Revista Científica Interdisciplinaria Investigación y Saberes
2024, Vol. 14, No. 2 e-ISSN: 1390-8146
Published by: Universidad Técnica Luis Vargas Torres
How to cite this article (APA):
Costales, et. al (2024) Level of uncertainty of caregivers towards the
patient hospitalized pediatric, Revista Científica Interdisciplinaria Investigación y Saberes, 14(2) 81-98
Level of uncertainty of caregivers towards the patient hospitalized
pediatric
Nivel de incertidumbre de los cuidadores frente al paciente pediátrico hospitalizado
Luis Ricardo Costales Vallejo
Médico Pediatra, Universidad Nacional de Chimborazo, Hospital General IESS
luisr.costales@unach.edu.ec
https://orcid.org/0000-0001-6552-0291
Génesis Karolina Huilca Villalba
Médico General, Universidad Nacional de Chimborazo, Hospital
genitho20@gmail.com
https://orcid.org/0000-0003-2466-3100
Josselin Mercedes Molina Flores
Médico General, Universidad Nacional de Chimborazo, Hospital General IESS
jossemolinaf105@gmail.com
https://orcid.org/0000-0002-5645-0129
Joselyn Viviana Huilca Villalba
Máster, Universidad Nacional de Chimborazo, Hospital San Juan joselyn_huilca_2014@hotmail.com
https://orcid.org/0000-0001-6895-6090
The hospitalisation of paediatric patients entails various psychological
implications for their caregivers. The main objective of this study was
to determine the degree of uncertainty experienced by caregivers of
hospitalised children using the Parents test at the Instituto
Ecuatoriano de Seguridad Social in Riobamba during the years 2021-
2022. The research adopted a descriptive, prospective and cross-
sectional approach, collecting data through the Parents test in
relation to different variables. This test was applied to caregivers of
paediatric patients hospitalised in the paediatric service of the IESS
Abstract
Received 2024-01-30
Revised 2024-03-24
Published 2024-05-01
Corresponding Author
Luis Ricardo Costales Vallejo
luisr.costales@unach.edu.ec
Pages: 81-98
https://creativecommons.org/lice
nses/by-nc-sa/4.0/
Distributed under
Copyright: © The Author(s)
Level of uncertainty of caregivers towards the patient hospitalized pediatric
Revista Científica Interdisciplinaria Investigación y Saberes , / 2024/ , Vol. 14, No. 2
83
General Hospital. The results revealed that of the 110 surveys
conducted, 0.9% of the respondents showed a low score (less than 55
points), 14.5% obtained a moderate score (between 56 and 85
points), and 84.5% obtained a high score (more than 85 points). It is
concluded that there is a significant level of uncertainty among
caregivers of hospitalised children, with 84.5% experiencing a high
degree of uncertainty, followed by 14.5% with moderate uncertainty,
and only 0.9% with a low level of uncertainty.
Key words:
uncertainty, parents' test, hospitalised, illness, paediatric,
patient
Resumen
La hospitalización de pacientes pediatricos conlleva diversas
implicaciones psicológicas sus cuidadores. El objetivo principal de
este estudio fue determinar el grado de incertidumbre
experimentado por los cuidadores de niños hospitalizados, utilizando
el test de Parents en el Instituto Ecuatoriano de Seguridad Social en
Riobamba durante los años 2021-2022. La investigación adoptó un
enfoque descriptivo, prospectivo y transversal, recolectando datos a
través del test de Parents en relación con distintas variables. Se aplicó
este test a cuidadores de pacientes pediátricos hospitalizados en el
servicio de pediatría del Hospital General IESS. Los resultados
revelaron que de las 110 encuestas realizadas, el 0.9% de los
encuestados mostraron una puntuación baja (menos de 55 puntos), el
14.5% obtuvo una puntuación moderada (entre 56 y 85 puntos), y el
84.5% obtuvo una puntuación alta (más de 85 puntos). Se concluye
que existe un nivel significativo de incertidumbre entre los cuidadores
de niños hospitalizados, con un 84.5% experimentando un alto grado
de incertidumbre, seguido de un 14.5% con una incertidumbre
moderada, y solo un 0.9% con un bajo nivel de incertidumbre.
