A randomized trial of a nursing intervention to promote the adjustment of children with chronic physical disorders

A nursing intervention that focuses on health rather than illness and that involves the family as well as the patient appears effective in preventing psychosocial maladjustment in children with chronic illnesses. A total of 332 children and their families were studied. Tests measuring the parent's evaluation of the child's behavior and the child's self-perception were administered before and after the intervention. Improvements were noted on tests of anxiety and depression as well as on tests of self-perception. Analysis of the parent-completed questionnaires indicated there were significant improvements in child behavior and adjustment. Surprisingly, children between four and seven years old rated themselves lower in peer acceptance after the intervention. This was not the case for the children between eight and 16 years old.
Objective. This study was conducted to determine whether a specialized form of nursing could help prevent or reduce psychosocial maladjustment among children, aged 4 to 16 years, with chronic physical disorders. In contrast to other studies, nurses were chosen to provide the intervention based on their central role in health care and the appropriateness of their training for this task. Methodology. A clinical trial was concluded in which 332 children and their families were randomly assigned either to receive this specialized nursing for a 1-year period, or to remain in the control condition. The children were all active outpatients in nine clinics at the Montreal Children's Hospital. Three measures of psychosocial functioning administered before and after the intervention were the basis for assessing its efficacy. The measures included the behavior problems profile of the Achenbach Child Behavior Checklist, the Personal Adjustment and Role Skills, completed by the parents, and two versions of the Self-Perception Profile (Harter) for children aged 4 to 7 years and 8 to 16 years. Results. Differences between groups were examined both categorically and quantitatively. In the former, the percent of children with clinical scores (those above or below a cut-off indicative of maladjustment) at baseline and postintervention were compared. In the latter, the mean scores at the end of the trial were analyzed using analysis of covariance with the baseline scores as covariates. Statistically significant positive differences were found in the domain of anxiety/depression on the Personal Adjustment and Role Skills, and in the areas of scholastic competence, behavior, and global self-worth on the Harter. Conclusion. The results indicate that this intervention helps children with chronic disorders by preventing or reducing maladjustment. Most university-prepared nurses already have the basic skills required to achieve these results; only a modest investment in reorientation may be needed. Thus, other pediatric centers should be able to replicate these findings and thereby take a major step toward improving the lives of children with chronic disorders. Pediatrics 1994,94:70-75, chronic physical disorders, randomized clinical trial, nursing intervention, psychosocial adjustment.