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Sun H, Wacharasin C, Hengudomsub P. Change in resilience among spousal caregivers of patients with newly-diagnosed advanced cancer over the first six months posttreatment in China. J Psychosom Res 2024; 183:111538. [PMID: 38823371 DOI: 10.1016/j.jpsychores.2023.111538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/13/2023] [Accepted: 10/23/2023] [Indexed: 06/03/2024]
Abstract
OBJECTIVE A longitudinal observational study was conducted and aimed to examine the change in resilience among spousal caregivers of newly-diagnosed advanced cancer patients over the first six months after initial treatment. METHODS In total, 312 Chinese spousal caregivers who were taking care of their patients with newly-diagnosed advanced cancer were recruited. The level of resilience was measured using the Connor-Davidson Resilience Scale at the first month post-initial treatment (T1), three-month post-initial treatment (T2), and six-month post-initial treatment (T3). Latent growth modeling analyses were performed to examine changes in resilience using Mplus 8.3. RESULTS The mean scores of resilience in spousal caregivers were 54.01 ± 7.68 at T1, 56.20 ± 6.38 at T2, and 57.97 ± 6.70 at T3, respectively. Results of latent growth modeling indicated that spousal caregivers showed a significant increase in their resilience scores over the first six months post-treatment (Mean slope = 1.98, p < 0.001). Furthermore, a significant individual variation in the rate of changes in resilience scores allowed spouses to be categorized into two groups: 42.9% participants with fast growth and 57.1% participants with slight growth. CONCLUSION Our findings highlight the importance that new knowledge about change patterns of resilience in the nursing field is beneficial to reveal different psychosomatic health. Acknowledging that resilience is a dynamic process that changes over time, it is crucial for healthcare providers to monitor the psychological adjustment and focus of vulnerable caregivers, particularly spouses.
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Affiliation(s)
- Haiyan Sun
- Faculty of Nursing, Burapha University, Chon Buri 20131, Thailand; School of Nursing, Jiangsu Vocational College of Medicine, Jiangsu 224005, PR China
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Saju L, Smith MB, Ainsworth E, Goldberg JM, Chertow DJ, Hartman ME. Feasibility and Acceptability of Mobile Phone-Based Surveys to Identify Mental Health Symptoms in Parents/Guardians of PICU Patients. Pediatr Crit Care Med 2024:00130478-990000000-00363. [PMID: 39016697 DOI: 10.1097/pcc.0000000000003573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
OBJECTIVE Parents experience psychologic distress during their child's admission to a PICU, but effective screening for parental mental health symptoms is not the standard of care. We aimed to test the feasibility and acceptability of a mobile phone-based mental health survey for parents/guardians of PICU patients to facilitate their support by the PICU team. DESIGN Post hoc analysis of a single-institution pilot study conducted in 2022. Mental health surveys were delivered by text message to parents/guardians of PICU patients over 1 month, beginning 3 days after their child's PICU admission. In-person interviews 1 month after hospital discharge were used to solicit participants' opinions on the survey platform and content. SETTING A quaternary U.S. academic medical center. PARTICIPANTS Parents/guardians of PICU patients. INTERVENTIONS None. MEASUREMENT AND MAIN RESULTS Of the 53 participants who consented, 31 (58%) completed the study. Symptoms of acute stress (ASS) were the most common and most severe: 21 participants screened positive for ASS, and 20 of those that screened positive had "moderate" or "severe" symptoms. Among the 23 participants who screened positive for one mental health condition, 10 met the thresholds for all three. Scoring of the protocol's usability, acceptability, and feasibility showed a System Usability Scale equal to 82 of 100, an Acceptability of Intervention Measure score equal to 4.2 of 5, an Intervention Appropriateness Measure score equal to 4.5 of 5, and Feasibility of Intervention Measure score equal to 4.5 of 5. CONCLUSIONS AND RELEVANCE Mobile phone-based screening for parental mental health symptoms is acceptable and may offer the advantage of privacy and flexibility.
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Affiliation(s)
- Leya Saju
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
| | - Mallory B Smith
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
| | - Elizabeth Ainsworth
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO
| | | | - Daniel J Chertow
- National Heart, Lung, Blood Institute of the National Institute of Health, Bethesda, MD
| | - Mary E Hartman
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
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Evans-Barns HME, Hall M, Trajanovska M, Hutson JM, Muscara F, King SK. Psychosocial Outcomes of Parents of Children with Hirschsprung Disease Beyond Early Childhood. J Pediatr Surg 2024; 59:694-700. [PMID: 38102052 DOI: 10.1016/j.jpedsurg.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 11/07/2023] [Accepted: 11/20/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE The lifelong impact of Hirschsprung disease (HD) upon children and their families is increasingly well recognized. Parental psychosocial wellbeing and family functioning are determinants of psychological and health-related outcomes in children with chronic conditions. We performed a cross-sectional cohort study to evaluate the psychosocial functioning of parents/caregivers of children with HD, beyond early childhood. METHODS Parents/caregivers of children with HD, aged 4-14 years, managed at a tertiary pediatric surgical center were surveyed. Parent psychosocial outcomes, including adjustment to illness and family response, were assessed using four validated measures: Family Management Measure (FaMM); Parent Experience of Child Illness (PECI); Patient Reported Outcomes Measurement Information System (PROMISR) anxiety; and PROMISR depression. The Pediatric Quality of Life Inventory (PedsQL) was administered to assess child quality of life (proxy-report). RESULTS Forty parents (mean age 38.7 ± 5.6 years) of children with HD (mean age 8.0 ± 2.5) participated. Parents expressed greater long-term uncertainty (PECI) and poorer perceived condition management ability (FaMM) than comparator chronic disease cohorts. Other scores for parental adjustment to their child's condition (PECI) and family response (FaMM) were comparable to reference cohorts. Symptoms of anxiety and depression were prevalent in our cohort (52.5 % and 42.5 % respectively); however, the proportion with moderate - severe PROMISR anxiety (χ2 = 2.50, p = 0.114) and depression (χ2 = 0.156, p = 0.693) scores did not significantly differ from the expected population distribution. Proxy-reported child quality of life (PedsQL) was significantly reduced relative to healthy children (p = 0.0003), but comparable to those with physical health problems with special healthcare needs (p = 0.624). CONCLUSIONS Parents of children with HD experience long-term uncertainty and have poorer perceived condition management ability than parents of children with other chronic childhood illnesses. This work highlights the importance of targeted parental education and support beyond primary surgical management, and provides a benchmark for this cohort, against which subsequent intervention-based studies may be assessed. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Hannah M E Evans-Barns
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Marnie Hall
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Misel Trajanovska
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - John M Hutson
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Department of Urology, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Frank Muscara
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Department of Psychology, The Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, Australia
| | - Sebastian K King
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
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Rothschild CB, Balistreri KA, Mulligan K, Lee KJ, Karst J, Privatt M, Magner K, Lee HJ, Scanlon M, Davies WH. Acceptability and Feasibility of Text Message Interface to Assess Parents' Real-time PICU Experiences. J Intensive Care Med 2024; 39:159-169. [PMID: 37605433 DOI: 10.1177/08850666231195754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
INTRODUCTION Parents of children in the pediatric intensive care unit (PICU) experience substantial stress; a parent's perception of their child's illness severity, more than objective measures, predicts psychological outcomes. No tools exist to assess parents' real-time experiences. This pilot study evaluated the feasibility and acceptability of a text-based tool to measure parental experience. METHODS Inclusion criteria included PICU stay >48 h, physician approval, smartphone access, and English-speaking caregiver. Eligible parents received a text-based baseline survey and surveys every other day while hospitalized regarding their mood/experiences and optional open-ended questions regarding stressors. They received post-discharge follow-up surveys at 1 week and 1, 3, and 6 months. Follow-up surveys assessed mood and symptoms of depression, anxiety, and post-traumatic stress. Interviews and surveys about the interface were conducted 1 week and 3 months following discharge. Feasibility was assessed by descriptive statistics (eg, response rates), and acceptability was assessed by descriptive statistics (survey results) and thematic analyses of interviews. RESULTS Of 20 enrolled participants, the first 5 were excluded due to technical issues. Of the 15 included, results demonstrated feasibility and acceptability. Most participants (86%) completed all surveys during the PICU stay and continued to complete surveys at a high rate: 79%-94% 3 months post-discharge. All participants agreed that the system was easy to use and were satisfied with the system at discharge, and 91% remained satisfied 3 months post-discharge. Additionally, 76% reported comfort, and 69% reported benefit. From the interviews, participants lauded the system's convenience and applicability of content. Some proposed changes to improve ergonomics. Many suggested this interface could help teams better support families. CONCLUSIONS A text-based interface for measuring experience in the PICU is feasible and acceptable to parents. Further research can explore how this could identify parents most at risk of adverse psychological sequelae and lead to earlier supportive interventions.
