1

THE PHYSICAL AND EMOTIONAL HEALTH OF PARENTS TAKING CARE OF

NEUROLOGICALLY CHALLENGED CHILDREN

An Undergraduate Thesis Proposal

Presented to

The Faculty of the College of Nursing

De La Salle Medical Health Sciences Institute

City of DasmariNas, Cavite

In Partial Fulfillment

of the Requirements for the Degree

Bachelor of Science In Nursing

Arvie M. Delos Santos Cassandra Jane Lopez

Royelle Villena

June 2018
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Chapter I

THE PROBLEM AND ITS BACKGROUND

Introduction

The parent is the person that cherishes the child from the very beginning of child’s

life up to the end, and the one who carries the child with love and hones him towards truth.

The parent must be the foundation a child stands on, and the reason a child can face the

world with grace and kindness. The parent is the one who supports, gives warmth and

discipline the child. But when a child is faced with neurological challenges, how does a

parent feel? Being the primary caregiver what does the parent experience in his/her body?

What do these bodily reactions and feelings do to the way he/she treat his/her own child?

What can be the challenges that affect the over-all being of the parent? In particular, what

can be the state of parent’s emotion and physicality in taking care of neurologically

challenged children?

According to The World Health Organization (2018), one billion people, or 15% of

the world’s population, experience some form of disability, and disability prevalence is

higher for developing countries. One-fifth of the estimated global total, or between 110

million and 190 million people, experience significant disabilities. The rates of disability are

increasing due to aging populations and an increase in chronic health conditions (World

Health Organization (WHO), 2018). According to the Philippine Statistics Authority (2010)

census out of 2.1 million households in the country about 1.43 (1000 persons) or 1.57%

has disability. Among 17 regions, region IV-A had the highest number of person with

Disabilities at 193,000 Philippine Statistics Authority (PSA), (2013).

Parent and family support is central to government policy on ensuring the well-being

of children. While much is known about the difficulties and challenges parents with a

disabled child face, and what parents want for their children, little is known about how
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these challenges affect the physical and emotional health of these parents and how these

can affect what and how they feel towards their children and their environment.

According to the World Health Organization (2018), persons with disabilities are

more likely to experience adverse socioeconomic outcomes than persons without

disabilities, such as less education, poorer health outcomes, lower levels of employment,

and higher poverty rates. This led the researchers to become interested in understanding

the experiences specifically involving their physical and emotional health parents have in

taking care of their children with neurologic condition. What do parents think about having

a child with neurologic conditions? Do these thoughts add stress to their lives? Do these

likely events affect their physical and emotional state of health?

“In some sense every parent does love their children. But some parents are too

broken to love them well”, a quote from William Paul Young (2010). This quote made the

researchers wonder if the parents of neurologically challenged children face crisis in their

lives that affect their care to their child, and how these parents show love to the child.

Does their child’s condition lessen or heighten their love for them? And how does that love

affect their own physical and emotional state of health?

According to a study by Rapp (2017), parenting stress was a prediction of lower

adolescent quality of life. Additionally, if parents are always in stress, the stress affects in

one way or the other the well-being of their child. In support to that, Garrip et al. (2018)

found out that fatigue levels of mothers with cerebral palsy children are higher than those

with healthy children. It was also found out that depression is associated with deterioration

in quality of life in terms of physical, social and emotional functioning.

It is also part of the Philippine culture that when parents get old, their children will

be their assistant, but what if the child needs more assistance than the parent? Parents

could not deny that when they planned to settle down and they got into family life, they

wished to have a child without any disorder. But when assessing the culture of Filipino,
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either good or bad, what they received should be cherished and loved unconditionally

because it is a gift from above, from heaven. It does not matter what is the condition of the

child, what they should have in mind is acceptance, that it is a blessing from God. The

researchers want to know that despite the modernity of today’s society, does the parent

still think having a neurologically challenged child is still seen as a blessing from above?

And with this kind of mind set, how does it affect their feelings and bodily functions?

