Family-Centred Care or Child-Centred Care: Generating the Evidence and Ethics

Family-centered care is used in hospitals for children in many countries. Evidence of its effectiveness is limited; qualitative research reveals problems with implementation. Emerging models compete to return the child to the focus of care. These presentations will discuss how an international collaboration from eight countries may integrate divergent perspectives.
Family-centered care (FCC) has been a considered a cornerstone of pediatric health care since the 1970s, but evidence of its effectiveness is lacking (Coch rev). Qualitative research about its implementation demonstrates that problems exist in its interpretation and applicability in health services. A new model, child-centered care (CCC), is emerging and it needs debate, philosophical argument (Coyne, Soderb, Halls) and ultimate testing to ensure it can be more effectively implemented than family-centered care. Some argue that child-centeredness cannot be done without the context of family; others believe that families, particularly parents, are called upon to participate in FCC in hospitals that is predicated on their parental roles that may be unlike their normal expectations in the home and fail to take into consideration the child's emerging autonomy.
To this end, an international collaboration comprising 18 paediatric nursing clinicians and academics has been formed to engage in discourse around the similarities and differences in their approaches to family and child-centered care. The countries to date are Australia, Iceland, Ireland, Jordan, Sweden Turkey, the UK and USA. The group has begun to dialogue via internet across oceans to develop a common ground of understanding that can suggest a framework from which to test new care models. Several of these points of view will be part of this symposium.
The debate surrounding the effectiveness of care models for hospitalized children continues; the research on FCC evolves; the execution from national points of view have been studied with weak results. The emerging viewpoint of CCC derives from philosophical and ethical foundations. Deconstructing FCC into components becomes essential, and philosophical and ethical arguments can emerge. This symposium will provide several divergent views with empirical evidence to harmonize a framework toward family-centered and child-centered care. Each of the presentations will offer a national perspective. It will include historical writings about the care of children in hospital, cultural factors from the different countries, and on-going discussion and debate. The new framework will rise from a philosophical theory with a consensus of opinions and an eclectic structure. This first step will form the base of collaboration and dialogue. Once a framework emerges from these discussions, nurse researchers from around the globe may begin to develop methods and tools to test the new model. Ultimately, the health and well-being of children and families across the world will be better understood with the convergence and divergence of perspectives enhanced by a strongly tested, empirical model of care.