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Gaskin KL, Barron D, Wray J. Parents' Journeys of Mastery and Knowledge Construction After Their Infant's First Stage of Surgery for Complex Congenital Heart Disease. Compr Child Adolesc Nurs 2024; 47:68-81. [PMID: 38090784 DOI: 10.1080/24694193.2023.2293993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 12/05/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND A growing body of conceptual evidence over the last decade has increased our understanding of parents' experiences of having an infant with complex congenital heart disease. These concepts include parents' feelings of uncertainty, fear, excitement, and mastery. However, little is known about parents' experiences, confidence, and knowledge acquisition during transition from hospital to home with their infant after the first stage of complex cardiac surgery. A theoretical framework to assess, plan and implement child and family centered care would assist children's cardiac nurses responsible for parental education, discharge planning and coordination. AIM To explore parents' experiences of the transition from hospital to home with their infant, following the first stage of cardiac surgery. DESIGN A prospective mixed methods longitudinal design. Semi-structured interviews were undertaken, including administration of the Maternal Confidence Questionnaire at four timepoints: before discharge following stage one cardiac surgery (T0), 2 weeks' post discharge (T1), 8 weeks' post discharge (T2) and after stage two surgery (T3). Qualitative data were thematically analyzed. Descriptive statistics were used to characterize the sample and non-parametric repeated measures analysis of variance was used to analyze changes over time in maternal confidence scores. RESULTS Sixteen parents of 12 infants participated. Four "patterns of transition experience" emerged, the fourth "Mastery", is discussed in this paper. Mastery can be contextualized in terms of the parents' journeys of knowledge construction, gaining confidence and reflection. Learning was dynamic and transformational, but successful learning and acquisition of knowledge was also dependent upon the parents' ability to absorb, integrate and adjust at any given time. Confidence at T0 was significantly lower than at T1 (p = .011), T2 (p = .018) and T3 (p = .012). There were no significant differences between scores at T1, T2 and T3. Liminality, as a concept, described the between and betwixt time that parents experienced as they were preparing for discharge from hospital; excitement to be going home balanced with the fear of being alone and confidence in looking after their fragile infant. CONCLUSION Parents of infants with complex congenital heart disease obtain knowledge, confidence, and mastery dependent upon their transition experience and their personal journey through pre-liminal, liminal, and post-liminal phases of discharge from hospital to home. A conceptual framework "Parenting through Transitions - hospital to home" emerged that could assist in structuring assessment of parents' knowledge and support needs within a coordinated discharge process. Identifying individualized support would promote adaptation and adjustment during transition from the pre to post liminal phase, following their infant's first stage of complex cardiac surgery.
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Affiliation(s)
- Kerry L Gaskin
- Children's Cardiac Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham Children's Hospital, Birmingham, UK
- Three Counties School of Nursing and Midwifery, University of Worcester, Worcester, UK
| | - David Barron
- Children's Cardiac Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham Children's Hospital, Birmingham, UK
- Division Head Cardiac Surgery, Hospital for Sick Children, Toronto, Canada
- CIT Endowed Chair, Professor of Surgery, University of Toronto, Toronto, Canada
| | - Jo Wray
- Health Psychology, Heart and Lung Directorate, Great Ormond Street Hospital for Children, London, UK
- Heart and Lung Directorate, NIHR Great Ormond Street Biomedical Research Centre, London, UK
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Bryant RA. Attachment processes in posttraumatic stress disorder: A review of mechanisms to advance theories and treatments. Clin Psychol Rev 2023; 99:102228. [PMID: 36493729 DOI: 10.1016/j.cpr.2022.102228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/31/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022]
Abstract
Current conceptualisations of posttraumatic stress disorder (PTSD) are driven by biological, learning, and cognitive models that have shaped current treatments of the disorder. The strong influence of these models has resulted in a relative neglect of social mechanisms that can influence traumatic stress. There is abundant evidence from experimental, observational, and clinical studies that social factors can moderate many of the mechanisms articulated in prevailing models of PTSD. In this review it is proposed that attachment theory provides a useful framework to complement existing models of PTSD because it provides explanatory value for social factors can interact with biological, learning, and cognitive processes that shape traumatic stress response. The review provides an overview of attachment theory in the context of traumatic stress, outlines the evidence for how attachment factors can moderate stress responses and PTSD, and considers how harnessing attachment processes may augment recovery from and treatment of PTSD. This review emphasizes that rather than conceptualizing attachment theory as an independent theory of traumatic stress, there is much to gain by integrating attachment mechanisms into existing models of PTSD to accommodate the interactions between cognitive, biological, and attachment processes.
