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Direct, indirect, and partner effects estimated among uplifts, respite care, stress, and marital quality across mothers and fathers of children with autism spectrum disorder (n = 102) and Down syndrome (n = 111) were examined in this cross-sectional study. Parents of children with ASD who reported more uplifts and less stress individually reported better marital quality; these wives reported better marital quality as their husbands reported more uplifts and less stress. Wives with children with DS who reported more uplifts, individually along with their husbands reported less stress and better marital quality. Respite was directly associated with marital quality for parents of children with ASD and indirectly associated with marital quality for parents of children with DS with reduced individual stress. Implications are discussed.

Adults who have lived much of their life with type 1 diabetes have learned lessons that can benefit health care providers (HCPs), families, and young people who live with the condition. This study was undertaken to gain a better understanding of the challenges of growing up and living with type 1 diabetes from adults who have experienced those challenges and to recommend strategies for parents, caregivers, and HCPs who work with children or adolescents with type 1 diabetes. Thirty-five adults with type 1 diabetes participated in this qualitative study consisting of two in-depth interviews with each participant. Six themes emerged: 1) It’s not who you are. 2) Don’t let it limit you. 3) Get involved in diabetes support groups. 4) It’s going to be OK. 5) Teach them; don’t scare them. 6) Don’t single kids out. Through hindsight and the more mature perspective of adulthood, study participants were able to share valuable insights that could inform the efforts of those who work with or care for younger people with type 1 diabetes.

Informed by family stress and family resilience perspectives, this study examined couples’ experiences with comorbid chronic illnesses in later life. Using data from semi-structured interviews with 28 couples coping with type 2 diabetes and osteoarthritis, we used a qualitative approach to explore stressors and resilience processes associated with comorbid chronic illnesses. Five types of stressors and four types of resilience processes were reported by couple participants. Various stressor and resilience patterns emerged, depending on comorbid illness severity. Respondents reporting high severity in diabetes and osteoarthritis demonstrated fewer resilience processes than did those whose illnesses were not severe. Although most couples exhibited some resilience processes in response to illness-related stress, resilience processes appeared less often among those with self-ratings of high diabetes and arthritis severity and more often among those whose illnesses were less severe. Future research should address buffers of severe comorbid illnesses in later life.

Parents of children with disabilities are at risk for high stress and low marital quality; therefore, this study surveyed couples (n = 112) of children with Down syndrome (n = 120), assessing whether respite hours, stress, and uplifts were related to marital quality. Structural equation modeling indicated that respite hours were negatively related to wife/husband stress, which was in turn negatively related to wife/husband marital quality. Also, wife uplifts were positively related to both wife and husband marital quality. Husband uplifts were positively related to husband marital quality. Therefore, it is important that respite care is provided and accessible to parents of children with Down syndrome.

Using Conger’s family stress model as a theoretical framework, a series of mediated associations among economic hardship, perceived economic pressure, parental depression, marital conflict, psychologically controlling parenting, and children’s reticent behaviors in Romanian families were studied. The sample consisted of 121 Romanian mothers and fathers of 4–5-year-old children. Children’s kindergarten teachers living in urban and rural locations evaluated child reticence. Findings generally support the family stress model. Structural equation modeling showed that after controlling for living in a rural location, economic pressure was indirectly linked with marital conflict through depression. Depression was indirectly related to psychological control through marital conflict, and marital conflict was indirectly linked to child reticence through psychological control. Directions for future research and recommendations for interventions and public policy are described.

The purpose of this study was to interview parents of children with severe or profound intellectual and developmental disabilities to determine the perceived value of support groups and identify recommendations for support group design based on their experiences and feedback. Despite varied experiences with support groups, most parents indicated the value of support groups is in providing a place where parents can feel understood and both share and gather information. Parents recommended support groups be targeted for parents of children with similar disabilities and needs, have flexible structures and qualified leaders, and offer a wide variety of content in various formats. Given parental recommendations for support group design varied, summary recommendations addressing a wide range of preferences are provided.

