Susan K. Riesch

Furthering the Understanding of Parent–Child Relationships: A Nursing Scholarship Review Series. Part 4: Parent–Child Relationships at Risk

PURPOSE The purpose of this integrative review is to synthesize nursing scholarship on parent-child relationships considered fragile because of parent-childs chronic condition or occurrence within a risky context. CONCLUSIONS Most reviewed studies demonstrated negative effects of risk conditions on parent-child relationships and documented importance of child, parent, and contextual variables. Studies were predominately single investigations. Varying theoretical perspectives complicated interpretation. Mainly White, middle-class, and small samples limited generalizability. Important areas for further research were identified. PRACTICE IMPLICATIONS Nurse researchers identified factors that may interfere with the parent-child relationship. Nurses are in a position to support families under these circumstances.

Enhancing survey data collection among youth and adults: Use of handheld and laptop computers

Tobacco use, alcohol and other drug use, early sexual behavior, dietary practices, physical inactivity, and activities that contribute to unintentional and intentional injuries are a significant threat to the health of young people. These behaviors have immediate and long-term consequences and contribute to diminished health, educational, and social outcomes. Research suggests that health risk behaviors exhibited during adolescence and adulthood have their origins earlier in childhood and preventive interventions are less successful after the risk behaviors have begun. Therefore, efforts to prevent health risk behaviors are best initiated in late childhood or early adolescence. However, to document the efficacy of these efforts, reliable, valid, and parent/child-friendly systems of data collection are required. Computerized data collection for research has been found to improve privacy, confidentiality, and portability over the paper-and-pencil method, which, in turn, enhances the reliability of sensitive data such as alcohol use or sexual activity. We developed programming tools for the personal computer and a handheld personal data assistant to offer a comprehensive set of user interface design elements, relational databases, and ample programming languages so that adults could answer 261 items and youth 346 items. The purpose of the article was to describe an innovative handheld computer-assisted survey interview method of collecting sensitive data with children aged 9 to 11. The method was developed as part of a large multisite, national study to prevent substance use.

Furthering the Understanding of Parent–Child Relationships: A Nursing Scholarship Review Series. Part 3: Interaction and the Parent–Child Relationship—Assessment and Intervention Studies

PURPOSE This integrative review concerns nursing research on parent-child interaction and relationships published from 1980 through 2008 and includes assessment and intervention studies in clinically important settings (e.g., feeding, teaching, play). CONCLUSIONS Directions for research include development of theoretical frameworks, valid observational systems, and multivariate and longitudinal data analytic strategies. PRACTICE IMPLICATIONS Observation of social-emotional as well as task-related interaction qualities in the context of assessing parent-child relationships could generate new questions for nursing research and for family-centered nursing practice.

Effects of communication training on parents and young adolescents

Two hundred fifty-eight middle school children and their parents attended communication skills training sessions for 6 weeks. Measures of satisfaction with the family system and communication of this group were compared with those of 201 young adolescents and parents who did not attend the sessions. Young adolescents, mothers, and fathers who were trained in communication skills reported increased satisfaction with the family system and open communication immediately and 6 months after training. Young adolescents who were not trained became increasingly dissatisfied with the family system. A subsample of families were observed resolving conflicts. Fathers and young adolescents who were in training used less antisocial and negative problem-solving techniques than those who were not trained. The authors cautiously recommend communication skill training as a “rite of passage” for families with young adolescents.

Students Feeling Unsafe in School: Fifth Graders’ Experiences

Children of late elementary school age (fifth grade) provide evidence that many do not feel safe in their schools. The purpose of this study was to examine how children express their experiences of feeling unsafe in school. Questions guiding the study were What percentage of children in this sample report feeling unsafe at school? What are the aftereffects of feeling unsafe? and How do children describe what makes them feel unsafe? Participants included 243 fifth-grade students who, as part of their participation in a larger study, were asked, “Have you felt unsafe at school?” Children responding affirmatively described what made them feel unsafe. Fifty-seven (23.8%) participants indicated they sometimes or always felt unsafe at school, citing teasing, bullying, or other threats that typically occurred when adults were not present. Of these, nearly a third reported being stressed and almost half felt at slight or great risk because of feeling unsafe. When children feel unsafe in school, there are implications for schools, neighborhoods, and larger communities. The related potential for children’s increased involvement in health risk behaviors because they feel unsafe merits immediate and thoughtfully planned action.

Communication approaches to parent-child conflict: young adolescence to young adult.

As trusted and accessible health care providers, pediatric nurses are asked frequently for advice on the rearing of children and adolescents, particularly during developmental transitions. The parent-adolescent relationship has been characterized as a continuing renegotiation of relational qualities. Aspects of communication, such as conflicts and approaches to them, expose the re-negotiation process. The purpose of this study was to examine how communication approaches and topics of conflict in a parent child relationship evolved over 10 years. Thirty-three families with young adults as children between the ages of 22 and 26 years old responded to a survey about conflict and conflict resolution. Parents and young adults, as respondents, were asked to describe two incidents of conflict. The first incident was a conflict from the past, when the young adult was 11 to 14, and the second incident was a conflict they recently experienced. Inductive analyses were used to substantiate themes from the data. Regarding past topics of conflict, parents and young adults had no difficulty recalling incidents. The approaches to solving the past conflicts were seldom effective. Both parent and teenager were reactive, negative, confrontational, or avoidant. Occasionally, incidents that reflected thinking, planning ahead, and caring were reported. Descriptions of more recent experiences indicated less conflict and more direct and healthy communication approaches; although manipulative, negative, and intimidating tactics were present.

