Families of Chinese children with malignancy: the factors impact on mother's anxiety

Parents' and nurses' affective perception of a pictorial intervention in a pediatric hospital environment: Quasi-experimental design pre-post-testing

BACKGROUND/AIM

The humanization of the hospital environment of pediatric departments represents an area of research and intervention on improving the quality of life for hospitalized patients, but also that one of relatives and health professionals. The aim of the study was to test, in a sample of nurses and hospitalized children's parents, whether the pictorial intervention impacted the perceptions of affective qualities of hospital environment.

METHODS

This quasi-experimental design study investigated the effects of a pictorial humanization intervention which consisted of some naturalistic and colorful illustrations in the corridor of two pediatric wards of an Italian hospital. A total of 425 parents of hospitalized children and 80 nurses were asked to complete the Italian version of the "Scale of measurement of the affective qualities of places" in two different moments: 1) before the pictorial intervention and 2) three months after its implementation.

RESULTS

For all participants (parents and nurses), results showed a significant effect of pictorial intervention with the four positive dimensions investigated (Relaxing, Exciting, Pleasant, and Stimulating) reporting higher scores after being performed it, and with the four negative dimensions (Distressing, Gloomy, Unpleasant, Sleepy) showing lower scores.

CONCLUSIONS

Data suggest that the pictorial intervention could be particularly useful to create more welcoming hospital environments, reducing distress levels from hospitalized patients, but also of relatives and healthcare professionals.

IMPLICATIONS TO PRACTICE

Pictorial interventions improve the emotional atmosphere in pediatric healthcare settings. Integrating visual elements related to care and healing enhances user experience, creating a more welcoming environment.

Outcomes of adverse childhood experience during late adolescence: Evidence from college and community samples

Scant studies have investigated adverse childhood experience (ACE) outcomes and mastery during adolescence in different cultural contexts. This cross-sectional study examines the impact of ACEs on subjective well-being, health complaints, and healthcare utilization during late adolescence, including the mediating role of the sense of mastery in the Saudi context. Adolescents (N = 396) aged 17-21 years were recruited via convenience sampling from colleges and local communities from two regions in Saudi Arabia. Data were collected using a paper-pencil anonymous survey and analyzed using path analysis. Of the sample, 85.5% experienced at least one ACE. ACEs had a direct effect on subjective well-being (p = 0.034), health complaints (p < 0.001), healthcare utilization (p < 0.001), and sense of mastery (p < 0.001). Sense of mastery had an effect on subjective well-being (p < 0.001) and health complaints (p < 0.001), but not on healthcare utilization (p = 0.436). Sense of mastery partially mediated the relationship between ACEs and subjective well-being (p = 0.034) and health complaints (p < 0.001), but not healthcare utilization (p = 0.438). ACEs have detrimental effects on adolescent health. Attention should be paid to primary prevention and early detection to avoid further harm, and interventions that address the role of the sense of mastery should be developed for adolescents.

Uncertainty associated with parents of preterm infants hospitalised in neonatal intensive care unit among selected governmental hospitals in Addis Ababa, Ethiopia, 2022: an institution-based cross-sectional study

OBJECTIVE

To assess the uncertainty associated with parents of preterm infants hospitalised in neonatal intensive care units of selected governmental hospitals in Addis Ababa, Ethiopia, 2022.

DESIGN

A cross-sectional study conducted from 3 March 2022 to 30 March 2022.

SETTING

The research was conducted at a government hospital in Addis Ababa, Ethiopia.

PARTICIPANTS

Out of 305 eligible participants, 303 were parents of preterm infants' participants with complete data.

PRIMARY OUTCOME MEASURE

Levels of parental uncertainty, assessed by using the Mishel scale of uncertainty. Simple and multivariable linear regression analyses were conducted to assess associations between variables.

