BACKGROUND:Depression is a common comorbidity in patients with chronic heart failure (HF) and linked to a wider range of symptoms which, in turn, are linked to a decreased health-related quality of life (HRQOL). Treatment of depression might improve HRQOL but detecting depression is difficult due to the symptom overlap between HF and depression. Therefore, clinical guidelines recommend to routinely screen for depression in HF patients. No studies have so far investigated the treatment after getting aware of a depressive symptomatology and its correlation with HRQOL in primary care HF patients. Therefore, we examined the factors linked to depression treatment and those linked to HRQOL in HF patients. We hypothesized that GPs' awareness of depressive symptomatology was associated with depression treatment and HRQOL in HF patients. METHODS:For this observational study, HF patients were recruited in primary care practices and filled out a questionnaire including PHQ-9 and HADS. A total of 574 patients screened positive for depressive symptomatology. Their GPs were interviewed by phone regarding the patients' comorbidities and potential depression treatment. Descriptive and regression analysis were performed. RESULTS:GPs reported various types of depression treatments (including dialogue/counselling by the GP him/herself in 31.8% of the patients). The reported rates differed considerably between GP-reported initiated treatment and patient-reported utilised treatment regarding psychotherapy (16.4% vs. 9.5%) and pharmacotherapy (61.2% vs. 30.3%). The GPs' awareness of depressive symptomatology was significantly associated with the likelihood of receiving pharmacotherapy (OR 2.8; p < 0.001) but not psychotherapy. The patient's HRQOL was not significantly associated with the GPs' awareness of depression. CONCLUSION:GPs should be aware of the gap between GP-initiated and patient-utilised depression treatments in patients with chronic HF, which might lead to an undersupply of depression treatment. It remains to be investigated why GPs' awareness of depressive symptomatology is not linked to patients' HRQOL. We hypothesize that GPs are aware of cases with reduced HRQOL (which improves under depression treatment) and unaware of cases whose depression do not significantly impair HRQOL, resulting in comparable levels of HRQOL in both groups. This hypothesis needs to be further investigated.

INTRODUCTION:To assess parents' knowledge regarding how to deal with children's fever in comparison to the updated recommendations published in 2016 by the HAS and to collect their views on the fever advice card of the 2006 health record to offer suggestions for possible improvements in order to disseminate the message. METHODS:Observational, descriptive, quantitative national study conducted with an online questionnaire among adult parents with children born between 2006 and 2017 who had a French health record. RESULTS:A total of 3295 parents were included from 03/12/2017 to 04/02/2018. The concordance of knowledge compared to current recommendations has improved in 10 years, especially regarding physical treatment (31% of parents had all the right answers) and drugs (95% paracetamol monotherapy). Shortcomings mainly concern the definition of fever, the idea that the temperature is correlated with severity, and the lack of knowledge of the sign of severity "age less than 3 months." The use of the fever advice card in the health record is limited (33% of parents only). They approve by a large majority its promotion and the standardization of the message of healthcare professionals. CONCLUSIONS:The improvement of how parents manage their child's fever first requires an update of the knowledge of healthcare professionals to homogenize their messages and practices. One of their essential roles is to inform parents of the existence of the fever advice card updated in the 2018 health record, which most particularly contains information that remains poorly known by parents. The health record should be the medium of dialogue with families to promote children's health.

Mental disorders contribute to high rates of sickness absence (SA) and impaired work functioning. The aim of the present study was to evaluate the efficacy of 3 interventions targeting SA of workers. Participants (n = 352; 78.4% females) of working age with current employment, and SA due to depression, anxiety disorders, or exhaustion disorder, were recruited to the study and randomized to (a) acceptance and commitment therapy (ACT), (b) a workplace dialogue intervention (WDI), (c) a combination of ACT and WDI, or (d) treatment as usual (TAU). For SA days, there was a significant interaction effect for the follow-up period, in which ACT + WDI generated more SA compared with TAU. When diagnostic group was included as a moderator, participants with exhaustion disorder had less SA days in the WDI group compared with TAU. For symptoms of depression, anxiety, and stress-related ill health, there were significant interaction effects for ACT and ACT + WDI, when compared with TAU, from pre- to postmeasurement (small to moderate between-groups effect sizes). Within-group effect sizes pre- to postmeasurement (Cohen's d) ranged from .55 to 1.17 (ACT), .40 to .94 (WDI), .26 to 1.13 (ACT + WI), and -.06 to .70 (TAU). There were no differences between groups during follow-up for symptoms. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

