Children's fear as experienced by the parents of children with cancer

It is known that children with cancer experience and express fear, but little is found in the literature about how the parents experience their child's fear. This study aimed to highlight the parents' lived experience and understanding of their child's fear. Focus group interviews with 15 parents were performed. Data were analyzed through a phenomenological hermeneutic method. Fear in children with cancer is described by the parents as a multidimensional phenomenon, which is somehow difficult to identify. It appears in contrast to the absence of fear. The comprehensive understanding of the results reveals that the parents experience their children's fear as both a suffering and an ethical demand for the parents to answer.     

Common stressors experienced by the well elderly. Clinical implications

The purposes of the article are twofold--first, to report on a study that determined the 10 most commonly experienced stressors in individuals 65 years of age and older, and second, to present nursing interventions for each of the top 10 stressors. The research was conducted on a convenience sample of 200 healthy older adults living in the community using the Stokes/Gordon Stress Scale. The two most commonly experienced stressors were slowing down and concern for world conditions. Others among the top 10 were constant or recurring pain or discomfort, time too short with children or grandchildren, and wishing parts of one's life had been different. Interventions discussed included careful planning of each day's activities, joining discussion groups on world events, participating in a political campaign, using e-mail and other technological communication methods, using reminiscence therapy, and implementing the use of various complementary therapies.     

The role of stressors and coping strategies in the burnout experienced by hospice workers

The helping professions have always been associated with high levels of stress and burnout because of the emotional intensity of the relationships with patients. The nature of hospice work can be both rewarding and challenging. Hospice workers encounter a variety of work- and client-related stressors. The work-related stressors they face include organizational stressors and role ambiguity they experience in their work environment. Social factors make up a third set of work-related stressors. Chronic exposure to these stressors may result in burnout if they are not adequately dealt with. Coping strategies can be divided into 3 categories, namely, problem-focused coping strategies, emotionally focused coping strategies, and ineffective coping strategies. The focus of this research is to determine how the stressors experienced by hospice workers in and outside the working environment as well as the coping strategies adopted by them can be used to predict the extent to which they experience burnout. The findings of this study suggest that hospice workers do experience a great deal of burnout, which affects their work performance and general functioning. The burnout is mainly the result of work-related stressors. Recommendations to alleviate this problematic situation are made.     

A meta-analytic comparison of echocardiographic stressors

Background: The relative performance of alternative stressors for stress echocardiography for the diagnosis of coronary artery disease (CAD) is not well established. Methods: All studies published between 1981 to December 2001 who met inclusion criteria were included in this analysis. We performed a summary receiver operator characteristic (SROC) analysis and calculated weighted mean of the likelihood ratio and sensitivity/specificity. A covariate analysis using meta-regression methods was also performed. Results: Forty-four studies presented data on Exercise, 11 on Adenosine, 80 on Dobutamine, 40 on Dipyridamole, 16 on transatrial pacing transesophageal echocardiography (Tap-TEE), and 7 on transatrial pacing transthorasic echocardiography (Tap-TTE). SROC analysis showed that the following order of most discriminatory to least: Tap-TEE, Exercise, Dipyridamole, Dobutamine and Adenosine. Weighted means sensitivity/specificity were Exercise: 82.6/84.4%, Adenosine: 68.4/80.9%, Dobutamine: 79.6/85.1%, Dipyridamole: 71.0/92.2%, Tap-TTE: 90.7/86.1%, and Tap-TEE: 86.2/91.3%. Covariate analysis showed that the discriminatory power of Exercise decreased with increasing mean age. Conclusions: Tap-TEE is a very accurate test for both ruling in and ruling out CAD although its invasiveness may limit its clinical acceptability. Exercise is a well-balanced satisfactory test for both ruling in and ruling out but performance might be lower for the elderly. Dobutamine offers a reasonable compromise for Exercise. Dipyridamole might be good for ruling in but not for ruling out CAD. The incapability in ruling-out CAD was a major problem in clinical application of the stress. Adenosine was the least useful stressor in diagnosing CAD.     

Coping with pediatric cancer: strategies employed by children and their parents to manage cancer-related stressors during treatment

Pediatric cancer patients and their families face significant physical, emotional, and psychosocial challenges. Few studies have investigated how children manage these challenges and how parents may help in the process. This qualitative study aimed to explore common cancer-related stressors for children and to examine child coping and parental assistance in coping with these stressors during treatment. Fifteen children undergoing cancer treatment and their parents participated in semistructured interviews. Four themes emerged capturing cancer-related stressors: cancer treatment/side effects, distressing emotions, disruption in daily routines, and social challenges. Six themes emerged regarding child coping strategies that were classified within an approach/avoidance coping framework. Approach coping strategies included the following: cognitive restructuring, relaxation, practical strategies, seeking social support, and emotional expression. Distraction was the only avoidant coping strategy. Parents tended to encourage approach coping strategies (eg, cognitive restructuring, social support). Within families, few coping strategies were reported (child: M = 1.47, SD = 0.99; parent: M = 3.33, SD = 1.18), suggesting that early family-based interventions teaching coping techniques for cancer-related stressors may be beneficial.     

