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de Silva GNJ, Gamage GP. Queens of hearts: Exploring the lived experiences of mothers caring for infants with complex congenital heart disease in Sri Lanka. J Health Psychol 2024:13591053241233382. [PMID: 38384242 DOI: 10.1177/13591053241233382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
This qualitative study explored the lived experiences of eight Sri Lankan mothers of infants with complex congenital heart disease (CCHD) using semi-structured interviews. Four themes were generated as: illness perception, communication with medical staff, challenges faced, and coping mechanisms. These provided insight into the multi-faceted nature of mothers' experiences, importance of medical-caregiver communications and their need for psychosocial services. The findings enhance the limited knowledge of South-Asian primary CCHD caregiver experiences and will help in improving psychosocial support services in Sri Lanka.
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Maraschin FG, Adella FJ, Nagraj S. A scoping review of the post-discharge care needs of babies requiring surgery in the first year of life. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002424. [PMID: 37992047 PMCID: PMC10664918 DOI: 10.1371/journal.pgph.0002424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/01/2023] [Indexed: 11/24/2023]
Abstract
Congenital anomalies are among the leading causes of under-5 mortality, predominantly impacting low- and middle-income countries (LMICs). A particularly vulnerable group are babies with congenital disorders requiring surgery in their first year. Addressing this is crucial to meet SDG-3, necessitating targeted efforts. Post-discharge, these infants have various care needs provided by caregivers, yet literature on these needs is scant. Our scoping review aimed to identify the complex care needs of babies post-surgery for critical congenital cardiac conditions and non-cardiac conditions. Employing the Joanna Briggs Institute's methodological framework for scoping reviews we searched Pubmed, EMBASE, CINAHL, PsychINFO, and Web of Science databases. Search terms included i) specific congenital conditions (informed by the literature and surgeons in the field), ii) post-discharge care, and iii) newborns/infants. English papers published between 2002-2022 were included. Findings were summarised using a narrative synthesis. Searches yielded a total of 10,278 papers, with 40 meeting inclusion criteria. 80% of studies were conducted in High-Income Countries (HICs). Complex care needs were shared between cardiac and non-cardiac congenital conditions. Major themes identified included 1. Monitoring, 2. Feeding, and 3. Specific care needs. Sub-themes included monitoring (oxygen, weight, oral intake), additional supervision, general feeding, assistive feeding, condition-specific practices e.g., stoma care, and general care. The post-discharge period poses a challenge for caregivers of babies requiring surgery within the first year of life. This is particularly the case for caregivers in LMICs where access to surgical care is challenging and imposes a financial burden. Parents need to be prepared to manage feeding, monitoring, and specific care needs for their infants before hospital discharge and require subsequent support in the community. Despite the burden of congenital anomalies occurring in LMICs, most of the literature is HIC-based. More research of this nature is essential to guide families caring for their infants post-surgical care.
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Affiliation(s)
- Francesca Giulia Maraschin
- Health Systems Collaborative, Centre for Global Health Research, The Nuffield Department of Medicine, The University of Oxford, Oxford, United Kingdom
| | - Fidelis Jacklyn Adella
- Health Systems Collaborative, Centre for Global Health Research, The Nuffield Department of Medicine, The University of Oxford, Oxford, United Kingdom
| | - Shobhana Nagraj
- Health Systems Collaborative, Centre for Global Health Research, The Nuffield Department of Medicine, The University of Oxford, Oxford, United Kingdom
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Gerlach J, Decker ES, Plank AC, Mestermann S, Purbojo A, Cesnjevar RA, Kratz O, Eichler A. Long-Term Effects of Child Early Surgical Ventricular Septal Defect Repair on Maternal Stress. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1832. [PMID: 38136034 PMCID: PMC10741485 DOI: 10.3390/children10121832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/07/2023] [Accepted: 11/18/2023] [Indexed: 12/24/2023]
Abstract
The ventricular septal defect (VSD) represents the most common congenital heart defect (CHD). The diagnosis of and cardiac surgery for their child's VSD are highly stressful experiences for parents; especially mothers, who are at risk of developing long-lasting stress-related symptoms. This study examined long-term alterations in maternal stress including self-reported psychological and biophysiological stress levels in a case-control design. We investigated 24 mothers of children with an isolated, surgically corrected VSD compared to non-affected controls. Maternal self-reports on psychopathology, everyday stress, parenting stress and hair cortisol concentrations (HCC) were measured during children's primary school age (6-9 years, t1) and early adolescence (10-14 years, t2). In maternal self-reports, psychopathology and stress symptoms in the VSD-group and controls were comparable at t1, whereas at t2, mothers in the VSD-group even showed a decrease in psychopathology. Maternal HCC levels in the VSD-group were significantly lower (hypocortisolism) than HCC levels of controls at t1. This effect was no longer observed at t2 reflecting an approximation of HCC levels in the VSD-group to controls' levels. This study highlights the potential for improved stress hormone balance and psychological well-being in mothers following their child's surgical VSD repair. However, the need for parent-centered interventions is discussed, particularly during peri-operative phases and in early child developmental stages.
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Affiliation(s)
- Jennifer Gerlach
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Elena S. Decker
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Anne-Christine Plank
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Stefan Mestermann
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Ariawan Purbojo
- Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität, Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Robert A. Cesnjevar
- Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität, Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Department of Pediatric Cardiovascular Surgery, Pediatric Heart Center, University Children’s Hospital, 8032 Zürich, Switzerland
| | - Oliver Kratz
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Anna Eichler
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
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Bally JMG, Burles M, Spurr S, McGrath J. Exploring the Use of Arts-Based Interventions and Research Methods in Families of Seriously Ill Children: A Scoping Review. JOURNAL OF FAMILY NURSING 2023; 29:395-416. [PMID: 37128884 PMCID: PMC10629247 DOI: 10.1177/10748407231165119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Family care is essential to pediatric nursing practice, as the entire family is affected by childhood illness. However, little is known about art making for therapeutic purposes and how art is used to better understand families' experiences. Our purpose was to examine the nature of arts-based interventions and research methods used with, and the experiences of families of children facing life-limiting and life-threatening illnesses, and those families who are bereaved. Academic peer-reviewed sources published between January 1999 and May 2022 were retrieved via four databases using key search terms. Twenty-five articles were analyzed, resulting in three multifaceted categories including Social, Emotional, and Family Health. Critical strengths and limitations were also identified. Art making has been incorporated into interventions and research studies due to its benefits for family well-being. Understanding the potential of art making can inspire nurses to implement such activities to enhance family nursing practice and research.
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Thorpe A, Delaney RK, Pinto NM, Ozanne EM, Pershing ML, Hansen LM, Lambert LM, Fagerlin A. Parents' Psychological and Decision-Making Outcomes following Prenatal Diagnosis with Complex Congenital Heart Defect: An Exploratory Study. MDM Policy Pract 2023; 8:23814683231204551. [PMID: 37920604 PMCID: PMC10619352 DOI: 10.1177/23814683231204551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 08/24/2023] [Indexed: 11/04/2023] Open
Abstract
Background. Parents with a fetus diagnosed with a complex congenital heart defect (CHD) are at high risk of negative psychological outcomes. Purpose. To explore whether parents' psychological and decision-making outcomes differed based on their treatment decision and fetus/neonate survival status. Methods. We prospectively enrolled parents with a fetus diagnosed with a complex, life-threatening CHD from September 2018 to December 2020. We tested whether parents' psychological and decision-making outcomes 3 months posttreatment differed by treatment choice and survival status. Results. Our sample included 23 parents (average Age[years]: 27 ± 4, range = 21-37). Most were women (n = 18), non-Hispanic White (n = 20), and married (n = 21). Most parents chose surgery (n = 16), with 11 children surviving to the time of the survey; remaining parents (n = 7) chose comfort-directed care. Parents who chose comfort-directed care reported higher distress (x ¯ = 1.51, s = 0.75 v. x ¯ = 0.74, s = 0.55; Mdifference = 0.77, 95% confidence interval [CI], 0.05-1.48) and perinatal grief (x ¯ = 91.86, s = 22.96 v. x ¯ = 63.38, s = 20.15; Mdifference = 27.18, 95% CI, 6.20-48.16) than parents who chose surgery, regardless of survival status. Parents who chose comfort-directed care reported higher depression (x ¯ = 1.64, s = 0.95 v. x ¯ = 0.65, s = 0.49; Mdifference = 0.99, 95% CI, 0.10-1.88) than parents whose child survived following surgery. Parents choosing comfort-directed care reported higher regret (x ¯ = 26.43, s = 8.02 v. x ¯ = 5.00, s = 7.07; Mdifference = 21.43, 95% CI, 11.59-31.27) and decisional conflict (x ¯ = 20.98, s = 10.00 v. x ¯ = 3.44, s = 4.74; Mdifference = 17.54, 95% CI; 7.75-27.34) than parents whose child had not survived following surgery. Parents whose child survived following surgery reported lower grief (Mdifference = -19.71; 95% CI, -39.41 to -0.01) than parents whose child had not. Conclusions. The results highlight the potential for interventions and care tailored to parents' treatment decisions and outcomes to support parental coping and well-being. Highlights Question: Do the psychological and decision-making outcomes of parents differ based on their treatment decision and survival outcome following prenatal diagnosis with complex CHD?Findings: In this exploratory study, parents who decided to pursue comfort-directed care after a prenatal diagnosis reported higher levels of psychological distress and grief as well as higher decisional conflict and regret than parents who decided to pursue surgery.Meaning: The findings from this exploratory study highlight potential differences in parents' psychological and decision-making outcomes following a diagnosis of complex CHD for their fetus, which appear to relate to the treatment approach and the treatment outcome and may require tailoring of psychological and decision support.
