Academic journal article Forum on Public Policy: A Journal of the Oxford Round Table

Family-Centred Care: Effective Care Delivery or Sacred Cow?

Academic journal article Forum on Public Policy: A Journal of the Oxford Round Table

Family-Centred Care: Effective Care Delivery or Sacred Cow?

Article excerpt


A visit to most paediatric health services almost anywhere in the world will find the term "family-centred care" in a variety of languages, on policy documents, frameworks, models of care, guidelines and people's lips (Shields, 2010a). The Institute for Patient- and FamilyCentered Care in America (2011) provides a list of elements of family-centred care, but most definitions are descriptive. Scholars suggest that family-centred care is a wonderful ideal but very difficult to implement in practice (Darbyshire, 1994), while some qualitative studies (Coyne and Crowley, 2007; Coyne, 2008) reflect an inability of health service staff to effectively implement a family-centred care model.

Family centred 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, et al. 2006, p. 1318). In countries around the world we have become used to seeing parents as an integral part of the child's care. In all countries, it is common to see parents helping to care for their child in a health care encounter. This is as true in developing countries as it is in wealthy developed nations (Shields, 1999; Shields and Nixon, 1998). This paper examines family-centred care, its evolution and development, and describes research about it. Questions are posed as to its applicability and the ethics of continuing with an untested model.

An historical overview

The evolution of family centred care started with the first freestanding children's hospitals. In 1802, the first children's hospital was opened in Paris, quickly followed by Vienna and St. Petersburg (Hayes, 1965). The first paediatric hospital in an English-speaking country was opened in 1856, the now famous Hospital for Sick Children, Great Ormond Street, London. As children's hospitals evolved, and nursing developed as a profession, styles of paediatric nursing developed. Until the 1960s, children's wards were regimented and controlled; tidiness and discipline took precedence over the emotional needs of the child (Shields and Nixon, 1998; Jolley and Shields, 2010). Children were often tied in their beds, ward furniture was adult size, and prevention of cross infection was paramount (Watkins and Lewis-Faning, 1949). Importantly, parents were very often excluded from the hospital ward in which the child was admitted. Nurses and doctors of the day genuinely believed that the presence of parents caused the child severe emotional upset, and reasoned that it was best if parents did not visit at all (Alsop-Shields and Mohay, 2001). Consequently, children who were admitted to hospital with long-term diseases such as tuberculosis or juvenile rheumatoid arthritis may not have seen their parents for up to three years, a common length of an admission for such conditions. Admission to hospital for a small child was a traumatic and distressing event, and was equally so for parents.

Some enlightened researchers and clinicians began to question such practices and attitudes in the 1920s and 30s (Jolley and Shields, 2009). Sir James Spence, a paediatrician in Newcastle-upon-Tyne in England admitted breastfeeding mothers with their infants (Spence, 1960), while in the United States, Renee Spitz, a child psychiatrist, coined the term "hospitalism" to describe a child who was highly institutionalized from long-term admission to hospital (Spitz, 1945). Two British men were arguably the most important influences on changes in attitudes about the hospitalization of children. John Bowlby, a child psychiatrist working in the Tavistock Clinic in London in the 1940s and onwards became the preeminent theorist about maternal and child attachment (Alsop-Shields and Mohay, 2001). He demonstrated that a child separated from his or her mother at an early age and for an extended period of time often suffered psychopathology in later childhood and adolescence (Bowlby, 1940; 1953). …

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