What Is the Child and Family Services Review Process Include

Reviewers

Linda Shields PhD, FRCNA¹ and Huaqiong Zhou MCN; BSc; RN; ACPCHN²

¹Centaur Swain; Professor of Paediatric and Child Health Nursing, School of Nursing and Midwifery and WACEIHP; A Collaborating Centre of the Joanna Briggs Institute. Affiliated with the Western Australia Heart for Evidence Informed Health Care Practice.

Contact: [email protected]

²Inquiry Officer, School of Nursing and Midwifery, Curtin University; WACEIHP. A Collaborating Eye of the Joanna Briggs Institute

Contact: [electronic mail protected]

Associate Reviewers

Ailsa Munns RN RM CHN (Cert) BSc (Nursing) Primary (Nursing) FRCNA

³Lectuer, Schoolhouse of Nursing & Midwifery, Curtin Academy

Contact: [email protected]

Marjory Taylor B App Sci; BA^four

⁴Head of Section, Library and Information Service, Child and Boyish Health Service Princess Margaret Hospital, Western Commonwealth of australia.

Contact: [email protected]

Elaine Pascoe MBiostat; BSc(Hons) ⁵

⁵ (1)Princess Margaret Infirmary for Children, Child and Adolescent Health Service Princess Margaret Hospital, Western Commonwealth of australia and Schoolhouse of Paediatrics and (2)Child Wellness, The University of Western Commonwealth of australia, Western Australia. Contact: [e-mail protected]

Judith Hunter MBE; MA; BSc(Hons); RGN; RSCN; RNT; Cert Ed^vi

^{half dozen}Nursing and Quality, City Hospitals Sunderland NHS Foundation Trust, Sunderland, Uk

Contact: [email protected]

Review objective

The objective is to identify the effectiveness of family unit-centred models of care for hospitalised children aged 0-12 years (excluding premature neonates) when compared to standard models of intendance.

Background

Until at least the late 1950s, hospitals worldwide tended to be bleak places for children. It was believed that visits from parents would inhibit constructive care ¹ and were detrimental to the child, who would become distressed when the parents left.^2,3 Researchers began to suggest, withal, that children whose parents did not visit them suffered acute emotional trauma which may take long-term psychological consequences in adolescence and adulthood.^four,5 In 1956, the British authorities commissioned a study into the welfare of children in hospital. The resulting report, the Platt Report ⁶, recommended that visiting be unrestricted, that mothers stay in hospital with their kid, and that training of medical and nursing staff should promote understanding of the emotional needs of children. The process of change has resulted in a humanisation of paediatrics, ^7,8 although the movement away from traditional approaches to wellness service commitment to the involvement of families in all aspects of the planning, commitment, and evaluation of health intendance has been slow.^9,10 The foundation for a family unit-centred arroyo to paediatric health care is the belief that a kid's emotional and developmental needs, and overall family wellbeing, are all-time achieved when the service system supports diligently the ability of the family unit to meet the needs of their child, past involving families in the plan of care.^11-13

