Parental involvement in children’s healthcare decisions at the hospital: A health-promoting perspective

Background: In many Western countries, parents have a legal right to be involved and influence children’s healthcare decisions, ensuring that children’s healthcare is shaped and customised as far as possible to meet the children’s and their families’ needs and preferences. It is expected that this kind of parental involvement increases patient safety and quality of care. Parental involvement in children’s healthcare decisions has been an important area of health services in several countries for many years; however, it has not been sufficiently implemented in clinical practice. Aim: This thesis’ overall aim was to gain insight, from a healthpromoting perspective, into parental involvement in decision-making about shaping and customising children’s healthcare in an interprofessional hospital environment. The purpose was to enhance the knowledge on parental involvement in these decision-making processes and to identify areas for improvement. The research aims were as following: 1) To describe and establish a synthesis of previous research on parents’ perceptions of their participation in decision-making and the challenges they face in healthcare services for children. (Paper I) 2) To explore parents’ experiences on parental involvement in decisionmaking about their child’s healthcare at the hospital and to identify how health professionals can improve parental involvement. (Paper II) 3) To explore and describe parents’ experiences of how healthprofessionals facilitate parental involvement in decision-making surrounding children’s healthcare and to identify how health professionals can improve parental involvement in the hospital. (Paper III) 4) To explore health professionals’ construction of the phenomenon parental involvement in decision-making about children’s healthcare at the hospital and identify how parental involvement can be improved. (Paper IV) Methodology: This thesis uses an explorative, sequential, descriptive, qualitative design; is situated within a constructivist research paradigm; and involves four sub-studies (Paper I-IV). Sub-study 1 is a systematic integrated review on literature, published from January 2000 to February 2011, concerning research aim 1). This review was conducted according to Whittemore and Knafl’s framework. Sub-studies 2 through 4 are explorative, descriptive, qualitative studies involving individual semi-structured interviews. Sub-studies 2 and 3 comprise a purposive sample of 12 parents. Qualitative content analysis was performed according to Graneheim, Lindgren and Lundman. Sub-study 4 recruited 12 health professionals using a purposive selection procedure. The construction of the phenomenon in the interviews was analysed according to Silverman. The cultural stories were then interpreted and organised using Graneheim et al.’s qualitative content analysis. Findings: This thesis contributes new insights into parents’ and health professionals’ roles during decision-making about shaping and customising children’s healthcare at hospital. Parents’ personal factors seemed to influence their involvement; however, health professionals’ individually tailored facilitation of parental involvement appeared to empower the parents and increase active engagement. The health professionals’ attitudes and competencies seemed to influence how they involved the parents. Important elements that seem to improve parental involvement included empathetic communication, confidence in the health professional-parent relationship, high-quality intra- and interprofessional collaboration and adequate organisational resources. Conclusion: This thesis highlights the complexity of shared decisionmaking about children’s healthcare, including parents’ and health professionals’ essential, demanding roles. These roles need to be supported according to family-centred care, the World Health Organisation’s health promotion strategy and the biopsychosocial theory. The foremost responsibility of healthcare managers is to facilitate health professionals’ parental involvement and arrange for adequate organisational resources. Furthermore, this thesis provides new knowledge of how health professionals’ practice of shared decisionmaking in paediatric clinical settings influences parents’ ability to cope with their parental role and the quality of their children’s healthcare. Increased understanding of involving both the paediatric patient and parents in these decision-making processes is required to safeguard the paediatric patients a technical, safe and justifiable healthcare that is in keeping governmental directives, evidence-based practice and the biopsychosocial theory

En integrert kunnskapsoppsummering som tilnærming til foreldres medbestemmelse i helsetjenester til barn

Master's thesis in Health and social sciencesBakgrunn: Foreldres medbestemmelse i helsetjenester til barn inngår i helsetjenestenes verdigrunnlag og er lovpålagt, men er ikke fullt ut implementert i klinisk praksis. Hensikt: Hensikten med studien var å få økt kunnskapen om foreldres medvirkning i beslutningsprosesser og bedre kvaliteten til barns helsetilbud. Målet var å få en bedre forståelse for foreldres behov og utfordringer som de møter, samt å foreta metodologiske overveielser i forskningsprosessen. Metode: En integrert kunnskapsoppsummering ble utarbeidet på bakgrunn av et systematisk litteratursøk. Det ble funnet 18 studier som oppfylte inklusjonskriteriene. Analyseprosessen bestod av dataekstraksjon, dataoppsett, sammenligning av data og syntese av funn. Resultater: Fire hovedtema relatert til beslutningsprosesser ble funnet: 1) Relasjonsfaktorer og gjensidig avhengighet, 2) foreldres preferanser og personlige faktorer, 3) helsepersonells holdninger og kompetanse og 4) organisatoriske faktorer. Konklusjon: Kunnskapsoppsummeringen bidro med et nytt og utvidet perspektiv på nyere forskningsbasert kunnskap om foreldres medvirkning i beslutningsprosesser. I tillegg til å studere foreldrenes medbestemmelse i konteksten av relasjonelle faktorer og foreldres personlige faktorer, ble faktorer som helsepersonells makt, holdninger og kompetanse tatt i betraktning. Implikasjoner for praksis, utdanning og forskning: Helsepersonell bør bli mer bevisst sitt ansvar og viktige rolle i foreldres medvirkning i beslutningsprosesser. Det bør legges større vekt på økt kunnskap om brukermedvirkning og helsepersonells kommunikasjons- og relasjonsferdigheter i utdanningen. Det er også behov for mer forskning for å undersøke årsaksforholdene som kan ligge til grunn for utfordringene som foreldrene møtte i beslutningsprosessene, med både kvalitative og kvantitative studier