RESULTS

The mean uncertainty expressed by parents was 101.3 (SD=21.12). There were significant associations found with various factors. The sex of the respondent fathers (β=-4.65, 95% CI -9.32 to -0.025), length of neonatal intensive care unit (NICU) stay >10 days (β=14.64, 95% CI 8.71 to 20.56), gestational week between 34 and 37 weeks (β=-7.47, 95% CI -11.42 to -3.52), parents with college degrees and above (β=-14.15, 95% CI -22.94 to -5.34), parents with neonates who were preterm and had neonatal sepsis (β=10.42, 95% CI -17.57 to -3.27), parents without a history of neonatal NICU admission (β=-6.16, 95% CI -11.69 to -0.63) and parents who were housewives (β=6.51, 95% CI 1.83 to 12.19) all showed significant associations.

CONCLUSION

Factors like educational status, gestational week, neonatal admission history and NICU stay length contribute to parental uncertainty. Promoting empathy and clear communication is crucial. Hospitals should develop compassionate protocols for information delivery, including regular updates and effective addressing of concerns. Fostering a supportive environment helps parents express emotions and seek support.

Mastery and social support moderate the effects of educational level on adjustment of Arab mothers of children diagnosed with cancer

The study explored the adjustment of Arab mothers of children diagnosed with cancer, as shown by the mothers' distress and quality of life. The aim was twofold: to examine the associations between educational level, psychosocial resources and adjustment indices and to assess the moderating effects of psychosocial resources on the education and adjustment association. The sample consisted of 100 Arab mothers who completed questionnaires assessing demographic and illness variables, mastery, social support, psychological distress and quality of life. High levels of education and psychosocial resources contributed to low distress and high levels of quality of life. Mastery and social support moderated the effects of education on adjustment: Under low levels of education, higher mastery was related to lower distress and higher quality of life, and higher social support was related to lower distress. Education, mastery and social support are important resources in the context of adjustment to cancer. In addition, psychosocial resources are important factors for adjustment under low levels of education and should be taken into consideration when developing intervention programmes for Arab parents coping with their child's cancer.

Uncertainty of Parents With Children Undergoing Herniorrhaphy

This study reports the association between parental uncertainty and characteristics of 123 parent-child dyads prior to the child's herniorrhaphy. A cross-sectional study design and Mishel's Parents' Perception of Uncertainty Scale (PPUS) were used. Parent participants were married (98%), had a university degree (45%), identified with a religion (77%), and worked (69%). More boys (76%) than girls (23%) underwent herniorrhaphy (average age = 2.26 years); 60% were the first-born child and 25% were premature. More children presented with unilateral (63.4%; right = 44.7%, left = 18.7%) than bilateral (36.6%) hernias and most were primary (98%). Overall uncertainty was perceived as moderate and ambiguity had the highest score. Religion, birth order (first child), and hernia site (bilateral) explained 20.6% of total variance of uncertainty. Providing information about postoperative symptom and pain management is important for all parents, particularly for parents identified with a religion and whose first-born child had bilateral hernias.

Assessing the Needs of Parents of Children Diagnosed With Cancer in China: A Psychometric Study Developing a Needs Assessment Tool

The psychosocial well-being of parents remains integral to the treatment and recovery of children diagnosed with cancer. However, limited research addresses the unique needs of this population. To better understand the supportive care needs of parents of children with cancer, this study tested the reliability and stability of the factorial structure of a revised version of the Cancer Patient Needs Questionnaire (rCPNQ) with Chinese parents of children who have cancer. Analysis of the generalizability of the rCPNQ with this population was determined through principle components analysis with varimax rotation. Reliability coefficient and split sample analyses were performed to determine reliability and stability of the resulting factors. The principal components analysis resulted in a 6-dimension, 8-factor, 29-item survey. Each of the factors had Cronbach’s α ≥ .74, indicating satisfactory internal consistency and reliability of the survey with the Chinese population. Similar loadings on splitting of the samples reflects the stability of the factors. Study results provided a preliminary understanding of the needs of Chinese parents of children with cancer and demonstrated that the rCPNQ offers a reliable measure for nurses and other health care providers to partner with Chinese parents throughout their children’s treatment and survivorship to determine areas for support.

