Biomedical subjects
Publications and source records attributed to E Ahmann.
Understanding and implementing family-centered care becomes easier as nurses are exposed to both the concept and examples of the concept in practice. An annotated bibliography of articles, books, films, training materials, and newsletters will be useful to individual nurses, nurse-educators, and nurse administrators.
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The United States does not have as clear a generalized culture as more homogenous nations. For this reason, cultural competence is an important goal of nursing practice. Culture and ethnicity affect access to care and use of health care services. The cultural biases of the health care system must be acknowledged so that nurses can dialogue effectively with families who may have different perceptions. Cultural differences in the perceived meaning of illness affect both help-seeking behavior and approaches to caring and curing. Cross-cultural communication includes attention to language differences and jargon, as well as sensitivity to the family's values and preferences. Intervention plans for the child should be developed in conjunction with the family and should reflect their choices and address their concerns.
The concept of family-centered care was first introduced in 1987. Since that time, legislation has mandated its implementation, training materials have been developed, and it has come to be considered "best practice." It is time now for pediatric nurses to learn strategies for implementation of family-centered care.
To practice in a family-centered manner requires nurses to shift from a professionally-centered view of health care to a collaborative model that recognizes families as central in a child's life and their values and priorities as central in the plan of care. Nursing strategies to promote the family's role as primary caregiver for their child include recognizing and accepting diverse styles of family coping, helping families recognize their strengths and methods of coping, reassuring parents regarding their essential role, and facilitating family involvement and caregiving. The use of communication models such as LEARN and the Nursing Mutual Participation Model of Care can facilitate collaborative parent-professional relationships. A brief review of research on families of children critically or chronically ill implies that care for children and their families can improve when family-centered practices are implemented in health care settings.
As part of a comprehensive study on the impact of home apnea monitoring on family functioning, we undertook an in-depth analysis of risk factors for poor family functioning in 93 families of monitored infants. A multistep correlation and regression analysis was used to examine the ability of 16 demographic, infant, family, and monitor-related variables to predict poor functioning in each of 12 different aspects of family life. Of note was the fact that monitor-related variables failed to be important predictors of poor family functioning. Rather, previous family problems and low satisfaction with social support were the most broad and powerful predictors of poor functioning. To enhance the capabilities of families to manage the added responsibility of home monitoring, clinicians might wisely assess both of these aspects of family life and then target extra support services to families identified to be at risk in these areas.
Parents and family members may be unable to visit a hospitalized child frequently for any number of logistical or emotional reasons. Strategies to promote parent-professional collaboration when parents visit infrequently include: reaching out to both establish a relationship with family members and encourage their relationship with the hospitalized child; providing logistical support to facilitate visiting; and providing training and support for staff in family-centered care, including accepting diversity in family styles and choices.
A child's disability or acute or chronic illness has an effect on all family members, including siblings of the affected child. Children's books, fiction and non-fiction, can be used to support siblings by providing information, addressing feelings, offering insight, assuring the child that others have had similar problems, and facilitating coping. Nurses can introduce children and their families to useful books by having books or book covers on display that the child can choose from; providing families with lists of books; and/or assessing the child's needs, interests and reading level, and recommending a specific title.
The issue of kinship care is explored through an interview with a clinical social worker who runs a support group for grandparents caring for their grandchildren. Starting in the 1980s, the kinship care phenomena spread across economic and racial lines. Nationwide, an estimated 3.2 million children live in grandparent-headed households. Issues faced by grandparents in this role include: the emotional impact of raising children, when past that typical stage of life; how to deal with the feelings of anger and resentment toward their own children; how to say no and be comfortable with it; how to reclaim parts of their own lives; taking care of themselves; special childraising challenges, including HIV, abuse, and neglect; and financial concerns. A kinship care support group is described, and lists of resources are provided.
Family-centered care is increasingly considered "best practice." Yet, recent research points to a discrepancy between philosophy and practice (Bruce & Ritchie, 1997). To make family-centered care a full reality will require the examination of the assumptions underlying the practice of individual health care providers, agencies, and institutions. Typical models underling the provision of health care today include the medical model, the child-focused model, the family-focused model, and the family-centered model. Understanding the assumptions of each of these models is important. Identifying them in practice will require a process of reflection. Once assumptions underlying the current practice of an individual or institution are made conscious, assumptions that interfere with family-centered practices can be identified.