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Affiliation(s)
| | | | - Kathryn Mulligan
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - K Jane Lee
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jeffrey Karst
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Miranda Privatt
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kristin Magner
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Han-Joo Lee
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Matthew Scanlon
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - W Hobart Davies
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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Bainton J, Trachtenberg F, McCrindle BW, Wang K, Boruta R, Brosig CL, Egerson D, Sood E, Calderon J, Doman T, Golub K, Graham A, Haas K, Hamstra M, Lindauer B, Sylvester D, Woodard F, Young-Borkowski L, Mussatto KA. Prevalence and associated factors of post-traumatic stress disorder in parents whose infants have single ventricle heart disease. Cardiol Young 2023; 33:2171-2180. [PMID: 36601959 DOI: 10.1017/s1047951122004012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Post-traumatic stress disorder occurs in parents of infants with CHD, contributing to psychological distress with detrimental effects on family functioning and well-being. We sought to determine the prevalence and factors associated with post-traumatic stress disorder symptoms in parents whose infants underwent staged palliation for single ventricle heart disease. MATERIALS AND METHODS A large longitudinal multi-centre cohort study evaluated 215 mothers and fathers for symptoms of post-traumatic stress disorder at three timepoints, including post-Norwood, post-Stage II, and a final study timepoint when the child reached approximately 16 months of age, using the self-report questionnaire Impact of Event Scale - Revised. RESULTS The prevalence of probable post-traumatic stress disorder post-Norwood surgery was 50% of mothers and 39% of fathers, decreasing to 27% of mothers and 24% of fathers by final follow-up. Intrusive symptoms such as flashbacks and nightmares and hyperarousal symptoms such as poor concentration, irritability, and sudden physical symptoms of racing heart and difficulty breathing were particularly elevated in parents. Higher levels of anxiety, reduced coping, and decreased satisfaction with parenting were significantly associated with symptoms of post-traumatic stress disorder in parents. Demographic and clinical variables such as parent education, pre-natal diagnosis, medical complications, and length of hospital stay(s) were not significantly associated with symptoms of post-traumatic stress disorder. DISCUSSION Parents whose infants underwent staged palliation for single ventricle heart disease often reported symptoms of post-traumatic stress disorder. Symptoms persisted over time and routine screening might help identify parents at-risk and prompt referral to appropriate supports.
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Affiliation(s)
- Jessica Bainton
- Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Brian W McCrindle
- Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Ke Wang
- HealthCore, Watertown, MA, USA
| | | | - Cheryl L Brosig
- Herma Heart Institute, Children's Wisconsin, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Erica Sood
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | | | - Tammy Doman
- University of Michigan Health System, Ann Arbor, MI, USA
| | - Katrina Golub
- Columbia University Irving Medical Center, New York, NY, USA
| | | | - Karen Haas
- Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Michelle Hamstra
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | | | | | - Lisa Young-Borkowski
- Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI, USA
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Sun H, Qian Q, Qin Y, Guo L, Hengudomsub P. Dynamic changes in resilience among family caregivers in the face of healthcare challenges: A scoping review. Arch Psychiatr Nurs 2023; 45:113-123. [PMID: 37544685 DOI: 10.1016/j.apnu.2023.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 06/14/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Resilience as a dynamic concept has already been described through various longitudinal studies. To better understand the changes in the resilience of caregivers over the course of care-providing, however, a scoping review can provide a clearer picture of their resilience process which, in turn, can be used to improve caregivers' well-being. OBJECTIVES To provide a comprehensive overview of dynamic change in the resilience of caregivers while caring for the family to enhance understanding and potential for future research. METHODS Following the methodological framework of Arksey and O'Malley, this scoping review was conducted using the Preferred Reporting Items for Systematic Reviews and the Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. Five electronic databases were searched for research published in English between January 2012 and May 2022, after which a manual search was performed. Key terms related to resilience and caregivers in longitudinal studies were included and screened for. Identified trajectories of patterns in resilience and factors associated with resilience process were categorized using content analysis. RESULTS In total, 24 longitudinal studies met the eligibility criteria. Conceptually, our findings demonstrate three modes of change following healthcare challenges, each of which varies substantially. Methodologically, the results reveal three subcategories of assessment tools that can be used to impact caregivers' resilience when confronted with significant healthcare challenges. Consequentially, personal traits and environmental resources interacting with the resilience process will then lead to various outcomes in their resilience, including stability, growth, or decline. CONCLUSION This review describes the change patterns of the resilience process, assessment instruments, and associated factors to offer a dynamic perspective for the investigation and intervention of psychological resilience. Major gaps nonetheless remain for future research regarding an operationalizing dynamic change in resilience.
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Affiliation(s)
- Haiyan Sun
- School of Nursing, Jiangsu Vocational College of Medicine, 224005, Jiangsu, P.R. China; Faculty of Nursing, Burapha University, 20131, Chon Buri, Thailand
| | - Qian Qian
- School of Nursing, Jiangsu Vocational College of Medicine, 224005, Jiangsu, P.R. China
| | - Yang Qin
- School of Nursing, Jiangsu Vocational College of Medicine, 224005, Jiangsu, P.R. China; Faculty of Nursing, Burapha University, 20131, Chon Buri, Thailand
| | - Lingling Guo
- School of Nursing, Jiangsu Vocational College of Medicine, 224005, Jiangsu, P.R. China
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Anderson V, Hearps SJC, Catroppa C, Beauchamp MH, Ryan NP. What predicts persisting social impairment following pediatric traumatic brain injury: contribution of a biopsychosocial approach. Psychol Med 2023; 53:3568-3579. [PMID: 35189999 PMCID: PMC10277758 DOI: 10.1017/s0033291722000186] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 01/06/2022] [Accepted: 01/13/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Psychosocial deficits, such as emotional, behavioral and social problems, reflect the most common and disabling consequences of pediatric traumatic brain injury (TBI). Their causes and recovery likely differ from physical and cognitive skills, due to disruption to developing brain networks and the influence of the child's environment. Despite increasing recognition of post-injury behavioral and social problems, there exists a paucity of research regarding the incidence of social impairment, and factors predicting risk and resilience in the social domain over time since injury. METHODS Using a prospective, longitudinal design, and a bio-psychosocial framework, we studied children with TBI (n = 107) at baseline (pre-injury function), 6 months, 1 and 2-years post-injury. We assessed intellectual ability, attention/executive function, social cognition, social communication and socio-emotional function. Children underwent structural magnetic resonance imaging (MRI) at 2-8 weeks post-injury. Parents rated their child's socio-emotional function and their own mental health, family function and perceived burden. RESULTS We distinguished five social recovery profiles, characterized by a complex interplay between environment and pre- and post-TBI factors, with injury factors playing a lesser role. Resilience in social competence was linked to intact family and parent function, intact pre-injury adaptive abilities, post-TBI cognition and social participation. Vulnerability in the social domain was related to poor pre- and post-injury adaptive abilities, greater behavioral concerns, and poorer pre- and post-injury parent health and family function. CONCLUSIONS We identified five distinct social recovery trajectories post-child-TBI, each characterized by a unique biopsychosocial profile, highlighting the importance of comprehensive social assessment and understanding of factors contributing to social impairment, to target resources and interventions to children at highest risk.
