[Clara: from containment to the transformation of separation anxiety]. / De la contenance à la transformation de l'anxiété de séparation.

In the psychological care of separation disorders in child psychiatry, hospitalisation intervenes as a last resort, when care in an out-of-hospital structure but also in environments close to the child is no longer sufficient to contain his anxiety. A clinical example illustrates how nurses are led to position themselves and to think about care. It shows to what extent our containing functions can be an adapted response to the needs of the child in hospital.

Separation Anxiety Symptom Profiles and Parental Accommodation Across Pediatric Anxiety Disorders.

Parental accommodation refers to ways in which caregivers modify their behavior to decrease child distress in the short-term. Accommodation is prevalent among anxious youth and related to decreased treatment and functional outcomes. Although separation anxiety disorder (SAD) is associated with increased accommodation, SAD is not a predictor of treatment response, suggesting that a diagnosis of SAD alone may not be enough to clarify the relationship between accommodation and separation anxiety symptoms within a clinical context. Participants were youth with a primary anxiety disorder (N = 186; aged 7-17) enrolled in an outpatient anxiety clinic. Latent class analysis was used to extract profiles from parent-reported SAD symptoms using the Anxiety Disorders Interview Schedule for DSM-IV/5. Profiles were compared on pre-treatment accommodation. Low, moderate, and interfering SAD classes emerged. Interfering SAD was associated with high accommodation. Results help to clarify the association between SAD and accommodation and has implications for personalized intervention.

Women's and children's exposure to mass disaster and terrorist attacks.

Published documents were used to identify women's and children's exposure experiences following two mass disasters and two terrorist attacks that occurred in the United States. Research reports, clinical needs assessments, and a case study were analyzed to determine the type and severity of women's and children's exposure. Research reports were given priority if pre-event/post-event data were reported, if the study reported was longitudinal in design, and if samples were representative of the populations from which they were drawn. Clinical needs assessments were included because these documents provide evidence of need for services by disaster victims. The case study selected was unique in the literature reviewed. The results showed that both the women's and children's severity of exposure was related to posttraumatic stress disorder (PTSD), depression, separation anxiety, and generalized anxiety. In studies that made gender comparisons, data collected from women and girls showed more negative mental health outcomes than data collected from men and boys. Implications for clinical practice and traumatic event policy are addressed. Longitudinal, prospective studies of potentially traumatic events (PTE) are needed to better understand the longer term plight of children, especially girls.

School phobia.

School phobia is a serious disorder affecting up to 5% of elementary and middle school children. Long-term consequences include academic failure, diminished peer relationships, parental conflict, and development of additional psychiatric disorders. Hiding behind such common physical symptoms as headaches, stomachaches, and fatigue, school phobia evades diagnosis with ease. Unraveling the problem of school phobia is challenging for the school nurse and is complicated by an overall lack of knowledge regarding the serious potential outcomes. The purpose of this article is to define school phobia, differentiate it from truancy, and highlight some interventions useful in the treatment of this increasingly common and potentially serious disorder.

Separation and induction behaviors in children: are parents good predictors?

In busy surgical outpatient settings, it is important to quickly yet thoroughly assess a child's preoperative needs to determine whether a premedication or perhaps a parent's presence is warranted to facilitate a smooth anesthetic induction. This observational study of 252 children evaluated factors related to separation and induction behaviors of children. Six percent of children had difficulty separating from their parents, and 22% were uncooperative with induction of general anesthesia via face mask. Logistic regression showed that parent prediction was the best indicator of separation behavior, whereas younger age and separation behavior were both predictive of induction behavior. Findings suggest that parents are good predictors of their child's preoperative behaviors and may, therefore, provide valuable input when perioperative nurses and anesthesiologists are making decisions about potential preoperative interventions.

Mother-loss: recreating relationship and meaning.

The purpose of this investigation was to describe adult women's experiences in losing their mother. Using an interpretive phenomenological frame of inquiry, 5 women were purposively selected to share their loss experience. Memories of the mother-daughter relationship were explored, and the meanings the daughters attached to their loss described, in written narratives, 2 in-depth interviews, and 1 group session. Seven themes emerged: Recalling, Holding On, Saying Goodbye, Longings of the Heart, Shifting Patterns of Relationship, Recreating the Dialogue, and Honouring Our Mothers/Ourselves. The loss of one's mother represents the loss of one's first intimate relationship, a relationship that has a unique meaning for daughters because their personal development is profoundly and uniquely shaped by it. This potentially pervasive and transforming life experience is best understood from an in-depth exploration and understanding of the nature of the mother-daughter relationship. Nurses who come to understand the dynamic interaction of grief and development through women's experience of mother-loss can more successfully offer their presence, their understanding of the complexity of the mother-daughter relationship, and their skills in bereavement care to facilitate healing and to promote health and personal growth.

Effects of divorce on the grandparent-grandchild relationship.

Although the detrimental effects of divorce on the immediate family have been studied extensively, few researchers have focused on how extended family members such as grandparents respond. This ex post facto study was a preliminary investigation of how 47 grandparents felt about their relationship with grandchildren whose parents had divorced. Chi-square analysis of study data revealed that these grandparents perceived a significant decline in the quality of their relationship with grandchildren. The quality of these grandparent-grandchild relationships was influenced by custodial arrangements but not geographic distance. Implications for pediatric nursing are discussed.

An analysis of the concept of homesickness.

This report analyzes the concept of homesickness, using the pattern for concept analysis presented by Chinn and Jacobs. Concept analysis is a process used to better understand a concept that has been first identified through clinical practice. This concept analysis clarifies and defines the concept of homesickness, and distinguishes homesickness from other concepts, including separation anxiety, school phobia, translocation syndrome, and relocation effects. By carefully defining what homesickness is and what it is not, criteria have emerged so that other instances of similar characteristics can be appropriately labeled. In addition, arising from the literature review and criteria are research questions and nursing interventions.

Using intuition to define homesickness at summer camp.

Camp nurses are in a unique position to assist in the study of homesickness because they are living the situation. This descriptive study was undertaken because homesickness has not been defined operationally, and nurses do not have a documented set of "defining characteristics" that might be used to make a diagnosis. Twelve camp nurses from eight states completed a questionnaire on homesickness. The nurses surveyed had a consistent set of defining characteristics regarding homesickness. Intuition is reported to play a significant part in the camp nurses's diagnosis of homesickness. Symptoms of homesickness and recommended interventions are included that will ultimately help to promote a more positive camp experience for the camper.

The fear of moving beyond one's parents.

The problem of separation-individuation is one of the core psychiatric nursing phenomena facing nurses in their clinical work. It comprises five separate but interacting component fears: existential-separation fear, refueling-separation fear, castration fear, aggression fear, and fear of outdoing the sibling. This article explains these fears, suggests five principles to guide nursing interventions, and includes clinical examples.

Nursing interventions for children with a parent in the intensive care unit.

Hospitalization of a family member in an intensive care unit is a stressful event for the entire family. Nurses should be concerned not only with the hospitalized patient but with the family, as a unit. Attention is often focused on the patient and to a lesser extent on the spouse. The needs of the children may be neglected. To reduce the long-term negative effects of the crisis event on the life of the child, appropriate interventions should be made at the time of the crisis. It is important for nurses to recall emotional and cognitive phases of growth and development when counseling parents. This information is used to help the nonhospitalized parent identify the needs of the child. The nurse can act as a resource person for this parent in planning strategies that will prevent or alleviate problems for the child.