AIM:The increase in the number of people with chronic obstructive pulmonary disease (COPD) and the disease burden, has prompted concerted efforts to improve healthcare, particularly outpatient services. In line with these attempts the Partnership-Based Nursing Practice Theoretical Framework for People with COPD was developed to guide outpatient nursing care. The principal approach of the framework is a 'Dialogue' with the patients, which has four components: 'Establishing family involvement', 'Assisting living with symptoms' and 'Facilitating access to healthcare', with the primary goal being 'Enhancement of the health experience'. With new knowledge, research on the framework, and extensive experience in using it, a need arose to modify the framework to maximize its clinical utility. DESIGN:Discursive paper. METHODS:A narrative review and critical reflection was conducted to revise the nursing practice framework via selected literature search from 2012 to 2022, research on the framework, and the authors' reflections on the clinical experience of using the framework. RESULTS:The nursing practice framework highlights capacities and possibilities that lie in the nurse-patient relationship. The overarching dialogue in the revised framework includes both patients and families. The action-related component 'Assisting living with the disease' was added to the framework to underscore the significance of attempting to understand what may lie ahead for patients and families. The other action-related components are as follows: 'Assisting living with symptoms' and 'Facilitating access to healthcare'. The primary goal remains unchanged: enhancing the 'Health experience'. CONCLUSION:Using the revised nursing practice framework in outpatient care may help to enhance the lives of people with COPD and their families, particularly at advanced stages of the disease. It may have transferability to other groups of people living with progressive diseases dealing with complicated health problems, and to reduce the usage of costly healthcare resources such as hospital care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE:The partnership-based nursing practice framework assumes an extension of conventional specialized respiratory service and embraces a comprehensive account for that which may influence the patient's health problems. This guidance, which holistically attends to patient-family needs of living with complicated and progressive health predicaments, is fundamental. It contributes to strengthening the disciplinary focus of nursing, interdisciplinary collaboration, person-family-centred quality nursing care and inspires research initiatives. Critical reflections and updates on nursing practice frameworks, such as this revision, are essential to advance nursing and healthcare. PATIENT OR PUBLIC CONTRIBUTION:There is no direct patient- or public contribution.

BACKGROUND:Internet-based cognitive behavioral therapy (iCBT) for children and adolescents is a persuasive system that combines 3 major components to therapy-therapeutic content, technological features, and interactions between the user and program-intended to reduce users' anxiety symptoms. Several reviews report the effectiveness of iCBT; however, iCBT design and delivery components differ widely across programs, which raise important questions about how iCBT effects are produced and can be optimized. OBJECTIVE:The objective of this study was to review and synthesize the iCBT literature using a realist approach with a persuasive systems perspective to (1) document the design and delivery components of iCBT and (2) generate hypotheses as to how these components may explain changes in anxiety symptoms after completing iCBT. METHODS:A multi-strategy search identified published and gray literature on iCBT for child and adolescent anxiety up until June 2019. Documents that met our prespecified inclusion criteria were appraised for relevance and methodological rigor. Data extraction was guided by the persuasive systems design (PSD) model. The model describes 28 technological design features, organized into 4 categories that help users meet their health goals: primary task support, dialogue support, system credibility support, and social support. We generated initial hypotheses for how PSD (mechanisms) and program delivery (context of use) features were linked to symptom changes (outcomes) across iCBT programs using realist and meta-ethnographic techniques. These hypothesized context-mechanism-outcome configurations were refined during analysis using evidence from the literature to improve their explanatory value. RESULTS:A total of 63 documents detailing 15 iCBT programs were included. A total of six iCBT programs were rated high for relevance, and most studies were of moderate-to-high methodological rigor. A total of 11 context-mechanism-outcome configurations (final hypotheses) were generated. Configurations primarily comprised PSD features from the primary task and dialogue support categories. Several key PSD features (eg, self-monitoring, simulation, social role, similarity, social learning, and rehearsal) were consistently reported in programs shown to reduce anxiety; many features were employed simultaneously, suggesting synergy when grouped. We also hypothesized the function of PSD features in generating iCBT impacts. Adjunct support was identified as an important aspect of context that may have complemented certain PSD features in reducing users' anxiety. CONCLUSIONS:This synthesis generated context-mechanism-outcome configurations (hypotheses) about the potential function, combination, and impact of iCBT program components thought to support desired program effects. We suggest that, when delivered with adjunct support, PSD features may contribute to reduced anxiety for child and adolescent users. Formal testing of the 11 configurations is required to confirm their impact on anxiety-based outcomes. From this we encourage a systematic and deliberate approach to iCBT design and evaluation to increase the pool of evidence-based interventions available to prevent and treat children and adolescents with anxiety.