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Jankowska DM, Omelańczuk I, Pisula E, Karwowski M. Evaluation of the Polish version of the Parenting Sense of Competence Scale in parents of typically developing children and children with autism spectrum disorders. Child Care Health Dev 2022; 48:443-454. [PMID: 34897764 DOI: 10.1111/cch.12945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 10/19/2021] [Accepted: 11/26/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Parental self-efficacy describes parents' self-perceived competence in fulfilling their roles. The Parenting Sense of Competence Scale (PSOC) is one of the most commonly used self-report instruments, allowing for parental self-efficacy measurement. METHODS This paper summarizes the results of three studies (total N = 2088) conducted to examine factor structure, internal consistency, test-retest reliability and criterion validity of the Polish version of PSOC (PSOC-PL). The studies were carried out among parents (mothers and fathers) of typically developing 14- and 15-year-olds (Study 1, n = 1404) as well as among parents of typically developing children aged 6-16 (Study 2, n = 248), parents of typically developing children and children with a diagnosis of autism spectrum disorder (Study 3, n = 436, ages ranged from 6 to 13). RESULTS Confirmatory factor analysis (Study 1) demonstrated an acceptable fit of the theorized two-factor model, with theorized Satisfaction and Efficacy factors. The subscales' internal consistencies were satisfactory across all studies (Studies 1-3), and PSOC's test-retest reliability (Study 2) over a 3-week interval was very high. Parents of children with developmental disorders (Study 3) reported lower efficacy than parents of typically developing children. CONCLUSIONS The results of these three studies attest that the Polish version of PSOC is a reliable and valid measure of parental self-efficacy beliefs.
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Affiliation(s)
- Dorota M Jankowska
- Department of Educational Sciences, The Maria Grzegorzewska University, Warsaw, Poland
| | - Iwona Omelańczuk
- Department of Educational Sciences, The Maria Grzegorzewska University, Warsaw, Poland
| | - Ewa Pisula
- Faculty of Psychology, University of Warsaw, Warsaw, Poland
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Topal S, Çaka SY, Yuvacı HU, Çınar N. Factors Affecting Paternal Fetal Attachment. INTERNATIONAL JOURNAL OF CHILDBIRTH 2020. [DOI: 10.1891/ijcbirth-d-19-00022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIMThere are very few studies examining how the prenatal attachment of the father to the fetus affects father–infant attachment, while there are numerous studies on maternal–fetal, maternal–infant attachment. The pregnancy period is a potential opportunity to increase the paternal attachment of fathers whose wives are expecting a baby. The aim of this study was to determine paternal–fetal attachment and the factors with an effect.METHODSThe sample group of this descriptive (comparative) study consisted of expectant fathers accompanied by their wives at 24–36 weeks of pregnancy (n = 182). Ethics committee approval and the necessary permissions were obtained from the relevant institution. The data were collected by the researchers using the Question Form and Paternal Fetal Attachment Scale. The data collected were analyzed using percentage distribution, the Independent samples t test and the one-way analysis of variance (ANOVA) test.RESULTSThe results of the study showed that the participants who experienced fatherhood for the first time and felt ready to be a father had higher paternal attachment scores than experienced fathers.CONCLUSIONFor the establishment of healthy attachment starting in the prenatal period and continuing thereafter, there are important tasks for healthcare professionals to ensure that fathers can cope with the new roles and responsibilities just as well as the mothers.