Psychometric properties of the Chinese version of the Parent Perception of Uncertainty Scale (PPUS) among parents of children with cancer diagnosis

OBJECTIVE

Parents of children diagnosed with cancer often experience high levels of illness uncertainty. This study evaluated the psychometric properties of the Chinese Version of the Parent Perception of Uncertainty Scale for Childhood Cancer (PPUS-CC) in Mainland China.

METHODS

Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed using study population of 420 parents. The participants were also given the social support questionnaire and assessed using the Self-Rating Anxiety Scale, Zarit Burden Interview, and Self-Rating Depression Scale to test the association with PPUS-CC and obtain the cut-off of the scale.

RESULTS

The Chinese version of PPUS-CC includes 14 items, and two factors were extracted by EFA, which could explain the 54.56% variances. The Cronbach's α of two factors ranged from 0.830 to 0.877. The dimensions of PPUS-CC show statistical association with other scales, and the cut-off is 42.5.

CONCLUSION

The Chinese version of PPUS-CC, as a reliable, valid, and easy-to-use clinical tool, can be adapted in clinical settings as a screening tool to recognize parents with high-risk psychological problems.

Meta-Analysis: Caregiver and Youth Uncertainty in Pediatric Chronic Illness

Objective

To conduct a systematic review on the construct of illness uncertainty in caregivers and youth as related to the following: demographic and illness variables, psychological functioning, illness-related distress, and reaction/coping style.

Methods

A meta-analysis was conducted with articles assessing the associations between illness uncertainty and variables of interest that were published between November 1983 and June 2016 ( n = 58).

Results

Psychological functioning and illness-related distress had primarily medium effect sizes. Demographic and illness variables had small effect sizes. More positive and fewer negative reaction/coping styles were associated with less illness uncertainty, with primarily small effects.

Conclusions

Illness uncertainty may be an important factor that influences psychological functioning and distress and coping in the context of pediatric chronic illness. However, additional research is needed to determine more precise mean effect sizes, as well as the potential efficacy of intervention to address uncertainty. adolescents, children, chronic illness, coping skills and adjustment, meta-analysis, parents, psychosocial functioning.

Cultural Influence on Family Management of Children With Cancer

A family's cultural context directly influences how they define and manage their child's cancer. Knowing this dynamic can guide nurses in delivering holistic, culturally competent care. This literature review examines the international and domestic pediatric oncology research as it relates to the inclusion of family and cultural variables. Most international studies and comparative studies have investigated Asian cultures and found that health beliefs, communication beliefs, religious practice, and family structure are common themes of cultural influences on families. Additional studies within the United States are needed to explore cultural beliefs through carefully tailored family assessments. Implications for practice include the possibility of providing evidence-based culturally competent care to families of children with cancer.

Parental Involvement in Restoring the Health of a Child with Cancer in Hong Kong

The parents of 93 children with cancer in Hong Kong participated in a research study to identify concepts related to the category of restoring health in their child with cancer. These concepts included providing adequate nutrition such as attempting to increase the child's appetite, the preparation of soups, providing food supplements, and restricting the intake of certain foods; using alternative therapy to supplement the Western medicine, using tonics to strengthen the body, using Chinese medicine to regulate the body functions, using Chinese herbs to prevent metastasis or reoccurrence, as well as providing another chance of a cure when Western medicine was not effective; and preventing infections by reducing exposure to crowded places, having a clean home environment, using a face mask to protect the child from infections, and screening visitors.

Meshing Gears

Adolescents with cancer and their parents have to deal with the challenge of returning to their pre-diagnosis social life. The purpose of this study was to describe the subjective lived experiences of Taiwanese mothers and their adolescents who had completed cancer treatment and were returning to school. Eight Taiwanese mother-adolescent dyads were recruited by purposive sampling. Core themes were extracted using phenomenological method and dyadic analysis. Findings were metaphorically captured by the theme “meshing gears.” The mothers and their adolescents were initially like 2 gears spinning alone, side by side due to experiencing different distress related to their social roles. To move toward a normal and healthy life journey, the mothers and their adolescents worked together as a well-tuned machine. This phenomenon is similar to gears meshing without friction to keep moving forward together. Our results suggest that health care professionals should provide follow-up care and interdisciplinary school reentry services to adolescent cancer survivors to improve their quality of life.

