We would like to comment on the research article by Hughes (2007). Family-centred care is a central concept of care provision in children’s nursing today and the work of Hughes contributes to what is known on the topic. It was especially interesting as the attitudes of parents and nurses in children’s wards in a general hospital are rarely sought, never mind published. However, the inclusion of further inpatient units, albeit at an increased cost, would have greatly enhanced the value of this study and would have improved the chance of it representing the Irish perspective, which the title suggests. We would also like to comment on sample selection and presentation of results in this study.
As the goal in quantitative research is to generalise findings to the larger population, it was disappointing to note that Hughes’ sample of parents fails to describe several variations that exist. Parents with poor or no English were excluded by choice of the researcher, though the most notable exclusion was perhaps the fathers. No fathers returned a questionnaire, and by only using a simple random sampling plan, the inclusion of fathers was left merely to chance. Hughes’ own review of literature identified that nurses overlooked fathers as a resource in family-centred care (Taylor & Daniel 2000) while more current research on the care of children with chronic illness identified that father’s involvement in care correlates to better coping amongst parents caring for children with chronic illness (Gavin & Wysocki 2006). In view of the changing climate of family care and acknowledgement of the importance of fathers’ involvement in their children’s care, and to improve representation of this variation, Hughes could have used stratified sampling, randomly selecting a sample of mothers and fathers based on the ratio of mothers versus fathers resident on the unit in the three months studied. It must also be noted that parents who were bereaved of their child were excluded. This was an understandable and appropriate decision, owing that research of this group is recognised as an ethical challenge for nurse researchers. Bereaved parents have, however, viewed participation in research as a therapeutic, positive experience (Hynson et al. 2006). The attitudes and experiences of this group of parents may be uniquely different, and these opinions are frequently lost by omission from many studies.
Although Hughes acknowledges the limitations imposed by the narrow focus of her sample, no attempt is made to discuss the possible implications that non-responses may have on the study’s findings. The nurse sample that received the self-report questionnaire consisted of all the nurses within the unit (n = 44), with 28 respondents. This equates to a 63·6% response rate rather than the 65% figure presented inaccurately in the text. Response rate from the parent group was lower, with 43% (n = 43) of those surveyed returning a questionnaire. This introduces the possibility that 57% of the parent group may have held a different viewpoint. A low response rate for self-report tools such as the one applied in this study threatens the external validity (Polit & Beck 2008). The sample is at risk of being interpreted as a volunteer sample, where replies come only from those who have something to say. Multiple contacts in postal questionnaires have been proven to increase response rates (Dillman 2000) and Hughes could have sent a reminder or repeat questionnaire to those who had not returned the first survey. In light of these limitations in sampling methodology, Hughes’ findings may merely be interpreted as those of an audit of practice for the inpatient unit on which this study took place.
Hughes’ descriptive survey does present important data on nurses’ and parents’ attitudes to family-centred care that has until now been unrecorded in the Irish setting. The presentation of descriptive statistics appears to have little structure, however, and may hinder their use. The inclusion of headings for presenting research results is a simple solution that would aid the reader in discerning if the purpose of the study has been met (Coughlan et al. 2007). It is at this juncture that the absence of a theoretical framework becomes a distinct disadvantage. In light of the plethora of literature on models of family-centred care and multiple concept analyses described by Hughes in her review, the inclusion of a theoretical framework throughout this study should have been a logical next step. Such a framework could help refine the scope of exploration of the study, and give the research a more coherent structure.
In the discussion section Hughes claims that nurses agreed with a statement that mothers were generally better at caring for sick children than fathers; however, there was no presentation of these findings in the results section. Neither was this identified as an issue of concern in the literature review and the validity of its inclusion is thus questionable, especially given the absence of any representation of fathers in the sample of respondents.
In conclusion, Hughes’ study does make a contribution to the limited body of knowledge on family-centred care in Ireland. In particular, it highlights the need for more research on care of the hospitalised child, and parental needs of those cared for in children’s units in general hospitals. The data collected by Hughes may best apply to service improvement in the unit studied. Description of that process, if it occurred, may be of interest to those responsible for developing services in similar children’s inpatient units in general hospitals, with a view to providing a research-based, holistic approach to family-centred care.