Ida M. Martinson

Caring for dying children: a comparative study of nurses' experiences in Greece and Hong Kong.

The purpose of this transcultural descriptive study was to explore the subjective experiences of 63 oncology and critical care nurses who provide care to dying children in Greece and Hong Kong. Semistructured interviews were conducted with 39 Greek and 24 Chinese nurses who described their experiences and responses to the dying process and death of children. The data were analyzed qualitatively and quantitatively, and nurses’ responses were compared for their work setting (oncology versus critical care) and their ethnic background (Greek versus Chinese). Findings revealed that most nurses experience a sense of helplessness when caring for a dying patient and difficulties in their communication with the child and parents during the terminal phase of the disease. The large majority acknowledge that the impending or actual death of a patient elicits a grieving process, which is characterized by a fluctuation between experiencing and avoiding loss and grief. Greek and Chinese nurses differ in their expression of their grief and how they attribute meaning to childhood death. Despite the suffering caused by multiple deaths, nurses report significant rewards from caring for chronically and acutely ill children, and the majority are satisfied with their job, despite the difficulties they encounter, in both countries, mostly as a result of shortage in personnel and cooperation problems with physicians.

The empty space phenomenon: The process of grief in the bereaved family

Abstract Forty-nine families who experienced a death following childhood cancer were interviewed 7–9 years after the death. Interviews were analyzed using grounded theory technique for qualitative data for the purpose of examining the long-term responses of families to childhood death. In contrast to bereavement theories which claim that grief is usually resolved within two years, findings of this study suggest that many parents and siblings still experience pain and loss after 7–9 years. Analysis suggests that the death of a child creates an “empty space” for surviving family members. Three patterns of grieving were described by family members in response to this sense of emptiness: “getting over it,” “filling the emptiness,” and “keeping the connection.” Differences and similarities of these patterns are enumerated. The perceived significance of the relationship to the pattern of grief is hypothesized. Situations which stimulate a recurrence or continuation of the “empty space” are suggested and changes...

Perceived stress and support of the Chinese postpartum ritual "doing the month".

Abstract “Doing the month” is the traditional ritual for Chinese postpartum women. A qualitative study involving in-depth interviews with 20 Hong Kong Chinese women was conducted to examine the womens perceptions of stress and support in “doing the month.” Four central themes were identified as follows: bound by the environmental constraints, difficulties in following the proscriptions of the rituals, conflicts between the parties involved, and attainment of the maternal role. The study revealed that “doing the month” is not necessarily protective and supportive of the postpartum women. It raises the critical question of how women can adapt the ritual to fit modern life. The study findings suggest that midwives and health care providers should provide culturally appropriate advice for new mothers. Suggestions are given on bridging the gap between traditional and modern postpartum practices.

Empowerment of Chinese patients with cancer through self-help groups in Hong Kong.

This study was conducted to identify the process and outcomes of empowerment as experienced by Hong Kong Chinese patients with cancer through participation in cancer self-help groups. The study involved in-depth individual interviews of self-help group members (n = 12) and participant observation of the group meetings over a period of 6 months. The empowered outcomes at a personal level included interconnectedness, confidence and hope, support and affirmation, and a feeling of usefulness. At a social level, expanded social network and opportunities to participate in more activities were reported. Collective efficacy also was demonstrated, although this happened only occasionally through participation in the group. One main theme that runs through the process of participation is empowerment among the members. On the basis of the efficacy demonstrated by self-help groups in this study, nurses should strongly consider referral of patients to such groups. Self-help groups serve as an important resource for patients with cancer in the Hong Kong Chinese community.

Comparison of Chinese and Caucasian families caregiving to children with cancer at home: Part I.

This 1-year, longitudinal comparative study of Chinese and Caucasian family caregiving for a child with cancer is reported in two parts. Part I describes data obtained from the initial interviews at diagnosis with Chinese and Caucasian families. Interviews revealed that Chinese families use supplemental care methods, Chinese families have fewer resources and are more isolated; Caucasian families emphasize emotional care; and family emotional coping patterns differed between the two groups. Measures of functional status of the child, the impact of the childs illness on the family, the symptomatic responses of the parents to the childs illness, and patterns of caregiving were also analyzed over the first year after diagnosis. There were no statistical differences between ethnic groups. General health was lower for the children with cancer than for chronically ill children. Part II reports on the results from the two following interviews during the first year after diagnosis.

