The health of family caregivers of older impaired persons in Lebanon: an interview survey

BACKGROUND: The majority of older persons in Lebanon live with their family, which provides the help and care required when their relative is functionally impaired. Knowing that taking care of an older impaired relative is considered a source of enrichment for the caregiver and an act of gratitude towards the older person in Lebanon. However, there are few formal resources to support these families. This study is informed by a theoretical framework of stress. OBJECTIVE: Identify the dimensions of the caring context related to the health of Lebanese family caregivers living with an older impaired relative. DESIGN: Exploratory correlational study. PARTICIPANTS: Convenience sample (N=319) drawn from all the regions of Lebanon according to predetermined quotas on the basis of relative demographic weight and socio-economic class. The inclusion criteria are: aged 18 years or over; primary caregiver; provided help with at least one ADL or IADL once a week; lived with the older impaired person. 13.5% refused to participate in the study. The caregivers recruited were female (84%), adult children (48%) or spouses (22.6%) with a mean age of 46 years. Almost half of them reported a post-compulsory level of education and a low monthly household income and no medical coverage for 68% of them. METHODS: The data were collected during a face-to-face interviews with the caregivers in their homes. RESULTS: The results from regression analyses indicate that the degree of functional impairment, the frequency of depressive and disruptive behaviours of cared-for relative are linked to at least one of three caregiver health indicators (p<.01). Also, caregiver cognitive appraisal of these stressors is associated with either role strain or feeling of helplessness (p<.05). The informal emotional support received by caregivers is positively related to well-being (p<.001), whereas interpersonal conflicts with family and friends diminish caregiver well-being and increase role strain (p<.001). Sufficiency of emotional support received is negatively associated with role strain (p<.001). CONCLUSION: Many stressors proved associated with one or other of the health indicators under study and the resources emerged as significant factors related to caregiver's health.     

Differences in stress and coping for mothers and fathers of children with Asperger's syndrome and nonverbal learning disorders

Research conducted on families of children with disabilities shows that family cohesion and positive family outcomes are influenced by how mothers and fathers cope with raising their child with disabilities. This study was designed to examine stress and coping differences between mothers and fathers (n = 103) of children with Asperger's syndrome (AS) and nonverbal learning disorders (NLD). A repeated measure design was used to compare how mothers and fathers cope with caring for a particular child to control for differences in the severity and nature of the disability across children. Few studies that compare mothers and fathers do so at the couple level. Responses indicated that mothers had higher rates of stress related to family problems and pessimism about their child's future, higher rates of antidepressant use, and higher rates of therapy use than did fathers. Mothers found some coping strategies more helpful than fathers did. Maternal education and child's age also were related to some stress and coping variables. Implications for nurses and future research are discussed.     

Reducing burnout in mothers with an intellectually disabled child: an education programme

Title. Reducing burnout in mothers with an intellectually disabled child: an education programme. Aim. This paper is a report of a study conducted to examine the effect of participating in an education program on burnout for mothers of children with an intellectual disability. Background. Mothers with an intellectually disabled child are prone to suffer from excessive stress and burnout. There is limited evidence for the effectiveness of education interventions aimed at reducing burnout levels in this population. Methods. After baseline screening, mothers who agreed to participate (n = 90) were randomized to an intervention or control group. The intervention group participated in an interactive education programme for 1 hour, in addition to using an educational booklet designed and presented by the researchers. The booklet contained information about the characteristics of intellectually disabled children, the specific health care and education they require, non‐profit organizations and foundations providing assistance, and ways in which mothers can cope with stress. The control group received the same intervention separately after completing the post‐test. The study was carried out from 2004 to 2005. Findings. Intervention group members reported fewer episodes of emotional burnout compared to the control group, indicating that participation in a nursing education programme reduced the level of burnout experienced by mothers who have an intellectually disabled child. There were no effects of the education programme on perceptions of personal success, i.e. mother’s feelings of competence and successful achievement in care of their intellectually disabled child. Conclusion. Nurse‐administered education should be provided for mothers who have an intellectually disabled child in order to reduce the degree of emotional burnout that these mothers typically experience.     

Family support and child adjustment in single-parent families

The complex phenomenon of single parenthood is explored within Roy's (Roy & Roberts, 1981) adaptation framework. Correlation analysis of a large family data set supported the literature and the conceptual framework. Findings suggested that single parents experienced a characteristic set of stressors distinguishing them from two-parent families. The mere availability of help with parenting seemed less important in fostering the children's positive adaptation than the quality of the relationship among the adults involved with the children. Practitioners are advised to address family support and the ability to cope with environmental factors when developing a treatment plan.     

