Clarifying the concept of normalization.
OBJECTIVE
To refine and develop the concept of normalization. While firsthand accounts, clinical observation, and numerous studies suggest that parents of children with chronic conditions often strive to lead a normal family life, the distinguishing characteristics of normalization need to be understood before evaluating the feasibility and consequences. Conceptualizing these efforts as normalization, researchers have identified cognitive and behavioral strategies used by parents to normalize family life.


METHODS
A total of 33 articles representing 14 studies were selected through computer-assisted searches of the topic from 1966-1997, hand searches of nursing journals from 1970-1997, and analysis of reference lists. Key words in the searches included: adaptation, psychological; chronic disease; disabled persons; family; child; adolescence; parent-child relations; models, psychological; and nursing theory. Articles (N = 19) that applied and expanded the concept comprised the sample used in the analysis. A normalization construct was used.


METHODS
Attributes for normalization were inductively derived based on the most recent methods for refining and developing concepts, with special attention to how family and illness affect manifestations of normalization.


RESULTS
The attributes identified in 1986 remained relevant, but required revision and expansion to reflect a contemporary understanding of normalization. Unique manifestations of normalization were identified within certain illness and family contexts.


CONCLUSIONS
Knowledge synthesized from previous studies can enhance how normalization is used in future qualitative and quantitative research and in theory development. Findings indicate the need for researchers to build on the current state of knowledge and continue to further develop the concept. Understanding the findings can also sensitize clinicians to the complex process of normalizing when a child has a chronic condition.
Deatrick
J A
JA
University of Pennsylvania, School of Nursing, Philadelphia 19104-6096, USA. deatrick@pobox.upenn.edu
Knafl
K A
KA
Murphy-Moore
C
C
D000223:Adaptation, Psychological; D002648:Child; D002908:Chronic Disease / Q000523:psychology / Q000534:rehabilitation*; D005192:Family Health; D006801:Humans; D008019:Life Style; D015399:Nursing Research; D016487:Parenting