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You may be familiar with Beads of Courage. They are not really jewelry; the beads are actually a linear story of strength, honor, and hope told in many colors and shapes, strung one after another. The person stringing the beads is not a jeweler but a storyteller who is also one of the bravest people anyone could know. The bead stringer is often a child enduring arduous treatments for cancer or some other serious illness. Each bead signifies a treatment milestone, thus procedure after procedure translates to bead after bead, providing visual and tactile proof of the “jeweler’s” bravery.

Jean Baruch, a pediatric oncology nurse, founded the Beads of Courage program while working on her PhD in nursing at the University of Arizona, College of Nursing in Phoenix. Since its inception in 2005, the Beads of Courage program has expanded from the Phoenix Children’s Hospital in Arizona to include more than 30,000 children in children’s hospitals in the United States, Japan, the United Kingdom, New Zealand, Canada, and Ireland. The program also includes patients with cancer and blood disorders, cardiac conditions, and burn injuries; neonatal ICU families; and children with chronic illness.

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These are not the trading beads we learned about in grade school, nor are they beads for counting, such as those in an abacus or rosary. No cultured pearl could outshine the white bead that signifies a chemotherapy treatment, and there are no decorative jewels or diamonds quite like the radiant glow-in-the-dark bead that a child gets for each radiation treatment.

The beads give young patients hope and help them to endure procedures. They think, “That bead means I did it before; so I can do it again.” Children can see their progress when they review their beads. For example, a child may receive one yellow bead for each night he or she stayed away from home. Some children have strands many feet long of those yellow beads.


When a child is enrolled in the Beads of Courage program, he or she receives a bead color guide and a membership card. The first length of beads is a strand that spells out the child’s name. From that point on, whenever the child undergoes a procedure, the child receives a colored glass bead representative of that treatment from the nurse, doctor, or social worker. The bead color or shape is determined by the Beads of Courage Bead Guide, which was developed with oncology nurses and other experts in order to depict the child’s course of treatment in the most accurate and meaningful way.

Beads of Courage programs rely on donations of all varieties of handmade beads. Many are polymer clay, others are lamp-worked glass; they can be simple or quite intricate. Special beads are designed and presented to siblings to help them deal with having a sick family member. Handmade glass beads are used as Act of Courage beads. A child might choose from among these unique small works of art to acknowledge a special milestone or having come through a particularly difficult time.

Red heart glass beads are given to children in cardiac care programs, while purple hearts appropriately signify that the heroic patient has completed all treatment. Then there are the otherworldly beads, extraordinary little glass works of art that literally flew in space.


Jamie Newton, an employee of a NASA support contractor whose daughter was ill with cancer, asked NASA if specially designed beads could fly on a space shuttle mission. He reasoned, “Nothing could be more encouraging to a child fighting cancer than to see a symbol of courage—a bead—actually flown to space by the very people who ride into orbit on the space shuttle.”1

A contest for bead designers produced 17 winning bead designs.1 The beads were awarded a place in the official flight kit of NASA Atlantis Space Shuttle Mission STS-132.1 Those beads now comprise part of an exhibit traveling to Beads of Courage member hospitals around the country. At each tour stop, children will receive a pewter space shuttle bead and a poster with pictures of all the beads that were on the launches. Some of the winning artists have replicated their beads, and those unusual little works of art are for sale on the Beads of Courage Web site (www.beadsofcourage.org).


In addition to collections of many different procedure and alphabet beads, Beads of Courage supplies hospital staff with training, manuals, and other literature, as well as ongoing support for staff throughout the program. In addition, Beads of Courage has a Bead Caring Program, which recognizes the role of nurses and other health care providers in the patient’s care. The program provides 50 unique beads, meditation cards, a reference booklet with monthly meditations, and a bead reference booklet. The Bead Caring Program also offers retreats and mantras to aid in reflection and renewal.


The Beads of Courage program is a great success. According to the program organizers, “Ongoing evaluation indicates that the program helps to decrease illness-related distress, increase the use of positive coping strategies, helps children find meaning in illness, and restores a sense of self in children coping with serious illness. The program also provides something tangible the child can use to tell about their experience during treatment and after.”2 ONA

Bette Kaplan is a medical writer based in Tenafly, New Jersey.


1. Bonds of courage, Beads of Courage fly on Atlantis, STS-132. NASA Web site. http://www.nasa.gov/topics/nasalife/features/beads.html. Accessed January 27, 2012.

2. Beads of Courage. Providing arts-in-medicine for children with serious illness. http://www.beadsofcourage.org/pages/beadsofcourage.htm. Accessed January 27, 2012.