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Based on a study exploring the phenomenon of coping among Hong Kong Chinese women afflicted with breast cancer, from diagnosis to completion of treatment, we report the findings on meaning making by the informants. Using the grounded theory method, we conducted 35 interviews with 24 women suffering from breast cancer. Among them, we followed and interviewed 5 women thrice, from diagnosis to 3 months after completion of treatment. We noted the evolution of reframing as the key category in the adjustment process through which the women identified meaning at different points of time in the cancer experience, to achieve different outcomes. Chinese women identified a sustaining force from minimizing social disturbance during treatment. The integration of cancer into their lives after completion of treatment was achieved through positive transformation in their philosophy of life and social relationships. Nurses should aim to understand the cancer patients’ interpretation of the situation, explore personally meaningful sustaining forces, and reflect on their cancer experience.

The growth and development of children with developmental disability depend very much on the parents.The present study was designed to examine whether family-focused education could enhance parental skills, knowledge and competency.The enhancement would in turn result in greater parental participation in the rehabilitation process of these children.The parental needs of Chinese parents were reviewed for the formulation of the Family-Focused Education Programme, which was then implemented, and evaluated using a pre-test/post-test control group design. Forty parents were invited to participate in the study using a convenience sampling technique.The mean scores of these variables were in the direction of increasing after the programme, though repeated measures ANOVA did not indicate any statistically significant changes in parenting knowledge, attitude and stress. It was apparent that the Family-Focused Education Programme enhanced parental competence. Undoubtedly, the family-focused approach is crucial for enhancing parenting competency, and education is fundamental to enabling parents.

Parenting children with developmental disability requires specialized caring skills and knowledge. The aim of this study is to explore the experiences of Chinese parents in caring for these children. The focus group research approach was adopted. Twenty-three parents of children hospitalized with developmental disability from a Maternal and Children Hospital, Guangzhou, China participated in four focus group interviews. Validity of interpretation was ascertained. Inter-coder reliability was established with inter-coder agreement at 0.77. Data were fully transcribed, coded and analysed by content analysis. Eventually, five categories of needs were identified: parental, informational, attitude towards the child, coping and support. Parents needed to be equipped with practical parenting skills and information on developmental disability, and they needed to have realistic expectations for the child. They also needed professional support to cope with caring tasks and activities. Education is recommended as a fundamental strategy to enhance parents’ caring competency.

Research on predictors of postpartum depression (PPD) in Hong Kong (HK) Chinese women is scant. A prospective study with 385 HK Chinese postpartum women was conducted to identify correlations between PPD and demographic variables, and antenatal depression and psychosocial variables, and to determine which of these variables were predictors of PPD. Using the Edinburgh Postnatal Depression Scale (EPDS), we classified 19.8% of participants as postnatally depressed. Fifty-six percent of the variance in PPD was explained by social support and stress factors. However, social support factors accounted for only a small percentage of that variance. The major predictors were antenatal depression, postnatal perceived stress, and childcare stress. HK women may benefit from a culturally appropriate intervention focused on reducing stress in the postpartum period.

The parents of 93 children with cancer in Hong Kong participated in a research study to identify concepts related to the category of restoring health in their child with cancer. These concepts included providing adequate nutrition such as attempting to increase the child's appetite, the preparation of soups, providing food supplements, and restricting the intake of certain foods; using alternative therapy to supplement the Western medicine, using tonics to strengthen the body, using Chinese medicine to regulate the body functions, using Chinese herbs to prevent metastasis or reoccurrence, as well as providing another chance of a cure when Western medicine was not effective; and preventing infections by reducing exposure to crowded places, having a clean home environment, using a face mask to protect the child from infections, and screening visitors.

