Health Professionals' Perceptions and Practice of Family Centred Care for Children Injured in Road Traffic Accidents: A Qualitative Study in Ghana

Development of an atraumatic care education model based on family-centered care to improve maternal behavior in reducing children's stress during hospitalization

PURPOSE

this study aimed to develop an atraumatic care education model based on family centered care to improve maternal behavior in minimizing hospitalization stress.

DESIGN AND METHODS

This study utilized a quantitative research design with a cross-sectional approach. A total of 120 mothers of hospitalized children were selected through purposive sampling. A self-designed questionnaire was administered, which included sections on nurse competency, maternal factors, service factors, and learning facilities. Data analysis was conducted using inferential statistics, specifically employing Smart PLS for structural equation modeling (SEM).

RESULTS

The results indicated that the atraumatic care education model, based on family-centered care, was directly influenced by nurse competency (t = 2.829, p = 0.005), maternal factors (t = 3.237, p = 0.001), service factors (t = 4761, p = 0.000), and learning facilities (t = 2.005, p = 0.046). However, none of these factors had a significant impact on maternal behavior in reducing child hospitalization stress (t = 0.970, 0.794, 0.039, 1.290; p = 0.333, 0.429, 0.969, 0.198). On the other hand, the atraumatic care education model based on family-centered care was found to directly influence maternal behavior in minimizing child hospitalization stress (t = 34.065, p = 0.000).

CONCLUSIONS

The atraumatic care education model based on family-centered care, includes four key variables: nurse competency, maternal factors, service factors, and learning facilities. This model can be used as a framework to enhance maternal behavior in reducing stress associated with child hospitalization.

PRACTICAL IMPLICATIONS

The findings suggest that the atraumatic care education model based on family-centered care, can be a valuable tool in improving maternal behavior and reducing stress during child hospitalization. Healthcare providers, especially pediatric nurses, should focus on enhancing their competency in delivering atraumatic care education, as well as addressing factors related to the mother, the quality of services, and the availability of learning resources.

Context matters: examining factors influencing the implementation of evidence-based family systems care for small and sick newborns across the care continuum

Introduction

The health and wellbeing of small and sick newborns and their families can be enhanced through family systems care (FSC) along the care continuum. FSC encompasses a broader approach than family-centered care. FSC identifies individual and family strengths while acknowledging illness-related suffering and providing expertise to help soften it through relational family systemic interventions. Contextual factors of the targeted healthcare setting need to be understood to implement FSC. This study aims to assess healthcare professionals' perceptions of health system features that may influence the successful context-adapted implementation of FSC into the care continuum for small and sick newborns and their families in the Ghanaian healthcare setting.

Methods

Cross-sectional data were collected from 143 healthcare professionals, comprising nurses, midwives, and physicians who provide maternal and newborn care at a secondary facility and 13 primary health facilities in the Hohoe Municipality, Ghana. The Context Assessment for Community Health (COACH) instrument, employing Likert scales ranging from 1 to 5 and including questions on training history, was used to collect data on FSC through self-administered interviews. Data were analyzed using descriptive statistics with STATA.

Results

While 48.9% of healthcare professionals reported never receiving any didactic or school-based training, the majority (96.5%) indicated a need for in-service training in FSC. From the highest score of 5, the COACH dimension for organizational resources had the lowest score (2.8). Community engagement, commitment to work, monitoring services for action, and informal payment reported scores between 3.7 and 3.9. The highest scores were reported for the leadership and work culture dimensions, at 4.1 and 4.2, respectively. Among the different units of the care continuum, the largest variations were observed in the subdimensions of organizational resources (2.5-3.4) and informal payment (3.6-4.4).

Conclusion

The COACH tool provided contextual guidance for developing training strategies to implement a contextually appropriate FSC program in Ghana, which is likely to be adaptable and relevant in other low- and middle-income countries. Healthcare professionals perceive themselves as committed, with a favorable work culture and a positive perception toward their leaders, but they report limited resources and challenges in accessing knowledge sources. These findings indicate a readiness for FSC training along the continuum of care in the perinatal period.

Developing conceptual guidelines for Family-Centered Care for standard ICU practice: A constructivist grounded theory

PURPOSE

To explore the constructs of family-centered care (FCC) from the perspectives of nurses, doctors, and families in the intensive care units (ICU) and to develop FCC guidelines for ICUs.

