Nurses’ Reflections on Benefits and Challenges of Implementing Family-Centered Care in Pediatric Intensive Care Units

Abstract

Background Family-centered care is a proposed way of supporting family involvement with a child’s care and decreasing distress associated with a child’s critical illness by improving communication, helping manage stress and coping, and decreasing conflicts. Nurses are critical to successful implementation of family-centered care. Objectives To describe nurses’ perceptions of the benefits and challenges of providing family-centered care in pediatric intensive care units. Methods Semistructured interviews of 10 bedside and charge nurses in pediatric, cardiac, and neonatal intensive care units. Questions were related to 4 domains: the intensive care unit environment and its relationship to the structure and delivery of critical care, stressors for nurses and families, communication challenges and strategies, and involvement of families in care and decision-making. Results The main thematic finding was the nurses’ descriptions of a “balancing act” to provide quality family-centered care. The balancing act was characterized by the interaction between 2 types of changes: (1) intensive care unit policies related to visitation hours and family presence at the bedside and (2) physical transformations in the intensive care unit from shared open space to individual private rooms. Conclusions All of the nurses viewed the transition to family-centered care as having benefits for families. They also described how changes had created new challenges for the delivery of nursing care in intensive care units, particularly regarding mentorship and the safety of patients and staff.

Families in Paediatric Oncology Nursing: Critical Incidents From the Nurses' Perspective

“…The parents' behaviour may change quickly and suddenly, and these changes seem to follow changes in the child's condition. Our results share similarities with those of Coats et al (2018), in which paediatric nurses reported that they were worried about their own safety when they were alone with family members who were upset, hostile or behaving inappropriately. Since nurses were alone, they felt they had no choice but to stay in the room and handle whatever came their way, even if they felt threatened.…”

Family‐centred care of children and young people in the acute hospital setting: A concept analysis

“…It appears that there is limited evidence examining the benefits, or otherwise, of FCC to either the hospitalised child, their parents and families, to nurses or to healthcare organisations (Shields, ; Shields et al, ; Smith et al, ). It is also well recognised that there are several barriers to its effective implementation (Boztepe & Kerimoğlu Yıldız, ; Coats, ; Feeg et al, ; Smith et al, ). Effective implementation is dependent on the development of research and theory, provision of education, and support for practice, all of which can only be achieved with adequate funding.…”

“…However, it is not always implemented effectively or with consistency, as it depends on the perceptions held by professionals delivering care and those receiving that care, the children and parents/guardians (Bruce et al, ; Coyne et al, ; Foster, Whitehead, & Maybee, ; Paliadelis, Cruickshank, Wainohu, Winskill, & Stevens, ; Smith, Shields, Neill, & Darbyshire, ; Smith, Swallow, & Coyne, ). There is a lack of clarity regarding the meaning of FCC among nurses (Boztepe & Kerimoğlu Yıldız, ; Coats, ; Coyne et al, ; Feeg et al, ; Murphy & Fealy, ) and the multidisciplinary team (Foster et al, ; Uniacke, Browne, & Shields, ). It is also known that many parents of hospitalised children do not understand the meaning of the term (Coyne et al, ; Smith et al, ).…”

“…This lack of clarity contributes to the recognised challenges to consistent and effective implementation of FCC in practice (Boztepe & Kerimoğlu Yıldız, ; Coats, ; Coyne et al, ; Feeg et al, ; Smith et al, ). Although FCC is a term used frequently among children's nurses and in the academic nursing literature, the concept is not clearly defined in the context of everyday practice.…”

Remember why you became a nurse in the first place

“…Patient survival rates are up, but so too are rates of morbidity—and having to make complex treatment decisions in the full glare of social media is a new, particularly 21st century, form of work‐related stress in this field . Furthermore, the welcome move towards more family‐centred care in ICU has been associated with a number of unforeseen consequences for nursing staff, such as reduced opportunities for on‐the‐job peer support and training, as well as increased exposure to the family's distress …”