Hilary Espezel - Academia.edu (original) (raw)
Papers by Hilary Espezel
Journal of Visual Impairment & Blindness, 1996
This article presents a study of the use of melatonin to treat sleep-wake-cycle disorders in 100 ... more This article presents a study of the use of melatonin to treat sleep-wake-cycle disorders in 100 visually impaired children aged 3 months to 17 years. The study found that these disorders are correlated with the children's visual diagnoses, visual loss, age, associated disabilities, level of independence, and type of placement and that the use of oral melatonin ameliorates these disorders without side effects and leads to numerous benefits, both to the children and their caregivers.
An interpretive descriptive design was used to explore and describe parents' experiences of i... more An interpretive descriptive design was used to explore and describe parents' experiences of interacting with nurses regarding the care of their children with chronic health conditions, and to gain a better understanding of these experiences from the parents' perspectives. Eight parents, representing seven families, participated in audiotaped interviews. Data were analyzed concurrently with data collection, and the three themes of establishing rapport, meeting parental needs for information and support, and,negotiating care,
Journal of nursing care quality
Today's nursing students need an understanding of quality and safety (Q/S) concepts as well a... more Today's nursing students need an understanding of quality and safety (Q/S) concepts as well as the nurse's role in all phases of Q/S activities. Nursing students' Q/S learning experiences are typically anecdotal. This article describes a practice-academic partnership that raised students' awareness of Q/S within the practice environment. This partnership also resulted in healthcare providers' increased commitment to a culture of safety.
Developmental Medicine and Child Neurology, Jun 1, 2003
International journal of nursing studies, 2012
Estimates of incidents (adverse events) occurring during inpatient hospital stays suggest patient... more Estimates of incidents (adverse events) occurring during inpatient hospital stays suggest patient safety demands attention. Improving the safety of health care systems requires understanding incidents and their causes. Labour and delivery nurses can contribute to understanding incidents and incident reporting because they actively identify and report incidents in practice. To explore Canadian labour and delivery nurses' perceptions about reporting incidents in practice and identify factors facilitating or constraining incident reporting. A descriptive qualitative study design using focus groups to collect data. Three labour and delivery units within one health authority in the province of British Columbia. Sixteen registered nurses participated in one of four focus groups between 2009 and 2010. We audio-taped interviews, transcribed the data, and analysed interview data using inductive content analysis and constant comparison. We identified four main themes. The themes included ...
Pediatric Neurology, 1994
A debilitating, regularly recurring, biphasic disorder is described in 6 severely multidisabled c... more A debilitating, regularly recurring, biphasic disorder is described in 6 severely multidisabled children. It was characterized by several days of lethargy, withdrawal, loss of abilities, irritability, and hypersomnolence followed or preceded by a high-energy state for several days during which the children slept very little, at times were euphoric, had improved mental ability, and were hyperactive. These cyclic episodes had been present for years but unexpectedly disappeared in one child. The etiology is unknown, in spite of detailed neurologic, metabolic, and endocrine investigations. All patients had family histories positive for affective disorder. Melatonin treatment helped to regulate the coexisting chronic sleep disorders of 3 children but failed to eliminate the cycles. Antiepileptic drug treatment, lithium, sedatives, stimulants, tranquilizers, and light therapy were largely ineffective. The children's symptoms and signs fit the diagnostic criteria of a bipolar affective illness, as it was modified for patients with associated neurologic disability; therefore, the patients appeared to have a unique disorder that closely resembles or is a variant of rapid cycling affective disorder.
