The invisible family dynamics of children with a sibling who has a tracheostomy: A qualitative study using drawings.

AIM: This study examines how children with a sibling who has a tracheostomy perceive family dynamics and express their emotional experiences through drawings. METHOD: A qualitative descriptive design using methodological triangulation was employed. Data were collected using an "Information About the Child and The Drawing Form", the Marmara Sibling Jealousy Scale-Short Form, and family drawings accompanied by narratives. Thematic analysis was conducted. RESULTS: Fourteen children (mean age = 11.5 years) participated, and the mean scale score was 31 ± 8.3. Five themes were identified: meaning of colors, expression of the sick sibling, expression of family members, self-expression, and communication. Jealousy-related expressions were identified in 8 of 14 drawings, including some children with low scale scores, suggesting differences between quantitative and qualitative findings. Drawings and narratives reflected perceived exclusion, unmet needs for parental attention, communication difficulties, emotional distance, and a desire for greater family support and interaction. Fathers were frequently depicted as important family figures. CONCLUSION: Self-report measures alone may not fully capture the emotional experiences of healthy siblings. Combining drawings with narrative provided a broader understanding of children's perceptions of family relationships, communication, and sibling experiences in families of children with tracheostomy. IMPLICATIONS FOR PRACTICE: Healthy siblings' emotional needs may be overlooked in families of children with tracheostomy. Drawings can serve as supportive communication tools to explore feelings of exclusion, need for attention, communication difficulties, and sibling jealousy. Pediatric nurses should include healthy siblings in family-centered care and provide opportunities for emotional expression and psychosocial support.