Heather Curry|Carol Schmer|Peggy Ward?Smith|Kristin Stegenga|A. Mehrhof|Susan Sarcone
Kid Cards: Teaching Children About Their Medicines
Children's Mercy Hospital
section editormary margaret gottesman phd rn cpnp faanohio state university college nursingcolumbus ohio mary margaret gottesman phd rn cpnp faan ohio state university college nursing columbus ohio incidence chronic health conditions among children increased twofold last decade hockenberry 2002hockenberry whaley wongs nursing care infants children 7th ed mosby publishers st louis2002google scholar conditions require medications throughout life prevent delay progression disease process thus increasing health literacy children essential providing health care knowledge understood valued child comprehension health care condition treatment plan consequences essential ensure adherence medication regimen continue throughout lives previous research supports use direct developmentally appropriate childcentered health care education pantell et al 1982pantell r stewart dias j wells p ross j physician communication children parentspediatrics 1982 70 396402pubmed google scholar perrin et al 1991perrin e sayer willet j sticks stones may break bones reasoning illness causality body functioning children chronic illnesspediatrics 1991 88 608619pubmed google scholar sanz 2003sanz e concordance childrens use medicinesbmj 2003 327 858860crossref pubmed scopus 44 google scholar sleath et al 2003sleath b bush p pradel f communicating children medicines pharmacists perspectiveamerican journal health systems pharmacy 2003 60 604607pubmed google scholar tates meeuwesen 2000tates k meeuwesen l let mum say turn taking doctorparentchild communicationpatient education counsultation 2000 40 151162abstract full text full text pdf pubmed scopus 88 google scholar research concluded medicine use treatment adherence might improved direct childappropriate education boorady 2006boorady r 2006 talking kids medication prescribed retrieved january 10 2006 httpwwwmednyueducigbinitwebprintablecgiurlhttp3awwwaboutourkidsorggoogle scholar obrien bush 1993obrien r bush p helping children learn use medicinesoffice nurse 1993 6 1419google scholar tieffenberg et al 2000tieffenberg j wood e alonso tossutti vicente randomized trial acindes child centered training model children chronic illnesses asthma epilepsyjournal urban health bulletin ny academy medicine 2000 77 280297pubmed google scholar studies teaching children medication regimen correlated improved knowledge decreased anxiety fear negativity knight et al 1990knight wigder k fortsch polcari medication education children worthwhilejournal child adolescent psychiatric mental health nursing 1990 3 2528crossref pubmed scopus 7 google scholar developing health literacy children important aspect ongoing transition toward adulthood critical element development selfmanagement skills 2004 surgeon general carmona stated healthliterate individual apt know answer asked keep well agency health care research quality 2004agency health care research quality 2004 ahrq briefing 80804 retrieved january 10 2006 httpwwwkaisernetworkorggoogle scholar statement resulted interventions aimed increasing health literacy among americans currently burgeoning movement among medical professionals address heath literacy patients including pediatric patients teaching health information children empowers actively participate current care provides selfmanagement skills assist keeping well throughout lives currently paucity medication administration instructional information appropriate children providing medication information child fully understands may result better treatment adherence fewer adverse effects increased knowledge united states pharmacopeia usp 1998 position paper outlined 10 principles used teaching children adolescents medications principles encourage developmentally based medication education children starting children want know paper also recognizes need directly address children rather exclude either actively passively medication teaching process united states pharmacopeia 1999united states pharmacopeiausp recommends children adolescents right information direct communications medicinesjournal child family nursing 1999 2 7478pubmed google scholar using data focus groups children grades 2 5 usp identified concepts children understand include information regarding medicines go body doctors know medications work bush 1998bush p ed 1998 guide developing evaluating medicine education programs materials children adolescents retrieved february 2 2006 httpwwwusporggoogle scholar pfizer 1999pfizertalking children medicine norwich ny1999google scholar developed booklet entitled talking children medication content developed usp recommendations booklet teaches children ask medicationspecific questions take medicine long take medication make better taste like side effects happen usp also suggested use pictures within educational program beneficial although hameenanttila et al 2004hameenanttila k kemppainen k enlund h bush p marja pictograms improve childrens understanding medicine leaflet informationpatient education counseling 2004 55 371378abstract full text full text pdf pubmed scopus 57 google scholar claim usefulness pictures exaggerated macphee 2002macphee evidence based practice actionjournal pediatric nursing 2002 17 313320abstract full text full text pdf pubmed scopus 5 google scholar proposed using usp handout might enhance pediatric patients interest medications clinical anecdotal evidence supported research done eggleston et al 1998eggleston p malveaux f butz huss k thompson l kolodner k rand c medications used children asthma living inner citypediatrics 1998 101 349354crossref pubmed scopus 140 google scholar indicate pediatric patients selfmedicate concern child may selfmedicating may know little nothing medications taking except color taste knowledge regarding medications assist transitioning pediatric patient adult care effective selfmanagement skills using piagets theory cognitive development children ages 7 11 typically concrete operational phase acquiring skills allow become logical coherent hockenberry 2002hockenberry whaley wongs nursing care infants children 7th ed mosby publishers st louis2002google scholar children stage able classify sort organize facts world thus may use knowledge problemsolve reasoning stage inductive overall thought becomes less selfcentered appropriate teach children information chronic illness developmental stage reasonable expect comprehend health care condition treatments consequences including potential complications appropriate educational interventions include building past experiences using memory retain information must also