NO, THANKS; I'D RATHER STAY AT HOME. MOTHERS WHO DO NOT WANT TO ACCOMPANY THEIR CHILDREN INTO HOSPITAL--THEIR CLASS, THEIR FAMILIES, AND THEIR READING HABITS

Questioning family-centred care

AIMS

This article poses topics for discussion around family-centred care as a model of care delivery to children and families in health services.

BACKGROUND

Family-centred care developed over three decades following awakening awareness that excluding parents during a child's hospital admission was detrimental to the child's mental health. Using resources from both past and current literature and existing research, I argue that it is time for a revision of practices and policies that espouse family-centred care as the optimum model of care in paediatrics. Once the historical development of family-centred care is discussed, current research shows a dearth of evidence about family-centred care, its use, implementation and applicability across cultures and nations.

DESIGN

Discursive.

METHODS

Five questions are discussed: is family-centred care relevant now? is it relevant only in Western countries?, what does it mean to implement family-centred care?, is family-centred care implemented effectively?, does it make a difference? Exemplars of good family-centred care practice are provided.

RESULTS

At this stage, it is difficult to know whether using family-centred care makes a difference to a child's and family's health outcomes, as there is no rigorous evidence to answer the question 'does it work?'

CONCLUSIONS

Nurses must undertake studies so we can either support the successful implementation of family-centred care, or abandon it in the best interests of children, families and health services.

RELEVANCE TO CLINICAL PRACTICE

Practitioners must be aware that family-centred care is a wonderful ideal that is almost impossible to implement and so new ways of delivering care to children may be needed.

Family-Centered Care in the Perioperative Area: An International Perspective

Family-centered care developed after research showed that children were emotionally compromised if separated from their parents during traumatic episodes. Few places within the health care system are more foreign and frightening to a child than the surgical department. Perioperative nursing evolved as a way to care for patients admitted to the OR for surgery. Family-centered care provides a model for the care of a child within the perioperative environment. This article examines the development of both family-centered care and perioperative nursing from a historical perspective and explains how family-centered care can be applied to perioperative nursing.

John Bowlby and James Robertson: theorists, scientists and crusaders for improvements in the care of children in hospital

AIMS

John Bowlby and James Robertson, two men who were extremely influential in the latter part of the 20th Century, combined scientific theory with evangelism to bring about changes in the way in which children were cared for in hospitals and other institutions. This paper discusses their work together, their theories and their influence on the care of children and paediatric nursing.

BACKGROUND

Bowlby and Robertson collaborated early in their working relationship on research about separation of mother and child. Bowlby was the scientist who developed classic theories about maternal separation. Robertson focused his research on separation of mother and child due to hospital admission. Between the two of them, they derived a classic theory about the phases of 'protest', 'despair' and 'denial' (Bowlby called this last stage 'detachment') through which small children pass when isolated from their mothers for a length of time.

DISCUSSION

Bowlby became an internationally recognized theorist, widely acclaimed and considered an expert in the field of maternal care and child development. Robertson, with his wife, Joyce, not only continued Bowlby's work investigating children separated from their mothers, but also took on the role of campaigner for the welfare of children in hospital. James Robertson, with his impressive speaking powers, established an international reputation proselytizing the need to admit parents to hospital with their children. The work of Bowlby and Robertson coincided with new knowledge about cross-infection, which had been one of the reasons for excluding parents from hospital wards. At the same time, and influenced by their work, community groups, which championed the idea of admitting parents with their children, developed. The combination of these factors provided a catalyst for changes within the health systems of many developed countries. Because of the theoretical work of Bowlby and Robertson's missionary zeal, government policies, staff attitudes and parents' expectations changed. Children's wards and hospitals in developed countries today admit parents as part of normal routine and actively involve them in the planning and implementation of their child's care.

