Response to Kendall GE & Tallon M (2011) Commentary on Shields (2010) questioning family-centred care. Journal of Clinical Nursing 20, 1788–1790


  • Linda Shields PhD, FRCNA

    1. Professor of Paediatric and Child Health Nursing Curtin University and Child and Adolescent Health Service Perth, Western Australia, Australia and Honorary Professor Medical School University of Queensland Brisbane, Australia
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Kendall and Tallon (2011) have written an erudite commentary on my article (Shields 2010). I find little to disagree with in their comments and support what they have said. We must, though, look closely at their points. They are right in saying that a large gap exists between theory about family-centred care (FCC) and the practice of it. In fact, this is the essence of my original argument for it to be questioned. It is pointless, inefficient and essentially detrimental to both children and families, and health services, to continue to implement a model for which no evidence of its effectiveness exists. Kendall and Tallon (2011) correctly cite the basis of FCC as the presence of the family during a stressful event of hospital admission because individual children and their families cannot be separated and that responsibility for the child must remain with the family, not the health professional. They show that there is ample evidence to illustrate the deleterious effects of separation of parent and child at times of stress and that unsupported hospital admission can be to the physical, emotional and social detriment of a child. Of course, I would agree with all of this; hence, my continued study of FCC and my advocacy for children and families.

I agree that social disadvantage, including low education level and disempowerment, limit families’ ability to access services fully and that families who accompany their children to hospital need psychosocial and physical support themselves, most often expecting health professionals to provide this. The well-known ‘therapeutic relationship’ is cited by Kendall and Tallon (2011), as the mainstay in providing communication between families and hospital staff – and they suggest it is an integral part of the relationships between parents and health professionals during a child’s hospital admission. Another element of support discussed by Kendall and Tallon (2011) is the education, provided by staff, to help parents and families deal with everything that is happening to their child. I agree with them on all these points.

Importantly, though, we differ on our belief that these things happen. While I have demonstrated that there is no level 1 or 2 evidence for the effectiveness of FCC in care delivery (Shields et al. 2011), there is some very good qualitative research which shows that all is not well with FCC. I have mentioned this in my original paper, but in short, sometimes, in organisations that have policies of FCC, parents are controlled, judged and ‘punished’ (Coyne 2008) by staff who act as gatekeepers to the children (Sanjari et al. 2009) often having to resort, at times, to duplicitous strategies to have their needs met (Kristensson-Hallström & Elander 1997). Communication is often difficult, and parents are sometimes not kept informed about their sick child (Aein et al. 2009, Manongi et al. 2009); and consequently, is anything but therapeutic. Kendall and Tallon (2011) are right to say that additional resources are required to support families, but how often do hospital managers see parents as a pair of hands to give ‘basic’ care to their children and reduce nurse-staffing levels in children’s wards?

While I continue to advocate that FCC (Institute for Patient- and Family-Centered Care 2010) is the ideal, I believe that it is not being properly implemented. In fact, my research leads me to ‘stand by my guns’ and quote Darbyshire once again, who described it as a wonderful ideal but almost impossible to implement properly, given the level of human interaction involved (Darbyshire 1994). It is for this reason and the ever-increasing emergence of reports of poorly implemented FCC in hospitals that espouse it as a model of care that I suggest it is time to seek an alternative that will effectively support children, their parents and all family members during a child’s admission to a health service.