Women's experiences of bulimia nervosa

AIM: This paper reports a study to interpret and understand bulimia nervosa as women experience it. BACKGROUND: Research into bulimia nervosa has focused on prevalence rates, health complications, comorbidity, neurochemical dysregulation, and cultural influences. Despite a multitude of investigations, little published research appraised bulimic women's personal experiences and understanding of this disorder. Such an understanding would assist health care professionals in providing sensitive, empathetic care. METHOD: The principles of Heideggerian phenomenology guided the study. Participants were 13 actively bulimic women, aged 18-36 years, with lengths of illness from 1 to 23 years. Data were obtained through interviews, personal diaries, and demographic questionnaires. FINDINGS: Participants' narratives revealed four themes that characterized the experience of living with bulimia: isolating self, living in fear, being at war with the mind, and pacifying the brain. The practices bulimic women engage in are carried out in secret, and hence participants experienced isolation. Binge eating and self-induced vomiting are considered abnormal behaviours; therefore, participants believed that they were subjected to negative public perceptions, which led to the experience of living in fear. The women feared being judged if others knew about the disorder. Several feared living without bulimia because it had become a significant part of their identity. In addition, these women were terrified of gaining weight or becoming fat. They experienced an internal struggle with the mind. In order to pacify the inner voice, many fed the compulsion to eat, and this resulted in guilt. The women subsequently balanced the experience by getting rid of fullness and erasing guilt, which was primarily achieved through self-induced vomiting. CONCLUSIONS: Understanding the experience of bulimia for women who suffer from this disorder is important. Bulimia often presents as a chronic and potentially lifelong health issue. Awareness of bulimic women's perspectives could promote a comprehensive appreciation of bulimia, its aetiology, and directions for treatment alternatives.     

Impact of eating disorders on family life: individual parents' stories

Aims and objectives. The aim of this study was to consider the impact that an eating disorder had on the family, particularly the parents. The objective was to give a voice to parents in order to develop new understandings of their experience leading to more appropriate clinical decision‐making. Background. The impact of an eating disorder on family life has not been well‐documented in the published literature. There are numerous articles from the sufferer's perspective and treatment modalities. The following paper describes a component of a larger study that explored the parent's perspective of having a child with an eating disorder. Design. Nineteen mothers and three fathers from Sydney, Australia, volunteered to be interviewed as the result of advertizements placed in parent support organization newsletters and by using the snowballing technique. Methods. A qualitative approach using semi‐structured interviews was used to explore parents’ experiences of having a child/adult child with an eating disorder. Themes were identified through in depth analysis. Results. Themes that were extrapolated from this research included, family unification or disintegration, parent's inability to cope, inconsiderate comments from significant others, social isolation and financial impacts. Conclusions. This study reports five overarching effects on family life. The authors conclude that one way in which the life of parents and families could be improved would be increased involvement and integration into the treatment process. For this to happen, health professionals would need to acknowledge the family as a resource. Relevance to clinical practice. This research documents the family struggle and highlights the current omissions concerning the family's role. The need for changes to clinical practice is substantiated. It requires health professionals to scrutinize their own clinical practice and consider modification of the treatment process.     

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.     

Maternal Employment and Family Responsibilities: the Perspectives of Mothers of Children with Intellectual Disabilities

Over recent decades, there has been a substantial increase in the proportion of women in the workforce with dependent children. However, this trend is not evident for mothers of children with disabilities. Their employment levels are greatly reduced. The present paper examines the nature of the restrictions which affect the employment participation of these mothers and explores the meaning work has for them. The data presented in this paper were derived from qualitative interviews with 18 mothers of children with disabilities aged between 5 and 15 years. These mothers found employment difficult. They encountered unusual time demands, and a lack of adequate and affordable child care. Furthermore, they felt that their employment opportunities were restricted by attitudes prevalent in society concerning appropriate roles for women, especially mothers of children with disabilities. The lack of opportunities to engage in employment led, in varying degrees, to feelings of isolation, a lack of fulfilment and low self‐esteem. The mothers felt that they were on the periphery of society with little release from the pressures of caring. Mothers who had part‐time jobs often did poorly paid work of low status, thereby encountering few opportunities to use their skills and abilities to the full. Those who attempted a full‐time job experienced stress from the dual demands of home and work, and from a fear that they were failing as mothers. The present paper highlights areas which require attention to improve the employment experience of these mothers.     