If it happens that a parent has a child who is neurologically challenged, exploring its

affectation on their activities of daily living, occupation, and most importantly, on family

relationships especially between a parent and the child with neurologic condition, this

research is worthy to delve into.

One of the researchers has observed that having a child with a neurological

condition is very different in terms of caring, the care must be filled with patience and

broad understanding. Being an actual neighbor, the researcher personally knew the

parents of the child and had an opportunity to listen to the family’s illness experience.

Based on the researcher’s observation and informal conversation with the family, the

parents have different styles in handling the child. Every morning the father feeds the child

and after feeding, he is also responsible in bathing the child. When the father was asked

why he is the one staying at home, and his wife is the one working, he explained, it’s a

mutual decision, one of them should take care of the child, and it so happened their child is

male, so they decided it’s better that the father will stay at home. Their situation is not

typical of the traditional Filipino custom wherein the father provides the financial aid of the

family, however in this case, the mother’s role is the main provider of their finance. To

augment financially, the father built a home-based business - a printing shop. Because of

the strain of caregiving, parents may experience physical and emotional difficulties and

may demonstrate certain coping behaviors to combat those difficulties.

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The above situation has led the researchers to study about the physical and

emotional health of parents having neurologically challenged child. This present study

simply intends to describe the state of health of these parents and expectedly in the future,

an attempt to have an in-depth outlook on the parent’s situation and their care to their

child.

Theoretical Framework

This study will be based on the Twenty One Nursing Problems Theory of Faye

Glenn Abdellah (Wayne, 2014) which was created to guide the nursing education and

nursing care in hospital and community settings. This Patient- Centered approach revolved

around addressing the 21 nursing problems namely: maintenance of good hygiene and

physical comfort; promoting optimal activity: exercise, rest, and sleep; safety through the

prevention of accidents, injury, or other trauma and through the prevention of the spread of

infection; maintenance of good body mechanics and prevent and correct deformities;

maintenance of a supply of oxygen to all body cell; maintenance of nutrition to all body

cells; maintenance of elimination; maintenance of fluid and electrolytes balance;

recognition of physiological responses of the body to disease conditions – pathological,

physiological, and compensatory; maintenance of regulatory mechanism and functions;

maintenance of sensory functions; acceptance of the interrelatedness of emotions and

organic illness; maintenance of effective verbal and nonverbal communication; promotion

of the development of productive interpersonal relationship; progress toward achievement

of personal spiritual goals and to create and/or maintain a therapeutic environment;

awareness of self as an individual with varying physical, emotional, and developmental

needs; acceptance of the optimum possible goals in the light of limitations, physical and

emotional; use of community resources as an aid in resolving arises from the illness and

lastly, understanding the role of social problems as influencing factors in the case of
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illness. These nursing problems shall be the bases of determining the maternal or

paternal’s physical and emotional health in the care of children with neurologic conditions.

The importance of Abdellah’s Theory to the study is mainly on identifying the

physical and emotional state of health of parents based on 21 nursing problems stated

previously.

Figure 1. The Physical and Emotional Health of Parents with Neurologically Challenged

Children

 Age of Parent The Physical and Emotional Health

 Family Structure of Parents Taking Care of
 Religion Neurologically Challenged Children
 Child’s Level of Activities of
Daily Living

Guided by Abdellah’s Twenty One Nursing Problem Theory, the diagram on Figure

1 shows the main variable of the study, the Physical and Emotional Health of Parents

taking care of neurologically challenged children which may or may not be influenced by

some intervening variables namely age of parent, family structure, religion and child’s level

of activities of daily living.

Statement of the Problem

This study primarily aims to determine the physical and emotional health of parents

taking care of neurologically challenged children. Specifically, this study seeks to answer

the following questions:

1. What is the profile of the respondents in terms of age of the parents, family

structure and religion child’s level of activities of daily living?

2. What is the physical and emotional state of health of parents taking care of

neurologically challenged children?

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3. Are there significant differences in the physical and emotional state of health of

parents taking care of neurologically challenged children when grouped according to age

of parents, family structure, religion, and child’s level of activities in daily living?