Palabras clave:
incertidumbre, test de parents, hospitalizados,
enfermedad, paciente
Pediátrico.
Level of uncertainty of caregivers towards the patient hospitalized pediatric
Revista Científica Interdisciplinaria Investigación y Saberes , / 2024/ , Vol. 14, No. 2
84
Introduction
Worldwide, illness and hospitalisation are situations known to provoke
a high level of stress that impacts both the sick child and their close
environment, triggering various emotional responses that make it
difficult for parents to adapt and understand the illness, which
represents a significant challenge for the child's well-being.
According to Contreras in 2017, hospitalisation has various
implications in the psychological sphere of the parents of the sick
child. One of the most difficult moments that parents face is receiving
the diagnosis, especially if it is a chronic illness, which can generate
an initial reaction of denial, characterised by disbelief in the diagnosis
or prognosis. To help parents overcome this stage, it is essential to
provide them with guidance on the most effective coping strategies
to deal with their child's illness (Contreras & Sibri, 2017).
On the other hand, Suarez points out that one of the main emotional
challenges faced by parents in this situation is uncertainty, which is
defined as the inability to understand the meaning of events related
to the illness. It is further described as a cognitive state that arises
when individuals are unable to organise or understand events related
to the disease and its treatment, which occurs especially in
ambiguous, complex situations or when the available information is
inconsistent. This uncertainty is experienced as a negative feeling that
leads to emotional distress and negatively affects the psychosocial
adjustment of both patients and their families. It is suggested that
uncertainty in general, and that experienced by parents of sick and
hospitalised children in particular, is characterised by four main
dimensions: ambiguity in relation to the illness, unpredictability of the
course and prognosis of the illness, lack of information about the
illness, its treatment and the healthcare system, as well as complexity
or lack of clarity in the information available (Suarez-Acuña et al.,
2018).
Level of uncertainty of caregivers towards the patient hospitalized pediatric
Revista Científica Interdisciplinaria Investigación y Saberes , / 2024/ , Vol. 14, No. 2
85
The main objective of this research is to determine the level of
uncertainty of parents or caregivers when faced with hospitalised
paediatric patients, applying the parents' test in the Instituto
Ecuatoriano Seguridad Social. Riobamba 2021-2022.
It is known worldwide that health is considered to be a state of
complete physical, mental and social well-being and not merely the
absence of disease or infirmity" (World Health Organization (WHO),
n. d.). Illness has an important psychological impact on parents and
siblings of paediatric patients, and can interfere with their socio-
emotional adjustment and health. The exposure of parents to the
illness of a son or daughter has in some cases led to frequent crises
of anxiety or depressive disorders.
Contreras conducted a study in Spain in 2017, which mentions that
the phases of coping of parents with a diagnosis are characterised by
denial and disbelief in the diagnosis or prognosis, in which the family
can delay the course of the disease, as a result of which depression,
anxiety, feelings of guilt, late treatment, increased hospital stay
emerge, all of which can affect the family and the hospital
environment (Contreras & Sibri, 2017).
In Ecuador, it is estimated that around 25% of children under the age
of 18 have been hospitalised at least once in their lifetime. Between
10% to 37% of hospitalised children would present significant
psychological disorders secondary to their hospitalisation. According
to a study conducted by Villacís and Sandoval in SOLCA Cuenca-
Ecuador in 2015, they found that families, upon learning of the
diagnosis of cancer, begin a process of mourning, attributing the
origin to hereditary factors and even religious punishments due to
their belief system. During the process of observation and interviews
with participants, the following emotions were identified in their body
and verbal language: feelings of guilt, worry, anguish, sadness,
helplessness, anxiety, nervousness, fear when a new evaluation has to
be carried out, fear of possible death and despair (Contreras & Sibri,
2017).
