Parental guidance and counselling by doctors and nursing staff: parents' views of initial information and advice for families with disabled children

[Psychoeducation for Parents of Children with Learning Disorders: A Satisfaction Study]

Psychoeducation for Parents of Children with Learning Disorders: A Satisfaction Study The present study investigates the implementation of psychoeducation for conveying a diagnosis of specific learning disorders to the parents of affected children. It addresses the question of how such consultations are structured and which factors predict how satisfied parents are with the psychoeducation they receive. 167 parents of children with specific learning disorders from Germany were surveyed via an online questionnaire and asked about their experiences and satisfaction with the psychoeducational aspects of their individual consultation. The results show that the implementation of psychoeducation was strongly heterogeneous. For example, the duration of the consultation varied from 4 to 120 minutes and the child in question was only present in around half of the cases. The methodical diversity was rather limited and the causes of learning disorders were rarely discussed with the parents. 54 % of the parents were satisfied or very satisfied with the psychoeducation. The findings of a regression analysis show that the consultant's professional and emotional competence as well as the practical value significantly predicted the parents' satisfaction. Overall, this regression model is able to explain 81.8 % variance in parents' satisfaction. An open and empathetic atmosphere during the consultation as well as specific and practical tips on how to support their child are particularly important.

Improving education and coping of scoliosis patients undergoing surgery, and their families, using e-health

PURPOSE

Healthcare providers have limited time to spend with scoliosis patients who are considering surgery and their families. The purpose of this study was to evaluate an e-health strategy to increase knowledge and coping in patients with scoliosis who are surgical candidates and their families.

METHODS

We enrolled patients with scoliosis who were candidates for surgery and their families. Patients and their families completed the scoliosis knowledge questionnaire, meaning of illness questionnaire, social support and coping questionnaires before and after access to a comprehensive evidence-based scoliosis website ( http://www.aboutkidshealth.ca/scoliosis ).

RESULTS

Seventy-four patients and 71 parents completed the evaluation. While both patients and parents improved their knowledge of scoliosis (p = 0.001 and p = 0.003, respectively), the scores of patients were consistently lower than those of the parents both before and after website use (p = 0.0001). Only parents demonstrated a change in the meaning of illness questionnaire, with a small increase in the negative attitude towards illness and a small decrease in the positive attitude towards illness (p = 0002 and p = 0.01, respectively). Of the 12 coping methods examined on the Adolescent Coping Orientation for Problem Experiences (A-COPE) instrument, patients were slightly more likely than parents to use relaxing and solving family problems as tools to cope following website access (p = 0.02 and p = 0.09, respectively). Parents demonstrated no significant changes in the four methods of coping on the Coping Health Inventory for Parents (CHIP) after website exposure. While the majority of patients and parents reported receiving sufficient support, over half of the patients indicated a need for more support in social participation.

CONCLUSION

An evidence-based website increased the knowledge of patients and parents but simply providing access to the website had minimal impact on their coping and perceptions of social support. The website, however, provides users with the opportunity to absorb vital information about scoliosis across several media.

Quality of life and coping strategies of caregivers of children with physical and mental disabilities

Background:

Developmental disability is a term that refers to permanent cognitive and or physical impairment. Arrested development of physical or mental capacities can lead to number of problems for the sufferer as well as the carers.

Methodology:

This study was conducted to assess the quality of life (QOL) and coping mechanisms used by the carers of physically challenged children. In this cross-sectional study, all the 116 children from a school for children with special needs in Anand, Gujarat and their carers were included. World Health Organization-QOL (WHO-QOL) and BREF COPE were administered to measure QOL and coping strategies, respectively.

Results:

On WHO-QOL, the social relationship domain was observed to be the best while environment domain had the lowest score. The main coping style used by the caregivers was Active emotional coping.

Conclusions:

Significant differences were found in QOL of the caregivers of physically challenged children based on the type of disability of the child. Rehabilitation programs can be planned to provide psychological support to the caregivers to ease the burden if any through collaborative efforts.

