A Survey of Nurses' Practices and Perceptions of ...

508224 research-article2013

JFN19410.1177/1074840713508224Journal of Family Nursing XX(X)Coyne et al.

Article

A Survey of Nurses’ Practices and Perceptions of FamilyCentered Care in Ireland

Journal of Family Nursing 19(4) 469–488 © The Author(s) 2013 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1074840713508224 jfn.sagepub.com

Imelda Coyne, BSc (Hons), PhD, RSCN, RGN, RNT1, Maryanne Murphy, MSc, RSCN, RGN, RNT1, Thomas Costello, BSc (Hons), RN, RCN1, Colleen O’Neill, MSc, RGN, RSCN2, and Claire Donnellan, PhD, RGN1

Abstract Family-centered care (FCC) is a philosophy of care that recognizes the family’s central role in the child’s life and in the delivery of care. We used a survey design to investigate the practices and perceptions of nurses toward FCC in Ireland. Data were obtained from 250 nurses in seven hospitals using the Family-Centered Care Questionnaire–Revised (FCCQ-R). Findings indicated that nurses’ practices were significantly different from their perceptions of FCC. Nurses with dual registration (children and adult) had significantly lower mean scores on the total current (practice) scale than the other registration subgroups. Nurses with a baccalaureate or a higher academic qualification had higher mean scores than nurses who held a certificate-level qualification on the total necessary (perception) scale, which assessed the activities perceived to be necessary for FCC. Findings showed that nurses support FCC but perceive the design of the health care system and parent–professional collaboration as barriers to FCC practice.

1Trinity 2Dublin

College Dublin, Ireland City University, Ireland

Corresponding Author: Imelda Coyne, BSc (Hons), PhD, RSCN, RGN, RNT, Professor of Children’s Nursing, School of Nursing and Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin 2, Ireland. Email: [email protected]

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Keywords family-centered care, pediatrics, nursing practice, nurses’ perceptions, practice with families, survey research Family-centered care (FCC) is a widely used philosophy of care in children’s nursing for providing care for children and families in hospital and community settings (Jolley & Shields, 2009). In more recent times, FCC has been accepted as the ideal philosophy around which to structure parents’ involvement in their child’s health care in developed and developing countries (Shields & Nixon, 2004). In the United Kingdom and Ireland, government reports recommend that the child and family should be placed at the core of all children’s health care services (Department of Health, 2003; Department of Health & Department for Education and Skills, 2009). The philosophy of FCC that was first described in the 1950s has evolved over time from parental involvement, to partnership, and finally to the provision of care for the whole family (I. T. Coyne, 1996). Parent participation could be seen as a concept contained within FCC, in that it is about parents’ participation in their child’s care. FCC is based on the assumption that families are their children’s primary source of nurturance and care during childhood (Gedaly-Duff, Nielsen, Heims, & Pate, 2010). For this paper, the family is defined as “who the members say it is” (Kaakinen, Gedaly-Duff, Coehlo, & Hanson, 2010, p. 3). Within family nursing, the alternate label for family centered is the “family as context” approach (Wright & Leahey, 1990), where the individual is foreground and the family is background. This approach is common in pediatric units; however, Shields (2010) argued that FCC is a way of caring for children and their families within health services that ensures that care is planned around the whole family, not just the individual child/ person, and in which all the family members are recognized as care recipients. This definition of FCC seems more consistent with the “family as client or system” (Wright & Leahey, 1990) rather than as just context within family nursing. While no one theoretical perspective is better than another, what is essential is that nurses use multiple theoretical perspectives to deliver quality nursing care to families (Kaakinen & Hanson, 2010; Wright & Leahey, 2013). The Institute for Family-Centered Care (IFCC; Shelton, Jepson, & Johnson, 1987) has identified several principles of FCC that include recognizing that family is the constant in a child’s life, supporting parent and professional collaboration, recognizing family strengths and individuality, incorporating the needs of children and families into health care systems, encouraging parent-to-parent support, implementing policies and programs that provide emotional and financial support to families, promoting a health


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care system that responds to families’ needs, and, finally, sharing information with parents about the care of their child on an ongoing basis. In 1992, this definition was updated in Canada by the Izaak Walton Killam (IWK) Children’s Hospital FCC Committee to include an element that recognizes the value of policies and programs that provide appropriate emotional support for staff members (Bruce et al., 2002). This additional element arose out of recognition that health care professionals need educational programs about how to care for families effectively.

Barriers and Facilitators of FCC Although FCC has become a cornerstone of health care systems globally in the 21st century, it has encountered numerous difficulties in effective implementation (Foster, Whitehead, & Maybee, 2010; Harrison, 2010; Mikkelsen & Frederiksen, 2011). Nurses find it easier to offer descriptions of FCC as opposed to promoting and delivering the philosophy in practice (Bruce et al., 2002; Petersen, Cohen, & Parsons, 2004). Reviews of the research about FCC suggest that health care professionals’ delivery of FCC is hindered by a lack of knowledge, skills, time, or available resources (Foster et al., 2010; Power & Franck, 2008). Others suggest that nurses experience difficulty with FCC because of concerns about parents’ abilities to perform care to necessary standards (Paliadelis, Cruickshank, Wainohu, Winskill, & Stevens, 2005), feeling threatened by a loss of professional authority and role blurring (Brown & Ritchie, 1990), and feeling intimidated by parents who are perceived to threaten nurses’ power and control (Corlett & Twycross, 2006). Similarly, reviews of existing research indicate that inadequate negotiation of roles and health care professionals’ perceptions influence the delivery of FCC (Foster et al., 2010; Harrison, 2010). Nurses value FCC and enjoy the opportunities for teaching and supervision (Brown & Ritchie, 1989; Gill, 1987b), but experience difficulties due to poor communication and inadequate negotiation skills (Bruce & Ritchie, 1997; I. Coyne, 2008). Previous surveys of nurses found that positive attitudes to FCC were associated with high levels of education (Daneman, Macaluso, & Guzzetta, 2003), senior positions (Johnson & Lindschau, 1996), being older and more experienced (Young et al., 2006), and being married and being a parent (Bruce et al., 2002; Gill, 1987a, 1993).