Thirty-one adults with type 1 diabetes participated in this qualitative study to explore reasons why they were willing (had an open attitude) or unwilling (had a closed attitude) to disclose diabetes-related information to others. Participants (61.3% female, mean age 38.48 years, mean duration of diabetes 21.94 years, 100% white) answered open-ended questions about living with type 1 diabetes. Interviews were transcribed verbatim and coded to identify major patterns that emerged in the data. Reasons for open attitudes included support from others, confidence and feeling comfortable, feeling normal despite diabetes, seeking to educate, and feeling that it was not a major concern to share information with others. Reasons for closed attitudes included fear of discrimination, misunderstanding from others, embarrassment and shame, and feeling that it was not a major concern to share information. A higher number of participants reported open attitudes after diagnosis than at initial diagnosis; a lower number of participants reported closed attitudes after diagnosis than at initial diagnosis. Professionals should consider effective forms of type 1 diabetes–related education to reduce diabetes misconceptions and discrimination against diagnosed individuals. This may help individuals feel more open and willing to adhere to and seek assistance with their diabetes-related self-care.

Single mothers of children with autism spectrum disorders are rarely studied, yet they may experience unique stressors. Researchers asked 122 single mothers to complete questionnaires concerning respite care, daily hassles/uplifts, depression, and caregiver burden. More than half (59.8%) accessed respite care, which was provided for 1 h per day, often by multiple sources (41%), such as grandparents and community agencies; most were satisfied with this care. Most mothers (77%) were at risk for clinical depression. While uplifts were negatively correlated with depression, hassles and caregiver burden were positively correlated with depression. Respite care was positively related to daily uplifts, and uplifts mediated the relationship between respite care and depression. Recommendations for researchers, policymakers, and school personnel are offered.

Utilizing grounded theory qualitative research methods, a model was developed for describing parental adaptation after voluntary placement of a child with severe or profound developmental disabilities in out-of-home care. Interviews of parents from 20 families were analyzed. Parents' cognitive appraisals of placement outcomes were classified as either inducing emotional stress (i.e., guilt, sadness, fear and worry, anger and frustration, and uncertainty) or relief. Parental appraisals of responses to placement by children, extended family, and friends were identified as factors affecting the parents' adaptation to placement. The primary coping methods used by parents to decrease emotional stress and increase relief consisted of reappraisals regarding the necessity of placement, involvement in the child's life, psychotherapy, and the passage of time.

Using family systems theory as a theoretical framework, we investigated direct and indirect associations between type of disability, caregiver burden, and sibling relationships with structural equation modeling. We recruited 172 families raising typically developing children or a child with a disability. Participants volunteered at meetings and workshops for families of children with disabilities and were also recruited through snowball sampling. Mothers and fathers independently completed self-report questionnaires on caregiver burden and perceptions of the sibling relationship. Mothers experienced higher levels of caregiver burden than fathers. Parents of children with autism reported higher levels of caregiver burden than parents of typically developing children. Mothers of children with Down syndrome and multiple disabilities reported more positive sibling relationships than mothers of typically developing children. Mothers' and fathers' perceptions of caregiver burden were negatively related to their perceptions of the sibling relationship. Caregiver burden mediated the relationship between having a child with autism and positive sibling relationships. Results indicate the benefits of using a systems framework in examining families raising children with disabilities. Future research should focus on interventions for families of children with disabilities that help alleviate parental burden and foster positive sibling relationships.

Background Past research focused on the effects of raising a child with autism spectrum disorder on families. However, most research examined parents’ perspectives rather than siblings’ perspectives. Therefore, the purpose of this qualitative descriptive design was to use photo elicitation to capture perspectives of siblings living with a child with autism spectrum disorder. Methods Fourteen siblings (nine male) of 13 children with autism spectrum disorder received disposable cameras with 24–27 colour exposures, and were asked to photograph what was important to them within 2 weeks. After developing snapshots, investigators interviewed siblings about their photographs, and used open, axial and selective coding to determine photograph categories and subcategories. Results Two major categories were found: people (family members, non-family members) and non-people (personal items/objects, animals, buildings, scenery). Interviews about photographs reflected experiences siblings had with people/non-people in the snapshots and their normal everyday activities. Most photographs revealed family life and activities any sibling would experience whether or not they lived in a family raising a child with autism spectrum disorder. Conclusions Photo elicitation facilitates communication between children and health-care professionals, and provides information about living with a child with autism spectrum disorder from the sibling’s perspective. This information contributes to our knowledge base and allows development of specific intervention plans for siblings of these children.