Hypothesis of the Study

It is hypothesized in the study that there are no significant differences on the

physical and emotional state of health of parents taking care of neurologically challenged

children when grouped according to age of parents, family structure, religion, and child’s

level of activities in daily living.

Scope and Delimitation of the Study

This research primarily focuses on the physical and emotional health of parents

taking care of neurologically challenged children. The intervening factors considered are

age of parents, family structure, religion, and child’s activities of daily living.

The respondents are either of the parent (mother or father) who takes care of

neurologically challenged children. The child must be under the parent’s custody on a full-

time (24 basis hours a day for 7 days a week. The age of the child should be below 18

years old and diagnosed with neurological condition for at least one year. The selected

population is limited to only fifty (50) respondents. Either of the parents will answer a

questionnaire regarding their physical and emotional health in relation to their involvement

in the full-time care of neurologically challenged children.

Significance of the Study

It is hoped that the following may gain benefits from this study:

Students of DLSMHSI. This study may give the students a broader understanding

on the physical and emotional health of parents who have neurologically challenged
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children. This may generate new information to those students to have them take into

consideration aspects of the family care.

Parents. This research may give a more in depth assessments and better

understanding of what it takes to be a parent with a neurologically challenged child and

see how much effort it takes in. Also to first time parents of neurologically challenged child,

it will help them be clarified about their expectations and adjustments, gain more

knowledge and take necessary care in their emotional and physical state of health.

Nursing Practice. This research may help the nursing practice itself on applying

interventions effective on the parents with neurologically challenged children. It will help

the practice on how to see the parent as a holistic being who needs attention and

empathy. It will improve their applications on the real life and acquire skills appropriate for

the parents.

Nursing Education. This study may help them be very detailed and precise on

their teachings with new insight or ideas about taking care of neurologically challenged

children. This research may widen the understanding of the educators as to how parents

feel and experience on their physical health. It will also highlight the importance of taking

into considerations the emotion and physical health of parents who take care

neurologically challenged child, and create a new and improved way of teaching and

helping cope the parents.

Future Researchers. This research will furnish knowledge on how parents feel

and what they experience on their body with regards to attending to the special needs of

their neurologically challenged child which will provide future researchers information that

can be used as a supplemental literature on their future studies.

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Definiton of Terms

The following terms were used and defined within the context of this study.

Age of the parents. This terms refers to the length of an existence of the parent

from the beginning to the present time. In this study, this is categorized as: young

adulthood ranging 18 to 40 years old; middle adulthood of 40 to 65 years old; Lastly, the

late adulthood of 65 years old and above.

Child’s Activities of Daily Living. This refers to the child’s level of ability in doing

the following activities: Feeding, Grooming, Bathing, General Mobility, Toiling, Cooking,

Bed Mobility, Home Maintenance, Dressing and Shopping. Continence management: a

bathing, dressing, grooming, oral care. In this study, this has the following levels:

Independence, Does with help, Requires no assistance, Some assistance, Complete

assistance needed.

Neurologically Challenged Children. This refers to the children who have

neurologic condition or a disorder affecting the nervous system. Examples are autism,

cerebral palsy, seizure and attention deficit hyperactivity disorder and the like.

Physical Health. This refers to the physical wellness of the respondents. This has

the following dimensions according to Abdellah’s 21 nursing problems which include:

maintenance of good hygiene and physical comfort; promoting optimal activity, exercise,

rest, and sleep; safety through the prevention of accidents, injury, or other trauma and

through the prevention of the spread of infection; maintenance of good body mechanics

and prevent and correct deformities; maintenance of a supply of oxygen to all body cells;

maintenance of nutrition of all body cells; maintenance of elimination; maintenance of fluid

and electrolyte balance; recognition of the physiological responses of the body to disease

conditions – pathological, physiological, and compensatory; maintenance of regulatory

mechanisms and functions; maintenance of sensory functions; acceptance of positive and

negative expressions, feelings, and reactions; acceptance of the interrelatedness of

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emotions and organic illness; maintenance of effective verbal and nonverbal

communication; promotion of the development of productive interpersonal relationship;

progress toward achievement of personal spiritual goals and to create and/or maintain a

therapeutic environment; awareness of self as an individual with varying physical,

emotional, and developmental needs; acceptance of the optimum possible goals in the

light of limitations, physical and emotional; use of community resources as an aid in

resolving problems arising from illness; and Lastly, understanding the role of social

problems as influencing factors in the case of illness.

