Concepts (page 1)

• "Join the family" by accepting and blending in with the family system. When nurses make an initial home visit to a child with disabilities, family members are generally on their best behavior and the visit is given high priority over the everyday activities in the home. As the nurse develops rapport with the parents and children, visits may become less formal and many everyday activities can take place during visits. It’s important to accept a little chaos, to wear comfortable clothing that can resist grimy fingers and soggy diapers, and to allow a little extra time for interruptions from phone calls, children’s demands, and the other minutiae of home life.

• Get to know and respect the whole family rather than just the more active parent. While it’s tempting to focus information and interactions on the family member who is most involved in the child’s special needs (often the mother), this approach is counterproductive. A nurse can spend several sessions over a year’s time convincing the child’s mother to enroll him in a special needs summer camp, for example. With a tentative "yes" from the mother, the nurse may send the registration forms to the house only to find that the child’s father has vetoed the idea. It’s vital that the nurse spend at least some time with both parents; in some cases, this means evening or weekend appointments.

• Acknowledge each family member’s contributions.
  It’s easy to identify the accomplishments and efforts of the more visible parent (again, usually the mother) and provide positive reinforcement. It takes more expertise (and interaction) to delve into the role of less active family members and compliment their efforts. Dad, for example, may be taking his child to the park to slide, swing, and climb. Often, no one in the family has identified this activity as therapy that benefits the child’s gross motor and sensory processing skills. The nurse is in an ideal position to point out the father’s contribution, and encourage further participation on the dad’s part.
  

• Stay neutral, avoiding alliances with one family member at the expense of others. While this sounds simplistic, it’s all too easy for the nurse to identify with the parent whose values and beliefs echo her own. Once the nurse has "joined forces" with one parent, there is an inevitable deterioration in the relationship with the other spouse. Be clear that the parents have a right to disagree, and outline the pros and cons of each viewpoint when asked to provide feedback.