The profile of pediatric care has gone through changes in Brazil and in the world. This process becomes more visible in surveys that deal with hospital admission or specialized outpatient care data. This fact leads us to the idea that it is in such spaces that these children and subjects who care for them are more visible and negotiate decisions. We aim to perform a state of the art literature review on decision making discussions and definitions, analyzing the current research in light of the theoretical Mol perspectives on the actors' logics of chronic diseases care; And the perspective of care goods exchanges in the dialogue between Martins and Moreira, triggering the Theory of Gift. The synthesis of the literature shows that decision making may be understood as a care planning process in which family, patients and health professionals are involved, and is linked to the family-centered care model. In terms of difficulties, we point out the prevalence of a dynamic that favors a criticizable choice because of the risks of inequality, such as the lack of discussion on the options and the actuation of the family mostly in times of difficult decisions.

AIM:This randomised controlled trial evaluated changes in parental self-efficacy and children's weight, after a Child-Centred Health Dialogue about preventing obesity. METHODS:We randomly assigned 37 Child Health Centres in Skåne county Sweden to provide usual care or the dialogue intervention. They included centres from high and low socioeconomic areas. The outcomes were changes in parental self-efficacy and any moderating effect on their children's body mass index 1 year later. RESULTS:The baseline data were based on 1115 mothers and 869 fathers representing 1197 children (52% females) aged 4 years (3.9-4.2) with a standardised body mass index (zBMI) of 0.1 ± 0.9. The participation rates at follow-up, 1.1 ± 0.2 years after the intervention were 817 mothers and 508 fathers. Overall, parental self-efficacy had decreased by the 1-year follow-up. There was a significant intervention effect on maternal self-efficacy in promoting physical activity, however with unclear clinical relevance. Mothers' change in perceived self-efficacy in promoting a healthy diet seemed to moderate the intervention effect on zBMI change in children with zBMI > 0 with -0.01 (95% CI: -0.025 to -0.001; p = 0.03). CONCLUSION:Our study suggested a possible link between increased maternal self-efficacy in promoting a healthy diet and a favourable development of zBMI.

OBJECTIVE:Patient-directed knowledge tools are designed to engage patients in dialogue or deliberation, to support patient decision-making or self-care of chronic conditions. However, an abundance of these exists. The tools themselves and their purposes are not always clearly defined; creating challenges for developers and users (professionals, patients). The study's aim was to develop a conceptual framework of patient-directed knowledge tool types. METHODS:A face-to-face evidence-informed consensus meeting with 15 international experts. After the meeting, the framework went through two rounds of feedback before informal consensus was reached. RESULTS:A conceptual framework containing five patient-directed knowledge tool types was developed. The first part of the framework describes the tools' purposes and the second focuses on the tools' core elements. CONCLUSION:The framework provides clarity on which types of patient-directed tools exist, the purposes they serve, and which core elements they prototypically include. It is a working framework and will require further refinement as the area develops, alongside validation with a broader group of stakeholders. PRACTICE IMPLICATIONS:The framework assists developers and users to know which type a tool belongs, its purpose and core elements, helping them to develop and use the right tool for the right job.

