Child abuse quilts: revealing and healing the pain of child abuse.

According to the recent government report, Child Maltreatment 1997: Reports From the States to the National Child Abuse and Neglect Data System, almost 3 million reports of child abuse and neglect were filed in the United States in 1997. The number of substantiated or indicated maltreatment cases decreased from more than 1 million child victims in 1996 to about 984,000 in 1997. More than half of the reports involved neglect, about one-fourth involved physical abuse, and 12% included sexual abuse, and an estimated 1,197 fatalities resulted from child maltreatment in 1997. In response to the issue of child maltreatment, the Child Abuse Quilts Project was conceived. At least 28 quilts were made for this project, visually addressing the subject of child abuse, child abuse prevention, and violence against children. Mary Beth Goodman, curator of the quilt exhibit says, "The quilters put these quilts before you, not to make you turn away from their quilts in distaste, but to make you think about child abuse and its impact on the child, the survivor, the family, the community. Change comes slowly, heart by heart. We hope that each person who sees these quilts with [be]... re-awakened to the tragedy of child abuse and resolved to prevent it" Ten of these quilts are displayed here; all 28 are displayed on the Internet at members.tripod.com/mbgoodman/ caqpics/caqindex.html.

Guns in the home: nurses' roles.

Firearms in the home are an increasing concern for parents and health professionals alike. A number of professional groups have begun to speak out about firearm safety and children. Both the American Academy of Pediatrics (AAP) and the Society of Pediatric Nurses (SPN) have position statements on the issue. The AAP recommends that pediatricians incorporate questions about guns into patient histories and also urge parents who possess guns, especially handguns, to remove them from the home. The SPN (1998) says that "[p]ediatric nurses, employed in a variety of settings, have the opportunity to educate parents and children about gun violence and prevention of firearm injuries." Nurses and other professionals can easily access information and strategies to address firearm safety with families. See Table 1 for a list of resources that are available online.

New guidance materials promote family-centered change in health care institutions.

Nurses can play an important role as effective change agents in helping health care agencies and institutions recognize the need to move to more family-centered models, understand the benefits of a family-centered approach, and develop strategies for implementing family-centered care. The Institute for Family-Centered Care has identified a number of areas in which many institutions wish to make changes and has been developing guidance materials that explore possibilities, highlight hospitals that have incorporated changes, and provide practical strategies and useful materials to facilitate change. Topics covered in these guidance resources include the following: Developing Family-Centered Vision, Mission, and Philosophy of Care Statements; Developing and Sustaining a Patient and Family Advisory Council; Collaborative Design Planning; Creating Children's Advisory Councils; Creating and Enhancing Patient and Family Resource Centers; Creating Patient and Family Faculty Programs; Working with Seniors and their Families to Enhance Geriatric Care; and Changing Visiting Practices--Families as Partners.

Supporting families' savvy use of the Internet for health research.

An increasing number of health care consumers are using the Internet for health-related research through Web sites, newsgroups, chat rooms, and listserves. This use of the Internet can be empowering for consumers. It encourages both collaboration and a family-centered approach to care and could contribute to improved outcomes and cost savings. At the same time, care and caution are needed regarding interpretation of health-related information obtained on the Internet. Nurses can help consumers become Internet savvy and learn ways to evaluate the likelihood that information they find on the Internet is from a reputable site. First, health care consumers using the Web should be encouraged to be skeptical and to approach Internet health research with a clear list of questions that can be used to evaluate Internet sites. Second, several on-line "site-checkers" can be applied to achieve a similar evaluation. A third approach is to look for the emblem of the Health on the Net Foundation's voluntary Code of Conduct (HONCode) for medical and health Web sites. Finally, open, collaborative relationships among health care consumers, families, and health care providers will encourage a discussion of the relevance and applicability of an individual's Internet research findings to the medical or nursing care plan.

Exploring language about families.

