Behavioural, emotional and family functioning of hospitalized children in China and Hong Kong

Caregiving burden among informal caregivers of people with disability

OBJECTIVE

Chinese informal caregivers experience burden due to their caregiving responsibilities that violate their belief of reciprocal parent-child relationship, but little is known about this burden and coping processes among Chinese. It is believed that internal coping (i.e., self-reliance) and external coping (i.e., seeking help from others) better captured cultural characteristics of coping styles observed among Chinese. Thus, the aim of this study was to estimate the prevalence of mental ill health, identify correlates, investigate the impact of caregiving burden on mental health, and explore the potentially moderating role of two coping strategies.

DESIGN

A purposive sample of 234 informal caregivers of family with intellectual or mental disability in Macao (SAR), China, from August to September 2018 was investigated.

METHODS

DASS-21, Caregiving Burden Inventory (CBI), Perceived Difficulty Scale (PD), and a modified Chinese Coping Scale were used. Multiple regression analyses were conducted.

RESULTS

CBI and PD were associated with depression, anxiety, and stress. Whereas internal coping buffered the effect of PD on depression and anxiety, external coping exacerbated the effect of PD on anxiety and the effect of CBI on depression and anxiety.

CONCLUSION

Poor mental health among caregivers is associated with greater caregiving challenges and burdens. Internal coping helped to buffer but external coping worsened the effect of burdens on mental health outcomes. Interventions that improve internal coping and mental health might be helpful for ageing informal caregivers.

Do Chinese Teachers Perform Emotional Labor Equally? Multi-Group Comparisons Across Genders, Grade Levels and Regions

The emotional aspects of teaching are important and teachers' emotional labor, or, how teachers manage emotions at school, has been attracting more and more attention recently. Using multi-group structural equation modeling, this study investigated the measurement invariance of, and the relationships between, teachers' emotional labor strategies and teaching satisfaction. Participants included teachers from primary and secondary schools in Hong Kong and mainland China. Three sets of group comparisons have been made between female and male teachers, between primary and secondary school teachers, and between teachers in Hong Kong and mainland China. The multi-group invariance tests showed no significant subgroup differences in the measurement and structural models. Thus, there was no difference of 'kind.' However, some differences of 'degree' were observed across genders, grade levels and regions. These differences in the relationship between surface/deep acting and teaching satisfaction can be attributed to the possible influence of some cognitive factors and socio-cultural contexts. With due methodological rigor, the results of this study provide deeper understanding of teachers' emotional labor and its relationship with teaching satisfaction.

Young people's experiences of living with epilepsy: The significance of family resilience

OBJECTIVE

Young people with chronic illnesses, such as epilepsy, tend to have poorer psychosocial outcomes compared to their peers. Nevertheless, not all young people experience difficulties adapting to living with epilepsy. The aim of this study was to examine family processes, as little is known about their impact on young people's adaptation to the condition.

METHOD

Semi-structured interviews were conducted with 15 young people, aged between 13 and 16 years old, to explore their experiences of living with epilepsy from the perspective of family resilience.

RESULTS

Findings from these interviews provided in-depth descriptions of stressful circumstances encountered and family processes. These processes, which in turn promoted positive adaptation, included shared family beliefs, family connectedness, and communication processes that supported collaborative problem-solving.

CONCLUSION

Practitioners who support young people living with chronic conditions, such as epilepsy, should consider interventions that promote family connectedness, as it allows young people to turn to their families for support in times of stress. Additionally, it is important to explore young people's beliefs, helping them and their families construct a new sense of normality if necessary. Supporting open communication between family members, where differing views were acknowledged, is likely to be important in facilitating resilience.

Expression of pain and distress in children during dental extractions through drawings as a projective measure: A clinical study

AIM: To evaluate the efficacy of drawings as a projective measure of pain and distress in children undergoing dental extractions.

METHODS: Children in the age range of 4-13 years with existence of untreatable caries or over-retained primary teeth, indicated for extractions were included. Pain was assessed using one behavioral, faces, legs, activity, cry and consolability (FLACC) scale; and a self report measure; faces pain scale-revised (FPS-R), at two points of time, after completion of local anesthetic administration and after extraction. The general behavior of children was assessed with Wright’s modification of Frankl rating scale. At the end of the session, children were instructed to represent, themselves along with the dentist and their experiences of the dental treatment through drawing. The drawings were scored utilizing Child drawing: Hospital scale (CD: H) manual and correlated with FLACC, FPS-R and Frankl using Pearson correlation test.

RESULTS: A positive correlation, though statistically not significant, was observed between CD: H scores and all other considered parameters (Frankl, FPS-R and FLACC) in the present study.