Risk factors for citation errors in peer-reviewed nursing journals Background. Citation errors are common among nursing journals. But, there are no data regarding the factors that predispose to these errors. Objective. To determine the risk factors that predispose to citation error in peer- reviewed nursing journals. Methods. Five hundred and fifty references were selected randomly from articles published in eleven nursing journals for the year 1998. The incidences of major and minor citation errors were determined by comparing with the original articles. The relative odds of citation errors for the number of authors, collaborating institutions and the length of the reference list were calculated. The correlation between the scientific quality of the journal (by means of journal impact factor and immediacy index) and the incidence of citation error were also determined. Results. The incidence of citation errors is comparable to those reported previously. Long reference lists in articles written by a single author predicted strongly the occurrence of minor citation errors. Journals with a high impact factor and immediacy index tend to contain fewer minor mistakes. None of these factors affect the incidence of major errors. Conclusion. Contributors to journals should be aware of the various risk factors for citation errors. Citation accuracy may be improved by modifying these factors.

This study reports the results of eighteen Korean families living in South Korea, twenty-five Chinese families living in Taiwan, and twenty-two American families whose child had died from cancer. All the families were interviewed in their own language and in their homes. All interviews were translated and transcribed into English as needed. The impact of the child's death from cancer on the family has four broad aspects: the manifestations of grief, the experiences of support or nonsupport, the meaning of life and of death, and changes in attitudes. Illustrations are given of the similarities and differences among the American, Chinese and Korean families in their responses.

This paper examines home care for urban chronically ill elderly and children in the People’s Republic of China. Seventy-five families with a chronically ill child living at home and 75 families with a chronically ill elderly person living at home responded to in-depth interview questions. These data provide insights into many dimensions of this home care situation including the severity of the illness and problems experienced by family caregivers. Study results show the difficulties of home health-care and provide a basis for nursing’s role in China’s future home care.

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 child's illness on the family, the symptomatic responses of the parents to the child's 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.

This studyfocuses on Koreanfamilies of asthmatic children in South Korea using a case study method to understand their experiences. Informants were 55 individual members from 16families. Analysis revealed that the parents perceived their child with asthma as having physical limitations, having psychological adjustments including both behavior changes and competence issues, and needing social adjustment. The parents reported management issues, their own emotional adjustments,feeling the burden of illness, and negative effects of the illness on the family. Thefamiliesfound the disease increasingly burdensome over time. The siblings were envious of the attention the asthmatic child received. Families experienced increased conflicts andfinancial strain.

To contribute to a better understanding of the utility of the Symptom Checklist90-Revised (SCL-90R; L. Derogatis, 1983) with bereaved samples, an exploratory factor analysis was conducted on SCL-90R responses of 97 parents 2 years after the death of their child from cancer. The factor analysis revealed one significant factor that accounted for 30% of the variance in this administration. This factor included many items that reflected the theme of somatic complaints. Although generalization of these results should be undertaken cautiously because of the study's nonrandom sample, these findings suggest that physical symptomatology of the bereavement process may account for the major residual symptoms of distress in bereaved parents, at least as assessed by the SCL-90R.

This paper reports on the social and personal relevance of religious faith entering into the situation of family stress due to the illness of a child with cancer. The expectations of religious faith may include, objectively, the actual physical healing of the child or the determination of the child's fate; it may include, subjectively, the hope for emotional support, the provision of moral guidance in time of difficulty, or an overarching life-view. There were major religious changes in 20% of the families. While all the major religious faiths in South Korea were represented in the study, 61% of the sample identified Christianity as their primary religious response.

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.

This study explores the practices of 25 Taiwanese families following the death of a child from cancer. Detailed description of the families’ Post-death practices was obtained through semi-structured interviews with at least one family member. Through content analysis of the data, 10 categories were identified. These were: caring for the body, funeral arrangements, mourning clothes, ashes, spirit tablets, child's belongings, child's room, visits to the grave or the temple, dreams, and talking about the dead child. The findings show that although the rituals performed following the death of a child are simpler than those traditionally performed for an adult, they are still an important part of the families’ lives during the post-death period.