DESIGN

A constructivist grounded theory (CGT) design was employed.

METHODS

We conducted 12 individual interviews and triangulated the data with 12 focus group discussions (FGDs) using an interview guide from February to December 2020. The interviews and the FGDs were conducted face-to-face. Data was analyzed using CGT analysis. The data analysis was assisted by MAXQDA version 2020 plus. The study was guided by the 32-COREQ checklist.

RESULTS

The participants (72) were nurses (n = 28), doctors (n = 8), and family (n = 36). Four themes were generated: respect, family support, participation, and collaboration. Each theme had subthemes to illuminate the participants' perspectives of the FCC constructs.

CONCLUSION

This study revealed that nurses and doctors had positive perspectives of FCC in the ICU and are willing to accept and implement it into standard ICU practice. Four main constructs of FCC emerged from this CGT study: respect, family support, participation, and collaboration and were used to develop a conceptual guideline.

PRACTICE IMPLICATION

FCC implementation in the ICU may be facilitated by designing family-inclusive ICUs with spacious subunits, kangaroo rooms, family areas, provision of counselling, as well as adopting regular and effective communication guidelines, and adequate staff training. Conceptual guidelines for FCC have been developed to promote FCC in standard ICU practice.

Higher and Middle Management Perspectives on Patient-Centered Care in an Oncology Setting: A Qualitative Study

BACKGROUND

Patient center care (PCC) plays a crucial role in achieving the organizational and patient outcomes. Literature suggests that PCC enhance patient's adherence to treatment, lower the cost of health care organization. This study aimed explore the higher and middle managers' perceptions of patient-centered care (PCC) in an oncology setting, identify the PCC implementation challenges in the oncology setting, and understand the role of managers in facilitating PCC within the oncology context.

METHODS

Sampling involved the use of the purposive sampling technique on 17 middle managers and 6 upper managers who had been working in an oncology setting. The six-step thematic analysis method was used for data analysis.

RESULTS

The interviews identified six main themes and seventeen subthemes: "comprehensive care, partnership, and informed decision-making", "infrastructure and support systems", "leadership influence on patient-centered care", "cultural and operational barriers", "perceived outcomes", and "strategies to enhance PCC in oncology". The subthemes of comprehensive care included fostering partnerships and enabling informed decisions. The infrastructure and support systems encompassed educational empowerment and service integration. Leadership influence highlighted the role of elevating awareness, providing organizational support, and promoting comprehensive care. The cultural and operational barriers addressed the challenges faced in implementation. The perceived outcomes focused on the results of patient-centered care, while strategies to enhance PCC in oncology provided actionable insights for improvement. This provides a comprehensive understanding of the perceptions of middle and higher managers on patient-centered care (PCC) in oncology settings. It identifies key challenges in PCC implementation, highlights the critical role of managers in facilitating PCC, and offers actionable strategies for enhancing PCC.

Nurses' beliefs and perceptions regarding family-centered care services in acute pediatric healthcare settings

OBJECTIVES

To describe pediatrics nurses' beliefs about family-centered services (FCS) as a model of providing healthcare to children in acute care settings in Jordan.

DESIGN AND METHODS

This is a cross-sectional descriptive study. Nurses who provide direct acute care to children (n = 246) completed the 'Measure of Beliefs about Participation in Family-Centered Service' questionnaire. Descriptive statistics were used to describe nurses' beliefs about participation, practical feasibility, implementation self-efficacy, principles, and potential adverse outcomes of FCS.

RESULTS

Many nurses feel confident (70%) about their ability to work with others in providing FCS and perceive having the ability to operate according to family-centered care (FCC) principles (68%). Many (75%) nurses believed parents should be encouraged to decide how much they want to be involved in the child's care. However, only 46% of the nurses valued attending to family priorities if the health decisions made by the family differed from the healthcare providers' priorities. Many nurses (70%) believed that healthcare professionals' competencies and capacities to work utilizing FCC are more important than their personal preferences and opinion.

CONCLUSIONS

The findings of this study clearly indicate that nurses positively viewed providing children's care within a FCS. This supports the efforts to reasonably integrate FCC as an operating model in the pediatric healthcare settings in Jordan.

PRACTICE IMPLICATIONS

FCS is a complex task requiring integrating multidisciplinary effort and healthcare providers' positive attitudes toward families as care partners. Steps should help maximize the organizational resources to facilitate family presence and create opportunities for professional-families partnerships for children's care.

