Nursing Assignment Diagnosed With Type 1 Diabetes

Question :

A comprehensive review of literatures to explore the experiences of parents of children under the age of 12 who have been newly diagnosed with type 1 diabetes.

Answer :

Target Journal

The journal is available in the online as well offline medium, and are published at the same time. The journal has become an excellent forum for the researchers, doctors, and nurses from around the world to contribute as well gain significant knowledge in the field of development of diabetes mellitus. 

Acknowledgement

Through profound professional knowledge, serious scientific attitude, rigorous spirit of research, and noble teaching ethics, professor has extended all forms of possible assistance throughout the completion of this project. I received careful instructions, as and when needed, that always kept me on the right path. Here, I would like to extend my sincere thanks and heartfelt gratitude to Dr Kathleen Markey.

Abstract

Aim: The aim of this study is to conduct a comprehensive review of literatures to explore the experiences of parents of children under the age of 12 who have been newly diagnosed with type 1 diabetes.

Background: The cases related to Type 1 diabetes have been on the rise. It is the situation where the child’s body fail to produce necessary hormone, that is, insulin. It requires that the child is given insulin via injections or insulin pumps. It is a painful process, and being a children, it increases the problem intensity. Children are required to adhere to the treatment, party restrictions, and candy eating. These are easier said than done for a children, which creates challenge for parents. Studies have been done on the experiences of such parents, but the findings are mostly scattered. Bringing these findings together will help gain comprehensive understanding of the parents’ experiences when they have diabetic children. 

Design: An integrated literature review will be conducted.

Method: The first step is to identify the problem, which can be understood from the research aim. After that, with the use of popular research paper databases useful studies will be collected for assessment. Some of databases are PsycArticles, Medline, CINAHLL, and others. The next stage is to use keywords to retrieve research papers related to the research topic for the past ten years. Boolean operators such as AND, NOT, OR will be used to conduct the search. PRISMA checklist and Crowe Critical Appraisal Tool will be used to identify the papers that are fit to study. After the identification of the possible studies, the next step will be to conduct thematic analysis on the findings of the studies based on Braun and Clarke’s six-phase framework. 

Conclusion: The study is expected to help researchers and practitioners understand various challenges that are faced by or the experiences of the parents. Interested researchers will get consolidated study of past ten years in one place. It is more likely to help practitioners who work with such parents. They can provide more informed suggestions. 

Keywords: Type 1 diabetes, diabetic children, integrative review, parents, experiences 

Table of Contents

CCAT (Crowe Critical Appraisal Tool): The abbreviation of Crowe Critical Appraisal Tool (CCAT) is made CCAT and the CCAT user guide can be used to under this tool properly. Crowe Critical Appraisal Tool (CCAT) has relatively high standards, and it assumes that the researcher is familiar with research design, sampling, ethics, data collection methods, and statistical and non-statistical data analysis techniques. 

CINAHL: It is mainly for the search of nursing and related health studies. It is the world's most comprehensive database of nursing-related health research, which contains many records and journals of excellent nursing articles.

Cochrane Library: It is an electronic library for health workers. Applicable to clinicians, clinical research, teaching workers, medical and health administrative departments, and other relevant personnel.

Medline: It is an international comprehensive biomedical information bibliographic database produced by The National Library of Medicine (NLM). It is currently the most authoritative biomedical literature database in the world. It includes all contents of the Index Medicus (IM) and some contents of the Index to Dental Literature and the International Nursing Index.

PEO: It stands for population, exposure, and outcome. PEO is quite helpful when conducting qualitative research for the problem. 

PsycInfo: It is a database of literature abstracts in the field of American psychology. Its mission is to promote the development of psychology as a science and a profession and as a way to promote health and education.  

TID: Type 1 Diabetes

1. Introduction

A rise in the Type 1 diabetes among children can be witnessed. It this condition, body of a child stops producing crucial hormone, insulin (Streisand et al, 2005). And thus in order for the survival of the children, it becomes important that missing insulin in the body is managed by injecting it externally. Type 1 diabetes among the children has another name called juvenile diabetes. There is no doubt that the when children are identified with this disease, it creates major challenge for the parents (Whittemore et al, 2012). T1D stays with children throughout their life and can be life threatening as well. In the treatment of T1D, efforts are made to ensure that the glucose level in the blood stays between the normal limit. This disease constantly pose long-term and short-term challenge to children. The effort to reduce the risks require combined effort of parents and their children (Landolt et al, 2002). Some of the key aspects that are regularly kept in consideration are glucose level in the blood, proper diet, and timely injection of insulin. In diabetes, it is very important that self-discipline is maintained by the children, which sounds quite tough, and constant care by the parents (Streisand et al, 2008). Studies have found that children are diagnosed with T1D at different ages, it can be between 10 and 14 years, or even younger (Dahlquist et al, 2011; Patterson et al, 2009). Studies by International Diabetes Federation (2011), Makcey et al (2016), and Marks et al (2013) have stated that the high number of individuals who are diagnosed with T1D are under the age of 5. 

