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

The impact of emotional neglect on internet addiction among left-behind adolescents in rural China: A moderated mediation model

BACKGROUND

Urbanization has led to a significant increase in left-behind adolescents in rural China, those aged 11 to 18 who remain in rural areas due to one or both parents migrating to cities for work for more than six months. Without parental support and guidance, those adolescents often face emotional neglect and develop internet addiction, which is associated with low parent-child closeness and high experiential avoidance. However, intentional self-regulation may serve as a protective factor against these adverse effects.

OBJECTIVE

Grounded in ecological systems theory, the present study proposes a moderated mediation model to examine the mechanisms by which emotional neglect experienced by left-behind adolescents contributes to the development of internet addiction.

PARTICIPANTS AND SETTING

Data was collected from Qiandongnan Miao and Dong Autonomous Prefecture in Guizhou Province, China, which has many ethnic minorities and faces economic challenges.

METHODS

A total of 407 left-behind adolescents between 13 and 16 years of age completed the anonymous self-report paper questionnaire. PROCESS for SPSS was adopted to test hypotheses and answer the research questions.

RESULTS

The results reveal a significant and positive correlation between emotional neglect and internet addiction. Parent-child closeness and experiential avoidance partially mediate this relationship. Additionally, intentional self-regulation functions as a buffering moderator. Higher levels of intentional self-regulation correspond to a reduced positive impact of emotional neglect and experiential avoidance on internet addiction while increasing the negative impact of parent-child closeness on internet addiction.

CONCLUSIONS

This study enhances the understanding of internet addiction in left-behind adolescents in rural China and extends the application of ecological systems theory within the Chinese family context. Practical implications for family, school, and society are discussed.

Mom, dad, put down your phone and talk to me: how parental phubbing influences problematic internet use among adolescents

BACKGROUND

The positive association of parental phubbing with internalising and externalising problems among adolescents has gained academic traction. To date, limited research has investigated the association of parental phubbing and adolescents' Problematic Internet Use (PIU). Furthermore, the mechanism underlying this association is largely unknown. These gaps limit our understanding of family-related issues affecting PIU among adolescents. The present study explores whether there is a relation between parental phubbing and PIU and investigates the mechanisms underlying this relation among adolescents.

METHODS

The participants were 495 junior high schoolers aged 11-15 years. Participants completed questionnaires on their experiences with PIU, parental phubbing, parent-child relationships, and basic psychological needs satisfaction.

RESULTS

The results showed a direct and indirect positive association between parental phubbing and PIU. Furthermore, parental phubbing indirectly influenced PIU and was mediated by the parent-child relationship and basic psychological needs satisfaction, respectively. Moreover, the parent-child relationship and basic psychological needs satisfaction were sequentially mediated.

CONCLUSIONS

Our study highlights the crucial role of parents in the development of adolescent PIU and provides theoretical and practical guidelines for PIU prevention and intervention.

Parenting Children with Cystic Fibrosis: Developmental Acquisition of Expertise

OBJECTIVE

This study was designed to increase our understanding of parents' experiences managing the needs of their children with cystic fibrosis (CF) and to identify potential gaps in services.

METHOD

We used grounded dimensional analysis of anonymous survey data obtained from a quality improvement initiative conducted by the Cystic Fibrosis Foundation (CFF). The Patient and Family Experience of Care (PFEC) survey was administered continuously at 125 CF care centers throughout the United States in 2017. The subsample of data for this study was completed by 80 parents/caregivers of children with CF (younger than 18 years).

RESULTS

Two unifying themes emerged from parents' survey responses: (1) parents' expertise expands continually as they learn and adapt to changes in their children's maturity or health and (2) parental expertise is sometimes visible or invisible to clinicians. Parents' expertise evolved with their children's development. Visible to care teams was at-home care, e.g., respiratory treatments and medications. Less visible were intangible management activities, e.g., social processes, emotions, and concerns that were omnipresent for parents but seldom disclosed to or seen/recognized by clinicians. Themes, such as the quality of encounters with care teams, progressive nature of CF, and hope derived from advances in research, were associated with specific contextual factors.

