Family-Centered Care has been recognized as the best current model for delivering care to all patients, particularly pediatric patients and their families. Although the concepts of family-centered care are accepted in theory, studies show barriers in implementing the model in clinical practice. The major problems reported during pediatric hospitalizations include lack of communication, lack of information and guidance, lack of clearly defined roles and expectations, lack of support for parents' psychosocial needs, disregard for parents' prior experience and concerns, stereotyping of parents by nurses, unfair expectations placed on parents, and the use of parents as unpaid caregivers. This thesis provides a comprehensive review of research literature regarding the barriers associated with implementing family-centered care. Studies included perspectives of parents, nurses, and health care professionals and the themes identified were used to make recommendations for clinical practice, nursing education, and future research

The purpose of this study was to assess parental and medical staff perceptions of the implementation of family-centered care during the surgical process at a pediatric hospital. Both children and parents experience hospitalization as a stressful process often characterized by painful, frightening medical procedures, interactions with strangers, and a loss of control and decision-making abilities. Medical staff members can play a vital role in alleviating parental distress by providing clear and consistent communication, support, and collaboration with parents throughout their child’s hospital care and recovery. Therefore, this study specifically sought to examine parental and medical staff members’ perceptions of the provision and importance of three types of social support: informational, emotional, and instrumental. This study also sought to examine the relationship between parental perceived provision and importance of social support and parental perceived stress. Qualitative questions were utilized to gather additional information regarding parents’ and medical staff members’ experiences throughout the surgical process. The sample for this study included 117 parents of surgical patients and 51 medical staff members (nurses, surgeons, and anesthesiologists) at a pediatric hospital in the southwestern United States. The quantitative data were analyzed using Mann-Whitney U Tests, Kruskal-Wallis Tests, and correlational analysis. Qualitative data were examined to identify major themes that have supported and contrasted with the quantitative results. The findings of this study revealed statistically significant differences between the perceived provision and importance of social support types among participant groups. Results also indicated statistically significant associations between parental perceptions of the provision and importance of social support type and parental perceived stress. These significant findings serve to inform care for families during the surgical process and guide future research in this area. / text

Although family centered care and natural environment services have been heralded as the ideal model in early childhood intervention and have been mandated by Part C of IDEA, research demonstrates that family centered principles are still not adhered to in many early childhood programs. Previous research in this area is lacking with regard to the limited diversity of participants (i.e., white, middle-class woman) and perspectives (i.e., childcare providers). This dissertation reports the results of a study that took into account perspectives of multiple stakeholders in early intervention including families, service providers, and program directors in order to understand the full range of difficulties and supports experienced when providing family centered care in the natural environment. This qualitative study used grounded theory methods to analyze information gathered through semi-structured interviews to elaborate the barriers and facilitators experienced in family centered care and natural environment services. The core theme identified in the data was the tension between the resources available to early intervention and the ideals of best practice. This core finding was supported by three themes regarding facilitators and barriers to service provision. Two of these, the need for theoretical buy-in to the model and the challenges of negotiating roles in family centered care, emerged as either facilitators or barriers, depending on service provider roles. The third theme was common across the data and indicated that the major barrier to natural environment services was the management of scarce resources.

The transition towards family-centered practice in early childhood intervention has shifted the focus from looking at the child in isolation towards understanding the child in context. The primary context for the child’s development is the family setting which is inextricably linked to the family’s culture, beliefs and values. The cultural context is transmitted through activity settings which make up the everyday experiences and events that involve the child’s interactions with various people and the environment. Activity settings are a part of daily life and include activities like eating dinner, bath time, listening to stories and getting ready for school. Furthermore, activity settings represent how families can and do structure their time, based on tradition, the orientations provided by culture and the socio-economic system within which they live. Intervention goals that fit easily into these settings are more likely to be adopted and practised, as they are less likely to disrupt the daily functioning and coherence of the family. While there is a clear emphasis in the literature on developing intervention approaches that are applicable to families from diverse cultural contexts, little is known about the beliefs and practices of low-income urban families in South Africa. Children in Africa have frequently been judged against Euro-American norms and standards, where the aim has been to change instead of understand the context in which children live. This study therefore aims to identify everyday activities that provide children with varied opportunities for learning and development within the natural environment of the family context. A descriptive design using structured interviews was utilised to obtain information about the activity settings that children aged 3-5 years engaged in. Face-to-face interviews with 90 caregivers were conducted, utilising a self-constructed interview schedule consisting of a written list of closed and open-ended questions. This approach was chosen as it holds no bias against respondents who have varied literacy levels. The interview schedule was developed through a process of consultation with parents/caregivers from the Soweto community, using focus group discussions. The results provide information on the types of activities that children participate in, the frequency of participation, the partners involved, as well as the purpose of the activities. Caregiver perceptions on the importance of activities were also obtained through closed and open-ended questions. / Thesis (PhD)--University of Pretoria, 2009. / Speech-Language Pathology and Audiology / Unrestricted