Religion. This refers to the system of faith and worship of either of the parents. In

this study, this refers to Catholic and Non-Catholic.

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Chapter 2

REVIEW OF RELATED LITERATURES

This chapter presents the review of conceptual literature and research literature

derived from different sources such as medical and nursing books, published journals,

online sources and past researchers.

The literature review revolved around the following topics: (a) Parenting and

Parenting Neurologically Challenged Children, (b) Physical Health, (c) Emotional Health,

(d) Neurological Developmental Disorders and (e) Neurologically Challenged Children.

Parenting and Parenting Neurologically Challenged Children

A parent is a mother or a father, someone who begets a child and even through

adoption. Being a parent is guiding, cherishing and welcoming a child in their lives. A

parent is a person who protects the child from danger, illness and physical and emotional

harm. A parent who supports the daily activities of a child; the growing and developing

path of children, and the future filled with love and success in life. The parent helps in

financial, physical, mental and emotional well-being of children.

According to a study done by Angkustsiri, Simon, and Hasting last 2017, parenting

is one modifiable factor that has been found in typically developing populations to promote

independent functioning and protect against the development of anxiety disorders. Parents

of children with 22q (Chromosome 22q11.2 deletion syndrome) use higher levels of

Parental Psychological Control (PPC), which is correlated with increased child anxiety.

These analyzes also provide support for parenting interventions to improve anxiety in

children with 22q and possibly mitigate the serious mental health risk in this population.

The amount or numbers of children who have disorder or disease staying at home

is increased. Intense parenting as the overarching theme refers to the extra efforts parents
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had to commit to in raising their children with complex care needs. Parenting was

described as labor-intensive, requiring a readiness to provide care at any time. Increasing

need to care for children has led to the need for additional support and resources for

parents, but they still lack adequate services and supports necessary to help them in their

role of intense parenting (Borton et al., (2015).

Parents need to understand that they may have collaboration with health, social and

educational networks. Most parents are not aware of any contact between school staff and

health or social professionals, although in some discussions might have been initiated

without their knowledge. For parents, the impact upon actual practices or collaborative

work is either minimal or non‐existente, according to a research done by Carrière et al.

(2013).

Parenting a neurologic challenged child is challenging for the parents, focusing on

the child's needs everyday needs; getting out of the bed in the morning, doing tasks of

brushing the teeth, eating breakfast and everyday exercise like an active range of motion

is done with the aid of a parent or a guardian. It is to make sure that the child is safe all

throughout, to affirm the child is doing the work correctly and appropriately and to gather

observation on the improvement and coping of the child.

According to a study conducted by Yuh-Ming Hou et al. (2018), one of the critical

goals in early intervention for young children with Autism Spectrum Disorder and their

families is to reduce children’s behavioral problems. In addition, parents with Autism

Spectrum Disorder experience more stress than those with Developmental Delay and this

is another important consideration.

Children with delays and disabilities can thrive in family contexts, particularly if

parents and caregivers receive proper training and ongoing support. Directive parenting,

combined with “sensitive, responsive, and reciprocal outcomes” and a stimulating home

and community environment, led to favorable developmental outcomes for infants and
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children with Down syndrome. Conversely, a lack of knowledge about their child’s

condition and needs, negative feelings, and lack of support adversely affected parent–child

interactions, child behavior, and development. If provided with nurturing and supportive

family care, children with delays and disabilities have a better chance of leading healthy

and full lives, especially when such care is provided from early in life. Nurturing care has

recently been defined as creating a stable environment that is sensitive to children’s health

and nutritional needs, with protection from threats, opportunities for early learning, and

interactions that are responsive, emotionally supportive, and developmentally stimulating

(Collins et al., 2017).

