Susanne Olsen Roper

Daily stressors and coping responses of children and adolescents with type 1 diabetes.

BACKGROUND Youth with type 1 diabetes cope with a variety of stressors related to daily life and disease management. While previous studies have focused on diabetes-related stressors, little research has examined daily stressors. METHODS In this qualitative descriptive study, daily stressors and coping responses of 19 children and 33 adolescents with type 1 diabetes (65% are female) were investigated. Participants recorded their own stressors and coping responses in daily diaries for 2-3 weeks. RESULTS Five broad themes of daily stressors emerged: people, self, context, no stressor and ambiguous. Coping responses included three general themes: submission, personal responsibility and ambiguous. Younger children reported more stressors related to friends/peers and siblings (people), and adolescents described more stressors related to self, parents (people) and school (context). Younger children used more coping that involved choosing an alternate activity, helping others and an emotional response (taking personal responsibility), whereas adolescents used more coping that involved persistence, alternate thinking and talking things over (taking personal responsibility). CONCLUSIONS Youth with diabetes did not report stressors related to diabetes and its management as major themes in their daily lives. Clinical interventions based on perceptions of how youth understand and cope with stress are explored.

Positive parenting of children with developmental disabilities: A meta-analysis

Although a large body of literature exists supporting the relationship between positive parenting and child outcomes for typically developing children, there are reasons to analyze separately the relevant literature specific to children with developmental disabilities. However, that literature has not been synthesized in any systematic review. This study examined the association between positive parenting attributes and outcomes of young children with developmental disabilities through meta-analytic aggregation of effect sizes across 14 studies including 576 participants. The random effects weighted average effect size was r=.22 (SE=.06, p<.001), indicative of a moderate association between positive parenting attributes and child outcomes. Publication bias did not appear to be a substantial threat to the results. There was a trend for studies with more mature parents to have effect sizes of higher magnitude than studies with young parents. The results provide support for efforts to evaluate and promote effective parenting skills when providing services for young children with disabilities.

Type 1 diabetes: children and adolescents’ knowledge and questions

AIM This paper is a report of a study conducted to describe what children and adolescents who have type 1 diabetes know and want to know about the disease. BACKGROUND Research indicates that young peoples knowledge of diabetes may minimize their health complications, because with greater knowledge they may engage in more effective management practices and adherence. METHODS In this qualitative study, a purposive sample of 58 children and adolescents with type 1 diabetes were interviewed in 2005 about what they knew and wanted to know about their disease. Through a process of induction, major themes were identified from the data. FINDINGS The six major themes were: (a) Care, including both physical and emotional care, (b) Physiology, (c) Consequences, including both short- and long-term, as well as positive and negative consequences, (d) Cure, (e) Effects on the Family and (f) Experience at Diagnosis. Themes related to the unique challenges associated with type 1 diabetes were also identified. CONCLUSION Nurses, diabetes educators and parents should provide developmentally appropriate information about diabetes care and management, scaffolding on existing knowledge. They should provide child-centred contexts in which children and adolescents can freely ask questions about their condition and problem-solve. Programmes that allow young people to develop coping skills and share experiences could also prove beneficial.

Metabolic Control, Self-care Behaviors, and Parenting in Adolescents With Type 1 Diabetes A Correlational Study

Purpose The purpose of this pilot study was to explore relationships among metabolic control, self-care behaviors, and parenting in adolescents with type 1 diabetes. Methods Twenty-nine adolescents (mean age, 14.1 years) and their parents participated. Metabolic control was determined by an average of 4 A1C values taken prior to study enrollment; self-care behaviors were measured with a 12-item self-report questionnaire; parenting style was evaluated using the Parenting Practices Report. Results The mean for A1C values was 8.5%; the mean for overall self-care behaviors was 4.93 (5 = usually). Participants rated themselves highest on the self-care behaviors of giving insulin shots when indicated and adjusting insulin when eating a lot. They ranked themselves lowest on eating a low-fat diet and testing urine for ketones. Parents tended to be more authoritative in their approaches to parenting than either authoritarian or permissive. A significant relationship was found between authoritative mothering and adolescent self-care behaviors and metabolic control. Regression analyses controlling for age and length of time with diabetes confirmed the significance of these relationships. Authoritative fathering positively correlated with the self-care behaviors of monitoring blood glucose, taking insulin, and not skipping meals. A relationship was also noted between permissive parenting by mothers/fathers and poorer metabolic outcomes. However, the permissive parenting correlations did not remain significant when controlling for age and length of time with diabetes. Conclusions Clinicians may help prevent declining participation in self-care behaviors and metabolic control in adolescents with type 1 diabetes by working with parents, particularly mothers, and encouraging authoritative parenting.

Older couples' management of multiple-chronic illnesses: Individual and shared perceptions and coping in Type 2 diabetes and osteoarthritis.