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Parents' Experiences of Transition From Hospital to Home After Their Infant's First-Stage Cardiac Surgery: Psychological, Physical, Physiological, and Financial Survival. J Cardiovasc Nurs 2020; 36:283-292. [PMID: 32842034 DOI: 10.1097/jcn.0000000000000727] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The intersurgical stage is a critical time for fragile infants with complex congenital heart disease, but little is known about the impact on parents. OBJECTIVE The aim of this study was to explore parents' experiences of the transition from hospital to home with their infant after stage 1 cardiac surgery for complex congenital heart disease. METHOD This is a prospective, longitudinal, mixed methods feasibility study using semistructured interviews and self-report instruments at 4 time points: before discharge (baseline), 2 weeks post discharge, 8 weeks post discharge, and after stage 2 surgery. Qualitative data were analyzed thematically; and quantitative data, descriptively. RESULTS Sixteen parents of 12 infants participated. All parents described signs of acute stress disorder; 4 parents described symptoms of posttraumatic stress disorder before discharge. Parents' fear and uncertainty about going home were multifaceted, underpinned by exposure to numerous traumatic events. By 8 weeks post discharge, parents' feelings and emotions were positive, relieved, and relaxed. Mean generalized anxiety and depression scores were higher before discharge; most individual anxiety and depression scores decreased over time. Physiological survival included self-care needs, such as eating and sleeping properly. Physical survival included preparation of the home environment and home alterations adapting to their infant's equipment needs. Financial survival was a burden, particularly for those unable to return to work. CONCLUSION Patterns of experience in surviving the transition included psychological, physical, physiological, and financial factors. Authors of further longitudinal research could test the effectiveness of psychological preparation interventions, while encouraging early consideration of the other factors influencing parents' care of their infant after discharge from hospital.
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Gaskin K, Kennedy F. Care of infants, children and adults with congenital heart disease. Nurs Stand 2020; 34:37-42. [PMID: 31468777 DOI: 10.7748/ns.2019.e11405] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2019] [Indexed: 12/13/2022]
Abstract
Congenital heart disease refers to an anatomical or physiological defect of the heart that is present at birth. Over the past three decades there have been significant advances in surgical, medical and nursing care for infants and children requiring cardiac surgery for congenital heart disease. This has meant that the number of adults with moderate and complex congenital heart disease now exceeds the number of children with the disease. This article details the background and diagnosis of congenital heart disease. It considers the implications for infants and children with congenital heart disease, as well as their parents, such as screening methods, risk factors, parental stress and psychosocial needs. This article also discusses the care of adults with congenital heart disease, including specialist monitoring and patient education.
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Affiliation(s)
- Kerry Gaskin
- Three Counties School of Nursing and Midwifery, University of Worcester, Worcester, England, and chairperson of the Congenital Cardiac Nurses Association
| | - Fiona Kennedy
- Barts Health NHS Trust, London, England, and member of the British Adult Congenital Cardiac Nurses Association
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Vance AJ, Pan W, Malcom WH, Brandon DH. Development of parenting self-efficacy in mothers of high-risk infants. Early Hum Dev 2020; 141:104946. [PMID: 31901656 PMCID: PMC7249225 DOI: 10.1016/j.earlhumdev.2019.104946] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/23/2019] [Accepted: 12/24/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of this prospective, longitudinal study was to (1) examine the development of parenting self-efficacy (PSE), (2) explore the influence of contextual factors (e.g., family functioning, family centered care, and infant medical caregiving complexity) on PSE development, and (3) whether PSE and contextual factors predict parent and infant health outcomes in a high-risk infant population. METHOD Mothers (n = 67) of infants diagnosed with a complex medical condition following birth were enrolled within 3 weeks of their infant's diagnosis and admission to intensive care. Participants completed an online study survey at study enrollment (T1), infant discharge (T2), and 3 months after discharge (T3). Change in PSE was examined using mixed modeling and predictors of parent and infant health outcomes were explored using multiple regression. RESULTS PSE significantly increased over time (b = 2.08, p < .0001). Family functioning was the only significant contextual factor, where worse family functioning at enrollment was associated with lower confidence over time. Mothers who were older and had more than one child were significant predicators of higher PSE. Interestingly, being married, compared to being single, was associated with decreased PSE. Higher PSE was also predictive of positive maternal psychological wellbeing at 3 months after discharge and a decrease in infant's medical complexity was associated with higher maternal psychological well-being. CONCLUSION These are important findings given that PSE is known to contribute to infant development and health status.
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Affiliation(s)
- Ashlee J. Vance
- National Clinical Scholars Program, Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Ave, Ann Arbor, MI 48109, University of Michigan School of Nursing, 400 N Ingalls, Ann Arbor, MI 48109
| | - Wei Pan
- Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710, United States of America.
