Caring for dying children: a comparative study of nurses' experiences in Greece and Hong Kong.

The purpose of this transcultural descriptive study was to explore the subjective experiences of 63 oncology and critical care nurses who provide care to dying children in Greece and Hong Kong. Semistructured interviews were conducted with 39 Greek and 24 Chinese nurses who described their experiences and responses to the dying process and death of children. The data were analyzed qualitatively and quantitatively, and nurses' responses were compared for their work setting (oncology versus critical care) and their ethnic background (Greek versus Chinese). Findings revealed that most nurses experience a sense of helplessness when caring for a dying patient and difficulties in their communication with the child and parents during the terminal phase of the disease. The large majority acknowledge that the impending or actual death of a patient elicits a grieving process, which is characterized by a fluctuation between experiencing and avoiding loss and grief. Greek and Chinese nurses differ in their expression of their grief and how they attribute meaning to childhood death. Despite the suffering caused by multiple deaths, nurses report significant rewards from caring for chronically and acutely ill children, and the majority are satisfied with their job, despite the difficulties they encounter, in both countries, mostly as a result of shortage in personnel and cooperation problems with physicians.

Risk factors for citation errors in peer-reviewed nursing journals.

BACKGROUND: Citation errors are common among nursing journals. But, there are no data regarding the factors that predispose to these errors. OBJECTIVE: To determine the risk factors that predispose to citation error in peer-reviewed nursing journals. METHODS: Five hundred and fifty references were selected randomly from articles published in eleven nursing journals for the year 1998. The incidences of major and minor citation errors were determined by comparing with the original articles. The relative odds of citation errors for the number of authors, collaborating institutions and the length of the reference list were calculated. The correlation between the scientific quality of the journal (by means of journal impact factor and immediacy index) and the incidence of citation error were also determined. RESULTS: The incidence of citation errors is comparable to those reported previously. Long reference lists in articles written by a single author predicted strongly the occurrence of minor citation errors. Journals with a high impact factor and immediacy index tend to contain fewer minor mistakes. None of these factors affect the incidence of major errors. CONCLUSION: Contributors to journals should be aware of the various risk factors for citation errors. Citation accuracy may be improved by modifying these factors.

Comparison of Chinese and Caucasian families caregiving to children with cancer at home: Part I.

This 1-year, longitudinal comparative study of Chinese and Caucasian family caregiving for a child with cancer is reported in two parts. Part I describes data obtained from the initial interviews at diagnosis with Chinese and Caucasian families. Interviews revealed that Chinese families use supplemental care methods, Chinese families have fewer resources and are more isolated; Caucasian families emphasize emotional care; and family emotional coping patterns differed between the two groups. Measures of functional status of the child, the impact of the child's illness on the family, the symptomatic responses of the parents to the child's illness, and patterns of caregiving were also analyzed over the first year after diagnosis. There were no statistical differences between ethnic groups. General health was lower for the children with cancer than for chronically ill children. Part II reports on the results from the two following interviews during the first year after diagnosis.

Common themes and ethnic differences in family caregiving the first year after diagnosis of childhood cancer: Part II.

Chinese immigrant and North American white family caregiving for a child with cancer was compared in a 1-year study. This second of a two-part report describes interview results after first remission and at 1-year postdiagnosis. (The first part reported results of the initial interview and family function, symptom and caregiving inventories administered at diagnosis and at first remission). In follow-up interviews, the ill child remained the family priority in both groups, with sequelae for siblings and parents. All children were physically well cared for, with strict adherence to Western medical protocols. Cultural differences and immigrant status contributed to lower verbal expression of distress, more isolation, and lower attention to emotional distress for the Chinese. Caregiving emphases were dietary for the Chinese; emotional for the Caucasians. Differences over time in family caregiving and coping were determined by demands of care and evolving expertise. Care inclusive routines were established by most families by the second interview, in spite of extent of continued difficulties. Emotional care demands, concern for needs of siblings, and marital conflict increased over time. At 1 year, all families complained of emotional and physical fatigue and the need to adapt to a tentative future with their child.

Development of the South-East Forum on Nursing Science (SEAFONS).