Level of uncertainty of caregivers towards the patient hospitalized pediatric
Revista Científica Interdisciplinaria Investigación y Saberes , / 2024/ , Vol. 14, No. 2
86
Echeverria refers that depending on the diagnosis of acute or chronic
illness in the child, it constitutes a stressful experience and represents
an enormous burden of anguish and suffering for the family. The lack
of studies and information on this topic led us to carry out this
research, as it is essential in the field of health because it affects the
family in its physical, social and emotional structure (Echeverria, 2017).
The lack of studies and information on this topic in Riobamba leads
us to carry out this research, as it is essential in the field of health
because it affects the family in its physical, social and emotional
structure. We asked ourselves the following question: What is the
level of uncertainty of parents or caregivers when faced with the illness
of hospitalised paediatric patients?
Worldwide, it is evident that the coping stages of caregivers with a
diagnosis are characterised by denial and disbelief of the prognosis,
in which the family may delay the course of the disease, resulting in
depression, anxiety, feelings of guilt, delayed treatment and
increased hospital stay.
Nationally, it is estimated that around 25% of children have been
hospitalised at least once in their lives, of which between 10% - 37%
have psychological disorders secondary to their hospitalisation, in
addition to family problems due to the inability to accept a diagnosis
and subsequent treatment. The family situation is a fundamental
concern in the health system in our country, which is why there is a
need to create strategies to determine the level of uncertainty faced
by parents or caregivers when their children are hospitalised.
The scale originally called Parents Perception Uncertainty in Illness
Scale (PPUS) designed by Mishel (1983), includes 31 items distributed
in 4 factors called ambiguity (13 items), lack of clarity (9 items), lack of
information (5 items), and unpredictability (4 items). The range of
scores oscillates between 31 and 155 given by a Likert-type response
scale that varies between 1 and 5, indicating that the higher the score,
the higher the level of uncertainty (Suarez-Acuña et al., 2018).
Level of uncertainty of caregivers towards the patient hospitalized pediatric
Revista Científica Interdisciplinaria Investigación y Saberes , / 2024/ , Vol. 14, No. 2
87
In the city of Riobamba, there has been no evidence of studies on the
level of uncertainty that parents or caregivers have regarding the
hospitalisation of their children; therefore, the purpose of this
research is to identify the level of uncertainty of parents or caregivers
regarding their children's illness, applying the parents' test in
paediatric patients at the Hospital Instituto Ecuatoriano Seguridad
Social. Riobamba 2021-2022.
Ramírez defines uncertainty as "a cognitive state in which people are
not able to determine what the facts that occur due to the disease
mean", which develops due to the lack of stimuli and information,
which does not allow the individual to process the most relevant facts
related to the disease in this case of a paediatric patient, which leads
them to construct negative reactions (Ramírez-Perdomo et al., 2018).
The presence of a family member who may require special hospital
care generates a stressful situation for the stability of the family
nucleus, which affects its members, especially the main caregiver, who
bears a greater emotional overload, which has a negative impact on
their physical and psychological health (Alcántara-Canabal et al.,
2019).
Uncertainty about the disease occurs when family caregivers are
unable to determine the meaning of disease-related events due to
lack of information about the disease, treatment and comorbidities.
Several studies report high levels of uncertainty among caregivers of
patients with cancer and other chronic and degenerative diseases.
Learning of the diagnosis of an incurable disease brings with it a
restructuring of the caregiver's daily life, as he/she has to deal with
basic aspects of patient care such as the management of signs and
symptoms, which may change according to the evolution of the
disease.
Several studies have shown the effect of uncertainty about the disease
and how it relates to social support since the caregiver assumes the
Level of uncertainty of caregivers towards the patient hospitalized pediatric
Revista Científica Interdisciplinaria Investigación y Saberes , / 2024/ , Vol. 14, No. 2
88
care of their loved one, in addition to the relationship between the
caregiver and the patient have constant changes since due to their
own illness the patient changes their behaviours which can become
harmful to the caregiver.
