Ethical and moral considerations of (patient) centredness in nursing and healthcare: Navigating uncharted waters

This discussion paper aims to explore potential ethical and moral implications of (patient) centredness in nursing and healthcare. Healthcare is experiencing a philosophical shift from a perspective where the health professional is positioned as the expert to one that re-centres care and service provision central to the needs and desires of the persons served. This centred approach to healthcare delivery has gained a moral authority as the right thing to do. However, little attention has been given to its moral and ethical theoretical grounding and potential implications for nurses, persons served and the healthcare system. Based upon a review of academic and grey literature, centredness is proposed as a value-laden concept in nursing inquiry. Potential moral and ethical implications of centredness on nurses/healthcare providers, persons served and the healthcare system are discussed. These challenges are then considered within the context of normative and relational ethical theories. These perspectives may offer guidance relative to how one should act in those circumstances as well as an understanding as to how interdependency and engagement with the other person(s) can help navigate the challenges of a centred care approach. Viewing centredness through an ethical theoretical lens provides a valuable discourse to nursing in efforts to expand the knowledge base and integrate centred approaches into practice and policy.

The experience of being a couple during an intensive care unit admission

BACKGROUND

In critical care nursing, a trend has been seen towards growing attention to the family experience of critical illness. Despite trends moving towards care of the family as a unit, previous research has focused on individual family members' experience of critical illness. Exploring the life world of the family, especially that of spouses and their interaction, is essential to providing family-centred critical care and has not previously been described.

AIM

To explore the lived experience of being a couple during admission to an intensive care unit.

DESIGN

Data were collected through dyadic semi-structured interviews with four couples who had experienced admission to an intensive care unit. Interviews were audio-taped and transcribed verbatim.

METHOD

Grounded in the phenomenological-hermeneutic tradition, data were analysed using Ricoeur's theory of interpretation, using a method described by Dreyer and Pedersen.

RESULTS

By way of analysis, the life world of being a couple during admission to an intensive care unit was disclosed and divided into themes: For better and for worse; The meaningful proximity; and Being a couple.

CONCLUSION

Although critical illness brings a sudden disruption of a couple's twosomeness, the need to remain, act as and be seen and cared for as a couple persists during admission to an intensive care unit. Therefore, couples need to be cared for as individuals and as a unit, underlining the need to follow trends towards family-centred critical care.

Family members' experiences in adult intensive care units: a systematic review

BACKGROUND

Admission to Intensive Care Units (ICU) exposures family members to a new environment, advanced monitoring systems and aggressive treatments. This is coupled with the critical condition of the patient being admitted in ICU. In such times of stress and crisis, families have varying experiences as they navigate the ICU journey. These happen more or less in chronological phases.

AIM

This review sought to describe the experiences of family members of patients admitted in adult ICUs.

DATA SOURCES

Four electronic databases (PubMed, Embase, Scopus and Web of Science) were searched, using keywords and free-text words.

METHODS

Curation of the review question involved problem identification, a scoping search, developing a search strategy, evaluation, data analysis, and reporting. Freehand search in reference lists of eligible articles was also done to obtain potentially eligible articles published in English language between 2007 and 2018. Studies were included if they reported on family members' experiences in adult ICUs. This review conforms to the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA).

RESULTS

Upon completion of the screening process, 28 studies were included. Most studies were conducted in the United States while no study was identified from Africa. We report on 717 family members. Family members' experience of the ICU journey falls into three main themes: (i) Floating, (ii) Probing and (iii) Continuity or Closure.

CONCLUSION

As healthcare technology advances, the ICU environment consequently needs to evolve. As such, healthcare providers will need to adjust their practice, support and consider the patients' family as the other part of the patient and members of the care team in order to meet their expectations. Further research highlighting family members' experience of the ICU journey in Africa is needed.

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.

Documentation in the neonatal unit: The support given to parents and their participation in their baby's care

AIMS

The aim of this study was to explore how often the participation of parents in their infants' care and professionals' support for parents was documented in the clinical records and to determine how such participation and support were documented.

BACKGROUND

Comprehensive documentation can facilitate collaboration between parents and healthcare professionals, supporting family-centred care, yet little is known about how this is reflected in practice.

DESIGN

A prospective, mixed methods approach was used to analyse the clinical records of newborns.