Much of the literature concerning family-centred care has originated from the UK and United states of america, which are developed and culturally-distinctive (predominately Anglo-Saxon) societies.¹⁴ In low and middle income countries with fewer technological, economical and human being resources, specific information about the psychosocial intendance of children in hospital is limited. ^fourteen,15 Shields found that in some developing countries, parents were encouraged to stay with their hospitalised child just if information technology fitted with hospital rules. ^fifteen Stanford reported that in Central America where children's health is poor, some hospitals immune parents to stay when their kid was acutely sick, while some restricted parental visiting to one hour per 24-hour interval. ¹⁶ These restrictions on parental visiting were thought to be the issue of space limitations and lack of facilities rather than a philosophical objection to parents existence present. A study in Tanzania found that mothers were concerned about environmental weather condition such as overcrowding and lack of food while their children in hospital, while staff's concerns included lack of trained staff, overwork and low pay ¹⁷, and a written report from Iran has as well highlighted problems with the implementation of family-centred care models.¹⁸ Family-centred intendance in high-income countries has been explored equally care that is led by parents, with the health professional interim as a consultant, encouraging open up and honest dialogue with the family unit. ^14,19 The family is acknowledged as expert in the intendance of their child, and the perspectives and information provided past the family unit have been described equally important to clinical determination-making. ^{thirteen,14,20} In the United kingdom of great britain and northern ireland, the importance of promoting the function of families in the intendance of the hospitalised child has been acknowledged. ²¹ A number of related terms has been used to describe the attributes of family-centred care^nineteen; these include partnership-in-care²², parental involvement(23), nurse-parent partnership²⁴, parental participation²⁵, and care-by-parent.^26,27 In 1992, the Institute for Family-Centered Care was established in the USA, taking over the role of the Association for the Care of Children's Health, whose chore it had been to develop a nationwide programme to enhance the implementation of a family-centred arroyo to the care of infants, children, and adolescents. Much of the family-centred care literature from the USA refers to the seminal piece of work of Shelton²⁸, who developed a framework for offer family-centred care to children. Inside this framework, Shelton and colleagues delineated eight elements which characterise health services which are family-centred.²⁹ Later, a 9th element was included.^three

The 9 elements of family unit-centred care include:

- recognising the family equally a constant in the child'due south life;

- facilitating parent-professional person collaboration at all levels of health care;

- honouring the racial, ethnic, cultural, and socio-economic multifariousness of families;

- recognising family strengths and individuality and respecting different methods of coping;

- sharing complete and unbiased information with families on a continuous basis;

- encouraging and facilitating family unit-to-family support and networking;

- responding to child and family developmental needs as role of healthcare practices;

- adopting policies and practices that provide families with emotional and fiscal support; and

- designing wellness care that is flexible, culturally competent, and responsive to family needs.

According to the Institute for Family-Centered Care'south definition:

Family-centered care is an approach to the planning, delivery, and evaluation of health intendance that is grounded in mutually beneficial partnerships among wellness care providers, patients, and families. It redefines the relationships between and among consumers and health providers. Family-centered practitioners recognise the vital part that families play in ensuring the health and well existence of infants, children, adolescents, and family members of all ages. They acknowledge that emotional, social, and developmental supports are integral components of wellness care. They promote the health and well being of individuals and families and restore nobility and control to them. Family-centered care is an approach to health intendance that shapes policies, programs, facility design, and staff twenty-four hours-to-day interactions. Information technology leads to meliorate wellness outcomes and wiser allocation of resources, and greater patient and family satisfaction".²⁰ It has been suggested that to practice in a family-centred mode requires a shift in the orientation of health services from a standard model to a collaborative model which recognises family involvement as central to their child'south care. Within this view, the healthcare provider is an equal partner and facilitator of care, and families are invited to participate actively in the decision-making, planning and provision of their kid's care to the extent they choose.^30,31

Potential Advantages and Disadvantages of Family-Centred Intendance

There are a range of potential benefits and difficulties associated with the provision of family unit-centred care. For instance, in one study, the stress levels of parents whose children were intensive care unit inpatients were reduced.³² Still, researchers accept also reported challenges when trying to implement changes which would result in meaningful family interest in the care of their hospitalised child. Healthcare providers accept reported a lack of acceptable education in relation to understanding and implementing the concept of family unit-centred intendance in a do state of affairs, besides a lack of shared understanding of, and commitment to, family-centred care among all wellness professionals and families.^ix,33-36 In add-on, the hospitalisation of a child, whether planned or unplanned, is stressful for fifty-fifty the well-nigh well-organised and functional family unit.³⁷ The significant adjustments to both parent and healthcare provider roles when a kid is hospitalised may effect in understandable levels of stress.³⁸ Potential disadvantages of family-centred care may exist that families experience that they are expected to provide input into the care of their child across their expectations or capabilities, or are given more information than either the child or the family unit is ready to hear. This may cause additional stress or feet for both the parents and kid. In summary, in 1994, Darbyshire^sevensuggested that family unit-centred intendance was a wonderful idea, but difficult to implement effectively, and some authors are commencement to concord, questioning family unit-centred care as a model of intendance^35,39, and the ideals of continuing a model which is condign increasingly described as ineffective are under scrutiny.⁴⁰