CONCLUSION

The findings expand our understanding of lived parental experiences of CF across childhood and offer direction for future quality improvement and research. Online parent surveys offer a valuable tool to identify unmet needs across subgroups of families affected by chronic childhood health conditions.

Parent-adolescent relationships, peer relationships, and adolescent mobile phone addiction: The mediating role of psychological needs satisfaction

INTRODUCTION

Prior studies have shown that parent-adolescent relationships and peer relationships may be important factors associated with adolescent mobile phone addiction (MPA). The present study aims to further explore the direct effects of parent-adolescent and peer relationships on adolescent MPA as well as the indirect effects through the mediating roles of autonomy, competence, and relatedness needs satisfaction.

METHODS

Our sample consisted of 1766 Chinese adolescents (53.10% male; M_age = 13.33, SD = 1.94, range from 10 to 18 years) who completed questionnaires regarding parent-adolescent relationships, peer relationships, psychological needs satisfaction, and MPA. SPSS 24.0 was used to analyze correlations among variables and Mplus 7.4 was used to test the structural equation model in this study.

RESULTS

(1) positive parent-adolescent relationships were negatively associated with adolescent MPA, while peer relationships did not show a significant association with MPA; (2) autonomy and competence needs satisfaction significantly mediated the effects of parent-adolescent and peer relationships on MPA, while the mediating role of relatedness need satisfaction between parent-adolescent and peer relationships and MPA was not significant; (3) the mediating effect of competence need satisfaction between peer relationships and MPA was significantly stronger than that between parent-adolescent relationships and MPA.

CONCLUSIONS

This study explored the different mechanisms by which parent-adolescent and peer relationships influence adolescent MPA. These discoveries may contribute to intervention and prevention programs for adolescent MPA.

Health Equity and Disparities in ROP Care: A Need for Systematic Evaluation

Retinopathy of prematurity (ROP) is a vasoproliferative retinal disorder that can have devastating visual sequelae if not managed appropriately. From an ophthalmology standpoint, ROP care is complex, since it spans multiple care settings and providers, including those in the neonatal intensive care unit (NICU), step down nurseries, and the outpatient clinic setting. This requires coordination and communication between providers, ancillary staff, and most importantly, effective communication with the patient's family members and caregivers. Often, factors related to the social determinants of health play a significant role in effective communication and care coordination with the family, and it is important for ophthalmologists to recognize these risk factors. The aim of this article is to (1) review the literature related to disparities in preterm birth outcomes and infants at risk for ROP; (2) identify barriers to ROP care and appropriate follow up, and (3) describe patient-oriented solutions and future directions for improving ROP care through a health equity lens.

"Parenting Beyond the Veil": The Continued Parenting Relationship After a Child's Death Due to Cancer

Background: Childhood cancer is the leading cause of illness-related death, leaving thousands of parents to experience bereavement. This article presents select findings about the nature of the continued parenting relationship, which is an essential theme of the parental bereavement experience. Method: Heideggerian phenomenology provided the philosophical underpinnings of this study, which aimed to describe the lived experience of bereaved parents who experienced the death of a child due to cancer. Van Manen's (1997) method guided data collection and analysis. Six parents participated in interviews to share what it has been like for them since their child's death. The researcher wrote analytic memos, documented detailed field notes, and used a member checking process to ensure trustworthiness of findings. Results: A structure of the lived experience of parental bereavement emerged, which included the essential theme of the continued parenting relationship. The parenting relationship continues throughout a parent's lifetime in spite of the child's physical absence, albeit in a different manner. This different nature of parenting is known as parenting beyond the veil. Bereaved parents continue to parent beyond the veil by engaging in meaningful activities, seeking activities that strengthen a deep connection with the child, and being open to comforting signs that enhance their continued relationship. Discussion: Parents believe sharing their experience can help nurses and other professionals understand the importance of their continued parenting relationship and their need to parent beyond the veil so that they can provide high quality care to bereaved parents in the future.

Parental stress and resilience in CHD: a new frontier for health disparities research

Parental stress is a universal experience for parents who have children diagnosed with CHD and has been studied within the context of the child's illness, but not through a broader health disparity lens. This paper provides a thorough synthesis of the current literature on parental stress addressing disparities in parents of children with CHD. Several theories and models from within this literature are described and a new comprehensive framework, the Parental Stress and Resilience in CHD Model, is presented. Future research and clinical implications are discussed.