METHODS

The study was carried out in a large tertiary Neonatal Unit in the United Kingdom, from 2013 - 2014. We analysed the clinical records of 24 critically ill newborns using content analysis and thematic analysis, enabling us to determine the frequency of documented support and participation and how support and participation were documented.

RESULTS

We identified four categories of support in the clinical records: "emotional", "spiritual", "social" and "practical support". We also identified instances where parents were encouraged to participate in their infant's care. Frequency differences in the documentation of support between infants facing a redirection of care decision and infants receiving active treatment were found. Two organisational themes were identified: "task focused documentation" and "minimal documentation of parental role". These were grouped together under the global theme "professional accountability". The perspectives and experiences of parents were minimally documented throughout.

CONCLUSION

Documentation of support towards parents and parents' participation in their infants' care was limited in terms of frequency and content. Encouraging regular, detailed documentation of these aspects of care may facilitate family-centred care.

Tokenism or true partnership: Parental involvement in a child's acute pain care

AIMS AND OBJECTIVES

To explore parental involvement in the child's acute pain care and establish ways in which parental preferences for involvement in their child's care can be identified, facilitated and enhanced by nurses.

BACKGROUND

Despite growing evidence supporting effective acute pain management in children and the availability of national and international practice guidelines, children still experience acute pain. Involving parents in their child's pain care has been identified as being a central tenet of pain management in children.

DESIGN AND METHODS

A qualitative study using an ethnographical approach with nonparticipant observation and follow-up semi-structured interviews was undertaken. Nurses (n = 14), parents (n = 41), grandparents (n = 2), other relative (n = 1) and children (n = 30) participated. The framework approach underpinned data analysis. Consolidated criteria for reporting qualitative research (COREQ) enabled comprehensive reporting of the study.

RESULTS

Three concepts emerged from the data: "parents as advocates for their child," "nurses promoting involvement and partnership" and "nurses unintentionally preventing involvement and partnership." Variations in the way parents were involved in their child's pain care were identified. Despite family-centred care being the dominant model of involving families in their child's care, evidence of this being implemented was limited. Parents attempted to advocate effective pain care for their child, whether or not they were supported by nurses.

CONCLUSIONS

Parental involvement in their child's acute pain care can improve the child's pain experience, reduce parental anxiety and increase parents' satisfaction in care. Nurses aspired to involve parents in pain care, but did not always enact this in practice.

RELEVANCE FOR PRACTICE

Children deserve optimum pain care, which includes parental involvement. Parental involvement underpinned by the principles of family-centred care was poorly implemented. Parents attempted to be involved and advocate for their child's pain care whether or not they were supported by nurses. An alternative approach for supporting parents to advocate in their child's acute pain care is offered, the "Partnership in Pain Care Model."

Cultural sensitivity in paediatric nursing care: a concept analysis using the Hybrid method

BACKGROUND

Cultural sensitivity is a core concept to establish awareness and knowledge about various ethnicities, cultures, genders and additional diversity characteristics to understand individual's requests and respond appropriately to them. A need for further development of the concept is warranted, especially in the context of paediatric nursing.

AIMS

The purpose of this paper was to determine the main elements of cultural sensitivity in the context of paediatric nursing in Iran.

METHODS

The Hybrid method was implemented consisting of three phases: theoretical, fieldwork and final analysis. In the theoretical phase, articles from 2007 to 2017 were reviewed for relevance. In the phase of fieldwork, 25 nurses and nine parents were interviewed to explore the aspects of cultural sensitivity in paediatric nursing. The interviews were transcribed, and content analysis was conducted. In the final phase, an overall analysis of the two previous phases was performed.

RESULTS

In the theoretical phase, the following attributes were determined: cultural encounter and awareness, acceptance of cultural diversity and designing programmes in accordance with family culture. The fieldwork phase explored three themes of intercultural encounters, intercultural communication and adapting the care plan with family culture. The final synthesis yielded that sensitivity to family requests and beliefs, effective intercultural communication and integration of family culture with the care plan are the main elements of cultural sensitivity in Iranian paediatric nursing.

CONCLUSION

With a deeper understanding of the term cultural sensitivity, nurses will have a foundation to improve paediatric nursing care and align the care plan with the patient's culture to provide trust, child/parent participation, secure care, effective communication and satisfaction. Since the concepts are the building blocks that underpin theory, the present concepts identified can help to serve as the foundation for the development of a theoretical model.