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Family-centered care (FCC) is recommended as “best practice” across a variety of pediatric service settings, as it yields better health and wellness outcomes for clients, and greater work satisfaction for practitioners and administrators (American Academy of Pediatrics, 2012). However, providers in multiple health care fields report challenges with translation of FCC concepts into their practice (Bamm & Rosenbaum, 2008; Graham, Rodger, & Ziviani, 2008; Lawlor & Mattingly, 1998; MacKean, Thurston, & Scott, 2005). Therefore, the aim of this doctoral project was to understand the barriers to FCC implementation, and to propose ways for supporting practitioners to enact FCC in their practice. The resulting solution is Better Together, an on-line professional development course designed to empower health care providers to become ambassadors of FCC and effectively enact the FCC practices in their daily interactions with clients and their families. The Better Together course content and structure are based on findings from a review of the literature specific to identifying core skills and knowledge essential for effective FCC practice, as well as best practices for professional development instruction. Methods for course implementation, funding, and dissemination are described, as well as a research plan for program evaluation.

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Background: In Peru it is estimated that ten percent of the population suffers from a disability. Nursing in rehabilitation setting is when the nurse aims to maximize the quality of life for a patient suffering from disability or chronic disease. Aim: The aim is to describe nursing by care providers on a rehabilitation center in rural Peru. Method: The method in this thesis is observational study with ethnographic approach. The observations is performed on a rehabilitation center in rural Peru. Result: Two themes and four sub-themes were identified from the collected data. Nursing care with including sub-themes clinical investigation and family-centered care. Mobilization and independency with including sub themes improve the chance to mobilize and promote self-management. Conclusion: The Peruvian nursing care provided through a rehabilitation center in rural Peru shows that care providers are working with very basic equipment and limited instructions about how to maximize the patient outcome with very few recourses. Education methods are adjusted to their patient group to promote family centered care. Further research: Guidelines for rehabilitation nursing should be developed for settings without high technologized equipment as well as how to maximize the patient and family outcome through family centered care with limited resources. / Bakgrund: I Peru beräknas tio procent av befolkningen vara drabbad av ett funktionshinder. Rehabiliterings-omvårdnad syftar till att maximera livskvalitén för den patient som lider av ett handikapp eller en kronisk sjukdom. Syfte: Syftet är att beskriva vårdgivarens omvårdnad vid ett rehabiliteringscenter på Perus landsbygd. Metod: Metoden i denna studie är en observationsstudie med etnografisk ansats. Observationerna är utförda vid ett rehabiliteringscenter på Perus landsbygd. Resultat: Två teman och fyra sub-teman har identifierats utifrån insamlad data. Omvårdnad som inkluderar klinisk undersökning och familjecentrerad vård. Mobilisering och ökad självständighet som inkluderar ökad chans till mobilisering och främjande av egenvård. Slutsats: Den peruanska omvårdnaden som erbjuds vid ett rehabiliteringscenter på landsbygden i Peru visar att vårdgivare arbetar med väldigt basal utrustning samt begränsade instruktioner för att patienten ska kunna uppnå maximal funktion med få resurser. Undervisningsmetoder är anpassade till deras patientgrupp för att främja familje-centrerad omvårdnad. Vidare forskning: Riktlinjer för rehabiliteringsomvårdnad bör utvecklas avsett för en miljö utan högteknologisk utrustning samt beskriva hur patienter tillsammans med sin familj uppnår maximalt resultat med få resurser att tillgå.