The focus on preventing neurologically challenged children should be on reducing

parenting stress and increasing support from family and friends to help improve life

satisfaction in mothers of children with cerebral palsy (Wang et al., 2017).

Lu et al. (2014) found out that parents of children with ASD had lower levels of life

satisfaction, self-esteem, and social support than parents of typically developing children.

Social support and self-esteem explained more variance of life satisfaction for parents of

children with ASD than the controls. Researchers have found that caregivers of children

with ASD and the general population have limited knowledge about autism spectrum

disorders in China.

Parenting a neurologically challenged children add stress and is labor extensive,

but all in all, it is fulfilling. With the right amount of support and effective services; the

parent’s stress can be lessened and converted into a more positive outlook for the

children’s life.
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Physical Health of Parents

A balanced diet, proper sleep, and cutting down unhealthy habits such as smoking,

alcohol, and drugs are some of the key physical health factors that can promote mental

wellbeing.

According to a study on stress exposure and its effect to mental and physical health

by Touissant et al. (2017) and team, greater lifetime stress severity and lower levels of

forgiveness each uniquely predicted worse mental and physical health. There’s also a

suggestion on developing a more forgiving coping style may help minimize stress-related

disorders.

Physical activity makes one person feel good and well, it also helps prevent chronic

diseases, improves your mood, increases your energy level and improves your quality of

sleep, additionally it helps a person manage and maintain one’s weight equating to a

quality physical health.

There is a study conducted regarding the healthy nutrition and physical activity

behaviors of parents, mothers reported greater consumption of sugar-sweetened

beverages, total energy, and percent saturated fat compared with women without children.

Both mothers and fathers had lower amounts of physical activity compared with

nonparents. Mothers had higher mean BMIs than women without children. No difference

was observed in BMIs between fathers and men without children; these behaviors can

affect the parents in the lng run and making them high-risk for obesity (Berge et al., 2011).

Parents are often the key advocates for children with disabilities and are likely to

have valuable insight into the opportunities and barriers to physical activity for their child.

The influence of a parent has an effect to child’s physical activity, the study showed

participants' responses indicated 74% of children were not meeting daily recommendations

of physical activity. Participation barriers including emotional, physical and environmental

issues. Three main themes emerged from qualitative data; segregation, access to facilities
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and resources and barriers specific to the child (Wakely, Langham, Johnston & Rae,

2018).

There is also the “pernicious stressor” hypothesis posits that the demands of paid

work combined with intensive mothering or involved fathering create unique time tensions

that act as chronic stressors and that these are associated with poorer health and well-

being; expressed time deficits are associated with distress, anger, and sleep problems,

even when adjusting for work and family factors (Milkie, Nomaguchi, and Schieman,

2018).

The physical health is often unconsidered due to the busy schedules of parents and

their stress affects how they treat themselves and their child. To gain a good physical

health ultimately, physical activity is of great importance; also the diet and sleep and rest

pattern of parents, because they can affect the child’s physical activity, mental, emotional

health and also the developmental years of the child.

Emotional Health of Parents

Many people think of special needs as necessarily involving a serious or chronic

medical condition. When it comes to these parents, it is clear that the additional demands

on parents of chronically ill children cause stress that affects the whole family (Cousino et

al., 2013). Previous research has not done enough to educate people about the effects on

parents of having a child with special needs. Existing researchers prove that parenting

children with special needs is often diagnosis-specific

Kandel and Merrick (2013) have complied results from studies about families having

a child with a disability. The birth of such a child usually follows five stages: "denial, anger,

bargaining, depression and acceptance." Parents usually react with "psychological stress,

a feeling of loss and low self-esteem." The child is "disappointing" and a "social obstacle"

leading to shame and embarrassment." Parents may direct their anger toward others, their
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partner, the physician, or other families who do not have this stress. Some parents bargain

with their higher power: e.g. If you heal my child of the disability, I'll quit drinking or... They

may feel guilt, that the child is a punishment for a past sin. They may overly protect this

child who is a symbol of their failure. The frustrations of finding specialized help, managing

added costs of care, maintaining social communications may mean that the parents aren't

able to communicate with each other. It is usually the mother who assumes more

responsibility, so that the father often feels neglected by his wife who is busy with the child.

