INTRODUCTION:
Stress is a part of life. A death in the family, the birth of a baby, moving, taking a vacation, getting a job promotion, arguing. all of these common occurrences are stressful. Since stress can’t be excised from the life experiences, it is very important to learn how to deal with it. Research shows that it isn’t necessarily the nature of the stressor that drives people to dizzying heights of fist- clenching, jaw- grinding, cold- sweating states of stress and panic. The key factor is one’s response to a stressful situation. Different people respond differently to stressors. One person may calmly face moving day, while another person (in same situation) might be totally wiped out by the stress that moving induces. So the ability to manage the stressors that bombard us daily is of utmost importance.
Stress is a major health issue that is always seen as the cause for the many health problems. Stress is associated with certain particular life events such as financial crisis, overwork, physical health problems and family problems. The concept of stress is as old as life. Hippocrates taught that disease is not only suffer (pathos) but also toil (ponos), that is the fight of the person to regain normality. However, too much stress can result in poor judgment, physical illness and inability to cope. (Laben Y.M. 2002)
Hanse Selye is generally considered as the father of stress research who introduces the concept of stress in 1936, and further did elaborate work on the subject. Selye defined stress as the non specific response of the body to any demand regardless of its nature. This response included a series of physiologic reactions that he labelled as general adaption syndrome, which has three stages Alarm, Resistance, and Exhaustion. During the alarm stage, physiological mechanisms in the body are mobilized so that the person can deal with whatever is threatening homeostasis. During the resistance stage, the person is adapting to the stressor and is trying to return to a stage of equilibrium. The stage of exhaustion occurs when the body stressor is overwhelming in the intensity or duration and the person no longer has the resources to handle the situation. (H. Selye)
One such stressful situation is children being admitted in the hospital. Parents of the children who are admitted in the hospital are at increased risk for psychological distress. A child's illness has an impact on the entire family. It may affect the economic functioning of a family by altering the employment pattern and earnings of parents. Children with disabilities are more likely to need continuous care and supervision of the parents and repeated hospitalization. Hospitalization of a child puts lot of burden on the parents in terms of psychological, financial, physical, social and environmental. (Gopal Singh, Raman Kalia)
Various kinds of the coping strategies can be used by the parents such as prayer, getting support from NGO’s, support from friends, writing diary, listen to music, reading novels and magazines and certain maladaptive coping strategies such as try to feel better by taking drugs, taking alcohol, blaming their fate, try to feel better by smoking, etc. The coping strategies used by the parents may be adaptive or maladaptive. Coping strategies are adaptive when they protect the individual from harm (or additional harm) or strengthen the individual’s ability to meet challenging situations. Adaptive responses help restore homeostasis to the body and impede the development of disease of adaption. Coping strategies are considered maladaptive when the conflict being experienced goes unresolved or intensifies. Energy resources become depleted as the body struggles to compensate for the chronic physiological and psychological arousal being experienced. The effect is a significant vulnerability to physical or psychological illness.
NEED OF THE STUDY:
Illness and hospitalization are a frequent occurrence in the lives of the children and their families. In an average, children of 1-3 years of age suffer from 7-9 illnesses per year and children of 9-10 years of age suffer four illnesses per year. Due to illness more than four million children are hospitalized per year.
Parenthood is an experience that requires changes. When a person becomes a parent it is always necessary to adjust to a new way of life. Having a child who is ill or with serious disability, causes stress and there are difficulties of adjustment and other problems among the parents (Margaret .M, 2003)
Riddle conducted a study in the paediatric unit to assess the stress level among the parents of children. Total sample of 150 parents were selected by using purposive sampling technique. Results revealed that both the parents had moderate stress level also find that mothers were having higher stress level than fathers. Altered parent and child relationships were perceived as more stressful than the other dimensions of the paediatric unit environment.
OBJECTIVES:
1. To assess the level of stress among the parents of children admitted in paediatric ward.
2. To assess the coping strategies among the parents of children admitted in paediatric ward.
3. To find out the correlation between the level of stress and coping strategies among the parents of the children admitted in paediatric ward.
4. To find out the relationship of the level of stress among the parents of children admitted in paediatric ward with selected demographic variables such as age, gender, education, occupation, marital status, income of family per month, type of family, size of family, duration of stay in hospital and diagnosis of the child.