PURPOSE:Advances in health care have led to an increase in infants and children being discharged home with increasingly complex conditions. Children with medical complexity require care from many physicians and specialties to thrive in their home environment. While some care coordination programs are in place, these programs are often dependent upon the child living within the geographic area of a major healthcare system. Additionally, children with medical complexity often need specialized care from providers outside the participating healthcare system, placing the onus of care coordination on the child's family. This literature review aimed to examine care coordination programs for children with medical complexity and what tools have been created to empower the child's family in the process. METHOD:Qualitative and quantitative research studies published from 2015 to 2021 found in Academic Search Complete, Cumulative Index to Nursing and Allied Health Literature, and Medline that included a review of a care coordination program for children with medical complexity were included. Nonresearch articles, articles written about adults, or written in languages other than English were excluded. The Johns Hopkins Nursing Evidence-Based Practice grading scale was used to appraise the evidence. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist was utilized to structure this review to deter the risk of bias. A qualitative synthesis was used to analyze and present the results. CONCLUSIONS:There are varying strategies used to facilitate care coordination of children with medical complexity. Effects of care coordination on the child are inconsistent; however, the child's caregiver considers high-quality care coordination to improve quality of life. There are limited tools available for caregivers of children with medical complexity to coordinate their child's care across healthcare systems. Generalizability is a concern due to the small sample sizes of studies and underrepresentation of non-English speaking families in the research. Risk of bias is possible due to highly engaged families willing to participate in the selected research studies. PRACTICE IMPLICATIONS:There is an opportunity to develop further and study care coordination tools to empower the caregivers of children with medical complexity.

PURPOSE:Information about nontraditional (kinship, foster, and adoptive) families is typically scattered or overlooked both in nursing education and nursing practice settings. Using a nursing-centric, population-focused lens, the current state of nontraditional families in the United States is briefly described. An overview of the challenges and psychological dynamics involved when a nonbiological parent assumes the role of caregiver is provided. CONCLUSION:Based on the 2010 Census findings and other indicators, we now understand that nontraditional families and their children make up a considerable portion of the population. Nurses, regardless of level of practice, have the potential to positively impact health outcomes of nontraditional parents and their children. Knowledge of the formation and needs of nontraditional families can inform, and improve, culturally safe, trauma-informed nursing care. PRACTICE IMPLICATIONS:This discussion is a first step in appreciating the formation of nontraditional families and the importance of trauma-informed, unbiased, nonstereotypic discourse in nursing care. By describing the heterogeneity of how families are built through kinship care, foster placements, and adoptive homes, nurses' assessments and interventions will be informed and through a lens of the high potential for past traumas. With this foundational knowledge, nurses interfacing with nontraditional families are better prepared to provide much needed support and relevant care for this unique population.

This integrative literature review aimed to identify the religious and spiritual experiences of family members and caregivers of children and adolescents with cancer. Through systematized searches in the databases/libraries CINAHL, PsycINFO, Pubmed, SciELO, and Lilacs, 69 articles produced between 2010 and 2020 were retrieved. There was a predominance of studies with parents developed in hospital facilities. The caregivers' religious and spiritual experiences helped them to cope with childhood cancer, especially in maintaining hope, reducing stress and anxiety symptoms, as well as in providing psychological and social support. Negative outcomes such as questioning faith, the feeling of punishment, and disruption with the religious and spiritual group were also perceived. It is recommended to include religiosity and spirituality for the provision of more humanized and comprehensive care, as well as further investigation of the negative experiences regarding religiosity and spirituality in this public.