Given the complexity of this situation, tools are needed to help health
professionals measure the level of uncertainty faced by caregivers
when faced with the illness of their family members so that care
actions can be taken to reduce the number of caregivers who
experience high levels of uncertainty.
Therefore, an instrument proposed by Mishel, in its original version,
which helps us to measure uncertainty taking into account 4
dimensions comprising: ambiguity, complexity, inconsistency and
unpredictability, is applied. However, this scale does not focus on
family caregivers of patients in palliative care, as in these cases
caregivers face a different reality (Arias et al., 2019).
Suarez refers that the intention of the Parent's Perception Uncertainty
in Illness Scale (PPUS) is to measure uncertainty in parents whose
children are ill and/or hospitalised in acute or chronic care settings. Its
original English version was designed by Mishel (1983) and has good
usability and reliability. It has been used with parents of critically ill
babies who need hospital treatment, premature babies, babies with
leukaemia, cystic fibrosis and with various chronic diseases (Suarez-
Acuña et al., 2018).
Since there is no Spanish version, it comes with good indicators of
face validity, content and reliability with the original English version.
In clinical practice and care management, this version of the scale will
enhance the measurement of parental uncertainty in sick children, as
a basis for the creation of multidisciplinary intervention strategies with
direct or indirect modification of uncertainty and contribution to the
institutional strengthening of policies to build quality health care
(Suarez-Acuña et al., 2018).
Level of uncertainty of caregivers towards the patient hospitalized pediatric
Revista Científica Interdisciplinaria Investigación y Saberes , / 2024/ , Vol. 14, No. 2
89
The score range is from 31 to 155 and is determined by a Likert-type
response scale, which varies from 1 to 5, indicating that the higher the
score, the higher the level of uncertainty. This scale gives good
indicators of overall validity and internal consistency, ranging
between 0.81 and 0.93. Similarly, for the internal consistency of each
component of the original scale, Cronbach's alpha of 0.87 for the
ambiguity factor, 0.81 for the low clarity factor, 0.73 for the lack of
information factor and 0.72 for the unpredictability factor. In addition,
an internal consistency level of 0.90 was reported for the PPUS and a
significant association was found in the so-called original version of
the Disease Penetrance Scale (p < 0.05), one of the aspects that limit
the assessment of parental uncertainty and therefore its use in
practice and research in Spanish society, the aim of this study was to
analyse the psychometric properties of the parental uncertainty
perception scale/illness child form, translated into Spanish (Suarez-
Acuña et al. , 2018).
Methodology
The type of research carried out was descriptive, prospective and
cross-sectional with data obtained previously using the Parents test in
relation to the different variables, through the application of surveys
to caregivers of hospitalised patients from May 2021 to April 2022.
Cross-sectional because it was carried out over a specific period of
time. The purpose of the parents' test is to measure the uncertainty
of caregivers in relation to children hospitalised for acute and chronic
illnesses. Its original version was designed by Mishel (1983), in
English. It has been used in parents of hospitalised critically ill
children, premature children, children with leukaemia, cystic fibrosis
(Suarez-Acuña et al., 2018).
The data used for this study were collected through surveys of
caregivers of paediatric patients using the Parents test, in addition to
other data on relationship to the patient, age, sex, level of education,
economic situation of the respondent, number and days of
hospitalisation of the paediatric patient; with which a database was
Level of uncertainty of caregivers towards the patient hospitalized pediatric
Revista Científica Interdisciplinaria Investigación y Saberes , / 2024/ , Vol. 14, No. 2
90
created in the Excel programme, which was then entered into the
SPSS version 21 system for subsequent analysis.
The entire population of paediatric patients requiring hospitalisation
who met the inclusion criteria was taken into account. A total of 350
patients were obtained, and subsequently the sample was calculated,
taking into account mothers, fathers and carers, since when the
surveys were carried out many of the paediatric patients were in the
care of other relatives such as grandparents, aunts and uncles or
siblings, obtaining a sample of 184 patients, but after accepting and
signing the informed consent form, 110 people agreed to participate
in the survey.
Results
Table 1.
