Furthering the understanding of parent-child relationships: a nursing scholarship review series. Part 2: Grasping the early parenting experience--the insider view

A systematic synthesis of qualitative studies on parents' experiences of participating in early intervention programs with their infant born preterm

Early intervention programs involving both the parent and the infant born preterm have demonstrated positive effects on developmental outcomes for the children. However, studies have also shown that parental engagement and adherence when implementing intervention programs can be challenging. The aim of this review was to provide a comprehensive description and new insights into key messages gleaned from the parent reports on participating in early intervention with their infant born preterm; knowledge vital to facilitate implementation of early interventions into clinical practice when using a model of direct parent involvement. Early intervention is broadly defined as a multi-interdisciplinary field provided to children from birth to five years of age to foster child health, wellbeing, development, adapting parenting and family function. For this systematic synthesis we define early intervention as programs with specific activities completed with the infant during the first year after birth. We assembled qualitative interview studies on parents' experiences with participation in early intervention and applied Malterud's qualitative systematic meta-synthesis to synthesize and translate the original findings across studies. In the analysis we applied enactive concepts of embodiment, autonomy, participatory sensemaking, and agency. 10 qualitative studies were identified and included. The systematic synthesis reveals how parents' successful and meaningful participation in early intervention programs were facilitated by their "active embodied doing." The "embodied doing" appeared as the basis for the parents' sense-making processes, development of confidence, and the ability for parents to see new possibilities for actions within themselves, with and in the child. In that respect, a perception of mutuality in the interaction between parent, infant and interventionist was central. Consequently, an important consideration when implementing early intervention into clinical practice is to promote embodied parent-infant interactions as well as trust between the parent and the interventionist.

Correlates of loneliness and dissatisfaction following SARS pandemic lockdown: Child and parent perspective

Background Studying loneliness among children is important because it causes much social pain and is considered to be a risk factor for many mental and physical problems. Methods We did an online survey between July and September 2020 among students and their parents from a cluster of government and private schools chosen from north, south, east and west of Chandigarh. The survey consisted of child and parent versions of the Loneliness and Social Dissatisfaction Questionnaire, Parent-Child Relationship (PCR) Questionnaire and Conflict Behaviour Questionnaire SF. Parental distress was assessed using the Depression, Anxiety and Stress Scale-21. Results The majority of children and parent participants reported high loneliness and dissatisfaction among children. A significant positive association was found between children and parent reported loneliness and dissatisfaction, and between child reported PCR and parent perception of PCR. A child's appraisal of her loneliness had a significant negative association with depression among parents. Parent's perception of child loneliness and dissatisfaction was negatively associated with PCR and parental anxiety. High loner boys reported poor quality of relationship and more conflicts with their parents than girls. Children who share cordial relations with their parents had fewer conflicts and also scored low on loneliness. Conclusion These results suggest that the issue of loneliness and dissatisfaction among children has attained epidemic proportions in the Covid-19 era, and active interventions are needed to safeguard the mental health of children. Our study emphasizes the need to plan guidance strategies with a joint effort of schools and families to strengthen within family relations of children.

Two-year motor outcomes associated with the dose of NICU based physical therapy: The Noppi RCT

BACKGROUND

Interventions involving both the parent and the preterm infant have demonstrated lasting effects on cognitive outcomes, but motor effects are less salient. It remains unclear when to commence early intervention and if dosages have impact on motor outcomes.

AIMS

To examine the effect on motor performance at 24-months corrected age following a parent-administered intervention performed with infants born preterm in the NICU. Intervention dosing and longitudinal motor performance were also analyzed.

STUDY DESIGN

Single-blinded randomized multicenter clinical trial.

SUBJECTS

153 infants born, gestational age ≤ 32 weeks at birth, were randomized into intervention or control group.

OUTCOME MEASURES

Infant Motor Performance Screening Test, Test of Infant Motor Performance, Peabody Developmental Motor Scales-2.

RESULTS

No significant difference was found between the intervention and the control group assessed with the PDMS-2 at 24-months CA. However, a significant positive association was found between dosing and the Gross Motor and Total Motor PDMS-2 scores. Analysis of longitudinal motor performance showed a decreasing motor performance between 6- and 24-months corrected age in both groups.

CONCLUSIONS

There was no difference in motor performance between groups at 24-months corrected age. However, increased intervention dosage was positively associated with improved motor outcome.