Understanding eating behaviours in Spanish women enrolled in a weight-loss treatment

Aim. To identify the beliefs and attitudes of a sample of obese and overweight Spanish women undertaking a weight‐loss treatment. Background. Obesity is a global epidemic. Weight‐loss treatments focus on changing eating behaviours; however, many patients fail to adhere to the diet. This suggests that more effective behaviour‐change interventions are required to help people change their eating behaviours. According to the theory of planned behaviour (TPB) human behaviour is influenced by beliefs. Identification of people's beliefs is an essential step in the design of behaviour‐change interventions. Design. A qualitative approach was employed using semi‐structured interviews to interview participants. Seventeen obese and overweight Spanish women enrolled in a weight‐loss treatment were recruited using a criterion sample strategy. Findings. Participants’ reported beliefs referring to the benefits of losing weight and the emotions related to dieting. The more positive these beliefs were the more positive their attitude towards the diet seemed to be. Findings highlight the importance of follow‐ups in creating a subjective norm to maintain a diet. Perceived behavioural control to diet seemed to be related to beliefs about social support; whereas beliefs about lack of willpower to overcome temptations seemed to decrease perceived control over eating behaviours. Conclusions. Participants reported several beliefs and attitudes that offer plausible explanations of their eating behaviours. Data from this study seemed to fit the propositions of the TPB and could be used in further research to develop effective eating behaviour‐change interventions. Relevance to clinical practice. Nurses could use the TPB to assess individuals’ attitudes, beliefs and expectations when following a diet. That assessment would provide insight into what aspects are relevant for individual patients when dieting, which could lead to more effective diet behaviour‐change interventions being designed.     

Latina mothers' beliefs and practices related to weight status, feeding, and the development of child overweight

ABSTRACT Objective: To examine maternal beliefs and practices related to weight status, child feeding, and child overweight in the Latino culture that may contribute to the rising rates of overweight among preschool Latino children in the United States. Design and Sample: This 2‐phase qualitative study relies on data obtained in 6 focus groups with a total of 31 primarily Spanish‐speaking, low‐income mothers, followed by 20 individual, in‐depth interviews with women participating in a health promotion educational program. Measures: Child‐feeding beliefs, practices, and weight status perceptions were elicited. Results: The findings indicated that most respondents reported personal struggles with weight gain, particularly during and after pregnancy, and were concerned that their children would become obese. Although subjects understood the health and social consequences related to overweight, many discussed the pressures of familial and cultural influences endorsing a “chubby child.” Conclusions: Education and interventions that incorporate “culturally mediated” pathways to address mothers' feeding practices are essential for the prevention and control of childhood overweight among low‐income Latinos. Nurses should be aware of the social and cultural influences on Latina mothers' beliefs and practices related to weight status and feeding practices and address these in their education approaches to prevent childhood overweight and obesity with this population group.     

Stress among Mothers of Children with Intellectual Disabilities in Urban India: Role of Gender and Maternal Coping

Background The study assessed stress among mothers of young children with intellectual disabilities in urban India and examined the extent to which child functioning and maternal coping predict maternal stress. Through qualitative analyses, the study identified negative and positive dimensions of Indian mothers’ caregiving experiences. Materials and Methods Mothers completed Parenting Stress Index‐Short Form, and children’s teachers completed Vineland‐II teacher rating form. Maternal responses to a semi‐structured interview were rated to assess maternal coping and content analysed to derive qualitative themes. Results Three‐fourths of the sample obtained a clinically significant stress score, and maternal coping emerged as a robust predictor of stress for mothers of boys with intellectual disabilities. Qualitative analyses indicated positive and negative maternal experiences related to self, child, family and community. Conclusions The high level of stress has important clinical implications. Similarly, the significant role of maternal coping, moderating role of child gender and the multidimensional caregiving experiences have implications for future research and family interventions in India.     

When caretaking competes with care giving: a qualitative study of full‐time working mothers who are nurse managers

Aim The purpose of this study was to explore the motivations and stresses associated with full‐time working mothers who practice as nurse managers. Background Full‐time work outside the home for mothers has been recognized as a circumstance which may present certain benefits and risks to family life. Nursing management is recognized as a high‐stress occupation, which may be filled by mothers who work full time. Little is known about the specific needs and stresses of full‐time nurse managers who are caring for children at home. Methods In‐depth interviews were conducted with 13 mothers who worked as nurse managers. Results Participants expressed challenges in several areas including balancing/separating work and home, self‐imposed advancement inhibitions, and constant giving. Challenges were offset by assets, which included complimentary roles, health insurance, added income, and professional and personal fulfilment. Conclusion Participants ‘wanted it all’, including the conveniences of part‐time employment and the benefits of full‐time employment. Implications for nursing management Full‐time nurse mangers with children at home experience unique tensions which characterize their work and home environments. Employers may assist nurses by adopting flexible scheduling, educational and child‐care support and assistance in negotiating work and home roles.     

Self-esteem Reactivity Among Mothers of Children with Attention-Deficit/Hyperactivity Disorder: The Moderating Role of Depression History

This study examined self-esteem reactivity to a variety of contextual cues in a sample of women prone to depression. Participants were 49 mothers of children with attention-deficit/hyperactivity disorder. Across a 9-month time-period, participants completed weekly measures of self-esteem, perceived stress, positive and negative affect, and child disruptive behavior. Results indicated that mothers reported lower self-esteem during weeks they experienced greater stress, lower positive affect, higher negative affect, and more inattentive, overactive, and oppositional behavior in their children. Depression history moderated these relationships such that mothers with prior histories of depression reported greater self-esteem reactivity to these cues than never depressed mothers.     

