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Nurses' Reflections on Benefits and Challenges of Implementing Family-Centered Care in Pediatric Intensive Care Units
Heather Coats1, Erica Bourget1, Helene Starks1
1Heather Coats is an assistant professor of research, University of Colorado College of Nursing, Denver, Colorado. Erica Bourget is a research assistant at the Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington. Helene Starks is an associate professor, Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, Washington. Taryn Lindhorst is a professor, University of Washington School of Social Work, Seattle, Washington. Shigeko Saiki-Craighill is a professor, Faculty of Nursing and Medical Care, Keio University, Tokyo, Japan. J. Randall Curtis is a professor, Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington School of Medicine. Ross Hays is a professor in the Center for Child Health, Behavior and Development, Seattle Children's Research Institute, and in the Department of Rehabilitative Medicine, University of Washington School of Medicine. Ardith Doorenbos is a professor in the Department of Biobehavioral Nursing and Health Systems, University of Washington School of Nursing; the Department of Bioethics and Humanities, University of Washington School of Medicine; and the Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine.
Background:
Family-centered care is a proposed way of supporting family involvement with a child's care and decreasing distress associated with a child's critical illness by improving communication, helping manage stress and coping, and decreasing conflicts. Nurses are critical to successful implementation of family-centered care.
Objectives:
To describe nurses' perceptions of the benefits and challenges of providing family-centered care in pediatric intensive care units.
Methods:
Semistructured interviews of 10 bedside and charge nurses in pediatric, cardiac, and neonatal intensive care units. Questions were related to 4 domains: the intensive care unit environment and its relationship to the structure and delivery of critical care, stressors for nurses and families, communication challenges and strategies, and involvement of families in care and decision-making.
Results:
The main thematic finding was the nurses' descriptions of a "balancing act" to provide quality family-centered care. The balancing act was characterized by the interaction between 2 types of changes: (1) intensive care unit policies related to visitation hours and family presence at the bedside and (2) physical transformations in the intensive care unit from shared open space to individual private rooms.
Conclusions:
All of the nurses viewed the transition to family-centered care as having benefits for families. They also described how changes had created new challenges for the delivery of nursing care in intensive care units, particularly regarding mentorship and the safety of patients and staff.