COPING IN YOUNG PEOPLE WITH CHRONIC KIDNEY DISEASE (CKD)

The significance of relationships and dynamics in families with a child with end-stage kidney disease: A qualitative study

AIM AND OBJECTIVES

To explore experiences and the significance of relationships and dynamics among family members living with a child with severe kidney disease.

BACKGROUND

Chronic kidney disease (CKD) in children is often incurable, leading to irreversible kidney damage. End-stage kidney failure in a child impacts daily life and routines, requiring significant social adaptation for all family members. However, little is known about how individual family members experience relationships, interactions and dynamics within the family.

DESIGN

A qualitative exploratory study taking a phenomenological-hermeneutic approach.

METHOD

Data were collected through semi-structured individual interviews with seven fathers, seven mothers, five children with end-stage kidney disease and five siblings. The data were analysed using Ricoeur's theory of narrative and interpretation, on three levels: naïve reading; structural analysis; and critical interpretation and discussion. The Consolidated Criteria for Reporting Qualitative Research checklist has been used (see Supporting Information).

RESULTS

All family members experienced relationships within and outside the family as a significant part of everyday life. The well-being of the sick child had an impact on the dynamics and emotional well-being of all family members. Siblings were in need of support; however, being fair could be challenging for parents.

CONCLUSION

CKD in a child has an impact on family dynamics and on the relationships between family members. Family members are vulnerable and in need of practical help and emotional support from close relatives, friends, health professionals and other individuals around them.

RELEVANCE TO CLINICAL PRACTICE

In clinical practice, the ability to reflect on, or interpret, a range of situations by initiating a dialogue is essential to shape both an individual perspective and the perspective of the entire family unit.

Everyday life experiences in families with a child with kidney disease

BACKGROUND

Chronic kidney disease in children is a complex medical and psychosocial disease with factors that differ from the adult disease in significant ways. Among parents, there is uncertainty about disease progression and lack of confidence in caring for the child. The disease has an impact on the emotional and social well-being of the whole family.

OBJECTIVES

To investigate everyday life experiences from the perspectives of members of a family that includes a child with end stage renal disease.

METHOD

The study took a phenomenological-hermeneutical approach. Semi-structured individual interviews were conducted with seven fathers, seven mothers, five children with kidney disease and five siblings. The data were analysed using Ricoeur's theory of narrative and interpretation, on three levels: naïve reading, structural analysis, critical interpretation and discussion.

RESULTS

It was significant that everyday life and caring for the child were structured around parents' energy reserves. The disease left its mark and changes to daily life caused anxiety, especially for siblings. The search for normalcy was significant and, although the families coped with conditions around the disease, it could be a challenge.

CONCLUSION

Family members feel vulnerable and concerned and need attention, support and care. Limitations in everyday life cause a dilemma, and the well-being of one family member has an impact on the well-being of the family as a whole.

IMPLICATIONS FOR PRACTICE

Health care professionals should focus on the impact of the family's experiences and needs, and the parents' role in family relationships, to support the entire family unit.