RESEARCH

doi: 10.1111/nicc.12142

Nurses’ perceptions of working

with families in the paediatric
intensive care unit
Ashleigh Butler, Georgina Willetts and Beverley Copnell

ABSTRACT
Background: Research exploring nurses’ experiences working with families in paediatric intensive care unit (PICU) is limited. No studies have
been undertaken in a mixed adult-paediatric ICU.
Objectives: To explore nurses’ perceptions of working with families of critically ill children in a mixed adult-paediatric intensive care unit (ICU).
Design: Descriptive qualitative design.
Methodology: Five PICU nurses participated in semi-structured interviews. Data were analysed using thematic analysis. Trustworthiness was
enhanced using an audit trail, member checks and peer review of all data.
Results: Three main themes and one overarching theme emerged. Role confusion and delineation examined the roles which nurses ascribed
to themselves and the families; and demonstrated the conflict which could arise if roles were challenged. Information sharing demonstrated
the positive and negative ways in which nurses utilized information with families in their daily practice. The contextual environment of the PICU
scrutinized the physical, cultural and institutional factors which impacted on the nurses’ ability to work with families in the PICU. Finally, the
overarching theme Competing values explores the interplay between the nurses’ personal values and those of the PICU and the institution.
Conclusions: Working with families in a mixed adult-paediatric ICU is influenced by multiple personal and institutional factors. The value
placed on families and on the time nurses spent with them often competed for priority with nurses’ other values and the wider culture of
the PICU. The potential for role confusion, the management of information and the physical environment of the PICU further contributed to
variability in nurses’ working with families.
Relevance to clinical practice: The results highlighted a need for education for both nurses and medical staff who work with families of
critically ill children. Additionally, the need for each PICU to have a written policy on family presence and participation is crucial to guide practice
and maintain continuity of care.
Key words: Families • Family centred care • Intensive care • Nurses • Nursing • Paediatrics • Perceptions

INTRODUCTION AND BACKGROUND paediatric nurses, working with families is thus an

Family centred care (FCC) underpins paediatric health
care, and requires a collaborative relationship between
the family and health care professionals (Shelton et al.,
1987; Jolley and Shields, 2009; Frazier et al., 2010). For
Authors: A Butler, RN, BNurs, MNurs, Clinical Nurse Specialist, Adult and
Pediatric Intensive Care, Monash Medical Centre, Monash Health, Victoria,
Australia; PhD Candidate, School of Nursing and Midwifery, Monash
University, Melbourne, Victoria, Australia; G Willetts, RN, BHSc, MEd, DEd,
Senior Lecturer, School of Nursing and Midwifery, Monash University,
Melbourne, Victoria, Australia; B Copnell, RN, BAppSc, PhD, Senior
Lecturer, School of Nursing and Midwifery, Monash University, Melbourne,
Victoria, Australia
Address for correspondence: A Butler, RN, Clinical Nurse Specialist,
Adult and Pediatric Intensive Care, Monash Medical Centre, Monash
Health, 246 Clayton road, Clayton, Victoria 3800, Australia
E-mail: Aebut2@student.monash.edu.au
integral part of their role.
While there is a wealth of literature concerning
working with families in general paediatric environ-
ments (Shields et al., 2006; Foster et al., 2010; Harri-
son, 2010; Shields et al., 2012), FCC in paediatric inten-
sive care unit (PICU) is under-researched (Butler et al.,
2014). Nursing perspectives of working with families
in PICU have received little attention. Studies con-
ducted in neonatal intensive care unit (NICU) identify
a number of positive and negative aspects of nurses
working with families to provide care to critically
ill infants, such as issues over who is in charge of
the infant’s care, the changing identity of the nurse
role and the impact of the physical environment on
the nurses’ ability to accommodate parental presence
(Heermann and Wilson, 2000; Higman and Shaw, 2008;

