以家庭为中心儿科护理模式创建与评价

目的：探索以家庭为中心儿科护理模式,提升患儿及家长的满意度和患儿安全。方法：创建以家庭为中心儿科护理模式,包括制定以家庭为中心儿科护理政策,配备数量充足和资历合格的护理人员,明确总责护士和责任护士的具体职责,对临床护理人员进行以家庭为中心儿科护理理论和实践的培训与考核,研制工具以评价护理人员执行以家庭为中心护理措施的情况,评价以家庭为中心儿科护理模式的实施效果。结果：患儿家长对以家庭为中心儿科护理模式的总体满意度为93.5%,患儿安全指标如给药错误发生率、跌倒/坠床发生率明显下降。结论：把以家庭为中心儿科护理理念转化为行动,深入到儿科护理实践的方方面面是一个长期持久的过程。而在患儿危机时刻,让家长和孩子在一起更是一个巨大的挑战,需要医护人员和患儿家长共同努力。     

Development of a family liaison model during operative procedures.

The essence of family-centered care is the provision, by all health professionals, of psychosocially supportive care that fosters family integrity and functioning. Data from a hospital-based satisfaction survey at The Children's Hospital of Philadelphia (CHOP) indicated that the primary reason for parents being "less than completely satisfied" was lack of communication. A search of recent literature suggests also that breakdown in family-centered care in intensive care units is neither new nor unique. The purpose of this article is to describe how efforts to improve communication with parents and families led to the development of a family liaison program and an expanded role for staff nurses in the Cardiac Intensive Care Unit (CICU). The goals of this family liaison program were three-fold: to facilitate establishment of a relationship between CICU nursing staff, parents, and families at the earliest possible point in time; to ensure communication with parents and families at regular intervals during their child's surgery; and to promote practice that incorporates principles of family-centered care within the CICU. The design and implementation of such a program presented nurses in the CICU with both a challenge and an opportunity to take an innovative approach to meeting the fundamental need for information reported by parents and families, and echoed throughout nursing literature. This family liaison program serves to educate parents and families, communicate updates, provide physical and emotional support, and establish continuity of care for the patient and family. Additionally, nurses involved in the program have given positive feedback regarding their expanded role in this family-centered care model.     

家长对"以家庭为中心护理"的认识

目的探讨家长对护理人员提供"以家庭为中心护理"的认识.方法目的抽样选择180例住院患儿的家长,采用美国波士顿儿童医院的"以家庭为中心护理"量表,在患儿出院前1天对其家长进行一对一调查.结果护士提供"以家庭为中心护理"的一致性与家长认为的重要性之间的平均匹配系数为0.59,范围在0.29～0.88.结论我院护士提供的以家庭为中心的护理措施,能满足家长和孩子生理上的需求及孩子和家长在一起的需求,能让孩子感觉受到很好的照顾.在关注孩子及家庭的心理、行为,为家长提供信息和心理支持,以及鼓励家长参与性方面与美国波士顿儿童医院的现况存在一定距离.     

Family-centered care in the NICU

Family-centered care is a philosophy of care that embraces a partnership between staff and families. Families, patients, and staff benefit in a family-centered care environment and the design of the newborn intensive care unit (NICU) must not interfere with its successful implementation. Unrestricted parental presence in the NICU, parental involvement in infant caregiving, and open communication with parents are basic tenets of family-centered care. By virtue of their continual presence and role in the NICU, nurses are in a unique position to support family-centered care.     

Quality in pediatric nursing care: children's expectations

Children's perceptions of pediatric nursing care have not been systematically taken into account in the development of the quality of care. Usually, parents have evaluated children's care and its quality. The purpose of this study was to examine children's expectations concerning the quality of pediatric nursing care by interviewing 20 preschool and 20 school-aged children in Finland. Twenty of them had insulin-dependent diabetes mellitus (IDDM) and visited the hospital on a regular basis, and 20 were treated on a surgical ward for a short period. Using content analysis, the interviews were coded and categories and subcategories identified. The children's expectations concerning the quality of nursing care were related to the nurse, nursing activities, and environment. They expected the nurses to be humane and reliable, have a good sense of humor, and wear colorful clothes at work. Both the nurses and the parents were expected to take part in nursing activities. The children expected from nurses, in particular, entertainment, educational, caring, and safety activities, while parents were expected to relieve fears and longing and to provide company. The children also emphasized the role of other children as part of good care. The results demonstrate that children are capable of offering valuable insights into the quality of pediatric nursing care. The results open new avenues for strengthening children's perspectives on pediatric nursing.     

