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Anxiety and pain are major concerns not only for children who undergo surgery, but also for their parents and health care professionals. A convenience sample of 74 adolescents who underwent major orthopedic surgery for repair of idiopathic scoliosis and their parents was used to investigate the relationships among children's and parents' preoperative and postoperative anxiety and children's postoperative pain. Age-appropriate versions of Spielberger's State-Anxiety scales measured children's and parents' anxiety, and a visual analog scale assessed children's pain intensities. Children's state anxiety increased from preoperative to postoperative levels, and their postoperative anxiety levels positively related to their pain intensities on days 2 and 4 following the operation. Parents' anxiety decreased from preoperative to postoperative levels, and their postoperative anxiety positively related to their children's postoperative anxiety. Studying both parents and children helped to explain the variance in children's self-reported anxiety. Parents' emotional states are important indicators of children's emotional states and, subsequently, their pain experience. The results of this study suggest that allowing children to assist in the assessment of their postoperative pain may help health care professionals better understand the subjective component of pain. The findings also emphasize the importance of including parents in future studies in which the aim is to understand children's behavioral responses and recovery outcomes.

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Assessing the manner in which children cope with surgery, by using a process-oriented perspective, requires attention to each child's viewpoint of the surgical event. Assessing coping as a process places great emphasis on the way a child appraises the event, which in turn determines the coping modes adopted. Illustrations are given from research with pediatric surgical patients that show how a coping interview based on a process-approach can be conducted clinically with children to gather data about their views of surgery and the ways they cope with it. Knowledge of how to assess coping that changes with appraisals provides nurses with the insight to clarify children's understanding of the event and to apply interventions to bolster children's coping and reduce the stress of both children and parents. Interventions for children and parents are suggested.

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BACKGROUND: How children cope with minor or major surgery is influenced by their attention focus appraisals. Although factors that predict children's coping with surgery have been identified (i.e., age, locus of control, parent-doctor information, worry), it still is not known whether the type of surgery per se affects the coping strategies used and influences previously established predictors of coping. Furthermore, questions remain concerning the relation among type of surgery, attention focus, and coping. OBJECTIVES: The purpose of this study was to determine whether the type of surgery (minor vs. major) would have a differential effect on coping, and whether coping can be predicted better if it is known what type of attention focus (appraisal) the child has. METHODS: Data from three studies of children (n = 189) undergoing minor or major surgery were combined to examine the effects that type of surgery and attention have on coping. Measures included the Preoperative Mode of Coping Interview, Locus of Control Scale for Children, Parent-Doctor Information Interview, and a measure for worry. RESULTS: The results showed that the factors previously found to predict coping were upheld in the combined sample and accounted for 50% of the variance in coping. Type of surgery was significantly associated with coping: Children undergoing minor surgery were somewhat more vigilant than children undergoing major surgery. The inclusion of attention in the analysis significantly improved the variance explained in coping (66%), and children who had a concrete-objective focus of attention were found to be more vigilant. Significant interactions were found between attention focus and type of surgery, locus of control, and age. Type of surgery also had a significant interaction with worry. Children who focused on the concrete-objective aspects of the situation were more vigilant if they were having minor rather than major surgery. Also, children who had an internal locus of control and a concrete-objective focus of attention were more vigilant in coping. Regardless of age, children who had a concrete-objective focus of attention were more vigilant. Furthermore, at low levels of worry, children undergoing major surgery were more vigilant than children undergoing minor surgery. CONCLUSIONS: Coping with surgery is influenced by multiple factors. Children's ability to focus attention on the concrete-objective aspects of surgery may help to reduce feelings of threat that could impede their use of vigilant coping.

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BACKGROUND: The burden produced by caring for relatives with dementia is an increasing problem in the United States and Taiwan, necessitating a better understanding of the interrelationships of the factors that influence burden. OBJECTIVES: To test a theoretical model specifying how the demands of care, filial obligation, caregiving self-efficacy, coping strategies, and caregiving involvement affect caregiver burden. METHOD: A descriptive cross-sectional design with a convenience sample (n = 150) from outpatient clinics of three hospitals in Taiwan was used. The Caregiver Burden Inventory and the Cost of Care Index assessed caregiver burden. The antecedents of burden were assessed by the Physical Self-Maintenance Scale, Instrumental Activities of Daily Living, the Mini-Mental State Examination, the Revised Memory and Behavior Problem Checklist, the Montgomery obligation subscale, Cicirelli's obligation scale, the Caregiving Self-efficacy Scale, the Caregiving Involvement Scale, and the Ways of Coping Questionnaire. RESULTS: The original model did not fit the data well but minor respecifications produced a good model as evidenced by a chi2/df ratio of 2.1, a goodness-of-fit index of .89, and a comparative fit index of .93. Demands of care on the caregiver and filial obligation had direct positive effects on caregiving involvement. Caregiving involvement and emotion-focused coping had direct positive effects on caregiving burden. Filial obligation, caregiving self-efficacy, and problem-focused coping had direct negative effects on caregiving burden. Six of the seven original hypothesized structural relationships were confirmed in the final model. CONCLUSIONS: The Burden Model tested in this study corroborates findings from other burden studies and extends our knowledge of caregiver burden. Filial obligation, self-efficacy, demands of care, involvement in care, and coping were shown to predict burden in this sample of Taiwanese caregivers. Future study is needed to evaluate interventions designed for family caregivers of persons with dementia. Especially needed is research in the area of counseling and mental health services to assist caregivers in dealing with manifestations of burden.

