ORCID

https://orcid.org/0000-0001-5333-5208

Keywords

autism, nurse practitioners, parenting stress, practices, perceptions, pediatric primary care

Abstract

Parenting stress is highly prevalent among families raising children with autism and is associated with adverse outcomes for both parents and children. Despite these implications for family health, little is known about how pediatric-focused primary care nurse practitioners (NPs) identify and respond to parenting stress when caring for children with autism. This dissertation addresses that gap through three complementary manuscripts that examine the current state of the evidence, describe pediatric-focused NP practices, and explore NP perceptions related to parenting stress. The first manuscript, an integrative literature review, synthesizes literature on pediatric clinician practices for identifying and responding to the mental health needs of parents raising autistic children. Findings indicate that although pediatric clinicians recognize the increased risk of mental health concerns, structured screening, intervention, and referral practices remain inconsistent. None of the 16 reviewed studies examined pediatric-focused NP practices or perspectives, and few specifically addressed parenting stress, highlighting an important gap addressed in this dissertation. The second manuscript reports findings from a qualitative descriptive study examining pediatric-focused NP practices for identifying and addressing parenting stress in families of children with autism. Semi-structured interviews with ten pediatric-focused primary care NPs revealed three overarching themes: building trusting relationships, noticing signs of parenting stress, and responding to parenting stress. These current approaches rely on therapeutic relationships and observational cues in the absence of structured tools, reflecting care that is responsive but often unsystematic. The third manuscript presents a secondary qualitative analysis examining these NPs’ perceptions of factors contributing to parenting stress, identifying four themes related to child-centered challenges, relational disruptions, systemic barriers, and parental psychological struggles. Collectively, findings indicate that pediatric-focused NPs are well-positioned to address parenting stress, but lack standardized, scalable strategies to do so. These findings highlight opportunities to strengthen family-centered autism care by intentionally supporting parental wellbeing alongside child health.

Completion Date

2026

Semester

Spring

Committee Chair

Quelly, Susan

Degree

Doctor of Philosophy (Ph.D.)

College

College of Nursing

Department

Department of Nursing Systems

Format

PDF

Document Type

Dissertation

Identifier

DP0053193

Release Date

5-15-2028

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Available for download on Monday, May 15, 2028

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