The purpose of this study was to describe maternal fatigue during the first six weeks postpartum. Forty-eight healthy, primiparous mothers who experienced uncomplicated vaginal births in a large urban hospital were asked to complete the Maternal Piper Fatigue Scale during their hospital stay, and at two and six weeks postpartum. Fatigue intensity was relatively high at two days and two weeks, but had significantly declined to a relatively "normal" level by six weeks postpartum. However, 25% of the mothers were still reporting "severe" fatigue at six weeks. The contributing factors most frequently identified by the mothers were labour and delivery issues (2 days), sleep pattern disturbances, and infant care issues (2 & 6 weeks). Rest, sleep, and instrumental support were consistently identified by mothers as helping alleviate their fatigue during the first six weeks postpartum.

A cross sectional study of separated and divorced families used self-report measures to explore the relationship between the psychological adjustment of mothers (n = 20) and their adolescents (n = 20), aged 13 to 18 years. The mothers' psychological adjustment was assessed in terms of reliable and valid measures of depression, sense of competence, self-esteem, and personal control. The adolescents' psychological adjustment was based on reliable and valid measures of sense of competence and self-esteem, and a measure of personal control. The mothers' perceived social competence was found to be significantly and positively related to the adolescents' perceived self-esteem (r (20) = .57, p = .00) and scholastic competence (r (20) = .40, p = .04), based on a one-way Pearson correlational analysis. The mothers' depression also was significantly and positively related to the adolescents' behavioural competence (r (20) = .38, p = .05) and approached significance in relationship to the adolescents' perceived poor levels of social acceptance (r (20) = -.33, p = .08). The study findings suggest significant relationships between the mothers' perceptions of their social competence and the adolescents' perceptions of their self-esteem and scholastic competence, and between the mothers' depression and the adolescents' behavioural competence after separation and divorce. The discussion of these findings raise a number of issues pertinent to separated and divorced families with adolescents. The results of this study may sensitize nurses to these factors when working with separated and divorced families with adolescents.

The purpose of this study was to test the relationship between conjugal support, family coping behaviours and the well-being of the elderly couple. A multistage sample of 135 couples, 65 years and over, was drawn from users of the health and social system, as well as from non-service users, in a large metropolitan area. Data were collected through home visits. A series of questionnaires to measure conjugal support, family coping behaviours, three indicators of well-being (self-assessed health, life satisfaction and marital satisfaction), and selected control variables were presented in interview format separately to each marital partner by two interviewers. Data analysis was performed on individual and couple data. Results revealed significant positive correlations between availability and reciprocity of conjugal support and well-being of both marital partners and a negative association between conflict within the conjugal relationship and well-being of husbands and wives. Only two cognitive family coping strategies, reframing and avoidance of passive appraisal, were positively related to the well-being of both partners. External family coping strategies related to seeking help outside the elderly dyad were not associated with well-being. Paired t-tests revealed that husbands tended to perceive more support from their spouse and to be more satisfied with their marital life than wives. Wives more than husbands perceived the couple to use more external social support and spiritual support. Repeated measures analysis of variance revealed that congruency of perception between husbands and wives had an effect on the well-being of the wives only. A path model in which conjugal support has direct and indirect effects on well-being through cognitive family coping strategies is proposed.

Note: / Pain requiring treatment is experienced by many cancer patients at the end of life. When these patients stay at home, family caregivers are often directly implicated in pain management. There are few studies that examine the process that these family caregivers engage in when they take on the responsibility of pain management. This means we need information on whether or not these family caregivers are prepared for management to ensure proper support and optimal pain control. The purpose of this qualitative study was to study the process used by family caregivers at home to manage the pain of palliative cancer patients using a grounded theory approach. A total of 24 family caregivers with differing relationships to the patient and differing lengths of caregiver experience participated. Family caregivers were recruited using purposeful then theoretical sampling. The data sources were taped, transcribed (semi-structured) interviews, field notes, and memos. Data analysis used Strauss & Corbin’s (1998) suggestions for substantive coding: open, axial, and selective coding.[...] / Les patients atteints de cancer en fin de v1e eprouvent souvent des douleurs qui doivent etre traitees. Lorsque ces patients demeurent a la maison, ce sont plus souvent les proches-aidants qui sont impliques directement dans la gestion de cette douleur. Peu d’etudes existent sur le processus que les prochesaidants adoptent lorsqu’ils prennent la responsabilite de gerer la douleur. Il est done opportun d’accroltre nos connaissances afin d’outiller les proches-aidants a gerer de fac;on optimale la douleur et de mieux les soutenir dans leurs roles. Le but de cette etude qualitative est d’etudier le processus que les prochesaidants utilisent lorsqu’ils prennent soin a domicile d’une personne en fin de vie. Cette etude se base sur une approche de theorisation an ere e. L’ echantillon de I’ etude se compose de 24 proches-aidants ayant des types et des durees de relation differentes avec le patient. Les proches-aidants ont ete selectionnes selon une procedure d’echantillonnage a choix raisonne, suivi par une procedure d’echantillonnage theorique. Les donnees recueillies sont basees sur des entrevues (semi-structurees) enregistrees et transcrites, ainsi que sur des notes de terrain et des memos. Les analyses de donnees ont ete basees sur les recommandations de Strauss & Corbin ( 1998) pour le codage; c’ est-a-dire codage ouvert, axial et selectif.[...]