Journal of Child Neurology, 1998
Journal of Advanced Nursing, 2003
Parent-nurse interactions: care of hospitalized children Background. An essential component of qu... more Parent-nurse interactions: care of hospitalized children Background. An essential component of quality nursing care is nurses' ability to work with parents in the hospital care of their children. However, changes in the health care environment have presented nurses with many new challenges, including meeting family-centred care expectations. Aim of the paper. To report a research study examining the experiences of parents who interacted with nurses in a hospital setting regarding the care of their children. Methods. A qualitative approach was employed for this study. In-depth audiotaped interviews were conducted with eight parents representing seven families. Data collection was completed over a 7-month period in 2001. Findings. Parents characterized their experiences with nurses caring for their children as interactions, and identified the elements of establishing rapport and sharing children's care as key to a positive perception of the interactions. These elements were influenced by parental expectations of nurses. Changes in nurses' approach were reported by parents as the children's conditions changed. Conclusion. Nurses were able to work with families in the hospital care of their children in ways that parents perceived as positive. However, in parents' views, their interactions with nurses did not constitute collaborative relationships. A deeper understanding of these interactions may provoke new thinking about how to promote an agency's philosophy, and how nurses enact this philosophy in practice.
Developmental Medicine & Child Neurology, 2008
ABSTRACT Eye-poking, -rubbing and -pressing are often incorrectly grouped together because of the... more ABSTRACT Eye-poking, -rubbing and -pressing are often incorrectly grouped together because of the assumption that they represent variations of the same self-stimulating behaviour. This prospective study of 21 children shows that eye-poking is a distinct, chronic, stereotyped, self-injurious act seen mainly among severely mentally disabled individuals, who may or may not be visually impaired. Eye-poking, which leads to intense, self-induced pain, is a harmful behaviour because it can result in permanent visual loss and even in total blindness. The cause is unclear, although it is probably multifactorial. The treatment is exceedingly difficult. Further studies are needed to develop specific management techniques to prevent eye-poking, which adds to the physical and emotional burden on the caregivers.
Developmental Medicine & Child Neurology, 2008
Developmental Medicine & Child Neurology, 2007
Melatonin as a sedation substitute for diagnostic procedures: MRI and EEG' SIR-We read with inter... more Melatonin as a sedation substitute for diagnostic procedures: MRI and EEG' SIR-We read with interest the experience of Espezel and colleagues 1 with the use of melatonin for Auditory Brainstem Response Threshold (ABR) testing. We too have used melatonin as a sedation substitute for diagnostic procedures. Espezel et al. report disappointing results. Only three of six children had successful ABRs. Although five of the six children fell asleep, none of the children stayed asleep during the test. We have used melatonin for EEGs in 30 children 2 . Twentyfour fell asleep after a mean of 21 minutes and an EEG was obtained in 28 children. We have also used melatonin as a sedative substitute for brain MRI in 27 children. This was less successful. Only 16 of 27 children fell asleep after a mean of 31 minutes and a satisfactory MRI was obtained in 12 children. Seven of the 16 children woke up during the procedure. The main difference between the EEG and MRI settings is the noisy environment of the MRI. Another difference is that during MRI the child is moved onto the scanner bed (although only three of 16 sleeping children woke up with movement). Like Espezel et al. we hypothesize that melatonin may not sufficiently mask environment disrupters of sleep. Noise disrupts normal sleep. Although melatonin induces sleep it cannot be relied upon to maintain sleep in a noisy environment. We agree with Espezel et al. that melatonin can be useful for diagnostic procedures as a sleep inducer, but is less useful in noisy environments.
Developmental Medicine & Child Neurology, 2008
Fifteen children (most of whom were neurologically multiply disabled) with severe, chronic sleep ... more Fifteen children (most of whom were neurologically multiply disabled) with severe, chronic sleep disorders were treated with 2 to 10mg of oral melatonin, given at bedtime. Nine had fragmented sleep patterns, three had delayed sleep onset and three others had non-specific sleep disturbance of unclear aetiology; all had failed to respond to conventional management. Nine patients had ocular or cortical visual impairment. The health, behavioural and social benefits of treatment were significant, and there were no adverse side-effects. While the response was not always complete, the study clearly showed that melatonin has an important role in the treatment of certain types of chronic sleep disorders.