A report concerning Down syndrome in Israel found that 25% of families abandon the child

in the hospital. One United State study found that "the divorce rate was ten times larger in

families with a disabled child than in the general population." Whether the child is placed in

an institution or kept at home the grief of the loss of an expected normal child is a life-long

"chronic sorrow." Parents need to talk with a competent professional about their reactions

and strategies for coping.

Shulman, (2015) states that “Recently, at a holiday meal with my extended family, it

came to light that neither of my typically developing teenage children really knows how to

tie his or her shoes. It seems that for the past decade or so, both have been using the

“bunny ears” technique introduced to preschoolers for tying their shoes. My children

appear never to have moved on from there to the mature “around the tree” technique.

Now, if just one had this pattern, it can be checked it up to individual differences, but the

fact that neither has mastered a skill expected by 7 years of age—well, before I knew it,

the eyes of all my relatives seemed focused accusingly on me…or so I thought. I, in turn,

found myself feeling an emotion I am not unfamiliar with: guilt. Ah, parental guilt. I believe

all parents experience this emotion at times. But based on my experiences over the past

20 years as a developmental pediatrician at Albert Einstein College of

Medicine’s Children’s Evaluation and Rehabilitation Center, parents of children with

disabilities take on far more parental guilt than other parents. It rolls in at the time of the
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initial diagnosis of developmental disability, and surfaces regularly through the years of

raising children into adults with developmental problems” (p. 23)

Neurodevelopmental Disorders

Neurodevelopmental disorders are a group of disorders in which the development

of the central nervous system is disturbed. This can include developmental brain

dysfunction, which can manifest as neuropsychiatric problems or impaired motor function,

learning, language or non-verbal communication (Nature, 2018).

The prevalence of Cerebral Palsy and Tic Disorders is lower than reported from

western countries. Cerebral Palsy prevalence is also comparatively lower than in many

community studies from India. Compared to western nations, higher proportion of Febrile

Seizures cases develops epilepsy. A third of the Cerebral Palsy cases have seizures

which is higher than in many Indian studies. Birth anoxia is a common cause of CP and

educational underachievement is frequent (Banerjee, 2017).

Primary outcome was neurodevelopmental impairment; considered present if a

child had any of the following: cerebral palsy, cognitive delay, visual impairment, or

deafness/neurosensory hearing impairment. Univariate and multivariate analyses were

performed. Preterm infants with a birth weight ≤ 1250𝑔 born to single parents at birth have

poorer intellectual functioning at 3 years corrected age (Lodha, 2018).

It is becoming clear that immune and inflammatory reactions do occur in the brain

despite the brain’s lack of conventional lymphatic drainage and graft acceptance and the

presence of vascular brain barrier that tightly regulates infiltration of blood monocytes and

lymphocytes. The critical roles of brain-resident immune mediators and of brain-infiltrating

peripheral leukocytes are increasingly recognized. Inflammatory processes, including

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activation of microglia and astrocytes and production of pro-inflammatory cytokines and

related molecules, occur in human epilepsy as well as in experimental models of epilepsy.

Immune mechanism that underlies evolution of drug-resistant epilepsy and epileptic

encephalopathy represents a new target and will aid in development of novel

immunotherapeutic drugs and therapies against the key constituents in immune pathways

(Sookyong, 2017).