Other Models of Health Care for Children

Family-centred intendance, which involves participation of, or partnering with parents (or family-members) is described equally different to the standard models of care used in paediatric health services. In these, often, the healthcare provider plays a major function in assessing and formulating a plan of care, based upon the perceived needs of the kid and/or family. In the medical or standard model of wellness care, the healthcare worker plans care around the kid'south affliction and treatment needs, and the family is by and large expected to comply with treatment recommendations.³¹

Implementation of Family-Centred Care

It is expected that the development, implementation and outcomes of family-centred models of care may differ co-ordinate to the population and setting in which the models are practical. For example, the needs and outcomes for families with a chronic condition who experience long hospital stays may differ from those of families of a previously healthy young child who is admitted for a treatment procedure. Also, older children may have a greater awareness and understanding of the reasons for their hospitalisation. Therefore, models of intendance may reflect increased participation of the kid in their hospital care. Still, even if the processes of family-centred care are seen every bit making a difference and advantageous in their own correct, reliable reassurance that they consequence in more than practiced than harm should exist sought. Currently there is piddling systematic information on how these principles have underpinned changes in healthcare practice and service commitment when a kid is hospitalised, and the effect of family-centred approaches on child and family outcomes and health service delivery.^eleven

Shields ⁴¹ conducted a Cochrane review of the effectiveness of family-centred care including RCTs, before and after and cohort studies from 1960 to 2004. However, there were no studies that either met the inclusion criteria of a family-centred intervention, or met the standard quality criteria of Cochrane Reviews.

An update of the Cochrane review was undertaken by Shields⁴² which examined randomised control trials from 2004 to December 2009. Five studies came close to inclusion, but none met the minimum score of family unit-centredness.

This review aims to examine whatever quasi-experimental studies on effectiveness of family-centred models of intendance for hospitalised children from 2004 to Dec 2009. Quasi-experimental design include studies in which participants are non randomly assigned to treatment conditions.

Inclusion criteria

Types of participants

This review will consider studies that include all hospitalised children aged 0-12 years (but excluding premature neonates), their family and/or health providers.

Definition:

• Child/children: throughout this review, the term 'kid' or 'children' is used to include all newborn infants, babies and children up to the age of 12 years being cared for in hospital; and all parts of hospitals that provide a service to children. The definitions of childhood can vary, and historic period limits are arbitrary. For the purpose of this review the National Library of Medicine's medical subject headings were used to ascertain the historic period cut off of 12 years. However, we take excluded neonates born prematurely and who are patients in a neonatal intensive or special care plant nursery, as their requirements for family-centred intendance, and the ethics and philosophies of care effectually this item group, are unlike to those in a ward/unit where total term infants and children are nursed. ⁴³ Nosotros have excluded studies most adolescents for similar reasons.
• Families: throughout the review the following definition of the family unit was applied:

The family unit is a basic social unit of measurement having as its nucleus two or more persons, irrespective of historic period, in which each of the following atmospheric condition are present:

a) the members are related by blood, or marriage, or adoption, or by a contract which is either explicit or implied;

b) the members communicate with each other in terms of defined social roles such equally female parent, father, wife, husband, daughter, son, brother, sister, gramps, grandmother, uncle, aunt; and

c) they prefer or create and maintain common customs and traditions. This definition has been modified from Nixon's original definition⁴⁴ to allow for inclusion of significant others who practice non unremarkably cohabit with the family.

• Healthcare providers involved in caring for hospitalised children. For the purposes of the review, a healthcare provider will be used to describe whatever health professional involved in the intendance of hospitalised children.