PROBLEM:Health diaries with both clinical and narrative elements have been widely used in pediatrics to study children's and families' experiences of illness and coping strategies. The objective of this study is to obtain a synthesis of the literature about narrative health diaries using the PRISMA extension for scoping reviews. ELIGIBILITY CRITERIA:Sources were limited to: English language; narrative diaries; children/adolescents and/or parents/caregivers. SAMPLE:The following databases were searched: PubMed, Embase and CINAHL with no time limits. RESULTS:Among 36 articles included the most common context where a diary was implemented was the home (61%), the hospital (17%) and the school (14%). The most common diarist is the child or adolescent (50%). Paper diary was the most common type (53%), followed by the video diary (19%), the e-diary (8%) or the audio diary (8%). None of the studies explored the impact of the use of diaries on patient outcomes. CONCLUSIONS:The narrative health diary is used to report patient experiences of illness or common life from the point of view of the child, adolescent or other family members. The diversity of the diaries found shows how the narrative diary may be 'adapted' to different settings and pediatric populations. IMPLICATIONS:The narrative diary is a relevant tool for the exploration of children's and adolescents' experiences of illness and common life. Studies are still needed to describe the impact of narrative diaries keeping on children's health outcomes.

For many individuals, living with epilepsy is truly a family affair throughout the life span. When it comes to childhood epilepsy, the unpredictability of seizure patterns, comorbid conditions, the risk of sudden unexpected death in epilepsy (SUDEP), and societal stigma can be emotionally taxing on children and their primary caregivers. To this end, this article proposes to review psychoeducational interventions provided to primary caregivers of children with an epilepsy diagnosis and the impact of such interventions on general parental coping skills. There were three main themes identified (1) caregivers' knowledge and self-efficacy about seizure management; (2) parental epilepsy-related fears, anxiety, and stress; (3) parental sleep quality and SUDEP psychoeducation. Overall, considering research limitations, providing epilepsy-related psychoeducational interventions to primary caregivers of children with epilepsy seems to have promising evidence in the literature. After receiving such interventions, the studies show that caregivers' psychosocial outcomes improved; they become more empowered to manage their children's seizures and advocate for their children's psychosocial needs.

PURPOSE:Depressive disorders in children and adolescents have an enormous impact on their general quality of life. There is a clear need to effectively treat depression in this age group. Effects of psychotherapy can be enhanced by involving caregivers. In our systematic review and meta-analysis, we examine for the first time the effects of caregiver involvement in depression-specific interventions for children and adolescents. METHODS:We included randomized controlled trials examining the effects of interventions for children and adolescents with depression involving their caregivers or families compared to interventions without including caregivers. Primary outcome was the severity of childhood and adolescent depression. RESULTS:Overall, 19 randomized controlled trials could be included (N = 1553) that were highly heterogeneous regarding outcome measures or the extent of caregiver integration. We were able to include k = 17 studies in our meta-analysis and find a small but significant effect for family-involved interventions against active control conditions without family-involvement at post intervention (α = 0.05, d = 0.34; [0.07; 0.60]; p = .01). CONCLUSIONS:We detected an overall significant but small effect of family/caregivers' involvement compared to control groups without it. Structured, guideline-based research is urgently needed to identify for which children/adolescents with depression, under what circumstances, and in what form the family should be effectively involved in their psychotherapy.

BACKGROUND:Fetal alcohol spectrum disorder (FASD) is a complex neurodevelopmental disorder that may arise following prenatal exposure to alcohol. Children with FASD tend to experience a diverse set of physical, social, cognitive, and behavioral symptoms. Caregivers of these children likely experience elevated levels of parenting stress; however, research in this area is still in its infancy. AIM:The present study sought to more fully understand the current state of the literature on parenting stress experienced by caregivers of children with FASD. METHOD:Databases including PsycInfo, Scopus, PsycArticles, and Google Scholar were searched for records meeting our inclusion criteria. RESULTS AND CONCLUSION:15 studies were deemed eligible for this review. This literature suggests that caregivers of children with FASD experience heightened levels of parenting stress. Child factors, especially child behavior and executive functioning difficulties are associated with Child Domain stress, while parent factors are associated with Parent Domain stress. Gaps were identified in child and caregiver mental health issues, as well as placement information.

