Pick the title

ARTICLE CRITIQUE
[Grey,M; Jaser,S; Whitemore, R; Jeon, S; & Lindemann, E (2011). “Coping Skills Training for Parents of Children With Type 1 Diabetes 12-Month Outcomes”. Nursing Research, 60(3), 173-181]
Name of the Student
Name of University
ARTICLE CRITIQUE
[Grey,M; Jaser,S; Whitemore, R; Jeon, S; & Lindemann, E (2011). “Coping Skills Training for Parents of Children With Type 1 Diabetes 12-Month Outcomes”. Nursing Research, 60(3), 173-181]
Background of the Problem
Any form of the chronic disease in a child is stressful for patients, and Type-1 Diabetes Mellitus (TID) is one of them. Managing and caring for a child with TID, is very stressful for both the parents and their children. TID is one of the common childhood chronic diseases and is prevalent in almost 3 children out of 2000. The incidence of TID is a concern all across the world, and the incidences of TID are increasing day by day. The complexity of treatment regime, which requires monitoring of the blood glucose levels under tight vigilance, imposes tremendous mental and physical strain on the parents of affected children (Grey et al, 2011).
The consequences of hypoglycemia and poor metabolic control lead to increased care giving responsibilities in a parent. Moreover, titrating the dose of insulin and administering the same is also one of the aspects of anxiety that dwells in the mothers of affected children. Hence, suitable coping strategies that help in reducing the depressive symptoms and anxiety of such mothers are of utmost importance.

However, very few initiatives or studies have been conducted to evaluate the role of interventional strategies for reducing such anxiety related issues in mothers of affected child. On the other hand, it is recognized that lack of coping or persistent anxiety lead to constraints in the mother-child relationship. Moreover, the problem is aggravated by the inability of a child to express his or her needs in times of exigency. This is because being a child; the physiological problems are often not recognized by the affected children. Moreover, it has been seen that educational awareness is also not appropriate for these parents, which perhaps may add to the issues with coping. This is because the parents may be too much over apprehensive or under apprehensive regarding the health condition of their child. Such lack of education and training on the disease may be the stimulating factor for stress and anxiety. The present study was aimed to compare group educational interventions for parents of children with TID with a coping skills training intervention (Grey et al, 2011).
Hypothesis (Research Questions)
The research questions that the study tried to evaluate were:
Does the individual parents whose child suffers from TID, has difficulty in coping with the problem?
Do educational programs and awareness help in an alleviation of anxiety and ads in coping?
Does Coping skills training program helps in an alleviation of anxiety and ads in coping?
Does educational programs/ Coping skills training program are effective intervention strategies in alleviating stress and anxiety, even when the treatment outcomes (clinical condition) in the patients remain the same? (Grey et al, 2011)
It was speculated that parents who receive cognitive skills training will have better coping strategies, better family functioning and improved quality of life with fewer conflicts in the family. Further children whose parents would have improvement in coping skills will also exhibit better metabolic control. Children’s age, gender and treatment outcomes may moderate coping. On the other hand, parents’ improved coping will be related to better metabolic control in their children (Grey et al, 2011).
Literature Review
TID or juvenile onset diabetes is a clinical condition, where the beta cells of the pancreas do not secrete adequate insulin. It may be due to an auto-immune destruction of beta cells or failure of signaling pathways to release insulin from those cells. Under any condition decreased insulin will not adequately stimulate the various insulin receptors in the different cells. This will lead to inadequate up regulation of GLUT-4 channels on the plasma membrane of different cells. GLUT-4 helps in transport of glucose from the blood to the cells. Therefore, decreased glucose within the cells will lead to decreased utilization of carbohydrates in the cells for a liberation of energy and also it will lead to increase in the blood glucose levels. Increased blood glucose will be filtered through the renal tubules and pulling excess of water. Hence, the volume and frequency of urine (polyuria) increases. Excess urination leads to hypovolemia (decrease in blood volume), which leads to inadequate perfusion of blood in various essential end organs like the rain, kidneys and the lungs. Decreased blood supply of blood in the brain may lead to diabetic coma in a child. This unpredictability of blood supply and coma leads to anxiety and depression in mothers of the affected children. Moreover, the quality of life and a compromise on daily activities impose coping issues on a mother (Grey et al, 2011).
