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Family centred care has been defined as a partnership
approach to healthcare decision-making between the healthcare provider, the
patient and the family and has been considered a standard of children’s
healthcare within contemporary nursing (Kuo et al, 2012). Family centred care
is a philosophy, framework and model of care that has been adopted and is
widely used by todays children’s nurses (Coyne, 2013). The word “family” refers
to two or more persons who are related in any way—biologically, legally, or
emotionally (IPFCC, 2015). Literature suggests that the family is the central
unit of care for the child, and there for, they are central to the health and
wellbeing of that child, especially during times of ill health and traumatic
experiences (Shields, 2015). Family centred care aims to include and involve
both patients, their families and any significant others in the healthcare of
hospitalised children. Many years ago, when children were admitted to hospital,
they were admitted without their families. Parents were only allowed to visit
for a short time every week or not at all (Jolley & Shields, 2009).  However, Bowlby’s (1982) attachment theory
suggests that children are biologically predisposed to form close relationships
as they provide them with security and comfort. Children have a strong need for
their familiar caregivers, and the involvement of the family and main
caregivers has been recognised as leading to positive outcomes for both the
child receiving the care and their family (Coyne & Livesley, 2010). It is
therefore important that today’s children’s nurses are able to provide good
family centred care in order to meet the needs of the family as this will help
towards meeting the healthcare needs of the child and facilitate building a
good therapeutic relationship with the child and their family.

There is a wide range of both facilitators and barriers in relation
to the implementation of family centred care in children’s nursing. The
facilitators include aspects such as good communication between family’s and
nurses, empowerment and encouragement, and collaboration and shared decision
making. Despite these aspects being ways of facilitating family centred care,
there are aspects of nursing that hinder modern day nurses’ ability to
successfully implement family centred care (Coyne et al, 2011). These include barriers
aspects such as nurses’ busy workloads and staff shortages, lack of
understanding of family centred care and the roles within it, and the
professional attitudes of nurses. This essay will critically discuss how these
facilitators and barriers affect the implementation of family centred care in
relation to children’s’ nursing.

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One facilitator to family centred care is communication. Effective
communication between patients, families and service providers is key to the
success of a family centred approach (Law et al, 2006). Communication, when
used appropriately, is one of the ways in which nurses can facilitate family
centred care as it provides a means to establish and build therapeutic
relationships with patients and their families. It has been identified that
providing understandable, unbiased and timely information that supports
patients and their families is an important way of enhancing family centred
care (Coyne et al, 2011). It is essential that nurses have skills and knowledge
of effective communication that demonstrate active listening and assist with
information sharing (Bramhall, 2014). Communication is integral to building a
therapeutic relationship between the healthcare professional, and the patient
and their family. It one of the six fundamental values of nursing that has been
identified in the government’s strategy to deliver high-quality, compassionate
care for patients (Department of Health, 2012).

The NMC (2015) states that children’s nurses must take into
account each child and young person’s individuality including their age, ability
to understand and any communication difficulties. This standard also applies to
the family in order to communicate with them effectively. It also states that
nurses must share information with patients and their families in a way that
that they can understand (Bramhall, 2014). It is the provision of this that
allows patients and their families to make good informed decisions.

There are a number of theoretical models that can help to aid
nurse’s communication in order to communicate effectively with patients and
their families. Ahmann’s (1994) ‘LEARN’ mnemonic provides a structured approach
to help guide conversations with patients. When used, this approach gives
nurses the information that they need and provides patients with an opportunity
to express their thoughts and feelings (Lambert, 2012). This will allow the
patient and their families to feel like they are being listened to and that
their needs and wishes are being respected. Nurses have highlighted that when
they listen to the wishes and concerns of those in their care, this allows for
the building of good rapport and enhances trust between all that are involved
(Coyne et al, 2011).

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Enablement and

Another facilitator to family centred care in children’s
nursing is enablement and empowerment. One of the most vital tasks of a nurse
is to provide support for their patient, and also their patients family. This
support can be provided through enablement and empowerment. Research has found
that the enablement and empowerment of patients and their families has been
considered one of the main roles of a children’s nurse (Coyne et al, 2011). Enablement
is an intervention by which the health care provider recognizes, promotes and
enhances patients and their family’s abilities to display current skills and
acquire new skills (Hudon et al, 2010).  Empowerment
refers to the ability of the nurse in giving patients and their families a
sense of control over their healthcare and life (Hockenberry & Wilson,
2015). Children’s nurses can achieve this through recognition of the family’s
strengths. Recognizing and building on the strengths of individual children and
families and enabling and empowering them to find their own strengths, build
confidence, and participate in making choices and decisions about their health
care is seen as a core element of family centred care (IPFCC, 2012). Support like this, enhances clinical outcomes for
children, ensuring a high standard of care for patients and their families, and
thus providing good and effective family centred care.