When we work with families in health care settings, it is important to be aware of the way we communicate. Often overlooked is how the language we use to describe and understand families affects how we work with them. The language we use in thinking about a family can shape our perceptions of the family and may affect how we approach working with them. The language we use in describing a family to another health care provider can affect how that person will perceive and approach the family. The language families hear us use can affect families' perceptions of themselves, their perceptions of us, and, consequently, how they relate to us. In Project Copernicus' Family Centered Communication Skills: Facilitator's Guide (Edelman, Greenland, & Mills, 1993), an activity entitled "Watch Our Language" explores commonly used negative terminology about families and guidelines for better language. This exercise has been used with groups of nurses and other health care providers at several conferences and has generated thoughtful brainstorming about negative language related to families, its impact on families, and its impact on the nurses working with them. Those participating in the workshops explored better terminology about families and brainstormed a list of selected family strengths which are shared here.

Working with families having parents who are gay or lesbian.

Families in which one or both parents are gay or lesbian are becoming increasingly common as social acceptance of this lifestyle increases and legal barriers slowly erode. Despite past concerns and occasional reports to the contrary, the bulk of research has shown no evidence that children of parents who are gay or lesbian suffer any greater physical or mental pathology than children of heterosexual parents. However, research does suggest that there may be ways in which health care providers can be more respectful and supportive of homosexual parents and their families. Health care providers should examine their own attitudes toward these families and consider how to provide a welcoming environment and presence. Using gender neutral language about spouses, displaying posters and publications related to varied family types, and acknowledging both parents as participants in care are some examples. Health care providers who are aware of the special concerns these parents and their children may have, including stigmatization, the issue of disclosure, teasing, feeling different, and the stress resulting from challenges faced due to anti-homosexual social attitudes, can demonstrate sensitivity to the involved children and provide families with anticipatory guidance, support, suggested reading material, and referrals to appropriate organizations.

Examining assumptions underlying nursing practice with children and families.

Family-centered care is increasingly considered "best practice." Yet, recent research points to a discrepancy between philosophy and practice (Bruce & Ritchie, 1997). To make family-centered care a full reality will require the examination of the assumptions underlying the practice of individual health care providers, agencies, and institutions. Typical models underling the provision of health care today include the medical model, the child-focused model, the family-focused model, and the family-centered model. Understanding the assumptions of each of these models is important. Identifying them in practice will require a process of reflection. Once assumptions underlying the current practice of an individual or institution are made conscious, assumptions that interfere with family-centered practices can be identified.

Review and commentary: two studies regarding giving "bad news".

Informing parents of the diagnosis of a chronic illness or disability in their child can be a difficult task. At the same time it is critical that the informing is done well. Two studies examining parental reactions to the "informing interview" (Krahn, Hallum, & Kime, 1993; Garwick, Patterson, Bennett, & Blum, 1995) support the conventional considerations that both parents, in a two-parent family, should be together when told of their child's diagnosis; parents should be informed early on; simple, direct language without medical jargon should be used; and the informing professional should be both empathetic and supportive of parental emotional expression. These studies raise additional considerations including the importance of meeting with parents in person, informing parents in a private setting, pointing out the child's strengths as well as limitations, and individualizing both the communication style and information shared. Cross cultural considerations, while not addressed in either of these studies, require attention to language interpretation, meaning assigned to the diagnosis, and potentially differing treatment preferences. In all cases, nurses should evaluate the effectiveness of the informing interview in relation to the family's affective and information needs. Each of these considerations should be part of the process of an informing interview.

Books for siblings of children having illness or disability.

A child's disability or acute or chronic illness has an effect on all family members, including siblings of the affected child. Children's books, fiction and non-fiction, can be used to support siblings by providing information, addressing feelings, offering insight, assuring the child that others have had similar problems, and facilitating coping. Nurses can introduce children and their families to useful books by having books or book covers on display that the child can choose from; providing families with lists of books; and/or assessing the child's needs, interests and reading level, and recommending a specific title.

Kinship care: an emerging issue.