Neonatal diagnosis of Down syndrome in The Netherlands: suspicion and communication with parents

OBJECTIVES

To analyse which dysmorphic features are most recognised in newborns with Down syndrome (DS). Furthermore to evaluate the communication techniques used by clinicians to inform parents about the postnatal diagnosis and compare these to current best practice guidelines.

STUDY DESIGN

Prospective study of a birth cohort of newborns with DS born between 1 January 2003 and 31 December 2006 registered by the Dutch Paediatric Surveillance Unit (DPSU).

RESULTS

A total of 586 children with trisomy 21 were analysed. Most recognised dysmorphic features in DS newborns were 'upslanted palpebral fissures' (74.1%; n = 426), 'hypotonia' (73.7%; n = 424) and 'epicanthic folds' (68.5%; n = 394). The majority of parents were informed about the suspected diagnosis on the day of birth (76.5%; n = 390). Hospital deliveries had a significantly earlier suspected diagnosis (mean age 3-4 days) compared with home deliveries (mean age 7 days) (P < 0.05). In 10% (n = 44), paediatricians described dissatisfaction with the first conversation with parents. In 88.9% (n = 499) parents were both present when the diagnosis was told, however the child was not present during the conversation in 51.3% (n = 288). In 10.8% (n = 61) parents were not informed about local parent support groups or community resources.

CONCLUSION

DS is still often diagnosed after birth, usually on the first day of postnatal life. Most identified clinical features were upslanted palpebral fissures, epicanthic folds and hypotonia. Special attention for recognition of all present clinical features is needed for early diagnosis. Appropriate communication with the parents of the message that their child has DS can be difficult. Guidelines can help to make counselling easier and more effective, which in turn may increase parental satisfaction. Not all recommendations for the first conversation with parents were fully implemented in Dutch clinical practice.

Breaking Bad News: Doctors' Feelings and Behaviors

The announcement about the handicap of a child is communicated to parents by gynecologists or ultrasonographists, in the prenatal period. Often, these professionals are not prepared to communicate this news to the parents, and they have some limitations that lead them to act inappropriately. Therefore, the aims of this research were to identify and to describe the feelings of professionals facing this situation, and to examine their behaviors when they have to inform a couple about the child's anomaly. Ten gynecologists and ultrasonographists were interviewed: five were consultants in Public Health Services and five were private clinicians. Interviews were carried out with a semi-structured script. The results showed that, according to the participants, there is no specific moment, nor a standard behavior, that is most appropriate for making such an announcement. Yet the data show that all the participants feel hurt or frustrated when they must announce this phenomenon, becoming involved with the case. In conclusion, no graduate course has prepared them to deal with this deficiency. Suggestions are made concerning the graduate curriculum in order to improve the preparation of future doctors. A mental health professional is even necessary among the multidisciplinary team formed to deal with the pain produced in the moment of the announcement.

The clinical profile of mentally retarded children in India and prevalence of depression in mothers of the mentally retarded

BACKGROUND

Mental retardation (MR) has a varied phenomenology in different parts of the world. While studying MR, psychological issues of caretakers are equally relevant. A study to investigate the phenomenology of MR in Indian children and the prevalence of depression in their mothers was planned in a teaching institute in Madhya Pradesh with an attached tertiary care hospital.

OBJECTIVES

The objective of the following study is to study the clinical profile of mentally retarded children in the study sample, prevalence of depression in the mothers and investigate various factors affecting it.

STUDY DESIGN

A cross-sectional study.

MATERIALS AND METHODS

A total of 60 patients diagnosed as MR were included in the study. Objective data was collected in a special proforma and mothers of these individuals were subjected to evaluation with Beck's Anxiety Inventory and the 17 item Hamilton Rating Scale for Depression.