Family-centred care for hospitalized preterm infants: A systematic review and meta-analysis

AIM

To evaluate the effects of family-centred care on hospitalized preterm infants.

BACKGROUND

With an increase in published reports on family-centred care for preterm infants, there is a need for an up-to-date review and meta-analysis of rigorously designed studies to measure the effects of family-centred care on preterm infants.

DESIGN

A systematic review and meta-analysis.

DATA SOURCES

The Cochrane Library (Issue 12, 2017), PubMed (1966 to December 2017), CINAHL (1982 to December 2017), EMBASE (1974 to December 2017), and Web of Science (1975 to December 2017) databases were searched.

REVIEW METHODS

Relevant terms were used to search for randomized controlled trials of family-centred care versus standard care. A modified rating scale was utilized to assess studies for the degree of family-centredness of the intervention.

RESULTS

Four studies involving 1026 preterm infants were included. Compared with standard care, family-centred care shortened the total length of hospital stay and length of neonatal intensive care unit stay. There was inadequate evidence to demonstrate any effects of family-centred care on infant morbidity, feeding, growth, or neurobehavioural performance.

CONCLUSION

Family-centred care is an effective and safe intervention to shorten the length of stay in the hospital and improve survival quality among hospitalized preterm infants.

Parents as partners: investigating the role(s) of mothers in coordinating health and education activities for children with chronic care needs

Interprofessional collaboration (IPC) between health professionals, and educators is an essential component of academic success and well-being for children who experience chronic illnesses. This study sought to understand parents' roles in and perceptions of IPC between their child's healthcare professionals and educators. We recruited 23 mothers to participate in our study. Data were analyzed using a combination of univariate analyses and content analysis. Overall, parents reported that they could effectively communicate their child's health and educational needs with health and educational professionals, but statistical analysis determined moderately increased challenges presenting information across professions. Most participants (n = 19) indicated that IPC between health and educational professionals could be improved. Effectively engaging parents as partners in IPC can promote more seamless collaboration and communication of a child's needs and offer a greater likelihood of achieving a child's health and educational goals.

Social support network of family members of abused children and adolescents: Perspectives and possibilities

AIMS AND OBJECTIVES

To analyse the network of care and social support from the perspectives of family members of children and adolescents who have been abused.

BACKGROUND

The theoretical-methodological background of the ecological model for understanding violence and the Paradigm of Complexity provide a broad perspective of violence. The paradigm considers all aspects that constitute a phenomenon as well as particular features.

DESIGN

Qualitative research based on the Paradigm of Complexity, developed by Edgar Morin, the primary philosopher. We have adhered to the COREQ Checklist guidelines for qualitative research.

METHODS

Data were collected through Minimal Maps of Personal Social Networks, and semi-structured interviews were held with 15 families who were assisted by a nongovernmental organisation in a Brazilian city. The notions of comprehension and contextualisation guided the data analysis.

RESULTS

Two categories emerged from the data analyses: "Social isolation" and "Affective relationships needs." The maps revealed a weakened and limited network with low-density, homogeneous bonds and few significant bonds. Therefore, the network provided predominantly instrumental and material social support with few important effective relationships. The participants disclosed some strategies to empower their lives.

CONCLUSIONS

We conclude that it is urgent to develop strategies in a broad manner to promote family empowerment, especially on education and employment dimension, and to construct supportive and respectful relationships between services and families as well.

RELEVANCE TO CLINICAL PRACTICE

The present study contributes to international clinical nursing, especially in low- and middle-income countries, by discussing (a) looking at and caring for family members of children and adolescents who have been abused in a contextualised manner; (b) family empowerment, which enables them to have access to healthier environments and to educational/employment opportunities; and (c) broad comprehension of health care among the family members, which provides perspectives not only for looking at violence but also for strengthening supportive social relationships.

Parent-directed commentaries during children's hearing habilitation appointments: a practice in family-centred care

BACKGROUND

Family-centred care (FCC) is recognized as best practice in the delivery of early intervention services for children with hearing loss (HL) and their families. However, there has been little research involving direct observation of family-centred communication practices in paediatric hearing habilitation appointments, which means little is currently known about how family members are involved within appointments, and how FCC is accomplished by health professionals through their interactions with families.

AIMS

To examine the interaction between hearing healthcare professionals, children with HL, and their parents within video-recorded paediatric hearing habilitation appointments (including both audiology and speech and language therapy appointments), with a particular focus on how parents were involved in the interaction.