Given a large body of research indicating links between child attachment and later mental health outcomes, interventions that promote children's secure attachment to their caregivers have the potential to contribute to prevention of psychopathology and promotion of well-being. A number of attachment-based interventions have been developed to support parents, enhance caregiving quality, and promote children's attachment security with the aim of improving children's mental health. There is now a growing evidence base to support the efficacy of a number of these interventions. The present literature review and introduction to the special issue on attachment-based interventions for families with young children describes key aspects of attachment theory and research that form the theoretical and empirical background for attachment-based interventions, and introduces seven case studies illustrating five different attachment-based interventions. The case studies represent a variety of attachment-based models, including both group and individual treatments, and show applications across a range of caregiver contexts.

BACKGROUND:It is estimated that 18,232 people received home enteral tube feeding (HETF) in the UK in 2013 and HETF often requires reliance on a caregiver. Caregivers are an essential resource, and so research is needed to explore their perspectives to inform how best to support them. Therefore, this meta-synthesis aimed to explore caregiver experiences of HETF. METHODS:A systematic search and a meta-synthesis of the literature relating to caregiver experiences of HETF were undertaken. Ethical approval was obtained from Coventry University Ethics. A comprehensive search of CINAHL, MEDLINE, Academic Search Complete and SCOPUS databases was conducted, followed by a reference list search of included studies. Studies were screened for eligibility using a priori inclusion criteria. Included studies used qualitative methodology, were in English, and explored caregivers' experiences of supporting an adult or child receiving HETF for at least 1 month. The meta-synthesis was conducted using a thematic-synthesis method. Included studies were assessed for quality, and rigour was ensured via transparent reporting of methodology, peer review and reflexivity. RESULTS:In total, 328 records were screened, with 10 studies included and a total of 97 caregivers' experiences were reported. Four analytical themes were developed: loss of a normal life, psychological impact, practical challenges and becoming the 'expert'. Overall quality of the included studies was assessed as good. CONCLUSIONS:This meta-synthesis highlighted the challenges experienced by caregivers, and revealed the need for improved HETF training for caregivers and psychological support from healthcare professionals, with the aim of providing personalised advice and regimes as part of holistic care.

Human infancy and early childhood is both a time of heightened brain plasticity and responsivity to the environment as well as a developmental period of dependency on caregivers for survival, nurturance, and stimulation. Across primate species and human evolutionary history, close contact between infants and caregivers is species-expected. As children develop, caregiver-child proximity patterns change as children become more autonomous. In addition to developmental changes, there is variation in caregiver-child proximity across cultures and families, with potential implications for child functioning. We propose that caregiver-child proximity is an important dimension for understanding early environments, given that interactions between children and their caregivers are a primary source of experience-dependent learning. We review approaches for operationalizing this construct (e.g., touch, physical distance) and highlight studies that illustrate how caregiver-child proximity can be measured. Drawing on the concepts proposed in dimensional models of adversity, we consider how caregiver-child proximity may contribute to our understanding of children's early experiences. Finally, we discuss future directions in caregiver-child proximity research with the goal of understanding the link between early experiences and child adaptive and maladaptive functioning.

Interpretation and response to behaviour is predicated on understanding. However, our present understanding of aggressive behaviour, especially for complex and vulnerable populations is limited. The purpose of this review is to enhance our understanding of aggressive behaviour by providing a comprehensive outline of the conditions and underlying mechanisms that drive aggressive behaviour for children and adolescents with neurodevelopmental disorders (NDDs), focusing on Fetal Alcohol Spectrum Disorder (FASD). This review will: (1) Synthesize the present literature regarding aggressive behaviour, via the cognitive, environmental, and emotional factors that drive it, for children and adolescents with NDDs; (2) Identify and integrate information specific to the elevated vulnerability for aggressive behaviour that FASD poses; and (3) Utilize the information derived from the review to propose frameworks, in the form of two corresponding models, for recognizing and responding to aggressive behaviour. The advantages of such neurodevelopmentally guided, comprehensive, and integrative framework are to clarify predisposing and perpetuating mechanisms, inform appropriate caregiver and caseworker support, and inform clinicians' preliminary intervention. These ultimately should improve the ability to respond and promote healthy outcomes for these vulnerable youngsters.