Objective: The purpose for this research was to conduct a comparative analysis of patterns of coping strength among families with a child or an adolescent with a chronic condition. Design: Mixed methods for the purpose of complimentarity were used to identify and describe family strength in caring for a child or adolescent with a chronic condition. When mixed methods are used to generate complementary data, the aim is to examine overlapping and different facets of the phenomenon. Both quantitative and qualitative data were collected simultaneously; the quantitative methods were dominant. Path analysis was used to test the hypotheses derived from the model. The qualitative methods were used to collect complementary data about the family experiences. Population, Sample, Setting, Years: Two separate samples of families with a child or adolescent with congenital, non-progressive neuromuscular disorders were compared for this study. The first sample was interviewed in 1991 and included 61 families with a child between the ages of six and twelve years. The second sample was interviewed in 1998 and included 37 families with an adolescent between 12 and 19 years. Convenience samples were selected from separate spina bifida clinics at large medical centers in the Eastern United States. Home interviews were conducted with both parents in the younger families and with both parents and the adolescent in the second sample. Concepts or variables studied: Concepts in this study were derived from the Double ABCX model of family adjustment and adaptation. The stressor was conceptualized as the functional status of the child or adolescent; Perception included the family's perceptions of their experiences in caring for a child with a chronic condition. Family resources were conceptualized as general family functioning and adaptation included both behavioral and social adaptation of the child or adolescent. Coping was conceptualized as a bridging concept that linked the family's perceptions of their situation with their resources to manage their situation. Methods: Informed consent was obtained from family members during a routine visit to the clinic and a home visit was scheduled. Four questionnaires were used including the Functional Status Measure (Stein and Jessop, 1991), The Impact on Family Scale (Stein and Reissman, 1980), the family Assessment Device (Epstein, Baldwin and Bishop, 1983), and the Child Behavior Checklist (Achenbach, 1981). Family members responded individually to structured questionnaires and jointly to open-ended questions. Open-ended questions were asked to elicit family members' perceptions of stressors related to caring for a child with a chronic condition, as well as the strengths they realized as a result of caring for their child with a chronic condition. Quantitative Data were coded and analyzed using SPSS. The qualitative data were content analyzed for general themes related to family strengths and family stressors.Data from both samples were analyzed for group differences. Findings: In both samples, the quantitative data provided partial support for the theory of family coping. The qualitative data offered a complementary understanding of family strength in the care of children with chronic conditions. The qualitative data also highlighted differences in family coping between families with children or adolescents with chronic conditions. In both samples, families readily identified how caring for their child or adolescent made them stronger. Families with young children struggled more to identify sources of stress and tended to identify worry about the child's future most predominantly. Adolescent families also described family strength; however, they were more likely to identify stressors in the present or near future. Conclusions: In this study, the interaction of family resources and perceptions provided a view of how families coped with a chronic condition. The use of mixed methods led to a more precise view of the families lives. As the child with a chronic condition matures family patterns of coping also evolve to manage the increasing complexity in care as well as in the family system. Implications: The families' strong beliefs in the positive effects of the condition, as well as the pervasive nature of their worries provided guidance for family directed nursing interventions. The results of this comparative analysis support the need to develop different nursing interventions to support family strength as the family and child matures. With further validation, this knowledge has the potential for use in the development of social, health and science policies related to care of families with children with chronic conditions.
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