Differences and similarities between mothers' and fathers' experiences of parenting a child with a disability

The NICU experience: how does it affect the parents' relationship?

There is much research about the negative effect of serious and chronic childhood illness on the parent's partner relationship. It is generally assumed that parents of newborns admitted to the neonatal intensive care unit (NICU) also share this risk of relationship strain. However, little research specific to the effects of the NICU on the parent's relationship exists. The focus of most research examining parents of NICU infants is the mother's emotional well-being. The effect on the father is rarely studied. Drawing from studies of other childhood illnesses, it is reasonable to hypothesize that the experience of a NICU hospitalization may also strain the parents' relationship, possibly to the point of dissolution. The implementation of family-centered care in the NICU has had promising outcomes, and it is hypothesized that family-centered care will minimize the emotional stressors that may lead to the dissolution of the parent's partner relationship.

Maternal Perspectives: Qualitative Responses about Perceived Barriers to Care among Children with Orofacial Clefts in North Carolina

Objective

To examine maternal perceptions of barriers to care of children with orofacial clefts (OFC) in a population-based survey that solicited open-ended qualitative responses.

Design and Setting

In 2006, a combination mail/phone survey was sent to all mothers of children with OFC. The questionnaire included 76 items. A final open-ended question was included for additional information about cleft-related care. The analysis included responses to the open-ended question and sociodemographic characteristics of the respondents. Qualitative responses were transcribed and entered into a qualitative software package for analysis, and common themes were elucidated.

Participants/Patients

The North Carolina Birth Defects Monitoring Program was used to identify all resident infants born with OFC from 2001 to 2004. Of 478 eligible mothers, 52.9% (n = 248) responded to the survey, and 39.5% (n = 98) responded to the final open-ended question.

Main Outcome Measures

Percentage reporting problems accessing care, frequency of positive and negative comments, and indicators of financial, personal, and structural barriers to care.

Results

Of the 98 respondents, the majority (n = 95, 96.99%) were the biological mother. Almost 40% of mothers indicated that accessing primary craniofacial care was a problem. Of those citing perceived barriers to care, the major issues cited were financial, structural, and personal barriers.

Conclusions

Collaborative efforts between craniofacial centers and teams, health care systems, and birth defects registries are warranted to reduce perceived barriers to care among families of children with OFC. Further exploration of the themes and factors associated with barriers to care and services is needed.

Fathers and mothers developing skills in managing children's long-term medical conditions: how do their qualitative accounts compare?

BACKGROUND

Little is known about the respective experience of fathers and mothers within couples when managing their child's long-term medical condition. This study therefore aimed to obtain and compare fathers' and mothers' accounts of managing long-term kidney conditions.

METHODS

Qualitative study involving individual then joint semi-structured interviews with 14 couples (biological fathers and mothers of 15 children whose care is managed at a specialist unit). Interviews were digitally recorded, transcribed and analysed using Framework Analysis. Transcripts within and across couples were compared.

RESULTS

Fathers and mothers made a significant contribution to management and a key theme identified was 'developing skills' in: information processing, sharing/negotiating caregiving, restraining children, adapting to treatment regimens and communicating. Although skill development was often a challenging and uncertain process, both fathers and mothers wanted to and did participate in caregiving; they often negotiated this with each other to accommodate caring for other children, paid employment and to provide mutual practical and emotional support. Developing skills in holding their child for procedures and treatments was a major concern, but it was fathers who assumed the 'protector' role and worried more about their child's long-term health and well-being, while mothers concerned themselves more with current clinical issues and maintaining relationships with professionals. Expressing appreciation for fathers' and mothers' skill development may promote good 'working relationships' between professionals and both parents over the many years of the trajectory.

CONCLUSION

Developing skills for home-based caregiving of long-term conditions is a challenging and uncertain process. Both parents often participate in caregiving, and the findings reported here may help professionals decide how best to support both parents in their home-based caregiving.

Fathers' contributions to the management of their child's long-term medical condition: a narrative review of the literature

CONTEXT

Fathers' contributions to the management of long-term childhood medical conditions are under-represented in the literature; therefore, the full extent of their involvement is poorly understood by practitioners and researchers, so strategies for promoting their involvement have not yet been fully considered.

OBJECTIVE

To review studies of fathers' actual contributions in a wide range of conditions, the potential to optimize their contribution through additional interventions by health professionals and a direction for future research.

DESIGN

Narrative review of the literature.