This study was designed to compare the behavioral pain responses of 2-month-old Canadian-born Chinese babies receiving a routine immunization to those of Caucasian infants in similar situations. Two groups of 26 infants were obtained through convenience from a pediatric clinic held by a Chinese pediatrician at the Chinese Hospital and a suburban pediatric practice of a large Canadian city. Facial expression using the Neonatal Facial Coding System (Grunau & Craig, 1987) and cry using the Fast Fourier Transform were measured during 30 seconds following the insertion of the needle. Acculturation in Chinese mothers, infant temperament, circadian rhythm, were assessed. Multivariate analysis of variance revealed significant differences in pain response between these two groups with the Chinese babies showing greater response. No significant effect of temperament, circadian rhythm, and gender was identified. This supports the presence of differences in pain response in relation to culture/race by at least 2 months of age.

A qualitative study design was used to describe the quality of life as perceived by spouses of persons who have had a laryngectomy within the preceding two years to treat cancer. A convenience sample of 17 spouses of individuals with laryngectomies participated in this study. / Data were collected through guided interviews. Data were analyzed according to Giorgi's (1985) phenomenological method of analysis. Spouses described their quality of life by referring to marital relationship, communication and life style. Spouses identified nine factors that affect their quality of life. These are stress, coping, social support, caring, knowledge, body image, uncertainty, emotional status, and physical function. / Findings from this study give the nurses an empirically derived perspective on the quality of life of spouses of individuals who have had a laryngectomy to treat cancer.

This study was designed to compare pain intensity during a clinical event (fingerstick) in children with Sickle Cell Disease (SCD) who have experienced recurrent episodic pain, against those children without SCD who have not experienced recurrent pain. A convenience sample of sixty-six 7--12 year old children was obtained, 33 with SCD from the sickle cell clinic and a matched (age, sex, ethnic origin) group of 33 children without SCD from the community. Pain intensity using the Coloured Analogue Scale (McGrath et al., 1996) and, medical fears using the Child Medical Fears Scale (Broome & Hellier, 1987) were measured following the fingerstick. The number of hospitalisations and the number of experiences with needles were examined for their relationship to pain intensity or medical fears. Multivariate analysis of variance revealed no significant differences in either pain intensity or medical fears between the two groups. There was a moderate, significant correlation between pain intensity and medical fears for the entire sample (r = .269, p < .03). Among children with SCD, those who had more than the median number of hospitalisations (6), reported lower medical fear scores (p < .01). This finding suggests adaptation on the part of these children to their chronic illness and to hospitalisations.

A randomized controlled trial was conducted to test the effects of an intervention centered on cognitive coping skills as compared to one focused on expression of emotions. Both interventions were concerned with emotional response regulation in human immunodeficiency virus (HIV)-positive persons experiencing an exacerbation of HIV-related symptoms. Ninety hospitalized patients were randomly assigned to one of three groups: cognitive group, expression group and control group. Interventions were administered on three consecutive days in 20--30 minute daily sessions. Pre/post data were gathered on mood, distress, and anxiety. / Both interventions produced a beneficial effect on negative affect, from the day before the intervention to the day after and on the other days. Neither intervention affected positive affect. Paired T-tests indicated a decrease in distress, specifically, intrusive thoughts for cognitive intervention participants. Also, this group experienced a decrease in anxiety from immediately before to immediately after each session. Conversely, expression-of-emotion intervention participants experienced an increase in anxiety. / The cognitive nursing intervention is effective in helping to regulate HIV-positive patients' emotional response to advanced disease. The cognitive nursing intervention can be used readily by skilled practitioners providing daily care.

While there is evidence that the interactions that occur in the early years of life between very-low-birthweight (VLBW) infants and their mothers affects later child development, little is known about the factors that are associated with responsive and sensitive mother-VLBW infant interaction. Belsky's (1984) model of the determinants of parenting proposes that multiple child, parent, and contextual factors influence parenting behaviour. This prospective study examined the combined influence of a set of infant (i.e., birthweight and perinatal illness severity), mother (i.e., state anxiety and parenting sense of competence), and contextual variables (i.e., maternal received and perceived helpfulness of support, and marital adjustment) on mother-infant interaction, and assessed which factors were associated with sensitive and responsive interaction. / The participants were 72 mothers and their VLBW infants (<1500 grams). Infant, mother, and contextual variables were assessed at 3- and 9-months of age (corrected). At 9 months, mother-infant teaching interactions were observed in the home and later coded using the Nursing Child Assessment Teaching Scale (NCATS). / Hierarchical multiple regression analyses were used to examine the relationship between mother-infant interaction and the infant, mother and contextual variables. The prospective model explained 33% of the variance in the interactive behaviour of the dyad. Dyads whose interaction was more sensitive and responsive at 9 months included mothers who were better-educated, less anxious at 3 months, and reported higher perceived support at 3 months. The concurrent model explained 29% of the variance in the interactive behaviour of the dyad. Dyads whose interaction was more sensitive and responsive included mothers who were better-educated and reported higher perceived support at 9 months. The hypothesis that the mother variables would be more important than the contextual variables in explaining mother-infant interaction was not supported. The findings highlight the importance of examining multiple infant, parent, and contextual variables to explain mother-VLBW infant interaction.

The purpose of this study was to examine child psychosocial adjustment (i.e., behavioural problems and self-esteem) as a function of maternal well-being, parenting competence, and maternal stress in a sample of children (8 to 16 years) with a chronic physical disorder (CPD) (n = 60) as compared to a sample of non-chronically disabled children (n = 60). While the groups did not differ on either maternal variables or child behavioural problems, CPD children had higher self-esteem than comparison group children. For both groups, mothers with high well-being, high competence, and low stress had children with fewer behavioural problems. Furthermore, mothers of older CPD children perceived themselves as more competent parents, which in turn was related to fewer behavioural problems and higher self-esteem in the child. Mothers who assessed their child's condition as less stressful also had a higher sense of well-being and/or perceived themselves as more competent mothers. While this sample consisted of children whose conditions were of mild to moderate severity, children with more severe conditions had higher self-esteem.