Summary of socio-demographic variables of respondents
Variable
n
%
Sex
Male
54
49.1
Female
56
50.9
Relationship
Mother
50
45.5
Father
54
49.1
Grandparents
2
1.8
Uncles
1
0.9
Siblings
3
2.7
Age of
respondent
<18 years old
4
3.6
Level of uncertainty of caregivers towards the patient hospitalized pediatric
Revista Científica Interdisciplinaria Investigación y Saberes , / 2024/ , Vol. 14, No. 2
91
18-24 years
old
9
8.2
25-44 years
old
60
54.5
45-60 years
35
31.8
>60 years
2
1.8
Education
Illiterate
1
0.9
Primary
3
2.7
Secondary
15
13.6
Higher
91
82.7
Economic
position
High
2
1.8
Medium high
21
19.1
Variable
Lower middle
77
70
Low
10
9.1
The main demographics of the respondents are detailed in table 1,
the results of the Parents test indicate that 84.5% (n=93) of caregivers
experience a high level of uncertainty about the hospitalisation of a
child, 14.5% (n=16) have a moderate level of uncertainty and only
0.9% (n=1) have a low level of uncertainty.
Level of uncertainty of caregivers towards the patient hospitalized pediatric
Revista Científica Interdisciplinaria Investigación y Saberes , / 2024/ , Vol. 14, No. 2
92
Table 2
. Results of the parents' test: level of uncertainty
n
%
Low (<55 points)
1
0.9
Moderate (56 to
85 points)
16
14.5
High (>85 points )
93
84.5
Total
110
100
A bivariate analysis was performed in table 2, to establish
relationships to the most common variables that exist during
hospitalisation. When analysing the relationship between the level of
uncertainty and the length of hospitalisation, it was determined that
the highest percentage of caregivers with a high level of uncertainty
had an average hospitalisation of 2 to 5 days (n=42) followed by those
who maintained hospitalisations of 5 to 10 days (n=25).
A high level of uncertainty was found in patients with 2 to 4
hospitalisations (n=40), as well as in caregivers of hospitalised
preschoolers (n=36).
In relation to the sex of the respondent, the only one who presented
a low level of uncertainty was the male, a moderate level was found
equally in both sexes, 8 males and 8 females, while a high level
predominated in the female sex (n=48) versus the male sex (n=45).
When establishing the relationship between the moderate level of
uncertainty and kinship, it is similar when referring to the mother (n=8)
Level of uncertainty of caregivers towards the patient hospitalized pediatric
Revista Científica Interdisciplinaria Investigación y Saberes , / 2024/ , Vol. 14, No. 2
93
and father (n=8), while a high level of uncertainty is predominant in
the father (n=45) compared to the mother (n=42).
Another variable of analysis was to identify the relationship between
socio-economic status and the level of uncertainty, where it was found
that a high level of uncertainty predominates in the lower middle
socio-economic status (n=67).
It can be distinguished that caregivers with a higher level of education
have a higher level of uncertainty (n=79) compared to the low and
medium levels. Although the most significant relationships have been
exposed after the respective statistical analysis, there are no
statistically significant relationships.
Table 3.
Summary of the bivariate analysis between the level of
uncertainty that parents have about the hospitalisation of their
children by means of surveys.
VARIABLE
STATISTICAL
TEST
VARIABLE
STATISTICAL
TEST
VARIABLE
STATISTICAL
TEST
Days of
hospitalisation
RATIONALE
11,286
p=0,080
Number of
hospitalisations
CHI person
square
There is a
relationship
between the
length of
paediatric
patient
hospitalisation
and the
uncertainty
generated in
parents.
6,005
p=0,43
Age of patient
CHI person
square
There is a
relationship
between the
5,47
p=0,706
Level of uncertainty of caregivers towards the patient hospitalized pediatric
Revista Científica Interdisciplinaria Investigación y Saberes , / 2024/ , Vol. 14, No. 2
94
number of
hospitalisations
of paediatric
patients and
the uncertainty
generated in
parents.
