5420801
Predicting child abuse and neglect: ethical, theoretical and methodological challenges.
AIMS
This paper explores the ethical, theoretical and methodological implications of predictive testing in studies of child abuse, neglect and harm.


BACKGROUND
The use of screening instruments to make predictions about children who may later be abused, neglected or at risk of exclusion is promoted in research and policy. The recent UK Action Plan on Social Exclusion suggests that health visitors and community midwives should be trained to use these tools in practice.


METHOD
Position paper.


CONCLUSIONS
The accuracy of screening instruments to identify children who will be abused or neglected has not been established. Even if the theoretical and methodological challenges of predictive instruments could be overcome, the ethical implications of their use are very difficult for nurses and midwives.


RELEVANCE TO CLINICAL PRACTICE
Nurses, midwives and health visitors require high levels of awareness of risk factors in working with children and families. We have a responsibility to reach professional judgements about risks of harm for individuals. This is best performed through improving skills in working with parents and carers to identify those factors which may impede their ability to offer safe developmental care to their children.
39760502
Commentary on Kong S and Bernstein K (2009) Childhood trauma as a predictor of eating psychopathology and its mediating variables in patients with eating disorders Journal of Clinical Nursing 18, 1897-1907.
8674073
Children, health and gender: recognition in nursing research?
AIM
This paper examines the hitherto mostly unrecognised relationship between gender, health and children; its significance for nursing practice and how it has been considered in nursing research.


BACKGROUND
Holistic nursing practice with children requires adequate assessment and consideration of all potential influences on children's lives. Socioeconomic disparities have received widespread attention and gender inequalities in adult health have been studied in some depth. The links between gender, health and children, however, have received little consideration. The paper first considers this context in depth; it then applies the context to research in practice.


DESIGN
Systematic review.


METHODS
A systematic literature search was undertaken on four mainstream nursing research journals over 38 months up to February 2007. A total of 567 articles met the key word searches. Duplicates, opinion pieces and articles not focusing on children were removed. The remaining 23 nursing studies relevant to child health were examined for their gender sensitivity.


RESULTS
Full consideration of gender issues was found largely to be absent in nursing research on children. Eight studies gave specific consideration to gender relevance, where boys and girls may have responded differently to care. Only six studies specifically addressed gender sensitivity. Allowing children a voice, however, was a strength in these studies, with 18 reflecting children's views directly.


CONCLUSIONS
Major gaps still exist in research and theorisation relating to children, health and gender. These need to be acknowledged and investigated, particularly in relation to how they might impact on nursing care.


RELEVANCE TO CLINICAL PRACTICE
Nursing practice and research needs to account for all potential health issues, of which gender may often be important.
18213491
The smacking controversy: what advice should we be giving parents?
BACKGROUND
Even among countries that have ratified the United Nations Convention on the Rights of the Child there is much disagreement about corporal punishment of children. Last year the Scottish Executive proposed a new law banning the smacking of children under the age of three, becoming the tenth European nation to do so. The proposal, currently abandoned whilst ostensibly still under debate, has raised a wave of controversy in child protection circles. In the nearest neighbouring country, England, a similar proposal was robustly rejected. PURPOSE OF THE PAPER: Given an increasing family and community focus in nursing, the implications of the debate for the profession cannot be ignored. What should we be telling 'ordinary' families about smacking? Thus this paper presents a positional statement on the smacking controversy and outlines some pointers for practice.


DISCUSSION
While for many the legislation proposed does not go far enough, others decry it as a breach of parental rights and, thus, the issue has become hugely controversial. Media opinion and various opposing campaigns dominate both public and professional spheres. Rights, responsibilities, examples from other countries, culture and gender are all used as fodder in the debate. Extreme examples are cited by both sides and used as grist for what are at times tenuous arguments. As there is even a division within child protection arenas, practising professionals may struggle to find a way through the maze of seemingly contradictory findings from research, policy and opinion.