Examining FCC FCC has been examined in a number of research studies using the FamilyCentered Care Questionnaire–Revised (FCCQ-R; Bruce & Ritchie, 1997).


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This instrument is a self-report questionnaire that directs respondents to rate which activities they perceive to be necessary for FCC (necessary practice) and to self-report on which activities they believe to be currently present in their practice (current practice). In previous studies that reported findings from the FCCQ and the FCCQ-R (Bruce et al., 2002; Bruce & Ritchie, 1997; Letourneau & Elliott, 1996), emotional and financial support for families was most often practiced by participants. Conversely, design of the health care system was the least practiced element in three of the six studies (Bruce et al., 2002; Bruce & Ritchie, 1997; Caty, Larocque, & Koren, 2001). This suggests that the design of the health care system was not optimum for FCC practice. Three of the six studies found that recognizing family individuality was the most highly rated essential element of FCC (Bruce & Ritchie, 1997; Caty et al., 2001; Letourneau & Elliott, 1996). Parent–professional collaboration was the least necessary element in three of the six studies (Bruce et al., 2002; Caty et al., 2001; Petersen et al., 2004). This is a surprising finding since collaboration is critical to negotiation of FCC. Apart from Caty et al. (2001) and Petersen et al. (2004), design of the health care system was reported in every study as having the widest gulf between what participants practiced and what was necessary to effectively implement FCC. In all of the above studies (three from Canada and one from the United States), pediatric nurses signified their acceptance and knowledge of FCC and also reported that they do not always incorporate this knowledge into their practice for various reasons. As discussed earlier, studies on FCC report that nurses have difficulty implementing FCC due to lack of knowledge, understanding, attitudes, lack of negotiation skills, and poor communication. Although this research is informative, in Ireland the educational program and the delivery of services for children’s health care differ from other countries so barriers and facilitators could be different or more salient. The FCCQ-R has been used only in one hospital site in Ireland (Murphy & Fealy, 2007) and therefore we wanted to extend the findings by conducting a larger study accessing nurses from children’s units across Ireland. In addition, there are plans to reconfigure children’s health care services in Ireland (Rawlinson Kelly & Whittlestone [RKW], 2007) in preparation for the building of a new National Children’s Hospital. Understanding the discrepancies that exist between the perceptions and practices of FCC is needed to develop FCC policies in the reconfigured services and help enhance the implementation of FCC. In the context of these changes as well as the significant deficit of research on FCC in Ireland, this study was undertaken to investigate pediatric nurses’ perceptions and practices of FCC and to examine the factors that influence those perceptions.


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Method Using a nonexperimental survey design, the FCCQ-R developed by Bruce and Ritchie (1997) was used to examine nurses’ perceptions and practices of FCC and the factors that influence those perceptions.

Sample and Settings This study aimed to recruit nurses working in 7 of the 19 pediatric units across Ireland (n = 750). The sites were selected based on their geographical location and size of the units to improve the representativeness of the sample. The sites selected were all from urban regions throughout Ireland. These included the three children hospitals in Ireland (these three hospitals are all in Dublin and have a combined bed/cot capacity of 526). Other sites included one children’s ward (20 beds/cots) in an adult hospital in the Dublin region, and three children’s units in an adult hospital from other urban national regions (west, southeast, and southwest of Ireland). The bed range in the units in the west, southeast, and southwest of Ireland was 25 to 45. FCC is the philosophy of care practiced in each of the sites sampled.

Data Collection Permission to use the questionnaire was obtained from the authors. Ethical approval was obtained from all participating hospitals. Members of the research team conducted site visits to deliver study information to all potential participants prior to commencement of data collection. A poster inviting nurses to participate in the research was placed on the notice board in each site. The inclusion criteria were Registered Children’s Nurses (RCN) and other Registered Nurses working in children’s units on other divisions of An Bord Altranais (Irish Nursing Board) nursing register, and the exclusion criteria were student nurses and agency staff. Members of the research team visited each site to distribute the questionnaire to the hospital sites (n = 7) from February to May in 2008. To encourage response rate, follow-up site visits were also conducted during the data collection period. Nurses were asked to place the completed questionnaires in a designated sealed container at their place of work. Anonymity and the voluntary nature of the study were assured.

Instruments The instruments used were the FCCQ-R (Bruce & Ritchie, 1997) and a demographic questionnaire, which recorded age group, gender, years of


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Table 1. FCCQ-R Subscales and Key Subscales With Reliability Analysis. Scales Subscales Family is the constant Parent and professional collaboration Recognizing family individuality Sharing information with parents Parent-to-parent support Developmental needs Emotional and financial support for families Design of health care system Emotional support for staff Total scale

No. of items

Current α

Necessary α

3 6

.74 .64

.52 .66

5 5 4 5 4

.75 .67 .60 .72 .63

.76 .71 .70 .78 .68

7 6 45

.83 .78 .93

.83 .85 .94

Note. FCCQ-R = Family-Centered Care Questionnaire–Revised; α = Cronbach’s alpha.

experience in children’s nursing, level of education, professional registration, and employment. The 45-item FCCQ-R includes nine subscales, which represent the nine key elements of FCC based on the original components of FCC by the Association for the Care of Children’s Health (ACCH; Shelton et al., 1987) and modified by the IWK FCC Committee (Bruce & Ritchie, 1997). The nine subscales in the instrument are outlined in Table 1. The instrument asked participants to indicate on a 5-point Likert-type scale (1 = strongly disagree to 5 = strongly agree) which activities they perceived to be present in their current nursing practice (current scale) and which activities they felt were necessary to effectively practice FCC (necessary scale). The level of agreement for each item is added to give a total score for each of the nine subscales and all items are added together to give a total overall score for current and necessary scales. A high score on the current and necessary scales of the FCCQ-R indicates high representation of FCC in practice. Bruce and Ritchie (1997) assessed internal consistency using Cronbach’s alphas from .5 to .8 for the subscales and .9 for the total scales for current practice and total scale for necessary practice. In this study, Cronbach’s alphas ranged from .52 to .85 for the subscales, and .93 for the total current scale and .94 for the total necessary scale (see Table 1). Content validity was established by Bruce and Ritchie using a panel of experts, including nurses, child life specialists, and parents knowledgeable in FCC.