Sex of
respondent
CHI person
square
1,061
p=0,588
Relationship to
paediatric
patient
CHI person
square
The age of the
patient
influences the
degree of
parental
uncertainty.
2,166
p=0,976
Economic
status
CHI person
square
A certain
gender may be
related to a
certain level of
uncertainty.
5,465
p=0,486
Level of
education
CHI person
square
Family
relationship is
related to an
increase in the
level of
uncertainty
that arises
5,544
p=0,476
Level of uncertainty of caregivers towards the patient hospitalized pediatric
Revista Científica Interdisciplinaria Investigación y Saberes , / 2024/ , Vol. 14, No. 2
95
during a
patient's
hospitalisation.
In a study carried out by Gudelia Nájera Gutiérrez in 2010, which
analysed the level of uncertainty in parents of children with cancer,
the sample consisted of 30 parents of children with cancer, the
biological personal factors were taken into account, the age that
stood out was between 30 and 40 years with an average of 38 years,
63% corresponded to the female sex in terms of the socio-cultural
personal factors, the marital status of the participating parents was
84% with a partner, The socio-economic level with more relevance
was the middle level with 70%, taking into account the formal
education 58% had primary education and finally if they had a family
member with cancer 34% said no, these data described is consistent
with those presented in this research since 54.5% of respondents were
in an age between 25 to 44 years, 50. In terms of level of education,
82.7% were of higher education. Regarding the economic situation,
70% have a medium-low economic level.
According to Nájera and collaborators in the relationship with the
study variables of both hypotheses Pearson correlations were used, in
the age variable there is no relationship for the existence or not of
uncertainty with a p= .023, with respect to sex the female refers high
uncertainty p= .010, with respect to the years of formal education a
negative correlation of p= -. 025, which means that the more
schooling the less uncertainty, with respect to socioeconomic level, it
was observed that there is no difference in the socioeconomic level
for uncertainty to exist with a p= .523, with respect to the variable
social support, it was observed that the more social support the less
uncertainty with a p= .008 (Najera et al., 2011).
In the relationship between the variables presented in this research
carried out in the paediatric service of the General Hospital IESS in
Riobamba, Ecuador, it is evident that the variable patient age is not
related to a high level of uncertainty with a p = 0.706, with respect to
the sex of the respondent it is not related to a high level of uncertainty
with a p = 0.588, 588, since regardless of sex the level of uncertainty
is high, with regard to the relationship to the paediatric patient,
Level of uncertainty of caregivers towards the patient hospitalized pediatric
Revista Científica Interdisciplinaria Investigación y Saberes , / 2024/ , Vol. 14, No. 2
96
grandparents, uncles, aunts and brothers have a high level of
uncertainty with a p=0.976, with regard to the economic level we have
that a high economic situation produces a higher degree of
uncertainty with a p=0.486. With regard to the level of education, it
was found that illiterate people and primary education have a high
level of uncertainty with a p=0.476, with regard to the length of
hospitalisation, those who remain hospitalised for one day generate
a high level of uncertainty with a p=0.080, and taking into account the
number of hospitalisations with only one hospitalisation that the
paediatric patient presents, the parent or carer has a high level of
uncertainty with a p=0.43, which despite being striking data are not
statistically significant compared to those mentioned by other
authors.
According to Matziou, parent-participants in the study reported less
pain than their children. The results of suitable studies show that
parents, with a percentage of 63%, believe that the pain experienced
by their children during their hospital stay is what affects them most
emotionally. However, other studies report that parents ignore or
overestimate their children's pain. The main cause of this is limited
knowledge about the ways in which they can help their child and avoid
the overprotective resource that brings with it some intrafamily
problems that make communication between parents and children
difficult and produce conflicts even with health professionals (Matziou
et al., 2016).
According to Matziou's study, parents underestimate children's pain
when they present acute pain. The parents' quality of life is affected,
especially when the pain reported by the child is caused by life-
threatening diseases such as cancer. However, the hope for
improvement taking into account the treatment of their children, the
care of health professionals and seeing their children's improvement
every day makes the level of uncertainty decrease considerably
(Matziou et al., 2016).