© 2015 British Association of Critical Care Nurses 1

 Nurses’ perceptions of working with families in the PICU
Trajkovski et al., 2012). However, as there are signif-
icant differences between NICU and PICU settings,
these results may not reflect the experiences of PICU
nurses.
Moreover, in some circumstances adults and chil-
dren may be accommodated in the same ICU; this is
likely to add complexity to the nursing care of families.
Research suggests that adult ICU environments may
place lower priority on family presence than do paedi-
atric environments, restricting family members’ pres-
ence to set visiting hours (Lee et al., 2007; Vandijck et al.,
2010; Spreen and Schuurmans, 2011), and often exclud-
ing families from ward rounds, procedures and resusci-
tation (Farrell et al., 2005; Santiago et al., 2014). It is not
known if this difference in practice has an impact on
settings where nurses care for both adults and children.
No study was found which examined nurses’ percep-
tions of working with families of critically ill children
in a PICU environment, or of working with families
of critically ill children for nurses who also work with
adult patients.
AIM
This study explored the question ‘What is it like
for Registered Nurses who work in a mixed
adult-paediatric intensive care unit (ICU) to work
with families of critically ill children?’
METHODOLOGY
A descriptive qualitative design was used. This
methodology was chosen as it allows data to be pre-
sented in the language of the participants, which is
important in the later development of policy or edu-
cation programs (Sandelowski, 2000; Magilvy and
Thomas, 2009).
Setting and sample
The study setting was a 26 bed public metropolitan
tertiary adult-paediatric ICU in Australia. Although
uncommon, a limited number of adult ICU’s within
Australia will admit a critically ill child. Typically,
such units will only provide high dependency level
care (e.g. non-invasive ventilation, 24-h monitoring
post removal of tonsils in children with severe sleep
apnoea), and will transfer any child requiring invasive
ventilation to a specialist paediatric ICU. The study
ICU is funded for six paediatric patients; however, it
will admit as many children as required. Children are
primarily cared for in a designated paediatric space
(the ‘PICU’), although this is still attached to the adult
ICU, and children are still cared for next to adult ICU
2 © 2015 British Association of Critical Care Nurses
Table 1 Inclusion criteria
Registered nurse in the adult/paediatric ICU
Cares for paediatric patients >1 per week
Works more than 4 days every 2 weeks
Completed PICU TSP or been working in PICU for more than 6 months
ICU, intensive care unit; PICU, paediatric intensive care unit; TSP, transition to
speciality practice program.
patients when necessary. The PICU cares for approx-
imately 450 critically ill children per year, with the
exclusion of children following cardiac surgery, organ
transplantation and trauma. At the time of the study,
there were approximately 110 nursing staff who cared
for both adult and paediatric patients; no nurses cared
exclusively for children. PICU nurses enter the ICU
as adult nurses and are required to have undergone
the adult ICU transition to speciality practice (TSP)
program and an adult postgraduate ICU qualification
before they can apply to undertake PICU training. They
are then required to participate in an in-hospital PICU
TSP, which provides introductory level education in
PICU nursing to 8–10 nurses annually. This 6-month
course is recognized by the university affiliated with
the hospital as contributing towards a postgraduate
qualification.
Five registered nurses were purposively recruited to
participate in the study after informal discussion at
ward meetings; three participants volunteered and two
were personally invited to provide diversity of expe-
rience and views (Barbour, 2001; Liamputtong, 2013).
The inclusion criteria and participant demographics
can be seen in Tables 1 and 2.
Ethical considerations
Ethical approval was gained from both the medical
institution and university through which the study
was conducted. Participants provided written consent
to take part in the study. As the primary researcher was
Table 2 Sample demographics
Participant Sex Years in PICU Years in ICU PICU training
Participant A F 3 4 PICU TSP
Participant B F 1.5 3 PICU TSP
Participant C F 3 5 PICU
Introductory day
Participant D F 6.5 7 PICU
Postgraduate course
Participant E F 1.5 4 PICU TSP
F, female; ICU, intensive care unit; PICU, paediatric intensive care unit; TSP,
transition to speciality practice program.