METHODS

CINAHL, Medline, PsychInfo and ERIC databases were searched electronically between the years 1995-2008. The terms adherence, adjustment, child, chronic, compliance, concordance, condition, coping, disease, father, illness, information, long-term, management/intervention, mother, role, self-care and treatment were searched for separately and in combination. English language papers reporting primary research were selected and supplemented by hand-searching reference lists. Thirty-five papers (arising from 29 studies) met criteria and were selected for narrative review.

RESULTS

Five themes were identified: (i) the impact of long-term conditions on fathers' ability to promote their child's well-being, (ii) factors influencing fathers' involvement in health care, (iii) personal growth/beneficial effects for fathers, (iv) the impact of father's involvement on family functioning and (v) strategies that increase fathers' participation in their child's health care and in research investigating fathers' participation.

CONCLUSIONS

The review suggests that fathers' involvement in children's health care can positively impact on fathers', mothers' and children's well-being and family functioning. A range of strategies are identified to inform the promotion of fathers' contributions and future research investigating their input.

Atravessando períodos nebulosos: a experiência da família da criança portadora da Síndrome de Down

O objetivo deste estudo foi o de compreender como é para a família ter uma criança com Síndrome de Down entre seus membros, para que, a partir dessa compreensão, as enfermeiras possam propor e realizar um cuidado com ênfase nas respostas da família aos problemas atuais e potenciais vividos. Utilizaram-se o Interacionismo Simbólico e os passos iniciais da Teoria Fundamentada nos Dados. Oito famílias compuseram o estudo, e apresentaram-se os resultados referentes a um fenômeno: "Atravessando períodos nebulosos" e suas categorias: "Deparando-se com o inimaginável", "Moldando-se à nova realidade" e "Vivendo desilusões". Ao longo da experiência, a família enfrenta períodos de incertezas e dúvidas, demandando novas atitudes e confronto com o desconhecido. Os profissionais da saúde, especificamente da enfermagem, têm ficado à margem do trabalho com essas famílias. Impõe-se a necessidade de orientá-las e apoiá-las, particularmente no enfrentamento de períodos de dificuldades e dúvidas, com o objetivo de minimizá-los e até evitá-los.

Perceived family burden and emotional distress: similarities and differences between mothers and fathers of children with type 1 diabetes in a population-based study

BACKGROUND

Parenting children with diabetes entail an extra burden for the families. More information is needed about associations between perceived family burden and emotional distress in both mothers and fathers.

OBJECTIVE

To analyze (i) perceived burden and emotional distress in mothers and fathers of children with type 1 diabetes and (ii) associations between parental burden and distress and factors related to the child.

METHODS

Mothers (n = 103) and fathers (n = 97) of 115 children (1-15 yr) with type 1 diabetes participated in this population-based survey. The parents completed the Hopkins Symptom Checklist-25 items (HSCL-25), measuring emotional distress, and the Family Burden Scale, which includes five questions measuring perceived family burden related to the child's diabetes.

RESULTS

Both mothers and fathers reported that the greatest burden was related to long-term health concerns. The mothers reported a significantly greater burden related to medical treatment and significantly more emotional distress than the fathers. The mothers' perceived burden was significantly correlated with emotional distress. Nighttime blood glucose measurements were significantly associated with perceived parental burden, and experienced nocturnal hypoglycemia was significantly associated with parental emotional distress.

CONCLUSIONS

The higher perceived burden related to medical treatment, the more emotional distress, and the correlations between burdens and emotional distress in mothers vs. fathers emphasize the importance of discussing both parents' roles and responsibilities in relation to the child's diabetes in follow-up. In the consultations, emphasizing nighttime caregiving and nocturnal hypoglycemia might also be important to prevent emotional distress.

Life and death of a child with down syndrome and a congenital heart condition: experiences of six couples

Individuals with Down syndrome are at increased risk of congenital heart conditions (CHCs), and mortality is higher in people with Down syndrome and a CHC than those without (J. C. Vis et al., 2009). As a consequence, parents of children with Down syndrome and a CHC are more likely to outlive their child. In this research, semistructured interviews were used to explore the experiences of 6 couples whose child with Down syndrome and a CHC had died. The interviews were analyzed qualitatively using interpretative phenomenological analysis (IPA), and 4 themes emerged: dilemmas associated with the dual diagnosis; treatment decisions during the life and the death of their child ("We had to make a decision"); ways couples coped when bereaved ("We weren't really going through it together"); and ripples from the child's life. There was a high degree of similarity of experience within couples. Differences between couples existed in their experiences of coping and supporting each other. Practical implications include the importance of considering the specific needs of couples, individuals, and fathers within partnerships.

Furthering the understanding of parent-child relationships: a nursing scholarship review series. Part 4: parent-child relationships at risk

PURPOSE

The purpose of this integrative review is to synthesize nursing scholarship on parent-child relationships considered fragile because of parent-child's chronic condition or occurrence within a risky context.