Parental involvement in decision-making about their child\u27s health care at the hospital

Aim: To explore parents\u27 experiences on parental involvement in decision-making about their child\u27s health care at the hospital and to identify how health professionals can improve parental involvement. Design: An explorative descriptive qualitative study within a constructivist research paradigm. Methods: Individual semistructured interviews were conducted with a purposive sample of 12 parents. Qualitative content analysis was performed. Results: This study gives unique insight into how parental involvement in children\u27s healthcare decisions influence parents\u27 ability to cope with the parental role at the hospital. The results showed that parents\u27 competence and perceived influence and control over their child\u27s health care appeared to affect how they mastered their role of involvement in decision-making. Individually tailored and respectful facilitation of parental involvement in these decisions by health professionals seemed to improve parents\u27 influence, control and ability to cope with the parental role. Nurses should thus strengthen parents\u27 sense of coherence enhancing the quality of health care

Health professionals’ involvement of parents in decision-making in interprofessional practice at the hospital

Health professionals have the responsibility of involving parents in decision-making regarding children’s healthcare. This is to ensure that healthcare is customised to meet children’s and families’ needs and preferences. There is inadequate knowledge about health professionals’ role in involving parents in these decisions in interprofessional practice in hospital settings. The aim of this study was to explore health professionals’ construction of the phenomenon of parental involvement in decision-making about children’s healthcare at the hospital and to identify how parental involvement can be improved. This explorative, descriptive qualitative study within a constructivist research paradigm selected a purposive sample of 12 health professionals who participated in individual semi-structured interviews. This qualitative data was used to construct a description of this phenomenon. The health professionals described ethical dilemmas and challenges related to parental involvement in decision-making while also providing technically safe, justifiable healthcare. Individual health professionals’ involvement of parents in decision-making and the intra- and interprofessional collaboration between health professionals seemed to be of great importance to increase parents’ active involvement in the co-production of children’s healthcare. Further research is required to confirm the findings for generalisation.acceptedVersio

Parent participation in decision-making in health-care services for children: an integrative review

Aim To describe and synthesize previous research on parents\u27 perceptions of their participation in decision making in child health-care services. Background Health policy in the area of user involvement emphasizes parent participation in decision-making (DM), thus ensuring that services are provided in accordance with their child\u27s needs and enhancing parents\u27 control over their child\u27s health-care services. Method A systematic literature search, covering the period January 2000 to February 2011, found 18 studies that met the inclusion criteria. The analysis process involved data extraction, reduction, comparison and synthesizing. Findings Three themes emerged: (1) relational factors and interdependence, (2) personal factors and attitudes and (3) organisational factors. Conclusions Parents highlighted the importance of the parent-health professional relationship, professionals\u27 competence and the possibility of varying the degree of participation in decision making. Challenges involved asymmetry in authority and power, professionals\u27 attitudes and competence and organisational shortcomings in health-care services. Health professionals need to become more aware of their critical role and responsibility in involving parents in DM. Implications for nursing management Health professionals\u27 attitudes and competence can be improved by knowledge of user involvement and research and facilitating the inclusion of parents in decision making by influencing the culture, routines and resources in the health service

Health professionals\u27 involvement of parents in decision-making in interprofessional practice at the hospital

Health professionals have the responsibility of involving parents in decision-making regarding children\u27s healthcare. This is to ensure that healthcare is customised to meet children\u27s and families\u27 needs and preferences. There is inadequate knowledge about health professionals\u27 role in involving parents in these decisions in interprofessional practice in hospital settings. The aim of this study was to explore health professionals\u27 construction of the phenomenon of parental involvement in decision-making about children\u27s healthcare at the hospital and to identify how parental involvement can be improved. This explorative, descriptive qualitative study within a constructivist research paradigm selected a purposive sample of 12 health professionals who participated in individual semi-structured interviews. This qualitative data was used to construct a description of this phenomenon. The health professionals described ethical dilemmas and challenges related to parental involvement in decision-making while also providing technically safe, justifiable healthcare. Individual health professionals\u27 involvement of parents in decision-making and the intra- and interprofessional collaboration between health professionals seemed to be of great importance to increase parents\u27 active involvement in the co-production of children\u27s healthcare. Further research is required to confirm the findings for generalisation

How health professionals facilitate parents\u27 involvement in decision-making at the hospital: A parental perspective

2017, The Author(s) 2017. In many western countries, parents have a legal right to influence and be involved in decision-making (DM) surrounding their children\u27s healthcare. This ensures that the healthcare is customized as far as possible to meet the children\u27s and families\u27 needs and preferences. However, parental involvement in such DM is not sufficiently implemented and the parental role during hospitalizations has become demanding. More knowledge is required to inform health professionals (HPs) about how to improve parental involvement in DM from a health-promoting perspective. The aims of this study were to explore parents\u27 experiences of how HPs facilitate their involvement in the DM surrounding their child\u27s healthcare and to identify how HPs can improve parental involvement at the hospital. This was an explorative, descriptive qualitative study within a constructivist research paradigm, comprising a purposive sample of 12 parents participating in individual semi-structured interviews. Qualitative content analysis was performed. The findings showed that HPs\u27 sensitivity to parents\u27 capacity, resources and needs was essential in order to facilitate the latter\u27s involvement in DM. HPs\u27 sensitivity also seemed to influence the quality of communication and the HP-parent relationship. Moreover, these factors appeared to affect parents\u27 coping ability during their children\u27s hospitalization