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UBC Theses and Dissertations

Ways parents help their preschool children with asthma Mitchell, Carol 1982

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WAYS PARENTS HELP THEIR PRESCHOOL CHILDREN WITH  ASTHMA  by CAROL MITCHELL B.N., U n i v e r s i t y  o f M a n i t o b a , 1972  THESIS SUBMITTED IN PARTIAL FULFILLMENT THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING  in THE FACULTY OF GRADUATE School  We a c c e p t to  STUDIES  of Nursing  this thesis  the required  as  conforming  standard  THE UNIVERSITY OF BRITISH COLUMBIA July ©  Carol  1982  M i t c h e l l , 1982  In p r e s e n t i n g requirements British freely that  this  thesis  in partial  fulfillment  f o r an a d v a n c e d d e g r e e a t The U n i v e r s i t y o f  Columbia, available  permission  I agree that f o r reference  the L i b r a r y  s h a l l make i t  and s t u d y .  I further  f o r extensive copying of t h i s  s c h o l a r l y p u r p o s e s may  agree  thesis f o r  be g r a n t e d by t h e Head o f my  D e p a r t m e n t o r by h i s / h e r  representatives. of t h i s  copying or p u b l i c a t i o n  gain  s h a l l n o t be a l l o w e d w i t h o u t my w r i t t e n  School of Nursing  The U n i v e r s i t y o f B r i t i s h C o l u m b i a 2075 Wesbrook P l a c e Vancouver, B r i t i s h Columbia Canada V6T 1W5  thesis  I t i s understood  that  Date:  of the  for financial permission.  Abstract This  s t u d y d e s c r i b e s ways t h a t p a r e n t s a t t e m p t  school children with mation  about  such  asthma meet t h e i r  p a r e n t a l guidance  to help t h e i r  b a s i c human n e e d s .  i s lacking  i n the  y e t p a r e n t s need a s s i s t a n c e from h e a l t h p r o f e s s i o n a l s  how  to accomplish  dren.  Ten  actions  and An  region of B r i t i s h  in their  they took  meet t h e i r  basic  homes.  affecting  developed  t h e c o u p l e s were a u d i o t a p e d communications.  actions  d r e n 's and  their and  physical  based  later  analysis  efforts  family's daily  in this  study  attacks.  tended  There  skills  ment o f t h e i r  and  about  to help these  the  asthma  lives.  children.  the U n i v e r s i t y  of  I t i s a model w i t h  analyzed  f o r content  r e v e a l e d 17  I t was  a  specific  additional their  concluded  s i c k o r w e l l , meet t h e i r The  attitudes  :  of  helpful  emotions,  asthmatic that  chil-  the  of h e l p i n g n e e d s t o grow  intensity  of  to i n c r e a s e d u r i n g the c h i l d r e n ' s  are i m p l i c a t i o n s  basic  A l l interviews with  to normalize  f o r d e v e l o p i n g programs t o a s s i s t ledge,  on  according to p a r e n t a l tasks.  helping behaviours  and  assumed t h e r e s p o n s i b i l i t i e s  preschool children,  develop  matic  efforts  common t o a l l o f t h e c o u p l e s , and  decisions,and  couples  The  were i d e n t i f i e d  framework.  and  chil-  t h e ways t h e y p e r c e i v e d asthma  their  systems t h e o r y  ill  the  preschool children with  Columbia's Model f o r N u r s i n g .  human needs and  about  from  c o u p l e s were a s k e d  human needs and  I n t e r v i e w G u i d e was  their  Columbia  The  to help t h e i r  i t s treatment  British  chronically  couples with asthmatic preschool c h i l d r e n  Lower M a i n l a n d interviewed  their  Infor-  literature  and  the task of r e a r i n g  pre-  the asth-  for health professionals  p a r e n t s t o a c q u i r e t h e know-  to f a c i l i t a t e  t h e g r o w t h and  c h i l d r e n w i t h a c h r o n i c d i s e a s e such  as  develop-  asthma.  iii Table of Contents  Page Abstract List  i i  of Tables  vi  Chapter I  Introduction  1  Background o f the Study. Statement o f the Problem Purpose o f t h e Study D e f i n i t i o n s o f Terms Approach t o the Problem II  T h e o r e t i c a l Framework Review o f t h e R e l a t e d  .  and Literature  Tasks of Parenthood Tasks of Parents Rearing Preschool Children Tasks of Parents C a r i n g f o r C h r o n i c a l l y 111 C h i l d r e n C h i l d ' s B a s i c Human Needs: A Framework t o G u i d e t h e R e s e a r c h . Review o f t h e R e l a t e d R e s e a r c h III  1 4 4 5 7  R e s e a r c h D e s i g n and Methods Overview of the Research Plan D e s c r i p t i o n o f t h e Sample I n t e r v i e w Guide Procedure f o r C o l l e c t i n g the Data Procedure f o r A n a l y z i n g the Data E t h i c a l Considerations Encountered i n the Research  9 10 11 12 . . .  13 13 20 20 21 24 27 28 30  iv  Page  Chapter IV  V  Presentation of the Findings  ..  33  D e s c r i p t i o n o f t h e Sample The c o u p l e s The p r e s c h o o l c h i l d r e n w i t h asthma. . The H e l p P r o v i d e d by t h e C o u p l e s Need: t o b r e a t h e Need: t o e a t and d r i n k Need: t o e l i m i n a t e waste p r o d u c t s . . Need: t o have a b a l a n c e between r e s t and a c t i v i t y Need: t o f e e l s a f e and s e c u r e . . . . Need: t o f e e l l o v e d Need: t o f e e l s e n s o r y s a t i s f a c t i o n . . Need: t o have a sense o f a c c o m p l i s h ment Need: t o d e v e l o p s e l f - r e s p e c t . . . . The Impact o f Asthma and I t s T r e a t m e n t . .  33 33 35 36 37 40 41  Discussion of the Findings  Recommendations  a n d Summary  Recommendations Recommendations Summary  References Additional  f o r Nursing f o r Nursing  45 46 46  49  Tasks of Parents Rearing Preschool C h i l d r e n w i t h Asthma and N u r s i n g I m p l i c a t i o n s . . .  VI  42 43 44 44  49  59 Practise Research  . . . . . . .  59 60 ^0  ^2 References  6  8  Page Appendices A.  S e l e c t e d Assumptions The  UBC  from  Model o f N u r s i n g Tasks o f P r e s c h o o l C h i l d r e n  70  B.  Developmental  . .  C.  I n t e r v i e w Guide  77  D.  Letter  8.2  E.  Written  F.  Letter  G.  Interview Procedure  86  H.  Consent  88  I.  C e r t i f i c a t e of Approval f o r R e s e a r c h I n v o l v i n g Human S u b j e c t s . . . .  to the P h y s i c i a n s consent from the P h y s i c i a n s to the Parents  from the P a r e n t s  73.  83 84  89  vi List  of  Tables  Table 1.  2.  3.  4.  Page The UBC M o d e l f o r N u r s i n g : S u b s y s t e m s and t h e C o r r e s p o n d i n g Needs  .  6  Demographic Data o f Couples of Preschool C h i l d r e n with Asthma  34  Demographic Data D e s c r i b i n g the P r e s c h o o l C h i l d r e n w i t h Asthma  36  The  38  Couples'  Helping Behaviours  1 CHAPTER I Introduction Background of the  Study  I n ..Western s o c i e t y , p a r e n t s for giving  their  care u n t i l  they  1976,  p.  11;  children,  reach maturity  Le M a s t e r s ,  a significant  impact  rear  children with  tude  o f complex and  parents  or w e l l , (Duvall,  1977,  p.  on p a r e n t s  6).  difficult  and  child  of asthmatic  1979,  p.  23;  children  and  children.  of l i v i n g  the e f f e c t s  of i l l n e s s ,  rearing  1977,  demanding  i n our  t h e i r ways t o s u p p o r t ,  society.  guide, and  of  7-8).  p.  care f o r i l l  guilt,  Some m o t h e r s parenthood p.  25;  324).  the major  Obviously  Despite  responsibility  p a r e n t s must  behaviours  w h i c h h e l p c h i l d r e n w i t h asthma meet t h e i r n e e d s t o grow Such a d e s c r i p t i o n  ful  f o r nurses  for  setting  p.  107;  1980,  p.  The  a p p r o p r i a t e and University  2).  study w i t h the  of p a r e n t s ' behaviours  i n planning care.  I t was  of B r i t i s h  of adding  (Neuman,  use-  adjunct  1974,  Columbia Model f o r N u r s i n g ,  therefore decided  intention  goals  and  c o u l d be  S u c h i n f o r m a t i o n i s an  realistic  alter  children.  There i s a l a c k o f i n f o r m a t i o n about p a r e n t s '  develop.  the  illness  (Crummette, 1979,  parents maintain  multi-  t o accomodate  feelings  1978,  who  Furthermore,  of the  pp.  has  Parents  t o the t a s k s of  & Rickards,  and  Hymovich,  as asthma have a  experience  Kapotes,  Reddihough, Landau, Jones,  26;  tasks t o perform.  have r e f e r r e d  as b e i n g burdensome and  p.  guidance,  This responsibility  a n x i e t y because of the e f f e c t s  (Crummette,  for c h i l d  1977,  of s i c k  f r e q u e n t l y change t h e i r way  responsibility  support,  c h r o n i c d i s e a s e s such  needs of the a s t h m a t i c grief,  sick  assume t h e m a j o r  to design a  descriptive  t o a knowledge base about  the  2 parents'  behaviours  asthmatic  children.  contribute children In  asthma  disease  and  and  being  1979,  of p.  bronchi  from  asthma 7).  of  child  may  1978,  p.  a  year;  i s thought of  10%  significant  disease  p.  be  of  age  one  1979,  p.  asymptomatic  be  to  for  the  of  the  a  with  chronic  symptoms may  of  of  suffer  the  living  1971,  p.  symptoms  1977,  p.  by  short  pp.  i n the 405; of  asthma  of  time  they  i n each  of  1979, once  every  p. or  day.  respiratory  the  disease  affects  countries of  1979,  before  p.  83).  they 1973,  asthmatic  asthmatic  are  Tse, only  Gordis, of  child  symptoms  1;  Western  the  breath  asthma  that  Guenter,  result,  of  chronic  324-325;  90%  a  asthma  Tonkin,  years  and  p.  310;  the  hyperresponsive  As  from  major  by  the  affecting  1978,  1976,  70%  by  as  persistent  Approximately  symptoms  to  care  presented  condition varies  83). 10  be  asthma  I t i s estimated  show  (Godfrey,  seem  problem,  problem  and  Kuzemko,  children  years  clinical  240;  a l l children  80%  the  obstruction.  The  children,  their  i n planning  manifested  317).  childhood.  of  would  definitions  (Bronheim,  wheeze,  these  no  childhood  i n airway  (Pless & Douglas,  are  of  a l l ages  world  Keslin,  study,  cough,  to  of  research w i l l  experience  other  study  to  families.  occasional episodic attack  diseases to  this  helpful  first.  is a  1977,  as  f o r nurses  the  the  is a  results  (Gregg,  Asthma  5%  asthma  Some c h i l d r e n  twice  of  importance  Asthma  which  the  to  discussed  3).  (Bronheim,  of  significance  purpose  children  asthmatic  their  the  approach  Childhood health  perceived  results  and  chapter,  statement,  meaning  The  were  information useful  with  concepts, the  to  this  problem  which  Of  reach p.  5  27;  children  children  adolescent  the  (Gold,  have 1976,  3 p.  1;  Kattan,  asthma  p.  but  there  symptomatic.  I t was  children.  Rearing  preschool  and  chronic  therefore decided  children  like  asthma  are preconceptual  of preschool egocentric  children  (Lovell,  are  can  of a c t i o n to help  reason  with  this  become w e l l  age  and  pp.  are  or t h a t they  This  logical  may  n o t be  724).  for certain  are  to i l l n e s s  times.  behaviour  exacerbations Appropriate  of t h e i r  like  illness  children  understand  anxiety  illness  results,  and  treatments.  anxious  because  (Nelms & M u l l i n s , i n any  child  may  (Nelms & M u l l i n s ,  asthma c h i l d r e n may /  and  feel  misdeeds  or completely  to t h e i r  to  may  either  Frequently, preschool  724).  ience  and  can  how  Sick children  illness  i f the parents  A normal response  To  them i n u n d e r s t a n d i n g p.  and  However, t h e p a r e n t s  Increased  c h i l d r e n ' s response  In a c h r o n i c i l l n e s s  Preschool  magical  1982,  724).  a  intuitive,  concerns  p.  have  a  guilt  i n regression of t h e i r  par-  Thoughts  recognize t h e i r parents'  result  for  immature.  children p.  parents  treatment  724).  i s f u r t h e r exaggerated  the  123).  what i s h a p p e n i n g t o t h e m s e l v e s . the  to  p.  punished  to v e r b a l i z e t h e i r  children  20-22; P i a g e t , 1972,  responsible for their  p.  of  task  175).  that  groups  children  p.  emotionally  group to a s s i s t  (Nelms & M u l l i n s , 1982,  altering  1976,  them b r e a t h e .  are being  a l l age  a difficult  when t h e s e  (Nelms & M u l l i n s , 1982,  t h a t they  are unable  be  (Travis,  young c h i l d r e n , m e d i c a l  guilty  i t i s apparent  t o f o c u s on  c h a r a c t e r i z e d as  1971,  course  feel  data,  f o r more p r e s c h o o l  i t i s even more d i f f i c u l t disease  children  these  From t h i s  i s a tendency  of preschool  ents  527).  i s a common c h i l d h o o d d i s e a s e a f f e c t i n g  children, be  1979,  regress during  p a r e n t a l approaches to a s s i s t  their  1982,  experthese children  4 during  such  deriving  times  secondary  dependent  cult  gains  (Mattss'on,  In summary,it rearing  are e s s e n t i a l  1975,  of preschool  study  80;  and  children  from  becoming o v e r l y  Nelms & M u l l i n s , 1982,  t h a t p a r e n t s may  children with  p.  724).  experience  the  asthma as a complex and  diffi-  n e e d s ; and parents  how  1.  designed  asthma and  the  their  the parents'  What a r e  the  treatment  affects  c h i l d r e n with  asthma?  Purpose of the  (Hymovich,  1976,  paucity  p.  effective  of  their  to care 13;  p.  and 1).  by  p e r c e p t i o n s o f t h e ways t h e y  help  p e r c e p t i o n s o f t h e ways asthma  efforts  to provide  for their  S p e r l i n g , 1978,  care  chronically p.  about s p e c i f i c  to  and  their  6).  ill  role  children  They r e q u i r e  phenomena p r i o r  to  a p p r o p r i a t e i n t e r v e n t i o n s (Gordon & A review  of the  asthma.  literature  the p a r e n t s '  efforts  do  This investigator  short testimonials indicating on  approached  questions:  i n f o r m a t i o n d e s c r i b i n g what p a r e n t s  preschool children with  treatment  p r o b l e m was  the  health professionals play a valuable  understanding  Sweeney, 1979,  the help  asthma meet t h e i r b a s i c human n e e d s ?  parents'  other  parents  knowledge and planning  The  affects  Study  N u r s e s and assisting  i t s treatment  children.  preschool c h i l d r e n with  help  asthma meet t h e i r b a s i c human  following research  What a r e  2.  t o i n v e s t i g a t e t h e ways p a r e n t s  c h i l d r e n with  provide  answering  Problem was  their preschool  only  p.  ill  the  task.  This  in  from b e i n g  i s comprehensible  Statement of the  its  to prevent  the  impact  t o help the  revealed a to help  their  identified  o f asthma and i t s asthmatic  preschool  5 c h i l d r e n meet t h e i r b a s i c obtaining  r e l e v a n t data  human n e e d s .  seemed t o be r e q u i s i t e ,  s t u d y was done a s a b e g i n n i n g knowledge base i n c l i n i c a l ducted  f o r the purpose  In t h i s  studies.  description preschool  The nursing,  concepts  t o be t e s t e d  s t u d y was t o p r o v i d e a  asthma meet t h e i r  toward  basic  helping the  human needs  t o i n f o r m a t i o n which i s u s e f u l  forthis  and m e d i c a l  s t u d y were d e r i v e d from  theories.  To f a c i l i t a t e  with  to nurses.  actions,  basic  developmental,  an e x p l i c i t and  o f the study t h e f o l l o w i n g  parents, helpful  t e r m s were  human n e e d s ,  asthma  i t s treatment. Parents  i n this  s t u d y were d e f i n e d as a c o u p l e , a m o t h e r  father o f a preschool asthmatic  a unit p.  r e s e a r c h i s con-  o f Terms  understanding  defined:  of this  of the parents' actions directed  children with  Definitions  and  Descriptive  o f developing hypotheses  The p u r p o s e  the o b j e c t i v e o f adding  and  nursing.  the development o f a  t y p e o f r e s e a r c h , o b s e r v a t i o n s a r e made and t h e y a r e  further  clear  s t e p toward  and a d e s c r i p t i v e  o f e v o l v i n g t h e o r i e s ( N o t t e r , 1974, p . 20).  analyzed f o r t h e i n t e n t i o n in  Thus, s y s t e m a t i c ways o f  in relation  to the children  78; Benedek, 1970, p . 1 1 0 ) .  a c t i o n s were t h e b e h a v i o u r s  aimed t o w a r d  The h e l p f u l  The c o u p l e  i n a family  In t h i s  study,  actions directed  they  tasks of both  basic  t h e p a r e n t s and  (Brammer, 1979, p . 5; Hymovich & C h a m b e r l a i n ,  22-23).  The c h i l d ' s requirements  performed  by t h e p a r e n t s a r e  children  mental  1979,  the h e l p f u l  w i t h asthma t o meet t h e i r  a c h i e v i n g developmental  basic  represents  (Anthony,  a couple reported that  to nurture the preschool c h i l d human n e e d s .  child.  1980, pp.  human n e e d s were d e f i n e d as t h e f u n d a -  for survival  and g r o w t h o f h i s / h e r b e h a v i o u r a l  6 system  (Campbell,  the U n i v e r s i t y is  C r u i s e , & Murakami, 1976,  of B r i t i s h  Columbia  (UBC)  p.  8).  According  M o d e l f o r N u r s i n g , man  c o n c e p t u a l i z e d as a b e h a v i o u r a l s y s t e m composed o f n i n e  s y s t e m s e a c h o f w h i c h r e p r e s e n t a b a s i c human n e e d .  The  tions  70).  nine  about n u r s i n g are c o n t a i n e d s u b s y s t e m s and  corresponding  i n Appendix A needs a r e  Table The  UBC and  (p.  listed  sub-  assumpThe  i n Table  1.  1  Model f o r N u r s i n g : The  to  Corresponding  Subsystems Needs  Subsystem  Need  1.  Reparative  For balance utilization  2.  Excretory  F o r t h e c o l l e c t i o n and r e m o v a l of accumulated wastes.  3.  Achieving  For  4.  Ingestive  For intake of f l o o d nourishment.  5.  Protective  For  6.  Affective  For love, belongingness dependence.  7.  Satiative  F o r s t i m u l a t i o n of the senses.  system's  8.  Ego-Valuative  For  self.  9.  Respiratory  For intake of  For  the  ceptualized for  purpose o f as  t h i s study  between p r o d u c t i o n of energy.  mastery.  s a f e t y and  and  fluid;  security.  r e s p e c t o f s e l f by  and  oxygen.  t h e p r e s c h o o l c h i l d was  a b e h a v i o u r a l s y s t e m as d e f i n e d by  t h e UBC  conModel  Nursing. The  meaning o f t h e t e r m  asthma was  interpreted  two  different  ways i n t h e s t u d y . the  study  ical was  For the purposes o f o b t a i n i n g  the i n v e s t i g a t o r used a d e f i n i t i o n  practitioners i n their defined  atory  as a " c o n d i t i o n  sible  partially  of varying  or completely  (Kuzemko, 1976, p . 1 ) . interpret ioural  asthma w i l l this  of diverse  state of r e s p i r -  stimuli resulting i n and r e v e r -  spontaneously o r under  On t h e o t h e r  to the disease.  be d i s c u s s e d  Asthma i n c h i l d r e n  d e g r e e and d u r a t i o n ,  asthma i n t e r m s o f t h e i r  reactions  work.  u n d e r s t o o d by med-  o f a l t e r e d dynamic  p a s s a g e s due t o t h e a c t i o n  airways o b s t r u c t i o n  of  clinical  subjects f o r  hand, t h e  treatment"  parents  seemed t o  c h i l d ' s symptoms and b e h a v The p a r e n t s '  i n greater  d e f i n i t i o n of  depth i n the a n a l y s i s  chapte  report.  The  t e r m t r e a t m e n t was d e f i n e d  which t h e p h y s i c i a n  o r other  health  as t h e p r e s c r i b e d care  actions  worker had d i r e c t e d t h e  couple t o take t o prevent o r c o n t r o l the c h i l d ' s asthmatic attacks.  