CONCLUSIONS

Most reviewed studies demonstrated negative effects of risk conditions on parent-child relationships and documented importance of child, parent, and contextual variables. Studies were predominately single investigations. Varying theoretical perspectives complicated interpretation. Mainly White, middle-class, and small samples limited generalizability. Important areas for further research were identified.

PRACTICE IMPLICATIONS

Nurse researchers identified factors that may interfere with the parent-child relationship. Nurses are in a position to support families under these circumstances.

Predictors of coping in parents of children with an intellectual disability: comparison between Lebanese mothers and fathers

This cross-sectional study was designed to assess the predictors of coping behaviors of 147 Lebanese parents (101 mothers and 46 fathers) with a child with intellectual disability. It assessed the contribution of child's and parent's characteristics, informal social support, and stress on the coping behaviors of fathers and mothers. Multiple regression analysis confirmed that the father's education, informal social support, and stress were the best predictors of coping. The child's age, severity of illness, and parental health did not significantly contribute to predicting coping behaviors. Contrary to expectations in a Middle Eastern culture, both fathers and mothers reported similar levels of stress, perceived informal social support, and coping. Although informal social support cannot be forced on parents, health professionals can mobilize resources that are culturally sensitive, such as home visitation by nurses or support from other parents. This may especially be beneficial in developing countries with limited resources.

How do mothers and fathers who have a child with a disability describe their adaptation/ transformation process?

This qualitative study explored the adaptation/transformation process in mothers and fathers at the individual, parental, marital and extrafamilial levels, and the similarities and differences in their experience of living with a child with cerebral palsy. Interviews were conducted with 13 mothers and 13 fathers of children with cerebral palsy. The results show that mothers and fathers are more likely to view the situation differently than similarly. For both parents, the situation offers the potential for transformation. Complementarity between mothers and fathers is an important factor in each of the adaptation or transformation subsystems. Both parents embark on a journey that changes their beliefs about difference, apply their new knowledge to every aspect of their life, and endeavour to normalize their situation.

A gender perspective on the extent to which mothers and fathers each take responsibility for care of a child with high and intermediate imperforate anus

Imperforate anus is a malformation of the child's anus. Parents' experiences of responsibility for care of the child may differ. The aim of this study was to evaluate a gender perspective on the extent to which mothers and fathers each take responsibility for the care of a child with high and intermediate imperforate anus. Parents of children with imperforate anus and two control groups of children and parents participated. Data collection with questionnaires focusing on responsibility was performed. In conclusion, our study revealed additional evidence of unevenly divided parental responsibility for care of a child with a chronic condition. The mothers in this study were shown to be the primary caregiver.

The size, extent and nature of the learning disability nursing research base: a systematic scoping review

BACKGROUND

A research base should be of sufficient quality and quantity to inform nursing practice. It must allow nurses to access information about clients' needs and to identify effective strategies for meeting those needs. This paper presents the findings of a scoping review of 'learning disability nursing research'. The review aimed to determine whether there is a research base sufficient to support learning disability nursing practice.

METHOD

We undertook searches of the Cochrane Library and electronic databases (Medline, Psychinfo, Embase, CINAHL and British Nursing Index) for the years 1996-2006. Full references and abstracts were downloaded for papers returned. Papers considered relevant to the topic of the review were organised into three categories according to whether the main focus of the research was people with learning disabilities, carers or family members, or nurses. For each paper, information about the locality of the research, the topic of the research, design/method and sample size was extracted.

FINDINGS

We identified 180 relevant research studies, most of which made use of convenience samples of less than one hundred people. Very few studies evaluated the clinical impact of nursing interventions or the delivery of care by learning disability nurses. A small number of studies examined the impact or patient experiences of nurse-led interventions. These tend to small-scale evaluations of new service initiatives, such as the management of behavioural problems. Overall there was an absence of strong evidence about the effectiveness of specific nursing interventions.

CONCLUSIONS

The extent of learning disability nursing research is limited in quantity and it is difficult to draw comparisons across research studies. Much of the available evidence is drawn from small-scale evaluations; which may provide useful guidance and inspiration for service development but do not, in themselves, constitute a sufficient body of research evidence to support learning disability nursing practice.