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Data Analysis Data were assessed for normal distribution using the Kolmogorov–Smirnov statistic and viewing additional histograms. Data were normally distributed for all subscales in current and necessary scales of the FCCQ-R. The only exception was the subscale design of the health care system in the necessary scale, which had a negatively skewed distribution. Data analysis was performed using SPSS (Version 18.0). Paired samples t tests were performed to test for differences between the current and necessary subscales. One-way ANOVA tests were used to test for differences between demographic and professional subgroups where there were more than two categories per subgroup. For all statistical analyses, the significance level was generally set at .05. However for subgroup comparisons, the Bonferroni correction was used to reduce the Type I error rate. The study was powered to determine an effect size of 0.8 if statistical differences were found between variables using Cohen’s d formula.

Results Demographic and Professional Status Details of Participants The sample consisted of 250 nurses working in children’s hospitals or wards in Ireland, The response rate was moderate at 33% (n = 250).1 Most participants were female (94%), between 20 and 40 years (81%) and had been working in children’s nursing for 15 years or less (70%). Two thirds of the participants (65%) were employed as staff nurse and nearly half had a degree qualification (45%; see Table 2).

Nurses’ Practices and Perceptions of FCC Participants’ mean scores on their current and necessary scales of FCC are presented in Table 3. The total mean score for the current practices scale (M = 32.20, SD = 5.06) was lower than the total mean score for the necessary practice scale (M = 39.55, SD = 3.67). The design of the health care system (M = 2.82, SD = 0.92) had the lowest mean scores meaning that it was the element least practiced. The emotional and financial support for families element (M = 4.04, SD = 0.69) had the highest mean score for current practices meaning that it was most often practiced. Recognizing family individuality (M = 4.64, SD = 0.43) had the highest mean score for necessary scale meaning that this was the most important element to have for FCC. The design of the health care system (M = 4.20, SD = 0.69) and parent-to-parent support (M = 4.20, SD = 0.66) had the lowest mean scores indicating that nurses considered these as the least necessary elements for FCC.


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Table 2. Sample Demographic and Professional Details. Variable name

n (%)

Age group (years) 20-30 31-40 41-50 >50 Gender Male Female Professional registration RGN/RCN All other nurse registrations Education qualification Certificate Diploma Degree Masters Missing Employment position Staff nurse Manager Specialist Years of experience 0-5 5-15 15-20 >20

88 (35) 114 (46) 38 (15) 10 (4) 14 (6) 236 (94) 183 (73) 67 (27) 37 (15) 68 (27) 112 (45) 15 (6) 18 (7) 162 (65) 57 (23) 31 (12) 68 (27) 106 (42) 36 (14) 40 (16)

Note. RCN = Registered Children’s Nurses.

Differences between nurses’ current practice and perceptions of FCC. Paired samples t tests were performed to test for significant differences between the nine paired combinations of subscales within the current and necessary scales (see Table 3). Participants had a higher total mean score for the necessary practice of FCC scale (M = 39.55, SD = 3.67) compared with the current practice of FCC scale (M = 32.20, SD = 5.06) and this difference was statistically significant (t(249) = −20.38, p < .0001). FCC subscales compared with current practice of FCC subscales were also statistically significant (p < .0001).


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Coyne et al. Table 3. Differences Between Nurses’ Practices and Perceptions of FCC. Scales Practices (current) Perceptions (necessary) M (SD)

M (SD)

t statistic

3.93 (0.74) 3.53 (0.65)

4.53 (0.53) 4.24 (0.52)

−11.91**** −17.73****

3.90 (0.70)

4.64 (0.43)

−15.97****

3.54 (0.75)

4.48 (0.50)

−17.04****

3.23 (0.83)

4.20 (0.66)

−16.06****

3.71 (0.77) 4.04 (0.69)

4.44 (0.54) 4.55 (0.47)

−13.34**** −11.30****

2.82 (0.92)

4.20 (0.69)

−17.62****

3.51 (0.85)

4.33 (0.68)

−12.13****

32.20 (5.06)

39.55 (3.67)

−20.38****

Subscales Family is the constant Parent and professional collaboration Recognizing family individuality Sharing information with parents Parent-to-parent support Developmental needs Emotional and financial support for families Design of health care system Emotional support for staff Total scale

Note. FCC = Family-centered care. ****p ≤ .0001.