Children with type 1 diabetes need to monitor their blood glucose and food intake, administer insulin, and participate in physical activity during school hours. School concerns for this group include school personnel, the medical directive plan, classmates, school lunches, and physical education classes. Nurse practitioners should take an active role in advocating for improved T1DM management in schools by talking with patients and their parents about experiences in school, identifying challenges and discussing possible solutions for improving diabetes management during school hours, and accessing online resources to assist patients, parents, and school personnel.

Aim To explore if young people with higher and lower levels of metabolic control of type 1 diabetes have different perceptions about their lives and illness. Background Adolescence through emerging adulthood is a developmental stage made more challenging when the person has type 1 diabetes. Little research has investigated if individuals with high and low levels of metabolic control in this age group perceive their disease differently. Design Qualitative descriptive. Methods In this study, 14 participants, ages 11–22 years were interviewed in 2008 about their perceptions of living with type 1 diabetes. Through a process of induction, major themes were identified. Results/findings Participants with high and low metabolic control levels reported similar themes related to reactions of others, knowledge about type 1 diabetes, and believed healthcare providers used authoritarian interactions. However, high metabolic control level participants believed type 1 diabetes would be cured; had negative initial responses to being diagnosed; rarely received parental support in managing their diabetes; and were negligent in self-care activities. Participants with low metabolic control levels did not believe a cure was imminent or have negative responses to being diagnosed; received parental support in managing diabetes; and were diligent in self-care activities. Conclusion Nurses should give information to young people with type 1 diabetes beyond initial diagnosis and help and support this age group learn appropriate ways to manage their disease, develop positive relationships with healthcare professionals, and participate in interactions with others their age successfully managing type 1 diabetes.

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 spouse's privacy and confidentiality rights and the non-offending spouse's 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 b...

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.

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.

Using daily diary data from 28 later life couples where one spouse had diabetes and osteoarthritis, we examined crossover effects of target spouses' daily activity limitations and their partners' daily mood. On days when target spouses' daily activity limitations were higher than average, partners' positive mood decreased and negative mood increased; when target wives' limitations were higher than average, husbands' positive mood was higher. Marital happiness and frequency of telephone conversations of target spouses buffered some relations. Results advance our understanding of daily health processes within later life marriages by identifying crossover effects of activity limitations of an ill spouse with the mood of their partner and underscore the role of marital happiness and social contacts in buffering these associations.

It is developmentally normative for preschoolers (aged four to five years) to have self-perceptions that are typically positive and even over-inflated. However, because not all children have positive self-perceptions in early childhood it is important to understand factors that influence the development of self-perceptions, especially low self-perceptions, in early childhood. Therefore, this study examined the associations between self-perceptions and teacher ratings of social behaviors, subtypes of withdrawal, and peer ratings of acceptance/rejection in preschoolers. Participants included 199 children (107 males, 92 females) attending two early childhood programs in a midsized community in the western United States. The major findings were that children in early childhood who have lower self-perceptions of their abilities than their peers tended to engage in more reticence, solitary-passive withdrawal, and solitary-active behavior.

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.