Hopelessness and depression levels of parents of children with cancer

The purpose of this descriptive study was to determine the hopelessness and depression levels of parents of children diagnosed with cancer and undergoing cancer treatment and factors affecting these levels. The study was carried out with parents of 44 children receiving treatment in a paediatric haematology clinic of a university hospital. Data were collected using a survey form, the Beck Hopelessness Scale (BHS) and the Beck Depression Scale (BDS). The mean BDS score of the mothers and fathers was 18.3 ± 11.30 and 15.2 ± 11.33, respectively. The mean BHS score of the mothers was 6.45 ± 4.40, whereas the mean BHS score of the fathers was 5.88 ± 4.27. The results showed that the levels of hopelessness and depression among the mothers were higher than among the fathers (p<0.001). There was a positive relationship between the hopelessness and depression scores of the mothers and the fathers (p<0.05), and the levels of hopelessness and depression scores of the fathers increased as those of the mothers increased. A weak financial situation of the family increased the hopelessness and depression levels of the fathers. The hopelessness and depression levels of the mothers who were supported by their families and relatives were decreased compared to those without such support (p<0.05). The results show that the parents of children with cancer face many psychosocial and spiritual problems. Using simple screening tools, nurses can identify at-risk parents and direct them to support services. We conclude that actively encouraging families to avail themselves of support resources and supporting them financially would positively affect the levels of depression and hopelessness of parents of children with cancer.

Understanding Parental Experiences Through Their Narratives of Restitution, Chaos, and Quest: Improving Care for Families Experiencing Childhood Cancer

The purpose of this secondary analysis was to develop an enhanced understanding of the experiences of parents who have children in treatment for cancer. Data collected from 16 parents (12 mothers and 4 fathers) were analyzed using Frank's dialogical narrative analysis. Findings demonstrated that parents' experiences were represented in chaos, restitution, and quest narratives. Each of these narratives was only one instance of a very complex and changing parental experience that cannot be understood in isolation from the others. The holistic understanding provided by these findings contributes to a more comprehensive understanding of parental experiences of their child's illness and highlights the need for health professionals to invite conversations about parents' illness experience and attend to the specific narrative type parents are presenting to support them adequately. Additional research is required to develop supportive approaches for each narrative which takes into account the complexities of parents' experiences.

Cultural Influences in Pediatric Cancer

Objective: To review the literature on cultural factors influencing clinical care and family management of pediatric cancer. Methods: A literature review including 72 articles related to cultural issues in pediatric cancer was conducted. Information was organized around several clinically driven themes. Results: Cultural factors influenced many aspects of the cancer experience including illness representations, reaction to diagnosis, illness disclosure patterns, complementary and alternative medicine use, management of medical procedures, coping strategies, and end of life issues. Conclusion: Increased awareness of cultural factors is needed to improve clinical care and reduce health disparities. Specific strategies to approach cultural differences are provided to enhance patient and family care from diagnosis to cure/end of life.

Câncer no lactente: readaptações na vida familiar

Pesquisa qualitativa do tipo estudo de caso que objetivou apreender o cotidiano da família do lactente com câncer. Os dados empíricos foram coletados por meio de entrevista semiestruturada com três mães, no período de maio a junho de 2010. A interpretação dos dados seguiu os fundamentos da análise temática. Os resultados demonstraram que o câncer representa um impacto para a família cuja reestruturação é prontamente necessária para atender às necessidades do filho doente. Nesse cenário, a mãe é compreendida como o alicerce no acompanhamento do filho, comprometendo o cuidado do lar e dos demais filhos. A mãe vivencia uma sobrecarga descomunal que envolve sofrimento emocional, além de desgaste físico. Toda a família sofre com o adoecimento do lactente e para amenizar esse sofrimento a equipe de saúde deve utilizar estratégias que fortaleçam os vínculos com a família.

