Reflective thought in memos to demonstrate advanced nursing practice in New Zealand

Dewey first described reflective thought as a way to solve issues of perplexity in his seminal work How We Think. Dewey's work underpinned Strauss' contribution to The Discovery of Grounded Theory. Grounded theory methods are characterised by memo writing. This paper will describe how memos, in the form of slides, were employed to demonstrate advanced skill acquisition in practice by an immigrant nurse and health visitor to a panel convened by the New Zealand Nursing Council. Globalisation and migration of the nursing workforce contributes to advancement of the nursing profession in some countries. New Zealand, whose critical mass of primary health care nursing leaders is small, with no specific postgraduate primary health care qualification, benefit from the transferable skills of migrant nurse and community practitioners. Finding easier ways to demonstrate advanced practice to New Zealand’s Nursing Council would maximise the potential contribution of immigrant nurses

Mastering Treatment for Sleep Apnoea: The Grounded Theory of Bargaining and Balancing Life With Continuous Positive Airway Pressure (CPAP), in the Context of Decisional Conflict and Change Theories

Continuous positive airway pressure (CPAP) treatment for sleep apnoea can be challenging for patients to master. Given limited evidence on this topic, we used constructionist grounded theory methodology to explore experiences of living with CPAP from participants' perspectives. Adults (n=16) were recruited through a main-center respiratory service in New Zealand and participated in semi-structured interviews. Data were analyzed until theoretical saturation was achieved.In this article, we present the newly constructed grounded theory of bargaining and balancing life with CPAP, which explains how participants made a series of personal decisions about whether to use and how to master CPAP. To situate, support and provide explanatory power the new theory is discussed in the context of change and decision theories to illustrate the varying phases of readiness experienced by persons preparing to engage with CPAP and the decision-making process required for effective management of CPAP at home.This study provides valuable CPAP-user centered information for the development of interventions to optimize CPAP use. Acknowledging individuals' abilities to make reasoned healthcare decisions and providing clinical environments that support the active process of bargaining and balancing may increase uptake of CPAP, and potentially other long-term therapies.Im Fall von Schlafapnoe kann das Umgehen mit Continuous Positive Airway Pressure (CPAP) für Patient/innen herausfordernd sein. Da hierzu wenig Forschung erfolgt ist, haben wir die konstruktivistische Grounded-Theory-Methodologie genutzt, um die Erfahrungen aus der Perspektive der Patient/innen zu explorieren. Sechzehn Erwachsene wurden in einem neuseeländischen Gesundheitszentrum für teilstrukturierte Interviews rekrutiert. Die Daten wurden analysiert, bis eine theoretische Sättigung erreicht war. In diesem Beitrag stellen wir unsere Grounded Theory des Aushandelns und Balancierens von CPAP-Beatmung vor, mit deren Hilfe wir erklären, welche individuellen Entscheidungen bei dem Umgang und der Nutzung von CPAP getroffen werden. Um die erklärende Kraft der Theorie zu situieren und zu stützen, diskutieren wir unsere Ergebnisse im Kontext von Entscheidungskonflikt- und Veränderungstheorien. So kann veranschaulicht werden, welche unterschiedlichen Phasen Patient/innen durchlaufen in ihrer Bereitschaft, sich mit CPAP zu befassen bzw. Entscheidungen für einen effektiven Einsatz in ihrer häuslichen Umgebung zu treffen. Mittels unserer Studie werden wichtige Nutzungsinformationen für die Optimierung von CPAP-bezogenen Interventionen verfügbar. Die Anerkennung individuell vernünftigen Gesundheitshandelns und die Bereitstellung klinischer Settings, die den Prozess des aktiven Aushandelns und Balancierens unterstützen, können die Akzeptanz von CPAP und potenziell auch anderer Langzeittherapien verbessern

South Asian immigrants' and their family carers' beliefs, practices and experiences of childhood long-term conditions: An integrative review

Aim: The aim was to examine South Asian immigrants' beliefs, practices and experiences of childhood long-term conditions. Design: This was an integrative review. Data sources: MEDLINE, PsycINFO, PubMed, Scopus and Web of Science were searched for primary peer-reviewed articles published in English between January 2011 and April 2021. Review methods: Articles were screened based on PRISMA guidelines. The quality of the studies was evaluated using the Critical Appraisal Skills Programme Checklist for qualitative studies and the Joanna Brigg's Institute Critical Appraisal Checklist for quantitative studies. Results: Fourteen studies were included in the review. South Asian immigrant children and their family carers experienced cultural clashes as they attempted to incorporate their cultural beliefs about long-term conditions into a more westernized biomedical approach. Families were overburdened by caregiving and struggled to find additional support for their children. The main findings were categorized into three themes: (1) cultural beliefs; (2) religious, spiritual and complementary and alternative medicine practices and (3) care and support of the child. Conclusion: Health-care providers should use a combination of culturally safe management strategies and a nuanced approach to educational initiatives on the biomedical aspects of various long-term conditions to effectively engage South Asian immigrant families with health services. Impact: The growth of South Asians worldwide along with the increased burden of long-term conditions among South Asian immigrant children has implications for health service delivery. However, no reviews to date have explored South Asian immigrants' experience of childhood long-term conditions. Incorporating South Asian immigrants' beliefs and practices into the plan of care promotes collaborative decision-making that can lead to better treatment adherence, improved health outcomes and higher patient and family satisfaction. The findings encourage clinicians, researchers and policymakers to develop culturally safe child/family-centred interventions to address the specific needs of South Asian immigrant children with long-term conditions

Giving voice to children in research: The power of child-centered constructivist grounded theory methodology

There has been a growing interest in giving voice to children in response to the introduction of the United Nations Convention on the Rights of the Child and evolving sociological discourses on childhood. Using child-sensitive methodologies such as constructivist grounded theory (CGT) enables children's voices to contribute authentic, meaningful, and eventually more actionable data, capable of informing policies and practices in children's best interests. In this article, we discuss how researchers using CGT can privilege children's voices through effective knowledge coconstruction by creating a child-sensitive research space and using methods that are appropriate to their abilities and interests. We draw on selected data from the first author's (I. S.) PhD project that explores Indian immigrant children's and their family carers' beliefs, practices, and experiences of asthma in New Zealand. We encourage researchers to consider CGT as one of the appropriate methodological choices to explicitly promote the voice of the child

Grounded Theory Method and Symbolic Interactionism: Freedom of Conceptualization and the Importance of Context in Research

Der symbolische Interaktionismus (SI), eine Perspektive zum Verständnis menschlichen Verhaltens, wird gemeinhin als Grundlage für die Grounded-Theory-Methodologie (GTM) angesehen. Der Zweck der GTM besteht jedoch darin, aus Daten eine substanzielle, erklärende Sozialtheorie zu erstellen, ohne sich auf vorherige Annahmen zu stützen. Daher argumentieren einige, dass SI eine unnötige theoretische Einschränkung des Hauptziels der GTM – der freien Konzeptualisierung von Daten – darstelle. In diesem Artikel verwenden wir Beispiele aus einer laufenden konstruktivistischen Grounded-Theory-Studie über die Aushandlung der Rollen von Krankenschwestern in der Allgemeinmedizin in Neuseeland, um zu zeigen, was SI in Bezug auf die konzeptionelle Entwicklung und das Verständnis des Kontextes beitragen kann. Wir argumentieren, dass durch das Stellen von drei Fragen aus einer symbolisch-interaktionistischen Perspektive in jeder Phase des Forschungsprozesses die Freiheit der Konzeptualisierung erhöht und das Bewusstsein für kontextuelle Belange gefördert werden kann, um eine bessere Brücke zwischen den Weltsichten zu schlagen.Symbolic interactionism (SI), a perspective used to understand human conduct, is commonly said to underpin grounded theory methodology (GTM). However, the purpose of GTM is to produce substantive explanatory social theory from data without reliance on prior assumptions. Therefore, some argue that SI is an unnecessary theoretical constraint on the principal aim of GTM—the free conceptualization of data. In this article we use examples from an ongoing constructionist grounded theory study into the negotiation of nurses' roles in general practice in New Zealand, to demonstrate how SI can inform GTM regarding conceptual development and context. We argue that by asking three questions from a symbolic interactionist perspective, at each stage of the research process, freedom of conceptualization may be enhanced and awareness of contextual matters promoted to better bridge world views

