A supportive environment is a core element for both professional nursing practice and quality patient outcomes. Supportive environments for nursing practice typically focus on elements such as staffing, scheduling, education, and shared governance. However, there are other aspects of a supportive environment that benefit patients and families. This special topic series in MCN explores several programs developed in a pediatric hospital to achieve this goal.

Family-centered care is a philosophy and approach to providing healthcare that originated in the field of maternal-child care. It has now spread to adult hospitals with the name "patient and family centered care." Pediatric nurses and children's hospitals have continued to evolve family-centered care practices, with benefits and challenges accompanying each innovation. In this issue, we share three different programs that were recently initiated at St. Louis Children's Hospital to improve our ability to provide outstanding patient- and family-centered care. These programs illustrate our continued progress in providing a supportive environment for care of families and children.

Nichols, Crow, and Balakas describe one unit's experience with implementing family-centered rounds in the context of a teaching hospital environment. After an initial successful implementation they found that the process was difficult to sustain, which is an all-too-common occurrence with practice changes. The team studied reasons for losing momentum and identified a number of obstacles that had not been addressed. A subsequent "reboot" involving continuous feedback from families has led to more success with family-centered rounds. This is a key element to provide a supportive environment for patients and families in the hospital.

Balakas, Gallager, and Tilley discuss a project undertaken by the team in our Same Day Surgery department to address special needs of children with developmental and behavioral challenges. This patient population is encountered in many pediatric healthcare settings, and these children often present safety risks for themselves, their parents, and the hospital staff. Family members and the child many times find the experience of surgery and hospitalization stressful. Recurrent stressful experiences when a child has a chronic condition requiring repeated surgeries can be traumatizing and result in maladaptive behaviors. The nurses found that a structured approach to ensuring advanced planning could make a big difference in the patient's and family's experience, significantly decreasing the stress that had typically been part of these children's hospital visits. Their work has now spread to the rest of the hospital and is making a difference in our care of this special population in all settings.

Branch and Klinkenberg cover compassion fatigue and the need to provide a supportive environment for caregivers in order to provide a supportive environment for patients and families. Nurses who are in continuous contact with seriously injured, ill, or dying children (and their families) are at risk for experiencing compassion fatigue, secondary posttraumatic stress, and burnout. This can lead to frequent absences, high turnover rates, and poor quality of care if not addressed. This study identified the prevalence of compassion fatigue in our highest risk areas and was the basis for developing a staff resiliency program to help them develop effective coping strategies.

These are just a few examples of strategies to create a supportive environment for children and families in the hospital. The common denominator for all is that they help nurses, physicians, and other caregivers establish and maintain effective caring relationships with the child and family. These relationships are the essence of high-quality nursing care. I am proud and honored to share this work with our readers!