Table 3 Interview schedule
Prompt one:
Can you tell me about your role as a PICU nurse? Does it differ from nursing
adults? How?
Prompt two:
Describe your interactions with families of children in the PICU.
Prompt three:
How do you feel about parents being present in the PICU?
Prompt four:
What do you think is the role for the parents or family of the child during their
stay in PICU?
Prompt five:
Are there any positives or negatives that accompany working with families in
the PICU?
Prompt six:
Do you feel supported to work with children and their families/in your decisions
regarding family presence or participation? How/How not?
PICU, paediatric intensive care unit.
a staff member in the PICU under study, considerable
effort was made to ensure informed and voluntary
consent was gained from each participant (McDougall,
2000), and participants were assured the responses
they provided would not in any way affect their rela-
tionship with the researcher or their employer (Coar
and Sim, 2006).
Data collection
Data were collected by individual semi-structured
interviews. The initial interview guide is included in
Table 3. Further questions or topic areas were devel-
oped from the interview data and emerging themes.
Interviews were conducted by the primary researcher
in a meeting room within the hospital over a 2-month
period in 2013. Each interview lasted 45–60 min and
was audio-recorded. A reflective journal was main-
tained by the primary researcher after each interview,
detailing important aspects, thoughts, feelings and
insights, and was reflected upon and reviewed prior
to the next interview.
Data analysis
Each interview was transcribed verbatim by the pri-
mary researcher, with data analysis beginning imme-
diately after the first interview (Sandelowski, 1995).
All data were de-identified, and each interview was
assigned a coded letter. Transcribed data were analysed
using thematic analysis to identify recurring themes
(Liamputtong, 2009). Each transcript was read sev-
eral times, then subjected to line by line analysis
to elicit primary codes (Colaizzi, 1978; Liamputtong,
2009). These codes were compared between transcripts.
They were then clustered into themes and related back
© 2015 British Association of Critical Care Nurses
Nurses’ perceptions of working with families in the PICU
to the data to guide subsequent readings and later
interview questions (Sandelowski, 1995; Liamputtong,
2009). Throughout the research process, a methodolog-
ical audit trail was maintained, detailing key deci-
sions undertaken by the researchers. This also detailed
the primary researcher’s own responses to each inter-
view question in an effort to identify any precon-
ceived ideas or beliefs, a process particularly important
when researching in one’s own workplace (Koch, 2006;
McBrien, 2008). All researchers involved in the study
discussed the transcripts and emergent findings in a
process of peer review and to balance any influence
of the primary researcher conducting research in her
own workplace (Magilvy and Thomas, 2009; Merriam,
2009). Emerging themes were discussed with partici-
pants during interviews in a process of member check-
ing to enhance trustworthiness (McBrien, 2008; Mag-
ilvy and Thomas, 2009; Ryan-Nicholls and Will, 2009).
FINDINGS
Three main, interconnected themes and one overarch-
ing theme were identified as key aspects of working
with families of critically ill children: role confusion
and delineation, information sharing, the contextual
environment of the PICU and the overarching theme
of competing values.
Role confusion and delineation
For the participants, the concept of their role as a PICU
nurse was well defined: they were advocates and car-
ers for the child and they were educators, counsel-
lors and protectors of the families. The nurses were
hyper-vigilant in their care of the child, recognizing
that ‘with a paediatric patient I find that you have to watch
everything so carefully.....you cannot just take everything at
face value’ (participant D). In attempting to ensure the
safety of their patient, the nurse became the controller
of access to the child, dictating when the parent could
cuddle the child or provide care. This role of the nurses
as gatekeepers to the child was not always negative,
with participant D noting that part of her role was ‘get-
ting the family involved in the child’s care even though the
child is critically ill’.
For the participants, many of these roles fell under
the heading of protector, using information to pro-
tect families from unpleasant and frightening sights,
sounds and events. Participant D mentioned that she
pre-warned the parents about the sights and sounds
associated with any intervention, so that she could
‘help them allay their anxieties and worries and fears … (so)
the next time you’re about to do a procedure … they are pre-
pared and that like sort of helps them … it calms them’. The
nurses also indicated that their role with the families of
3
 Nurses’ perceptions of working with families in the PICU
children differed from families of adult patients, most
specifically in terms of their level of involvement; in
paediatrics nurses were intensely involved with par-
ents, but only mentioned updating families of adult
patients.
In contrast to their own well defined role, the PICU