"Shifting family boundaries" after the diagnosis of childhood cancer in stepfamilies

The childhood cancer experiences of stepfamilies have not been described despite the fact that nearly one third of U.S. children will live in a stepfamily household. To describe the impact of diagnosis on parental relationships in stepfamilies, we undertook a secondary analysis of data from a study of parental decision making in structurally diverse families. As described by 13 parents of six stepfamilies, the crisis of a childhood cancer diagnosis immediately changed family dynamics. Parental relationships changed, which shifted family boundaries, creating instability in families who were trying to cope with a very stressful life experience. Through increased understanding of parental relationship changes that occur after the diagnosis of childhood cancer in stepfamilies, clinicians can anticipate these changes and provide supportive interventions to reduce overall family conflict and distress. These distinctive stepfamily responses underscore the need to include structurally diverse families in future trials targeting parental coping in childhood cancer.

Pediatric oncology: the use of cluster analysis to examine maternal concerns

PURPOSE/OBJECTIVES

To examine data from mothers whose children have cancer and to identify the characteristics of uncertainty and distress that they reported. The objectives were (a) to use cluster analysis to identify subgroups of maternal uncertainty and distress, (b) to examine whether the subgroups differed based on demographics and children's illness-related variables, and (c) to explore whether mothers in the subgroups differed on quality of life (QOL) and hope.

DESIGN

Descriptive, correlational study.

SETTING

Pediatric oncology units in northern Taiwan.

SAMPLE

200 mothers of children with cancer.

METHODS

Participants completed the Parental Perception of Uncertainty Scale, the Symptom Checklist-35-Revised, the Short-Form 36 Health Survey, the Herth Hope Index, and a demographic questionnaire. Cluster analyses were used to identify subgroups of mothers regarding maternal perceived uncertainty and distress. Differences in demographic variables, disease characteristics, and outcome measures were evaluated with descriptive statistics, analysis of variance, and chi-square analysis.

MAIN RESEARCH VARIABLES

Subgroup, maternal uncertainty, distress, QOL, and hope.

FINDINGS

Four subgroups were identified by the cluster analyses: high uncertainty and high distress, moderate uncertainty and moderate distress, low uncertainty and low distress, and high uncertainty and low distress.

CONCLUSIONS

The subgroup of mothers who reported low uncertainty and low distress reported the highest QOL and hope.

IMPLICATIONS FOR NURSING

The findings of this study provide insight for pediatric oncology clinicians and offer issues related to uncertainty, distress, and QOL that such professionals can discuss with the mothers of their patients.

Anticipatory grieving among parents living with a child with cancer

AIM

This paper is a report of a comparative study of anticipatory grief of parents of children newly diagnosed with cancer and those whose children were diagnosed 6-12 months earlier.

BACKGROUND

Public perceptions of cancer as a fatal illness persist despite improved prognosis for children. Parents may experience feelings of despair, hopelessness, and worthlessness - the most common psychological expressions of anticipatory grief. With a focus on developing more effective therapeutic intervention, healthcare professionals have developed greater interest in the concept of anticipatory grief.

METHOD

One hundred and forty parents, divided between 'newly diagnosed' and '6-12 months after diagnosis' groups, were recruited in 2006 from two hospitals representative of the healthcare sector in Jordan. Structured interviews were conducted to assess anticipatory grief, using the Marwit and Meuser Caregiver Inventory: Childhood Cancer. Analysis was performed using t-tests.

RESULTS

Fewer than half of the parents in both groups reported being at peace with themselves and their situation in life. Parents of newly diagnosed children reported more severe anticipatory grief responses than those in the second group. No statistically significant differences were found in responses between mothers and fathers.

CONCLUSION

Healthcare professionals should encourage parents to discuss negative feelings related to their child's illness and potential outcome. Hospital policies need to include the provision and promotion of support group services for parents, and nurses should encourage parents to exploit such services.

