INTERNATIONAL PEDIATRIC NURSING Column Editor:Bonnie Holaday, DNS, RN, FAAN Parenting Stress and Mothers of Young Children with Chronic Illness: A Cross-Cultural Study Tamar Krulik, DNS, RN, Anne Turner-Henson, DNS, RN, Yuriko Kanematsu, MS, RN, Rowiada A1-Ma'aitah, RN, MPH, DPH, James Swan, PhD, and Bonnie Holaday, DNS, RN, FAAN This study examined the sources of parenting stress among mothers from Israel, Japan, Jordan, and the United States who had a young child with a chronic illness. The results indicated mothers from all four countries experienced high levels of child-focused and parent-focused stress that indicated a need for nursing intervention. Copyright 91999by W.B. Saunders Company T HE BIRTH OF a child usually brings joy and excitement. The birth also brings new chal- lenges and responsibilities for parents as they adjust to the new family members. The birth of a child with a chronic health problem may bring many new and additional problems for the parents. This adjustment process may be more difficult, and additional demands may be placed on the parents owing to needed hospitalization or medical care and basic caregiving needs. These adjustments may be not only more pronounced but also prolonged as families accommodate to new demands that arise over the years with the growing child. The determinants and implications of parenting stress for parent-chronically ill child interactions and subsequent child development are of interest to nurses in many different cultures. From a cross- cultural perspective, however, little is known about the stress experienced by families with a chroni- cally ill child. Because of the paucity of research in this area, this study was undertaken to describe From Tel Aviv University, Tel Aviv, Israel; University of Alabama, Birmingham, Alabama; Chiba University, Chiba, Japan; University of Science and Technology, Irbid, Jordan; Wichita State University, Wichita, Kansas; Clemson University, Clemson, South Carolina. Address reprint requests to Dr. Tamar Krulik, Dept. of Nursing, Tel Aviv University, Ramat Aviv, Israel. Supported by grants from Sigma Theta Tau International and The Ministry of Education of Japan. Copyright 91999 by W.B. Saunders Company 0882-5963/99/1402-0012510.00/0 parents' reports of stress related to parenting a young child with a chronic illness. The study sought to explore the following research questions. First, what are the sources of parenting stress for mothers of young chronically ill children? Second, can we identify mothers who deal successfully with the demands and stress of rearing a young chroni- cally ill child from those who do not? We inter- viewed at least 30 mothers from the United States, Japan, Israel, and Jordan who had a child under 3 years of age who was diagnosed with a chronic illness. REVIEW OF LITERATURE This review of literature examines possible deter- minants of parenting stress. The review focuses on three classes of events: characteristics of the envi- ronment, characteristics of the child, and character- istics of the parent. Chronic Childhood Illness and Parental Distress Personal and family life is profoundly affected by the diagnosis of chronic illness in a young child. Within a short time after the diagnosis, families must initiate a number of substantive changes in family structure and function, including a possible redistribution of roles and responsibilities for some family members. Depending on illness severity, family members also may be required to become intensely involved in the care of the ill child. The 130 Journal of Pediatric Nursing, Vo114,No 2 (April), 1999