Developmental Medicine & Child Neurology, 2003
Child: Care, Health and Development, 2012
While evidence suggests sleep problems are common in young children and linked to behavioural pro... more While evidence suggests sleep problems are common in young children and linked to behavioural problems, studies of toddlers are rare. This community-based cross-sectional study examined associations between sleep problems and daytime behaviour among 58 children aged 1 to 3 years who attended daycare centres. Mothers and daycare providers completed four and three questionnaires, respectively, about children's sleep patterns and behaviour. Two hypotheses were tested: (1) children with higher sleep problem scores would have more behavioural problems by parental and daycare provider report; (2) problematic napping behaviours would be associated with night sleep problems. Mothers' reports of sleep problems were positively associated with children's behavioural problems at home and daycare providers' reports of nap problems were positively correlated with children's behavioural problems at daycare. Daycare providers' reports of children's behavioural problems at daycare were associated with maternal reports of behavioural problems. Older children in the sleep problem group had maternal reports of more behavioural problems. Daycare providers reported that children with sleep problems were less happy at daycare. Children who were happier following naps had less reported night settling difficulties. Children with difficulty settling for naps at daycare had maternal reports of more behavioural problems. Napping in daycare settings is an important component of toddlers' sleep. Crossover effects between children's sleep and behaviour at daycare and home indicate similarities in mothers' and daycare providers' perceptions. Findings suggest parent and daycare provider interactions include discussions about sleep problems and settling at home and in daycares. Parents and daycare providers would benefit from education about relationships between sleep and behavioural problems.
Journal of Nursing Care Quality, 2009
Today's nursing students need an understanding of quality... more Today's nursing students need an understanding of quality and safety (Q/S) concepts as well as the nurse's role in all phases of Q/S activities. Nursing students' Q/S learning experiences are typically anecdotal. This article describes a practice-academic partnership that raised students' awareness of Q/S within the practice environment. This partnership also resulted in healthcare providers' increased commitment to a culture of safety.
Journal of Visual Impairment & Blindness, 1996
This article presents a study of the use of melatonin to treat sleep-wake-cycle disorders in 100 ... more This article presents a study of the use of melatonin to treat sleep-wake-cycle disorders in 100 visually impaired children aged 3 months to 17 years. The study found that these disorders are correlated with the children's visual diagnoses, visual loss, age, associated disabilities, level of independence, and type of placement and that the use of oral melatonin ameliorates these disorders without side effects and leads to numerous benefits, both to the children and their caregivers.
An interpretive descriptive design was used to explore and describe parents' experiences of i... more An interpretive descriptive design was used to explore and describe parents' experiences of interacting with nurses regarding the care of their children with chronic health conditions, and to gain a better understanding of these experiences from the parents' perspectives. Eight parents, representing seven families, participated in audiotaped interviews. Data were analyzed concurrently with data collection, and the three themes of establishing rapport, meeting parental needs for information and support, and,negotiating care,
Journal of nursing care quality
Today's nursing students need an understanding of quality and safety (Q/S) concepts as well a... more Today's nursing students need an understanding of quality and safety (Q/S) concepts as well as the nurse's role in all phases of Q/S activities. Nursing students' Q/S learning experiences are typically anecdotal. This article describes a practice-academic partnership that raised students' awareness of Q/S within the practice environment. This partnership also resulted in healthcare providers' increased commitment to a culture of safety.
Developmental Medicine and Child Neurology, Jun 1, 2003
International journal of nursing studies, 2012
Estimates of incidents (adverse events) occurring during inpatient hospital stays suggest patient... more Estimates of incidents (adverse events) occurring during inpatient hospital stays suggest patient safety demands attention. Improving the safety of health care systems requires understanding incidents and their causes. Labour and delivery nurses can contribute to understanding incidents and incident reporting because they actively identify and report incidents in practice. To explore Canadian labour and delivery nurses' perceptions about reporting incidents in practice and identify factors facilitating or constraining incident reporting. A descriptive qualitative study design using focus groups to collect data. Three labour and delivery units within one health authority in the province of British Columbia. Sixteen registered nurses participated in one of four focus groups between 2009 and 2010. We audio-taped interviews, transcribed the data, and analysed interview data using inductive content analysis and constant comparison. We identified four main themes. The themes included ...