Family resiliency during childhood cancer: the father's perspective.

Most studies of childhood cancer have focused on mothers, but few studies have examined the views of fathers on the effects of their child's cancer diagnosis and treatment on the family. The purpose of this study was to explore the resources that help fathers adapt to life after their child's diagnosis using the resiliency model of family stress, adjustment, and adaptation as a framework. Eight fathers whose children had received treatment in a university pediatric oncology clinic in the prior 12 months were interviewed in depth. Data were coded thematically using NVivo. Results indicated that support from extended family, the church, and health care professionals was necessary for fathers to remain positive during their child's illness; spousal and parent-child relationships strengthened; and changes in family life varied based on the composition of the household. Further studies are warranted to better understand how fathers cope, so that pediatric oncology nurses and other health care professionals can provide holistic care that addresses the unique needs of all family members.     

Using the concept of family strengths to enhance nursing care

This article was written to help nurses better understand the family strengths framework and encourage them to incorporate family strengths into the nursing care they give. In times of stress or crisis for families, nurses can use the conceptual framework of family strengths as a mechanism to promote strong, healthy relationships. The family strengths perspective identifies and builds on positive attributes in family functioning. Family strengths qualities are (a) commitment, (b) appreciation and affection, (c) positive communication, (d) time together, (e) a sense of spiritual well-being, and (f) the ability to cope with stress and crisis. With the family strengths approach, nurses help families define their visions and hopes for the future instead of looking at what factors contribute to family problems. Family strengths assessment can be used in nursing practice, nursing education, and everyday life.     

Adaptation and resiliency in Swedish families

A longitudinal research project began in 1993 of Norwegian, Swedish and American mothers' perception of her family's dynamics and adaptation during childbearing and childrearing. Results indicated that Swedish mothers adapted better than other mothers. In 2003, a mixed design study was conducted with original Swedish mothers that aimed to describe the experience of motherhood, the meaning mothers attached to events in their lives that made adaptation necessary, and ways in which they achieved adaptation. Fourteen mothers completed quantitative instruments and 13 of those mothers were interviewed. Audiotaped interviews were transcribed and analysed for themes using a protocol based on a model of family resiliency. Quantitative findings revealed statistically significant findings in areas of children, mother's work outside the home and families in which a major illness had occurred. Qualitative findings revealed that protective factors far outweighed vulnerability and risk factors. Mothers' satisfaction with life manifested itself in love of home, contentment with employment, fulfillment from an active and healthy life and support from a society that provides a wide range of social benefits for the family. Vulnerability occurred primarily when mothers were tired, lacked personal time or someone in the family was experiencing a serious illness. Results of this study enhance the scholarly scientific knowledge about the uniqueness of Swedish mothers, and increased understanding of family dynamics and adaptation. Many of the findings relate in some way to overall social benefits and supports available for families.     

Psychological morbidity of Thai families of a person with schizophrenia.

The paper presents data on families of a person with schizophrenia in rural Thailand, using the resiliency model of family stress, adjustment, and adaptation. The aim is to assess the impact of family factors on psychological morbidity of the mothers and relatives of a person with schizophrenia. One hundred and eight Thai families were interviewed based on family assessment instruments. Multiple regression analysis was performed. The findings suggest that in a stable stage of illness, other stresses of family life may have stronger impact on psychological status of family members, than the illness. Implications for clinical nurses and researchers are presented.     

Maternal perceptions of family-provider relationships and well-being in families of children with Down syndrome.

The purpose of this study was twofold: (a) to describe parental perceptions of family-provider relationships, and (b) to explore links between parental perceptions of family-provider relationships and well-being in families with children who have Down syndrome. Mailed questionnaires were used to collect data from 94 families that include a child with Down syndrome. Data from 89 mothers are the focus of this report. The results indicate that when mothers of children with Down syndrome believe that their family's relationship with health care providers is positive and family-centered, they feel more satisfied with the care that their child is receiving and they are more likely to seek help from health care providers. In addition, when a discrepancy exists between what mothers want the family-provider relationship to be and what they believe the relationship is, mothers feel less satisfied with the care that their child is receiving. Finally, higher levels of individual and family well-being are reported by mothers who (a) want, and believe they have, positive family-centered relationships with providers, and (b) feel more satisfied with care received. Results of this study contribute to a better understanding of the role that health care providers play in individual and family adaptation to chronic conditions.     