Research on maternal-child relations have been shown to be under difficulty due to a lack of proper coping in mothers. Moreover, a lack of coping has been related to the onset of depressive symptoms in both mothers and school going children. The role of interventional strategies to reduce anxiety and depression and to improve the levels of coping are very few and scanty. However, a study found that greater use of coping strategies like intervening problem-solving skills in mother reduced the degree and severity of depression in mothers. It was also reflected that a mothers coping strategy was independent of the level of metabolic control achieved by the child. This means that without improving the metabolic status of a child, it could be possible to increase coping strategies in a mother which will lead to the decrease in depression and anxiety. Hence, such interventions may appeal to improve the quality of life of both mothers and their children. Family functioning based on the parent-child relationship was linked to metabolic control of diabetes and psychosocial adjustments. It has been shown that family conflict over diabetes management leads to poor management of the disease and also decreases the quality of life of both parents and their child. On the other hand, family support improves better metabolic control and treatment compliance. Better cohesion in the family leads to stronger adjustments in parents and child concerning the disease. Office-based interventions to promote parent-child teamwork is successful as intervention strategies. Behavioral family therapy has been shown to improve better metabolic control. However, no studies were available for indicating coping improvement in patients. Hence, cognitive training based on a social cognitive theory of Bandura (1996), was speculated to improve the coping strategies in parents. The social cognitive therapy was shown to be useful in improving coping with TID in adolescents (Grey et al, 2011).
Ethics Related to the Study
The parents who were selected to the study was recruited from the pediatric diabetes clinic of a large University-based medical center. Further, consent process done through the approval of the university institutional review board. The doctors in the diabetic clinic were the backup consent producers, for including such parents for the study (Grey et al, 2011).
Data Collection and Methodology
Parents selected for the study was recruited from the pediatric diabetes clinic of a large University-based medical center. Data was collected from two separate randomized clinical trials of cognitive, social therapy interventions. In one trial children belonged to 8-12 years and the other study parents belonged to children (< 8 years of age). The two groups were pooled into one, and the pooled groups of parents were randomly subjected to two groups. One group was provided educational training, and the other group was provided cognitive skills training. The number of parents of children who were randomized to the educational group was 106, and the number of parents who were randomized to the coping skills group was 75. The parents completed various assessments before the interventional programs concerning family conflict, a responsibility of treatment, coping (as indicated by the quality of life of themselves and their children). The same assessments were undertaken after the interventional programs started at regular intervals of 3 months, 6 months, 9 months and 12 months. For assessing the metabolic control of the condition, the glycosylated hemoglobin levels (Hb1Ac) were routinely monitored at the interval of 3 months duration in the child. It was reflected that there were no significant effects on treatment outcomes after twelve months, on TID in the children, after interventional strategies were used. However, the coping related variables and the educational training programs significantly improved the quality of life (p=0.005), decreased family conflicts (p<0.001) and improved responsibility of treatment (p<0.001.). However, the metabolic control in the children decreased, but it was not statistically significant. However, the recommended control of Hb1Ac <8 was maintained, in such affected children, even after worsening of metabolic conditions (Grey et al, 2011).
Discussion and Conclusion
The study indicated that family based interventional programs like educational awareness and coping skills training are independent, successful strategies to reduce the stress and anxiety of parents. However, improved coping and improved awareness do not necessarily mean it will have better treatment outcome on patients. This is because a metabolic condition is a clinical situation and there are various variables that might affect such control. It can still be argued that irrespective of the severity of the clinical condition and worsening of the metabolic condition, the Hb1Ac was maintained below 8. It may be speculated that if such intervention programs were not applied the condition of their children, could have worsened further. Another interesting situation that vibrates the success of the coping program or the educational program was reflected in the adapting behaviors. In spite of their children showing worsening metabolic conditions, they still had better coping. This means the programs were effective in reducing anxiety and stress, and treatment did not bias the successfulness of the two programs (Grey et al, 2011).
Future Implications
Parents of juvenile onset diabetes must be intervened with both educational awareness programs and coping programs, to sensitize them regarding the complexity of the disease. However, such programs must not be too complex, so that the concern of parents does not increase. On the other hand, it should also be important to have regular metabolic profiling of the children on clinical aspects. This is because coping or behavioral strategies would not be able to address the clinical needs of a child. However, improving family intervention strategies certainly would improve compliance to such treatment schedules as planned by their respective physicians.
References
Grey,M; Jaser,S; Whitemore, R; Jeon, S; & Lindemann, E (2011). “Coping Skills Training
for Parents of Children With Type 1 Diabetes 12-Month Outcomes”. Nursing Research,
60(3), 173-181