nurses seemed unclear on what the parental role
entailed. Parents were not expected to perform any
tasks viewed as medical, but were generally able to
do ‘normal care, like sponging their child or the basic care
that they would do at home’ (participant E), and ‘give
comfort’ (participant C). Three nurses recognized the
role of the parents in decision-making, with partici-
pant B noting ‘it’s their child so it’s their decision really’.
Families in the PICU were viewed by all of the partic-
ipants as fragile and vulnerable. Descriptions of the
parents as ‘anxious’, ‘overwhelmed’, ‘stressed’ and
‘afraid’ permeated the interviews. This perception of
families as fragile and broken appeared to reinforce
and validate for the nurses their role as carer for
the family, enabling them to justify acting as gate-
keeper to the child, keeping the parents away for their
own good.
Central to this theme was participants’ identification
of the differences in working with families of acutely
versus chronically ill ‘frequent flyer’ (participant A)
children (children with chronic illnesses who are fre-
quently admitted and readmitted to the PICU). Nurses
felt that parents of acutely ill children ‘need more expla-
nation, more reassurance’ (participant C), in contrast to
parents of ‘frequent flyer’ children who have ‘picked
up on things on every single admission, they’ve equipped
themselves with more knowledge’ (participant A). Nurses
mentioned feeling threatened by the knowledge these
parents possessed, noting that ‘you have to be on your
game, because they know exactly what you’re doing and what
you’re not doing’ (participant A). Participants stated that
this situation could often lead to conflict and power
struggles between nurse and family, as the family ‘has
a routine of how things must be done’ (participant A),
which challenges the nurse’s role as expert because it is
‘against what you know as a nurse, as a critical care nurse,
to just sort of continue on with that action … then you will
have a bit of a fight on your hands’ (participant B).
Information sharing
The sharing of information emerged as a key aspect
of working with families of critically ill children. Two
participants felt information was generally well shared
with parents while the other three noted that there
was a difference between the information known, and
that given to families. Regardless of their perception of
information sharing, each of the nurses indicated that
the families were told ‘what they need to know, just the
4 © 2015 British Association of Critical Care Nurses
basics’ (participant E), suggesting that while the partic-
ipants felt that parents were kept well informed, many
of the medical and nursing staff used their own judge-
ment to decide how much information to impart. This
appeared to be related to the participants’ desire to pro-
tect families, giving or withholding information based
on their perception of the families’ coping ability, and
concern over the family’s ability to comprehend what
was being told to them: that more technical explana-
tions would confuse and overwhelm parents and that
‘too much knowledge is not a good thing as well.....and
then they have the Google and … the matter could be easily
resolved but it could become a big issue for no good reason’
(participant E).
Although mentioning that they used information to
protect parents, no participant felt that information
sharing was part of their role. Instead, participants felt
they were “a channel of communication between the doctors
and the family” (participant E). Additionally, two nurses
felt that parents wanted to hear information from med-
ical staff; they felt information they provided was not
respected by the families, mentioning that ‘we reiterate
what’s happened....this is what the doctor said and every-
thing, you know, they still want to talk to the medical staff ’
(participant B). Although viewing information sharing
as a medical role, participants remarked that doctors
were reluctant to provide information to parents.
The contextual environment of the PICU
The physical, cultural and institutional environment
of the PICU, while not viewed as a barrier to work-
ing with families for the participants, had a significant
impact on the way in which nurses worked with fam-
ilies in the unit. The main aspects were parental pres-
ence and participation; the locked doors; and continu-
ity of care.
There was no consensus on parental participation
or presence amongst the participants. Although all
the nurses felt that there were activities and tasks
that a parent can undertake, these tasks tended to be
non-technical aspects of care such as ‘getting them to
change the nappy, getting them to take the temperature,
getting them to put the feeds in the little burettes’ (partic-
ipant A). Although the adult ICU had clear visiting
hours at the time of the study, there was no consensus
on whether open visitation for children’s families was
encouraged. Additionally, the nurses were unclear
on whether parental presence overnight should be
allowed.
The PICU itself prohibited parental access by a
locked front door; to enter parents must ring the ward
clerk or bedside nurse and request to be let in. All
participants felt that the locked doors were beneficial
to their work environment and did not preclude family

