Parental Uncertainty Research Articles

Childhood fever: a qualitative study on GPs’ experiences during out-of-hours care

Fever in children is common and mostly caused by self-limiting infections. However, parents of febrile children often consult in general practice, in particular during out-of-hours care. To improve management, it is important to understand experiences of GPs managing these consultations. To describe GPs' experiences regarding management of childhood fever during out-of-hours care. A descriptive qualitative study using purposeful sampling, five focus group discussions were held among 37 GPs. Analysis was based on constant comparative technique using open and axial coding. Main categories were: (i) Workload and general experience; (ii) GPs' perceptions of determinants of consulting behaviour; (iii) Parents' expectations from the GP's point of view; (iv) Antibiotic prescribing decisions; (v) Uncertainty of GPs versus uncertainty of parents and (vi) Information exchange during the consultation. GPs felt management of childhood fever imposes a considerable workload. They perceived a mismatch between parental concerns and their own impression of illness severity, which combined with time-pressure can lead to frustration. Diagnostic uncertainty is driven by low incidences of serious infections and dealing with parental demand for antibiotics is still challenging. Children with a fever account for a high workload during out-of-hours GP care which provides a diagnostic challenge due to the low incidence of serious illnesses and lacking long-term relationship. This can lead to frustration and drives antibiotics prescription rates. Improving information exchange during consultations and in the general public to young parents, could help provide a safety net thereby enhancing self-management, reducing consultations and workload, and subsequent antibiotic prescriptions.

PC-FACS

PC-FACS

PO-0380 Parental Emotional Reactions To Paediatric Hospitalisation

Background and aims When the child is admitted to hospital, parents are faced with a crisis generated by the traumatic events of disease and hospitalisation. This questionnaire-based survey aims to explore the emotional responses of parents to their children’s hospitalisation and associate them to health-care professionals’ behaviour. Methods Parents (80 mothers, 75 fathers) of 155 children aged 2–12 years, hospitalised at least 4 days, completed the questionnaire and engaged in private structured interviews. The questionnaire contained demographic data (age, sex, and educational background), questions about parent’s psychological characteristics in general and their specific emotions during the pre-admission and in-hospital phase. Results Participants were 10% affluent, 65% from middle-class social groups and 25% of relatively deprived minority status. Two – thirds of parents regard themselves as overprotective and highly anxious, 32% present responsible and caring and 1% tend to be indifferent. 19% of parents initially refused admission. The major pre-admission emotions are self- blame, anger and fear, positively associated to previous hospital stays. Stress and discomfort dominate through the in-hospital phase, during which 23% of parents experienced psychosomatic symptoms. Negative emotions become reversed when the need for information by doctors and nurses is satisfied. Fathers expressed less effectively both positive and negative emotions. Limitations Parents of children with chronic diseases were excluded from the study. Conclusions Children’s sickness and hospitalisation disorganizes the family, resulting in parental emotional disturbance, confusion and uncertainty. Stress-related emotions are better coped with, when parents feel they are respectfully treated and adequately fed-back by the hospital personnel.

Family support in the transition to adulthood in Portugal – Its effects on identity capital development, uncertainty management and psychological well-being

In a familistic southern European society such as the Portuguese, the family has historically played a prominent role in supporting the negotiation of transition pathways into adulthood. The present study aimed at capturing (1) the relative weight of parental financial support and autonomy support in contributing to the youngsters' psychological well-being (PWB), and (2) the mediating role of identity capital and uncertainty management in this relationship. A total of 620 participants completed measures of parental support, identity capital, uncertainty management and PWB. Autonomy support was found to be the strongest predictor of PWB, both directly and indirectly through its effects on identity capital and the use of target focused uncertainty management strategies. Conversely, financial support evidenced only a minor indirect impact through the mediation of tangible identity capital. Autonomy stimulation may constitute one of the most developmentally determinant family challenges in assisting the process of coming of age in Portugal.

Sexual selection under parental choice: a revision to the model

Across human cultures, parents exercise considerable influence over their children's mate choices. The model of parental choice provides a good account of these patterns, but its prediction that male parents exercise more control than female ones is not well founded in evolutionary theory. To address this shortcoming, the present article proposes a revision to the model. In particular, parental uncertainty, residual reproductive value, reproductive variance, asymmetry in the control of resources, physical strength, and access to weaponry make control over mating more profitable for male parents than female ones; in turn, this produces an asymmetrical incentive for controlling mate choice. Several implications of this formulation are also explored.

