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Surviving Siblings’ Illnesses, Treatments/Health Services Over 13 Months After A Sibling’S Death, Dorothy Brooten, Joanne M. Youngblut, Rosa M. Roche, Carmen Caicedo, Timothy Page

JoAnne Youngblut

Two million children experience sibling death annually and have problems that require clinical intervention although few receive such help. Effects on surviving siblings’ mental health has been well documented, however their physical health has not. This study described surviving siblings’ illnesses, treatments/health services at 2, 4, 6, and 13 months post-sibling death. The 132 children (76 girls, 56 boys, M 10.6 years, SD 3.43); 30% Hispanic, 51% Black, 26% White were recruited via hospital ICUs and published obituaries. Using a longitudinal design, parents reported types and numbers of surviving siblings’ illnesses, treatments/health services, and dates post-sibling death. Most of the …

Women With High-Risk Pregnancies, Problems, And Apn Interventions, Dorothy Brooten, Joanne M. Youngblut, Deborah Donahue, Margaret Hamilton, Jean Hannan, Donna Felber Neff

JoAnne Youngblut

Purpose

To (a) describe women’s prenatal and postpartum problems and advanced practice nurses (APN) interventions; and (b) determine if problems and APN interventions differed by women’s medical diagnosis (diabetes, hypertension, preterm labor).

Design and Methods

Content analysis of 85 interaction logs created by APNs during a randomized clinical trial in which half of physician-provided prenatal care was substituted with APN-provided prenatal care in the women’s homes. Patients’ problems and APN interventions were classified with the Omaha Classification System.

Findings

A total of 212,835 health problems and 212,835 APN interventions were identified. The dominant antenatal problems were physiologic (59.2%) and health-related …

Use Of Spiritual Coping Strategies By Gender, Race/Ethnicity And Religion At 1 And 3 Months After Infant’S/Child’S Intensive Care Unit Death, Dawn Hawthorne, Joanne M. Youngblut, Dorothy Brooten

JoAnne Youngblut

Background and purpose

In the US, 57,000 children (newborn-18 years) die annually. Bereaved parents may rely on religious or spiritual beliefs in their grief. The study’s purpose was to examine differences in parents’ use of spiritual and religious coping practices by gender, race/ethnicity and religion at one and three months after infant/ICU death.

Methods

The sample consisted of 165 bereaved parents; 78% minority. The Spiritual Coping Strategies Scale was used to measure religious and spiritual coping practices, separately. One-way ANOVAs indicated that Black non-Hispanic mothers used significantly more religious coping practices at 3 months than White non-Hispanic mothers. Protestant and …

School Aged Children’S Experiences 7 And 13 Months Following A Sibling’S Death, Dorothy Brooten, Joanne M. Youngblut

JoAnne Youngblut

This study described 6-year to 12-year-old children's responses 7 and 13 months after siblings' NICU/PICU/ED death. Using semi-structured interviews, at 7 months, children were asked about events around their sibling's death. At both 7 and 13 months, children were asked about their thoughts and feelings about the deceased, concerns or fears, and life changes since the death. Thirty one children (58% female), recruited from four South Florida hospitals and Florida obituaries, participated. Children's mean age was 8.4 years; 64.5% were Black, 22.5% Hispanic, 13% White. Interviews were analyzed using conventional content analysis. Resulting themes: circumstances of the death, burial events, …

Preschool Children With Head Injury: Comparing Injury Severity Measures And Clinical Care, Joanne M. Youngblut, Carmen Caicedo, Dorothy Brooten

JoAnne Youngblut

The purpose of this study was to compare child, hospital course, and discharge characteristics by admitting unit, injury type, head Abbreviated Injury Scale (AIS), and Glasgow Coma Scale (GCS), and test congruence of AIS and GCS categories. Chart data were collected from seven hospitals on 183 preschool children with head injury (90 admitted to PICU, 93 to general care unit). Injury events included falls (n = 89, 49%), hit by car (n = 35, 19%), motor vehicle crashes (n = 26, 14%), bicycle crashes (n = 12, 7%), and blunt traumas (n = 21, 11%). Most children (68%) had head …

