A mixed methods sequential explanatory study of the impact of chronic pain on family resilience

West, Caryn Patrice (2012) A mixed methods sequential explanatory study of the impact of chronic pain on family resilience. PhD thesis, James Cook University.

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Aim: The aim of this study, undertaken between 2007 and 2010, was to measure and explore the nature of family resilience in the context of families where a member has chronic pain.

Background: Chronic pain poses a potentially life changing, ongoing challenge to many people. While the impact of the pain on the individual should not be underestimated, having a family member with chronic pain creates many additional stressors and problems for the entire family. Apart from the physical effects of chronic pain on the individual, the family may also experience financial, social, and psychosocial challenges. However, individuals and families can be resilient in the face of adverse situations such as chronic pain. Family resilience is not merely about surviving adverse events, trauma, or catastrophes. It also includes the critical influence of positive relationships between family members and how these relational bonds assist families to emerge stronger and more resourceful from difficult situations. While some authors claim positive outcomes for families when faced with adversity, there is currently little empirical evidence on family resilience in the context of chronic pain. It has been purported that a family resilience approach to the management of pain and chronic pain may be a more effective approach than deficit approach, but there is urgent need of further work in the area to support the argument.

Method: A mixed method sequential explanatory study was undertaken using Walsh's Family Resilience Framework (2002) to position the study. In the first quantitative phase, assessment measures were administered to individuals with chronic pain and their family members; the Connor Davidson Resilience Scale (CD-RISC), Family Impact of Pain Scale (FIPS), Medical Outcomes Study Short Form 36 (MOS SF-36), and the Medical Outcomes Study Social Support Survey (MOS SSS). Data was collected from 31 family cases (n= 67 participants). Numerical data were described using mean and standard deviation (SD) when approximately normally distributed and using median and inter-quartile range (IQR) when skewed. Categorical variables were described by percentages. Standard deviations for all participants and for family members without the patient with pain were estimated and adjusted for the clustering effect of family. Statistical analysis was conducted using PASW (SPSS version 18; IBM SPSS; Chicago, Illinois) and STATA release 8. Comparisons between demographic and characteristics to resilience and the impact of pain on the family were conducted using independent t-tests, Analysis of Variance, Pearson's and Spearman's correlation coefficients.

In the follow-up qualitative phase, semi-structured interviews exploring the impact of chronic pain and family resilience were undertaken with 10 families to help explain and deepen understanding of the quantitative results. The data was subjected to two types of analytic techniques; content and interpretive thematic analysis.

Findings: The impact of pain on the families was high. Resilience was found to be higher than average overall, but higher for family members without pain. Individuals with pain perceived they had more support than other family members. As part of Phase 1, the FIPS was tested for its psychometric properties and found to be a reliable tool for measuring the impact of chronic pain on Australian families. Thematic analysis of interview data revealed that while living with chronic pain was generally a negative experience, the participants also revealed a number of strengths and ways of overcoming the challenges of chronic pain, illuminated in the themes: (i) Recognising Individual Strength; (ii) Looking for the positives in life; (iii) Accepting the pain; and (iv) Learning to accept help. For family members, the study revealed the impact of chronic pain to be extensive, resulting in physical, social and emotional changes for family members. Integration of the qualitative findings with Walsh's Family Resilience Framework found some factors but not all evident in participants' stories.

Conclusion: The findings of this study indicate that family resilience is based on complex interactions at individual and family levels. Given that families are evolving and dynamic structures, it is important to note that levels of resilience at individual and family levels fluctuate during times of crisis. Importantly, the findings suggest that it is not as simple as determining whether a family is resilient, but how they are resilient. The resilient qualities identified by this study offer a starting point for the development of family resilience interventions that may benefit families where a member has chronic pain. For healthcare providers, especially nurses, this provides evidence to support strengths-based interventions that may be applicable in a number of chronic conditions. Identifying the strengths inherent in families and using those as part of the planning and implementation of care, especially in chronic conditions such as chronic pain, is pivotal to individuals' quality health outcomes.

Item ID: 24720
Item Type: Thesis (PhD)
Keywords: chronic pain, family health, family resilience, mixed methods, pain management, psychosocial stress, resilience
Date Deposited: 23 May 2013 01:35
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1110 Nursing > 111099 Nursing not elsewhere classified @ 100%
SEO Codes: 92 HEALTH > 9202 Health and Support Services > 920210 Nursing @ 100%
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