Pediatric Neurology, 1994
A debilitating, regularly recurring, biphasic disorder is described in 6 severely multidisabled c... more A debilitating, regularly recurring, biphasic disorder is described in 6 severely multidisabled children. It was characterized by several days of lethargy, withdrawal, loss of abilities, irritability, and hypersomnolence followed or preceded by a high-energy state for several days during which the children slept very little, at times were euphoric, had improved mental ability, and were hyperactive. These cyclic episodes had been present for years but unexpectedly disappeared in one child. The etiology is unknown, in spite of detailed neurologic, metabolic, and endocrine investigations. All patients had family histories positive for affective disorder. Melatonin treatment helped to regulate the coexisting chronic sleep disorders of 3 children but failed to eliminate the cycles. Antiepileptic drug treatment, lithium, sedatives, stimulants, tranquilizers, and light therapy were largely ineffective. The children's symptoms and signs fit the diagnostic criteria of a bipolar affective illness, as it was modified for patients with associated neurologic disability; therefore, the patients appeared to have a unique disorder that closely resembles or is a variant of rapid cycling affective disorder.
Journal of Child Neurology, 1998
Journal of Advanced Nursing, 2003
Parent-nurse interactions: care of hospitalized children Background. An essential component of qu... more Parent-nurse interactions: care of hospitalized children Background. An essential component of quality nursing care is nurses' ability to work with parents in the hospital care of their children. However, changes in the health care environment have presented nurses with many new challenges, including meeting family-centred care expectations. Aim of the paper. To report a research study examining the experiences of parents who interacted with nurses in a hospital setting regarding the care of their children. Methods. A qualitative approach was employed for this study. In-depth audiotaped interviews were conducted with eight parents representing seven families. Data collection was completed over a 7-month period in 2001. Findings. Parents characterized their experiences with nurses caring for their children as interactions, and identified the elements of establishing rapport and sharing children's care as key to a positive perception of the interactions. These elements were influenced by parental expectations of nurses. Changes in nurses' approach were reported by parents as the children's conditions changed. Conclusion. Nurses were able to work with families in the hospital care of their children in ways that parents perceived as positive. However, in parents' views, their interactions with nurses did not constitute collaborative relationships. A deeper understanding of these interactions may provoke new thinking about how to promote an agency's philosophy, and how nurses enact this philosophy in practice.
Developmental Medicine & Child Neurology, 2008
ABSTRACT Eye-poking, -rubbing and -pressing are often incorrectly grouped together because of the... more ABSTRACT Eye-poking, -rubbing and -pressing are often incorrectly grouped together because of the assumption that they represent variations of the same self-stimulating behaviour. This prospective study of 21 children shows that eye-poking is a distinct, chronic, stereotyped, self-injurious act seen mainly among severely mentally disabled individuals, who may or may not be visually impaired. Eye-poking, which leads to intense, self-induced pain, is a harmful behaviour because it can result in permanent visual loss and even in total blindness. The cause is unclear, although it is probably multifactorial. The treatment is exceedingly difficult. Further studies are needed to develop specific management techniques to prevent eye-poking, which adds to the physical and emotional burden on the caregivers.