Weight Gain In High-Risk Pregnant Women: Comparison By Primary Diagnosis And Type Of Care, Jennifer Herrera-Perdigon, Ellen Hopkins, Martha Marcalle, Dorothy Brooten, Joanne M. Youngblut, Maria Lourdes Lizardo

JoAnne Youngblut

Reasonable weight gain in pregnancy is essential for the health of the woman and fetus. The purpose of this secondary analysis was to examine patterns of prenatal weight gain in women with diabetes and hypertension using data from a randomized controlled trial examining physician-only (n = 29) versus APN and physician-delivered (n = 38) prenatal care. Data collection included gestational age at enrollment, delivery, diagnosis (diabetes, hypertension), prepregnancy body mass index (BMI), weight every 4 weeks during pregnancy, and total weight gain during pregnancy. Based on prepregnancy BMI, 21% of the sample was normal weight, 16% overweight, and 63% obese. …

Perinatal And Pediatric Issues In Palliative And End-Of-Life Care From The 2011 Summit On Compassionate Care, Joanne M. Youngblut, Dorothy Brooten

JoAnne Youngblut

More than 25,000 infants and children die in US hospitals annually; 86% occur in the NICU or PICU. Parents see the child’s pain and suffering and, near the point of death, must decide whether to resuscitate, limit medical treatment and/or withdraw life support. Immediately after the death parents must decide whether to see and/or hold the infant/child, donate organs, agree to an autopsy, make funeral arrangements, and somehow maintain functioning. Few children and their families receive pediatric palliative care services, especially those from minority groups. Barriers to these programs include lack of services, difficulty identifying the dying point, discomfort in …

Psychometric Evaluation Of The Spanish And English Versions Of The Spiritual Coping Strategies Scale, Dawn Hawthorne, Joanne M. Youngblut, Dorothy Brooten

JoAnne Youngblut

The Spiritual Coping Strategies (SCS) Scale measures how frequently religious and nonreligious (spiritual) coping strategies are used to cope with a stressful experience. This study’s purpose is to evaluate the psychometric properties of the newly translated Spanish version of the SCS. A total of 51 bilingual adults completed the SCS in Spanish and English, with 25 completing them again 2–3 weeks later. Internal consistency reliability for the Spanish (r = 0.83) and English (r = 0.82) versions of the SCS in the total sample were good. Test–retest reliability was .84 for the Spanish and .80 for the English …

Parents’ Reactions At 24–48 Hours After A Preschool Child’S Head Injury, Joanne M. Youngblut, Dorothy Brooten, John Kuluz

JoAnne Youngblut

Objectives

1) Compare mothers’ and fathers’ early reactions (stressors, concerns) to the preschool child’s head injury, their perceptions of the child’s injury severity, their social support and mental health; 2) compare families with a child in the pediatric intensive care unit (PICU) vs. general care unit (GCU) on these variables; 3) describe the relationships between parents’ early reactions and perceived and objective injury severity, their social support and mental health.

Design

Analysis of data collected in the hospital 24–48 hours after the child’s admission as part of a longitudinal study of parent and family functioning after a preschool child’s head …

Pediatric Head Trauma: Parent, Parent-Child, And Family Functioning 2 Weeks After Hospital Discharge, Joanne M. Youngblut, Dorothy Brooten

JoAnne Youngblut

OBJECTIVE:

To investigate effects of pediatric head trauma on parent mental health, parent-child relationship and family functioning 2 weeks after discharge.

METHODS:

Ninety-seven mothers and 37 fathers of 106 preschool children hospitalized with head injury completed Mental Health Inventory (MHI), Parenting Stress Index, Family Adaptability and Cohesion Evaluation Scales II (FACES II) and Multidimensional Scale of Perceived Social Support (MSPSS) 2 weeks after discharge, and perceived injury severity, Parental Concerns Scale (PCS), Parental Stressors Scale: Pediatric Intensive Care Unit (PSS: PICU), and MHI 24-48 h after hospital admission.