Individual Empowerment among Chinese Cancer Patients in Hong Kong

Among the various chronic diseases, cancer is the leading cause of death in Hong Kong. This article presents the process of how cancer patients are being enabled and strengthened to overcome powerlessness based on the interviewfindings of 12 participants. Interviews were analyzed using constant comparison. The basic social process of empowerment included finding meaning in life, seeking mastery over illness, and acceptance of illness. This study’s unique findings suggest that the process of empowering cancer patients consists of more than giving patients control, choice, or resources, such as knowledge and skills. Nurses have an important role in facilitating patients to find meaning in life, as well as in the transformation of thoughts and attitudes. Nurses’ personal qualities and skills embedded in the nurse-patient relationship constitute an important source of empowerment for patients.

Parental depression following the death of a child

Abstract Forty mothers and 26 fathers were examined for depression 2 and 7 years after the death of a child from cancer. There was no difference between parental depression at 2 and 7 years; however, 22% of the variance in parental depression at 7 years was accounted for by depression at 2 years. Both times, parental depression was unrelated to either the gender of the parents or the length of the childs illness. The findings suggest that parental depression following the death of a child from cancer does not change significantly between the second and seventh years postdeath in the natural course.

Common themes and ethnic differences in family caregiving the first year after diagnosis of childhood cancer: Part II

Chinese immigrant and North American white family caregiving for a child with cancer was compared in a 1-year study. This second of a two-part report describes interview results after first remission and at 1-year postdiagnosis. (The first part reported results of the initial interview and family function, symptom and caregiving inventories administered at diagnosis and at first remission). In follow-up interviews, the ill child remained the family priority in both groups, with sequelae for siblings and parents. All children were physically well cared for, with strict adherence to Western medical protocols. Cultural differences and immigrant status contributed to lower verbal expression of distress, more isolation, and lower attention to emotional distress for the Chinese. Caregiving emphases were dietary for the Chinese; emotional for the Caucasians. Differences over time in family caregiving and coping were determined by demands of care and evolving expertise. Care inclusive routines were established by most families by the second interview, in spite of extent of continued difficulties. Emotional care demands, concern for needs of siblings, and marital conflict increased over time. At 1 year, all families complained of emotional and physical fatigue and the need to adapt to a tentative future with their child.

Behavioral responses of healthy chinese siblings to the stress of childhood cancer in the family: A longitudinal study+

Advances in the treatment of childhood malignancies have dramatically altered survival rates of children with cancer, changing the nature and scope of stressors that their families encounter. Very little is known about how childhood cancer affects healthy Chinese siblings and what can be done to help children adjust to this stressful life event. The cognitive theory of psychological stress was the framework for this study. The purpose of this research was to explore behavioral responses of healthy Chinese siblings in Taiwan to childhood cancer in the family and to examine the factors that may contribute to the presence or absence of behavioral problems in these siblings, using a 12-month longitudinal data set. Forty-five Chinese families were selected through referrals and a cancer foundation name roster. Content analysis of qualitative and quantitative sibling data revealed major stressor themes of inadequate knowledge, reduced family communication, and insufficient support. Healthy Chinese siblings showed significantly more behavior problems and fewer social competence behaviors than a standardized normal western population.

DISTRESS SYMPTOMS AND SUPPORT SYSTEMS OF CHINESE PARENTS OF CHILDREN WITH CANCER

This study focused on the physiopsychological reactions to the stress of parents of children with cancer in China. Eighty-nine families who had a child with cancer were recruited into four groups: group A, the child was newly diagnosed with cancer; group B, the child was under treatment for cancer; group C, the child had relapsed and was not expected to live; and group D, the child with cancer had already died. Interviews were conducted in Cantonese. The semistructured interviews were conducted in the hospital or in the home. Specific questions were asked regarding colds, headaches, dizziness, loss of appetite, and weight loss. The Parent Stress Rating Scale (PSRS) and the Parents Support Scale (PSS) were administered. Results indicated that parents most often reported symptoms of loss of appetite, weight loss, and sleeping difficulty, followed by headache, dizziness, and, least of all, colds. Mothers experience more symptoms than fathers. Only in the newly diagnosed group and the under treatment group did the fathers report having had more colds than the mothers. Parents rated the childs death as having caused the highest stress, followed by the terminal stage and the diagnosis. Spouses received the highest rating for being supportive, across all groups.