The parent-nurse relationship from the perspective of parents of children with cancer

Research to date has overlooked the specific relationship between parents and nurses, particularly in the context of family-centered care for a hospitalized child with cancer. The purpose of this study was to describe how parents perceive the relationship with the pediatric staff nurse necessitated by the hospitalization of their child with cancer. Using a symbolic interactionist framework and a modified grounded theory methodology, this study explored the parent-nurse relationship when a child with cancer is hospitalized. A purposive, theoretical quota sampling method was used to recruit 16 parents. Both parents' and nurses' care were examined from the parents' perspectives; mothers and fathers were interviewed separately. Analysis of the data led to the development of a substantive theory describing parent care (Making it Better), nursing care (Going Through the Motions, Caring Incompletely and Caring Completely), and the parent-nurse relationship (Working Together). Conditions influencing the care provided by parents and nurses and in turn the parent-nurse relationship were also identified. This research describes strategies nurses use to enhance the family-centered care they provide and reveals the effect nursing care has on parents' hospital experiences. Recommendations are made for nursing research, practice, and education.     

The developing role of children's nurses in community palliative care

This article addresses some of the contemporary issues in relation to providing palliative care for children in Ireland, particularly focusing on the creation of the specialist palliative care nursing outreach posts. The recent publication of an Irish national policy on palliative care for children with life-limiting illness is welcome news for paediatric nurses in Ireland. Children are valued members of society and have a right to receive quality health care and support appropriate to meet both children and the families' precise needs. However, community services for children with life-limiting illnesses remain inadequate, with many parents and families struggling to provide palliative care for children in the home. Currently, community nurses, who are not always registered children's nurses, are providing palliative care for children at the end of life. These nurses may not fully understand the specific needs of critically or chronically ill children and their families. In addition, there are no specific palliative care educational programmes in Ireland with regard to end-of-life care for children. The challenges of providing palliative care to children and their families in relation to symptom control, controversial ethical and legal issues, and emotional and practical support, mean that advanced knowledge is required in order to progress the agenda and thus provide excellence in children's palliative care in Ireland. It is important that the agenda is moved forward so that children and their families requiring palliative care and nursing support do not suffer from a lack of professional provision for their needs.     

Psychological care of children and family in the critical care setting

Admission to the critical care setting can be a traumatic experience for a child and his or her parents. Besides providing physical care, the nurses should assess the psychological and emotional responses of the children and their parents. By integrating the child's psychosocial development and the principles of family-centered care into critical care nursing, the impacts of emergency admission on hospitalized children and their families can be reduced in order to facilitate adaptation on the part of the families.     

Challenging the philosophy of partnership with parents: a grounded theory study

BACKGROUND: Parent participation is viewed as a pivotal concept to the provision of high quality nursing care for children and their families. Since the 1990's, the term 'partnership with parents' has increasingly been reported in the literature and adopted as a philosophy of care in most paediatric units in the United Kingdom. OBJECTIVES: To explore children's, parents', and nurses' views on participation in care in the healthcare setting. DESIGN: Using grounded theory, data were collected through in-depth interviews, and participant observation. Sample consisted of eleven children, ten parents and twelve nurses from four paediatric wards in two hospitals in England. RESULTS: Most nurses assumed that parents would participate in care and viewed their role as facilitators rather than 'doers'. Nurses reported that the ideology of partnership with parents did not accurately reflect or describe their relationships with parents. Parents could never be partners in care as control of the boundaries of care rested with the nurses. Parents felt compelled to be there and to be responsible for their children's welfare in hospital. CONCLUSIONS: The pendulum of parent participation has swung from excluding parents in the past to making parents feel total responsibility for their child in hospital. It is argued that the current models or theories on parent participation/partnership are inappropriate or inadequate because they do not address important elements of children's, parents' and nurses' experiences in hospital.     