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Affiliation(s)
- Vicki Anderson
- Murdoch Children's Research Institute, Flemington Road, Parkville, Victoria, 3052, Australia
- Royal Children's Hospital, Flemington Road, Parkville, Victoria, 3052, Australia
- University of Melbourne, Flemington Road, Parkville, Victoria, 3052, Australia
| | - Stephen J. C. Hearps
- Murdoch Children's Research Institute, Flemington Road, Parkville, Victoria, 3052, Australia
| | - Cathy Catroppa
- Murdoch Children's Research Institute, Flemington Road, Parkville, Victoria, 3052, Australia
- Royal Children's Hospital, Flemington Road, Parkville, Victoria, 3052, Australia
- University of Melbourne, Flemington Road, Parkville, Victoria, 3052, Australia
| | - Miriam H. Beauchamp
- University of Montreal, P.O. Box 6128, Center-ville branch, Montreal, QC, H3C 317, Canada
- St Justine Hospital, Avenue Ellendale, Montreal, QC, Canada
| | - Nicholas P. Ryan
- Murdoch Children's Research Institute, Flemington Road, Parkville, Victoria, 3052, Australia
- Deakin University, 221 Burwood Highway, Burwood, Australia
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Dewan T, Birnie K, Drury J, Jordan I, Miller M, Neville A, Noel M, Randhawa A, Zadunayski A, Zwicker J. Experiences of medical traumatic stress in parents of children with medical complexity. Child Care Health Dev 2023; 49:292-303. [PMID: 35947493 PMCID: PMC10087969 DOI: 10.1111/cch.13042] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 05/25/2022] [Accepted: 08/07/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Parents of children with medical complexity (CMC) experience high levels of stress and adverse mental health outcomes. Pediatric medical traumatic stress (PMTS) could be an important contributor that has not yet been explored. PMTS describes parents' reactions to their child's illness and medical treatment and can lead to post-traumatic stress symptoms. This is the first study to describe the experiences and impact of PMTS among parents of CMC. METHODS We conducted semi-structured interviews with 22 parents of CMC. Reflexive thematic analysis was used to generate themes that described the experiences of PMTS and potential contributing factors in the healthcare setting. Themes were validated by study participants. RESULTS Parents experienced a spectrum of events and circumstances that impacted PMTS. These corresponded to three major themes: (a) the distinctive context of being the parent of a CMC, (b) interactions with healthcare providers that can hurt or heal and (c) system factors that set the stage for trauma. The consequences of repeated PMTS were a common point of emphasis among all the themes. Parents identified numerous changes that could mitigate PMTS such as acknowledgement of trauma and provision of proactive mental health support. CONCLUSIONS Our study highlights the issue of PMTS among parents of CMC and presents opportunities to mitigate their traumatic experiences. Supporting the integration of trauma-informed care practices, increasing awareness of PMTS and advocating for parental mental health services could better support parents and families.
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Affiliation(s)
- Tammie Dewan
- Department of Pediatrics, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, Calgary, Canada
| | - Katie Birnie
- Department of Anesthesia and Pain Medicine, University of Calgary, Calgary, Canada
| | | | | | - Megan Miller
- Rotary Flames Children's Hospice and Palliative Care Service, Calgary, Canada
| | | | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Alam Randhawa
- Department of Pediatrics, University of Calgary, Calgary, Canada
| | - Anna Zadunayski
- Department of Pediatrics, University of Calgary, Calgary, Canada
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Abstract
OBJECTIVES Perform a longitudinal analysis of parental traumatic stress up to 30 months after PICU discharge. DESIGN Prospective observational cohort study. SETTING Two tertiary care children's hospitals with mixed medical/surgical/cardiac PICUs. SUBJECTS Parents of patients unexpectedly admitted to the PICU. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Two hundred sixty-five parents of 188 children were enrolled. Of the 195 parents who completed the 3-9-month assessments, 29 (14.8%) met posttraumatic stress disorder (PTSD) qualification on the PTSD Symptom Scale Interview for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Multivariable analysis showed parents who met acute stress disorder (ASD) qualification (odds ratio [OR] 8.01; 95% CI 2.64-24.3), parents of children with Pediatric Overall Performance Category score of severe or coma at discharge (OR 5.21; 95% CI 1.65-16.4), parents who had concerns for their child's permanent injury (OR 1.82; 95% CI 1.36-2.43), and parents who reported increased knowledge of child illness during admission (OR 1.82; 95% CI 1.13-2.93) had increased odds of developing parental PTSD. Of the 175 parents (66%) who completed the 18-30-month assessments, 22 (12.5%) met PTSD qualification. Multivariable analysis showed parents who met ASD qualification (OR 4.19; 95% CI 1.12-15.7), parents who had a history of a family member or themselves being admitted to ICU (OR 6.51; 95% CI 1.43-29.6), and parents who had concerns of child's susceptibility to death post discharge (OR 1.58; 95% CI 1.19-2.09) had increased odds of developing parental PTSD. At 18-30 months post discharge, parents who met the PTSD qualification were more likely to report a decrease in household income following discharge (OR 9.23; 95% CI 1.71-49.9). CONCLUSIONS Parental PTSD remains a significant morbidity of PICU admission for a subgroup of parents greater than 18 months post admission. Identifiable risk factors will inform the development of targeted interventions.
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Cepuch G, Kruszecka-Krówka A, Samardakiewicz M, Gniadek A, Micek A. Hematopoietic and Lymphoid Cell Neoplasms in Children as a Factor Inducing Negative Emotions and Toxic Stress in Parents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11307. [PMID: 36141586 PMCID: PMC9516952 DOI: 10.3390/ijerph191811307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/26/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
Parents whose children suffer from cancer experience chronic negative emotions, which may have a detrimental influence on their mental health. The aim of this study, conducted with a group of parents whose children were hospitalized for leukemia or lymphoma, was to assess stress, anxiety, depression, aggression and stress coping strategies as well as the correlations that take place between them. The study was conducted with a group of 101 parents of early school children (aged between 7 and 12) who were hospitalized for cancer in three medical centers in southern Poland. The HADS -M, PSS-10 and COPE questionnaires were used in the study. Mothers were found to experience higher levels of anxiety, depression and stress as compared to fathers. It was more common for men to resort to the strategy of substance use. Socio-demographic variables did not determine the examined emotions, the level of stress and the choice of stress coping strategies, with the exception of the strategy of suppression of competing activities. A positive relationship was found between the incidence of negative emotions and the selected strategies of coping with stress. Early diagnosis of disorders and assessment of parents' strategies of coping might help to counteract long-term consequences of trauma.
