Self-esteem before and after treatment in Chinese children with nocturnal enuresis and urinary incontinence : a qualitative approach

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Self-esteem before and after treatment in Chinese children with nocturnal enuresis and urinary incontinence : a qualitative approach


Author: Shit, Kam-yee Frances
Title: Self-esteem before and after treatment in Chinese children with nocturnal enuresis and urinary incontinence : a qualitative approach
Degree: M.Sc.
Year: 2002
Subject: Hong Kong Polytechnic University -- Dissertations
Pediatric urology -- China -- Hong Kong
Enuresis -- China -- Hong Kong
Children -- Health and hygiene -- China -- Hong Kong
Self-esteem in children
Department: Multi-disciplinary Studies
Dept. of Nursing and Health Sciences
Pages: vi, 120, [125] leaves : ill. ; 30 cm
Language: English
InnoPac Record:
Abstract: Nocturnal enuresis (NE) / bedwetting is an involuntary discharge of urine by day or night, or both, in the absence of congenital or acquired defects of the central nervous system or urinary tract in a child aged 5 or over ( Forsythe and Butler, 1989). The prevalence of enuresis decreases with age. From published epidemiological studies it was apparent that although the figures vary somewhat among different countries, the overall prevalence of NE remains relatively constant irrespective of geographical locations. It has been estimated that 20-25% of children by age 4 and 10% of children by age 7 are frequent bed-wetters ( de .Jonge, 1973; Foxman B et al., 1986; Watanabe & Kawauchi, 1994). In general, the prevalence decreases with growing age and only about 1-2% of enuretics will remain to do so in adulthood. However, the condition may have profound psychological and social impact on the child. In many cases, the condition seriously interfere with the child's normal activities and have adversely affected their normal psychological development. As such the problem often becomes a cause of significant anxiety to the family. In a local study, questionnaires to assess the epidemiology of NE in Hong Kong were completed by 3521 school children, aged 4- 12 years, the majority of whom (99.8%) were ethnic Chinese. Analysis of these questionnaires revealed the prevalence of NE in this population of children was 3.5 %. Furthermore, NE was found to be associated with arousal difficulties, nightmares, positive family history or enuresis, poor school performance and poor relationships with classmates ( Yeung, 1996 ). Some children may have urinary incontinence for many years but have never seek proper medical advice due to either lack of public awareness of the potential sequelae or simply parental negligence. Enuresis is a shame to children who are at the stage of peer interaction. They may feel guilt because of his nocturnal enuresis which threatens to give a significant impairment of self-esteem at an age when an intact self-image is extremely important for an optimal development of the child's personality. It is perhaps the most frustrating disorders to the children and also the family members ( Richman et.aI.,1982 ). Self concept of enuretic children was reported to be low because of their negative experience ( Moffatt, et al., 1987 ). Nevertheless, these studies were almost done by quantitative approach and in western cultures only. Local research into this area is still lacking as far as the present researcher knows. The aim of the study is to investigate the improvements in self-concept among Chinese children after treatment of nocturnal enuresis and urinary incontinence. In order to carry out in-depth exploration about the self-concept in children with nocturnal enuresis and urinary incontinence before and after treatment, qualitative research was used in this study. Total 12 children ( age range from 8 to 14 ) with nocturnal enuresis at least 4 nights per weeks and / or urinary incontinence problems before treatment were recruited to the study. A self-structured interview guide was developed according to Butler (1987). Six aspects were included in the interview guide: (1) impact on self; (2) the child's beliefs and thoughts about bedwetting; (3) children's efforts; (4) impact on lifestyle; (5) attitudes of significant others and (6) secrecy. The interview guide was revised with the comments from a panel of 3 experts to verify its content validity. The data of the study was gathered by the method of semi-structured interview on a one-to-one basis during initial success period i.e. 14 consecutive dry nights have been achieved within 16 weeks' treatment period ( Butler, 1991 ). The whole interview process was taped and transcribed for documentation and analysis. Afterwards, the statements of the transcript were categorized and content analysis was conducted. The data was read repeatedly so as to code and group common themes and patterns of findings into the following 4 study areas, they are: (1) physical self before and after treatment; (2) psychological self before and after treatment; (3) social self before and after treatment, and (4) spiritual self before and after treatment. Moreover, different categories were further divided into sub-categories before and after treatment. All data were classified according to the definition of each sub-category. Besides, the attitudes of others before and after treatment; the belief and thought about NE; the effort to overcome bedwetting by informants and secrecy were then classified and synthesized. Two independent research assistants were invited to verify the data classification and coding of the transcriptions so as to ensure the reliability and validity of data analysis. The inter-rater agreement among all 12 cases was 98.2%. From the study, all of the informants of different age and sex found physical discomfort with NE. In order to decrease the chance of bedwetting, they all sleep late and restricted their fluid intake. As s result, they all became tired at daytime and lacked vitality. Although NE hasn't caused any physical defects, the informants have no mood and initiative to perform daily activities. Besides, all informants expressed emotional distress. They hated themselves, felt unhappy, sad, depressed, unbearable, stressful, uneasy and inferior. All informants were afraid of disclosure of their problem. They have to conceal their illness by telling lie to others. Because of lack of confidence with NE, they found themselves useless, stupid and abnormal. NE also affected the informants' academic performance. Lastly, NE has prevented the informants to participate in social events such as attending camp; staying at friends overnight etc. They were being ridiculed by other people as 'enuresis prawn'. Some of them were being isolated and repelled by others. They all felt disappointed and hopeless. Some of them were worried about their future prospect. After the treatment, all informants were free from physical discomfort and became energetic. They have new perception, new sense of confidence and positive personality change. They felt comfortable to join camping and different activities. Apart from improvement in academic performance, they became harmonious with classmates and their family relationships were strengthened. To conclude, nocturnal enuresis has severely affected the 'physical'; 'psychological'; 'social' and 'spiritual' self of the children. All informants (100%) thought that there have absolutely no disadvantages after being treated. Significant improvement of self-esteem can be achieved after appropriate treatment.

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