Considering an example, Norway has one of the highest rates of diagnosis of type 1 diabetes among the children, which is around 36.5 per 100,000 people in 2015 (Skrivarhaug et al., 2016). The International Society for Paediatric and Adolescent Diabetes (ISPAD) shows parental attitudes and lifestyles along with the environment in which children are raised are very significant for children with type 1 diabetes (Acerin et al., 2014).

When a child is diagnosed with type 1 diabetes, strict adherence to the diet and activities of a diabetic patient is required. This can be a huge challenge. Parents often worry about their children because type 1 diabetes will be with the children or the rest of their lives and will affect every aspect of their lives. If children with type 1 diabetes have too much glucose or sugar in their bodies, it can cause many complications, and even cause death (Doyle and Grey, 2010). Notable complications include nerve damage, peripheral vascular disease, and kidney disease. Its treatment methods include insulin therapy, diet therapy, daily life management, and blood glucose monitoring (Rifshana, 2017). International Diabetes Federation (2011) described children should be injected with insulin or treated with an insulin pump four times a day, and monitored closely after each injection. The best way to treat type 1 diabetes is to control blood sugar to prevent complications. These are a high degree of responsibility for parents and may increase the burden and anxiety of an average family (Jönsson et al., 2016; Rewers et al., 2014).

1.1 Background

When a child is diagnosed with type 1 diabetes, family members and children should know what they will face next in life. After the diagnosis, the child's health and the family's quality of life normally gets complicated and deteriorates (Sundberg et al., 2015; Whittemore et al., 2012). Study conducted by Jönsson et al. (2015) have shown that when a child is diagnosed with type 1 diabetes at a younger age, the pressure on parents and life adjustment is more pronounced. Parents often accompany young children, but young children are highly sensitive to the intake of insulin, and how to open their inner world. To let their children grow up healthily is undoubtedly a great challenge for parents (Jönsson et al., 2015). Some challenges may include child's diet, insulin use, regular daily monitoring of insulin levels, and participation in sports (Streisand and Monaghan, 2014). However, the attitude of parents is very important. Many parents find it difficult to do follow through the procedures such as such as clearly recording islet volume and actively communicating with their children. These factors often affect children's blood sugar fluctuations to varying degrees (Wennick et al., 2019). A large number of parents stay worried, anxious and vigilant state due their child having type 1 diabetes (Niedel et al., 2013). Merkel and Wright (2012) found that social support, family intervention, and self-efficacy are important for families with type 1 diabetes. 

Study by Smaldone and Ritholz (2011) have shown that the psychological prevalence of parents of children with type 1 diabetes is between 20% and 30%, because family members have to worry about too many things about their children, which is a long-term stress. Over time, management of the situation can become more and more complex, especially when the child faces additional complicated situations. As for instance once a child has hypoglycemia at night, it becomes a greater challenge for parents (Monaghan et al., 2009; Barnard et al, 2010). Nevertheless, studies by Haugstvedt et al. (2010), Haugstvedt et al. (2011), and Iversen (2018) shows that parental stress and psychosocial risk were not related to the age at which the child was diagnosed with diabetes.

Parents have a different attitude when they know their child has been diagnosed with type 1 diabetes. Mothers tend to pay more attention to their children, while fathers adapt to the family environment gradually with the change of time. However, many mothers get disappointed at the absence of fathers in the management of the situation (Sparud-Lundin et al., 2013). Smaldone and Ritholz (2011) showed a large number of mothers feel helpless when they are take care of their diabetic children. Tiberg et al. (2012) described that parents are happier with short-term management of children with type 1 diabetes.