PARENTING A CHILD WITH A DISABILITY: AN EXAMINATION OF RESIDENT AND NON-RESIDENT FATHERS

Children with disabilities often require more extensive family involvement and greater paternal support than other children. Yet these children are the children least likely to live with their fathers. This paper uses data from the National Longitudinal Survey of Youth 1997 from the United States to examine the association between child disability and resident and non-resident biological fathers' supportiveness, relationship, and monitoring of their children. Regression analyses indicate significant challenges for all fathers of children with disabilities. Children of resident fathers report more positive interactions than children of non-resident fathers. However, earlier co-residence and more frequent contact significantly improve the quality of father-youth relationships among men who do not live with their children.

Images of life: siblings of children with Down syndrome

This qualitative, descriptive study used photography to capture important symbols in the lives of 16 siblings living in families raising a child with Down syndrome (CWDS). Content analysis revealed two categories: people/nonpeople. The people category included family members and friends, whereas the non-people category included objects, animals, and buildings. Similarities/differences also were noted according to age and gender. Seven- to 9-year-olds took more snapshots of themselves and their parents than did the other age groups; the 10-to 12-year-olds and 13- to 15-year-olds took more photographs of the CWDS than did the younger age group. Female siblings took more snapshots of their typically developing brothers/sisters, family members in mixed groups, and people not in their family than did male siblings. Male siblings took more photographs of their parents and themselves. Results validate the importance of gathering qualitative data from children and confirm the use of photography as one of these methods.

Difficulties experienced by families with disabled children

PURPOSE

This study was designed to determine the difficulties experienced by families with disabled children.

DESIGN AND METHOD

This descriptive research study was carried out in one public and two private rehabilitation centers. A questionnaire was used for data collection.

RESULTS

Families did not have enough knowledge about their child's condition. Mothers felt severe sadness, and they indicated that after having a disabled child, their social life, working life, and family relationships were all affected. Families also have financial problems.

PRACTICE IMPLICATIONS

Parents with a disabled child need support from professionals. Nurses have a vital role in providing support for these families.

Study on the social adaptation of Chinese children with down syndrome

PURPOSE

To evaluate social adjustment and related factors among Chinese children with Down syndrome (DS).

PATIENTS AND METHODS

A structured interview and Peabody Picture Vocabulary Test (PPVT) were conducted with a group of 36 DS children with a mean age of 106.28 months, a group of 30 normally-developing children matched for mental age (MA) and a group of 40 normally-developing children matched for chronological age (CA). Mean scores of social adjustment were compared between the three groups, and partial correlations and stepwise multiple regression models were used to further explore related factors.

RESULTS

There was no difference between the DS group and the MA group in terms of communication skills. However, the DS group scored much better than the MA group in self-dependence, locomotion, work skills, socialization and self-management. Children in the CA group achieved significantly higher scores in all aspects of social adjustment than the DS children. Partial correlations indicate a relationship between social adjustment and the PPVT raw score and also between social adjustment and age (significant r ranging between 0.24 and 0.92). A stepwise linear regression analysis showed that family structure was the main predictor of social adjustment. Newborn history was also a predictor of work skills, communication, socialization and self-management. Parental education was found to account for 8% of self-dependence. Maternal education explained 6% of the variation in locomotion.

CONCLUSION

Although limited by the small sample size, these results indicate that Chinese DS children have better social adjustment skills when compared to their mental-age-matched normally-developing peers, but that the Chinese DS children showed aspects of adaptive development that differed from Western DS children. Analyses of factors related to social adjustment suggest that effective early intervention may improve social adaptability.

Gender differences and similarities in the experience of parenting a child with a health problem: current state of knowledge

The birth of a child is a transitional situation that triggers stress in the family and each person has to use adjustment strategies allowing them to reposition gradually in relation to themselves and other members of the family, and to make space for the new arrival. When the child has a health problem, the stress on the parents is correspondingly greater. Research shows that fathers and mothers of a child with a health problem experience this ordeal differently. This article reports on the current state of knowledge about the experience of fathers and mothers of a child with a health problem, and suggests new directions for research to provide a fuller understanding of their experience.

Family photographs: expressions of parents raising children with disabilities

The purpose of this qualitative, descriptive study was to capture the everyday lives of parents raising a child with a disability. Fifteen parental dyads raising a child with Down syndrome, developmental disabilities, visual impairments, or speech disorders used a disposable camera to photograph images important to them. Interviews about these photographs reflected everyday life. Four themes emerged from content analysis of the photos: active activities, quiet activities, activities of daily living, and care of the child with a disability. Six themes emerged when discussing photographs participants would have liked to take but did not. These themes were acceptance, concern for the future, joys, struggles, balance of good and bad times, and normalcy. Findings support the usefulness of photography as a method of obtaining information from parents raising a child with a disability through qualitative means and provide nurses with a beginning understanding of these parents' lives.