Fathers' experiences of caring for children living with cerebral palsy: A qualitative study in a low resourced socioeconomic context, Ghana

BACKGROUND

In Ghana, little is known about fathers' experiences caring for children with cerebral palsy.

PURPOSE

The purpose of this study is to explore a. the caregiving demand and burden on fathers of children with cerebral palsy and b. describe the caregiving consequences and coping strategies of fathers of children with cerebral palsy.

DESIGN AND METHODS

The study utilized an exploratory, descriptive qualitative approach with a sample size of fifteen fathers purposively selected. The study used a semi-structured interview guide to conduct a one-on-one interview with participants. The analysis performed was thematic and content analysis.

RESULTS

The results revealed complexities of care demand and burden; thus, meeting the child's needs resulted in physical and mental exhaustion, frequent hospital visits, and substantial financial implications for fathers.

CONCLUSIONS

We conclude that the family, particularly fathers, need support to embrace the challenging care roles as parents to children with cerebral palsy. It is evident that caring for children is mainly reserved for mothers in the African context. However, the demanding nature of care for a child with a developmental disability requires the involvement of both parents to meet the child's care needs and reduce the caregiver's care burden.

PRACTICE IMPLICATIONS

Health professionals, particularly nurses must initiate and advocate for fathers' active participation in daily childcare. Tailored supportive care for families with children with disabilities in sub-Saharan Africa is required.

Physical and socioeconomic burden of caregiving on family caregivers of children with cancer at a tertiary Hospital in Ghana

BACKGROUND

Childhood cancer is proportionately higher in Africa and these result in increased demands on caregivers. The inability of affected children to take care of themselves; coupled with prescribed medical interventions presents physical and social burdens on family caregivers.

AIMS AND METHODS

This study used a qualitative exploratory design to explore the physical and socioeconomic challenges for family caregivers of children diagnosed with cancer and receiving care at one of the biggest tertiary hospitals in Ghana. A total of thirteen family caregivers of children with cancer were interviewed.

FINDINGS

Two major themes were identified: Burden of care on Physical Health and Socioeconomic burdens of caregiving on the family caregiver. It was reported that family caregivers encounter physical challenges such as Aches and Pains when performing caregiving activities, Loss of Appetite, Fatigue, Compromised Functional State and Sleep Disruption. The second theme, Socioeconomic burdens of caregiving on family caregivers account for the consequences of caregiving on social lives, family relationships, finance and employment.

CONCLUSIONS AND RECOMMENDATIONS

The study recommends that measures that provided relief for the caregivers such as teaching them to adopt local measures of pain relief such as massage should be encouraged. Policies should adopt measures that encourage caregivers to have some days of rest whiles providing care to their children with cancer. Also, health insurance packages that provide relief for the cost of accessing healthcare, should be extended to children with cancers to support their caregivers.

"Mind the gap": Exploring pediatric nurses` perceptions of the theory and practice of caring for children and families

PURPOSE

To investigate how pediatric nurses interpret and conceptualize theoretical underpinnings and daily practice scenarios pertaining to their role in pediatric care.

DESIGN AND METHODS

139 pediatric nurses completed a survey in which they were asked to endorse to what extent practices related to pediatric concepts are expected from their role ("Expected") or are actually implemented in their clinical work ("Actual"). Survey items were derived from a nursing textbook that outlines the theoretical tenets of the "art of pediatric nursing", along with scenarios and conflicts encountered in everyday practice, covering family-child centered care, child growth and development, and emotional boundaries.

RESULTS

In both Expected and Actual practices, the highest level of endorsement was for items focused on core elements of family-centered care (80-96%), and moderate-low endorsement levels were observed for items related to therapeutic relationship management and emotional boundaries. A factor analysis yielded 12 factors representing themes related to pediatric nursing. However, the division of items per factor indicated diffusion between key concepts and a discrepancy between theory and practice, especially in regard to maintaining emotional separateness and objectivity, advocacy, managing conflicts within the nurse-child-family triad, and navigating oneself boundaries.

CONCLUSIONS

Nurses' ability to manage and contain various types of unclear boundaries is crucial for optimal care provision when working with children and families.

PRACTICE IMPLICATION

Variability in nurses' theoretical role-perception and practical care provision is largely attributed to the way they navigate various ambiguous boundaries in practice and this could be a focal point in educational programs and on-the-job training.