CONCLUSION: Drawings could not act as surrogate measure of child’s pain; however, they acted as a narrative of his/her experiences and reflection of inner emotions. Hence, drawings can be used as an additional dental armamentarium.

Hospital leadership perspectives on the contributions of Ronald McDonald Houses

Purpose

– The purpose of this paper is to describe an international survey of hospital executives and administrators’ perspectives on the contributions of their affiliation with a Ronald McDonald House (RMH) as an example of accommodation in family-centered care to the hospital’s mission, operations and patient experience.

Design/methodology/approach

– RMHs worldwide provided the names and e-mail addresses of the people holding key leadership positions in their main hospital partner, who in turn were invited to complete an internet-based survey (530 participants; response rate of 54.5 percent).

Findings

– Hospital leaders reported very positive opinions about the contributions of their RMHs affiliation to their ability to serve seriously ill children and their families. This included such important outcomes as increasing family integrity and family participation in care decisions; and decreasing psychosocial stress and hospital social work resource burdens associated with lodging, food, transportation and sibling support. Hospital chief executive offices (CEOs) and medical directors reported very strong and positive opinions regarding the value-added of their RMHs affiliation in many areas, including enhanced marketing of hospital specialty services and reduced length of stay.

Research limitations/implications

– Survey response bias is a limitation, although the results are still useful in terms of identifying multiple ways in which RMHs are perceived as contributing to hospitals’ operations and provision of family-centered care.

Practical implications

– Overall, the results suggest that, internationally, hospital leaders believe that RMHs play a key and valued role in their provision of family-centered care to seriously ill children and their families.

Social implications

– Family accommodation is more than the simple provision of lodging and plays an integral role how hospitals approach family-centered care.

Originality/value

– This international study contributes to the general literature on the role of family accommodation in hospitals’ provision of family-centered care and the specific and very sparse literature on RMHs in particular.

Prevalence of behavioral problems and related family functioning among middle school students in an eastern city of China

INTRODUCTION

This study was carried out to explore the prevalence of behavioral problems among adolescents in junior high school as well as their families' levels of function or dysfunction that contribute to children's behavioral problems in Mainland China.

METHODS

One thousand, four hundred and seventy-six adolescents (ages 12-17 years) and their families participated in the study. Parents completed a self-administered questionnaire consisting of the Child Behavior Checklist (CBCL), Family Assessment Device (FAD) and a number of demographic questions. Student's t-tests, chi-square tests and stepwise multiple regression models were performed to examine the variables.

RESULTS

The estimated prevalence of behavioral problems was 10.5% based on the cutoff point for behavioral problems according to the CBCL. Behavioral problems identified by the CBCL occurred differently at various developmental stages (F = 10.06, P = 0.007). The study showed that inappropriate affective responsiveness, poor affective involvement and low ability of problem solving in the family were significantly associated with increased risk for externalizing behavior problems and total behavior problems of boys. Inappropriate affective responsiveness and poor communication in the family were significantly associated with increased risk for internalizing problems for boys. Poorly established patterns of family behavior were important factors contributing to the development of externalizing behavior problems, internalizing behavior problems and total behavior problems for girls'.

DISCUSSION

The present findings suggest that functional levels of family are associated with the adolescent's mental health, and that specific family dynamics may influence the development of behavioral problems among adolescents in China.

An interpretive phenomenological study of Chinese mothers' experiences of constant vigilance in caring for a hospitalized sick child

AIM

To examine Chinese mothers' experience of caring for their hospitalized sick child.

BACKGROUND

Engaging the mother in providing care for a hospitalized sick child is considered one of the key elements for high-quality care in advanced paediatric nursing. There is evidence that a mother's belief in her capacity to manage stressful situations could improve the nurse-parent relationship because they might play an important role in protecting mothers against heightened stress during crisis situation.

DESIGN

An interpretive phenomenological approach involving semi-structured interview and thematic analysis was used.

METHOD

Fifteen interviews were conducted in Hong Kong, China from April 2009-January 2010, with 15 mothers caring for their hospitalized sick children with acute injury or illness. Crist and Tanner's circular process of hermeneutic interpretive phenomenology was chosen to guide the data analysis.

FINDINGS

The prevailing concept identified through analysis was the 'constant vigilance' that mothers developed. Interpretation of data resulted in the identification of four key themes: 'being sensitive to others', 'providing helping hands', 'monitoring health conditions', and 'maintaining dialogues'. The findings highlight Chinese mothers' desire for participation in caring for their hospitalized child, their unexpressed needs for communication, and concern about being uncared by the busy health professionals, which affect their care for the child's health outcomes.

CONCLUSION

The findings facilitate the development of family-centred care focuses on partnership of care between the nurse and family to enhance the Chinese family's active and participatory role.