RESULTS:

Mental health after discharge was related to social support and baseline …

Patient Problems, Advanced Practice Nurse (Apn) Interventions, Time And Contacts Among Five Patient Groups, Dorothy Brooten, Joanne M. Youngblut, Janet Deatrick, Mary Naylor, Ruth York

JoAnne Youngblut

PURPOSE:

To describe patient problems and APN interventions in each of five clinical trials and to establish links among patient problems, APN interventions, APN time and number of contacts, patient outcomes, and health care costs.

DESIGN AND METHODS:

Analysis of 333 interaction logs created by APNs during five randomized controlled trials: (a) very low birthweight infants (n = 39); (b) women with unplanned cesarean birth (n = 61), (c) high-risk pregnancy (n = 44), and (d) hysterectomy (n = 53); and (e) elders with cardiac medical and surgical diagnoses (n = 139). Logs containing recordings of all APN interactions with …

Parent’S Perceptions Of Health Care Providers Actions Around Child Icu Death: What Helped, What Did Not, Dorothy Brooten, Joanne M. Youngblut, Lynn Seagrave, Carmen Caicedo, Dawn Hawthorne, Ivette Hidalgo, Rosa M. Roche

JoAnne Youngblut

Purpose

To describe parents’ perspectives of health care provider actions that helped or did not around the time of infant/child’s intensive care unit (ICU) death. Semistructured interviews with 63 parents (Black, White, and Hispanic) 7 months post infant/child death were audio-recorded, transcribed, analyzed, and themes identified.

Findings

What helped most: compassionate, sensitive staff; understandable explanations of infant’s/child’s condition; experienced, competent nurses; providers did everything to help infant/child; and parents’ involvement in care decisions. What did not help: insensitive, nonsupportive staff; conflict between providers and parents; communication problems around the death; inexperienced nurses and doctors; parents not understanding child’s …

Parent & Child Perceptions Of Child Health After Sibling Death, Rosa M. Roche, Dorothy Brooten, Joanne M. Youngblut

JoAnne Youngblut

Background

Understanding children’s health after a sibling’s death and what factors may affect it is important for treatment and clinical care. This study compared children’s and their parents’ perceptions of children’s health and identified relationships of children’s age, gender, race/ethnicity, anxiety, and depression and sibling’s cause of death to these perceptions at 2 and 4 months after sibling death.

Methods

64 children and 48 parents rated the child’s health “now” and “now vs before” the sibling’s death in an ICU or ER or at home shortly after withdrawal of life-prolonging technology. Children completed the Child Depression Inventory and Spence Children’s …

Mother’S Mental Health, Mother-Child Relationship, And Family Functioning 3 Months After A Preschooler’S Head Injury, Joanne M. Youngblut, Dorothy Brooten

JoAnne Youngblut

Objective

Investigate mothers’ mental health, mother-child relationship, and family functioning 3 months after preschool children’s head trauma and hospital discharge.

Design

Prospective survey.

Setting

7 hospitals; families’ homes.

Participants

Eighty mothers of children (ages 3–6) with head trauma.

Measures

Perceived injury severity, Mental Health Inventory (MHI), Parental Stressor Scale: PICU 24–48 hours after admission; MHI, Parenting Stress Index, FACES II, Multidimensional Scale of Perceived Social Support 3 months post-discharge.

Results

Injury severity had negative effects on mothers’ mental health at 3 months after discharge, but not on the mother-child relationship and the family’s functioning. Mothers’ baseline mental health and ongoing …

Parenting Stress: A Comparison Of Grandmother Caretakers And Mothers, Carol M. Musil, Joanne M. Youngblut, Sukhee Ahn, Vanessa L. Curry

JoAnne Youngblut

Parenting stress in grandmother caretakers has not been directly compared with a matched sample of mothers in the caretaker role. This study examined the main and interaction effects of caretaker status, employment, and race on parenting stress and whether these factors affect parenting stress in a convenience sample of grandmothers raising grandchildren (n = 86) and a sample of mothers of preschoolers (n = 86), matched for women’s partner status, race, and employment. Grandmothers raising grandchildren reported more overall parenting stress and parental distress than mothers. Non-employed women reported more negative perceptions of their children and more difficult …

