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ORIGINAL ARTICLE
Year : 2018  |  Volume : 15  |  Issue : 2  |  Page : 27-35

The stress experienced and coping strategies adopted by the mothers of children suffering from Leukemia


1 Associate Professor, IOP, Kolkata, India
2 Professor cum Principal, B. M. Birla College of Nursing, Kolkata, India
3 Lecturer, College of Nursing, MMC Hospital, Midnapore, India

Date of Web Publication9-Jul-2019

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2231-1505.262447

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  Abstract 


The main purpose of the study was to identify the stress experienced by the mothers of children suffering from leukemia and the related coping strategies.
Methods: A descriptive co-relational design was chosen for the present study to find relationship with the level of stress experienced and coping strategies adopted by the mothers of the children suffering from leukemia, relationship between stress and selected variables and relationship of coping and selected variables. The sample subjects of the study were 70 mothers of the children suffering from leukemia at the outpatient and inpatient departments of the institution(N.C.R.I.), Kolkata. Tools were: Tool 1) A Structured scale to measure the stress of the mothers (4 points rating scale) and 2) A Structured questionnaire to assess Coping Strategies adopted by the mothers (a check list). Results: Most of the mothers i.e. 28 out of 70 (40 %) of the mothers of children suffering from leukemia were in the age group 20-30 years, majority mothers 43 out of 70 (61.43 %) were from lower socio-economic group. From the major findings of the study it is shown that majority of the mothers of children suffering from leukemia had been experiencing moderate level of stress and coping strategies adopted by them in most of the samples also were moderately successful. There is negative correlation between the experienced stress and adopted coping strategies; i.e. when stress experience is increasing, coping is decreasing and significantly as well. There was no association found between stress and selected variables and coping strategy also has no association with selected variables.

Keywords: The Stress, Coping Strategies, Children with Leukemia


How to cite this article:
Purkait G, Ganguly S, Dey T. The stress experienced and coping strategies adopted by the mothers of children suffering from Leukemia. Indian J Psy Nsg 2018;15:27-35

How to cite this URL:
Purkait G, Ganguly S, Dey T. The stress experienced and coping strategies adopted by the mothers of children suffering from Leukemia. Indian J Psy Nsg [serial online] 2018 [cited 2019 Oct 20];15:27-35. Available from: http://www.ijpn.in/text.asp?2018/15/2/27/262447




  Introduction Top


Cancer is the third major killer disease in India among children after infection and malnutrition.(l) Leukemia is the most common type of childhood malignancy. (2) During the period of suffering, the child encounters various complications and also sustains several side-effects as unavoidable consequences of the compact treatment. Current therapy for leukemia consists of chemotherapy and radiotherapy or a combination of both and sometimes surgery.(3),(4)

The maximum number of malignancies was noticed amongst children aged between 1-4 years. The male and female ratio was 2:1. 36% of all malignant lesions in children are leukemia.(5) The incidence of leukemia is higher in <15 years of aged children.(4) Leukemia is the most common childhood cancer in India. 60-85% of all leukemia reported is Acute Lymphoblastic Leukemia (ALL).(6)

Leukemia causes stress for the following reasons:

  • □ Consequences of leukemia are difficult/ problematic and expensive unbearable treatment cost, may have to take loan/ sell property;
  • □ Painful disease - severe long bones and joints pain occur,
  • □ Crying of anxious and fearful child,
  • □ Unfulfilled child’s physical, mental/ emotional, recreational, social needs;
  • □ Painful diagnostic and treatment procedure - repeated Bone Marrow aspiration, Intrathical injection, Chemotherapy, Radiotherapy, Surgery etc.;
  • □ Lethargy, weakness, irritation, frustration, non-cooperation of the child;
  • □ Dangerous side-effects of medication and radiotherapy;
  • □ Sometimes with treatment deterioration of the child’s condition in spite of improvement,
  • □ Sometimes inadequacy of skillful staffs during emergency situations,
  • □Role displacement of parents,
  • □Uncertain outcome in spite of proper timely treatment(8)


So, in India it is very important to adopt effective coping strategies by the mothers of the children suffering from leukemia for fighting with the stressors for survival of the whole family.