Mothers of Children Who have an Intellectual Disability: Their Attributions,Emotions and Behavioural Responses to Their Child’s Challenging Behaviour

Background This paper examines the application of Weiner’s attribution model to the responses of mothers to the challenging behaviour of their children who have an intellectual disability. It was expected that the attributions, assignment of responsibility and emotional and behavioural responses of mothers of children with an intellectual disability would vary as a function of the child’s behavioural topography and level of intellectual disabilities. The paper further examines whether, as suggested by Weiner’s model, anger mediates the effect of attribution of responsibility on likelihood of punishment as an intervention. Method Fifty‐six mothers of children with an intellectual disability rated their attributions, assignment of responsibility and emotional and behavioural responses to three vignettes describing challenging behaviours. Results Mothers rated their children as significantly more in control of, responsible for, and felt significantly more angry about aggressive behaviour than stereotypic behaviour and were significantly more likely to punish aggressive behaviour than self‐injurious or stereotypic behaviour. Regression analysis suggests that mothers who assign more responsibility to their child were more likely to consider punishing their child and that this relationship is mediated by anger. Conclusions The study offers support for some aspects of Weiner’s attribution model with this group of parents. Implications for clinical work with parents of children who have an intellectual disability are discussed.     

Child care use by low-income single mothers of preschoolers born preterm versus those of preschoolers born full term

This study describes prewelfare reform child care use by 64 primarily low-income single mothers (65.6% African American) with preschoolers (half born preterm). Forty percent used child care for more than 75% of their children's lives, 20% did when not employed. Preschool children born preterm were more likely to receive child care from nonrelatives throughout their lives than children born full term. Children with health problems used a greater number of child care arrangements. Findings suggest addressing child care issues with both employed and nonemployed mothers and adequacy of child care for children with special needs.     

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.     

Mothers and Fathers of Children with Cerebral Palsy: Differences in Future Expectations

Parents’ expectations are known to be a central component in children’s development through multiple pathways; however, limited information exists regarding expectations of parents of children with developmental disabilities. The purpose of the current study was to examine future expectations of parents of children with cerebral palsy (CP), as well as the differences in expectations between mothers and fathers. Forty-nine mothers and fathers of children with CP (6–12 years) participated in this study. Parents completed a Parental Future Expectations Questionnaire for Children with Disabilities, and a Perception of Child’s Ability questionnaire, as well as the Pediatric Evaluation Disability Inventory (PEDI). The Gross Motor Function Measure-66 (GMFM-66) was completed by physical therapists. Parental differences in future expectations were analyzed and multiple-stepwise regressions established parental expectations’ predictors. Parents’ expectations correlated with their child’s characteristics. Parents of children with lower levels of functioning reported lower expectations. No differences were found between mothers’ and fathers’ future expectations; however, differences were found between expectations’ predictors. Predictors of mothers’ expectations were their perceptions of their child’s abilities as well as child’s performance. Fathers’ predictors were child’s level of functional impairment and their perceptions of their child’s abilities. The results indicate that parental expectations relate to their child’s functional ability and differ between parents in relation to the child’s level of impairment (fathers) or child’s actual performance (mothers). These differences should be acknowledged by clinicians when they provide specific support for children with chronic physical disabilities and their families.     

A qualitative study of depressive symptoms and well-being among first-time mothers

Scand J Caring Sci; 2012; 26; 458–466 A qualitative study of depressive symptoms and well‐being among first‐time mothers Background and aim: Ten to 15% of women experience postpartum depression. First‐time mothers are particularly at risk. The present qualitative study aimed to gain insight in terms of why some women find the transition of becoming a mother to be so emotionally taxing that they feel some level of depressed mood, while others feel mostly content after having a baby. Method: Semi‐structured interviews were conducted with 12 self‐selected first‐time mothers. Participants described their pregnancy and birth experience, expectations and experiences with regard to the postpartum period, social support and what they considered important with regard to well‐being and depression in the postpartum period. Data were analysed by means of thematic analyses. Ethical approval was granted by the Regional Ethics Committee. Results: Two approaches to motherhood emerged, which we refer to as ‘relaxed’ and ‘controlled’. These approaches influenced how the mothers had envisioned the postpartum period, their need for mastery and how they experienced it emotionally. Social support and managing breastfeeding stood out as important with regard to well‐being and depressive symptoms. Conclusion: Frequent consultations with midwifes and public health nurses during the pregnancy and the postpartum period gives unique opportunities for preventive work. The consultations should to a greater extent focus on the woman’s expectations and needs, and the partner should be present for an open discussion on how they best support each other in this vulnerable period.