Phenomena of interest

The review will consider studies that evaluate the effectiveness of family-centred models of care for hospitalised children when compared to standard models of care.

Whatsoever healthcare intervention that aims to promote the family-centred model of care during a child's hospitalisation will be examined. But studies that provide clear bear witness that the family and/or child were actively involved in the planning and/or delivery of health intendance during the kid's hospitalisation will exist considered for inclusion. For the purposes of the review, the minimum criteria for active involvement included evidence of collaboration between health carers and the family unit and/or kid in the planning and/or delivery of care equally soon every bit possible after admission or during the preadmission flow. Included studies must likewise accept compared family-centred models with standard models of care.

Types of interventions could include:

• Environmental interventions as evidenced past collaboration with the family and/or child in the pattern or redevelopment of facilities to provide an environment that maximises parental involvement and enhances child recovery and/or convalescence, care-by-parent units, privacy areas;
• Family unit-centred policies which may include open visiting hours for siblings or extended family unit, parent participation in their child's intendance to the extent they choose (for example, feeding, bathing);
• Communication interventions could include parental presence and participation at daily interdisciplinary ward rounds and family unit conferences to plan time to come care, developing collaborative care pathways where both parent and/or child and health carer certificate bug and progress, reorganisation of health care to provide continuity of intendance-giver (such as, primary nursing), shared medical records, local infirmary based interpreters;
• Educational interventions could include structured educational sessions for parents of technologically dependant children, continuing education programs to equip staff to provide care inside a family-centred framework, preadmission programs;
• Family support interventions such every bit flexible charging schemes for poor families, referrals to other infirmary or community services (such as, social workers, chaplains, patient representatives, mental health professionals, home health care, rehabilitation services). Facilitating parent-to-parent support studies where there is no articulate evidence of collaboration between the family and/or child and health care provider in the planning and/or delivery of intendance will be excluded. Such studies could include parental presence during wellness care procedures such every bit routine examinations, anaesthetic induction, venepuncture and postal service-anaesthetic recovery or bereavement team/protocols considering singular interventions such as parental presence without whatsoever collaboration, communication etc. does not meet the holistic principles on which family-centred intendance is based. Studies which examine parental presence for a singular process, for the same reason, will also be excluded. As an example, parental presence for anaesthesia induction might occur in the operating room, merely the same hospital might non let parents be involved in any other aspect of the child's care. Similarly, a report that examines parental presence for venepuncture is not studying family-centred care, rather merely parental presence for a specific reason.

Types of outcomes

This review volition consider studies that include the following effect measures:

Kid

- Psychosocial outcomes including psychological wellness such as feet, confidence, sense of command, coping, aligning, stress, upset, crying, insomnia, fears, behavioural regression, attitudes towards caregivers and attitudes towards rehospitalisation

- Behaviour outcomes such every bit level of co-operation, compliance with care, and appetite

- Physical health outcomes including physiological measures such equally claret pressure and pulse rate; pain cess or command such as use of medication or other means to reduce pain; length of hospital admission, readmission

- Developmental outcomes including weight gain, developmental milestones

- Knowledge outcomes including knowledge of condition, treatment, knowledge about personnel or procedure

- Satisfaction: for example, with interest in conclusion making, with level of communication

- Attitudes: for example, views of cultural ceremoniousness, flexibility. Parent

- Psychological health (for example, stress, anxiety, perceptions of coping, sense of control) and satisfaction (for instance, involvement in decision making, level of communication)

- Attitudes (such as complaints, evaluations of cultural ceremoniousness, flexibility and responsiveness of the intervention).

Staff

- Psychological health (for example, stress, responsiveness to patient's needs, confidence) and

- satisfaction (for example with the intervention, with care provided, with the level of education provided about family-centred care).

Health services

Health-service provision outcomes, such equally staffing requirements, costs of the intervention, time needed for the intervention, utilise of other hospital department services, litigation claims.