Parent-Child Communication and Adjustment Among Children With Advanced and Non-Advanced Cancer in the First Year Following Diagnosis or Relapse

Objectives

To examine parent-child communication (i.e., openness, problems) and child adjustment among youth with advanced or non-advanced cancer and comparison children.

Methods

Families (n = 125) were recruited after a child's diagnosis/relapse and stratified by advanced (n = 55) or non-advanced (n = 70) disease. Comparison children (n = 60) were recruited from local schools. Children (ages 10-17) reported on communication (Parent-Adolescent Communication Scale) with both parents, while mothers reported on child adjustment (Child Behavior Checklist) at enrollment (T1) and one year (T2).

Results

Openness/problems in communication did not differ across groups at T1, but problems with fathers were higher among children with non-advanced cancer versus comparisons at T2. Openness declined for all fathers, while changes in problems varied by group for both parents. T1 communication predicted later adjustment only for children with advanced cancer.

Conclusions

Communication plays an important role, particularly for children with advanced cancer. Additional research with families affected by life-limiting conditions is needed.

Highly Educated Men Establish Strong Emotional Links with Their Dogs: A Study with Monash Dog Owner Relationship Scale (MDORS) in Committed Spanish Dog Owners

The characteristics of the human-animal bond may be influenced by both owner-related and dog-related factors. A study was designed to explore the existence of different dog ownership patterns and their related factors. We created an on line questionnaire that included demographic questions about the dog and the owner, a Spanish version of the Monash Dog Owner Relationship Scale (MDORS) and a validated measure of satisfaction with life (Cantril’s ladder). We collected 1140 valid responses from adult dog owners, who were recruited using the client databases of Spanish veterinary practices. We explored the presence of groups within the population using Principal Components Analysis (PCA) of the MDORS variables combined with Hierarchical Cluster Analysis (HCA). Two groups were found; Group I having a higher level of emotional involvement with their dogs compared with Group II. Binary logistic regression was used to explore demographic factors that influenced group membership. Four variables were significantly associated with membership of Group I (p<0.0001); male gender of the owner (OR = 32.36), high school level of maximum educational attainment (OR = 0.052), university level of maximum educational attainment (OR = 8.652), and owner Cantril’s score (OR = 0.807). The results obtained from this convenience sample demonstrate that different patterns of dog-ownership may be present within a population of owner-dog dyads, and that certain owner characteristics are associated with the type of owner-dog relationship. Future research could apply a similar approach to different types of sample population in order to identify specific patterns of dog-ownership.

Study protocol for a randomized clinical trial of a fatherhood intervention for African American non-resident fathers: Can we improve father and child outcomes?

PURPOSE

African American (AA) fathers who live apart from their children face multiple obstacles to consistent and positive involvement with their children. Consequently, significant numbers of children are bereft of their father's positive involvement. Intervention research that is explicitly focused on promoting the positive involvement of non-resident AA fathers with their young children is limited. The purpose of this article is to describe the study protocol of a randomized trial (RCT) designed to test the Building Bridges to Fatherhood program against a financial literacy comparison condition; and discuss early implementation challenges.

METHODS

Fathers (n=180) are recruited to attend 10 group meetings, reimbursed for transportation, given dinner and activity vouchers for spending time with their child, and incentivized with a $40 gift card at each data collection time point. Mothers are incentivized ($40 gift card) at data collection and must be amenable to father child interaction. Intervention targets include father psychological well-being, parenting competence, communication, problem-solving ability; father-mother relationship quality; and child behavioral and emotional/social development.

RESULTS

To date, 57 fathers have been randomized to study condition. Recruitment has been influenced by father and mother hesitancy and the logistics of reaching and maintaining contact with participants. Strategies to surmount challenges to father and mother recruitment and engagement have been developed.

CONCLUSIONS

The prospective benefits of positive father involvement to children, fathers and families outweigh the challenges associated with community-based intervention research. The findings from this RCT can inform the body of knowledge on engaging AA non-resident fathers in culturally relevant fatherhood programming.

