Clinical Practice Column
Column Editor: Maura MacPhee, PhD, RN
The Evolution of Family-Centered Care

https://doi.org/10.1016/j.pedn.2008.03.010Get rights and content

Aim

The aim of this study is to explore the history of family-centered care (FCC).

Background

FCC was developed after Word War II, when nursing, then deeply paternalistic, had become asynchronous with changing social expectations for the care of hospitalized children.

Methods

This is a historical review of literature reflecting development of pediatric models of care using publications of classic theorists and others.

Results

Development of FCC resulted from work by U.S. and UK researchers, theorists, and advocates. Their research was right for its time, and its acceptance was the result of social readiness for change resulting from people's experience of Word War II.

Conclusion

Word War II brought about changes enabling emergence of lobby groups concerned with children in hospital, awakening of pediatric health professionals to family-oriented practice, and development of models of care that allowed widescale adoption of FCC.

Section snippets

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,

References (61)

  • BradleyS.

    Suffer the little children: The influence of nurses and parents in the evolution of open visiting in children's wards 1940–1970

    International History of Nursing Journal

    (2001)
  • BurlinghamD. et al.

    Young children in war-time

    (1942)
  • CaseyA.

    Partnership nursing: Influences on involvement of informal carers

    Journal of Advanced Nursing

    (1995)
  • Children in Hospital Ireland

    CHI history

  • Citizen's Committee on Children of New York City

    Liberal visiting policies for children's hospitals

    Journal of Pediatrics

    (1955)
  • ClearyJ.

    Caring for children in hospital: Parents and nurses in partnership

    (1992)
  • CoyneI.

    Disruption of parent participation: Nurses' strategies to manage parents on children's wards

    Journal of Clinical Nursing

    (2007)
  • CoyneI.T.

    Partnership in care: Parents' views of participation in their hospitalized children's care

    Journal of Clinical Nursing

    (1995)
  • CrosbyT.L.

    The impact of civilian evacuation in the second world war

    (1986)
  • DarbyshireP.

    Family centered care within contemporary British pediatric nursing

    British Journal of Nursing

    (1995)
  • European Association for the Care of Children in Hospital

    About EACH

  • FaustO.A.

    Stop scaring the children

    Modern Hospital

    (1953)
  • FleuryS. et al.

    Visiting in the pediatric department

    The Canadian Nurse

    (1954)
  • FrankR.

    Parents and the pediatric nurse

    American Journal of Nursing

    (1952)
  • FreudA.

    Discussion of Dr. John Bowlby's paper

    Psychoanalytic Study of the Child

    (1960)
  • GodfreyA.E.

    A study of nursing care designed to assist hospitalized children and their parents in their separation

    Nursing Research

    (1955)
  • GoffmanE.

    Asylums: Essays on the social situation of mental patients and other inmates

    (1962)
  • GofmanH. et al.

    Parents' emotional response to child's hospitalization

    American Journal of Diseases of Childhood

    (1957)
  • GoodbandS. et al.

    Parent care: A US experience in Indianapolis

  • IllingworthR.S.

    Young children in hospital

    Nursing Times

    (1956)
  • Cited by (140)

    • Development and Psychometric Evaluation of a Caregiver Survey to Assess Family-Centered Care in the Emergency Department

      2023, Academic Pediatrics
      Citation 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

    • Discrepancies 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 Nursing
      Citation 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).

    View all citing articles on Scopus
    View full text