Ambiguous loss and boundary ambiguity experienced by families during the process of placing their child in out-of-home care was described by parents in 20 families raising a child with severe or profound developmental disabilities. In retrospective interviews, parents discussed their experiences before and after placing their child and how they experienced ambiguous loss as they raised a child that was psychologically absent but physically present. Parents faced ambiguities related to the nature and diagnosis of the disability, support services, and placement. A second situation of ambiguous loss was created when the child was placed. Parents experienced two forms of boundary ambiguity (role and membership ambiguity) and ambivalence regarding placement decisions. Research and clinical implications for working with families are presented. Key Words: ambiguous loss, boundary ambiguity, developmental disabilities, placement. Approximately 4.5 million individuals in the United States have some type of developmental disability, defined as "severe, life-long disabilities attributable to mental and/or physical impairments, manifested before age 22" (Administration on Developmental Disabilities, n.d.). Developmental disabilities may be the result of genetic makeup, environmental factors, such as illness or pregnancy complications (The Arc of the United States, n.d.), or involve both genetic and environmental components. Lenhart (2000) divided developmental disabilities into four categories that are not necessarily mutually exclusive: (a) cognitive impairments, (b) sensory and other physical impairments, (c) genetic disorders, and (d) neurological disorders. Depending on the type and severity of the impairments, families raising a child with severe or profound developmental disabilities (SPDD) may encounter multiple stressors that can disrupt family functioning (Dyson, 1993; Hodapp, 2002). Family Stressors may be related to the initial diagnosis, parental roles, additional caregiving demands, the level of disability, availability of and access to services, financial resources, decisions about guardianship, and family functioning and relationships (Jackson, 2004). Background Although the extant literature has examined many of these Stressors (Jackson, 2004), family stress theory posits that not all Stressor events occurring in families are clear-cut, which may result in situations of ambiguity. Consequently, families raising a child with SPDD may experience situations of ambiguous loss (Boss, 1999) which involve "[an] unclear loss resulting from not knowing whether a loved one is . . . absent or present" (Boss, 2004b, p. 554). When families experience an ambiguous loss, they cannot obtain definitive facts about a situation, making it difficult to correct or manage (Berge & Holm, 2007; Boss, 1999, 2002). Boundary ambiguity refers to the family members' perceptions of the ambiguous loss and may exist in any situation of loss-expected or unexpected, normative or nonnormative (Boss et al., 1990). Boundary ambiguity can range from high to low, and situations of ambiguous loss often are high in boundary ambiguity. Moreover, high boundary ambiguity can be a barrier to a family's stress management, as well as a risk factor for both personal and relational well-being (Boss, 2004b). Sensitizing Concepts and Purpose of the Study Chronic illness and disability are both conditions where the potential exists for ambiguous loss and boundary ambiguity (Boss, 1993, 1999, 2002, 2004a); however, much past research has focused on other situations of ambiguous loss, such as when a family member is diagnosed with Alzheimer's disease. Only recently have studies (Berge & Holm, 2007; Boss & Couden, 2002; Garwick, 2005) examined boundary ambiguity in families who have members with chronic illnesses or medically fragile conditions. The purpose of this research was to extend recent work (Berge & Holm; Garwick) by describing ambiguous loss and boundary ambiguity experienced by families raising a child with SPDD prior to and after placing their child in out-of-home care. …

Researchers have identified specific parenting practices used by parents of preschoolers in mainland China (e.g., physical coercion, overprotection, shaming, directiveness, encouragement of modesty). Some of the intrusive practices have been linked to social withdrawal in western societies (e.g., United States, Canada). It seemed important to examine these associations in China because recent research suggests that young Chinese children who exhibit wariness in peer settings may be at risk for negative outcomes such as peer rejection. Therefore, the purpose of this study was to examine the relation between Chinese parenting practices and preschoolers' social withdrawal. Mothers of preschool-age children from mainland China ( N = 446) completed self-report parenting questionnaires. Teachers rated children's reticent, solitary-passive, solitary-active, and modest behaviors. Results showed that (a) maternal directiveness was positively associated with reticent behavior in girls and negatively associated with solitary-passive behavior in boys, (b) maternal overprotection, for girls, was positively related to both reticent behavior and solitary-passive behavior, and negatively related to modest behavior, (c) coercion was positively associated with solitary-active and reticent behavior in girls, and (d) shaming was positively related to all forms of withdrawn behaviors in boys and girls, as well as positively related to modest behavior in boys.

Authors of this qualitative descriptive study interviewed 30 parents concerning their experiences raising a child or adolescent with type 1 diabetes (T1D) and celiac disease (CD). Analysis revealed six themes: (a) health complications of T1D, (b) challenges of daily disease management, (c) financial concerns, (d) the young person's emotional/mental health, (e) experiences with healthcare providers, and (f) experiences with people outside the family and at school. Results suggest nurses need to be sensitive to challenges young people living with T1D and CD and their parents face, conduct ongoing assessments, and provide time during interactions to adequately address concerns.

