The Forgotten Visionaries of Family-Centered Care
Article Outline
I believe the time has come—and it is frankly long overdue—to give recognition to pediatric nursing and interdisciplinary experts and leaders who were among the first health care professionals to propose the concept of family-centered care. Their contribution to improving the quality of care for ill and hospitalized children and their families was significant as it spearheaded an entirely innovative approach to providing developmentally appropriate and family-centered care, in contrast to the restrictive approach that typified much of pediatric hospital care up to that time. These visionaries are as follows: Audrey Beatty, RN, BSN; Lynne Power Deakers, BS, RN; Maria Tortoreto Duran, BS, RN; Patricia J. Eyres, MN, RN; Karen Ikuno Fond, MS, RN, CPNP; Lucy Kunzman, MS, RN; Kathyrn Luciano, BS, MSN, RN; and Natalie Issner, BA, MS—all from Children's Hospital Los Angeles (CHLA).
Their work, which constituted the first comprehensive discourse on family-centered care, was published in 1972 in the Nursing Clinics of North America. That issue contained eight articles addressing a myriad of issues pertaining to the implementation of family-centered care. This Nursing Clinics of North America issue on family-centered care was written to provide pediatric and child and family nurses and interdisciplinary health care professionals an introduction to this philosophical concept and examples of its clinical application to the continuum of child and family health care needs in varied practice settings. As Beatty (1972) stated in the introduction to this historic issue, the purpose of the symposium was to share the implementation of family-centered care at CHLA:
The philosophy of patient-centered nursing care which allowed for parent participation was modified to embrace the entire family's needs, enhance discharge planning, and promote the preventive and teaching aspects of care … It is the aim of this symposium to share this knowledge and other important concepts related to providing such care (p. 2).
The range of symposium topics addressed service continuity between the hospital and the home, the needs of the family in caring for a dying child, and provision of care for adolescents. Other topics ranged from staff development strategies to nursing care approaches to facilitate the implementation of family-centered care, and developmental concerns of hospitalized children necessitating this new service model.
One of Luciano's (1972a) articles provided an overview of the components of family-centered care predicated on the premise that “… significant family members are included in establishing objectives to meet the health care needs of this child. It implies a systematic approach to the identification and resolution of family needs, and it demands an environment conducive to therapeutic relationships” (p. 41). That statement of purpose regarding the inclusiveness of family members in the provision of care is as relevant today as it was proposed to be 35 years ago. Then as for today, professional nursing practice in promoting family-centered care involved not only the provision of direct nursing care but referral to interdisciplinary colleagues and service coordination (Luciano, 1972a).
One of the contributors to this issue was Issner (1972), who served as one of the CHLA social workers who addressed the structure and function of the family and the impact of a child's illness on family members. In this article, Issner conceptualized the family in a manner very atypical of the societal period and the professional literature. As Issner stated, “… today we have different kinds of families or family units, but families nonetheless. Therefore, the single parent with an adopted child is as much a family as the unit consisting of father, mother, and children”—a statement that could have been written today … 35 years later!
Kunzman's (1972) article, “Some Factors Influencing a Young Child's Mastery of Hospitalization,” provides readers with nursing strategies not only to support the child in coping with stresses associated with the hospital experience but to master it. Again, consider the context of the period during which these and other articles were written. Restrictions on parental visiting existed, and evidence for liberalizing visitation policies and implementing interventions to decrease the child's hospitalization distress were in the seminal stages of development (Lewandowski & Tesler, 2003, Robertson, 1958). Duran's (1972) article, entitled “Family-Centered Care and the Adolescent's Quest for Self-Identity,” extended the concept of family-centered care in describing the role of nurses in working with ill adolescents. Concepts related to the importance of supporting the transition of adolescents into adulthood, such as self-care, independence, and youth involvement, are featured throughout the article. These are principles of care that are receiving renewed attention in light of the efforts to test and implement evidence-based health care transition planning models to assist the youth in achieving their goals for adulthood, including their transfer from pediatric care to adult health care (Betz, 2004).
The remarkable aspect of this symposium on family-centered care was the application of this philosophy of care to the spectrum of settings that was not only innovative but reflected the true essence of providing care that was based on family, not institutional, needs. Deaker's (1972) article, entitled “Continuity of Family-Centered Nursing Care Between the Hospital and the Home,” addressed issues associated with ensuring that the child's home care needs following hospital discharge would be met. Deaker's article also addressed the need for nursing coordination and referral to facilitate transition into the home—a concept of care that has contemporary relevance in terms of both health care economics and philosophical orientation to care. Fond's (1972) article explored the application of family-centered care to caring for children and families dealing with death and dying. In this article, as presented in Deaker's, Fond advocates for nursing follow-up care for bereaved family members based on the philosophical concepts of family-centered care.
