Refocusing the Lens of Child Advocacy Reform on the Child
When placed within family court jurisdiction, children need lawyers. Dependency [FN1] cases in the family court--in which parents are accused of abusing or neglecting their children--are fraught with constitutional tensions regarding the state's and parents' rights to regulate the well-being of children, [FN2] along with systemic pressures such as federal statutes and state funding [FN3] that substantially affect family relationships. Children sit at *482 the heart of these proceedings; indeed they are the very reason for them. Facing abrupt state intervention into their family life and the oft-accompanying physical removal [FN4] from their homes, these children travel a tumultuous and uncertain road from the time the alleged abuse or neglect occurs until the allegations are resolved. Threatened also with termination of parental rights, [FN5] they--for better or worse--face the potential permanent loss of their natural family life. The recognition that children are not mere property to be tossed between their parents and the state has prompted states to require representation of children as independent parties. Children possess unique rights and interests--to be free from harm and to access relevant social services, among others--that need separate advocacy, particularly in light of the frequent conflicts between the respective interests of parents and children. [FN6] Though a relatively common practice, child representation in dependency proceedings remains both inconsistent and disputed across the country.
Two Distinct Roles/Bright Line Test
It is a mistake to try to develop a single lawyer role for children in child welfare cases which tries to accommodate their developing capacities from infants to articulate teens. The older child needs a traditional attorney; the youngest child, incapable of directing counsel, needs a substitute to define and advocate for his or her best interests. We should adopt different standards for the different advocate roles. Trying to define a single lawyer role for children of all ages and all capacities is an impossible task.' A better approach towards recognizing and accommodating the child's developing cognitive abilities and judgment would be to adopt a bright line age test, say at seven. At age seven (or eight or ten) and above the youth would receive a client directed advocate, that is, a child's attorney, and below the bright-line age a child gets a best interests (or substituted judgment) advocate. The court should appoint either one or the other, or both, under certain circumstances as set out in law. Both roles should be clearly established in law with duties that are aggressive and active. 3
Nurse responsiveness to cancer patient expressions of emotion.
OBJECTIVE
This theoretically based study examined nurse responses to cancer patient expressions of emotion using a videotaped, simulated cancer patient.


METHODS
This study used an experimental crossover design with a videotaped patient expressing anger, sadness, and neutral emotion to elicit nurse responses. Seventy-four nurses from eight sites participated. Responses were coded using Roter interaction analysis system. Correlations explored relationships between variables that impact communication (age, gender, work experience, trait anxiety, work stress, self-efficacy). Regression models explored the effect of variables on nurse affective responsiveness.


RESULTS
Patient expressions of sadness elicited more affective responses than anger. Expressions of anger or neutral emotion elicited more instrumental behaviors than sadness. Variables such as age, work stress and work experience were significantly correlated. No variables predicted affective responsiveness to patient expressions of anger or sadness.


CONCLUSION
Nurse communication showed significant variation in response to patient emotional expressions. Understanding the relationships between demographic, personality, and work variables, and identification of new variables that influence nurse-patient communication, has implications for interventional studies.


PRACTICE IMPLICATIONS
Over 90% of the participants indicated that the videotape simulation would be a useful method for teaching and practicing communication skills with patients expressing emotions.