Pediatric-onset multiple sclerosis (POMS), once thought to be rare, is now being

diagnosed in increasing numbers in children. Despite improvements to diagnostic criteria,

the diagnosis and management of POMS remains challenging. The aim of this study is to

retrospectively describe a growing POMS patient population seen at a single center over a

13 year period. Epidemiologic, clinical, neuroimaging, laboratory features and therapeutic

management and outcome data were collected and analyzed. These data support

associations between MS and environmental triggers such as obesity and vitamin D

deficiency. Presenting symptoms, magnetic resonance imaging and laboratory findings

were consistent with the existing literature; however, the prevalence of cortical lesions and

abnormal saccadic pursuit is higher than other reports. Data also demonstrate a shift in

practice from first- to second-line therapies over the observed period (Yamato, Ginsberg,

Rensel, Manikum and Moodly, 2017).

Neurologically Challenged Children

There are different types of aggression: toward others (hitting, biting, kicking);

destructive/disruptive behaviors (breaking objects, screaming); and toward self (biting,

self-hitting, head banging). The first two types of aggression can be further subdivided into

planned and reactive aggression. In planned aggression, as in conduct disorder, the

subject is calm and plans his aggression. In contrast, reactive aggression is a reaction to a

situation or an environment. Children with an ID manifest aggressive behaviour more often

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than children with average intelligence (Bélanger, Brunet, D’Anjou, Tellier, Bolvin,

Gauthier, 2017). It is harder to pinpoint exactly why children with cerebral palsy are more

likely to have behavioral challenges. Some risk factors seem to be having learning

disabilities, having a seizure disorder, being male, having multiple disabilities, and having

communication difficulties. Outside factors may also contribute, including lack of proper

care or stress and an inability to cope in the parents. Difficulty with communication seems

to be a major factor in challenging behaviors (Egan, 2018).

Attention deficit hyperactivity disorder is characterized by poor ability to attend to

tasks (makes careless mistakes, avoids sustained mental effort), motor over activity

(fidgets, has difficulty playing quietly) and impulsiveness (blurts out answers, interrupts

others) (Henderson, 2016). Children with this condition often find it difficult to maintain their

posture and balance. There is no established cause for the condition as it is believed that

each person’s nerve cells controlling muscle movement develop differently. A seizure is

caused because of a temporary disturbance in the brain cells. Epilepsy may be caused by

genetic factors, developmental disorders, infectious diseases and injury caused to the

brain prior to birth (Arora,2017).

Neurologically challenged children are at increased risk of malnutrition due to

several nutritional and non-nutritional factors. Among the nutritional factors, insufficient

dietary intake as a consequence of feeding difficulties is one of the main issues Penagini

et al. (2015). With that added condition to the neurologically challenged children, other

studies have proven of the difficulties in feeding and getting the nutrient. According to

Stone et al. (2017), gastroesophageal reflux (GER), aspiration, and secondary

complications lead to morbidity and mortality in neurologically challenged children,

dysphagia, and gastrostomy feeding. Fundoplication and Gastrojejunal (GJ) feeding can

reduce risk. Discussing another topic of neurologically challenged children is their

intellectual capability, a study conducted by Adeboye et al. (2018) had the need to identify
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the intellectual capability of neurologically impaired children dictates their educability which

can be estimated through their intelligence quotient (IQ). The results of the study

concluded that ninety-six per cent of the study population had IQ below normal. Epilepsy

was the commonest condition seen in the Pediatric Neurology clinic and all categories of

IQ are seen among children with epilepsy.

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Synthesis

With all the gathered literature, there are different outcomes reported on the

physical and emotional state of health of parents with neurologically challenged children.

Borton et al. (2015) described parenting as a labor intensive, requiring a readiness to

provide care at any time, if not properly initiated, parent’s full time involvement in the care

of children can create impetus to their health and well-being.

Studies have shown that of effective parenting skills in the care of neurologically

challenged children offers a variety of benefits both for parents and children. Wang et al.

(2017) stated that improved life satisfaction in mothers of children with cerebral palsy

comes from reduced parenting stress and increasing support from family and friends. In

addition, directive parenting led to favorable developmental outcomes for infants and

children with down syndrome (Collins et al., 2017). Wakely et al. (2018) behavioral

problems. In relation to the above literature, the present study intends to dig deeper on

how full time care of neurologically challenged children can add stress to parents and how

their stress affect their physical and emotional well-being.