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Affiliation(s)
- Alistair Thorpe
- University of Utah Intermountain Healthcare Department of Population Health Sciences, Salt Lake City, UT, USA
- Department of Applied Health Research, University College London, London, UK
| | - Rebecca K. Delaney
- University of Utah Intermountain Healthcare Department of Population Health Sciences, Salt Lake City, UT, USA
| | - Nelangi M. Pinto
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
- Division of Pediatric Cardiology at Seattle Children’s Hospital, Seattle, WA, USA
| | - Elissa M. Ozanne
- University of Utah Intermountain Healthcare Department of Population Health Sciences, Salt Lake City, UT, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mandy L. Pershing
- University of Utah Intermountain Healthcare Department of Population Health Sciences, Salt Lake City, UT, USA
| | - Lisa M. Hansen
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Linda M. Lambert
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Angela Fagerlin
- University of Utah Intermountain Healthcare Department of Population Health Sciences, Salt Lake City, UT, USA
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation
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Mangin-Heimos KS, Strube M, Taylor K, Galbraith K, O’Brien E, Rogers C, Lee CK, Ortinau C. Trajectories of Maternal and Paternal Psychological Distress After Fetal Diagnosis of Moderate-Severe Congenital Heart Disease. J Pediatr Psychol 2023; 48:305-316. [PMID: 35976135 PMCID: PMC10118854 DOI: 10.1093/jpepsy/jsac067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 07/18/2022] [Accepted: 07/23/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare trajectories of maternal and paternal psychological distress after prenatal diagnosis of fetal moderate-severe congenital heart disease (CHD), from pregnancy through early-mid infancy. METHODS Pregnant women who received a prenatal diagnosis of fetal moderate-severe CHD, and their partners, were enrolled in a prospective, longitudinal study. Symptoms of psychological distress were measured twice during pregnancy and twice after birth, using the Depression Anxiety Stress Scales (DASS-42). Patterns and predictors of psychological distress were examined using generalized hierarchical linear modeling. RESULTS Psychological distress was present in 42% (18/43) of mothers and 22% (8/36) of fathers at least once during the study. The rates of distress did not differ between mothers and fathers. There was also no change in probability of distress over time or difference in distress trajectories between mothers and fathers. However, individual trajectories demonstrated considerable variability in symptoms for both mothers and fathers. Predictors of psychological distress included low social support for mothers and a history of mental health conditions for fathers. CONCLUSIONS Parents who receive a prenatal diagnosis of fetal CHD commonly report symptoms of psychological distress from the time of diagnosis through early-mid infancy and display highly variable trajectories. These data suggest that early and repeated psychological screening is important once a fetal CHD diagnosis is made and that providing mental health and social support to parents may be an important component of their ongoing care.
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Affiliation(s)
- Kathryn S Mangin-Heimos
- Department of Psychological and Brain Sciences, Washington University in St. Louis, USA
- Department of Pediatrics, Washington University in St. Louis, USA
| | - Michael Strube
- Department of Psychological and Brain Sciences, Washington University in St. Louis, USA
| | - Kaylin Taylor
- Department of Pediatrics, Washington University in St. Louis, USA
| | | | - Erin O’Brien
- Department of Pediatrics, Washington University in St. Louis, USA
| | - Cynthia Rogers
- Department of Psychiatry, Washington University in St. Louis, USA
| | - Caroline K Lee
- Department of Pediatrics, Washington University in St. Louis, USA
| | - Cynthia Ortinau
- Department of Pediatrics, Washington University in St. Louis, USA
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Watkins S, Isichei O, Gentles TL, Brown R, Percival T, Sadler L, Gorinski R, Crengle S, Cloete E, de Laat MWM, Bloomfield FH, Ward K. What is Known About Critical Congenital Heart Disease Diagnosis and Management Experiences from the Perspectives of Family and Healthcare Providers? A Systematic Integrative Literature Review. Pediatr Cardiol 2023; 44:280-296. [PMID: 36125507 PMCID: PMC9895021 DOI: 10.1007/s00246-022-03006-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/06/2022] [Indexed: 02/06/2023]
Abstract
The experience of diagnosis, decision-making and management in critical congenital heart disease is layered with complexity for both families and clinicians. We synthesise the current evidence regarding the family and healthcare provider experience of critical congenital heart disease diagnosis and management. A systematic integrative literature review was conducted by keyword search of online databases, MEDLINE (Ovid), PsycINFO, Cochrane, cumulative index to nursing and allied health literature (CINAHL Plus) and two journals, the Journal of Indigenous Research and Midwifery Journal from 1990. Inclusion and exclusion criteria were applied to search results with citation mining of final included papers to ensure completeness. Two researchers assessed study quality combining three tools. A third researcher reviewed papers where no consensus was reached. Data was coded and analysed in four phases resulting in final refined themes to summarise the findings. Of 1817 unique papers, 22 met the inclusion criteria. The overall quality of the included studies was generally good, apart from three of fair quality. There is little information on the experience of the healthcare provider. Thematic analysis identified three themes relating to the family experience: (1) The diagnosis and treatment of a critical congenital heart disease child significantly impacts parental health and wellbeing. (2) The way that healthcare and information is provided influences parental response and adaptation, and (3) parental responses and adaptation can be influenced by how and when support occurs. The experience of diagnosis and management of a critical congenital heart disease child is stressful and life-changing for families. Further research is needed into the experience of minority and socially deprived families, and of the healthcare provider, to inform potential interventions at the healthcare provider and institutional levels to improve family experience and support.
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Affiliation(s)
- S. Watkins
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - O. Isichei
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | | | - R. Brown
- National Hauora Coalition, Auckland, New Zealand
| | - T. Percival
- Department of Paediatrics, The University of Auckland, Auckland, New Zealand
| | | | - R. Gorinski
- Heart Kids New Zealand, Tamariki Manawa Maia, Auckland, New Zealand
| | - S. Crengle
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - E. Cloete
- Te Whatu Ora, Christchurch, New Zealand
| | | | - F. H. Bloomfield
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - K. Ward
- School of Nursing, The University of Auckland, Auckland, New Zealand
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Muñoz-Violant S, Violant-Holz V, Rodríguez MJ. Factors of well-being of youth with complex medical conditions from the experience of hospitalization and convalescence: A pilot study. PLoS One 2023; 18:e0285213. [PMID: 37141278 PMCID: PMC10159209 DOI: 10.1371/journal.pone.0285213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 04/18/2023] [Indexed: 05/05/2023] Open
Abstract
Well-being in children with a complex medical condition (CMC) impacts the way they view and communicate with their immediate environment as well as their development, and it is thus necessary to inquire about the contextual issues and different needs that a CMC carries. This pilot study aimed to identify factors of pediatric well-being from the experience of hospitalization and convalescence of youth with CMC and their caregivers, in a cross-sectional analysis using a selective methodology complemented by an indirect observational methodology. We analyzed the quality of life and well-being of youth with CMC using a validated KINDLR questionnaire. We collected 35 surveys: 11 from youth with CMC and 24 from caregivers from Spain. We focused the analysis on sociodemographics, well-being perceptions, and coping strategies variables. The results show that children aged between 3 and 6 years and their caregivers scored physical well-being the lowest out of all dimensions of well-being, and they scored family well-being the highest. Moreover, youth between the ages of 7 and 17 years and their caregivers scored school-related well-being the lowest. Coping strategies to deal with stressful situations differ between children and caregivers. While children mainly engage in social withdrawal, caregivers engage in cognitive restructuring and expressing emotions. However, we did not find a relationship between coping strategies and well-being perceptions. These results highlight the need to facilitate communication spaces with both families and health professionals where the voice of children is considered.
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Affiliation(s)
- Sarah Muñoz-Violant
- Hospital Pedagogy in Neonatology and Pediatrics-Research Group, Universitat de Barcelona, Barcelona, Spain
| | - Verónica Violant-Holz
- Hospital Pedagogy in Neonatology and Pediatrics-Research Group, Universitat de Barcelona, Barcelona, Spain
- Department of Didactics and Educational Organization, Faculty of Education, Universitat de Barcelona, Barcelona, Spain
- International Observatory in Hospital Pedagogy, Universitat de Barcelona, Barcelona, Spain
| | - Manuel J Rodríguez
- Department Biomedical Sciences, Institute of Neurosciences, School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
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The Relationship of Family Factors to Psychosocial Outcomes in Children with Hypoplastic Left Heart Syndrome at 6 Years of Age. J Pediatr 2022; 255:50-57.e2. [PMID: 36265572 DOI: 10.1016/j.jpeds.2022.10.016] [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: 05/13/2022] [Revised: 10/08/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The objective of this study was to describe the relationships between family factors and outcomes for children with hypoplastic left heart syndrome (HLHS). STUDY DESIGN This cross-sectional study was ancillary to the Pediatric Heart Network Single Ventricle Reconstruction Extension Study to examine family factors including parental mental health, quality of life (QOL), family resources, function and management, and their relationships to child psychosocial outcomes (adaptive behavior, internalizing and externalizing behaviors and health-related quality of life [HRQOL]) at 6 years of age. RESULTS Participants were parents (115 mothers, 71 fathers) of children with HLHS. Parents reported anxiety, QOL and family resources that were worse than the general population; 33% reported family dysfunction. There were no meaningful differences between reports from mothers and fathers. Parental perception of better child health was associated with better family management of the condition (P < .05). Several family management factors explained a moderate amount of variance in adaptive behavior (ΔR2 = 0.08-0.14), adaptive skills (ΔR2 = 0.19-0.21), and HRQOL scores (ΔR2 = 0.04-0.18); little variance was explained in internalizing problems (ΔR2 = 0.02-0.03) (all P < .05) above and beyond demographic and clinical variables. CONCLUSIONS HLHS has a significant impact on both children and families. Relationships between child and family characteristics may impose risk or protection. Improved understanding of these associations should guide counseling and tailored interventions.
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Demianczyk AC, Driscoll CFB, Karpyn A, Shillingford A, Kazak AE, Sood E. Coping strategies used by mothers and fathers following diagnosis of congenital heart disease. Child Care Health Dev 2022; 48:129-138. [PMID: 34519072 PMCID: PMC9007227 DOI: 10.1111/cch.12913] [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: 03/15/2021] [Revised: 08/23/2021] [Accepted: 09/05/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Parents of children with congenital heart disease (CHD) exhibit high rates of mental health difficulties, which can influence child developmental and behavioural outcomes. While extensive research has focused on CHD-related stressors that contribute to parental mental health difficulties, few studies have investigated parental coping strategies that may mitigate or heighten risk. This study aimed to identify parental coping strategies following diagnosis of CHD and compare use of coping strategies among different groups (mothers vs. fathers; prenatal vs. postnatal diagnosis). METHODS A diverse sample of 34 parents (20 mothers and 14 fathers) of young children with CHD participated in semistructured interviews focused on their responses to CHD-related stressors. Coping strategies were identified from qualitative data and categorized according to the COPE Inventory, an instrument that assesses common adult responses to stress. Coping strategies deemed as unique to parenting a critically ill child were identified. χ2 and independent sample t tests evaluated group differences. RESULTS Parents described using between 1 and 10 different adaptive and maladaptive strategies measured by the COPE Inventory. Most parents (82.35%) also described coping strategies that may be unique to parenting a critically ill child. Mothers were more likely than fathers to report a focus on and venting of emotions (70% vs. 21.43%) and behavioural disengagement (25% vs. 0%). Compared with parents receiving a postnatal CHD diagnosis, those receiving a prenatal diagnosis described a greater variety of coping strategies (6.23 vs. 4.52) and more often reported positive reinterpretation and growth (69.23% vs. 14.29%), behavioural disengagement (38.46% vs. 0%) and denial (38.46% vs. 0%). CONCLUSIONS Parents of children with CHD utilize a variety of coping strategies, some of which are maladaptive. Interventions tailored to the needs of mothers and fathers of young children with CHD, including those receiving a postnatal diagnosis, are needed to promote adaptive coping and optimize family psychosocial outcomes.