| | | | - Debra H. Brandon
- Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710, Duke University Medical Center, 5023 Hock Plaza, Durham, NC 27710
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Psychometric Properties of the Italian Perceived Maternal Parenting Self-Efficacy (PMP S-E). J Clin Psychol Med Settings 2018; 26:173-182. [PMID: 30132096 DOI: 10.1007/s10880-018-9578-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
To validate the Italian Perceived Maternal Parenting Self-Efficacy (PMP S-E), the first questionnaire specifically developed for mothers of preterm neonates hospitalized in the Neonatal Intensive Care Unit. Two hundred mothers filled the PMP S-E, the General Self-Efficacy Scale (GSES), the Edinburgh Postnatal Depression Scale (EPDS), the Parental Distress Index (PSI-SF/Pd). The Explanatory Factor Analysis outlined four factors: care-taking procedures, evoking behaviours, reading and managing bodily cues, reading and managing emotional cues. This factor-solution demonstrated adequate goodness of fit when the Confirmatory Factor Analysis was carried out. Internal consistency was high for the overall scale (α = 0.932), and the all the factors (all α > 0.80). There was a moderate correlation with GSES (r = .438; p < .001), while the associations with EPDS (r = .295; p < .001) and PSI-SF/Pd (r = .193; p = .006) were low. Good test-retest reliability was found over 2 weeks (r = .73; p < .001). These findings support the validity and reliability of the Italian PMP S-E.
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Vance AJ, Brandon DH. Delineating Among Parenting Confidence, Parenting Self-Efficacy, and Competence. ANS Adv Nurs Sci 2018; 40:E18-E37. [PMID: 28825934 PMCID: PMC5664183 DOI: 10.1097/ans.0000000000000179] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This article examined the concepts of parenting self-efficacy, parenting confidence, and competence. Using Morse's method of concept delineation, a literature review of each concept was conducted to uncover commonalities, distinctions, and measurement overlaps between concepts and provide conceptual boundaries. Findings revealed that parenting confidence and parenting self-efficacy describe a parents' internal attribution or beliefs about their ability to engage in parenting behaviors. Both terms have similar antecedents, attributes, and consequences, whereas competence is a concept that should be used as an objective measure by someone other than the parent to assess parenting quality.
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Affiliation(s)
- Ashlee J Vance
- Division of Women and Children (Dr Brandon), Duke University School of Nursing (Ms Vance), Durham, North Carolina
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Findler L, Klein Jacoby A, Gabis L. Subjective happiness among mothers of children with disabilities: The role of stress, attachment, guilt and social support. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 55:44-54. [PMID: 27037989 DOI: 10.1016/j.ridd.2016.03.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 03/07/2016] [Accepted: 03/10/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Parenting a child with disabilities might affect the happiness of the mothers. Hence we adapted Wallander, Varni, Babani, Banis, and Wilcox's (1989) disability-stress-coping model to examine the impact of risk factors (specific stressors related to the child's disability) on the mother's adaptation (happiness). Intrapersonal factors (attachment) and social-ecological factors (social support) were hypothesized to predict adaptation. Both constitute 'risk-resistant' factors, which are mediated by the mother's perceived general stress and guilt. METHOD 191 mothers of a child with a developmental disability (ages 3-7) answered questionnaires on happiness, specific and general stress, attachment, guilt and social support. RESULTS Attachment avoidance was directly and negatively associated with mothers' happiness. General stress was negatively associated with happiness, and mediated the association between anxious attachment, support, and specific stress with happiness. Guilt was negatively associated with happiness, and served as a mediator between attachment anxiety and support and happiness. CONCLUSION The findings of the current research show direct and indirect associations of risk factors with happiness and the role of general stress and feelings of guilt as mediators. IMPLICATIONS This study stresses the importance of attachment and social support to happiness and sheds light on the unique role of guilt in promoting or inhibiting happiness.
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Affiliation(s)
- Liora Findler
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat-Gan 5290002, Israel.
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Baumann SL, Braddick M. On Being a Father or Sibling in Light of the Humanbecoming Family Model. Nurs Sci Q 2015; 29:47-53. [PMID: 26660776 DOI: 10.1177/0894318415614902] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The following article provides an updated discussion on two Parse grounded exploratory descriptive studies in light to her recently added humanbecoming family model. The comments of the fathers and siblings from the studies reveal that family life is unpredictable and that family relationships are paradoxical evolutional emergences of shifting hopes and dreams. The humanbecoming family model provided a useful way to consider fathering and being a sibling, as unexpected unfoldings of joy-sorrow reveal purposeful new possibilities. It guides health professionals to avoid the imposition of their views on what is best for the family in favor of bearing witness to the suffering and disappointments that unfold in family life. It is important to remain open to families' sources of meaning, courage, and hope in the moment.
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