Clinically,  to prevent ponsibility dren. sist  chest  and c o n t r o l t h e a t t a c k s . to provide  Therapy  the prescribed  f o r c h i l d r e n with  o f a combination  tions,  asthma c a n o f t e n  be s u c c e s s f u l l y  Parents are given treatments  the res-  fortheir  o f one o r more o f t h e f o l l o w i n g :  and p s y c h o t h e r a p y  chil-  asthma may be complex a n d c o n -  e n v i r o n m e n t a l c o n t r o l , d i e t and f l u i d therapy,  treated  therapy,  (Green & H a g g e r t y ,  333-338; K e e n s , 1 9 7 9 , pp. 510-523; Knapp & W e l l s ,  medicaexercises,  1977, pp.  1978, p . 115;  L a n d a u , 1979, pp. 5 8 4 - 5 8 6 ) . These f i v e tion  d e f i n i t i o n s were u s e d t o p r o v i d e  o f what was t o be  a clear  descrip  studied.  Approach t o the Problem Descriptive  research  i n nursing  i s done f o r many  reasons  8 such  as t o e x p l o r e t o p i c s ,  hypotheses Isaac  f o r future studies  & Michael,  gathered guide.  develop  from  new k n o w l e d g e , o r g e n e r a t e  ( B r i n k & Wood, 1978, p. 79;  1979, p . 18; N o t t e r ,  1974, p. 2 0 ) .  D a t a were  the subjects using a semi-structured i n t e r v i e w  T h i s method was i n t e n d e d  abundant r e s p o n s e s  from  to obtain guided  b u t f r e e and  t h e p a r e n t s who were i n t e r v i e w e d .  UBC M o d e l f o r N u r s i n g was u s e d  to develop  the i n t e r v i e w guide  as w e l l as t h e c a t e g o r i e s f o r a n a l y z i n g t h e d a t a o b t a i n e d the content of  the parents.  t h e r e s e a r c h were t h e r e f o r e a d e s c r i p t i o n  action  directed  asthma on  of the interviews with  toward h e l p i n g t h e i r  and a summary o f t h e i m p a c t  the parents'  efforts  The  The  from  results  of the parents'  preschool children  with  o f asthma and i t s t r e a t m e n t  to help t h e i r  preschool  asthmatic  children. In  the subsequent chapters  following w i l l study,  be i n c l u d e d :  a review  of this  research report the  the t h e o r e t i c a l  of the r e l a t e d  a description  of the  r e s e a r c h d e s i g n and p r o c e d u r e ,  a summary o f t h e a n a l y s e s  of the  data  a d i s c u s s i o n of the r e s u l t s ,  and r e s u l t s ,  implications research  and f i n a l l y ,  literature,  b a s i s f o r the  f o r n u r s i n g , and r e c o m m e n d a t i o n s  related  t o the study.  f o r future  CHAPTER Theoretical of The  the  research  will  foundation  nursing  and  be  Framework and  Related  theoretical basis  related etical  the  for t h i s research  their children,  g r o w t h and 77;  Pringle,  children  are  factors  parents'  1974,  retical  p.  factors  of  59).  chronically  illness  child-rearing practices p.  statements are  39;  .parenthood  I t was and  that  related  ents  found  to  the  additional  in  and  the  pp.  65  & 69;  l i t e r a t u r e and  support  f o r the  that  p.  p.  a f e e l i n g of  pride  Crummette, 1979,  p.  Hymovich  These  from the  theo-  chronically the  tasks  specialized  care  area  study.  par  children resulted (Burton,  These f i n d i n g s  clinical  ill  of  Some  satisfaction  this descriptive  the  clinical  their activities  27).  29-67).  85;  i t s treatment.  and  and  alter  82).  rearing  involved  that  thei  can  their chronically i l l  indicated  development of  1975,  pp.  investigator's  and  1972,  e f f o r t s to help  1980,  to  optimal  numerous i n d i v i d u a l  1975,  the  that  Cur-  Havighurst,  parents performed  tasks  observations  children.  i t s treatment  families  tasks of helping others  learning  by  (Burton,  child's disease  burdensome, and new  and  s u p p o r t e d by  noticed  the  26;  parents'  Mattsson,  observations while working with children.  ill  of  parents perform tasks  p.  influenced  theor-  investigator's  t o meet n e e d s f o r  1977, The  The  the  from a r e v i e w  the  (Hymovich & C h a m b e r l a i n ,  a chronic  & C h a m b e r l a i n , 1980,  1975,  derived  l i t e r a t u r e and  (Duvall,  t h o u g h t t o be  environmental The  was  s i c k or w e l l ,  development  a c r i t i q u e of  i n t h i s chapter.  developmental theory purports that  assist  p.  s t u d y and  discussed  health-related  Review  Literature  f o r the  observations of parents r e a r i n g rent  II  in  provided  10 The  following  discussion w i l l  hood, t h e d e v e l o p m e n t a l dren with  present a theory of  tasks of parents rearing  a chronic i l l n e s s ,  and  the  parent-  preschool  framework u s i n g t h e  chil-  UBC  Model f o r N u r s i n g . Tasks  of  Parenthood  Parenthood life  with  children  i s g e n e r a l l y a c k n o w l e d g e d as  the p r i n c i p a l  goal of parents being  p.  95;  theory of parenthood  Camilleri  will  A developmental  about  a certain  p e r i o d i n the  1977,  p.  177;  Parents  of  have s e v e r a l  the  as  the next  the  an  s o c i e t y ' s v a l u e s and  adult  emotional  their  children  growing ings and  fully  parents needs and  children.  about life  rearing  their  children  adjustment  achieve  their  their  d u r i n g the  Benedek  of care, t r a i n i n g (p. 9 5 ) .  (1970)  To  l e a r n how  schedules  t o the  (1972) adds t h a t on  Theoretically,  developmental  stage  t a s k s , they  states  and en.cul.turati.on  Havighurst  i s the g r e a t e s t  Parents  child-  i s , the p a r e n t s ' task i s to  are a r e f l e c t i o n  (p. 7 7 ) .  at or  (Duvall,  (1972)  responsibility perform  t o h e l p c h i l d r e n meet t h e i r  (p. 7 7 ) .  Havighurst  develop-  (1963) d e s c r i b e s t h e  266-268).  children  adapt  to  This  2).  that  norms"  learn  (Anthony  237).  individual"  d u r i n g the y e a r s o f parenthood.  responsibility and  p.  o f an  Erickson  (pp.  p.  in relation  tasks to accomplish  "tasks of parents consists  emphasizes t h a t of  life  "generativity,"  generation  1978,  their  task i s a "task which a r i s e s  1972,  years of adulthood.  parenthood  guide  of  Havighurst,  & Glenn,  be p r e s e n t e d  tasks.  rearing  to prepare  t o become wholesome, a d u l t members o f s o c i e t y  & Benedek, 1970,  mental  a major phase o f  this physical  to deal with requirements the p a r e n t s '  their  of feel-  p e a c e o f mind  i f parents experience  success-  satisfaction, if  approval,  the parents  approval tasks  by  fail  tasks  society.  The  assisting  their  itiative  and  difficulty p.  f r o m one  developmental children  a positive  limits  and  I n summary, t h e  D u v a l l has  in society.  described These  to d i f f e r  and  children, and  our  include:  (a)  t o have i n -  (c) h e l p i n g  healthful  working with  child-  routines  pp.  fulfill  p s y c h o l o g i c a l , and  their  h e a l t h y ways  that parenthood  involves  tain  tasks  children  (Wandersman, Poppen,  parents  Rearing  may  I f parents  ( A p p e n d i x B,  to accept  p.  c h i l d r e n may  73).  During  autonomy, and these  changes.  l o s e some c o n t r o l  while maintaining  & R i c k s , 1976,  p.  their  could and  10).  Preschool Children  rearing preschool  are developing  l e a r n i n g how  needs.  f u n c t i o n s , c h i l d r e n w o u l d grow i n p r o d u c t i v e  Tasks of Parents Parents  social  the  169-175).  m a j o r r e s p o n s i b i l i t i e s w h i c h i n c l u d e h e l p i n g c h i l d r e n meet physical,  the  children within  ( D u v a l l , 1977,  indicate  affectional  t o conform to  (d) e s t a b l i s h i n g  expectations  gen-  in  (b) e s t a b l i s h i n g  of others  theorists  tasks  f r o m one  subculture to another  their  playing,and  of the parents'  developmental  tasks of parenthood  ren a d j u s t to the e x p e c t a t i o n s  of e a t i n g , r e s t i n g ,  later  dis-  or u n i v e r s a l l y a p p l i c a b l e .  self-image,  culture,  t a s k s ; whereas,  t o become autonomous, and  bonds between t h e p a r e n t s  demands o f t h e  with  tasks are thought  and  later  tasks, unhappiness,  177).  all-inclusive  the parents' to another  their  f o r a l l parents  a r e n o t meant t o be  eration  and  ( D u v a l l , 1977,  developmental  In f a c t ,  success with  to achieve  society,  results  and  necessary  over  limits  the  concentrate preschool  parents As  their  are  cer-  years,  faced  a consequence, child's  on  with the  behaviours  (Hymovich & C h a m b e r l a i n ,  1980,  p.  266).  One  from t h e i r  of p a r e n t s ' major t a s k s  preschool  child  assume may  (Hymovich, 1979,  these  parents  lines  for their  ren's  appropriate behaviours,  their  children's efforts  ities  f o r the  children  children  include: to  express  follow,  86).  (c) l i s t e n i n g  and  e m o t i o n s i n h e a l t h y ways,  from p o t e n t i a l  specific  life  events,  258-268; Hymovich  that parents  that  specific  Tasks of Parents  and  Caring  w h i c h can  be  normal l i f e tioning.  refers  fatal,  t o be  Hymovich  (1976) p u r p o r t s  perform.  These tasks  understand  and  of  manage t h e i r  to understand  It is certain  and  c h a n g e d when  a chronic i l l n e s s ,  such  a  as  children's illness, the  p.  course  funcillness p.  tasks  (b) a s s i s t and  11).  asthma,  able to:  illness,  4).  relatively  1976,  have a d d i t i o n a l being  their  1978,  a protracted  attention (Travis,  cope w i t h  tasks  Children  p h y s i c a l and/or mental  i n v o l v e the p a r e n t s '  pp.  maturity.  (Magrab & C a l c a g n o ,  that parents  about  ( D u v a l l , 1977,  f r e q u e n t l y show p e r i o d s o f a c u t e  develops  oppor-  to  children  perform  are  to a disorder with  requiring medical  When a c h i l d  opportun-  children  p r o g r e s s i v e , or a s s o c i a t e d with  Such d i s e a s e s  to  independent,  266-269).  children  of parents  span d e s p i t e i m p a i r e d  exacerbations  pp.  f o r C h r o n i c a l l y 111  behaviours  child-  responding  their  children's level  have c h r o n i c i l l n e s s e s  A chronic i l l n e s s  1980,  guide-  children with  as h o s p i t a l i z a t i o n  of preschool  to t h e i r  Child-rearing children  such  tasks  (h) p r o t e c t i n g t h e i r  (i) teaching  & Chamberlain,  apparent are  harm,  the  (d) p r o v i d i n g  (f) p r o v i d i n g t h e i r  separate  behavioural  t o make d e c i s i o n s , (g) a l l o w i n g t h e i r their  to  Other  (b) r e i n f o r c i n g  to d i s c o v e r , share,  children  children  p.  (a) s e t t i n g  t o communicate,  (e) p r o v i d i n g a f f e c t i o n , tunities  i s t o l e a r n how  (c)  to (a) their  help  13 their  ill  children maintain  .(Hymovich, 1976, parents  p.  11).  have a d d i t i o n a l  a chronic i l l n e s s  like  a healthy state  The  tasks to perform  their  integrity  seems t o s u p p o r t  that  when t h e i r  has  child  asthma.  C h i l d ' s B a s i c Human N e e d s : As  literature  and  A Framework t o G u i d e t h e  Research  s t a t e d p r e v i o u s l y the b a s i c f u n c t i o n of parents  society  i s t o meet t h e g r o w t h and  children. parents  The  aim  of t h i s  developmental  r e s e a r c h was  help preschool children with  grow and  develop;  t h e r e f o r e , the  Model f o r N u r s i n g ,  a conceptual  in  needs of  their  t o d e s c r i b e t h e ways  asthma meet t h e i r  investigator  needs  selected  the  to  UBC  framework w h i c h d e s c r i b e s b a s i c  human n e e d s . T h i s model was First,  t h e UBC  selected  for this  Model f o r N u r s i n g  was  study  f o r two  thought  t o be  a t e c o n c e p t u a l model b e c a u s e i t s a s s u m p t i o n s general tion  s y s t e m s and  of developmental  which a f f e c t for Nursing It  learning  the  concepts  chronically  specified  ual  ill  a definition  Model f o r N u r s i n g  framework t o g u i d e  helped  In the  Related  are d e r i v e d  i t allows  for  child.  direction  f o r the  From t h e r e v i e w  inquiry  integra-  S e c o n d , t h e UBC  I n t e r v i e w G u i d e and  appeared  from  c o n s i d e r a t i o n s of f o r c e s  t o be  an  Model  research. guidance  f o r the c a t e g o r i e s of the  literature,  appropriate  a b o u t t h e ways  t h e i r preschool children with  Review o f t h e  their  the  and  an a p p r o p r i -  o f b a s i c human n e e d s , gave  the a n a l y s i s of the data.  t h e UBC  and  p r o v i d e d the necessary  t o the development of the for  theory  reasons.  concept-  parents  asthma.  Research  f o l l o w i n g p r e s e n t a t i o n of r e s e a r c h about p a r e n t s  children with  asthma, t h e  investigator w i l l  discuss  the  and  14 results and  of s t u d i e s which i n d i c a t e d  their  asthmatic  added f a c t o r s  children  about  the m a j o r i t y o f  parents  are normal i n d i v i d u a l s w i t h  of the c h i l d r e n  parents are concerned  that  having  their  a chronic disease?  children's  illness  the and  and  p r o v i d e a d d i t i o n a l h e l p f o r the c h i l d r e n which i s r e l a t e d their  d i s e a s e and Norrish,  and  The  Tooley,  and  Godfrey  psychological tests.  reliable  The  to non-asthmatic  goal  s t u d y was  912).  deviance  The  results  and  1977,  considered  that  i n the  in this  the s e v e r i t y  of the c h i l d ' s  916).  that  emotional  the m a j o r i t y of asthmatic  asthma of  children  Tooley,  study are  (p.  children  (Norrish,  of t h i s  The  between  deviance  i n normal c h i l d r e n For the purpose  study  same r e g i o n .  the r e l a t i o n s h i p  indicated  p.  physiological,  children  children  school-aged centered  to c l a r i f y  w i t h asthma i s no more t h a n & Godfrey,  clinical,  asthmatic  were compared  emotional  (1977) s t u d i e d 63  were a t t e n d i n g a h o s p i t a l  r e s e a r c h e r s used  of t h e i r  to  i t s treatment.  c h i l d r e n w i t h asthma who clinic.  that  i t was  mentally  healthy. Parents, p a r t i c u l a r l y research review tudes  s t u d i e s i n c h i l d h o o d asthma.  of r e s e a r c h from  1937  t o 1963,  i n f a m i l i e s with asthmatic  unsatisfactory found  m o t h e r s , have been a c e n t r e o f  a child's ment and  asthmatic others  like  attacks  They compared  He  especially  reported  (Chong, 1977,  p.  influence  on  65 m o t h e r s o f s c h o o l - a g e d  that  the mother's,  i n t h e c a u s a t i o n and  i t have been q u e s t i o n e d .  (1977) s t u d i e d t h e m a t e r n a l  literature  described parental a t t i -  children.  parental attitudes,  t o be v e r y i m p o r t a n t  Chong, i n a  are  precipitation  78).  This  state-  B y r n e and  children with asthmatic  of  Murrell  asthma.  children  to  15 100  mothers o f normal c h i l d r e n  description  q u e s t i o n n a i r e (Semantic  i n s t r u m e n t measured maternal  relationship  than  This study  d i d not  find  of overconcern.  i s s e t up  self-  Scale).  The  t h a t mothers  that  they  suggested  that  a  cyclical  in  asthma a t t a c k f u r t h e r e x a c e r b a t e s  illness.  whether the a c t i o n  of  possessed  i n which the mother's behaviour  to her c h i l d ' s  a m e l i o r a t e s the  I t was  T h i s s t u d y was  what t h e p a r e n t s d i d t o a m e l i o r a t e t h e i r and  using a  Differential  c h i l d r e n were a n x i e t y p r o n e b u t  characteristics  response  same age  t h e m o t h e r ' s a n x i e t y and o v e r - p r o t e c t i v e  behaviour.  asthmatic  o f the  c o u l d be  judged  rather  an e x a m i n a t i o n  child's  asthmatic  as b e i n g e f f e c t i v e  of  attack or  ineffective. From t h e r e v i e w  o f the  literature,  which p r o v i d e d i n f o r m a t i o n about gave a s t h m a t i c ment on  children  study,  years  and  their  Jones  and  Rickards  t o study  41  m o t h e r s , two severe closed  i n g s about that  they  ried  about  impact  had  about  The and  concerns  father,  and  how felt  their  common c o n c e r n  about  children  to eleven  Reddihough,  Landau,  d u r i n g an  o f p a r e n t s was  their  children with  family.  school-  moderate  open-ended  and  Parents  their  attack.  whether the c h i l d r e n ' s  feel-  reported  c h i l d r e n w i t h asthma, and asthmatic  was  Thirty-six  They were a s k e d  their  having  research  p a r e n t s and  asthma, i t s t r e a t m e n t ,  asthma a f f e c t e d guilty  42  i t s treat-  ages n i n e  i t s treatment.  asthma were i n t e r v i e w e d . q u e s t i o n s about  by  they  child.  major g o a l o f t h e i r  asthma and  c o u p l e s , one  o f asthma and  children,  p a r e n t s were s u r v e y e d (1977).  found  the h e l p p a r e n t s r e p o r t e d  to care f o r t h e i r  asthmatic  the understanding  aged c h i l d r e n  and  the  the p a r e n t s ' e f f o r t s  I n one  to  and  t h r e e s t u d i e s were  wor-  Another medications  were g o i n g  t o be e f f e c t i v e  S e v e r a l mothers e x p r e s s e d in  during  children  mothers b e l i e v e d they s t i l l further  attacks.  attacks.  to their  children's  their  children  Some p a r e n t s were r e l u c t a n t  i n t h e c a r e o f someone e l s e .  their  limited  asthmatic  a n e e d t o be c l o s e  c a s e t h e y h a d an a t t a c k .  leave t h e i r  their  to  Most o f t h e  asthma was u n d e r c o n t r o l b u t  children's  activities  The m o t h e r s i n t h i s  to prevent  study c o n t r o l l e d the  c h i l d r e n ' s m e d i c a t i o n s and made d e c i s i o n s w h e t h e r t h e i r  children  w i t h asthma  stated  that  In  children  In f a c t ,  school-aged  once u s i n g regarding  children  allergy  how t h e i r  for helping  clinic.  Crummette i n t e r v i e w e d  children's  children's  focusing  asthma  and t h e m o t h e r s ' p e r c e p t i o n s  asthma a f f e c t e d  their  lives.  of  care.  their got  The m o t h e r s d e s c r i b e d  controlling  their  children's  children's nutritional  the required  activities, In  fact,  to  care  sleep,  addition,  their  From an  five  categories  actions as:  e n v i r o n m e n t , (b) c a r i n g f o r  needs,  (c) e n s u r i n g  (d) c o n t r o l l i n g  their  their  children  children's  a n d (e) managing  their  c h i l d r e n ' s medical regime.  the mothers a l t e r e d  their  usual patterns of mothering  f o r the asthmatic children's  example, t h e y w o u l d p r e v e n t limiting  each mother  on t h e m o t h e r s ' c o n c e r n s  o f t h e i n t e r v i e w d a t a Crummette d e r i v e d  (a)  30 m o t h e r s  they attended a  analysis child  their  (1979) s t u d i e d  w i t h asthma w h i l e  open-ended q u e s t i o n s their  the mothers  (pp. 2 9 6 - 2 9 7 ) .  t h e s e c o n d s t u d y , Crummette  pediatric  of  school.  they had t h e major r e s p o n s i b i l i t y  asthmatic  of  should attend  their  activities  their  special  children's  or controlling  t h e mothers found i t d i f f i c u l t  needs.  For  asthma a t t a c k s by  their  environment.  t o help  In  the children  become independent, but d i d t e a c h them how selves. limits  t o care f o r them-  A n o t h e r d i f f i c u l t y the mothers e x p r e s s e d was f o r the a s t h m a t i c  children.  