An extensive review of literature was done on ‘Leukemia in children’, impact of leukemia on patients, parents and families of children suffering with leukemia and stress and coping strategies of the parents especially mothers of the children suffering from leukemia. Although child health continues to be the priority health issue, childhood cancer is not yet a major area of focus in India. Worldwide, the annual number of new cases of childhood cancer exceeds 200,000 and more than 80% of these are from the developing world. In India 1.6 - 4.8%, a higher proportion, of all cancer cases occur in children less than 15 years of age. Overall incidence: The childhood cancer in the world ranges from 75 to 150 per million children per year. In India it ranges from 38 to 124 per million children per year. 60-85% of all leukemias reported are “Acute Lymphoblastic Leukemia (ALL)”. In India, leukemia continues to be the largest contributor to cancer-related mortality in children followed by lymphomas and CNS tumors (National Cancer Registry Programme reports 2009).(6)

Childhood cancer requires families to deal with many stressors, including decision making in terms of their child’s treatment(2010). (5) Leukemia becomes a chronic disease; the parents must integrate the child’s illness and treatment into their daily lives for a sense of normalcy within the family (Marlow 2006).(4) The majority of mothers with 3-12 year old children with leukemia was experiencing moderate to major depression and that the depression levels did not vary with age, education level, number of children, employment status and income level.(8)


  Methodology Top


It is a A descriptive co-relational design was chosen for the present study.The study setting was the Netaji Subhash Chandra Bose Cancer Research Institute, a Unit of Himadri Memorial Cancer Welfare Trust, 16A, Park Lane, Kolkata, India. The study population was 70 mothers of the children suffering from leukemia attending the outpatient and inpatient departments of the institution. In this preset study a purposive sampling technique was used to select the sample. The data analysis was done by Frequency, Percentage, Correlation coefficient method and Chi-square test.


  Results Top


The distributions of the mothers according to each demographic variable are given in [Table 1] in Frequencies and Percentages.
Table 1: Frequency and percentage-wise distribution of the mothers of the children suffering from leukemia according to demographic variables n=70

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  • □ It was observed that 28 out of 70 i.e. 40 % of the mothers of children suffering from leukemia were in the age group 20-30 years.
  • □ In regard to their educational qualification out of 70, 27 (38.57 %) of the mothers had primary level of education.
  • □ Majorities (62/ 88.57 %) of the mothers were home maker and most of the fathers were doing business i.e. 27 out of 70.
  • □ It is also noted that, most of the mothers i.e. 43 out of 70 (61.43 %) were from lower socio-economic group, who had Rs. 3000 -5000 or less monthly income.
  • □ Most of the mothers i.e. 41 out of 70 (58.57 %) had 3 -5 or less members in their family and again many of them came from joint family i.e. 37 out of 70 (52.86 %).
  • □ It was found that 44 out of 70 (62.86 %) mothers had 2-3 children.
  • □ It was also noted that as per the duration of suffering of the children, (28/ 40 %) of the mothers were with children suffering from >6 months to 2 years.


As given in [Table 2] that majority (78 %) of the mothers of the children suffering from leukemia i.e. 55 sample had moderate level of stress due to their child’s diagnosis and treatment. In [Table 3] , mothers had “Severe Stress” with the statements, i.e. (88.57%), “Gradual deterioration of the child’s condition”, (85.71%), “Child suffering from pain”, (67.14%), “Nutritional needs of child (increased requirement and refusing by child due to loss of appetite”, (77.14%), “Anxious and fearful child often cries”, (60%), “Child is listless and lethargic”, (77.14%), “Waiting long time for test-results”, (72.86%) - “Therapy is painful for the child”, (78.57%, “Treatment is not improving child’s condition”, (72.86%), “Expenses of treatment and hospital stay may be unbearable”, (61.43%) , “Taking loan/ selling property (house, land)”, (81.43%) - “Absence of skillful staff to manage emergency situations”, (57.14%), “Inadequate responses of staff to the questions about child’s condition and treatment”. Mothers had “No Stress” in items, i.e. (78.57%, “Unwanted changes in behavior of other children, spouse and in-laws”, (77.14%),”Other children show behavioral problems”, (42.86%), “Inability to perform social obligations” and (38.57%), “Isolation from friends and relatives.
Table 2: Frequency and Percentage-wise Distribution of Mothers of the children suffering from leukemia in 3 Levels of Stress n=70

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Table 3: Frequency and percentage-wise distribution of the mothers of the children suffering from leukemia according to level of stress n=70