Background: Intensive care unit (ICU) admission is often life threatening, and may cause severe anxiety within the family system. Anxiety can impair decision-making ability. A majority of ICU patients cannot direct their own treatment; therefore, family members are often required to make major decisions under stressful conditions. Patient and family-centered care (PCFF) has been shown to reduce anxiety, improve decision-making, and improve outcomes for patients and their families. However, no published study has examined outcomes of a comprehensive PFCC program in the ICU. Purpose: The study purposes were to evaluate a comprehensive program to improve PFCC within an adult ICU, and to determine the usefulness of specific PFCC interventions. Methods: An exploratory comparative design was used. Data from ICU patients' family members and ICU nurses, before and after implementation of a PFCC program, were compared using the 30-item combined Critical Care Family Needs Inventory/Needs Met Inventory (CCFNI/NMI). Convenience samples of 49 adult family members of patients admitted to the ICU for at least 36 hours and 85 nurses employed in the ICU full-time for at least six months were recruited from an adult ICU in a 337-bed tertiary care hospital in the southwestern region of the United States. The program was conducted in 3 stages: baseline assessment, program development and implementation, and evaluation. Results: After the PFCC implementation statistically significant differences between nurses' and family members' responses were reported for18 items on the CCFNI and 20 items on the NMI. Five of the10 items family members ranked highest at baseline remained in the top 10 after PFCC implementation, and 3 needs ranked lowest at baseline moved up to the top 10. Conclusions: The results show that the nurses' education was likely the most efficacious program intervention. There may be a hierarchy of needs specific to ICU patients' family members, similar to those described by Maslow. Further study is needed to determine the effectiveness of the CCFNI/NIM in measuring outcomes before and after a PFCC intervention.

Bakgrund: Hälsan hos barn med funktionsnedsättning är sämre än hos andra barn. Tillståndet påverkas av den familj som barnet lever i samt den omgivande miljön. Familjerna har många samarbetspartners i vård och omsorg och barnet kräver mer stöd och omvårdnad än barn i allmänhet behöver av sina föräldrar. Det är viktigt att hitta metoder som sänker påfrestningarna samt förebygger ohälsa i familjen. Syfte: Syftet med denna uppsats har varit att beskriva föräldrars, barns och vårdgivares upplevelse av familjecentrerad omvårdnad, FCC, som riktar sig till familjer som har barn med funktionsnedsättning. Metod: Litteraturöversikt valdes som metod och baseras på 13 vetenskapliga artiklar med både kvalitativ och kvantitativ ansats som analyserats. Resultat: FCC definieras i artiklarna i termer av kvalitét och tillgänglighet men även som att som förälder bli lyssnad på, få tillräckligt med tid, bli bemött med respekt, ha ett gemensamt beslutsfattande mellan föräldrar och professionella och att få information, vid behov anpassad. Genom flexibla arbetssätt som är anpassade efter barnet och familjens behov både inom sluten och öppen vård och inom habilitering, kan stress minska både i familj och hos vårdpersonal. Det finns dock grupper med funktionsnedsättning som uppfattar vården som lägre familjecentrerad än andra familjer. Slutsats: Hörnstenen i familjecentrerad omvårdnad är samarbete mellan vårdgivare och familj vilket främjas av att vårdgivare tar hänsyn till och respekterar familjens kultur och bakgrund. Artiklarna i studien visar på att familjecentrerad omvårdnad ger stöd för att vara en framgångsfaktor inom vården. FCC främjar barnets och familjens hälsa vilket gynnar samhällsekonomin på sikt. / Background: The health of children with disabilities is worse than other children. The state is influenced by the family that the child live in and the surrounding environment. The families have many partners in health care and the child needs more support and care than children in general need of their parents. It is important to find ways to reduce stress and prevent illness in the family. Purpose: The purpose of this study was to describe parents, children and healthcare experience of family-centered care, the FCC, which is aimed at families who have children with disabilities. Method: Literature review was elected as a method and is based on 16 scientific articles with both qualitative and quantitative approach analyzed. Results: The FCC defined in the Articles in terms of quality and availability, but also as a parent to be listened to, given enough time, be treated with respect, have a joint decision between parents and professionals and to get information, if necessary, adapted. Through flexible approaches that are tailored to the child and family's needs both in inpatient and outpatient care, and in rehabilitation, stress can reduce both the family and the health professionals. However, there are groups with disabilities who perceive health care as a less family-centered than other families. Conclusion: The cornerstone of family-centered care is the collaboration between caregivers and family, which is promoted by the health care provider will take into account and respect the family's culture and background. Articles in the study shows that family-centered care provides support to be a success factor in health care. FCC promotes child and family health, which benefits the economy in the long term.