Developmentally supportive care in the newborn intensive care unit: early intervention in the community

The traditional focus of hospital nurses on the medical concerns of infants and toddlers is expanding to encompass the more global view that integrates the developmental level of each infant/toddler into the nursing care plan. Research on early brain development has supported the focus on developmentally supportive care in the NICU. Nursing support of the early relationship between infant and parent that will influence the infant's future development is part of this process. The integration of developmental care concepts including family-centered care that begins on admission to the NICU may continue into the process of discharge and transition to home. The nurse is in an excellent position to support the family in naming their concerns, their strengths, and the hopes and dreams they have for their infant. Nurses in the NICU, home care, community, and public health increasingly focus on a developmental perspective in their work but will be continually challenged to increase their knowledge and understanding of developmental milestones, neurodevelopmental assessment, and their role in collaborating with the wider world of early intervention. This collaboration includes the health care system, the educational system, and the social service system as equal players. For some nurses, this will be a new experience whereby the responsibility for the child is shared among members of an interdisciplinary team that includes the parents. Nurses are key to providing developmentally supportive care and working collaboratively on behalf of the infants and toddlers and their families.     

Partnership in care: a critical exploration of how this may be applied to children attending the Accident and Emergency department

Partnership in care is an emerging theme within children's nursing. There has, however, been much debate in the literature about what partnership in care is, but little consensus has been achieved as to its meaning. Partnership in care has been examined from the perspectives of both the parents and the nurses, although principally the work to date has focused on children's wards. More recently the work on partnership in care has examined how this may work in the children's out-patient department and also within community children's nursing. Little appears to have been written about partnership in care in the Accident and Emergency (A&E) environment, and some possible reasons for this have been postulated. Three aspects of partnership in care: negotiation and equality of care, parents as equal partners, and responsibility for care being shifted have all been examined and applied to the A&E setting. Suggestions for research are offered throughout the discussion. Finally, the role of the registered children's nurse is examined in view of the analysis.     

Parent-nurse interactions: care of hospitalized children

BACKGROUND: An essential component of quality nursing care is nurses' ability to work with parents in the hospital care of their children. However, changes in the health care environment have presented nurses with many new challenges, including meeting family-centred care expectations. AIM OF THE PAPER: To report a research study examining the experiences of parents who interacted with nurses in a hospital setting regarding the care of their children. METHODS: A qualitative approach was employed for this study. In-depth audiotaped interviews were conducted with eight parents representing seven families. Data collection was completed over a 7-month period in 2001. FINDINGS: Parents characterized their experiences with nurses caring for their children as interactions, and identified the elements of establishing rapport and sharing children's care as key to a positive perception of the interactions. These elements were influenced by parental expectations of nurses. Changes in nurses' approach were reported by parents as the children's conditions changed. CONCLUSION: Nurses were able to work with families in the hospital care of their children in ways that parents perceived as positive. However, in parents' views, their interactions with nurses did not constitute collaborative relationships. A deeper understanding of these interactions may provoke new thinking about how to promote an agency's philosophy, and how nurses enact this philosophy in practice.     

Nursing telephone triage and its influence on parents' choice of care for febrile children

Nursing telephone triage is a mechanism whereby parents call for advice and referrals. One common call in pediatrics concerns children's fever, which may be managed at home. Giving parents proper advice may avoid unnecessary visits. This study investigated whether home-care advice given by nurses changed parents' original preference for care. Data were collected using an existing database to determine parents' preference for location of care before and actual location of care after a call. Of the 110 calls, 73 parents wanted a physician or emergency department visit but 53 followed nursing advice for home care. Findings suggest that although most parents wanted to have their child seen, a majority followed nursing advice for home care.     

Pediatric nursing practice: keeping pace with technological advances

Over the past 25 years, extensive technological and medical advances have had a major impact on the way pediatric nursing is practiced. Pediatric nurses have expanded their nursing roles, established professional organizations and certification standards to ensure clinical competence at the bedside, and tirelessly advocated for the health care needs of children and their families. In addition, pediatric nurses have collaborated with other health care providers to institute family-centered and developmentally appropriate philosophies of care. All of these changes will assist pediatric nurses to remain focused on the most important aspect of their work: Supporting the unique needs of children and their families.     