Differences in nurses’ practices of FCC in terms of demographic variables. Differences were examined in the total mean scores of the current practice of FCC for the demographic variables: age, gender, professional registration status, education qualification, employment position, and years of experience in pediatric nursing (presented in Table 4). We used the demographic variables of years of experience in children’s nursing, level of education, professional registration, and employment as these have been shown in the literature to influence the practice and perception of FCC. There has been significant financial investment in nursing education in Ireland over the past 10 years to ensure that all nurses are educated at baccalaureate level. Ireland is one of only a few countries where undergraduate and postgraduate programs in children’s nursing can be undertaken that lead to the professional registration: RCN. Examination of the differences in professional registration status revealed that dual Registered General Nurses/Registered Children’s Nurse (RGN/ RCN; M = 31.54, SD = 4.74) had lower total mean scores for current


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Table 4. Comparisons of Total Mean Scores for Present and Necessary Practice Subscales by Different Subgroups. Subgroup

Current M (SD) Statistic

Age (years) 20-30 32.32 (5.17) 31-40 32.12 (4.89) 41-50 31.88 (5.38) >50 33.23 (4.36) Gender Male 30.26 (4.98) Female 32.31 (5.01) Professional registration RGN/RCN 31.54 (4.74) 34.00 (5.36) All other nurse registrations Education qualification Certificate 32.34 (5.48) Diploma 32.93 (4.77) Degree 31.74 (5.24) Masters 30.63 (3.73) Employment position Staff nurse 32.28 (5.30) Manager 32.29 (4.84) Specialist 31.61 (3.80) Years of experience 0-5 32.59 (4.13) 5-15 31.30 (5.44) 15-20 33.51 (4.85) > 20 32.73 (5.16)

F = 0.21

p value

Necessary M (SD) Statistic

p value

F = 0.09

p = .96 p = .57 p = .14

p = .88 39.58 (3.70) 39.59 (3.67) 39.53 (3.55) 38.95 (4.22)

t = −1.48

p = .13

t = −0.55 39.02 (3.16) 39.58 (3.70)

t = −3.49

p = .001***

t = −1.46

39.35 (3.74) 40.11 (3.43) F = 1.24

p = .29

F = 3.98 38.11 (4.58) 39.68 (3.99) 40.07 (3.10) 37.76 (2.41)

F = 0.23

p = .79

F = 0.77 39.77 (3.53) 39.15 (3.91) 39.19 (3.96)

F = 2.27

p = .08

F = 1.00 39.65 (3.80) 39.84 (3.39) 39.52 (4.06) 38.67 (3.79)

p = .009** p = .46 p = .39

Note. RGN/RCN = Registered General Nurses/Registered Children’s Nurses. **p ≤ .01. ***p ≤ .001.

practices compared with all other registered nurses subgroups in that variable (M = 34.00, SD = 5.36) and this were statistically significant, t(248) = −3.49, p < .001. No statistical significant differences were found between the total mean scores for current practices according to age, gender, education qualification, employment position, and years of experience in children’s nursing. Differences were examined in the total mean scores for the necessary practice of FCC for the variables: age, gender, professional registration status, education qualification, employment position, and years of experience in children’s nursing. For education qualification, there were statistical significant differences between the subgroups’ mean scores, F(231) = 3.98, p ≤ .01. Post hoc analyses showed that nurses with a degree qualification had


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statistically higher total mean scores (M = 40.07, SD = 3.10) for the necessary practice scale compared with nurses with a certificate qualification (M = 38.11, SD = 4.58). No statistical significant differences were found between the total mean scores for the necessary scale according to age, gender, professional registration, employment position, and years’ of experience in children’s nursing.

Discussion This study sought to measure nurses’ practices and perceptions of FCC using the FCCQ-R (Bruce & Ritchie, 1997). With the exception of design of the health care system, nurses felt that elements of FCC were present in their current practice. Nurses reported that they practiced FCC but there were significant differences between their practices and perceptions of FCC. Nurses’ mean total scores for current practice were significantly lower than their mean total scores for the necessary practice suggesting that they did not consistently apply the FCC elements in their actual practice. The findings are consistent with previous research that reported statistically significant differences between respondents’ self-reported practices and their perceptions of FCC (Bruce et al., 2002; Bruce & Ritchie, 1997; Caty et al., 2001; Letourneau & Elliott, 1996; Murphy & Fealy, 2007; Petersen et al., 2004).

Emotional and Financial Support for Families Emotional and financial support for families was the FCC element most frequently practiced and the same finding has been reported by participants in other studies (Bruce et al., 2002; Bruce & Ritchie, 1997; Letourneau & Elliott, 1996). This is an encouraging finding as previous studies suggest that families experience emotional support as inadequate and value staff that empathizes with their situation (Hallstrom, Runeson, & Elander, 2002; Sarajärvi, Haapamäki, & Paavilainen, 2006). Perhaps the differences may be explained by the fact that nurses may think that they are providing support, but families may not experience nurses’ behavior as being supportive. Participating in care can be stressful for many families (Coyne, 2007; Ygge & Arnetz, 2004) and the provision of emotional support contributes toward positive interactions between families and staff (Galvin et al., 2000). Emotional support is an essential element of FCC as families appreciate kindness and support and value nurses being present and knowing them as individuals (Coyne, 2007; Sarajärvi et al., 2006). The financial impact on families caring for a sick child has been highlighted by a number of studies (Callery, 1997; Fitzgerald, 2004; Miedema,


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Easley, Fortin, Hamilson, & Mathews, 2008). Callery (1997) documented the numerous costs incurred by families of sick children involving income loss from extended time off work, food and drink costs, and the emotional “cost” of supporting a sick child in hospital. A survey of parents (n = 110) from four hospitals in Ireland found that parents spent on average 80 euro a day on costs associated with having a child in hospital (Fitzgerald, 2004). The costs involved travel costs, extra housekeeping, convenience food, phone costs, laundry, treats for sick child and other children, and child minding. Therefore, it is encouraging that nurses report addressing financial support for families as common practice.