Reliability and validity of the Chinese version of the behavioral pain scale in intubated and non-intubated critically ill patients: Two cross-sectional studies

BackgroundSelf-report pain assessment scales may be inappropriate when critically ill patients are incapable of adequate communication because of sedation or mechanical ventilation. The Behavioral Pain Scale (BPS, for intubated patients) and the BPS-non intubated (BPS-NI, for non-intubated patients) measure objective behavioral indicators of pain in non-communicating critically ill patients.ObjectivesTo develop a Chinese version of the BPS combining the original version of the BPS and BPS-NI suitable for pain assessment among critically ill patients and to determine its reliability and validity.DesignTwo cross-sectional studies.SettingsA 15-bed surgical intensive care unit (ICU) in a teaching hospital in Beijing, China.ParticipantsIn the first study, 129 patients (53 intubated and 76 non-intubated) were recruited; in the second study, 83 (43 intubated and 40 non-intubated) were recruited.MethodsThe Chinese version of the BPS (BPS-C) was developed via rigorous translation methods, including double back-translation and content validation involving 13 clinical experts. Internal consistency, discriminative validity, and criterion-related validity were established using the BPS-C and the Numeric Rating Scale (NRS). The BPS-C and NRS were used to assess pain in 53 intubated and 76 non-intubated post-abdominal surgery patients during low pain exposure and increased pain exposure in the first study. To establish interrater reliability, a researcher and a bedside nurse independently performed 172 paired assessments in 43 intubated patients and 160 paired assessments in 40 non-intubated patients with the BPS-C under the same conditions in the second study.ResultsThe BPS-C achieved conceptual and semantic equivalence with the original tool. Internal consistency was established through Cronbach's alpha (α = 0.724–0.743 in intubated patients, α = 0.701–0.762 in non-intubated patients). Interrater reliability was confirmed through the intraclass correlation coefficients (ICCs), which ranged from 0.962 to 1.000 in both intubated and non-intubated patients with high agreement percentages (95.3–100.0% in intubated and 95.0–100.0% in non-intubated patients). BPS-C scores during increased exposure to pain were significantly higher than those obtained during low exposure to pain, indicating discriminative validity. Criterion-related validity was confirmed by strong positive correlations between BPS-C and NRS scores (Pearson's correlations r = 0.815–0.937 for intubated patients, Pearson's correlations r = 0.755–0.899 for non-intubated patients).ConclusionsThe Chinese version of the BPS (BPS-C) is appropriate for pain assessment among intubated and non-intubated ICU patients.     

A comparison of the stress and coping strategies between the parents of children with Duchenne muscular dystrophy and children with a fever

This university hospital-based case control study included 31 parents with a Duchenne muscular dystrophy (DMD) child and 30 parents (control group) of a child with a fever. The study was conducted in southern Taiwan. The study compared the differences of stress and coping strategies between the two groups using closed-ended questionnaires. The control group (fever group) showed higher "stress," "conflict," and "help needs." The DMD subjects had a tendency to use wish-fulfilling fantasy to cope. "Impact" was influenced by income and religion, and income and mother's age influenced coping strategies. Professionals need to manage the parent's conflict, to provide information and resources, and to support the parent's emotional reactions to caring for a child with acute and chronic illness.     

A comparison, by quantitative and qualitative methods, between the self-management behaviors of parents with asthmatic children in two hospitals

This study compared the self-management behaviors of parents with asthmatic children staying in two hospitals and explored barriers to self-management behaviors by interviewing. 227 parents were recruited for quantitative analysis by completing a self-report structured questionnaire, 94 of these parents were from the Taipei area and 133 were from the Taoyuan area. Sixteen parents were interviewed from this population. The results indicated that the parents in theTaoyuan area had younger age, lower socioeconomic status (SES), and higher exercise limitations for children. Their knowledge, enabling factors, and self-management behaviors were also lower than their counterparts in the Taipei area. The determining factors of self-management behaviors were socioeconomic status, self-efficacy, sources of education, and perceived effectiveness (Adjusted R2= .593) in 227 parents. Six major themes about the influencing factors of self-management were deduced from the interview data: lack of understanding and dislike of the asthma label, less self-perceived severity, lack of understanding about asthma medication, lack of confidence in environmental controls, financial burden of anti-mite products, and doubt about effectiveness. Three major barriers to self-management behaviors of parents in the Taoyuan area were inconsistent use of alternative treatments, overdependence on medical service, and lack of use of peak flow meter. Parents with asthmatic children living in the Taoyuan area had poorer self-management behaviors than those in the Taipei area, and SES was one of the determining factors. The health beliefs of Taoyuan parents included many misconceptions. Conducting the educational needs assessment through quantitative and qualitative methods could provide proficiency information for designing educational content appropriate to specific populations.     