CONCLUSIONS
A wide range of literature suggests that both public and professional opinion is divided on the use of smacking as a form of discipline of young children. Opinion is also divided on the ability of legislation to bring about change in social attitudes and behaviour. Health care professionals need to be in a position to recommend best practice and to do so consistently.
36834793
Experiences of a feasibility study of children with albinism in Zimbabwe: a discussion paper.
BACKGROUND
Feasibility studies are often a helpful prelude to constructing fundable research proposals. Where the intended research is in a foreign country, focuses on a vulnerable population, and is aggravated by political and pragmatic challenges, feasibility studies become essential. Albinism, a genetic condition of reduced melanin synthesis, is a major public health issue in southern Africa. Whilst much is known about the health needs of children with albinism, little is understood about how to address these effectively in low income countries. Further, the child care and protection needs of children with albinism are largely unexplored. Zimbabwe's current political and economic climate presents additional challenges to research on the topic.


METHOD
The technical, economic, legal, collaborative, operational, schedule and political feasibilities (acronym TELCOSP) to undertaking a study on children with albinism in Zimbabwe were explored over a six week period of fieldwork in the country.


RESULTS
Using the TELSCOSP framework allowed a deconstruction of each challenge to provide innovative solutions. The economic and legal feasibility aspects presented some difficulties that will require flexibility and perseverance to overcome.


CONCLUSION
With the assistance of the local communities and people with albinism in Zimbabwe, the obstacles appear surmountable. The feasibility study provided a productive framework for addressing potential challenges in studying the needs of Zimbabwe's children living with albinism.
205326823
Practitioner assessments of 'good enough' parenting: factorial survey.
AIM
The aim of this study was to measure health visitors' professional judgements on 'good enough' parenting and identify what factors and combinations of these are important when making such judgements.


BACKGROUND
The relationship between parenting and child health is unclear. Whilst agreement exists that 'good enough' parenting requires boundary setting, consistency and putting the child's needs first, attempting to define 'good enough' parenting in precise terms is complex. When faced with a complex situation, practitioners rely on relatively few factors to form judgements.


DESIGN
Factorial survey methods were employed using vignette techniques.


METHODS
Vignettes were constructed using previous research on those variables, which may influence nurses' judgements, for example, accommodation and child dentition. The level of factors was randomly varied. Two thousand vignettes were administered to a sample of 200 health visitors in two Health Boards who then made a judgement about this scenario.


ANALYSIS
Data were analysed through multiple regression with dummy variables and one-way analysis of variance. Regression equations for both good enough mothering and good enough parenting are reported.


RESULTS
The models used are significant predictors of parenting and mothering. Significant predictors on health visitor judgements' were boundary setting in sleep behaviours, type of housing inhabited and health behaviours. Although parenting and mothering are often conflated, health visitors appear to separate these aspects when making judgements based on type of housing.


CONCLUSIONS
Most professionals can articulate what makes a 'good' parent, equally they may have strong views regarding what constitutes 'poor' parenting. The difficulty is in determining when parenting is 'good enough' to provide a child with a nurturing environment.


RELEVANCE TO CLINICAL PRACTICE
This study suggests that practitioners move their thresholds of what is 'good enough' depending on a narrow range of factors. Awareness of the factors, which influence individuals' judgements is important in safeguarding children.
13643640
Driving anxiety and fear in young older adults in New Zealand.
BACKGROUND
driving anxiety and fear can have a marked impact on mobility and independence, although there is no data on the prevalence of this problem, and specific information about the rate of driving anxiety and fear in older adults is unknown.


METHODS
the present study examines the prevalence of self-reported driving anxiety and fear in a sample of 2,491 adults aged 55-72 from a longitudinal survey of health and ageing in New Zealand.


