Single mothering as experienced by Burundian refugees in Australia: a qualitative inquiry

Background

Refugee mothers have fled from their homeland to escape persecutions with their children only to find other threats to their well-being in the new country. Building on previous research, it is known that being a new immigrant is challenging and requires adaptation. The adaptation process, known as acculturation, may not be successful leading to psychological distress. It is also known that a generation gap can occur when children acculturate faster than their parents. What was lacking was understanding about the experiences of single refugee mothers.

Methods

Interpretative phenomenological study was undertaken to explore the lived experiences of eight Burundian refugee single mothers in Australia. Data were collected by in-depth interviews. Each interviews were transcribed and analyzed using thematic analysis.

Results

Findings revealed three themes. First theme ‘Traditional mothering practices of Burundian culture’ illustrated mothering strategies as practiced prior to their arrival in Australia including mothering with sufficient social support, strong position of parents, and regular use of physical disciplining. Second theme ‘Challenges identified after arrival to new country’ revealed that mothers felt their children acculturated faster than themselves which led to intergenerational gap. This has also led participants to live in a continuous dilemma, experiencing inner conflicts and struggles associated with their mothering practices, especially when mothers had arrived with a lack of knowledge relating to acceptable mothering practices in a new culture. Final theme, ‘Reforming family life in Australia’ highlighted the decisions made by single refugee mothers which is to embrace both new and original cultures, leading to successful acculturation. However, lack of appropriate knowledge of acceptable mothering practices led to involvement of legal authorities who threatening to remove children from the mother’s care. This has led mothers feeling change of power from ‘mother to child, ‘to child to mother’, raises concerns for family wellbeing.

Conclusions

A need for parenting information when entering a new country including education about any legal obligations for parents such as a Child Protection Act will assist successful acculturation. As nurses are likely to encounter refugee single mothers, they are well placed to provide support and education to new refugee single mothers.

     

Managing infant feeding practices: the competing needs of bulimic mothers and their children

Aim. This paper seeks to explain how bulimic mothers accommodated infant feeding demands in conjunction with managing their disordered eating practices. Background. Eating disorders are chronic and disabling illnesses primarily affecting women. There are few qualitative studies describing bulimia in the context of motherhood. Design. The study employed an inductive qualitative approach. Methods. A purposive sample of childbearing women (n = 16), who self‐defined as living with an eating disorder, were recruited. Data were generated from one‐to‐one interviews; a thematic analysis identified key issues. Results. Participants were primarily responsible for ensuring child/ren’s socialisation processes, including modelling appropriate dietary behaviours and these demands often conflicted with their personal needs for food restraint. Pressures to participate in social activities with children were widely experienced as stressful especially when these events focused on food. Participants viewed early and repeated exposure to ‘healthy’ eating as protective against their children acquiring an eating disorder and in this respect commercial child‐care facilities provided alternative environments for children to explore food‐related activities. Conclusions. Participants employed a variety of strategies to ensure children’s exposure to normalising influences and socialising processes. Concerns about personal competencies with respect to food preparation and storage were articulated by all participants. Relevance to clinical practice. Professionals involved with providing care to mothers and their infants are well placed to support bulimic clients and to foster confidence in their mothering skills. Early and appropriate intervention is key to effecting positive changes in bulimic patterns, with potential benefits to women’s future health and well‐being and that of their children.     

Stresses and coping strategies of mothers living with a child with cystic fibrosis: implications for nursing professionals

