Psychological distress: testing hypotheses based on Roy's adaptation model

Effectiveness of Roy Adaptation Model-Based Cognitive Stimulation Therapy in Elderly Patients with Non-Small Cell Lung Cancer Undergoing Curative Resection

This study aimed to investigate the effects of a Roy adaptation model (RAM)-based cognitive stimulation therapy (CST) intervention on elderly patients diagnosed with primary non-small cell lung cancer (NSCLC) undergoing curative resection. A total of 280 patients diagnosed with primary NSCLC were randomized into RAM-based CST group and control group. Outcomes were assessed at three intervals: pre-surgery, discharge, and one-month post-discharge. Cognitive function was evaluated using Mini-Cognitive test. Postoperative delirium prevalence was determined within 48 hours post-surgery using Nursing Delirium Screening Scale. The Hospital Anxiety and Depression Scale evaluated anxiety and depression symptoms, while Quality of Life (QoL) was assessed via Short Form-36 (SF36) Health Survey. The RAM-based CST group demonstrated significantly higher Mini-Cog test scores than the control group upon discharge and post-intervention. Patients with RAM-based CST exhibited a decrease in postoperative delirium compared to the control group. The RAM-based CST intervention yielded an improvement in anxiety and depression at discharge and 1-month post-discharge compared to preoperative levels. Additionally, the RAM-based CST group exhibited substantial enhancements in SF36 subcategory scores at 1-month post-discharge compared to pre-surgery. At post-intervention, the RAM-based CST group demonstrated significantly higher scores than the control group across various health-related domains, including role limitations due to emotional problems, mental health, general health perception, bodily pain, and role limitations due to physical problems. The RAM-based CST intervention in elderly NSCLC patients undergoing curative resection yielded significant enhancements in cognitive function, reduced delirium incidence, improved emotional well-being, and better QoL postoperatively.

Transition from Acute Treatment to Survivorship: Exploring the Psychosocial Adjustments of Chinese Parents of Children with Cancer or Hematological Disorders

Objectives: Parents of children diagnosed with critical illnesses face multiple challenges during their caregiving experience. However, relevant studies have been limited in the Chinese context. Guided by the stress and coping model, we conducted a qualitative study to identify the stressors, coping strategies, and adjustment experiences of Hong Kong parents of children with cancer or hematological disorders. Methods: We recruited 15 parents of children with cancer or hematological disorders requiring bone marrow transplantation and were currently >2 years post-treatment. They participated in a 30-min semi-structured interview. Thematic analysis was performed using the grounded theory approach. Results: The stressors reported by parents included a high caregiving burden during their children’s diagnosis and treatment stages. The fear of recurrence, the need for information, and concerns about late effects were also common among the parents during their children’s transition/survivorship stage. To cope with these stressors, the parents commonly used problem-focused (e.g., seeking help from professionals and support groups) and emotion-focused (e.g., behavioral distractions, venting, and crying) strategies. Despite these stressors, parents reported positive changes through the caregiving experience, such as improved family relationships, developing health-protective habits, and the reprioritization of different aspects of life. Conclusions: Parents encounter different stressors during the cancer care continuum. Using different coping strategies, parents experience positive changes amidst caregiving. Future studies should explore culturally relevant adaptive coping strategies to enhance parents’ psychosocial adjustment.

Integrating a problem-solving intervention with routine care to improve psychosocial functioning among mothers of children with sickle cell disease: A randomized controlled trial

OBJECTIVE

To assess the feasibility of a problem-solving skills training intervention in improving psychological outcomes in mothers of infants with sickle cell disease (SCD).

DESIGN AND METHODS

This parallel randomized controlled trial recruited 64 babies with SCD, 6 to 12 months of age, and their mothers. Baseline measurements assessed mothers' coping and problem-solving skills, depression, and parental stress before random assignment to intervention or control groups (n = 32 each). Problem-solving skills intervention was delivered through 6 monthly sessions, when babies attended for routine penicillin prophylaxis. All measurements were repeated for both groups at the end of the intervention period. Intention to treat analysis used repeated measures mixed models with the restricted estimation maximum likelihood approach.