Transition From Hospital to Home in Parents of Preterm Infants: A Literature Review

Transition from hospital to home is a complex and multidimensional phenomenon for parents of prematurely born infants (<37 weeks of gestation). The absence of a clear conceptualization of this particular transition coupled with the challenges parents have when they return home and higher costs of healthcare service usage postdischarge dictates the need for a better understanding of this phenomenon. A literature review was undertaken using Whittemore and Knafl's theoretical framework for integrative review as a guide. A systematic search of the electronic databases (PsycINFO, PubMed, Medline, Cumulative Index of Nursing and Allied Health Literature, EMBASE, Cochrane Database for Systematic Reviews, and EBSCO) was performed. Fifty selected reports of research conducted on parents of preterm infants during 1980-2014 are included in this article. Five themes emerged from the review-disruption of parental role development, distorted development of parent-infant relationships, psychological consequences of a preterm birth and infant hospitalization, learning caregiving and parenting, and need for social and professional supports-which appear to reflect parental challenges during transition from hospital to home after discharge. Several inconsistencies in results of the studies dictate the need for further research in this vulnerable population; the better conceptualization and measurement of transitional challenges are warranted.

Psychosocial experiences of parents of infants with hypoplastic left heart syndrome in the PICU

OBJECTIVE

To evaluate the psychosocial status of mothers and fathers of infants with hypoplastic left heart syndrome while in the PICU.

DESIGN

A retrospective study combining interviews and psychometric testing of parents.

SETTING

Tertiary hospital PICU.

SUBJECTS

Twenty-nine parents (16 mothers and 13 fathers) of surviving children.

INTERVENTION

A semistructured face-to-face interview was conducted to explore parental experiences, and a Structured Clinical Interview for Diagnosis-Clinical Version (posttraumatic stress disorder module) was conducted to determine the possibility of an acute stress disorder or a posttraumatic stress disorder.

MEASUREMENT AND MAIN RESULTS

All parents reported multiple stresses which commenced with their infant's diagnosis and endured throughout their infant's time in PICU. The Structured Clinical Interview for Diagnosis revealed that acute stress disorder or posttraumatic stress disorder developed in 24 parents (83%). Of 18 parents whose infants were diagnosed with hypoplastic left heart syndrome in utero, eight of nine mothers (88%) and six of nine fathers (66%) had posttraumatic stress disorder. Of 11 parents whose infants were diagnosed with hypoplastic left heart syndrome postbirth, six of seven mothers had acute stress disorder and one mother had posttraumatic stress disorder, and of four fathers, two fathers had acute stress disorder and one father had posttraumatic stress disorder. The prevalence of parental stress-related disorder was not different between mothers and fathers (p = 0.85). Only five parents were free of traumatic stress-related illness. Parents also experienced losses. Many parents were marginalized from their infant's care by the environment of PICU. Fifty percent of mothers experienced difficulties with parental-infant bonding. Ten parents (34%) began the process of adaptation to their infant's hypoplastic left heart syndrome and were assisted by the support and sensitivity of staff or had discovered other resources.

CONCLUSIONS

All parents of surviving infants with hypoplastic left heart syndrome in PICU, irrespective of timing of diagnosis, experienced numerous stresses and losses, and the majority exhibited clinical levels of traumatic stress. Receiving the diagnosis itself is very traumatic and is compounded by the environment of the PICU which alienates parents from their infants and interferes with parent-infant bonding. Parental adaptation to this situation can be assisted by staff.

Facets of parenting a child with hypoplastic left heart syndrome

The purpose of the study was to conceptualize the needs of parents of young children with hypoplastic left heart syndrome (HLHS) to provide a theoretical framework to inform the development of future parent interventions. Participants were parents and grandparents (n = 53) of 15 young children who had undergone the Sano surgical approach for HLHS. Analysis of recorded and transcribed single interviews with each participant was done as directed by interpretive description methodology. A model of five facets of parenting was conceptualized. These included survival parenting, “hands-off” parenting, expert parenting, uncertain parenting, and supported parenting. The facets of parenting delineated through this study provide a theoretical framework that can be used to guide the development and evaluation of interventions for parents of children with complex congenital heart disease and potentially other life-threatening conditions. Each facet constitutes a critical component for educational or psychosocial intervention for parents.

