Family-centred practice : empowerment, self-efficacy, and challenges for practitioners in early childhood education and care

Family-centred practice has been included in the Victoria, Australia Early Years Learning and Development Framework as a key practice principle for professionals working across all early years programs in that state. While this model of partnership for engaging and collaborating with families has long been used in the early intervention sector, the efficacy of adopting this model more widely across the wider early childhood education and care sector has not been explored. This article presents a discussion on family-centred practice as a model for engaging with families in the care and education of their children. Through an analysis of the underlying philosophy and an examination of the core principles and characteristics, the article explores family-centred practice as it sits within a broader theory of partnership. This analysis identifies that while there are essential principles and characteristics that position the model within a partnership framework, it is the notion of empowerment, an underpinning philosophy guiding the model, that adds another dimension to the way practitioners in early childhood education and care settings collaborate with families. In examining the broader early childhood context, the capacity of many early childhood practitioners to effectively implement empowering behaviours is challenged.

Family centred care before and during life-sustaining treatment withdrawal in intensive care: a survey of information provided to families by Australasian critical care nurses

BACKGROUND: A core component of family-centred nursing care during the provision of end-of-life care in intensive care settings is information sharing with families. Yet little is known about information provided in these circumstances.

OBJECTIVE: To identify information most frequently given by critical care nurses to families in preparation for and during withdrawal of life-sustaining treatment.

DESIGN: An online cross-sectional survey.

METHODS: During May 2015, critical care nurses in Australia and New Zealand were invited to complete the Preparing Families for Treatment Withdrawal questionnaire. Data analysis included descriptive statistics to identify areas of information most and least frequently shared with families. Cross tabulations with demographic data were used to explore any associations in the data.

RESULTS: From the responses of 159 critical care nurses, information related to the emotional care and support of the family was most frequently provided to families in preparation for and during withdrawal of life-sustaining treatment. Variation was noted in the frequency of provision of information across body systems and their associated physical changes during the dying process. Significant associations (p<0.05) were identified between the variables gender, nursing experience and critical care experiences and some of the information items most and least frequently provided.

CONCLUSIONS: The provision of information during end-of-life care reflects a family-centred care approach by critical care nurses with information pertaining to emotional care and support of the family paramount. The findings of this study provide a useful framework for the development of interventions to improve practice and support nurses in communicating with families at this time.

Partnerships in early childhood education and care : empowering parents or empowering practitioners

Research acknowledges that outcomes for young children are enhanced when effective partnerships are developed between educators and families. The Australian Early Years Learning Framework provides direction for the professional practice of early childhood educators by acknowledging the importance of educators working in partnership with families. In the Victorian state-based early years framework, family-centred practice has been included as the practice model. Family-centred practice has as its core a philosophy of professionals supporting the empowerment of parents as active decision makers for their child. The early childhood education and care sector in Australia, however, is made up of a workforce which is largely perceived as being undervalued as a profession. This raises questions as to the capacity of these educators to support the empowerment of parents when they themselves are coming from a position of disempowerment due to their professional status. This article reports on findings from a small-scale study of childhood educators working in a long day-care setting which aimed to identify perceptions of the partnerships that exist between themselves and parents. In the course of the investigation, it became evident that some of educators felt disempowered in the relationships that exist with some families.

Above and beyond: exploring outcomes and practices of Scope Southern Region Early Childhood Intervention Service for children with disability

This research project is an exploration of the early childhood intervention service (ECIS) provided by Scope Southern Region. The research seeks to examine the benefits and outcomes for families and children. In doing so, the project’s emphasis is on key practices such as family centred practice and transdisciplinary practice, while examining the enablers and barriers to providing positive benefits to families and children. The central question is whether the interventions are of assistance to families and children.

The road map to building new dreams : raising a child with developmental delay or disability

Research on early childhood education emphasises the importance of quality in early childhood intervention. This study examines the quality of Early Childhood Intervention Services based on parents’ experiences raising a child with developmental delay or disability. The study builds on the philosophy of Family-Centred Practice and professionals’ experiences with family-centred interventions. A qualitative case study approach was adopted to gain insight about families who are raising a child with additional needs. Nine in-depth parent-interviews and three focus groups with professionals were conducted in the first two terms of 2010. The case explicates the experiences of parents and professionals who were associated with Specialist Children’s Services in a metropolitan region of Victoria. The research concentrated on the first point of entry to early intervention, the referrals process and the waiting list. It also addressed parents' experiences, priorities and expectations. As a small-scale study, it examined parents’ and children’s needs as well as children’s access to therapy in early intervention. It also investigated community support and parent-professional relationships in the context of early childhood intervention services. The study found that family-centred intervention is beneficial to both parents and children with developmental delay or disability. However, to implement an effective family-centred approach, practitioner support in the form of professional development, supervision and peer mentorship is required to develop professionals’ reflexivity and self-efficacy in family-centred interventions. The study also identified strategies to promote effective practice, gaps in universal and specialised services, and implications for policy.

