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Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript assigned to receive either the intervention or standard care in the NICU (Byers et al., 2006). No differences in parental satisfaction or in infant physiologic measures (heart rate, respiratory rate, and oxygen saturation) were found between groups. However, behavioral stress cues were significantly lower in the intervention group. In a second study, parental participation in care was examined in a small sample of mothers of children with cancer (Evans, 1996). Five mothers trained to administer intravenous antibiotics to their hospitalized child reported less anxiety, improved coping, and feeling more in control. The remaining two intervention studies included one based in the NICU and one in a community setting. In the first, parents with infants in the NICU reported benefits of parent support programs, including facilitation of greater parent participation in infant care and improvement in communication with health professionals (Hurst, 2006). In the second, a community-based intervention of a comprehensive asthma education program for over 500 low income Latino children and their families was tested that incorporated the FCC elements of family participation in educational programs, support groups, and a community advisory board (Lewis, Lewis, Leake, Monahan, & Rachelefsky, 1996). Significant reductions were found in number of physician visits, percentage of children hospitalized, and percentage of children requiring emergency care. Perspectives of health professionals The perspective of health professionals was the focus of numerous studies. Nurses were found to have reservations about providing FCC. Ten NICU nurses were interviewed about their experiences in transitioning from a traditional model of nursing care to a family centered model of providing developmentally supportive care (Heerman and Wilson, 2000). Although the nurses reported positive responses to facilitating a relationship between a mother and her infant, negative feelings of being intimidated by parents and of losing control and power were also expressed. Difficulties in delivery of FCC were also described in a study of hospital-based pediatric nurses (Paliadelis, Cruickshank, Wainohu, Winskill, & Stevens, 2005). Nurses believed that family members should be involved in the care of a hospitalized child, but found it difficult to implement in practice, largely because of conflicting beliefs about their role as a nurse, including: (a) nurses are the experts, (b) nurses have the legal responsibility to care for the children, and (c) nurses need to assess parents’ abilities before allowing their participation. Reluctance to provide care based on principles of FCC was again demonstrated in a study of decision making about parental presence during invasive procedures in the pediatric intensive care unit (Jefferson & Paterson, 2001). The decision about parental presence was made by the health professional and depended upon that individual’s goal, which was most often “to perform a procedure with maximal efficiency and minimal disruption” (p. 17) and only rarely to support the parent-child relationship, two goals seen as mutually exclusive. Differences in attitudes towards parent participation in care were found in a sample of 256 pediatric health care providers including nurses, physicians, respiratory therapists, and nursing assistants (Daneman, Macaluso, & Guzzetta, 2003). The majority (51%) of respondents were nurses. No differences in attitudes were found between nurses and physicians. Although respondents valued the benefits of parents participating in routine tasks such as feeding, there was less support for allowing parents to visit whenever they wished and for doing things normally done by health care providers, such as giving medications, even when the parent normally gave those medications at home. Health care providers working on specialty units and those with higher levels of education had higher scores in support of parental participation. Differences in attitudes were also revealed in a small qualitative study of empowerment of parents by acute care pediatric nurses (Valentine, 1998). Empowerment in the context of FCC was described by the authors as a shifting in the balance of power between health care professionals and families wherein the health care professional supports and enables the family Harrison Page 7 J Pediatr Nurs. Author manuscript; available in PMC 2011 October 1. NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript to maintain their parental role of advocating for, caring for, and making decisions involving their child’s health and well-being. Although all nurses were knowledgeable about the theoretical basis for empowerment of parents, experienced nurses had a more positive attitude about the abilities of parents to participate in their child’s care and were less threatened by negotiating this change of traditional roles than nurses with less experience.