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Felizardo MJDA, Macêdo MML, Henriques NL, Deodato S, Duarte ED. Families' situation of caring for a child with a chronic condition: a mixed methods study. Rev Esc Enferm USP 2024; 58:e20230304. [PMID: 38466905 PMCID: PMC10927268 DOI: 10.1590/1980-220x-reeusp-2023-0304en] [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] [Received: 09/22/2023] [Accepted: 01/05/2024] [Indexed: 03/13/2024] Open
Abstract
OBJECTIVE To analyze the meanings attributed by family members to the situation of caring for a child with a chronic condition (CCC), in the light of the Family Management Style Framework (FMSF). METHOD A mixed-methods, parallel-convergent study, guided by the FMSF theoretical framework, using the conceptual component "Definition of the Situation". Fifty-three CCC families took part. Data was collected using a semi-structured interview, a questionnaire to characterize the participants and a Family Management Measure scale. Descriptive and inferential statistical analysis was carried out on the quantitative data and the qualitative data was subjected to deductive thematic analysis. RESULTS Family members reported a view of normality in relation to CCC, also verified by the Child's Daily Life scale. However, they indicate the repercussions of the chronic condition on the family, and that they devote more attention and time to meeting the child's care needs, which was also verified in the View of the Impact of the Condition and Management Effort scales. CONCLUSION Families have a positive view of the situation of caring for CCC at home, but point out some negative effects, such as the greater time spent caring for the child.
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Affiliation(s)
- Melissa Joice de Abreu Felizardo
- Universidade Federal de Minas Gerais, Escola de Enfermagem,
Departamento de Enfermagem Materno-Infantil e Saúde Pública, Belo Horizonte, MG,
Brazil
| | - Maísa Mara Lopes Macêdo
- Universidade Federal de Minas Gerais, Escola de Enfermagem,
Departamento de Enfermagem Materno-Infantil e Saúde Pública, Belo Horizonte, MG,
Brazil
| | - Nayara Luiza Henriques
- Universidade Federal de Minas Gerais, Escola de Enfermagem,
Departamento de Enfermagem Materno-Infantil e Saúde Pública, Belo Horizonte, MG,
Brazil
| | - Sérgio Deodato
- Universidade Católica Portuguesa, Faculdade de Ciência da Saúde e
Enfermagem. Centro de Investigação Interdisciplinar em Saúde. Lisboa,
Portugal
| | - Elysângela Dittz Duarte
- Universidade Federal de Minas Gerais, Escola de Enfermagem,
Departamento de Enfermagem Materno-Infantil e Saúde Pública, Belo Horizonte, MG,
Brazil
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Smith AD, Saqib B, Lee RR, Shoop-Worrall S, Hyrich KL, McDonagh JE, Cordingley L. Is time a healer? How quality of life changes over time reported by parents of children and young people with juvenile idiopathic arthritis. Rheumatology (Oxford) 2023; 62:794-803. [PMID: 35608307 PMCID: PMC9891422 DOI: 10.1093/rheumatology/keac312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/13/2022] [Accepted: 05/13/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To investigate changes in health-related quality of life (HRQoL) in children and young people with JIA (Juvenile Idiopathic Arthritis) over 3 years following diagnosis. METHODS Data on children and young people recruited to the Childhood Arthritis Prospective Study (CAPS) were selected if >5 years of age at diagnosis. HRQoL was assessed at diagnosis (baseline), 1 year and 3 years using the proxy-reported Child Health Questionnaire (CHQ) completed by a parent or guardian. The CHQ measures aspects of HRQoL including physical functioning and mental health. Analyses included descriptive statistics, comparison with a US reference population and analysis of CHQ scores longitudinally and by gender and age of onset. RESULTS Using CHQ data from parents/guardians of 182 CAPS study participants [median age 9.6 years (interquartile range 7.2-12.2)], all HRQoL domains significantly improved over the 3 year follow-up, except general health perceptions. Physical health domains showed greater improvement than psychosocial domains, although psychosocial scores were generally higher than physical scores throughout. Although similar at diagnosis, at 1 year females had significantly worse HRQoL than males in physical functioning (P = 0.03), bodily pain (P = 0.03), mental health (P = 0.00), social-emotional (P = 0.02) and social-physical (P < 0.001). Differences largely remained at 3 years. Age at onset was not significantly associated with HRQoL. CONCLUSION Children and young people with JIA have low HRQoL across domains compared with the reference population. This improves within 3 years of diagnosis, with the greatest improvement within the first year. Early developmentally appropriate clinical intervention is recommended to reduce both psychosocial and physical impact of JIA. The lower HRQoL scores of females require further investigation.