setting  They b e l i e v e d the c h i l d r e n  would become f r u s t r a t e d which would p r e c i p i t a t e asthma a t t a c k s . To r e s o l v e t h i s problem, the mothers s e t l i m i t s f o r t h e i r ren f i r s t , and then t r e a t e d t h e i r c h i l d r e n ' s a s t h m a t i c  child-  attack  (pp. 24-25). In the t h i r d s t u d y , T r a v i s  (1976) i n t e r v i e w e d n i n e  of p r e s c h o o l  c h i l d r e n w i t h asthma i n t h e i r homes u s i n g  unstructured  format.  information.  couples an  T h i s approach f u r n i s h e d a c o p i o u s amount of  T r a v i s n o t e d t h a t the p a r e n t s :  (a) s t a y e d w i t h  the  c h i l d r e n t h r o u g h o u t the n i g h t t o c o m f o r t them i f they were e x p e r i e n c i n g symptoms of asthma, (b) gave the c h i l d r e n p r e s c r i b e d medications,  (c) c o n t r o l l e d the c h i l d r e n ' s environment, (d) o f f e r e d  the c h i l d r e n a cup of warm t e a or water when they had an asthma attack,  (e) changed the c h i l d r e n ' s d i e t a r y h a b i t s as i t was  r e q u i r e d , (f) l i m i t e d the c h i l d r e n ' s a c t i v i t i e s t o p r e v e n t another asthma a t t a c k , and  (g) took the c h i l d r e n t o the  h o s p i t a l ' s emergency s e r v i c e s when the c h i l d r e n needed f u r t h e r h e l p t o b r e a t h e (pp.  175-176).  parents  t h e i r e f f o r t s t o h e l p the c h i l d r e n meet  concentrated  I t was  apparent t h a t t h e s e  t h e i r needs. There appears t o be some weaknesses i n these t h r e e which were c o n s i d e r e d  by the w r i t e r .  The  samples i n the  were s m a l l and not r e p r e s e n t a t i v e of p a r e n t s children.  rearing  studies studies  asthmatic  I n the Crummette (1979) and Reddihough e t a l (1977)  s t u d i e s , the m a j o r i t y of p a r e n t s  i n t e r v i e w e d were mothers of  school-aged asthmatic  I n a d d i t i o n , b o t h of t h e s e  children.  18 studies  tended  viewed and  lower  toward  samples.  socioeconomic,  Reddihough  asthmatic  biased  et  al  children  black  (19 77)  who  were  Crummette  women i n R i c h m o n d ,  interviewed  only  attending  clinic  a  Children's  H o s p i t a l i n Melbourne,  Australia.  and  factors  characteristic  of  results  of  social  biased  the  convenience  r a t h e r than  children.  The  Crummette  by  these  was  p.  their  The  the  Recent active  of  children  i n the  family.  directed  unit  p.  ( 1 9 7 9 ) who  fathers  are  not  child-rearing (1977), children parents  of  of  clinic the  indicates i n the  system  parents  two  interdependent  Other  theorists the  demarcated  and  as  are  a  and i l l  the  team  to  Voysey,  clinic  of  see  routine of  care  1981,  in  research According  in relation  to  viewed  as  and  a  interacting this,  such  mothers  According care  to  as and  share  to  Le  for  s e p a r a t e l y , found tried  the  goal  parents  provide  children  and  i n theory.  today  78).  been  fathers  functions of  (p.  of  have  parents  support  and  asthmatic  (McKeever,  i s supported a  of  used  f a t h e r s i n both  daily  both  have  environment.  that  illnesses  may  studies  visiting  of  cultural  researchers  parents  The  Barsch  handicapped  samples  their  Royal  Specific  i n the  medical  represent  cooperate  60).  of  and  i n the  ( 1 9 7 7 ) may  involving  responsibilities  parents (p:  chronic  reports that  clearly  al  involvement  of  110).  Anthony  the  parenthood  parents  (1970,  et  inter-  Virginia,  parents  The  of  parents  participants  with  made u p  studies.  purpose  research  the  parts  the  of  importance  tasks  Benedek,  tone  these  samples  Reddihough  lack of  children  124).  about to  as  of  families'  and a  studies.  themselves for  the  strangeness There  and  two  random  responses  (1979)  influenced the  these  (1979)  f u l f i l l  the Masters  their that the  19 r e s p o n s i b i l i t i e s o f c a r e and  c o n t r o l o f c h i l d r e n and m a i n t a i n  f a i r d i s t r i b u t i o n o f t h e h e l p and ( B a r s c h , 1968, It  p.  311;  resources w i t h i n the f a m i l y  V o y s e y , 1975,  s h o u l d be n o t e d  t h a t these  p.  139).  s t u d i e s d i d not use  a  develop-  mental approach.  However, t h e r e s e a r c h e r s d i d i d e n t i f y  o f a s p e c i f i c age  group of c h i l d r e n t o i n t e r v i e w ; f o r example,  Crummette  (1979) and  a  parents  R e d d i h o u g h e t a l . (1977) i n t e r v i e w e d  parents of school-aged  c h i l d r e n and  parents of preschool c h i l d r e n .  T r a v i s (1976) i n t e r v i e w e d  The  developmental  c h i l d r e n a f f e c t t h e i r p a r e n t s ' r e s p o n s i b i l i t i e s and  stages  of  tasks; there-  f o r e , t h e a g e s o f t h e c h i l d r e n c o n s t i t u t e an e s s e n t i a l  consider-  a t i o n when s t u d y i n g p a r e n t a l t a s k s . From t h e l i t e r a t u r e r e v i e w and gator found  insufficient valid  and  i t s a n a l y s i s , the  r e l i a b l e d a t a f o r use  n u r s i n g care of f a m i l i e s of asthmatic preschool Therefore,  a d e s c r i p t i v e s t u d y was  ill  i n the  children.  done w i t h an a i m t o i m p r o v e  t h e q u a l i t y o f t h e r e s e a r c h a v a i l a b l e , and about c h r o n i c a l l y  investi-  add  t o the  c h i l d r e n using a developmental  knowledge and  nursing  approach. The  n e x t c h a p t e r d e s c r i b e s t h e r e s e a r c h method u s e d  study the parents' perceptions of t h e i r behaviours  to help  p r e s c h o o l c h i l d r e n w i t h a s t h m a meet t h e i r n e e d s t o grow develop.  to  and  their  CHAPTER I I I Research The  evidence  from  Design  the  review  experience  as p r e s e n t e d  tive  about the behaviours  study  preschool content ing from  the  research plan w i l l the  sample, t h e  Lastly,  This descriptive couples * behaviours school children. c o m p l e t e and (Selltiz, One to  the  subjects.  p.  284).  of  study  secured  the p a r e n t s of  and  of  procedure.  the e t h i c a l  con-  summarized.  their  efforts  accounts  of  10  to help t h e i r  pre-  D e s c r i p t i v e r e s e a r c h i s aimed a t o b t a i n i n g  Support  pp.  data  asthmatic  for this  p.  20).  c o u p l e s ' r e p o r t s about t h e i r  and  Douglas,  study  In t h i s  and  as  p r o v i d e d from II.  behaviours  I t was  of the  both  assumed  in relation  p r e c i s e (Hymovich,  i n a review  is  study,  c h i l d r e n were c h o s e n  d e c i s i o n was  c h i l d r e n were h o n e s t  studied  102-103).  in a descriptive  ( N o t t e r , 1974,  preschool  Barnard  of  the  a description  provided detailed  r e s e a r c h as d i s c u s s e d i n C h a p t e r  their  The  Plan  o f t h e ways t o g a t h e r  couples  helping  and  interview  be  their  includ-  a c c u r a t e i n f o r m a t i o n about the group b e i n g  ten  the  to  necessary.  an o v e r v i e w  the data  W r i g h t s m a n , & Cook, 1976,  t h e o r y and  the  study w i l l  including  interview subjects  that  and  that a descrip-  the data  f o l l o w e d by  to analyze  Overview of the Research  analyze  Initially,  I n t e r v i e w Guide,  clinical  research plan  investigator  be p r e s e n t e d ,  involved in this  the  and  in relation  t i m e l y and  t o a c q u i r e and  t h e method u s e d  siderations  II indicated  f o c u s on  preschool children.  literature  of parents  i n t e r v i e w s between t h e  asthmatic  of the  asthma was  chapter w i l l  t h e methods u s e d  Methods  i n Chapter  children with  of t h i s  and  to  1979,  literature,  reported: their that  "Parents  perceptions" people  them,  p.  parents  were i l l  investigator purpose  their ance  with  t h e UBC  chapter,  the data. their  children.  Model  needs  a detailed  account  was  used  by t h e  f o rthe  of the couples'  helping behaviours  f o r Nursing.  planned  behaviours.  The a n a l y s i s  as p r o v i d e d  facts  their  C, p . 7 7 ) , d e v e l o p e d  were  see  i n her research  the investigator their  stated  see the  d i d with  f o r Nursing,  The d a t a  (1949)  as o t h e r s  they  found  they  about  (Appendix  t h e UBC M o d e l  b a s i c human  t h e way  (1975)  Therefore,  Guide,  reflected  asthmatic  Burton  and a s k them  of collecting  interactions  with  accurate i n  and Snygg  to the facts  t o d i s c u s s what  children.  from  Coombs  according  i n keeping  eager  Interview  instances, quite  p. 8 ) .  Furthermore,  interview parents The  by  behave  17).  chronically to  (1974,  do n o t b e h a v e  but they  (1949, that  a r e , i n many  then  i n relation  to  sorted i n accord-  by t h e framework  offered  In the f o l l o w i n g sections of  of the research  procedure  will  this be  described. Description The sample  o f t h e Sample  following discussion presents  o f 10 c o u p l e s ,  procedure section  f o r c o n t a c t i n g them  of couples  with  a s t h m a was  1974,  p. 7 6 ) .  Columbia  the c r i t e r i a  were  were  for their  f o r the research  currently  rearing  Two  pediatric  approached  the c r i t e r i a .  and  discussed  allergists  to provide  project. preschool  The i n v e s t i g a t o r  the following: to nursing,  (a) p u r p o s e  (b) c r i t e r i a  the  cross-  children  who  allergists  of the study  for selecting  A  British  of parents  interviewed  and t h e  (Notter,  i n Vancouver,  t h e names  of the  selection,  d e s i r e d f o r a r e p r e s e n t a t i v e sample  met  significance  who  the description  and i t s  the subjects  for  the  cedure  study,  (c) c o n t e n t  of the  I n t e r v i e w Guide,  f o r o b t a i n i n g . t h e names, a d d r e s s e s ,  and  and  (d)  telephone  pro-  numbers  f o r the p o s s i b l e s u b j e c t s . A l e t t e r was which o u t l i n e d collection  left  with  the purposes  (Appendix  D,  p.  made w i t h t h e a l l e r g i s t s , agreement t h a t the through  their  the a l l e r g i s t s of the 82).  they  After  (Appendix  his medical  clinic.  t o be is  not  p.  97).  E, p.  not  a t the  t h i s was  strategy  p.  for participation  other  allergists  four from was  sampling.  i n the  study,  ( B r i n k & Wood,  s t u d y w h i c h was  In f a c t ,  Phillips the  d a t a on  and  1978,  aimed  at  about p a r e n t s ' p e r c e p t i o n s r a t h e r  than  limitation  s t a t e d : " I f the  was  defini-  context of d i s c o v e r y , a  ( t o random sample)  f o r a given problem  a n o n p r o b a b i l i t y sample"  might  (Phillips,  95).  A set of f i v e couples  The  sample o f c o u p l e s  or d i s p r o v i n g a given hypothesis, t h i s  to secure d e t a i l e d  1971,  time  of the problem emphasized  superior be  t h i s , method.  of the p e d i a t r i c  a descriptive  a major concern.  tion  their  i s a n o n p r o b a b i l i t y sample t h a t happens  g a t h e r i n g more d e t a i l s proving  was  83).  r e p r e s e n t a t i v e of the p o p u l a t i o n As  data  indicating  t h e p r e f e r r e d method o f random  sample  available  one  t h e method o f  the v e r b a l agreement  Thus, a c o n v e n i e n c e  obtained r a t h e r than A convenience  by  reference  o b t a i n t h e p a r e n t s ' names  S i x c o u p l e s were o b t a i n e d by c o u p l e s were r e f e r r e d  and  signed a consent  investigator  offices  study  for further  from  the  list  T h i s .method e n s u r e d p r o v i d e the data  c r i t e r i a was  used  of r e f e r r a l s  to select  s u p p l i e d by  a sample o f p a r e n t s  r e q u i r e d and  limited  t h e names o f the  allergists.  w h i c h w o u l d be  the  the  able  to  intervening variables  w h i c h may  have c o n f o u n d e d  r a t i o n a l e were u s e d 1. from  The  to s e l e c t  range  f r o m two  (Duvall,  1977,  p.  diagnosed for  by  at least  illnesses confound helped  had  year  from  until p.  one  year.  preschool  years of  age  other i l l n e s s e s  and  t h e y had  as e p i l e p s y  or c y s t i c  the  about  how  the  and  p.  one  as h a v i n g 88;  to  treatments;  of at l e a s t  t h e c h i l d r e n were d i a g n o s e d ( C a r l s o n , 1978,  factors  f o r parents  illnesses  s e t the c r i t e r i a  to  parents  embroiled with  I t takes time  children's  investigator  the time  f i b r o s i s would tend  c h i l d r e n w o u l d be  the other d i s e a s e s .  asthma  children with other chronic  clear distinctions  asthmatic  been  asthma  Smith,  1981,  17).  This  The  study  parents both  theoretical  the f a t h e r 110; 4.  lived  as a u n i t  M c K e e v e r , 1981, The  i n the  British  support  to p a r t i c i p a t e  c o u p l e and  the  i n the  study.  sample b e c a u s e o f  f o r i n c l u d i n g both  (Anthony, p.  1979,  p.  78;  the  the mother  Benedek,  preschool children with  asthma  same h o u s e i n t h e a r e a o f t h e Lower M a i n l a n d  Columbia.  The  environment,  c o u p l e s were i n t e r v i e w e d i n t h e i r  and  1970,  124).  their  rather than'in a c l i n i c relaxed  agreed  i n v o l v e d t h e c o u p l e as  r e s e a r c h and  p.  definition,  years to f i v e  Asthmatic  the date of s e l e c t i o n  3.  and  half  no  become a c c u s t o m e d t o t h e i r therefore,  By  ranged  t h e i r p h y s i c i a n as h a v i n g m o d e r a t e t o s e v e r e  t h e d a t a and  concerning  and  and  249).  children  such  their  following c r i t e r i a  couples:  y e a r s o f age.  children  The  the  The  a g e s o f t h e p r e s c h o o l c h i l d r e n w i t h asthma  three to f i v e  2.  the data.  or h o s p i t a l  i n an a t t e m p t  to f a c i l i t a t e  t o have  the couples'  of homes, a  responses  24 during  the  interview.  ideal  setting  which  the  spoke  (1976, The  and  interviewing i s a  respondents  opinions" 5.  for  Kornhauser  are  p.  study  was  limited  to  voice  couples  ten  couples'  names w e r e  situation  their  who  obtained,  their  participation  (Appendix  F,  84)•  After  couples them to  by  set  Interview The  p. had  a  volunteered  telephone date  to  the  in  frank  understood  and  days  the  for their  i n the  couples  p r o j e c t by  i t was  and  interview.  the  were  letter  anticipated  investigator  decision to  A l l ten  that talked  volunteer  couples  willingly  study.  Guide interview  i s an  (Brink  discussion,  the  will  be  (b)  fine  its  or  (d)  man,  & Cook,  1978, of  (a)  enough  ability  1976,  Interview primarily  pp.  In  a  because  an  the  what  particular  not  an  research.  of  i t s measuring being  i t makes  i t was  repeatability  was  and  ideal  i t i s to  semi-structured  for  following  concepts  i s , that  purposes  there  the Guide  of  160-163; W i l l i a m s o n ,  Guide,  for this  or  to  data  perceptions  Interview  that  measure  collect  about  features  f o r the to  to  106).  i t s relevance  i t s reliability  available  the  The  way  data p.  i t s sensitivity,  distinctions  and  obtain  described.  described,  ure,  to  development  include:  validity  and  appropriate  & Wood,  instrument  developed  i n the  letter  ask  participate  individuals  The  to  f o r the  studies  features  seven  r e c e i v e d the  descriptive  tive  to  that  564).  about  and  "permissive  encouraged  contacted  with  report  English. After  the  Sheatsley  serve,  intended (Selltiz,  1981,  pp.  (c)  to  Wrights-  154-160).  questionnaire, applicable The  UBC  meas-  was  alterna-  Model  for  Nursing  was  because  i tprovided  needs  an a p p r o p r i a t e  an a p p r o a c h  and i t allowed  items ing,  standard  were  from  with  and t h e i r  two n u r s i n g  Cruise,  Soothill, intended  and 264-268;  children's  volunteered  One q u e s t i o n  their  suggestions  from  because they  asked  asked  children parents  t h e items  were  included  from were  statements  to  information  about:  with the  the parents'  (c) t h e h e l p  asthma, parents'  and  to help  efforts Both  two  Guide.  made of  their  of  parents  these  The  to the  and t h e r e Guide designed  and r e l e v a n t  data  (b) t h e c h i l d r e n ' s  their  o f asthma  questions  by  and i n c l u d e d questions  provided  with  definition  information  (a) d e m o g r a p h i c  (d) t h e i m p a c t  efforts  relevant  responsibilities,  parents  developmental  t o be s i g n i f i c a n t  i n the Interview  the problem  concerning  As a r e s u l t ,  infections.  elicited  were  children  f o r the couples'  thought  1980;  development, the  preschool  for specific  reflected obtain  Following  t o be i n t e r v i e w e d .  and t h e second  asthma,  Perry,  preschool  protect  fore  1976, pp. 11-13;  couples-of  Campbell,  1980; D u v a l l , 1977,  t o be c o n s i s t e n t w i t h  added.  study  1 9 7 7 , p p . 8-9;  f o r the Guide  Two  Its  and i n c o n s u l t a t i o n  (Arkinstall,  conditions.  Guide  preschool  A l l items  was p r e t e s t e d .  to  with  (Riehl  f o r Nurs-  1979, pp. 385-389).  Guide  asthma  working  human  theory  t h e UBC M o d e l  asthma,  Hymovich,  basic  1974, pp. 66-67).  1 9 7 6 , p . 8; C a m p b e l l ,  and asthmatic  were  with  researchers  needs  asthma  experience  families  & Murakami,  249-258  (Notter,  the Guide  of the Interview  the literature,  and t h e r e s e a r c h e r ' s  children  pp.  derived  of developmental  The development  procedures  t o use t o develop  to the individual's  integration  & Roy, 1974, p. 2 6 ) . followed  framework  preschool  children  and i t s treatment  preschool  children.  on  26 Three  types  instrument's This  to  the  Interview  was  based  the  on  and  to  the  1974,  p.  asthma meet  their  of  the  how  helped  needs.  In  to  by  the  addresses  the  degree  d e v i c e was  r e p r e s e n t a t i v e of 1974,  in this  were  p.  of  from  In  the  a wide  the  validity  consultants  and  parents  addition,  the  framework  f o r the  asthma.  range  UBC  of  Model  of of  contained  Guide.  encompassing  the  to  120; study  and  there-  parents'  children  with  of  the  the w i l l i n g n e s s  as  of  a  data  about  the  which collection topic  previously  i n the  referred  Interview  relevant theories.  items  for Nursing  Interview  theory  study,  preschool  in this  validity,  this  the  p.  project,  and  content  of  guide  1978,  about  II.  interviews.  i s known  range  collection  used  and  validity  face v a l i d i t y  what  items  instrument  growth  face  & Wood,  content  the  was  this  underlying  i n Chapter  preschool  the  to  examined.  The  asthma,  research  addition,  to which  about  a wide  data  Guide  their  validity,  140).  chapter,  developed  ation  the  (Brink  during  type  to  of  was  theory  described  pretest results  respond  in relation  163).  addressed  for this  third  (Notter,  were  Interview  they  enhanced  couples  The  p.  childhood  validity  The  and  a p p l i c a b l e f o r obtaining data of  was  1981,  investigated  74).  perceptions  Guide  of  which  particularly  i t was  concepts  to  pertinence  being  developed  fore,  of  (Williamson,  form  considered  construct validity  soundness  nursing  second  variables  was  were  theories related  refers  Notter,  the  First,  Guide  development,  which  validity  usage.  