Recognizing Family Individuality Nurses’ highest rating of the element necessary for FCC was recognizing family individuality, which has been reported in other studies (Bruce & Ritchie, 1997; Caty et al., 2001; Letourneau & Elliott, 1996; Petersen et al., 2004). This indicates that nurses felt strongly that this element was necessary to effectively implement FCC, which is encouraging since families are not a homogeneous group. Previous qualitative research has revealed how nurses often make assumptions about families instead of assessing families individually (Corlett & Twycross, 2006; Coyne, 2008). Recognizing family individuality is intricately linked to FCC, because parents are the best sources of information on the unique needs of their child (Sarajärvi et al., 2006). As parents’ needs and preferences have been shown to change as trust is built between parents and staff, it is important that nurses regularly assess parents’ preferences, discuss roles, explain care, and provide teaching and support (I. Coyne & Cowley, 2007). The 15-Minute (or less) Family Interview (Wright & Leahey, 2013) could be a very useful tool for helping nurses recognize family individuality as it has been shown to assist nurses to better identify and respond to family needs (LeGrow & Rossen, 2005; Martinez, D’Artois, & Rennick, 2007; Svavarsdottir, Tryggvadottir, & Sigurdardottir, 2012).

Design of the Health Care System Nurses reported that design of the health care system was their least practiced element of FCC and this has also been found in other studies (see Bruce et al., 2002; Bruce & Ritchie, 1997; Caty et al., 2001). Nurses reported that outpatient services were not available either evenings or weekends, nor were written materials available in a variety of languages. Furthermore, they indicated that staffing patterns were not planned according to the developmental needs of the child. But along with parent-to-parent support, the design of the health


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care system also received the lowest rating as necessary for FCC. In Bruce et al’s (2002) study, participants gave less support to the design of the health care system also. It is difficult to conjecture why design was lowest rated item as the design of the health care system was the least practiced element of nurses’ practice. Similar finding was reported in other studies (see Bruce et al, 2002; Bruce & Ritchie, 1997; Letourneau & Elliott, 1996; Murphy & Fealy, 2007). Perhaps nurses did not view the design of health care system as a critical element in the delivery of FCC or alternatively that this was an aspect that they felt they had little control over or could not change, for example, staffing patterns, physical layout, and provision of nonurgent services for evenings and weekends. These are possible explanations for this finding. Delivering FCC in a health care system with workforce shortages and financial difficulties has also been identified as a barrier to implementing FCC in children’s hospitals (Smith, Coleman, & Bradshaw, 2002).

Demographic Characteristics and Participants’ Practices and Perceptions of FCC The dual RCN (RGN/RCN) had statistically significant lower total mean scores for current practices compared with all other nurses. When seeking to explain the relationship between professional registration and self-reported current practice, it is important to consider how a specialized qualification in children’s nursing may influence the way in which an individual evaluates and reflects upon his or her current nursing practice. Nurses without a specialized children’s nursing registration may have reported higher total current practice scores, because they have different perceptions of what each element of FCC actually entails. In other words, the more advanced level of clinical and theoretical education that nurses acquire as a result of the RGN/RCN qualification may influence these individuals to more critically evaluate their everyday practice of FCC. For 40 years or more, researchers have indicated that higher education is related to more positive support for parent participation and more accepting attitudes toward families (Bruce et al., 2002; Bruce & Ritchie, 1997; Caty et al., 2001; Daneman et al., 2003; Gill, 1987b; Seidl, 1969). Nurses in this study who held a baccalaureate degree had significantly higher necessary practice scores than those with a certificate in nursing. This finding is very positive, as there has been significant financial investment in Ireland during the past 10 years into nurse education so that all nurses are educated at baccalaureate level (Ryan, 2008). Other research has found that a baccalaureate qualification in nursing can influence nurses to see beyond an immediate situation and critically evaluate their practice more efficiently (Aiken, Clarke, Cheung, Sloane, & Silber, 2003). These findings suggest that continued educational


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workshops or updates could help nurses to continue to apply the principles of FCC and be motivated to persist with FCC despite challenges. The study had several limitations that need to be considered. The FCCQ-R is still undergoing development and testing, which may affect the reliability of the data (Bruce et al., 2002). Sample size was small with only 250 nurses from 7 of the 19 children’s hospitals/units across Ireland completing the FCCQ-R. The low response rate of 33% renders the findings both context and participant specific, and may have produced bias. The survey accessed only nurses’ experiences and did not include families or other health care professionals such as doctors, allied health care staff, and nurse auxiliaries.

Implications for Practice Lack of knowledge or understanding has been frequently offered in previous studies as a reason for nurses’ difficulty with FCC. This research shows that nurses support the philosophy of FCC, but are unable to apply all the elements in practice because of organizational barriers, lack of resources, and hospital design. This finding is supported by other research from Canada and Ireland (Bruce et al., 2002; Coyne et al, 2011; Letourneau & Elliott, 1996; Murphy & Fealy, 2007; Petersen et al., 2004). It illustrates how poor resources, inadequate facilities and inadequate support can hinder nurses’ abilities to implement FCC satisfactorily. Supporting nurses’ efforts to implement FCC in their everyday practice requires specific hospital policies, supportive management practices, and family-friendly facilities. In Denmark, research showed how environment design has a major impact on the realization of essential FCC concepts, namely, participation and collaboration (Allermann Beck, Weis, Greisen, Andersen, & Zoffmann, 2009). The construction of a new National Children’s hospital in Ireland presents an ideal opportunity to ensure that hospital design and policies supports the delivery of FCC. Involving children and families in hospital advisory groups is also necessary to advance the implementation of FCC and raise professionals’ awareness of and sensitivity to families’ experiences and needs. Advisory groups and parent evaluations are not widely used in Ireland despite the obvious benefits.