Stress and coping in high-risk mothers: difficult life circumstances,psychiatric-mental health symptoms,education, and experiences in their families of origin

A pilot study was conducted to test methods and measures used to assess factors related to stress and coping in high-risk mothers and their effect on parenting. Twenty mothers with 12-month-old toddlers were recruited from a WIC population; they came into an observational laboratory where they were interviewed about stressors in their lives and their symptoms of stress and were videotaped interacting with their children. Maternal difficult life circumstances, psychiatric-mental health symptoms, education, maternal experiences in their families of origin, and parenting stress explained 74% of the variance in maternal sensitive-responsiveness with their toddlers in the laboratory setting. The findings support the methods of the study. Clinical implications and implications for future research to assist in the development of interventions for this population are discussed. Increased attention to screening for maternal psychiatric-mental health symptoms and for negative experiences in mothers' families of origin may provide important opportunities for intervention with these mothers.     

Patterns of family adaptation to childhood asthma

This study examined patterns in adaptation among parents with a child who had moderate to severe persistent asthma. Specifically, we were interested in examining the differences in adaptation between mothers and fathers in which it was hypothesized that gender effects would be obtained in patterns of coping. Eighty-four parents participated in the study, representing 37 intact families in which both parents were present and 13 single-parent families. Within intact families, mothers exhibited greater efforts than fathers in coping patterns including strategies to acquire social support outside the family, enhance self-worth, and decrease psychological tensions. When compared to mothers in single-parent families, mothers within intact families had a greater tendency to use coping patterns related to family integration and cooperation. Such findings demonstrate a need for additional support for mothers in their role in caring for the chronically ill child. The implications of these findings for clinical practice are discussed.     

Families of children with Down syndrome: responding to "a change in plans" with resilience

The purpose of the present investigation, which was guided by the Resiliency Model of Family Stress, Adjustment, and Adaptation, was twofold: (a) to describe maternal perceptions of parental and family adaptation in families raising a child with Down syndrome, and (b) to examine linkages between family demands, family resources, family problem solving and coping, and family adaptation in families of children with Down syndrome. Seventy-six mothers completed mailed questionnaires. Seventy percent of the mothers rated their family's overall functioning as either a 4 or a 5 on a 5-point scale (1 = poor; 5 = excellent). In their written comments, most mothers reported that their family was doing well or very well. Three family variables (i.e., family demands, family resources, and family problem-solving communication) were significantly associated with family adaptation. These results provide support for the belief that many families of children with Down syndrome respond to "a change of plans" with resilience. That is, they are able to endure, survive, and even thrive in the face of ongoing challenges associated with raising a child with Down syndrome.     

The relationship between caregiver’s strain and social support among mothers with intellectually disabled children

Aims and objectives. To explore caregiver’s strain, the relationship between social support and caregiver’s strain and the predictors of caregiver’s strain among mothers with school‐aged intellectually disabled children in Taiwan. Background. Strain is a common condition among mothers who take care of intellectually disabled children; this correspondingly reduces their ability to care for children, thereby affecting the functioning of the entire family. Yet, there have been very few studies on caregivers of intellectually disabled children of school age. Design. Cross‐section correlational design. Methods. Data collection consisted of face‐to‐face interviews combined with a structured questionnaire. Instruments employed were the Caregiver Strain Index, Social Support Scale and three open‐ended questions. In total, 127 mothers completed the questionnaire. Results. Results showed that mothers with intellectually disabled children had a rather high level of strain and received inadequate social support. Social support and strain had a significant and negative correlation. Stepwise regression analysis revealed that mothers’ health status, social support and amount of time spent as a caregiver, as well as the intellectually disabled children’s dependent degree of daily living activity, were major predictors of caregiver’s strain, which accounted for 38·4% of the total variance. Conclusions. The results provide a guide for healthcare professionals in designing effective interventions and preventive care to reduce the level of strain in mothers with intellectually disabled children. This, in turn, could improve the quality of life of the mother and her family. Relevance to clinical practice. In Taiwan, care of intellectually disabled children is primarily provided by family members. Therefore, we should emphasise family‐centred care to enable healthcare professionals to become more effective as case managers in local clinics, schools and communities.     

A Model for Predicting the Adaptation of Families to Medical Crisis: An Analysis of Role Integration

Summary. Medical crises produce conditions that precipitate rapid and extensive role transformation and increase families' vulnerability to the development of psychosocial problems that are secondary to the illness. Therefore, the incidence of these crises necessitate the development of strategies that will facilitate identification of those families at high risk for poor adaptation. This paper has presented a model for evaluating the effectiveness with which families will be able to cope with this kind of change and stress, based on assessment of their level of functioning prior to the crisis. Role theory provided the framework for the model, as the analysis of role behavior is particularly relevant to the underlying functional dynamics of family relationships. Although intervention has not been incorporated within the model, this assessment of family interaction can be used to suggest needed points of intervention.     

