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with families of disabled children. Modeling can show parents appropriate ways to behave around

their children, and parental support groups can be useful for identification with other in similar

situations. If the parents needs are acknowledged, the adjustment process can be facilitated through

the provision of appropriate interventions. Parents may respond in a number of different ways to the

diagnosis of a disability or serious illness in their child, but their responses in most parents. Theseresponses form a series of stages, which end in acceptance of the disabled child. A well trained and

caring counselor may facilitate progress through these stages. Recommendations for a familytreatment approach include: awareness of a sensitive to stages of adjustment to a disability,

application of an eclectic counseling model, the use of modeling, the efficacious use of a

multidisciplinary team treatment, and participating in parents support groups. (Kubbler Ross-1991)3

This study aims to asses the defense and coping mechanism of parents who have child with

cleft lip and palate. The emotional reactions that arises when they see their newborn child, how do

they cope with the loss of a perfect child and the difference between the socio demographic profile of

respondents and their ability to cope with their deformities.

Statement of the Problem

This study aims to assess the coping and defense and coping mechanism of parents who have

cleft lip and palate children in X-OPD Hospital.

Specifically, it seeks to answer the following questions:

1. What is the profile of the respondents in terms of:a. age

b. religious affiliation

c. no. of children with cleft lip and palate

2. What are the coping repertoire commonly used by respondents with cleft lip and palate

child?

Objectives of the Study

This research work was conducted for the purpose of knowing the defense and coping

mechanism of parents who have children with cleft lip and palate.

1. What are the profile of the respondents in terms of:- age

- religious affiliation

- no. of children with cleft lip and palate

2. What are the coping repertoires commonly used by parents with lip and palate child?

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Theoretical Framework

Ideally, every treatise should be appropriately founded upon some theories, which centrally be

related to the general and specific problems of the study.

As such, grief theory is presented here and serve as theoretical basis of this study.According to Caplan (1961), this theory linked mental health, or successful crisis resolution,

with Ego function. He listed three criteria used to assess ego function. The first criterion is thecapacity to modulate affect, such as anger, anxiety, or frustration, during stress period. People with

healthy ego function tend to mobilize internal and external resources to maintain health or

homeostasis. The second criterion is the use of adaptive problem solving. Does the person cope

effectively with stress, or does person become ill or use maladaptive problem solving to reduce the

overwhelming effects of stress?

The third criterion is the ability to maintain realty testing. People who used adaptive coping

behaviors have a repertoire of internal and external resources that maintain reality testing. In face of

a threat or loss, the person handles the crisis effectively. People with inadequate coping skills tend to

regress when faced with the crisis situation in which internal and external resources are overtaxed.

Regression is a primitive defense mechanism use to revert to an earlier stage of development or child

like thinking to deal with crisis. Impaired reality testing may range from several anxiety reactions to

psychosis (Caplan 1961). The impact of crisis is based on complex processes that determine howanxiety is modulated, how problem solving skills are mobilized, and how reality testing is

maintained.4

According to Grief theory of Lindenmann (1944) stated that the time frame of heath

grief reaction rest on the mastery of grief work, particularly freedom from intense emotional tieswith the deceased, adaptation to the loss of the love one, and establishment of new meaningful

relationships. Further, he postulated a relationship between the absence of mourning and the

formation of maladaptive responses, and he noted the following characteristic of those who fail to

mourn:

They continue to their lives as usual.

They fail to cry or express emotional pain.

They complain of feeling numb.

They lack pre occupation with love ones.

They deny feelings regarding their loss.

They experience alterations in their social interaction.

This people are likely to develop un illness and express anger and resentment toward health

professionals to facilitate the grief process by recognizing, adaptive, and maladaptive behaviors in

the mourning client.5

According to Grief theory of Lazarus (1966) emphasized the significance of secondary appraisals as

follows:

They are the bases of coping mechanism.

They enhanced or promote a positive outcome of primary appraisals.

They strengthen coping resources and options.

The outcome of the coping process depends in individual efforts to alter threatening eventsand attempt to change the persons appraisal of the stress to minimize the threat (Hansen and

Johnson 1979). Reappraisal refers to alteration in appraisal based on new information from the

4 Deborah, Antai Otong 2003 by, Delmar Thomson learning5 Deborah, Antai Otong 2003 by, Delmar Thomson learning


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individual and the environment. Reappraisal is a form of cognitive processing that differs from other

appraisals because it occurs after the initial appraisal ( Lazarus and Folkman, 1984 ).6

Conceptual Framework

From the theory, the independent variables used were, respondents profile such as; age,

number of children with cleft lip and palate, while the dependent variables were, knowledge andunderstanding on cleft lip and palate, use of proper coping repertoire of parents.

Conceptual Paradigm

From the theory discussed a conceptual framework was develop and presented in the

paradigm of the study. That illustrates the respondent profile in coping repertoire commonly used by

parents with cleft and lip palate children.

Input Process Output

Significance of the Study

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The researcher believes that the findings of the study will be beneficial to the following:

Respondents/Parents-This will access their perception and problem accompanying with cleft and

lip palate child. Through this study parents will be guided on how they will accept and use properdefense and coping mechanism.