Using data from interviews with 28 older couples in which 1 spouse was diagnosed with diabetes and osteoarthritis, we examined illness perceptions and coping activities as they relate to illness management and relationship resilience. Qualitative analysis of interview transcripts revealed categories of data related to perceptions, coping, and cross category comparisons. Findings suggest that couples experience both negative and positive perceptions of their illnesses, indicating a balance between the reality of their illness challenges and an optimistic outlook of the future. Coping activities included a variety of tasks and were performed by individuals, by both spouses in a shared effort, and by individuals and shared couple efforts. Findings highlight the complexity of individual and shared couple illness perception and couple efforts in managing multiple-chronic illnesses.

Parental perceptions of sibling relationships in families rearing a child with a chronic condition.

This study examined sibling relationships in families raising children with autism, Down syndrome, orthopedic conditions, and diabetes. Parents from 108 families independently completed the 28-item Schaefer Sibling Inventory of Behavior. Parents rated siblings as very empathetic, fairly often kind and involved, and rarely avoidant. Mothers rated sibling empathy higher than fathers did and older siblings more avoidant than younger siblings. Fathers rated male siblings kinder than female siblings; they also rated siblings of children with Down syndrome or autism more kind and involved than siblings of children with orthopedic conditions or diabetes. Sibling intervention efforts should consider these findings and be individualized according to the need of each child and family.

Images of life: siblings of children with Down syndrome.

This qualitative, descriptive study used photography to capture important symbols in the lives of 16 siblings living in families raising a child with Down syndrome (CWDS). Content analysis revealed two categories: people/nonpeople. The people category included family members and friends, whereas the non-people category included objects, animals, and buildings. Similarities/differences also were noted according to age and gender. Seven- to 9-year-olds took more snapshots of themselves and their parents than did the other age groups; the 10-to 12-year-olds and 13- to 15-year-olds took more photographs of the CWDS than did the younger age group. Female siblings took more snapshots of their typically developing brothers/sisters, family members in mixed groups, and people not in their family than did male siblings. Male siblings took more photographs of their parents and themselves. Results validate the importance of gathering qualitative data from children and confirm the use of photography as one of these methods.

Perspectives of Adolescent Siblings of Children With Down Syndrome Who Have Multiple Health Problems

Authors of this qualitative descriptive study interviewed 21 adolescent siblings of children with Down syndrome (DS) who also had additional health problems rated as requiring extensive care by parents. Analysis revealed positive/negative aspects of the experience; however, participants emphasized the positive rather than negative experiences and focused more on the fact that the child had DS rather than health problems requiring additional care. Most said they would not change anything about their experience and did not believe the child with DS would ever live independently. They did, however, acknowledge their family was affected by the caregiving needs of the child which often required extra vigilance or specific care depending on the health problem. Information gained can help improve understanding of adolescent sibling perceptions about living with a child with DS who also requires additional care because of ongoing health problems so more appropriate and individualized nursing interventions can be provided.

Religiosity, spirituality, and marital relationships of parents raising a typically developing child or a child with a disability.

In order to discover if differences or relationships exist between religiosity, spirituality, and marital relationships, 111 parents raising a child with a disability (CWD) and 34 parents raising typically developing children independently completed self-report questionnaires assessing religiosity, spirituality, and marital relationships. Parents raising typically developing children scored higher on private and public religiosity and marital satisfaction than parents raising a CWD; mothers scored higher on religiosity variables than fathers. Mothers’ ratings of spirituality and family type (disability or typically developing child) predicted their ratings of marital conflict. Higher spirituality and raising typically developing children were associated with higher ratings of marital satisfaction for both mothers and fathers. However, spirituality also moderated the relationship between private/public religiosity and marital satisfaction only for fathers. This information helps improve interventions for families raising CWD and adds to the literature on the interplay of religiosity/spirituality/marital relationship.

Infidelity Secrets in Couple Therapy: Therapists’ Views on the Collision of Competing Ethics Around Relationship-Relevant Secrets

Infidelity is a common presenting problem in marriage and family therapy, and infidelity secrets are its common companion issue. When confronted with infidelity secrets, therapists encounter tension between the offending spouses privacy and confidentiality rights and the non-offending spouses right to relationship choice, which entails access to all relationship-relevant information. Professional ethical codes for relational therapy affirm both confidentiality considerations and equal advocacy for all persons in therapy. A relational therapy practice policy about disclosure of infidelity secrets is both critical and simultaneously fraught with tensions among competing accountabilities. A survey design was employed to investigate therapists’ attitudes concerning the relational impact of infidelity secrets and their judgments concerning how they should be handled in relational therapy. Findings reveal that relational therapists’ clinical judgment is that healing and attachment security are best promoted by disclosure, and that therapists support facilitated disclosure of infidelity in a context of informed, voluntary consent.