Conclusion FCC is a widely embraced health care philosophy for children and their families, yet its application in clinical practice continues to be problematic. Carter (2008) pointed out that in recent years FCC “has evolved to become part of our psyche, part of our professional raison d’être” (p. 2092). Delivering FCC is challenging for nurses against a background of a harsh economic recession


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and a health service that is facing rapid and unprecedented change globally. Technological advances, the increased complexity of patient care, increased consumer expectations, and inadequate staffing levels and resources all add to the challenge of providing FCC. Nurse academics and clinicians are rethinking and questioning concepts underpinning FCC (Franck & Callery, 2004; Mikkelsen & Frederiksen, 2011), while others are questioning the suitability of FCC as a model of care (Shields, 2010). Although family nursing theory is more clearly developed than FCC, the implementation of the theoretical concepts to clinical practice is “visibly absent or developing very slowly” (Duhamel, 2010, p. 9). Translating the knowledge into practice remains problematic whether it is family nursing or FCC, but Duhamel’s (2010) excellent paper offers relevant teaching and research strategies. In FCC, the child and family are the recipients of care, but the focus of care does not include all family members as with family nursing. The findings from this study indicate that nurses view FCC as including child and family only. Perhaps that it as much nurses can achieve in busy pediatric units with limited resources as seen in some units that are attached to large adult hospitals. The findings demonstrate that nurses have good knowledge and understanding of FCC and support the importance of FCC. Therefore, it is imperative that we do not abandon support for the key principles of FCC; instead, we should focus on developing family nursing interventions and providing sufficient resources that will help nurses to work collaboratively with children and families in all settings. Acknowledgments We are grateful to all the nurses who completed a questionnaire, the sites that supported the study, and Dr. Beth Bruce for permission to use the Family-Centered Care Questionnaire–Revised (FCCQ-R). We thank Ms. Rita O’Shea, all the senior nursing staff, and Ms. Breda Hanlon for their kind support for this study. We acknowledge Jade Bailey’s contribution with the statistics for the study.

Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was partly supported by funding obtained by Professor Imelda Coyne from the academic start-up fund provided by Trinity College Dublin.


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Note 1. At the time of data collection, there was a seasonal outbreak of the Nora virus in some of the participating hospitals in the study, which may have resulted in a lower response rate.

References Aiken, L. H., Clarke, S. P., Cheung, R. B., Sloane, D. M., & Silber, J. H. (2003). Educational levels of hospital nurses and surgical patient mortality. Journal of American Medical Association, 290, 1617-1623. doi:10.1001/jama.290.12.1617 Allermann Beck, S., Weis, J., Greisen, G., Andersen, M., & Zoffmann, V. (2009). Room for family-centered care—A qualitative evaluation of a neonatal intensive care unit remodeling project. Journal of Neonatal Nursing, 15, 88-99. doi:10.1016/j.jnn.2009.01.006 Brown, J., & Ritchie, J. A. (1989). Nurses’ perceptions of their relationships with parents. Maternal-Child Nursing Journal, 18, 79-96. Brown, J., & Ritchie, J. A. (1990). Nurses’ perceptions of parent and nurses roles in caring for hospitalised children. Children’s Health Care, 19, 28-36. Bruce, B., Letourneau, N., Ritchie, J., Larocque, S., Dennis, C., & Elliott, M. R. (2002). A multisite study of health professionals’ perceptions and practices of family-centered care. Journal of Family Nursing, 8, 408-429. doi:10.1177/107484002237515 Bruce, B., & Ritchie, J. (1997). Nurses’ practices and perceptions of familycentered care. Journal of Pediatric Nursing, 12, 214-222. doi:10.1016/S018825963(97)80004-8 Callery, P. (1997). Paying to participate: Financial, social and personal costs to parents of involvement in their children’s care in hospital. Journal of Advanced Nursing, 25, 746-752. doi:10.1046/j.1365-2648.1997.t01-1-1997025746.x Carter, B. (2008). Peer commentary on the paper “Family centered care: A review of qualitative studies” by L. Shields, J. Pratt, & J. Hunter (2006) Journal of Clinical Nursing, 5, 1317–23. Journal of Clinical Nursing, 17, 2091-2093. doi:10.1111/ j.1365-2702.2007.02106.x Caty, S., Larocque, S., & Koren, I. (2001). Family-centered care in Ontario general hospitals: The views of pediatric nurses. Canadian Journal of Nursing Leadership, 14, 10-18. Corlett, J., & Twycross, A. (2006). Negotiation of parental roles within familycentered care: A review of the research. Journal of Clinical Nursing, 15, 1308-1316. doi:10.1111/j.1365-2702.2006.01407.x Coyne, I. (2007). Critical engagement with practice: Being a human caring presence for children and their parents. Journal of Children’s and Young People’s Nursing, 1, 298. Retrieved from http://www.internurse.com/cgi-bin/go.pl/library/ abstract.html?uid=27666 Coyne, I. (2008). Disruption of parent participation: Nurses’ strategies to manage parents on children’s wards. Journal of Clinical Nursing, 17, 3150-3158. doi:10.1111/j.1365-2702.2006.01928.x


485

Coyne et al.