Nursing student- This will enable them to gain more knowledge and understanding to the patientwith cleft and lip palate child, the coping and defense mechanism of parents how they will deal with

it. it will be able to deal with similar clients in the community and hospital more possibly.

Future researcher- This will serve as guide or tool for follow up studies.

Nursing profession- Through the study nursing profession can give a foster optimum care. For

client, can have their clinical expertise and the health care preference of their parents. Client and

have their existence of a body of knowledge.

Scope and Limitation of the Study

This study was conducted to find out the coping repertoire of parents with cleft lip and palate

children. It was focused on identifying how parents cope, as perceive by the respondents.

Because of limited resources of researchers and limited number of population the researcherselected at least 20 respondents who have children with cleft lip and palate.

The sample population was limited to the parents of children with cleft lip and palate

accessible in PGH OPD. The study was conducted only until May 2008.

Definition of Terms

This study uses operational definition or conceptual definition to the following terms below:

Acceptance as conceptually defined acceptance is the last stage of loss and grief in the study it is

the one of the most important stage where the respondent parents reorganized their selves and think

to incorporate the loss.7

Anger as conceptually defined anger in the study comes up when the parents/respondents become

angry because of the loss, it is an intense emotional state induced by displeasure.8Denial as conceptually defined by the parents/respondents have a displacement feelings from one

person, it is the first stage of grief .Denial is a psychological defense mechanism in which

confrontation with a personal problem or with reality is avoided by denying the exercise of the

problem reality.9

Depression as conceptually defined it is the stage when the respondents/parents had difficulty in

thinking, in concentration and had the feeling of rejection and hopelessness. It is a state of being sad,

psychoneurotic or psychotic disorder mark especially by sadness, in activity, difficulty in thinking, in

concentration, a significant increase or decrease in appetite and time spent is sleeping, feeling of

rejection.10

Grief as conceptually defined as grief by parents/respondents who have child with cleft lip occuras the result of loss of a perfect child. It is a cognitive reaction to loss when parents/respondents

experience of loss, it is a deep and poignant distress.11

Loss as operationally defined as a loss of a perfect child dreamed by parents/respondents.

METHODOLOGY

7 Ross, Elizabeth Kubbler Loss and Grief 19918 Webster Dictionary9 Ross, Elizabeth Kubbler Loss and Grief 199110 Webster Dictionary11 Ross, Elizabeth Kubbler Loss and Grief 1991


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This chapter discussed the research design and the techniques of the researcher that was

applied in the study. The researcher gathered the data through questionnaire and it was given to

parents with cleft lip and palate child.

Research Design:

The researchers used descriptive research in conducting the study. This approach involves a

collection of data through the questionnaire in order to test the hypothesis or to answer.The survey research involves the systematic application of representative sampling,

questionnaire design, information collection and statistical analysis to obtain data which describes

aspect of a market in as much detailed required by the researcher user.

The Respondents

The researchers conducted a survey regarding the coping repertoire of parents with cleft and

lip palate children. The researchers handpicked 20 parents/respondents with cleft lip and palate

children in Philippine General Hospital X-OPD.

Sampling Technique

The study used non probability accidental sampling type of sampling procedure. This

procedure is also known as accessible sampling procedure.12

Research Instrument

The researcher conducted a survey regarding the coping repertoire of parents with cleft and

lip palate children in Philippine General Hospital X-OPD. It uses questionnaire as key instrument indata collection. The questionnaire is the primary instrument for gathering the design data it is self-

structured so that it was subjected for validity testing among selected parents who have a child with

cleft lip and palate. The questionnaire is divided into four parts. Part I asked the demographic profile

of the respondents, Part II was used to assess the coping mechanism of parents. Part III assessed the

coping behavior of the respondents, and Part IV determined the common emotional reactions of the

respondents when they first see their child.

Data GatheringThe researchers conducted a survey with the use of questionnaire and interviewed to selected

parents who have child with cleft lip and palate. Questionnaires were presented in a nice way

proceeding from general to more specific responses. This order helps respondents to organize their

own thinking, so that their answers are logical and objective.

Statistical Treatment

Individual responses were recorded in tally sheets, and put it in table form for statistical

treatment.

The formula for percentage is:

P=f/x (100)Where:

P=percentageF=frequency

X=total no. of respondents

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This table shows that the coping mechanisms used by the respondents according to 20

respondents, 95 % of the respondents provides anything they can afford for the child because they

know that during the pregnancy they had failed to do something or did something that pregnant

woman shouldnt do, 85 % daydream that they have normal child, 80 % says to oneself that God has

a plan for everything and only God knows why he gives trials, 70 % brings the child with different

places to enjoy, 65% provides the child with glamorous dress and jewelries, wishes that it isnt true

that the child has cleft lip and palate or simply do not want to see the baby first, believes that there

are many ways and operation that can correct the child deformity so there is no need to worry, 55 %

blames God/self or the partner for having a child with cleft lip and palate, 50 % gives the needs of

his or her child but rather living as if single again, gives the needs of his or her child but rather living

as if single again, came a point in life wherein parents forget they have a child with cleft lip andpalate, 45 % got an illness after that knowing that he/she has a child with cleft lip and palate.

