Nurses' and Families' perceptions and practices and factors influencing the implementation of family-centred care for hospitalised children and their families

The moderating effects of nurses' characteristics on the perceptions and practices of family-centered care for chronically ill children and their families in Saudi Arabia

BACKGROUND/PURPOSE

Nurses play a vital role in providing effective family-centered care (FCC) to enhance the quality of healthcare for children with chronic illnesses and increase family satisfaction. This study aimed to investigate nurses' perceptions and practices of FCC for children with chronic illnesses, and how nursing characteristics influence this relationship.

METHOD

This multicenter cross-sectional study involved a convenience sample of 405 nurses, each with at least six months of experience caring for chronically ill children, infants, and toddlers in Saudi Arabia. An online survey was conducted between February 2023 and August 2023. A paired sample t-test of differences between nurses' perceptions and practices of FCC among chronically ill children was performed. Correlations were carried out to test the relationships between nurses' perceptions and practices of FCC and their sociodemographic factors, including age, gender, marital status, education level, and years of work experience, and attributes of nurses, including professional competence, interpersonal skills, job commitment, and knowing one's self. Moderation analyses were conducted using the SPSS PROCESS macro version 4.

RESULTS

Nurses' FCC practice was significantly poorer than their perception. The moderation analysis highlighted that marital status (β = 0.122, p = .014), interpersonal skills (β = 0.131, p = .002), job commitment (β = 0.096, p = .024), and self-awareness (β = 0.127, p < .001) significantly strengthened the relationship between FCC perception and practice.

CONCLUSIONS

Nurses' sociodemographic factors and personal attributes influenced the relationship between their perceptions of FCC and its implementation. Leaders should consider aspects such as marital status, interpersonal skills, job commitment, and self-awareness as these factors affect the strength of this relationship. Further research is needed to assess these impacts through longitudinal design and causal intervention studies to create a conceptual model of FCC for children with chronic illnesses.

Understanding the Experience of Cancer Survivorship Among Pediatric and Adolescent Cancer Survivors and Their Parents Through Camera Lenses: A Photovoice Study

OBJECTIVE

Although the relative survival rate of childhood cancer has increased substantially in recent years, the pursuit of successful outcomes is often accompanied by negative impacts on pediatric and adolescent cancer survivors and their parents' physical and psychological well-being. However, little is known about their experiences during the period of cancer survivorship. This study aimed to gain an understanding of the experience of cancer survivorship among pediatric and adolescent cancer survivors and their parents.

METHODS

This study utilized a descriptive qualitative study employing the photovoice design. From September 2022 to March 2023, 17 pediatric and adolescent cancer survivors (9-18 years), who had completed active treatment at least 6 months before recruitment, participated in this study. A total of 217 photographs submitted by survivors and their parents and the interview data, were thematically analyzed to identify themes and subthemes.

RESULTS

The analysis revealed five prominent themes: indelible marks, struggling with late effects, striving to return to normalcy, the strength of support, and living in the moment and hope for the future.

CONCLUSION

The findings shed light on the experiences of pediatric and adolescent cancer survivors and their parents throughout the cancer journey, elucidating the influence on both negative and positive aspects. Additionally, the study highlighted that photovoice facilitated self-reflection, the discovery of values, and the recognition of strengths and can be a therapeutic strategy for pediatric and adolescent cancer survivors and their parents in further research.

Factors affecting family-centered care practice by nurses: A systematic review

PURPOSE

This study presents a systematic review of the obstacles to and enablers of family-centered care (FCC) implementation by nurses. FCC, which has demonstrated beneficial outcomes, is regarded as a crucial quality measure in certain pediatric units. However, not all nurses incorporate FCC into their practice.

DESIGN AND METHODS

A systematic review was conducted from January to June 2023, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Various medical subject heading keywords and terms were used to search electronic databases, with the aim of synthesizing and evaluating the results.

RESULTS

Twenty-three articles were identified for review. Most of these studies were carried out in Western countries. They revealed several facilitators and obstacles to FCC implementation by nurses when caring for sick children. Some of these factors are linked to the personal attributes of the nurses, while others are associated with the characteristics of the families and the healthcare system itself.

CONCLUSION

Nurses face multi-level barriers that hinder their ability to implement FCC practice. This systematic review identifies the need to leverage nurses' attributes, foster effective nurse-client relationships, and promote organizational changes.

PRACTICE IMPLICATIONS

Nurses need to comprehend and work toward altering the factors that influence the delivery of FCC. The findings of this review can be used by healthcare organization leaders and policymakers to customize interventions and allocate resources to promote FCC practice. Further research in diverse cultural contexts is needed to examine the cause-and-effect relationship concerning the influence of the identified barriers and facilitators on FCC practice. In addition, experimental studies are required to evaluate the effectiveness of evidence-based interventions on FCC practice by nurses.

