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Stress and coping strategies among parents of hospitalized children in selected tertiary hospitals, Kathmandu
ABSTRACT: Introduction: Stress is non-specific responses that are resulted from a variety of different kinds of Stimuli Stresses experienced by individuals during the acute illness of a family member are profound and adverse health and psychological consequences may occur as a result. A child's hospitalization is a source of anxiety, depression, and stress for parents. Coping refers to the conscious efforts that are used to reduce the physical, psychological, or social harm of a stressful situation and facilitate the interaction of parents with their ill child. The type of coping strategies used by family against stress is important. Therefore, the professionals should determine the coping skills of parents to avoid negative consequences for family life and family function during Hospitalization. This study was conducted to find out stress and coping strategies among parents of hospitalized children in selected tertiary hospitals of Kathmandu. Methods: A cross-sectional descriptive study design was used for this study. All the parents (mothers or fathers) with children at the time of data collection admitted to different wards (pediatric and neonatal) TUTH and Kanti Children hospital (medical, surgical, paying, oncology and ICUs) were included as study participants. Altogether 200 participants were selected using non-probability purposive sampling technique. Structured interview schedule was used as research instrument. It consisted three parts such as socio-demography characteristics of parents and different stress related factors; Depression, Anxiety and Stress Scale (DASS 21) which is four point Likert scale for measuring parental stress; and Coping Health Inventory for Parents (CHIP). The Likert Rating scale of parental coping consist of 30 items. Data analysis was done using both descriptive and inferential statistics as per necessary. Ethical approval was taken from IRC of IOM, IRC of KCH and NHRC also. Duration of this study was January to September 2020. Results: Regarding to socio-demographic characteristics of parents the more than half (53.0%) were belongs to age more than 30 years, 56.5% of parents were female (mother), majority (77.5%), of the respondents were followed Hinduism; more than half (58.5%) from outside Kathmandu Valley. Likewise, ethnicity, 47.0% were Janajati, nearly half (49.0%) were from joint family and most (92.0%) of the respondents were able to literate. Regarding to socio-economic condition, 21.5% had service (Government & non-government); 77.0% had interrupted their job due to hospitalization of their child and less than half(45.0%) of the respondents 'income was only enough for less than 6 months. Regarding treatment cost, nearly two third (64%)had perceived as average cost. Regarding to child factor, majority (64%) of hospitalized children belongs to male, one third (37.5%) of the respondents were infant and 38.5% parents perceived moderate severity of illness. Regarding to stress factors, related to hospital professionals nearly half(45%)had reported that health professionals always explained about medical procedure and 41.0% experienced of empathetic behavior from health care professionals. Related to hospital environment, two third (66.5%) experienced peaceful environment during hospitalization followed by normal/usual temperature (62.5%), without bad odour (36.0%) and only 18.0%. experienced crowded and noisy environment. Concerning to available hospital facilities, majority (79.5%) reported adequate number of toilets and bathrooms followed by lab investigations (74.0%), having safe drinking water (61.0%), supply of medicine (57.0%) and foods for children (43.5%) of parents. Regarding the stress, 71.5%had normal level of stress; 12.0% 9.0%, 5% .2.5% had mild, moderate, severe and extremely severe level symptoms respectively. Likewise, almost all (100.0%) had normal level of anxiety; and 89.0% reported normal level symptoms. There is significant association of parental stress with their education level (p = 0.029), family income (p=.032) and crowed noisy environment of hospital (p = 0.009). Concerned to maintaining family Integration, cooperation and an optimistic towards the Situation, two third of parents (73.0%) were believing their child will get better followed by believing in god (65.0%), and nearly half of parents were doing things with my children (58.5%) and building a closer relationship with my spouse (54.0%) for coping from stress. Concerning to maintaining social support, self-esteem and psychological stability, two third of parents investing them self in children (70.0%), followed by believing things will always work out (69.0%) and talking personal feelings and concerns with spouse (68.0%) respectively for coping stress during hospitalization of their children. Regarding the communication with other parents and consultation with medical staff, two third (70.0%) parents talk with doctor for their child concern for coping stress when their children were hospitalized. Conclusions: Parents experience considerable symptoms distress during hospitalization of their children. Level of stress is significantly associated with their level of education (p=0.029), income status (p=0.32), adequate number of toilet and bathrooms (p=0.27), supply of medicine (p=0.040) and crowded and noisy hospital environment(p=0.009). Different coping strategies against stress were used by parents. Further study with large sample size to confirm the findings and explore the factors associated with stress should be done. Interventions package to reduce maladaptive coping strategies will be beneficial to provide quality nursing care. Key Words: Hospitalized Children, Parents, Anxiety, Depression, Stress, Coping Strategy