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Affiliation(s)
- Grażyna Cepuch
- Nursing and Midwifery Institute, Faculty of Health Sciences, Jagiellonian University Medical College, Kopernika Str. 25, 31-501 Krakow, Poland
| | - Agnieszka Kruszecka-Krówka
- Nursing and Midwifery Institute, Faculty of Health Sciences, Jagiellonian University Medical College, Kopernika Str. 25, 31-501 Krakow, Poland
| | - Marzena Samardakiewicz
- Department of Psychology, Faculty of Medical Sciences College Academicum, Medical University of Lublin, Chodźki Str. 7, 20-093 Lublin, Poland
| | - Agnieszka Gniadek
- Nursing and Midwifery Institute, Faculty of Health Sciences, Jagiellonian University Medical College, Kopernika Str. 25, 31-501 Krakow, Poland
| | - Agnieszka Micek
- Nursing and Midwifery Institute, Faculty of Health Sciences, Jagiellonian University Medical College, Kopernika Str. 25, 31-501 Krakow, Poland
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11
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Timko CA, Dennis NJ, Mears C, Rodriguez D, Fitzpatrick KK, Peebles R. Post-traumatic stress symptoms in parents of adolescents hospitalized with Anorexia nervosa. Eat Disord 2022; 31:212-224. [PMID: 35938512 DOI: 10.1080/10640266.2022.2099604] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The current study was a planned secondary analysis to examine post-traumatic stress symptoms (PTSS) in parents of youth hospitalized for medical stabilization due to anorexia nervosa (AN). Questionnaires were administered to 47 parents (34 mothers, 13 fathers; 10 parental dyads) after admission; follow-up occurred at discharge and 4 weeks, 3 months, and 6 months post-discharge. PTSS were present in the majority of mothers (55.9%) and fathers (61.5%). PTSS were not associated with illness severity, but were associated with parental report of mood symptoms, avoidance, inflexibility, and symptom accommodation. Parental PTSS may negatively impact the adolescent rate of weight gain post-discharge. As hospitalization of a child for medical management of AN can be a traumatizing experience for parents, astute attention should be paid by medical staff to their needs. More work needs to be done to understand the impact of PTSS on parents of adolescents with AN.
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Affiliation(s)
- C Alix Timko
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Psychiatry, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nicholas J Dennis
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA
| | - Connor Mears
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Daniel Rodriguez
- Department of Public Health, LaSalle University, Philadelphia, Pennsylvania, USA
| | | | - Rebecka Peebles
- Craig Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania, USA
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12
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Kaplan D, Nesfield MW, Eldridge PS, Cuddy WI, Ansari N, Siller P, Li S. Acute Stress in Parents of Patients Admitted to the Pediatric Intensive Care Unit: A Two-Center Cross-Sectional Observational Study. J Intensive Care Med 2022; 38:11-20. [PMID: 35593071 DOI: 10.1177/08850666221100482] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine medical and psychosocial risk factors associated with the development of acute stress in parents of patients unexpectedly admitted to the PICU. DESIGN Cross-sectional observational study. SETTING Two tertiary care children's hospitals with mixed medical/surgical/cardiac PICU. PATIENTS Parents of patients unexpectedly admitted to the PICU. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS 265 parents of 188 children were enrolled of whom 49 parents (18%) met ASD qualification and 108 (41%) parents developed ASD symptoms as determined by the ASDS-5 scale. Risk factors making parents likely to meet ASD qualification include parents from area served by Penn State (p < 0.001), prior psychiatric illness (p < 0.01), and female gender (p < 0.05), while graduating college was protective (p < 0.05). In the multivariate analysis, parents from area served by Penn State (OR 3.00 (1.49-6.05) p < 0.01) and parents with prior psychiatric illness (OR 2.16 (1.03-4.52) p < 0.05) were associated with ASD qualification. Parents who graduated college or had prior medical problems were not significant.Risk factors making parents more likely to develop ASD symptoms (significant symptoms that do not meet ASD qualification) include patients with higher PRISM-III scores (p < 0.01), patients receiving cardiovascular support (p < 0.05), parents with a history of prior physical/sexual abuse (p < 0.01), parental involvement in the past with a major disaster/accident (p < 0.01), a family member admitted to an ICU in the past (p < 0.05) and preexisting parental psychiatric/medical disorders (p < 0.001). In a multivariate analysis, prior parental psychiatric disorder (OR 4.11 (1.80-6.42) p < 0.001), history of parental abuse (OR 3.11 (1.14-5.08) p < 0.05), and parental prior medical problem (OR 2.03 (1.01-3.05) p < 0.05) were associated with the development of ASD symptoms. However, PRISM-III score and prior involvement in major disaster were not significant. CONCLUSIONS A combination of psychosocial parental risk factors and patient factors were associated with acute stress in parents. Further studies evaluating targeted hospital interventions towards parents most at-risk are needed.
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Affiliation(s)
- Daniel Kaplan
- Department of Pediatrics, Division of Pediatric Critical Care, 554322Northwell Health Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Mekela Whyte Nesfield
- Department of Pediatrics, Division of Pediatric Critical Care, Children's National Hospital, Washington, DC, USA
| | - Peter S Eldridge
- Department of Pediatrics, Division of Pediatric Critical Care, 583289Maria Fareri Children's Hospital, Valhalla, NY, USA
| | - WIlliam Cuddy
- Department of Pediatrics, Division of Pediatric Critical Care, 583289Maria Fareri Children's Hospital, Valhalla, NY, USA
| | - Nadia Ansari
- Department of Pediatrics and Child Health, 66705The Aga Khan University, Karachi, Pakistan
| | - Pamela Siller
- Interborough Developmental and Consultation Center, Brooklyn, NY, USA
| | - Simon Li
- Department of Pediatrics, Division of Pediatric Critical Care, 25044Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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13
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Golfenshtein N, Lisanti AJ, Cui N, Cooper BM. Predictors of Post-traumatic stress symptomology in parents of infants with Congenital Heart Disease post-surgery and after four months. J Pediatr Nurs 2022; 62:17-22. [PMID: 34839196 PMCID: PMC8942906 DOI: 10.1016/j.pedn.2021.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 11/04/2021] [Accepted: 11/10/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE To identify predictors of post-traumatic stress symptomology among parents of infants with complex congenital heart defects at hospital discharge and after 4 months. DESIGN & METHODS A secondary analysis utilizing data from a larger RCT performed in three pediatric cardiac centers in North America. Analysis included 158 parent-infant dyads. Generalized Linear Modeling was used to identify predictors of parental post-traumatic symptomology at hospital discharge, and after 4 months. Considered predictors included demographics/SES, illness, and psychosocial parameters. RESULTS At discharge, parenting stress, education, and infant's medication number were linked to post-traumatic stress symptomology severity; Parenting stress, education, insurance type, and medications number predicted number of symptoms; Tube-assisted feeding predicted PTSD. At 4 months, parenting stress, ethnicity, and number of ED visits predicted PTSS severity; Parenting stress, ethnicity, and cardiologist visits predicted number of symptoms; Parenting stress, single ventricle physiology, and number of children predicted PTSD. CONCLUSIONS & PRACTICAL IMPLICATIONS Parental psychosocial factors, additionally to illness and sociodemographic indicators, can potentially risk parents to experience PTSS/PTSD. Nursing and other healthcare professionals can participate in early screening of such factors to determine familial risk. TRIAL REGISTRATION NCT01941667.
