The development of children's concepts of death

Abstract

This study had three purposes. The first was to construct a reliable test to assess children's concepts of death. Such a test was devised and was found to be reliable. The second purpose was to assess the development of children's understandings of subconcepts of the concept of death (cessation, necessity, irreversibility, causality, and university) for different content (humans and animals). The findings were: More younger than older children correctly judges tasks measuring these subconcepts, some of the subconcepts were more difficult than others, and there were no differences between children's understanding of these subconcepts for humans and animals. The third purpose was to find two kinds of developmental sequences. The first was development between the subconcepts. Two sequences were predicted based on an analysis of prerequisite relations: One of these was found in part, and the other was within a subconcept. It was found that children believe that in death there is cessation of external events (moving, speaking) before internal events (thinking, dreaming).     

Life events, social support, and children's competence after parent and sibling death.

The purpose of this study was to ascertain whether children's competence after a parent or sibling death is related to stressful life events and the social support which occur around the time of a death. The sample consisted of 37 children between the ages of 7 and 15 years old who lost a sibling or parent by death 1 to 4 years previously. Study variables were measured through parent completion of mailed questionnaires. Life events, parent support, and support by other people were examined in relation to children's current cognitive, social, physical, and behavioral competence. Stressful life events were found to be related differentially to the four aspects of children's competence. Neither parental support nor support by others was associated with any of the competence dimensions.     

Assessment of the convergent validity of pain intensity in the Pain Sensory Tool

The purpose of this study was to examine the convergent validity of the Pain Sensory Tool with the Poker Chip Tool. Both tools were used to assess children's pain intensity (ages 5 to 14 years). A total of 104 hospitalized Taiwanese children with acute pain were asked to participate in this study. All children were required to use both the Pain Sensory Tool and the Poker Chip Tool to measure their pain. The results of Pearson correlation revealed a coefficient of.79 to.88. The convergent validity of the Pain Sensory Tool with the Poker Chip Tool was therefore supported. No significant differences in preferences of using the PST and the PCT were found by age group and sex. The findings of this study also demonstrated that the Poker Chip Tool can be used to measure Taiwanese children's pain intensity. In addition, the Pain Sensory Tool and the Poker Chip Tool were reliable instruments to measure pain intensity of Taiwanese children (ranged from 5 to 14 years of age). However, 27 % of five-year-old children failed to understand the instructions of the PST although these children were dropped from the study. This raises concerns about the validity of the PST for five-year-old children. It is not clear whether these five-year-old children were outliers or whether the PST is difficult for younger children. The authors suggested duplicating this study and specifying the five-year-old age group for the validity test.     

The meaning of death for children and adolescents: A phenomenographic study of drawings

The purpose of this study was twofold: to investigate the qualitative differences in children's concepts of death, as reflected in their drawings and to study the gender differences in children's death concepts. Subjects were 431 children. of four age groups (9, 12, 15, and 18 years) and both sexes. The children were asked to draw their impression of the word death and to give a verbal commentary on what they had drawn. The drawings were analyzed according to a phenomenographic method and assigned to one of 3 superordinate and 10 subordinate qualitative categories. The categories were found to be both age and gender related. Biochemical death concepts dominated the younger age groups, and metaphysical death concepts were found predominately in the older age groups. Boy had more violent death concepts then did girls and personified death more often. Girls depicted death in me emotional terms than boys did.     

Exploratory study of elementary-aged children's conceptions of death through the use of story

Research on death-related experiences has proliferated over the last decade. However, the amount of formative research that lay the foundation for using children's literature to examine elementary-aged children's conceptions of death following story presentations has been marginal at best. This study explored elementary school children's perceptions of death through story presentations. The subjects were 31 elementary-aged children (12 kindergartners, 9 second graders, and 10 fourth graders) randomly divided into Group I and Group II. Group I listened to three contextual stories that reflected real-life stories adapted from children's literature. While Group II listened to three media stories that presented an actual death experience based upon newspaper accounts. Group discussions followed each story session to assess children's conceptions using Kane's (1979) components of death. The ten components were realization, separation, immobility, irrevocability, causality, dysfunctionality, universality, insensitivity, appearance, and personification.

