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Pediatric injury is both common and expensive. Finding ways to prevent pediatric injury is a major public health concern. Many studies have investigated various aspects of pediatric injury, and some suggest that birth order may be an important risk factor for pediatric injury. This study further examined the relationship of birth order with pediatric injury, specifically studying the association of birth order with emergency department-attended infant injury while adjusting for other important family and individual covariates. Data for analysis included Utah birth certificate, death certificate, and hospital emergency department datasets, which were probabilistically linked to obtain complete demographic and injury information for infants born in 1999—2002. Three groups of risk factors were defined for analysis: maternal demographics, maternal risk behaviors, and infant demographics. Two outcome variables were defined for this study, “injury event” and “severe injury event.” Data was analyzed using generalized estimating equations (GEE). Birth order was associated with infant injury events and severe infant injury events. Birth order 4th or greater had the greatest effect for both injury outcomes. Additionally, several maternal characteristics were associated with infant injury events and severe infant injury events. In particular, maternal age and maternal smoking behavior were associated with increased infant injury risk. This study identified two targeted populations that are well-suited to injury prevention efforts: infants born to mothers who smoke, and infants born to mothers who are young and have many other children.

Understanding undergraduate student success is central to addressing issues in the current education climate. Many barriers exist for students; however, even more barriers exist for first-generation college students. Especially difficult for first-generation college students is access to social capital with regards to higher education. The current study focused on addressing the following overall research question: does having a sibling who attended college make a difference in the academic outcomes of a student? The sample for the study included all undergraduate students who enrolled as first-semester freshman in a large, Research 1 university in the Northeastern United States from fall 2016 through fall 2021. Transfer students were excluded. The data were provided by the selected institution’s Office of Institutional Research and Assessment (IRA). These data included the primary variables that were used to define academic success-- the student’s first semester GPA, first to second semester retention, first to second year retention, and four-year graduation rate. Additional variables were collected which included student’s SAT scores, high school GPA, gender, and data from a survey that is administered to all incoming freshmen- the New Student Questionnaire (NSQ), which included information about the level of education of each student’s mother, father, and siblings. The analysis of the data revealed that as the number of family members who attended college increased, so did high school GPA, 1st semester GPA, 1st to 2nd semester retention, and 4-year graduation rate. Ultimately, this indicates that as the number of family members who attended higher education increases so does student success. Siblings play a critical role in that they add an additional access point to social capital for the student in question. While siblings are important though, the results suggest that the number of family members who have attended college and not the relationship to the student may be a more important consideration. / Educational Leadership

Introduktion: Idag drabbas cirka 350 barn i Sverige av cancer varje år. I många fall har det sjuka barnet friska syskon som hamnar på sidan av sjukdomen, till följd av bland annat tuffa behandlingar och biverkningar som kräver föräldrarnas uppmärksamhet. Syfte: Syftet var att beskriva hur syskon till cancersjuka barn upplever sjukdomstiden och därmed få en fördjupad förståelse för deras situation. Metod: En allmän deskriptiv litteraturöversikt baserat på tio kvalitativa originalartiklar genomfördes. Litteratursökningarna utfördes i databaserna CINAHL och PubMed samt kompletterades med en manuell genomgång av referenslistor. Alla artiklar granskades utifrån SBU:s granskningsmall för bedömning av studier med kvalitativ design. Resultatanalysen genomfördes med hjälp av Graneheim och Lundmans kvalitativa innehållsanalys. Resultat: Resultatet visade att syskonen upplevde flertalet förändringar som påverkade deras liv i olika utsträckning. Dessa förändringar återfanns inom familje-, och vänskapsrelationer, skolan och vardagen. Resultatet visade också på flertalet känslor som syskonen upplevde till följd av sjukdomen men också på olika strategier som de fann för att hantera situationen på. Det framkom även att det fanns olika behov som var viktiga att tillgodose för syskonen under sjukdomstiden, såsom stöd och involvering. Avslutningsvis påvisades även en del positiva effekter som cancersjukdomen förde med sig. Slutsats: Syskonen rapporterade både negativa och positiva upplevelser till följd av sjukdomen. Många syskon uppskattade bland annat att bli informerade, stöttade och involverade av både familjen och andra personer i dess omgivning. Involvering av det friska syskonet var något som även sjuksköterskan kunde bidra med på ett värdefullt sätt i hens omvårdnadsarbete. / Background: Today, around 350 children gets diagnosed with cancer in Sweden each year. The sick child does often have a healthy sibling who gets put aside due to the fact that the tough treatments and side effects often require the parents attention.  Purpose: The aim was to describe how siblings of children with cancer experience the duration of the illness and thereby get a deeper understanding of their situation.  Method: A general descriptive literature review based on ten qualitative original articles was conducted. The literature searches were performed in the databases CINAHL and PubMed and was supplemented with a manual review of reference lists. All articles were reviewed by using the SBU review template for reviewing studies with qualitative design. The result analysis was conducted with the help of Graneheim and Lundmans qualitative content analysis.  Result: The main findings showed that the siblings experienced multiple changes that affected their lives to different extents. These changes were found in friends- and family relationships, school and everyday life. The result also established several feelings that the siblings experienced due to their siblings' illness, but also different strategies to cope. Different needs that were important to meet were also identified, such as support and involvement. In conclusion, some positive effects of the cancer illness were also detected.    Conclusion: The siblings reported both negative and positive experiences as a result of the disease. A lot of siblings appreciate when they get informed, supported and involved by both their family and other persons in their surroundings. Involvement of the healthy sibling was something that the nurse could contribute with in a valuable way in her nursing care.