Health Equity and Disparities in ROP Care: A Need for Systematic Evaluation

Retinopathy of prematurity (ROP) is a vasoproliferative retinal disorder that can have devastating visual sequelae if not managed appropriately. From an ophthalmology standpoint, ROP care is complex, since it spans multiple care settings and providers, including those in the neonatal intensive care unit (NICU), step down nurseries, and the outpatient clinic setting. This requires coordination and communication between providers, ancillary staff, and most importantly, effective communication with the patient's family members and caregivers. Often, factors related to the social determinants of health play a significant role in effective communication and care coordination with the family, and it is important for ophthalmologists to recognize these risk factors. The aim of this article is to (1) review the literature related to disparities in preterm birth outcomes and infants at risk for ROP; (2) identify barriers to ROP care and appropriate follow up, and (3) describe patient-oriented solutions and future directions for improving ROP care through a health equity lens.

Effects of a Parent-Administered Exercise Program in the Neonatal Intensive Care Unit: Dose Does Matter-A Randomized Controlled Trial

BACKGROUND

Despite the risk of delayed motor development in infants born preterm, knowledge about interventions in the neonatal intensive care unitt (NICU) and the effects of dosing is sparse.

OBJECTIVE

The objectives of this study were to examine the effectiveness of a parent-administered exercise program in the NICU on motor outcome at 3 months corrected age (CA) and the effect of dosing on motor performance.

DESIGN

This was a randomized clinical trial.

SETTING

The study was conducted at 3 university hospitals in Tromsø, Trondheim, and Oslo, Norway.

PARTICIPANTS

A total of 153 infants with gestational age <32 weeks at birth were randomly assigned to intervention or control groups.

INTERVENTION

A 3-week parent-administered intervention designed to facilitate movements in preterm infants was performed in the NICU. Parents were asked to administer the intervention 10 minutes twice a day.

MEASUREMENTS

Test of Infant Motor Performance (TIMP) was used to assess short-term outcome at 3 months CA.

RESULTS

No significant difference in the TIMP z-score was found between intervention and control groups at follow-up 3 months CA, but a significant positive relationship was found between total intervention dose and TIMP z-scores. The adjusted odds of having a clinical z-score < 0 at 3 months CA was about 6 times higher for infants with less than median intervention time than for infants with a longer intervention time.

LIMITATIONS

The number of infants born before 28 weeks was small. A spillover effect in favor of the control group was possible. We do not know if the infants received physical therapy after discharge from the hospital.

CONCLUSIONS

There was no difference in motor performance between the intervention group and the control group at 3 months CA. However, an increased intervention dose was positively associated with improved motor outcome.

Factors Affecting Time NICU Nurses Spend With Fathers: Results From a Larger Study

BACKGROUND

Father involvement in the neonatal intensive care unit (NICU) is important for outcomes of children and should be encouraged. Neonatal nurses have been identified as a major source of support for fathers; yet, nurses have identified obstacles to family-centered care of the father.

PURPOSE

The purpose of this article is to present results that broaden the knowledge of factors that affect time NICU nurses spend with fathers. The information presented here is a portion of results from a larger survey that examined factors affecting NICU nurse caring beliefs of fathers.

METHODS

This survey study included NICU nurses and was administered anonymously online. Content analysis was completed on responses to open-ended questions.

RESULTS

Questions asked nurses about the time they spend with fathers. Nurses described problems with workflow and encouraged family bonding. Some nurses described spending equal amounts of time with both parents, whereas others focused on either the mother or the father. Paternal attributes that affected time nurses spent with fathers included confidence, motivation, level of competence, beliefs, attitudes, and availability. Maternal factors included culture and gatekeeping. Infant factors were level of illness and tolerance to activity.

IMPLICATIONS FOR PRACTICE

Unmotivated fathers may benefit from encouragement from nurses to participate in the care of their infants. Nurses can encourage parental partnerships in caring for their infants.

IMPLICATIONS FOR RESEARCH

Factors identified in this study can help guide future studies. Understanding the relationship between NICU fathers and nurses can help improve interactions and communication.

Transition From Hospital to Home in Parents of Preterm Infants: Revision, Modification, and Psychometric Testing of the Questionnaire

BACKGROUND AND PURPOSE

Transition from hospital to home in parents of prematurely born infants can be challenging. This methodological study aimed to develop an instrument to measure transitional problems in parents after hospital discharge.