Nurses' practices of children and family-centered care for chronically ill children: A cross-sectional study

PURPOSE

There is limited evidence of children and family-centered care (CFCC) practice in different cultural contexts, particularly regarding the factors that predict it among nurses providing care to chronically ill children. Also, the CFCC's impact on the quality of care has not been well studied. This study aimed to test a hypothesized model in which nurses' attributes and care environments predict CFCC, thereby increasing the quality of nursing care.

DESIGN AND METHODS

A multicenter cross-sectional study recruited a convenience sample of 405 nurses caring for chronically ill children in Saudi Arabia for an online survey between February 2023 and August 2023. Structural Equation Modeling evaluated the hypothesized model.

RESULTS

The hypothesized model fits the data based on the fit indices. Care environment affected CFCC (β = 0.831, p = .000), while nursing attributes only indirectly affected CFCC practices through the mediating effect of the work environment (β = 0.553, p = .000). The CFCC practices positively affect the quality of nursing care (β = 0.636, p = .000).

CONCLUSIONS

Nursing attributes impact the work environment, which affects the practice of CFCC and enhances the quality of care for chronically ill children. Investing in nurses' attributes and a positive work environment is crucial for nursing leaders to enhance CFCC practice and the quality of care.

PRACTICAL IMPLICATIONS

The findings of this study can be used to shape policies and develop interventions to improve nursing CFCC practices and promote better quality of care for chronically ill children.

Impact of family-centered care in families with children with intellectual disability: A systematic review

Background

Family-Centered Care (FCC) is an approach to healthcare planning, delivery and evaluation, based on beneficial partnerships between health professionals, patients and families. FCC may be particularly relevant for families with children with intellectual disability (ID), given their needs of continuum care.

Objective

To identify which components of the FCC are practiced and which health outcomes are considered effective in families with children with ID.

Method

A systematic review guided by the PRISMA STATEMENT 2020 approach and the STROBE reporting guidelines was performed on specific databases through the EBSCOhost Web platform: MEDLINE with Full Text, CINAHL PLUS with Full Text, Academic Search Complete and Psychology and Behavioral Sciences Collection. Peer-reviewed articles published in English or Portuguese languages from 2018 to September 2023 were retrieved. Methodological quality was established using the Quality Assessment Tool for Observational, Cohort and Cross-Sectional Studies - NHLBI, NIH.

Results

Ten studies met the eligibility criteria and were synthetized. The results revealed nine components, reflecting the way FCC was developed: shared decision-making; family education; respect for culture; family engagement; recognition of the family's needs, characteristics and interests; specialized care support; social and emotional support; family functionality; and family seen as a unit. The health outcomes demonstrate effective gains in improving children's health through family satisfaction with health services. Also achieved psychological and social benefits, with improved family well-being and quality of life, favoring family empowerment.

Conclusions

The evidence suggests that FCC components involves an effective partnership between the family and health professionals as the main key in developing care plans, as well as the experience that the family unit brings to the delivery of care. FCC approach include all family members as decision-makers, providing emotional, physical and instrumental levels of support. Health outcomes emerged in three strands; for children with ID, families and health services.

The barriers to family-centered care in the pediatric rehabilitation ward: A qualitative study

BACKGROUND

Family-centered care (FCC) is one of the fundamental principles of care provision to children with disability (CWD). It is based on the collaboration of healthcare providers, patients, and families. However, there is limited information about the barriers to FCC in pediatric rehabilitation settings in Iran. This study aimed at exploring the barriers to FCC in the pediatric rehabilitation ward.

METHODS

This descriptive qualitative study was conducted in 2022. Participants were nine rehabilitation staff and twelve mothers of hospitalized CWD purposively selected from the pediatric rehabilitation ward of hospital Rofeideh, Tehran, Iran. Rehabilitation staff were three nurses, a head nurse, a nursing manager, a medical specialist, a social worker, a physical therapist, and an occupational therapist. Eleven semi-structured interviews and three focus group discussions were conducted for data collection, and conventional content analysis proposed by Graneheim and Lundman (2004) was used for data analysis.

RESULTS

The three main categories of the barriers to FCC in the pediatric rehabilitation ward were family-related barriers (subcategories: knowledge about child rehabilitation, sociocultural background, and participation), staff-related barriers (subcategories: knowledge, ethical concerns, and collaboration), and organizational barriers (subcategories: factors related to FCC policies, managerial factors, environmental factors, and factors related to the coronavirus disease 2019 pandemic).

CONCLUSION

The barriers to FCC in the pediatric rehabilitation ward are very diverse due to the long-term course of child disability and long-term interaction of families with rehabilitation centers. Data collection from both families and rehabilitation staff helped acquire an in-depth understanding about these barriers. More in-depth explorations of family-related barriers such as sociocultural factors are essential to determine the reasons for family resistance to healthcare providers' recommendations to develop more effective care plans.