COPING WITH STRESS IN PARENTS OF CHILDREN AFTER RENAL TRANSPLANTATION Mgr. Lucia Lukackva Mgr. Zuzana Kcabva University Hspital Mtl Sectin fr Pediatric Nephrlgy Prague, Czech Republic
Research gals pint ut the specifics f care fr children after kidney transplantatin detect the frequency and character f stressful events in parents f transplanted children examine the perceptin f stress in parents and explre their cping strategies
Methdlgy PIP - PEDIATRIC INVENTORY FOR PARENTS (Streisand et al, 2001) cntaining 42 items fcused n prblematic events and gruped int fur scales: Cmmunicatin - CM Emtinal damage - ED Health care - MC Rle functin - RF fr purpse f ur research we created a separate scale cntaining 8 items - After renal transplantatin
Methdlgy subscale After transplantatin 8 items statements abut pst-transplant situatins parents scred each f the items n a five - grade scale item 1 I feel there is imprvement f my child s health cnditin after transplantatin. item 2 Transplantatin met my expectatins f better quality f life. item 3 I am wrried abut my failure in administratin f medicatin t my children. item 4 I m afraid f renal graft failure. item 5 I m afraid f my child s failure in schl demands. item 6 I think that my child desn t understand the necessity f taking pills, visits t the nephrlgy utpatient ward and regular drinking after transplantatin. item 7 I tend t anxiusly bserve changes in the health cnditin f my child. Item 8 I have enugh time fr my hbbies.
Results wmen achieved a higher scre in Health care frequency and Emtinal damage - frequency subscales cmpared t men a) * ED-F 60 scre [pints] 30 20 10 0 * 40 20 Health care - frequency subscale MC-F wmen (27.6 ± 4.93 pints) men (24.2 ± 4.55 pints) en m w m en en m m en 0 w scre [pints] b) MC-F Emtinal damage frequency subscale ED-F wmen (52.5 ± 9.96 pints) men (47.0 ± 10.1 pints)
Results wmen reprted a higher incidence f stressful situatins in Rle functin subscale cmpared t men RF-F scre [pints] 150 ** Rle functin frequency subscale: 100 wmen (112 ± 4.16 pints) men (109 ± 4.62 pints) 50 en m w m en 0
Results stressful events ccurred mre frequently in wmen than in men F ttal 250 ** scre [pints] 200 wmen (219 ± 18.9 pints) men (205 ± 18.4 pints) 150 100 50 m en w m en 0
Results in the grup f wmen we fund negative crrelatin between age and scre f Rle functin - frequency subscale RF-F [pints] 130 120 110 100 90 20 30 40 50 wmen - age [years] 60
Results in the grup f men we fund negative crrelatin between age and scre f Emtinal damage - frequency and Emtinal damage - difficulty subscales we als fund a negative crrelatin between age and ttal scre f difficulty 260 80 80 60 60 220 200 180 160 140 20 30 40 50 men - age [years] 60 ED-F [pints] ED-O [pints] O-ttal [pints] 240 40 20 0 20 30 40 50 men - age [years] 60 40 20 0 20 30 40 50 men - age [years] 60
Results university educated wmen reprted a higher incidence f stressful situatins after Tx cmpared t high schl educated wmen 30 Health care - dificulty subscale 20 University educated (UE) 24.0 ± 2.28 10 High schl educated (HS) 20.36 ± 5.72 E 0 U HSS G S MC-O [pints] * educatin
Results divrced and single wmen reprted a higher incidence f prblem situatins cmpared t wmen living with a partner ** 30 Cmmunicatin - frequency subscale Divrced / single wmen scre 30.0 ± 3.97 20 Married / partner 25.13 ± 3.88 10 0 D M CM-F [pints] 40 marital status
Results All participants (men and wmen) *** 30 20 Cmmunicatin - frequency subscale Divrced / single scre (wmen + men) 29.3 ± 4.44 10 Married / partner (wmen + men) 24.9 ± 3.41 D 0 M CM-F [pints] 40 marital status
Subscale After transplantatin Negative crrelatin between: age f wmen and the respnse t item number 1: I feel there is imprvement f my child s health cnditin after transplantatin. age f men and the respnse t item number 4: I m afraid f renal graft failure.
Subscale After transplantatin Significant differences between married and divrced wmen: item 2: Transplantatin met my expectatins f better quality f life. married 4.66 ± 0.48, divrced 3.63 ± 1.28 item 4: I m afraid f renal graft failure. married: 3.45 ± 1.02, divrced 4.27 ± 0.90 item 5: I m afraid f my child s failure in schl demands. married: 3.04 ± 1.12, divrced 3.81 ± 1.16
Discussin Significant factrs gender age marital status educatin
Discussin Gender wmen reprt prblem situatins mre ften than men mthers usually prvide hme care fr children and spend mre time with children than fathers in mst cases, mthers are thse wh stay in a hspital with the child and are well infrmed abut changes in their medical cnditin
Discussin Age parents age influences stress perceptin (same results in Streisand et al., 2001) chrnic illness parents exhaustin prblems and lack f cping strategies better understanding f pssible cmplicatins chrnic illness ften means nly ne incme, but mre financial demands stress anxiety increasing vulnerability fr mental illness and verreactins adjustment
Discussin Marital status divrced wmen reprt stressful situatins mre ften than wmen with a partner lack f emtinal supprt - prblems are easier, when yu are nt alne mre financial prblems (ne incme r just disability cmpensatins, lack f practical help,...)
Discussin Educatin university educated wmen reprted a higher incidence f stressful situatins after Tx cmpared t high schl educated wmen university educatin ability t find mre infrmatin abut the disease and pssible cmplicatins (fr example abut limited renal graft functin in time) stress we didn t find the same relatinship fr men (small number f participants?)
Cnclusin and practical recmmendatin Prfessinals shuld be interested in parents prblems and their perceptin f stressful situatins after transplantatin and prvide emtinal supprt (it is als imprtant fr patient - prfessinal relatinship and fr cmpliance). Mthers, mainly divrced mthers, are at higher risk f burn-ut syndrme and they may need prfessinal help (psychtherapy) mre ften. But we shuld nt frget the fathers!! Chrnic illness can be exhausting fr parents and lder parents can be mre sensitive and anxius (need mre supprt and understanding). Necessity f multidisciplinary cperatin - dctrs, nurses, psychlgists, scial wrkers
Sme histrical picture frm ut renal unit Visit f Lady Diana at the pediatric renal unit, University Hspital Mtl
EWOPA -Annual Meeting in Prague psychlgist f sectin fr Pediatric Nephrlgy Dr. Jana Pekárkvá and Prf. Dr. med. Thmas Lennert, Berlin, BRD
Evelyn ReichwaldKlugger, psychlgist frm Heidelberg in Prague- (pening f a new dialysis unit) invaluable help f the HD team supprting Prague
Janusz Feber, Eva Šimkvá, Jan Janda, Tmáš Seeman Janusz Feber, Sectin fr Pediatric Nephrlgy, CHEO Ottawa, CN Eva Šimkvá, Sectin fr Pediatric Nephrlgy, Belfast, UK
Thank yu!