presence. Participants were unanimous in their belief
that locked front doors were required ‘for controlling
visitors coming in, people entering and leaving the unit’
(participant D). During the interviews, it became
apparent that the nurses wanted to control visitors’
access, with one nurse stating ‘ if you, you know, give
them an inch and they’ll take everything, so I do sometimes
think that the locked door plays a positive role because you
can sort of have control over that’ (participant B). No
participant mentioned security, for staff or patients, as
a rationale for locking the doors.
The third aspect of this theme was continuity of
care – or, more specifically, a lack of continuity. Within
the ICU and PICU, continuity of patient allocation
to the same nurse over a number of shifts was not
practised. All participants, although acknowledging
the need to provide consistent care to the parents to
reduce mistrust and confusion, stated that even if given
the choice, they would not wish to care for the same
patient multiple shifts in a row. Participants mentioned
they would ‘hate to come back to the same patient every
day; I don’t think that’s healthy. You get too attached or
you get too bored’ (participant C). Participant B felt that
continuity of care, even between nurses on different
shifts, was non-existent, remarking ‘it’s the end of your
shift, and someone else takes over completely different’.
Overarching theme: competing values
The concept of competing values emerged as an over-
arching theme, permeating each of the above themes.
Three main domains of competing values were iden-
tified: value of families themselves; value of working
with families as a component of FCC; and value of staff
time with families in PICU. This theme describes the
difficulties which nurses faced when their personal val-
ues conflicted with the values of other staff members
or with the PICU culture, and the ensuing struggle to
harmonize these differing values.
The nurses were all able to articulate the value of
family presence in the PICU; however, they felt it
was difficult to show families they were important,
because they were not in control of family presence
for ward rounds or procedures. Participants felt that
they showed families they were valued by providing
them with open and honest information, and support-
ing them to be with their child, but felt this process was
hindered, because some ‘consultants feel very strongly
about parents not being here very much … they’ll make it
sort of publically known....if you’re doing the rounds, if the
parents are there, they act like they’re not sitting there, they
act like they’re not important enough to … to really involve
them in the conversation’ (participant B).
Additionally, participants felt that although they
spent a significant portion of their work day with the
© 2015 British Association of Critical Care Nurses
Nurses’ perceptions of working with families in the PICU
family of a critically ill child, they ‘don’t feel that [they’re]
appreciated and respected’ (participant D). The nurses
mentioned that even if they have ‘spent time with a cry-
ing family there hasn’t been any time when someone’s gone
“Oh you did really well talking to that family”’ (participant
B), revealing that perhaps spending time with families
might be an overlooked aspect of nursing care, taken
for granted.
Lastly, the concept of FCC as an overarching tenet of
working with families was under-recognized, with key
aspects often overlooked. Notably, none of the partici-
pants mentioned the term ‘family centred care’ unless
prompted. The nurses also struggled with many of the
other key aspects of FCC, such as recognizing the child
and family as a whole. Of the five participants, three
specifically remarked that they ‘tend to care for the child
first, then the family. Not so much as a whole’ (participant
C). This may be attributed to the limited focus the par-
ticipants felt was given to FCC concepts and working
with families in PICU education. Participants felt that
working with families was only ‘skimmed on’ (partici-
pant A) in education sessions, mostly only brought up
in conversation ‘when someone brings up something that
was a … that they were concerned about. But it wasn’t any-
thing specific’ (participant E).
DISCUSSION
This study contributes to the understanding of how
nurses work with families within a PICU environment.
This is the first study to our knowledge to focus specif-
ically on a PICU situated within an adult ICU. This
environment creates specific challenges for nurses who
work within it.
The overarching theme in this study was competing
values within the PICU. This has not previously been
identified in specific PICU research. This multifaceted
overarching theme was established through the nurses’
interactions with both the PICU environment and the
PICU families. The nurses in the study struggled to
reconcile their personal values with those adopted by
the PICU, often leading to inconsistent care and diffi-
culties in interacting with families. These complexities
are rarely acknowledged in literature, particularly in
relation to PICU, but have been described on some
level in NICU research. Trajkovski et al. (2012) demon-
strated that some NICU nurses saw their primary
concern as being the patient, while others viewed
the family as equally important. Participants in this
study expressed similar viewpoints, with a conflict
being created between two sets of values. Addition-
ally, our study found that working with families was
not emphasized in institution-based education pro-
grams. Rather, focus, and hence value, was on the
