Factors associated with emotional response of parents at the time of diagnosis of Down syndrome

Listening to the voices of mothers in Indonesia: Qualitative content analysis of experiences in parenting children with down syndrome

INTRODUCTION

Generally, mothers provide the majority of caring for children who have Down syndrome. They pose challenges not only with regard to the acceptability of the child situation but also with regard to the provision of care for children with DS.

AIM

To explore the experiences of mothers parenting children with DS in Indonesia, to give a better understanding of their needs, which is necessary for the delivery of treatment.

METHODS

A descriptive qualitative research with content analysis was used. Study participants (15 mothers) were purposively sampled from attendees of a State Special School for students with disabilities. Data was collected via semi-structure interviews and were audio recorded. Participant's statements underwent content analysis, and the principle of trustworthiness was subsequently applied.

RESULTS

Five main themes describing participants' experiences were identified: (1) parenting experiences - the impacts, (2) special needs, (3) parenting barriers, (4) parenting facilitators, and (5) mothers' expectations.

CONCLUSIONS

The study findings showed that the mothers viewed their situation in both positive and negative ways. Despite the limited sample size in this exploratory study, the results offer new insights into raising a child with DS in a particular cultural setting.

IMPLICATIONS FOR PRACTICE

This study offers important information to families and healthcare providers to improve awareness of the disorder and its appropriate management methods. It is important that an exploration of the experiences of mothers will provide healthcare professionals and families with an understanding of the situation. This understanding is essential for the effective management and delivery of treatment.

Challenging and Facilitating Factors When Coping with the News of a Newborn's Down Syndrome Diagnosis: Perceptions of Activist Israeli Mothers

Studies have shown that healthcare professionals (HP) play a significant role in parents' experience when informed of the birth of a child with Down Syndrome (DS). Past studies have focused on faith dilemmas of religious mothers that were informed that their child was born with DS and on understanding how faith was a source of emotional support for them. Studies that focus on religious activist mothers are scarce. We utilized a qualitative methodology to explore the experiences of Jewish mothers who are religious and activists. Semistructured interviews and focus groups were conducted with 17 religious Jewish mothers of children with DS, who participated in an activist, self-support group. The data were analyzed using interpretative phenomenological analysis (IPA). Most mothers felt unsupported by the HP although a few mentioned being congratulated on the birth and empowered by a physician who focused on their child's potential to develop. The mothers appreciated when HPs considered their opinions and values. They shared the common goal of changing the existing pathological, statistics-based discourse concerning children with DS. The study reinforces the important role of HP and policymakers' in collaborating with parents and their support groups early in the diagnostic stage.

Avaliação de intervenção para promoção de resiliência em famílias de crianças com Síndrome de Down

Este estudo objetiva avaliar efeitos de uma intervenção que busca promover resiliência em oito famílias de crianças com síndrome de Down (SD) de até dois anos de idade. Classificou-se as famílias segundo arranjos e renda, distribuídas aleatoriamente nos grupos experimental e controle. Visitas domiciliares ocorreram no pré-teste, pós-teste e follow up, onde todos responderam ao questionário sociodemográfico e à entrevista acerca da resiliência familiar, além dos genitores responderem ao Inventário de Sintomas de Estresse de Lipp e ao Inventário de Depressão de Beck. Um diário de campo e entrevistas de avaliação para as famílias foram realizados durante a intervenção. Não foram obtidas diferenças estatisticamente significativas entre os valores da resiliência nas famílias nos diferentes momentos (p = 0,77). Entretanto, alguns membros percebem mudanças na família após participação no trabalho, como melhorias na comunicação e aquisição de conhecimentos sobre SD. Estudos com mais participantes e período de tempo prolongado são necessários.

Parental perspective: Factors that played a role in facilitating or impeding the parents' understanding of their child's developmental diagnostic assessment

BACKGROUND

Full parental understanding of a child's diagnosis of a developmental disability is critical to be able to ensure the best health outcome for their child. Yet factors that parents perceived as influencing their comprehension during the final diagnostic meeting have not been well identified.