METHODS & PROCEDURES

The data for this study involved a corpus of 48 video-recorded paediatric hearing habilitation appointments from three clinical sites (including 33 audiology appointments and 15 speech pathology appointments). Participants included 14 audiologists, 8 speech and language therapists, 41 children with HL (aged 18 months and over) and 48 of their attending family members (e.g., parents/carers). The data were analyzed using conversation analysis.

OUTCOMES & RESULTS

Analysis revealed one specific practice that health professionals used to engage parents in the interaction during child-directed assessment and therapy tasks: that of 'parent-directed commentaries', where health professionals shifted their attention to the parent(s) to describe or evaluate what they were observing during appointment tasks. Health professionals were observed to produce two types of parent-directed commentaries: (1) a positive evaluation of the child's just-prior response; and (2) an account for the child's prior behaviour (sometimes also accompanied by a positive evaluation). These commentaries appeared at systematic points in the interaction when the child had been displaying difficulty with their response to the health professional. The parent-directed commentaries accomplished several important functions: they engaged the parent's attention in the interaction; focused the parent's attention on positive responses from the child (while shrouding less positive responses); played down potential negative perceptions of the child's previous missed/incorrect responses; and provided parents with reassurance of their child's progress during the ongoing task.

CONCLUSIONS & IMPLICATIONS

The parent-directed commentaries identified in this study provide an example of the practical, interactional resources that health professionals can draw on within paediatric appointments to facilitate FCC with parents.

How should we understand family-centred care?

What is family-centred care of a hospitalized child? A critical understanding of the concept of family-centred care is necessary if this widely preferred model is to be differentiated from other health care ideals and properly evaluated as appropriate to the care of hospitalized children. The article identifies distinguishable interpretations of family-centred care that can pull health professionals in different, sometimes conflicting directions. Some of these interpretations are not qualitatively different from robust interpretations of the ideals of parental participation, care-by-parent and partnership in care that are said to be the precursors of family-centred care. A prominent interpretation that regards the child and his or her family collectively as the 'unit of care' arguably arises from ambiguity and is significantly problematic as a model for the care of hospitalized children. Clinical practice driven by this interpretation can include courses of action that do not aim to do what will best promote a hospitalized child's welfare, and such cases will not be unusual. More broadly, this interpretation raises challenging questions about the responsibilities and authority of health professionals in relation to the interests of hospitalized children and their families.

Developing a model of factors that influence meeting the needs of family with a relative in ICU

AIM

To develop a model of factors influencing meeting family needs when a relative was admitted to the intensive care unit (ICU).

BACKGROUND

Studies identify individual factors impact on the needs of family members with a relative in ICU. No studies have reported on relationships between these factors and/or the extent of influence of multiple factors on family needs.

DESIGN

Observational, correlational, and predictive study design.

METHODS

Data were collected from August 2013 to June 2014 using validated scales and a demographic tool. The setting was a large tertiary referral hospital in Brisbane, Australia. Structural equation modelling was undertaken.

RESULTS

One hundred and seventy ICU family members participated. Factors included in the developed model were consistent with the literature. Family member anxiety had direct and significant influence on ICU family needs (β = 0.21). Gender was also found to have direct influence (β = 0.19), suggesting female family members were more likely to report needs being met. Family member coping self-efficacy (β = -0.40) and family member depression (β = -0.33) were mediating variables.

DISCUSSION

Interventions to meet family needs within the ICU should take into account family member levels of anxiety, depression, and coping self-efficacy with consideration of gender. Further model validation is required to confirm findings.

Being we and being me: Exploring the needs of Austrian families with caring children

Children and adolescents with caring responsibilities are an uncontested reality in our society. Most are hidden from public view, and they perform a broad range of caring activities for chronically ill or disabled family members. The research literature has accumulated a comprehensive body of knowledge about young carers' personal needs. However, knowledge and understanding are limited regarding the needs of young carers' families. This knowledge can contribute to preventing children and adolescents from assuming inappropriate caring roles. A qualitative research approach was used to investigate the needs of young carers' families in terms of managing daily caring demands. Nine family interviews were conducted with 34 individuals including 15 young carers during spring/summer 2015 in eastern Austria. Open and axial coding procedures and constant comparison method were used to analyse the data. The findings revealed that young carers' families need to live in accordance with their inherent family logic. Family logic is generated and maintained via (i) family reciprocity that involves the natural help within the family, (ii) individual developmental space that allows family members to be perceived and act as individuals and (iii) network cooperation that offers formal and informal support and recognition from society in general. The findings contribute to understanding how families with caring children manage the caring demands of their everyday lives. The findings also indicate that formal support for families with young carers should consider the individuality of caring arrangements with respect to the holistic and personal needs and avoid stigmatising families that integrate children into caring.