Children with type 1 diabetes, between the ages of 2 and 8, are likely to engage in behaviours that are detrimental to their health, such as lifestyle habits, skipping meals and eating sugary snacks (Chisholm et al., 2014). Also, parents' living habits and social environment directly affect their children's cognition and exercise of diabetes knowledge (Dwyer et al., 2017; Joyal-Desmarais et al., 2019; Zhen-Duan et al., 2019). For example, parents can influence their children's eating habits by controlling their own foods like those with high sugar content (Zhen-Duan et al., 2019). In addition, to strengthen children's physical exercise habit, mother and father can take their children to the park or walk for physical exercise (Carver et al., 2010)

1.2 Rationale

The rational for this comprehensive review is to learn more about the relevant knowledge surrounding the experience of parents when they know their child has been diagnosed with type 1 diabetes. Study conducted by Katz et al. (2012) describes that type 1 diabetes has a great impact on the family. The physical management requirements of many aspects of it are very difficult (Rifshana et al., 2017).The management of type 1 diabetes has a lot of pressure on the family's economy and may also limit parents' work. In addition, family member’s quality of life also get negatively affected (Smaldone and Ritholz, 2011). In children with type 1 diabetes, a large number literatures has described significant changes in thier lifestyle, quality of life, relationships, and children's lives and emotions. However, there is very little in the literatures on type 1 diabetes about parents' experience in caring for children with type 1 diabetes (Sparud-Lundin et al., 2013). Besides, when a child is diagnosed with type 1 diabetes, the impact of the child's growth on family members is rarely described (Jönsson et al., 2016). The purpose of this comprehensive assessment is to allow medical staff, nurses, and researchers to understand more accurately the experiences of the parents. This study targets parents of the children with type 1 diabetes who are aged between 1 and 12. The aim of the study is to explore the experience of father and mother or parents in caring for children with type 1 diabetes aged 1 to 12 years. There's a lot of literature that shows that parents are try to give their children a normal family life and try to change their lives but struggle significantly (Iversen et al., 2018; Jönsson et al., 2016). Social support and nurses can look for family and social interaction strategies to reduce parental stress during these tiring times. They can communicate effectively with parents to create open channels for maintaining care management (dos Santos Pennafort et al., 2016).

1.3 Research Aim

The aim of this research is to conduct a comprehensive review of literatures to explore the experiences of parents of children under the age of 12 who have been diagnosed with type 1 diabetes.

1.4 Research Objectives

The objectives of the study are mentioned below:

- To conduct system retrieval of literature on the research topic and conduct comprehensive review.

- To understand the impact of a child’s diagnosis of type 1 diabetes on parents’ lives and psychology.

- To increase social and medical attention to parents of children with type 1 diabetes.

1.5 Research Question

Given below is the research question:

- What experiences parents of newly diagnosed type 1 diabetes children encounter?

References

Acerini,C., Craig, M. E., De Beaufort, C., Maahs, D. M., and Hanas, R. (2014). Introduction to ISPAD clinical practice consensus guidelines 2014 compendium, Pediatric Diabetes, 15 (Suppl 20), 1-3.

Aveyard H. (2010). Doing A Literature Review in Health and Social Care: A Practical Guide. Second edition. McGraw Hill International: Maidenhead.

Barnard, K., Thomas, S., Royle, P., Noyes, K. and Waugh, N. (2010). Fear of hypoglycaemia in parents of young children with type 1 diabetes: a systematic review. BMC pediatrics, 10(1), p.50.

Braun, V., and Clarke, V. (2006). Using thematic analysis in psychology. Qualitative research in psychology, 3(2), 77-101.

Carver, A., Timperio, A., Hesketh, K., and Crawford, D. (2010). Are children and adolescents less active if parents restrict their physical activity and active transport due to perceived risk? Social Science and Medicine, 70 (11), 1799 – 1805.

Chisholm, V., Atkinson, L., Bayrami, L., Noyes, K., Payne, A., and Kelnar, C. (2014). An exploratory study of positive and incongruent communication in young children with type 1 diabetes and their mothers,Child: care, health and development, 40(1), 85-94.

Crowe, M. (2013). Crowe critical appraisal tool (CCAT) user guide. Conchra House: Scotland, UK.

Dahlquist, G.G., Nyström, L., Patterson, C.C., Swedish Childhood Diabetes Study Group and Diabetes Incidence in Sweden Study Group (2011). Incidence of type 1 diabetes in Sweden among individuals aged 0–34 years, 1983–2007: an analysis of time trends. Diabetes care, 34(8), pp.1754-1759.

dos Santos Pennafort, V. P., Queiroz, M. V. O., Nascimento, L. C.,and Guedes, M. V. C. (2016). Network and social support in family care of children with diabetes/Rede e apoio social no cuidado familiar da criança com diabetes/Red y apoyo social en el cuidado familiar del niño con diabetes,Revista brasileira de enfermagem, 69(5), 856.