Types of studies

The review will consider Quasi-experimental studies for inclusion to enable the identification of current best show regarding the effectiveness of family unit-centred models of care on child, family and health service outcomes.

Search strategy

The search strategy aims to find both published and unpublished studies. There will be no limitation by publication linguistic communication and databases will be searched from inception to date. A three-step search strategy volition be utilised in each component of this review. An initial limited search of MEDLINE and CINAHL volition be undertaken followed past assay of the text words contained in the title and abstract, and of the index terms used to describe article. A 2d search using all identified keywords and index terms will then be undertaken across all included databases. Thirdly, the reference list of all identified reports and manufactures volition be searched for boosted studies.

The databases to be searched include:

Medline

CINAHL

Embase

PsycINFO

the Cochrane Library (Key)

CSA Sociological Abstracts

The search for unpublished studies will include:

Web of Science Conference Proceedings

Australian Research Online

Clinical Trials Registry

Current Controlled Trails

Great britain Clinical Research Network: Portfolio Database

Bandolier

Google

Mednar

Initial keywords to exist used will be:

child/children, parent/s, health services, family centered care/family centred intendance

Assessment of the family-centredness

To begin with, we will screen all potential studies for family unit-centredness. In lodge to assess relevant studies for the degree of family-centredness, this review will use a modified rating scale based on that developed by Trivette ²⁹(Appendix Ii). These authors used the 9 elements of family-centred care, every bit described by the Association for the Intendance of Children'due south Wellness, to develop xiii evaluation items that depict the features of family-centred care. These sub-elements are farther grouped into three cluster groups:

Cluster 1: family unit as a constant; Cluster ii: culturally responsive; Cluster 3: supporting family individuality) derived from an original cluster analysis past Trivette²⁹. The clusters were designed to be used to help draw the model of family-centred care in individual trials.

A rating of 0 to 4 will be practical to each of the 13 sub-elements of family-centred care, as follows:

0. Article includes no evidence that the intervention either implicitly or explicitly was based upon the elements of family-centred care.

1. Commodity includes a minimal corporeality of implicit evidence that the intervention was based on the elements of family-centred intendance.

2. Article includes numerous instances of implicit prove that the intervention was based upon the elements of family-centred care.

three. Article includes a minimal amount of explicit show that the intervention was based upon the elements of family unit-centred care.

four. Commodity includes numerous instances of explicit evidence that the intervention was based upon the elements of family-centred care.

The maximum possible score is 52, and a score of 42 (or 80% of total score) (see below) or greater would indicate a high degree of family-centredness.

We will assign degrees of family-centredness, using 80% as the cut-off point, above which the study would exist considered as having a "high degree of family-centredness". A score of 42 from a possible total of 52 (80%) was chosen as a cut-off point for inclusion/exclusion based on the Pareto distribution, which states that for many events, roughly lxxx% of the effects come from 20% of the causes.⁴⁵ We made the next cut-off point 50%, making 50-fourscore% "moderate caste of family-centredness"; and below 50% every bit a low degree of family-centredness. We plan to exclude studies with a family-centeredness score of less than 50%. Whatsoever disagreements that ascend on either instrument, family unit centeredness or quality of studies between the reviewers volition be resolved through discussion, or with a third reviewer.

Assessment of methodological quality

Quantitative papers selected for retrieval volition be assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardised critical appraisal instruments from the Joanna Briggs Plant Meta Analysis of Statistics Cess and Review Instrument (JBI-MAStARI) (Appendix I).

Information collection

Quantitative data will be extracted from papers included in the review using the standardised information extraction tool from JBI-MAStARI (Appendix Three).

The information extracted will include specific details about the interventions, populations, study methods and outcomes of significance to the review question and specific objectives.

Data synthesis

Quantitative papers will, where possible be pooled in statistical meta-analysis using the Joanna Briggs Institute Meta Assay of Statistics Cess and Review Instrument (JBI-MAStARI). All results will be subject field to double data entry. Odds ratio (for categorical data) and weighted mean differences (for continuous data) and their 95% confidence intervals will exist calculated for analysis. Heterogeneity will be assessed using the standard Chi-square. Where statistical pooling is not possible the findings will exist presented in narrative form.

