|
Article Excerpt
Significance of the Problem
FASD is the leading known preventable cause of mental retardation in western civilization and one common reason a child's development and learning is affected. The need to address the prevention of secondary disabilities caused by prenatal alcohol exposure has become a national priority (CDC, 2002). Secondary disabilities are those not present at birth but that occur because of the primary disability. Research has demonstrated that secondary disabilities associated with FASD can be prevented or lessened by a better understanding and appropriate interventions (Streissguth, Barr, Kogan, & Bookstein, 1996).
Nurses encounter children and families throughout all parts of their lifespan who are at risk for or who have FASD, and nursing interventions are key to the prevention and treatment of this problem. Secondary and tertiary nursing interventions have proven to prevent secondary disabilities and enhance outcomes for high-risk children in multiple research studies (see Alexander, Younger, Cohen, & Crawford, 1988; Brooten et al., 1988; Brooten et al., 1986; Brooten et al., 1994; Lipman, 1988; Melnyk et al., 2001; Olds, Henderson, Chamberlin, & Tatelbaum, 1986; Weisman, 1992). While many of the interventions in these studies apply to children and families with FASD, we only included those strategies specifically aimed at children and families with FASD in this review.
The Clinical Question
We undertook this review to answer the question, "What is the state of the evidence for nursing interventions to prevent secondary disabilities in children and families affected by FASD?" This was a necessary first step prior to developing effective interventions in this area. According to van Meijel, Gamel, van Swieten-Duijfjes, and Grypodonck (2004), identification of existing intervention practices is an extremely valuable and necessary aspect of developing evidence-based interventions.
Search Strategy
This review followed the method described by Garrard (1999) in Health Sciences Literature Review Made Easy: The Matrix Method. Garrard's method describes steps for planning and managing the search of the literature, selecting and organizing documents for review, abstracting and synthesizing the findings. Some common terms used to conduct such a review are shown in Table 1.
A preliminary search identified no previous review of nursing interventions for preventing secondary disabilities in FASD. Therefore, a wide net was cast in undertaking this search to identify articles or research studies written by nurses or in the nursing literature about FASD. Three of the authors, the reference librarian at the University at Buffalo, and staff from the SAMHSA Center for Excellence on FASD all conducted searches for articles between 1980 through 2004 using Journals at Ovid, CINAHL, Medline, PsychInfo, Cochrane Reviews, the metasearch engine Dogpile, and Digital Dissertations. The search terms included fetal alcohol syndrome, fetal alcohol effects, alcohol related neurological disorders, FASD, nursing interventions, prevention, secondary disabilities, foster care, questionnaires, and surveys. The search yielded 1,090 references. Endnote Reference Manager Software was used to capture the article information.
Selection and Organization of Articles for Abstraction
References were exported to Microsoft Excel and abstracted in two rounds. Three of the authors reviewed the articles separately. All members of the team were pediatric or school nurse practitioners (PNP/SNP) or PNP students enrolled in a graduate nursing program who had successfully completed the research course requirements for their respective graduate program.
In round one, the articles were coded for the profession they were written by or aimed at by reading the abstract. The codes were: 1.1 nursing, 1.2 health professionals, 1.3 social workers, 1.4 juvenile justice, 1.5 foster care, 1.6 other, and 1.7 non human studies, lf at least two of the three coders agreed that an article was written by or was specifically aimed at nurses, contained nursing interventions for FASD, or addressed health professionals in general, it was included in the next round for abstraction. If there was any doubt the article met the criteria, it was included for abstraction. This resulted in 110 references chosen for abstracting.
In round two, the remaining 110 references were read completely for abstraction. During this process, 46 were further excluded due to inability to obtain the full article, inability to translate the article from the language in which it was written, or the fact that there was no actual information in the article about FASD. Articles written before 1990 were eliminated since many contained information no longer considered relevant given the latest research or were not consistent with recent guidelines (Bertrand et al., 2004). Sixty-four references remained for abstraction.
Data Extraction Strategy
To abstract the data from the remaining articles, a review matrix was set up in Microsoft Excel. The matrix included a summary of the article; whether it...
|
