Family Priorities Research Articles

Parent decision-making when selecting schools: The case of Nepal

This paper analyzes the parent decision-making processes underlying school selection in Nepal. The analysis is based on primary survey and focus group data collected from parent meetings in diverse local education markets in two districts of Nepal in 2011. It highlights three main arguments that are less frequently discussed in the context of school choice, including in developing countries. First, children who go to public schools play a significant role in their own decision-making on schooling; this complicates the currently predominant conceptualization that schooling decisions are primarily made by parents and school officials. Second, the gradual growth in private schools has led to significant sorting of students and created a stigma around public education. Finally, in contexts such as Nepal, that suffer from political conflict, and poor conditions for law and order, a school’s proximity to their home becomes a greater priority for students and families.

Role of the registered nurse in primary health care: Meeting health care needs in the 21st century

There is widespread interest in the redesign of primary health care practice models to increase access to quality health care. Registered nurses (RNs) are well positioned to assume direct care and leadership roles based on their understanding of patient, family, and system priorities. This project identified 16 exemplar primary health care practices that used RNs to the full extent of their scope of practice in team-based care. Interviews were conducted with practice representatives. RN activities were performed within three general contexts: episodic and preventive care, chronic disease management, and practice operations. RNs performed nine general functions in these contexts including telephone triage, assessment and documentation of health status, chronic illness case management, hospital transition management, delegated care for episodic illness, health coaching, medication reconciliation, staff supervision, and quality improvement leadership. These functions improved quality and efficiency and decreased cost. Implications for policy, practice, and RN education are considered.

Teaching the essentials of "well-child care": inspiring proficiency and passion.

Before the pediatric clerkship, most medical students learn to take a patient history starting with the “chief complaint.” Upon encountering their first pediatric patients, students quickly recognize that they are not prepared to ask the appropriate follow-up questions when the chief complaint is “well-child visit.” In this article, we present a practical method for teaching medical students how to approach pediatric health supervision visits that build upon their existing clinical skills. Primary care pediatricians address the health care needs of each child in the context of their family and community. They acknowledge the important ways in which social and psychological determinants of health impact wellness. Clinical teachers of pediatrics can inspire future physicians to use patient-centered communication skills to address the needs and priorities of families by making explicit the different aspects of a pediatric health supervision visit that include the following: 1. Identifying patient and family concerns by practicing a structured communication strategy. 2. Using reliable resources to identify the established priorities for each age and access most up-to-date anticipatory guidance recommendations. 3. Delivering prioritized anticipatory guidance that is specific to each patient within his or her community. A useful strategy for approaching the conversation with parents and children is for students to: “Elicit and ask…then assess, prioritize, and advise.”1 Clinical preceptors should explain the importance of eliciting patient and family concerns by asking open-ended questions. Then, with feedback on their ability to assess the most important issues, preceptors ask students to prioritize which topics to address and then together, advise the family accordingly. Eliciting concerns through open-ended questions creates the essential foundation for the health supervision visit.2 Recent studies have demonstrated that using a patient-centered communication style with open-ended questions is not only time-effective but allows for greater adherence to the current standards for well-child … Address correspondence to Erin K. Balog, MD, CDR, MC, USN, Department of Pediatrics, Uniformed Services University of the Health Sciences. E-mail: erin.balog{at}usuhs.edu

Psychosocial Factor of being Street Children in Rwanda

This qualitative study investigates the reason why Rwanda still has street children despite a number of existing strategies against this phenomenon. Fourteen individual interviews were conducted. They included ten boys hosted in the “Enfants de Dieu” centre, who were former Street children; and four girls who were still living in the street and who were about to be recruited in one of the centres. Participants were aged between 10 and 14. The informed consent was obtained from all participants in agreement with their supposed responsible surrogates from the “Enfants de Dieu” centre as per the age of the participants. Findings revealed that poverty, lack of food, family priorities, family violence, and lack of shelter, deprivation of studies and inadequate upbringing of the children were said to be influencing the persistence of the phenomenon of street children in Rwanda. More effort to cover the children's basic needs as well as the effective support for their studies may be possible solutions to successfully face the persisting phenomenon of street children. It also would be good to provide parents with training on effective children upbringing in terms of the effectiveness of parental affection and in terms of guidance for children.