Parental Uncertainty in Illness: Managing Uncertainty Surrounding an "Orphan" Illness

Parents of children with complex chronic illnesses experience substantial uncertainty that is heightened when the condition is an "orphan" illness not belonging to one medical specialty. The current study explores uncertainty experienced by parents of children with "orphan" illnesses requiring multidisciplinary care. Participant-observations over 13 months (n=200) were combined with questionnaire data (n=55) to assess parental uncertainty at a multidisciplinary pediatric clinic. Five unique types of uncertainty emerged from a grounded analysis (Glaser & Strauss, 1967), revealing 11 interrelated uncertainties these parents experience. Findings can help providers understand parents' uncertainty and assist in family-centered decision-making.

Impact of childhood mental health disorders on the family: A Case report

Background : Care of the children with mental health disorders is fraught with challenges particularly in developing countries and, where the family is the major source of care. Consequently assessing the impact of these disorders on the family is relevant to providing these children with optimal care. Objective : To assess the impact of childhood mental health disorders on family function and parental burden. Method : A monogamous family that had 3 children diagnosed as having childhood onset schizophrenia using the International Classification of Disease version 10(ICD 10) Classification was studied. Family function was assessed using the Family APGAR Score and the Zarit Burden Interview (ZBI) Score used in assessing parental burden. \Results : The Family APGAR Scores were low (highly dysfunctional family) and the ZBI Scores high (highly burdened) in the family. Areas of serious dysfunction in the family were in adaptation, partnership and growth. In the ZBI Scores feelings about quality and cost of care offered, stress and other negative attributes associated with providing care, inability to meet other parental obligations and uncertainty about the future, were the major contributors to the highly burdensome outcome. Conclusion : The study highlights significant family burden and dysfunction in a family who had three children with schizophrenia. It underscored the need for provision of more comprehensive health and social support services to children with mental health disorders and their families. Key Words : Childhood, Schizophrenia, Parent, Burden, Family function

Varicella vaccine uptake and associated factors in children in Hong Kong.

Varicella is a common and highly contagious childhood disease which impacts the public worldwide. Hong Kong children can only be vaccinated against the disease in private practice. The varicella vaccination rate of local children in preschool is uncertain. Therefore a cross-sectional kindergarten-based parent-administered questionnaire survey was conducted in Hong Kong during 2012. Twelve kindergartens were randomly selected from a complete school list from the Education Bureau of Hong Kong. In total, 1285/1538 (83·6%) parents consented to join the study and completed the questionnaires. The overall varicella infection rate was 19·5% and the uptake of varicella vaccination rate was 57·6%. Barriers against varicella vaccination were mostly due to parental uncertainties about the effectiveness of vaccine, lack of recommendations from doctors or government, and adverse side-effects of the vaccine. The government and healthcare professional bodies are strongly recommended to further enhance health education among healthcare professionals, encouraging their active promotion of varicella vaccination for their patients. Furthermore, health education through various stakeholders is crucial to enhance parental awareness of varicella, as well as the effectiveness and safety of varicella vaccine.

G84 A Parents View of Cardiac Screening For Down Syndrome

BackgroundCardiac disorders are common in children with Down syndrome and the Down Syndrome Medical Interest Group (DSMIG) guidelines were updated in 2007. This project aims to review if parents thought...

Child protection under Swedish law—legal duality and uncertainty

Society's responsibility to protect children from harm as prescribed by the UN Convention on the Rights of the Child raises complex questions about the fundamental rights of both children and parents, as well as when and how authorities are to intervene in order to protect children from maltreatment. Many child protection systems around the world attract considerable criticism, due in part to how the law responds to child protection matters. This article examines the Swedish child protection system from a critical legal perspective with the ideas conveyed within Therapeutic Jurisprudence as a theoretical starting point. The aim is to describe and analyze the legal challenges and dilemmas that meet this system. A legal ambiguity about when and how responsible authorities are to intervene, leading to significant uncertainty for both children and parents, is identified. Furthermore, the strong focus by Swedish authorities on voluntary measures to resolve child protection matters can lead to vulnerable children not receiving the protection to which they are entitled. Certain of the challenges and dilemmas described here are specific to the Swedish system due to its legal context and family support approach. However, other aspects resonate across legal systems and, therefore, may be of a more general interest.