Background: Raising a child with a disability (CWD) in the home is increasing across the globe. Because of caregiver burden and the complexity of care, there is growing concern for typically developing sibling (TDS) outcomes. Objective: The aim of the study was to examine whether caregiver burden, parenting style, and sibling relationships in families raising a CWD are associated with cooperative and externalizing behaviors in TDS. Methods: This correlational study included 189 families raising both a CWD and a TDS. Multilevel modeling was used to identify which variables were most predictive of TDS outcomes and if there were parent gender effects. Results: Authoritative parenting was positively associated with cooperative behaviors. Authoritarian parenting was positively associated with externalizing behaviors. Multilevel modeling revealed caregiver burden was a significant predictor of sibling behaviors in the first model. When parenting style was added as a predictor, it was also significant. When sibling relationships were added as predictors, they were significant predictors for both cooperative and externalizing TDS behaviors; however, caregiver burden was no longer significant. Authoritarian parenting significantly predicted externalizing behaviors, and authoritative parenting was significantly related to cooperative behaviors. Discussion: In families raising a CWD, positive sibling relationships may help negate the effects of caregiver burden and are more predictive of TDS outcomes than some parenting practices.

The purpose of this research is to examine how metabolic control, parents' marital conflict, and parental caregiver burden are related to parents' use of psychological control in families raising a child with Type 1 diabetes (T1D). Differences between mothers and fathers are also considered. In this cross-sectional study, parents of 85 children with T1D independently completed self-report questionnaires; metabolic control levels were obtained through patient medical records. Structural equation modeling showed that better metabolic control is related to lower levels of fathers' caregiver burden, and marital conflict is positively related to both mothers' and fathers' ratings of caregiver burden. Mothers' caregiver burden is positively related to their psychological control (a type of parental behavior that threatens children's autonomous thoughts and feelings) and, similarly, fathers' caregiver burden is positively related to their psychological control. Paths in the model differed by parent gender, but there were no crossover effects. Future research is needed to develop new, effective interventions for children with diabetes and their parents, focusing not only on the child but on multiple family systems.

Parents of children with autism spectrum disorders (ASD) are at risk for having higher stress and lower marital quality than other parents. Survey data regarding respite care, marital quality, and daily hassles and uplifts were obtained from 101 mother-father dyads who were together raising at least one child with ASD (total # of children = 118). Number of hours of respite care was positively related to improved marital quality for both husbands and wives, such that a 1-h increase in weekly respite care was associated with a one-half standard deviation increase in marital quality. This relationship was significantly mediated by perceived daily stresses and uplifts in both husbands and wives. More respite care was associated with increased uplifts and reduced stress; increased uplifts were associated with improved marital quality; and more stress was associated with reduced marital quality. The number of children in the family was associated with greater stress, and reduced relational quality and daily uplifts. Results suggest policymakers and practitioners should develop supports for providing respite for families raising children with ASD.

Many studies examining illness within marriage have investigated how illness in one spouse influences the other spouse. In later-life marriages, where both spouses are more likely to have health challenges, there is an increased likelihood that health symptoms from both spouses affect each other. In the current study we examined how health symptoms in a "healthy" spouse may exacerbate health problems in a partner (the patient) who is managing multiple chronic illnesses. Surveys were collected across 14 days from 27 later-life couples where patients had both diabetes and osteoarthritis. Results indicated that higher healthy spouse symptoms were generally associated with higher patient symptoms, suggesting a spillover effect. Spouse reports of positive and negative mood were inversely linked with patient health outcomes. Spouse reports of higher positive marital interactions were surprisingly linked with higher patients' arthritis activity and activity limitations, possibly indicating a compensatory effect where marital interactions increase with symptoms. Daily spouse reports of positive marital interactions and mood were linked with patient health outcomes even after the spillover of health symptoms was taken into account.