Parents’ Acute Illnesses, Hospitalizations, And Medication Changes During The Difficult First Year After Infant Or Child Nicu/Picu Death, Dorothy Brooten, Joanne M. Youngblut, Carmen Caicedo, Teresa Del Moral, G. Patricia Cantwell, Balagangadhar R. Totapally

JoAnne Youngblut

Infant/child death is described as a most stressful life event; however, there are few reports of effects on parent physical health during the first year after the death. The study's purpose is to examine the patterns of parent acute illnesses, hospitalizations, and medication changes over 1 to 13 months after neonatal intensive care unit (NICU) or pediatric intensive care unit (PICU) infant/child death in 3 racial/ethnic groups.

METHODS:

Secondary analyses were conducted with longitudinal data on parent health and functioning 1 to 13 months after infant/child NICU/PICU death. Parents (176 mothers, 73 fathers; 44% Hispanic, 35% black non-Hispanic, and 21% …

Lessons Learned From Testing The Quality Cost Model Of Advanced Practice Nursing (Apn) Transitional Care, Dorothy Brooten, Mary D. Naylor, Ruth York, Linda P. Brown, Barbara Hazard Munro, Andrea O. Hollingsworth, Susan M. Cohen, Steven Finkler, Janet Deatrick, Joanne M. Youngblut

JoAnne Youngblut

Purpose

To describe the development, testing, modification, and results of the Quality Cost Model of Advanced Practice Nurses (APNs) Transitional Care on patient outcomes and health care costs in the United States over 22 years, and to delineate what has been learned for nursing education, practice, and further research.

Organizing Construct

The Quality Cost Model of APN Transitional Care.

Methods

Review of published results of seven randomized clinical trials with very low birth-weight (VLBW) infants; women with unplanned cesarean births, high risk pregnancies, and hysterectomy surgery; elders with cardiac medical and surgical diagnoses and common diagnostic related groups (DRGs); and …

Infant And Child Deaths: Parent Concerns About Subsequent Pregnancies, Dorothy Brooten, Joanne M. Youngblut, Jean Hannan, Carmen Caicedo, Rosa M. Roche, Fatima Malkawi

JoAnne Youngblut

Purpose—examine parents' concerns about subsequent pregnancies after experiencing an infant or child death (newborn to 18 years). Data Sources—39 semi-structured parent (White, Black, Hispanic) interviews 7 and 13 months post infant/child death conducted in English and/or Spanish, audio-recorded, transcribed and content analyzed. Mothers' mean age was 31.8 years, fathers' was 39 years; 11 parents were White, 16 Black, 12 Hispanic. Conclusions—Themes common at 7 and 13 months: wanting more children; fear, anxiety, scared; praying to God/God's will; thinking about/keeping the infant's/child's memory and at 7 months importance of becoming pregnant for family members; and at 13 months happy about a …

High-Risk Pregnancy: Postpartum Rehospitalization, Margaret S. Hamilton, Dorothy Brooten, Joanne M. Youngblut

JoAnne Youngblut

OBJECTIVE

Examine frequency, timing, and reasons for maternal postpartum rehospitalizations and acute care visits 1 year postpartum after a high - risk pregnancy.

STUDY DESIGN

Secondary analysis of data collected during a randomized clinical trial of advanced practice nurses giving transitional care for women with high - risk pregnancies. The 171 women were primarily African American, never married, Medicaid eligible, diagnosed with pregestational diabetes (20), gestational diabetes (23), either diagnosed (48) or at risk (44) for preterm labor, and chronic hypertension (36).

