Western Journal of Nursing Research

Older school-age children and early adolescents with asthma have demonstrated and verbalized difficulty in accepting their condition. Although researchers have explored adult acceptance, few have explored child or adolescent acceptance. The purpose was to explore the fit of the data to a specified latent variable acceptance of asthma model. School-age children and early adolescents (N = 118), ages 9 to 14 years enrolled in Grades 4 to 9, diagnosed with asthma and their parents completed self-report instruments. EQS was used for structural equation modeling analyses. The specified model was a good fit to the data and accounted for more than 70% in the explained variance of vigilance, 30% of participation in life activities, 25% of taking control, and 20% of asthma health behaviors. Support for the model possess implications for development of theory-based education and counseling interventions to support participation in life activities by targeting cognitive, behavioral, and psychosocial aspects of living with the asthma.

Children experience moderate to severe pain in the days after tonsillectomy surgery. This article describes the challenges of analyzing data from pain diaries 24 hours after ambulatory tonsillectomy surgery. Instructions were to record pain levels every 4 hours and the analgesic as given; however, the number of entries was inconsistent, making comparison of groups difficult. The use of analgesics can threaten the construct validity of cause and must be considered and controlled statistically. Opioids were converted to morphine equivalents and the nonopioids were held as a separate covariate. This article describes the steps taken to find an appropriate statistical means of dealing with inconsistent diary entries and analgesic use. Hierarchical linear modeling (HLM) provides a means to analyze unbalanced data and control for analgesics. Issues of control must be addressed in research that measures children's pain in the home. HLM can address issues of incomplete data in repeated-measures studies.

Improving our ability to prevent or diminish suffering in dying children and adolescents and their families is dependent on the completion of high-quality pediatric end-of-life studies. The purpose of this article is to provide useful evidence-based strategies that have been used to implement and complete clinically useful pediatric end-of-life studies in oncology. The article describes specific peer-review and methodological challenges and links those to evidence-based solutions. The challenges and solutions described in this article are from eight end-of-life studies involving pediatric oncology patients. It is hoped that the solutions described here will benefit others in their efforts to implement pediatric end-of-life studies so that clinically useful findings will result and will improve the care of dying children and adolescents.

This article discusses the issue of assent of school-age bilingual children to participate in a research study. The article reviews cognitive, cultural, and linguistic factors influencing verbal and nonverbal concept formation in bilingual children. At the applied level, the focus of the article is on methodological considerations in using this information to obtain assent from a child who is bilingual and speaks English as a second language. Recommendations for the assessment of the child's language dominance, language proficiency, and the development of the assent form are provided. Language diversity and its potential effects on the assent process need to be formally acknowledged and appropriately addressed.

Recruiting participants for research studies is often a challenging task. Recruitment requires careful planning, collaboration, and flexibility on the part of researchers and health care providers at the recruitment sites. This article describes six major barriers to recruiting study participants as identified from a review of the literature and from the coauthors' research experiences. These barriers include challenges related to regulations of the Health Insurance Portabililty and Accountability Act (HIPAA), health care providers' work burden, providers' financial disincentives, competition, health care provider concerns regarding research, and provider protection of patients. Each barrier is described, and specific strategies are suggested based on the empirical literature. In some instances, the coauthors' experiences are also shared.

Gaining access to the schools and recruiting children as research participants are challenging tasks. To facilitate gaining access to the schools, multiple strategies are necessary, including understanding specific characteristics of the schools, using the proper lines of authority and communication, identifying the gatekeepers, and persuading the schools of the significance and mutual benefits from the study. Once access is gained, strategies for successful recruitment of children include use of developmentally appropriate motivators and incentives; multilevel communications with administrators, principals, teachers, staff, parents/guardians, and children; and provision of privacy and confidentiality during data collection and sharing of the findings. Specific examples from an ongoing study are used to illustrate helpful strategies.