Tough-skinned kids: identifying psychosocial effects of psoriasis and helping pediatric patients and families cope

Outward appearance is exquisitely and undeniably tied to self-perception. Pediatric patients with psoriasis face the challenge of coping with psychosocial issues because of the visibility of their skin lesions. The burden of psoriasis also affects the quality of life of family members. This article discusses pediatric psoriasis, current literature on psychosocial impact, role of the nurse to help patients and families cope, and recommendations for further research. Through clinical intervention, patient education, and referral to resources, the nurse can hope to relieve some stress and help the child, adolescent, and family maintain their improved quality of life.     

"Fret no more my child ... for I'm all over heaven all day": religious beliefs in the bereavement of African American, middle-aged daughters coping with the death of an elderly mother

This article examines the ways in which religious beliefs of 30 African American, middle-aged daughters help them cope with the death of their elderly mothers. This qualitative, exploratory study found that daughters use their beliefs to move through states of grief that allow them to prepare, relinquish control, accept death, and maintain a connection to their mothers beyond death. Important themes identified in this study include the belief in an afterlife and the reunification of family members there. Findings suggest that religious beliefs provide a means for adult daughters to cope with the tasks of living in the present yet maintain a tie with their deceased mothers that serves to enhance their religious beliefs and fortitude in daily living.     

'FRET NO MORE MY CHILD… FOR I'M ALL OVER HEAVEN ALL DAY': RELIGIOUS BELIEFS IN THE BEREAVEMENT OF AFRICAN AMERICAN,MIDDLE-AGED DAUGHTERS COPING WITH THE DEATH OF AN ELDERLY MOTHER

This article examines the ways in which religious beliefs of 30 African American, middle-aged daughters help them cope with the death of their elderly mothers. This qualitative, exploratory study found that daughters use their beliefs to move through states of grief that allow them to prepare, relinquish control, accept death, and maintain a connection to their mothers beyond death. Important themes identified in this study include the belief in an afterlife and the reunification of family members there. Findings suggest that religious beliefs provide a means for adult daughters to cope with the tasks of living in the present yet maintain a tie with their deceased mothers that serves to enhance their religious beliefs and fortitude in daily living.     

The impact of high and low stress on the health of Lebanese families

During the Lebanese war (1975-1991) families were subjected to a substantial number of war and nonwar life events that were shown to have a negative impact on family adaptation. The study was undertaken to classify and predict family adaptation outcomes in high and low perceived stress groups for war and nonwar life events. The study took the form of an analysis of cross-sectional data of families in Beirut. The cluster sample consisted of 438 families chosen at random. Variables included perceived stress for war and nonwar events, and health and interactional indicators of the outcome family adaptation assessed in terms of physical and psychological health, depression, and interpersonal and marital relationships. Families were classified into high/low stress based on their score for war and non-war life events. Based on discriminant function analysis, a significant difference existed between the high- and low-stress groups (for war, nonwar, and a combination of the two) on all predictor variables. Interpersonal relationships, physical health, and depression were the best predictors of membership in the high/low war stress groups. In the perceived nonwar stress groups, depression, interpersonal relationships, marital relations, and physical and psychological health were the best predictors separating high/low stress groups. When the combination score of war and nonwar stress was used, interpersonal relationships, physical health, depression, and marital relations were the best predictors distinguishing among the groups. Findings indicated a high degree of consistency in the prediction and classification of the high/low stress groups and for all stress categories. Families in the low-stress groups had a more positive adaptation than those in the high-stress groups and could be classified on the basis of their stress score. Families in the high-stress groups had more complaints than their counterparts in the low-stress groups. This classification may help mental health professionals understand how families adapt in response to normative and non-normative life situations.     

Individual and family adaptation in Taiwanese families living with down syndrome

The primary aim of this study was to examine the effects of family demographics, family demands, and family appraisal on adaptation in Taiwanese families of children with Down syndrome. A second aim was to assess the potential mediating effect of family appraisal on the relationship between family demands and adaptation. Eighty-three families completed mailed questionnaires. Data were analyzed using a principal component analysis and a mixed linear modeling. Gender, family demands, and family appraisal were significantly associated with individual health. Age of the child with Down syndrome, family demands, and family appraisal significantly accounted for family functioning. Family appraisal partially mediated the relationship between family demands and individual and family adaptation. Identification of family factors that influence adaptation will help in the development of culturally sensitive interventions to improve outcomes in Taiwanese families of children with Down syndrome.