become discriminate respect information applies directly symbols drawings ageappropriate wording used develop medication education card study education card developed using theory framework principles outlined united states pharmacopeia 1999united states pharmacopeiausp recommends children adolescents right information direct communications medicinesjournal child family nursing 1999 2 7478pubmed google scholar guide content sample card presented figure children bleeding disorders routinely receive aminocaproic acid amicar prevent excessive bleeding especially mucous membranes bleeding disorders group lifelong chronic conditions always require medical attention may impacted selfmedication skills thus children represent population could benefit increased medication knowledge brief pilot study assessed impact medication cards knowledge among children aged 7 11 years receiving aminocaproic acid advanced practice nurse apn employed study setting responsible providing health education medication cards written 9th grade reading level widely available within hospital web site appropriate parents many teens cards encourage child become informed medications medication card developed study provides information regarding purpose administration method available form sideadverse effects associated aminocaproic acid developed readability statistics determined using spelling grammar feature word feature combines use passive sentences fleisch reading ease fleischkincaid grade level determine readability document six children randomly chosen study site also reviewed medication card hematologyoncology clinical pharmacist institutional review board approval obtained prior data collection approval included review medication card openended response study questions friday apn reviewing upcoming weekly appointment schedule identified potential participants potential participants included children 1 ages 7 11 years 2 taking aminocaproic acid 3 able speak read write english 4 parentguardian present could provide consent 5 able assent 6 available followup data collection using telephone interview 7 receiving primary care bleeding disorder study site individuals excluded participation included whose health care condition fragile changing unstable study participation judged burdensome health care professionals study site discussed potential study participant appropriateness questioned health care professional potential participant excluded study identified study explained verbally potential participant parent guardian routine clinic visit study participation commenced consent assent obtained occurred three phases first phase consisted apn assessing childs knowledge regarding aminocaproic acid verbal education child apn assisted kid card selfdisclosure demographic data provision kid card child second phase data collection obtained longitudinal data use followup phone call occurring 2 weeks post intervention data collected time surrounded purpose side effects adverse effects administration method amicar last phase data collection additional phone call 2 weeks later questions asked thus study data assessed knowledge retention accuracy 1month timeframe data treated nominally indicating whether knowledge retained positive response lost incorrect remembered data entered spss prior analysis nine children participated study participants ranged 703 1108 years age mean 8 years 8 months standard deviation 186 7 males 78 2 females 22 8 89 participants selfreporting ethnicity caucasian 1 11 selfreporting african american ethnicity participant received drug aminocaproic acid prophylactically prevention coagulation complications associated bleeding disorder nonparametric statistics used analyze data technique appropriate small sample sizes siegel castellen 1988siegel castellen nj nonparametric statistics behavioral sciences mcgraw hill publishers philadelphia1988google scholar data treated nominal collected longitudinally one sample population choice analyses limited descriptive binomial statistics siegel castellen 1988siegel castellen nj nonparametric statistics behavioral sciences mcgraw hill publishers philadelphia1988google scholar developing discrete categories based upon responses question 1 serving knowing appropriate information 2 knowing correct information analysis reveals knowledge administration method item statistically significant across data collection interval p 039 tabletableinterview questions number correct responsesstudy questionpost intervention correct responsesinterview 2 weeks post intervention correct responsesinterview 4 weeks post intervention correct responsesis pills liquid shots methods medication698how long take it253when take often144why take medicine546does side effects154what health care problem needs medication365 open table new tab results indicate participants knew method aminocaproic acid administered knowledge retained throughout data collection interval study knowledge pertaining medication side effects statistically significant time initial data collection knowledge dissipated time interview questions failed obtain statistical significance generalizability pilot results used caution indicate drug education needs performed reinforced regularly population results pilot study interpreted caution participants study one study site receiving care small number health care professionals extrapolating results health care conditions medications avoided results study indicate medication education appropriate children ages 7 11 years education needs reinforcement future encounters ensure knowledge retention pilot study demonstrated development kid cards aimed information children age group want know treatment increase retention aspects medicationrelated information obtaining data children chronic illness provides evidencebased care valued appropriate feasible united states pharmacopeia 1998united states pharmacopeia 1998 position statement retrieved january 20 2006 httpwwwusporgdruginformationchildrenprincipleshtmlgoogle scholar funding study provided grant private funding source dee lyons authors would like thank stacey shoman rn assistance development kid card nurses hematologyoncology section assistance data collection heather curry clinical nurse specialist childrens mercy hospitals clinics kansas city mo carol schmer doctoral student university missouri kansas city school nursing kansas city mo peggy wardsmith associate professor university missouri kansas city school nursing kansas city mo kristin stegenga research coordinator childrens mercy hospitals clinics kansas city mo ann mehrhof nurse coordinator childrens mercy hospitals clinics kansas city mo susan sarcone nurse clinician childrens mercy hospitals clinics kansas city mo