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Affiliation(s)
- Nadya Golfenshtein
- University of Haifa, Department of Nursing, Israel; School of Nursing, University of Pennsylvania, USA.
| | - Amy Jo Lisanti
- School of Nursing, University of Pennsylvania, USA; Children's Hospital of Philadelphia, USA
| | - Naixue Cui
- School of Nursing and Rehabilitation, Shandong University, China
| | - Barbara Medoff Cooper
- School of Nursing, University of Pennsylvania, USA; Children's Hospital of Philadelphia, USA
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14
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Byra S, Zubrzycka R, Wójtowicz P. Sense of Stress and Posttraumatic Growth in Mothers of Children with Cystic Fibrosis-The Moderating Role of Resilience. J Dev Behav Pediatr 2021; 42:e8-e14. [PMID: 34334723 DOI: 10.1097/dbp.0000000000000967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 02/01/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to examine the moderating role of resilience in the relationship between sense of stress and posttraumatic growth (PTG) in mothers of children with cystic fibrosis (CF). METHODS This cross-sectional study was conducted in a group of 139 mothers of children with CF. A diagnostic survey with Polish versions of the inventories was used. RESULTS Over half of the mothers (52.89%) reported average and 26.11% high levels of general sense of stress. Mothers also experienced high (37.68%) and average (34.06%) PTG. Generally, mothers of children with CF manifested low general resilience. Sense of stress and PTG were significantly and positively correlated in this group of mothers. Positive correlations were revealed between resilience (total and individual dimensions), total PTG, and 1 dimension of PTG: changes in self-perception. Moreover, resilience was found to correlate with sense of stress. The obtained results indicate that resilience manifested as an optimistic life attitude and the ability to mobilize in difficult situations, and tolerance of failures and treating life as a challenge is a moderator in the relationship between sense of stress and PTG. CONCLUSION The relationship between sense of stress and PTG in mothers of children with CF depends on the level of resilience.
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Affiliation(s)
- Stanisława Byra
- Faculty of Education and Psychology, Institute of Pedagogy, Maria Curie-Skłodowska University, Lublin, Poland
| | - Renata Zubrzycka
- Faculty of Education and Psychology, Institute of Pedagogy, Maria Curie-Skłodowska University, Lublin, Poland
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15
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McCarthy MC, Marks IR, Mulraney M, Downie P, Matson A, De Luca CR. Parental adjustment following their child's completion of acute lymphoblastic leukemia treatment. Pediatr Blood Cancer 2021; 68:e29302. [PMID: 34411413 DOI: 10.1002/pbc.29302] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 07/28/2021] [Accepted: 08/03/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Few studies haveexamined parent and family adaptation in the early period following the end of childhood cancer treatment. We examined parent adjustment at the end of their child's treatment for acute lymphoblastic leukemia (ALL). METHODS Parents of childhood cancer survivors (CCS), who were 3 months post-ALL treatment, and parents of typically developing children completed measures of psychological and family functioning. Parents of CCS also completed distress and posttraumatic stress symptom (PTSS) questionnaires related to their child's cancer experience. RESULTS One hundred twenty-nine parents were recruited: 77 parents of CCS and 52 comparison parents. Overall mean psychological symptoms of depression, anxiety and stress, and family functioning were within normal limits for both groups. Parents of CCS endorsed higher scores for stress, depression, and family problems; however, mean scores for emotional distress were low for both groups, in particular the comparison group. Parents of CCS endorsed low rates of PTSS. Fifty-one percent of parents of CCS scored above the distress thermometer (DT-P) clinical cutoff (>4), with items elevated across all six DT-P domains. However, most parents did not indicate a wish to speak to a health professional about their symptoms. CONCLUSION Specialist psychosocial intervention may be indicated for only a subset of parents at the end of treatment. As per psychosocial standards of care, effective screening at this timepoint is warranted. Further examination of appropriate timing of psychosocial information and support services that are tailored to parents' circumstances is needed. eHealth approaches may be appropriate.
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Affiliation(s)
- Maria C McCarthy
- Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - India R Marks
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Melissa Mulraney
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Peter Downie
- Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Children's Cancer Centre, Monash Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Alice Matson
- School of Psychological Science, University of Melbourne, Melbourne, Victoria, Australia
| | - Cinzia R De Luca
- Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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16
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Procter C, Morrow B, Pienaar G, Shelton M, Argent A. Outcomes following admission to paediatric intensive care: A systematic review. J Paediatr Child Health 2021; 57:328-358. [PMID: 33577142 DOI: 10.1111/jpc.15381] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/12/2021] [Accepted: 01/24/2021] [Indexed: 12/12/2022]
Abstract
AIM To describe the long-term health outcomes of children admitted to a paediatric intensive care unit. METHODS A systematic review of the literature was performed. Studies of children under 18 years of age admitted to a paediatric intensive care unit were included. Studies focussed on neonatal admissions and investigating specific paediatric intensive care unit interventions or admission diagnoses were excluded. A table was created summarising the study characteristics and main findings. Risk of bias was assessed using the Newcastle Ottawa Quality Assessment Scale for observational studies. Primary outcome was short-, medium- and long-term mortality. Secondary outcomes included measures of neurodevelopment, cognition, physical, behavioural and psychosocial function as well as quality of life. RESULTS One hundred and eleven studies were included, most were conducted in high-income countries and focussed on short-term outcomes. Mortality during admission ranged from 1.3 to 50%. Mortality in high-income countries reduced over time but this trend was not evident for lower income countries. Higher income countries had lower standardised mortality rates than lower income countries. Children had an ongoing increased risk of death for up to 10 years following intensive care admission as well as increased physical and psychosocial morbidity compared to healthy controls, with associated poorer quality of life. CONCLUSIONS There is limited high-level evidence for the long-term health outcomes of children after intensive care admission, with the burden of related morbidity remaining greater in poorly resourced regions. Further research is recommended to identify risk factors and modifiable factors for poor outcomes, which could be targeted in practice improvement initiatives.
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Affiliation(s)
- Claire Procter
- Pediatric Intensive Care, Division of Pediatric Critical Care and Children's Heart Disease, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa
| | - Brenda Morrow
- Department of Paediatrics, University of Cape Town, Cape Town, South Africa
| | - Genee Pienaar
- Public Health, Mental Health and Behavioral Sciences, Western Cape Department of Health, Cape Town, South Africa
| | - Mary Shelton
- Reference Librarian, University of Cape Town, Cape Town, South Africa
| | - Andrew Argent
- Pediatric Intensive Care, Division of Pediatric Critical Care and Children's Heart Disease, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa
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17
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Elliott M, Erickson L, Russell CL, Chrisman M, Gross Toalson J, Emerson A. Defining a new normal: A qualitative exploration of the parent experience during the single ventricle congenital heart disease interstage period. J Adv Nurs 2021; 77:2437-2446. [PMID: 33591609 DOI: 10.1111/jan.14785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/03/2021] [Accepted: 01/16/2021] [Indexed: 11/28/2022]
Abstract
AIM To explore parents' experience of transition in the period between the palliative cardiac surgeries (i.e., the interstage period) of an infant with single ventricle congenital heart disease. DESIGN We conducted an exploratory naturalistic inquiry using a qualitative descriptive approach. METHODS A purposive sample of 11 parents of children with single ventricle disease was selected among families that participated in an interstage-period parental home monitoring program during the past 2 years. Interviews and field observations were conducted September-October 2019, and data were analyzed for themes. Analysis of data was inductive, although study questions and the interpretation of results were informed by Meleis' transition theory. RESULTS Parents described the experience of transition in interstage as a striving for normality, a theme that was clustered in subthemes of home, self, and infant. CONCLUSION Parents' experiences of striving for normality indicated a need for more targeted efforts to address parents' psychosocial needs during the highly stressful interstage transition. IMPACT This research underscored the complexity of parents' psychosocial support needs on returning home after their child's first palliative surgery. The findings also suggest need for examination of the transition following the second palliative heart surgery, when the home monitoring program is withdrawn. Understanding parent needs will help guide healthcare teams in developing ways to support parents as they adjust to home, self, and child.
