WIN October 2019

48 Focus

Family first

A lack of an agreed definition and clear understanding of family-centred care is a major barrier to its consistent and effective implementation, write Siobhan O’Connor, Maria Brenner and Imelda Coyne

The way in which children’s healthcare is delivered has changed dramatically over the past 60 years. Currently, many hos- pital-based services for children in Dublin are accommodated in facilities that are not fit for purpose. Consequently, children’s healthcare in Ireland is undergoing a major reconfiguration with the development of a new children’s hospital to replace the exist- ing three children’s hospitals in the city. The plan for acute children’s health ser- vices is outlined in the National Model of Care for Paediatric Healthcare Services in Ireland. 1 This publication describes how acute paediatric healthcare services are best provided within a national context, aiming to deliver acute paediatric health services as close to home as possible and with all specialised and national ser- vices consolidated centrally at the new children’s hospital. Regional and local units will receive clinical support from colleagues in the new hospital. This recon- figuration is in line with international best practice and is supported by national and international health policy reports. Evidence-based models of nursing care guide critical thinking and decision-making for professional practice. 2 Such frameworks support nurses in the assessment , planning, implementation and evaluation of care and the delivery of consistent, high quality patient care. 3 The Roper-Logan-Tierney model 4 and a modified version of the Nottingham

Table 1: Key attributes of family-centred care and their contributing attributes

Key attributes

Contributing attributes

Parental participation in care

• Parental participation in care • Parental involvement in care • Care-by-parent

Development of respectful and trusting partnerships

• A partnership formation with the child, family and the nursing team • The development of respectful and trusting relationships • Mutually agreed goals and a shared responsibility for the child’s care

Information sharing

• Communication and negotiation • Patient and family empowerment

All family members as care recipients

• Recovery process for the child and the family starts with caring for the family

model 5 were introduced in Dublin children’s hospitals during the 1990s. Evidence-based nursing care plans, which include the parents/guardians in the care of their sick child while in hospital, were developed to support the nursing models of care. These care plans continue to be in use today and are subject to ongoing audit, regular review and update to incorporate emerging evidence. Background to family-centred care Children’s nursing has been described as a partnership, where the process of nursing is carried out in partnership with the child and family. 6 This partnership approach to

children’s nursing is recognised as a pre- cursor to family-centred care as we know it today. 7 Although the term is widely used in children’s healthcare, there is no interna- tionally accepted definition. It is described as “a way of caring for children and their families within health services which ensures that care is planned around the whole family, not just the individual child/ young person, and in which all the family members are recognised as care recipi- ents”. 8 The core concepts of patient- and family-centred care have been described as dignity and respect, information shar- ing, participation and collaboration. 9

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