Table 1.

Discovery Model: Nursing Research Studies on At-Risk Parent-Child Relationships: 1980-April, 2008

Source	Design/Theory	Focus	Sample	Results
Andrews, Williams, & Neil (1993)	Mixed methods, surveys and open-ended interviews/Feminist theory	Examination of mother-child relationship in families who were reporting for care to a pediatric AIDS clinic	n = 80 first interview, n = 20 second interview, HIV-positive mothers, child age not specified, mothers: 56% African-American, 25% Caucasian, 18% Latina, USA	Children perceived by mothers as sources of support: They decrease feelings of isolation, force mothers to approach life positively, provide source of self-esteem for mothers, prevent mothers from engaging in high-risk behaviors Children perceived as sources of stress: Concerns about eventual placement of surviving children, fear for seropositive child’s health, anxiety about long hospitalizations and eventual death
Buckwalter, Kerfoot, & Stolley (1988)	Qualitative, descriptive interview-based, pilot study/No explicit theory	Children of affectively ill parents who were outpatients at a community mental health center	n = 9, child ages 12–20 ethnicity/race not described, parent not described, USA	All subjects had a limited understanding of their parents’ disorders; developed misunderstandings and did not feel they were coping well.
Deatrick, Brennan, & Cameron (1998)	Descriptive, mixed methods, interviews and questionnaire Rolland’s (1994) Family Systems-Illness Model	Mothers with MS and the relationship between fatigue and functional status to the perception of physical affection with their children	n = 35 mother-child dyads, child ages 6–20 years, mothers: 80% Caucasian, 20% African American, USA	Functional status and fatigue not significant predictors of physical affection during exacerbation. When the mothers’ symptoms were stable, perceptions of mothers and children of maternal physical affection were similar. Significant changes reported in mothers’ perceptions of their physical affection and children’s perceptions of mothers’ physical affection during exacerbations. Mothers significantly underestimated changes in their physical affection.
Deatrick, Knafl, & Walsh (1988)	Qualitative, descriptive, open-ended interviews/Normalization (1986)	Description of the management behavior adopted by parents with children diagnosed with osteogenesis imperfecta (OI)	n = 15 children and adolescents with OI from 13 families, children ages 4 – 21 years, 12 families Caucasian, 1 – African American, USA	Parents described behaviors used to normalize their family’s life. Parents’ relationships with the children were affected in the areas of showing affection, discipline, and monitoring the children’s behavior. Nurturing was made difficult because of fear of injury as a result of physical contact. Parents felt discipline was important to keeping children’s experiences similar to siblings’. Monitoring activities and finding appropriate activities was difficult.
Gross (1983)	Qualitative, descriptive, videotapes/No explicit theory	Two part study: Part I - quantitative analysis of usefulness of Maternal Sensitivity Scale (MES); Part II – qualitative analysis of how maternal insensitivity and ineffectiveness are manifested in mother-child dyads who were scored low on the MES	n = 20 mothers with mental illness and n = 20 matched well mothers with children from 3 to 36 months old, mothers with mental illness: 15% African American, 8% Latino, 31% Caucasian; well mothers: 31% African American, 15% Caucasian, 0 Latino	Four patterns observed in both groups: Mothers had unrealistic expectations of their children’s cognitive capabilities. Mothers were unable or unwilling to allow the children the lead in the interactions. The children were unable to manage their anger. The children were resistant to maternal bids for affection. Three maladaptive patterns were observed in the dyads with mentally ill mothers: The children exhibited an expressive language deficiency. The mothers denied the children’s affect. The children were invested in maintaining the conflict. Both mothers and children contributed to the interactive disorganization.
Julion, Gross, Barclay-McLaughlin & Fogg (2007)	Qualitative, descriptive, Focus groups, Billinsley (1992) African American Family Model	Description of African American non-resident fathers’ perspectives on paternal involvement in general and their own actual involvement with their children	n = 69 fathers in 7 focus groups, fathers’ ages = 18 – 65 years, mean age of the fathers = 37.5, child age not specified, all African American, USA	Fathers described four major categories of involvement with their children: sharing and caring, providing guidance, providing support, and serving in culturally specific roles. The fathers spoke of barriers to their involvement and expressed a desire to be more involved.