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Affiliation(s)
- Abigail C Demianczyk
- Department of Child and Adolescent Psychiatry and Behavioral Sciences and Cardiac Center, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Colleen F Bechtel Driscoll
- Division of Behavioral Health, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Allison Karpyn
- Center for Research in Education and Social Policy, Department of Human Development and Family Sciences, University of Delaware, Newark, Delaware, USA
| | - Amanda Shillingford
- Cardiac Center, Children’s Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anne E Kazak
- Center for Healthcare Delivery Science, Nemours Children’s Health System, Wilmington, Delaware, USA., Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Erica Sood
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA., Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
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11
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Role alteration predicts anxiety and depressive symptoms in parents of infants with congenital heart disease: a pilot study. Cardiol Young 2021; 31:1842-1849. [PMID: 33818351 PMCID: PMC8490483 DOI: 10.1017/s1047951121001037] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Parents of infants born with critical congenital heart disease are at risk for adverse mental health symptoms. The purpose of this study was to identify infant-, parent-, and environmental-based stressors for mothers and fathers after their infants' cardiac surgery, and to explore relationships between stressors and mental health symptoms of anxiety and depression. METHODS This study enrolled 28 biological mother-father dyads from families admitted to the paediatric cardiac intensive care unit for cardiac surgery at one free-standing children's hospital in the Northeast. Paired t-tests were used to examine group differences between mothers and fathers on perceived stressors and mental health symptoms, while linear mixed effects modelling was used to explore the predictive relationship between perceived stressors, personal factors, and mental health symptoms. RESULTS Mothers reported higher perceived stressor scores of parental role alteration (t = 4.03, p < 0.01) and infant appearance and behaviour (t = 2.61, p = 0.02), and total perceived stress (t = 2.29 p = 0.03), compared to fathers. Mothers also reported higher anxiety (t = 2.47, p = 0.02) and depressive symptoms (t = 3.25, p < 0.01) than fathers. In multivariable analysis, parental role alteration significantly predicted anxiety (t = 5.20, p < 0.01, d = 0.77) and depressive symptoms (t = 7.09, p < 0.01, d = 1.05) for mothers and fathers. The consensus subscale of the Dyadic Adjustment Scale also significantly predicted depressive symptoms (t = -2.42, p = 0.02, d = 0.04). CONCLUSION Parents were distressed during their infant's admission for surgical repair for critical congenital heart disease. Parental role alteration was significantly associated with parental anxiety and depressive symptoms, while poor relationship quality was associated with depressive symptoms, highlighting areas for potential nursing-led psychosocial led interventions.
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MacKay L, Benzies K, Raffin Bouchal S, Barnard C. Parental and Health Care Professionals' Experiences Caring for Medically Fragile Infants on Pediatric Inpatient Units. CHILDRENS HEALTH CARE 2021. [DOI: 10.1080/02739615.2021.1973900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Lyndsay MacKay
- Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Karen Benzies
- Nursing, University of Calgary, Calgary, Alberta, Canada
| | | | - Chantelle Barnard
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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13
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Mussatto KA, Van Rompay MI, Trachtenberg FL, Pemberton V, Young-Borkowski L, Uzark K, Hollenbeck-Pringle D, Dunbar-Masterson C, Infinger P, Walter P, Sawin K. Family Function, Quality of Life, and Well-Being in Parents of Infants With Hypoplastic Left Heart Syndrome. JOURNAL OF FAMILY NURSING 2021; 27:222-234. [PMID: 33535863 PMCID: PMC8594631 DOI: 10.1177/1074840720987309] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Survival for hypoplastic left heart syndrome (HLHS) has improved dramatically. Little is known about early family function, quality of life (QOL), or well-being/adjustment for parents of infants with HLHS. Parent/family outcomes over time, predictors, and differences in 143 mothers and 72 fathers were examined. Parents reported better family function compared with published norms, but 26% experienced family dysfunction. QOL and well-being were significantly lower than adult norms. QOL scores generally declined over time, whereas self-reported well-being improved. Responses from mothers and fathers showed different trends, with mothers having worse scores on most measures and at most time points. Being a single parent was a risk factor for poorer family function, but not for lower individual QOL or well-being. Family characteristics, stress, and coping skills were predictive of outcomes. Parents' psychosocial responses to the challenges of life with infants with HLHS change over time. Individually tailored psychosocial support is needed.
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Affiliation(s)
| | | | | | | | | | - Karen Uzark
- C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | | | | | | | | | - Kathleen Sawin
- Milwaukee School of Engineering, WI, USA
- Children's Hospital of Wisconsin, Milwaukee, USA
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14
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Sood E, Lisanti AJ, Woolf-King SE, Wray J, Kasparian N, Jackson E, Gregory MR, Lopez KN, Marino BS, Neely T, Randall A, Zyblewski SC, Brosig CL. Parent mental health and family functioning following diagnosis of CHD: a research agenda and recommendations from the Cardiac Neurodevelopmental Outcome Collaborative. Cardiol Young 2021; 31:900-914. [PMID: 34082841 PMCID: PMC8759239 DOI: 10.1017/s1047951121002134] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Diagnosis of CHD substantially affects parent mental health and family functioning, thereby influencing child neurodevelopmental and psychosocial outcomes. Recognition of the need to proactively support parent mental health and family functioning following cardiac diagnosis to promote psychosocial adaptation has increased substantially over recent years. However, significant gaps in knowledge remain and families continue to report critical unmet psychosocial needs. The Parent Mental Health and Family Functioning Working Group of the Cardiac Neurodevelopmental Outcome Collaborative was formed in 2018 through support from an R13 grant from the National Heart, Lung, and Blood Institute to identify significant knowledge gaps related to parent mental health and family functioning, as well as critical questions that must be answered to further knowledge, policy, care, and outcomes. Conceptually driven investigations are needed to identify parent mental health and family functioning factors with the strongest influence on child outcomes, to obtain a deeper understanding of the biomarkers associated with these factors, and to better understand how parent mental health and family functioning influence child outcomes over time. Investigations are also needed to develop, test, and implement sustainable models of mental health screening and assessment, as well as effective interventions to optimise parent mental health and family functioning to promote psychosocial adaptation. The critical questions and investigations outlined in this paper provide a roadmap for future research to close gaps in knowledge, improve care, and promote positive outcomes for families of children with CHD.
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Affiliation(s)
- Erica Sood
- Nemours Cardiac Center & Nemours Center for Healthcare Delivery Science, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA; Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Amy Jo Lisanti
- Department of Nursing and Clinical Care Services, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | | | - Jo Wray
- Centre for Outcomes and Experience Research in Children’s Health, Illness and Disability and NIHR GOSH Biomedical Research Centre, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Nadine Kasparian
- Cincinnati Children’s Center for Heart Disease and Mental Health, Heart Institute and the Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Heart Centre for Children, The Sydney Children’s Hospitals Network, Sydney, Australia
| | - Emily Jackson
- Department of Patient and Family Services, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Mary R. Gregory
- Department of Nursing, School of Nursing and Health Professions, Missouri Western State University, Saint Joseph, Missouri, USA
- Department of Developmental Medicine/Behavior Sciences, Children’s Mercy Hospital, Kansas City, Missouri, USA
| | - Keila N. Lopez
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Bradley S. Marino
- Department of Pediatric Cardiology, Cleveland Clinic Children’s Hospital, Cleveland, Ohio, USA
| | - Trent Neely
- Sisters by Heart/Brothers by Heart, El Segundo, California, USA
| | - Amy Randall
- Mended Little Hearts of Wisconsin, Mended Hearts/Mended Little Hearts, Albany, Georgia, USA
| | - Sinai C. Zyblewski
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Cheryl L. Brosig
- Herma Heart Institute, Children’s Wisconsin, Milwaukee, Wisconsin, USA; Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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15
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Lisanti AJ, Demianczyk AC, Vaughan K, Martino GF, Ohrenschall RS, Quinn R, Chittams JL, Medoff-Cooper B. Parental role alteration strongly influences depressive symptoms in mothers of preoperative infants with congenital heart disease. Heart Lung 2021; 50:235-241. [PMID: 33340826 PMCID: PMC7969439 DOI: 10.1016/j.hrtlng.2020.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Mothers of infants with congenital heart disease are at risk for depression. OBJECTIVES This study explored the influence on maternal depressive symptoms of several known factors for mothers in the pediatric cardiac intensive care unit, including perceived stressors, attachment, and anxiety. METHODS This study was a secondary analysis of 30 mothers of infants awaiting cardiac surgery. Linear regressions were calculated to determine the relationships between perceived stressors, maternal attachment, anxiety, and maternal depressive symptoms. RESULTS Nearly half of mothers reported depressive symptoms above the measure cut-off score, indicating they were at risk for likely clinical depression. Subscales of perceived stress explained 61.7% of the variance in depressive symptoms (F = 11.815, p<0.0001) with parental role alteration subscale as the strongest predictor (standardized beta=0.694, p = 0.03). CONCLUSIONS Findings underscore the importance of mental health screening and instituting nursing practices to enhance parental role for mothers of infants awaiting cardiac surgery.
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Affiliation(s)
- Amy J Lisanti
- Nursing and Clinical Care Services, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States of America; University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA 19104, United States of America.
| | - Abigail C Demianczyk
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States of America.
| | - Kayla Vaughan
- Nursing and Clinical Care Services, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States of America.
| | - Giordana Fraser Martino
- Nursing and Clinical Care Services, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States of America.
| | - Rachel Schaake Ohrenschall
- Nursing and Clinical Care Services, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States of America.
| | - Ryan Quinn
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA 19104, United States of America.
| | - Jesse L Chittams
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA 19104, United States of America.
| | - Barbara Medoff-Cooper
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA 19104, United States of America; Research Institute, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States of America.