Results revealed that variable patterns of Kane's components were found in the various grades as the sequence of the three stories unfolded in both groups. Further consideration should be given to examine the therapeutic benefits from bibliotherapy with young children related to the death concept.     

The zone of proximal development in in-hand manipulation skills of nondysfunctional 3- and 4-year-old children

The purpose of this study was to assess the influence of verbal and visual cues on 28 nondysfunctional 3- and 4-year-old children's performance of in-hand manipulation skills. During the uncued version of the test (pretest), the children were presented with play activities known to elicit in-hand manipulation skills in young children but were given no cues for specific manipulative skill use. Within 1 week of the pretest, after the children were randomly assigned to groups, a posttest was given in which the children were provided with verbal or visual cues. The results indicate that both visual and verbal cues were effective in increasing the groups' test scores, but no significant differences were found based on the type of cue provided. Approximately 30% of the children in the study showed marked improvement on the posttest scores, whereas the others showed little change. The children who had lower pretest scores showed greater score increases on the posttest than did the children who scored somewhat higher initially. The use of an uncued test followed by a cued test may be an effective method for the identification of those children who are most likely to show improvement in these manipulation skills with intervention. This study's findings lend tentative support to Vygotsky's (1978) zone of proximal development theory and extends the application of his work into the domain of fine motor skills.     

Positive parenting as a protective resource for parentally bereaved children

Positive parenting was examined as a protective resource against the adverse effects of negative life events on parentally bereaved children's mental health problems. The sample consisted of 313 recently bereaved children ages 8 to 16 and their current caregiver. Both the compensatory (direct effect independent of negative life events) and the stress-buffer (interactive effect with negative life events) protective resource models were examined and child gender was explored as a moderator of both models. Results revealed evidence for the compensatory protective resource model for both child and caregiver reports of mental health problems. No evidence of the stress-buffer model or child gender as a moderator was found. Implications for the understanding of children's responses to the death of a parent and the development and implementation of preventive interventions are discussed.     

Young children's death concepts revisited

One hundred forty-one children, ages three to seven, were interviewed and presented with different play situations to assess their death concepts. Chi-square analysis and post hoc pairwise contrasts tests were used to examine differences in responses by parents' marital status and socioeconomic background The feasibility of a play activity involving puppets for assessing death concepts was also explored. It was concluded that there is no relationship between parents' marital status and young children's death concepts, that young children from different socioeconomic backgrounds are far more similar than different in their understandings of death, and that a play situation with undefined cause of death is a potentially useful supplementary means for assessing young children's death concepts.     

Parents associated with children in measuring acute and delayed nausea and vomiting

The purpose of this study was to identify the relationship between parents and children in measuring children's acute and delayed nausea and vomiting induced by cancer chemotherapy. Twenty parent-child dyads participated in the study. Both instruments: Adapted Rhodes Index of Nausea and Vomiting by parent and by child (8-18 years old) were used every 12 h. The reliability and validity of these instruments have been established. There were significantly moderate to strong associations between parents and children in measuring these symptoms from Day 1 to Day 3 (total scores: r = 0.85-0.93; nausea scores: r = 0.67-0.93; and vomiting scores: r = 0.91-0.99, all P < 0.01). Therefore, parents' observation of their children's symptoms was strongly associated with their child's self-report of symptoms. Parents were able to assess their children's acute and delayed nausea and vomiting because in this sample almost all parents accompanied their children all day long.     

Stress and coping responses to proficiency testing in school-age children

Nurses encounter school-age children experiencing multiple stressors and stress symptoms. Performance on proficiency tests is viewed as stressor. The purpose of this repeated measures study was to assess 53 fourth grade children's appraisal of proficiency tests, concurrent stressors, stress symptoms, and coping strategies. During October, February, March, and April, children completed a ranking of their stress associated with proficiency testing and also reported their stressors, stress symptoms, and coping strategies. Results indicated that children appraised proficiency tests as most stressful at the beginning of the school year but less stressful at the time of the test. Stressors and stress symptoms increased from baseline to 1 month before testing then declined. The number of coping strategies used by the children decreased throughout the year. Nurses can work with parents and teachers to identify children with test anxiety and target these children for interventions to improve their coping strategies.     