Qualitative analysis of the care of children in hospital in four countries-Part 1

As part of a large study of the care of children in Australian, British, Indonesian, and Thai hospitals, qualitative methods were used to examine differences influenced by culture. Two groups were surveyed: parents of hospitalized children, and staff caring for them. Vignettes were used to invoke discussion, and content analysis was used to examine the data. Subjects were interviewed singly, or in focus groups. These interviews were audiotaped and transcribed verbatim. The data were explored by using content analysis to extract themes of understanding of cultural experiences. This article is the first of a two-part series, and includes a review of the literature, description of the methods used, and results of the parents' interviews. The staff results and discussion will be published in Part 2. Analysis revealed that parents in all countries were primarily concerned with treating the child's illness and the child's recovery. Parents were concerned with their work (employment), but this was a much larger consideration in Indonesia and Thailand, where no social security systems exist, than in Australia and Britain. Communication with staff was the most commonly mentioned theme for parents, indicating that irrespective of the culture in which the care was given, good communication between parents and staff was of paramount importance.

A review of the literature from developed and developing countries relating to the effects of hospitalization on children and parents

There is a literature base about the care of children in hospital in developed nations, but little from, or about, developing countries. The aim of this review was to critically examine publications relating to the effect of hospitalization on children and their parents. 'Parents', in this context, were considered as the child's natural or adoptive parents, step-parents or any other context of parent-child relationship, in other words, the primary care-giver to the child. Most of the work reviewed from developed countries was sourced from the nursing literature, while in developing countries, the available literature was largely from medicine. Conclusions from developed countries indicated that parents should be allowed to stay in hospital with their child, and that care must be developmental-stage appropriate. Furthermore, staff need to be educated about special needs of children, children should be prepared for hospital admission (if possible) and parents' needs met. In developing countries, the meagre literature available suggested that recognition of the important role parents play in a child's hospitalization is starting to become recognized.

"I want my mummy". Changes in the care of children in hospital

The Welfare of Sick Children in Hospital' was the formal title of a report published in Britain in 1959 which came to be known as the Platt Report, after Sir Harry Platt, the chairman of the parliamentary committee which investigated the care of children in hospital. The committee found the hospitals were miserable places for children, where they were expected to conform to ward routines, not allowed to play; where to lie quietly was the accepted norm, and where, under no circumstances, were the parents allowed to visit outside the declared visiting hours. Subsequent to the publication of the Platt Report a revolution occurred in children's hospitals in Britain and other western countries, including Australia. This paper explores these changes, and discusses implications for paediatric care in hospitals and paediatric nursing education today.

Parent participation: a concept analysis

Parent participation has become a central tenet of paediatric nursing in the United Kingdom. The purpose of this paper is to explore the meaning of parent participation, to clarify the concept to benefit children and their families, and to increase understanding among practitioners. The concept analysis utilized was directed by Rodgers' "evolutionary approach' that views concept development as an ongoing dynamic process. A review of British literature and research studies indicated that parent participation is a complex and multi-dimensional concept. In the evolution of parent participation, the terminology changed from "parental involvement' to "partnership in care', to "care-by-parent' and finally to "family-centred care'. The analysis reveals a lack of coherence in the descriptions, with the terminology changing but the underlying theme remaining parent participation. Parent participation can be conceptualized as a composite of attributes that relate to the family, the nurse and their relationships. Those attributes include: negotiation, control, willingness, competence and autonomy. The concept of family-centred care is gradually assuming importance in the literature. This acknowledgement of the family is long overdue. However the concept remains poorly defined and urgent clarification is needed in this area. To adopt a family-centred care approach, a radical paradigm shift is required.

Partnership in care: parents' views of participation in their hospitalized child's care

This paper describes parents' experiences of participation in their hospitalized child's care on a general surgical paediatric ward. The findings indicate that parents chose to participate because of concern for the child's emotional welfare. Influencing factors included sense of parental duty, past experiences with hospitals, and concern for consistency of care. Parents' readiness to care was encouraged by a supportive family network, support from other parents, familiarity and experience with care. Parents were willing to adapt their parenting skills in order to be able to care for their child at home and were willing to perform more care provided it did not cause pain for the child, had the nurses' approval and increased their confidence and competence as carers. Lack of information, non-negotiation of roles, inadequate facilities, feelings of anxiety and loneliness were the difficulties parents experienced.

Mother and child in hospital--two years' experience

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