RESULTS

The mean age of patients in the sample was 11.6 years, had received an average of 2.42 years of schooling, mean age at diagnosis of MR was 6.5 years and their mean IQ was 53. Out of the total 60 patients, 88% of the patients had significant co-morbidities. The prevalence of depression in mothers was 85% and it was more in mothers of, the ones with significant co-morbidities (OR = 2.67), severer forms of retardation and with higher levels of anxiety in the mother.

CONCLUSIONS

Prevalence of depression in mothers of mentally retarded children in India seems to be much greater than those reported from studies around the world. Medical services offered to the mentally retarded should move from an individual level to the family level, especially toward the mothers, who are the main caretakers. Counseling services, treatment if required and regular screening of mothers of the mentally retarded should be included in the protocol for management of mental retardation.

The relationship between mothers' coping patterns and children's anxiety about their hospitalization as reflected in drawings

This study explored the relationships between hospitalized children's anxiety level, mothers' use of coping strategies, and mothers' satisfaction with the hospital experience. Twenty-four hospitalized children and their mothers participated in this study. Children were asked to draw a person in the hospital, which was then coded as a projective measure of anxiety; mothers were asked to complete questionnaires on their coping behaviors and their satisfaction with their child's hospital experience. The use of more coping strategies by the mothers was related to less anxiety in the children. In addition, the more coping strategies the mothers used, the higher they reported their satisfaction. The findings suggest the importance of providing resources aimed at increasing maternal coping and satisfaction with the quality of care of a child's hospitalization in order to minimize the negative effects of the hospitalization on the children.

Rehabilitation after multilevel surgery in ambulant spastic children with cerebral palsy: children and parent experiences

PURPOSE

This study explores post-operative family situation, rehabilitation and interdisciplinary cooperation for ambulant children with cerebral palsy (CP), after multilevel surgery.

METHODS

Eight ambulant spastic children with varied severity of CP and their parents were included. Qualitative, semi-structured interviews were carried out separately with children and parents.

RESULTS

Children experiencing a low degree of post-operative pain were satisfied due to improved strength and ambulation, leading to increased social participation. A few experienced severe pain and modest physical improvement. Most families experienced a lack of information and communication between rehabilitation levels. Rehabilitation was considered strenuous because of complex and intense training programmes. Schools were mostly responsive to children's extra post-operative needs, but some examples of serious neglect and bullying occurred.

CONCLUSION

Results imply the need for systematic securing of interdisciplinary knowledge transfer regionally and locally by the university hospital, aiming at empowering families and health professionals involved in this complex rehabilitation.

Children Having Spinal Surgery to Correct Scoliosis

In order to assist parents to cope with the stress of their child undergoing major spinal surgery, health professionals need an understanding of what the key stressors are. In this study, 13 interviews and questionnaires from parents in the UK and USA were carried out and analysed using Interpretative Phenomenological Analysis (IPA). Five themes emerged: ‘Information’; ‘Parenting role’; ‘Confidence in professionals’; ‘Pain’; and ‘Effect on life’. Findings suggested that parents need appropriate information and support from health professionals throughout their experience to help minimize uncertainty and distress and that pain management is a major source of stress to parents.

Emotional and behavioral changes in parents of children affected by hemolytic-uremic syndrome associated with verocytotoxin-producing Escherichia coli: a qualitative analysis

BACKGROUND

The long-term clinical outcome for children affected by hemolytic uremic syndrome associated with verocytotoxin-producing Escherichia coli (VTEC-HUS) is well documented, but the parental experience is not.

OBJECTIVE

The authors investigated the effects of the critical-care hospitalization for this condition on well-being of patients' families.

METHOD

A group of 30 parents completed a free-response format survey when their child presented to the hospital; 19 of this cohort completed a 1-year follow-up.

RESULTS

Content analysis demonstrated that this cohort of parents experienced long-term emotional distress and substantive disruption to family and daily life.

DISCUSSION

These results corroborate anecdotal clinical observations. The authors suggest future research initiatives and best practices to reduce parental distress.