Effects of a child bereavement training program for teachers

A quasi-experimental design was used to evaluate a child bereavement training program for elementary and preschool teachers. The treatment group (n - 10) received a four-hour workshop based on a model by Corr (1). When compared to a control group (n = 10), the treatment group gained significantly more knowledge of children's grief children's conceptions of death, and an awareness of teaching resources. No significant differences in comfort in discussing death with children was found between the two groups. Workshops that include skills training as well as knowledge were proposed as a way to increase teacher's comfort in discussing death with children.     

Bilateral motor coordination in 5- to 9-year-old children: a pilot study

The purpose of this study was to collect normative data on and to assess the clinical usefulness of scales designed to measure the quality of children's ability to perform three bilateral motor coordination tasks: jumping jacks, symmetrical stride jumps, and reciprocal stride jumps. One hundred children, aged 5 to 9 years, were tested according to the scales developed for this study. Results indicated that scores tended to increase with age and that sex differences were not significant. Jumping jacks were found to be the most reliable and the easiest of the three tasks. Reciprocal stride jumps were the most difficult. Quality of performance was assessed, and the number of jumps in a 10-sec trial was recorded for each age. The data from this study may be useful in comparing the performance of children with motor deficits to the performance of normal children of the same age.     

Swedish and U.S. children's thinking about death: A qualitative study and cross-cultural comparison

The objective of this study was two-fold: (a) to investigate the qualitative differences in children's death-related thinking regardless of nationality, and (b) to discover what qualitative differences exist between Swedish and U.S. children in their concepts of death. Phase I of the study included a sample of 316 Swedish and U.S. children, ages 4-19, 53 percent of which were girls. Phase II consisted of a cross-cultural comparison of 124 Swedish and 122 U.S. children matched for age and sex. The children participated in this study as intact classroom groups. They were asked to draw what they thought of when they heard the word “death”, or, in the case of the young children, the word “dead”. They were also asked to give a brief verbal commentary on what they had drawn. Each child's drawing and comments were analyzed as a unit. The drawings were assigned to one of ten qualitatively different categories identified post hoc. The categories were found to be age-related and in accord with previous studies of the development of concepts of death in children. The cross-cultural comparison indicated considerable similarities in the qualities of Swedish and U.S. children's depictions of death. Some cross-cultural differences were also observed, but these are differences in frequency or emphasis rather than in quality of depictions. More Swedish children depicted cultural and religious practices and symbols, whereas more U.S. children depicted violent causes of death. Possible explanations of these differences are suggested, and recommendations for future cross-cultural research in this area are made.     

Children's understanding of illness: Students' assessments

The purpose of this study was to examine the perceptions of graduate students in the fields of nursing, social work, child life, and counseling education regarding children's understanding of illness concepts. Students were assessed as to their knowledge of children's perceptions of illness as described from a Piagetian developmental viewpoint. Eighty-five graduate students from a southern university in the fields of nursing, social work, child development/child life, and counseling categorized statements made by children regarding their understanding of illness concepts. A data-gathering instrument, developed by Perrin & Perrin (1983), was used to assess the graduate students' ability to assign a developmental age to children's responses to illness-concept questions. Additionally, the students were evaluated on their knowledge of how children perceive illness identification, causality, prevention, treatment, and use of medication. The students correctly categorized by age, children's statements regarding illness concepts only 38% of the time and correctly identified knowledge statements 50% of the time. No remarkable differences were found among the areas of specialization. Without a knowledge base of developmental theories that can be applied directly to clinical practice, nurses are at a disadvantage when working with children and their families. A better understanding of children's communication needs can ultimately lead to improved coping abilities on the part of the child and appropriate interventions on the part of the nurse. The relatively low number of correct responses suggests a need for additional training opportunities that would incorporate cognitive developmental theory into clinical practice for nurses and other health care professionals who plan to work with children.     