refers  The  of  was  obtained  children provided The  with a  Consult-  from  nursing  asthma.  In  comprehensive  Guide's  preschool  Guide  items  children  represented with  27 Reliability repeatability The  t o the concepts  ately  to the interviewer's questions appropriThe i n t e r v i e w p r o c e d u r e  according t o a planned  t o address  chers experienced  their  t h e i n t e r v i e w s , (c)  interviews with  s i s t e n t with that of the i n v e s t i g a t o r . a s an a c c e p t a b l e way t o a d d r e s s ( N o t t e r , 1974, p . 6 ) .  interview the couples Interview Procedure  randomly  selected  the couples  by t h e i n v e s t i g a t o r .  the nursing consultants' categorization  ment o f d a t a  In  and com-  placement o f the i n t e r v i e w content t o  the t r a n s c r i b e d data prepared  nized  the consistency of  of the i n v e s t i g a t o r ' s  i n t h i s method o f a n a l y s i s  independent  (b)  o f t h e i n t e r v i e w s , two n u r s i n g r e s e a r -  segments o f t h e a u d i o t a p e d pared  (a) i n t e r v i e w e d  ( W i l l i a m s o n , 1981, pp. 1 5 4 - 1 6 0 ) .  the r e l i a b i l i t y  placement o f the content  was made  and c o n s i s t e n t p r o c e d u r e ,  a l l of the interviews, f a c i l i t a t i n g  interviewing techniques  addition,  of  i n that a l l couples  t h e same I n t e r v i e w G u i d e t h r o u g h o u t  conducted  1981, p . 1 6 4 ) .  i n t h e f o l l o w i n g ways: t h e i n v e s t i g a t o r  the p a r e n t s used  responded  and d e s c r i p t i v e l y .  reliable  o f c o n s i s t e n c y and  ( N o t t e r , 1974, p. 75; W i l l i a m s o n ,  I n t e r v i e w G u i d e i t e m s were r e l i a b l e  consistently  the  relates  o f t h e d a t a was  con-  T h i s method i s r e c o g reliability  The s p e c i f i c  and o b t a i n t h e d a t a  (Appendix  The r e s u l t s  of the placemethod u s e d t o  i s described i n the  G, p . 8 6 ) , and i n t h e f o l l o w i n g  discussion. Procedure The and  forCollecting procedure  t h e Data  which d i r e c t e d  i t seemed t o be e f f e c t i v e  and e f f i c i e n t .  (Appendix  p . 88) was r e v i e w e d  to  data  beginning  collection  t h e i n t e r v i e w s was c o n s i s t e n t A written  consent  w i t h each o f the couples  and was s i g n e d by b o t h  prior  the f a t h e r  28 and  t h e mother.  During  the i n t e r v i e w s both  p a r e n t s were  and  freely  was  experienced  participated  i n the d i s c u s s i o n .  The i n v e s t i g a t o r ,  interviews. complete. thanked  i n the s k i l l  of interviewing, directed  Each i n t e r v i e w took  approximately  the parents  f o rtheir  participation  and p r o v i d e d t h e  to collect  helped  their  asthmatic  the data  section,  obtained  couples w i l l  from  the c r i t e r i a  be d e s c r i b e d .  analysis.  of i n f e r e n c e  (Holsti,  as a  F o r example, t h e h e l p  b a s i c human needs and t a s k s o f framework t o s o r t "help."  the statements  T h i s i s an a c c e p t -  a c c o r d i n g t o B r i n k a n d Wood:  a study has a c o n c e p t u a l o r t h e o r e t i c a l  t h e r e s e a r c h e r c a n s e t up c l a s s i f i c a t i o n s ,in a d v a n c e , s i m p l i f y i n g analysis.  serves  p r e s c h o o l c h i l d r e n was t h e  of t h e c o u p l e s ' p e r c e p t i o n s o f t h e i r  If  to analyze  s e l e c t e d f o r a n a l y s i s and t h e b a s i s f o r i n f e r -  as a c l a s s i f i c a t i o n  able procedure  to analyze  T h i s method c a n be a p p l i e d  1969, p . 2 ) .  The i n v e s t i g a t o r u s e d  parenthood  used  o f communication  s t a t e d they p r o v i d e d t h e i r content  used  interviews with the  The main t e c h n i q u e  t o any p r o b l e m where t h e c o n t e n t  ences.  children.  and t e c h n i q u e  the investigator's  i n t e r v i e w s was c o n t e n t  semantic  percep-  f o r A n a l y z i n g t h e Data  In t h i s  parents  of pre-  home u s i n g a G u i d e w h i c h  in-depth d e s c r i p t i o n s of the parents'  t i o n s o f how t h e y Procedure  requested.  interviewed ten couples  s c h o o l c h i l d r e n w i t h asthma i n t h e i r  basis  a l l ofthe  At the termination of the interviews, the i n v e s t i g a t o r  In summary, t h e i n v e s t i g a t o r  the  who  s i x t y minutes t o  names o f r e s o u r c e s and i n f o r m a t i o n t h e c o u p l e s  helped  present  framework, or categories  somewhat, t h e p r o c e s s  ( B r i n k & Wood, 1978, p. 1 4 6 ) .  of content  29 From cribed  the  each  couples'  appropriate child's  data,  the  needs  as  the  the  the  and  that  data  being  are  the  each  "need"  help  their  p.  be  99).  the  of  the  this  this  By  within meet  fact  which  to  each inter-  (Campbell,  therefore,  the  of  what  that  category  investigator  couples  under  they  did  of  their  examples  the  is  single  the  each  6).  that  stipulates  problem,  identified  partially  the  criterion  one  by  p.  definition,  the  than  specific  1,  subsystem  meet  human  framework  thought,  presented  content  to  to  exclusiveness  i n more  gave  a  interview  basic  (Table  subsystem  other  not  couples  then  a  I t was  approach  The  appeared  by  would  as  due  the  to  "appropriate criterion  of  exclusiveness.  Sorting  the  couples'  responses  according  c h i l d r e n ' s . b a s i c human n e e d s  reflected  As  a  a  one  the  as  theory."  every  6).  placed To  and  Grouping  restraints  Mutual  responses  children  category  p.  needs  category.  behaviours.  with  of  for Nursing  represented  1976,  can  common  into  of  f o r Nursing  "system  exclusive.  datum  Model  some  placement  definitions  Model  on  interdependent  ( H o l s t i , 1969,  mutual  based  needs  help  represented  i n the  the  UBC  UBC  c a t e g o r i e s of  content  need"  the  imposed  was  mutually  grouped  used  the  & Murakami,  the  category  of  trans-  needs.  by  of  investigator  expressions  investigator  provided  nine  Cruise,  Each  investigator  framework  acting  no  the  application  organize  of  category.  guide  interviews, the  verbatim  b a s i c human  To  The  audiotaped  result  of  the  analyses,  parents'  perceptions  of  children  with  meet  asthma  (a)  the  their  the  description ways  they  to  the  research evolved helped  human n e e d s ,  and  preschool question.  including  the  preschool (b)  how  asthma  30 and  i t s treatment  preschool To  affected  asthmatic  the help the parents  provided  their  children.  summarize, t h e c o n t e n t  analyses of the interviews with  ten couples o f preschool c h i l d r e n  w i t h asthma f r o m  Mainland  of B r i t i s h  C o l u m b i a were g u i d e d  Nursing,  a b a s i c human n e e d s framework.  G u i d e and t h e c a t e g o r i z a t i o n  t h e Lower  by t h e UBC M o d e l f o r Both t h e I n t e r v i e w  o f t h e d a t a were d e v e l o p e d  from  this  n u r s i n g framework. Ethical  C o n s i d e r a t i o n s Encountered  In t h i s  study,  certain  a p p r o v a l was s e c u r e d Screening  from  i n the Research  ethical  i s s u e s were c o n s i d e r e d .  The U n i v e r s i t y  Committee f o r R e s e a r c h  and O t h e r  Human S u b j e c t s : B e h a v i o u r a l S c i e n c e following discussions w i l l ways t h e i n v e s t i g a t o r Obtaining participation igator  were t e l e p h o n e d  opportunity  i s s u e s and t h e  informed  consents  regarding  f o r them t o make a d e c i s i o n  i n the study.  and asked  This telephone f o r further  i f they  A t t h a t time, had d e c i d e d  the couples  to participate i n  contact with the couples  clarification  addition  to this,  a t each i n t e r v i e w t h e i n v e s t i g a t o r  contents  of the w r i t t e n consent o f i t (Appendix  w r i t t e n consents  and t o s e t  and a v e r b a l c o n s e n t .  t o the couples p r i o r  H, p . 8 8 ) .  p r o v i d e d an  about t h e study  f o r the interview  and  their  a b o u t t h e s t u d y by  the time and date  signing  The  them.  a n d one week was a l l o w e d  study.  the e t h i c a l  E a c h c o u p l e was i n f o r m e d  about p a r t i c i p a t i n g  the  I , p. 89 ) .  i n t h e r e s e a r c h was one o f t h e i s s u e s t h e i n v e s t -  considered.  a letter  approached  Columbia  Studies Involving  (Appendix  present  the couples'  of B r i t i s h  An  The c o n t e n t s  In  read the to their  of the verbal  were c o n s i s t e n t , a n d c o n t a i n e d t h e p u r p o s e  31 and  possible  tion  benefits  to the couples  specified. during  They  the  The  study.  draw  from  care  of t h e i r  the study  couples  involvement  were  children.  The  study  i n the  study.  ethical  three  Council, tape  major  15).  However,  was  p r o t e c t e d by k e e p i n g  the  couples'  the  completion  were  be  the second  Canadian  the taped  anonymous.  erased  1977,  their  initial  to  interviewed i n their  be  family.  The  disclosure gator  letter,  p.  third  consider  threat  this  sufficient threat  t h r e a t s was  were  their  their  that  in their  presented  time  helped  their  p r i v a c y was  t o withdraw  from  (The  to  in  their  the  The  opportunity f o r the couples option  data  consented  convenient  children.  at  homes  This  willingly  and  that  and w r i t t e n  was  the  privacy  privacy  intent  that  the use of a  to the couples'  to the couples'  and an  that  (The C a n a d i a n  assured  Interviews  with-  there  made e x p l i c i t and  of  medical  about  study,  privacy  couples  homes a t a  they  the  confident  In t h i s  but a l l the couples  o f t h e ways  provided  14).  could  c o n s i d e r e d was  a l l the audiotaped  threat  they  interviews confidential  or destroyed.  potential  Council,  The  and  the completion  informed  f o r research only  of the study  either  felt  the investigator  o f t h e i n f o r m a t i o n was  names  of these  clearly  audiotaped  jeopardizing  adequately  privacy.  was  explana-  use during,  that  the investigator  One  use  would  informed  investigator  with  be  following  threats to the families'  1977, p.  recorder.  would  the exact  without  were  issue  providing the couples  were  also  In the  involvement  they  about  a t any time  i n this  Another  that  of the audiotapes  couples  research.  of their  informed  t h e i n t e r v i e w and t o l d after,  of  the extent  were  disposition  the  of the completed  investi-  to  the  study  32 a t any t i m e .  Furthermore,  questions which allowed they  c o u p l e s were a s k e d  the parents  open-ended  t o answer t h e q u e s t i o n s as  chose. Another e t h i c a l  the c o u p l e s ' intent  confidentiality  and a n o n y m i t y .  The i n v e s t i g a t o r ' s  t o p r o t e c t t h e c o u p l e s was made e x p l i c i t  initial prior  i s s u e c o n s i d e r e d was t h e p r o t e c t i o n o f  letter  to the couples  t o the couples  clearly  i n bath, t h e  and i n t h e v e r b a l e x p l a n a t i o n  s i g n i n g of the w r i t t e n consents.  explained that the audiotapes  were i d e n t i f i e d  I t was o n l y by  number, and t h a t names w o u l d n o t be a s s o c i a t e d w i t h t h e r e c o r d e d information. addition (two  In a d d i t i o n ,  to herself  t h e c o u p l e s were a s s u r e d  only the i n v e s t i g a t o r ' s  f a c u l t y members) w o u l d have a c c e s s I n summary, t h e e t h i c a l  consent,  t o the tapes.  The i s s u e s were t h a t o f an  p r i v a c y and c o n f i d e n t i a l i t y  T h i s r e s e a r c h p r o j e c t was a c c o m p l i s h e d interviews with ten couples with asthmatic The  data  basic  from  and anonymity.  by a u d i o t a p i n g preschool  children.  t h e i n t e r v i e w s were c a t e g o r i z e d a c c o r d i n g t o  human n e e d s .  couples' statements  Within  each need, the c o n t e n t  o f t h e way t h e y  s c h o o l c h i l d r e n were a n a l y z e d . t h e p a r e n t s were e t h i c a l l y the next  Committee  i s s u e s were s y s t e m a t i c a l l y  approached t o p r o t e c t the s u b j e c t s . informed  Thesis  that i n  chapter  the couples w i l l  the asthmatic  The i n v e s t i g a t o r  p r o t e c t e d throughout  the f i n d i n g s be  helped  presented.  d e r i v e d from  of the  ensured  prethat  the study.  In  the interviews with  CHAPTER Presentation In  this  chapter,  i n t e r v i e w s w i t h 10 will  be  of the  First,  a description  t o summarize t h i s  interviews w i l l they  be  helped  b a s i c human n e e d s . categorized  asthma.  data.  their  couples' verbatim  t h e p r e s c h o o l c h i l d r e n ' s asthma and to provide care w i l l  o f 10  couples  III  (pp. 23-24) and  and  were  couples. i n the  an  account  treatment  of the  on  the  impact  couples'  summarized.  the c r i t e r i a  Relevant study  was  obtained  2  from  (p. 3 4 ) .  i n the The  28  All  Chapter  i n the  study.  demographic data  par-  were  recorded.  a m o t h e r and  a father for  ages, e d u c a t i o n a l backgrounds,  from  the  following discussion  o f e a c h i n t e r v i e w and  of describing their  in  d a t a d e s c r i b i n g t h e c o u p l e s who  subdivided into  They r a n g e d  specified  participated  are presented  o b t a i n e d a t the b e g i n n i n g  occupations.  be  they w i l l i n g l y  i n Table  Each couple  Finally,  specified  o f p r e s c h o o l c h i l d r e n w i t h asthma.  i n t e r v i e w e d met  summarized  purposes  responses  d e s c r i b e s the p e r t i n e n t data  couples  ticipated  asthma meet  Sample  the  The  the  preschool children with  of  interviews  of  parents  Model f o r N u r s i n g .  section  and  statistics  Second, the c o n t e n t  t h e UBC  This  be  d e s c r i b e d a c c o r d i n g t o t h e ways t h e  The  of the  asthma  the couples  a c c o r d i n g t o t h e n i n e b a s i c human n e e d s  Description  the  sample w i l l  Descriptive  by  efforts  of the  which i n c l u d e s i n f o r m a t i o n about both  were u s e d  from  of preschool c h i l d r e n with  t h e i r preschool children with  stated  Findings  relevant findings obtained  couples  summarized.  presented  the  IV  t o 41 y e a r s  o f age  with  and  a mean  34 Table  2  Demographic Data o f C o u p l e s o f Preschool  Number assigned to the couple  Education  Asthma  3  Occupation*  3  Mother  Father  1  30  34  2  2  4/1  3  2  37  41  1  4  4  3  3  35  37  2  2  4  2  4  30  33  2  3  2  3  5  34  40  1  3  4  1  6  34  38  1  3  4  1  7  37  31  3  3  1  1  8  32  33  2  1  4  2  9  33  36  2  4  2  2  10  28  32  1  2  2  2  Mean  33  35. 5  Number a  Ages  Children with  Mother  Father  Mother  Father  Class  Education 1 2 3 4  Grade X I I Graduate Community C o l l e g e G r a d u a t e U n i v e r s i t y Graduate Other (apprenticeship)  ^Occupation 12 3 4  P r o f e s s i o n a l (nurse, t e a c h e r , professor) Technical (hairdresser, secretary) . Business Homemaker  35 age of  of  33  years  the parents  the  20  this  mothers  level.  community  f o r the mothers  completed  and  obtained  or  i n four  i n s i x cases,  iced  that  that  i n one  involved  were  the  10  were  both  couples'  more boys  than  The  average  family,  and  in six families  twin. the  On  eldest  I n one  average child  size  and  employed  had  two  was  fathers  reported  were  occupations.  a r e summarized  i n the  mean  The age  children's  was  two  with  asthma  asthma  children  4.2  asthma  was  with  not-  por-  ( 2 . 3 t o 1) w i t h  the c h i l d  time;  S i g n i f i c a n t data  (p. 3 6 ) .  their  a  couples'  I t was  couples  beyond from  full  the mother of the  children  the c h i l d r e n  the couples  to the  and b u s i n e s s  3  13  graduates  employed.  none  of the families  family,  having  were  asthma.  i n Table  study.  first-born.  with  were  the other  technical  girls  out of  X I I and  regard  were  and  A l l of  3 to 5 years  Grade  situation  preschool  and  A l l  educational levels  With  parents  S i x mothers  children  f o r the f a t h e r s .  fathers  the fathers  homemakers.  from  seven  o f the couple's  description  ranged  There  cases only  preschool  following ages  and  i n professional,  The  had  a university.  part-time.  they  traying  fathers  S i x mothers  and,  employed  35.5  i n t e r v i e w e d had  college  occupations  and  per  years.  i n  children  was  were a  this per the  dizygotic  family,  with  asthma.  \  Table  3  Demographic Data D e s c r i b i n g the P r e s c h o o l C h i l d r e n w i t h Asthma  Number assigned to the couple  Child's age ( y e a r s )  Sex  1  5  M  1  2  2  3  M  3  3  3  3  M  1  2  4  5  F  1  1  5  3  M  1  6  5  M  2  3  7  4  M  2  2  8  4  F  1  2  9  5  F  2  2  10  5  M  1  2  N =  The  Help  10  cations  Mean =  P r o v i d e d by  In the  the  the  o f t h e ways t h e y  helped  p r e s c h o o l . c h i l d r e n on asthmatic  couples'  free  audiotapes  and  Mean =  the couples' verbatim  p e r c e i v e d themselves asthma w i l l  be  b a s i s and  t o be  2.1  their  The  to couples  asthmatic  d u r i n g the c h i l d r e n ' s  A b u n d a n t d a t a were o b t a i n e d to the  communi-  helpful  presented.  (helping behaviours)  open r e s p o n s e s  o f the  2  Couples  a daily  attacks.  (Twin)  Ratio 2.3:1  following description,  r e p o r t e d ways t h e y  The  4.2  preschool children with  acute  Number o f children i n the family  Position i n the family  investigator's  from  the  questions.  i n t e r v i e w s were t r a n s c r i b e d , c a t e g o r i z e d ,  and  validated  as o u t l i n e d  i n Chapter  III.  couples' reported helping behaviours (p.  38)  and  The  the d e t a i l e d  analysis  basic  Need:  summary o f  a r e made e x p l i c i t  o f the  couples' helping behaviours  the c h i l d ' s  A  the i n Table  interviews follows.  are d e s c r i b e d under each  to breathe.  they  provided their  trol  the  The  10  couples reported that  asthma b r e a t h e  i n two  c h i l d r e n with treatments,  factors that  T r e a t m e n t was  triggered  their  d e f i n e d i n Chapter  and  children's  they  helped  m a j o r ways:  managed t o  I as p r e s c r i b e d a c t i o n s ,  to take t o prevent or c o n t r o l the c h i l d ' s couples  their  reported that  children Firstly,  couples tions  such  on  that  they  gave t h e i r  a daily  coughing  and  basis.  "We  go  v i a an  Three other couples  g i v e him  the wheezing,"  give her Somophyllin b e f o r e we  felt  their  medications "As  and A l u p e n t , "  or  children  every  day  took  physician.  their  made by  the  to control  s t a r t s wheezing  they  children  children  r e q u i r e d the  t o g r a n d m o t h e r ' s h o u s e where t h e r e a r e  they  subcu-  medica-  gave t h e i r  " J . gets h i s  were n o t e f f e c t i v e ,  a l l  i n h a l e r or  children  s o o n a s she  the m e d i c a t i o n s  a  is,  Some sample s t a t e m e n t s  When t h e c o u p l e s t h o u g h t  consulted  to help  p r e s c r i b e d medica-  Seven c o u p l e s gave t h e i r  t o h e l p them b r e a t h e .  