How parents search, interpret, and evaluate genetic information obtained from the internet

This study describes how parents of a child referred for genetic services searched the Internet for information, summarizes how they interpreted and evaluated the information they obtained, and identifies barriers that they encountered. Audio-taped interviews were conducted with 100 ethnically diverse families referred to a pediatric genetics clinic. After transcription, coded text was entered into a software program (QSR N6) for searching and data retrieval. Matrices were created to systematically categorize and compare families' Internet use. Eighty-three percent of families obtained Internet information about the diagnosis, the clinic visit, and/or treatment and services. Those not conducting searches lacked access, Internet experience, or a diagnostic term and had lower incomes and less education, regardless of ethnicity. Families sought information in preparation for the clinic visit but barriers to obtaining and interpreting relevant information were common. Parents' Internet searching experiences illustrate common barriers to obtaining and understanding genetic information. Identifying them can help genetic counselors facilitate parents' searches for relevant information.

Clinical communication: Innovative education for graduate nurses in paediatrics

The Royal Children's Hospital (RCH) is a specialist paediatric centre in Melbourne, Australia. RCH provides a full range of clinical services including tertiary care and health promotion and prevention for children and adolescents. RCH has 250 beds and treats approximately 32,000 in-patients a year. A total of 280,000 children are seen by this centre annually. The graduate nurse programme (GNP) at RCH has been established for over 20 years, as a twelve-month internship following a three-year bachelor degree in nursing. The aim of our GNP is to support each newly qualified registered nurse through their experience of transition from student to registered nurse. After initial orientation, the programme requires attendance at ten development days. The graduate nurses are supported by preceptors in the clinical environment whose role is to enable the application of new knowledge and skills. The Programme philosophy is that through a combination of reflective practice and individual goal setting, the graduate will fulfil the scope of their practice as set out in their Hospital job description.

Dealing with epilepsy: parents speak up

In this study, focus groups were used to examine parents' attitudes toward mental health services, use of mental health and other services, as well as service-related and other challenges encountered by parents of children with epilepsy. Both quantitative and qualitative analytic approaches were used to analyze the transcripts of 36 parents grouped into six focus groups by socioeconomic status (SES) (high, low) and ethnicity (African-American, Caucasian, Hispanic). The quantitative analyses demonstrated that, irrespective of SES and ethnicity, the parents were highly aware of their children's behavioral, emotional, and cognitive difficulties and the lack of knowledge about epilepsy among medical, educational, and mental health professionals. The higher-SES parents were significantly more concerned about inadequate educational services and the need for medical services, but less concerned about mental health and medical service use than the lower-SES parents. Insufficient knowledge about epilepsy and about services, parent emotional difficulties, and use of educational services differed significantly by ethnicity. The qualitative analyses highlighted the parents' concerns regarding misconceptions about epilepsy and the stigma toward mental health care among the African-American and Hispanic parents. These findings suggest the need for accessible and better-quality mental health, educational, and medical services for children with epilepsy irrespective of SES and ethnicity. They also underscore the importance of educating parents, service providers, and the general public about epilepsy.

Informational needs in families after their child's mild head injury

OBJECTIVE

When a child is hospitalized due to an illness or injury, the entire family may experience stress and/or anxiety. According to parents who have been in such a situation, providing adequate information is one of the most valuable ways to help the family deal with such feelings. Most mild head injuries suffered by children do not require hospitalisation and in such cases, their families should be provided with appropriate information in connection with their visit to the emergency ward. In the present study, family informational needs are characterized.

METHODS

The families of 57 children who had suffered a mild head injury at 0-15 years of age answered one open-ended question. The analysis was carried out using content analysis.

RESULTS

This analysis revealed two types of needs, i.e., a need for information concerning the head injury itself and how to provide care, as well as a need for reassurance and support in sharing and coping with the emotional burden.

CONCLUSION

Despite differences in the severity of the child's head injury and requirement for hospitalisation, all the families expressed the same informational needs but also the need for emotional support.