Children's and young people's experiences of a parent's critical illness and admission to the intensive care unit: A qualitative meta-synthesis

BACKGROUND

Little is known about how children and young people experience and manage the critical illness of a parent and a parent's admission to the intensive care unit (ICU).

OBJECTIVE

The aim of this study was to search and interpret the existing literature describing children's and young people's experiences of a parent's illness trajectory in the ICU.

METHOD

A qualitative meta-synthesis was conducted based on a systematic literature search of online databases.

FINDINGS

Four main themes were identified and synthesised to describe the integrated experiences of children and young people: (a) the parent-child bond, (b) the unfamiliar environment, (c) the impact of the illness and (d) the experience of being overseen as close family members.

CONCLUSION

Experiencing a parent's critical illness and admittance to the ICU is overwhelming. The bond between the parent and child is exposed by the separation from the ill parent. To comprehend and manage the experience, children and young people seek information depending on their individual capacities. They express a need to be close to their ill parent and to be seen and approached as close members of the family. However, children experience being overseen in their needs for support during their parent's ICU illness with the risk of being left in loneliness, sadness and lack of understanding of the parent's illness.

RELEVANCE FOR CLINICAL PRACTICE

Children and young people as relatives need to be acknowledged as close members of the family, when facing the illness trajectory of a parent, who is admitted to the ICU. They need to be seen as close family members and to be approached in their needs for support in order to promote their well-being during a family illness crisis. Early supportive interventions tailored to include children of the intensive care patient are recommended.

Experiences with unregulated respite care among family caregivers of children dependent on respiratory technologies

Increasingly, children with respiratory conditions who are dependent on medical technology (e.g. ventilators and tracheostomies) are cared for at home by family caregivers who are at risk for significant health, financial and social burdens. In many jurisdictions, access to quality respite is varied and often the availability of regulated (nursing) providers is insufficient. Rather than go without, some families have secured alternative and unregulated providers to supplement formal home care systems. The purpose of this study was to explore the experiences of family caregivers of children dependent on respiratory technologies who have used unregulated providers for in-home respite care. Through an interpretative description approach, data was gathered from 20 semi-structured parent interviews and analysed using constant comparative analysis. Four themes emerged from the data, which were conceptualized as both opportunities and tensions that parents experienced with both unregulated and regulated home care providers: finding the right fit for the child and family; trusting the provider is everything; using unregulated providers offers unique advantages; and accepting that regulated and unregulated care present challenges. Findings signal that unregulated providers play a pivotal role in supporting parents of children who are dependent on respiratory technologies. Implications for practice, policy and future research initiatives are discussed.

How do clinicians practise the principles of beneficence when deciding to allow or deny family presence during resuscitation?

AIMS AND OBJECTIVES

To examine how clinicians practise the principles of beneficence when deciding to allow or deny family presence during resuscitation.

BACKGROUND

Family presence during resuscitation has important benefits for family and is supported by professional bodies and the public. Yet, many clinicians restrict family access to patients during resuscitation, and rationales for decision-making are unclear.

DESIGN

Secondary analysis of an existing qualitative data set using deductive category application of content analysis.

METHODS

We analysed 20 interview transcripts from 15 registered nurses, two doctors and three paramedics who had experienced family presence during resuscitation in an Australian hospital. The transcripts were analysed for incidents of beneficent decision-making when allowing or denying family presence during resuscitation.

RESULTS

Decision-making around family presence during resuscitation occurred in time poor environments and in the absence of local institutional guidelines. Clinicians appeared to be motivated by doing "what's best" for patients and families when allowing or denying family presence during resuscitation. However, their individual interpretations of "what's best" was subjective and did not always coincide with family preferences or with current evidence that promotes family presence during resuscitation as beneficial.