Socio-cultural barriers to the delivery and utilisation of child healthcare services in rural Ghana: a qualitative study

BACKGROUND

Over half of global deaths among children under five years of age occur in sub-Saharan Africa. Prompt and consistent access to and utilisation of child healthcare services improves child health outcomes. However, socio-cultural barriers impede the utilisation of child healthcare services among rural dwellers in Ghana. There is a paucity of studies that explore the experiences of nurses and caregivers regarding the socio-cultural barriers to the delivery and utilisation of child healthcare services in rural areas in Ghana such as the Nkwanta South Municipality.

PURPOSE

The purpose of this study was to explore the experiences of nurses and caregivers regarding the socio-cultural barriers that impede the delivery and utilisation of child healthcare services by caregivers for their children in the Nkwanta South Municipality, Ghana.

METHODS

Data were collected through semi-structured interviews conducted with a purposive sample of ten nurses and nine caregivers of children under five years of age who utilised the available child healthcare services in a rural setting. The consent of all participants was sought and given before interviews were conducted. Data analysis entailed coding and the generation of themes the codes.

RESULTS

The exploration of experiences of nurses and caregivers of children under-five years of age revealed that certain socio-cultural beliefs and practices, language barriers and reliance of caregivers on self-medication were the main socio-cultural barriers that impeded the delivery and utilisation of child healthcare services in the Nkwanta South Municipality.

CONCLUSION

Nurses and caregivers experienced several socio-cultural barriers which either delayed care seeking by caregivers for their sick children or interfered with the smooth and prompt delivery of needed child healthcare services by nurses. Some of the barriers negatively affected the interaction between nurses and caregivers with the tendency to affect subsequent child healthcare service utilisation. It is recommended that healthcare managers and nurses should foster close collaboration with caregivers and community leaders to address these socio-cultural barriers and facilitate prompt and consistent utilisation of child healthcare service in rural areas.

The Image of Nurses and Midwives in Ghana: Patient and Family Perspectives

This study aims to explore the perceptions of patients and family caregivers on the image of nurses and midwives in Ghana. The study adopted a qualitative exploratory descriptive approach. A total of 25 participants were interviewed during data collection. Content and thematic analysis were applied in the data analysis to develop themes. The findings are captured under two major themes that describe the primary influences on participant images of nurses: Thus, (1) nurses' and midwives' attributes with four subthemes; staff appearance, communication strategies and behaviors, work attitudes, and professional competence and (2) patients' status and subthemes were; uneducated poor and educated rich. We conclude that patients and families in Ghana recognize the professional attributes of the nurse and midwife, which reflect in their personality, grooming, communication, competencies, and attitudes. However, low publicity of the professional roles of nurses and midwives may have negative repercussions for their professional image. A policy to perform a regular public audit on the image of the Nurse/Midwife is important for professional advancement.

Nurses' Perceptions and Attitudes toward Family-Centered Care in Acute Pediatric Care Settings in Jordan

PURPOSE

Perceptions and attitudes toward working with parents may influence nurses' family-centered clinical care practices. There is a paucity of research measuring family-centered care among nurses working with children and their parents in Jordan. The purpose of this study was to explore nurses' perceptions of family-centered care by examining nurses' attitudes toward working with children and their parents, as well as toward family-centeredness. Also investigated was the extent to which the selected demographic characteristics of nurses explain the discrepancies between their child- and parent-focused attitudes.

DESIGN AND METHODS

Using a cross-sectional descriptive study, 246 nurses completed the 'Working with families' questionnaire. A paired t-test used to compare the working with children versus working with parents' attitude scores, and independent t-test and ANOVA to explore the influence of nurses' demographic characteristics attitude scores.

RESULTS

The nurses scored higher for working with children than with parents, suggesting more positive attitudes toward the former than the latter (p < 0.001). The family-centeredness scores varied with nurses' years of clinical experience (p < 0.001) and years of employment (p < 0.005).

CONCLUSIONS

The applicability of the family-centered care model in Jordan's hospitals is challenged by the fact that pediatric nurses register more positive attitudes for working with children than with parents.

PRACTICE IMPLICATIONS

Nurses' attitude toward working with children's families requires more evaluation prior to implementing family-centered care in practice. Further research is needed to explore factors contributing to discrepancies between child- and parent-focused attitudes among nurses.