Active agents of health promotion? The school's role in supporting the HPV vaccination programme

By providing a place in which children can be accessed, the school has long been a site for population-level health initiatives. Recent policy shifts towards health-promoting schools have however re-cast the school from passive host to active collaborator in public health. This paper examines secondary school teachers' views of their roles as partners in Scotland's human papilloma virus vaccination programme. Focus groups were held in seven schools across Scotland. Confusion was evident in relation to this role, with competing understandings of young women's sexuality, concerns about parental perceptions and uncertainty about professional responsibilities. Many teachers sought to distance themselves from the vaccination programme. Evidence was found of a ‘sedimentation of discourses’, as mass models of state-sanctioned health intervention persist alongside contemporary discourses of individual choice.

My Child Needs or Has an Implantable Cardioverter-Defibrillator

The identification of a heart problem in a child can create fear and uncertainty for parents. This patient page will address some common questions from parents of school-age children who require therapy with an implantable cardioverter-defibrillator (ICD). It is intended to be a parental resource to promote understanding and confidence in children and young adults to live successfully with an ICD. ### What Is an ICD? An ICD is not a cure, but instead can be viewed as an insurance policy, protecting at-risk individuals against dangerous heart rhythms. Previous research has indicated that ICDs significantly reduce the risk of sudden cardiac arrest in patients at risk for sudden cardiac death.1 An ICD is a small implanted device that monitors the heart rhythm and is able to stop a dangerous heart rhythm that could result in sudden cardiac death by either rapidly pacing or shocking the heart back to a normal rhythm. Open-heart surgery is not required to implant the device. The ICD is typically placed in the upper left chest and has sensing wires that attach to the walls of the heart muscle. Your child will likely have the ICD throughout his or her lifetime and will need the battery changed every 5 to 7 years. It will require monitoring by a cardiologist, typically every 3 to 6 months, which can be done painlessly with a monitoring system from home or in the cardiologist's office. ### What Questions Should I Ask? At first, it may feel like you have so many questions that you don't know where to start. The Table details a number of key questions and answers. In addition, here are some important things you may want to ask your child's cardiologist: View this table: Table. Children's Frequently Asked Questions and Answers

Efficacy and safety of influenza vaccination in children with asthma

The mean global prevalence of asthma among children is approximately 12%, making it the most common chronic disease in children. Influenza infection has been associated with complications such as exacerbations of wheezing and asthma, increased airway hyper-reactivity and hospitalization. Although influenza vaccination is recommended for asthmatic patients by all health authorities, vaccination coverage remains significantly lower than expected and is lowest of all in children. Compliance is affected by the uncertainty of parents and physicians concerning the clinical risk of influenza in asthmatic subjects, the benefits of influenza vaccination in preventing asthma exacerbations and the safety of immunization. The aim of this review is to analyze the rationale for using influenza vaccine, discuss the relationship between influenza and the severity of asthmatic episodes and document the efficacy and safety of influenza vaccination in the pediatric asthmatic population.

635 Understanding parent perceptions of healthy physical activity for their child with a chronic medical condition

635 Understanding parent perceptions of healthy physical activity for their child with a chronic medical condition

The Association of Illness Uncertainty to Parent and Youth Adjustment in Juvenile Rheumatic Diseases: Effect of Youth Age

: This study sought to examine the differential effect of youth age on the association between parental uncertainty and both parent distress and youth depressive symptoms within the context of juvenile rheumatic disease. : The sample comprised 51 youth aged 9 to 17 years diagnosed with a juvenile rheumatic disease and their parents. Youth completed a measure of depressive symptoms (i.e., Children's Depression Inventory); parents completed measures of illness uncertainty (i.e., Parental Perceptions of Uncertainty Scale) and parental distress (i.e., Brief Symptom Inventory). : Parental uncertainty demonstrated a significant main effect on both parent distress and youth depressive symptoms. However, these main effects were qualified by significant parental uncertainty × youth age interactions. Parental uncertainty was significantly related to parent distress for both younger and older youth but was only significantly related to youth depressive symptoms in the sample of older youth. : Parental uncertainty due to illness seems to be more predictive of both parent and youth distress with increasing youth age. These findings indicate that the impact of parental illness uncertainty on adjustment outcomes is pronounced as children transition into developmental periods of increasing autonomy and independence.