Nurses' perceptions of parental involvement in hospital care

Parental involvement is an essential element of quality of care for children in hospital. However, there is often confusion in role perception between parents and nurses which may be affected by nurses' attitudes, their ability to provide information, their communication and interpersonal skills and willingness to relinquish control. AIM: This study examined nurses' perceptions of parental involvement and communication with parents of children in hospital and explored differences in perceptions of recent graduate nurses and more experienced nurses. METHOD: Two focus groups were carried out at a university paediatric hospital in Sweden, one with experienced paediatric nurses (n = 7) and one with recent nursing graduates (n = 6). FINDINGS: Analysis of the discussions identified five themes: clarifying roles, information, work environment, support and clinical competence. These nurses confirmed the belief that involving parents in the child's care is an important part of nursing in paediatric care and suggested that the nurses should play the role of being the communicator with the parents. CONCLUSION: Nurses need to be aware of the impact their communication has on parents and help them to clarify their role as parents in hospital.     

Perceptions of female Saudi undergraduate nursing students toward family-centered care

BackgroundWhile family-centered care is considered a vital part of nursing care, nursing students seem to struggle in incorporating family-centered care in the clinical setting. Several factors such as minimal exposure in family interactions throughout their clinical practice, lack of experience in organizing family-centered clinical experiences, access to restricted clinical areas, and inadequate supervision from clinical instructors present as challenges among nursing students in practicing family-centered care.ObjectivesThis study explored the perceptions of nursing students toward family-centered care in Saudi Arabia.DesignThis study used the quantitative approach through the cross-sectional survey method.SettingsThe study was conducted in the Faculty of Nursing of a government university in Saudi Arabia.ParticipantsA total population sample comprising 232 female junior and student nurses participated in the study.MethodsAfter the approval of the Ethical Board Committee had been secured, a survey containing a demographic information sheet and the Family-Centered Care Questionnaire was distributed to the students from June 2018 to February 2019.ResultsThe overall mean of the students' responses in the questionnaire was 3.76 (SD = 0.67, range = 3.40–4.08), indicating a modest perception toward family-centered care. The dimension “family is the constant” received the most positive response from the students (M = 3.90, SD = 0.77), whereas the dimension “parent-to-parent support” was rated the lowest with a mean of 3.64 (SD = 0.89). Junior nursing students had more positive perception toward family-centered care than the seniors. Weak negative correlations were observed between students' age and family-centered care perception.ConclusionsThis study provides insights into family-centered care, which could be used in crafting policies and interventions in various health care settings and nursing education in Saudi Arabia. Such insights could foster positive perceptions toward family-centered care among student nurses and guarantee excellent family-centered care nursing practice.     

Level 1 neonatal nursing staff perceptions of their role: A qualitative Framework Analysis study investigating the complex and diverse workload undertaken by nurses in special care baby units

This study investigated Level 1 Special Care Bay Unit (SCBU) nurses’ perceptions of the skills required for their role. Eight nurses from a UK inner city Level 1 neonatal unit participated in qualitative interviews about their role. Analyses were based on data collected from semi -structured interviews supported by open -ended questions and use of a topic guide. The SRQR (Standards for Reporting Qualitative Research) checklist was used as a framework to support the qualitative analytical methods undertaken. Level 1 neonatal nurses reported use of a wide range of skills with a high level of parent – infant engagement. Analysis of the participant interviews revealed six themes: a) balancing nursing workload and demands; b) delivering nursing care in a Level 1 SCBU; c) managing clinical risk and emergencies; d) function and sustainability of a SCBU neonatal team; e) delivering family-centered care; and f) external perceptions of Level 1 nursing care. Work on a Level 1 unit consists of a broad range of skills, possibly greater in scope in comparison with skills used by neonatal nurses on Level 2 and Level 3 units. Further in - depth analysis of this role would be useful for the development of practice skills and for recruitment and retention.     

Mommy first

Parents of children with special health care needs are often required to assume responsibility for the complex care of their children. It is important for pediatric nurses to remember these parents are, first and foremost, the child's parents and primarily responsible for loving their child, providing a safe and secure home, and fostering their child's development as a person. Pediatric nurses should support the parents in the medical/nursing care of their child in whatever way possible so the parents have more time to parent. This account from a mother of a child with developmental delay helps remind us of our need to help support parents in being "parents first."