Evaluation of a conceptual model based on Mishel's theories of uncertainty in illness in a sample of Taiwanese parents of children with cancer: a cross-sectional questionnaire survey

BACKGROUND

The prognoses of childhood cancers have improved over the last few decades. Nevertheless, parental uncertainty about the absolute cure and possible relapse pervades the entire illness trajectory. Despite illness-related uncertainty is significantly related to psychological distress, continual uncertainty may serve as a catalyst for positive psychological change and personal growth in the context of surviving cancer.

OBJECTIVES

The purpose of this study was to examine a conceptual model that depicts coping and growth in Taiwanese parents living with the continual uncertainty about their child's cancer. The conceptual model was guided by Mishel's theories of Uncertainty in Illness. The impact of the child's health status, parents' education level and perceived social support on parental uncertainty was analyzed. The mediating effect of coping as well as the influence of parental uncertainty and parents' perceived social support on growth through uncertainty was incorporated in the model testing.

METHODS

This study involved a sample of 205 mothers and 96 fathers of 226 children enrolled in a longitudinal cancer study in Taiwan. This study only analyzed the data collected at baseline. A cross-sectional design was utilized to examine the relationships among proposed variables. Parental uncertainty and growth through uncertainty were measured by the translated questionnaires originally developed by Mishel. Parents' perceived social support and coping were measured by culturally sensitive instruments developed in Taiwan.

RESULTS

The full research model and its alternative models fit adequately to the data via structural equation modeling tests. Parental uncertainty and parents' perceived social support were associated with growth through uncertainty which was mediated by coping. Child's health status and parents' perceived social support would significantly predict parental uncertainty.

CONCLUSION

This study suggests that parental uncertainty has negative impact on coping strategies such as interacting with family members while these coping strategies may help Taiwanese parents gain growth through uncertainty. Coping strategies of searching for spiritual meaning and increasing religious activities were not significantly influenced by parental uncertainty in this study. The two coping strategies may be relevant to growth through uncertainty due to Taiwanese cultural belief. Moreover, the availability of social support promotes growth through uncertainty by its impact on lowering parental uncertainty and encouraging more coping. The findings indicate that Taiwanese parents may gain growth through uncertainty while experiencing their child's cancer. The research model provides possible guidelines for oncology nurses to deliver more culturally competent health care for Taiwanese parents of children with cancer.

Assessment of parental psychological stress in pediatric cancer: a review

OBJECTIVES

We present an overview of the literature between 1997 and 2007 on parental stress reactions following the diagnosis of childhood cancer and we evaluate methodological strengths and weaknesses of the studies.

METHODS

PubMed, PsychInfo, and Cinahl databases were used. Sixty-seven were included in the review.

RESULTS

The conceptualization of parental stress and timing of assessment varies considerably between the studies, which makes comparison difficult. Most emotional stress reactions are seen around the time of diagnosis, with mothers reporting more symptoms than fathers. As a group, parents seem relatively resilient, although a subset of parents reports continuing stress even up to 5 years or more postdiagnosis.

CONCLUSIONS

The authors recommend clear definitions of parental stress, fixed points in time to assess parental stress, and an approach that highlights both parental strengths and weaknesses. Improved assessment can contribute to tailoring psychological care to those parents most in need.

Developing a literature base to understand the caregiving experience of parents of children with cancer: a systematic review of factors related to parental health and well-being

GOAL OF WORK

This paper describes a literature review conducted to identify important factors that have been investigated as explanations of variability in the health and well-being of parents of children with cancer. Our purpose was to build a literature base that could be used to guide and direct future research.

MATERIALS AND METHODS

Medline, Cinahl, EMBASE, PsycINFO, and Sociological Abstracts were searched from 1980 to 2005 using the keywords neoplasms; child(ren) aged 0-18 years; parent(s), caregiver(s), mother(s), or father(s). For papers that met the study inclusion criteria, sample characteristics and information about factors related to caregiver health, or the relationship between such factors, were extracted. The findings were organized according to the six main constructs that form the caregiving process and caregiver burden model: background/context variables; child characteristics; caregiver strain; self-perception; coping factors; and caregiver physical and psychological health.

