Sept 7, 2011 A Correlational Study of Family Stress and Adaptation Among the Surviving Parents of the New York City Firemen Who Perished in the World Trade Center Disaster A Thesis Presented by Mary Frances McGibbon DNP,RN,MSN,FNP-BC, RNFA A Thesis Presented by Mary Frances McGibbon DNP,RN,MSN,FNP-BC, RNFA Purpose of the Study The purpose of this study is to examine the relationship between family stress and stress related health problems in the parents of the deceased 9/11 Firefighters Background & Problem Among the victims of the September 11th Attack on the World Trade Center were 343 Uniformed New York City Firefighters. The parents of these Firefighters have endured tremendous stress and emotional challenges over the past 10 years. Survivors of traumatic events continue to suffer from a variety of physical and mental health problems long after the event. Among the victims of the September 11th Attack on the World Trade Center were 343 Uniformed New York City Firefighters. The parents of these Firefighters have endured tremendous stress and emotional challenges over the past 10 years. Survivors of traumatic events continue to suffer from a variety of physical and mental health problems long after the event. Aim and Significance of the Study The aim and significance of this study will help to examine the major family stressors for these parents in the adaptation and healing process after 9/11. This study provided comprehensive health information on these parents 10 years post- Attack. This study attempted to draw correlations between the variables of stress and stress related health problems. The aim and significance of this study will help to examine the major family stressors for these parents in the adaptation and healing process after 9/11. This study provided comprehensive health information on these parents 10 years post- Attack. This study attempted to draw correlations between the variables of stress and stress related health problems. Research Questions The study answered the following research questions: RQ1: What is the perceived level of stress experienced by the parents of the New York City Firefighters who died in the World Trade Center Disaster? The study answered the following research questions: RQ1: What is the perceived level of stress experienced by the parents of the New York City Firefighters who died in the World Trade Center Disaster? Research Questions RQ2: What is the incidence of stress related health problems experienced by the parents of the New York City Firefighters who died in the World Trade Center Disaster? Research Questions RQ3: What is the relationship between family stress and stress-related health problems experienced by the parents of the New York City Firefighters who died in the World Trade Center Disaster? Theoretical /Conceptual Framework The theoretical framework for this study is the Family Stress and Adaptation Model a Middle Range Theory taken from The Double ABCX Model of Family Stress (McCubbin & Patterson, 1983). Theoretical /Conceptual Framework In this model, the A Factor represents the original stressor as well as pileup stressors. Factor B is the familys crisis-meeting resources Factor C represents the familys definition of the stressor event. These factors interact to produce Factor X, which represents the Crisis or Non-crisis In this model, the A Factor represents the original stressor as well as pileup stressors. Factor B is the familys crisis-meeting resources Factor C represents the familys definition of the stressor event. These factors interact to produce Factor X, which represents the Crisis or Non-crisis Theoretical /Conceptual Framework In this study, the A Factor is the death of these parents sons and the stress surrounding the loss. The pileup stressors are many and include: the collapse of the World Trade Center on September 11 th, financial uncertainties and loss of income, loss of services, the nature of the event as a terrorist activity, the fear of future terrorist attacks, the intense and ongoing media coverage, recurring thoughts of the collapse. Theoretical /Conceptual Framework The B Factor, the crisis meeting resources factor, may include personal emotional/mental stability, cohesiveness of the family and friends, personal financial situation and personal physical health. Theoretical /Conceptual Framework The C Factor, the definition of the event, for these family members it may be similar to parents who have lost a son in a war situation. They may view their loss as a casualty of war/terrorism and this may produce a variety of personal emotions within them. Theoretical /Conceptual Framework The final factor, Factor X represents the crisis or non-crisis the family has been left to address. This is the end product of the stressful event for the family to live with. Design of the Study This is a descriptive correlational one episode study that will identify a relationship between two select variables. Perceived level of Stress and Stress Related Health Problems. The rationale for choosing this non- experimental design is that this type of design helps to explain a relationship between the variables, and the direction the variables are moving. This is a descriptive correlational one episode study that will identify a relationship between two select variables. Perceived level of Stress and Stress Related Health Problems. The rationale for choosing this non- experimental design is that this type of design helps to explain a relationship between the variables, and the direction the variables are moving. Setting The study was conducted by using a one- event mailing, controlled by the Fire Department of New York (FDNY) Counseling Service Unit. The envelopes were mailed from and received at the Laffayette Street Office of the FDNY Counseling Service Unit The study was conducted by using a one- event mailing, controlled by the Fire Department of New York (FDNY) Counseling Service Unit. The envelopes were mailed from and received at the Laffayette Street Office of the FDNY Counseling Service Unit Sampling Plan A convenience sample will be chosen to perform the proposed study. The parents