p a r e n t s were:  That  children  as b r o n c h o d i l a t o r s , o r a l l y ,  t h e b r o n c h o d i l a t o r s when t h e y drug  asthmatic attacks.  treatments  administered medications.  taneous i n j e c t i o n s . tions  p r o v i d e d two  par-  breathe. they  stated  they  con-  asthma.  a p h y s i c i a n o r o t h e r h e a l t h c a r e p r o f e s s i o n a l have d i r e c t e d  The  of  human n e e d s .  t h e i r preschool children with  ents  4  the we  medications animals."  gave t h e i r  children  for further help  and  Table 4 The C o u p l e s ' H e l p i n g  C h i l d ' s need  Behaviours  Couples' helping behaviours  Daily  P r o v i d e s t r e a t m e n t such a s : 1.1 a d m i n i s t e r s m e d i c a t i o n s 1.2 p e r f o r m s c h e s t t h e r a p y  To b r e a t h e  Controls factors t r i g g e r i n g asthmatic attacks i n c l u d i n g : 2.1 environmental allergens 2.2 e m o t i o n a l s t a t e s 2.3 e x e r c i s e 2.4 r e s p i r a t o r y i n f e c t i o n s To e a t drink  and  Prepares n u t r i t i o u s and s n a c k s  To have a balance between r e s t and a c t i v i t y To be s a f e and s e c u r e  To f e e l  loved  To have sensory satisfaction To have a sense o f accomplishment  To d e v e l o p self-respect  to  Enforces r e s t / s l e e p  routines  X X X  X X X  X  x  X X  x  activity  x  1 . Prepares c h i l d f o r s e p a r a t i o n and s t r a n g e e x p e r i e n c e s  x  X  2. Supervises d a i l y  X  X  X  X  X  X  1 . Expresses affection  activities  reciprocal  1. Provides o p p o r t u n i t i e s sensory s a t i s f a c t i o n 2. I n t e r a c t s w i t h the  for  child  1 . Teaches t h e c h i l d i n r e l a t i o n to: 1.1 b r e a t h i n g e a s i e r 1.2 p e r f o r m i n g a c t i v i t i e s o f daily living 1.3 p r a c t i s i n g s a f e t y r u l e s  x  2. P r o v i d e s o p p o r t u n i t i e s make d e c i s i o n s  x  X  x  X  x  X  1.  Praises  2 . Shows 3. Sets  Note.  x  of  Provides assistance practise: 1.1 c l e a n l i n e s s • 1.2 t o i l e t h a b i t s  Promotes  x X  meals  Urges a d e q u a t e i n t a k e f o o d and f l u i d s To e l i m i n a t e waste products  D u r i n g an asthmatic attack  consideration limits  X  to  X  " x " r e f e r s t o a g e n e r a l consensus o f t h e c o u p l e s '  responses  In  addition,  they performed  those  w h i c h promote ations. matic his  chest therapies; that i s ,  a c t s p r e s c r i b e d by a h e a l t h p r o f e s s i o n a l  d r a i n a g e o f b r o n c h i a l s e c r e t i o n s and e a s i e r  T h e s e were done d u r i n g and a f t e r  attacks.  Some s t a t e d  their  examples o f t h e r a p y  o r "We  ask h e r t o t a k e  children's  asth-  included:  "Iput  deep b r e a t h s , " o r "We p r o p  h i m up  pillows." Secondly,  ronmental  the couples performed  allergens,  emotional  acts which c o n t r o l l e d  states,  exercise,  a l l examples o f f a c t o r s which p r e c i p i t a t e d  vated  children's  their  to  prevent  an  asthma a t t a c k .  procedures walls,  their  such  floor,  electronic control  electronic  In  exposure  F o r example,  exposure  that  dust  t o dust.  triggered  avoidance  children's  Some p a r e n t s t o l d  tried  bedroom  of purchasing  f o r the children  One c o u p l e  stated:  to help  "We p u t i n  a i r c l e a n e r , and h a d o u r f u r n a c e ' s a i r d u c t s  . . . The bedroom g e t s washed down once a d a y . "  allergens  this  some p a r e n t s such  statement:  avoided walking One c o u p l e  prevented  children  from  dander.  One m o t h e r  "We  as c a t s ,  dogs, and  a v o i d t h i n g s such t o them."  through  Another  the t a l l  the  summer.  cal  i n g r e d i e n t s i n foods which r e s u l t e d  ing  a severe  asthmatic  their  a s p o l l e n s and a n i m a l  h o r s e s b e c a u s e she i s a l l e r g i c how t h e y  to allergens  they p r a c t i s e d  and a c c e s s o r i e s .  or aggra-  The c o u p l e s  as f r e q u e n t washing o f t h e i r  addition,  inhaling voiced  children's  a i r c l e a n e r s , and w a t e r b e d s  their  cleaned.  asthmatic condition.  envi-  and r e s p i r a t o r y  infections,  an  respir-  body o v e r my k n e e u p s i d e down a n d p a t h i s b a c k o v e r h i s  lungs," on  a l l couples performed  father  g r a s s e s and weeds i n  o f a s m a l l b o y spoke a b o u t  attack:  "We  recalled  i n their  are very  certain  child  strict  criti-  experienc-  about h i s  diet,  and  i n f a c t we  of h i s food." in  their  attack; the  The  select  couples t r i e d  homes t o p r e v e n t o n l y two  fathers  same room as t h e i r  reported  that  added t h a t  they  i t was  h i s food c a r e f u l l y  the c h i l d stated  to prevent  couple  said  that  couple  s a n g and  gered  their  prevent  sedentary  and  and  his  w a r m l y on Need: two  ways t h e y h e l p e d  their that to  need  ingest  by  a  and  p l a y and  another  exercise  These c o u p l e s  having t h e i r  "We  tried  to do  play with  read to her,"  keep him  trig-  children  or  "He  indoors to play  methods o f p r e v e n t i n g  felt  their  "cold."  had  their  their  children's  The  cleanliness  fluid  children's  a d e q u a t e amounts o f  asthmatic  couples  children  interviewed described  balance. f o o d and  f o o d and  that  routines.  preschool children with  and  respira-  These c o u p l e s r e c o u n t e d  "colds," dressed their  drink.  for nutrition  they prepared  One  them f r o m a c t i v e  "We  d a y s , and p r a c t i s e d  t o e a t and  their  friends."  o t h e r s who  cool  they  child.  attacks.  restricting  discussed their  a t t a c k s were t r i g g e r e d avoided  active  record player," or  without  couples  homes; however,  a "warm b a t h , "  f r o m w h e e z i n g by  i n f e c t i o n s because they  they  child  Some e x a m p l e s were:  Six couples tory  asthmatic  children  the  not i n  an asthma a t t a c k .  to their  d e s c r i b e d how  activities,  plays with quietly  gave t h e i r  talked quietly  other children.  A l l of the  they would t r y to calm  them f r o m h a v i n g  children's  their  asthmatic  "infrequent" occurrence.  they  Seven c o u p l e s  an  most  smoking  smoked a t home b u t  smoking i n t h e i r  F o u r c o u p l e s d e s c r i b e d how children  from h a v i n g  they  prepare  the c i g a r e t t e  asthmatic c h i l d r e n .  allowed an  to l i m i t  and  The  parents  urged  fluids.  asthma meet  their  reported children  All foods.  the p a r e n t s emphasized t h a t Some c o u p l e s  made t h e i r ple,  one  avoided prepared  of the mothers s t a t e d : due  "We  at r e g u l a r times;  m e a l s a day."  When t h e i r  parents d i d not prepare encouraged  their  him  asthmatic  to drink lots  fact,  two  n o t wean t h e i r ensure  stated  children attacks.  the c h i l d r e n  p a r e n t s who sufficient  from  d r a n k an  were w o r r i e d t h a t nutrients  exam-  Most o f t h e c o u p l e s  had  have  w i t h asthma,  three the  that  they encouraged  drink fluids.  their  A l l ten of  t o d r i n k more f l u i d s  sick with  bottles  "We  asthma."  stated  that  In  they d i d  a d e q u a t e amount o f f l u i d s . c h i l d r e n were n o t  the  persuade  b e c a u s e t h e y wanted  supplemented t h e i r  the  during  A common comment was:  their  but  fluids.  3-year-old children  children  and  ad-  o f f l u i d s when he's  couples with  For  t h e y r e p o r t e d : "We  to drink  t o e a t t h e i r m e a l s and  children's  foods  ingredients.  c h i l d r e n were i l l  children  their  "good"  them m e a l s as t h e y n o r m a l l y w o u l d  Six of the couples  parents enticed  ate  make a l l h i s f o o d and  to his allergies."  meals p r e p a r e d  families  or convenience  c h i l d r e n ' s meals from b a s i c  just his diet  children  their  to Two  ingesting  diets with vitamin  and  mineral preparations. Need: their  t o e l i m i n a t e waste p r o d u c t s .  children  assisting  them t o p r a c t i s e  parents guided brush  their  children  their  teeth.  performed  supervision. ed d a i l y  e l i m i n a t e waste p r o d u c t s  One  hygiene  children  and  t o bathe,  The from  toilet  couples their  bodies  habits.  wash t h e i r  helped  The  hands,  E i g h t of the couples r e p o r t e d t h a t  felt  the medication  their  and  their  most o f t h e s e h y g i e n i c p r a c t i c e s w i t h couple  by  child  t o p r o v i d e b r o n c h o d i l a t i o n c o n t a i n e d a sweetener  minimal ingestwhich  42 contributed brush  t o t o o t h decay; t h e r e f o r e , they encouraged  her t e e t h a f t e r  stated that  they provided t h e i r  when t h e y were i l l The since Only  t a k i n g the drug.  with  reminding dinner,  had  the c h i l d  and  Need;  them f r o m  a reward  and  daytime  full  toilet  toilet  control  at night  and  activity.  Six couples t o l d  regularly  preschool  c h i l d r e n were i l l  alleviate  their  children's  and  about  One  their  children  couple  sleep with  efforts to  d e s c r i b e d the  "We  p u t him  down f o r a  a t 7:30  or so."  Whenever  w i t h asthma t h e p a r e n t s t r i e d distress  after  The  preschool children  sleep patterns with their  i n t o bed  and  for continence.  they e n f o r c e d a r o u t i n e of r e s t  3-year-old c h i l d :  habits.  withholding fluids  between r e s t  to help t h e i r  habits  t o become c o n t i n e n t by  system  becoming f a t i g u e d .  routine with t h e i r daily  developed  to the t o i l e t ,  normally. and  children with their  children  t o have a b a l a n c e  to enforce r e s t  nap  their  establishing  asthma d e v e l o p  couples  c h i l d r e n w i t h more a s s i s t a n c e  not developed  promoted a c t i v i t i e s  prevent  had  t o go  couples reported they and  their  a l l of the c h i l d r e n  the p a r e n t s encouraged  to  asthma.  couples a s s i s t e d  three children  A l l of the  her  before s e t t l i n g  the to  them f o r  the n i g h t . All  of the couples r e p o r t e d t h a t  ren's p a r t i c i p a t i o n  in physical  cluded organized r e c r e a t i o n a l members and dancing, about  the c h i l d r e n ' s  gymnastics,  they promoted t h e i r  activities.  p r o g r a m s and  friends.  s o c c e r , and  h a v i n g w a l k s i n p a r k s , b o a t i n g , and  to play f r e e l y  outdoors  with their  Such a c t i v i t i e s i n p l a y w i t h the f a m i l y  Some e x a m p l e s were  skating.  friends  child-  Nine  couples  allowing their and  siblings.  swimming, spoke children However,  43 the p a r e n t s  restricted  their  began d e v e l o p i n g a s t h m a t i c J.  i s wheezy we  down w i t h h i m Need: their  limit  and  do  to f e e l  children  feel  him  their  their  families  symptoms. and  them, and  s a f e and  s e c u r e by  and  or a nurse. children  pitalizations, parents a new  children's  dangers  t o and  such  about  t h e y had their  couples reported that  In a d d i t i o n ,  educational encounters. until  reported feeling  activities  triggers  that  t a k e him w i t h u s , "  and  relatives their  appointments, I n two  children's  cases,  hosthe  to  oversee  "We  traffic  demonstrated  t h e home and  outdoors.  mainly  taught  children  Ten about  and  do n o t  to t h e i r  children  safety:  him;  leave h i s from  them s a f e t y  of the couples traffic  leave  don't  children  taught  to  asthma a t t a c k s .  "When he wheezes we  around  their  informed  t h e y had  such  couples t o l d  children  hospitalization.  dangers  and  the  t h e y became a d j u s t e d t o  A l l of the couples p r o t e c t e d t h e i r as r o a d s  were  t o p r o t e c t them f r o m b e i n g e x p o s e d  for their  and,  before.  as some c l o s e they  The from  not encountered  side."  The  separations  involving medical  children  helped  activities.  c h i l d r e n when t h e y  Some o f t h e c o u p l e s ' comments i n c l u d e d : we  Sometimes we s i t  t h i n g s as p r e p a r i n g  potential  s u c h as p l a y - s c h o o l o r  couples  "When  A l l of the couples  c a r e t a k e r s such  experiences and  they  stated:  they would o n l y l e a v e t h e i r  stayed with t h e i r  Eight their  that  substitute  situation,  rest.  where t h e y were g o i n g .  Three  about  couple  supervising their  experiences  c o u p l e s emphasized w i t h competent  make him  secure.  F o r example, t h e p a r e n t s t o l d leaving  One  s a f e and  children  and  a c t i v i t i e s when  a puzzle."  them f o r f u t u r e e v e n t s couples t o l d  children's  about  stated "We  other rules. safety they  talk  to  44  P.  about  the dangers  Some c o u p l e s reminding about  felt  about  of the s t r e e t  that  safety  their  children  rules.  One  t e a c h i n g her c h i l d about Need:  to f e e l  the c o u p l e s their  said  loved.  how now  road."  only required  parent expressed  To h e l p t h e i r  special  to c r o s s the  taking medications  they expressed  children with  and  concern  safely.  children  affection  a  feel  f o r them and  loved, provided  a t t e n t i o n when t h e y were i l l  with  asthma.  A l l o f t h e c o u p l e s r e p o r t e d t h a t when t h e y  sensed  children  needed a t t e n t i o n  to  children with affection. in  a variety  o f ways:  w a l k a l o n g we or  "We  and  loving  The  p a r e n t s demonstrate  "We  g i v e her  h o l d h i s hand," o r  speak k i n d l y  to her," or  "He  spoke o f i n c r e a s i n g  their  became i l l  stated was  that  wheezing.  rocked  He  child  perceived sensory viding  that  they helped by  sits  spent  tion with  time  their  onment.  Nine  on my  being near  "As  satisfaction.  bed  him,"  when  couple  c h i l d r e n meet t h e i r  their  he  be  couples needs f o r  children  senses.  and  A l l of  read to t h e i r  and  the  children  c o u p l e went f o r w a l k s w i t h  the d i f f e r e n t  pro-  t o enhance s e n s o r y s t i m u l a -  Some p a r e n t s  children  at night or  A l l o f the  interacting with their  One  we  knee a l o t . " A l l  F o r example, one  c o l o u r s and  o f t h e c o u p l e s commented t h a t  talking with t h e i r  affection  knee.  their  children.  to p o i n t out  just  in their  talking or playing  others" p l a y e d music.  their  t h e amount o f a f f e c t i o n  o p p o r t u n i t i e s f o r them t o u s e  couples  child  cuddled  sensory  satisfaction  their  s p e n t most o f h i s t i m e w i t h them when  a parent's  to f e e l  like  w i t h asthma.  w o u l d be  t o s l e e p on  Need:  and  their  responded  a l o t of c u d d l i n g , " or  "We  of the couples children  they  their  answering  their  sounds i n t h e they  spent  envir-  time  their questions.  All  45 of t h e c o u p l e s promoted o p p o r t u n i t i e s f o r t h e i r their such  senses  by t h e p r o v i s i o n  p l a y equipment.  their  children's  such  children  asthma when t h e y  couples arranged  for their  development.  environments the p a r e n t s  stated  that  attacks.  to potential  triggers of  to attend a special  factors  trigger  to prevent  F o r example,  appro-  t h e y were  "We  Six  activity the c h i l -  i n the alternate  the c h i l d r e n ' s  they would g i v e t h e c h i l d r e n  c a t i o n s b e f o r e such events asthmatic  stated  lessons" to f a c i l i t a t e  Since c e r t a i n  could potentially  and o t h e r  selected play materials.  children  a s " p l a y - s c h o o l " o r "music  dren's  crayons,  Eight of the couples  c a u t i o u s n o t t o expose t h e i r  t o use  o f m a t e r i a l s and r e s o u r c e s f o r them  as b o o k s , r e c o r d p l a y e r s , p a p e r ,  priate  children  the children  asthma, their  from  medi-  having  g i v e him h i s m e d i c a t i o n s  b e f o r e he goes on a w a l k o r a t t e n d s p l a y - s c h o o l . " Need: taught  t o have a s e n s e  their  them f e e l  children  a sense  their  children  daily  living,  reported  that  o f accomplishment.  how t o p e r f o r m  certain  of accomplishment.  either  to breathe  easier,  The to relax,  perform  safety  rules.  their  had d e v e l o p e d  some o f t h e s e a r e a s t o be i n d e p e n d e n t decisions  actions to help  A l l of the couples  or to practise children  The p a r e n t s  a c t i v i t i e s of  Three  of the parents  sufficient  skills in  and were a l l o w e d t o make  f o r themselves. parents  told  o r showed t h e i r  to avoid s p e c i f i c  children  allergens,  as p r e s c r i b e d .  to breathe  and t o t a k e  correctly  their  children  their  hands and f a c e , d r e s s i n g , e a t i n g , and p e r f o r m i n g  t o perform  d u t i e s such  A l l of the couples  their  tions  household  taught  activities  such  slower, medica-  instructed  as b a t h i n g , washing  as d r y i n g d i s h e s o r washing t h e i r  simple own  bedroom f u r n i t u r e . required  Three  only a reminder  Need:  to develop  considered,  and  children from  had  their  and  parents.  self-respect.  set limits  learned these tasks  for their  A l l the couples p r a i s e d , children  to help  develop  self-respect.  A l l of the c o u p l e s  praised  their  frequently f o r doing tasks f o r others.  One  couple  thing that  their  children  told child  the c h i l d  provided  how  that  selected.  Four  gave s p e c i f i c  consideration for their  children  F o r example, t h e p a r e n t s a l l o w e d t h e i r  select  play, clothing,  and  feelings.  their  Two  children  three couples their from  avoidance  described  about  how  their  children  stated  children.  that  These l i m i t s  I f the c h i l d r e n  of  child,  they would r e s o r t their  t h e i r own  their basic  children.  behaviours  for  their  The  Impact o f Asthma and The  couples  they  In a d d i t i o n  to  to  experiences.  parental expectations, maintained  children's  to screaming,  an  listened  limits of  t o t a b l e manners.  violated  as  they  experiences  the  limits  ignoring,  behaviours  such  the  parents  isolating,  or  description  preschool children  reported additional  as  i f they d i d  t o the c o u p l e s '  of helping t h e i r  for  Couples  behaviours  or t h r e a t e n i n g the c h i l d  human n e e d s , t h e y  asthmatic  their  how  children  i n c l u d e d a wide r a n g e  t h e y managed t h e i r  not  spanking  s e t and  o f known a l l e r g e n s  their  stated  about  hospital  understand  they  talking with comply.  tell  o f t h e c o u p l e s d i s c u s s e d how  tell  To h e l p t h e i r  and  specific  rewards  of the couples expressed  individual. their  they  t h e y gave a p p r o v a l a c c o r d i n g t o t h e  d i d ; f o r example, t h e y  r e s p e c t and  stated  them  tasks to  meet care  children. Its  Treatment  r e p o r t e d t h r e e ways t h a t  asthma and  i t s treat-  ment a f f e c t e d children.  