Clinical Practice ColumnColumn Editor: Maura MacPhee, PhD, RNThe Evolution of Family-Centered Care
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What is FCC?
“Family-centered care is a way of caring for children and their families within health services which ensures that care is planned around the whole family, not just the individual child/person, and in which all the family members are recognized as care recipients” (Shields, Pratt, & Hunter, 2006 p. 1318). The Institute for Family-Centered Care (2007) in the United States has listed elements of which it consists (Figure 1). Other terms connote similar things, for example, the term parental
A Brief History of Hospitalization for Children
In the middle years of the 20th century, children were admitted to the hospital without their parents, and parents were either not allowed to visit or could visit for perhaps only half an hour per week. In young children, this resulted in psychological trauma, which was often serious and enduring in nature (Robertson, 1970). In this era, children were hospitalized for long periods, especially for chronic illnesses such as tuberculosis, which could result in a hospital stay of 2 years or more (
Progress to FCC
There were isolated examples of practitioners who tried to develop FCC practices in the years between 1920 and 1970. However, these examples were isolated, unrepresentative, and unsustained. In the UK, Sir James Spence established the first mother-and-child unit in 1927 (Spence, 1947, Robertson, 1962), and in the United States, infection as a reason to restrict visiting to children was questioned in the 1940s and 1950s (Citizen's Committee on Children of New York City, 1955, Faust, 1953, Fleury
The Evolution of FCC
The changes in the care of children in hospital that saw the evolution of FCC developed largely from the work of two British theorists and investigators, John Bowlby and James Robertson (Bowlby, 1944a, Bowlby, 1944b, Bowlby, 1973, Robertson and Bowlby, 1952, Alsop-Shields and Mohay, 2001). Bowlby and Robertson worked in the Tavistock Institute, a child guidance clinic in London. However, although these men were hugely influential, that influence was there only because of citizens' readiness to
The Role of Parents in the Evolution of FCC
Consumers (largely, in this case, parents) have been influential in improving the care for their hospitalized children. The Citizens Committee on Children of New York City (1955) advocated more “child-friendly” hospitals, including allowing parents more access to their children, whereas the British government in 1959 published a report of an inquiry into conditions in children's hospitals, commonly known as the “Platt Report” (Ministry of Health, 1959). British parents who were committed to
The Evolution of Family-Centered Models of Care
The movement to change the way children was cared for in hospitals had a profound effect on nursing. Initially, nurses were divided in their attitudes. They undertook little research into FCC themselves but relied instead on the theories of Bowlby, 1973, Robertson, 1970. Some nurses were pleased to have parents stay with their children (Fleury et al., 1954), others were not convinced that it was in the best interests of the child (Gofman & Schade, 1957), and some were hostile to the idea (
Implications for Practice Today
Today, most pediatric health practitioners believe that FCC is the best way to deliver care to children in hospitals and in the wider health services. However, although many say they believe they practice FCC, it is not implemented effectively (Coyne, 2007), and parents are becoming resentful that they are being “made” to do the nurses' work (Coyne, 1995, Coyne and Crowley, 2007, Darbyshire, 1995). Indeed, this finding effectively shows that FCC, with its emphasis on effective negotiation of
Conclusion
The message for today is the same as it was a generation ago. Children need both affection and their parents. It is not too extreme to suggest that children in hospital need a loving environment. Children's medical and surgical needs are, of course, important but only unusually superordinate. The child's trusting relationship with his or her parents is a thing of great value and a core component of what it is to be a child, and this must be upheld during a child's admission to hospital, or,
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Cited by (140)
Research on Family-Centered Care in pediatric patients: A Bibliometric Analysis
2024, Journal of Pediatric NursingDevelopment and Psychometric Evaluation of a Caregiver Survey to Assess Family-Centered Care in the Emergency Department
2023, Academic PediatricsCitation Excerpt :Of note, although the adjusted partial correlation between our scale's 9-item summary score and the ED CAHPS summary score supports convergent validity, it also suggests that these 2 scales give different results. Family-centered care has been the gold standard approach to pediatric care delivery for decades.39 Although less recognized, there is growing emphasis on an alternative concept: child-centered care.1,40
A phenomenological study exploring pediatric hospitalization: The voices of accompanied and unaccompanied hospitalized children
2023, Journal of Pediatric NursingDiscrepancies between nurses' current and perceived necessary practices of family-centred care for hospitalised children and their families: A cross-sectional study
2022, Journal of Pediatric NursingCitation Excerpt :For instance, associations between a greater degree of FCC implementation and nurses' age, gender, years of experience, and number of children have been documented in developed countries (Bruce et al., 2002; Matziou et al., 2018). In contrast, studies in developing countries that examined current and necessary practices of FCC using the nine elements outlined in the IPFCC framework (Jolley & Shields, 2009) are limited compared with those in Western and developed countries. Studies that use elements of FCC and their evaluative terms are regarded as robust, providing an overall family-centredness of care (Foster et al., 2013).
Nurses' perceptions and attitudes toward family-centered care in acute pediatric care settings in Jordan
2021, Journal of Pediatric Nursing