CONCLUSIONS

The decision to allow or deny family presence during resuscitation is complex, and often impacted by personal preferences and beliefs, setting norms and tensions between clinicians and consumers. As a result, many families are missing the chance to be with their loved ones at the end of life. The introduction of institutional guidelines and policies would help to establish what safe and effective practice consists of, reduce value-laden decision-making and guide beneficent decision-making.

RELEVANCE TO CLINICAL PRACTICE

These findings highlight current deficits in decision-making around FPDR and could prompt the introduction of clinical guidelines and policies and in turn promote the equitable provision of safe, effective family-centred care during resuscitation events.

Randomized, controlled trial of a brief family-centred care programme for hospitalized patients with bipolar disorder and their family caregivers

Family interventions have been emphasized in the treatment of bipolar disorder (BPD) due to the bidirectional and entangled relationships between patients and the family system, and have benefits for patients' symptoms and health; however, the effects of family interventions on family function and caregivers' health-related outcomes have not been well investigated. This randomized, controlled trial with 47 hospitalized patients with BPD/family caregiver dyads at a medical centre in northern Taiwan compared the effects of a brief family-centred care (BFCC) programme with treatment as usual (TAU). All of the family caregivers in two groups were invited to attend a routine 60-min family discussion group about violence and suicide prevention. The TAU group without specific family interview for patient and family caregiver dyad. In the BFCC group, four 90-min BFCC programme sessions were additionally provided twice a week for each hospitalized family dyad. We hypothesized that, first, family caregivers in the BFCC group could increase their family function, and second, improve perceived health status and reduce caregiver's burdens compared to the TAU. The results showed that family caregivers in the BFCC group significant interaction effects in overall family function (P = 0.03) and subscale conflict (P = 0.04), communication (P = 0.01), and problem-solving (P = 0.04), but there were no significant interaction effects on the caregivers' perceived health status and caregivers' burdens. Our findings support both the feasibility of using the BFCC programme for inpatients and its specific benefits for family function. An intensive family intervention during hospitalization has been suggested in psychiatric practice to support patients with BPD and family caregivers.

Maternal perceptions of family-centred support and their associations with the mother-nurse relationship in the neonatal intensive care unit

AIMS AND OBJECTIVES

To evaluate maternal perceptions of family-centred support with hospitalised preterm infants and their relationship between mothers and nurses in the neonatal intensive care unit (NICU).

BACKGROUND

Mothers who gave birth to preterm infants tend to suffer more stress and need individual support based on family-centred care. However, there may be a shortage of support for mothers to obtain parent-crafting skills before bringing their infants home.

DESIGN

This cross-sectional study used path analysis and multiple group analysis to evaluate a structural equation model of the relationship between maternal perception based on family-centred support in parent-crafting training and the mothers-nurses collaboration.

METHODS

We analysed data from 98 mothers (valid response proportion, 41.0%) whose infants were hospitalised in the NICU of two types of perinatal centres in Japan. We used three revised standardised questionnaires in Japanese: Measure of Process of Care in the NICU (Neo-MPOC 20), Enabling Practice Scale in the NICU (Neo-EPS) and the author-developed Mother and Infant Questionnaire.

RESULTS

Path analysis revealed that the relationship between mothers and nurses was linked to three factors related to the perinatal centres' support: consideration of parents' feelings, ability to deal with specific needs and coordination in dealing with situations that interact with provision of parent-friendly visual information. Separate path analyses for each perinatal centre showed the same pattern, although the standard coefficients were different.

CONCLUSIONS

Maternal perceptions of family-centred support with hospitalised preterm infants promoted better collaboration between mothers and nurses to obtain parent-crafting skills at two types of perinatal units in Japan.

RELEVANCE TO CLINICAL PRACTICE

Clear visual information materials might promote better maternal understanding of their infants, help in acquisition of parent-crafting skills and improve mother-nurse collaboration, with the result that mothers are better able to care for their infants autonomously at home.

Acute care nurses' views on family participation and collaboration in fundamental care

AIMS AND OBJECTIVES

To understand the beliefs, attitudes and perceptions of nurses regarding family participation and collaboration in the care of their hospitalized adult relative.

BACKGROUND

Family participation in care is known to enhance the quality of patient care. Nurses are uniquely placed to support such participation, including the delivery of fundamental care. However, nurses' attitudes and beliefs may help or hinder participation.

DESIGN

A mixed methods approach with an exploratory sequential design was used.

SETTING

A regional referral hospital in Australia.

