Edna M. Menke

The impact of a child's chronic illness on school‐aged siblings

Seventy‐two school‐aged children and their parents participated in tape‐recorded interviews to identify the needs and concerns of the children and their perceptions of changes experienced by the family related to having a child with a chronic illness. The majority of the child subjects expressed worries about their sibling who had a chronic illness. The subjects identified more changes in their parents than in themselves.

School-aged Children's Perception of Stress in the Hospital

This article is based on a research study of hospitalized school-aged childrens perception of stress. Forty-two different stimuli were identified through the use of a projective-type game developed by the investigator. The findings of the study did not support the hypotheses that there is a relationship between the stimuli that children perceive as stressful and their preparation for hospitalization nor their length of time in the hospital.

A Comparative Study of Homeless, Previously Homeless, and Never Homeless School-Aged Children's Health

The purpose of this cross-sectional study was to compare the mental health, physical health, and healthcare practices of homeless, previously homeless, and never homeless poor school-aged children. The sample was comprised of 134 children who ranged in age from 8 to 12 years. The children participated in health assessments and completed two psychometric tests: the Childrens Depression Inventory (CDI) (Kovacs, 1985) and the Revised Childrens Manifest Anxiety Scale (RCMAS) (Reynolds & Richmond, 1985). Their mothers completed the Child Behavior Problem Checklist (CBCL) (Achenbach, 1991) and participated in an interview. The homeless (n = 67), previously homeless (n = 30), and never homeless children (n = 37) were similar in regard to their health assessment findings, reported health problems, healthcare practices, and CBCL scores. The proportions of homeless and previously homeless children with CDI scores in the clinical range were significantly greater than the never homeless poor children. The homeless children had significantly higher anxiety scores than the previously homeless and never homeless children. All three groups of children were at risk for physical and mental health problems; however, the findings suggest that school-aged children who experience homelessness may be at greater risk for depression and anxiety than never homeless poor children.

Comparison of the stressors and coping behaviors of homeless, previously homeless, and never homeless poor children.

The purpose of this study was to compare the stressors and coping behaviors of homeless, previously homeless, and never homeless poor school-aged children. Content analyses of interview data from 132 children were used. Forty-four (68%) of the homeless children identified at least one stressor related to being homeless. The three groups of children were similar in regard to stressors related to the family, self, peers, health, school, and environment. In regard to the violent behavior category, significantly more of the previously homeless and never homeless children expressed stressors compared to the homeless children. Significantly more previously homeless and never homeless children identified more social support coping behaviors compared to the homeless children. The three groups of children did not differ in regard to the use of behavioral and cognitive coping strategies.

The Interconnection of Childhood Poverty and Homelessness: Negative Impact/Points of Access:

Child poverty negatively impacts the development of children; family homelessness compounds the issues. Both have dramatically increased over the last two decades with far-reaching, poorly understood consequences. The impact of the instability of poverty and homelessness on children is often hidden or difficult to comprehend. Few studies critically examine the impact on a childs sense of safety and security. Using mixed method inquiry, this research sought to examine the effects of poverty and homelessness on children 8 to 12 years of age. The voices of the children illuminate the underlying strengths and vulnerabilities. Results indicate that homelessness leaves children feeling a decreased sense of support and an increased sense of isolation.

Perspectives Regarding Adherence to Prescribed Treatment in Highly Adherent HIV-Infected Gay Men.

Focus group methodology was used to describe the medication adherence experience of 24 HIV‐infected gay men who reported being adherent to their medication regimens. A conceptualization of medication adherence as an evolving process consisted of challenges to adherence (learning the diagnosis, starting the medications, struggling with the medications, dealing with side effects, coping with stigma) as well as those factors supportive of adherence (believing in medications, finding motivating factors, using reminders, depending on others, owning the disease). Themes associated with challenges to adherence focused on diagnosis and the physical and emotional adjustments individuals made to incorporate antiretroviral medications into their daily lives and move toward medication adherence. The factors supportive of adherence were related to the ongoing behaviors identified with establishing and maintaining adherence behaviors. What can be taken from the study is that adherence is a complex and dynamic process rather than a static behavior.

Homelessness as One Component of Housing Instability and Its Impact on the Development of Children in Poverty

The number of families with children living in poverty and experiencing housing instability and homelessness has increased dramatically over the last two decades. Current public policy decisions will lead to further increases. Understanding the impact of this instability on the emotional, behavioral, and cognitive development of children is imperative. Few studies critically examine the effects of instability on both domiciled and homeless children. This research examined the effects of homelessness and housing instability on 133 children 8 to 12 years of age living in poverty. Results indicate that whether a child is currently homeless is not as significant as overall stability which may have a long ranging effect on a childs future development.

The Experience of Homeless Female-Headed Families

Eighty-five percent of homeless families are headed by single women who are extremely vulnerable and at risk for poor physical, emotional, and social health. The purpose of this naturalistic inquiry was to describe the experiences of 16 women in homeless female-headed families. These women participated in tape-recorded interviews. The themes that emerged from the interviews were a loss of freedom, a sense of being different, feeling down, maternal survival, and living under pressure. Being homeless was compared to a nightmare in which one does not know what will happen or where one will be from day to day. Implications for nursing practice and research are discussed.

SUBSTANCE USE BY HOMELESS PREGNANT MOTHERS

Substance use during pregnancy contributes significantly to complications for both the mother and the developing child. Women who smoke cigarettes, use illicit drugs, or drink alcoholic beverages are at greater risk for the development of premature labor, spontaneous abortions, miscarriages, and stillbirths. Drug-exposed infants are more likely to develop low birth-weight, impaired neurological development, congenital anomalies, and symptoms of withdrawal. These effects maybe worse in poor and underprivileged populations if the mother also has inadequate prenatal care, poor nutritional status, chronic illnesses, or additional coexisting complications of pregnancy. Research concerning the substance use of pregnant women is beginning to accumulate. However, no published studies investigate the health behaviors of homeless pregnant women relative to drugs. Data obtained from 29 homeless pregnant women indicated that 38 percent of these women drank alcohol, 69 percent smoked cigarettes, seven percent smoked marijuana, and 10 percent used other illegal substances. These findings suggest a need to develop and implement programs of care targeted at this population.

Case management of homeless families.

Homeless families are the fastest growing subgroup of the homeless population. They have multiple health care needs that can be best met by the community clinical nurse specialist. Nursing actions must be planned based on an assessment of this groups unique service needs. Interventions require the use of individualized delivery strategies such as case management, which necessitates that the clinical nurse specialist develop specialized skills in both service stimulation and system advocacy.