A study of role negotiation between nurses and the parents of hospitalized children

Abstract

The role of the parent of a hospitalized child has changed considerably over the past 30 years. Where parents were previously expected to had responsibility for care over to their child's nurses, there is now an expectation that parents will be extensively involved in the care of their hospitalized children. The negotiation of roles between nurses and parents has been advocated by workers concerned about conflicts between nurses and parents. However, it is not known whether such negotiation takes place between nurses and parents. It is clear that power is not evenly distributed between nurses and parents: issues of territory, stress, anxiety, uncertainty, control and conflicts arising from parental competence all place the parent in a weaker position. It is argued that the nurse holds the initiative in the decision about whether negotiation takes place. A small study is described in which nurses were invited to describes their response to their perception that a parent wanted to increase or decrease her or his involvement in her or his child's care. The critical incident technique (Flanagan 1954) was used to collect data. Nurses' responses were categorized into categories of 'encouragement', 'explanation/advice' and 'negotiation'. Responses were then placed in more specific subcategories. The inter-rater reliability of the categorization was measured. Owing to the limitations of the study, the results can only be regarded as suggestive. Nevertheless, significant association was found between the category of response and the grade of staff, with a stratified pattern of category of response demonstrated. The implications of the study for future research are discussed.

O significado da hospitalização para a criança pré-escolar: um modelo teórico

“…Enfocam que os conflitos surgem em função da diferença de expectativas e de poder de decisão sobre o cuidado da criança, entre os pais e a equipe, assim como em decorrên-cia do estresse e do sofrimento determinados pela vivência que os procedimentos causam tanto na criança e nos pais, como na própria equipe (9)(10)(11)(12)(13) .…”

"Running to stand still": Nurses' roles with children and families in the community in Scotland. Relationships between policy and practice.

“…Role negotiation appears as a relatively recent concept in nursing literature, one that evolves, as Gallery and Smith (1991) suggest, from the concept o f patient participation. This concept usually refers, in the case of children and families, to parental involvement in the care o f the hospitalized child.…”

“…This concept usually refers, in the case of children and families, to parental involvement in the care o f the hospitalized child. In the nursing literature, negotiation tends to refer to discussion that results in a mutual agreement (Knight, 1995) The research by Gallery and Smith (1991), however, concerning role negotiations between ' The others are production, reproduction, and sexuality (Humm, 1995). nurses and parents, suggests that nurses hold a position o f power relative to the patient, and they state: "It is only the nurse who has the power to relinquish control and to choose to negotiate with the parent about roles or about care" (p. 776). Whether the negotiations take place in the hospital or community, these views suggest that nurses themselves own, control, and negotiate their roles.…”

“…A contrasting view suggests that, although efforts to achieve negotiation may occur between individual nurses and clients, and between nurses and other role partners, the parties involved are not necessarily equal (Gallery & Smith, 1991), nor does either party necessarily control the process or the outcome. Negotiation takes place in a context o f power in which more powerftil groups control the allocations, as well as the definitions o f the situation (Twigg & Atkin, 1994;Hugman, 1991).…”

“…The negotiation that was implied by the concept o f patient participation in the hospital setting, does not appear to have a place, at least not in the community. As Strauss (cited in Gallery & Smith, 1991) If the tube fell out, the parent might replace it or the district nurse. We have one family where the grandpa does the tube when dad is away, the [dad's] girlfiiend does the feedings.…”