their  efforts  t o provide care  f o rtheir  The p a r e n t s ' e f f o r t s were a f f e c t e d  by a d d i t i o n a l  d e c i s i o n s t h a t h a d t o be made r e g a r d i n g t h e i r  children's health  needs, e x t r a p h y s i c a l  demands r e q u i r e d t o c a r e  asthma, a n d e m o t i o n a l  upheavals  asthmatic The  c h i l d r e n ' s asthmatic  asthmatic  experiencing  medical In  aids,  treatment,  two c a s e s ,  children their  during their  and w o r r y .  a t home u n t i l  and t h e n  the couples  they  In f a c t ,  A l l of the couples  care f o rt h e i r Five and  and  asthmatic  their  families' t h a t they  by p e r f o r m i n g  children  d e f i n e d asthma a s a and c h i l d r e n ' s attempted t o  additional  tasks to  asthma.  feeling  "scared,"  "panicky,"  h a d an asthma a t t a c k .  They  t h a t t h e i r c h i l d r e n w o u l d n o t be a b l e t o b r e a t h e  i n previous  descriptions  asthmatic  tothe  f o rtheir  the couples  expressed  e v e n t u a l l y choke t o d e a t h .  reported  caring  preschool children with  " s a d " whenever t h e i r  fortheir  d i d not respond  emphasized  family l i f e  of the couples  were c o n c e r n e d  limited  They r e p o r t e d t h a t t h i s d i s r u p t e d  b r e a t h i n g problem which a f f e c t e d  their  that  resorted to hospitalization.  continued  i n the h o s p i t a l .  "normalize"  environ-  attacks at night reported  They c a r e d  the children  family routines.  lives.  treat-  E i g h t c o u p l e s who h a d been c a r i n g f o r  children  fatigue  c o s t s f o r drugs,  and b e h a v i o u r a l r e s t r i c t i o n s  children.  asthmatic  children  with  during the c h i l d r e n ' s  a t t a c k s imposed m e d i c a l  and h o s p i t a l v i s i t s ,  mental c o n t r o l  their  f o rchildren  attacks.  ments, c l i n i c  the  especially  asthmatic  This data  studies cited  indicated  supports  i n Chapter  II.  the findings The c o u p l e s '  t h a t they performed a d d i t i o n a l  physical  48 tasks  and made d e c i s i o n s i n e f f o r t s  lives,  and e x p e r i e n c e d e m o t i o n a l  children's  to normalize  upheavals i n r e l a t i o n  the data  that  t o meet t h e i r  by e m o t i o n a l  will  basic  upheavals,  for their  human n e e d s .  physical  children.  couples  theoretical  framework  with  The c o u p l e s r e v e a l e d c h i l d r e n were  affected  demands, and d e c i s i o n s i n  In the next  be d i s c u s s e d i n r e l a t i o n  selected  The  17 ways o f h e l p i n g t h e i r p r e s c h o o l c h i l d r e n  the help they p r o v i d e d the asthmatic  caring  to t h e i r  from i n t e r v i e w s w i t h  10 c o u p l e s o f p r e s c h o o l c h i l d r e n w i t h asthma.  asthma  families'  asthma and i t s t r e a t m e n t .  T h i s c h a p t e r has p r e s e n t e d  described  their  to their  chapter, these significance  and n u r s i n g c a r e .  findings  t o the  CHAPTER V Discussion The tion ren of  primary  of the Findings  purpose o f t h i s  of parents'  s t u d y was t o p r o v i d e a d e s c r i p -  actions directed  toward h e l p i n g p r e s c h o o l  child-  w i t h asthma meet t h e i r b a s i c human n e e d s , w i t h an o b j e c t i v e adding The  appears their and  t o knowledge which i s u s e f u l  f i n d i n g s o f the study presented t o support  children,  development  Perdue,  sick  or well,  (Havighurst,  outlined  that parents  1972, p. 77; Horowitz,  1982, p. 79; P r i n g l e ,  rearing  chapter  t o meet n e e d s f o r o p t i m a l  and t h e i m p l i c a t i o n s  t o the developmental  assist growth  Hughes, &  1974, p. 5 9 ) . I n t h i s  be d i s c u s s e d i n r e l a t i o n  parents  i n the l a s t  the t h e o r e t i c a l p o s i t i o n  the major f i n d i n g s o f the study will  t o nurses.  chapter, f o r nursing  tasks of  p r e s c h o o l c h i l d r e n w i t h asthma, a s p r e v i o u s l y  i n Chapter I I .  Tasks o f Parents Rearing P r e s c h o o l C h i l d r e n w i t h Asthma a n d N u r s i n g I m p l i c a t i o n s According  t o developmental  rearing preschool children 1977,  and n u r s i n g t h e o r i s t s ,  parents  have s e v e r a l t a s k s t o assume  p p . 2 5 8 - 2 6 8 ; Hymovich & C h a m b e r l a i n ,  1 9 8 0 , pp.  266-269).  These i n c l u d e t a s k s r e q u i r e d f o r t h e c a r e o f p r e s c h o o l p l u s a d d i t i o n a l ones e s s e n t i a l chronic will  d i s e a s e s such  relate One  a s asthma.  their  i n Chapter I I . by p a r e n t s  children  To h e l p p r e s c h o o l c h i l d r e n  nomy, t h e p a r e n t s  t o separate  from  rearing  pre-  i n developing  nomy a n d i n d e p e n d e n c e . learn  with  The d i s c u s s i o n o f t h e f i n d i n g s  o f the major t a s k s undertaken i s to assist  children  f o r the care of c h i l d r e n  t o t h e t a s k s as p r e s e n t e d  school children  (Duvall,  their  auto-  develop  children,  auto-  teach  50 them t o make d e c i s i o n s and (Duvall,  1977,  p.  255;  L i k e most p a r e n t s , encouraged sense  their  thus  Hymovich and  the couples  children  some c o n t r o l Chamberlain,  in this  cleanliness,  appropriately.  A l l of the p a r e n t s  choosing teaching,  foods.  reminding,  and  t o become autonomous. attacks,  the couples  children,  The  daily  their  potentially  tended  childrens'  attention  children  on  the  ill  the  asthmatic  asthmatic physically  had  couples'  developmental  p r o t e c t i v e p a t t e r n may of t h e i r  and  methods o f  had  children  asthmatic  ability  c h i l d r e n may or  result, i t i s necessary  and  and  Even a f t e r  substitutes. asthmatic  the  attacks could  achievement of who  child-  Thus,  t o promote t h e i r  Parents  the  to leave t h e i r  preschool  the  assume t h i s  have a d e l e t e r i o u s i m p a c t  on  the  overly  behaviour  Psychological studies indicate  become f e a r f u l ,  regressed,  (Mattsson,  to i d e n t i f y  1975,  the asthmatic  a t r i s k f o r untoward developmental  problems.  that  rebellious,  lack self-confidence i n relation  parents' p r o t e c t i v e behaviours  ents  trained  tasks.  children.  inactive,  i n dress-  children,  d u r i n g the a t t a c k .  d e v e l o p m e n t o f autonomy  c o u p l e s ' own  t o use  to  a l l o w e d more d e p e n d e n c y , d i d more f o r t h e i r  d u r a t i o n of the c h i l d r e n s '  affect  a  children  p r o v i d i n g o p p o r t u n i t i e s f o r the  ren w i t h o t h e r s u n l e s s they and  they  dressing  play a c t i v i t i e s ,  asthma a t t a c k s , t h e c o u p l e s were r e l u c t a n t  frequency  266).  develop  care p a r t i c u l a r l y  However, when t h e c h i l d r e n  centered t h e i r  stayed with  and  encouraged t h e i r  couples  p.  i n developing h a b i t s of  t o the bathroom, s e l e c t i n g  certain  them  reported that  b e d t i m e r o u t i n e s , s a f e t y , and  make some d e c i s i o n s a b o u t t h e i r going  study  over 1980,  t o become i n d e p e n d e n t  of accomplishment, p a r t i c u l a r l y  toileting,  ing,  lose  p.  82).  child The  to  the  As  a  and  par-  health  51 care approach regular  includes early  diagnosis, effective  treatment,  f o l l o w - u p , and e d u c a t i o n a l and s u p p o r t i v e p r o g r a m s t o  promote g r o w t h and d e v e l o p m e n t o f p r e s c h o o l c h i l d r e n who asthma.  T h i s approach  members s u c h  1981,  teaching,  and p s y c h o l o g i s t s ( D o l o v i c h and  a s c o l l a b o r a t e members  and c o u n s e l l i n g  children.  The  t o the parents of preschool  i n this  study  concerning safety,  set limits  behaviours  and  interactions with others.  ill  w i t h asthma t h e c o u p l e s ' e f f o r t s  sistent.  p.  According to certain  successful  a r e t o reduce the  rigorous  limits  self-esteem  s e t t i n g may t h w a r t  and r e s i s t a n c e  parents of preschool asthmatic  ren i n c l i n i c a l  seemed i n c o n -  In t h i s  the c h i l d r e n  from  study, having  Yet, overly  and c r e a t e n e g a t i v e  (Hersey  & Blanchard,  Hughes, and P e r d u e , 1 9 8 2 , p . 9 3 ) .  There-  c h i l d r e n , whether t h e c h i l d -  may n e e d g u i d a n c e  setting.  were  & Blanchard, 1978,  1 9 8 2 , p. 9 2 ) .  to authority  fore,  appropriate'limit  (Hersey  the c h i l d  p. 94; H o r o w i t z ,  or well,  routines,  l i m i t s must be c o n s i s t e n t  activities.  1978,  ren are i l l  and t o  preschool  daily  to set limits  to prevent  a t t a c k s , by r e s t r i c t i n g limit  for their  involving  authors,  Hughes, and P e r d u e ,  set additional  asthmatic  children  However, when t h e c h i l d r e n  b e h a v i o u r a l compliances  70; H o r o w i t z ,  parents  asthmatic  g r o w t h and d e v e l o p m e n t .  couples  children  Nurses  o f t h e h e a l t h team p r o v i d i n g  of o v e r p r o t e c t i o n of preschool asthmatic their  Hargreave,  1 9 7 5 , p. 8 7 ) .  The outcome o f t h e team's e f f o r t s  facilitate  for  pharmacists, physicians,  p . 1 0 3 8 ; D y e r , 1 9 7 7 , p. 2 0 ; M a t t s s o n ,  participate  risk  r e q u i r e s t h e e x p e r t i s e o f t h e h e a l t h team  as n u r s e s , n u t r i t i o n i s t s ,  physiotherapists,  have  r e g a r d i n g c o n s i s t e n t and  N u r s e s may e n c o u n t e r  asthmatic  s e t t i n g s o r t h e community w i t h s u c h  child-  behaviours.  52 Appropriate ways  parental education  to  intervene  The  couples  daily  One  couple  train  the  their  children  child  in  this  to  educated,  as  children  rather of  Effective  use  rewards,  situations.  ations  are and  couples  be  of  used  pectations  of  their  p.  that  parents  use  of  daily  of  the  i s most  by  each  and of  196).  the  caring  behaviour  be  and  their  when  situ-  self  with  ways  considered  the  t o manage  information  the  par-  appro-  I t i s apparent  for families  behaviour  dependency,  disciplinary  This  i n f o r m a t i o n about  punishment  in  of  un-  Perdue  achieved  approaches  children.  and  is  toward  sense  such  their  that  approaches  1  362).  reinforce-  t h r e a t s of  from  p.  negative  likely  couples  attributed  1966,  childhood  childrens  the  spanking  children  ignoring  Praising  that  Hughes  and  to  punishments  and or  additional  131  childrens'  acceptable  with  Horowitz,  resentment  f o r nurses  I t appears  the  of  produce  preschool  children.  achieve  However,  (1982,  technique  eradicate behaviour  i n c r e a s e the  study  children  (Bronfenbrenner,  S u c c e s s f u l outcomes  their  valuable  used  Punishment  or  discipline  to  their  behaviour.  isolating,  punishment,and  maturity  in this  behaviour to  likely  rewarded  d e s c r i b e d the  c o e r c i v e power  initiative,and  or  i s consistent  ignoring,  dangerous.  priate  worth  approach  may  possible  appropriately in their  commonly  decrease  rewards  two  11).  h i s bed-wetting  misbehaved.  to  are  behavioural modification techniques  couples  they  that  than  behaving  most  screaming,  or  parents. ents  the  i s intended  indicate  lack  This  p.  praised  middle-class parents  when  desirable  the  counselling  1976,  they  control  was  study  threats,  or  used  to  study.  this  ment  stated  f o r performing  lives.  In  (Hymovich,  and  the  appears  asthmatic  parents'  ex-  the  parents  i n the  nursing  53 history. parental  A p p r o p r i a t e n u r s i n g i n t e r v e n t i o n s may c o u n s e l l i n g and  childrens' The children smiling.  behaviours  couples  Macoby, and  Levin  (1957)  from  tended  provided affection as h u g g i n g ,  i s an  (Duvall,  important 1977,  affectionate with  problem behaviours. had  they  amount o f a f f e c t i o n  received.  their  for  If may  develops  children  and  a t t a c k s become t h e  affection.  asthma  The  develop  their  relatively  s t u d y when  attention  chronically  the  praise  and  a t t a c k the p a r e n t s  i l l but  b e h a v i o u r a l p r o b l e m s and  the  stated  their to  child-  comfort  i l l children  focus i n the f a m i l y  p a t t e r n r e c u r s each time  (Norrish, Tooley,  or  Sears,  & Godfrey,  1977,  t h i s p a t t e r n c o n t i n u e s , e v e n t u a l l y the c h i l d r e n w i t h  ensue p.  recurrent asthmatic  attention  child  are  of  used  c o n t e n t , and  and  their  164-175).  In g e n e r a l , i t i s normal f o r p a r e n t s  c h i l d r e n when t h e y  having  asthmatic  history.  to  aspect  However, i n t h i s  preschool children  ren  pp.  their  t o become s e l f - r e l i a n t ,  i n c r e a s e d the  observed  h o l d i n g hands,  r e p o r t e d t h a t p a r e n t s who  an  specific  data o b t a i n e d i n the n u r s i n g  o f ways s u c h  relationships  o f t e n were warm and  free  and  Sharing of a f f e c t i o n  parent-child  children  t e a c h i n g , d e p e n d i n g upon t h e  s t a t e d that they  in a variety  include  p.  a 917).  asthma  disruptions i n family  life  ( M i n u c h e n , B a k e r , Rosman, L i e b m a n , M i l m a n , & Todd, 19 7 5 ,  1033).  Identifying  with preschool children  affectional with  relationships within  recurring  significant  nursing intervention.  affectional  problems w i t h i n the  may  disruptions i n family l i f e  prevent  Liebman, Milman, The  couples  & Todd, 1 9 7 5 , listened  and  asthma a p p e a r s  Early  t o be  identification  family with appropriate  p.  families  (Minuchen, Baker,  of therapy Rosman,  1038).  responded  to their  a  childrens'  54 efforts  t o communicate.  sensory  satisfaction,  achievement, a c t i v i t y ,  Couples  also  to their  listened  cough w h i c h was or  treat  This  their  The  a signal children  children  would seek  children's  who  may  be  having  an  the o b s e r v a t i o n noted  that parents  listened  carefully for their  breathing before planning their This data r e f l e c t s  listen  coughing  their  some p r e s c h o o l c h i l d r e n a p p r o p r i a t e way to  meet t h i s  importance  resource  (19 76)  children's  in this  signal  their  study  learned  of wheezing  or  c h i l d r e n ' s need t o b r e a t h e .  Since  seems t o be  their  an  childrens'  t o i n c l u d e i n the n u r s i n g h i s t o r y  communicate t h e i r  couples  parents  children  had  addition, as  in this  children  during quiet  needs, p a r t i c u l a r l y  ability the  ways p r e about  their  f r e q u e n t l y are a v a l u a b l e  or meal times  a stressful  telling  emotional  the emotional  to l i s t e n  d u r i n g t h e day  experience  such  their  through  by  to t h e i r  or a f t e r  for life  talking  and  child-  their In  events  with  play a c t i v i t i e s .  to preschool children  coping a b i l i t i e s  express-  as h o s p i t a l i z a t i o n .  children  hospitalizations  stories,and  significant  facilitated  t a k i n g time  the couples prepared  particularly  arbitrary  study  by  s e p a r a t i o n s and  children,  limited  Travis  attack.  to care f o r  are p r e v e r b a l , t h i s  Furthermore,  ions of t h e i r  such  by  care  for this information.  The  ren  or f o r a  These o b s e r v a t i o n s appear t o s u p p o r t  of nurses  school children symptoms.  the couples  f o r parents to i d e n t i f y  need.  food.  asthmatic  asthmatic  approaches  to the p r e s c h o o l c h i l d r e n ' s to determine  or  f o r the parent t o p r o v i d e s p e c i a l  supports  to  rest,  respirations  finding  children.  affection,  their This i s  s i n c e they  have  an u n p r e d i c t a b l e ,  view of the world which p e r p e t u a t e s  an a t m o s p h e r e  of  55 anxiety  surrounding t h e i r  necessary  illness  and m e d i c a l p r o c e d u r e s .  f o r t h e p a r e n t s t o be s u p p o r t i v e , u n d e r s t a n d i n g ,  loving,  y e t be a b l e t o b o l s t e r  arrange  f o r compensatory e x p e r i e n c e s  F o r example, their  t o compensate f r o m  or environmental  restrictions.  r e n how t o g a i n m a s t e r y  seems t o s u p p o r t  asthma and i t s t r e a t m e n t ,  study  children  or t e l l i n g  breathing matic pp.  and c o p i n g w i t h c h r o n i c  7-10).  tions tion  illness.  their  They t r i e d  children  stories.  children their  another  A l l of the couples  in this  children child-  to their  R e l a x a t i o n and d u r i n g an a s t h -  chest therapy i f clearing  (Keens,  1979,  d e s c r i b e d as of the a i r -  1976, pp. 6-7; T s e , 1979, study  children  administered medica-  as p r e s c r i b e d .  i s c o n s i d e r e d the major treatment which are used  t o under-  to help t h e i r  t o s t a y calm  i s required (Arkinstall,  drugs  illnesses.  chest muscles e f f e c t i v e l y  One c o u p l e u s e d  asthma i n c l u d i n g  This  f o r a program f o r  They t a u g h t  children  (bronchodilators) to their therapy  child-  children.  and p u m m e l l i n g , w h i c h i s u s e d  ways o f mucus pp.  their  a t t a c k and u s e t h e i r  posturizing  their  r e q u i r e k n o w l e d g e and  by s u c h methods as s i n g i n g  exercises assist  520-521).  due t o i l l n e s s  g r o w t h and d e v e l o p m e n t , c h i l d h o o d  and i t s t r e a t m e n t .  r e n r e l a x and s t a y c a l m  experiences f o r  r e l a x i n g , and r e s t i n g .  the couples a s s i s t e d  s t a n d and cope w i t h t h e i r asthma  and  1978, p . 5 8 ) .  couples taught  c o n s i d e r t h e s e as c o n t e n t a r e a s  In t h i s  of mastery  isolated  that parents  parents of preschool asthmatic  about  being  and  by c o p i n g w i t h t h e symptoms o f asthma by  concerning childrens'  N u r s e s may  sense  (Sperling,  Other  the c o r r e c t medications,  information skills  the c h i l d ' s  some c o u p l e s w o u l d p l a n s p e c i a l  children  taking  Iti s  Medica-  f o r children  to prevent  and c o n t r o l  with  asthmatic 7-10).  be  a result  Godfrey,  skills  1977,  their  recurring  of inadequate  p.  children  ation,  917).  asthmatic  cope.  and  from  harm by  o b s e r v i n g and  role-modelled  medications concern cited  supervising their  appears  medication asthmatic The  specifically  nurses  ways  in a  help  include parent  educ-  to other h e a l t h  of p r o t e c t i n g  their  environmental  and  dangers  on  They  repeatedly discussed  the roads w i t h t h e i r  concerns  about  the  child-  safety of  asthmatic  child.  the This  been r e p o r t e d i n o t h e r s t u d i e s w h i c h were I t i s an  important  finding  t h e r a p i e s s u c h as t h e m e d i c a t i o n s .  that  and  i n c l u d e items  and  i t may  t h a t p a r e n t s r e q u i r e a d d i t i o n a l knowledge about  childrens'  Tooley,  children's behaviour.  (bronchodilators) f o r their  II.  (Norrish,  care.  t e a c h i n g them a b o u t  o f p a r e n t s has  child-  the regime t o p r e -  N u r s e s may  appropriate behaviours  i n Chapter  suggest  to follow  appropriate referrals  couple voiced t h e i r  pp.  t h e r a p e u t i c r e g i m e and  interventions  s a f e t y p r e c a u t i o n s i n t h e home and One  1979,  require understanding  couples r e p o r t e d the importance  children  Tse,  therapy  t h e ways p a r e n t s  Nursing  counselling,  The  ren.  drug  attacks.  