The development of regional cooperation in doctoral programs in Asia is described along with the names of the program in each of the following countries: South Korea, Thailand, Japan, Hong Kong, Philippines, and Taiwan. The need for doctoral education in nursing is also described.

Funeral rituals in Taiwan and Korea.

PURPOSE/OBJECTIVES: To explore the diversity of rituals and attitudes surrounding death in the context of the Asian cultures of China and Korea. DATA SOURCES: Published books and journal articles; author experience. DATA SYNTHESIS: The death of any family member can evoke a myriad of emotional responses, and the bereavement processes and the expression of grief may vary among cultures. In the Chinese and Korean cultures, the principles of Confucianism, Buddhism, and Christianity strongly influence many aspects of daily living, including bereavement. The most prominent example is displayed in the complexity of funeral rituals and postfuneral ceremonies. CONCLUSIONS: Integral to the tenets of Confucianism and Buddhism are the notions of dignity and harmony. The funeral ritual is vitally important because it ensures safe passage of the deceased into the afterlife. IMPLICATIONS FOR NURSING PRACTICE: As healthcare professionals in a culturally diverse nation, nurses should begin to understand what takes place during funeral rituals as well as increase their sensitivity to the underlying cultural contexts.

The experience of the family of children with chronic illness at home in China.

The increasing prevalence of the nuclear family in China challenges the cultural ideal and tradition of the extended family caring for children with chronic illness at home. This study examined and documented the caregiving experiences in a sample of this population of children and their families. A descriptive survey with both quantitative and qualitative questions was developed and used to interview a total of 75 families in three urban areas of China. Factors such as the severity of illness, physical symptoms, the amount of assistance the child needed for daily living, and the emotional and social impact on the child were identified. Descriptions of the family's living circumstances, caregiving situations, and the child's experiences are illustrated through the use of three case studies.

Distress symptoms and support systems of Chinese parents of children with cancer.

This study focused on the physiopsychological reactions to the stress of parents of children with cancer in China. Eighty-nine families who had a child with cancer were recruited into four groups: group A, the child was newly diagnosed with cancer; group B, the child was under treatment for cancer; group C, the child had relapsed and was not expected to live; and group D, the child with cancer had already died. Interviews were conducted in Cantonese. The semistructured interviews were conducted in the hospital or in the home. Specific questions were asked regarding colds, headaches, dizziness, loss of appetite, and weight loss. The Parent Stress Rating Scale (PSRS) and the Parent's Support Scale (PSS) were administered. Results indicated that parents most often reported symptoms of loss of appetite, weight loss, and sleeping difficulty, followed by headache, dizziness, and, least of all, colds. Mothers experience more symptoms than fathers. Only in the newly diagnosed group and the under treatment group did the fathers report having had more colds than the mothers. Parents rated the child's death as having caused the highest stress, followed by the terminal stage and the diagnosis. Spouses received the highest rating for being supportive, across all groups.

Measuring parental grief after childhood cancer: potential use of the SCL-90R.

To contribute to a better understanding of the utility of the Symptom Checklist-90-Revised (SCL-90R; L. Derogatis, 1983) with bereaved samples, an exploratory factor analysis was conducted on SCL-90R responses of 97 parents 2 years after the death of their child from cancer. The factor analysis revealed one significant factor that accounted for 30% of the variance in this administration. This factor included many items that reflected the theme of somatic complaints.

Behavioral responses of healthy Chinese siblings to the stress of childhood cancer in the family: a longitudinal study.

Advances in the treatment of childhood malignancies have dramatically altered survival rates of children with cancer, changing the nature and scope of stressors that their families encounter. Very little is known about how childhood cancer affects healthy Chinese siblings and what can be done to help children adjust to this stressful life event. The cognitive theory of psychological stress was the framework for this study. The purpose of this research was to explore behavioral responses of healthy Chinese siblings in Taiwan to childhood cancer in the family and to examine the factors that may contribute to the presence or absence of behavioral problems in these siblings, using a 12-month longitudinal data set. Forty-five Chinese families were selected through referrals and a cancer foundation name roster. Content analysis of qualitative and quantitative sibling data revealed major stressor themes of inadequate knowledge, reduced family communication, and insufficient support. Healthy Chinese siblings showed significantly more behavior problems and fewer social competence behaviors than a standardized normal western population.