Table 4.5 Coping behavior utilize by the respondents.

Defense mechanism Question Yes % No %

Displacement 1. Providing the child with glamorous

dress and jewelries.

13 65 7 35

Sublimation 2. Bringing the child with different places

to enjoy.

14 70 6 30

Introjection 3. Got an illness after that knowing that

he/she has a child with cleft lip andpalate.

9 45 11 55

Regression 4. Wishes that it isnt true that the child

has cleft lip and palate or simply do not

want to see the baby first.

13 65 7 35

Denial 5. Daydream that you have normal child. 17 85 3 15

Intellectualization 6. Saying to oneself that God has a plan

for everything and only God knows why

he gives trials.

16 80 4 20

projection 7. Blame God/self or the partner for

having a child with cleft lip and palate.

11 55 9 45

Rationalization 8. Believe that there are many ways and

operation that can correct the childdeformity so there is no need to worry.

13 65 7 35

Suppression 9. Give the needs of his or her child but

rather living as if single again.

10 50 10 50

Repression 10. Came a point in life wherein parents

forget they have a child with cleft lip and

palate.

10 50 10 50

Reaction formation 11. Provide anything you can afford for

the child because you know that during

your pregnancy you had failed to do

something or did something that pregnantwoman shouldnt do.

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This table shows that the coping behavior utilize by the respondents according to 20

respondents, 77 % of the respondents experience acceptance, 65 % experience bargaining, 53 %

experience depression, 50 % experience denial, 48 % experience anger.

SUMMARY, CONCLUSION AND RECOMMENDATION

The researchers decided to study one particular topic about coping repertoire of parents withcleft lip and palate child in X-Hospital OPD in PGH.

Summary of Findings

In terms of respondents profile the researcher found out that 70 % of the respondents belongs

to the age bracket of 18-28 years old. 80 % of the respondent are Roman Catholic, and 95 % of the

respondent has one no. of children who have cleft lip and palate in their family.

With reference to coping repertoire of parents, the respondents gave ratings in terms of

coping mechanism used by the respondents 95 % of the respondents provides anything they can

afford for the child because they know that during the pregnancy they had failed to do something or

did something that pregnant woman shouldnt do, 85 % daydream that they have normal child, 80 %says to oneself that God has a plan for everything and only God knows why he gives trials, 70 %

brings the child with different places to enjoy, 65% provides the child with glamorous dress and

jewelries, wishes that it isnt true that the child has cleft lip and palate or simply do not want to see

the baby first, believes that there are many ways and operation that can correct the child deformity sothere is no need to worry.

With regards to coping repertoire of parents, the respondents gave ratings in terms of coping

behavior utilize by the respondents out of 20 respondents, 77 % of the respondents experience

acceptance, 65 % experience bargaining, 53 % experience depression, 50 % experience denial, 48 %

experience anger.

Using handpick or expert sampling, the survey questionnaires were distributed to the

respondents, who answered each of the items as impartially as possible. The questionnaires werecollected, tailed, and collated. The researchers have decided to distribute 20 survey questionnaires

and collected exactly 20 questionnaires which give a 100 % retrieval rate.

In as much as the questionnaire appeared using 5-point Likert scale, the corresponding

weighted means were computed for.

Based on the result arrived, the data were then presented concretely through the use of table,

interpreted and analyzed in the context of how the research study has been undertaken.

Conclusion

Based on findings arrived, the researchers therefore come up with the following conclusion.

That the commonly used coping repertoire of parents with cleft lip and palate are the

following: providing anything they can afford for the child because they know that during the

pregnancy they had failed to do something or did something that pregnant woman shouldnt do,

daydream that they have normal child, says to oneself that God has a plan for everything and only

God knows why he gives trials, brings the child with different places to enjoy, provides the child

with glamorous dress and jewelries, wishes that it isnt true that the child has cleft lip and palate or

simply do not want to see the baby first, believes that there are many ways and operation that can

correct the child deformity so there is no need to worry.


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77 % of the respondents experience acceptance, 65 % experience bargaining, 53 %

experience depression, 50 % experience denial, 48 % experience anger.

Recommendation

Based on the study findings, the researcher recommends the following:

1. To nursing students of seminar and training for parents to increase their knowledge andunderstanding on cleft lip and palate its nature, etiologic cause and proper management.

2. The use of proper coping mechanism, respondents provides anything they can afford for the

child because they know that during the pregnancy they had failed to do something or did

something that pregnant woman shouldnt do. And common coping mechanism used by the

respondents is acceptance. They have undergone five stages of coping repertoire.

3. To government and health organization, facilitate increase dissemination of information,

education, communication about cleft lip and palate especially for every woman of

reproductive age.

4. To all health personnel and students of health profession, the use of proper coping repertoire

should be taught to clients with cleft lip and palate children.

5. To future researcher, the researcher recommends future and ongoing research on this topic

and study findings are available foe future use.

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