MAIN RESULTS

Articles meeting the inclusion criteria totaled 57. We found substantial research showing that certain child characteristics (e.g., child behavior; time since diagnosis) and indicators of coping (e.g., family cohesion, social support, stress management) are related to parental psychological health. Other aspects of the caregiving process (e.g., parental self-perception, family-centered care, and physical health) have received less research attention.

CONCLUSION

Various limitations and gaps in the current literature were identified in our review. Future research to understand the complex interrelationships between factors involved in the caregiving process should examine hypotheses that are guided by a theoretical framework and tested using advanced statistical techniques.

Understanding the supportive care needs of parents of children with cancer: an approach to local needs assessment

The objective of this study was to conduct an assessment of supportive care needs from the perspective of parents of children diagnosed with cancer within an urban-rural region in Eastern Ontario, Canada. Guided by a conceptual framework for supportive care, the exploratory, mixed-method study used a standard needs survey and semistructured interviews. Fifteen parents completed (75% response rate) the survey, and 3 parents participated as key informants in the follow-up interview. Parents reported needs in all 6 of the need categories outlined within the Supportive Care Needs Framework. The proportion of parents expressing a need ranged from 23% to 39%. Dealing with the fear of their child's cancer spreading was frequently identified by parents. Emotional and informational needs were the 2 most frequently acknowledged categories of need. With further refinement, the use of the conceptual framework will provide a methodology for planning care based on the individual needs identified by parents of children with cancer.

A Review of the Literature on the Pain Experience of Chinese Patients With Cancer

Over 2 million new cases of cancer are diagnosed annually in China. In addition, cancer is the leading cause of death in China. Because cancer is often diagnosed in more advanced stages in China, a higher percentage of patients will experience pain related to their disease or treatment. This article presents a review and critique of the studies that examined the experience of pain in Chinese cancer patients. Because pain is a subjective experience with multiple dimensions, this review used the multiple dimensions of cancer pain to describe the pain experience in adult Chinese patients with cancer. The results from 24 studies of cancer pain in Chinese patients are summarized. Most of these descriptive correlational studies evaluated the physiologic and sensory dimensions of the pain experience. Most of the patients reported moderate to severe pain and that pain interfered with their normal activities and mood. In contrast, little information is available about the impact of cancer pain on the cognitive and sociocultural dimensions of the pain experience for Chinese patients.

Acculturation and stress in Chinese-American parents of infants cared for in the intensive care unit

PURPOSE

To describe the stressful experiences of Chinese-American parents who have an infant in the intensive care unit (ICU), and to assess the influence of acculturation, parents' characteristics, and social supports on parental stress.

DESIGN

A cross-sectional, descriptive, correlational study.

SAMPLE/SETTING

A convenience sample of 30 Chinese-American families (30 mothers, 25 fathers) who had an infant hospitalized in 3 ICU sites in the San Francisco area.

METHODOLOGY

Measures included: (1) Infant's health data from the medical records and parents' demographic data, and (2) Parental Stressor Scale: Infant Hospitalization, Suinn-Lew Asian Self-Identity Acculturation Scale, and Family Support Scale.

MAIN OUTCOME MEASURE

The dependent variable was mothers' and fathers' stress levels. Independent variables included personal/family characteristics, acculturation, uncertainty regarding infants' illness, and social supports.

PRINCIPAL RESULTS

The ICU stressors were ranked by both mothers and fathers in the following order: infant's appearance, parental role alteration, staff communication and behaviors, and ICU environment. The combined effects of uncertainty about their infant's illness and its future impact, a strong belief in Asian family values, and lack of support from healthcare providers accounted for 26% and 55% of the variance in parental stress for mothers and fathers, respectively.

CONCLUSIONS

Findings from this study suggest implications for the education of both families and the ICU staffs.

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.

