A scoping review of the perceptions and practices of pediatric nurses’ toward family-centered care

Family-centered care (FCC) is described as a method of providing care for children and their families within the context of health services, which ensure that healthcare is designed not only for the child but also for all family members who are identified as care recipients.^1,2 FCC is conceptualized by 8 basic elements. These include: (1) “recognizing the family is a constant in the child’s life”; (2) “facilitating parents/professional collaboration”; (3) “recognizing family strengths and individuality”; (4) “sharing unbiased and complete information with parents”; (5) encouraging and facilitating parent-to-parent support”; (6) “understanding and incorporating the development needs of infants, children, and adolescents and their families”; (7) “implementing appropriate policies and programs that are comprehensive”; and (8) “assuring that the design of the healthcare delivery system is flexible, accessible, and responsive to family needs.”³

In the context of families and their hospitalized children, the FCC approach is widely accepted as the gold standard for pediatric healthcare settings.^4–6 Given that, FCC is an approach to healthcare that emphasizes understanding pediatric patients within the context of their families and encourages parental participation in child-related decision-making.^2,7

Accordingly, for maximizing pediatric patients’ well-being, pediatric care has integrated the FCC approaches’philosophy.^1,8 In other words, the philosophy is based on nurses and families collaborating to plan, implement, and evaluate care for a child in the hospital.^1,8,9 Invariably, FCC is best characterized as a model of care for children and their parents within the field of healthcare services, which ensure that care is arranged with and around the whole family rather than only the particular child.^10,11 Arguably, FCC generally views the family as the focus of care, rather than the individual hospitalized child.

More importantly, FCC interventions for ill children and their families have obvious advantages.^5,11 FCC is thought to enhance health outcomes and parent satisfaction, promote family awareness of the need for treatment, and build on the strengths of the family and the child, resulting in efficient use of healthcare resources and improving staff satisfaction.^12–15 As a result, FCC is expected to establish the optimal environment for interaction between nurses, families, and children. In addition, a child’s adaptation to the hospital is facilitated by the unique and remarkable relationship between the family and the nurse, which also helps to reduce stress, anxiety, and fear when the child is admitted to the hospital.^13,15

In more recent times, the issue of pediatric nurses’ perceptions and practices regarding FCC has received considerable critical attention.^{8,9,12,16–21} In the literature, there are considerable variations between how nursing practices and their perceptions of FCC. Despite the need for FCC being accepted, the evidence consistently indicates that it is challenging to implement FCC in daily practice settings. The evidence also shows that pediatric nurses may have enough understanding of FCC but have difficulty in applying that information to practice.^{8,9,12,16–22} To date, no review has been published on pediatric nurses’ perceptions and practices regarding FCC in pediatric settings. Therefore, this review is an attempt to investigate and map the evidence available related to pediatric nurses’ perceptions and practices about FCC in pediatric settings.

The scoping review approach is particularly helpful when examining an extensively covered subject to map the literature thoroughly and find main concepts and evidence, or identify research gaps. Scoping reviews, unlike systematic reviews or meta-analyses, do not even narrow the review criteria or require a quality appraisal. The authors adopted the scoping review process proposed by Arksey and O’Malley.²³ Arksey and O’Malley²³ categorized the 5 steps of the scoping review that are outlined below.

2.2.

Step 2: identifying the relevant studies

The chosen databases were selected with keywords as part of the literature search. Medical databases such as EBSCO host, PubMed, Springer, Science Direct, Ovid, and CINAHL were searched to identify the literature on this topic. The following four steps constitute the search process: (1) identifying the problem related to the research questions, (2) performing a literature search, (3) reviewing the article to determine themes, and (4) organizing and critically analyzing the themes. The following search terms were used as keywords: “pediatric nurses,” “nurse perception,” “and nurses practices,” and “family-centered care.” A combination of “pediatric nurses” OR “nurses” AND “nurses perception,” AND “nurses practices” AND “family-centered care” was used as the advanced search terms. Figure 1 illustrates the flowchart of the search process for articles. The relevant articles were thoroughly read, analyzed, and notes were taken to provide a summary of the main ideas, the aim of the study, the methodology, the study’s tools, and the key findings. A total of 725 articles were found using the search strategy (91 from CINAHL, 103 from Springer, 101 from Science Direct, 99 from Ovid, 133 from PubMed, and 198 from EBSCO host). However, 593 of them were excluded due to irrelevance to this review. Meanwhile, 39 articles were duplicates. As a result, 10 articles were identified as pertinent to the scoping review.

Figure 1.

PRISMA flowchart of search process.

Table 1 provides the details of the following: author(s), year, setting, study aim, study design, study characteristics, study instruments, and main key findings.

To the author’s knowledge, this scoping review is the first attempt that evaluate up-to-date evidence on pediatric nurses’ perceptions and practices toward FCC in pediatric settings. Table 1 shows articles that provided outcome data on nurses’ perceptions and practices regarding FCC. Results from the review found that pediatric nurses had a modest positive perception of and comprehended the FCC principles; however, it was inconsistently applied in a clinical area.