METHODS

Kenner's Transition Questionnaire was modified based on findings of the literature review and a qualitative study. Content validity of the revised tool was determined by a panel of experts, and field testing was conducted via an online survey of parents of preterm infants (N = 704). Exploratory factor analysis (principal axis factoring and direct oblimin rotation) was performed.

RESULTS

Results showed four correlated factors in parental transition from hospital to home: Isolation, Worry, Confidence, and Professional Support (17 items total). Factor loadings ranged from .59 to .87, and reliability estimates ranged from .77 to .87.

CONCLUSION

The revised instrument demonstrated adequate psychometric characteristics; further testingand validation of the instrument is warranted.

Using Play to Improve Infant Sleep: A Mixed Methods Protocol to Evaluate the Effectiveness of the Play2Sleep Intervention

BACKGROUND

One in four Canadian families struggle with infant sleep disturbances. The aim of this study is to evaluate Play2Sleep in families of infants with sleep disturbances. In addition to parental education on infant sleep, Play2Sleep uses examples from a video-recorded, structured play session with mothers and fathers separately to provide feedback on parent-infant interactions and their infant's sleep-related social cues. The quantitative phase will answer the research question: Does one dose of Play2Sleep delivered during a home visit with mothers and fathers of infants aged 5 months reduce night wakings at age 7 months? The qualitative phase will answer the research question: What are parental perceptions of family experiences, processes, and contexts related to Play2Sleep and infant sleep? The overarching mixed methods research question is as follows: How do parental perceptions of family experiences, processes, and contexts related to infant sleep explain the effectiveness of Play2Sleep?

METHOD AND ANALYSIS

An explanatory sequential mixed methods design will be used. In the quantitative phase, a randomized controlled trial and RM-ANOVA will compare night wakings in infants whose parents receive Play2Sleep versus standard public health nursing information. Sixty English-speaking families (mothers and fathers) of full-term, healthy, singleton, 5-month-old infants who perceive that their infant has sleep disturbances will be recruited. The primary outcome measure will be change in the number of night wakings reported by parents. The qualitative component will use thematic analysis of family interviews to describe parental perceptions and experiences of infant sleep. Mixed methods integration will use qualitative findings to explain quantitative results.

DISCUSSION

Play2Sleep is a novel approach that combines information about infant sleep with personalized feedback on parent-infant interactions and infant cues. Including fathers and mixed methods should capture complex family experiences of infant sleep disturbances and Play2Sleep. If effective, Play2Sleep has possible application for preventing infant sleep disturbance and tailoring for other populations.

CLINICAL TRIAL REGISTRATION

www.ClinicalTrials.gov, identifier: NCT02742155. Registered on 2016 April 23.

Metaanálisis: efecto de las intervenciones para disminuir el nivel de estrés en padres de prematuros

Introducción: El nacimiento prematuro de un bebé genera estrés en los padres, por el riesgo de aumento en la morbimortalidadque esto conlleva. Existen intervenciones que disminuyen el nivel de estrés en los padres beneficiando a su vez el neurodesarrollo delrecién nacido. Objetivo: Categorizar los principales componentes de los programas de intervención temprana y determinar el efecto deestas intervenciones en la disminución del nivel de estrés en padres de prematuros hospitalizados. Método: Meta-análisis con 9 ensayosclínicos controlados, que cumplieron los criterios de rigurosidad metodológica. Resultados: las intervenciones aplicadas a los padresde prematuros hospitalizados, mostraron efecto de intensidad media-baja sobre el nivel de estrés percibido (d=0,36 IC [-0.68, -0,05]).Sin embargo, las pruebas de heterogeneidad indican alta variabilidad inter-estudio (Q(df=8) = p-val: <0,00001), I2=85% ), explicadaparcialmente por las características moderadoras codificadas para los estudios. Conclusiones: aunque las intervenciones mostraronefectos positivos en la disminución del nivel de estrés en los padres, se evidencia que la educación y el apoyo emocional en conjunto logranun mejor efecto. Las futuras investigaciones deben analizar aspectos como calidad de los estudios, intervenciones con apoyo emocional,edad de los padres y diversidad en los contextos de aplicación.