PARTICIPANTS

Nurses were eligible to participate in the study if they were permanent staff of the hospital, and who in their day-to-day work had direct contact with adult patients and their families on acute care wards.

METHODS

Observer-as-participant observation data and semi-structured interviews were undertaken. 30 hr of observational data were gathered, and 14 nurses were interviewed. Data collection occurred between September and December 2016. Following separate analysis, data were triangulated.

RESULTS

Analysis uncovered two contrasting categories: (i) enacting family participation (four themes); and (ii) hindering family participation (five themes).

CONCLUSION

The findings of our study demonstrated that the practices of nurses do not always align with healthcare policies, and strategies to support nurses to enact patient- and family-centred practices are needed.

RELEVANCE TO CLINICAL PRACTICE

Nurses can use these findings to make informed evidence-based changes to the way they practice and communicate with families to ensure fundamental care is delivered.

Family-centred care for families living with cystic fibrosis in a rural setting: A qualitative study

AIMS AND OBJECTIVES

To explore experiences of family-centred care among parents of children with cystic fibrosis living far from tertiary treatment centres and to understand what such distances mean to their care.

BACKGROUND

Australia is a large continent. However, many families with a child with cystic fibrosis live in regional areas, often thousands of kilometres away from the primary treatment centres located in Australia's coastal capital cities.

DESIGN

A qualitative, phenomenological design using a Van Manen () approach.

METHODS

Individual, semi-structured interviews were conducted with parents (n = 7) of a child with cystic fibrosis who lived in regional Australia. Thematic content data analysis was used.

RESULTS

The essence of the participants' experience was their seeking certainty and continuity in the changeable realm of cystic fibrosis while negotiating a collaborative approach to their child's care. Five core themes and two subthemes were identified: "Daily care: a family affair," including the subtheme "Accessing expert care"; "Family-centred care: seeking inclusion"; "Control versus collaboration: seeking mutual trust," with the subtheme "The team who grows with you"; "Future projections"; and "The CF circle."

CONCLUSION

Some concerns are not unlike those of their city counterparts, but can be intensified by their sense of distance and isolation.

RELEVANCE TO CLINICAL PRACTICE

Insight into this unique milieu from the parents' perspective is requisite so that care is appropriate to such a challenging environment and incorporates the whole family.

Sleep quality and mood in mothers and fathers accommodated in the family-centred paediatric ward

AIMS AND OBJECTIVES

To describe sleep quality and mood in parents accommodated with their sick child in a family-centred paediatric ward. Secondary aims were to compare mothers' and fathers' sleep quality and mood in the paediatric ward and to compare the parents' sleep quality and mood between the paediatric ward and in a daily-life home setting after discharge.

BACKGROUND

Frequent interruptions, ward noise and anxiety affect parents' sleep quality and mood negatively when accommodated with their sick child in paediatric wards. Poor sleep quality and negative mood decrease the parents' ability to sustain attention and focus, and to care for their sick child.

METHODS

This was a prospective and descriptive study. Eighty-two parents (61 mothers and 21 fathers) with children (median age 6.25 years) admitted to six paediatric wards participated in the study. Uppsala Sleep Inventory, a sleep diary and the Mood Adjective Checklist were used to measure sleep quality and mood.

RESULTS

The parents had a good sleep quality in the paediatric ward even though they had more nocturnal awakenings compared to home. Moreover, they were less alert, less interested and had reduced concentration, and were more tired, dull and passive in the hospital than at home after discharge. Vital sign checks, noises made by the staff and medical treatment were given reasons influencing sleep. Poor sleep quality correlated with negative mood.

CONCLUSION

Parents' sleep quality in family-centred paediatric care is good. However, the habitual sleep efficacy before admittance to the hospital is lower than expected and needs to be further investigated.

RELEVANCE TO CLINICAL PRACTICE

The healthcare professionals should acknowledge parents' sleep and mood when they are accommodated with their sick child. Further should care at night be scheduled and sleep promoted for the parents to maintain health and well-being in the family.

Patients' and their family members' experiences of participation in care following an acute exacerbation in chronic obstructive pulmonary disease: A phenomenological-hermeneutic study

AIM AND OBJECTIVES

To explore the experiences of patients with chronic obstructive pulmonary disease and their family members relating both to participation in care during hospitalisation for an acute exacerbation in chronic obstructive pulmonary disease, and to the subsequent day-to-day care at home.