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16
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Lumsden MR, Smith DM, Twigg E, Guerrero R, Wittkowski A. Children with single ventricle congenital heart defects: An interpretative phenomenological analysis of the lived parent experience. PROGRESS IN PEDIATRIC CARDIOLOGY 2020. [DOI: 10.1016/j.ppedcard.2020.101297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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17
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Bishop M, Cohen LL, Robbertz AS. Illness-Related Parenting Stress and Maladjustment in Congenital Heart Disease: Mindfulness as a Moderator. J Pediatr Psychol 2020; 45:1208-1215. [PMID: 33051657 DOI: 10.1093/jpepsy/jsaa081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 08/16/2020] [Accepted: 08/17/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Congenital heart disease (CHD) is characterized by structural defects to the heart or the coronary blood vessels and often requires surgical repair. Raising an infant or toddler with CHD can be challenging and lead to high parenting stress and maladjustment. The parenting literature suggests that mindfulness may buffer parenting stress. The purpose of this study was to examine whether mindfulness might moderate the relationship between illness-related parenting stress and maladjustment in parents of infants and toddlers with CHD. METHODS Parents of infants and toddlers with CHD attending an outpatient clinic provided background information and completed measures of illness-related parenting stress, mindfulness, and maladjustment. RESULTS Results indicated that illness-related parenting stress was associated with maladjustment, and mindfulness moderated this relationship. Specifically, illness-related parenting stress was related to maladjustment at low and average levels of mindfulness; at high mindfulness, there was no association between illness-related parenting stress and maladjustment. CONCLUSIONS Consistent with the broader literatures, our sample of parents of infants and toddlers with CHD reported high illness-related parenting stress and maladjustment. Building on other studies demonstrating the benefits of mindful parenting, our results suggest that engaging in mindfulness might thwart the association between illness-related parenting stress and maladjustment in parents of infants and toddlers with CHD.
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18
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MacKay L, Benzies K, Barnard C, Raffin Bouchal S. Parental Experiences Caring for Their Hospitalized Medically Fragile Infants: A Description of Grief, Stress, and Coping. Can J Nurs Res 2020; 53:191-201. [PMID: 32847405 DOI: 10.1177/0844562120954125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Advances in care have increased survival and improved outcomes of infants with complex and chronic diseases. These medically fragile infants require long-term hospitalization and depend on technology for survival. Parents of these infants experience stress and difficulties adapting to their parental role. PURPOSE To present an account of parental experiences as they provided care for their hospitalized medically fragile infant. METHODS This study was part of a larger constructivist grounded theory study to provide a holistic understanding of the processes of care for medically fragile infants. For this sub-study, 21 parents of hospitalized medically fragile infants were recruited from a pediatric hospital in Western Canada. Parents participated in face-to-face, semi-structured interviews, which were transcribed and analyzed using initial and focused coding. RESULTS Parents of hospitalized medically fragile infants grieved the loss of parenting a healthy infant, and they experienced multiple stressors. Parents utilized various coping strategies to manage their grief and stressors. Some parents were unable to cope, which exacted a heavy toll on their physical and mental health. Parents recommended psychological support, access to physical activity, primary nursing, and health system navigators. CONCLUSIONS Parental recommendations can inform the design of interventions for parents of hospitalized medically fragile infants.
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Affiliation(s)
- Lyndsay MacKay
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Karen Benzies
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.,Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Chantelle Barnard
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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19
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Mackay L, Benzies K, Barnard C, Raffin Bouchal S. Health Care Professionals' Experiences of Providing Care to Hospitalized Medically Fragile Infants and Their Parents. J Pediatr Nurs 2020; 53:14-21. [PMID: 32339972 DOI: 10.1016/j.pedn.2020.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To understand contemporary experiences of pediatric health care professionals' (HCPs) caring for hospitalized Medically Fragile Infants (MFI) and their parents. DESIGN AND METHODS Convenience sampling was adopted to recruit 26 HCPs who provided care to MFI and their parents on inpatient units at a large tertiary pediatric hospital in Western Canada. Participants participated in either a focus group or individual face-to-face interview. Themes and concepts emerged during open and focused coding. FINDINGS HCPs encountered barriers to establishing relationships with parents, including: (a) intricate nature of MFI, (b) lack of social supports, (c) inconsistency, (d) moral distress, (e) burnout, and (f) struggle to gain control. HCPs utilized strategies to establish relationships with parents, including: (a) normalizing and building parental confidence, (b) tailoring care and being flexible, (c) providing parent care, and (d) optimizing communication. CONCLUSION HCPs aimed to establish relationships built on trust with parents of MFI to empower and enable parents to care for their infants. The relationship was the vehicle to enhance the care provided and well-being of MFI. HCPs encountered barriers to establishing trusting relationships and utilized strategies to establish such relationships. PRACTICE IMPLICATIONS It is valuable to understand the importance that the parent-HCPs relationship plays in the care provided to hospitalized MFI and how lack thereof can lead to moral distress and burnout among HCPs. Increasing HCPs' awareness of barriers and strategies to the establishment of a trusting relationship with parents could help improve the collaborative relationship between parents and HCPs.
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Affiliation(s)
- Lyndsay Mackay
- Faculty of Nursing, University of Calgary,, Alberta, Canada.
| | - Karen Benzies
- Faculty of Nursing, Departments of Paediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.
| | - Chantelle Barnard
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada.
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20
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Hwang JH, Chae SM. Experiences of Fathers of Young Children With Severe Congenital Heart Defects in Korea: A Qualitative Descriptive Study. J Pediatr Nurs 2020; 53:e108-e113. [PMID: 32178884 DOI: 10.1016/j.pedn.2020.02.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 02/23/2020] [Accepted: 02/24/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE This qualitative descriptive study sought to explore the experiences of fathers of children with severe congenital heart defects (CHDs) in Korea. METHODS The participants were nine fathers of children under 5 years of age who had undergone open heart surgery within the last 5 years. Data were collected using in-depth individual interviews from February to March 2015. Qualitative data were analyzed using the thematic analysis method. RESULTS Three themes and nine sub-themes emerged from the data. The three themes were "heartbreaking suffering," "self-control during a great struggle," and "being a father of a child with CHD." This study described coping strategies that fathers used to balance their life, including self-control, redefinition of the situation, and seeking family support resources, which enabled them to practice normalization and live an ordinary life despite limitations. CONCLUSION The findings of this study indicate that considerable psychological distress of fathers was similar to that of mothers for weeks to months after the sudden diagnosis of CHD and heart operations. The results also depict the coping strategies, contemporary fathering experience and the parenting role of fathers in raising children with severe CHDs. PRACTICE IMPLICATIONS Healthcare professionals should understand the experience of fathers of children with severe CHDs and their needs for social support. It is also necessary to develop nursing interventions that focus on fathers' needs.
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Affiliation(s)
- Ji-Hye Hwang
- Seoul National University, College of Nursing, Seoul, Republic of Korea.
| | - Sun-Mi Chae
- Seoul National University, College of Nursing, The Research Institute of Nursing Science, Seoul, Republic of Korea
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21
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"Why and how did this happen?": development and evaluation of an information resource for parents of children with CHD. Cardiol Young 2020; 30:346-352. [PMID: 31920192 DOI: 10.1017/s1047951119003226] [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] [Indexed: 11/07/2022]
Abstract
BACKGROUND The causes of CHD are complex and often unknown, leading parents to ask how and why this has happened. Genetic counselling has been shown to benefit these parents by providing information and support; however, most parents currently do not receive this service. This study aimed to develop a brochure to determine whether an information resource could improve parents' knowledge about CHD causation and inheritance and increase psychosocial functioning. METHODS In development, the resource was assessed against several readability scales and piloted. Parents of children attending preadmission clinic for surgery were included. Assessments occurred pre- and post-receiving the information resource using a purpose-designed knowledge measure and validated psychological measures. RESULTS Participant's (n = 52) knowledge scores increased significantly from the pre-questionnaire ( ${\overline x}\, = \,5/10$ , sd = 2.086) to post-questionnaire ( $\overline x\, = \,7.88/10$ , sd = 2.094, p < 0.001), with all aware that CHD can be caused by genetic factors after reading the brochure. Perceived personal control also increased from pre- ( $\overline x\, = \,11.856/18$ , sd = 4.339) to post-brochure ( $\overline x\, = \,14.644/18$ , sd = 3.733, p < 0.001), and many reported reduced feelings of guilt. No negative emotional response to the brochure was reported. The information provided was considered relevant (88%), reassuring (86%), and 88% would recommend the brochure to other parents. However, some wanted more emotional support and assistance in what to tell their child. CONCLUSIONS Use of the information resource significantly enhanced parents' knowledge of CHD causation and increased their psychosocial functioning. It is a valuable resource in the absence of genetic counselling; however, it should not replace formal genetic counselling when required.
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22
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Mackay LJ, Benzies KM, Barnard C, Hayden KA. A scoping review of parental experiences caring for their hospitalised medically fragile infants. Acta Paediatr 2020; 109:266-275. [PMID: 31343765 DOI: 10.1111/apa.14950] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/07/2019] [Accepted: 07/23/2019] [Indexed: 11/26/2022]
Abstract
AIM To synthesise and summarise evidence from published research articles regarding parental experiences caring for their hospitalised medically fragile infant. METHODS We searched four electronic databases in April 2018 using three main concepts individually and in combination: infant, medically fragile, parents. We examined articles about experiences of parents caring for the medically fragile infant in a hospital setting. We conducted thematic analysis on the 34 included articles. RESULTS Parents experienced high rates of depressive symptoms, depression, stress, anxiety, distress and post traumatic stress. Parent-infant interactions were disrupted. Parents experienced loss and worry in response to the diagnosis of their infant, which altered or delayed parental role attainment. Supports and coping were key for parents to manage their stress. CONCLUSION Parents of medically fragile infants experience multiple stressors, elevated levels of mental health difficulties, trouble attaining their parental role and often struggle to cope. Development of interventional research is needed to test targeted strategies aimed at reducing parental stress and mental health difficulties. Interventions should include: screening for parental mental health, psychological support, healthcare professional education, strategies to enhance parent-infant interactions and improved relationship competencies among healthcare professionals.
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Affiliation(s)
| | - Karen M. Benzies
- Faculty of Nursing University of Calgary Calgary AB Canada
- Departments of Paediatrics and Community Health Sciences, Cumming School of Medicine University of Calgary Calgary AB Canada
| | - Chantelle Barnard
- Department of Pediatrics, Cumming School of Medicine University of Calgary Calgary AB Canada
| | - K Alix Hayden
- Libraries and Cultural Resources University of Calgary Calgary AB Canada
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23
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Callahan K, Steinwurtzel R, Brumarie L, Schechter S, Parravicini E. Early palliative care reduces stress in parents of neonates with congenital heart disease: validation of the "Baby, Attachment, Comfort Interventions". J Perinatol 2019; 39:1640-1647. [PMID: 31488903 DOI: 10.1038/s41372-019-0490-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/17/2019] [Accepted: 07/26/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To test our hypothesis that an innovative method of early palliative care called "Baby, Attachment, Comfort Interventions" reduces psychological distress in parents of neonates with congenital heart disease. STUDY DESIGN Prospective cohort study of parents of neonates with congenital heart disease. Distress was evaluated at admission and discharge using Neonatal Unit Parental Stressor Scale and Depression Anxiety Stress Index-21. Control parents received standard of care. Intervention parents received interdisciplinary interventions aimed at improving neonatal comfort and parenting experience. RESULTS Seventy-seven parents participated. Stress decreased in the intervention group (26 parents) but not in the control group (51 parents). There was no decrease in anxiety or depression in either group. CONCLUSION Early palliative care reduces stress in parents of neonates with congenital heart disease. Further work is needed to address depression/anxiety in this group of high-risk parents.