Conclusions
84.5% of the 110 respondents showed a high level of uncertainty
(mean: 102.4 points) while only 0.9% showed a low level of
uncertainty. Different socio-demographic variables were analysed to
find if there is a relationship with the caregivers' level of uncertainty
Level of uncertainty of caregivers towards the patient hospitalized pediatric
Revista Científica Interdisciplinaria Investigación y Saberes , / 2024/ , Vol. 14, No. 2
97
about the child's hospitalisation. Caregivers who experienced a high
level of uncertainty were related to the following variables:
An average hospitalisation of 2-5 days for the child. Predominantly
caregivers of patients with 2-4 hospitalisations. Within age, caregivers
of hospitalised preschoolers had a high level of uncertainty as well as
predominance of the father over the mother.
A high level of uncertainty predominates in the lower middle socio-
economic level. Caregivers with a higher level of education have a
high level of uncertainty compared to the lower and middle level.
These relationships are not statistically significant p>0.05, so it can be
concluded that the level of uncertainty is independent of the
mentioned relationships.
Reference
Alcántara-Canabal, L., Martínez-Pérez, L., Gutiérrez-Alonso, S.,
Fernández-Baizán, C., & Méndez, M. (2019). Calidad de vida de
los padres de escolares nacidos prematuros con peso menor de
1.500 gramos. Anales de Pediatría, 91(3), 151-157.
https://doi.org/10.1016/j.anpedi.2018.10.013
Arias, M., Carreño, S., & López, J. (2019, septiembre 17). Validación
de la Escala de Incertidumbre ante la Enfermedad en
cuidadores de pacientes en cuidados paliativos.
https://www.medicinapaliativa.es/Validacion-de-la-Escala-de-
Incertidumbre-ante-la-Enfermedad-en-cuidadores-de-
pacientes-en-cuidados-paliativos455
Contreras, J. A., & Sibri, J. V. (2017). Estrategias de afrontamiento
parental ante hijos internados en pediatría del hospital vicente
corral moscoso, cuenca 2016 [Universidad de cuenca].
http://dspace.ucuenca.edu.ec/bitstream/123456789/27433/1/
PROYECTO%20DE%20INVESTIGACI%C3%93N.pdf
Echeverría, N. (2017). Nivel de estrés en padres de niños
hospitalizados en la unidad de pediatría [Universidad del BÍO-
BÍO].
http://repobib.ubiobio.cl/jspui/bitstream/123456789/2642/1/E
cheverr%c3%ada%20Iba%c3%b1ez%2c%20Nicol%c3%a1s%20
Esteban.pdf
Level of uncertainty of caregivers towards the patient hospitalized pediatric
Revista Científica Interdisciplinaria Investigación y Saberes , / 2024/ , Vol. 14, No. 2
98
Matziou, V., Vlachioti, E., & Megapanou, E. (2016, agosto 31).
Perceptions of children and their parents about the pain
experienced during their hospitalization and its impact on
parents’ quality of life | Japanese Journal of Clinical Oncology |
Oxford Academic. 46(9), 862-870.
Najera, G., Ledezma, M., & Patiño, J. (2011). Incertidumbre en padres
de niños con cáncer. 9(1), 20-22.
Ramírez-Perdomo, C. A., Rodríguez-Velez, M. E., & Perdomo-Romero,
A. Y. (2018). Incertidumbre frente al diagnóstico de cáncer.
Texto & Contexto - Enfermagem, 27, e5040017.
https://doi.org/10.1590/0104-07072018005040017
Suarez-Acuña, C. E., Carvajal-Carrascal, G., & Serrano-Gómez, M. E.
(2018). Escala de incertidumbre en la enfermedad–forma
padres/hijos: Validación de la adaptación al español. Enfermería
Intensiva, 29(4), 149-157.
https://doi.org/10.1016/j.enfi.2017.12.002
World Health Organization (WHO). (s. f.). Recuperado 8 de marzo de
2024, de https://www.who.int/es