Transition From Hospital to Home in Preterm Infants and Their Families

When the day of discharge from a neonatal intensive care unit (NICU) comes for the parents of newborn infants, they are filled with long-awaited joy and happiness. They go home feeling as parents, away from scheduled routines of the hospital, monitor alarms, clinical rounds, numerous tests, and so on. What do we know about what happens after these little patients and their families leave the NICU? What happens from the point of leaving the hospital until when things get settled and life becomes perceived as normal? This article presents a short summary of research conducted with the vulnerable population of high-risk and preterm infants and their families postdischarge. Available evidence suggests that transition to home after hospital discharge, a phenomenon that many families experience, is challenging and requires attention from clinicians and researchers if we are to provide effective, efficient, and high-quality care.

Transition From Hospital to Home in Parents of Preterm Infants: A Literature Review

Transition from hospital to home is a complex and multidimensional phenomenon for parents of prematurely born infants (<37 weeks of gestation). The absence of a clear conceptualization of this particular transition coupled with the challenges parents have when they return home and higher costs of healthcare service usage postdischarge dictates the need for a better understanding of this phenomenon. A literature review was undertaken using Whittemore and Knafl's theoretical framework for integrative review as a guide. A systematic search of the electronic databases (PsycINFO, PubMed, Medline, Cumulative Index of Nursing and Allied Health Literature, EMBASE, Cochrane Database for Systematic Reviews, and EBSCO) was performed. Fifty selected reports of research conducted on parents of preterm infants during 1980-2014 are included in this article. Five themes emerged from the review-disruption of parental role development, distorted development of parent-infant relationships, psychological consequences of a preterm birth and infant hospitalization, learning caregiving and parenting, and need for social and professional supports-which appear to reflect parental challenges during transition from hospital to home after discharge. Several inconsistencies in results of the studies dictate the need for further research in this vulnerable population; the better conceptualization and measurement of transitional challenges are warranted.

Effect of Skin-to-Skin Holding on Stress in Mothers of Late-Preterm Infants: A Randomized Controlled Trial

PURPOSE

To examine the effect of skin-to-skin care (SSC) on stress perception between mothers who provided SSC to their late-preterm born infants and mothers who provided blanket holding.

DESIGN AND METHODS

This was a longitudinal 2-group randomized controlled trial of 40 infant-mother dyads recruited from a level 3 neonatal intensive care unit in the upper Midwest.

OUTCOME MEASURE

Maternal stress was measured using the Parental Stressor: Neonatal Intensive Care Unit (PSS: NICU) scale pre- and post-SSC intervention. Demographic and other mother and infant covariates were extracted from medical records. Physiologic stability was measured by the Stability of the Cardiorespiratory System in Preterm Infants (SCRIP) score. Study personnel used daily logs to track frequency and duration of SSC and holding sessions.

RESULTS

The intervention and the control groups had similar pre- (mean ± standard deviation, 2.34 ± 0.86 for SSC and 2.94 ± 0.87 for holding) and post-intervention (mean ± standard deviation, 2.55 ± 0.95 for SSC and 2.78 ± 0.90 for holding) overall stress scores. Hours of SSC holding positively correlated with the change in stress scores for the entire scale (r = 0.58; P = .001), and for infant appearance (r = 0.58; P = .001) and parent role alteration (r = 0.48; P = .02) subscales. This relationship remained significant after controlling for the infant's length of stay and SCRIP score.

IMPLICATIONS FOR PRACTICE

Mothers who provide SSC may experience more stress related to a more facilitated progression in the mother and infant relationship.

IMPLICATIONS FOR RESEARCH

The relationship between increased stress and the number of hours of SSC holding warrants further investigation.

Tasks and communication as an avenue to enhance parenting of children birth-5 years: an integrative review

Every day, normative functions of parenting and their significance are under-investigated. An integrative review of tasks and communication involved in parenting young children informed by Horowitz (1995) and Blumer (1969) was conducted.Research articles consistent with inclusion criteria were published from 1995 to 2013 and focused on parenting tasks and communication. Themes consistent with Horowitz and Blumer were identified. Nurses are reminded about the significance of attending to the everyday, normative work of parenting young children, the potential meaning derived from this work, and the importance of assessing parental development as well as the importance of continuing research in this area.