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Affiliation(s)
- Katharine Callahan
- Department of Pediatrics, Columbia University Irving Medical Center/NewYork-Presbyterian, New York, NY, USA. .,Children's Hospital of Philadelphia, Division of Neonatology, Philadelphia, PA, USA.
| | - Rochelle Steinwurtzel
- Department of Pediatrics, Columbia University Irving Medical Center/NewYork-Presbyterian, New York, NY, USA
| | | | - Sarah Schechter
- Department of Pediatrics, Columbia University Irving Medical Center/NewYork-Presbyterian, New York, NY, USA
| | - Elvira Parravicini
- Department of Pediatrics, Columbia University Irving Medical Center/NewYork-Presbyterian, New York, NY, USA
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24
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Needs and stressors of parents of term and near-term infants in the NICU: A systematic review with best practice guidelines. Early Hum Dev 2019; 139:104839. [PMID: 31439386 DOI: 10.1016/j.earlhumdev.2019.104839] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Having a sick infant in the NICU can be quite stressful and overwhelming to parents. They require support and may have varied needs. A systematic review of qualitative and quantitative studies from 5 electronic databases (Ovid Medline, EMBASE, PsycINFO, CINAHL and Sociological Abstracts), covering January 2001 - March 2016 identified the needs and stressors of parents of term or near-term Infants in the NICU. Six articles addressed the needs and 14 identified the stressors of parents. Parents' most important need was for accurate and honest information. Needs focused around sensitive infant care and involvement in decision-making. The greatest stressor for parents was alteration to the parental role, followed by infant appearance. Fathers and parents of infants undergoing surgery are an under-researched population. Based on the evidence, enhancing staff-parent communication would better meet parental needs and reduce stressors. Our key recommendations highlight the need for family-centred and individualised care practices in the NICU.
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25
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Ryan KR, Jones MB, Allen KY, Marino BS, Casey F, Wernovsky G, Lisanti AJ. Neurodevelopmental Outcomes Among Children With Congenital Heart Disease: At-Risk Populations and Modifiable Risk Factors. World J Pediatr Congenit Heart Surg 2019; 10:750-758. [PMID: 31658880 DOI: 10.1177/2150135119878702] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
As survivable outcomes among patients with complex congenital heart disease (cCHD) have continued to improve over the last several decades, more attention is being dedicated to interventions that impact not just survival but quality of life among patients with cCHD. In particular, patients with cCHD are at risk for impaired neurodevelopmental outcomes. In this review summarizing select presentations given at the 14th Annual Pediatric Cardiac Intensive Care Society's Annual Meeting in 2019, we discuss the neurodevelopmental phenotype of patients with cCHD, patients at greatest risk of impaired development, and three specific modifiable risk factors impacting development.
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Affiliation(s)
- Kathleen R Ryan
- Division of Cardiology, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Melissa B Jones
- Division of Cardiac Critical Care, Children's National Health System, Washington, DC, USA.,Division of Pediatric Cardiology, Children's National Health System, Washington, DC, USA
| | - Kiona Y Allen
- Division of Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, IL, USA.,Division of Critical Care Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, IL, USA
| | - Bradley S Marino
- Division of Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, IL, USA.,Division of Critical Care Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, IL, USA
| | - Frank Casey
- Department of Cardiology, Belfast Health and Social Care Trust, Belfast, Ireland
| | - Gil Wernovsky
- Division of Cardiac Critical Care, Children's National Health System, Washington, DC, USA.,Division of Pediatric Cardiology, Children's National Health System, Washington, DC, USA
| | - Amy Jo Lisanti
- Department of Cardiac Nursing and the Center for Pediatric Nursing Research and Evidence-based Practice, Children's Hospital of Philadelphia, PA, USA
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26
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McGrath LB, Kovacs AH. Psychological resilience: Significance for pediatric and adult congenital cardiology. PROGRESS IN PEDIATRIC CARDIOLOGY 2019. [DOI: 10.1016/j.ppedcard.2019.101129] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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27
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Bishop MN, Gise JE, Donati MR, Shneider CE, Aylward BS, Cohen LL. Parenting Stress, Sleep, and Psychological Adjustment in Parents of Infants and Toddlers With Congenital Heart Disease. J Pediatr Psychol 2019; 44:980-987. [DOI: 10.1093/jpepsy/jsz026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 03/29/2019] [Accepted: 04/02/2019] [Indexed: 02/06/2023] Open
Abstract
Abstract
Objective
Parents of children with chronic medical needs report increased parenting challenges, poor sleep, and maladjustment. The impact of parenting stress on both sleep and adjustment has yet to be evaluated for parents of infants and young children with congenital heart disease (CHD). We studied the relations among parenting stress, sleep, and adjustment in parents of infants and toddlers with CHD. We expected that sleep quality would mediate the relationship between parenting stress and adjustment.
Methods
Sixty-nine parents of infants and toddlers with CHD were evaluated on self-report measures of illness-related parenting stress (Pediatric Inventory for Parents), sleep (Pittsburgh Sleep Quality Index), and psychological adjustment (Brief Symptom Index-18).
Results
The parents of infants and toddlers with CHD reported elevated levels of parenting stress, sleep problems, and maladjustment. The positive relationship between parenting stress and parent maladjustment was mediated by sleep quality.
Conclusions
Findings suggest that parents of infants and toddlers with CHD report high parenting stress, poor sleep, and maladjustment. Analyses indicate the stress-adjustment relationship is mediated by quality of sleep. Given the multiple demands on parents of infants and children with CHD, it is important to attend to parents’ overall functioning and mental health. Our findings highlight targets for intervention to improve the well-being of parents of young children with CHD.
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Affiliation(s)
| | - Jensi E Gise
- Department of Psychology, Georgia State University
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28
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Al-Yateem N, Brenner M, Alrimawi I, Al-Shujairi A, Al-Yateem S. Predictors of uncertainty in parents of children living with chronic conditions. Nurs Child Young People 2019:e1102. [PMID: 31468904 DOI: 10.7748/ncyp.2019.e1102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Uncertainty in illness implies no meaning has been attributed to an illness event. Although many studies focus on this issue in adults, there is limited research into children with chronic illnesses. Parental uncertainty has been associated with increased risk of post-traumatic stress, which can in turn adversely affect child and parent coping strategies. AIM To identify the characteristics of parents who are at greater risk of uncertainty and the associated characteristics of their children's chronic illnesses. METHOD An exploratory, cross-sectional study design was adopted across three different sites in the United Arab Emirates. Data were collected from parents who accompanied their children, who were receiving treatment, using a validated, culturally adapted Parent Perception of Uncertainty Scale. RESULTS Scores for illness uncertainty ranged from 86.5 to 92.6, on a scale of 31-155, with higher scores indicating greater uncertainty. The highest scores were found in parents of children being cared for in ward settings who had previously been hospitalised, parents of children up to two years of age or those approaching adolescence, fathers, and parents whose first language was Arabic. CONCLUSION The groups of parents with the highest illness uncertainty may benefit most from interventions to improve communication and psychological support.
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Affiliation(s)
- Nabeel Al-Yateem
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates, adjunct lecturer and researcher, School of Nursing, Midwifery and Indigenous Health, Faculty of Science, Charles Sturt University and Research Institute for Medical and Health Science, University of Sharjah, United Arab Emirates
| | - Maria Brenner
- School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, Ireland
| | | | - Arwa Al-Shujairi
- Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
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Wray J, Cassedy A, Ernst MM, Franklin RC, Brown K, Marino BS. Psychosocial functioning of parents of children with heart disease-describing the landscape. Eur J Pediatr 2018; 177:1811-1821. [PMID: 30232593 DOI: 10.1007/s00431-018-3250-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/31/2018] [Accepted: 09/10/2018] [Indexed: 01/23/2023]
Abstract
The aim was to describe the psychological functioning of parents of school-age children with heart disease (HD) in a large-scale, transnational evaluation of parent dyads across the spectrum of cardiac diagnoses and a range of psychosocial domains. Parents of children with HD attending routine out-patient cardiology follow-up visits completed questionnaires assessing their mental health, coping, and family functioning. Parents (1197 mothers and 1053 fathers) of 1214 children (mean age: 12.6 years; S.D. 3.0 years; median time since last surgery: 8.9 years) with congenital or acquired HD from three centers each in the UK and the USA participated (80% response rate). Parents of children with milder HD demonstrated few differences from healthy norms and had significantly lower scores on measures of illness-related stress and post-traumatic stress than parents of children with single ventricle conditions or cardiomyopathy. Parents in these latter two diagnostic sub-groups had significantly higher levels of anxiety and depression than healthy norms but did not differ on other measures of family functioning and coping skills. There were few differences between parents from the UK and the USA. Agreement between mothers and fathers within a dyad was highest for the measure of frequency of illness-related stressors (ICC = 0.67) and lowest for anxiety (ICC = 0.12).Conclusion: Our results suggest two different pathways for the long-term psychological well-being of parents of children with HD: on the one hand, more complex HD is associated with poorer long-term psychosocial outcomes; in contrast, there are also grounds for optimism, particularly for parents of children with less complex conditions, with better psychological outcomes noted for some groups of parents compared to previously reported early psychosocial outcomes. Future work needs to identify factors other than disease severity which might explain poorer (or better) functioning in some parents of children with more complex HD. What is Known: • Parents of children with congenital heart disease report elevated levels of anxiety, depression, and stress after cardiac surgery in infancy. • Maternal mental health problems can have an adverse impact on the psychological adjustment of the child with congenital heart disease. What is New: • Parents of children with milder forms of heart disease do not differ from healthy norms in the longer term and psychological outcomes are better than might be expected from early findings. • More complex diagnoses, particularly functional single ventricle conditions and cardiomyopathy, are associated with poorer long-term psychosocial outcomes for parents.