5. To find out the relationship of coping strategies used among the parents of children admitted in paediatric ward with selected demographic variables such as age, gender, education, occupation, marital status, income of family per month, type of family, size of family, duration of stay in hospital and diagnosis of the child.
6. To prepare the guidelines for the parents to cope up positively with the stress.
METHODOLOGY:
Research approach - Quantitative research approach
Research Design - A non experimental, exploratory research design
Research Setting - The study was conducted in selected hospital of Ludhiana, Punjab. The selected hospital was Deep Hospital which is located at 481, Model Town near Montgemy Chowk, Ludhiana, Punjab.
Sampling Technique - Convenient sampling technique
Sampling Criteria - Inclusion criteria:
· Parents (either father or mother) whose children were from age of 4 to 12 years and were admitted in the paediatric wards of the selected hospital.
· Parents (either father or mother) who were willing to participate in the study.
· Parents (either father or mother) who were present at the time of study.
Exclusion criteria
· Parents (either father or mother) who were not willing to participate in study.
· Parents (either father or mother) whose children were seriously ill and had undergone any surgery.
· Parents (either father or mother) whose children were admitted in NICU or PICU.
Sample - Sample size was calculated by power analysis method and the figure was 100.
Development and Description of Data Collection Tool
The tool used in the study was divided into:
Part I – Socio demographic variables tool.
Part II – Stress Assessment Scale was used to assess the stress level.
Part III – Modified Coping checklist was used to assess the coping strategies.
Description of tool
Part I – Demographic tool
It consists of age, gender, education, occupation, marital status, income of family per month, size of family, type of family, duration of stay in hospital, diagnosis of child.
Part II – Stress Assessment Scale
Self structured questionnaire was used to assess level of stress among the parents of children admitted in paediatric ward. It is a likert scale of total 30 items with 3 alternatives as always (3), sometimes (2) and never (1).
Criterion measurement
Scoring of stress scale
|
SCORE |
LEVEL OF STRESS |
|
30 – 50 |
Mild stress |
|
51 – 70 |
Moderate stress |
|
71 – 90 |
Severe stress |
Part III – Coping checklist:
Modified coping checklist was used. A standardized coping checklist was originally formed by Dr. Kiran and Dr. Prabhu, Subha Krishna and Prof. G.G. Prabhu (1989), NIMHANS, Bangalore to identify coping strategies (Coping Mechanisms) used by Indians. It consists of 76 items. After pilot study the tool was modified and some items were deleted as these items were not applicable to the study. Modified coping checklist consists of 68 statements (39 adaptive and 29 maladaptive coping strategies) items to assess the coping strategies with 2 alternatives Yes or No. Adaptive coping was score as Yes = 1, No = 0 and maladaptive coping was scored as Yes = 0, No = 1.
Criterion measure
|
Coping strategies |
Scores |
|
Adaptive coping |
≥ 35 |
|
Maladaptive coping |
≤ 34 |
Content Validity:
Content validity was done by obtaining the valuable opinions and suggestions from the experts in psychiatric field such as Psychiatrist, Clinical Psychologist, Professors and Assistant Professors in Mental Health Nursing, Community Health Nursing, Obstetric and Gynaecological Nursing. Opinions were also taken from lecturers in Medical Surgical Nursing and Paediatric Nursing.
Reliability of the Tool:
Reliability was calculated by applying split half method and Karl Pearson’s correlation coefficient.
The reliability of stress scale was 0.82. Hence the tool was reliable.
The reliability of coping checklist was found 0.83. Hence the tool was reliable.
DISCUSSION:
Based upon the findings from the analysis of data and review of literature discussion was done according to the objectives of the study.
Objectives 1:
To assess the level of stress among the parents of children admitted in paediatric ward.
The findings of the study revealed that 66% of parents had moderate level of stress and 32% of the parents had mild stress and only 2% of the parents had severe stress.
Objective 2:
To assess the coping strategies among the parents of children admitted in paediatric ward.
The findings reveal that 64% of the parents whose children were admitted in the Paediatric Ward were using adaptive coping strategies and only 36% were using maladaptive coping strategies.
Objective 3:
To find out the correlation between the level of stress and coping strategies among the parents of the children admitted in paediatric ward.
The findings reveal that there was negative correlation between stress and coping among the parents of children admitted in the paediatric ward of the hospital.