5
 Nurses’ perceptions of working with families in the PICU
technical aspects of nursing care. This left the junior
nurses struggling to understand how to effectively
work with families. Similar findings emerged in the
NICU literature (Higman and Shaw, 2008). The need
for nurses to be competent both technically and in
meeting needs of patients and families is emphasized
in the literature (Ray, 1987; Benner et al., 1992; Cooper,
1993), but appears to be poorly taught. In our study,
the lack of formal education on working with families,
amongst other aspects of FCC, and a focus instead on
purely technical aspects of care, appeared to reinforce
the conflict between different sets of values. Given that
the study PICU is co-located within an adult ICU, it is
possible that the lack of focus on working with fam-
ilies was influenced by the model of care adopted by
the adult ICU, which commonly practises restrictive
visiting hours, family exclusion from ward rounds and
a lack of family involvement in care.
The complex nature of the nurses’ work in manag-
ing the PICU patient complicated their focus on work-
ing collaboratively with families. One of the key find-
ings was the differentiated roles of the parent and
nurse, with participants typically describing the nurse
as the expert and the parent as comforter. This finding
is supported by extant literature (Heermann and Wil-
son, 2000; Paliadelis et al., 2005; Roden, 2005); the rela-
tionship between nurse and parent is often described
as unequal, with the balance of power lying with the
nurse. This power inequality has been demonstrated
in general paediatric wards (Paliadelis et al., 2005) and
NICU settings (Trajkovski et al., 2012). If a parent is
knowledgeable about the care of their child and wishes
to participate more than the nurse is ready to allow, the
balance of power is disrupted and conflict may occur.
In this study, this occurred mainly with parents of
chronically ill children. These parents were described
as threatening the nurses’ role as expert, resulting in the
nurse often feeling intimidated by the parents’ knowl-
edge of their child. Additionally, all of the PICU nurses
were originally trained as adult nurses, where fam-
ilies traditionally have little to no involvement into
the patients’ care, especially in critical care environ-
ments (Hammond, 1995; Soury-Lavergne et al., 2012).
It is likely that this factor heightens the role conflict for
nurses who work both in the adult ICU and the PICU.
The physical, cultural and institutional environment
of the PICU was noted to have a significant impact
on the way in which nurses in the study were able to
work with families, both in a positive and negative
way. Limited research has explored the relationships
between the PICU environment and nurses’ ability to
work with families. Macdonald et al. (2012) found that
while nursing staff encouraged families to decorate the
bed space of the child and found ways for the family
6 © 2015 British Association of Critical Care Nurses
to have access to the child, the PICU environment
still remained the physical property of the nursing
staff. This ownership was mirrored by participants in
our study, who maintained control of their environ-
ment via the locked front doors. Additionally, Lam
et al. (2006) identified that the physical environment
of the PICU was not supportive of parental needs,
with limited resources for parents to sleep and eat,
making it increasingly difficult for nurses to work
collaboratively with parents. The nurses in this study
also lacked the desire to practise continuity of care
for patients between shifts. This finding has not pre-
viously been described in the literature. We suspect a
multifactorial cause for this finding: the nurses work
a mix of 8 and 12 h shifts, often on a part time basis,
and so often have a number of days off between shifts;
nurses working a limited number of shifts may desire
an increased level of patient diversity for skill devel-
opment; and the institutional culture of a mixed ICU,
based on anecdotal evidence from the adult ICU that
caring for the same patient will increase error, foster
inappropriate staff-patient relationships, and increase
staff burnout and fatigue, especially when dealing
with patients or families seen as ‘difficult’.
LIMITATIONS
This study is limited in that it has been conducted
across a single site with a small number of registered
nurses who care for both adult and paediatric critically
ill patients. Findings reflect local conditions and may
or not be transferable to other settings. The sample size
of five may have been insufficient to uncover every
aspect of the topic, but data saturation was achieved
within the identified themes; this is consistent with
previous studies employing similar numbers (Guest
et al., 2006; Cooper and Endacott, 2007; Magilvy and
Thomas, 2009). Additionally, the primary researcher
was employed in the setting; however every effort
has been made to acknowledge researcher preconcep-
tions and assumptions. Attempts to recruit male PICU
nurses were unsuccessful leading to a homogenous
female sample and thus, potential gender bias.
IMPLICATIONS AND RELEVANCE TO
CLINICAL PRACTICE
This study has significant potential to influence future
research, educational curriculum and policy devel-
opment. The findings from this study support other
research that identifies that nurses struggle to define
the role of the parent in the PICU.
Further research is required to investigate in detail
how nurses negotiate roles with parents in the PICU,
 Nurses’ perceptions of working with families in the PICU

