Table of Contents

Table 3
Results:  How Nurses Can Promote Family Health

Reinforce Parenthood -

• Negotiate parents' role in hospital

• Give positive feedback

• Assess the family's situation regularly

• Offer alternatives and provide support in decision making

• Encourage parents to accept support

Look After Child's Welfare -

• Assume primary responsibility when necessary

• Get to know child's habits and personality

• Support child in learning new things

Share Emotional Burden -

• Assume responsibility for family's situation

• Be available to family

• Encourage family to vent emotions

• Be aware of parents' feelings (guilt)

• Create a supportive atmosphere

Support Everyday Coping -

• Learn family's habits and routines

• Adjust information given to family

• Look ahead and maintain hope

Create Confidential Care Relationship -

• Spread out own work load

• Intervene in difficult situations and resolve with family

• Keep family up to date and involved

• Strengthen parent's coping strategies

     Few situations are more stressful for a family than having a child in the hospital.  Beyond the obvious stress and anxiety, parents may also have feelings of insecurity, guilt, and fear.  The hospitalized child is taken completely out of their element which sometimes results in regression type behavior.  Siblings are effected as well; in addition to the fear and sadness they may feel, brothers and sisters are often neglected to various degrees during the time of crisis.  The  situation is charged with intense emotion for the entire family, who may have varying abilities to cope.
    While some research has been done in this area, most studies have focused on the mother and in supporting her role.  Despite the situation's obvious impact on the entire family, little work has been done on the family as a whole.  So what can be done to help families during this difficult time?
     Hannah Hopia, a registered nurse and doctoral student at the University of Tampere, Finland believes that nurses can play a critical role in promoting family health.  Building upon research which has shown that nursing staffs can have a positive impact on families and even the follow-on care of sick children, Hopia led a study which looked specifically at what nurses can do to promote family health when a child is in the hospital.  She recently published her findings in the February 14, 2005 issue of the Journal of Clinical Nursing.
      To determine what role nurses can play, Hopia conducted extensive interviews with 29 families who had a child with a chronic illness and was either currently in the hospital, or had recently been there for treatment and care.  The interviews were centered around several themes (see Table 1), such as the child's diagnosis, hospitalization, how it changed the family, what the hospital experience was like, and how they interacted with the nursing staff.  Hopia employed a technique created by a different researcher (Price) in which the families are first asked to describe the early stages of their child's illness, the situation where they were admitted to the hospital, and the role of the parents during the hospital stay.  After this, the questions become more emotionally focused and deal with things such as how the family members had felt during that time, and what, if anything, helped them.  All together the researcher conducted interviews with 43 parents and 39 children.
     The interview responses were then analyzed using what is known as the grounded theory of qualitative research (qualitative research means there are no numerical measures or statistics).  The process involved taking individual response items and developing codes related to the family's needs or what helped them (see Table 2) below:

Table 2 - Example of Analysis Which Led To Reinforcing Parenthood

    The codes were then mapped to more substantive codes and grouped into higher-level categories.  In this case, the responses from family members led to the development of five high-level domain areas where nurses can impact family health (see Table 3):  reinforce parenthood, look after the child's welfare, share the emotional burden, support everyday coping, and create a confidential care relationship.
    The results revealed that reinforcing parenthood is important because parents often feel insecure and helpless in the hospital.  They are not sure what to do or how to help their child.  Nurses can help by talking openly with parents about what they want to do and are capable of doing.  Nurses can also provide positive feedback to reaffirm a parent's confidence in their parental role and monitor the family dynamic in addition to just checking on the sick child.
     The interviews also showed that it is important for nurses to look after the child's welfare.  During a hospital stay there will be times when a family does not have the resources to do so and may not ask for help.  Thus, it is important for a nurse to know when to step in when necessary.  It is equally as important for a nurse to learn about the sick child's individual personality and habits to help ease the transition to the hospital.
     The emotional burden on parents during this time is tremendous and nurses can have a large, positive impact by sharing this burden.  Hopia encourages nurses to be aware of the family's emotional state and how they are coping with the situation.  Provide encouragement when necessary, and take charge when necessary - for example sending home an exhausted parent to rest.
     For many families, the stress does not end when their child is discharged.  Different levels of home care are required and may impact families in different ways.  This uniqueness was revealed in the study and translated to the need for nurses to learn about an individual family's habits and routines in order to give them the proper type and amount of information in regards to home care.  A second important role nurses can play in aftercare is in providing hope for the future in both the family's ability to cope and that treatments will work.
     Finally, given  the incredible influence which nurses can have on a family it is no surprise that the study revealed that it is important for nurses to develop a strong, confidential relationship with the family.  The primary care nurse may be privy to all types of private and personal information (which is actually necessary for them to have a positive impact), so any perception that they are callous or indifferent may offend the family, create a negative emotional situation, and greatly limit the nurse's ability to be a positive influence on the family's health.
    The fact that this research was qualitative somewhat limits the conclusions that can be drawn from it; however, it does reveal the critically important role which nurses can play in helping families during a very difficult time.

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Key Points

1. Having a child in the hospital is an extremely stressful situation for families

2. Parents often suffer from insecurity, guilt, and fear; the patient sometimes regresses due to the stress; and siblings are often ignored during the time of crisis

3. Past research has focused on the role of the mother in situations like this

4. Study conducted extensive interviews with 29 families with a child who has a chronic illness that required hospitalization to determine how nurses can improve family health

5. Responses were analyzed and put through a series of codings and categorizations

6. Results included five domains where nurses can have a positive impact:  reinforce parenthood, look after child's welfare, share emotional burden, support everyday coping, create a confidential care relationship

Table 1
Family Interview Themes

• Child's diagnosis

• Child's hospitalization

• Changes in family life

• Roles in family

• How family responds to stress

• Values, habits, customs

• Resources and family coping strategies

• Family togetherness

• Hospital experience

• Cooperation with nursing staff

• Support for participation in child's treatment

• How family's individual habits and values are taken into account

Source:  Hopia H, Tomlinson PS, Paavilainen E, Astedt-Kurki P.
Child in hospital: family experiences and expectations of how nurses can promote family health. J Clin Nurs. 2005 Feb;14(2):212-22.