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Affiliation(s)
- Jo Wray
- Critical Care and Cardiorespiratory Department, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK.
| | - Amy Cassedy
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Michelle M Ernst
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Rodney C Franklin
- Department of Pediatric Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Katherine Brown
- Critical Care and Cardiorespiratory Department, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Bradley S Marino
- Department of Pediatrics, Divisions of Pediatric Cardiology and Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Abstract
Parental stress is a universal experience for parents who have children diagnosed with CHD and has been studied within the context of the child's illness, but not through a broader health disparity lens. This paper provides a thorough synthesis of the current literature on parental stress addressing disparities in parents of children with CHD. Several theories and models from within this literature are described and a new comprehensive framework, the Parental Stress and Resilience in CHD Model, is presented. Future research and clinical implications are discussed.
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Hunter LE, Seale AN. EDUCATIONAL SERIES IN CONGENITAL HEART DISEASE: Prenatal diagnosis of congenital heart disease. Echo Res Pract 2018; 5:R81-R100. [PMID: 30012852 PMCID: PMC6107762 DOI: 10.1530/erp-18-0027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 07/16/2018] [Indexed: 12/31/2022] Open
Abstract
This review article will guide the reader through the background of prenatal screening for congenital heart disease. The reader will be given insight into the normal screening views, common abnormalities, risk stratification of lesions and also recent advances in prenatal cardiology.
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Affiliation(s)
- Lindsey E Hunter
- Department of Paediatric Cardiology, Royal Hospital for Children, Glasgow, UK
| | - Anna N Seale
- Department of Paediatric Cardiology, Birmingham Children’s Hospital, Birmingham, UK
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Parent's Perspectives on How They Cope With the Impact on Their Family of a Child With Heart Disease. J Pediatr Nurs 2018; 40:e9-e17. [PMID: 29396310 DOI: 10.1016/j.pedn.2018.01.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/24/2018] [Accepted: 01/24/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE Studies of familial coping with a child's chronic condition have highlighted psychological distress; family functioning; and quality of life; as issues that demand coping strategies. There are conflicting findings on impact and coping and a paucity of information about the specific coping challenges for parents of a child with heart disease, with few qualitative studies in this area. The purpose of the study was to explore the way parents coped with their child's heart condition as it impacted on different domains of family functioning. DESIGN AND METHOD In this qualitative study, interviews were held with 17 parents attending a pediatric hospital-based family support program in 2015. Fifteen of the 17 children's conditions were classified as "major". Domains covered in the interviews included: coping challenges posed at different stages of the illness trajectory, parenting, condition management, transitions, psychological impact, social support and coping strategies. Interview transcripts were coded thematically. RESULTS Multiple points of stress and challenges to coping were identified: coping with the diagnosis, including consideration of termination; dealing with the challenges facing their child; coping with parenting including co-parenting issues; the role of social support in coping; and identification of adaptive and maladaptive coping behaviours. CONCLUSION A large range of positive coping strategies were identified, as was the need for coping-focused psychological support throughout the parents' and children's journey. PRACTICE IMPLICATIONS The strategies identified have formed the basis of a manualised intervention for these parents.
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Qin C, Li Y, Wang D, Shi Z, Yao R, Wang D, Tang S. Maternal factors and preoperative nutrition in children with mild cases of congenital heart disease. Jpn J Nurs Sci 2018; 16:37-46. [PMID: 29569860 DOI: 10.1111/jjns.12211] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 10/19/2017] [Accepted: 01/24/2018] [Indexed: 01/14/2023]
Abstract
AIM The preoperative poor nutrition of children with congenital heart disease (CHD) impacts the postoperative rehabilitation process of pediatric CHD cases. The factors of these children's preoperative poor nutrition, excluding the disease, have been underreported. The aim was to investigate the preoperative nutritional status of children with CHD who required a simple surgical repair and to analyze the maternal characteristics that are associated with poor nutrition in these sick children. METHODS This was a cross-sectional survey. The weight and height of the children were measured, maternal data were collected via a questionnaire and a univariate analysis and multivariate logistic regression were used to analyze the association between maternal factors and the preoperative poor nutrition of the children with CHD. RESULTS A total of 119 children with simple CHD were recruited to the study. The prevalence of poor nutrition was higher in the children with CHD ("cases") than in the healthy children ("controls"). An increased risk of poor nutrition was associated with lower mothers' perception, education level, understanding of the disease, and higher anxiety. CONCLUSIONS Paying attention to maternal anxiety, depression, and knowledge and providing interventions for the mothers of children with CHD are important in order to promote the nutritional status of these children.
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Affiliation(s)
- Chunxiang Qin
- Obstetric Department, Third Xiangya Hospital, Xiangya School of Nursing, Third Xiangya Hospital, Central South University, Changsha, China
| | - Ying Li
- Neonatology Department, Third Xiangya Hospital, Central South University, Changsha, China
| | - Dianjun Wang
- Cardiac Surgery Department, Third Xiangya Hospital, Central South University, Changsha, China
| | - Zeya Shi
- Nursing Department, People's Hospital of Hunan Province, Changsha, China
| | - Rui Yao
- Psychological Counseling Center, Hunan University of Chinese Medicine, Changsha, China
| | - Dan Wang
- Genetics Department, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, China
| | - Siyuan Tang
- Xiangya School of Nursing, Central South University, Changsha, China
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van Hövell Tot Westerflier CVA, Stegeman I, Muradin MSM, Smit AL, Breugem CC. Parental preferences for the first consultation for microtia. Int J Pediatr Otorhinolaryngol 2018; 106:10-15. [PMID: 29447879 DOI: 10.1016/j.ijporl.2017.12.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 12/29/2017] [Accepted: 12/29/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The aim of our study was to investigate subjective information concerning parental experiences and preferences with regard to the initial information that is provided right after the birth of a child with microtia. The analysis of these data is intended to help professionals improve the way in which such conversations are conducted. As a result, future parents may feel better informed and, hence, better fit to cope with challenges they may encounter having a child with microtia. METHODS A self-administered questionnaire was sent to 106 parents and caretakers of children with microtia who visited the annual International Microtia and Atresia Conference in the Netherlands, May 2016. RESULTS Eighty-seven questionnaires were returned (response rate 82%). Results revealed that 26% of the participants did not receive any information about the condition in the perinatal period. Participants who did receive information right after birth were informed by pediatricians and otolaryngolosits in most of the cases. Plastic surgeons and maxillofacial surgeons were the less commonly serving specialties in this role. A majority of the participants experienced their informing consultation as either being "terrible", or "bad". Parents desired more information about all domains regarding microtia. Development, clothing and appearance, and psychology were believed to be the least important domains. CONCLUSIONS Parents are dissatisfied with several aspects of the initial information that is provided right after the birth of a child with microtia. We believe that there is a need for correct information and patient- and family centered care administered by multiple disciplines.
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Affiliation(s)
- Claire V A van Hövell Tot Westerflier
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584 EA Utrecht, The Netherlands.
| | - Inge Stegeman
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; Department of Otorhinolaryngology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | - Marvick S M Muradin
- Department of Oral en Cranio-Maxillofacial Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584 EA Utrecht, The Netherlands.
| | - Adriana L Smit
- Department of Otorhinolaryngology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | - Corstiaan C Breugem
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584 EA Utrecht, The Netherlands.
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Abstract
BACKGROUND Parents may experience anxiety and stress when their children undergo cardiac catheterisation. The goal of this study was to assess the level of anxiety in parents of children undergoing cardiac catheterisation and to identify factors that were associated with level of anxiety. METHODS This was a cross-sectional survey of parents of children who underwent cardiac catheterisation. Anxiety levels were measured using a validated self-report questionnaire - State-Trait Anxiety Inventory, which generates state anxiety scores on the current state of anxiety and trait anxiety scores on the stable aspects of anxiety proneness. One sample t-test was used to compare the data with normative data. Multiple linear regression was used to assess the factors associated with the state score. RESULTS A total of 113 parents completed the survey. The mean age of parents was 34.0±7.7 years and the mean age of children undergoing catheterisation was 6.7±5.7 years. Compared with normative data, mean state score was significantly higher in our cohort (p<0.05) despite no difference in the trait score. Final multivariate model showed that the state score was significantly associated with child age group (<1 year [coefficient β 7.2] and 10-18 years [6.3], compared to 1 to <10 years of age [reference]) and history of previous catheterisation (-5.2) (p<0.05). CONCLUSIONS Concurrent state anxiety level was high among parents of children undergoing cardiac catheterisation, whereas trait anxiety level was not. Higher anxiety was experienced by parents of infants and adolescents without a history of previous catheterisation.
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Simeone S, Pucciarelli G, Perrone M, Rea T, Gargiulo G, Dell'Angelo G, Guillari A, Comentale G, Palma G, Vosa C. Comparative Analysis: Implementation of a Pre-operative Educational Intervention to Decrease Anxiety Among Parents of Children With Congenital Heart Disease. J Pediatr Nurs 2017; 35:144-148. [PMID: 28131545 DOI: 10.1016/j.pedn.2017.01.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 01/20/2017] [Accepted: 01/20/2017] [Indexed: 02/05/2023]
Abstract
PURPOSE The present study evaluated the efficacy of a nursing educational intervention in alleviating the level of parental anxiety in the parents of children who required heart surgery for the first time. DESIGN AND METHODS A comparative study was used to explore the parents of children who had to undergo cardiac surgery. Parents of children were randomized into 2 groups: 1) control group and 2) experimental group or parents that received the educational intervention about PICU stay. RESULT The results of STAY-1 showed that the average anxiety score of group 1 was lower than that of group 2 (63.0 [SD=3.5] vs. 70.4 [SD=2.8]). CONCLUSION In order to decrease levels of parental anxiety and stress prior to paediatric surgery, parents should be adequately informed about planned therapeutic procedures. PRACTICE IMPLICATIONS We speculate that pre-surgery parent education on what to expect before, during and after their child's cardiac surgery may improve parents' knowledge and satisfaction and decrease anxiety.
