Subgrouping the autism "spectrum": reflections on DSM-5

DSM-5 has moved autism from the level of subgroups ("apples and oranges") to the prototypical level ("fruit"). But making progress in research, and ultimately improving clinical practice, will require identifying subgroups within the autism spectrum

Understanding advocacy in children’s nursing: a Hermeneutic Study

This study describes how Irish registered children’s nurses understand and interpret the experience of being an advocate. Advocacy, both internationally and nationally, is endorsed as being an integral component of the role of the nurse. In children’s nursing, advocacy is viewed as central to the care of the child because of their perceived vulnerability and developing maturity. Despite its centrality in nursing care, advocacy continues to be difficult to define and operationalize in clinical practice. Few studies have explored advocacy in the context of children’s nursing therefore the advocacy role of the children’s nurse is not clearly delineated. Sampling was purposive and eight registered children’s nurses volunteered to participate in the study. This study used a qualitative approach, based on Gadamer’s hermeneutic philosophy. Data collection methods included identification of the researcher prejudices, purposive sampling, twelve hermeneutic interviews and the compilation of the researcher’s reflexive journal. Benner’s (1994) method of data analysis was used and paradigm cases, exemplars and themes were identified. The themes identified included advocacy as protection, advocacy as representing the expressed wishes of the parent/child, advocacy as enabling the voice of the child and the work of advocacy. The study identified advocacy as being integral to the role of the children’s nurse. Advocacy was described as a complex concept capable of encompassing various models of advocacy including those of Kohne, Gadow Curtin, Jezewski and Mallik. It highlights the interdisciplinary differences that exist in the conceptualization and operationalization of the concept. In particular, advocacy in children’s nursing comprised both acting in the best interests of the child and facilitation of child self-advocacy, thus supporting the differing ethical principles of autonomy and best interests. Representation of the parents and child’s views were also central to the role. </jats:p

Preparation of children for elective surgery and hospitalisation: A parental perspective

Parents play a central role in the preparation of their child for hospitalisation and surgery. This research examined the parental perspective on educating their child for an elective admission to hospital for surgery. The study employed a qualitative descriptive design and sampled eight parents from a private hospital in Dublin, Ireland, prior to their child’s discharge, after ear, nose and throat surgery. A thematic analysis revealed four themes: how parents educate themselves about surgery and hospital, factors influencing parent’s decisions on the quantity of information to share, sources of education about hospitalisation and aspects of hospitalisation not discussed by parents. Findings indicated that although the internet was used as a general source of information, parents relied more on information provided by the hospital. Parents used their child’s age, individual needs and level of autonomy to determine what information to communicate. Specific areas that parents found difficult to communicate included pain and fasting. This research highlights the need for hospitals to invest and support the delivery of parental education for children prior to surgery. Clarification of the children’s nurses’ role in the development, implementation and evaluation of education programmes that support education delivery in the home by parents is also warranted. </jats:p