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Parental stress and coping strategies during pediatric hospitalization: a descriptive study at the University Hospital of Salamanca
Authors
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JonathanAdaliaRodriguez
PsyD
1,2✉Email
Full Professor
AnaMaríaUllán
de la
Fuente
PhD
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1Department of Social PsychologyUniversity of SalamancaSalamancaSpain
2Calle Figueira da Foz 9, 2ºD37006SalamancaSpain
Jonathan Adalia Rodriguez, PsyD
 Doctor of Psychology
Department of Social Psychology 
University of Salamanca, Salamanca, Spain
Email: [idu040201@usal.es]
Ana María Ullán de la Fuente, PhD, Full Professor
 
Department of Social Psychology 
University of Salamanca, Salamanca, Spain
Email: [ullan@usal.es]
Corresponding Author
Jonathan Adalia Rodriguez Address: Calle Figueira da Foz 9, 2ºD, 37006 Salamanca, Spain
Email: idu040201@usal.es
Abstract
Background
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Child hospitalization generates significant psychological distress in parents, who may experience stress, anxiety, and feelings of helplessness. Nursing support can play a key role in facilitating coping and family adaptation.
Objective
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To identify levels of stress and coping strategies used by parents during their child’s hospitalization in pediatric units at the University Hospital of Salamanca, and to analyze the influence of nursing interventions on this process.
Methods
A descriptive, quantitative, cross-sectional study was conducted between December 2023 and May 2024. Data were collected through an ad hoc self-administered questionnaire including the Parental Stressor Scale: Infant Hospitalization (PSS:IH) and the Coping Strategies Inventory. Participants were parents of children under 14 years hospitalized ≥ 48 hours. Sociodemographic, clinical, stress, coping, and nursing support variables were analyzed using descriptive and inferential statistics (SPSS v28).
Results
A total of 84 parents were included (62.7% women; mean age 36.1 years; mean number of children 1.65). The mean parental stress level was moderate (x̄=2.77). The most stressful items were: child on mechanical ventilation (75.6%), presence of tubes/catheters (73.6%), child in pain (72.6%), and alarms from monitors/equipment (71.8%). Mothers showed higher stress related to disruption of parental role (p = 0.05). The most frequent coping strategies were wishful thinking (x̄=22) and problem-solving (x̄=20.3). Nursing information and support were positively correlated with the use of problem-solving (rho = 0.779; p = 0.003) and social support (rho = 0.631; p = 0.005).
Conclusions
Parental stress during pediatric hospitalization is mainly associated with invasive procedures and medical devices. Nursing interventions focused on communication and emotional support foster adaptive coping strategies and facilitate family adjustment.
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Background
Hospitalization of a child is a stressful experience for parents, often associated with anxiety, depression, and vulnerability (1, 2). This situation disrupts family routines and is intensified by exposure to invasive procedures and medical devices.
In Castilla y León, Spain, 52,080 children under 14 years were hospitalized in 2023, of whom 35% were admitted to neonatal units and 64.7% to pediatric units; 3.32% and 8.11% respectively required intensive care (3).
Previous studies highlight that professional support and adequate information can reduce parental stress and enhance the use of adaptive coping strategies (4, 5). Nurses play a central role in this process, as they are the professionals most frequently in contact with the child and family, integrating physical, psychological, and social care (6–9).
Parental coping depends on several factors, including communication with healthcare providers, disruption of parental role, and the quality of information received (10–13). Nursing interventions can therefore promote psychological adaptation by providing support and effective communication.
The aim of this study was to identify parental stress levels and coping strategies during pediatric hospitalization at the University Hospital of Salamanca, and to explore the role of nursing interventions in this process.
Methods
Design
Descriptive, quantitative, cross-sectional study.
Setting and period
Pediatric hospitalization units at the University Hospital of Salamanca, from December 2023 to May 2024.
Participants: Parents of children under 14 years hospitalized for ≥ 48 hours. Inclusion criteria: Spanish language comprehension and informed consent. Sampling was non-probabilistic, by convenience.
Instruments:
1.
Parental Stressor Scale: Infant Hospitalization (PSS:IH), Spanish validated version (14), consisting of 36 items in 7 subscales.
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Coping Strategies Inventory (CSI), Spanish adaptation by Cano (15), 40 items in 8 subscales.
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Ad hoc sociodemographic and clinical questionnaire.
Variables:
Independent: parental age, sex, role, number of children; child’s age, reason for admission, previous hospitalizations, unit.
Dependent: parental stress level, coping strategies, perceived nursing information and support.
Analysis
Means and standard deviations for quantitative variables; frequencies and percentages for categorical variables. Hypothesis testing and correlations (Pearson/Spearman depending on normality; Shapiro-Wilk, Levene tests). Significance threshold p < 0.05. Analyses performed using SPSS v28.
