8 There is a plethora of published literature which documents the evolution of family-centred care over seven decades. The term family-centred care is synonymous with children’s nursing, yet a consensus on a single definition has not been achieved. The literature identifies that family-centred care is socially constructed and relevant to the time, culture and place in which it is practised and it has been interpreted in various models. Family-centred care considers the child or young person and their family as one unit. Fathers also have a unique contribution to make within family-centred care. Fathers are often viewed as the breadwinner and supporting the mother. This has the potential for fathers to feel ‘less important’ when they may wish to participate in the care of the child. There is a dearth of literature which considers the role of siblings within family-centred care. Siblings are likely to have the longest relationship. Following the United Nations Convention on the Rights of the Child (UNCRC, 1989), there has been a growing acknowledgement of children and young people’s rights within family-centred care. Considering the needs of the children and young people in family-centred care is enhanced by the unique and vital contributions made by their parents and carers. Without their knowledge and contributions, caring for children and young people would be more challenging. Accurate nursing assessment underpins family-centred care and partnership working. It is a complex process which draws from a range of models, concepts and ideals. From nursing assessment it is important to identify and understand the individual child or young person, their family dynamics and the context of the family environment. Understanding the needs of children and young people will enable children’s nurses to move beyond the physical, emotional, intellectual and social assessments to facilitating participation in care. When communicating with children and young people, it is important to acknowledge the age and stage of development of the child and young person in relation to language development and vocabulary. Children’s nurses should be mindful of selecting appropriate vocabulary in order that the meaning is understandable and not subjective. Children draw meaning from life experiences and do not always share their thoughts with adults. Children may interpret these terms as indicators of danger or fatality. Research has shown that younger children prefer adults to communicate on their behalf. As children develop, they wish to communicate directly with the health professionals, however, parents may still communicate on their behalf, thus the ‘child’s voice’ will be ‘silenced’ or only partially included according to parenting styles. Young people move into a position where they assume a lead in communicating with health professionals and establish an active voice. Effective communication within family-centred care is complex and requires active listening skills. A single conversation with a family may include the child or young person and their family. Each child or young person and their family is unique and has different care needs and requires different levels of support. Therefore, it is important to negotiate the parts of care they wish to undertake. Negotiation of care should be meaningful and avoid tokenism. Negotiation requires the children’s nurse to wish to share the care. Children’s nurses should be mindful of the language they use. Well-meaning phrases such as ‘my patient’ do not indicate a readiness to share care. Children, young people and their families should not feel compelled to participate in care. Effective communication is the basis for meaningful negotiation of care between the child or young person, the family and the children’s nurse. Enabling children and young people to participate in their care may be a straightforward transition. Children and young people with complex care needs can be empowered to learn new skills in order that they are less dependent on their parents for their care needs. The literature identifies that children and young people should be active participants in their healthcare journeys. Empowering children, young people and their parents to participate in care shifts the locus of control to enable them to be active participants in their healthcare. This will be particularly important where the child has a chronic or long-term condition. Children’s nurses are in a pivotal position to teach children, young people and their families any new skill. New knowledge, information and skills will enable children and young people to become active participants in their care. In order for the child, young person and their families to learn these new skills or techniques, it is important to plan participatory experiences. The demonstration of the skills or technique should be broken down into smaller, sequential stages. The opportunity for questioning should be expected and a range of answers to anticipated questions could be prepared. As children’s nurses are accountable for their actions or omission, careful consideration of the documentation of competence to undertake the skill or technique is required.
Family-centred care
Defining family-centred care
Competence in nursing assessment
Communication and negotiation of care
Participation in care
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