Family centered care (FCC) has been adopted as a philosophy of care for pediatric nursing (Indian Nurses Association and Society of Pediatric Nurses, 2003 ). Providing FCC means that the clinician incorporates into care giving the knowledge and conviction that family is the constant in children’s lives, children are affected by and affect those with whom they have relationships, and, by including families in care processes, children will receive higher quality care. Formally adopting FCC as the philosophy of care for pediatric nursing serves to provide a framework for pediatric nurses to take on the responsibility and the goal to care for infants and children in ways that not only support and promote physical health but that support and promote the healthy emotional and psychological development that occurs in the context of the family. The purpose of this paper is to examine the current state of pediatric nursing research related to FCC and to propose directions for future study. Other specialties within nursing, as well as other health care disciplines, have adopted a family centered approach to providing care.
Historically, hospitalized children in the early half of the twentieth century were cared for exclusively by health professionals and visitation by parents was either extremely restricted or completely prohibited. Attitudes and practice began to change in the 1950s and 1960s largely who demonstrated serious emotional, psychological, and developmental consequences of separation between mother and child, And who focused specifically on direct observations of hospitalized children, documenting child behavior changes associated with separation from the mother. As a result of their work, attitudes began to change and articles appeared in the nursing literature advocating not only increased visiting hours, but allowing the mother to room-in with her child. These changes in practice and policy were supported and made more compelling with the publication of seminal research demonstrating that hospitalized toddlers cared for in institutions allowing mothers to room-in were significantly less likely to experience serious emotional and behavioral problems after discharge when compared with toddlers cared for in institutions with restricted visitation. Although the focus was limited to effects of the mother’s presence, she concluded that changes in the roles and attitudes of nurses when a child was hospitalized were needed with the goal of “encouraging the mother to become a participant in the hospital experience”.
The earliest description of the multiple components of family centered pediatric nursing care was provided by the proposal for improving health care services delivered to children and families . The proposal focused on addressing the psychosocial, as well as physical, needs of children and families and included attending to the relationship of children with their families. This emphasized that nurses must make a deliberate effort to establish a relationship with parents that fostered understanding of parents’ as well as children’s needs concerning adapting to illness and hospitalization. This focus was on significant changes in the philosophy and practice of educating pediatric nurses, but recognized other aspects of health care that would need to be addressed for successful adoption of this new philosophy. These included changes in hospital practices so parents could stay with and care for their hospitalized child, provision of home care services for sick children who could safely be cared for at home, and education of staff nurses and other hospital personnel. The components of care described in Blake’s proposal included many of the components currently associated with FCC, such as caring for the child in the context of family, facilitating parent participation in care, identifying and supporting family strengths, caring for children within the context of their development, providing information to children and families, recognizing that each family is unique, and designing health care that is flexible and responsive to families.
These components of family centered pediatric care were examined by nurse leaders from a large metropolitan children’s hospital in several articles providing a comprehensive overview of the practice of FCC and its clinical application. Of special importance was the discussion of implementation of this philosophy of care in a large institution. This relatively early work demonstrates the leadership of pediatric nursing in valuing, committing to, and working toward implementation of this philosophy of nursing practice.
The eight elements of FCC according to this definition are:
The illness of a child can have a traumatic affect on both families and the child. Pediatric care has adopted the philosophy of a family-centered care approach in order to maximize the well being of pediatric patients. The philosophy is founded on the collaboration of the family, nurses and hospital staff to plan, provide, and evaluate care. The philosophy is grounded on several principles that revolve around the central idea that the family is the constant in a child’s life . Nurses must work with the family to develop the best plan of care for a child. Parents are experts in their child’s care and know more about their child then we can ever learn through assessments or charts. The family is also the child’s main source of support providing stability in what can be an otherwise traumatic period in a child’s life. The presence of the family during health related procedures can significantly reduce both the child’s and parent’s anxiety Decreased anxiety from the patient and family decreases the stress on healthcare workers, positively affecting their ability to provide treatment. In essence the nurse must attend to both the needs of the family and child in order to maximize a child’s outcomes.