Evaluating the feasibility, effectiveness and acceptability of an active play intervention for disadvantaged preschool children : a pilot study

Australian children from disadvantaged families are at increased risk of delays in acquiring fundamental movement skills, with physical inactivity and increased risk of the potential consequences of obesity. The aims of this pilot study were to: 1) assess the fundamental movement skills of disadvantaged children; 2) evaluate the feasibility and effectiveness of adapting an existing parenting and child development program to incorporate additional weekly play activities (the intervention); and 3) examine the acceptability of the intervention. Children aged 1.5-5 years were assessed pre-intervention (n = 26) and postintervention (n = 16) over a period of 22 weeks using the gross motor component of the Peabody Developmental Motor Scales - 2nd Edition (PDMS-2) (Folio &amp; Fewell, 2000). Parents completed a demographic and environmental survey and those implementing the intervention were interviewed to assess the feasibility and acceptability of the intervention. Pre-intervention the children from disadvantaged families had locomotion, object manipulation and Gross Motor Quotient (GMQ) scores significantly below the norm-referenced standards of the PDMS-2 (p &lt; 0.05). The intervention was associated with improvements in the locomotion (8.35 to 9.5; p = 0.009), and object manipulation (8.6 to 9.6; p = 0.04) subtest scores and the GMQ scores (92.6 to 99.3; p &lt; 0.01). The intervention was deemed feasible and acceptable by those implementing the program. Low levels of physical activity in disadvantaged communities may be related to delayed acquisition of fundamental movement skills in childhood. This pilot study raises the possibility of correcting this deficit in early childhood, and improving the potential for all children to lead an active life.<br /

Understanding child and youth migrant wellbeing: Reflections from a systematic literature review in the Western Pacific region

One of the key social determinants of health that can impact children and young people is migration. Advances in health research have seen a shift away from a biomedical model of health to understanding health as a multifactorial, holistic state - mentally, physically, and socially. The aim of this article is to illustrate how different methods (i.e., adult-centric, child/youth-centered) and frameworks (i.e., biomedical, strengths-based) can impact on research findings in childhood research. Drawing on findings from a systematic review, we examine the approaches taken in eleven studies investigating the health and wellbeing of young migrants in the Western Pacific region. The systematic review highlighted a range of methods (quantitative surveys, drawings, photo novellas) that were used to capture child/youth perspectives, and identify contextual factors beyond immediate biomedical factors that impacted their wellbeing. Adult-centric biomedical approaches were limited in understanding these broader environmental contexts, yet these approaches were prevalent in this body of literature. We highlight the importance of developing more strengths-based approaches and child/youth-centered methods to gain a comprehensive understanding of social and physical environments that child and youth migrants draw upon to support their wellbeing

Characterisation of the treatment provided for children with unilateral hearing loss

