Family-centred care for pediatrics: This is a bit of a slippery topic. The family is viewed as a unit and the patient is viewed in the context of the family. Parents and older siblings know the patient best and should be considered resources for the nurse. Ideally, it should mean that parents and siblings, where appropriate, are included in care planning and execution. It is assumed that parents only want what's best for their child and that their actions will reflect this. (You know what they say about assumptions.) Practices that support family-centred care may include unrestricted visitation, rooming in, inclusion in daily rounds, family presence at resuscitation, multidisciplinary conferences and development of support groups. Historically, children were admitted to hospital for care and their parents came back and picked them up when they were ready for discharge. In the 1970s this model was challenged and overhauled. Over the intervening 4 decades family-centred care has evolved into a living, breathing entity that may at times go off the rails. It's one thing to include parents in care activities such as complex dressing changes, it's quite another to be expected to plan the dressing change around the parent's schedule rather than when the nurse might realistically be able to carve out time to do it. That I would call family-directed care and it may not be as valuable or appropriate as the original intent of family-centred care.
Family dynamic implications: Family is whomever the patient says is family. This could include biological parents, foster parents, grandparents, aunts, uncles, cousins, siblings, close friends, step-parents, teachers... the list is endless. Children in medical foster placements usually have biological parents who are deeply involved and have legal authority while other children may be completely under the care of the foster family. Socioeconomic conditions influence family dynamics. Young parents who may be essentially still being parented themselves may defer decisions about their child's care to their own parents. Families who struggle to pay their bills at the best of times will have difficulty with things the rest of us take for granted, such as having transportation to the hospital, eating properly, paying for accommodations if the hospital is at a distance from home, filling prescriptions and a number of other issues. Single-parent families have concerns of their own, while two-parent families usually have one parent who is more involved, more dominant in interactions with health care staff. They may not agree with each other over a course of action and that will create new problems. This is a very complex factor that demands its own seat at the table.
Therapeutic communication: The most important technique is to ensure that all information shared with families is in language they can understand. We tend to use a lot of jargon and over time families whose children are frequently hospitalized will come to understand and use a lot of it too, but most won't have any frame of reference. Reflecting and restating assist in assessing the parent's/patient's understanding of what is happening and what is likely to happen. It's also important to explore their understanding of the information provided. Engaging parents with open-ended questions while providing care is very effective when gaining cooperation and collaboration. Something as simple as saying, "Tell me about Joey. What is his usual bedtime routine? How does he like his meds to be given? What does he do for fun?" displays an interest not only in the child but also in the family as a whole. Giving recognition to the parent as the ultimate expert in Joey is huge. Making observations is also very helpful. I often will point out a child's quirky little personality traits: "Joey really has a great sense of humour doesn't he?", or an observation such as, "Joey looks an awful lot like his dad. But I think he has your eyes, Mom." That sort of interaction shows that I see their child as an individual, that I pay attention to small details and that I'm getting to know the child.
Not everyone is cut out for pediatrics, often because they have trouble integrating these factors into their care. But all of them are vitally important to providing good care to children. Good luck with your rotation.