to i d e n t i f y  8-9;  a t t a c k s o f asthma i n  Parents  team members f o r c o m p r e h e n s i v e  and  pp.  recurring  preschool children  nursing history their  that  1980,  concerning the i n d i v i d u a l i z e d  to a s s i s t vent  (Arkinstall,  I t i s thought  hood may and  attacks  the  Therefore, i t  ought t o i n c l u d e a c c i d e n t p r e v e n t i o n  and  e d u c a t i o n i n programs f o r p a r e n t s o f p r e s c h o o l children.  couples  in this  t h e h e a l t h and  integrity  they c a r e f u l l y  prepared  s t u d y were p a r t i c u l a r l y of t h e i r nutritious  asthmatic foods  concerned  children;  for their  about  f o r example,  children  and  57 e n c o u r a g e d them t o e a t efforts  to protect t h e i r  triggered support  their  children  of t h e i r guilt,  another  I t was  felt  actively  relevant  to nurses. parents  through  r e p o r t e d how  they  and  asthma grow and  nomous, have i n i t i a t i v e , described  how  they  their and  assisted  their  children  their  resting,  and  that  couples  the  playing.  The  in this  but  assumed a d d i t i o n a l  associated with additional  and  to  The  become  pre-  auto-  They loved  r o u t i n e s such study  of  couples  Furthermore, the  and  couples as e a t i n g ,  indicated  only performed p a r e n t a l  as d e f i n e d by  Duvall  Hymovich  children's chronic disease.  teaching their  of  programs.  to f e e l  t a s k s as d e s c r i b e d by  of treatments  care  actively  self-image.  tasks i n c l u d e d p r e v e n t i o n of the  administration therapy,  their  feelings  children  findings of t h i s  tasks to rear preschool c h i l d r e n  i n the  were d e s c r i p t i v e  develop.  children  not  health  toward h e l p i n g t h e i r  healthful  study  She  These f i n d i n g s are  study  a positive  develop  involvement  community  preschool  c o n f o r m t o t h e demands o f s o c i e t y . helped  fibrosis.  opportunity  findings in this  helped  rearing  performed p r e v e n t i v e  a c t i o n s w h i c h were d i r e c t e d  school children with  about p a r e n t s  self-esteem.  hospital  These f i n d i n g s  hope, d e c r e a s e d  They have t h e  I n summary, t h e parents'  attacks.  t h a t the p a r e n t s '  increased their  special  " c o l d s " which f r e q u e n t l y  chronic disease, cystic  children mobilized their  and  support  from  (1975) o b s e r v a t i o n s  some o f t h e p a r e n t s  measures.  F u r t h e r m o r e , t h e y made  c h i l d r e n ' s asthmatic  Burton's  children with found  i t .  children  (19 76)  These  asthmatic  when t h e c h i l d r e n  (1977),  attacks,  required  about t h e i r  disease  the and  its  treatment.  appeared  The p r e s c h o o l c h i l d r e n ' s a s t h m a t i c  t o i n f l u e n c e these  affectional  responses  with  from  limit-setting,  ren,  (d) e n c o u r a g e a f l u i d  help t h e i r The  t o : (a) enhance  ill  children,  the a c t i v i t y  diet,  for their  breathe.  f o r nurses  children.  The Nursing  rearing  child-  therapies to  caring  study  appears  f o r families with  I t was s u g g e s t e d  chronically  ill  t h a t t h e knowledge be such  children.  use o f the developmental  a p p r o a c h and UBC M o d e l f o r  seemed t o be an a p p r o p r i a t e way t o g u i d e  because the couples  t o be  preschool  i n n u r s i n g a s s e s s m e n t s and i n t e r v e n t i o n s w i t h  families  their  (b) w i t h d r a w  and (e) p e r f o r m  information acquired i n this  asthmatic  their  their  (c) r e s t r i c t  children  significant  used  parents  attacks  described their  helpful  this  research  actions related to  p r e s c h o o l c h i l d r e n ' s b a s i c human n e e d s and a d u n d a n t  r e s u l t e d which appears  t o have e n h a n c e d n u r s i n g k n o w l e d g e .  Furthermore,  the findings  by  (1979),  Crummette  data  support  the previous research  R e d d i h o u g h e t a l (1977),  results  and T r a v i s ,  (1976) . In t h i s  chapter,  the s i g n i f i c a n t  findings  were d i s c u s s e d as w e l l as t h e i m p l i c a t i o n s nursing. derived  The n e x t from  chapter w i l l  the study  provide  of the study  of the f i n d i n g s f o r  recommendations  and a summary o f t h e r e s e a r c h .  CHAPTER V I Recommendations This chapter w i l l further research.  and Summary  p r e s e n t r e c o m m e n d a t i o n s f o r n u r s i n g and  A summary o f t h e s t u d y w i l l  conclude  this  research report. Recommendations 1. ill  One  children  ness;  f o r Nursing  Practise  of the tasks of the parents i s to understand  t h e r e f o r e , the parents  skills  and a t t i t u d e s  sequently, health  and manage t h e i r  to perform  children's ill*-,  team i n p r o v i d i n g v a l i d  knowledge,  the tasks adequately.  Con-  participate with  a  and c u r r e n t e d u c a t i o n a l p r o g r a m s ,  a p p r o p r i a t e c o u n s e l l i n g , and r e s o u r c e s  and  chronically  r e q u i r e the necessary  i t i s recommended t h a t n u r s e s  children with  rearing  f o r parents  of preschool  asthma a b o u t g r o w t h and d e v e l o p m e n t , t h e d i s e a s e ,  i t s treatment. 2.  Parents  asthma a r e e a g e r others insight  like  rearing t o share  nurses.  into  children with their  This data  concerns,  t h e dynamics o f f a m i l i e s  childrens'  to  w h i c h i n v o l v e t h e knowledge  professionals.  asthma.  of promoting  ways t h a t t h e y  helped  t o cope  have a d d i t i o n a l  and s k i l l s  tasks  of health facilitate  could cooperatively help  children with i n this  information f o r nurses  a b o u t t h e ways p a r e n t s  with  g r o u p s w h i c h w o u l d have t h e  The I n t e r v i e w G u i d e u s e d  dant,and u s e f u l  ability  T h u s , i t i s recommended t h a t n u r s e s  each o t h e r i n the care o f t h e i r 3.  and t h e i r  The p a r e n t s  the development of p a r e n t - s u p p o r t potential  and knowledge  like  seems t o be v a l u a b l e i n p r o v i d i n g  with t h e i r perform  chronic illnesses  their  asthma.  study  provided  abun-  and o t h e r p r o f e s s i o n a l s  preschool children  with  asthma grow and d e v e l o p .  Therefore,  i t i s recommended  that the  I n t e r v i e w G u i d e be a d a p t e d and u s e d as an a s s e s s m e n t g u i d e f o r parents  of preschool asthmatic  Recommendations f o r N u r s i n g 1.  this  Research  The s u b j e c t s i n t h i s  sample o f p a r e n t s study  children.  study  were n o t a r e p r e s e n t a t i v e  of preschool c h i l d r e n with  and t h e o t h e r s c i t e d  i n Chapter  asthma.  I I have  v a l u a b l e and u s e f u l i n f o r m a t i o n about f a m i l i e s children.  Thus i t i s recommended  vide  The I n t e r v i e w  a way  to gather  of  the parent's  of  the Interview  ation  criptive use  cents,  of t h e i r  Guide i n o t h e r  form d i d p r o -  behaviours.  descriptive  Applications  r e s e a r c h w o u l d enhance i t s v a l i d -  Therefore,  G u i d e be r e f i n e d  with parents  r e p r e s e n t a t i v e sample.  a b u n d a n t r e l e v a n t d a t a w h i c h was  perceptions  studies.  asthmatic  Guide i n a s e m i - s t r u c t u r e d  and r e l i a b i l i t y .  Interview  provided  t h a t f u r t h e r r e s e a r c h be  implemented which would use a l a r g e r , 2.  of  However,  i t i s recommended  and m o d i f i e d  that the  f o r use i n f u r t h e r des-  M o d i f i c a t i o n s o f the Guide a r e suggested f o r of other  age g r o u p s o f c h i l d r e n  and h e a l t h p r o b l e m s s u c h  as c y s t i c  such  as a d o l e s -  fibrosis.  Summary Parents for  their  This  children,  study  parents'  assume t h e m a j o r r e s p o n s i b i l i t y sick or well,  was d e v e l o p e d  behaviours  to provide  they  reach  maturity.  information f o r nurses  which h e l p c h i l d r e n w i t h  n e e d s t o grow a n d d e v e l o p . by  until  f o r p r o v i d i n g care  asthma meet  The r e s e a r c h p r o b l e m was  about  their  addressed  a s k i n g two q u e s t i o n s : 1.  preschool  What a r e t h e parents'" p e r c e p t i o n s o f t h e ways t h e y children with  asthma meet t h e i r  b a s i c human n e e d s ?  help  2. and  What a r e t h e p a r e n t s '  i t s treatment  children with The couples  and  of preschool children with Guide developed  being  were a n a l y z e d  10  The c o u p l e s  asthma and i t s t r e a t m e n t  intellectual. sel with  and s u p p o r t  children  clinics  inter-  of the i n t e r v i e w s were  categor-  The f i n d i n g s were  tasks of parents  children with  The  were c o n t a c t e d t o  discussed  rearing preschool  From t h e f i n d i n g s ,  d e s c r i b e d 17 h e l p i n g b e h a v i o u r s  preschool  their  allergist  h e l p i n g behaviours  a c h r o n i c d i s e a s e o f asthma.  grow and d e v e l o p .  provided  t o i n t e r v i e w 10  p a r e n t s were  The c o n t e n t  t o b a s i c human n e e d s .  couples  ed t o a s s i s t  Ten w i l l i n g  audiotaped.  t o developmental  children with  pediatric  p r o t o c o l the parents  and t h e p a r e n t s '  according  relation  care to t h e i r  asthma u s i n g a s e m i - s t r u c t u r e d  through  i n the research.  viewed w h i l e  the  to provide  f r o m t h e UBC M o d e l f o r N u r s i n g .  names were o b t a i n e d  participate  in  efforts  asthma?  f o l l o w i n g an e t h i c a l  ized  their  a p p r o a c h t o t h e r e s e a r c h q u e s t i o n s was  Interview parents'  affects  p e r c e p t i o n s o f t h e ways asthma  t h a t were  asthma meet t h e i r  intend-  needs t o  reported that the c h i l d r e n ' s  significantly  affected  the help  i n t h r e e ways: e m o t i o n a l ,  they  physical,  Nurses, t h e r e f o r e , are encouraged t o teach, parents  in their  asthma t o grow a n d  develop.  efforts  to help  their  and coun-  children  References Anthony, E. 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Health Education Quarterly, W i n t e r 1980, 278-297.  of  C r e e r , T., R e n n e , C., a n d C h r i s t i a n , W. Behavioral contributions t o r e h a b i l i t a t i o n and c h i l d h o o d asthma. Rehabilitation L i t e r a t u r e , A u g u s t 1976, 226-232. Davids, John  A. C h i l d p e r s o n a l i t y and Wiley, 1975.  psychopathology.  New  York:  D i n n a g e , R. The h a n d i c a p p e d c h i l d : A r e s e a r c h r e v i e w . L o n d o n : The N a t i o n a l B u r e a u f o r t h e C o o p e r a t i o n i n Child Health, 1970. D o n i a d e s , S. (Ed.). T o r o n t o : Pergamon  The c h i l d i n t h e Press, 1979.  world  of  tomorrow.  F o l t a , J . , a n d D i c k , E . A. A s o c i o l o g i c a l framework care. New York: John W i l e y & Sons I n c . , 1966. G e r s h w i n , E . , a n d N a g y , S. (Eds.). a l l e r g i c and a s t h m a t i c Diseases. 1979.  Evaluation New York:  for  patient  and management o f Grune & S t r a t t o n ,  G r a h a m , P. J . , R u t t e r , M., Y u l e , W., a n d P l e s s , I . B. Childhood asthma: A psychosomatic d i s o r d e r ? Some e p i d e m i o l o g i c a l considerations. B r i t i s h J o u r n a l o f P r e v e n t a t i v e and Social Medicine, 1967, 21, 78-85. H u l l , D. Recent Advances and L i v i n g s t o n , 1976,  in Pediatrics.  New  York:  Churchill  I s h w a r a n , JK. T h e C a n a d i a n f a m i l y CRev. e d . ) . Toronto: R i n e h a r t & Winston of Canada L i m i t e d , 1976.  Holt,  K e n t , D., and S m i t h , J . P s y c h o l o g i c a l i m p l i c a t i o n s of pulmonary disease. C l i n i c a l N o t e s on R e s p i r a t o r y D i s e a s e s , Winter 1977, 16, 3-11  69 L o n s d a l e , G. F a m i l y l i f e w i t h a h a n d i c a p p e d c h i l d : The p a r e n t s speak. C h i l d C a r e H e a l t h and D e v e l o p m e n t , 1978, <4, 99-120. M c N i c h o l , K. N., a n d W i l l i a m s , H. B. S p e c t r u m o f asthma i n children. I : C l i n i c a l and p h y s i o l o g i c a l components. B r i t i s h M e d i c a l J o u r n a l , 1973, 4, 7-11. (a) M c N i c h o l , K. N., and W i l l i a m s H. B. S p e c t r u m o f asthma i n c h i l d h o o d . I I : P s y c h o l o g i c a l and s o c i a l components. B r i t i s h M e d i c a l J o u r n a l , 1973, 4, 16-20. (b) M e i j e r , A. E m o t i o n a l d i s o r d e r s o f a s t h m a t i c c h i l d r e n . P s y c h i a t r y a n d Human D e v e l o p m e n t , 1979, j ) , 161-169. P a r e , P. Asthma: A m u l t i f a c t o r i a l S p r i n g 1979, 3-5.  disease.  Your  Health,  R i v a r d , G. An u p - d a t e on asthma and i t s t r e a t m e n t . Lung A s s o c i a t i o n B u l l e t i n , 1979, 5_8, 11-12. Shannon, D. Diseases,  Asthma i n c h i l d r e n . 1976, 15, 3-9.  Clinical  Child  Canadian  N o t e s on R e s p i r a t o r y  S k o l n i c k , A., and S k o l n i c k , J . H. ( E d s . ) . T o r o n t o : L i t t l e , Brown, & Co., 1977.  Family  i n transition.  Smoking H a b i t s  Spring  1978, 13.  Smoking P a r e n t s  of Canadians.  Your H e a l t h ,  and T h e i r K i d s .  Your H e a l t h ,  Summer 1980, 13.  S t r a u s s , A., and G l a s e r , B. C h r o n i c i l l n e s s and t h e q u a l i t y of l i f e . S a i n t L o u i s : The C V . Mosby Co., 1975. W i l l i a m s , H. E . , and M c N i c h o l l , K. N. The s p e c t r u m o f asthma i n c h i l d r e n . P e d i a t r i c C l i n i c s o f N o r t h A m e r i c a , 1975, 22, 43-52. W i l l i a m s , J . Aspects o f dependence-independence c o n f l i c t i n c h i l d r e n w i t h asthma. J o u r n a l o f C h i l d P s y c h o l o g y and P s y c h i a t r y and A l l i e d D i s c i p l i n e s , 1975, 16_, 199-218.  70 APPENDIX A S e l e c t e d Assumptions from The UBC M o d e l o f N u r s i n g The The  UBC M o d e l f o r N u r s i n g  i s based  assumptions which a r e p a r t i c u l a r l y  include those  relating  on t h e o r y  and  assumptions.  relevant to this  study  t o man, man a s a b e h a v i o u r a l s y s t e m , and  nursing. Assumptions 1.  a b o u t Man  Man h a s b a s i c human needs w h i c h he e x p e r i e n c e s a s  tensions. 2.  Man c o n s t a n t l y s t r i v e s  need by u s i n g a r a n g e o f c o p i n g 3. to  Man c o n s t a n t l y s e e k s  t o s a t i s f y e a c h b a s i c human behaviours.  harmony and b a l a n c e  s a t i s f y m u l t i p l e and c o - e x i s t i n g 4.  Man's c o p i n g b e h a v i o u r s  a s he  strives  needs.  are organized  into  p r e d i c t a b l e p a t t e r n s w h i c h become h i s c h a r a c t e r i s t i c  repetitive, way o f  meeting h i s needs. 5.  D e v e l o p m e n t o f man's c o p i n g b e h a v i o u r s  upon h i s g r o w t h , m a t u r a t i o n , 6.  When man e n c o u n t e r s  his  repertoire  one  o r more o f h i s n e e d s . 7.  and l i f e  experience.  a critical  of coping behaviours  When c o p i n g b e h a v i o u r s  b a s i c human needs man e x p e r i e n c e s  i s dependent  period i n h i s l i f e  cycle,  may n o t a l l o w h i m t o s a t i s f y  do n o t p e r m i t  satisfaction of  a threat to h i s survival or  growth. Assumptions 1. nine  a b o u t Man a s a B e h a v i o u r a l  System  Man may be v i e w e d a s a b e h a v i o u r a l s y s t e m made up o f  subsystems.  71 2. one  Each subsystem i s r e s p o n s i b l e  f o r the s a t i s f a c t i o n of  b a s i c human n e e d . 3.  Each  s u b s y s t e m may be v i e w e d a s a l i f e  4.  The s t r u c t u r e o f e a c h s u b s y s t e m c o n s i s t s o f two p a r t s : a)  an i n n e r - p e r s o n a l  human n e e d b)  and a b i l i t i e s  region  space.  representing  t o meet t h a t  a basic  need,  a p s y c h o l o g i c a l environment r e p r e s e n t i n g the  need-satisfying  goal  and t h e f o r c e s i n f l u e n c i n g i t s  attainment. 5. specific  The f u n c t i o n o f e a c h s u b s y s t e m goal  b)  r e c o g n i t i o n o f need, g o a l , a b i l i t i e s  c)  planning  7. each o t h e r  by the  t o be met by t h e s u b s y s t e m , and f o r c e s ,  possible alternatives) to  the goal, a c t i o n d i r e c t e d toward g o a l i s interacting  achievement.  and i n t e r d e p e n d e n t  with  subsystem.  The s u b s y s t e m s  are i n a balanced  and t h e s y s t e m i s i n a b a l a n c e d  environment. 8.  (selecting  Each subsystem  other  o f t h e need  process:  perception  d)  every  through the f o l l o w i n g behavioural  a)  achieve  6.  i s t o achieve i t s  (Behavioural  Behavioural  system  r e l a t i o n s h i p with i t s  balance).  system balance  f e e d b a c k mechanisms o p e r a t i n g  r e l a t i o n s h i p with  (steady  state)  i s maintained  w i t h i n t h e s y s t e m and between  s y s t e m and t h e e n v i r o n m e n t . 9. 10.  Each subsystem has t h e p o t e n t i a l t o d e v e l o p The b e h a v i o u r a l  system has t h e p o t e n t i a l f o r growth  through the o r d e r l y progression system.  abilities.  of maturation  w i t h i n each  sub-  72 11.  The b e h a v i o u r a l  tensions  arising  12.  from i n t e r n a l  The b e h a v i o u r a l  r e s p o n s e s t o make b o t h the  Maturation  a t any g i v e n 14.  internal  tension-reducing  a d j u s t m e n t s and a d a p t a t i o n s t o  When t e n s i o n - r e d u c i n g  Beliefs  about N u r s i n g  1.  Nursing  Nursing's  critical utilize  periods  responses are inadequate  system b a l a n c e ,  i s the optimal unique  of h i s l i f e  man  during  c y c l e so t h a t he may d e v e l o p  behaviours  c y c l e makes a s i g n i f i c a n t these  professions  h e a l t h o f man.  which permit  the c r i t i c a l  and  him t o s a t i s f y  move t o w a r d o p t i m a l  The n u r t u r i n g o f man d u r i n g  copes w i t h  results.  function i s to nurture  b a s i c human n e e d s and t h e r e b y  life  to  and i t s P r a c t i c e  a range o f coping  3.  imbalance  i s a member o f t h e team o f h e a l t h  whose u l t i m a t e g o a l 2.  responses  time.  behavioural  his  system uses  sources.  influences the tension-reducing  maintain  his  and e x t e r n a l  experiencing  environment. 13.  used  system i s c o n s t a n t l y  health.  periods of  d i f f e r e n c e t o t h e way he  periods.  Reference C a m p b e l l , M., C r u i s e , M., and M u r a k a m i , R. A model f o r n u r s i n g : U n i v e r s i t y of B r i t i s h Columbia School o f Nursing, Nursing P a p e r s , 1976, 8_, 5-6.  APPENDIX B Developmental Tasks Preschool 1.  Settling  into healthy  of  Children  daily  routines of rest  and  activ-  ity: Going t o bed Taking  and  h i s nap  Enjoying  g e t t i n g h i s needed r e s t w i t h o u t  or r e s t ,  active play  and  l e a r n i n g t o r e l a x when he  in a variety  Becoming i n c r e a s i n g l y f l e x i b l e 2.  Mastering  Becoming adequate Accepting Enjoying and  new  3.  