Background: Children with permanent unilateral hearing loss (UHL) are an understudied population, with limited data to inform the guidelines on clinical management. There is a funding gap in healthcare provision for the children with UHL in the United Kingdom, where genetic screening, support services, and devices are not consistently provided or fully funded in all areas. They are a disparate population with regard to aetiology and their degree of hearing loss, and hence their device choice and use. Despite having one “good ear”, some children with UHL can have similar outcomes, socially, behaviourally, and academically, to children with bilateral hearing loss, highlighting the importance of understanding this population. In this longitudinal cohort study, we aimed to characterise the management of the children with UHL and the gaps in the support services that are provided for the children in Nottingham, United Kingdom. Methods: A cohort study was conducted collecting longitudinal data over 17 years (2002–2019) for 63 children with permanent congenital confirmed UHL in a large tertiary regional referral centre for hearing loss in Nottingham, United Kingdom. The cases of UHL include permanent congenital, conductive, mixed, or sensorineural hearing loss, and the degree of hearing loss ranges from mild to profound. The data were taken from their diagnostic auditory brainstem responses and their two most recent hearing assessments. Descriptors were recorded of the devices trialled and used and the diagnoses including aetiology of UHL, age of first fit, degree of hearing loss, when and which type of device was used, why a device was not used, the support services provided, concerns raised, and who raised them. Results: Most children (45/63; 71%) trialled a device, and the remaining 18 children had no device trial on record. Most children (20/45; 44%) trialled a bone-conduction device, followed by contralateral routing of signal aid (15/45; 33%) and conventional hearing aids (9/45; 20%). Most children (36/45; 80%) who had a device indicated that they wore their device “all day” or every day in school. Few children (8/45; 18%) reported that they wore their device rarely, and the reasons for this included bullying (3/8), feedback from the device (2/8), and discomfort from the device (2/8). Only one child reported that the device was not helping with their hearing. The age that the children were first fitted with their hearing device varied a median of 2.5 years for hearing aids and bone-conduction devices and 7 years for a contralateral routing of signal aid. The length of time that the children had the device also varied widely (median of 26 months, range 3–135 months); the children had their bone-conduction hearing aid for the longest period of time (median of 32.5 months). There was a significant trend where more recent device fittings were happening for children at a younger age. Fifty-one children were referred by the paediatric audiologist to a support service, 72.5% (37/51) were subsequently followed up by the referred service with no issue, whilst the remaining 27.5% (14/51) encountered an issue leading to an unsuccessful provision of support. Overall, most children (65%, 41/63) had no reported concerns, and 28.5% (18/63) of the children went on to have a documented concern at some point during their audiological care: five with hearing aid difficulties, five with speech issues, four with no improvement in hearing, three facing self-image or bullying issues, and one case of a child struggling to interact socially with friends. Three of these children had not trialled a device. We documented every concern reported from the parents, clinicians, teachers of the deaf, and from the children themselves. Where concerns were raised, more than half (58.6%, 10/18) were by schools and teachers, the remaining four concerns were raised by the family, and further four concerns were raised by the children themselves. Conclusion: To discover what management will most benefit which children with permanent UHL, we first must characterise their treatment, their concerns, and the support services available for them. Despite the children with UHL being a highly disparate population—in terms of their aetiology, their device use, the degree of hearing loss, and the age at which they trial a device—the majority report they use their device mostly in school. In lieu of available data and in consideration of the devices that are available to them, it could be useful to support families and clinicians in understanding the devices which are most used and where they are used. Considering the reasons for cessation of regular device use counselling and support services would be vital to support the children with UHL

Randomised controlled trial of paracetamol or ibuprofen, as required for fever and pain in the first year of life, for prevention of asthma at age 6 years : paracetamol or ibuprofen in the primary prevention of asthma in Tamariki (PIPPA Tamariki) protocol

Introduction Asthma is one of the most common diseases in the world and is a global public health burden. There is an urgent need for research that leads to evidenced-based primary prevention strategies to reduce the prevalence of asthma. One novel risk factor that might have a role in the pathogenesis of asthma is the use of paracetamol in early life. This trial aims to determine if paracetamol, compared with ibuprofen use, as required for fever and pain in the first year of life, increases the risk of asthma at age 6 years. Methods and analysis The Paracetamol and Ibuprofen in Primary Prevention of Asthma in Tamariki trial is a multicentre, open-label, two-Arm parallel randomised controlled trial. 3922 infants born at ≥32 weeks' gestation will be randomly allocated to receive only paracetamol or only ibuprofen for treatment of fever and pain, if required in the first year of life. The primary outcome is asthma at 6 years of age, defined as the presence of wheeze in the preceding 12 months. Secondary outcomes include hospital admissions for bronchiolitis, wheeze or asthma in the first year of life, and within the first 6 years of life; wheeze at 3 years of age; eczema within the first year and at 3 and 6 years of age; atopy at 3 and 6 years of age. Ethics and dissemination The trial has been approved by the Northern A Health and Disability Ethics Committee of New Zealand (17/NTA/233). Dissemination plans include publication in international peer-reviewed journals, and presentation at national and international scientific meetings, assimilation into national and international guidelines, and presentation of findings to lay audiences through established media links. Trial registration number ACTRN12618000303246; Pre-results