Empowerment in early childhood intervention : perspectives of parents of children with disabilities

There have been various changes to the manner in which early intervention services for children with disabilities have been provided in recent decades. One of the most significant paradigm shifts that has accoured pertains to a change in the level of family involvement in early intervention, so that families are now required to be equal partners with professionals in the service provision process. It is now policy in Victoria that early intervention services follow a family-centred model of practice. Services adopting this model aim to empower parents, so that they may have impact on their lives, and the lives of their family members, both during and beyond the years of direct service participation. Much of what is known about empowerment to date is based on theory, author opinion, and research that is largely survey-based. There has been little interview-based research, particulary involving parents of children with disabilities, as well as little Australian research conducted regarding empowerment. To the researcher's knowledge, there has been no interview-based research that specifically asked parents of children with disabilities about their perspectives on empowerment and disempowerment. Parents of children with disabilities are not invited to contribute their opinions in services and research. Empowerment is an individual concept and this research provided parents with an opportunity to express their views on this topic. Parent's perspectives on empowerment are vital for service providers who aim to follow the intervention model required by policy. This research, which was guided by the principles of ecological theory and critical theory, involved to individual semi-structured interviews with 37 Victorian families of children with disabilities. Twenty-one of these families had children currently participating in early intervention services, and 16 families had children of mid-primary school age, who had previously participated in early intervention experiences; the factors that they believe influence empowerment and disempowerment; and helpful and unhelpful experiences with early intervention staff and other people in their lives. Data were analysed primarily inductively, in the context of grounded theory. Responses from the two groups of parents were then compared, as were different emergent themes according to helpfulness and empowerment. The nature of enduring empowerment, one of the key objectives of early childhood intervention, was also considered. From the analysis of data, several themes emerged as influential in the empowerment process for both groups of parents including: information, education and knowledge; meeting and talking with other families of children with disabilities; decision-making and choice; having confidence; participation, involvement and input; meeting or addressing families' practical needs; and having a child with a disability. The results of this research provide valuable information for parents, professionals, agencies, organisations, and the wider community, regarding how families can be supported more effectively and how power can be more equitably balanced.

Is psychotherapy a vector for isolation and anomie?

A key traditional question the client learns in the conventional psychotherapies is ‘Am I getting what I want?’. But can this question incite a mindset that does not align with the ‘give and take’ essence of sustainable everyday relations? Is it possible that the psychotherapies—if these practices can be bundled together—might teach clients to become more self-centred and relationally illiterate? MARK FURLONG suggests that well-intentioned practitioners can inadvertently de-empathise, ignore or even disrupt their clients’ intimate networks. Findings from his research support the proposition that the action of the mainstream therapies tends to undermine the service users’ prospects for sustainable personal relationships. Exceptions were found in the specialist settings of paediatric and aged care, and in narrative and family therapy practice.

Quality care outcomes following transitional care interventions for older people from hospital to home: a systematic review

 Background
Provision of high quality transitional care is a challenge for health care providers in many western countries. This systematic review was conducted to (1) identify and synthesise research, using randomised control trial designs, on the quality of transitional care interventions compared with standard hospital discharge for older people with chronic illnesses, and (2) make recommendations for research and practice.

Methods
Eight databases were searched; CINAHL, Psychinfo, Medline, Proquest, Academic Search Complete, Masterfile Premier, SocIndex, Humanities and Social Sciences Collection, in addition to the Cochrane Collaboration, Joanna Briggs Institute and Google Scholar. Results were screened to identify peer reviewed journal articles reporting analysis of quality indicator outcomes in relation to a transitional care intervention involving discharge care in hospital and follow-up support in the home. Studies were limited to those published between January 1990 and May 2013. Study participants included people 60 years of age or older living in their own homes who were undergoing care transitions from hospital to home. Data relating to study characteristics and research findings were extracted from the included articles. Two reviewers independently assessed studies for risk of bias.

Results
Twelve articles met the inclusion criteria. Transitional care interventions reported in most studies reduced re-hospitalizations, with the exception of general practitioner and primary care nurse models. All 12 studies included outcome measures of re-hospitalization and length of stay indicating a quality focus on effectiveness, efficiency, and safety/risk. Patient satisfaction was assessed in six of the 12 studies and was mostly found to be high. Other outcomes reflecting person and family centred care were limited including those pertaining to the patient and carer experience, carer burden and support, and emotional support for older people and their carers. Limited outcome measures were reported reflecting timeliness, equity, efficiencies for community providers, and symptom management.

Conclusions
Gaps in the evidence base were apparent in the quality domains of timeliness, equity, efficiencies for community providers, effectiveness/symptom management, and domains of person and family centred care. Further research that involves the person and their family/caregiver in transitional care interventions is needed.