Strengthening families program (10-14): effects on the family environment.

This study examined whether parent–youth dyads participating in the Strengthening Families Program 10-14 (SFP 10-14) would demonstrate greater postprogram family cohesion, communication, involvement, and supervision and if youth would report less alcohol, tobacco, and other drugs involvement in contrast to a comparison group. From 16 randomly selected schools, we recruited 167 parent–youth dyads: 86 from intervention and 81 from comparison schools. The intention-to-treat analysis found one significant change in family environment. Considering dose, it was found that among dyads receiving a full dose, all the outcomes were in the expected direction and effect sizes were moderate. Among dyads receiving a partial dose, 10 of 18 outcomes were in the direction opposite that expected. Youth participation in alcohol, tobacco, and other drugs was very low and did not differ postprogram. Although the expected outcomes were not realized, findings descriptive of dosage effects make a valuable contribution to the field. Study of factors that distinguish intervention completers from noncompleters is recommended.

The Strengthening Families Program 10–14: influence on parent and youth problem-solving skill

The aim of this paper is to report the results of a preliminary examination of the efficacy of the Strengthening Families Program (SFP) 10-14 in improving parent and youth problem-solving skill. The Hypotheses in this paper include: (1) youth and parents who participated in SFP would have lower mean scores immediately (T2) and 6 months (T3) post intervention on indicators of hostile and negative problem-solving strategies; (2) higher mean scores on positive problem-solving strategies; and (3) youth who participated in SFP would have higher mean scores at T2 and at T3 on indicators of individual problem solving and problem-solving efficacy than youth in the comparison group. The dyads were recruited from elementary schools that had been stratified for race and assigned randomly to intervention or comparison conditions. Mean age of youth was 11 years (SD = 1.04). Fifty-seven dyads (34-intervention&23-control) were videotaped discussing a frequently occurring problem. The videotapes were analysed using the Iowa Family Interaction Rating Scale (IFIRS) and data were analysed using Dyadic Assessment Intervention Model. Most mean scores on the IFIRS did not change. One score changed as predicted: youth hostility decreased at T3. Two scores changed contrary to prediction: parent hostility increased T3 and parent positive problem solving decreased at T2. SFP demonstrated questionable efficacy for problem-solving skill in this study.

Health-risk behaviors among a sample of US pre-adolescents: Types, frequency, and predictive factors

BACKGROUND Children as young as 10 years old report curiosity and participation in health-risk behaviors, yet most studies focus upon adolescent samples. OBJECTIVE To document the types and frequencies of health risk behavior among pre-adolescents and to examine the child, family, and environment factors that predict them. METHOD A sample of 297 pre-adolescents (mean age=10.5, SD=0.6) from two Midwestern US cities and their parents (child-parent dyads) provided data about demographic characteristics, health risk behavior participation, child self-esteem, child pubertal development, child and adult perception of their neighborhood, and parent monitoring. Their participation was at intake to a 5-year clustered randomized controlled trial. RESULTS Pre-adolescents participated in an average of 3.7 health-risk behaviors (SD=2.0), primarily those that lead to unintentional (helmet and seatbelt use) and intentional (feeling unsafe, having something stolen, and physical fighting) injury. Factors predictive of unintentional injury risk behavior were self-esteem, pubertal development, parent monitoring, and parent perception of the neighborhood environment. Boys were 1.8 times less likely than girls to use helmets and seatbelts. Pre-adolescents whose parents were not partnered were 2.8 times more likely than pre-adolescents whose parents were partnered to report intentional risk behavior. RECOMMENDATIONS These data demonstrate trends that cannot be ignored. We recommend, focused specifically upon boys and non-partnered families that (a) developmentally appropriate, appealing prevention messages be developed and delivered for parents and pre-adolescents and community interventions targeting both parent and pre-adolescent together be provided to help them establish and monitor behavioral expectations and (b) organized nursing endorse policy in the US and globally that assures adequate family environments for children.

Furthering the Understanding of Parent–Child Relationships: A Nursing Scholarship Review Series. Part 1: Introduction

PURPOSE Understanding the parent-child relationship is fundamental to nursing of children and families. The purpose of this integrative review is to explore nursing scholarship published from 1980-2008 concerning parent-child relationships. Study approaches are examined, critiqued, and future directions for research identified. CONCLUSIONS A historical review of nursing research is presented and methods described as an introduction to a review series of the parent-child relationship. IMPLICATIONS Definition and explication of the parent-child relationship is a first-step in understanding factors amenable to nursing intervention. A clear definition of the concept of parent-child relationship will support further study using appropriate theoretical frameworks, and enable development and testing of supportive nursing interventions.