Double ABCX model of stress and adaptation in the context of families that care for children with a tracheostomy at home: application of a theory

Families under pressure: A qualitative study of stressors in families of children with congenital heart disease

The objective of this study was to better understand the stressors in families of children with congenital heart disease (CHD) to assist with formulating targeted stress management plans for such families. A descriptive qualitative study was undertaken at a tertiary referral hospital in China. Following purposeful sampling, interviews were conducted with 21 parents of children with CHD regarding the stressors in their families. Following content analysis, 11 themes were generated from the data and categorised into six main domains: the initial stressor and associated hardships, normative transitions, prior strains, the consequences of family efforts to cope, intrafamily and social ambiguity, and sociocultural values. The 11 themes include confusion regarding the disease, hardships encountered during treatment, the heavy financial burden, the unusual growth track of the child due to the disease, normal events becoming abnormal for the family, impaired family functioning, family vulnerability, family resilience, family boundary ambiguity induced by role alteration, a lack of knowledge about community support and family stigma. Various and complex stressors exist for families of children with CHD. Medical personnel should fully evaluate the stressors and take targeted measures before implementing family stress management practices. It is also necessary to focus on the posttraumatic growth of families of children with CHD and strengthen resilience. Moreover, family boundary ambiguity and a lack of knowledge about community support should not be ignored, and further research is needed to explore these variables. Most importantly, policymakers and healthcare providers should adopt a range of strategies to address the stigma of being in a family of a child with CHD.

A Descriptive Qualitative Study of Home Care Experiences in Parents of Children with Tracheostomies

PURPOSE

The number of pediatric patients who require a long-term tracheal tube at home is gradually increasing. Studies have demonstrated that the parents of these children report high levels of stress, anxiety and other negative emotions as early as shortly after discharge from the hospital. The purpose of this study is to describe the home care experiences of parents of children with tracheostomies during the transition from hospital to home in China to more effectively address their needs.

DESIGN AND METHODS

This study used a qualitative descriptive design and face-to-face interviews with semi-structured questions to learn about the home care experiences of parents whose children had undergone a tracheostomy.

RESULTS

Thirteen parents were recruited from the otorhinolaryngology outpatient ward of Xinhua Hospital in Shanghai, China. These parents described three categories of home care experiences: "direct care overload," "psychological overload," and "personal growth." Subcategories included parental "role change," "from helplessness to skillfulness," "lack of professional support," "anxiety and depression," and "social isolation." They also reported personal growth, which was mainly reflected by "changing their perspectives" and "developing potential."

CONCLUSION

Although the findings of this study indicate that the physical and psychological overload reported by parents of children with tracheostomies during home care is inevitable, a better understanding of parents' caring experiences among professionals may facilitate clinical practice and promote continued community nursing care in China.

PRACTICE IMPLICATIONS

Parents hope to receive systematic education during hospitalization, including web-based video education for skills training after discharge. In addition, parents desire public recognition so that they can participate in normal family and community activities.

Psychometric properties of an instrument to measure family disease management

An instrumental study of 392 households with sick or disabled members was conducted to analyze the psychometric properties of the Family Disease Management Scale. Three different models were analyzed using the Confirmatory Factor Analysis (CFA). One was a single-dimensional factor (family disease management) with 30 items; and two hierarchical models with three factors, which represent the dimensions, family support, family normalization and family participation, that placed the workload into another of higher order called family disease management, the first with 30 items and the second with 29. The CFA results showed that the latter 29-item model provided a better fit. The internal consistency analysis using the Cronbach alpha test showed a value of .93 for the complete scale and above .80 in the three subscales. This instrument may be useful to assess how families manage the illness or disability of its members, especially in clinical practice given the importance of the family as the primary caregiver. As well as in performing epidemiological studies, and in the field of management, planning and assistance.