Parental perceptions of barriers to physical activity in children with developmental disabilities living in Trinidad and Tobago

Background: Parents have a strong influence on their child’s engagement in physical activities, especially for children with developmental disabilities, as these children are less likely to initiate physical activity. Knowledge is limited regarding parents’ perceptions of this phenomenon in low- and middle-income countries (LMICs); yet many rehabilitation providers work with children with developmental disabilities and their parents in these contexts. Purpose: The aim of this study was to explore the barriers perceived by parents of children with developmental disabilities to their children’s engagement in physical activity. Methods: An occupational perspective was used to explore how parents speak about barriers to their child’s engagement in physical activity. Interviews were conducted with nine parents in Port-of-Spain, Trinidad and Tobago. Findings: Parent’s perceived barriers were categorized into four themes: family priorities, not an option in our environment, need to match the activity to the child’s ability, and need for specialized supports. Conclusions: Findings provide opportunities for future rehabilitation and community programming in LMICs.Implications for RehabilitationChildren living with a developmental disability may engage more in solitary and sedentary pursuits as a result of parents choosing activities that do not present extensive social and physical demands for their child.Therapists can play an important role in providing knowledge to parents of appropriate physical activity and the benefits of physical activity for children with developmental disabilities in order to promote children’s participation.In environments where there is limited social support for families, therapists need to consider and be particularly supportive of parental priorities and schedules.

Family-clinician interactions in children's health services: a secondary analysis of occupational therapists' practice descriptions.

Effective family-clinician interactions are important for good health outcomes. Two types of interactions are consistently recommended: relational (e.g. listening, empathy, and respect) and participatory (e.g. shared decision-making, planning and problem-solving), but there is little specific guidance on how to implement these interactions in practice. To identify specific, practice-based examples of relational and participatory family-clinician interactions in children's occupational therapy. A qualitative secondary analysis was used. The data consisted of a list of occupational therapists' self-reported practice actions (n = 217) and direct quotes describing their content and context. The practice actions were categorized into a range of relational and participatory family-centred interactions using a modified framework analysis. Of the 217 practice actions, the majority [121 (55.76%)] did not describe examples of therapists implementing family-clinician interactions. Of the remaining practice actions, 19 (8.76%) described 'relational' interactions (e.g. 'Listen to carer', 'Gather perspectives from others'); 47 (21.66%) described 'participatory' interactions (e.g. 'Identify the family's goals and priorities', 'Allow the family to choose'); 2 (0.92%) described both ('Take guidance from carers'); and 28 (12.9%) were excluded from the analysis. A range of relational and participatory interactions were identified. Descriptions of participatory interactions were more frequent than descriptions of relational interactions, and overall the therapists described their family-clinician interactions less frequently than their other practice actions. The specific, real-life examples of different types of interactions identified in the study can be used as a basis for reflection on practice and developing more specific guidance.

Carol Bradley, MSN, RN, CENP

Carol Bradley, MSN, RN, CENP, is the Senior Vice President and Chief Nursing Officer, Legacy Health System in Portland, Oregon. Legacy Health, based in Portland, Oregon includes 6 hospitals and a regional network of primary care clinics. The system employs 3,500 nurses and approximately 200 advanced practice nurses. This is Carol's third experience as a health system nurse executive, and she considers this to be her "destination job." Legacy Health is on the cutting edge of what is happening in healthcare. Oregon is a very progressive state in promoting healthcare access and is actively involved in care transformation. Within Legacy, all of the primary care clinics have adopted the health home model, and the organization has a strong orientation toward performance excellence and patient engagement. Among Carol's many professional contributions is her service as American Organization of Nurse Executives (AONE) president in 1999.

What Can Health Communication Science Offer for ACA Implementation? Five Evidence-Informed Strategies for Expanding Medicaid Enrollment

Implementing the Affordable Care Act (ACA) in 2014 will require effective enrollment and outreach efforts to previously uninsured individuals now eligible for coverage. From 1996 to 2013, the Health Communication Research Laboratory conducted more than 40 original studies with more than 30,000 participants to learn how to improve the reach to and effectiveness of health information for low-income and racial/ethnic minority populations. We synthesized the findings from this body of research and used them to inform current challenges in implementing the ACA. We found empirical support for 5 recommendations regarding partnerships, outreach, messages and messengers, life priorities of low-income individuals and families, and the information environment. We translated these into 12 action steps. Health communication science can inform the development and execution of strategies to increase the public's understanding of the ACA and to support the enrollment of eligible individuals into Medicaid or the Health Insurance Marketplace.