出生缺陷儿童父母心理应激因素分析与对策

目的了解出生缺陷儿童父母的心理状态,采取相应措施以提高患儿父母的心理应激能力。方法采用有目的观察法和症状自评量表(SCL-90)进行测评2种途径,对66名患儿父母出现的心理应激反应进行分析。结果出生缺陷儿童父母SCL-90评分明显高于国内常模(P<0.01),存在不同程度的心理应激反应。结论提出相应的心理护理对策,在一定程度上改善了患儿父母的负性情绪,转变了他们消极的应对方式,有利于患儿的康复。     

出生缺陷儿童父母心理应激因素分析与对策

目的 了解出生缺陷儿童父母的心理状态,采取相应措施以提高患儿父母的心理应激能力.方法 采用有目的观察法和症状自评量表(SCL-90)进行测评2种途径,对66名患儿父母出现的心理应激反应进行分析.结果 出生缺陷儿童父母SCL-90评分明显高于国内常模(P＜0.01),存在不同程度的心理应激反应.结论 提出相应的心理护理对策,在一定程度上改善了患儿父母的负性情绪,转变了他们消极的应对方式,有利于患儿的康复.     

Beliefs and feelings experienced by mothers of children under phototherapy

Case study with mothers of newborn babies submitted to phototherapy held in a maternity in Fortaleza, Brazil. The purpose was identifying the mother's beliefs and feelings before the treatment. The data were collected in an interview performed with two open questions about the mother's beliefs and feelings. The result was: 36.5% of the mothers feel fear and sadness; 27.3% with sorrow and fault. Regarding beliefs, 45.5% of the mothers think that the baby feels uncomfortable; 27.3% of the mothers think that the baby is at risk of life. Conclusion: the mothers feel insecurity and unhappiness before the phototherapy treatment and they think that the treatment is uncomfortable for the newborn.     

A comparison of nurses'' and patients'' perceptions of intensive care unit stressors

This study was designed to compare intensive care unit (ICU) nurses' and patients' perceptions of the stressfulness of items in the environment for patients in an ICU. The sample consisted of 20 ICU patients and 23 registered nurses employed in the medical and surgical ICUs at a large midwestern university hospital. The patients were contacted 1 to 2 days after transfer from an ICU and asked to complete the Intensive Care Unit Environmental Stressor Scale (ICUESS), a Likert-type questionnaire designed to measure the stressfulness of commonly occurring items in the ICU environment. The nurses were asked to complete the same questionnaire as they believed an ICU patient would complete it. They were asked to complete the questionnaire after the completion of a shift worked in an ICU. A series of one-way ANOVAs were done to compare the patients' and nurses' responses. In every comparison, nurses rated the items as being significantly more stressful than did the patients. Items with the highest mean ratings by patients were: (1) having tubes in your nose or mouth; (2) being stuck with needles; (3) being in pain; (4) not being able to sleep; and (5) being thirsty. Patients and nurses also were asked to list the three most stressful items from the ICUESS. These responses were compared using chi-square tests for homogeneity. Nurses mentioned 'being tied down by tubes' and 'not being in control of oneself' significantly more times than did patients. The items 'being in pain', 'having tubes in your nose or mouth', and 'not being able to sleep' were listed most often by both nurses and patients.     

对高热患儿家长的健康指导

高热是小儿的常见病症。据调查，90％以上患儿家长缺乏此病症的相关知识，甚至存在认识误区。因此，对高热患儿家长的健康指导尤为重要。给予患儿家长口头讲解结合操作示范，使家长掌握对高热患儿的护理常识，为积极应对疾病提供帮助。     

Health-related stressors experienced by patients who underwent total knee replacement seven days after being discharged home

BACKGROUND: Empirical evidence indicates that the first few weeks after total knee replacement are likely to be stressful for patients. However, no reported studies have examined the type of stressors that individuals encounter during the first few days at home. PURPOSE: The purpose of this study was to describe stressors experienced by patients 7 days post-hospitalization after total knee replacement who were managing their care at home. METHOD: The stressor of most concern to the patient was identified using an open-ended question. Intensity, frequency, and duration of the stressors were measured using five-point Likert response scales. RESULTS: Various stressors were identified, but those of most concern related to pain management and bowel difficulties. Respondents indicated the stressors caused a great deal of concern/worry and occurred daily and most could have been prevented if patients had sufficient self-care knowledge. IMPLICATIONS: The study suggests that preoperative education of patients may need to be improved and that nurses may need to contact patients after discharge to assist them with postoperative problems and concerns.     

A concept analysis of social support as experienced by siblings of children with cancer

Social support is a complex phenomenon. The concept is variably defined by multiple disciplines. This article analyzes the concept of social support by using the methods outlined in the nursing literature. The concept analysis focuses on psychosocial support of siblings of children with cancer. Each step in the concept analysis is presented to show the relevance of the concept with siblings of children with cancer.