This study can greatly contribute to theories and other literature by giving out more

information regarding physical and emotional state of health of parents taking full-time care

of their neurologically challenged children. It will be elaborated and studied into deeper

context and wider knowledge for a more descriptive view.

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Chapter 3

METHODOLOGY

This chapter deals with steps, procedures and strategies to gather and analyze the

data collected with the use of statistics. It is divided into the research method, research

design, respondents or participants of the study and sampling technique, research

instruments, validation of the instrument, data gathering procedure and statistical

treatment data.

Research Design

In this study, the researchers will use a quantitative non-experimental descriptive

research design to determine the numeric and quantifying data obtained. It is based as is

on the natural order of things in life. It is used to describe and document characteristics of

a condition as it occurs and as a function for a starting point of hypothesis theory

development (Polit and Beck, 2012). This study aims to determine the physical and

emotional state of health of parents with neurologically challenged children. This method is

appropriate to use for observing and describing the state of health of parents.

Respondents of the Study and Sampling Technique

The study will be conducted in schools or centers catering children who are

neurologically challenged specifically in Dasmarinas, Cavite. A total of 50 respondent

parents with neurologically challenged child will be considered.

A set of inclusion and exclusion criteria will be used to screen out participants.

Inclusion criteria include: parents should reside in Cavite and with neurologically

challenged child. The child should have an age of 0-18 years; also their child should be
 23

diagnosed of Neurological Disorder for at least one year, and the child should have any

type of neurological condition.

Research Instrument

The instrument was partly developed based on the 21 nursing problems of Faye

Glenn Abdellah. There were a total of 20 questions for the Physical Health and 30

questions regarding the parent’s emotional health, presented in English to obtain answers

needed for the study regarding the physical and emotional health of parent’s with

neurologically challenged children.

The first part is about the demographic data of the respondents, consisting of age of

parent, religion, family structure and child activities of daily living.

The second part is about the physical and emotional health of the respondents or

the parents wherein they will be required to choose from pre-determined choices.

Data Gathering Procedure

The data gathering techniques are divided into two phases:

Phase I: Social Preparation – In order to ensure that the study is ethically sound, this was

subjected to ethical evaluation by the College of Nursing Ethics Review Committee. The

researches asked their thesis adviser’s approval and presented a letter of consent to the

Dean of the College of Nursing. Another letter requesting for data gathering is made to the

principal of the target school.

Phase II: Data Gathering - The researchers will conduct the study on schools where the

parents will be present. The explanation of informed consent will be discussed together

with the procedures, and any questions from the respondents will be clarified. If the parent

is not present, they will be considered and the researchers will revisit according to the time

that the parents are in the schools. If the parent is still not present in the school, the parent
 24

will be visited in their respective houses. In case of a break-down of a parent, the

researchers will comfort and use therapeutic communication and slight touch for warmth

and give the parents time to break down with support. After the signing of the informed

consent, the researchers will proceed to the data collection and distribute, the

questionnaires which include the gathering of the physical and emotional state of health of

parents. The researchers will personally administer and retrieve the questionnaires.

Statistical Treatment Data

The following statistical measures will be used by the researchers to gather answer

to problems and to test hypothesis formulated in the study.

Frequency Distribution. This refers to a systematic array of numeric values from the

lowest to the highest, together with a count of the number of time each value was obtained

(Polit & Beck, 2012). It is used to answer the profile of the respondents in terms of age of

parent, child’s level of activities of daily living, family structure and religion.

Mean Distribution. This refers to the mean of the samples is the mean of the

population from the scores that were sampled. It is used to determine the physical health

and emotional health of the parents with neurologically challenged children.

ANOVA (Analysis of Variance). This refers to a statistical procedure for testing

mean differences among three or more groups by comparing variability between groups to

variability within groups, yielding an F-ratio statistic (Polit & Beck, 2012). This is used to

determine whether there is a difference in the parent’s physical and emotional health when

grouped according to age, religion, family structure and child’s activities of daily living.
 25

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