positive effects", "Deficits regarding advice and competence" and "The struggle between following the advice and doing the best for one's child". Conclusions: The treatment at the childcare centre aroused a lot of emotion in the parents and they had their child's best interests in focus regardless they chose to follow the treatment or not. The parents described both positive and negative experiences of the district nurse's advice and treatment, which largely influenced whether the family changed their lifestyle.

Family-centred service (FCS), which acknowledges the importance of family engagement in therapeutic processes and focuses on needs of all family members, is increasingly being recognized as an optimal care delivery model for families of children with developmental disabilities. However, services for families are oftentimes ‘child-centric’, wherein family members are seen as partners in therapy or care delivery only, while their own or family needs are not addressed. This arises from the lack of awareness of complex and highly individual family needs by professionals with whom they interact, but also from a significant lack of services oriented toward parent-specific needs in current delivery models. This thesis aims to address this knowledge gap and provides solutions for parental support in the context of pediatric developmental rehabilitation, which might also be applicable to other settings (e.g., community, education). The objectives of this thesis were: (a) to conduct a systematic review synthesizing randomized controlled trials aiming to address parents’ physical, psychological and socioeconomic well-being; (b) to perform cross-cultural and language adaptation and proof-of-concept pilot exploration of an innovative, strengths-based support program ‘ENabling VISions And Growing Expectation’ (ENVISAGE) for parents of children with neurodevelopmental disabilities in Croatia; (c) to refine the Croatian version of the program according to the pilot study results; (d) to run the first set of ENVISAGE workshops and evaluate their impact on Croatian parents’ perception of self, their child with a disability and their family; and (e) to learn about participants’ experience with the program. The findings show that interventions aiming to improve parents’ well-being have limited but promising effectiveness on parents’ health and well-being outcomes. ENVISAGE has proven to be a comprehensive, acceptable, usable, feasible and impactful program for parents of children with developmental disabilities in Croatia. / Dissertation / Doctor of Science (PhD) / Parents raising children with developmental disabilities have unique challenges in their parenting role, which might impact their health and well-being. However, there has been very little focus on parental and family needs in the context of pediatric developmental rehabilitation. Parents are often expected to focus on their child’s issues when their own support needs are usually also significant. This thesis aimed to address this research and practice gap through: a) evaluating best quality evidence on how to support parental well-being; and b) piloting a novel ‘early intervention’ support program for parents of children with disabilities, ‘ENabling VISions And Growing Expectation’ (ENVISAGE), in a new culture and language setting, Croatia. These findings have implications for spreading awareness of innovative programs to improve well-being of parents of children with developmental disabilities in various sectors (e.g., healthcare, community).

Yes / Children’s hospices provide a range of services for babies, children and young people who have life-shortening conditions, including care after death in specialist ‘cool bedrooms’. Caring for children after death is a challenging area of hospice care, with variation seen within, and between organisations. The study aims to identify current practices and to produce guidelines that promote safe practice in moving and handling and managing physiological deterioration of children after death. An electronic questionnaire was sent to all 54 British children’s hospices; 33 responded (=62% of hospices). Variation in the way in which children’s hospices delivered care after death was identified, in terms of the length of stay, care provision and equipment used, owing to demands of individual families and the experience and confidence of practitioners. Internal variation in practice can lead to practitioner anxiety, and risk-taking when providing care, particularly in the presence of family members. Practice recommendations have been made that reflect the practical demands of caring for a child’s body after death; these have been split into two parts: moving and handling considerations and managing physiological deterioration. These recommendations should be used to support the development of policy and practice, allowing organisations to standardise staff expectations and to support practitioners when caring for children after death.

Collaborative care is a philosophy which guides the work of interdisciplinary teams and patients and their families internationally. It has been demonstrated to improve quality of care, safety, and patient and staff satisfaction, yet applying this philosophy still requires much investigation. This thesis describes processes of change directed towards a vision to enhance collaborative care relationships with patients and families within one hospital site of a non-acute academic health science centre in Ontario, Canada. By building focused conversations around existing patient and family centred education and using an initial conceptual framework of customer service, healthcare providers, mid- and senior level leaders shared their perspectives, negotiated meanings and created innovations to enhance collaborative relationships within the organization. Based within the critical paradigm, a critical collaborative ethnography was constructed with the use of sequential and mixed research methodologies. The ethnography evolved over three phases in a step-wise and additive design during the three year period of study. Phase 1 examined the perspectives of healthcare providers in an exploratory case study which contributed to mid-level leaders’ discussions in Phase 2. Cumulative findings from Phases 1 and 2 were brought to discussions with senior leaders in Phase 3. Members of a participative action research team assisted with research design and study processes. Shared meanings and innovative change ideas were developed and captured through the use of semi-structured focus groups and interviews, survey, participant observation and inductive analysis. A conceptual framework of ‘partners-in-care’ emerged and was used to assist participants to make sense of the values and factors important in their work with respect to collaborative relationships. The research processes facilitated the development of many innovations to enhance collaborative practice within the hospital. The organization was described by the research as undergoing directed change to enhance collaborative care as evidenced through participant self-reports, observed initiatives and the ethnographic descriptions. / Thesis (Ph.D, Rehabilitation Science) -- Queen's University, 2012-06-25 15:06:24.687

Nowadays the parental presence in the pediatric intensive care units (PICU) is quite common. Building a fellowship between parents and health care staff and high quality parents' integration into the care is a very demanding process. First of all, the success of this process largely depends upon the nurse. It is the very nurse who leads, educates, supports and also professionally integrates parents into their child's care. In addition, critically ill child's care in cooperation with parents is complicated by a high parental stress level, child's serious condition and high professional and technical requirements posed to the nurse. The graduation thesis concentrates on the parents' integration into the care of a critically ill child from the nurse's point of view. The goal of this thesis was to describe the general conditions of parents' integration into the critically ill child's care and to map the actual state of the cooperation within the nurse ? parent ? critically ill child relation from the nurse's point of view. Other goals included the analysis of nurse's feeling of readiness for work with parents of critically ill children, and elaboration of a booklet concerning the initial introduction of an intensive care and resuscitation unit for infants and older children for better parents' awareness. In the research part of the thesis a qualitative research was used. The data collection technique was a semi-standardized interview. A research sample was represented by seven nurses working in the sphere of the critically ill children care in four selected hospitals in the Czech Republic. The study took place in the period starting May 2011 till July 2011. The research results revealed that the parental integration conditions are not quite optimal. First of all, in this sphere the nurses pointed to a limited accommodation capacity for parents, lack of supporting services and unsatisfactory site layout of the intensive care units. The nurses expressed their readiness to the closer cooperation with critically ill children's parents in the basic nursing sphere, mostly, thereafter, in the sphere of hygiene care. The parental cooperation in the special-care sphere was accepted rather negatively by the respondents. As the research results show, most of the nurses consider the work with parents psychologically very demanding and during their school education they had never been prepared for it by anybody. Findings flowing from the research results gave birth to the information booklet that is a basic informational and educational material for parents of children admitted to the intensive and resuscitation care unit for older children and infants in Hradec Králové University Teaching Hospital. It also represents a detailed instruction for a similar material for other facilities of this type and, last but not least, it facilitates the whole process of initial parents' education for nurses. This graduation thesis can also assist in the education of children's nurses, help students and nurses working with critically ill children's parents understand the "Family-centered care" principles and their practical introduction.