particularly with parents of chronically ill children.
The findings indicate a theory-practice gap: even when
education is provided on FCC, nurses continue to
struggle in implementing these skills into their daily
practice. The findings reinforced the concept that FCC
is not an innate skill in nurses and therefore needs to
be taught. This along with the support of policy devel-
opment focussing on FCC is fundamental to progress
the understandings and practices of managing children
and families in the PICU. The findings could be used
to help inform the development of a FCC framework
to support the standards of care set by the Australian
Institute for Patient and Family Care (2011), the Royal
Australasian College of Physicians (2009) and Ameri-
can College of Critical Care Medicine taskforce (David-
son et al., 2007).
The lack of continuity of care practised and desired
by nurses in this study was an unexpected finding.
Given the lack of literature examining continuity in a
PICU setting, it is difficult to determine whether this is
a local or contextual problem, potentially compounded
by co-location within an adult ICU, or whether the
issue exists on a broader scale. Anecdotally, however,
continuity of care or primary nursing appears to be
commonplace in a number of other PICUs globally.
Increased staff education and an increased focus on
staffing arrangements may help to overcome this issue.
CONCLUSIONS
This study highlights important aspects of working
with families of critically ill children for nurses, and
identifies the unique challenges of such relationships in
a mixed adult/paediatric ICU. The findings identified
that FCC was not universally espoused as an important
philosophy and was not readily translated into the
nurses’ practices. Education for nurses and medical
staff and written guidelines may facilitate a change in
culture towards provision of FCC.

WHAT IS KNOWN ABOUT THIS TOPIC

• Many aspects of family centred care have been well researched in general paediatric and neonatal settings, and demonstrate positive
and negative ways in which nurses interact and work with families. However, it is unknown whether nurses who work with both adult
and paediatric patients are influenced by adult models of care, and whether this impacts on how they work with families of paediatric
patients.

WHAT THIS PAPER ADDS

• This paper explores key aspects which influence how nurses in the unique environment of a mixed adult-paediatric intensive care unit
work with families of critically ill children.
• The paper identifies the need for further nursing and medical education on working with families of critically ill children, as well as the
need for written policies on family presence and participation to guide practice.

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