Aims The concept of family centred care (FCC) has informed the provision of care to hospitalised children since the late 1980s. However, there is a well acknowledged gap between the principles and practice of FCC. Differences between the expectations of care providers have been demonstrated as has nurses’ reticence to share decision-making and cede control to family members. Family members, in turn, have pointed to the lack of support received from nurses. This paper presents findings from a study which sought to explore the potential for care contracts to support family – enabled hospital care for children.
Methods A 10 month, focused ethnographic study was carried out in 2 medical and 2 surgical wards in one Children’s Hospital in the North of England. Data, focusing upon activities of daily living and the administration of oral medication, were generated via observation, interviews and focus group discussion with 144 family members (children aged up to 15 and their parent/s) and 65 nurses and Health Care Assistants. All data were subjected to thematic analysis.
Results Although parents generally considered it their ‘duty’ to provide basic care for their children while in hospital, they did not necessarily know what they were ‘allowed’ to do or how they might achieve this. This role confusion was particularly significant during acute, short stay hospitalisations. Nurses recognised the vital role that parents’ play in care provision and considered it their responsibility to control and direct negotiations with family members. Both parents and nurses valued informal aspects of care negotiation and neither considered formal contracts to be the way forward.
Conclusions There remains clear evidence of a gap between the principles and practice of FCC, particularly during one-off and short stay hospitalisations, which account for a significant proportion of all admissions. This paper will conclude by suggesting approaches that may enable parents’ participation in their child’s care that could also be, on the basis of our findings, acceptable to nurses.
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