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This definition is not child or healthcare setting specific, it applies to patients of all ages in any setting. Family-centred care has evolved in an unstructured and unco-ordinated fashion without any formal theory or process of evaluation. This lack of an agreed definition and a clear under- standing of family-centred care has been cited as the main challenge to its consist- ent and effective implementation. 10,11 It is now timely to evaluate the appropriate- ness of family-centred care as a model of nursing care within which to deliver children’s nursing in the 21st century in Ireland. Concept analysis of family-centred care Concept analysis is widely acknowl- edged as a form of inquiry to develop the knowledge base of nursing and pro- vide clarification of the concept being analysed. 12 Family-centred care for hospi- talised children/young people was critically analysed to identify related concepts, sur- rogate terms, attributes, antecedents and consequences for the child, the child’s par- ents/guardians and children’s nurses. Surrogate terms – words or phrases wh i c h a re o f t en u s ed t o de s c r i be family centred care – included partner- ship-in-care, negotiated care and parent participation. Related concepts – a con- cept that bears some relationship to family-centred care – were identified as person-centred care, patient- and fami- ly-centred care and patient-centred care. The key attributes identified, and associ- ated attributes are listed in Table 1 . A number of antecedents that must be in place in order for family-centred care to occur were identified. These antecedents largely refer to the understanding of and attitudes of nurses and parents towards family-centred care (see Table 2) . The concept analysis revealed that there is some evidence that family-centred care enhances the hospital experience for both the child and parents as well as improving their wellbeing. 13 A lack of attention to cul- tural and societal changes, which impacts not only on those receiving care but also on those delivering care, was also high- lighted. Developments in the delivery of acute hospital care have resulted in shorter length of stay, increased patient through- put and, consequently, increased patient acuity. These factors reduce opportunities for the development of trusting relation- ships between families and nurses and pose challenges to the effective and con- sistent implementation of family-centred care in practice.
Table 2: Antecedents of family-centred care and related attributes
Antecedent
Related family-centred care attributes
Parents at the bedside
• Parental participation in care
Parent’s willingness to perform some aspects of their child’s care Staff willing to collaborate respectfully with parents and families Open, honest, respectful communication and negotiation
• Parental participation in care
• Respectful and trusting partnerships
• Information sharing • Respectful and trusting partnerships
Adequate time for communication
• Information sharing
Flexible visiting arrangements
• Parental participation in care • Family members as care recipients
Facilities for parents to be resident
• Parental participation in care
Literature review A literature review of primary research papers was also carried out. Reviewing the literature in qualitative research helps to position the proposed study within ongo- ing discussions and provides evidence to support the argument that the problem exists. 14 Five key themes were identified from the literature review: • The importance of parental presence with their hospitalised child in the context of providing comfort, emotional support and reassurance for the child • Parental willingness to participate in care of their sick child in hospital • The value of forming a partnership rela- tionship with members of the healthcare team • Family needs, including emotional, infor- mational and physical needs • The challenges and barriers experienced when attempting to effectively imple- ment family-centred care in practice. A review of the literature confirmed that the fundamental principles of fami- ly-centred care, as identified in the concept analysis, are key concerns of parents when their child is in hospital. There is evidence that children’s nurses have been applying some elements of family-centred care to their clinical practice for decades. However the concept continues to evolve, as does the context within which health services, including nursing, are organised and deliv- ered. It is evident from this review that parents wish to participate actively in the care of their child in hospital; the degree to which they wish to do so, however, varies and needs to be negotiated between the nurse and individual parent and child on an ongoing basis. 15,16
Implications for research and practice Despite extensive empirical research there is still no hard evidence to inform children/young people, their parents and the healthcare community if the applica- tion of a family-centred approach to care makes a difference to the child’s health outcomes or the family’s healthcare experience. Additionally, the voice of the child is noticeably absent from the literature. It is still unknown what the hospitalised child’s and parents’ experiences and expectations of family-centred care are, if family-cen- tred care supports parents to care for their child in hospital and if family-centred care supports parents and children to make informed healthcare decisions. Further research must examine these areas in the context of the current health- care delivery system and must reflect cultural diversity and social norms. The evidence generated will inform practice and promote consistent and effective implementation of a model of care that is truly child- and family-centred. It will also promote a move away from the cur- rent ad hoc implementation of the model to a more systematic and evidence-based approach. Siobhan O’Connor is a PhD researcher, Maria Brenner is director of research and Imelda Coyne is a professor of children’s nursing, all at the School of Nursing and Midwifery,Trinity College Dublin This research is in progress as part of a PhD study in conjunction with the School of Nursing and Midwifery in Trinity College Dublin and is funded by the National Children’s Hospital Foundation,based at Tallaght University Hospital References available on request by email to: nursing@medmedia.ie (quote O’Connor WIN 2019: 27 (8): 48-49)
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