RESULTS

Of the total rehospitalizations (17%) and acute care visits (32%), over one third occurred in the first …

Editorial: Parent, Grandparent, And Sibling Responses To The Death Of An Infant Or Child In Intensive Care, Joanne M. Youngblut, Juanjuan Li

JoAnne Youngblut

The death of a child is a devastating event for most parents and other family members1. However, responses to a child’s death vary by culture, generation, and often the age of the deceased child. For the Chinese, child death is a “bad death” and brings shame to the family2. Filipino parents of a deceased child feel severe guilt after their loss3. In some Caribbean cultures young mothers are prevented from attending the child’s funeral or going to the cemetery by women in the previous generation in the belief that if you “take one to …

Health And Functioning In Grandparents After A Young Grandchild’S Death, Joanne M. Youngblut, Dorothy Brooten, Kathleen Blais, Colleen Kilgore, Changwon Yoo

JoAnne Youngblut

This cross-sectional study examined the physical and mental health, grief and role functioning of 136 grandparents in the first year after death of their young grandchild (newborn through 6 years). Grandparents were 36–77 years old; 73 % female; 24 % Hispanic, 38 % Black/African American, and 38 % White. Mean age of the 115 deceased grandchildren was 12.8 months (SD = 20.71) with 37 %\1 month old; 65 % were male, 77 % died in the hospital. Grandparents were recruited through state death records and interviewed by telephone. Grandparents experienced: clinical depression (31 %), PTSD (35 %); illnesses (28 %), …

Grandparent Health & Functioning After A Grandchild’S Death, Joanne M. Youngblut, Dorothy Brooten, Kathleen Blais, Jean Hanna, Theophile Niyonsenga

JoAnne Youngblut

Approximately 160,000 grandparents experience the death of a grandchild each year; this represents a permanent, irrevocable loss for the grandparent resulting in physical and emotional responses. Grandparents who lose a grandchild experience increased alcohol and drug use, thoughts of suicide, and pain for their adult child who is also grieving. Supportive resources available to grieving grandparents, the effects of the grandchild’s death on the grandparent-parent relationship and the influence of race/ethnicity on grandparent grieving are discussed. Despite about 40,000 child and infant deaths each year, knowledge about grandparent health and functioning following the death of a grandchild is limited.

Effects Of Maternal Employment And Prematurity On Child Outcomes In Single Parent Families, Joanne M. Youngblut, Dorothy Brooten, Lynn T. Singer, Theresa Standing, Haejung Lee, Willard L. Rodgers

JoAnne Youngblut

Background

Effects of maternal employment for preschool children vary based on specific characteristics of the mother’s employment, the family’s economic status, and the mother’s attitudes about employment. However, there is limited research on a growing group of children at developmental risk—those born prematurely and living in a single-parent family.

Objective

To examine the effects of maternal employment and prematurity on child cognition and behavior in single-parent families.

Methods

Sixty preterm and 61 full-term preschool children were recruited through NICU admission records and birth records. Data were collected with the Kaufmann Assessment Battery for Children, Peabody Picture Vocabulary Test, Child Behavior …

Health Problems And Apn Interventions In Pregnant Women With Diabetes, Dorothy Brooten, Joanne M. Youngblut, Jean Hannan, Frank Guido-Sanz, Donna Felber, Wannee Deoisres

JoAnne Youngblut

The purpose of this study was to compare health problems and advanced practice nursing (APN) interventions in two types of APN care provided to 41 childbearing women with diabetes. The study’s design involved content analysis of interaction logs containing the process of APN care during two clinical trials: 1) APN care was added to physician care (n = 22); and, 2) half of physician care was substituted with APN care (n = 19). Women’s’ health problems and APN interventions were classified using the Omaha System’s Problem Scheme and Intervention Scheme. The women, in the study, had a mean age of …

Death Rituals Reported By White, Black, And Hispanic Parents Following The Icu Death Of An Infant Or Child, Dorothy Brooten, Joanne M. Youngblut, Donna Charles, Rosa M. Roche, Ivette Hidalgo, Fatima Malkawi

JoAnne Youngblut

Purpose

To examine rituals (disposing remains, wakes, funerals/burials, celebrations) of White, Black, Hispanic parents post ICU infant/child death.

Design and methods

Qualitative design, 63 parents completed English or Spanish semi-structured interviews at 7 & 13 months after infant’s/child’s death. Interviews were audio-recorded, transcribed verbatim, and entered into Atlas.ti for analysis. An inductive approach to thematization was used to develop codes.