Syfte: Syftet med studien var att undersöka barn och unga vuxnas (5-25 år) upplevelser av att ha ett syskon med barncancer. Metod: Metoden var en allmän litteraturöversikt med deskriptiv design för datainsamling. Studien baserades på tretton vetenskapliga artiklar med kvalitativ ansats. Sökningarna efter artiklar genomfördes i databaserna PubMed och PsycInfo. De insamlade artiklarna kvalitetsgranskades utifrån mallen Bedömning av studier med kvalitativ metodik av Statens beredning för medicinsk och social utvärdering och analyserades genom en latent innehållsanalys där meningsbärande enheter identifierades. Därefter kondenserades, kodades och kategoriserades datan. Utifrån detta skapades fyra teman.  Resultat: Resultatet delades in i fyra teman; förändringar inom familjen, starka känslor, involvering och livet utanför familjen. Det visade att syskonen upplevde blandade känslor som exempelvis sorg, ilska, avundsjuka och försummelse. Det framkom även att syskonen hade olika stort behov av information och hanterade situationen på olika sätt. Vidare upplevde syskonen ett ökat ansvar och en rollförändring inom familjen i och med det sjuka barnets cancerdiagnos. Vänner och skola kunde bidra både positivt och negativt till syskonens upplevelse av situationen. Slutsats: Slutsatsen var att syskonen upplever blandade känslor efter det sjuka barnets cancerdiagnos och hanterar situationen på olika sätt. Syskonen har även olika stort behov av att få ta del av information angående det cancersjuka barnet. Det är nödvändigt att fler studier genomförs på detta område för att ytterligare öka kunskapen om syskonens upplevelser. Denna studie bidrar med en ökad kunskap kring hur sjuksköterskor bör bemöta syskonen till cancersjuka barn för att underlätta deras situation och kunna vara ett stöd för dessa. / Aim: The aim of this study was to examine the experiences of children and young adults (5-25 years) when having a sibling with cancer.  Method: The used method was a general literature study with a descriptive design for data collection. The study was based on thirteen scientific articles with a qualitative approach. The search was performed in the databases PubMed and PsycInfo. The collected articles were quality reviewed through Assessment of studies with a qualitative methodology of Governmental preparation for medical and social evaluation and were analyzed through a latent content analysis where meaning units were identified. Further, the data was condensed, coded and categorized. Based on this, four themes were established. Results: The result was categorized into four themes; changes within the family, strong emotions, involvement and life outside the family. It showed that siblings experienced mixed feelings such as grief, anger, jealousy and neglect. It also appeared that siblings had a varied need of receiving information and that they coped with the situation in different ways. Furthermore siblings experienced an increased responsibility and a change of roles within the family because of the sick child's cancer diagnosis. Friends and school could contribute with both positive and negative aspects of siblings experiences of the situation. Conclusion: The conclusion was that siblings experienced mixed feelings after the sick child's cancer diagnosis and were coping with the situation in different ways. Siblings also had a varied need of receiving information about the child with cancer. It is necessary to perform other studies in the same area to continue to increase the knowledge about siblings' experiences. This study contributes with an increased knowledge about how nurses should meet the needs of siblings of a child with cancer to help ease their situation and to support them.