BACKGROUND: Cystic fibrosis (CF) is the most common inherited disease of childhood. Caring for a child with CF is stressful and this has implications for the main carer, the parental relationship, well siblings, family functioning as well as the affected child. AIM: This study aimed to explore current stresses and coping strategies used by mothers and to identify roles and strategies that nursing professionals could extend or adopt to support them and families of children with CF. METHOD: Semi-structured interviews were carried out with 17 mothers of children with CF who attended the regional cystic fibrosis hospital clinic. Interviews were analysed using the Framework method of analysis. FINDINGS: The study suggests that major stresses for many mothers are feeling in the middle in terms of decision-making particularly concerning the genetic implications of CF, the burden of responsibility for parenting a child with a chronic illness, and coming to terms with a personal change in identity. The most commonly used coping strategy was seeking support from others including nursing professionals. Relationships with health professionals in secondary care were generally positive, with nurses often the first people mothers turned to when they had concerns and also key in interpreting medical information. Relationships with primary care health professionals appeared to be more limited with a role reversal described by some mothers who felt it their responsibility to educate and inform primary care professionals about CF. CONCLUSIONS: This study suggests that nursing professionals in primary and secondary care need to look beyond the care of the child to the needs of the mother. It provides evidence to suggest that nursing professionals in primary and secondary care have a number of important roles to play as holders of hope, bridge builders and in providing continuity of care for such families. It also suggests strategies to strengthen nurse-patient relationship.     

Mothers' experiences of parenting a child with attention deficit hyperactivity disorder

Title. Mothers’ experiences of parenting a child with attention deficit hyperactivitydisorder. Aim. This paper is a report of a study to explore the perceptions and experiences of mothers parenting a child with attention deficit hyperactivity disorder. Background. Previous quantitative studies have focussed on parenting styles and treatments, and highlight that attention deficit hyperactivity disorder has a negative impact on family functioning. However, fewer researchers have explored maternal experiences of parenting a child with this disorder. A narrative‐based feminist approach can provide greater insights into complex issues related to mothering a child with this disorder. Method. Data were collected in 2007 with a volunteer sample of 11 mothers of children with attention deficit hyperactivity disorder via in‐depth interviews. Analysis was completed by listening for self‐evaluative statements, paying attention to meta‐statements and by identifying both consistencies and incongruities within participant’s narratives. Findings. Dominant issues identified were: It’s been 10 years of being on edge: The caring responsibility as overwhelming; If I had my time over again, I wouldn’t tell the truth: Stigmatized, scrutinized and criticized; What have I done? What did I do? How come I’ve got this child: Guilt and self‐blame and He doesn’t stand a chance: Mother as advocate. Conclusion. Mothering a child with attention deficit hyperactivity disorder is stressful and demanding, and mothers felt marginalized. Media portrayal of this disorder contributes to confusion related to causes, diagnosis and treatment choices. More education for healthcare professionals is needed to enable them to give appropriate guidance and support to enhance outcomes for children and their parents.     

Modeling ADHD child and family relationships

Little information is available on how to help families manage common negative sequelae of attention deficit/hyperactivity disorder (ADHD). This article is a report of the extent to which a theoretical formulation of child behavior, maternal distress, and family conflict was explained by data obtained from a community sample of families with children and adolescents with ADHD. Structural equation modeling was used to test the theoretical model. The primary variables of interest were (a) child behavior problems, (b) maternal distress, and (c) family conflict. The results suggest that maternal distress may mediate the relationship between child behavior problems and family conflict, indicating the critical importance of mothers in ADHD families and the need to provide them with additional support.     

Parenting stress in mothers with cystic fibrosis*

Aim: To assess the parenting experience of mothers with cystic fibrosis (CF) and to compare with normative data. Methods: Cross-sectional study with a validated generic parental stress questionnaire (PSQ). This PSQ differentiates four components of parental stress: main factor “parental stress”, compounding factor “role restrictions”, protective factors “support from spouse”, and “social support”. Cut-off scores categorise results as “normal”, “borderline” or “concerning”. Sample: Seventy-three women were informed by their local CF centre. Of these, 36 enrolled and had a first-born child aged 1–12 years (consistent with reference values of the PSQ). Of these, 31 (86%) returned the PSQ. Mean age of mothers was 32.6 years?±?6.9 years, mean age of first-born child was 5.2 years?±?3.4 years. Most of the mothers had one biological child, five women had two children and one had three children. Results: Parental stress scores were normally distributed, the same applies for contributing factors and for the two protective factors. Favourable scores were twice as frequent as concerning scores. Mothers of younger children scored slightly better than mothers of school-aged children. Conclusion: In line with the only comparable study, mothers with CF seem to be a remarkably resilient group who mostly cope well with parental stress even in the face of a progressive, chronic disease requiring time-consuming treatment.