Collaboration and
shared decision making

A final facilitator to the implementation of family centred
care in children’s nursing is collaboration and shared decision making. The involvement
of children and their families in their own care is critically important to the
successful implementation of family centred care. In a study of nurse’s
perceptions of family centred care, nurses viewed the participation of family
members in the child’s care, as a crucial component (Coyne et al, 2011).
Furthermore, one of the core aspects of this successful implementation is being
able to provide a collaborative partnership approach between nurses, patients
and their families (Shields, 2015). Family centred care sees the family as the
constant in the child’s life. They are also recognised as the experts on the
child (Coyne et al, 2011) and family centred care strongly focuses on involving
family’s in the care of their child to promote collaboration and partnership
between the healthcare professionals, the patient and the family. Some studies
have found that some parents feel they are relied on too heavily by nurses and
this can have a negative effect on the partnership between the nurse and the family
(Shields, 2005; Coyne, 2015). However, with recognition of the nurse-family relationship
being a partnership rather than two separate parties, nurses can achieve the
standard set by the NMC (2015) to work in collaboration with patients and their
families in order to negotiate and deliver safe and effective care.

Shared decision-making has been defined as a patient-centred collaborative
process (Malone et al, 2017) and is the way in which children and their
families can contribute to the decision-making process in relation to their own
healthcare (Coyne et al, 2014). Despite doubts existing about the
appropriateness of sharing illness related information and decisions with
children (Young et al, 2003), registered children’s nurses must communicate
with all patients and their families in an open and honest way (NMC, 2015). When
children have a voice in decisions that affect their own healthcare and
treatment, it enables them to develop a sense of themselves, build confidence,
enhance their communication skills, improve the effectiveness of services and
encourages their participation in society as active health consumers (Cohen and
Emanuel, 1998).

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Despite these aspects of family centred care facilitating its
implementation in the daily routines of today’s children’s nurse’s, there are
still a number of barriers that hinder its successful implementation. In 1994, Darbyshire
stated that “Family centered care is an ideal that can never be fully reached.”
This has been backed up by recent research by Coyne, Murphy & Costello as they highlighted
that while nurses fully support the philosophy of family centered care and want
to implement it into their practice, they are unable to apply all the elements
in practice due to a range of challenges. One of these challenges is nurses busy workloads and staff

Busy workloads and
staff shortages

Due to the
complexities of today’s healthcare environment—from patient care and clerical
duties, to digital storage systems and documentation—the responsibilities of a
contemporary children’s nurse are challenging and complex (Lichtenberg, 2013).

Research has
found that within contemporary nursing, nurses are struggling to provide ‘basic
care’ to their patients. As well as the duties mentioned before, the nurses’
role also now includes things such as mentoring student nurses, supervising
agency staff, co-ordinating staff and performing technical procedures. This ever
expanding role strongly highlights the amount of tasks, and time restraints
that is put on today’s nurses on a daily basis.

Coyne (2013)
notes that from a study of children, parents and nurse’s experiences of family
centred care, that family centred care can be difficult to achieve due to nurses
busy workloads. Parents in the study perceived nurses to be too busy to provide
constant attention for their child, so they in turn felt forced to stay and
help out. Shields (2010) supports this idea that parent’s feel that they must
stay with their child while they are in hospital due to nurse’s heavy workload.

was cited as a key barrier to family-centred care by nurses themselves. A
recent audit conducted by Audit Scotland (2017) reported an increase in NHS
costs with little movement in funding. Nurses voiced this financial strain as
having an impact on their staffing levels therefore increasing there already
busy workload. They emphasised that understaffing caused them to result in an
over-reliance on parents and hindered their ability to negotiate and work
along-side patients and their families. Shields (2015), identified that in fact
what this healthcare system really needs is more nurses in order to care for
the whole family unit and provide true family centred care.

Lack of understanding of FCC

Nurse’s need
an adequate amount of education and training of what family centred care really
is in order to implement it successfully and to fully understand their role
within it. However, the role of the nurse and of the family members is not
fully made clear in today’s nursing.

held by nurses and families about what family centered care really is, leads to
little negotiation about what parents can and want to do (Coyne, 2008). A study
by Imelda Coyne, found that some parents resented being made to do what they
perceived to be nurses’ work. This reinforces a lack of understanding about
family centered care is and the roles of both nurses and families. Shields 2011, states that families can feel that
they are expected to provide care for their child that is beyond their
expectations or capabilities. This can cause the child and family stress, due
to nurses having an unclear understanding of what family centered care is and
the roles within that really are.

lack of guidelines and policies for nurses specifically aimed at family centred
care and how to implement it, strongly shows why a lack of understanding
continues to be a challenge for nurses when trying to successfully implement
family centred care.

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