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Affiliation(s)
- Andrew D Smith
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre
| | - Bishma Saqib
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research
| | - Rebecca Rachael Lee
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre
| | - Stephanie Shoop-Worrall
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester
- Centre for Health Informatics, University of Manchester
| | - Kimme L Hyrich
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre
| | - Janet E McDonagh
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre
- Department of Paediatric and Adolescent Rheumatology, Royal Manchester Children’s Hospital, Manchester University Hospitals Trust, Manchester, UK
| | - Lis Cordingley
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre
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Brandelli YN, Tutelman PR, Chambers CT, Parker JA, Stinson JN, Huber AM, Stirling Cameron E, Wilson JP. "Every Little Furrow of Her Brow Makes Me Want To Stop": An Interpretative Phenomenologic Analysis of Mothers' Experiences With Juvenile Idiopathic Arthritis Treatments. Arthritis Care Res (Hoboken) 2022; 74:1761-1769. [PMID: 34151534 DOI: 10.1002/acr.24735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/29/2021] [Accepted: 06/17/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Children with juvenile idiopathic arthritis (JIA) are faced with a complex medical journey requiring consistent adherence to treatments to achieve disease management. Parents are intimately involved in JIA treatments; however, little is known about their experiences in this role. This is relevant as many treatments necessitate procedural pain (e.g., self-injections) or side effects (e.g., nausea), which may impact a parents' ability to follow treatment plans. The objective of this study was to explore the lived experiences of parents who identified challenges with their child's JIA treatments. METHODS Parents of children with JIA who identified challenges with their child's treatments were invited to take part in semistructured interviews. Data were analyzed using interpretative phenomenological analysis. RESULTS Ten mothers of children with JIA (60% female with a mean age of 11.83 years [range 4-16 years]) participated. Four superordinate themes were present in mothers' experiences: 1) treatments altered mothers' roles within the family, increasing their caregiver burden and advocacy; 2) treatments positively and negatively impacted their relationships (e.g., increased support from others, decreased time with others); 3) treatments elicited various emotional responses (e.g., frustration, grief), which affected their well-being; and 4) treatments were at times a source of internal conflict, affecting mothers' actions and adherence. CONCLUSION Mothers' experiences with their child's JIA treatments affects them in various ways that can subsequently impact treatment adherence. Results highlight the value of supporting parents through these complex treatment regimens and incorporating their experiences in treatment decisions to help promote optimal outcomes for children with JIA and their families.
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Affiliation(s)
- Yvonne N Brandelli
- Dalhousie University and IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Perri R Tutelman
- Dalhousie University and IWK Health Centre, Halifax, Nova Scotia, Canada
| | | | | | - Jennifer N Stinson
- University of Toronto and Hospital for Sick Children, Toronto, Ontario, Canada
| | - Adam M Huber
- Dalhousie University and IWK Health Centre, Halifax, Nova Scotia, Canada
| | | | - Jennifer P Wilson
- Cassie & Friends: A Society for Children With Juvenile Arthritis and Other Rheumatic Diseases, Vancouver, British Columbia, Canada
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Baudino MN, Roberts CM, Edwards CS, Gamwell KL, Tung J, Jacobs NJ, Grunow JE, Chaney JM. The impact of illness intrusiveness and overparenting on depressive symptoms in parents of youth with inflammatory bowel disease. J SPEC PEDIATR NURS 2022; 27:e12362. [PMID: 34811881 DOI: 10.1111/jspn.12362] [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: 05/21/2021] [Revised: 10/11/2021] [Accepted: 10/28/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Inflammatory bowel disease (IBD) management creates significant caregiver demands that can interfere with parents' ability to engage in a number of role functions (i.e., illness intrusiveness) well into their child's adolescence, potentially resulting in excessive or misdirected parenting (i.e., overparenting). Disruptions and limited access to routine and valued activities (e.g., family, work, and leisure) due to IBD and excessive parenting may result in parents neglecting their own personal and emotional self-care needs, increasing their risk for depressive symptoms. To explore these associations, the present study examined parents' experience of illness intrusiveness and subsequent overparenting as serial mediators in the association between disease severity and parent depressive symptoms. DESIGN AND METHODS Participants were 146 caregivers of adolescents with IBD from an outpatient pediatric gastroenterology clinic. During a scheduled outpatient visit, parents completed measures of illness intrusiveness, overparenting, and depressive symptoms. Pediatric gastroenterologists provided ratings of disease severity. RESULTS Several direct and indirect associations were observed among the modeled variables. Notably, mediation analysis revealed a significant disease severity → illness intrusiveness → overparenting → depressive symptoms serial indirect effect. CONCLUSIONS Parents' experience of greater IBD-induced lifestyle disruptions is associated with increased overparenting and a heightened risk for depressive symptoms. PRACTICE IMPLICATIONS Parents should be encouraged to establish and maintain a healthy balance between parenting and self-care/role function activities, especially during adolescence when greater youth autonomy and independence are crucial. These types of clinical efforts may reduce the likelihood of parents experiencing depressive symptoms, and have the added benefit of improving adolescent IBD self-management.