Results

Parents: mean age 35.1 years (SD = 9.03); 33% Black, 27% White, 40% Hispanic; from 17 countries. Three themes emerged: immediately after death - shock and stress, needing help with arrangements, decisions on burial or cremation (conflicts due to …

Apn-Physician Collaboration In Caring For Women With High-Risk Pregnancies, Dorothy Brooten, Joanne M. Youngblut, Kathleen Blais, Deborah Donahue, Ivette Cruz, Michelle Lightbourne

JoAnne Youngblut

Purpose

To examine: (a) frequency and focus of APN-physician collaborations in a clinical trial in which half of physician prenatal care for women with high-risk pregnancies was substituted with APN prenatal care delivered in women’s homes; and (b) characteristics of women requiring greater numbers of collaborations.

Design and Methods

Descriptive study with secondary analysis of data from 83 of the original trial’s 85 intervention participants followed by APNs prenatally through 8 weeks postpartum. APN practices, recorded in logs, included APN interactions with the women and the physician, and type of APN contact (e.g., home visit, telephone call). Each APN-physician collaboration …

Child Care Use By Low-Income Single Mothers Of Preschoolers Born Preterm Versus Those Of Preschoolers Born Full Term, Joanne M. Youngblut, Dorothy Brooten, Sandra L. Lobar, Laura Hernandez, Mary Mckenry

JoAnne Youngblut

This study describes prewelfare reform child care use by 64 primarily low-income single mothers (65.6% African American) with preschoolers (half born preterm). Forty percent used child care for more than 75% of their children's lives, 20% did when not employed. Preschool children born preterm were more likely to receive child care from nonrelatives throughout their lives than children born full term. Children with health problems used a greater number of child care arrangements. Findings suggest addressing child care issues with both employed and nonemployed mothers and adequacy of child care for children with special needs.

A Comparison Of Maternal Attachment Between American Adolescent And Adult Mothers Of Preschoolers, Ratchaneewan Ross, Joanne M. Youngblut

JoAnne Youngblut

American adolescent mothers have been viewed as less effective parents than adult mothers. The socioeconomic disadvantages of adolescent mothers should be taken into account. The objectives of this study were to compare maternal attachment between adolescent and adult mothers of preschoolers and to examine changes of adolescents’ maternal attachment over time. A secondary analysis of data from a larger study of maternal employment and low birth weight infant outcomes were used. Data were collected through home visits using structured questionnaires at two different time points. Forty-three pairs of adolescent and adult mothers who could be matched on family structure, maternal …

Adolescents’ Experiences 7 And 13 Months Following The Death Of A Brother Or Sister, Dorothy Brooten, Joanne M. Youngblut, Rosa M. Roche

JoAnne Youngblut

This qualitative study used semi-structured interviews to describe adolescents’ responses at 7 and 13 months to siblings’ NICU/PICU/ED death. At 7 months, adolescents were asked about events around the sibling’s death; at 7 and 13 months, about concerns/fears, feelings, and life changes. Seventeen adolescents participated (13-18 years; M=15); 65% Black, 24% Hispanic, 11% White. Themes included death circumstances, burial events, thinking about the deceased sibling, fears, and life changes. Adolescents reported shock and disbelief that the sibling died; 80% knew the reason for the death; many had difficulty getting through burials; all thought about the sibling. From 7 - 13 …

Comparison Of Mothers And Grandmothers Physical And Mental Health And Functioning Within 6 Months After Child Nicu/Picu Death, Joanne M. Youngblut, Dorothy Brooten

JoAnne Youngblut

Background

Losing a child is devastating for parents and grandparents. Family and friends generally focus on comforting and supporting the bereaved parents, unintentionally ignoring the bereaved grandparents. Grandmothers and grandfathers often struggle with wanting to help their adult children (deceased child’s parents) without usurping the parents’ responsibilities and decisions regarding the deceased child. Research on mothers’ and grandmothers’ health at about the same time after the same child’s death in the neonatal or pediatric intensive care unit is lacking. The aim of this study was to compare mothers and grandmothers on physical health, mental health, and functioning in the first …