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

Parents' and nurses' perceptions and behaviours of family-centred care during periods of busyness

PURPOSE

Busyness as a construct within modern healthcare is complex and multidimensional. To date, few studies have sought to explore how busyness influences family-centred care. This study explored the influence of busyness on the delivery of family-centred care for nurses and parents.

DESIGN AND METHOD

Ethnography was selected as the research design. The study site was a metropolitan tertiary hospital inpatient paediatric unit in Sydney, Australia. Semi-structured interview and non-participant observation techniques were used for data collection. Ten paediatric nurses and 10 parents were interviewed and 40 h of non-participant observations were undertaken. The COREQ was used to report the study.

RESULTS

The findings are presented as three key themes: (i) 'Supporting family-centred care' in which participants detail beliefs about the nurse-parent relationships and how despite busyness nurses sought out moments to engage with parents; (ii) 'Being present at the bedside' identified the challenges in optimising safety and how parents adapted their way of being and interacting on the unit; and (iii) 'The emotional cost of busyness' and how this influenced nurse-parent interactions, care delivery and family-centred care.

CONCLUSIONS

The ethnography has given shape to social understandings of busyness, the complexities of paediatric nursing and family-centred care. The culture of care changed in moments of busyness and transformed parent and nursing roles, expectations and collaborative care that at time generated internal emotional conflict and tension.

PRACTICE IMPLICATIONS

Given the increasing work demands across health systems, new agile ways of working need to ensure maintenance of a family-centred approach. Strategies need to be developed during periods of busyness to better support collaborative connections and the well-being of paediatric nurses and parents. At an organisational level, fostering a positive workplace culture that shares a vision for family-centred care and collaboration is essential.

PATIENT OR PUBLIC CONTRIBUTION

Parents of sick children admitted to an acute paediatric inpatient ward were invited to be a participant in a single interview. Parents were aware of the study through ward advertisement and informal discussions with the researchers or senior clinical staff. Engagement with parents was important as healthcare delivery in paediatrics is focused on the delivery of family-centred care. To minimise the risk of child distress and separation anxiety, children were present during the parent interview. Whist children and young people voices were not silenced during the interview process, for this study the parent's voice remained the focus. While important, due to limited resources, parents were not involved in the design analysis or interpretation of the data or in the preparation of this manuscript.

DATA SHARING

The data that support the findings of this study are available from the corresponding author upon reasonable request.

'With every fibre of their being': Perspectives of healthcare professionals caring for children with non-malignant life-limiting conditions

BACKGROUND

Children with non-malignant life-limiting conditions (NMLLCs) constitute the largest proportion of children requiring palliative care. In part, due to technological advances, growing numbers of such children are experiencing improved survival. Care is mostly provided at home by the family, with significant professional input at different points in the child's life trajectory. This study explored the experience of healthcare professionals caring for this cohort of children.

METHODS

A qualitative descriptive study design using single-occasion one-to-one semi-structured interviews collected data from 12 healthcare professionals' including nurses, social workers and doctors. Data were analysed using thematic analysis.

RESULTS

The findings highlighted the unfailing determination and dedication of healthcare professionals who provided care despite challenges with what seemed like 'with every fibre of their being'. Three key themes marked such strength and commitment; those were 'being there', 'being focused' and 'being strong'. 'Being there' explicitly highlighted expert care that was individualized and responsive to the child and family's unique needs. The provision of such care was often threatened and potentially compromised by the intricacies and challenges associated with children's palliative care (CPC) and service provision. 'Being focused' captured the sense that the healthcare professionals remained entirely focused on providing expert care despite these challenges. 'Being strong' epitomized the personal and professional impact on healthcare professionals who are working in this area and the manner in which they sustain themselves in 'being focused' and in 'being there'.

CONCLUSIONS

The healthcare professionals demonstrated their unwavering commitment to deliver quality care required by children and families, however against a background of issues relating to organizational constraints. The findings have implications for education/service providers such as the need for specific palliative care education at both pre-registration level and continuing professional development.

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.

Translation, Cross-Cultural Adaptation, and Psychometric Testing of Perception of Family-Centered Care Measurement Questionnaires in the Hospitalized Children in Iran

PURPOSE

This study aimed to offer a translation, cross-cultural adaptation, and psychometric testing of the Perception of Family-Centered Care-Staff (PFCC-S) and Perception of Family-Centered Care-Parents (PFCC-P) questionnaires for use in pediatric nursing in Iran.

DESIGN AND METHODS

The study was comprised of six steps. The first five steps included the preparation, forward translation, reconciliation, back translation, and back translation review of the translated questionnaires. In the sixth step, the content validity ratio, content validity index, confirmatory factor analysis, and reliability were estimated. Through the convenience sampling method, 456 nurses and mothers were included in the study for confirmatory factor analysis, while 40 nurses and mothers were selected to evaluate the reliability of the two questionnaires.

RESULTS

Harmonized versions of the Persian PFCC-S and PFCC-P questionnaires were developed (steps 1-5). The content validity ratio of all items of the questionnaires was >0.62. The content validity index for the PFCC-S and PFCC-P questionnaires was 0.81 and 0.83, respectively. One item was added to each questionnaire, which contained 21 items. The confirmatory factor analysis verified the three subscales of respect, collaboration, and support in the two questionnaires. The intraclass correlation and Cronbach's alpha coefficients for the PFCC-S questionnaire were 0.89 and 0.87, respectively, and 0.79 and 0.81, respectively, for the PFCC-P questionnaire.

CONCLUSIONS

This study developed questionnaires that were compatible with the Iranian culture to measure the perception of family-centered care.

PRACTICE IMPLICATIONS

Nurses can use these questionnaires to measure and compare the perceptions of family-centered care by staff and parents.