• Implications for Rehabilitation

• Today, motherhood is increasingly becoming an option in fertile women with cystic fibrosis.

• The additional burden of parenting seems to be rewarded by fulfilling essential personal goals.

• CF clinics should routinely address a possible wish for a child and to discuss it, openly.

     

Mothers in postdivorce families caring for a child with cystic fibrosis

This study explored the experiences of mothers of children with cystic fibrosis (CF) in postdivorce family structures. In-depth interviews of mothers were conducted by registered nurses with expertise in CF. Interviews focused on responsibility for care of the CF child within the context of postdivorce families (e.g., extent of nonresidential fathers' involvement in children's care, communication between households). Interviews were audiotaped and transcribed verbatim. The constant comparison method was used for analyzing interview data. Marital transitions contributed to the closeness between mothers and children with CF, but they also added to the mothers' sense of being overwhelmed with responsibilities. It is likely that children and mothers are more at risk for stress-related problems when mothers are overburdened by the demands of caregiving, earning a living, and other responsibilities.     

Mothering young children with disabilities in a challenging urban environment.

OBJECTIVE: This study examined the occupations of mothering very young children with physical disabilities. METHOD: Two single, urban, Black mothers in their mid-20s were interviewed with a semistructured protocol. The audiotaped, transcribed data were analyzed with a phenomenological method. RESULTS: The context of the challenging urban environment was a constant influence that shaped the participants' occupations of mothering. The major over-arching theme derived from the data was that mothering was "what I got to do" in relation to their particular child. Two sub-themes were identified: (a) mothering as caring and (b) the impact of social supports on the occupations of mothering. CONCLUSION: To plan meaningful, effective interventions, occupational therapy practitioners need to understand the context in which mothering occupations occur and to ensure that mothers' caring occupations and social support needs are addressed in the therapeutic partnership.     

Family functioning when children have cystic fibrosis.

The purpose of this study was to compare family functioning between 32 mothers with a child who had been diagnosed with cystic fibrosis (Group 1) and 32 mothers with a child who did not have cystic fibrosis (Group 2). The children's ages ranged from 4 months to 3 years. The mothers' perceptions of their family's functioning was measured by the Feetham Family Functioning Survey. There were no significant differences found between the groups on the total score of the Feetham Family Functioning Survey. Both groups of mothers reported that they were quite satisfied with their family functioning.     

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.     

Childhood and adolescent attention-deficit hyperactivity disorder: Diagnosis, clinical practice guidelines, and social implications

Purpose: To review the diagnostic criteria for attention-deficit hyperactivity disorder (ADHD), present an overview of the effects that ADHD has on family dynamics, school performance, and substance abuse, and provide an overview of the American Academy of Pediatrics (AAP) clinical practice and treatment guidelines.
Data sources: An extensive health science literature review was carried out using PubMed and Cumulative Index to Nursing and Allied Health Literature. Other information was collected by searching reference lists of published reports.
Conclusions: The diagnostic criteria and guidelines are important to make an accurate clinical assessment and manage a child with ADHD. Early diagnosis and treatment of ADHD decreases academic failure, family conflict, social isolation, substance abuse, and occupational adversity in later years for these children.
Implications for practice: Often primary care nurse practitioners are the first healthcare provider a child with ADHD will see. Awareness of the diagnostic criteria and treatment for children with ADHD can assist with early identification and perhaps eliminate much impairment that accompanies this chronic disorder.     

How do adults with cystic fibrosis cope following a diagnosis of diabetes?

