Parental reflective functioning: analysis and promotion of the concept for paediatric nursing



Aims and objectives

To identify the definitional elements of parental reflective functioning and develop a framework for nurses to apply this concept in their clinical work with families.


In recent years, researchers have concluded that parental reflective functioning is a key mechanism in the development of child attachment security leading to lifelong mental and physical health benefits. Despite its clinical relevance, little has been published in the nursing literature on this concept.


Concept analysis.


The Walker and Avant (2011, Strategies for theory construction in nursing. Prentice Hall, Upper Saddle River, NJ) method of concept analysis and the Whittemore and Knafl (Journal of Advanced Nursing, 52, 2005, 546) method of integrative review were used. A search of the literature published from 1989–2013 was conducted using edited texts and online databases – Scopus, CINAHL, PubMed and PsychInfo. Among the 85 sources, 31 empirical studies, 17 book chapters, 32 review papers and five case studies were identified concerning parental reflective functioning.


The concept of reflective functioning, defined as the capacity to envision the mental states of self and other, was first described in 1989 by Fonagy. Slade (Attachment and Human Development, 7, 2005, 269) expanded the concept specifically for parents (i.e. parental reflective functioning). Results of this concept analysis describe seven defining attributes and five antecedent conditions. Consequences of parental reflective functioning are related to a child's attachment early in life and behaviour later in life. A model case is provided to contextualise the concept. To date, there are three measures for parental reflective functioning.


While parental reflective functioning has been predominately featured in psychology and parenting interventions, the potential consequences of secure attachment and longer-term children's behavioural outcomes suggest that the concept has global implications for paediatric nurses and primary healthcare clinicians.

Relevance to clinical practice

Parental reflective functioning offers exciting and promising opportunities for paediatric health and new approaches for those who provide paediatric health care.