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As given in [Table 4] the physical and psycho-social manifestations of stress, 18 mothers had “very much” and another 18 had feeling “to some extent” of stress on item - “you feel that your heart beats faster than before the child’s diagnosis”. 26 mothers felt at “very much” level and 22 mothers gave response “to some extent” of stress for “you feel restlessness”. Mothers had given “very much” response for items, i.e. (55.71%), “You feel yourself becoming worried because of the diagnosis”, (55.71%), “You are fearful about the prognosis of the disease”, (84.29%) - “you feel that you need guidance or direction for caring of your child”. Mothers responded “not at all” for the items - i.e. (68.57%), “You feel nausea”, (94.29%), “You have excessive appetite”, (75.71%) - “You feel the urge of urination frequently”, (90%) - “You feel the urge of defecation frequently”, (80%), “You have twitching or shivering in your extremities”, (67.14%) - “You feel chest pain, tightness, or discomfort”, (77.14%) - “You feel extremities become cool”, (67.14%) - “You feel backache”, (54.29%), “You feel guilty by the diagnosis of the child”, (81.43%) - “you feel shy to participate in the social functions”, (71.43%), “you feel bad to celebrate social functions and religious gatherings”.
Table 4: Frequency and percentage-wise distribution of the mothers of the children suffering from leukemia according to level of stress n=70

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As given in [Table 5] , there were 39 mothers out of 70 (55.71%) adopted moderately effective coping strategies and hopefully 31 mothers out of 70 had excellent successful coping.
Table 5: Frequency and percentage-wise distribution of the mothers of the children suffering from leukemia in 3 levels of coping strategies n=70

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As given in [Table 6] , that the negative statements are subscribed with “n” and in the statements of coping strategies, mothers responded “Yes” for “Talk to my spouse and cry to seek help”, (97.14%), “Seek reassurance and emotional support from friends and relatives”, (90%), “Seek information from hospital staff’, (98.57%), “Go over the problem again and again in my mind, to try to understand it”, (97.14%) and “Analyze the problems and solve it bit by bit”, (98.57%), “Console myself that things are not at all that bad could be worse”, (97.14%), “Make a plan of action and follow it, like try to pay adequate attention towards other children”, (95.71%), “Have the hope of things getting better/ miracle may happen”, (97.14%), and “Pray to God for help and visit places of worship”, (97.14%), “Listen to music for comfort”, (71.43%), “Watch movies or other programs”, (75.71%),”Practice meditation/ relaxation exercises”, (71.43%), “Plan family budget in a way to spend”, (92.86%), “Take loan or borrow money”, (64.29%), “Hide the feelings and suffer silently”, (70%), “Blame fate”, (62.86%), “Schedule activities in a way that I would do what I enjoy”, (95.71%), and “Spend time in the company of children”, (100%). And mothers gave response “No” for “Sleep more than usual”, (95.71%) and “Try to feel better by more eating”, (90%), “Attend counseling sessions/ yoga classes”, (94.29%), “Attend bhajan groups”, (67.14%), “Swallow analgesics or minor sedatives not on medical advice”, (88.57%).
Table 6: Frequency and percentage-wise distribution of the mothers of the children suffering from leukemia according to adopt coping strategies n=70

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Here as given in [Table 8] , negative co-relation between Stress and Coping; suggests when stress was increasing, the effectiveness of coping was decreasing and Correlation Coefficient is also significant. From the Chi-square test there was no significant association present with the levels of stress experienced by the mothers of the children suffering from leukemia and the selected variables; there was no significant association present with the levels of coping strategies adopted by the mothers of the children suffering from leukemia and the selected variables. Besides, the analysis done based on the set objectives, the Researcher found that 52 out of 70 i.e. 72.29 % children had been diagnosed as case of ALL, 54 out of 70 cases were male i.e. male: femal = 3.4:1.
Table 7: Range, Mean, Median and Standard Deviation of the obtained scores of Stress experienced and Coping Strategies adopted by the mothers of the children suffering from leukemia n=70

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Table 8: Correlation Co-efficient between Stresses experienced and Coping Strategies adopted by the mothers of the children suffering from leukemia n=70

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The Researcher found in this study that majority of children were >5 up to 15 years – 29 out of 70 i.e. 41.43 % and 21 (30 %) children out of 70 were up to 5 years, >15 up to 20 years category there were 7 children and above 20 years there were 13 persons.