Coyne, I., & Cowley, S. (2007). Challenging the philosophy of partnership with parents: A grounded theory study. International Journal of Nursing Studies, 44, 893-904. Retrieved from http://dx.doi.org/10.1016/j.ijnurstu.2006.03.002 Coyne, I., O’Neill, C., Murphy, M., Costello, T., & O’Shea, R. (2011). What does family-centered care mean to nurses and how do they think it could be enhanced in practice. Journal of Advanced Nursing, 67, 2561-2573. doi:10.1111/j.13652648.2011.05768.x Coyne, I. T. (1996). Parent participation: A concept analysis. Journal of Advanced Nursing, 23, 733-740. doi:10.1111/j.1365-2648.1996.tb00045.x Daneman, S., Macaluso, J., & Guzzetta, C. E. (2003). Healthcare providers’ attitudes toward parent participation in the care of the hospitalized child. Journal for Specialists in Pediatric Nursing, 8, 90-98. doi:10.1111/j.1088-145X.2003.00090.x Department of Health. (2003). Getting the right start: National service framework for children, young people and maternity services: Standard for hospital services. London, England: Author. Retrieved from http://www.nhs.uk/ NHSEngland/AboutNHSservices/Documents/NSF%20children%20in%20hospitlalDH_4067251[1].pdf Department of Health and Department for Education and Skills DfES. (2009). Healthy lives, brighter futures: The strategy for children and young people's health. London: Department of Health. Duhamel, F. (2010). Implementing family nursing: How do we translate knowledge into clinical practice? Part II: The evolution of 20 years of teaching, research, and practice to a Center of Excellence in Family Nursing. Journal of Family Nursing, 16, 8-25. doi:10.1177/1074840709360208 Fitzgerald, E. (2004). Sick children, money worries: The financial cost of a child in hospital. Dublin: Children in Hospital Ireland. Foster, M., Whitehead, L., & Maybee, P. (2010). Parents’ and health professionals’ perceptions of family centred care for children in hospital, in developed and developing countries: A review of the literature. International Journal of Nursing Studies, 47, 1184-1193. doi:10.1016/j.ijnurstu.2010.05.005 Franck, L. S., & Callery, P. (2004). Re-thinking family-centred care across the continuum of children’s healthcare. Child: Care, Health and Development, 30, 265-277. doi.10.1111/j.1365-2214.2004.00412.x Galvin, E., Boyers, L., Schwartz, P. K., Marion, W., Mooney, P., Warwick, J., . . . Ahmann, E. (2000). Challenging the precepts of family-centered care: Testing a philosophy. Pediatric Nursing, 26, 625-633. Gedaly-Duff, V., Nielsen, A., Heims, M. L., & Pate, M. F. (2010). Family child health nursing. In J. R. Kaakinen, V. Gedaly-Duff, D. P. Coehlo, & S. M. H. Hanson (Eds.), Family health care nursing: Theory, practice, and research (4th ed., pp. 332-378). Philadelphia, PA: F. A. Davis. Gill, K. M. (1987a). Nurses’ attitudes toward parent participation: Personal and professional characteristics. Children’s Health Care, 15, 149-151. doi:10.1080/02739618709514761


486


Gill, K. M. (1987b). Parent participation with a family health focus: Nurses’ attitudes. Pediatric Nursing, 13, 94-96. Gill, K. M. (1993). Health professionals’ attitudes toward parent participation in hospitalized children’s care. Children’s Health Care, 22, 257-271. doi:10.1207/ s15326888chc2204_2 Hallstrom, I., Runeson, I., & Elander, G. (2002). An observational study of the level at which parents participate in decisions during their child’s hospitalization. Nursing Ethics, 9, 202-214. doi:10.1191/0969733002ne499oa Harrison, T. M. (2010). Family-centered pediatric nursing care: State of the science. Journal of Pediatric Nursing, 25, 335-343. doi:10.1016/j.pedn.2009.01.006 Johnson, A., & Lindschau, A. (1996). Staff attitudes toward parent participation in the care of children who are hospitalised. Pediatric Nursing, 22, 99-102. Jolley, J., & Shields, L. (2009). The evolution of family-centered care. Journal of Pediatric Nursing, 24, 164-170. doi:10.1016/j.pedn.2008.03.010 Kaakinen, J. R., Gedaly-Duff, V., Coehlo, D. P., & Hanson, S. M. H. (Eds.). (2010). Family health care nursing: Theory, practice, and research (4th ed.). Philadelphia, PA: F. A. Davis. Kaakinen, J. R., & Hanson, S. M. H. (2010). Family child health nursing. In J. R. Kaakinen, V. Gedaly-Duff, D. P. Coehlo, & S. M. H. Hanson (Eds.), Family health care nursing: Theory, practice, and research (4th ed., pp. 63-102). Philadelphia, PA: F. A. Davis. LeGrow, K., & Rossen, B. E. (2005). Development of professional practice based on a Family Systems Nursing Framework: Nurses’ and families’ experiences. Journal of Family Nursing, 11, 38-58. doi:10.1177/1074840704273508 Letourneau, N., & Elliott, M. R. (1996). Paediatric health care professionals’ perceptions and practices of family-centered care. Children’s Health Care, 25, 157-174. doi:10.1207/s15326888chc2503_1 Martinez, A.-M., D’Artois, D., & Rennick, J. E. (2007). Does the 15 minute (or less) family interview influence family nursing practice? Journal of Family Nursing, 13, 157-178. doi:10.1177/1074840707300750 Miedema, B., Easley, J., Fortin, P., Hamilson, R., & Mathews, M. (2008). The economic impact on families when a child is diagnosed with cancer. Current Oncology, 15, 173-178. Retrieved from http://current-oncology.com/index.php/ oncology/article/view/260/273 Mikkelsen, G., & Frederiksen, K. (2011). Family-centered care of children in hospital—A concept analysis. Journal of Advanced Nursing, 67, 1152-1162. doi:10.1111/j.1365-2648.2010.05574.x Murphy, M., & Fealy, G. (2007). Practices and perception of family-centred care among children’s nurses in Ireland. Journal of Children’s and Young People’s Nursing, 1, 312-319. Retrieved from http://www.internurse.com/cgi-bin/go.pl/ library/abstract.html?uid=27669 Paliadelis, P., Cruickshank, M., Wainohu, D., Winskill, R., & Stevens, H. (2005). Implementing family-centred care: An exploration of the beliefs and practices of paediatric nurses. Australian Journal of Advanced Nursing, 23, 31-36.


487

Coyne et al.