PRACTICE IMPLICATIONS

In connection with the treatment of children with head injuries, health-care personnel should provide the parents both with information concerning the injury and its treatment and with emotional support.

Difficulties experienced by families with disabled children

PURPOSE

This study was designed to determine the difficulties experienced by families with disabled children.

DESIGN AND METHOD

This descriptive research study was carried out in one public and two private rehabilitation centers. A questionnaire was used for data collection.

RESULTS

Families did not have enough knowledge about their child's condition. Mothers felt severe sadness, and they indicated that after having a disabled child, their social life, working life, and family relationships were all affected. Families also have financial problems.

PRACTICE IMPLICATIONS

Parents with a disabled child need support from professionals. Nurses have a vital role in providing support for these families.

Newborns with an impairment: discourses of hospital staff

The birth of a baby with an impairment goes against dominant cultural ideals about a happy event. Therefore, the interaction between professionals and parents is particularly important, from the hospital maternity ward to the home. In this article, the author examines both the representations of neonatal impairments constructed by professionals and the consequent subject positions for these babies with impairments. The study is based on interview data collected among 19 staff members of one Finnish county hospital. The author analyzed the data by means of qualitative discourse analysis and concludes that it would be important for health care professionals to provide many-sided elements for parents to consider in the construction of the image of their baby other than traditional tragically and negatively biased cultural interpretations.

Stress and well-being among parents of children with rare diseases: a prospective intervention study

AIM

This paper reports a study to assess stress, well-being and supportive resources experienced by mothers and fathers of children with rare disabilities, and how these variables were affected by an intensive family competence intervention.

BACKGROUND

Despite diagnosis-specific studies, little overall knowledge exists about life-consequences for families of children with rare disorders.

METHOD

We used a prospective design with baseline data and two follow-ups (at 6 and 12 months) after an intervention. The intervention aimed at empowering parents in managing their child's disability. Parents from all parts of Sweden visiting a national centre for families of children with rare disabilities were consecutively selected (n = 136 mothers, 108 fathers). Instruments of parental stress, social support, self-rated health, optimism and life satisfaction and perceived physical or psychological strain were used. Stratified analyses were carried out for mothers and fathers, and related to parental demands: single mothers, full-time employment, participation in a parent association, child's age and type of disability.

RESULTS

We found high parental stress, physical and emotional strain among mothers, especially among single mothers. Fathers showed high stress related to incompetence, which decreased after the intervention. Decreased strain was found among full-time working mothers and fathers after the intervention. Parents' perceived knowledge and active coping and mothers' perceived social support were increased at follow-up. Factors related to parents' overall life satisfaction (57-70% explained variance) changed after the intervention, from being more related to internal demands (perceived strain, incompetence and social isolation) to other conditions, such as problems related to spouse, paid work and social network.

CONCLUSION

Parents, especially fathers and full-time working parents, may benefit from an intensive family competence programme.

Children with a long-term illness: parents' experiences of care

A diagnosis of a long-term illness in a child will bring on a major upheaval in the lives of the whole family involved and leads to a long-standing relationship with health care personnel. The purpose of this study was to describe parents' experiences with their child's illness and treatment and with their relationships with health professionals during the process of learning to care for their child. Data were collected by conducting open-ended interviews with parents (N = 11) whose child had been diagnosed with a physical long-term illness at least 1 year previously and were analyzed using qualitative content analysis. Parents' needs for information and support varied and consisted of different components in different phases of the process. During the diagnostic phase, parents were recipients of information; it was important for them to receive consistent empathetically provided information. In the next phase, parents, having gained experience of day-to-day home care, engaged in a change toward a two-way flow of information with the professionals; mutual trust was essential for the exchange of information needed for a child's proper care. Without a permanent relationship with health professionals, parents showed lack of trust in professionals' knowledge of their child's condition and care. Professionals' lack of trust in parents' expertise in their child's care was also problematic. Health professionals should lay the groundwork for a partnership in which both parties acknowledge each other's competencies; parents' needs ought to be continuously reassessed. A permanent relationship between families and health care personnel is required to achieve this.