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Affiliation(s)
- Silvio Simeone
- Department Activities Integrated Cardiology, Cardiac Surgery and Emergency cardiovascular - ICU Cardiac Surgery University Hospital Policlinico Federico II, Naples, Italy.
| | | | - Marco Perrone
- Department Activities Integrated Cardiology, Cardiac Surgery and Emergency cardiovascular - ICU Cardiac Surgery University Hospital Policlinico Federico II, Naples, Italy
| | - Teresa Rea
- Department of Hygiene and Public Health, AOU Federico II, Naples, Italy
| | | | - Grazia Dell'Angelo
- Department Activities Integrated Cardiology, Cardiac Surgery and Emergency cardiovascular - ICU Cardiac Surgery University Hospital Policlinico Federico II, Naples, Italy
| | - Assunta Guillari
- Department of Hygiene and Public Health, AOU Federico II, Naples, Italy
| | | | - Gaetano Palma
- Pediatric Cardiac Surgery, AOU Federico II, Naples, Italy
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Stonawski V, Vollmer L, Köhler-Jonas N, Rohleder N, Golub Y, Purbojo A, Moll GH, Heinrich H, Cesnjevar RA, Kratz O, Eichler A. Long-term Associations of an Early Corrected Ventricular Septal Defect and Stress Systems of Child and Mother at Primary School Age. Front Pediatr 2017; 5:293. [PMID: 29379779 PMCID: PMC5775274 DOI: 10.3389/fped.2017.00293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 12/20/2017] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Ventricular septal defect (VSD) is the most common congenital heart defect, with larger VSDs typically being corrected with an open-heart surgery during infancy. Long-term consequences of a VSD-corrective surgery on stress systems of child and mother are still unknown. The aim of the present study is to investigate the associations of an early corrected VSD and diurnal cortisol release of child and mother. METHODS 26 children (12 boys) between 6 and 9 years old, who underwent surgery for an isolated VSD within the first 3 years of life, and their mothers participated in the study. Their diurnal cortisol profiles were compared to a sex-, age-, and socioeconomic status-matched healthy control group. Within the VSD group, associations between cortisol and characteristics of surgery and hospitalization were investigated. Child and mother psychopathological symptoms were considered as a possible interfering mechanism of altered cortisol profiles. RESULTS Diurnal cortisol profiles of children with an early corrected VSD did not differ from those of controls. However, mothers of affected children exhibited higher cortisol levels in the morning (p < 0.001, [Formula: see text]) and a steeper diurnal cortisol slope (p = 0.016, [Formula: see text]) than mothers of healthy children. CONCLUSION Results indicate a favorable development of children with an early corrected VSD, in terms of comparable diurnal cortisol profiles with healthy controls, according to a comparable mother-rated psychopathology. Mothers of affected children reveal altered diurnal cortisol levels, without differences in self-rated psychopathology. This divergence should be clarified in future research.
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Affiliation(s)
- Valeska Stonawski
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.,Department of Psychology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Laura Vollmer
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Nicola Köhler-Jonas
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Nicolas Rohleder
- Department of Psychology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Yulia Golub
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Ariawan Purbojo
- Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Gunther H Moll
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Hartmut Heinrich
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.,kbo-Heckscher-Klinikum, München, Germany
| | - Robert A Cesnjevar
- Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Oliver Kratz
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Anna Eichler
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
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Diffin J, Spence K, Naranian T, Badawi N, Johnston L. Stress and distress in parents of neonates admitted to the neonatal intensive care unit for cardiac surgery. Early Hum Dev 2016; 103:101-107. [PMID: 27565126 DOI: 10.1016/j.earlhumdev.2016.08.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 08/08/2016] [Accepted: 08/08/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Parents of infants admitted to the Neonatal Intensive Care Unit (NICU) are at risk of psychological distress and NICU-related stress. However, parents of infants admitted to NICU for cardiac surgery are an under-researched population. AIMS Identify levels of NICU-related stress, and levels of psychological distress, reported by parents of infants admitted to the NICU for cardiac surgery. STUDY DESIGN Observational study. SUBJECTS 69 parents of infants admitted to the NICU for cardiac surgery (cardiac group) and 142 parents of healthy infants (control group). OUTCOME MEASURES Questionnaire packs provided to parents prior to discharge (time-point 1), and at six and 12months corrected age included: Hospital Anxiety and Depression Scale, Coping Inventory for Stressful Situations, and Family Support Scale. The Parental Stressor Scale:NICU was administered to the cardiac group at time-point 1. RESULTS The cardiac group reported (i) that parental role alteration was the most stressful aspect of the NICU and (ii) higher scores for anxiety and depression than the control group at all three time-points, with the highest levels reported during the NICU stay. Correlation analyses indicated (i) stress associated with the sights and sounds of the NICU, and the appearance and behaviour of the infant in the NICU, had a significant positive association with anxiety and depression, and (ii) a significant negative relationship between anxiety and task-focused coping. CONCLUSIONS An individualised parent-targeted intervention aimed at reducing stress associated with the NICU and enhancing task-focused coping style may help to reduce levels of anxiety and depression within this group of parents.
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Affiliation(s)
- J Diffin
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK.
| | - K Spence
- Grace Centre for Newborn Care, Children's Hospital Westmead, Sydney, Australia; School of Nursing and Midwifery, Queen's University Belfast, Northern Ireland, UK
| | - T Naranian
- School of Nursing and Midwifery, Queen's University Belfast, Northern Ireland, UK
| | - N Badawi
- Grace Centre for Newborn Care, Children's Hospital Westmead, Sydney, Australia; Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - L Johnston
- School of Nursing and Midwifery, Queen's University Belfast, Northern Ireland, UK; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
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Parents' preparedness for their infants' discharge following first-stage cardiac surgery: development of a parental early warning tool. Cardiol Young 2016; 26:1414-24. [PMID: 27431411 DOI: 10.1017/s1047951116001062] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
UNLABELLED Aim The aim of this study was to explore parental preparedness for discharge and their experiences of going home with their infant after the first-stage surgery for a functionally univentricular heart. BACKGROUND Technological advances worldwide have improved outcomes for infants with a functionally univentricular heart over the last 3 decades; however, concern remains regarding mortality in the period between the first and second stages of surgery. The implementation of home monitoring programmes for this group of infants has improved this initial inter-stage survival; however, little is known about parents' experiences of going home, their preparedness for discharge, and parents' recognition of deterioration in their fragile infant. METHOD This study was conducted in 2011-2013; eight sets of parents were consulted in the research planning stage in September, 2011, and 22 parents with children aged 0-2 years responded to an online survey during November, 2012-March, 2013. Description of categorical data and deductive thematic analysis of the open-ended questions were undertaken. RESULTS Not all parents were taught signs of deterioration or given written information specific to their baby. The following three themes emerged from the qualitative data: mixed emotions about going home, knowledge and preparedness, and support systems. CONCLUSIONS Parents are not adequately prepared for discharge and are not well equipped to recognise deterioration in their child. There is a role for greater parental education through development of an early warning tool to address the gap in parents' understanding of signs of deterioration, enabling appropriate contact and earlier management by clinicians.
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O'Connor AM, Wray J, Tomlinson RS, Cassedy A, Jacobs JP, Jenkins KJ, Brown KL, Franklin RCG, Mahony L, Mussatto K, Newburger JW, Wernovsky G, Ittenbach RF, Drotar D, Marino BS. Impact of Surgical Complexity on Health-Related Quality of Life in Congenital Heart Disease Surgical Survivors. J Am Heart Assoc 2016; 5:e001234. [PMID: 27451455 PMCID: PMC5015349 DOI: 10.1161/jaha.114.001234] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 05/03/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Surgical complexity and related morbidities may affect long-term patient quality of life (QOL). Aristotle Basic Complexity (ABC) score and Risk Adjustment in Congenital Heart Surgery (RACHS-1) category stratify the complexity of pediatric cardiac operations. The purpose of this study was to examine the relationship between surgical complexity and QOL and to investigate other demographic and clinical variables that might explain variation in QOL in pediatric cardiac surgical survivors. METHODS AND RESULTS Pediatric Cardiac Quality of Life (PCQLI) study participants who had undergone cardiac surgery were included. The PCQLI database provided sample characteristics and QOL scores. Surgical complexity was defined by the highest ABC raw score or RACHS-1 category. Relationships among surgical complexity and demographic, clinical, and QOL variables were assessed using ordinary least squares regression. A total of 1416 patient-parent pairs were included. Although higher ABC scores and RACHS-1 categories were associated with lower QOL scores (P<0.005), correlation with QOL scores was poor to fair (r=-0.10 to -0.29) for all groups. Ordinary least squares regression showed weak association with R(2)=0.06 to R(2)=0.28. After accounting for single-ventricle anatomy, number of doctor visits, and time since last hospitalization, surgical complexity scores added no additional explanation to the variance in QOL scores. CONCLUSIONS ABC scores and RACHS-1 categories are useful tools for morbidity and mortality predictions prior to cardiac surgery and quality of care initiatives but are minimally helpful in predicting a child's or adolescent's long-term QOL scores. Further studies are warranted to determine other predictors of QOL variation.
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Affiliation(s)
- Amy M O'Connor
- Division of Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jo Wray
- Cardiorespiratory Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK Department of Pediatric Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Ryan S Tomlinson
- Division of Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Amy Cassedy
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jeffrey P Jacobs
- Division of Thoracic and Cardiovascular Surgery, The Congenital Heart Institute of Florida, All Children's Hospital and Children's Hospital of Tampa, University of South Florida College of Medicine, Cardiac Surgical Associates, St. Petersburg and Tampa, FL
| | - Kathy J Jenkins
- Department of Cardiology, Children's Hospital Boston, Harvard Medical School, Boston, MA Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Kate L Brown
- Cardiorespiratory Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Rodney C G Franklin
- Department of Pediatric Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Lynn Mahony
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Kathleen Mussatto
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Wisconsin, Milwaukee, WI
| | - Jane W Newburger
- Department of Cardiology, Children's Hospital Boston, Harvard Medical School, Boston, MA Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Gil Wernovsky
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, PA Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, PA
| | - Richard F Ittenbach
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Dennis Drotar
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Bradley S Marino
- Division of Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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42
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Marokakis S, Kasparian NA, Kennedy SE. Prenatal counselling for congenital anomalies: a systematic review. Prenat Diagn 2016; 36:662-71. [DOI: 10.1002/pd.4836] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/07/2016] [Accepted: 04/30/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Sarah Marokakis
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine; University of New South Wales; Sydney NSW Australia
| | - Nadine A. Kasparian
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine; University of New South Wales; Sydney NSW Australia
- Heart Centre for Children; The Sydney Children's Hospitals Network (Westmead and Randwick); Sydney NSW Australia
| | - Sean E. Kennedy
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine; University of New South Wales; Sydney NSW Australia
- Nephrology; Sydney Children's Hospital; Randwick NSW Australia
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43
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Brenner M, Côté SM, Boivin M, Tremblay RE. Severe congenital malformations, family functioning and parents' separation/divorce: a longitudinal study. Child Care Health Dev 2016; 42:16-24. [PMID: 26174996 DOI: 10.1111/cch.12269] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND We aim to explore the association of a severe congenital malformation (SCM) with postnatal family functioning and parents' separation/divorce and to examine if this association might be moderated by birth order of the child and parental level of education. SCM refers to malformations that, without medical intervention, cause handicap or death. METHODS Using the Quebec Longitudinal Study of Child Development, an ongoing population-based birth cohort study initiated in 1998, we compared 1675 families of children with and without a SCM to identify if having a child with a SCM was associated with maternal perception of family functioning. We examined if an SCM was associated with parents' separation and examined parents' education level and birth order of the children to evaluate whether these factors had any moderating effect on the results. RESULTS There were no significant differences in family functioning between families with and without a SCM child at 5 and 17 months. At 5 months, family functioning was significantly better (P = 0.03) for families with a SCM firstborn child than for families with a SCM child that is not firstborn. For parental separation, no significant differences were observed at 5 and 29 months and 4 years. No significant moderating effects were observed for birth order and parental education on parental separation. CONCLUSIONS Families of children with a SCM do not appear to be at higher risk of family dysfunction within the first 17 months after birth nor of parental separation within the first 4 years after birth. Family functioning tends to be worst in families where the child with SCM is the second or subsequent child born.