RESULTS

The problem-solving intervention had no significant effect on mothers' problem-solving skills (adjusted treatment effect: -1.69 points (95% CI:-5.62 to 2.25)), coping behaviours (adjusted treatment effect: 0.65 points (95% CI:- -7.13 to 8.41)) or depressive symptoms (adjusted treatment effect: -0.41 (95% CI: -6.00 to 5.19)). It reduced mothers' level of difficulty in managing stressful events by 9.5 points (95% CI (-16.86 to -2.16); effect size: 0.21 SD). In the subgroup of mothers at risk of depression (n = 31 at baseline), the intervention reduced depression scores with treatment effect of 10.4 points (95%CI: -18.83 to -1.88; effect size: 0.67 SD).

CONCLUSION

This problem-solving skills intervention study suggests feasibility and possible efficacy in improving some maternal outcomes. Further refinement and culturally appropriate adaptations of the intervention could lead to stronger effects.

Impact of Low Anorectal Malformation on Parenting Stress: A Mixed-Method Study

The purpose of this study was to investigate parenting stress among parents of children with low ARM.

STUDY AIMS

1) Compare parenting stress among parents of children with low ARM, with parents of healthy children using questionnaires. 2) Identify subscales within the questionnaire which needed to be further explored. 3) Use semi-structured interviews with parents of children with low ARM, to explore parenting stress and to explain, expand and or support the quantitative findings.

DESIGN AND METHODS

An explanatory sequential mixed methods design was used in this follow up study. The parents completed the Swedish Parenthood Stress Questionnaire (SPSQ), semi-structured interviews were conducted.

RESULTS

Fifteen mothers and 13 fathers of children with low ARM age 8-18, returned completed questionnaires. A control group of 17 mothers and 6 fathers of healthy children age 8-18 that had visited the hospital for a minor procedure was recruited for comparison purposes. There were no significant differences found between index group and controls except in the subscale Incompetence, where parents of children with low ARM reported lower levels of stress compared to controls. Nine semi-structured interviews were conducted with parents of children with low ARM. Qualitative content analysis was used and revealed three themes - Communication between parents, Expectations of parenthood, and Challenges concerning parenthood.

CONCLUSIONS

Parents of children with low ARM did not report high levels of stress. When interviewed, they told about earlier experiences of emotional stress, feelings of guilt, and chaos at the time the child was born and during infancy.

Effects of Nia exercise in women receiving radiation therapy for breast cancer

PURPOSE/OBJECTIVES

To compare a 12-week nontraditional exercise Nia program practiced at home to usual care on fatigue, quality of life (QOL), aerobic capacity, and shoulder flexibility in women with breast cancer undergoing radiation therapy.

DESIGN

Randomized clinical trial.

SETTING

Large community-based hospital in the midwestern United States.

SAMPLE

41 women with stage I, II, or III breast cancer starting radiation therapy.

METHODS

22 women were randomized to the Nia group and 19 to the usual care group. Those in the Nia group were instructed to practice Nia 20-60 minutes three times per week for 12 weeks. Those in the usual care group were instructed to continue normal activities.

MAIN RESEARCH VARIABLES

Fatigue, QOL, aerobic capacity, and shoulder flexibility.

FINDINGS

Controlling for baseline scores, change over time between groups was significantly different for the women who practiced Nia at least 13 times during the 12-week period; those in the Nia intervention reported significantly less fatigue between weeks 6 and 12, as compared to control group (p = 0.05). No statistical differences in QOL, aerobic capacity, or shoulder flexibility were found, but trends favoring Nia were identified.

CONCLUSIONS

For women undergoing radiation therapy for breast cancer, Nia can help relieve fatigue. Additional research in arm and shoulder mobility and preservation also may be beneficial.

IMPLICATIONS FOR NURSING

Oncology nurses are in a unique position to offer suggestions to help manage fatigue, and Nia could be considered as part of a cancer survivorship program.

KNOWLEDGE TRANSLATION

Exercise is beneficial for women with breast cancer, and interest is growing in nontraditional exercise options. Nia can benefit women with breast cancer undergoing radiation therapy.

Parenting stress among caregivers of children with chronic illness: a systematic review

OBJECTIVE

To critically review, analyze, and synthesize the literature on parenting stress among caregivers of children with asthma, cancer, cystic fibrosis, diabetes, epilepsy, juvenile rheumatoid arthritis, and/or sickle cell disease. Method PsychInfo, MEDLINE, and Cumulative Index to Nursing and Allied Health Literature were searched according to inclusion criteria. Meta-analysis of 13 studies and qualitative analysis of 96 studies was conducted. Results Caregivers of children with chronic illness reported significantly greater general parenting stress than caregivers of healthy children (d = .40; p = ≤.0001). Qualitative analysis revealed that greater general parenting stress was associated with greater parental responsibility for treatment management and was unrelated to illness duration and severity across illness populations. Greater parenting stress was associated with poorer psychological adjustment in caregivers and children with chronic illness. Conclusion Parenting stress is an important target for future intervention. General and illness-specific measures of parenting stress should be used in future studies.