Hospitalized children drawing their pain: the contents and cognitive and emotional characteristics of pain drawings

Describing pain is difficult. Children like to draw, and through their drawing they reveal worrying issues. This study aimed to examine how hospitalized children express pain through drawings, and was carried out by examining children's thematic drawings of pain. A comparison was made between hospitalized children and healthy control groups with respect to the thematic contents and cognitive and emotional characteristics of pain drawings. The drawings were sorted in categories on the basis of content, and cognitive competence and emotional disturbances by the Draw-a-Person procedure. The hospitalized children showed a lower level of cognitive capacity than their healthy controls. The control group children revealed a higher level of emotional disturbance than the hospitalized children. The groups differed in the contents of their drawings. The drawings of the hospitalized children frequently depicted medical procedures, whereas the drawings of the healthy controls depicted more consoling human and family relations.

Validity and reliability of the Chinese version of the Feetham Family Functioning Survey (FFFS)

A Chinese version of the Feetham Family Functioning Survey (Chinese FFFS) was developed and psychometrically tested using a sample of 317 child-rearing mothers in Hong Kong. The Chinese FFFS is a self-administered questionnaire consisting of 25 items from which an instrument discrepant score (d score) can be extracted. The results from the confirmatory factor analysis and exploratory factor analysis confirm that the Chinese FFFS has a five-factor structure based on the family ecological model, thereby affirming its construct validity. Cronbach's alpha for d scores was .91, indicating a high internal consistency. In the test-retest study of 39 mothers, the correlation coefficient for "total d score" over a 2-week period was .82, which showed high test-retest reliability. The highest discrepant scores in family functioning were at the level of the marital relationship, which requires family nurses to be skilled at assessing and intervening at this family subsystem.

Reviewing the process of preparing children for MRI

BACKGROUND

MRI is a common medical imaging investigation. Patients, including young children, can be required to keep still for up to 60 min for the study to be completed successfully. Children often find the confined space, noise, need to lie still and possibility of intravenous administration of contrast agent anxiety-provoking and sometimes so distressing that they are unable to cope and require general anaesthesia.

OBJECTIVE

A practice MRI intervention was introduced at the Royal Children's Hospital in Melbourne, Australia. The program is conducted by educational play therapists in conjunction with the Department of Medical Imaging. This study explored the effectiveness of this intervention.

MATERIALS AND METHODS

The intervention was conducted in a practice MRI unit devoid of magnets. Data were collected as a clinical audit with respect to age, gender, times of scans, position in bore, diagnostic scans and movement artefact. Epidata and Stata were used to analyze the data.

RESULTS

A total of 291 children were included; their ages ranged from 3 years 7 months to 17 years (mean 7.9 years), and 48.8% were male. Of the 291 children, 218 (74.9%) were considered a pass at practice, 35 (12 %) were considered borderline pass, and diagnostic images were obtained from 218 (96%) of those children who went onto a clinical MRI.

CONCLUSION

We conclude that practice MRI intervention facilitated by educational play therapists is a useful intervention in supporting children to cope with MRI without general anaesthesia.

Parents’ experiences of participation in the care of hospitalised children: A qualitative study

BACKGROUND

The introduction of unrestricted visiting hours has led to the encouragement of parents to stay with and participate in the care of their hospitalised child. In order to stay with the hospitalised child, parents have to be away from home or work, which in turn impacts on their personal and family life. However, no published study on parents' experiences of childcare participation during paediatric hospitalisation has been found for a Chinese population.

OBJECTIVES

This study explored Chinese parents' experiences of their participation in taking care of their hospitalised child.

DESIGN

A qualitative exploratory design was adopted to capture parents' experiences of participation.

SETTINGS

The study was conducted in four paediatric wards of a regional acute general hospital in the New Territories, a major geographical region of Hong Kong.

PARTICIPANTS

Nineteen parents (16 mothers and three fathers) who had a child hospitalised for more than 48 h and identified themselves as staying comparatively longer with the child than their counterpart were recruited.

METHODS

Data were collection by tape-recorded semi-structured interview.

RESULTS

Four major categories that illustrated parents' experiences of participation in childcare were identified: reasons for staying with the child, rescheduling of family's routine, expectations of nurses, and comments on facility provisions. The findings highlight parents' desire for participation in caring for their hospitalised child, their unexpressed needs for communication and concern about the non-monetary costs of participation.

CONCLUSIONS

Most parents viewed accompanying their hospitalised child as an unconditional aspect of being a parent and had a strong desire for participation. Parents' need for communication and emotional support during their participation of childcare in paediatric unit are universal. As Chinese parents are passive in seeking help, nurses should take the initiative in assessing their needs and offering them support accordingly.