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Affiliation(s)
- M Brenner
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - S M Côté
- School of Public Health, University of Montreal, Montreal, Canada.,Institute of Genetic, Neurobiological and Social Foundations of Child Development, Tomsk State University, Tomsk, Russian Federation
| | - M Boivin
- School of Psychology, Laval University, Québec, Canada.,Institute of Genetic, Neurobiological and Social Foundations of Child Development, Tomsk State University, Tomsk, Russian Federation
| | - R E Tremblay
- Institute of Genetic, Neurobiological and Social Foundations of Child Development, Tomsk State University, Tomsk, Russian Federation.,School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland.,Departments of Pediatrics and Psychology, University of Montreal, Montreal, Canada
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44
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Anxiety and depression in the caregivers of children with congenital heart disease. MIDDLE EAST CURRENT PSYCHIATRY 2015. [DOI: 10.1097/01.xme.0000471465.50470.5f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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45
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Families of children with congenital heart disease: A literature review. Heart Lung 2015; 44:494-511. [PMID: 26404115 DOI: 10.1016/j.hrtlng.2015.08.005] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 07/13/2015] [Accepted: 08/25/2015] [Indexed: 11/21/2022]
Abstract
In 2000 and 2002, the National Heart, Lung, and Blood Institute launched two initiatives to encourage treatment innovations and research on children with heart disease and their families. Since then, no systematic reviews have examined the evidence regarding the impacts of having a child with congenital heart disease (CHD) on families. This review synthesized key findings regarding families of children with CHD, critiqued research methods, described what has been done, and provided recommendations for future inquiry. Databases searched included PubMed, CINAHL, Family & Society Studies Worldwide, Women's Studies International, and PsycINFO. The literature search followed the PRISMA guidelines. As a result, ninety-four articles were reviewed. Four major themes were derived: parents' psychological health, family life, parenting challenges, and family-focused interventions. In conclusion, while they found parents having psychological symptoms, researchers did not explore parents' appraisals of what led to their symptoms. Research is needed to explore parents' experiences and expectations.
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46
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Early Traumatic Stress Responses in Parents Following a Serious Illness in Their Child: A Systematic Review. J Clin Psychol Med Settings 2015; 23:53-66. [DOI: 10.1007/s10880-015-9430-y] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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47
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Abstract
The purpose of the study was to illuminate the meanings of the lived experiences of support as disclosed by fathers of children with congenital heart defect (CHD). Narrative interviews were conducted individually with five fathers of children diagnosed with CHD. A phenomenological-hermeneutic method was used to interpret the verbatim transcribed narrative interviews. The meanings of the lived experiences of support for the fathers were identified in two themes and illustrate the fathers’ feelings of being supported when being in a mutual relationship with others. A third theme illustrates the situation when support is absent. Our findings indicate that support for fathers of children with CHD might be best promoted by the philosophy of family-centered care.
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48
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Jackson AC, Frydenberg E, Liang RPT, Higgins RO, Murphy BM. Familial impact and coping with child heart disease: a systematic review. Pediatr Cardiol 2015; 36:695-712. [PMID: 25618163 DOI: 10.1007/s00246-015-1121-9] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 01/16/2015] [Indexed: 10/24/2022]
Abstract
Families of children with congenital heart disease (CHD) cope differently depending on individual and familial factors beyond the severity of the child's condition. Recent research has shifted from an emphasis on the psychopathology of family functioning to a focus on the resilience of families in coping with the challenges presented by a young child's condition. The increasing number of studies on the relationship between psychological adaptation, parental coping and parenting practices and quality of life in families of children with CHD necessitates an in-depth re-exploration. The present study reviews published literature in this area over the past 25 years to generate evidence to inform clinical practice, particularly to better target parent and family interventions designed to enhance family coping. Twenty-five studies were selected for inclusion, using the PRISMA guidelines. Thematic analysis identified a number of themes including psychological distress and well-being, gender differences in parental coping, and variable parenting practices and a number of subthemes. There is general agreement in the literature that families who have fewer psychosocial resources and lower levels of support may be at risk of higher psychological distress and lower well-being over time, for both parent and the child. Moreover, familial factors such as cohesiveness and adaptive parental coping strategies are necessary for successful parental adaptation to CHD in their child. The experiences, needs and ways of coping in families of children with CHD are diverse and multi-faceted. A holistic approach to early psychosocial intervention should target improved adaptive coping and enhanced productive parenting practices in this population. This should lay a strong foundation for these families to successfully cope with future uncertainties and challenges at various phases in the trajectory of the child's condition.
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Affiliation(s)
- Alun C Jackson
- Heart Research Centre, 14-20 Blackwood Street, North Melbourne, VIC, 3051, Australia,
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49
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Muscara F, McCarthy MC, Woolf C, Hearps SJC, Burke K, Anderson VA. Early psychological reactions in parents of children with a life threatening illness within a pediatric hospital setting. Eur Psychiatry 2015; 30:555-61. [PMID: 25618445 DOI: 10.1016/j.eurpsy.2014.12.008] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 12/15/2014] [Accepted: 12/15/2014] [Indexed: 10/24/2022] Open
Abstract
RESEARCH IN CONTEXT Parents of children with life threatening illness or injuries are at elevated risk of distress reactions, involving symptoms of acute stress disorder, depression and anxiety. Currently, the impact of child illness factors is unclear, and to date research systematically examining the prevalence of these psychological reactions across different illness groups with an acute life threat is sparse. This is important to explore given that studies show that parent functioning impacts on the psychological adjustment and recovery of the ill child. WHAT DOES THIS STUDY ADD?: At four weeks following a child's diagnosis of a serious illness, 49-54% of parents met DSM-IV criteria for acute stress disorder, across a number of illness groups, whereas 15-27% of parents were in the moderate/severe range for depression and anxiety, and 25-31% for stress. Results from this study demonstrate that rates and severity of these psychological reactions in parents of seriously ill children do not vary according to illness type. BACKGROUND A life threatening childhood illness/injury can lead to significant distress reactions in parents, with independent studies finding such reactions in several different illness groups. To date, there is limited research systematically comparing the prevalence of adverse parental psychological reactions across different childhood illness groups with an acute life threat. This study aimed to investigate the frequency and severity of symptoms of acute traumatic stress, depression, anxiety and general stress in parents, following admission of their child to hospital for a life threatening illness. The study also aimed to explore the relationship between these symptoms, and to determine whether they differ according to illness/injury. METHODS Cross-sectional data from a prospective, longitudinal study are reported. Participants were 194 parents of 145 children (49 couples), admitted to cardiology (n=53), oncology (n=40) and pediatric intensive care units (n=52), for serious illnesses/injuries. Parents completed self-report questionnaires within four weeks of hospital admission. RESULTS Rates of acute traumatic stress (P=0.262), depression (P=0.525), anxiety (P=0.453) and general stress symptoms (P=0.720) in parents were comparable across illness type, with 49-54% reaching criteria for acute stress disorder, 15-27% having clinical levels of depression and anxiety, and 25-31% for general stress. Anxiety was most strongly associated with acute traumatic stress (r=0.56), closely followed by stress (r=0.52) and depression (r=0.49), with all correlations highly significant (P<0.001). CONCLUSIONS These findings provide evidence that the child's medical condition is not associated with parents' experience of clinically significant psychological symptoms, and emphasize the importance for health care providers to be aware of these potential psychological reactions in parents, regardless of the type of illness.
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Affiliation(s)
- F Muscara
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia; Department of Pediatrics, School of Psychological Science, University of Melbourne, Melbourne, Australia; Psychology Service, Royal Children's Hospital, Melbourne, Australia.
| | - M C McCarthy
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia; Department of Pediatrics, School of Psychological Science, University of Melbourne, Melbourne, Australia; Children's Cancer Centre, Royal Children's Hospital, Melbourne, Australia
| | - C Woolf
- Department of Pediatrics, School of Psychological Science, University of Melbourne, Melbourne, Australia
| | - S J C Hearps
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia
| | - K Burke
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia; The Parenting Research Centre, East Melbourne, Australia; Parenting and Family Support Centre, School of Psychology, University of Queensland, Queensland, Australia
| | - V A Anderson
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia; Department of Pediatrics, School of Psychological Science, University of Melbourne, Melbourne, Australia; Psychology Service, Royal Children's Hospital, Melbourne, Australia
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Abstract
OBJECTIVE The aim of this study was to explore the acute psychosocial risk in families with infants undergoing surgery for a congenital heart disease and, secondarily, to explore the psychosocial impact of antenatal versus post-natal diagnoses. METHOD The study sample comprised 39 caregivers (28 mothers) of 29 children diagnosed with a congenital heart disease and requiring surgery within the first 4 weeks of life. Psychosocial risk was measured using the Psychosocial Assessment Tool, which was adapted to include four novel items examining infant risk factors, namely, sleeping, feeding, crying, and bonding difficulties. Parents' psychosocial risk was measured within 4 weeks after their child's surgery and stratified into a three-tiered framework: Universal, Targeted, and Clinical risk. RESULTS Of the total sample, 61.5% of parents were classified as Universal, that is, at lowest risk; 35.9% as Targeted, and 2.6% as Clinical. The within-family parent total Psychosocial Assessment Tool score correlations were non-significant, and there were no differences between families of infants who received post-natal versus antenatal diagnosis or single ventricle versus biventricular repair. Linear regression found that a higher parent education significantly predicted a lower total Psychosocial Assessment Tool score. CONCLUSIONS Findings indicate that, although the majority of parents adapt to the acute stress of surgery for a serious cardiac illness in their infant, the remaining 38.5% report an increased psychosocial risk associated with higher rates of emotional distress, which may impact on the parental quality of life and capacity for optimal parenting. The distribution of psychosocial risk in parents of children undergoing surgery for a congenital heart disease is consistent with that described for parents of children with other serious paediatric diagnoses.
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