Doyle, E. A., and Grey, M. (2010). Diabetes mellutus (Types 1 and 2), Primary care of the child with a chronic condition.

Dwyer, L. A., Bolger, N., Laurenceau, J. P., Patrick, H., Oh, A. Y., Nebeling, L. C., and Hennessy, E. (2017). Autonomous motivation and fruit/vegetable intake in parent–adolescent dyads,American journal of preventive medicine, 52(6), 863-871.

Haugstvedt, A., Wentzel-Larsen, T., Rokne, B.,and Graue, M. (2011). Perceived family burden and emotional distress: Similarities and differences between mothers and fathers of children with type 1 diabetes in a population-based study, Pediatric Diabetes, 12(2), 107–114.

Haugstvedt,A., Wentzel-Larsen, T., Graue, M., Søvik, O., and Rokne, B. (2010).Fear of hypoglycaemia in mothers and fathers of children with type 1 diabetes is associated with poor glycaemic control and parental emotional distress: A population-based study,Diabetic Medicine, 27(1), 72–78.

International Diabetes Federation. (2011). Global IDF/ISPAD Guideline for Diabetes in Childhood and Adolescence. http://www.idf.org./sites/default/files/Diabetes-in-Childhood-and-Adolescence-Guidelines.pdf.

Iversen, A. S., Graue, M., Haugstvedt, A., and  Råheim, M. (2018). Being mothers and fathers of a child with type 1 diabetes aged 1 to 7 years: a phenomenological study of parents’ experiences, International journal of qualitative studies on health and well-being, 13(1), 1487758.

Jönsson, L., Lundqvist, P., and Hallström, I. (2016). Parents HRQOL, Their Satisfaction with Care, and Children Over the Age of Eight’s Experiences of Family Support Two Years Subsequent to the Child’s Diagnosis with Type 1 Diabetes,Comprehensive Child and Adolescent Nursing, 39(4), 287-300.

Jönsson, L., Lundqvist, P., Tiberg, I., and Hallström, I. (2015). Type 1 diabetes–impact on children and parents at diagnosis and 1 year subsequent to the child's diagnosis,Scandinavian journal of caring sciences, 29(1), 126-135.

Joyal-Desmarais, K., Lenne, R. L., Panos, M. E., Huelsnitz, C. O., Jones, R. E., Auster-Gussman, L. A., and Rothman, A. J. (2019). Interpersonal effects of parents and adolescents on each other’s health behaviours: a dyadic extension of the theory of planned behaviour, Psychology and health, 34(5), 569-589.

Katz, M. L., Laffel, L. M., Perrin, J. M., and Kuhlthau, K. (2012). Impact of type 1 diabetes mellitus on the family is reduced with the medical home, care coordination, and family centered care,Journal of Pediatrcs, 160, 861–867.

Landolt, M.A., Ribi, K., Laimbacher, J., Vollrath, M., Gnehm, H.E. and Sennhauser, F.H. (2002). Brief report: Posttraumatic stress disorder in parents of children with newly diagnosed type 1 diabetes. Journal of Pediatric Psychology, 27(7), pp.647-652. 

Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P., ... and Moher, D. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Annals of internal medicine, 151(4), W-65.

Mackey, E.R., Herbert, L., Monaghan, M., Cogen, F., Wang, J. and Streisand, R. (2016). The feasibility of a pilot intervention for parents of young children newly diagnosed with type 1 diabetes. Clinical practice in pediatric psychology, 4(1), p.35.

Marks, A., Wilson, V. and Crisp, J. (2013). The management of type 1 diabetes in primary school: review of the literature. Issues in comprehensive pediatric nursing, 36(1-2), pp.98-119.

Merkel, R. M., and Wright, T. (2012). Parental self-efficacy and online support among parents of children diagnosed with type 1 diabetes mellitus, Pediatric nursing, 38(6), 303.

Moher, D., Liberati, A., Tetzlaff, J. and Altman, D.G. (2010). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg, 8(5), pp.336-341. 

Monaghan, M. C., Hilliard, M. E., Cogen, F. R., and Streisand, R. (2009). Nighttime caregiving behaviors among parents of young children with Type 1 diabetes: Associations with illness characteristics and parent functioning,Families, Systems and Health, 27(1), 28.

Niedel, S., Traynor, M., McKee, M., and Grey, M. (2013). Parallel vigilance: Parents’ dual focus following diagnosis of type 1 diabetes mellitus in their young child, Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, 17, 246–265. 