This study examines the home care situation of seventy-five urban chronically ill men and women and their caregivers in three cities in the People's Republic of China. It documents the type of home care provided, the severity of illness, and the dependency in activities of daily living in order to appreciate the complexity of these care situations. The findings reveal that women serve as the caregivers in the majority of the cases and often they are elderly spouses with health problems of their own. The physical, social, psychological, and financial problems experienced by these patients create an enormous burden for the caregivers whether spouses or younger family members coming home from work to a second shift. If alternatives to home care, such as nursing homes, were available, 54 percent of these caregivers would be willing to institutionalize their elderly relative. All caregivers express the need for more assistance in providing home care. This study raises questions regarding the role of the family, the state, and specifically the health care system in caring for the elderly chronically ill in light of their increasing numbers in the population.

Improvements in health status in the People's Republic of China have led to a shift in the burden of illness from acute, communicable disease to long-term illness, particularly in urban areas. The Chinese family's response to chronic illness is influenced by many factors, including the traditional cultural value of family responsibility as well as economic determinants. Through direct interviews with 75 women, we sought to understand the financial, social, emotional, and physical effects of caring for a chronically ill child on a Chinese mother's life and caregiving ability and to identify the sources of support available to her.

As part of a major study of the impact of childhood cancer on Chinese families, 17 families agreed to be interviewed after the death of their child from cancer. They convey what happens to the child's body after death and what remembrances the family has kept of their child's belongings. They share how they have adjusted and what they would like other parents who have a child with cancer to know. A picture emerges of what it is like to have a child die from cancer in China.

Several recent articles have begun to provide a broader understanding of the complexity of family caregiving for Alzheimer's patients, though caregiving is a complex phenomena and additional studies are clearly still needed (Kuhlman, Wilson, Hutchinson, & Wallhagen, 1991). Family caregivers take on the responsibility for an impaired loved one at home in absence of viable alternatives and experience the course of Alzheimer's disease as an insidious, progressive, and deteriorative situation (Morgan & Laing, 1991; Robin, Mace, & Lucas, 1982; Willoughby & Keating, 1991; Wilson, 1989a, 1989b). Central to this article is the premise, derived from Lazarus and Folkman's model of stress and coping (Lazarus & Folkman, 1984) that some Of the demands of caregiving are unique to the illness that is being cared for. Care for a family member who has a cardiac illness or diabetes is not the same as care for a member with Alzheimer's disease. The distinct qualities of the illness substantially influence the way that careg...

In this article, we present findings from a larger study that explored how Chinese women cope with breast cancer. We report on the process of early psychological adjustment, along with contextual factors and how they influence the women's coping mechanisms at the beginning of the cancer experience. Twenty-four women with diagnoses of breast cancer were interviewed. The grounded theory method was adopted in data collection and analysis. “Reframing” was the core category of the early adjustment process. Focus and approach were the two contextual conditions. Women adopted “fighting,” “following the natural course,” “struggling,” and “bearing” modes in coping with the disease. These findings highlight the significance of focusing on coping and realizing the role of the self in creating a subjective positive interpretation, which subsequently enhances acceptance of the disease at the beginning of the cancer experience. Characteristics of the Chinese people with respect to coping include the collaborative meaning of control and the philosophy of acquiescence to fate.

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 child's 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.

One part of a study on the effects of childhood cancer on families focused on the emotional reactions of school-age siblings. The authors identify themes in the siblings' feelings taken from transcripts of interviews with them. Responses were categorized as experience of diagnosis and hospitalization; awareness of prognosis and mortality; need for information; continuing effect of disease or death on the well child; correct understanding of cancer; and hopes and desires for the future. The responses were grouped either in a sibling with a living child category or sibling with a deceased child category. From their analysis, the authors present implications for nurses' interactions with these children: children's need for information; their feelings of being displaced and unimportant; need for encouraging involvement in the life of the ill child. The authors also identify additional questions that could direct future nursing research.

"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 women's 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 prescriptions 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.