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Affiliation(s)
- Melissa Elliott
- University of Missouri-Kansas City, Kansas City, Missouri, USA.,Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Lori Erickson
- University of Missouri-Kansas City, Kansas City, Missouri, USA.,Children's Mercy Hospital, Kansas City, Missouri, USA
| | | | | | - Jami Gross Toalson
- University of Missouri-Kansas City, Kansas City, Missouri, USA.,Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Amanda Emerson
- University of Missouri-Kansas City, Kansas City, Missouri, USA
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18
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Lövgren M, Udo C, Alvariza A, Kreicbergs U. Much is left unspoken: Self-reports from families in pediatric oncology. Pediatr Blood Cancer 2020; 67:e28735. [PMID: 32975361 DOI: 10.1002/pbc.28735] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Communication about illness-related subjects is complex and difficult. To support entire families in pediatric oncology, health care professionals need to know what family members think, but leave unspoken. The aim of this study was to explore how families in pediatric oncology experienced illness-related information and communication with professionals and within the family. PROCEDURE A cross-sectional web survey was used. Families were recruited from one pediatric oncology center in Sweden, 2-3 months after diagnosis. One hundred eighteen family members (ill children, siblings, and parents) representing 27 families filled out age-adapted surveys. RESULTS Eighty-six percent of the parents and 71% of the siblings reported that they had not received enough or any information about how the cancer and its treatment could affect the child's psychological health. The families reported that they did not dare ask professionals questions about psychosocial issues and future-related subjects. Nor did they talk with one another, even though 55% of the parents and 24% of the children wanted to reveal more about how they felt to someone in the family. The parents reported the lowest family communication, and few families had all members reporting the same perception of family communication. CONCLUSIONS Much is still left unspoken in pediatric oncology and the needs of the families are prominent. Assessments of each family member's needs might form a basis for professionals to give each person adequate information and family support. An increased awareness in families about family members' different needs might lead to mutual understanding.
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Affiliation(s)
- Malin Lövgren
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Department of Women's and Children's Health, Childhood Cancer Research Unit, Karolinska Institute, Stockholm, Sweden
| | - Camilla Udo
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,School of Education, Health and Society, Dalarna University College, Falun, Sweden.,Center for Clinical Research Dalarna, Falun, Sweden
| | - Anette Alvariza
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Capio Palliative Care, Dalen Hospital, Stockholm, Sweden
| | - Ulrika Kreicbergs
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Department of Women's and Children's Health, Childhood Cancer Research Unit, Karolinska Institute, Stockholm, Sweden
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19
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Palmor Haspel S, Benyamini Y, Ginzburg K. Transactional Model of Parental Adjustment and Caregiving Burden Following a Children's Acquired Disability. J Pediatr Psychol 2020; 45:1177-1187. [PMID: 33094315 DOI: 10.1093/jpepsy/jsaa075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Pediatric-acquired disability is often a crossroads in the lives of children and their parents, as they set out to adjust to a new physical impairment. This longitudinal study examined associations between the severity of children's-acquired disability, their parents' caregiver burden and adjustment, and parents' perception of the children's adjustment over time. METHODS Participants were parents and medical staff of 140 children with acquired disability, aged 1-18, hospitalized in pediatric or rehabilitation departments. Data were collected about 1 month after diagnosis (T1) and about 4 months later (T2). Parents completed background information, caregiver burden, child, and parental adjustment questionnaires. Medical staff contributed the disability severity indices. RESULTS The severity of the child's disability was negatively associated with parents' adjustment and perception of the child's adjustment. Caregiver burden was positively associated with the severity of the disability, and negatively with parents' adjustment and perception of their child's adjustment, at both time points. Over time, the severity of the disability and caregiver burden decreased, and parents' adjustment and perception of the child's adjustment improved. At T2, parents' and children's adjustment were strongly associated. CONCLUSIONS The findings revealed the relationship between objective severity indices and caregiver burden. They suggest that parents' adjustment may affect their perception of the child's adjustment to disability, and emphasize the role of parental perceptions over time. Therefore, parents who are less likely to adjust effectively should be identified early on to facilitate professional intervention.
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Affiliation(s)
- Shoshi Palmor Haspel
- Shaare Zedek University Medical Center, Jerusalem.,Department of Special Education in the Herzog Academic College, Jerusalem.,Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv
| | - Yael Benyamini
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv
| | - Karni Ginzburg
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv
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20
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Graj E, Muscara F, Anderson V, Hearps S, McCarthy M. Quality of life in parents of seriously Ill/injured children: a prospective longitudinal study. Qual Life Res 2020; 30:193-202. [PMID: 32910402 DOI: 10.1007/s11136-020-02624-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Parents of children with serious childhood illness or injury (SCII) are at risk of experiencing poor quality of life (QoL). This study investigated the nature of parent QoL at the time of child diagnosis and seven months post-diagnosis, the change in parent QoL over time, and early factors influencing short-term and longer-term parent QoL. METHODS The sample was drawn from a prospective longitudinal cohort study conducted within a paediatric hospital setting. Participants comprised 223 parents of 167 children diagnosed with a life-threatening illness and hospitalised in the cardiology, oncology, or intensive care departments. Examined data included QoL ratings completed by parents within four weeks of diagnosis and seven months post-diagnosis, and demographic, illness-related, and psychosocial predictor measures collected within four weeks of diagnosis, or four months post-diagnosis. RESULTS Generalised Estimating Equations were utilised to analyse data. Results indicated poor parent QoL at diagnosis, and normalised parent QoL at seven months. Improvement occurred most noticeably in the psychosocial domain. Reduced acute stress symptomatology and increased psychological flexibility were associated with higher parent QoL at diagnosis. Increased perceived emotional resources predicted enhanced parent QoL at seven months. CONCLUSION Paediatric medical care teams should consider the challenges to QoL experienced by parents of children with SCII. Parents reporting acute stress symptoms during the acute-illness phase should be prioritised for intervention. Further, parent-dyads presenting at post-acute care settings reporting poor emotional resources would benefit from psychosocial and educative support.