Allergist-Immunologist perspectives on Primary Immunodeficiency in Brazil

S U N D A Y 445 Impact of Hazard Control over Risk Assessment on the Allergic Consumer: A FARRP study M. Costello, S. Taylor, J. O. B. Hourihane, A. DunnGalvin; University College Cork, Cork, IRELAND, University of Nebraska, Nebraska, NE. BACKGROUND: We have previously shown that uncertainty is a core theme in living and coping with food allergy (FA). Concerns about labelling result in anxiety/avoidant behaviour.and also frustration/risky behaviours. AIM: To ascertain parents understanding and acceptance of defined thresholds and risk stratification in the context of food labelling. METHOD: Focus groups were held with parents of children aged 5-16 years. Data was analysed using grounded theory and major themes were extracted. RESULTS: 30 participants took part in three focus groups. 24% had more than one child diagnosed with food allergy. 60% of the children had had a food allergic reaction within the last two years that required the administration of the epipen. Four major themes emerged from the analysis: maintaining a balance between risk and normality; measuring risk, feeling informed and in control; importance of getting the message right. Parents overwhelmingly want the provision of defined thresholds, linked to risk stratification, by clinicians and by food manufacturers. CONCLUSION: The regulatory acceptance of accessible and interpretable food allergen thresholdsmay reduce parental uncertainty and promote better quality of life for families living with food allergy.Parents understand risk cannot be eliminated but feel that it can be minimised and it can be measured.

Parents' beliefs about appropriate infant size, growth and feeding behaviour: implications for the prevention of childhood obesity

BackgroundA number of risk factors are associated with the development of childhood obesity which can be identified during infancy. These include infant feeding practices, parental response to infant temperament and parental perception of infant growth and appetite. Parental beliefs and understanding are crucial determinants of infant feeding behaviour; therefore any intervention would need to take account of their views. This study aimed to explore UK parents' beliefs concerning their infant's size, growth and feeding behaviour and parental receptiveness to early intervention aimed at reducing the risk of childhood obesity.MethodSix focus groups were undertaken in a range of different demographic localities, with parents of infants less than one year of age. The focus groups were audio-recorded, transcribed verbatim and thematic analysis applied using an interpretative, inductive approach.Results38 parents (n = 36 female, n = 2 male), age range 19-45 years (mean 30.1 years, SD 6.28) participated in the focus groups. 12/38 were overweight (BMI 25-29.99) and 8/38 obese (BMI >30). Five main themes were identified. These were a) parental concern about breast milk, infant contentment and growth; b) the belief that the main cause of infant distress is hunger is widespread and drives inappropriate feeding; c) rationalisation for infants' larger size; d) parental uncertainty about identifying and managing infants at risk of obesity and e) intentions and behaviour in relation to a healthy lifestyle.ConclusionsThere are a number of barriers to early intervention with parents of infants at risk of developing obesity. Parents are receptive to prevention prior to weaning and need better support with best practice in infant feeding. In particular, this should focus on helping them understand the physiology of breast feeding, how to differentiate between infant distress caused by hunger and other causes and the timing of weaning. Some parents also need guidance about how to recognize and prepare healthy foods and facilitate physical activity for their infants.

Parental evaluation of popular brand names given as Christmas gifts and sources of information used in these decisions

PurposeParents' exposure to children's brands appears rather limited; while brands sell at Christmas, there are extraordinary purchases of low‐cost toys and stocking filler fun toys. Maybe, toy brand purchases satisfy the child's request, rather than parents' value or quality preferences. Generally, the theories of branding feature the positive functional, symbolic and emotional attributes. This paper aims to examines parental evaluation of popular brand names to be given as gifts at Christmas and the sources used to gather information about brands.Design/methodology/approachData were gathered via a survey of parents in the period prior to Christmas. The analysis consisted of a principal component analysis of the functional, symbolic and emotional evaluations. A frequency analysis and a gender‐based crosstabs series identified gender variations in the evaluations and use of information sources.FindingsThe study indicated that parents hold low evaluations of popular brands when buying Christmas gifts for their children. These low evaluations are across functional, symbolic and hedonic elements. Since mothers generally attend to the gift purchase decisions, there were significant gender differences on a few evaluations. The most popular source of information is asking children what they want and is closely followed by the use of store catalogues.Practical implicationsThe evaluation and purchase of toys and gifts predominate at Christmas. Having such a high level of product or brand choice in the children's market could create confusion or uncertainty for parents. A negative image of children's exposure to toy advertising and the resultant pester power may combine to cloud parents' evaluations of giving brands as gifts. In essence, Christmas is the major chance for brand owners to sell their toys and other products. The idea of “… ask mom to get one … ” may be appropriate in high turnover, supermarket products, but not effective in a one‐chance, Christmas gift situation.Originality/valueThis research spans the value sets of two generations. Simply, the promotion of toys is primarily directed toward children who develop desires, expectations and values that are different from those values and attitudes of parents. Research into parental Christmas giving ascertains the value of children's brands to parents.