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Affiliation(s)
- Marissa N Baudino
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Caroline M Roberts
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Clayton S Edwards
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Kaitlyn L Gamwell
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jeanne Tung
- Pediatric Gastroenterology, University of Oklahoma Children's Physicians, Oklahoma City, Oklahoma, USA
| | - Noel J Jacobs
- General and Community Pediatrics, University of Oklahoma Children's Physicians, Oklahoma City, Oklahoma, USA
| | - John E Grunow
- Pediatric Gastroenterology, University of Oklahoma Children's Physicians, Oklahoma City, Oklahoma, USA
| | - John M Chaney
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
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Smith S, Tallon M, Clark C, Jones L, Mörelius E. "You Never Exhale Fully Because You're Not Sure What's NEXT": Parents' Experiences of Stress Caring for Children With Chronic Conditions. Front Pediatr 2022; 10:902655. [PMID: 35832577 PMCID: PMC9271768 DOI: 10.3389/fped.2022.902655] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
Children with chronic conditions are experiencing improved survival worldwide, and it is well-known that their parents are stressed. Yet, despite this knowledge, parents continue to experience stress. Our study explored the lived experience of parental stress when caring for children with various chronic conditions to identify opportunities to potentially reduce stress for these parents. This was an exploratory qualitative study using semi-structured interviews. To ensure appropriate research priorities were addressed, the study was co-designed with consumer and stakeholder involvement. Twenty parents were interviewed. Parents were recruited through a recognized family support organization for children with various care needs in Western Australia. Interviews were audio-recorded, transcribed verbatim, anonymized, and analyzed using Interpretative Phenomenological Analysis. Two superordinate themes were identified: (1) Gut instinct to tipping point included parents as unheard experts and their experiences of stress and becoming overwhelmed. (2) Losses and gains covered the parents' identity and relationship challenges and coping strategies with their children's unpredictable conditions. Parents' experiences of stress caring for children with chronic conditions can be applied to the Job-Demand Control-Support Model for occupational stress. Not only does this application provide a useful framework for practitioners but it adds a unique perspective that reflects the dual role of parents in caring for their children with chronic conditions as a parent but also a professional with a 24/7 workload. The parents' experiences highlight a need for improved support access, effective communication between parents and health care professionals, discharge preparation and information provision, and regular screening of parental stress with a referral pathway.