The purposes of this study were to explore the needs and concerns of the siblings of children hospitalized with a chronic illness and to explore the role that Child Life Specialists play in the lives of siblings. Face-to-face and telephone interviews with Child Life Specialists from three central Florida pediatric hospitals were conducted and analyzed. Through these interviews, I gained the perspective of the Child Life Specialist’s role concerning the needs and concerns of siblings as well as their role in meeting those needs. The interviews were tape-recorded and later transcribed and analyzed with a qualitative approach. I predicted that the results would show many similarities among Child Life Specialists' perceptions related to their experiences with siblings and would solidify the role that they play in meeting the needs of siblings. This study validated the worth of the Child Life Specialist in the hospital setting in aiding in the psychosocial development of hospitalized children and their families. I concluded from the data that all of the Child Life Specialists agreed that they were needed in the hospitals to help siblings deal with the psychosocial needs separate from the needs of the hospitalized child. All the Child Life Specialists helped siblings in the hospital; however there was a fair amount of inconsistency regarding how the needs of siblings were met. All the Specialists believed they were relieving anxiety; with differences in the methods to relieve anxiety. They all believed they made a positive impact in the siblings’ hospital experiences with a fair amount of variance in their perceived level of impact. There are very few research studies in the fields of child development and child life regarding psychosocial development of siblings of chronically ill children. Therefore, I felt it pertinent to conduct an exploratory study that would provide relevant and factual information to both fields that could, in turn, inspire future research in both fields. Through this study, I have discovered that Child Life Specialists employ a variety of methods in meeting the needs of siblings of children diagnosed with a chronic illness. I have also discovered that Child Life Specialists perceive themselves as being able to make a positive impact on the coping and psychosocial needs of the siblings of children hospitalized with chronic illness Further research in this area is needed. First and foremost, a study is needed in which the siblings are interviewed so that their needs are correctly identified, and Child Life Specialists can intervene appropriately. Second, this particular study focused on central Florida, and future studies should expand the geographic regions to other areas of the United States. Third, this particular study focused on chronic disease diagnosis of the child in the hospital, and additional studies are needed so that all siblings of all children in the hospital for any reason are studied. Therefore, I predicted that siblings would have different needs of attention from one another, depending on diagnosis of chronically ill sibling and family situation, and that Child Life Specialists would employ a variety of methods in differentiating for and meeting those needs.

Gridlocks and Padlocks is a collection of short fiction and personal essays whose goal is to create characters with depth in both real-world and not-entirely-real-world situations. The strength of nonfiction is the capacity to observe the writer's thinking and motivation. "Ashes to Ashes, Trust to Dust" is a personal essay that explores my struggle with the faith I was raised in, with an emphasis on how friendships and relationships have shaped my perceptions. "The List of Unacceptable Faults" is a personal essay about unwanted interactions with the opposite sex; it is an examination of men and boys through the lens of naive dissatisfaction. "Sing Me Rebecca" is a personal essay that delves into my relationship with my mentally handicapped sister. While the nonfiction writer focuses on his or her own development and struggles, a fiction writer can investigate the human condition by exploring the depth found in imagined people who face everyday situations and what characteristics and behaviors make them believable and absorbing. "Object of Study" is a short story about a girl named Taylor, who in her formative years stumbles upon a friendship between her sister and a boy she does not trust. This story examines Taylor's quirky, multi-faceted character through the actions she takes to investigate and ultimately end the friendship between a boy and her younger sister. "Crossing Fault Lines" is a work of short short fiction that focuses on three characters-a mother and her two sons-and their strained relationship. Whether writing personal essays or fiction, my goal is to create overarching conflicts that reflect people's struggle with being "stuck" in some situation in life.

As youth with disabilities age and transition to adulthood, they will often need to learn how to manage their healthcare. Siblings are members of the family who can provide support to their sibling with a disability, but their roles during transition have not been well described in the literature. Typically developing (TD) siblings identified that they require information and resources in their roles. The overall objectives of the research studies in this doctoral dissertation are: 1) to synthesize existing resources and programs to support TD siblings of individuals with a disability; and 2) to develop a deeper understanding about the experiences of TD siblings. The findings from these studies are summarized in six scholarly manuscripts prepared for peer review and publication. All studies were conducted in partnership with siblings with lived experiences. Results from the review and qualitative document analysis of online resources to support TD siblings (Chapter 2) identified that limited resources are available to support TD siblings with healthcare management of their sibling with a disability. The scoping review (with the protocol described in Chapter 3 and results presented in Chapter 4) identified that programs for TD siblings are focused on knowledge development and skill acquisition for the TD siblings themselves or on empowerment by training TD siblings in skills that they can apply with their sibling with a disability. In addition to synthesizing existing knowledge, the qualitative study provided an in-depth understanding of the experiences of TD siblings (with the protocol described in Chapter 5) in two distinct areas: their roles and responsibilities (Chapter 6) and the influence of their sibling and family relationships on their identity formation during developmental stages (Chapter 7). Overall findings from this dissertation suggest areas for future directions, including knowledge transfer to share synthesized resources with target audiences, co-creation of resources to support siblings in their roles, and enhancement of programs to involve siblings and the whole family. / Dissertation / Doctor of Philosophy (PhD) / As youth with a disability transition to adulthood, many will assume greater responsibility for their own health management, activities often supported by family members, including siblings. Little information is available about the roles that siblings have to their sibling with a disability in this process. Siblings have mentioned that they need information and resources for their roles. The purpose of this work is to summarize resources and programs in Canada and internationally for siblings, as well as better understand the experiences of siblings of an individual with a disability. The information from this work can be helpful by sharing the summary of resources with siblings and families, create new resources to support siblings of an individual with a disability, and build on programs that allow for siblings and the whole family to participate.

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