are composed of the surviving mothers and fathers of the 343 New York City Firefighters that died on September 11 th, The names and addresses of these parents are known only to the FDNY Counseling Service Unit. A convenience sample will be chosen to perform the proposed study. The parents are composed of the surviving mothers and fathers of the 343 New York City Firefighters that died on September 11 th, The names and addresses of these parents are known only to the FDNY Counseling Service Unit. Sampling Plan For the purpose of determining the sample size, the G*Power 3 (Erdfelder, Faul, & Buchner, 1996) was employed With the parameters entered into the program the G*Power revealed a minimum number of study participants at 34. The degree of freedom was set at 32. (Page 53) For the purpose of determining the sample size, the G*Power 3 (Erdfelder, Faul, & Buchner, 1996) was employed With the parameters entered into the program the G*Power revealed a minimum number of study participants at 34. The degree of freedom was set at 32. (Page 53) Inclusion and Exclusion Criteria Inclusion: 1) the participants will be parents, natural or adopted, of a New York City Fireman that died in the WTCD 2) the participant will be able to provide an understanding and informed consent for participating in the study. Inclusion: 1) the participants will be parents, natural or adopted, of a New York City Fireman that died in the WTCD 2) the participant will be able to provide an understanding and informed consent for participating in the study. Inclusion and Exclusion Criteria Exclusion The exclusion criteria for the participants include being the parent of a New York City Fireman who did not die in the WTCD. Instruments One instrument chosen for the study is the Family Inventory of Life and Changes (FILE, 1991). The authors of this instrument are Hamilton McCubbin, Joan Patterson and Lance Wilson. The FILE is a 71 item instrument designed to measure the pile-up of life events experienced as an index of family stress (McCubbin, Patterson & Wilson, 1991). One instrument chosen for the study is the Family Inventory of Life and Changes (FILE, 1991). The authors of this instrument are Hamilton McCubbin, Joan Patterson and Lance Wilson. The FILE is a 71 item instrument designed to measure the pile-up of life events experienced as an index of family stress (McCubbin, Patterson & Wilson, 1991). FILE There are 9 subscales in the FILE. These subscales include: 1) Intra-family Strains, 2) Marital Strains, 3) Pregnancy and Childbearing Strains, 4) Finance and Business Strains, 5) Work-Family Transitions and Strains, 6) Illness and Family Care Strains, 7) Losses, 8) Transitions in and Out, and 9) Family Legal Violations. Instruments Second instrument used was the Center for Disease Control and Prevention Health Related Quality of Life-14 (CDC HRQOL-14) survey tool. The CDC HRQOL-14 is a standard 14-item set of core questions that are divided into three sections. This tool was chosen to measure stress related health problems. Second instrument used was the Center for Disease Control and Prevention Health Related Quality of Life-14 (CDC HRQOL-14) survey tool. The CDC HRQOL-14 is a standard 14-item set of core questions that are divided into three sections. This tool was chosen to measure stress related health problems. Instruments CDC-HQROL-14 The first section contains 4 questions that concentrate on healthy days the participant has experienced in the last 30 days. The next section addresses activity limitations, and specific health problems that led to these limitations. The possible answers to these questions included 13 choices of health problems The first section contains 4 questions that concentrate on healthy days the participant has experienced in the last 30 days. The next section addresses activity limitations, and specific health problems that led to these limitations. The possible answers to these questions included 13 choices of health problems CDC HQROL-14 The final section deals with healthy days that psychological and physical symptoms were relieved and not present. The possible answers in this section are the exact number of days, none, not sure, and refused Demographic Data Tool The researcher created this tool. The questions in this survey include: age, gender, primary language, ethnicity, place of birth, highest level of education, where in New York do they live, length of time living in New York City, number of children, religion, employment status, and marital status. Recruitment of Participants The FDNY Counseling Service Unit, alone, will recruit the participants for the study using a letter of introduction and explanation of the study. In this letter the researcher outlined the purpose and importance of the study. Data Management The returned surveys are placed in a locked Box in the FDNY Counseling Service Unit. Only the researchers have access to the returned surveys The returned surveys are placed in a locked Box in the FDNY Counseling Service Unit. Only the researchers have access to the returned surveys Protection of Human Subjects informed consent was obtained in writing at the time the instruments were employed. Information was provided in a language that was understandable, sufficient time was provided for the participant to review the consent to eliminate the possibility of coercion or unjustifiable influence. The research was conducted in an ethical manner in accordance with the Belmont Report. Results The initial size for the primary mailing, conducted by the FDNY, included 240 participants, with 120 participants being male parents and 120 being female parents. However, 13 surveys were returned to the NYC Fire Department (address unknown). There were 43 completed surveys returned for a sample size of 43. This represents a 17% return rate for the study. General Statistics The average participant was years of age. The age range lies between years, with 72.1% of participants between years of age. The data specific to participant age was collected as a range, the participants were not asked their actual age General Statistics The majority of the participants were female (n = 26, 60.5%), the male participants numbered 17 (n=17, 39.5%). Most participants were born in the United States (n = 41, 95.3%), and all listed English as their primary language (n = 43,100.0%). The majority of the participants were female (n = 26, 60.5%), the male participants numbered 17 (n=17, 39.5%). Most participants were born in the United States (n = 41, 95.3%), and all listed English as their primary language (n = 43,100.0%). Age Participant Age % % % % % % >8512.3% Participant Age % % % % % % >8512.3% Place of birth United States4195.3% Europe24.7% United States4195.3% Europe24.7% Place of residence Queens920% Brooklyn24.7% Staten Island920.9% Long Island920.9% Other1432.6% Queens920% Brooklyn24.7% Staten Island920.9% Long Island920.9% Other1432.6% Level of education Grade % Associate614.0% Bachelor818.6% Doctorate12.3% Grade % Associate614.0% Bachelor818.6% Doctorate12.3% Religion Catholic % Protestant716.3% Jewish24.7% Other12.3% Catholic % Protestant716.3% Jewish24.7% Other12.3% Employment status Employed F/T24.7% Employed P/T716.3% Retired3479.1% Employed F/T24.7% Employed P/T716.3% Retired3479.1% Marital Status Married2660.5% Divorced511.6% Widowed1023.3% Separated12.3% Change in Marital Status in the last 9 years. Yes change614.0% No change3683.7% Missing12.3% Married2660.5% Divorced511.6% Widowed1023.3% Separated12.3% Change in Marital Status in the last 9 years. Yes change614.0% No change3683.7% Missing12.3% Member of a support group? Yes1023.3% No3274.4% Yes1023.3% No3274.4% Research Question 1 What is the perceived level of stress experienced by the parents of the New York City Firefighters who died in the World Trade Center Disaster? The Family Inventory of Life Events and Changes (FILE) measured the description of family stress that was experienced over the previous 12 month period from receiving and completing the FILE. FILE A total score, a score for each of the sub- scales and a score achieved by isolating the scores as low, moderate and high levels of stress were obtained. The participants scores were separated into two groups. The two groups included participants that identified as a Working group or a Retirement group. A total score, a score for each of the sub- scales and a score achieved by isolating the scores as low, moderate and high levels of stress were obtained. The participants scores were separated into two groups. The two groups included participants that identified as a Working group or a Retirement group. Research Question 1 The Retirement group was made up of participants that self-identified as retired individuals. The Working group was compiled by those participants not identified as retired. They were those participants that self-identified as presently working part-time or full-time. Participants working part-time or full-time The scores falling between the 0 to 160 ranges were used to identify participants with Low Stress levels. Scores ranging from 161 to 689 represent Moderate Stress levels. Scores falling into the 690 or greater ranges are considered to represent a High Stress level. Retired Participants The standardized scores falling into the 0-75 ranges are considered Low Stress levels. Scores ranging from 76 to 699 represent Moderate Stress levels. Scores falling into the 700 or greater ranges are considered to represent a High Stress level. FILE Pile-up scores Cont Stress Levels Working Group Stress Levels Low1637.2% Moderate2353.5% High37.1% Missing 12.3% Research Question 2: What is the incidence of stress related health problems experienced by the parents of the New York City Firefighters who died in the World Trade Center Disaster? To answer this question the participants were asked to complete the Center for Disease Control and Prevention Health Related Quality of Life-14 (CDC HRQOL-14) survey tool Unhealthy Days- Physical and Mental To obtain this estimate, the responses to questions 2 and 3 are combined to calculate a summary index of unhealthy days. This number of unhealthy days is subtracted from 30 to reveal the number of healthy days experienced by the participant. To obtain this estimate, the responses to questions 2 and 3 are combined to calculate a summary index of unhealthy days. This number of unhealthy days is subtracted from 30 to reveal the number of healthy days experienced by the participant. General Health An overwhelmingly number of participants rated their general health as good (N=23), nine participants rated very good (N=9), eight participants rated fair (N=8), two participants rated poor (N=2) and one participant rated excellent (N=1). General Health Excellent12.3% Very Good920.9% Good2353.5% Fair818.6% Poor24.7% Excellent12.3% Very Good920.9% Good2353.5% Fair818.6% Poor24.7% Research Question 3 Research Question 3 What is the relationship between family stress and stress-related health problems for the parents of the New York City Firefighters who died in the World Trade Center Disaster? To answer this question, correlations were drawn between the data collected from the FILE and the CDC HRQOL-14. Research Question 3 What is the relationship between family stress and stress-related health problems for the parents of the New York City Firefighters who died in the World Trade Center Disaster? To answer this question, correlations were drawn between the data collected from the FILE and the CDC HRQOL-14. Pearson Product-Moment Correlations were drawn to test the strength and direction of the relationships between the variables isolated in the FILE and the CDC HRQOL- 14. The FILE were computed by two separate methods. First, as a total sum of the File scores. Second, as a total sum of the FILEs standardized weighted scores, the instruments developer assigned to each sub-scale. Significant Findings When the days the participants self- identified as not getting enough sleep from the CDC HRQOL-14 was correlated to the total sum score on the FILE the results revealed: a Pearson Correlation of.249, Sig. (2-tailed).039, and the N=30. The results here revealed a significant difference between the participants reporting less sleep and their total sum score on the FILE with the p