Incertidumbre en padres de niños con cáncer

El cáncer es una enfermedad crónica que amenaza la vida de las personas; simboliza lo desconocido, pero cuando la persona que padece cáncer es un niño, todas estas reacciones emocionales son más intensas, aún cuando está controlada la incertidumbre está presente. Mishel (1988); señala que la incertidumbre es un estado cognitivo en el que las personas no son capaces de comprender el significado de los hechos o eventos que ocurren debido a la enfermedad. Objetivo: identificar la incertidumbre de los padres de niños con cáncer, mediante la relación de las características sociodemográficas, tiempo de diagnóstico y apoyo social de la teoría de Mishel (1988). Metodología: diseño descriptivo correlacional y transversal. Material y métodos: la muestra fue de 30 personas, las variables se midieron con tres instrumentos: una cédula de factores sociodemográficos de padres de hijos con cáncer, cédula de apoyo social (Norbeck NSSQ, 1981) y escala de percepción de incertidumbre en padres PPUS-FM (Mishel, 1988). Resultados: para la comprobación de las relaciones entre variables se utilizaron correlaciones de Pearson, observando que la variable sexo femenino refiere incertidumbre con alta p= .010, en cuanto a los años de educación formal se vio que a mayor educación menor incertidumbre una correlación negativa de p= -.025, respecto a nivel socioeconómico no existe ninguna diferencia para que exista incertidumbre p= .523, referente al apoyo social se observó que a mayor apoyo social menor incertidumbre con una p= .008. Conclusiones: se sugiere realizar estudios de tipo cualitativo en donde se aprecie cuáles son los sentimientos que los padres tienen al conocer el diagnóstico de sus hijos y como los profesionales de enfermería pueden ayudar a comprender la incertidumbre que ellos experimentan.

Evaluation of a conceptual model based on Mishel's theories of uncertainty in illness in a sample of Taiwanese parents of children with cancer: A cross-sectional questionnaire survey

Background The prognoses of childhood cancers have improved over the last few decades. Nevertheless, parental uncertainty about the absolute cure and possible relapse pervades the entire illness trajectory. Despite illness-related uncertainty is significantly related to psychological distress, continual uncertainty may serve as a catalyst for positive psychological change and personal growth in the context of surviving cancer. Objectives The purpose of this study was to examine a conceptual model that depicts coping and growth in Taiwanese parents living with the continual uncertainty about their child's cancer. The conceptual model was guided by Mishel's theories of Uncertainty in Illness. The impact of the child's health status, parents’ education level and perceived social support on parental uncertainty was analyzed. The mediating effect of coping as well as the influence of parental uncertainty and parents’ perceived social support on growth through uncertainty was incorporated in the model testing. Methods This study involved a sample of 205 mothers and 96 fathers of 226 children enrolled in a longitudinal cancer study in Taiwan. This study only analyzed the data collected at baseline. A cross-sectional design was utilized to examine the relationships among proposed variables. Parental uncertainty and growth through uncertainty were measured by the translated questionnaires originally developed by Mishel. Parents’ perceived social support and coping were measured by culturally sensitive instruments developed in Taiwan. Results The full research model and its alternative models fit adequately to the data via structural equation modeling tests. Parental uncertainty and parents’ perceived social support were associated with growth through uncertainty which was mediated by coping. Child's health status and parents’ perceived social support would significantly predict parental uncertainty. Conclusion This study suggests that parental uncertainty has negative impact on coping strategies such as interacting with family members while these coping strategies may help Taiwanese parents gain growth through uncertainty. Coping strategies of searching for spiritual meaning and increasing religious activities were not significantly influenced by parental uncertainty in this study. The two coping strategies may be relevant to growth through uncertainty due to Taiwanese cultural belief. Moreover, the availability of social support promotes growth through uncertainty by its impact on lowering parental uncertainty and encouraging more coping. The findings indicate that Taiwanese parents may gain growth through uncertainty while experiencing their child's cancer. The research model provides possible guidelines for oncology nurses to deliver more culturally competent health care for Taiwanese parents of children with cancer.