The findings of the present study indicate that 61.43 % from Rs.3000 – Rs. 5000 /- or less and 8.57 % from Rs. 5000 – Rs. 8000 /- income per month categories.

Frequently used coping strategies, mothers responded “yes” for “talk to my spouse and cry to seek help”, 97.14%; 69 out of 70 for “seek information from hospital staff” and “analyze the problems and solve it bit by bit”; “console myself that things are not at all that bad could be worse”, 97.14%; “have the hope of things getting better/ miracle may happen” and “pray to God for help and visit places of worship”, 97.14%; “listen to music for comfort”, 71.43%; “watch movies or other programmes”, 75.71%; “practice meditation/ relaxation exercises”, 71.43%; “plan family budget in a way to spend”, 92.86%; “take loan or borrow money”, 64.29%; “spend time in the company of children”, 100%; “schedule activities in a way that I would do what I enjoy”, 95.71%. Mothers gave response “no” for “sleep more than usual”, 95.71%; “try to feel better by more eating”, 90%; “attend counseling sessions/ yoga classes”, 94.29%; “attend bhajan groups”, 67.14%; “swallow analgesics or minor sedatives not on medical advice”, 88.57The study findings support SP Kaur (2006),(1) in her study she found most frequently used Adaptive behaviours by majority of attending parents were - praying to God, having hope of things getting better, talking to spouse and making efforts to overcome the problem; mal-adaptive behaviours were: hiding feelings, blaming themselves and others, crying, getting angry with children and spouse; less frequently used maldaptive behaviours were: avoiding social contacts, taking drugs and alcohol, etc. S. Kumar (1996), in her study, she got frequently used coping strategies were: “pray to God” (94.6%), “wish that you can change what happened” (90.54%), “you go over the problem again and again in your mind to try to understand it” (89.2%), “accept it since nothing can be done” (83.2%), “analyze the problem and solve it bit by bit” (86.5%), “visiting places of worship, going to pilgrimage and offering special offering” 86.49%). The less commonly used coping strategies were: “try to feel better by eating”, “make your selves better by smoking”, “attend counseling sessions” all accounting for 6.8% each.(2)

The researcher found negative correlation (– 0.39) between stress and coping strategies and also significant, i.e. while stress level was increasing, effectively applying of coping strategies was decreasing.
Table 9: Greater stress in the Mothers of the Children suffering from leukemia decreasing coping strategies adaptation

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  Discussion Top


The study findings agree with the findings of Shyamla Kumar (1996) in her study found that mothers with high and moderate stress used effective coping without any significant association.(2) Tapati Bhowmik (2006), in her study got computed Person “r” between stressor and coping strategies of the parents was r(48) = 0.556513 at 0.05 level of significance when tabulated values were, – r(48) = -, r(45) = 0.288, r(50) =0.273, p< 0.05; so, the stressors of the parents were positively correlated with their coping strategies; e.g. as higher the stressor there will be higher the coping strategies and significant.(7)

In the present study, the researcher found out that 55 out of 70 (78 %) had moderate level of stress due to their child’s diagnosis and treatment; 9 mothers had mild level of stress and 6 mothers had severe level of stress. Shyamla Kumar (1996) in her study found 33 mothers out of 74 i.e. 44.6 % had low stress, 22 mothers had moderate level of stress and remaining 19 had high level of stress experience.(2) SP Kaur (1992), in her study she got 24 out of 40 mothers i.e. 60 % had high stress with stress score mean 79.70 and Low stress in 16 mothers out of 40, 40% with mean stress scores 69.75.(1)

Tapati Bhowmik (2006), in her study she got no parents were there in mild stress (1-33%) category, 10 parents out of 50 samples i.e. 20% had moderate level of stress (34-66%) and 40 parents out of 50 i.e.80% had experienced severe level of stress (67-100%). (7)

The researcher found no association from calculated Chi-Squares between stress levels and selected variables. Shyamla Kumar (1996) in her study found that 17 out of 41 mothers (41.6%) experienced high stress when their children were diagnosed as having leukemia for less than a year with X2 (2) = 20.95, P = 0.05. A significant association between the stress level and type of family was observed with X2 (2) = 10.11, P = 0.05.(2) Tapati Bhowmic (2006) in her study Chi square value computed between intensity of stress and selected factors of the parents whose baby admitted to NICU, she found no significance association with parents’ age and socio-economic status of parents was not computed.(7)