Conceptualization and measurement of coping during adolescence: a review of the literature

PURPOSE

The purpose of this review was to examine the conceptualization and measurement of coping in adolescent research.

DESIGN

A review of the literature published and abstracted in four scientific databases was undertaken between July 2008 and June 2009 with the following key words: adolescent(s), cope/coping, stress(ors), and adaptation/psychological.

METHODS

A total of 367 articles were initially identified, and review of published abstracts yielded 104 empirical articles to retrieve and examine more closely for inclusion. Criteria for inclusion in the review were that the study (a) measured coping, (b) presented original data, (c) primarily targeted adolescent participants, (d) was reported in English, and (e) was published between 1998 and June 2009. Fifty-nine subsequent articles were organized using a matrix approach that facilitated cross-study comparisons of purpose, sample, and dependent variables.

FINDINGS

Fewer than half of the studies reviewed included a specific statement defining coping. Instead, many authors described coping in the context of stress response by identifying particular types or ways of coping or naming specific coping strategies used. The theoretical frameworks guiding examination of coping varied across studies. A range of measures, congruent with adolescent developmental processes, were used to assess adolescent coping. A wide range of stress-related risks or conditions were examined, including psychological stressors such as eating disorders, suicidal ideation, and depression; physical stressors such as chronic illness, HIV infection, sports participation, violence, or sexual abuse; familial stressors such as domestic violence or interparental conflict; social stressors such as romantic relationships or difficulties in settings such as school, prison, or a homeless shelter; and societal stressors such as discrimination.

CONCLUSIONS

Coping is an important construct in understanding how adolescents react to the extensive stressors and adjustments they experience. Coping is a complex construct yet worthy of examination because it can be a critical point of intervention in the health trajectory of adolescents and young people. Research is needed to advance the conceptualization and measurement of adolescent coping such that interpretation of findings across studies is enhanced. In this way, future research, including interventions targeting coping, will work synergistically to advance the science and adolescent well-being.

CLINICAL RELEVANCE

Nursing and other healthcare providers working with adolescents understand the need for interventions that promote use of healthy coping strategies and minimize unhealthy coping. Findings from this study demonstrate the state of coping conceptualization and measurement in adolescent research and indicate a need for research that will advance the science and improve the usefulness of adolescent coping data.

Moving nursing science forward within the framework of the Roy adaptation model

In 1999, the Boston-Based Adaptation in Nursing Research Society associates published their analysis of Roy adaptation model-based research. This earlier analysis supported the model's conceptual framework, its adaptive processes, and the influences that effect human responses. The purpose of this article is to describe more recent research within the context of the Roy adaptation model's structural framework, and ongoing developments that include expanded research programs, middle-range theory construction, and research that is related to the philosophic assumptions. An additional aim is to present an expanded worldview or an integrated paradigm that includes both sets of the Roy adaptation model's assumptions (scientific and philosophic), as well as a holistic-adaptation inquiry that could be used to derive Roy adaptation model-based nursing knowledge in future research investigations.

Developing a literature base to understand the caregiving experience of parents of children with cancer: a systematic review of factors related to parental health and well-being

GOAL OF WORK

This paper describes a literature review conducted to identify important factors that have been investigated as explanations of variability in the health and well-being of parents of children with cancer. Our purpose was to build a literature base that could be used to guide and direct future research.

MATERIALS AND METHODS

Medline, Cinahl, EMBASE, PsycINFO, and Sociological Abstracts were searched from 1980 to 2005 using the keywords neoplasms; child(ren) aged 0-18 years; parent(s), caregiver(s), mother(s), or father(s). For papers that met the study inclusion criteria, sample characteristics and information about factors related to caregiver health, or the relationship between such factors, were extracted. The findings were organized according to the six main constructs that form the caregiving process and caregiver burden model: background/context variables; child characteristics; caregiver strain; self-perception; coping factors; and caregiver physical and psychological health.