Families caring for a chronically-ill child are known to experience a significant degree of stress that often is not fully understood by health professionals. The purpose of this study was to examine, cross culturally, the experience of families caring for children with chronic conditions both in terms of the impact on their lives and the nature of the support received. The responsibility of caring for a child with a chronic condition had considerable impact on family life in both groups, with the disturbance to harmony possibly being felt more keenly in the Hong Kong group. Effective communication with parents was seen in both countries as key for effective practice. Expectations of health services differed between cultures. Implications can be drawn for the design of future health services addressing the specific health needs of families with children with chronic illness.

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.

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.

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.

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 Parent's 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 child's 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.

An increased understanding of the frequency and troublesomeness of symptoms for family members who are caring for a victim of Alzheimer's disease (AD) would be helpful for nurses in working with these families. This article reports on the changes of these symptoms over time as well as the troublesomeness of these symptoms for 30 families over an 18-month period. A symptom checklist based on George's Patient Illness Symptoms Checklist (George, 1983) was used. Over time the reported symptoms reflected increased mental impairment, which is associated with AD. For some of the symptoms, there was an increase in the symptoms' frequency, but their troublesomeness did not increase. Family caregivers who reported more symptoms for each time period also reported an increase in institutionalization of the AD member.

The psychological and social functioning of a sample of 16 children with cancer was assessed 3-5 years after diagnosis using Achenbach's Child Behavior Checklist. Analysis indicated that 81% of the children were involved in age-appropriate social interactions and the same percentage showed normal behavioral patterns. No significant differences were found due to gender, type of tumor, or behavior over time. The children in this sample appeared to be functioning normally, both psychologically and socially, three to five years after a diagnosis of cancer.

Of the 100,000 children who die each year in the United States, close to 15,000 children could benefit from hospice/home care services. This article describes the concept of pediatric hospice care, reviews the Martinson study that was conducted in the 1970s, gives a chronological report on some institutions that provide hospice care for children in the United States and other parts of the world, and discusses the future of pediatric hospice care.

As part of a larger study, a descriptive study of the impact of childhood cancer on 50 Chinese families was conducted in Guangzhou (Canton) in the Guangdong Province of the Peoples' Republic of China. The parents of children whose cancer was newly diagnosed (n = 25) or undergoing treatment (n = 25) were interviewed in Chinese and their responses were then translated to English. The children ranged in age from 3 to 16 years and had a variety of cancer diagnoses. Parental occupations and incomes varied. The majority (42%) of the families only had the child with cancer. The duration of symptoms before the diagnosis ranged from 1 week to greater than 2 years. Thirty-five parents (70%) believed that their child knew very little or nothing about their disease. The children learned of their diagnosis in a variety of ways. The parents varied in their degree of openness regarding the child's diagnosis with relatives, friends, and colleagues. Some families had previous experience with a serious illness or death, but all identified cancer as the most frightening disease. Forty-one percent of the families felt they had not adjusted yet to the diagnosis. Few acknowledged the impact on siblings. Families also described their outlook on life and their fears of death. Seventy-six percent of the families were paying the total cost of their child's care themselves, and 14% of the total number of families reported major financial problems.

This paper reports an analysis of the bereavement experience described by 13 caregivers of family members with Alzheimer's disease. Utilizing the constant comparative method, four patterns of experience and two major concepts describing bereavement were identified. Two stages of bereavement are described: The first during caregiving and the second following the death of the family member. Findings support the need for professional intervention for caregivers during the caregiving period, which may also be a time of intense bereavement.

Children with leukemia from the time of remission to full recovery or death will more often reside in their own home than in the hospital. Competent professional nursing can provide the support needed to the family throughout the experience. While all periods of treatment will be covered, home care of the dying leukemic child will be emphasized. The feasibility of home care as an alternative to hospitalization for children dying of cancer was studied. The home care system was defined as nurse-directed with a consultant physician and did not entail extensive participation by other health professionals. Of 58 children cared for at home during the 2-year project, 79% died at home and 21% died in the hospital or en route to it. The findings, as shown by interview data, suggest that home care at the end stage of life is a viable alternative for children dying of cancer and for their families. Overall, the study has demonstrated that physicians will refer patients, and that children and parents agree to participate. It further demonstrated that home care nurses can be recruited and that they can secure needed equipment, supplies, and medications. No clear criteria have emerged that would rule out the home care alternative for any child dying of cancer.