This scoping review observed that various research designs were employed in reviewed studies. There were six cross-sectional designs,^{8,9,16,18,21,22} three studies with mixed method,^12,17,20 and one study was of qualitative method.¹⁹ Regarding study location, one each was carried out in Ireland, Australia, Saudi Arabia, Nigeria, Italy, Korea, Sri Lanka, Thailand, and Jordan. As for the year of publication, one each was published in 2013,⁹ 2014,¹⁸ 2021,²¹ and 2023.²² Two studies were published in 2017,^8,12 2018,^16,19 and 2020.^17,20 Concerning the sample size, all descriptive and mixed studies included relatively large sample sizes. For instance, Coyne et al.⁹ (n = 250), Gill et al.¹⁸ (n = 519), Dall’Oglio et al.¹⁶ (n = 455), Okunola et al.⁸ (n = 176), Razeq et al.²¹ (n = 264), Al-Oran et al.²² (n = 102), Alabdulaziz et al.¹² (quantitative phase n = 219; qualitative phase n = 14), Done et al.¹⁷ (quantitative phase n = 157; qualitative phase n = 18), Prasopkittikun et al.²⁰ (quantitative phase n = 142; qualitative phase n = 16), and a qualitative method by Jung and Jung¹⁹ (n = 56). For study participants, seven studies recruited only pediatric nurses who are working in pediatric units,^{8,9,12,17,18,20–22} while two studies recruited other pediatric healthcare providers.^16,19 As for the outcomes, assessment perceptions of FCC were performed by five studies.^8,17–19,21 Whereas, both perceptions and practices of FCC were evaluated by five studies.^{9,12,16,20,22}

Coyne et al.⁹ reported that the nurses’ overall average scores for perception were significantly higher than their overall average scores for practice, indicating that nurses did not regularly apply the FCC principles in their clinical setting. Participants in other study have reported the same results.¹⁶ Besides that, a mixed-method study conducted by Alabdulaziz et al.¹² indicated that participants evaluated the majority of elements as necessary for FCC; however, they reported that some elements were not frequently applied in their clinical setting. In addition, the qualitative data confirmed these findings and emphasized the areas where nurses’ perceptions and practices varied. This result was parallel to that stated in a more recent study.^20,22

On the other side, Gill et al.¹⁸ examined only the perception of nurses toward FCC; they found that pediatric nurses who are working in pediatric settings reported a positive response to the perception of FCC. This result is supported by Okunola et al.⁸ and Razeq et al.²¹ The methodological approach taken in the study conducted by Done et al.¹⁷ is a mixed methodology, and they found that the overall perceptions of nurses regarding FCC were modest. In addition, the qualitative findings indicated the importance of the parents in providing care for hospitalized children and implementing FCC elements. A qualitative study by Jung and Jung¹⁹ found that the FCC model has been incompletely implemented.

Investigations did not assess nurses’ perceptions and practices using the same questionnaire. Various tools were utilized in the reviewed studies, including the FCC Questionnaire-Revised,²⁵ FCC Questionnaire-Revised,²⁶ Modified FCC Scale,²⁷ Working with families Questionnaire.^28,29 All these questionnaires are validated psychometrically; nevertheless, using different questionnaires in the review studies makes it challenging to accurately assess nurses’ perceptions and practices. Investigations on FCC themes are growing rapidly and the number of instruments used to assess perceptions and practices is currently increasing. As pointed out earlier, the review studies demonstrate that nurses who are working in pediatric settings recognized the importance of each FCC component; however, the nurses incorporate FCC principles in their daily clinical practice. These results highlight the implementation’s challenges.

FCC has received widespread support in Western and non-Western countries and is associated with better outcomes of care for hospitalized children and their families. A considerable amount of literature has been published on pediatric nurses’ perceptions and practices toward FCC in different pediatric units. These studies indicated that FCC is a generally accepted approach to providing healthcare for children and their families, but its implementation in practical clinical settings is still challenging. Establishing the desired level of collaboration between parents and nurses requires ongoing education of nurses regarding the implementation of FCC. To conclude, this scoping review significantly contributes to future research by serving as a key for the development of interventional interventions that are primarily focused on implementing the core components of FCC.

Despite the significant findings that have been synthesized in this scoping review, the authors consider that some limitations should be noted. Only studies published in English were thoroughly searched for this review. There might be other research published in different languages that could show evidence for nurses’ perception and practice toward FCC. Conclusions were preliminary since there was little research regarding nurses’ perceptions and practices of FCC. There was only one qualitative study found in this review that mainly focused on the perceptions of nurses toward FCC.

From the review results, future intervention studies are proposed to educate pediatric nurses about the implementing of FCC in clinical settings. Further research should encourage discussions toward the methods for evaluating and assessing the implementation of FCC in clinical settings. In the future, questionnaires and interview methods can be used together to conduct the research in scientific and practice investigation.