BACKGROUND

When recovering from an exacerbation, the challenges associated with an unpredictable health condition dominate everyday life for patients and can involve their family members. Proper patient and family participation in care during discharge and follow-up can help patients to improve self-management. However, knowledge of the significance of patient and family participation for recovery and subsequent everyday life is still limited.

DESIGN

This study adopted a longitudinal design informed by ethnographic fieldwork principles.

METHODS

Participant observations and interviews with 15 patients and 12 family members were conducted on a Danish hospital ward and twice at the participants' homes. A phenomenological-hermeneutic approach inspired by Ricoeur's theory of interpretation guided the data analysis.

RESULTS

Participation in care was perceived as valuable, but could be associated with tensions and increased uncertainty. While patients mostly demonstrated a reactive approach to care, family members strived to be more proactive. In hospital, preparing for discharge included an effort to find a balance between powerlessness and influence during interactions with healthcare professionals. At home, managing further recovery and self-management were characterised by navigating between mutual pressure and consideration within the family.

CONCLUSION

Family members play an important role in ensuring that patients are seen, heard and understood, but want to be acknowledged more by healthcare professionals. Appropriate interactions with healthcare professionals are crucial in order to support discharge and daily self-management.

RELEVANCE TO CLINICAL PRACTICE

Knowledge of the challenges that patients with chronic obstructive pulmonary disease and their family members face in participating in care activities could inform future development of family-centred care approaches tailored to individual needs.

Implementing a collaborative coaching intervention for professionals providing care to children and their families: An exploratory study

The growing complexity of healthcare requires family and interprofessional partnerships to deliver effective care. Interprofessional coaching can enhance family-centred practice and collaboration. The purpose of this study was to explore the acceptability and feasibility of collaborative coaching training to improve family centredness within acute paediatric rehabilitation. Using a participatory action design, service providers (SPs; n = 36) underwent a 6-month coaching programme involving coaching workshops, learning triads, and tailored sessions with a licensed coach. The feasibility and acceptability of coaching on SPs' family interactions and care was explored. Measure of Processes of Care (MPOC) and MPOC-SP, a coaching skills questionnaire, and focus groups were used to evaluate the acceptability of coaching training. We found that structured coaching training was feasible and SPs reported significant improvements in their coaching skills; however, MPOC and MPOC-SP scores did not reveal significant differences. Qualitative themes indicated that clinicians are developing coaching competencies and applying these skills in clinical practice. Participants perceived that the coaching approach strengthened relationships amongst colleagues, and they valued the opportunity for interprofessional learning. Findings suggest that coaching offers promise as an approach to facilitate successful patient outcomes and improve processes of care. Preliminary findings indicate that interprofessional coaching training is acceptable, feasible, and can significantly improve SP coaching skills and improve team cohesion. Further research to study the effects of coaching on interprofessional care using validated outcome measures and to assess the impact on service delivery is recommended.

Parents' experiences of their child being admitted to a paediatric intensive care unit: a qualitative study-like being in another world

BACKGROUND

There is very little research on the parent's experiences of having a child admitted to a paediatric intensive care unit. Identifying and describing 'such experiences' could facilitate better parental support from the paediatric intensive care team and help the parents manage a stressful situation.

AIMS

This study aimed to describe parents' experiences of having their child admitted to a paediatric intensive care unit.

METHODS

Interviews were conducted with 12 parents whose children had been admitted to a paediatric intensive care unit. A qualitative design was used, and the interviews were analysed based on content analysis.

RESULT

The analysis revealed two categories: 'being involved' and 'being informed' with seven subcategories: 'caring for the parents', 'security and trust', 'altering the parental role', 'stress and fear', 'the importance of knowing', 'interaction in the care process' and 'being prepared'. An overarching theme emerged: the experience was 'like being in another world'. The study concludes that a child's admission to a paediatric intensive care unit is a stressful situation, and for the parents to be able to handle the anxiety and stress, they need to be informed of and involved in their child's care.

CONCLUSIONS

The parents' experience when their child is admitted to a paediatric intensive care unit is fraught with a range of emotion and fear. There are indications that things such as good information, involvement and a positive experience of the transfer to the paediatric ward reduce the stress and anxiety associated with paediatric intensive care admission. The result of this study could be used as a basis for a post-paediatric intensive care follow-up service for the children and their families.