Paper
Wednesday, July 11, 2007
Towards a theory of family and professional dynamics in neonatal and pediatric critical care
Elisabeth O.C. Hall, PhD, MScN, RN, Institute of Public Health, Department of Nursing Science, Aarhus University, Århus, Denmark
| Learning Objective #1: understand challenges in theory development in family-centred care. |
| Learning Objective #2: identify a theory of family-professional dynamics for use in further research and family-centred care. |
Neonatal and paediatric nursing of today is expected to be family-centred. The parents participate in the daily care and often spend all their time together with their hospitalized child. Thus, nursing is caring for both the critically ill child and the family. The presentation illuminates three interpersonal relationships (here named dynamics) in this context: family dynamics, professional dynamics and family-professional dynamics. Family refers to parents and grandparents; the professionals are mainly nurses, however, physicians are indirectly involved. Dynamics as phenomena are seen as the dialectics between external systemic and internal existential factors. A secondary analysis of the author’s earlier published studies was done with the purpose to further illuminate the dynamics of family-centred care when a newborn or small child is critically ill. The results are gathered in a theory of dynamics, the Theory of Family Professional Dynamics (TFPD). The results emphasized that the dynamics took place in a reality field situated between the ideal (caring, knowing, mutuality, pleasant tone) and the unacceptable (un-caring, knowing, isolation and unpleasant tone). In other words, there was a dialectic relationship between good or less good dynamics as well as nursing when a newborn or small child was critically ill. The TFPD discloses the complexity of dynamics in family-centred neonatal and paediatric care; many factors are of importance to achieve well-being in the families and among the professionals. The TFPD, that includes concepts on different levels, is in its beginning phase; further development of the theory will strengthen and validate its usefulness. In spite of this limitation, the TFPD has in its present state, the potential to conceptualize family-centred care and develop empirical indicators. Thus, the theory is promoting evidence-based family-centred care, which both the society and the discipline are asking for.