MAIN RESULTS

Articles meeting the inclusion criteria totaled 57. We found substantial research showing that certain child characteristics (e.g., child behavior; time since diagnosis) and indicators of coping (e.g., family cohesion, social support, stress management) are related to parental psychological health. Other aspects of the caregiving process (e.g., parental self-perception, family-centered care, and physical health) have received less research attention.

CONCLUSION

Various limitations and gaps in the current literature were identified in our review. Future research to understand the complex interrelationships between factors involved in the caregiving process should examine hypotheses that are guided by a theoretical framework and tested using advanced statistical techniques.

Adherence behaviours in Taiwanese children and adolescents with type 1 diabetes mellitus

aims and objective: To describe the current non-adherence behaviours of Taiwanese children with type 1 diabetes mellitus.

BACKGROUND

Poor adherence to prescribed protocols of long-term therapies is a pervasive and costly problem in the care of children with chronic illnesses. Non-adherence to diabetes mellitus treatment regimens of Taiwanese children with type 1 diabetes mellitus in Taiwan has not been well documented.

DESIGN

Cross-sectional data were collected from 101 patients who had type 1 diabetes mellitus and were between the ages of 10 and 18 years.

METHOD

Five types of adherence behaviours were measured: number of calories consumed per day, frequency of meals, self-monitoring of blood glucose, amount of time between injections and meals and frequency of exercise.

RESULTS

Only 25% of patients consumed the ideal daily number of calories (within +/-10% of the ideal range), while 48% of patients consumed 10% fewer calories than the suggested ideal daily number of calories. Only 28% of patients consumed the ideal percentage (50-60%) of calories from carbohydrates. Approximately 15% of patients consumed >60% of their calories from carbohydrates and 30% of their calories from fat. Approximately 30% of patients ate their meals 20-40 minutes after injection; some patients ate their meals within 20 minutes after injection (45% in the morning and 33% in the evening). For frequency of meals, most patients (> or =90%) ate their regular three meals, three or four times per day; only 18% ate the ideal number of six times per day. For self-monitoring of blood glucose, most patients (>70%) tested their blood sugar twice a day, once in the morning and again in the evening. In terms of frequency of exercise, 48% of patients exercised once per day and 43% of patients did not exercise at all. Only 7% of patients met the good diabetes control of HbA(1c) < 7%; almost half of the patients had HbA(1c) > 10%.

CONCLUSIONS

Overall, the patients had poor adherence behaviours in each aspect of diabetes mellitus management and diabetes control total glycosylated haemoglobin (HbA(1c)) was very poor.

RELEVANCE TO CLINICAL PRACTICE

Studies are needed to explore factors related to non-adherence to treatment regimens as well as poor control of diabetes among Taiwanese children with type 1 DM.

Using the Roy Adaptation Model to explore the dynamics of quality of life and the relationship between lung transplant candidates and their caregivers

Using theory to support nursing research may be considered superfluous by some authors, yet a theoretical framework provides structure and consistency to a research study. This article presents the use of the Roy Adaptation Model within the theoretical framework underpinning an investigation of quality of life as perceived by lung transplant candidates and their caregivers. Each step of the research process is identified in this article and the link to the theoretical framework is demonstrated. The use of nursing frameworks to guide research strengthens the theoretical framework itself and also adds another dimension to the body of nursing knowledge.

Comparing stress levels of parents of children with cancer and parents of children with physical disabilities

AIM

To evaluate whether parental stress differs between parents of children with physical disabilities and parents of children with cancer.

METHODS

Parents (92 with disabled children and 89 with children with cancer) were recruited to complete the measures of the Parenting Stress Index/Short Form.

RESULTS

Diagnostic group differences were found across the parenting stress measures used in this study. The parents of children with cancer experienced significantly higher levels of stress compared with the parents of disabled children. The mean scores of each subscale (PD, PCDI, and DC) and total score scales in both groups approached were above the 90th percentile of Abidin's normative sample (PD = 36, PCDI = 27, DC = 36, Total = 91), except for the PD and DC subscales in the disabled children group, which approached the 90th percentile.

CONCLUSION

The results of the study suggest that most of the parents in our sample should be referred for more in-depth diagnostic study and professional counseling in stress management. Therefore, a normative score on the PSI/SF for Taiwanese parents with healthy children should be established to identify whether differences exist between parents whose children are healthy and those whose children have been diagnosed with a chronic illness.