Next steps towards child-focused nursing

Duncan Randall *

Nursing and Physiotherapy, School of Health and Population Sciences, College of Medical and Dental
Sciences, University of Birmingham 52 Pritchatts Road, Edgbaston, Birmingham, B15 2TT,

UKAilsa MunnsLecturer,

School of Nursing and Midwifery, Curtin University, Nurse Researcher, Child and Adolescent Health
Service Perth, WA, Australia

Linda ShieldsProfessor of Nursing — Tropical Health, Tropical Health Research Unit, Townsville Health
District and James Cook University, and Honorary Professor, Medical School, The University of
Queensland, QLD, Australia*

Corresponding author

What is known about this topic•

Family-centred care (FCC) is a widely acknowledged professional concept but evidence that nurses enact
it in practice has been difficult to substantiate The philosophy of FCC has been the focus of much of the
literature rather than evidence of its effects on care or health outcomes. FCC has been developed in a
social and cultural vacuum, implying that it applies irrespective of cultures, societies and history.

What this paper adds•

Cultural safety and ethical symmetry are discussed as starting places to critically examine how nurses
interact with children. Considering cultural aspects and the sociology of childhood can allow nurses to
take account of cultural, social and temporal differences in the childhoods and the effect these
differences have on the child's health.• A critical approach is suggested, recognising the potential
challenges to these approaches and suggesting the rigour of empirical research is required to see if
cultural safety and ethical symmetry are useful adjuncts to FCC.DeclarationsCompeting interests Nil
known.Funding This work was supported by a 2008–09 Channel 7 Telethon Fellowship (Western
Australia) and made possible by a Universitas 21 travel fellowship from the University of
Birmingham.Ethical approval Not required.Guarantor DR.Contributorship Conception of idea,
supporting funding, drafted paper —

DR; developed ideas, found supporting literature, helped draft paper — AM; helped development of
ideas, drafting paper, funding support —

LS. All authors were responsible for the final writing and editing of the
manuscript.AcknowledgementsThis work was supported by a 2008–09 Channel 7 Telethon Fellowship
(Western Australia) and made possible by a Universitas 21 travel fellowship from the University of
Birmingham.IntroductionFamily-centred care (FCC) is ubiquitous in health services around the world. At
its centre is the concept that parents and family members are the centre of the child’s life, and that care
should be planned around the whole family, not just the ill child. However, this model is untested by
rigorous research, while qualitative studies are highlighting increasing concerns with it.This paper
discusses FCC and its problems, while presenting two other models, cultural safety and ethical
symmetry. These may not be replacements for FCC, but could provide us with ways to critically examine
FCC and rethink our ways of caring for children and their families, taking account of the cultures in which
they live and understanding of children and childhoods derived from the sociology of
childhood.BackgroundResearch into delivery of FCC in various geographical and psychosocial
environments has demonstrated that AbstractFamily-centred care (FCC) is widely promoted as a model
for children’s health care in many countries throughout the world and in all spheres of children’s nursing
education, management, policy and practice. However, research has failed to show that clinical practice
uses the partnership model, central to FCC. In this paper we suggest that, in part, the failure of FCC, as a
project, is due to the lack of attention paid to the cultural, social and political context in which children’s
health care is delivered. We propose that while the concepts of cultural safety and ethical symmetry
may not replace that of FCC, they can be used to locate child-centred care within the complexity of
children’s lives, as lived with illness.Keywords: Family-centred nursing, cultural diversity, ethical
relativism, nurse–patient relations.

References (45)

... This personalized approach is a dynamic process that might require combining various ethical
principles including some degree of paternalism, SDM, and/or FCC. CCC should combine elements of PCC
and FCC, such that the provider is essentially adhering to a model that gives voice to children and their
families (Majamanda, Munkhondya, Simbota, & Chikalipo, 2015;Randall, Munns, & Shields, 2013).
Ultimately, the role of the provider and the state is to act in the best interests of the child-this stems
from a need to protect those who are unable to protect themselves. ...

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