Mandie Foster

The parents’, hospitalized child’s, and health care providers’ perceptions and experiences of family-centered care within a pediatric critical care setting: A synthesis of quantitative research

Family-centered care (FCC) purports that unlimited presence and involvement of the family in the care of the hospitalized child will optimize the best outcome for the child, family, and institution. A systematic appraisal was conducted of peer-reviewed, English-language, primary quantitative research conducted within a pediatric critical care setting reported from 1998 to 2014. The aim of this review was to explore the parents’, hospitalized child’s, and health care providers’ perception of FCC within pediatric critical care. Fifty-nine articles met the criteria that generated themes of stress, communication, and parents’ and children’s needs. This review highlighted that communication tailored to meet the parents’ and child’s needs is the key to facilitating FCC and positive health outcomes. Health care providers need to be available to provide clinical expertise and support throughout the health care journey. Future initiatives, education, and research are needed to evaluate the benefits of parent- and child-led FCC practice.

The Parents’, Hospitalized Child’s, and Health Care Providers’ Perceptions and Experiences of Family-Centered Care Within a Pediatric Critical Care Setting

The delivery of family centered care (FCC) occurs within varied pediatric care settings with a belief that this model of care meets the psychosocial, emotional, and physical needs of the hospitalized child and family. The aim of this review was to explore the attitudes, experiences, and implementation of FCC from many studies and to facilitate a wider and more thorough understanding of this practice from a diverse sample of parents, hospitalized children, and their health care providers within a pediatric critical care setting. A metasynthesis is an integration of qualitative research findings based on a systematic review of the literature. Thirty original research articles focusing on family-centered care experiences from the hospitalized child’s, parents’, and health care providers’ perception published between 1998 and 2011 met the criteria for the review. Nine syntheses from 17 themes emerged from the synthesis of the literature: Prehospital, Entry into the Hospital, Journeying Through Unknown Waters, Information, Relationships, The hospital Environment, The Possibility of Death, Religion and Spirituality, and The Journey Home. The individual cultures of the critical care units helped create and reinforce the context of parental needs where satisfaction with communication, information, and relationships were interconnecting factors that helped maintain the positive or negative experiences for the parent, hospitalized child, and/or health care providers.

Family Centred care in the paediatric high dependency unit: Parents' and Staff's perceptions

Aim: This study explored parent and staff perceptions of family centred care (FCC) within a paediatric high dependency in one New Zealand hospital. Background: FCC is a partnership approach to healthcare delivery where the child’s treatment is aligned to the family’s needs. Despite widespread endorsement of FCC, variations between parents and staff in healthcare settings continues to be evident. Method: A descriptive qualitative cross-sectional design was used with a convenience sample where written responses for one open ended question from 91 parents and 66 staff resident with their child or working within a paediatric high dependency unit in New Zealand. Results: The parents’ responses generated three themes (family, treatment and relationships) and the staff’s responses generated two themes (family and treatment). Conclusion: Whilst there were similarities in describing the meaning of family centred care between parents and staff, their views on the central focus of this differed.

Parent and staff perceptions of parental needs during a child's hospital admission to a paediatric high-dependency unit: A New Zealand study

This study aimed to identify parents’ and staffs perceptions of parents’ needs during a paediatric high‐dependency unit admission and the relationships between needs, socio‐demographic and clinical variables and explores if these perceptions have changed.

International commentary on Phiri et al. ‘Registered nurses’ experiences pertaining to family involvement in the care of hospitalised children at a tertiary government hospital in Malawi’:

This commentary has been written by academics who are part of an international network of nurses who study family-centred care (FCC), the model widely used in paediatrics and children’s nursing. Called ‘International Research Network for Child and Family Centred Care’, its members are drawn from across the world and their goal is to promote evidence-based FCC. Members share and discuss articles related to FCC and nursing practice, research and policy. In 2017, an article about FCC in Malawi highlighted issues that generated debate in the group, initiating discussion around the low nurse–patient ratio of 1:84 in a children’s ward. We examine the article from several perspectives, and ask the question as to whether it is ethical to suggest that FCC should be implemented given the constraints on health priorities. Comments specifically address four important issues: a) lack of resources and the impact of this on FCC; b) lack of empowerment of family members in their child’s care; c) lack of policies to guide and support FCC; and d) the importance of nursing ethics in FCC. This discourse presents commentary written by several authors. Each section contains the thoughts of each individual author, listed per country. Fatch Kalembo, Maggie Zgambo, Linda Shields

Toward developing consensus on family-centred care: An international descriptive study and discussion:

Nurses around the world have described family-centred care (FCC) in various ways. With limited evidence regarding its implementation and with dissent among professionals regarding outcomes that are amorphously defined across age groups, systems and global settings, a group of children’s nursing experts from around the world collaborated to seek clarification of the terms, deconstruct the elements in the model and describe empirically a consensus of values toward operationally defining FCC. A modified Delphi method was used drawing on expert opinions of participants from eight countries to develop a contemporary and internationally agreed list of 27 statements (descriptors of FCC) that could form the foundation for a measure for future empirical psychometric study of FCC across settings and countries. Results indicated that even among FCC experts, understandings of FCC differ and that this may account for some of the confusion and conceptual disagreement. Recommendations were identified to underpin the development of a clearer vision of FCC.

Using drawings to understand the child’s experience of child-centred care on admission to a paediatric high dependency unit

Family- and child-centred care are philosophies of care used within paediatrics where the family and/or the child are central to healthcare delivery. This study explored the lived experience of hospitalized school-aged children admitted to a paediatric high dependency unit in New Zealand to gain insight into child-centred care from a child’s perspective. An interpretive thematic approach was used where the child was asked to draw a picture of ‘a person in the hospital’ that was further explored through interviews. The interviews were recorded and transcribed verbatim with an inductive thematic analysis completed, drawing on the child-centred care framework. Twenty-six school-aged children participated. The pictures included drawings of family, staff, children and themselves. The themes generated from the interviews were relationships with themselves, family and staff and psychosocial, emotional and physical support. Children described themselves as co-creators of their own healthcare experience, consistent with child-centred care, while drawing on the principles of family-centred care. Further exploration of the concepts of ‘participation versus protection’ and ‘child as becoming versus child as being’ will contribute to translation and integration of child-centred care and family-centred care principles into practice, theory, research and policy.