Background: Worldwide, 78,000 children develop type 1 diabetes annually with European cases increasing every year. In the United States, 215,000 children under 20 years of age have type 1 diabetes and over 6.5 million adults with either type 1 or type 2 diabetes need daily administration of insulin. Misunderstanding the complexity of diabetes management on the part of health care providers can affect their attitudes and negatively affect patient outcomes. The purpose of this descriptive qualitative study was to explore family nurse practitioner and undergraduate nursing students’ perceptions of diabetes management while using an insulin pump in order to more effectively prepare them to understand the complexities of diabetes management faced by patients with diabetes and, therefore, provide better patient care. Methods: Nurse practitioner and undergraduate students, who participated in a week long diabetes simulation experience, were asked to participate. Consents were obtained allowing analysis of journals detailing their experiences. The journals were analyzed for common themes according to qualitative methodology. Results: Three themes emerged from the data: 1) handling self-management issues, 2) living with an insulin pump, and 3) gaining an appreciation for those who live with diabetes. Self-management subthemes included making dietary changes and monitoring blood glucose levels. Making dietary changes included carbohydrate counting, eating a balanced diet, and not snacking all day. Issues related to the monitoring of blood glucose levels included the pain of poking their fingers, difficulty getting enough blood, forgetting to check blood glucose, and not wanting to check blood glucose in front of people. Living with an insulin pump subthemes included learning where to wear the pump, having the pump get in the way, interfering with daily activities, including changing clothes or using the bathroom, interfering with intimacy, and having to change the needle site. Subthemes of gaining an appreciation for those who live with diabetes included having empathy for patients related to complying/not complying with treatment regimes, understanding the inconveniences of required lifestyle changes, and obtaining support from others having the same experience. Conclusions: Diabetes requires many lifestyle changes. Study participants cited an increased understanding of the hassles and inconvenience of living with diabetes, particularly dietary changes, monitoring blood glucose, and living with an insulin pump. Undergraduate and graduate nursing students caring for patients with diabetes would benefit from a similar simulation experience in order to gain an understanding of the complexity of diabetes management and learn ways to help their patients. Nursing faculty should consider implementing a similar simulation experience in their curriculum.

Aims and objectives To identify challenges children and youth with type 1 diabetes encounter from their own perspectives. Background Type 1 diabetes requires lifestyle changes involving diet modification, monitoring blood glucose, counting carbohydrates and administering insulin. Learning self-care and developing positive attitudes can improve glucose management and promote long-term benefits. Therefore, understanding challenges of youth living with type 1 diabetes from their own perspective is an important first step in improving diabetes outcomes for this age group. Design Qualitative descriptive design using focus groups to identify the experiences and challenges of children and youth living with type 1 diabetes. Methods Six focus groups were held over a four-month period in 2010; each participant attended one focus group. A total of 16 children and youth with type 1 diabetes participated. The focus group discussions were audio recorded, transcribed verbatim and analysed for common themes according to qualitative methodology. To assure trustworthiness, investigators independently coded interviews and themes were refined and adjusted until consensus was reached. Results Three themes emerged after analysing transcripts from the focus groups that embody challenges children and youth with type 1 diabetes faced: (1) low blood glucose; (2) self-care activities; and (3) feeling different and/or alone. Conclusions Data indicated type 1 diabetes is challenging for this age group. These challenges must be addressed to assist youth in learning to manage their disease and promote healthy outcomes. Relevance to clinical practice It is important for nurses to discuss challenges, understand perspectives of this age group, listen to their concerns, work with them to develop strategies promoting health, minimise complications, reduce or eliminate feeling different or alone and assist parents' efforts to be supportive.

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.

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

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.

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.

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.

The purpose of this qualitative, descriptive study was to capture the everyday lives of parents raising a child with a disability. Fifteen parental dyads raising a child with Down syndrome, developmental disabilities, visual impairments, or speech disorders used a disposable camera to photograph images important to them. Interviews about these photographs reflected everyday life. Four themes emerged from content analysis of the photos: active activities, quiet activities, activities of daily living, and care of the child with a disability. Six themes emerged when discussing photographs participants would have liked to take but did not. These themes were acceptance, concern for the future, joys, struggles, balance of good and bad times, and normalcy. Findings support the usefulness of photography as a method of obtaining information from parents raising a child with a disability through qualitative means and provide nurses with a beginning understanding of these parents' lives.

Tina Taylor Dyches *, Timothy B. Smith , Byran B. Korth , Susanne Olsen Roper , Barbara Mandleco e,4 Department of Counseling Psychology and Special Education, 340-F McKay Building, Brigham Young University, Provo, UT 84602, USA Department of Counseling Psychology and Special Education, 340-N McKay Building, Brigham Young University, Provo, UT 84602, USA Department of Teacher Education, 206-H McKay Building, Brigham Young University, Provo, UT 84602, USA d School of Family Life, 2089 Joseph F. Smith Building, Brigham Young University, Provo, UT 84602, USA College of Nursing, Brigham Young University, 474 SWKT, Provo, UT 84602, USA