Correlates of career priority and family priority among hospital-based nursing staff

Purpose – This study explored the relationship of measures of career priority and family priority with a number of other variables including personal demographics, work situation characteristics, work motivations, work outcomes and indicators of extra-work outcomes such as affluence and psychological well-being. The paper aims to discuss these issues. Design/methodology/approach – Data were collected from 290 nursing staff, the vast majority female, working in Ontario, Canada, using anonymously completed questionnaires. Findings – Career priority and family priority were significantly and positively correlated in this sample. Nursing staff also rated family priority significantly higher than career priority. Personal demographics were associated with levels of both career priority and family priority such that married nursing staff, nursing staff with children, and nursing staff working part time reported lower levels of career priority, while married nurses and nursing staff having children rated family priority higher. Nursing staff having higher levels of work motivation also rated career priority higher. Career priority was significantly correlated with several work outcomes. Nursing staff indicating a higher career priority were more satisfied and engaged in their jobs. Somewhat surprisingly, family priority was generally unrelated to these work and well-being outcomes. Research limitations/implications – Recent writing on women in organizations has raised the question of can women “have it all”, a successful and demanding career and a satisfying home and family life. The findings contribute to this debate. Practical implications – Suggestions for both women and organizations to facilitate career and family facilitation are offered. Social implications – Increasing interest has been shown in women in the workplace, and whether they should “lean in” to advance their careers. The authors suggest that this strategy may be at odds with what women, and men, increasingly want. Originality/value – The paper highlights differences in the antecedents and consequences of career priority and family priority in a predominately female sample bringing work and family issues into the forefront once again.

Zayed Al Hussaini Group: the road ahead for the family business in the UAE

Subject area Corporate strategy and family business management. Study level/applicability The case is designed for usage in senior-level undergraduate courses of strategic management and managing family businesses. Case overview This case study relates the story of the launch and development of Zayed Al Hussaini Group, a family business in the United Arab Emirates (UAE). The business had been established a year after the unionization of the different Emirates by the founder, Zayed Al Hussaini, in partnership with his brother. Following a series of strategic moves, such as acquisitions and divestures, and adverse family-related events, the Group was led solely by the founder himself. Over the years, Zayed Al Hussaini Group has grown to become a successful family business in various industries of its operation, but following the death of the founder's son, the company activities have been struck with chaos. Zayed's nephew, Ahmed, who had left the family business to continue his studies and work at McKinsey & Company in London, has been called back home after eight years to take the lead of the entire Group. However, he is faced with several challenges, such as dealing with the family gap he has developed over time and balancing family and business priorities. Will Ahmed be able to make the right decisions in the role and responsibilities that have been bestowed upon him? Expected learning outcomes To analyse the process of launching a family business and making strategic decisions for managing its development over time. To assess the potential difficulties and challenges which are associated with managing a family-run organization. To evaluate the effectiveness of decisions with regards to the company's growth and succession management planning. To apply relevant theoretical concepts to the analysis of complex situations in the specific context of family businesses. Supplementary materials Teaching notes are available for educators only. Please contact your library to gain login details or email support@emeraldinsight.com to request teaching notes.

Experiences of Caregivers of Children with Complex Chronic Conditions with Home Health Nurses (SA509-B)

Objectives 1. Identify at least two qualities that caregivers of children with complex chronic conditions (CCC) desire in home health nurses (HHN). 2. Identify at least three struggles caregivers face in identifying and retaining HHN for children with CCC at home. 3. Identify at least three ways that HHN can improve relationships with caregivers and other healthcare providers. Background. One-fourth of pediatric deaths in theUnitedStates are fromcomplex chronic conditions (CCC). Children with CCC, also known as medically fragile, technology dependent, ormedically complex, are living longer because of technological advances. In recent years, the number of children with CCC receiving care at home from homehealthnurses (HHN)has steadily increased. It is important to understand the role of HHN in the care of these children. Research Objectives. To assess caregiver experiences with HHN in the care of their children with CCC related to HHN skills, challenges in hiring and retaining HHN, and partnerships of HHN with caregivers and other healthcare providers. Methods. Using qualitative methodology, we conducted 20 semi-structured in-depth interviews with primary caregivers (15 English, five Spanish) of children with CCC. Data were transcribed verbatim and imported into Atlas.ti v.7 for coding. During an iterative analysis process, we identified recurrent themes by their prevalence and salience in the data. Results. HHN perform a wide range of services for children with CCC, but their skills are variable. Consistent, reliable nursing care is a high priority for families but is often difficult to achieve. When the ‘‘perfect fit’’ is not achieved, caregivers struggle with decisions about dismissing nurses, or lowering their standards rather than taking the risk that nurses will not be replaced promptly. Caregivers do what they can to keep nurses happy. Good relationships between nurses and the entire family are important to caregivers. Overall, caregivers feel satisfied with communication between themselves and the nurses. Despite the multiple HHN involved in the care of these children, caregivers are the hub of collaboration between multiple healthcare providers. Conclusions. Although there are gaps in services offered by HHN, they play an important role in the care of children with CCC. Implications for research, policy, or practice. Optimizing home health nursing delivery will have a positive impact on children with CCC and their families.