Criança com anomalia congênita: estudo bibliográfico de publicações na área de enfermagem pediátrica

OBJETIVO: conhecer o que tem sido publicado na área de enfermagem sobre a criança com anomalia congênita. MÉTODOS: foi realizada uma revisão bibliográfica em bases de dados indexadas no período de 1995 a 2005. RESULTADOS: os dados foram categorizados em cinco áreas temáticas: exposição da população a fatores de risco para ocorrência de anomalia congênita; uso de tecnologia para o cuidado à criança com anomalia congênita; avaliação de programas de assistência à criança com anomalia congênita e sua família; capacitação do enfermeiro para cuidar da criança com anomalia congênita; e vivências do profissional enfermeiro, da criança e da família com a anomalia congênita. CONCLUSÃO: o enfermeiro tem buscado fundamentação teórica e prática para cuidar da criança com anomalia congênita, mas existem lacunas no conhecimento em relação às propostas de intervenções de enfermagem na família da criança com anomalia congênita.

Caught in a balancing act: parents' dilemmas regarding their ADHD child's treatment with stimulant medication

The authors explored parents' perceptions of and everyday experiences with the stimulant medication used to treat their child's attention deficit hyperactivity disorder (ADHD) in this phenomenological study. They elicited experiences through semistructured interviews with 10 Canadian parents of children with ADHD. In the interviews, parents revealed the meaning the stimulant medication had taken on in the context of their everyday lives. Through the interview analysis, dilemma emerged as the dominant theme. Parents were caught in a dynamic balancing act, as they considered the medication's desirable and undesirable effects in various settings. In addition, parents shared their expectations regarding the medication's role in their child's future. The study's findings reinforce the necessity of further qualitative research in this area, given the growing number of families around the globe whose children have been diagnosed with ADHD.

A qualitative investigation of changes in the belief systems of families of children with autism or Down syndrome

BACKGROUND

There have been few reports of the world views, values and priorities of families of children with autism or Down syndrome, despite the fact that family belief systems are considered to be among the most important factors affecting the adaptation and resilience of families.

METHODS

Transcripts from three focus groups involving 19 key informants (15 parents of children with autism or Down syndrome, and 4 service providers) were analysed using qualitative methods.

RESULTS

The themes indicated that raising a child with a disability can be a life-changing experience that spurs families to examine their belief systems. Parents can come to gain a sense of coherence and control through changes in their world views, values and priorities that involve different ways of thinking about their child, their parenting role, and the role of the family. Although parents may grapple with lost dreams, over time positive adaptations can occur in the form of changed world views concerning life and disability, and an appreciation of the positive contributions made by children to family members and society as a whole. Parents' experiences indicate the importance of hope and of seeing possibilities that lie ahead.

CONCLUSIONS

The information from this study may be used to provide families with an advance understanding of the changes in beliefs that they might undergo, and assists service providers in providing individualized and family-centred services and supports to families.

L’expérience des pères et mères ayant un enfant atteint d’un problème de santé : état actuel des connaissances*

La naissance d’un enfant est une situation transitionnelle qui suscite un stress au sein de la famille et implique la mise en oeuvre de stratégies adaptatives qui permettront graduellement à chacun de se resituer face à lui-même et face à l’autre et de faire une place à ce nouvel être. Lorsque l’enfant présente un problème de santé, le stress ressenti par les parents est d’autant plus important. Les recherches montrent que les pères et les mères d’enfant atteint d’un problème de santé vivent différemment cette expérience. Cet article vise à faire le point sur l’état actuel des connaissances de l’expérience des pères et des mères d’enfant atteint d’une problématique de santé et à proposer de nouvelles avenues de recherche permettant une meilleure compréhension de leur expérience.

Parental satisfaction with an early family intervention program

The objective of this study was to evaluate parental satisfaction with a family intervention program. The program provides help and support for parents with newborns who have specific health problems (e.g., cleft palate and/or lip; Down syndrome). Four family subscales, personal (emotional and cognitive), marital, parental, and extended family and others, were examined. The majority of parents were satisfied with the intervention. Most felt that the intervention had helped them to adapt to the unexpected situation. They received guidance in discerning and discussing their own emotions and those of their partner or spouse, and the help they received gave them confidence about the care their child would receive. Results revealed significant differences in satisfaction levels (depending on the sex of the parent), the child's diagnosis, and annual income. Mothers of newborns with Down syndrome were more satisfied than fathers with the personal-emotional support they received. Low-income families were more satisfied than those with higher incomes for all subscales. On the parental subscale, those whose child had a cleft lip/palate were more satisfied than those whose child had Down syndrome. The results raised several important questions about this type of early intervention program, which will require further in-depth investigation.