Abstract
Introduction:Children with long-term conditions are an important sub-group for consideration in healthcare as they represent a large proportion of healthcare participants. With increased risk of hospital admissions, morbidity and mortality, children with long-term conditions and their families need to be supported by paediatric models of care that engage with their individual needs. This doctoral thesis aimed to explore how nurses partner with families of children with long-term conditions. Core characteristics across partnership theories include attributes of ‘Communication’, ‘Shared roles and decision-making’, ‘Negotiation’, ‘Mutual trust and respect’ and ‘Participation’. This work aimed to explore partnerships in paediatric nursing care of children with long-term conditions.
Methods:
A qualitative research approach was utilised to explore experiences and perceptions of partnership for children, parents and nursing staff in the context of children having a long-term condition for more than six months. Three systematic reviews were completed to understand the literature from the three perspectives (experiences of children, parents and nurses). These were performed sequentially to determine the next stage of inquiry and led to an empirical study in response to the knowledge gaps identified in the reviews. These knowledge gaps led to a case series design in a metropolitan paediatric day stay unit, guided by the theoretical framework of Symbolic Interactionism. The study aimed to explore if triadic partnerships (child, parents and nurses) existed and, if so, how triadic partnerships were developed, experienced and maintained.
Findings:
Between the three systematic reviews (children, parents and nurses) 15,391 articles (5,150+4,404+5,837 respectively) were screened, 819 articles (251+162+406 respectively) were reviewed, and 66 articles (21+6+41) were included, with two articles being included in two of the systematic reviews. Overall, the children’s review found that children want to be viewed as individuals within a partnership and crave more knowledge and power regarding their long-term conditions. The parents’ review concluded that parents value collaboration with nursing staff, appreciating when nurses empower and help them to develop new knowledge and skills. The nurses’ review found that paediatric nurses recognised the importance of developing partnerships with children and parents, valuing collaborative communication and shared decision-making processes.
Throughout the three systematic reviews, nurses demonstrated partnership in their practice but focused on developing dyadic nurse–parent and nurse–child partnerships. Gaps in the literature included lack of diverse representation in settings, characteristics of participants, conditions other than cancer and a lack of Oceanic studies. This synthesis informed next steps of empirical research to explore whether and how triadic partnerships are developed, experienced and maintained.
An empirical case study series (Study Four) included observations and interviews with nine children (ages five-17), 11 parents and eight nurses. Thematic analysis was completed within-case and cross-case to identify unique patterns. Cross-case analysis identified the empirical findings that triadic partnerships existed within an Australian nursing paediatric setting, with each of three parties placing meaning and importance on forming interconnected triadic partnerships rather than separate dyadic nurse-child or nurse-parent partnerships. The strength of each triadic partnership depended on the nurse’s approach to guiding the partnership, the child’s condition and competency/capacity, and the level of involvement from parents. Each triadic partnership was predominantly led by the nurse and individualised to the family’s needs, supported by meaningful and authentic connections between the three parties. Five triadic nursing partnership guidance typologies were identified within this work: nurse guided; nurse-and-parent guided; parent-guided; equally guided; and child-guided.
Informed by the systematic reviews, the five established attributes of partnership nursing – ‘Communication’, ‘Shared roles and decision-making’, ‘Negotiation’, ‘Mutual trust and respect’ and ‘Participation’ – were consistently seen in all nine cases; however, additional attributes were revealed that supported triadic partnership in nursing. These attributes – ‘Rapport and connection’, ‘Recognising expertise’, ‘Education and empowerment’, ‘Continuity of care’ and ‘Trauma-informed care’ – helped to build working partnerships between families and nurses and are a new contribution to the new ‘triadic partnership nursing’ theory.
Discussion and Conclusion:
Triadic partnerships in paediatric nursing are nurse-led, child-orientated and can be guided by any member of the triad. This thesis highlights the role of the nurse in leading a flexible and individualised triadic partnership with a child-centred focus, as well as the practical implications of recognising the active roles of both children and parents. The necessity of recognising the triad, rather than just dyads, in this work is crucial for progressing the field of supporting children to become autonomous in their decision-making as they develop capacity, competency, and self-management skills. Further research is required to explore how triadic partnerships are developed in other settings such as acute hospital wards, in other jurisdictions, and what policies and workforce strategies may further support nursing to develop triadic partnerships in practice.
Community abstract:
This doctoral research project looked at how nursing staff partner with children and their parents when the child has a long-term condition. Within a paediatric Day Stay Unit at an Australian hospital, triadic partnerships were seen as three-way between children, parents and nursing, which allowed for collaboration. Triadic partnership had not been previously explored within paediatric nursing research, but has now been revealed to exist, develop and be maintained by children, parents and nursing staff. The findings of this work show that nursing staff play a key role in leading these partnerships, by developing and maintaining triadic partnerships built on trust, respect and continuity in the care delivered. Importantly, nursing staff used moment-to-moment assessments of child and parent preferences to determine their level of preferred decision-making involvement, giving them the option to participate at a level they were able or comfortable with. These findings are important so that we can maximise positive and effective experiences of the three-way relationship between children, parents and nurses. Future work can include investigating how to support nurse education, workplace environment, policies and procedures to better enable triadic partnerships.
| Date of Award | 2025 |
|---|---|
| Original language | English |
| Supervisor | Kasia BAIL (Supervisor) & Natasha JOJO (Supervisor) |