O'Connor, A. M., Anderson, K. M., Goodell, C. K., and Sargeant, J. M. (2014). Conducting systematic reviews of intervention questions I: writing the review protocol, formulating the question and searching the literature. Zoonoses and public health, 61, 28-38.

Patterson, C.C., Dahlquist, G.G., Gyürüs, E., Green, A., Soltész, G. and EURODIAB Study Group (2009). Incidence trends for childhood type 1 diabetes in Europe during 1989–2003 and predicted new cases 2005–20: a multicentre prospective registration study. The Lancet, 373(9680), pp.2027-2033.

Rewers, M. J., Pillay, K., De Beaufort, C., Craig, M. E., Hanas, R., Acerini, C. L., and Maahs, D. M. (2014). Assessment and monitoring of glycemic control in children and adolescents with diabetes,Pediatric Diabetes, 15(Suppl 20), 102–114.

Rifshana, F., Breheny, M., Taylor, J. E., and Ross, K. (2017). The parental experience of caring for a child with type 1 diabetes, Journal of child and family studies, 26(11), 3226-3236.

Skrivarhaug,T., Kummernes,S.J., and Drivvoll, A. K. (2016). Barnediabetesregisteret: The Norwegian Childhood Diabetes Registry (NCDR) annual report 2016. Retrieved from 6th of December,2017, available:https://oslo-universitetssykehus.no/Documents/Barnediabetesregisteret/Årsrapport% 202016%20BDR.pdf.

Smaldone, A., and Ritholz, M. D. (2011). Perceptions of parenting children with type 1 diabetes diagnosed in early childhood,Journal of Pediatric Health Care, 25, 87–95. 

Sparud-Lundin, C., Hallstrom, I., and Erlandsson, L. K. (2013). Challenges, strategies, and gender relations among parents of children recently diagnosed with type 1 diabetes. Journal of Family Nursing, 19, 249–273. doi:10.1177/1074840713484386.

Streisand, R., Mackey, E.R., Elliot, B.M., Mednick, L., Slaughter, I.M., Turek, J. and Austin, A. (2008). Parental anxiety and depression associated with caring for a child newly diagnosed with type 1 diabetes: opportunities for education and counseling. Patient education and counseling, 73(2), pp.333-338. 

Streisand, R., Swift, E., Wickmark, T., Chen, R. and Holmes, C.S. (2005). Pediatric parenting stress among parents of children with type 1 diabetes: the role of self-efficacy, responsibility, and fear. Journal of pediatric psychology, 30(6), pp.513-521.

Streisand,R., and Monaghan, M. (2014). Young children with type 1 diabetes: Challenges, research, and future directions,Current Diabetes Reports, 14(9), 520.

Sundberg, F., S and,P., and Forsander, G. (2015).Health-related quality of life in preschool children with type 1 diabetes. Diabetic Medicine,32,116-119. available:http://dx.doi.org/10.1111/dme.12557.

Tiberg, I., Katarina, S. C., Carlsson, A., and Hallstrom, I. (2012). Children diagnosed with type 1 diabetes: a randomized controlled trial comparing hospital versus home-based care, Acta Paediatrica, 101, 1069–1073. 

Timmins, F. and McCabe, C. (2005). How to conduct an effective literature search. Nursing standard, 20(11), pp.41-47. 

Tripathy, J.P. (2013). Secondary data analysis: Ethical issues and challenges. Iranian journal of public health, 42(12), p.1478.

Wakefield, A. (2014). Searching and critiquing the research literature. Nursing Standard,28(39), 49.

Wakefield, A. (2015). Synthesising the literature as part of a literature review,Nursing Standard ,29(29), 44.

Wennick, A., Lundqvist, A., and Hallström, I. (2009). Everyday experience of families three years after diagnosis of type 1 diabetes in children: a research paper,Journal of Pediatric Nursing, 24(3), 222-230.

Whittemore, R., Jaser, S., Chao, A., Jang, M., and Grey, M. (2012). Psychological experience of parents of children with type 1 diabetes: A systematic mixed-studies review,The Diabetes Educator, 38, 562–579. available:http://dx.doi.org/10.1177/01457217 12445216.

Whittemore, R., and Knafl, K. (2005). The integrative review: updated methodology. Journal of advanced nursing, 52(5), 546-553.

Zhen-Duan, J., Engebretsen, B., and Laroche, H. H. (2019). Diet and physical activity changes among low-income families: perspectives of mothers and their children, International journal of qualitative studies on health and well-being, 14(1), 1658700.