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This study examines what parents identified as their primary stressor before their child's invasive procedure, what coping strategies were used to manage the stress, what level of distress their children experienced during each phase of the procedure, and whether parents' coping modes were associated with their children's distress. Twenty children with cancer from 3 to 11 years of age and the parent present during the procedure participated in the study. Parents' primary stressors were identified as uncertainty about parent role and anticipating the child's distress during the procedure. Although parents used both emotion-focused and problem-focused strategies for coping with their primary stressors, they primarily relied on emotion-focused strategies. Children experienced the most behavioral distress during the procedural phase, and girls exhibited more distress than boys. The parents' coping modes were not associated with their children's distress, but children of parents whose primary stressor was uncertainty about parent role had higher distress than children of parents whose primary stressor was anticipating the child's distress. The findings related to parents' stressors, their coping strategies, and their children's distress were consistent with previous research. Directions for future research and suggestions for dealing with invasive procedures for childhood cancer are described.

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The purpose of this study was to compare the behavioral responses of term newborns of insulin-dependent diabetic mothers (NDMs) with newborns of nondiabetic, healthy mothers. The research design involved matched controls with repeated measures. Participants included 40 NDMs matched with 40 newborns of nondiabetic, healthy mothers. The main outcome measures were the seven dimensions of the Neonatal Behavioral Assessment Scale (NBAS) and the modal response score. The results showed that NDMs performed significantly poorer than their matched controls on motor processes and reflex functioning. For all newborns, motor processes, autonomic stability, reflex functioning, and the modal performance score were better on Day 2 than Day 1. It was concluded that although NDMs' behavioral responses improved by Day 2, their overall pattern of responses could be described as listless or sluggish. Due to their poorer motor and reflex responses, NDMs may require increased efforts to facilitate sensitive maternal responding during their first days of life.

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The purpose of this study was to determine how children's preoperative focus of attention on the stresses of surgery related to their preoperative coping and return to usual activities during recovery. Children's attention was classified according to three different foci: concrete-objective, emotion, and vague. Children (N = 97) between the ages of 8 and 17 years who were undergoing major orthopaedic surgery participated in the study. Data were collected the day before surgery, and at 3, 6, and 9 months postoperatively. Children who focused on the concrete-objective aspects of surgery had the most positive activity outcomes, followed by the emotion-focused attention group. Children who were classified as having vague focused attentions had the least favorable activity outcomes. When there were significant coping by attention interaction effects, vigilant copers who had a concrete-objective focus of attention had the most favorable activity outcomes at each time of measurement. Children who were able to focus their attention on concrete aspects of the experience tended to use vigilant coping and were able to return to their usual activities sooner.

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After the publication of Ernest Boyer's book on Scholarship Reconsidered in 1990, campuses across the nation began debating how scholarship is recognized and rewarded. The current system mainly recognizes and rewards faculty for their scholarly achievements in research. However, Boyer's book has called attention to the need for a paradigm for evaluating scholarship that better articulates with the world of an academician. According to Boyer (1990), it is time to recognize the full range of faculty talent that includes research as well as three other equally important areas of scholarship: teaching, integration, and application (practice). The emergence of nursing science as an independent academic discipline valued by society and health consumers parallels the professional and social demands to assume full responsibility for nursing decisions, actions, and outcomes. The scholarly mission of VUSN is based on the values shared by the faculty that excellence and innovation in preserving and advancing the science, art, philosophy, and history of nursing is accomplished through the components of theory, research, and practice. The faculty believe the interrelatedness of the three components forms the basis for the development of scholarliness in both its students and faculty.

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A model was tested to assess children's preoperative coping with major orthopedic surgery and how coping is related to two different postoperative outcomes, anxiety and return to normal activities. Ninety children, ages 8 to 17, participated. Data were collected the day before surgery, the second postoperative day, and at 3-, 6-, and 9-month recovery periods. A respecified model was not significantly different from the data (p = .90), indicating a good fit. Children who were older, more anxious, and more internal in locus of control exhibited more vigilant coping. Avoidant coping was associated with less anxiety 2 days postoperatively, and vigilant coping was associated with return to normal activities over the course of recovery.