Academic outcomes of very low birth weight infants: the influence of mother-child relationships

It is commonly accepted that parent-child interactions are bidirectional and complex and are influenced by many different factors. The current study examined the academic and behavioral skills in the early elementary years of preterm infants and the influence of their early mother-child interactions on these skills. Using a sample of 21 premature infants and their mothers, this study found that positive early interactions during feeding were related to later mutual enjoyment during a teaching task at school age, but early maternal depression was not. Early risk factors of premature infants, specifically the number of days spent on a ventilator, were positively related to maternal perceptions of hassle associated with feeding and negatively related to maternal sensitivity during feeding. Finally, mutual enjoyment was strongly associated with language, cognitive, and behavioral skills at school age. These results suggest that it is not only the infant risk factors following a premature birth that influence later development but also the parent-child relationship and emphasize the importance of understanding and promoting these early positive parent-child interactions for premature infants.

'My special time': Australian women's experiences of accessing a specialist perinatal and infant mental health service

Women who have few social supports, poor health and a history of stressful life events are at risk of poor mental health during the perinatal period. Infants of parents whose parenting capacity is compromised are also at risk of adverse outcomes. Specifically, poor perinatal mental health can impact maternal-infant attachment. To identify women at risk of poor perinatal mental health, psychosocial assessment and depression screening in the antenatal and early postnatal periods are recommended. This qualitative study is part of a larger mixed methods study, which explored two specialist perinatal and infant mental health (PIMH) services in New South Wales (Australia). Eleven women who had accessed and been discharged from a PIMH service participated in either face-to-face or telephone interviews. Data were transcribed verbatim and analysed thematically. One overarching theme, 'my special time' and three sub-themes, 'there is someone out there for me', 'it wasn't just a job' and 'swimming or stranded: feelings about leaving the service', were identified. The themes describe the women's experiences of being a client of a PIMH service. Overall, women reported a positive experience of the service, their relationship with the clinician being a key component. Findings from this study highlight the importance of the relational aspect of care and support; however, women need self-determination in all therapeutic processes, including discharge, if recovery and self-efficacy as a mother are to be gained. Importantly, further research is needed about how clinicians model a secure base and how mothers emulate this for their infants.

Key components of early intervention programs for preterm infants and their parents: a systematic review and meta-analysis

BACKGROUND

Preterm infants are at greater risk for neurodevelopmental disabilities than full term infants. Interventions supporting parents to improve the quality of the infant's environment should improve developmental outcomes for preterm infants. Many interventions that involve parents do not measure parental change, nor is it clear which intervention components are associated with improved parental outcomes. The aim of this review was to categorize the key components of early intervention programs and determine the direct effects of components on parents, as well as their preterm infants.

METHODS

MEDLINE, EMBASE, CINAHL, ERIC, and Cochrane Database of Systematic Reviews were searched between 1990 and December 2011. Eligible randomized controlled trials (RCTs) included an early intervention for preterm infants, involved parents, and had a community component. Of 2465 titles and abstracts identified, 254 full text articles were screened, and 18 met inclusion criteria. Eleven of these studies reported maternal outcomes of stress, anxiety, depressive symptoms, self-efficacy, and sensitivity/responsiveness in interactions with the infant. Meta-analyses using a random effects model were conducted with these 11 studies.

RESULTS

Interventions employed multiple components categorized as (a) psychosocial support, (b) parent education, and/or (c) therapeutic developmental interventions targeting the infant. All interventions used some form of parenting education. The reporting quality of most trials was adequate, and the risk of bias was low based on the Cochrane Collaboration tool. Meta-analyses demonstrated limited effects of interventions on maternal stress (Z = 0.40, p = 0.69) and sensitivity/responsiveness (Z = 1.84, p = 0.07). There were positive pooled effects of interventions on maternal anxiety (Z = 2.54, p = 0.01), depressive symptoms (Z = 4.04, p <.0001), and self-efficacy (Z = 2.05, p = 0.04).

CONCLUSIONS

Positive and clinically meaningful effects of early interventions were seen in some psychosocial aspects of mothers of preterm infants. This review was limited by the heterogeneity of outcome measures and inadequate reporting of statistics. IMPLICATIONS OF KEY FINDINGS: Interventions for preterm infants and their mothers should consider including psychosocial support for mothers. If the intervention involves mothers, outcomes for both mothers and preterm infants should be measured to better understand the mechanisms for change.

More than information: a qualitative study of parents' perspectives on neonatal intensive care at the extremes of prematurity

PURPOSE

To describe parental perceptions of decision making concerning their extremely premature newborns who received care in a level III neonatal intensive care unit (NICU).