RESULTS
most of the sample (90%) described themselves as drivers who drove daily or weekly. Around 70% of the sample reported no driving anxiety or fear, yet 17-20% endorsed a mild and 4-6% rated a moderate to severe level of driving anxiety and fear. Women reported higher levels of anxiety and fear about driving than men, but there were no age differences. Those who reported some level of driving anxiety engaged various alternative modes of transport, and a small number (2.4%) reported that their driving anxiety had affected their usual activities or work for at least a day in the previous month. Duration of driving anxiety was highly variable, from relatively recent onset to being present for much of some participants' lifetimes.


CONCLUSION
driving anxiety and fear may be a significant problem for some young older adults that is likely to affect their independence and mobility. Further research to clarify the content and nature of driving anxiety, pathways to driving anxiety and the effect of factors associated with ageing on driving anxiety is needed in order to better understand this experience for older adults and develop effective interventions.
36044044
What does the Driving and Riding Avoidance Scale (DRAS) measure?
Driving anxiety can have a significant impact on everyday functioning and usually results in some kind of avoidance behaviour. The Driving and Riding Avoidance Scale (DRAS; Stewart, A. E., & St. Peter, C. C. (2004). Driving and riding avoidance following motor vehicle crashes in a non-clinical sample: psychometric properties of a new measure. Behaviour Research and Therapy, 42, 859-879) shows promise in the self-report assessment of the degree of such avoidance. The present study investigated the psychometric properties of the DRAS in a sample of 301 university students. Internal consistency for the DRAS was 0.89 and temporal stability over two months was 0.71. The factor structure of the DRAS supported the use of the general and traffic avoidance subscales but not the weather and riding avoidance subscales in the present non-clinical sample. However, a significant limitation of the DRAS is that it does not assess the reasons for driving avoidance, and is therefore not a measure of avoidance that is due to driving anxiety. Some items may be rated highly for practical reasons, such as avoidance because of increasing fuel and other costs associated with driving. Modified instructions for the DRAS should ensure that it measures anxiety-related avoidance behaviour.
33909578
The polypeptides of influenza virus. 1. Cytoplasmic synthesis and nuclear accumulation.
25074678
Towards evidence-based general practice in rural and remote Australia: an overview of key issues and a model for practice.
There is an extensive global move towards evidence-based practice intended to increase the quality and effectiveness of health care. However there are barriers and issues when rural general practitioners attempt to incorporate evidence-based medicine in their practice. Key issues affecting the uptake of evidence-based medicine by rural general practitioners include the gaps in the scientific evidence relevant to general practice, time limitations, and the cost of Internet access, geographical isolation from centres of evidence-based practice and limited training opportunities. General practitioner consultations may involve multiple, ill-defined problems and the patients' views about their treatment may conflict with an evidence-based treatment approach. Rural general practitioners may require additional supports to access information from research through Internet-based resources, accessible summaries of evidence or clinical practice guidelines. In addition a model to assist rural general practitioners use evidence-based medicine is suggested. This model may enable the clinical decision-making process to integrate clinical experience, patient preferences and an understanding of the rural context of practice with the best available evidence, to in turn produce best practice.
20101328
Community participation in organising rural general practice: is it sustainable?
OBJECTIVE
We analysed community participation in organising rural general medical practice in order to suggest ways to extend and sustain it.


DESIGN
A multisite, embedded case-study design collecting data through semistructured interviews, non-participation observation and a document analysis.


SETTING
One remote and two rural communities in Australia.


PARTICIPANTS
Community members, GPs, health professionals, government officers and rural medical workforce consultants.


RESULTS
High levels of community participation in recruiting and retaining GPs, organising the business model, and contributing to practice infrastructure were evident. Community participation in designing health care was uncommon. Participation was primarily to ensure viable general practice services necessary to strengthen the social and economic fabric of the community. There were factors about the decision-making and partnership processes in each of the communities that threatened the viability of community participation.


CONCLUSIONS
We recommend that a concept of community development and explicit facilitation of the processes involved is necessary to strengthen participation, create effective partnerships and ensure inclusive decision-making.