A RANDOMIZED TRIAL OF A NURSING INTERVENTION TO PROMOTE THE ADJUSTMENT OF CHILDREN WITH CHRONIC PHYSICAL DISORDERS

Objective. This study was conducted to determine whether a specialized form of nursing could help prevent or reduce psychosocial maladjustme nt among children, aged 4 to 16 years, with chronic physical disorders . In contrast to other studies, nurses were chosen to provide the inte rvention based on their central role in health care and the appropriat eness of their training for this task. Methodology. A clinical trial w as conducted in which 332 children and their families were randomly as signed either to receive this specialized nursing for a 1-year period, or to remain in the control condition. The children were all active o utpatients 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 bet ween groups were examined both categorically and quantitatively. In th e former, the percent of children with clinical scores (those above or below a cut-off indicative of maladjustment) at baseline and postinte rvention were compared. In the latter, the mean scores at the end of t he trial were analyzed using analysis of covariance with the baseline scores as covariates. Statistically significant positive differences w ere found in the domain of anxiety/depression on the Personal Adjustme nt and Role Skills, and in the areas of scholastic competence, behavio r, and global self-worth on the Harter. Conclusion. The results indica te that this intervention helps children with chronic disorders by pre venting or reducing maladjustment. Most university-prepared nurses alr eady have the basic skills required to achieve these results; only a m odest 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 disord ers.