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Affiliation(s)
- Ella Graj
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.
| | - Frank Muscara
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.,Psychology Services, Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Vicki Anderson
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.,Psychology Services, Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Stephen Hearps
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Maria McCarthy
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.,Royal Children's Hospital, Children's Cancer Centre, Melbourne, Australia
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21
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Longitudinal Trajectories of Caregiver Distress and Family Functioning After Community-Acquired Pediatric Septic Shock. Pediatr Crit Care Med 2020; 21:787-796. [PMID: 32541376 PMCID: PMC9125433 DOI: 10.1097/pcc.0000000000002404] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To identify trajectories and correlates of caregiver distress and family functioning in families of children who survived community-acquired septic shock. We hypothesized that: 1) a substantial subset of families would demonstrate trajectories of persistent elevated caregiver distress and impaired family functioning 12 months after hospitalization and 2) sociodemographic and clinical risk factors would be associated with trajectories of persistent distress and family dysfunction. DESIGN Prospective cohort. SETTING Fourteen PICUs in the United States. PATIENTS Caregivers of 260 children who survived community-acquired septic shock. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Caregivers completed ratings of distress on the Brief Symptom Inventory and of family functioning on the Family Assessment Device at baseline, 1, 3, 6, and 12 months after hospitalization. Results from group-based trajectory modeling indicated that 67% of the current sample was characterized by persistent low caregiver distress, 26% by persistent moderate to high distress that remained stable across 12 months (high-risk caregiver distress group), and 8% by initial high distress followed by gradual recovery. Forty percent of the sample was characterized by stable high family functioning, 15% by persistent high dysfunction across 12 months (high-risk family functioning group), 12% by gradually improving functioning, and 32% by deteriorating function over time. Independently of age, child race was associated with membership in the high-risk caregiver distress group (non-white/Hispanic; effect size, -0.12; p = 0.010). There were no significant sociodemographic or clinical correlates of the high-risk family functioning group in multivariable analyses. CONCLUSIONS Although the majority of families whose children survived community-acquired septic shock were characterized by resilience, a subgroup demonstrated trajectories of persistently elevated distress and family dysfunction during the 12 months after hospitalization. Results suggest a need for family-based psychosocial screening after pediatric septic shock to identify and support at-risk families.
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22
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Parents' Experiences of Transition From Hospital to Home After Their Infant's First-Stage Cardiac Surgery: Psychological, Physical, Physiological, and Financial Survival. J Cardiovasc Nurs 2020; 36:283-292. [PMID: 32842034 DOI: 10.1097/jcn.0000000000000727] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The intersurgical stage is a critical time for fragile infants with complex congenital heart disease, but little is known about the impact on parents. OBJECTIVE The aim of this study was to explore parents' experiences of the transition from hospital to home with their infant after stage 1 cardiac surgery for complex congenital heart disease. METHOD This is a prospective, longitudinal, mixed methods feasibility study using semistructured interviews and self-report instruments at 4 time points: before discharge (baseline), 2 weeks post discharge, 8 weeks post discharge, and after stage 2 surgery. Qualitative data were analyzed thematically; and quantitative data, descriptively. RESULTS Sixteen parents of 12 infants participated. All parents described signs of acute stress disorder; 4 parents described symptoms of posttraumatic stress disorder before discharge. Parents' fear and uncertainty about going home were multifaceted, underpinned by exposure to numerous traumatic events. By 8 weeks post discharge, parents' feelings and emotions were positive, relieved, and relaxed. Mean generalized anxiety and depression scores were higher before discharge; most individual anxiety and depression scores decreased over time. Physiological survival included self-care needs, such as eating and sleeping properly. Physical survival included preparation of the home environment and home alterations adapting to their infant's equipment needs. Financial survival was a burden, particularly for those unable to return to work. CONCLUSION Patterns of experience in surviving the transition included psychological, physical, physiological, and financial factors. Authors of further longitudinal research could test the effectiveness of psychological preparation interventions, while encouraging early consideration of the other factors influencing parents' care of their infant after discharge from hospital.
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23
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van Meijel EPM, Gigengack MR, Verlinden E, van der Steeg AFW, Goslings JC, Bloemers FW, Luitse JSK, Boer F, Grootenhuis MA, Lindauer RJL. Long-Term Posttraumatic Stress Following Accidental Injury in Children and Adolescents: Results of a 2-4-Year Follow-Up Study. J Clin Psychol Med Settings 2020; 26:597-607. [PMID: 30924029 PMCID: PMC6851392 DOI: 10.1007/s10880-019-09615-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In this study, we determined the long-term prevalence of posttraumatic stress disorder (PTSD) in children and adolescents after accidental injury and gained insight into factors that may be associated with the occurrence of PTSD. In a prospective longitudinal study, we assessed diagnosed PTSD and clinically significant self-reported posttraumatic stress symptoms (PTSS) in 90 children (11–22 years of age, 60% boys), 2–4 years after their accident (mean number of months 32.9, SD 6.6). The outcome was compared to the first assessment 3 months after the accident in 147 children, 8–18 years of age. The prevalence of PTSD was 11.6% at first assessment and 11.4% at follow-up. Children with PTSD or PTSS reported significantly more permanent physical impairment than children without. Children who completed psychotherapy had no symptoms or low levels of symptoms at follow-up. Given the long-term prevalence of PTSD in children following accidents, we recommend systematic monitoring of injured children. The role of possible associated factors in long-term PTSS needs further study.
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Affiliation(s)
- Els P M van Meijel
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands. .,de Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands.
| | - Maj R Gigengack
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands.,de Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands
| | - Eva Verlinden
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands
| | - Alida F W van der Steeg
- Pediatric Surgical Center of Amsterdam, Amsterdam UMC, Emma Children's Hospital, University of Amsterdam & VU University, Amsterdam, The Netherlands
| | - J Carel Goslings
- Trauma Unit Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Frank W Bloemers
- Department of Trauma Surgery, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Jan S K Luitse
- Emergency Department, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Frits Boer
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands
| | - Martha A Grootenhuis
- Pediatric Psychology Department of the Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Princess Maxima Center for Pediatric Oncology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Ramón J L Lindauer
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands.,de Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands
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Abstract
PURPOSE OF REVIEW Children with medical or surgical critical illness or injury require skillful attention to physical, emotional, psychological, and spiritual needs, whereas their families need support and guidance in facing life-threatening or life-changing events and gut-wrenching decisions. This article reviews current evidence and best practices for integrating palliative care into the pediatric intensive care unit (PICU), with a focus on surgical patients. RECENT FINDINGS Palliative care is best integrated in a tiered approach, with primary palliative care provided by the PICU and surgical providers for all patients and families, including basic symptom management, high-quality communication, and end-of-life care. Secondary and tertiary levels of care involve unit or team-based 'champions' with additional expertise, and subspecialty palliative care teams, respectively. PICU and surgical providers should be able to provide primary palliative care, to identify patients and families for whom a palliative care consult would be helpful, and should be comfortable introducing the concept of palliative care to families. SUMMARY This review provides a framework and tools to enable PICU and surgical providers to integrate palliative care best practices into patient and family care.