The diversity of family health: constituent systems and resources

The purpose of this study was to explore changes in family health associated with child's chronic illness and hospitalization. The aim was to answer the following questions: (i) What kind of changes do families experience when a child in the family is afflicted by a chronic illness; and (ii) What kind of changes do families experience when their child is admitted to hospital? The data were collected in 2002 in interviews with 29 such families whose children were receiving treatment or who had previously received treatment on the paediatric wards of two hospitals in Finland. Data were collected until reaching theoretical saturation, in which no additional data are found. Data analysis was based on the grounded theory method, proceeding to the stage of axial coding. Family health was formed out of two different dimensions: the constituent systems and the resources of family health. The constituent systems describe the impact of the child's chronic illness and period of hospitalization at the level of both individual family members and the family as a whole. These systems were described by five categories: (i) ill child at the centre of family attention, (ii) siblings in a minor role, (iii) the child's illness governs parental well-being, (iv) the roller coaster of the couple relationship and (v) the whole family is ill. The resources promoting and maintaining family health were divided into six different categories: (i) creative and maintaining mental images, (ii) active involvement, (iii) internal coping means, (iv) reinforcement of coping means, (v) awareness and change of values and (vi) social network shares emotional burden and responsibility for care. The results of the study show that family health is highly vulnerable when a child has to be admitted to hospital because of a chronic condition. They should help nursing staff gain a clearer picture of the depth and diversity of family health and support the resources that promote family health. Future research should study the methods of family nursing used in the care of families with children with chronic conditions.

Child in hospital: family experiences and expectations of how nurses can promote family health

AIMS AND OBJECTIVES

This study set out to explore, from the family's point of view, ways in which nursing staff can promote family health during the child's hospital stay.

BACKGROUND

Having a child in hospital is a major source of stress and anxiety for the whole family. Earlier studies have described parental coping strategies, ways to strengthen those strategies and to support parental participation in child care, but no one has studied the promotion of family health during the child's hospitalization from the family's point of view.

DESIGN

Interviews were conducted in 2002 with 29 families who had a child with a chronic illness which were receiving or had received treatment on the paediatric wards of two Finnish hospitals.

METHODS

Data analysis was based on the grounded theory method, proceeding to the stage of axial coding. Data collection and analysis phases proceeded simultaneously.

RESULTS

Five domains were distinguished in the promotion of family health: (1) reinforcing parenthood, (2) looking after the child's welfare, (3) sharing the emotional burden, (4) supporting everyday coping and (5) creating a confidential care relationship.

CONCLUSIONS

The results strengthen the knowledge base of family nursing by showing how nursing staff can promote family health during the child's hospital stay.

RELEVANCE TO CLINICAL PRACTICE

The results have a number of practical applications for nursing, both for clinical practice and research. The results can be used in paediatric hospital wards caring for chronically ill children and their families. The five domains of family health promotion described here should be tested in other paediatric wards and in other geographical locations.

Caregivers' experiences of interaction with families expecting a fetally impaired child

BACKGROUND

On the basis of earlier research, caregivers' actions when interacting with clients should be developed. However, nursing research has focused little attention on the interaction between caregivers and families expecting a fetally impaired child.

AIM

The study aimed at generating a practical family nursing theory of caregivers' interaction with families expecting a malformed child.

METHODS

A grounded theory study was undertaken at Tampere University Hospital in Finland in 1999-2000. Data consisted of semi-structured interviews with 22 (n=22) nurses and doctors. The data were analysed using the constant comparative method.

RESULTS

The interaction process starts when a caregiver informs the parents of the fetal impairment. The process is influenced by caregivers' attitude towards issues related to the family's life situation. Caregivers' views of their job, and of human coping and cultural attitudes towards these issues are also of importance. These factors account for their goals in the interaction, which, in turn, underlie their actions. When the caregiver's interpretation is that the family accepted the help provided, the outcome of the interaction is satisfaction with having been able to help. Correspondingly, in the case of an opposite interpretation, the caregiver experiences strain caused by inadequacy of the help he/she is providing. The core of interaction consists of two dimensions: gaining strength and losing strength in relation to impairment issues.