SUBJECTS

Seven parents of preterm infants who were born at 24 to 26 weeks' gestation at a western Canadian tertiary NICU.

DESIGN

Qualitative, interpretive description, semistructured interviews.

METHODS

The first author conducted interviews with both parents together or the mother alone. Interviews were recorded, transcribed, and analyzed.

RESULTS

Three main themes related to decision making, culture shock, and relationships emerged: (1) decision making before and in the NICU: moving beyond information, (2) culture shock in the NICU: plunging into a strange land, and (3) relationships in the NICU: enduring in a strange land.

CONCLUSIONS

Although information and decision making are interconnected and fundamental to parents' experiences of their preterm baby's NICU stay, they also identified the culture and language of the NICU and genuine relationships formed with healthcare professionals as significantly influencing their experiences.

Parental interaction with infants treated with medical technology

BACKGROUND

It is well established that parents must interact with their new-born babies to facilitate attachment. However, very little is known about how parents perceive different types of medical technology products commonly used in the neonatal intensive care unit (NICU) as barriers to their wish to interact with their infants.

AIM

This study aims to examine to what extent the different medical technology products commonly used in the NICU are perceived by parents to be obstacles in their wish to interact with their babies.

DESIGN AND METHODS

In 2010, a cross-sectional survey, using a questionnaire specifically developed for this study, was conducted among the parents of children who were discharged from any of the five NICUs of the Västra Götaland region in Sweden. A consecutive sample of 248 parents participated, and multiple regressions and t-tests were used to analyse the data.

RESULTS

The parents generally perceived the various medical technology products differently, according to the perceived level of obstruction. The variables of gender, age, educational level, origin, gestational age, previous experience of being a parent, and the offer of accommodation at the NICU were significantly associated with the perceived level of obstruction in the parents' wish to interact with their baby while the baby was being treated with different medical technology products.

CONCLUSION

The primary implication for practice is that to facilitate attachment, nurses should involve different categories of parents in different ways in the care of their children, depending on the equipment being used in the treatment of the children. Thus, the individual care plan should explicitly include the details of the specific medical equipment, because although its use is medically beneficial for the child, it is associated with potential liabilities regarding parent-child interaction and, consequently, regarding parent-child attachment.

Furthering the understanding of parent-child relationships: a nursing scholarship review series. Part 4: parent-child relationships at risk

PURPOSE

The purpose of this integrative review is to synthesize nursing scholarship on parent-child relationships considered fragile because of parent-child's chronic condition or occurrence within a risky context.

CONCLUSIONS

Most reviewed studies demonstrated negative effects of risk conditions on parent-child relationships and documented importance of child, parent, and contextual variables. Studies were predominately single investigations. Varying theoretical perspectives complicated interpretation. Mainly White, middle-class, and small samples limited generalizability. Important areas for further research were identified.

PRACTICE IMPLICATIONS

Nurse researchers identified factors that may interfere with the parent-child relationship. Nurses are in a position to support families under these circumstances.

Furthering the understanding of parent-child relationships: a nursing scholarship review series. Part 3: Interaction and the parent-child relationship--assessment and intervention studies

PURPOSE

This integrative review concerns nursing research on parent-child interaction and relationships published from 1980 through 2008 and includes assessment and intervention studies in clinically important settings (e.g., feeding, teaching, play).

CONCLUSIONS

Directions for research include development of theoretical frameworks, valid observational systems, and multivariate and longitudinal data analytic strategies.

PRACTICE IMPLICATIONS

Observation of social-emotional as well as task-related interaction qualities in the context of assessing parent-child relationships could generate new questions for nursing research and for family-centered nursing practice.

Furthering the understanding of parent-child relationships: a nursing scholarship review series. Part 1: Introduction

PURPOSE

Understanding the parent-child relationship is fundamental to nursing of children and families. The purpose of this integrative review is to explore nursing scholarship published from 1980-2008 concerning parent-child relationships. Study approaches are examined, critiqued, and future directions for research identified.

CONCLUSIONS

A historical review of nursing research is presented and methods described as an introduction to a review series of the parent-child relationship.

IMPLICATIONS

Definition and explication of the parent-child relationship is a first-step in understanding factors amenable to nursing intervention. A clear definition of the concept of parent-child relationship will support further study using appropriate theoretical frameworks, and enable development and testing of supportive nursing interventions.