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Rensen N, Steur LMH, Schepers SA, Merks JHM, Moll AC, Grootenhuis MA, Kaspers GJL, van Litsenburg RRL. Concurrence of sleep problems and distress: prevalence and determinants in parents of children with cancer. Eur J Psychotraumatol 2019; 10:1639312. [PMID: 31448065 PMCID: PMC6691919 DOI: 10.1080/20008198.2019.1639312] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/23/2019] [Accepted: 06/18/2019] [Indexed: 12/20/2022] Open
Abstract
Background: Parents of children with cancer are at risk for sleep problems. If these problems persist, an important perpetuating factor might be ongoing parental distress. Objective: The aim of this study is to assess the prevalence of sleep problems and the concurrence with distress in parents of children treated for cancer, and to identify predictors of this symptom clustering. Method: Parents completed the Medical Outcomes Study (MOS) Sleep Scale and Distress Thermometer for Parents (DT-P). Clinically relevant sleep problems were defined as a score >1SD above the norm and clinical distress as a thermometer score above the established cut-off of 4. Four parent categories were constructed: neither sleep problems nor distress; no distress but sleep problems; no sleep problems but distress; both sleep problems and distress. Predictive determinants (sociodemographic, medical, psychosocial) for each category were assessed with multilevel multinomial logistic regression. Results: Parents (202 mothers and 150 fathers) of 231 children with different cancers participated. Mean time since diagnosis was 3.3 ± 1.4 years (90% off-treatment). The prevalence of sleep problems was 37%. Fifty percent of parents reported neither sleep problems nor distress, 9% had only sleep problems, 13% only distress, and 28% reported both. Compared to parents without sleep problems or distress, parents who reported both were more likely to report parenting problems (OR 4.4, [2.2-9.1]), chronic illness (OR 2.8, [1.2-6.5]), insufficient social support (OR 3.7, [1.5-9.1]), pre-existent sleep problems (OR 6.2, [2.0-18.6]) and be female (OR 1.8, [1.1-4.2]). Conclusions: Sleep problems are common in parents of children treated for cancer, and occur mostly in the presence of clinical distress. Future research must show which interventions are most effective in this group: mainly targeted at sleep improvement or with prominent roles for stress management or trauma processing.
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Affiliation(s)
- Niki Rensen
- Pediatric Oncology-Hematology, Cancer Center Amsterdam, Amsterdam UMC, Emma Children’s Hospital, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Lindsay M. H. Steur
- Pediatric Oncology-Hematology, Cancer Center Amsterdam, Amsterdam UMC, Emma Children’s Hospital, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Sasja A. Schepers
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Psychosocial Department, Amsterdam UMC, Emma Children’s Hospital, University of Amsterdam, Amsterdam, Netherlands
| | - Johannes H. M. Merks
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Pediatric Oncology-Hematology, Amsterdam UMC, Emma Children’s Hospital, University of Amsterdam, Amsterdam, Netherlands
| | - Annette C. Moll
- Ophthalmology, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands
| | - Martha A. Grootenhuis
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Psychosocial Department, Amsterdam UMC, Emma Children’s Hospital, University of Amsterdam, Amsterdam, Netherlands
| | - Gertjan J. L. Kaspers
- Pediatric Oncology-Hematology, Cancer Center Amsterdam, Amsterdam UMC, Emma Children’s Hospital, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Raphaële R. L. van Litsenburg
- Pediatric Oncology-Hematology, Cancer Center Amsterdam, Amsterdam UMC, Emma Children’s Hospital, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
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26
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Darling SJ, Hearps SJC, Muscara F, McCarthy M, Nicholson JM, Burke K, Dimovski A, Anderson V. Psychological trajectories of mothers and fathers following their child's diagnosis of a life-threatening illness or injury: A longitudinal investigation. J Clin Psychol 2019; 75:1930-1942. [PMID: 31254362 DOI: 10.1002/jclp.22829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Explore the mental health trajectories of parents following their child's life-threatening illness/injury. METHODS Participants were 217 parents (mean age: 34.9-40.0; 66 fathers) of 165 children who presented to a tertiary hospital with a life-threatening illness/injury. Parents completed questionnaires about their mental health and psychosocial stressors within 4 weeks of the child's illness/injury (T1), and 4 months (T2), 7 months (T3), and 19 months (T4) postdiagnosis. RESULTS For both mothers and fathers, mental health symptoms were elevated at diagnosis declining to normal levels by T3, with a pattern of increase at T4. Fathers demonstrated a faster decline in symptoms between T1 and T2, and fathers, but not mothers, experienced a relapse in depressive symptoms at T4. Fathers reported higher rates of work changes. CONCLUSIONS These findings have important implications for the design and timing of parental interventions to support families of children with life-threatening disease/injury.
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Affiliation(s)
- Simone J Darling
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Stephen J C Hearps
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Frank Muscara
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Maria McCarthy
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Children's Cancer Centre, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Jan M Nicholson
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Kylie Burke
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, St. Lucia, Queensland, Australia
| | - Anica Dimovski
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Vicki Anderson
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Psychology Department, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
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27
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Therapeutic massage to enhance family caregivers' well-being in a rehabilitation hospital. Complement Ther Clin Pract 2019; 35:361-367. [PMID: 31003683 DOI: 10.1016/j.ctcp.2019.03.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/31/2019] [Accepted: 03/31/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND PURPOSE A massage therapy program was implemented to address the psychological well-being of family caregivers to patients in a rehabilitation hospital. The impact of massage "dosage" on caregiver stress and psychological well-being was examined in this study. Participants' perspectives on the program were also explored. MATERIALS AND METHODS Thirty-eight family caregivers were randomized to receive either one massage per week or three massages per week for two weeks. Caregivers reported psychological symptoms and stress pre- and post-program. Program acceptability was assessed via responses on an exit survey. RESULTS Overall, 79% of massages were received (89% among program completers). Post-program symptom scores were lower than baseline scores for both groups (F (1, 31) = 8.74 - 24.50, P < 0.01). Exit surveys indicated high program acceptability and perceived benefits. CONCLUSION Findings suggest that massage services would be welcomed, utilized, and beneficial for improving the psychological well-being of family caregivers in a rehabilitation hospital.
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28
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Integrating the Comfort Theory™ Into Pediatric Primary Palliative Care to Improve Access to Care. J Hosp Palliat Nurs 2019; 21:382-389. [PMID: 30920492 DOI: 10.1097/njh.0000000000000538] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Primary palliative care improves access to symptom control and quality-of-life care for children and families and can reduce moral distress in clinicians. This article describes the application of a nursing theory framework for an evidence-based practice/quality improvement project that embedded pediatric primary palliative care into a hospital-based setting using unit-specific projects. An evidence-based practice/quality improvement project, guided by the Comfort Theory™, provided primary palliative care education and mentorship to improve knowledge, skills, and attitudes of direct care clinicians. Training consisted of didactic and self-directed learning, mentoring, and completion of unit-based projects to establish meaning and impact best practices and policies. A total of 149 direct care clinicians, comprising 3 cohorts, enrolled in the program. Improvements in interdisciplinary collaboration in care were demonstrated through 21 unit-based projects, the development of triggers for specialty palliative care consults in several high-risk populations, and the development of institutional guidelines for end-of-life care. The Comfort Theory™ guided integration of palliative care for children with serious illness and their families. This project empowered direct care clinicians in caring for patients, providing support to clinical staff, and in developing best practices.
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29
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Mangelsdorf SN, Mehl MR, Qiu J, Alisic E. How Do Mothers and Fathers Interact With Their Children After An Injury? Exploring the Role of Parental Acute Stress, Optimism, and Self-Efficacy. J Pediatr Psychol 2019; 44:311-322. [DOI: 10.1093/jpepsy/jsy107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 11/28/2018] [Accepted: 12/05/2018] [Indexed: 01/23/2023] Open
Affiliation(s)
- Shaminka N Mangelsdorf
- School of Psychological Sciences, Monash University
- Monash University Accident Research Centre, Monash University
| | | | - Jianrong Qiu
- Monash University Accident Research Centre, Monash University
| | - Eva Alisic
- Murdoch Children’s Research Institute
- Jack Brockhoff Child Health and Wellbeing Program, Melbourne School of Population and Global Health, The University of Melbourne
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