Conflicts of interest

All authors work for institutions which have a stated policy of family-centred intendance. There is no potential conflict of interest.

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Appendix I JBI Critical Appraisement tools

Quasi-Experimental studies

Table:

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APPENDIX II Family Centredness Score Class

Table:

No Explanation bachelor.

Tabular array:

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Instructions for Applying the Form

Q1:

Include any health intendance intervention that aims to promote the family-centred model of care during a child's hospitalisation. Just studies which provide clear evidence that the family and/or child were actively involved in the planning and/or delivery of healthcare during the kid's hospitalisation will be considered for inclusion in this review.

For the purposes of the review, the minimum criteria for active involvement will include evidence of collaboration betwixt health carers and the family and/or child in the planning and/or delivery of care as shortly as possible later admission, or during the preadmission period. Included studies must also compare family-centred models with standard model of care.

Types of interventions could include:

• Environmental interventions as evidenced by collaboration with the family and/or child in the blueprint or redevelopment of facilities to provide an surroundings that maximises parental interest and enhances kid recovery and/or convalescence, care-past-parent units, privacy areas;
• Family-centred policies which may include open visiting hours for siblings or extended family, parent participation in their kid's intendance to the extent they choose (for case, feeding, bathing);
• Communication interventions could include parental presence and participation at daily interdisciplinary ward rounds and family conferences to programme time to come care, developing collaborative care pathways where both parent and/or child and health carer document problems and progress, reorganisation of health care to provide continuity of care-giver (such as, principal nursing), shared medical records, local hospital based interpreters;
• Educational interventions could include structured educational sessions for parents of technologically dependant children, standing didactics programs to equip staff to provide care inside a family-centred framework, preadmission programs;
• Family support interventions such equally flexible charging schemes for poor families, referrals to other infirmary or community services (such as, social workers, chaplains, patient representatives, mental health professionals, home health intendance, rehabilitation services), facilitating parent-to-parent support.

EXCLUDE Studies where at that place is no clear prove of collaboration between the family and/or child and health intendance provider in the planning and/or delivery of care. Such studies could include parental presence during health intendance procedures such as routine examinations, anaesthetic induction, venipuncture and post-anaesthetic recovery, bereavement team/protocols, because atypical interventions such as parental presence without any collaboration, communication etc does not run into the holism of FCC.

Studies which examine parental presence for a singular procedure, for the same reason. As an example, parental presence for anaesthesia induction might occur in the OR, but at that place's nothing to say that the same hospital will let parents be involved in any other aspect of the child'south care. Similarly, a report that examines parental presence for venepuncture is non studying FCC, rather it is only parental presence for a specific reason.

Q2: Scoring Criteria for Family Centredness

0 Commodity includes no prove that the author(s) either implicitly or explicitly addressed, endorsed, or advocated adoption of adherence to the elements of FCC.

1 Article includes a minimal amount of implicit show that the author(s) avant-garde adoption or support of the elements of FCC.

2 Article includes numerous instances of implicit prove that the writer(s) avant-garde adoption or support of the elements of FCC.

iii Commodity includes a minimal amount of explicit evidence that the author(s) avant-garde adoption or support of the elements of FCC.

4 Article includes numerous instances of explicit evidence that the author(south) advanced adoption or support of the elements of FCC.

Explicit evidence = an element was clearly stated and distinctly expressed

Implicit evidence = If it could be inferred that the author(south) descriptions, arguments etc. were consistent with the intent of the elements of FCC

Appendix Three JBI Mastari data extraction tool for all study designs.

Table:

No Caption available.

© 2011 past Lippincott Williams & Wilkins, Inc.

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Source: https://journals.lww.com/jbisrir/fulltext/2011/09161/family_centred_care_for_hospitalised_children_aged.23.aspx

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