A pragmatic approach to children’s nursing
It’s time to change the mantra from family-centred care to pragmatic children’s nursing, argues Duncan Randall.
It’s time to change the mantra from family-centred care to pragmatic children’s nursing, argues Duncan Randall
We would not place a child on an adult’s bicycle and expect them to ride it. It has been designed for an adult, and a child would struggle to pedal or steer. So why use adult theories of nursing for children?
Don’t children deserve their own nursing theory? Family-centred care (Smith and Coleman 2010), though more of a philosophy than a theory, has been used successfully by nurses to secure child focused facilities and services, and arguably to promote partnerships between nurses and parents.
However, it has not been used to describe all of children’s nursing, nor prescribed measurable outcomes.
There is now a new theory of children’s nursing, designed for children and their childhoods, with eight outcome measures. Pragmatic children’s nursing has a simple aim, for nurses to create a childhood for children living with illness which matches, as far as is possible, that of their peers.
What needs to be done
This is done by first attempting to promote, stabilise or restore the child’s health status. A child can’t play if they are haemorrhaging, nor are they likely to interact with other children if they are threatened and in fear.
There needs to be a stable environment within the child’s body and external to it for children to participate in their childhoods with their peers. Once these elements have been stabilised there is a negotiation of care.
This entails dialogue between children, carers and nurses. Where possible children should learn to care for themselves, although at times carers need to provide help and support.
Nurses can help children to self-care and carers to deliver care, and may have to take responsibility for the child’s care. These negotiations occur in a cultural context influenced by community views of children, and the roles of both carers and nurses.
To be pragmatic, the theory must capture all of the elements of children’s nursing describing and prescribing care for neonates to young people, in community, hospital and hospice settings.
Pragmatism based on practice
Pragmatic children’s nursing has two helpful features. First, it is based on the practices of children’s nurses, and children’s nursing literature. This means it makes public many of the aspects of children’s nursing that nurses already do, for instance play.
Second it opens a new, ever-rolling vista, by which I mean pragmatics is relative and bound by time. Rather than saying there is one way to do children’s nursing, pragmatists state that just as childhood in societies changes over time, so does children’s nursing.
They also recognise that childhoods are different in different communities, so children’s nursing should, like childhoods themselves, reflect the time, place and relationships that make up the context of the child’s life.
Thus the landscape of children’s nursing will constantly change. We now need to evaluate the theory to see if the child will ride his new bike.
Smith L, Coleman V (2010) Child and family-centred healthcare: concept, theory and practice. Palgrave Macmillan, Basingstoke.
More information at www.pragmaticchildrensnursing.com
About the author
Duncan Randall is principal teaching fellow at the University of Southampton’s faculty of health sciences