The relationship of coping and family function to outcomes of care in families of tracheostomized infants and children

Abstract

The purpose of this study was to examine the relationship of parent coping and family function to outcome measures in terms of the rate of re-hospitalization, emergency physician utilization, and infection. Major questions included: (a) What coping behaviors do parents find most useful in dealing with the tracheostomized child? (b) How is coping related to family functioning? (c) Is there a relationship between outcome measures and family functioning or outcome measures and coping? (d) How do two measures of family functioning correlate over time?

This descriptive, exploratory study examined the association of coping and family function to outcomes after discharge of the tracheostomized child from the hospital. The subjects for the study consisted of 25 families of tracheostomized infants and children under three. Parents agreed to complete the research questionnaires (Family APGAR, Feetham Family Functioning Survey, and Chronicity Impact and Coping Instrument: Parent Questionnaire--CICI:PQ) prior to the child's discharge and at intervals of two, six, and twelve weeks post-discharge. Frequencies of readmission, emergency physician utilization, and infection in children were tabulated at six and twelve weeks post-discharge. Each child was assessed at the time of discharge using the researcher developed tool, the Pediatric Index of Tracheostomy Stability (PITS), as a measure of patient acuity in terms of the tracheostomy. Fully completed questionnaires were obtained from six sets of parents. A follow-up phone survey of 19 families, using questions from the Family APGAR and CICI:PQ, permitted parental elaboration on problems encountered after discharge.

Nonparametric analysis of the data found prayer, talking to someone, and asking for help as frequently used coping behaviors. No correlations between family functioning and coping were found. Correlations between family functioning, coping, and outcome measures were not proven. Measurements on two family function instruments were correlated at certain time period post-discharge. Mothers saw the tracheostomy as the major adjustment problem whereas fathers were concerned with patient-care equipment, finances, and the presence of care providers in the home. Findings indicate that having a tracheostomized child is a stressful event. Parents generally had positive support from spouses and family members. Implications for nursing practice and recommendations for further research are included.