The issue of kinship care is explored through an interview with a clinical social worker who runs a support group for grandparents caring for their grandchildren. Starting in the 1980s, the kinship care phenomena spread across economic and racial lines. Nationwide, an estimated 3.2 million children live in grandparent-headed households. Issues faced by grandparents in this role include: the emotional impact of raising children, when past that typical stage of life; how to deal with the feelings of anger and resentment toward their own children; how to say no and be comfortable with it; how to reclaim parts of their own lives; taking care of themselves; special childraising challenges, including HIV, abuse, and neglect; and financial concerns. A kinship care support group is described, and lists of resources are provided.

Parent-professional collaboration when hospital visits are infrequent.

Parents and family members may be unable to visit a hospitalized child frequently for any number of logistical or emotional reasons. Strategies to promote parent-professional collaboration when parents visit infrequently include: reaching out to both establish a relationship with family members and encourage their relationship with the hospitalized child; providing logistical support to facilitate visiting; and providing training and support for staff in family-centered care, including accepting diversity in family styles and choices.

Resources for family-centered care: an annotated bibliography.

Understanding and implementing family-centered care becomes easier as nurses are exposed to both the concept and examples of the concept in practice. An annotated bibliography of articles, books, films, training materials, and newsletters will be useful to individual nurses, nurse-educators, and nurse administrators.

Thinking critically about family-centered home care nursing.

Family-centered care is receiving increasing attention. Nowhere is this approach to care more fitting than in the home care setting. Yet, in this setting, critical questions arise that test the boundaries of family-centered practice. Nurses must address these questions, and must engage in dialogue both with other nurses and with family members as part of thinking critically about family-centered home care nursing.

"Chunky stew:" appreciating cultural diversity while providing health care for children.

The United States does not have as clear a generalized culture as more homogenous nations. For this reason, cultural competence is an important goal of nursing practice. Culture and ethnicity affect access to care and use of health care services. The cultural biases of the health care system must be acknowledged so that nurses can dialogue effectively with families who may have different perceptions. Cultural differences in the perceived meaning of illness affect both help-seeking behavior and approaches to caring and curing. Cross-cultural communication includes attention to language differences and jargon, as well as sensitivity to the family's values and preferences. Intervention plans for the child should be developed in conjunction with the family and should reflect their choices and address their concerns.

Family-centered care: shifting orientation.

To practice in a family-centered manner requires nurses to shift from a professionally-centered view of health care to a collaborative model that recognizes families as central in a child's life and their values and priorities as central in the plan of care. Nursing strategies to promote the family's role as primary caregiver for their child include recognizing and accepting diverse styles of family coping, helping families recognize their strengths and methods of coping, reassuring parents regarding their essential role, and facilitating family involvement and caregiving. The use of communication models such as LEARN and the Nursing Mutual Participation Model of Care can facilitate collaborative parent-professional relationships. A brief review of research on families of children critically or chronically ill implies that care for children and their families can improve when family-centered practices are implemented in health care settings.

Family-centered care: the time has come.

The concept of family-centered care was first introduced in 1987. Since that time, legislation has mandated its implementation, training materials have been developed, and it has come to be considered "best practice." It is time now for pediatric nurses to learn strategies for implementation of family-centered care.

Home apnea monitoring and risk factors for poor family functioning.

As part of a comprehensive study on the impact of home apnea monitoring on family functioning, we undertook an in-depth analysis of risk factors for poor family functioning in 93 families of monitored infants. A multistep correlation and regression analysis was used to examine the ability of 16 demographic, infant, family, and monitor-related variables to predict poor functioning in each of 12 different aspects of family life. Of note was the fact that monitor-related variables failed to be important predictors of poor family functioning. Rather, previous family problems and low satisfaction with social support were the most broad and powerful predictors of poor functioning. To enhance the capabilities of families to manage the added responsibility of home monitoring, clinicians might wisely assess both of these aspects of family life and then target extra support services to families identified to be at risk in these areas.

Family impact of home apnea monitoring: an overview of research and its clinical implications.

PURPOSE: To determine the clinical applicability of research findings related to home apnea monitoring. METHOD: A critical review of descriptive and explanatory research on family impact of home apnea monitoring. FINDINGS: Strengths and limitations of the research are identified. CONCLUSIONS: Clinical practice implications of the research findings are discussed.