Care Families come in all different shapes and sizes, and just like people, no two are alike. One role of the nurse is to acknowledge and honor diversity. Nurses are responsible for understanding the various influences of social, cultural, economic, and spiritual aspects of an individual’s life. Spiritual and cultural beliefs can have a profound effect on a person’s perceptions of well being. Nurses should work with the family so that these practices can be incorporated into a child’s care if appropriate. A family that believes strongly in certain religious practices, such as prayer, may rely on them to cope with an event or put faith into their child’s outcome. A patient’s socioeconomic status can have a profound impact on the quality of care a child receives. The nurse has an obligation to find resources for the client and family in order to receive adequate Running head; care such as referrals for community services or home care. Overall the nurse should help to tailor care in order meet the needs of the family and patient. The family should be updated continuously about the child’s condition and procedures. Keeping the parents well informed an including them in procedures can have a dramatic affect on decreasing their’s and the child’s stress. The results have yielded better patient and family outcomes. Children have the added comfort of their parents' presence and parents are given the opportunity to witness procedures, reducing their questions and concerns. Once the family is properly informed the nurse can help to facilitate and support the family with decisions regarding care. Keeping open an honest communication between the family and hospital staff improves the family’s emotional state and enhanced the staff’s ability to treat the patient. The most important task of the nurse is to provide support to the family. There are two key components of support, these are enabling and empowerment. Enabling refers to providing opportunities for the family to display their current skills while learning and acquiring new skills. Empowerment refers to the ability of the healthcare team to allow families to acquire a sense of control over their family’s lives. To achieve this the nurse should first recognize a family's strengths and help the family to build on them. Simply reassuring the parent that they know what is best for their child, and encouraging them to make decisions based on what they believe is best can give help them regain a sense of control. Encouragement can help a parent feel more confident in a time of uncertainty. Parents also need support in these difficult times, and the nurse should assess their coping abilities and emotional state. Referring parents to a parent to parent support group may aid in their coping and allow them to discuss concerns with other parents in similar circumstances. Nurse can provide support and confidence for a family to learn new skills and make critical decisions.
There are many benefits associated with the practice of family-centered care. Nurses should not only establish rapport with the patient but also with the family. This allows for optimal collaboration and collaborating with the family maximizes each child’s growth and well being. Working together parents and health care workers can make more personal and informed decisions regarding what the best treatment is for a child. Parents also receive support and encouragement that the old philosophy of care neglected. Supporting a parent in coping with their child’s illness allows them to provide better care for their child and enhances the stability of a parent child relationship. The nurse has a greater understanding of the family’s capabilities and strengths allowing the nurse to further build upon and enhance those skills ensuring the patient is provided the best care even after discharge. Together the family, nurse, and healthcare staff are empowered to provide the most optimal care for a child.
A recent movement towards implementing the family-centered care approach leads to the further study of its benefits. Children were found to have cried less, require less medicine, be less restless, and even experience earlier discharge when the family was present during most aspects of care. Others studies show that parents who receive specialized care and one to one support do significantly better in handling and coping with stress during adjustment periods. It is no wonder then that many health care practices are reviewing and improving their guidelines for family-centered care.
As students we are taught continuously to develop a trusting relationship with our patients. In the pediatric setting nurses have the additional responsibility of establishing a relationship with the family. require a unique delivery of care that includes treating the family as a whole. The family-centered care philosophy can enhance patient and family satisfaction, build on their strengths, patient and family outcome, increase the nurse and healthcare staff’s satisfaction, and decrease healthcare costs. Most of all research has proven that patient and family outcomes are improved. As nurses we should remember to appreciate the family and their children for who they are, and embrace their differences. We are their advocates, and our responsibility is to do what is best for the child.
Given the documented benefits, pediatricians who practice patient- and family-centered care may experience the following benefits: