Resilience Processes in Children with Leukemia: Developing a New Resilience Model

Abstract

Background: To clarify the details of resilience processes in children with leukemia who repeatedly undergo examination and treatment, with the aim of providing a basis for the prevention of posttraumatic stress disorder in such children. Methods: A qualitative study based on the hybrid model of concept development. To demonstrate that resilience processes have been exclusively examined in theoretical studies in the theoretical phase, and clarify the details of such processes in the fieldwork phase, semi-structured interviews regarding examination and treatment were conducted with 7 children (aged 9 to 15 years) with leukemia. In the final analytical phase, the findings obtained in the theoretical and field phases were integrated to confirm the details of resilience processes in children with leukemia based on evidence and develop a new resilience model. Results: Through interviews, 273 codes, 45 labels, 15 sub-categories, and 6 categories were extracted. In children with leukemia, resilience comprised processes by which protective factors control the senses of disgust and fear associated with stressors and vulnerability factors, and induced resilient responses, such as self-denial, proactive preparedness, coping, and emotional adjustments (in this order), leading to adaptation at the time of the study. Among these responses, self-denial and proactive preparedness were promoted by protective factors, while emotional adjustments were made through coping, consequently controlling the senses of disgust and fear and developing an accepting attitude toward unwillingness. This had helped the children achieve adaptation in the absence of post-traumatic stress disorder by the time of the study. Conclusion: This study clarified the details of resilience processes in children with leukemia, including their resilient responses promoted by protective factors, and confirmed the usefulness of a new resilience model for such children.