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Crisis theory, stress and coping theory, and research on parental stress and coping during pediatric critical care experiences are integrated into a conceptual framework for understanding, assessing, and ultimately intervening to reduce parental stress and bolster coping. Within this framework, cognitive appraisal of stress, coping and person and situation factors are discussed as important determinants of parents' adaptation to this stressful situation. The nurse's ability to respond to the evolving nature of parental stress and coping processes over the course of the experience enhances the use of the framework in designing coping interventions.

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Psychological factors are associated with how parents cope during a child's intensive care hospitalization. However, little is known about the role of physiological-stress responses in parents' coping and adaptation to such situations. This study investigates the relationship between parents' psychophysiological-stress responses, as measured by urine catecholamine excretion, and their coping and activities during a child's intensive care experience. Parents who appraised the situation as one that is amenable to change and who used more problem-focused strategies, such as seeking social support, had lower anxiety and lower catecholamine levels. Further, parents who were more problem focused performed more child care activities during the experience. The results of this study provide information for planning interventions to promote parental coping and adjustment to the child's critical care situation.

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Beliefs about control have been shown both clinically and empirically to be associated with children's distress reactions to medical events. This article focuses on bolstering children's control through coping strategies found useful to children in ameliorating their distress responses during illness and/or hospitalization.

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OBJECTIVE: To investigate the relationship of locus of control, parental age, and state anxiety to parental coping and activities performed during hospitalization of a child in a pediatric critical care center. DESIGN: Cross-sectional. SETTING: Pediatric critical care center at a university medical center. PARTICIPANTS: A convenience sample of 47 parents of 47 children hospitalized in a critical care center. MAIN OUTCOME MEASURES: Parental coping strategies and activities performed during hospitalization in a critical care center. RESULTS: Older, more self-directed and less anxious parents were found to use coping strategies focusing on problem solving rather than on their emotional response to a child's hospitalization. Further, those who used the problem-focused coping modes were more likely to be involved in caring for the child, while parents who used emotion-focused coping modes participated less in care activities. CONCLUSIONS: Appropriate strategies to bolster coping and reduce stress of parents need to be constantly reassessed because coping mechanisms vary according to parental age, locus of control, anxiety level, and parental involvement in child-care activities. More research is needed in the changes of parental coping mechanisms with time and child-care activity, to assess the benefits of interventions planned to encourage a problem-focused approach.

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Children's ratings of their postoperative pain were compared to nurses' and physicians' ratings of the children's postoperative pain. Children and adolescents were able to rate their pain using a visual analogue scale (VAS). Although there were differences between groups on their mean pain ratings, the ratings of the nurses and physicians correlated significantly with the children's pain ratings. Also, the correlation between nurses and physicians was highly significant, indicating that the use of a VAS may help nurses and physicians explore the cues used to estimate children's pain. This dialogue may enhance communication and collaboration between professionals about pain management strategies specific to each child's pain experience.

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Knowing what parents find stressful about having a child in a pediatric intensive care unit and how they cope is essential before professionals can bolster their coping and provide support. In a semistructured interview we asked parents to discuss the aspects of the situation that they found stressful and to identify their predominant stressor. Then, using the Ways of Coping Questionnaire, we asked them to identify what coping strategies they used to cope with that predominant stressor. The questionnaire is designed to measure whether the strategies used are focused on the problem (situation) or on emotions engendered by the stressor or on both. Data on selected demographic characteristics of the family also were obtained. Fifty percent of the parent subjects identified stressors that were classified as loss of parenting role, 40% uncertainty over outcome, and 10% information need. Although the specific coping strategies used differed by the classification of stressors, all of the parents used a combination of both problem- and emotion-focused forms of coping. Seeking social support and positive reappraisal were the two most often used strategies by all parents regardless of the classification of stressors. No significant associations were found between stress or coping and any of the demographic variables. Research such as this can be useful to practicing clinicians who plan strategies that offer assistance and emotional support to parents of children hospitalized in the pediatric intensive care unit.

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This study examined the ways 42 children coped with surgery in relation to their locus of control beliefs, age, and the amount of preoperative information given them by their parent(s) and surgeon. Lazarus' (1966) cognitive appraisal perspective of stress and coping provided the theoretical framework for the study. From this perspective, a person's appraisal or evaluation of stress and one's coping modes are determined by both personal and situational factors specific to the individual. Children were interviewed preoperatively and rated as using avoidance modes, active modes, or a combination of avoidance-active coping. Results showed that all three independent variables related to children's adopted coping strategy. The results also replicated findings of previous research that showed locus of control and parent-doctor information were associated with particular coping behaviors.

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