Petersen, M. F., Cohen, J., & Parsons, V. (2004). Family-centered care: Do we practice what we preach? Journal of Obstetric, Gynecologic, & Neonatal Nursing, 33, 421-427. doi:10.1177/0884217504266772 Power, N., & Franck, L. (2008). Parent participation in the care of hospitalized children: A systematic review. Journal of Advanced Nursing, 62, 622-641. doi:10.1111/j.1365-2648.2008.04643.x Rawlinson Kelly & Whittlestone. (2007). High level framework brief for the national paediatric hospital: Final report. Dublin, Ireland: Health Service Executive. Retrieved from http://www.hse.ie/eng/services/Publications/services/Hospitals/ High_Level_Framework_Brief,_National_Paediatric_Hospital,_Part_1.pdf Ryan, D. (2008). Third-level nurse education: Learning from the Irish experience. British Journal of Nursing, 17, 1402-1407. Retrieved from http://www.internurse.com/cgi-bin/go.pl/library/article.cgi?uid=31865;article=BJN_17_22_1402 _1407;format=pdf Sarajärvi, A., Haapamäki, M. L., & Paavilainen, E. (2006). Emotional and informational support for families during their child’s illness. International Nursing Review, 53, 205-210. doi:10.1111/j.1466-7657.2006.00479.x Seidl, F. W. (1969). Pediatric nursing personnel and parent participation: A study in attitudes. Nursing Research, 18, 40-44. Shelton, T., Jepson, E. S., & Johnson, B. H. (1987). Family-centered care for children with special health care needs. Washington, DC: Association for the Care of Children’s Health. Shields, L. (2010). Models of care: Questioning family-centred care. Journal of Clinical Nursing, 19, 2629-2638. doi:10.1111/j.1365-2702.2010.03214.x Shields, L., & Nixon, J. (2004). Hospital care of children in four countries. Journal of Advanced Nursing. 45, 475-486. Smith, L., Coleman, V., & Bradshaw, M. (Eds.). (2002). Family-centred care: Concept, theory and practice. Hampshire, UK: Palgrave. Svavarsdottir, E. K., Tryggvadottir, G. B., & Sigurdardottir, A. O. (2012). Knowledge translation in family nursing: Does a short-term therapeutic conversation intervention benefit families of children and adolescents in a hospital setting? Findings from the Landspitali University Hospital Family Nursing Implementation Project. Journal of Family Nursing, 18, 303-327. doi:10.1177/1074840712449202 Wright, L. M., & Leahey, M. (1990). Trends in the nursing of families. Journal of Advanced Nursing, 15, 148-154. doi:10.1111/j.1365-2648.1990.tb01795.x Wright, L. M., & Leahey, M. (2013). Nurses and families: A guide to family assessment and intervention (6th ed.). Philadelphia, PA: F. A. Davis. Ygge, B. M., & Arnetz, J. E. (2004). A study of parental involvement in pediatric hospital care: Implications for clinical practice. Journal of Pediatric Nursing, 19, 217-223. doi:10.1016/j.pedn.2004.02.005 Young, J., McCann, D., Watson, K., Pitcher, A., Bundy, R., & Greathead, D. (2006). Negotiation of care for a hospitalized child: Nursing perspectives. Neonatal, Paediatric, and Child Health Nursing, 9, 7-14.


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Author Biographies Imelda Coyne, BSc (Hons), PhD, RSCN, RGN, RNT, is a professor of Children’s Nursing, School of Nursing and Midwifery, Trinity College Dublin, Ireland. Her research focuses on family-centered care, children and decision making, transitions for children with chronic illness, and health service evaluation. Her recent publications include, “What Does Family-Centered Care Mean to Nurses and How Do They Think It Could Be Enhanced in Practice” in Journal of Advanced Nursing (2011, with I. Coyne, C. O’Neill, M. Murphy, T. Costello, & R. O’Shea), “Disruption of Parent Participation: Nurses’ Strategies to Manage Parents on Children’s Wards” in Journal of Clinical Nursing (2008, with I. Coyne), and “Challenging the Philosophy of Partnership With Parents: A Grounded Theory Study” in International Journal of Nursing Studies (2007, with I. Coyne & S. Cowley). Maryanne Murphy, MSc, RSCN, RGN, RNT, is an assistant professor, School of Nursing and Midwifery, Trinity College Dublin, Ireland. Her research interests include family-centered care, children’s nursing education, and service-user involvement in health care policy. Her recent publications include, “What Does FamilyCentered Care Mean to Nurses and How Do They Think It Could Be Enhanced in Practice” in Journal of Advanced Nursing (2011, with I. Coyne, C. O’Neill, M. Murphy, T. Costello, & R. O’Shea) and “Practices and Perception of Family-Centred Care Among Children’s Nurses in Ireland” in Journal of Children’s and Young People’s Nursing (2007, with M. Murphy & G. Fealy). Thomas Costello, BSc (Hons), RN, RCN, is a researcher at the School of Nursing and Midwifery, Trinity College Dublin, Ireland. He has previously worked in the national neuroscience intensive care unit at Beaumont Hospital and at the Children’s University Hospital Temple Street. Research interests include family-centered care, various neuroscience-related topics, and nursing skills as the foundation of excellence in care. His recent publications include, “What Does Family-Centered Care Mean to Nurses and How Do They Think It Could Be Enhanced in Practice” in Journal of Advanced Nursing (2011, with I. Coyne, C. O’Neill, M. Murphy, T. Costello, & R. O’Shea). Colleen O’Neill, MSc, RGN, RSCN, is a lecturer and deputy BSc co-coordinator in the School of Nursing and Human Sciences, Dublin City University, Ireland. Her research interests include preparing children for hospitalization and preadmission techniques. Her recent publications include, “What Does Family-Centered Care Mean to Nurses And How Do They Think It Could Be Enhanced in Practice” in Journal of Advanced Nursing (2011, with I. Coyne, C. O’Neill, M. Murphy, T. Costello, & R. O’Shea). Claire Donnellan, PhD, RGN, is a lecturer in the School of Nursing and Midwifery, Trinity College Dublin, Ireland. Research interests include life span developmental psychology, psychometrics, and health services research.


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