Developmental Medicine & Child Neurology, 2008
Developmental Medicine & Child Neurology, 2007
Melatonin as a sedation substitute for diagnostic procedures: MRI and EEG' SIR-We read with inter... more Melatonin as a sedation substitute for diagnostic procedures: MRI and EEG' SIR-We read with interest the experience of Espezel and colleagues 1 with the use of melatonin for Auditory Brainstem Response Threshold (ABR) testing. We too have used melatonin as a sedation substitute for diagnostic procedures. Espezel et al. report disappointing results. Only three of six children had successful ABRs. Although five of the six children fell asleep, none of the children stayed asleep during the test. We have used melatonin for EEGs in 30 children 2 . Twentyfour fell asleep after a mean of 21 minutes and an EEG was obtained in 28 children. We have also used melatonin as a sedative substitute for brain MRI in 27 children. This was less successful. Only 16 of 27 children fell asleep after a mean of 31 minutes and a satisfactory MRI was obtained in 12 children. Seven of the 16 children woke up during the procedure. The main difference between the EEG and MRI settings is the noisy environment of the MRI. Another difference is that during MRI the child is moved onto the scanner bed (although only three of 16 sleeping children woke up with movement). Like Espezel et al. we hypothesize that melatonin may not sufficiently mask environment disrupters of sleep. Noise disrupts normal sleep. Although melatonin induces sleep it cannot be relied upon to maintain sleep in a noisy environment. We agree with Espezel et al. that melatonin can be useful for diagnostic procedures as a sleep inducer, but is less useful in noisy environments.
Developmental Medicine & Child Neurology, 2008
Fifteen children (most of whom were neurologically multiply disabled) with severe, chronic sleep ... more Fifteen children (most of whom were neurologically multiply disabled) with severe, chronic sleep disorders were treated with 2 to 10mg of oral melatonin, given at bedtime. Nine had fragmented sleep patterns, three had delayed sleep onset and three others had non-specific sleep disturbance of unclear aetiology; all had failed to respond to conventional management. Nine patients had ocular or cortical visual impairment. The health, behavioural and social benefits of treatment were significant, and there were no adverse side-effects. While the response was not always complete, the study clearly showed that melatonin has an important role in the treatment of certain types of chronic sleep disorders.
Developmental Medicine & Child Neurology, 2003
Child: Care, Health and Development, 2012
While evidence suggests sleep problems are common in young children and linked to behavioural pro... more While evidence suggests sleep problems are common in young children and linked to behavioural problems, studies of toddlers are rare. This community-based cross-sectional study examined associations between sleep problems and daytime behaviour among 58 children aged 1 to 3 years who attended daycare centres. Mothers and daycare providers completed four and three questionnaires, respectively, about children's sleep patterns and behaviour. Two hypotheses were tested: (1) children with higher sleep problem scores would have more behavioural problems by parental and daycare provider report; (2) problematic napping behaviours would be associated with night sleep problems. Mothers' reports of sleep problems were positively associated with children's behavioural problems at home and daycare providers' reports of nap problems were positively correlated with children's behavioural problems at daycare. Daycare providers' reports of children's behavioural problems at daycare were associated with maternal reports of behavioural problems. Older children in the sleep problem group had maternal reports of more behavioural problems. Daycare providers reported that children with sleep problems were less happy at daycare. Children who were happier following naps had less reported night settling difficulties. Children with difficulty settling for naps at daycare had maternal reports of more behavioural problems. Napping in daycare settings is an important component of toddlers' sleep. Crossover effects between children's sleep and behaviour at daycare and home indicate similarities in mothers' and daycare providers' perceptions. Findings suggest parent and daycare provider interactions include discussions about sleep problems and settling at home and in daycares. Parents and daycare providers would benefit from education about relationships between sleep and behavioural problems.
Journal of Nursing Care Quality, 2009
Today's nursing students need an understanding of quality... more Today's nursing students need an understanding of quality and safety (Q/S) concepts as well as the nurse's role in all phases of Q/S activities. Nursing students' Q/S learning experiences are typically anecdotal. This article describes a practice-academic partnership that raised students' awareness of Q/S within the practice environment. This partnership also resulted in healthcare providers' increased commitment to a culture of safety.