The potential to predict the course of childhood asthma

Many children experience pre-school or early childhood wheezing. In a significant proportion symptoms disappear as the child grows, but others have persistent and troublesome asthma which can be life-long. Tools to predict course of disease in young children are a priority for families and clinicians. This review summarizes evidence from several longitudinal population-based birth-cohort studies that have identified risk factors for persistence and remission of childhood asthma. These factors include clinical characteristics, environmental and other exposures, familial factors, biomarkers of allergic inflammation, measurements of lung function and airway responsiveness, and genetic variants. This review also introduces the concept of polygenic risk and genetic risk scores, and describes results from a recent study that suggests promise for the use of genetic information in predicting the course of childhood asthma. We conclude with a discussion of implications and future directions.

Ecosystem Service Delivery in Wales: Evaluating Farmers' Engagement and Willingness to Participate

ABSTRACTThis paper reports on the findings of a project undertaken by the Wales Rural Observatory to investigate factors influencing farmers' willingness to participate in the delivery of ecosystem services through the current agri-environment framework and prospective future mechanisms. The analysis draws on 50 in-depth interviews with farmers across Wales, including case-study groups where ecosystem service delivery is being piloted. The results show increased levels of potential engagement with environmental schemes, due to the perceived financial benefits in an increasingly difficult economic climate. However, there are still significant barriers present with the communication of policy aims. In particular, a more considered negotiation of the compatibility between food provisioning and other ecosystem services is needed, as the majority of the farmers interviewed remain committed to food production and were unwilling to compromise these priorities even for short-term financial gain. This was explained through reference to their sense of identity and family priorities. They were also critical of the government's current approach to food and environmental policy. As a consequence, a more coherent sustainable land management strategy is recommended to maximize the synergies between different goods and services and reduce inconsistencies across the production chains surrounding farm businesses.

Communication Commentary: It Takes a Village: Effective Interprofessional Collaboration in Health Care Teams

Health care is changing. The technologies available for diagnostics are improving. The methods of acquiring and sharing information are burgeoning with the advent of the electronic medical record and information technology. Care is expected to be patient-centered, ensuring that the patient and familyunderstandtheoptionsavailable for treatment and are the decision-makers guiding care. In addition, health care is increasingly team-based. A broadly accepted definition of team-based health care is “the provision of health services to individuals, families, and/or their communities by at least two health providers who work collaboratively with patients and their caregivers—to the extent preferred by each patient—to accomplish shared goals within and across settings to achieve coordinated, high-quality care” (1). “The high-performing team is now widely recognized as an essential tool for constructing a more patient-centered, coordinated, and effective health care delivery system” (2, p. 3). With the literature burgeoning with new research findings, and with the research evidence that serves as the metric for quality of care continually changing, no single physician can absorb all of this information. Physicians must rely on specialists in other fields. Patient consumers are frequent utilizers of physician services. For example, the “typical Medicare beneficiary visits two primary care clinicians and five specialists per year,” as well as utilizing the ancillary services of diagnostic radiology, laboratory testing, pharmacy, and other services (3). Individuals suffering frommultiple

Defining Quality of Life in the Children of Parents with Severe Mental Illness: A Preliminary Stakeholder-Led Model

