br Sharing negative emotions and unfavorable information
Sharing negative emotions and unfavorable information with family members is a difficult decision. This depends on how parents evaluate the ability of their family members to deal with the unpleasant news. When parents thought that their family members did not have this abil-ity, they USP7/USP47 inhibitor tended to protect them by concealing the unpleasant informa-tion and suffering the psychological burden alone. As Rarick (2007) reported, the concept of self-sacrifice is common in traditional Chinese families. It is common for individuals to sacrifice themselves for the wel-fare of the family. The resilience exhibited by Chinese individuals during stressful events is largely attributed to their culture, valuing self-sacrifice for the collective good.
For the purpose of protecting other from worrying, a number of par-ents in this study were reluctant to share information with their friends. This may be determined by the Chinese culture, in which individuals tend to ‘share happiness but not worries (Bao Xi Bu Bao You)’. Another reason may be that parents were afraid of being labeled as pathetic or appearing to be weak. They did not wish to ‘lose face’ in front of others. This is closely related to the Chinese ‘Face-culture (Mian Zi)’. ‘Face (Mian Zi)’ is regarded as a ‘self-image’ experienced by an individual be-cause of others' evaluations of a specific situation (Hwang, 2006). Indi-viduals may have experienced feelings of gaining or losing face because of positive or negative social evaluation (Hwang, 2006; Hwang, 2010). Feelings of ‘losing face’ experienced by the parents may result in some assistance being ineffective and/or unsatisfying during the hospitaliza-tion of their children. This implied that not all healthcare professionals actually deliver effective help, and some may even increase the psycho-logical burden of parents. This reminds clinical nurses that the influ-ences of Chinese culture on family coping should be taken into consideration during the development and implementation of family-centered interventions.
There were several limitations in the present study that should be acknowledged. Firstly, this study included only parents as the respon-dents. The perceptions of parents may not accurately reflect the per-spectives of all family members, limiting the richness of the findings. However, their opinions cannot be undervalued and are crucial for an initial assessment of families in clinical settings. Secondly, most of the
participants in the present study were mothers. This is indicative of the fact that, usually, mothers serve as the primary caregivers and re-main close to their children in hospital. Although very few fathers par-ticipated in the study as proxy informants, their perspectives are certainly worthy of further exploration. Thirdly, the wide range of pa-tient ages and family experiences (i.e., 1–15 hospital readmissions) may lead to variation in family coping strategies. Therefore, the present data may not be sufficient to note such differences. Lastly, this study was limited to families with hospitalized children for the treatment of cancer in mainland China. Therefore, the results may not be generalizable or transferable to other populations worldwide.
Implications for clinical practice
The findings of the present study may assist healthcare professionals in understanding how Chinese families cope with the challenges caused by the repeated and prolonged hospitalizations of their children. These coping strategies include increasing family strength, maintaining opti-mistic thoughts, seeking external support, and not disclosing unfavor-able information. With the implementation of appropriate interventions, families can be supported in dealing with these challeng-ing situations. Interventions that foster “family inner strength”, by en-couraging families to seek support and comfort among themselves can be instrumentation in facilitating family adaptation (Ghaffari, Fatehizade, Ahmadi, Ghasemi, & Baghban, 2013). Parents may find the mindfulness strategy to be helpful in maintaining an optimistic view of their children's situation (Chan, Zhang, Bögels, et al., 2018).