Impact of childhood cancer on religious life of Korean families.

This paper reports on the social and personal relevance of religious faith entering into the situation of family stress due to the illness of a child with cancer. The expectations of religious faith may include, objectively, the actual physical healing of the child or the determination of the child's fate; it may include, subjectively, the hope for emotional support, the provision of moral guidance in time of difficulty, or an overarching life-view. There were major religious changes in 20% of the families. While all the major religious faiths in South Korea were represented in the study, 61% of the sample identified Christianity as their primary religious response.

Funeral rituals following the death of a child in Taiwan.

This study explores the practices of 25 Taiwanese families following the death of a child from cancer. Detailed description of the families' post-death practices was obtained through semi-structured interviews with at least one family member. Through content analysis of the data, 10 categories were identified. These were: caring for the body, funeral arrangements, mourning clothes, ashes, spirit tablets, child's belongings, child's room, visits to the grave or the temple, dreams, and talking about the dead child. The findings show that although the rituals performed following the death of a child are simpler than those traditionally performed for an adult, they are still an important part of the families' lives during the post-death period.

Improving care of dying children.

Every year about 5,000 children aged 0 to 14 years need hospice care in the United States. Children seem to know that they are dying, although this is difficult for parents to accept. Clear, empathic understanding is needed. Communication with clarity and understanding is imperative with the changes in goals from cure to palliation to comfort. The ideal place for most dying children is at home, where symptoms can be managed as effectively as in a hospital.

Chinese mothers' reactions to their child's chronic illness.

Improvements in health status in the People's Republic of China have led to a shift in the burden of illness from acute, communicable disease to long-term illness, particularly in urban areas. The Chinese family's response to chronic illness is influenced by many factors, including the traditional cultural value of family responsibility as well as economic determinants. Through direct interviews with 75 women, we sought to understand the financial, social, emotional, and physical effects of caring for a chronically ill child on a Chinese mother's life and caregiving ability and to identify the sources of support available to her.

The frequency and troublesomeness of symptoms associated with Alzheimer's disease.

An increased understanding of the frequency and troublesomeness of symptoms for family members who are caring for a victim of Alzheimer's disease (AD) would be helpful for nurses in working with these families. This article reports on the changes of these symptoms over time as well as the troublesomeness of these symptoms for 30 families over an 18-month period. A symptom checklist based on George's Patient Illness Symptoms Checklist (George, 1983) was used. Over time the reported symptoms reflected increased mental impairment, which is associated with AD. For some of the symptoms, there was an increase in the symptoms' frequency, but their troublesomeness did not increase. Family caregivers who reported more symptoms for each time period also reported an increase in institutionalization of the AD member.

Impact of childhood cancer on Korean families.

A health care system that includes institutions such as the home, clinic, or hospital as well as interpersonal relationships between providers and receivers of health care is a part of any culture. Clinical issues are a part of all cultures, and cross-cultural comparisons are useful in understanding health care. With immigration and travel, a better understanding of the situation of families who have a child with cancer in various countries, different health care systems, and different cultures is needed. Understanding the situation for families with a child who has cancer in South Korea will lead one to a better understanding of a Korean family who has immigrated to the west and has a child develop cancer or is in need of treatment.

A comparative study of health care for children with cancer in 1981 and 1991 in Taiwan.

This study compared the differences in health care for children with cancer in 1981 and 1991 in Taiwan. The concept of a well-established health care delivery system, including accessibility, continuity, efficiency, dynamism, and integration, served as the conceptual framework for the study. The results showed that: (a) medical care improved--the length of time between symptom and diagnosis was shorter, the number of clinic visits before diagnosis decreased, and the length of time for hospitalization was much shorter with most children receiving their health care in the hospital near their home town; (b) pain control at the terminal stage improved with 70% of mothers stating that their child's pain had received appropriate care; and (c) the role and function of the physician and the nurse were more recognized by parents. The results of the study will assist program planners who are helping children with cancer to improve their health care system.