Ethical considerations: This study was conducted in accordance with the principles of the Declaration of Helsinki. Ethical approval was obtained from the Research Ethics Committee of the University of Salamanca (CEIm: 2023/04/1271-TD).
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Written informed consent was obtained from all participants.
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Funding Statement:
This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Results
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Of 96 parents recruited, 84 met inclusion criteria. Most were women (62.7%), with a mean age of 36.1 years and mean 1.65 children.
Main reasons for admission were respiratory pathology (34.6%), infectious disease (11.5%), and prematurity (10.3%). The mean child age was 3.3 ± 4.7 years; 87% were under 8 years. Mean hospital stay was 9.4 days.
Mean parental stress level was moderate (x̄=2.77). Most stressful items: mechanical ventilation (75.6%), tubes/catheters (73.6%), child in pain (72.6%), monitor/equipment alarms (71.8%). Significant correlation between stress related to communication with healthcare staff and child age (rho = 0.309; p = 0.02). “The differences are summarized in Table 1.”
Mothers showed higher stress linked to disruption of parental role (p = 0.05). Most frequent coping strategies: wishful thinking (x̄=22), problem-solving (x̄=20.3), cognitive restructuring (x̄=16). “Detailed correlations are shown in Table 2.”
Fewer children were associated with greater use of problem-solving (rho=-0.331; p = 0.045). Nursing information and support correlated with problem-solving (rho = 0.779; p = 0.003) and social support (rho = 0.631; p = 0.005).
Discussion
This study found moderate parental stress levels, consistent with previous reports (16, 17). “A machine is breathing for my child” was the most stressful item, in line with earlier findings (18–20).
Although not statistically significant in this sample, duration of hospitalization has been linked to parental stress in other studies, with higher levels reported during the first 7–15 days (21, 22).
Coping strategies most commonly used were problem-solving and cognitive restructuring, both problem-focused, consistent with prior research (23–25).
Nursing support and communication were associated with greater use of adaptive strategies, reducing anxiety and facilitating family integration during hospitalization (26–28).
Table 1
Mann-Whitney W test between hospitalization units and parental stress levels
Hospitalization units
Communication subscale
Behavior subscale
Neonatal ICU / Neonatal Intermediate
Ranks = 10/5
Ranks = 15,50/8,79
W = 7 / p = 0,023
W = 27,5 / p = 0,013
Pediatric ward/ Neonatal Intermediate
Ranks = 23,57/8,5
Ranks = 29,14/15,79
W = 31,50 / p = 0,001
W = 111,5 / p = 0,005
Pediatric ICU/ Neonatal Intermediate
Ranks = 9,25/6,57
Ranks = 10,44/10,54
W = 18 / p = 0,25
W = 47,5 / p = 0,984
Pediatric ward/ Neonatal ICU
Ranks = 21,46/18,79
Ranks = 25,23/26,45
W = 103,5 / p = 0,604
W = 204/ p = 0,81
Pediatric ward/ Pediatric ICU
Ranks = 23,31/13,81
Ranks = 26,10/13,75
W = 74,5 / p = 0,046
W = 74/ p = 0,018
Neonatal ICU / Pediatric ICU
Ranks = 9,71/6,50
Ranks = 12,14/7,06
W = 16 / p = 0,178
W = 20,5 / p = 0,051
Notes: Units were compared in pairs using the mean parental stress level in the communication and staff behavior subscales. A significance level of p < 0.05 was applied.
Table 2
Correlations between coping strategies and information and support received by parents
Coping strategies
Information received
Support received
Problem solving
(rho = 0,779; p = 0,003)
(rho = 0,634; p = 0,02)
Social support
(rho = 0,631; p = 0,005)
(r = 0,523; p = 0,018)
Notes: Correlations between coping strategies and the means of information and support received. Pearson’s r was used for parametric values and Spearman’s rho for non-parametric values, with a significance level of p < 0.05.
Limitations
The study was limited by sample size and descriptive cross-sectional design, which did not allow assessment of changes over time or causality.
Conflicts of Interest:
The authors declare no conflict of interest.
Conclusions
Parental stress during pediatric hospitalization is mainly driven by invasive procedures and the use of medical devices. Disruption of the parental role is an additional stressor, particularly for mothers.
Nursing interventions focusing on communication and emotional support promote the use of adaptive coping strategies, such as problem-solving and social support, thereby improving the family’s adaptation process.
Validated instruments to assess family coping could be integrated into routine practice to guide tailored interventions.
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Author Contribution
Jonathan Adalia Rodriguez: Conceptualization, Methodology, Investigation, Writing – original draft.Ana María Ullán de la Fuente: Supervision, Writing – review & editing.
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Data Availability
https://gredos.usal.es/handle/10366/164979
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Total Reference count: 28