Objective 4:
To find out the relationship of the level of stress among the parents of children admitted in paediatric ward with selected demographic variables such as age, gender, education, occupation, marital status, income of family per month, type of family, size of family, duration of stay in hospital and diagnosis of the child.
Analysis of the findings related to age depicts that maximum (55.33) mean stress score was in parents of age group 24.1 – 29 years and least (53.50) were in age group of 29.1 – 35. The tabulated value for df (3/96) is 2.68 and calculated value F = 0.223, which is less than the tabulated value, which is non significant. Hence it was concluded that age of parents had no impact on level of stress regarding the admission of the children in paediatric ward.
Analysis of findings related to gender depicts that mean stress score was higher in females (54.88) followed by mean stress score of males (54.32). The mean stress score of both groups were compared and found to be non-significant. Hence it was concluded that gender had no impact on level of stress among parents of children admitted in paediatric ward.
Analysis of findings in relation to education depicts that maximum mean stress score was in the parents who were secondary (55.23) and graduate and above had lowest mean stress score (53.53). The tabulated value for df (3/96) is 2.68 and calculated value F = 0.20. The calculated value was less than the table value, which was non-significant. Hence it was inferred that education had no impact on level of stress among parents of children admitted in paediatric ward.
Analysis of findings related to occupation depicts that mean stress score was higher in the parents who were laborer (56.42) and who were in business had a lowest mean stress score of (52.42). The tabulated value for df (4/95) was 2.45 and calculated value F = 0.33, which was less than the tabulated value, which was non-significant. Hence it was inferred that occupation had no impact on level of stress among parents of children admitted in paediatric ward.
Analysis of findings according to marital status depicts that the mean stress score was higher in the parents who were widow/widower (56) than those who were married (54.55). Hence it was concluded that marital status had no impact on the level of stress among the parents of children admitted in the paediatric ward.
Analysis of findings related to income of family per month depicts that maximum mean stress score was in parents whose family income per month was less than Rs.20000 (56.77) and least (53.97) in the parents whose family income was Rs.20000 – 40000. The tabulated value for df (2/97) is 3.07 and calculated value F = 0.69, which was less than the tabulated value, which was non-significant. Hence was concluded that income of family per month had no impact on level of stress among parents of children admitted in paediatric ward.
Analysis of findings according to type of family depicts that the mean stress score was higher in nuclear families (54.79) than in joint families (54.45). The mean stress score of both groups of type of family were compared and found to be non-significant. Hence it was concluded that type of family had no impact on level of stress among parents of children admitted in Paediatric ward.
Analysis of findings related to size of family depicts that maximum mean stress score was in parents with more than 8 family members (57.91) and the least in those who had 5-8 family members (53.85). The tabulated value for df (2/97) was 3.07 and calculated value F = 0.827, which was less than the tabulated value, which was non- significant. Hence it was concluded that size of family had no impact on stress level among the parents of children admitted in paediatric ward.
Analysis of findings related to duration of stay in hospital depicts that maximum mean stress score was higher in those whose stay in the hospital was between 2- 4 days (55.07) and minimum in those whose stay was between 5 -7 days (54.28). The mean stress score of both the groups of stay in the hospital were compared and found to be non-significant. Hence it was concluded that stay in the hospital had no impact on the level of stress among the parents of children admitted in paediatric ward.
Analysis of findings related to diagnosis of the child depicts that maximum mean stress score was in parents of children with diagnosis of Fever (57.20) and least with diagnosis of Diarrhea (52.29). The tabulated value for df (3/96) was 2.68 and calculated value F = 1.197, which was less than the tabulated value, which was non- significant. Hence it was concluded that diagnosis of the child had no impact on stress level among the parents of children admitted in paediatric ward.
Objective 5:
To find out the relationship of coping strategies used among the parents of children admitted in paediatric ward with selected demographic variables such as age, gender, education, occupation, marital status, income of family per month, type of family, size of family, duration of stay in hospital and diagnosis of the child.
Analysis of findings related to age depicts that maximum mean coping score was in parents of age group 29.1 – 35 years (41.35) and least were in age group of 24.1 – 29 years (38.97). The tabulated value for df (3/96) is 2.68 and calculated value F = 0.703, which is less than the tabulated value, which is non-significant. Hence it was concluded that age of parents had no impact on coping strategies used among the parents of children admitted in paediatric ward.