The researcher assessed that majority of the mothers i.e. 39 out of 70 (55.71%) adopted moderately effective coping strategies and hopefully 31 out of 70 had excellent successful coping. This findings support Shyamla Kumar (1996) in her study with 74 samples identified the percentages of applied coping strategies i.e. 40 out of 74 mothers (54%) had adopted at/ above median level of coping strategies; and Kaur SP (1992), in her study she observed 37 out of 40 mothers adopted adaptive coping style i.e. 92.50 %.(2),(1)

The researcher detected no significant association between coping strategies adopted by the mothers and selected variables, S Kumar, SP Kaur checked only the most frequently used adaptive behaviors by majority of attending parents like-“praying to God”, etc.(2),(1)


  Conclusion Top


From this study it is shown that the study should be done on more sample than 70 mothers of the children suffering from leukemia. Majority of the mothers of children suffering from Leukemia had been experiencing moderate level of stress and Coping Strategies adopted by them in most of the samples also were moderately successful. There was negative correlation between the experienced stress and adopted coping strategies; i.e. when stress experience was increasing, coping was decreasing and also had significant correlation. There was no significant association between stress and selected variables and coping strategies also had no significant association with selected variables. Recommendations[8]

The following recommendations are made based on the present study

  • A similar study can be done on large sample from various hospitals for definite generalization of the findings.
  • This type of study should be included at least one intervention and evaluation of that’s effectiveness.
  • An evaluative study may be carried out to find the effectiveness of counseling programmes to promote better coping and reduce stress level of the mothers of children suffering from leukemia.
  • A study can be done on other family members’ stress with a child suffering from leukemia.
  • The study findings suggest that factors such as staff’s responsibilities, behaviours, and communication are very important to provide holistic care; so further studies can be done on the basis of these factors.




 
  References Top

1.
Kaur SP (1992). A Study to assess and analyze the level of stress and coping styles of attending parents of children with cancer, admitted to a hospital and relationship of stress level to selected factors with a view to provide basis for structural nursing interventions. Unpublished M. Sc. Nursing thesis, Rajkumari Amrit Kaur College of Nursing. New Delhi.  Back to cited text no. 1
    
2.
Kumar Shyamala (1996). An exploratory study of the stress experienced & coping strategies adopted by the mothers of Leukemic children in a selected hospital in Karnataka. A published master of nursing dissertation. College of Nursing. Manipal Academy of Higher Education, Manipal.  Back to cited text no. 2
    
3.
In Incidence of Cancer in India, Indian Pediatrics, October 1994, volume 31 available from the site - http://indianpediatrics.net/oct1994/1281.pdf  Back to cited text no. 3
    
4.
The epidemiology (incidence, survival & mortality) of childhood cancer across different population - based cancer registries in India and compared it with data from the resource - rich countries [Online], Arora. 2009 Oct [cited 2009 Oct 25]; available from the site - URL: hppt://www.indianjcancer.com/article.asp?issn-0019- 509x;year2009;vol-46;issue-4;page-264  Back to cited text no. 4
    
5.
Woodgate RL, Yanofsky RA. Parents’ Experiences in Decision making with Childhood Cancer Clinical Trials. Cancer Nursing 2010;33(1):11-18.  Back to cited text no. 5
    
6.
A Study on the Depression Levels of Mothers of Leukemic Children.[serial online] Semra E, Yeter K. (2009). [cited 2010 Mar 28]; 6(1):[6 screens]. available from the site - URL:http://medwelljournals.com/fulltext/?doi=pjssci.2009.42.47  Back to cited text no. 6
    
7.
Bhowmik T (2006). A Study to determine the stressors and coping strategies of the parents whose children are admitted to neonatal intensive care unit in selected hospital, Kolkata, West Bengal. A published master of nursing dissertation. B. M. Birla College of Nursing. Kolkata, West Bengal University of Health Sciences, Kolkata.  Back to cited text no. 7
    
8.
Neelakshi G. Stress Management Thru’ Self Management. Nightingale Nursing Time 2006 May;2(2):43-4.  Back to cited text no. 8
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9]



 

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