Family-centred or family-censored care?
Child- and family-centred care is considered the essential tenet of global children’s nursing practice. The Journal of Advanced Nursing has been prominent in publishing high quality and frequently cited seminal evidence to inform practice development, including concept analyses, primary research and systematic reviews, on child- and family-centred care and parent participation.
Professional bodies, hospitals and health services all profess their child- and family-friendly credentials in their philosophies of care, mission statements and values. There also has been significant investment in building or upgrading children’s hospitals and services in developed countries over the past decade. Many children’s health facilities ‘look’ child-centred in that they are brightly designed and colourful, and well equipped with age-appropriate toys, children’s furniture, fixtures and fittings.
Why is it then that reports in many developed countries, such as the recent Kennedy Report in the United Kingdom (Kennedy 2010), consistently indicate that hospitals and health services can be experienced as unfriendly and alien places by children and their families, and frequently fail to meet basic needs for communication, pain relief, comfort and wellbeing?
In this issue of the Journal of Advanced Nursing,Coyne et al. (2011, pp 2561–2573) dismiss the previously held assumption that nurses need more training and lack understanding and knowledge of the core components of family-centred care. Qualitative evidence from their survey of 250 nurses in Ireland showed that they had clear understanding of what family-centred care was, but nurses experienced significant challenges in trying to implement this. Moving beyond the provision of children’s age-appropriate toys, furniture, fixtures and fittings, family-centred care required other critical ingredients to implement the philosophy in the way it was conceived. Coyne et al. suggest that organizational and environmental factors are bigger barriers to implementation than the negative attitudes of nurses. Put frankly, the built environment, facilities and staffing levels of many, even modern, children’s services prevent families from actively engaging with family-centred care in meaningful ways.
Systems, processes of care and physical environments, that were not designed primarily around children and their families were seen as the ultimate ‘censor’ to the implementation of evidence-based, innovative family-centred practice. Their findings are particularly timely and relevant, and the authors hope they will be taken on board to help shape the design and construction of the new, all-Ireland Children’s Hospital in Dublin. In a harsh economic climate hospital designers and directors of finance may feel inclined to cut back on facilities that could be considered ‘luxuries’, such as accommodation for both parents and sufficient space for parents and nurses to work together to care for their children. Coyne et al.’s study tells us that the effects of poor design cannot be mitigated by highly motivated and family-centred nurses.