Analysis of findings related to gender depicts that the mean coping score was higher in males (54.32) followed by mean coping score of females (40.04). The mean coping score of both groups were compared and found to be significant at p≤0.05 level. Hence it was concluded that gender had an impact on coping strategies among parents of children admitted in paediatric ward.
Analysis of findings according to education depicts that maximum mean coping score was in the parents who were primary (40.73) and secondary had least mean coping score (39.26). The tabulated value for df (3/96) is 2.68 and calculated value F = 0.302. The calculated value was less than the table value, which was non-significant. Hence it was inferred that education had no impact on coping strategies used among the parents of children admitted in paediatric ward. Analysis of findings related to occupation depicts that maximum mean coping score was in the parents who were in business (42.14) and labourer had lowest mean coping score (38.71). The tabulated value for df (4/95) is 2.45 and calculated value F = 0.230. The calculated value was less than the table value, which was non-significant. Hence it was inferred that occupation had no impact on coping strategies used among the parents of children admitted in paediatric ward.
Analysis of findings related to marital status depicts that maximum mean coping score was in the parents who were married (40.10) than those who were widow/widower (40.00). The mean coping score of both groups were compared and found to be non-significant. Hence it was concluded that marital status had no impact on the level of coping among the parents of children admitted in the paediatric ward.
Analysis of findings related to income of family per month depicts that the mean coping score was higher in parents whose family income per month was more than and equal to Rs.40001 (43.42) and lowest (38.90) in the parents whose family income was less than and equal to Rs. 20000. The tabulated value for df (2/97) is 3.07 and calculated value F = 1.030, which was less than the tabulated value, which was non-significant. Hence was concluded that income of family per month had no impact on coping strategies among parents of children admitted in paediatric ward.
Analysis of findings according to type of family depicts that the mean coping score was higher in nuclear families (40.44) than in joint families (39.84). The mean coping score of both groups of type of family were compared and found to be non-significant. Hence it was concluded that type of family had no impact on coping strategies among parents of children admitted in Paediatric ward.
Analysis of findings according to size of family depicts that maximum mean coping score was in parents with less than and equal to 4 family members (40.75) and the lowest in more than 8 family members (37.25). The tabulated value for df (2/97) was 3.07 and calculated value F = 1.101, which was less than the tabulated value, which was non- significant. Hence it was concluded that size of family had no impact on coping strategies among the parents of children admitted in paediatric ward.
Analysis of findings according to duration stay in hospital depicts that the mean coping score was higher in those whose stay in the hospital was between 2- 4 days (40.32) than those whose stay was between 5 -7 days (39.95). The mean coping score of both the groups of stay in the hospital were compared and found to be non-significant. Hence it was concluded that stay in the hospital had no impact on coping strategies among the parents of children admitted in paediatric ward.
Analysis of findings according to diagnosis of the child depicts that maximum mean coping score was in parents of children with diagnosis of Diarrhea (40.95) and the lowest with other diagnosis (39.50). The tabulated value for df (3/96) was 2.68 and calculated value F = 0.180, which was less than the tabulated value, which was non- significant. Hence it was concluded that diagnosis of the child had no impact on coping strategies among the parents of children admitted in paediatric ward.
CONCLUSION:
On the basis of results of data analysis the following conclusions were drawn.
· There was statistically significant impact of gender on coping strategies among the parents of children admitted in paediatric ward. It was concluded that males had higher adaptive coping strategies.
· There was statistically no significant impact of age, gender, education, occupation, marital status, income of family per month, type of family, size of family, duration of stay in hospital and diagnosis of the child on level of stress among the parents of children admitted in paediatric ward.
· There was statistically no significant impact of age, education, occupation, marital status, income of family per month, type of family, size of family, duration of stay in hospital and diagnosis of the child on coping among the parents of children admitted in paediatric ward.
· Maximum parents were using adaptive coping strategies which were praying to god, try to look on the bright side of the things, spend time in the company of children, talking to some family member who can do something concrete about the problem, accept it since nothing can be done, attend the religious talks.
· Maximum maladaptive coping strategies used by the parents were wish that they can change what has happened, keeping their feelings to themselves, read novels, magazines etc. much more than usual and feel that remedy to things; the only thing to do is wait
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Received on 31.01.2017 Modified on 29.03.2017
Accepted on 20.06.2017 © A&V Publications all right reserved
Int. J. Nur. Edu. and Research. 2017; 5(3): 297-302.
DOI: 10.5958/2454-2660.2017.00061.8