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research examining the perspective of parents or family caregivers, and research examining the perspective of health professionals. Observations of parent-nurse interactions Participant observation was used to explore the relationship between nurses and parents of well children aged birth to three years hospitalized with an acute illness (Rowe, 1996). Nurses were clearly the “insiders” or “hosts” while parents were viewed by nurses as “visitors” (p. 105– 106). Both held themselves responsible for the child’s care, yet this was not discussed between nurse and parent. Three types of relationships were identified. In the first, and most common, a parallel relationship was described in which the parent and the nurse worked side by side, complementing each other’s care, yet conducting it independently. Still, lack of collaboration or a sense of partnership between nurse and parent was illustrated by the nurses’ perspective that “parents were not part of the daily planning but were useful for relieving the pressure of time by bathing or feeding their child” (p. 103). In a second, less common, type of relationship, described as cooperative, the parent and the nurse cooperated in care with some negotiation of roles, yet the nurse controlled and directed the activities. Finally, no partnership or collaboration was present in a type of relationship described as excluding, in which the nurse undermined the role of the parent by taking over the child’s care, with parents described by the observers as “bystanders” (p. 104). The author concludes that changes in the relationship between nurses and parents will occur only if the nurse initiates and facilitates such a relationship. In a second observational study, little evidence was found that the philosophy of FCC was incorporated into the care of infants and families in a neonatal intensive care unit (NICU; Fenwick, Barclay, & Schmied, 1999). Nurses directed and managed the infant’s care, even when the care did not require technologic skill, with little role negotiation between nurse and Harrison Page 4 J Pediatr Nurs. Author manuscript; available in PMC 2011 October 1. NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript parent. Slightly more positive (47%) than negative (37%) communication patterns were identified, and 16% included both positive and negative components. Positive patterns included evidence of support for the mother, friendliness, and included engagement of both participants. Negative patterns demonstrated nurses’ efforts to “exert their authority, establish expertise, and demonstrate their own power in the relationship” (p. 61). Within positive communication patterns, only 6% were described as egalitarian, in which both partners were observed to have equal status. These interactions were described as relationship building and occurred when nurses and mothers shared life experiences. Interactions with mothers by nurses were on the whole task oriented or providing information with little evidence of nurses working to assist parents in developing a relationship with their infant and preparing to assume caregiving. Perspectives of parents or family caregivers This group of papers will be discussed in three sections: how parents or family caregivers perceived the caregiver-nurse relationship, how parents or family caregivers perceived the value and provision of FCC, and intervention studies examining the effect of FCC on children or families. Caregiver-nurse relationship—The majority of research in which caregivers’ perspectives were examined focused on FCC as a relationship of respect and collaboration between families and health professionals. Parents of children hospitalized with cancer described characteristics of staff nurses with whom they had or had not developed a relationship in which caregiving and decision making were shared (Romaniuk & Kristjanson, 1995). The relationship was influenced by several factors, including the way in which the nurse approached the practice of nursing, staffing levels, and the quality of working relationships between physicians and nurses. Parents valued their positive relationships with nurses and wanted to be involved in their child’s care. In another study, parents reported that having a positive relationship with nurses in which rapport was developed and care of the child was shared was not enough to be considered collaborative as long as the nurse was perceived as maintaining control of the relationship (Espezel & Canam, 2003). The parents’ definition of collaboration was not reported. In a study of mothers of infants in an NICU, mothers actively sought out and worked toward collaborative relationships with their baby’s health professionals (Hurst, 2001). This was difficult because, in order to succeed at this, mothers needed to work to increase their position of authority in the face of the power differential accorded health professionals in the institution (i.e., the health professionals controlled the provision of care to their infant and the interactions between mothers and health professionals). Mothers reported numerous barriers to their attempts to develop a partnership with nursing staff, including lack of adequate staffing which limited time for communication and sharing of information, experiencing multiple caregivers which limited the ability of the mother to develop rapport with individuals, and
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