Parental responses to health care services for children with chronic conditions and their families: a comparison between Hong Kong and Scotland

Families caring for a chronically-ill child are known to experience a significant degree of stress that often is not fully understood by health professionals. The purpose of this study was to examine, cross culturally, the experience of families caring for children with chronic conditions both in terms of the impact on their lives and the nature of the support received. The responsibility of caring for a child with a chronic condition had considerable impact on family life in both groups, with the disturbance to harmony possibly being felt more keenly in the Hong Kong group. Effective communication with parents was seen in both countries as key for effective practice. Expectations of health services differed between cultures. Implications can be drawn for the design of future health services addressing the specific health needs of families with children with chronic illness.

Assessing ambiguity at the family-nurse boundary interface in pediatric health crisis

This article discusses the conceptualization and measurement of family-nurse relationships in pediatric intensive care unit (PICU) from the perspective of family systems and boundaries. The 14 items for the Family-Nurse Boundary Ambiguity Scale for PICU (FNBAS-PICU) were developed from a qualitative study. Nurse panels established face and content validity. Parents (156) from four PICUs participated in reliability estimates (Cronbach's alpha = .81) and validity testing with measures of illness uncertainty and role alteration stress. Principal components analysis confirmed the conceptual intent of the FNBAS-PICU.

Promoting health for families of children with chronic conditions

AIM

This paper reports a study whose aim was to describe how nurses in a paediatric unit promote the health of families of children with chronic conditions during the children's hospitalization.

BACKGROUND

It is stressful for a family when a child has a chronic condition and hospitalized. Nurses have the opportunity to promote family health while a child is hospitalized, and previous studies contain a wealth of recommendations on how this should be done. However, there is little research evidence about family care and how nurses promote the health of a family with a chronically ill child.

METHODS

Forty nurses who worked in two paediatric units providing care for children with chronic conditions and their families participated in the study. Data were collected in two Finnish hospitals in 2002 using group interviews, and nursing actions were observed in both units for a period of 84 hours. Data analysis was based on the grounded theory method, proceeding to the stage of axial coding. Data were collected until theoretical saturation was reached.

FINDINGS

Family care was based on three distinctive strategies. Nurses used a systematic, selective or situation-specific strategy while promoting family health during a child's hospitalization.

CONCLUSIONS

The findings indicate that nurses used different strategies while promoting family health during a child's hospitalization. The systematic way of working with families identified in the study seems a useful strategy. All three strategies of family nursing described here should be tested in other paediatric wards and in other geographical locations.

Supportive care needs of parents of children with cancer: transition from diagnosis to treatment

PURPOSE/OBJECTIVES

To analyze research related to the pediatric oncology population supportive care needs from diagnosis to treatment.

DATA SOURCES

Articles published from 1992-2002.

DATA SYNTHESIS

49 studies were included. All six categories of the Supportive Care Needs Framework were found, with most studies addressing one to three of the need categories. Informational (88%) and emotional (84%) needs were identified most frequently.

CONCLUSIONS

No one study examined the entire range and types of supportive care needs from diagnosis to treatment. This knowledge is key to planning appropriate care and services. Future research should be directed at understanding the full constellation of needs encountered by parents during this time. Further refinement of the Supportive Care Needs Framework is required to fully define the categories of need.

IMPLICATIONS FOR NURSING

Although more research is required, supportive care that focuses on informational and emotional support appears to be most important from diagnosis to treatment. Using a conceptual framework such as the Supportive Care Needs Framework provides a methodology for planning care based on needs.

Families of children with cancer: the impact on anxiety experienced by fathers

By using the contextual model of family stress, this study examined fathers' family stress experience when caring for a child receiving cancer treatments. A descriptive correlational study was designed to examine the relationships between fathers' uncertainty, sense of mastery, and anxiety. Eighty fathers were recruited from two teaching hospitals in Taiwan. A pilot study was conducted to establish the reliability and validity of the Chinese language version of the above instruments. These instruments showed an acceptable internal consistency and satisfactory construct validity. Results showed that fathers' level of education had a significant effect on paternal anxiety. Uncertainty and fathers' education level equal to or higher than university are good predictors of paternal anxiety, which explain 25% of the variance. The results provide insight into the paternal experience of family stress and suggest ways to improve family-centered nursing interventions and thereby establish better family well-being.