The role of the music therapist in promoting parent infant attachment

Abstract
This paper provides a brief overview of recent literature relating to infant musicality and its basis for effective parent-infant work in music therapy. Two strong trends are revealed: the international breadth of the developing work by music therapists within family-centred contexts of practice, especially work with infants and their parents in the early years; and the use oftheoretical principles of communicative musicality (Malloch &Trevarthen, 2008] combined with knowledge of early musical skills. This focus on musical perception and musical development (Briggs, 1991; Trehub, 2003] provides a rationale as to why musical interaction supported by a qualified music therapist can offer a potential pathway for improved attachment between the parent and infant when therapeutic support is indicated.

Identifying educational priorities for occupational therapy students to prepare for mental health practice in Australia and New Zealand: opinions of practising occupational therapists

BACKGROUND: The effective preparation of occupational therapy students for mental health practice is critical to facilitate positive consumer outcomes, underpin optimal practice and support new graduates' professional identity. This project was established to determine a set of 'educational priorities' for occupational therapy students to prepare them for current (and future) entry-level practice in mental health, from the perspective of mental health occupational therapists in Australia and New Zealand. METHODS: The study included two phases. In Phase One, participants identified what they considered to be important educational priorities for occupational therapy students to prepare them for practice in mental health. For Phase Two, an 'expert panel' was assembled to review and rank these using a Policy Delphi approach. RESULTS: Eighty-five participants provided educational priorities in Phase One. These were grouped into a total of 149 educational themes. In Phase Two, the expert panel (consisting of 37 occupational therapists from diverse locations and practice settings) prioritised these themes across three Delphi rounds. A final priority list was generated dividing educational themes into three prioritised categories: 29 'Essential', 25 'Important' and 44 'Optional' priorities. Highest-ranked priorities were: clinical reasoning, client-centred practice, therapeutic use of self, functional implications of mental illness, therapeutic use of occupation and mental health fieldwork experience. CONCLUSION: The priority list developed as part of this project provides additional information to support the review of occupational therapy curricula across Australia and New Zealand to ensure that new graduates are optimally prepared for mental health practice.

An integrative review of how families are prepared for, and supported during withdrawal of life-sustaining treatment in intensive care

AIM: To conduct an integrative review on how nurses prepare families for and support families during withdrawal of life-sustaining treatments in intensive care.

BACKGROUND: End-of-life care is widely acknowledged as integral to the practice of intensive care. However, little is known about what happens after the decision to withdraw life-sustaining treatments has been made and how families are prepared for death and the dying process.

DESIGN: Integrative literature review.

DATA SOURCES: MEDLINE, CINAHL Plus, PsychINFO, PUBMED, Scopus, EMBASE and Web of Knowledge were searched for papers published between 2000 - May 2015.

REVIEW METHODS: A five stage review process, informed by Whittemore and Knafl's methodology was conducted. All papers were reviewed and quality assessment performed. Data were extracted, organised and analysed. Convergent qualitative thematic synthesis was used.

RESULTS: From an identified 479 papers, 24 papers were included in this review with a range of research approaches: qualitative (n=15); quantitative (n=4); mixed methods (n=2); case study (n=2); and discourse analysis (n=1). Thematic analysis revealed the nurses: equipped families for end of life through information provision and communication; managed the withdrawal of life-sustaining treatments to meet family need; and continued care to build memories.

CONCLUSION: Greater understanding is needed of the language that can be used with families to describe death and dying in intensive care. Clearer conceptualisation of the relationship between the medically focussed withdrawal of life-sustaining treatments and patient/family centred end-of-life care is required making the nursing contribution at this time more visible.

Understanding the bereavement care roles of nurses within acute care: a systematic review

AIM AND OBJECTIVES: To investigate nurses' roles and responsibilities in providing bereavement care during the care of dying patients within acute care hospitals.

BACKGROUND: Bereavement within acute care hospitals is often sudden, unexpected and managed by nurses who may have limited access to experts. Nurses' roles and experience in the provision of bereavement care can have a significant influence on the subsequent bereavement process for families. Identifying the roles and responsibilities nurses have in bereavement care will enhance bereavement supports within acute care environments.

DESIGN: Methods: A mixed-methods systematic review was conducted utilising the databases Cumulative Index Nursing and Allied Health Literature (CINAHL Plus), Embase, Ovid MEDLINE, PsychINFO, CareSearch and Google Scholar. Included studies published between 2006 to 2015, identified nurse participants, and the studies were conducted in acute care hospitals. Seven studies met the inclusion criteria and the research results were extracted and subjected to thematic synthesis.

RESULTS: Nurses' role in bereavement care included patient-centred care, family-centred care, advocacy and professional development. Concerns about bereavement roles included competing clinical workload demands, limitations of physical environments in acute care hospitals and, the need for further education in bereavement care.

CONCLUSIONS: Further research is needed to enable more detailed clarification of the roles nurse undertake in bereavement care in acute care hospitals. There is also a need to evaluate the effectiveness of these nursing roles and how these provisions impact on the bereavement process of patients and families.