and  able  and  to accept  places  changes  good e a t i n g h a b i t s : i n the  flavors  use  and  h i s food with  o f the  textures  customary u t e n s i l s i n foods  with  for eating  interest  lessening incidents of s p i l l i n g ,  the  social  Mastering  as w e l l as  Cooperating Finding  messing,  satisfaction  4.  and  personnel  development:  Learning  to climb,  expected  balance,  manual s k i l l s  coloring,  of  eating  training:  training  program  of b o y s / g i r l s of h i s t o use  available to  i n w h o l e - b o d y use  Developing  toilet  of  run,  variety  appropriate  s k i p , push, p u l l ,  l a r g e muscle  for buttoning,  m o d e l i n g , and  the  place,  age of  resources,  him  the p h y s i c a l s k i l l s  o f motor  catch  i n the  in his ability  Developing  pleasures  i n b e h a v i n g a p p r o p r i a t e l y as t o t i m e ,  ways o f t o i l e t i n g  places,  sensual  t o i n d i c a t e h i s needs f o r e l i m i n a t i o n  comfortably  Becoming f l e x i b l e  the  the b a s i c s o f t o i l e t  Growing i n h i s a b i l i t y  ing,  of s i t u a t i o n s  i s weary  toying  Learning  and  a struggle  to h i s  throw,  stage  and  systems zipping, cutting,  manipulating  small objects  draw-  deftly  74 Becoming i n c r e a s i n g l y self  effectively 5.  independent  in a variety  in his ability  of physical  Becoming a p a r t i c i p a t i n g  t o handle  him-  situations  member o f h i s f a m i l y :  A s s u m i n g r e s p o n s i b i l i t i e s w i t h i n t h e f a m i l y h a p p i l y and e f f e c tively Learning the  t o g i v e and r e c e i v e a f f e c t i o n  and g i f t s  freely within  family  I d e n t i f y i n g with Developing  parent  ability  o f t h e same s e x  t o share  h i s parents with  another  c h i l d and  with others generally Recognizing friends  h i s f a m i l y ' s ways as compared w i t h  and  6.  t o master h i s impulses  and t o c o n f o r m t o  expectations:  Outgrowing the i m p u l s i v e , urgent Learning t o share,  outbursts of infancy  t a k e t u r n s , h o l d h i s own,  panionship  o f other c h i l d r e n — a n d a t times  Developing  the sympathetic,  ensure  of his  neighbors  Beginning  others'  those  his inclusion  t h e com-  to play happily  c o o p e r a t i v e ways w i t h o t h e r s  alone  that  i n groups  Learning appropriate behaviour himself  and e n j o y  for situations  i n w h i c h he  ( t i m e s and p l a c e s f o r n o i s e , q u i e t , m e s s i n g ,  finds  nudity,  etc. ) 7. iety  Developing  healthy emotional  expressions  f o r a wide  var-  of experiences:  Learning to play out h i s feelings,  frustrations,  n e e d s , and  experiences Learning  t o p o s t p o n e and t o w a i t  E x p r e s s i n g momentary h o s t i l i t y  for satisfactions  and m a k i n g up r e a d i l y  afterwards  75 Refining  g e n e r a l i z e d joy or pain into  o f p l e a s u r e , eagerness, anxiety,  tenderness,  affection,  sympathy,  fear,  remorse, sorrow, e t c .  8.  Learning  number o f  t o communicate e f f e c t i v e l y w i t h  an i n c r e a s i n g  others:  Developing  the  vocabulary  and  ability  g r o w i n g number o f t h i n g s , f e e l i n g s , and  d i s c r i m i n a t i n g expressions  to talk  about a  experiences,  rapidly  impressions,  curiosities  Learning  to  attention  listen,  take  s p a n , and  i n , follow directions,  respond  intellectually  increase his  to s i t u a t i o n s  and  to  others Acquiring ness, with  the  social  skills  needed t o get over  s e l f - c o n s c i o u s n e s s , and other people 9.  awkwardness, and  feelings to  of  shy-  participate  comfortably  Developing  the  ability  to handle  potentially  dangerous  situations: Learning bathing Learning uations streets,  t o r e s p e c t the areas,  poisons,  to handle calling  high places,  many o t h e r p o t e n t i a l without  hazards  undue f e a r i n  safety precautions  dogs, r e s p o n d i n g  to accept  help  undue d e p e n d e n c e o r t o o Learning  t o be  of h i s  sit-  (crossing  to a stranger's  offer  to h i s  an  in situations impulsive  t h a t are beyond  him  independence  autonomous p e r s o n  with  initiative  and  own:  increasingly  appropriate  traffic,  etc.)  a conscience Becoming  and  himself e f f e c t i v e l y  f o r c a u t i o n and  Becoming w i l l i n g  10.  animals,  g r e e t i n g strange  of a ride,  without  dangers i n f i r e ,  r e s p o n s i b l e f o r m a k i n g d e c i s i o n s i n ways  readiness  76 Taking  initiative  innovations,  experiments,  Internalizing culture  in  the  groups  Becoming  for projecting  11.  trials,  expectations  with  Laying  and  and  i n his developing  reasonably  accordance  himself  original  with  achievements his  family  and  conscience  makeup  foundations  situations  demands o f  self-sufficient h i s own  into  in a  and  variety  stage  of  for understanding  of  situations—  development the  meanings  of  life: Beginning differ;  to  and  Trying  to  things  are,  Accepting the  nature  understand to  be  aware  understand how  the of  they  and  of  the  origins his or  nature  work  religious God  the  and  faith  about  of  the  her  of  why,  of  life  and  how  the  sexes  gender  the  physical  and  what  h i s parents spiritual  they and  nature  world—what mean  to  learning of  life.  Reference D u v a l l , E. M a r r i a g e and P h i l a d e l p h i a : J . B.  two  f a m i l y development (5th Ed.). L i p p i n c o t t Co., 1977, 244-246.  him about  77 APPENDIX C I n t e r v i e w G u i d e ; How P a r e n t s H e l p The P r e s c h o o l C h i l d r e n w i t h Asthma Meet T h e i r Needs  Date: A.  Code Number: Demographic Data.  Ask t h e p a r e n t s  f o r the f o l l o w i n g  information:  in  1.  What i s t h e p r e s c h o o l c h i l d ' s  2.  How many c h i l d r e n  3.  Where does t h e a s t h m a t i c  the family?  are there  age?  and s e x ?  i n the family?  child  come among t h e c h i l d r e n  1 s t , 2nd, 3 r d , 4 t h , e t c .  4.  How many o t h e r  children  5.  What a r e t h e p a r e n t s '  i n t h e f a m i l y have asthma?  ages?  a) M o t h e r ' s age b) 6.  Father's  How much f o r m a l (Mark  "M"  less  b  )  8-10th  c  )  ll-12th -  have t h e p a r e n t s  than  8th grade  grade grade  community c o l l e g e o r t e c h n i c a l education  )  university  f)  school  degree  other  7.  What i s t h e f a t h e r ' s o c c u p a t i o n ?  8.  What i s t h e m o t h e r ' s o c c u p a t i o n ?  9.  How many h o u r s a r e s p e n t b y t h e p a r e n t s  preschool c h i l d Father  had?  f o r m o t h e r , and "F" f o r f a t h e r )  )  e  .  education  a  d )  tic  age  _  p e r day? ; Mother  \ with  '  t h e asthma-  78 10.  How much t i m e d o e s t h e a s t h m a t i c c h i l d s p e n d i n o t h e r  situations? 11. his/her  hours  p e r day.  Where d o e s t h e a s t h m a t i c p r e s c h o o l c h i l d s p e n d most o f time?  12. preschool  Who  takes the r e s p o n s i b i l i t y f o rh e l p i n g the asthmatic  child? a)  t h e mother t a k e s  the predominant  role  b)  the father  the predominant  role  c) t h e r o l e  takes  i s s h a r e d by b o t h  t h e f a t h e r and t h e  mother d) 13.  other caretakers  Do t h e p a r e n t s a)  Father: much?  smoke?  Yes  , No  '.  I f y e s , how  , a n d do y o u smoke a t home?  '  Yes,  No. b)  Mother: much?  Yes  , No  .  I f y e s , how  , and do y o u smoke a t home?  Yes,  No. c) Do y o u p e r m i t o t h e r s t o smoke i n y o u r Yes  , No  .  and when?  home?  I f y e s , how much?  .  14.  What does t h e word asthma mean t o t h e p a r e n t s ?  15.  What was t h e l a s t  attack? 16.  time  ' What m e d i c a l  treatment  t h e c h i l d had an a s t h m a t i c '' i s prescribed f o r the child?  '  17. the  How  often  doctor  do t h e p a r e n t s  f o r medical times  Interview What a)  her b)  help from  child  breathe  your  do p a r e n t s  your  child  what  help  their  do y o u do t o h e l p food  your  efforts drink  does  and  child  and  to  breathe?  t o prevent  him/  your  child  asthma  e a t and d r i n k  t o e a t and d r i n k  and i t s treatment your  nourishing  food  and  do t o h e l p from  to  fluids?  meet  products  do y o u p r o v i d e  fluids?  to help  do p a r e n t s  What  child  easier?  and adequate food  impact  waste a)  do t o h e l p  What  What  asthma?  wheezing?  help  and  their  do y o u p r o v i d e  nourishing b)  do t o a s s i s t  wheezes,  What  his/her  child  p e r month  child  nourishing a)  regarding  When y o u r  What  the asthmatic  Questions  do p a r e n t s What  help  take  their  his/her  do y o u do t o h e l p  child's  have  need  on  to eat  fluids? child  eliminate the  body? your  child  develop  toilet  habits? b)  What  do y o u do t o h e l p  your  child  wash and  c)  What  do y o u do t o h e l p  your  child  care  bathe?  f o r his/her  teeth? d)  What  impact  your  efforts  products What  rest  and  asthma  to help  from  do p a r e n t s  between  does  and i t s treatment  your  his/her  do t o h e l p activity?  child  have  on  e l i m i n a t e the waste  body? their  child  t o have  a  balance  a)  What do y o u do t o h e l p y o u r c h i l d  rest  b)  What do y o u do t o h e l p y o u r c h i l d  get the exercise  he/she  needs o r wants?  c) " What i m p a c t d o e s your e f f o r t s for  and s l e e p ?  rest  and  asthma and i t s t r e a t m e n t h a v e on  t o help your c h i l d  meet h i s / h e r  needs  activity?  What do p a r e n t s do t o h e l p t h e i r  child  protect  himself/  herself? a)  What do y o u do t o h e l p y o u r c h i l d or  b)  injured?  What do y o u do t o h e l p y o u r c h i l d has  avoid being hurt  done s o m e t h i n g  understand  he/she  wrong?  c)  What do y o u do t o h e l p y o u r c h i l d  feel  secure?  d)  What do y o u do t o h e l p y o u r c h i l d  avoid  e)  What do y o u do t o p l a n  f o r your absence  from  f)  What do y o u do t o p l a n  f o r your c h i l d ' s  absence  infections? home? from  home? g)  What i m p a c t does your e f f o r t s i) ii)  asthma a n d i t s t r e a t m e n t have on  t o h e l p p r o t e c t your c h i l d  emotional stress physical  and/or  stress?  What do p a r e n t s do t o h e l p t h e i r  child  a)  What do y o u do t o h e l p y o u r c h i l d  b)  What i m p a c t does your e f f o r t s  feel feel  loved? loved?  asthma and i t s t r e a t m e n t have on  t o help your c h i l d  What do p a r e n t s do t o h e l p t h e i r satisfaction?  from:  feel  child  loved?  have s e n s o r y  a)  What do y o u do t o e n c o u r a g e  your c h i l d  t o use h i s / h e r  senses? b)  What do y o u do t o h e l p y o u r c h i l d sufficient  c)  stimulation?  What i m p a c t efforts  experience  does  asthma and i t s t r e a t m e n t have on y o u r  t o h e l p your c h i l d  feel  What do p a r e n t s do t o h e l p t h e i r  sensory  child  satisfaction?  have a s e n s e o f  accomplishment? a)  What do y o u do t o e n c o u r a g e according  b)  to the l e v e l  your c h i l d  of his/her  What do y o u do t o e n c o u r a g e  t o do t a s k s  ability?  your c h i l d  t o do a c t i v i t i e s  independently? c)  What do y o u do t o h e l p y o u r c h i l d according  d)  to h i s her l e v e l  What i m p a c t orts  does  make  decisions  of a b i l i t y ?  asthma and i t s t r e a t m e n t have on  t o help your c h i l d  feel  a sense o f  What do p a r e n t s t o do t o h e l p t h e i r  child  for  himself/herself?  a)  What do y o u do t o h e l p y o u r c h i l d  accomplishment?  develop  feel  eff-  "good"  respect  about  himself/herself? b)  What do y o u do t o h e l p y o u r c h i l d  receive  respect  from o t h e r s ? c)  What do y o u do t o h e l p y o u r c h i l d a  d)  about  being  boy/girl?  What do y o u r e s p o n d t o y o u r c h i l d completes  e)  learn  he/she  a task?  What i m p a c t efforts  when  does  asthma and i t s t r e a t m e n t have on y o u r  t o h e l p your c h i l d  feel  self respect?  82 APPENDIX Letter  to the  D  Physicians  Dear As  a Master's  British  Columbia,  fulfill  the  I am  Student  i n Nursing  I need t o c o m p l e t e  requirements  o f the  i n t e r e s t e d i n pursuing  at the  U n i v e r s i t y of  a research p r o j e c t , to  degree.  The  i s designed  research project  t o answer t h e  following  questions: 1.  What a c t i o n s dp  parents  take  to help  their  child  with  asthma meet h i s / h e r b a s i c human n e e d s ? 2.  In what way  ment a f f e c t i n g basic  do  their  parents  efforts  o b t a i n data  t o answer t h e s e  view the  parents  children  have a l l e r g i e s ,  for with  to help  asthma and  their  of preschool  possible volunteers you  to provide  asthma?  fidential. troyed  after  You The the  me  list  be will  study  children.  I t h o u g h t you f o r the  with  may  questions,  meet  his/her  m i g h t be  study.  be  their  helping behaviours I trust my  you  be  result able  me,  and  be  kept  will  o f the  be  condes-  parents'  i n improved n u r s i n g  t o h e l p me  care.  i n getting subjects  research. Sincerely  me  possible  i s completed.  should  will  asthmatic  of preschool c h i l d r e n  names w i l l  u s e d o n l y by  inter-  able to help  Would i t be  names o f p a r e n t s  assured  I plan to  S i n c e many  I b e l i e v e that a b e t t e r understanding  for  child  i t s treat-  human n e e d s ? To  find  perceive  yours,  Carol Mitchell,  B.N.  83 APPENDIX E Written  TITLE  Consent  OF THE RESEARCH PROJECT:  from t h e P h y s i c i a n s  What P a r e n t s  Do t o H e l p  their  P r e s c h o o l C h i l d w i t h Asthma Meet h i s / h e r B a s i c Human N e e d s .  I grant Carol M i t c h e l l information 1.  f r o m my  permission  t o obtain the f o l l o w i n g  office:  t h e names o f p a r e n t s w i t h  preschool children  asthma.  FROM: DATE:  2.  the addresses  o f the parents.  3.  the telephone  numbers o f t h e p a r e n t s .  with  84 APPENDIX Letter  F  to the Parents  Dear I  am a g r a d u a t e  University  of British  ents help t h e i r  The  give  Columbia,  s t u d y i n g t h e ways  i n this  purpose  and how  their  t h a t y o u may be i n t e r e s t e d i n  child  study  i s to learn  t h e ways i n w h i c h  w i t h asthma meet h i s / h e r b a s i c  asthma and i t s t r e a t m e n t  child.  par-  study.  of this  help t h e i r  i n which  asthma grow and d e v e l o p .  has suggested  participating  needs;  i n the School of Nursing o f the  children with  Dr.  parents  student  The r e s u l t s  affect  the help  o f the study w i l l  human parents  benefit  health  c a r e p r o f e s s i o n a l s by p r o v i d i n g i n f o r m a t i o n f o r u s e i n c o u n s e l ling an  and e d u c a t i o n a l p r o g r a m s .  i n t e r v i e w w i t h both o f you p r e s e n t .  imately  s i x t y minutes t o conduct  venient  f o r y o u , we  The will  t a k e me  (two f a c u l t y members)  will  approx-  I f i t i s con-  names w i l l  Only  I and my  have a c c e s s  the tapes w i l l  involve  home.  and your  the recorded i n f o r m a t i o n .  the end o f the study,  would  be r e c o r d e d on an a u d i o t a p e .  be i d e n t i f i e d b y a number,  Committee  It will  the interview.  c o u l d meet i n y o u r  interview w i l l  c i a t e d with  At  Your p a r t i c i p a t i o n  be  The  tape  n o t be  asso-  Thesis  to the tapes.  erased.  85  You w o u l d be without  free  jeopardizing  call  study.  you  f o r your  I f you  f r o m t h e s t u d y a t any  the m e d i c a l care o f your  In one week, a f t e r will  t o withdraw  you have had decision  are w i l l i n g  about  t o be  child.  time t o t a l k  this  participating  i n t e r v i e w e d we  for considering  can a r r a n g e f o r  this request. Sincerely,  Carol Mitchell,  over, I  i n the  a t i m e t o meet. Thank y o u  time  B.N.  86 APPENDIX G Interview  Procedure  Read t h e f o l l o w i n g i n s t r u c t i o n s b e f o r e  conducting the  interview: 1.  A s s i g n t h e Demographic Data s h e e t  number and f i l l 2. role  a rapport with the parents  and e x p l a i n y o u r  a s an i n t e r v i e w e r . Review t h e c o n t e n t s  o f the consent  o b t a i n the parents' permission 4.  and  a code  i n the date.  Establish  3. and  and a u d i o t a p e s  Ask t h e p a r e n t s  completely 5.  Tell  the parents  t o be i n t e r v i e w e d .  t o respond  to the questions  as h o n e s t l y  as p o s s i b l e . the parents  a) The f i r s t about t h e c h i l d  t h e r e a r e two p a r t s t o t h e i n t e r v i e w :  part of the interview i s to obtain  facts  and t h e p a r e n t s .  b) The s e c o n d  part of the interview i s t o obtain the  p a r e n t s ' d e s c r i p t i o n s o f what with  form w i t h  they  asthma and t o o b t a i n t h e i r  its  treatment  affect  6.  Ask t h e p a r e n t s  7.  Begin  do t o h e l p t h e i r  child  o p i n i o n s o f how asthma and  t h e way t h e y  help t h e i r  child.  t h e q u e s t i o n s on t h e D e m o g r a p h i c  Data  form.  a b o u t what "During like  t h e d i s c u s s i o n by a s k i n g t h e p a r e n t s  they  child  on a d a i l y b a s i s .  t h e day y o u do many t h i n g s t o h e l p y o u r  you t o t e l l  help your how y o u r  do t o h e l p t h e i r  child child's  me i n a s much d e t a i l  to think  child.  I would  a s p o s s i b l e what  y o u do t o  meet h i s / h e r n e e d s t o grow and d e v e l o p . asthma  and i t s treatment  affect  your  State:  Explain  efforts to  help your c h i l d  meet h i s / h e r n e e d s .  help your c h i l d  i n the  8. direct 9. 10.  Use the  the  For  example, how  Interview  the  G u i d e q u e s t i o n s whenever  audiotape.  Terminate the  you  morning?"  interview.  Start  do  interview with  the  parents.  necessary  88  Consent  Consent  for Participation  "What P a r e n t s Do  to Help  understand  what p a r e n t s do and  from  Parents  the  of Parents  i n the  Study:  B a s i c Human N e e d s . "  the purpose  to help t h e i r  of t h i s  study i s to d e s c r i b e  p r e s c h o o l c h i l d w i t h asthma grow  develop. We  by  that  H  their Preschool Child  w i t h Asthma Meet H i s / H e r  We  APPENDIX  agree  to p a r t i c i p a t e  the r e s e a r c h e r about  the  i n the topic  s t u d y by b e i n g i n t e r v i e w e d  f o r approximately  sixty  minutes. We  agree  to having the  i n t e r v i e w r e c o r d e d on  We  agree  to permit Carol M i t c h e l l  p r o v i d e , w h e t h e r i t be w r i t t e n o r on graduate It  thesis  t h e work o f h e a l t h  time  the tape  i n N u r s i n g a t the U n i v e r s i t y  i s our u n d e r s t a n d i n g  We  t o use  understand  that  of our  audiotape.  i n f o r m a t i o n we  i n a study of B r i t i s h  the i n f o r m a t i o n w i l l  be  for a Columbia.  useful  t h a t we  can withdraw  from the  study  at  jeopardizing  any the  child.  Date:  S i g n a t u r e o f the  to  professionals.  o r r e f u s e t o answer q u e s t i o n s , w i t h o u t  treatment  the  an  Parents:  and  

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