Leonard, Garwick & Adwan (2005)	Qualitative, descriptive, open-ended interviews/No explicit theory	How adolescents with higher versus lower HbA1c levels view their parents’ involvement in their diabetes management and the quality of their relationships with their parents	n = 18 adolescents with Type 1 diabetes, all Caucasian, ages 14 – 16 years, USA	Adolescents described 5 themes: gaining freedom and responsibility for diabetes management, feeling bothered by parental reminders to manage their diabetes, closeness of family and parental relationships, parental involvement in diabetes management monitoring, and parent-teen conflict related to diabetes
Meadus & Johnson (2000)	Phenomenological study	Description of the experiences of adolescent children living with a parent who has a mood disorder	n = 3 youth, all 17 years old, race/ethnicity not described, USA	Participants experienced serious disruption in family life due to the unavailability of the ill parent, evoked feelings of an intense sense of responsibility, fear and loss in children. Adolescents took on parental roles and tasks. Participants perceived lack of knowledge and understanding, felt frustration and fears that their parents may not get better, and that they themselves may become ill. Participants struggled to come to terms with the burden of a psychiatrically ill parent. Effort of trying to cope and make sense involved a variety of cognitive and affective responses.
Monsen (1999)	Phenomenological, Hermeneutic	Description of the lived experiences of parenting a child with Spina Bifida	n = 13 mothers of children 12–18 years, all Caucasian, USA	“Living worried” emerged as a major theme; two related themes that emerged were “treating them like other children” and “staying in the struggle.”
Neu & Keefe (2002)	Qualitative, descriptive/No explicit theory	Description of the behavioral style and personality characteristics of young school-age children who were identified as colicky infants and their parents’ perspectives of any residual behaviors or effects	n = 20 mothers, (12 had colicky infants, 8 no colic), children mean ages: colicky group = 6.0 years, noncolicky group = 5.7 years, race/ethnicity of mothers not described, USA	There were perceived or real persistent child characteristics, residual feelings, and parent-child interaction issues among mothers of colicky infants. Mother-child relationship may be affected by the colic.
Pelchat, Lefebvre, & Perreault (2003)	Qualitative, descriptive, focus groups/No explicit theory	Identification of differences and similarities in the experiences of parents of children with a disability	n = 9, child ages 2–5 years, mothers and fathers, race/ethnicity not described, Canada	Two themes emerged “actual and expected roles” and “normalization and stigmatization of the child with Down syndrome.”
Rempel & Harrison (2007)	Qualitative, Grounded theory	Description of parenting a child with life-threatening heart disease	n = 16, child ages 2 mo – 5 yrs, 9 mothers, 7 fathers, most were Caucasian, Canada	Extraordinary parenting involving advanced technology within the context of uncertainty regarding treatment and outcome
Shands, Lewis, & Zahlis (2000)	Qualitative, descriptive, semi-structured interviews/No explicit theory	Description of mothers’ reported methods of interacting with the mothers’ school-age children about their breast cancer	n = 19 mothers, child ages 7–12 years, all Caucasian, USA	Mothers used a number of methods to bring children into the mothers’ breast cancer experiences. The conceptual domains included talking about the breast cancer, explaining treatment and care, providing experiences, and doing things to help children cope
White (1994)	Qualitative, Grounded theory	Exploration of the concerns of parents following a child’s discharge from a bone marrow transplant unit	n = 7 mothers and fathers, child ages 2–9 years, all Caucasian, USA	Themes: “Good to be home,” “changing relationships,” “working with this,” “learning the rules,” “the new norm,” “the uncertain future”
Wuest, Merritt-Gray, & Ford-Gilboe (2004)	Qualitative, Grounded theory	Family health promotion in the aftermath of intimate partner violence	n = 40 mothers and 11 children, child ages not specified, mothers: 4 First Nations, 3 French Canadian, 2 new immigrants, 31 Caucasian, Canada	Families strengthened their emotional health by purposefully replacing previously destructive patterns of interaction with predictable, supportive ways of getting along in a process called regenerating family.