METHOD

This study used a qualitative interpretive description approach. Seventeen parents were interviewed who received a child's developmental diagnosis from one of the clinical multidisciplinary teams located in northern British Columbia. The interviews focused on the factors that played a role in facilitating or impeding the parents' understanding of their child's diagnosis, and on the identification of factors that influenced the way in which the child's clinical recommendations were pursued.

RESULTS

Two overarching themes with nine subthemes emerged from parents' reported experiences of receiving their child's developmental diagnosis. The themes and subthemes included (a) clinical encounter (including the subthemes structural considerations, professional diversity and new insights, questions regarding the assessment process, and validation) and (b) manner of the delivery of the diagnosis (emotional impact, impact on parenting practices, professionalism, professional language, and quantity of information).

CONCLUSIONS

Parents' accounts established and clarified the positive and negative parental determinants that aided or challenged their ability to understand their child's developmental diagnosis during the final clinical interaction with the multidisciplinary team.

A nurses' ethical commitment to people with intellectual and developmental disabilities

Aim: This article explores the issues of knowledge deficits of healthcare professionals in meeting the needs of people with IDD throughout the life span, and to identify factors that contribute to these deficits. Although statistics vary due to census results and the presence of a "hidden population," approximately 1%-3% of the global population identify as living with an intellectual or developmental disability. People with intellectual or developmental disability experience health inequities and confront multiple barriers in society, often related to the stigma of intellectual or developmental disability. Disparities in care and service are attributed to a lack of knowledge and understanding among healthcare providers about people with intellectual or developmental disability, despite their increased risk for chronic health problems. The near absence of educational programs in nursing both nationally and internationally contributes to this significant knowledge deficit. In addition, ethical considerations between paternalistic beneficence and idealized autonomy have resulted in a lack of clear direction in working with a population that is often ignored or exploited. Nurses who view people with intellectual or developmental disability as vulnerable without assessing or acknowledging their capabilities may err toward paternalism in an effort to "first do no harm." Likewise, nurses who fail to recognize the challenges and limitations faced by people with intellectual or developmental disability may not provide sufficient protections for a vulnerable person. People with intellectual or developmental disability are not binary, but rather complex individuals with a myriad of presentations. This article seeks to encourage a well-informed model of nursing care. Through an ethical lens, this article explores the nurse's ethical commitments in cases of victimization, access to care, decision making, and the provision of optimal end-of-life care for people with intellectual or developmental disability.

Adaptation and Resilience in Families of Children With Spina Bifida in South Korea

PURPOSE

The purpose of this study, which was guided by the Family Resilience Model, was twofold: (1) to assess the risk and protective factors related to adaptation and resilience in families of children with spina bifida (SB) in South Korea and (2) to examine predictors of family adaptation and resilience.

DESIGN

This is a descriptive study using survey methodology.

METHODS

Data were collected from 203 parents of children with SB between June 2013 and February 2014 at the SB clinic in South Korea and analyzed using stepwise linear regression.

FINDINGS

The best predictors of family adaptation and resilience in children with SB included one risk factor (parental depression) and four protective factors (parental health, family cohesion, family communication skills, and supportive friends/relatives). These five factors explained 39.7% of the total variance in family functioning (an indicator of family adaptation and resilience; F = 26.43, p < .001).

CONCLUSION AND CLINICAL RELEVANCE

Findings suggest that nursing interventions designed to strengthen protective factors and reduce risk factors are likely to promote adaptation and resilience in families of children with SB.

Relationship-Based Care for Newborns With Down Syndrome and Endocardial Cushion Defect

Down syndrome with endocardial cushion defect is a challenging diagnosis for parents as well as members of the health care team. Utilizing a framework of relationship-based care, nurses are in a position to positively affect parents' experience by providing education, advocacy, and support from initial diagnosis through discharge. The plan of care is multidisciplinary and focuses on critical developmental needs, such as bonding and feeding. Because Down syndrome is associated with multiple anomalies, anticipatory guidance is needed to assist parents with establishing a health maintenance plan for their child after discharge.

