This study developed a grounded theory of the stresses and coping responses of parents to the repeated hospitalization of chronically ill and disabled children. The theoretical sampling spanned four years and included 30 mothers of children who have a chronic illness or disability and 30 mothers of healthy children; 100 parents of disabled children who attended a weekend retreat: six community health nurses; nine mothers of chronically ill and disabled children before, during and after a hospitalization. The resulting mid-range theory identifies the most stressful aspect as "hazardous secrets" which force the parent to "reluctantly take charge" of the situation. "Vigilance", "calling a halt", "exhaustion" and "taking a break" are key constructs in the process. "Trusting parent and professional relationships" emerged only when a professional assisted in revealing secrets.

Parents of repeatedly hospitalized children with chronic conditions are considered veterans of the health care system. Yet each hospitalization presents unique problems, can be more stressful, and has potential for lasting problems. A family-focused, supportive intervention, Stress-Point Intervention by Nurses (SPIN), was designed to reduce family problems. It was hypothesized that parents who participated in SPIN compared with those with usual care would have more satisfaction with family functioning and better parent coping after their children’s hospitalizations. A three-site clinical trial with random assignment of 23 ambulatory clinic nurses and their respective child-patients and families to experimental SPIN or usual care control groups was employed with 115 children aged 1 through 15. The Feetham Family Functioning Survey and Coping Health Inventory for Parents were completed before hospitalization and 3 months after discharge. SPIN parents were more satisfied with family functioning and had better parental coping after hospitalization than parents who received usual care.

Nurses working with families who have children with a chronic condition are aware of the complexity of the tasks and stresses they deal with daily. The challenge is to uncover the issues that require the most immediate intervention while noting others for the future. This article describes the development of a comprehensive guide for experienced nurses to identify a family's stressors and tasks. It can be used with a broad range of chronic diagnoses. Nurses who have used the guide report that it helped them to focus and plan timely, appropriate nursing interventions with these families. It also serves as a record and planning tool for documenting issues that may become priorities for future interventions.