Title. How do adults with cystic fibrosis cope following a diagnosis of diabetes? Aim. This paper is a report of a study examining the experience of adults with cystic fibrosis in adapting to the diagnosis of diabetes, a second chronic illness. Background. Diabetes is a common complication of cystic fibrosis; the onset signifies the development of a second chronic illness. Both cystic fibrosis and diabetes are complex conditions, which require daily treatment schedules as part of their management. However, it is unclear how people already living with cystic fibrosis respond to the diagnosis of diabetes. Method. A qualitative method was chosen to obtain an ‘insider’ experience of adjusting to a second chronic illness. Semi‐structured interviews were conducted in 2004 with 22 adults with cystic fibrosis‐related diabetes. The data were analysed using interpretative phenomenological analysis. Findings. Four recurring themes were identified: emotional response to diagnosis of diabetes, looking for an understanding, learning to live with diabetes, and limiting the impact of diagnosis. Having cystic fibrosis appeared helpful in limiting the impact of the diagnosis of diabetes. Juggling conflicting dietary demands of cystic fibrosis and diabetes coupled with the lack of practical professional advice available was seen as one of the biggest challenges in adapting to diabetes. Conclusion. Healthcare professionals need increased awareness of diabetes amongst adults with cystic fibrosis and provide adequate support and structured evidence‐based education throughout the course of the illness, particularly in relation to diet. Nevertheless, patients’ familiarity with regular daily routines and problem‐solving attitudes, already developed in the context of cystic fibrosis, may be drawn on to limit the impact of diabetes.     

Helping teen mothers succeed.

Because the success of teen mothers is enhanced by completing high school, school districts should give high priority to supporting teen mothers to remain in school and to graduate. This article reviews the literature on the educational attainment of these students, their school aspirations, and the policies affecting their education. Although teens often begin mothering with a range of educational and social disadvantages, many teen mothers recommit to school to enhance their future opportunities. Unfortunately, rising school aspirations among teen mothers often are undermined by competing demands and the lack of consistent family and school support. School nurses can support teen mothers' aspirations and contribute to their long-term success by linking them to resources and advocating for policies and practices that promote high school graduation.     

Single mothers' views of young children's everyday routines: a focus group study

Consistent daily routines have been associated with children's well-being, but children of single parents are less likely to engage in regular family meals or bedtime routines. This study explored routines and the challenges of maintaining routines as experienced by single mothers with a preschool age (3-5) child. Four focus groups (N?=?12) were conducted and qualitative content analysis was used. Mothers described routines as an integral part of their parenting role and a reflection of successful parenting but maintaining routines around bedtimes and mealtimes were major concerns. Difficulties managing their child's behavior and their own fatigue were major challenges but mothers described a wide range of helpful strategies as well.     

Mental health of mothers caring for ventilator-assisted children at home

The complex management of ventilator-assisted children cared for in the home can place emotional and mental strain on parents, in particular, mothers. The purpose of this study was to explore the relationships among functional status of the child, impact of ventilator-assistance on the family, coping, social support, and depression in mothers caring for ventilator-assisted children at home. Thirty-eight mothers participated in the study. Almost half of the mothers experienced depressive mood symptoms. Impact on family was positively related to depression and social support was inversely related to depression. In addition, social support was a significant predictor of depression. The findings show that the high demands related to the care of ventilator-assisted children can be a significant risk factor for poor mental health outcomes of those mothers providing care at home. Interventions by mental health and pediatric nurses should focus on enhancing mothers' coping skills and assisting mothers in accessing a positive social network to help mediate the stress related to caring for their child.     

MENTAL HEALTH OF MOTHERS CARING FOR VENTILATOR-ASSISTED CHILDREN AT HOME

The complex management of ventilator-assisted children cared for in the home can place emotional and mental strain on parents, in particular, mothers. The purpose of this study was to explore the relationships among functional status of the child, impact of ventilator-assistance on the family, coping, social support, and depression in mothers caring for ventilator-assisted children at home. Thirty-eight mothers participated in the study. Almost half of the mothers experienced depressive mood symptoms. Impact on family was positively related to depression and social support was inversely related to depression. In addition, social support was a significant predictor of depression. The findings show that the high demands related to the care of ventilator-assisted children can be a significant risk factor for poor mental health outcomes of those mothers providing care at home. Interventions by mental health and pediatric nurses should focus on enhancing mothers' coping skills and assisting mothers in accessing a positive social network to help mediate the stress related to caring for their child.     

Toward an understanding of mothering: a comparison of two motherhood stages.