Adaptation in families of children with Down syndrome in East Asian countries: an integrative review

AIM

The purpose of this integrative literature review was to understand the experiences of East Asian families of children with Down syndrome and identify factors affecting their adaptation in the Resiliency Model of Family Stress, Adjustment and Adaptation.

BACKGROUND

Socio-cultural factors influence how well families adapt following the birth of a child with Down syndrome. Existing literature in this area has focused primarily on families from Western cultures. This is problematic because nurses care for families from all over the world. Therefore, the focus of this review is on families of children with Down syndrome living in East Asia, where Confucianism is dominant.

DESIGN

Integrative literature review.

DATA SOURCES

Online databases (i.e. PubMed, CINAHL and PsycINFO) and a public search engine (i.e. Google Scholar) were used along with manual searches of reference lists and major journals. Studies were limited to original publications written in English and published between 1990-2014.

REVIEW METHODS

Two authors independently performed integrative review processes proposed by Whittemore and Knafl and a quality assessment using the Mixed Methods Appraisal Tool.

RESULTS

Like families in Western cultures, some East Asian families of children with Down syndrome adapted well and even thrived while others struggled. Various socio-cultural factors, including some associated with Confucianism, played a role in how individuals, dyads and families adapted.

CONCLUSION

An understanding of socio-cultural influences can help nurses implement culturally sensitive family-centred interventions with families of children with Down syndrome. It may also facilitate policy changes concerning resources for these families.

Pakistani mothers' and fathers' experiences and understandings of the diagnosis of Down syndrome for their child

Down syndrome (DS) is a relatively common chromosomal condition, which can be diagnosed prenatally. However, little is known about the diagnosis of the condition in developing countries. This qualitative study explored parents' experiences of the diagnosis of DS in Pakistan. Fifteen mothers and fifteen fathers of children with DS had semi-structured interviews, which were analysed using thematic analysis. All the parents received their child's diagnosis after birth, ranging from the postnatal period to 7 years of age. Parents recalled receiving little or no information at the time of diagnosis, leading to misunderstandings about the cause and nature of their child's condition. Some parents referred to their child being "Mongol" and were unaware of "Down syndrome" as the more appropriate term for the condition. Use of such terms for DS restricted parents' ability to source further information about the condition. Many parents showed poor understanding of the aetiology and prognosis of the condition. Improved training for healthcare professionals in recognising key features of DS in the neonatal period or in early childhood could enable earlier diagnosis of the condition. In addition, provision of accurate information in a sensitive manner following diagnosis could enable parents to optimise their child's well-being.

Resilience in families of children with Down syndrome in Korea

This study aims to identify the factors related to resilience of the families of children with Down syndrome (DS). Data were collected from 126 parents of children with DS in Korea, using a self-administered questionnaire. The age of the child, developmental level of the child, parental depression, and stress and strain were negatively related with family adaptation, whereas health of parents, family cohesiveness, flexibility, communication skills, supportive family/relatives, and quality of community service were positively related. Parental depression, family cohesiveness and communication skills were the factors that were strongly related to family resilience and adaptation. It is suggested that nursing interventions to decrease parental depression and increase family cohesiveness and communication skills should be included to increase resilience of the families of children with DS.

Emotional reactions of mothers who have babies who are diagnosed with Down syndrome

PURPOSE

The aim of this study was to explore a deeper insight into experiences of Turkish mothers living with/diagnosed with Down syndrome (DS) baby.

METHODS

Individual and audiotaped interviews were carried out with 11 women after amniocentesis in Karaman city of Turkey between August 2012 and February 2013. Transcribed semistructured interviews were qualitatively and analyzed using a thematic analysis approach to code and categorize emerging themes.

RESULTS

Three principal themes emerged from the study: mothers' emotional reaction after diagnosed DS, mother and healthcare professional interactions, and mother's coping with diagnosed DS.

CONCLUSIONS

Understanding the experiences of women living with/diagnosed with DS baby enables nurses to devise appropriate strategies to provide better support at every stage and thus helping them to cope with daily life.