Severe parental mental illness poses a challenge to quality of life (QoL) in a substantial number of children and adolescents, and improving the lives of these children is of urgent political and public health concern. This study used a bottom-up qualitative approach to develop a new stakeholder-led model of quality of life relevant to this population. Qualitative data were collected from 19 individuals participating in focus groups or individual interviews. Participants comprised 8 clinical academics, health and social care professionals or voluntary agency representatives; 5 parents and 6 young people (aged 13–18 yrs) with lived experience of severe parental mental illness. Data underwent inductive thematic analysis for the purposes of informing a population-specific quality of life model. Fifty nine individual themes were identified and grouped into 11 key ‘meta-themes’. Mapping each meta-theme against existing child-centred quality of life concepts revealed a multi-dimensional model that endorsed, to a greater or lesser degree, the core domains of generic quality of life models. Three new population-specific priorities were also observed: i) the alleviation of parental mental health symptoms, ii) improved problem-based coping skills and iii) increased mental health literacy. The identification of these priorities raises questions regarding the validity of generic quality of life measures to monitor the effectiveness of services for families and children affected by severe mental illness. New, age-appropriate instruments that better reflect the life priorities and unique challenges faced by the children of parents with severe mental illness may need to be developed. Challenges then remain in augmenting and adapting service design and delivery mechanisms better to meet these needs. Future child and adult mental health services need to work seamlessly alongside statutory education and social care services and a growing number of relevant third sector providers to address fully the quality of life priorities of these vulnerable families.

Genome size variation and evolution in the family Asteraceae

The nuclear DNA content data available in “A genome size database in the Asteraceae” (GSAD: www.asteraceaegenomesize.com) have been analyzed, together with other parameters (i.e. ecological, karyological, cytogenetic), in order to establish hypotheses on the systematic, phylogenetic and evolutionary aspects of genome size in one of the largest angiosperm families. The novelty of this work is a comprehensive analysis of the whole family with the following aims: (1) to update the knowledge of genome size values in the Asteraceae; (2) to infer evolutionary trends of genome size, compared with other plant groups; and (3) to detect gaps in this field in the family and outline further research priorities. The analysis of this dataset shows that most Asteraceae genomes (57.23%) range from very small (1C ⩽ 1.4 pg) to small (1C ⩽ 3.5 pg). Gains and losses of DNA occur throughout the phylogeny of the family but although ancestral values for the basal nodes remain mostly equivocal, often small and very small ancestral genome sizes are reconstructed. Most genome size data (96.74%) are concentrated in five tribes, which broadly reflect their species richness. The relationships between genome size and other cytogenetic and ecological features have been analyzed and discussed, highlighting several general patterns. Further studies are needed to fill the gaps in genome size knowledge in the Asteraceae and more detailed research in some groups could provide information about mechanisms regulating genome expansions and contractions.

Women’s experiences of doing long-term pelvic floor muscle exercises for the treatment of pelvic organ prolapse symptoms

This study investigated women's experiences of doing prescribed pelvic floor muscle exercise (PFME) after participation in the Pelvic Organ Prolapse Physiotherapy (POPPY) trial. The aim was to understand post-supervised treatment adherence to PFME and to inform future advice for women being treated for pelvic organ prolapse (POP). Five women were purposively selected from the New Zealand branch of the multi-centre, multi-national POPPY trial and took part in a semi-structured interviews about their experiences of PFME. The interviews were subjected to an interpretative phenomenological analysis (IPA). Three core themes were identified in the analysis. The first theme, "Patterns of PFME behaviour", described exercise characteristics and behaviours. The second theme, "Influences on PFME maintenance cycles", captured the participants' responses to and evaluations of their exercise practice and related PFME self-efficacy. The "cycle" referred to the changing influences on exercise behaviour. The third theme, "Family as priority", was expressed in terms of either putting family first or successfully combining the priorities of family and self. This study revealed the importance of family in influencing PFME patterns and behaviours in the treatment of POP. It is possible that identifying strategies to help women reach their PFME goals within the context of their families will promote more successful PFME adherence. The importance of family when prescribing exercise for women with other chronic health conditions is also worth exploring.

Assessing Competence for Reentry

Assessing Competence for Reentry

Understanding Parental Support of Child Physical Activity Behavior

To examine parental support of child physical activity with an adapted theory of planned behavior model. A representative sample of Canadian mothers (N = 663) who completed measures of family priorities, social cognition, and child physical activity. An assessment of family priorities showed that mothers ranked physical activity almost as high as homework and far higher than other activities. Attitude about providing support for child physical activity predicted intention, yet only perceived control over support predicted behavior. Mothers perceive great import of physical activity for their children but they are inhibited by a low perception of control.

AMA’s Psychiatrist President Hails Involvement of APA

Jeremy Lazarus, M.D., says that the high profile of psychiatry within the AMA has helped to sharpen that organization’s focus on mental health issues.