OBJECTIVE: This study sought to understand the tasks and activities involved in the caring and nurturing work of mothering, a common and important occupation for many women. METHOD: In-depth, semistructured individual interviews were conducted with 40 mothers: 20 mothers of preschool-age children and 20 mothers of young adults. In addition, participants completed a questionnaire describing the tasks and activities that they currently engage in when caring for their children. RESULTS: The activities involved in mothering are different for the mothers at the two stages of mothering examined. The mothers of preschool-age children are very involved in caretaking tasks and meeting the basic needs of the child, whereas the mothers of young adults are involved in emotional and supportive type activities. Mothers at both stages are involved in caring and nurturing work but this work evolves and changes as children mature. CONCLUSION: These findings extend our awareness of mothering and the tasks and activities involved in the occupation of mothering at both the preschool stage and young-adult stage.     

Use of drug therapy in children with attention deficit hyperactivity disorder (ADHD): maternal views and experiences

Aims and objectives. The aim of this paper is to explore maternal views and experiences of stimulant pharmacotherapy in children with attention deficit hyperactivity disorder (ADHD). Background. The very nature of ADHD means that it exists in a climate of scepticism and doubt. However, parents must make decisions about how to treat their children affected by ADHD. Of the treatments available, the use of stimulant therapy is the most controversial. Design. Qualitative. Method. Snowball sampling was used to recruit mothers (n = 11) of children with ADHD and a narrative‐based qualitative methodology was used. Results. Decisions around the use of stimulant medication for children with ADHD were difficult for these mothers. Detailed findings are presented under the themes of: Ambivalence and confusion: everybody would be down on me like a ton of bricks; Influence of the media: so much bad publicity; Deciding against medication: you’re changing their whole personality; and, Deciding for medication: he’s just been wonderful. Conclusions. While these mothers revealed that they were discriminating in selecting information to guide their decision‐making, many of their friends and family were influenced solely by media reports. Mothers experienced misgivings from family and friends who were sceptical about the need for medication and the implications and ethics of administering stimulant medication to children. Relevance to clinical practice. Nurses and healthcare professionals have an important role in providing accurate and current information for parents and families and should be aware of the pressures parents are under when making decisions about treatments for their children with ADHD.     

Adaptive strategies of mothers with children with attention deficit hyperactivity disorder: enfolding and unfolding occupations.

OBJECTIVE: To describe adaptive strategies of time use among mothers with children with attention deficit hyperactivity disorder (ADHD) and, in particular, the adaptive strategies of unfolding occupations that were commonly used by these mothers. METHOD: In-depth interviews were conducted with 17 families with children with ADHD. Parents were asked to describe their family's daily schedule, routines, and how occupations were performed. Data were analyzed using the grounded theory approach. FINDINGS: Mothers used three adaptive strategies: enfolding occupations, temporal unfolding of occupations, and unfolding occupations by inclusion. Enfolding occupations means performing more than one occupation at a time. Unfolding occupations means taking chunks of activities or occupations out of previously established sequences of enfolded occupations to be performed at a different time (temporal unfolding) or by a different person (unfolding by inclusion). The child's special needs and the availability of financial and human resources influenced the selection of adaptive strategy. Using these adaptive strategies enabled the mothers to care for their children. However, using enfolding or temporal unfolding meant that mothers had less time for other occupations. CONCLUSION: The benefits and limitations of the adaptive strategies of enfolding and unfolding occupations suggest a need to study time use in different contexts. Before suggesting use of these adaptive strategies by parents of children with special needs, therapists need to be aware of the family's financial and human resources.     

Single Mothers' Views of Young Children's Everyday Routines: A Focus Group Study

Consistent daily routines have been associated with children's well-being, but children of single parents are less likely to engage in regular family meals or bedtime routines. This study explored routines and the challenges of maintaining routines as experienced by single mothers with a preschool age (3–5) child. Four focus groups (N?=?12) were conducted and qualitative content analysis was used. Mothers described routines as an integral part of their parenting role and a reflection of successful parenting but maintaining routines around bedtimes and mealtimes were major concerns. Difficulties managing their child's behavior and their own fatigue were major challenges but mothers described a wide range of helpful strategies as well.