Methods to test feeding tube placement in children

PURPOSE: This replication study examined the extent to which feeding-tube aspirates (pH and enzyme content) are effective predictors of feeding tube location in acutely ill children. STUDY DESIGN AND METHODS: A convenience sample of 56 children was obtained at a metropolitan children's hospital. Approximately 2.5 ml of fluid were withdrawn from children's nasogastric, orogastric, or nasointestinal tubes within 30 minutes of radiographic examination. Fluid was tested for pH and enzymes, and results were compared with radiographic results of tube location. RESULTS: Mean gastric pH was significantly lower than mean intestinal pH. Mean fasting gastric pepsin level was significantly higher than mean fasting intestinal pepsin level. Usual intestinal constituent, trypsin, was significantly higher in the small bowel than in the stomach. Mean fasting trypsin level was 70 microg/ml in the intestine, and only 10 microg/ml in the gastric site. Predictive positive value was >90% for all tests; predictive negative value was < 65%. Colors of the gastric aspirates were distinctly different from those observed in intestinal aspirates. CLINICAL IMPLICATIONS: Methods of aspirating fluid from feeding tubes and testing visually or assaying for aspirate characteristics were found to be adaptable from adults to children. The clinical implications of being able to use a test as simple as pH of feeding aspirates means that nurses can easily test these aspirates in any clinical setting using reliable pH test strips, similar to what was done in this study. These data add evidence that suggests indicators of tube location effective in adults are also effective in children.     

Cultural variations in children's coping behaviour, TV viewing time, and family functioning

AIM: To examine children's coping behaviour, TV viewing hours and family functioning in four ethnic groups and factors related to children's coping behaviour. METHODS: This study was part of two larger research projects investigating children's health behaviours in the United States and Taiwan. Fifty-six White American children of European ancestry, 66 Mexican American children, 68 Chinese American children and 95 native Taiwanese children were included in the analysis. Standardized instruments were used to measure coping strategies, children's TV viewing hours and family functioning. RESULTS: There were significant differences in the types of stressor that children of different ethnicity reported. Similarities and differences were found in the four ethnic groups regarding the top five most frequently used and most effective coping strategies. Multiple regressions identified two variables that contributed significantly to the variance in the frequency of children's coping strategies--ethnicity and poorer behaviour control in the family. Ethnicity was the only variable found to contribute to the variance in coping effectiveness. Significant differences were found in the number of hours children spent watching TV. CONCLUSIONS: Findings suggest that children of different ethnicity utilized different types of coping strategies and ethnicity is one of the important factors related to children's coping behaviour. These findings provide evidence for nurses to assess children's coping behaviour and TV viewing and provide children with healthier alternatives.     

Effect of disease-related pain on the health-related quality of life of children and adolescents with cystic fibrosis

OBJECTIVES: The authors' objective was to describe the effect of recurrent pain symptoms on the health-related quality of life (HRQOL) of children and adolescents with cystic fibrosis (CF). Frequent pain, independent of disease severity, was hypothesized to be associated with broad decrements in physical, psychological, and social functioning. METHODS: Forty-six children and adolescents (mean age 12.9 years; 52% female) completed the Cystic Fibrosis Questionnaire-Revised (CFQ-R) to assess their HRQOL and a retrospective pain interview to assess pain location, frequency, intensity, duration, and bother during a routine clinic visit. Forced expiratory volume in 1 second as percent of predicted (FEV1%) was recorded from medical charts to assess the children's disease severity. RESULTS: As hypothesized, pain symptoms were related to children's physical, emotional, and role functioning, CF-related symptoms, and overall perception of their health. Children with frequent pain had significantly reduced physical functioning, vitality, role limitations, and overall perceptions of their health, and increased eating disturbances, treatment burden, respiratory, and digestive symptoms compared with children with no pain or less frequent pain. After controlling for the effects of disease severity, pain frequency continued to predict children's HRQOL in each of these areas. DISCUSSION: Children with frequent CF-related pain experienced broad decrements in their HRQOL. These findings are similar to those found in other populations of children experiencing disease-related pain, suggesting a pervasive impact of pain on overall health and well-being. Future research is needed to evaluate treatments to reduce pain symptoms and improve HRQOL in children with cystic fibrosis.