CONCLUSIONS

Caregivers' views of helpful interaction were consistent with earlier research on the subject, but the findings of this study showed that more attention should be focused on the family as a whole. Furthermore, caregivers rarely criticized their own actions, thus their interaction skills should be upgraded by focusing on systematic self-assessment through training. Nursing research deepening our understanding of why interaction fails is warranted.

RELEVANCE TO CLINICAL PRACTICE

The study results can be used in the family nursing practice as tools in reinforcing the caregivers' ability to helpful interaction with families expecting a fetally impaired child. The results may enhance caregivers' systematic self-evaluation and conscious use of the self.

A qualitative study, using focused interviews, of the information needs of families whose children's names are on a cerebral palsy register

BACKGROUND

We were concerned that information held on a register of children with cerebral palsy was not being made available to contributing families, and that the existence and purpose of the register was not sufficiently understood.

METHODS

Focused interviews with 13 families selected by purposive sampling.

RESULTS

Many parents would like more information about the data on registers which include their child. They would also like to be more involved in the design of the register and its reports, but there are practical difficulties in making time available for such activity. Although parents were surprised that they had not already been given more information about the existence and purpose of the register, none were resentful that their child's name was on the register once they were reassured about confidentiality and database security. Parents also had general concerns unrelated to the register which were about their need to be treated as equals by professionals, to have more information about equipment and to have earlier and clearer diagnoses.

CONCLUSIONS

Registers of children with uncommon conditions have well-established roles in epidemiology, planning and research. By fully involving parents in ways suggested by this study, registers can also empower parents. The study should also provide reassurance to those who hold such registers without explicit consent that the requirement to now obtain consent should not create resentment or jeopardize completeness.

Coping of parents with physically and/or intellectually disabled children

OBJECTIVE

The aim was to clarify how families with physically and/or intellectually disabled children cope, what kind of coping strategies they use and how the families with good and poor coping capacities differ.

METHODS

The parents of eight children (aged 8-10 years) with physical and/or intellectual disability were interviewed twice, and the data elicited in these interviews were analysed qualitatively using the grounded theory method.

RESULTS

Information and acceptance, good family co-operation and social support were related to the coping strategies most frequently used. Half of the families seemed to have found successful ways of coping, whereas another half had major problems. There were five main domains in which the high- and low-coping families differed most from each other: (1) parents' initial experiences; (2) personal characteristics; (3) effects of the child's disability on family life; (4) acting in everyday life; and (5) social support.

CONCLUSION

The findings can be utilized in developing supportive activities for families with disabled children. By recognizing the coping strategies used by the family, professionals and service providers can find the right ways to support their adaptation. As the role of physicians, nursing staff and other professionals in this process is very important, more attention should be attached to the collaboration between these groups, to enable them to view the situation from the perspective of the whole family.

Factors associated with the coping of parents with a child in psychiatric inpatient care

The purpose of this study was to establish the parental coping' factors associated with having a child in psychiatric inpatient care. The data were collected from 19 hospitals with child psychiatry units. At the time of data collection, all parents of children in psychiatric inpatient care in these hospitals were recruited. The method of data collection was a questionnaire (n = 79). The data were analysed with the Statistical Package for the Social Sciences (SPSS) for Windows statistical software. The connections between variables were studied with cross-tabulation, and the chi2 test was used to determine significance. Changes in internal and external family relationships and matters related to the upbringing of the child with mental problems statistically correlated significantly with parental coping (P < 0.001). Problem-oriented and emotionally-oriented coping strategies, skills and palliative strategies correlated significantly with parental coping (P < 0.001). Emotional support, support for the care and upbringing of the child in inpatient care, and love and acceptance also had statistically significant associations with parental coping (P < 0.001).