Other articles published in this symposium expanded on the nursing role in providing family-centered care. Eyre's (1972) article, entitled “The Role of the Nurse in Family-Centered Nursing Care,” refers to concepts evident in practice standards for pediatric nursing practice today (Society of Pediatric Nurses & American Nurses Association, 2003). Luciano's (1972b) article, “Staff Development: Toward the Implementation of Family-Centered Care,” explicates how family-centered care was first implemented at CHLA in 1969.
More recently, I contacted Luciano, Fond, and Kunzman to gather more information about their experience in implementing family-centered care at CHLA. Admittedly, 35 years is a considerable time frame from which to resurrect memories of the events surrounding their work on the implementation of this family-centered care model. Luciano (personal communication, February 2, 2007) described the atmosphere of practice at CHLA at that time as follows:
In the 1960s, visiting hours at CHLA were from 2p.m. to 4 p.m., Monday to Saturday, and noon to 4p.m. on Sundays. One of the first things Audrey [referring to Audrey Beatty] did was expand visiting hours, and she did this as the In-service Education Director. I assure you that there were those who were NOT in favor of this change. Parents were seen as “in the way.” Audrey decided to put on a symposium to teach our own CHLA staff about family-centered care. It was an all-day Saturday event, held in Dining Room A. Attendance filled the room, but it was NOT a standing-room-only event. The first speaker, a psychiatrist, spoke for only about 20 minutes. Audrey was totally ticked that he [referring to the speaker] did not have more content, so she picked up the microphone and filled in another 30 minutes about the “psychological needs of sick children.” This I will never forget.
As Luciano's account relates, the change to family-centered care was a challenge, but having nursing leaders committed to facilitating the change was essential to realizing it. As Fond (personal communication, February 19, 2007) shared, this new philosophy of care required time, patience, persistence, and unwavering commitment:
So many times, I remember trying to inform our nurses that there were different and better ways to care for the children and families. I believe that we also tried to put our concepts into nursing practice on the units by modeling behavior, rewriting nursing plans, etc. We watched and evaluated to see if families became more participative (some did) and if families seemed to like more involvement or not. In those days, we did not have evidence-based practice, but it was a beginning which we did not realize.
As both their clinical practice and writings illustrated, the effort to effect substantial change requires not only leadership and commitment by dedicated professionals but the intangibles of the good fortune of timing and the unusual group of individuals who were ready for this professional challenge. During my entire tenure as the founder and editor-in-chief of this journal, I have never written an editorial like this. I summarized articles contained in Nursing Clinics Symposium to illustrate for the reader the breadth of topics written to convey this early thinking by a group of outstanding pediatric nursing professionals as to how family-centered care could be implemented in a hospital setting. I believe it is important to recognize this significant yet overlooked contribution to the evolution of pediatric nursing practice. I believe this group of pediatric nursing professionals made an important contribution to our specialized field of nursing practice to improve the quality of care provided to children and their families, which deserves recognition even 35 years later.
References
- . Symposium on family-centered care in a pediatric setting. Nursing Clinics of North America. 1972;7:1–3
- . Transition of adolescents with special health care needs: Review and analysis of the literature. Issues in Comprehensive Pediatric Nursing. 2004;27:179–240
- . Continuity of family-centered nursing care between the hospital and the home. Nursing Clinics of North America. 1972;7:83–93
- . Family-centered care and the adolescent's quest for self-identity. Nursing Clinics of North America. 1972;7:65–73
- . The role of the nurse in family-centered nursing care. Nursing Clinics of North America. 1972;7:27–38
- . Dealing with death and dying through family-centered care. Nursing Clinics of North America. 1972;7:53–64
- . The family of the hospitalized child. Nursing Clinics of North America. 1972;7:5–12
- . Some factors influencing a young child's mastery of hospitalization. Nursing Clinics of North America. 1972;7:13–26
- . Family-centered care: Putting it into action: The SPN/ANA guide to family-centered care. Silver Spring, MD: nursebooks.org; 2003;
- . Components of planned family-centered care. Nursing Clinics of North America. 1972;7:41–52
- . Staff development: Toward the implementation of family-centered care. Nursing Clinics of North America. 1972;7:75–82
- . Young children in hospitals. London: Tavistock Publications; 1958;
- . Scope and standards of pediatric nursing practice. Silver Spring, MD: nursebooks.org; 2003;
PII: S0882-5963(07)00178-9
doi:10.1016/j.pedn.2007.04.002
© 2007 Published by Elsevier Inc.