Quality of the parent-child interaction in young children with type 1 diabetes mellitus: study protocol

Background

In young children with type 1 diabetes mellitus (T1DM) parents have full responsibility for the diabetes-management of their child (e.g. blood glucose monitoring, and administering insulin). Behavioral tasks in childhood, such as developing autonomy, and oppositional behavior (e.g. refusing food) may interfere with the diabetes-management to achieve an optimal blood glucose control. Furthermore, higher blood glucose levels are related to more behavioral problems. So parents might need to negotiate with their child on the diabetes-management to avoid this direct negative effect. This interference, the negotiations, and the parent's responsibility for diabetes may negatively affect the quality of parent-child interaction. Nevertheless, there is little knowledge about the quality of interaction between parents and young children with T1DM, and the possible impact this may have on glycemic control and psychosocial functioning of the child. While widely used global parent-child interaction observational methods are available, there is a need for an observational tool specifically tailored to the interaction patterns of parents and children with T1DM. The main aim of this study is to construct a disease-specific observational method to assess diabetes-specific parent-child interaction. Additional aim is to explore whether the quality of parent-child interactions is associated with the glycemic control, and psychosocial functioning (resilience, behavioral problems, and quality of life).

Methods/Design

First, we will examine which situations are most suitable for observing diabetes-specific interactions. Then, these situations will be video-taped in a pilot study (N = 15). Observed behaviors are described into rating scales, with each scale describing characteristics of parent-child interactional behaviors. Next, we apply the observational tool on a larger scale for further evaluation of the instrument (N = 120). The parents are asked twice (with two years in between) to fill out questionnaires about psychosocial functioning of their child with T1DM. Furthermore, glycemic control (HbA_1c) will be obtained from their medical records.

Discussion

A disease-specific observational tool will enable the detailed assessment of the quality of diabetes-specific parent-child interactions. The availability of such a tool will facilitate future (intervention) studies that will yield more knowledge about impact of parent-child interactions on psychosocial functioning, and glycemic control of children with T1DM.

Furthering the understanding of parent-child relationships: a nursing scholarship review series. Part 3: Interaction and the parent-child relationship--assessment and intervention studies

PURPOSE

This integrative review concerns nursing research on parent-child interaction and relationships published from 1980 through 2008 and includes assessment and intervention studies in clinically important settings (e.g., feeding, teaching, play).

CONCLUSIONS

Directions for research include development of theoretical frameworks, valid observational systems, and multivariate and longitudinal data analytic strategies.

PRACTICE IMPLICATIONS

Observation of social-emotional as well as task-related interaction qualities in the context of assessing parent-child relationships could generate new questions for nursing research and for family-centered nursing practice.

Furthering the understanding of parent-child relationships: a nursing scholarship review series. Part 1: Introduction

PURPOSE

Understanding the parent-child relationship is fundamental to nursing of children and families. The purpose of this integrative review is to explore nursing scholarship published from 1980-2008 concerning parent-child relationships. Study approaches are examined, critiqued, and future directions for research identified.

CONCLUSIONS

A historical review of nursing research is presented and methods described as an introduction to a review series of the parent-child relationship.

IMPLICATIONS

Definition and explication of the parent-child relationship is a first-step in understanding factors amenable to nursing intervention. A clear definition of the concept of parent-child relationship will support further study using appropriate theoretical frameworks, and enable development and testing of supportive nursing interventions.

Furthering the understanding of parent-child relationships: a nursing scholarship review series. Part 2: Grasping the early parenting experience--the insider view

PURPOSE

The purpose of this integrative review is to systematically and critically synthesize nursing scholarship on parents' perspectives of the parent-child relationship during infancy.

CONCLUSION

Research has shown that the process of establishing the parent-child relationship is highly individualized and complex. Numerous barriers and facilitators influencing this relationship have been identified that are relevant to nursing.

PRACTICE IMPLICATIONS

Nurses have an important opportunity to positively affect the developing parent-infant relationship. Screening parents for depression and providing parents with resources and support are key nursing interventions supporting the parent-infant relationship.