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Affiliation(s)
- Stephanie Smith
- School of Nursing and Midwifery, Edith Cowan University, Joondaulup, WA, Australia.,Perth Children's Hospital, Nursing Research Department, Nedlands, WA, Australia
| | - Mary Tallon
- School of Nursing, Curtin University, Bentley, WA, Australia
| | - Carrie Clark
- Kalparrin, Perth Children's Hospital, Nedlands, WA, Australia
| | | | - Evalotte Mörelius
- School of Nursing and Midwifery, Edith Cowan University, Joondaulup, WA, Australia.,Perth Children's Hospital, Nursing Research Department, Nedlands, WA, Australia
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Bristow S, Usher K, Power T, Jackson D. Understanding maternal resilience; Lesson learnt from rural mothers caring for a child with a chronic health condition. J Clin Nurs 2021; 31:2593-2604. [PMID: 34693563 DOI: 10.1111/jocn.16081] [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: 07/22/2021] [Revised: 09/14/2021] [Accepted: 09/30/2021] [Indexed: 11/30/2022]
Abstract
AIM This study aimed to understand the lived experience of rural mothers caring for a child with a chronic health condition and to understand their perspectives on the support, services and resources they identify as necessary to effectively manage caregiving. BACKGROUND Maternal caregivers in rural areas experience difficulty accessing specialist health care for their child and can also experience geographical and social isolation. Understanding the factors that enable these maternal caregivers to overcome the challenges and adversities faced is crucial to help nurses identify and facilitate avenues for support and resources. DESIGN This study employed a phenomenological design. The study is reported in line with Consolidated criteria for reporting qualitative research guidelines (COREQ). METHODS Semi-structured interviews were conducted with 17 maternal caregivers in rural New South Wales, Australia, who had at least one child with a chronic health condition aged between 2-18 years. Data were collected from March to June 2018. Thematic analysis was used to develop a thematic framework. This paper reports on one of the major themes identified in this research, specifically maternal resilience. RESULTS Participants demonstrated maternal resilience by creating meaningful social connections, cultivating networks, developing problem-solving skills, enhancing their self-efficacy and finding a sense of purpose through hope and optimism. These strategies provide nurses insight into how some rural women overcome adversities associated with their maternal labour required in caring for a child with a chronic health condition. CONCLUSION This study found that participants overcame the challenges related to their caregiving work, emerging as resilient caregivers. Understanding maternal resilience assists nurses to provide the services rural mothers in Australia need to care for their child with a CHC. RELEVANCE TO CLINICAL PRACTICE Findings from this study provide insight into the experiences of rural maternal caregivers of children with a chronic health condition and identify the strategies they adopt to overcome caregiver challenges. Understanding these strategies allows nurses to improve care and support for rural mothers using a strength-based approach to build maternal resilience.
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Affiliation(s)
- Sally Bristow
- School of Health, University of New England, Armidale, Australia
| | - Kim Usher
- School of Health, University of New England, Armidale, Australia
| | - Tamara Power
- Susan Wakil School of Nursing, University of Sydney, Sydney, New South Wales, Australia
| | - Debra Jackson
- Susan Wakil School of Nursing, University of Sydney, Sydney, New South Wales, Australia
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Palman J, McDonagh JE. Young Minds: Mental Health and Transitional Care in Adolescent and Young Adult Rheumatology. Open Access Rheumatol 2020; 12:309-321. [PMID: 33324121 PMCID: PMC7732171 DOI: 10.2147/oarrr.s228083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 11/11/2020] [Indexed: 12/27/2022] Open
Abstract
Consideration of the mental health and emotional wellbeing is an important component of health care for all young people, irrespective of setting. Mental health disorders are common during adolescence and young adulthood and young people with rheumatic musculoskeletal diseases (RMD) are not exempt. For such young people, risks of poor outcomes are related to both mental health as well as their RMD. Times of change during adolescence and young adulthood-transitions-are potentially vulnerable life stages for young people with RMD and warrant specific attention in health care provision. Such transitions include those occurring at puberty, during education, training, and employment, socially with moves away from the parental home, as well as from child to adult-centered health services. There is great potential for rheumatology professionals to support young people with RMD at these transitions in view of their frequent encounters and ongoing therapeutic relationships. In this review, we aim to assess the impact of mental health on RMD during adolescence and young adulthood with particular reference to transitional care provision and how rheumatology professionals can be involved in addressing mental health issues during this time of change.
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Affiliation(s)
- Jason Palman
- Department of Paediatric and Adolescent Rheumatology, Royal Manchester Children’s Hospital, Manchester University Hospitals NHS Trust, ManchesterM13 9WL, UK
| | - Janet E McDonagh
- Department of Paediatric and Adolescent Rheumatology, Royal Manchester Children’s Hospital, Manchester University Hospitals NHS Trust, ManchesterM13 9WL, UK
- Versus Arthritis Centre for Epidemiology; Centre for MSK Research, University of Manchester, Manchester, UK
- NIHR Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester, UK
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