Oja Charlotte, Edbom Tobias, Nager Anna, Månsson Jörgen, Ekblad Solvig
Department of Neurobiology, Care Sciences and Society (NVS), Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden.
Department of Clinical Neuroscience (CNS), Center for Psychiatric Research, Karolinska University Hospital, Stockholm, Sweden.
Scand J Prim Health Care. 2021 Sep;39(3):268-278. doi: 10.1080/02813432.2021.1928835. Epub 2021 Jun 21.
To understand the main concern of chronically ill parents and how they resolve this concern in relation to their children.
Grounded theory.
Three primary health care clinics in Sweden.
Thirty-two interviewed parents and their children.
Processes and typologies of upholding family relationships.
A concern of chronically ill parents is , achieved through a process of . How a parent upholds depends upon his/her of the illness and of their child's . In response to the parent's upholding behaviours, children the effect of the illness to the parent, the child's specific behaviour depending on his/her level of comprehension regarding the parent's illness. Their combined behaviours create an that may be or .When the parent drives and facilitates the evolution of comprehension, the context quickly evolves from closed to open. When the parent hinders the process by and the child responds by and and they become locked into a suspicious or conflicted awareness context with high relational tension. To create family equilibrium the parent needs to reveal and facilitate the awareness process.
Parents on long-term sick leave in primary health care can need assistance to facilitate the awareness context of themselves and their child. Clinicians can identify the current awareness context of their patient and help their patient towards increased understanding of their illness; their child's needs and the parental capacities needed to reveal the illness and its impacts.Key PointsChildren are affected when parents are ill; they wish for information on their parent's illness. Effective interventions are available in settings other than primary health care and possibilities seen by GPs and families in Scandinavian primary health care have been previously described. There is a knowledge gap in how parents view themselves and their parenting when ill in primary health care. An analysis grounded in interviews was needed to generate a hypothesis (theory) of parental concerns and behaviours.This theory proposes that an important concern of chronically ill parents is to sustain family equilibrium, which they attempt to do by upholding family relationships.Specific upholding behaviours include masking, resisting, colluding, and revealing. In response, children will engage in mirroring behaviours. Which paired behaviours are enacted will depend upon the respective levels of comprehension of parent and child regarding the illness and on the child's need for parenting. In their interactions, parent and child create one of six awareness contexts.Identifying the current awareness context in the family about chronic parental illness provides clinicians with a conceptual tool to better support those families locked in suspicious or conflicted awareness contexts.
了解慢性病患儿父母的主要担忧，以及他们如何针对子女解决这一担忧。
扎根理论。
瑞典的三家初级保健诊所。
32名接受访谈的父母及其子女。
维持家庭关系的过程和类型。
慢性病患儿父母的担忧是通过一个过程实现的。父母如何维持取决于其对疾病以及子女需求的理解。针对父母的维持行为，子女会向父母反映疾病的影响，子女的具体行为取决于其对父母疾病的理解程度。他们的共同行为会营造一种可能是封闭或开放的情境。当父母推动并促进理解的发展时，情境会迅速从封闭转变为开放。当父母通过隐瞒和回避阻碍这一过程时，子女会以怀疑和反抗回应，他们会陷入关系紧张的怀疑或冲突意识情境中。为了实现家庭平衡，父母需要揭示并促进意识过程。
在初级保健中休长期病假的父母可能需要帮助来促进他们自身及其子女的意识情境。临床医生可以识别患者当前的意识情境，并帮助患者更好地理解自身疾病、子女需求以及揭示疾病及其影响所需的父母能力。
关键点
父母患病时孩子会受到影响；他们希望了解父母的病情。在初级保健以外的环境中有有效的干预措施，之前已经描述了全科医生和斯堪的纳维亚初级保健中的家庭所看到的可能性。在初级保健中，父母患病时如何看待自己和养育子女方面存在知识空白。需要通过访谈分析来生成关于父母担忧和行为的假设（理论）。
该理论提出，慢性病患儿父母的一个重要担忧是维持家庭平衡，他们试图通过维持家庭关系来做到这一点。具体的维持行为包括掩饰、抗拒、勾结和揭示。作为回应，子女会做出镜像行为。采取哪一对行为取决于父母和子女对疾病的各自理解程度以及子女对养育的需求。在他们的互动中，父母和子女会营造六种意识情境之一。
识别家庭中关于父母慢性病的当前意识情境为临床医生提供了一种概念工具，以更好地支持那些陷入怀疑或冲突意识情境的家庭。