Twenty-two families who had a child dying from cancer in hospitals in China were interviewed regarding their situation. The interviews were all conducted in Chinese, and the results were analyzed descriptively. Cancer was identified by all families as the most frightening aspect of their situations. Not having enough money for medicines and hospitalization were identified as being the most difficult problem. Sixteen of 22 families paid for the total cost of medical treatment and hospitalization by themselves. The families gave suggestions for other families who may have a child with cancer.

The central concern in research on families and Alzheimer's Disease (AD) in the past ten years has been to identify factors that place family members at risk for negative outcomes because of their involvement in AD care (Bowers, 1987; Colerick & George, 1986; Liptzin, Grob, & Eisen, 1988; Ory et al., 1985; Quayhagen & Quayhagen, 1988). This research has identified AD family caregivers to be at risk for poor physical health, mental health, and quality of life, when compared with family members who are not caregivers (Kuhlman, Wilson, Hutchinson, & Wallhagen, 1991). Family burden, resources (including social support), and AD patient characteristics and symptoms impact negative family outcomes, although factors that place family members most at risk remain to be specified (Baumgarten, 1989). In all of this research, however, AD patients are assumed to be a demand or a drain on family members. Persons with AD are frequently described as experiencing a loss of self as the disease unfolds (Cohen & Eisdorfer, 1986). Progressive loss of memory, along with personality and behavior changes common to the disease, are thought to overwhelm those with the disease. AD patients are characterized as suffering from a biomedical disorder that severs them from their history and severely restricts their potential in life. The biomedicalization of dementia (Lyman, 1989) has restricted the scope of research to disease progression and biologic processes that give rise to the disease. Research about those who care for demented elders has similarly been restricted by the pervasiveness of the biomedical perspective to the questions about how the disease, in its various stages of progression, impacts family members. Largely unasked, and therefore unanswered, are questions about the lived experience of AD for the person with the disease, the family member's experience of living with and caring for the person with AD, and how qualities of the caregiving environment might influence disease progression (Lyman, 1989). Research on caregivers of AD patients often progresses from the implicit assumption of particular relations between the ill family member and others in the family. One member in the relationship is assumed to be the passive recipient of care, holding less interpersonal power yet imposing demands and burdens. In a parallel way, the caregiving member is assumed to be an active provider, possessing relatively greater interpersonal power, but at risk of negative outcomes because of the burdens and risks experienced. Recent caregiver research suggests that the quality of relations between ill and other family members is complex, and that factors such as centrality of the relationship, personal qualities of both members, and the degree of reciprocity in the relationship may impact outcomes for both the ill and non-ill family members (Walker, Pratt, & Oppy, 1992; Wright, Clipp, & George, 1993). One aim of this investigation was to question the assumption of a fixed relation between the family and the person with AD and additionally to specify the range of relations that were apparent in the day-to-day lives of family members living with a person with AD. As part of a larger study aimed at understanding the experiences of family members who cared for a person with AD over time, we critically examined family members' self-initiated discussion of relations with the person with AD, as well as the content and nature of those relations. Working directly from family members' narratives, we attempted to understand these relations in ways that formal theories, such as exchange or friendship theory, may have missed. We were interested in the whole of the family's experience; what was salient and meaningful for the family members themselves, the difficulties or demands they encountered (Martinson, Chesla, & Muwaswes, 1993) and the skills and practices they developed in living with a person with AD. Through family members' narratives over an 18-month time span, it was evident that relationship issues were paramount to family members in their everyday lives and that qualitatively distinct forms of relations between ill members and other family members were evident. …