stress, coping, social support and adjustment among families

242 Pages·2006·2.54 MB·English

STRESS, COPING, SOCIAL SUPPORT AND ADJUSTMENT AMONG

FAMILIES OF CHD CHILDREN IN PICU AFTER HEART SURGERY

BY

HALA SAIED

ADVISOR

DR. CAROL MARIE MUSIL

Submitted in partial fulfillment of the requirements

For the degree of Doctor of Philosophy

Frances Payne Bolton School of Nursing

CASE WESTERN RESERVE UNIVERSITY

August, 2006
CASE WESTERN RESERVE UNIVERSITY

SCHOOL OF GRADUATE STUDIES

We hereby approve the dissertation of

______________________________________________________

candidate for the Ph.D. degree *.

(signed)_______________________________________________
(chair of the committee)

________________________________________________

________________________________________________

________________________________________________

________________________________________________

________________________________________________

(date) _______________________

*We also certify that written approval has been obtained for any
proprietary material contained therein.
Copyright © (2006) by Hala Saied
All rights reserved

TABLE OF CONTENTS
TABLE OF CONTENTS………………………………………………………………….v
LIST OF TABLES…………………………………………………………………...…viii
LIST OF FIGURES………………………………………………………………………xi
ACKNOWLEDGEMENTS……………………………………………………………...xii
ABSTRACT ……………………………………………………………………………xiii
Chapter Ι: Introduction
Significance of the Problem……………………………………….………………4
Nursing as a Discipline and Meta-paradigm………………………………………8
Purpose of the study ……………………………………………………………..10
Research Questions...…….……………………………………………………....11
Theoretical Model ……………………………………………………………….11
Application of the Resiliency Model to this Study………………………………15
Assumptions……………………………………………………………………...20
Definitions of Terms …………………………………………………………….20
CHAPTER ΙΙ: Literature Review………………………………………………………. 23
Congenital Heart Disease ………………………………………………………..23
Scope of the Problem…………………………………………………….24
Conceptualization of Stress ……………………………………………………...26
Family stress and CHD…………………………………………………..27
Family stress and PICU………………………………………………….32

v
Conceptualization of Coping ……………………………………………………36
Coping and CHD…………………………………………………………38
Family coping and the PICU……………………………………………..40
Conceptualization of social support ...……………………………………….…..43
Social Support and CHD…………………………………………………45
Social Support and PICU………………………………………………...47
Conceptualization of Adjustment ………………………………………….……49
Family Adjustment and CHD……………………………………………50
Family Adjustment and the PICU………………………………………..54
Linkage Between Study Variables……………………………………………….58
Conclusion…………………………………………...…………………………..66
CHAPTER III: Methods ……………………………………………………………......67
Introduction ……………………………………………………………………..67
The Study Design ……………………………………………………………….67
Setting and Sample ……………………………………………………………...68
Procedure for Data Collection …………………………………………………..72
Instrumentation ………………………………………………………………….73
Data Management ……………………………………………………………….81
Data Analysis ……………………………………………………………………83
Research Questions Testing……………………………………………………...84
Protection of Human Subjects…………………………………………………...87

vi
CHAPTER ΙV: Results…………………………………………………………………. 89
Parents’ demographic characteristics ……………………………………………89
Children demographic characteristics ………………………………...................93
Preliminary data analysis ………………………………………………………..94
Analysis of Research Questions …………………………………………………97
CHAPTER V: Discussion ………………………………………...................................125
Stress …………………………………………………………….......................126
Coping ………………………………………………………………………….131
Social support …………………………………………………………………..133
Adjustment ……………………………………………………………………..135
Findings of the Study and the Resiliency Model ………………………….. ….137
Limitations ……………………………………………………………………..138
Implications of the Study for Practice.…………………………………………138
Theory Development …………………………………………………………..140
Implications of the Study for Future Research ………………………………...140
Conclusion……………………………………………………………………...142
Summary………………………………………………………………………..143
APPENDICES………………………………………………………………………….145
REFERENCES…………………………………………………………………………

vii
LIST OF TABLES
Table
1 Parent’s Demographic Characteristics ……………………………………...90
2 Children Demographic Characteristics……………………………………...93
3 Summary of participants scores on major study variables…………………..96
4 Correlations between Family and Child Demographic Variables
(Parent’s Age, Child’s Age, Parent’s Gender, Family Stress,
Social Support, Coping and Adjustment)…………………………………..98
5 Correlation matrix of major study variables………………………………...99
6 Effects of Stress, Coping, Social Support on (FAD General Family
Functioning)………………………………………………………………..100
7 Effects of Stress, Coping, Social Support on Adjustment (FAD
Communication)………………………………………………………..…100
8 Summary of Hierarchical Regression of FAD General on
Intra-family Strain, Stressful Family life Events, PICU Parental stress,
Coping, and Social Support Controlling for Parent’s and Child’s
Demographics (Parent’s Age, Gender, and Child’s Age)………………….103
9 Summary of Hierarchical Regression of FAD General on Family stress,
Coping, and Social Support Controlling for Parent’s and Child’s
Demographics (Parent’s Age and Gender, and Child’s Age, Marital Status,
Child Gender, Prior Surgery)……………………………………………….105

viii
10 Summary of Hierarchical Regression of FAD Communication
on Intra-family Strain, Stressful Family Life Events, PICU
Environmental Stress, Coping, and Social support when Controlling
for Parent’s and Child’s Demographics (Parent’s Age, Gender,
and Child’s Age)……………………………………………………………107
11 Summary of Hierarchical regression of FAD communication on
intra-family strain, stressful life family events, PICU parental stress,
coping, and social support when controlling for parent’s and child’s
demographics (parent’s age and gender, and child’s age, marital status,
child’s gender, and prior surgery)…………………………………………109
11 Summary of Hierarchical Regression of Adjustment (FAD General
Family Functioning) on Intra-family Strain and Social Support with
Intra-family Strain x Support………………………………………………112
13 Summary of Hierarchical Regression of Adjustment (FAD general
family functioning) on Stressful Family Life Events and Social
Support with Stressful Family Life Events x Support…………………….113
14 Summary of hierarchical regression of adjustment (FAD general) on
parental stress in the PICU and social support with PICU environmental
stress x support………………………………………………………….…114
15 Summary of Hierarchical Regression of Adjustment (FAD
Communication) on Stressful Family Life Events and Social Support
with Stressful Family Life Events x Support………………………………115
ix
16 Summary of Hierarchical Regression of Adjustment (FAD Communication)
on Intra-family Strain and Social Support with Intra-family Strain x Social
support………………………………………………………………………116
17 Summary of Hierarchical Regression of Adjustment (FAD Communication)
on PICU Environmental Stress and Social Support with PICU Environmental
Stress x Support…………………………………………………………….117
18 Effects of the Independent Variables on the Mediator Variable
(Social Support)……………………………………………………………118
19 Effects of Intra-family Strain on Adjustment (FAD General Family
Functioning)………………………………………………………………..119
20 Effects of intra-family strain on adjustment (FAD communication)
21 Most Stressful Items Identified by Mothers and Fathers on the Parental
Stressor Scale: PICU (N=74)……………………………………….…..…120
22 Mean Scores for PSS/PICU for Mothers (n = 66) and
Fathers (n = 8)………………………………………………………..……122

x