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Abstract
Support
provided to families experiencing parenting should be based on a trust
relationship between nurses and parents. Satisfaction experienced with
the process of care, both by parents and nurses, assumes great
relevance and can be considered as an outcome of nursing care. Purpose:
To understand the experience and meaning given by parents and nurses
of participating in the implementation of an innovative nursing
intervention, with Touchpoints (TP) methodology, of parents of
children, from 11 to 24 months, and of nurses. Study Design and
Methods: Qualitative study using a phenomenological approach. Data
collection was performed using (i) field-notes (FN) written by the
nurses who implemented the TP methodology and (ii) focus groups (FG)
with 10 parents of children from the intervention group. Results:
Parents considered that the TP sessions implemented by nurses
contributed to: Acquisition of knowledge and skills; Validation of
parental practices; Improvement of child behavior; Parental confidence;
Interpersonal relationship; Professional competences; Specific
competences; Satisfaction. Participant nurses perceived that the TP
methodology contributed to: Mobilization and application of TP
principles; Learning process; Parents interest; Feelings/emotions;
Satisfaction. Clinical Implications: Nurses caring for families should
implement innovative methodologies that facilitate adaptation to
parenting, such as Touchpoints. Implementing the TP methodology
contributed to parents and nurses satisfaction.
Key
words: Parenting; patient
satisfaction; job satisfaction; Touchpoints methodology; nursing
intervention.
Resumo
O
apoio prestado às famílias que vivenciam a parentalidade deve
basear-se numa relação de confiança entre enfermeiros e pais. A
satisfação dos clientes e dos enfermeiros durante a prestação de
cuidados assume grande relevância e pode ser considerada um ganho em
saúde. Objetivo: Compreender a experiência e o significado atribuído
pelos pais de crianças entre os 11 e os 24 meses e dos enfermeiros
que participaram na implementação da metodologia Touchpoints (TP),
uma intervenção de enfermagem inovadora. Desenho do Estudo e Métodos:
Estudo qualitativo de cariz fenomenológico. A recolha de dados foi
efetuada através de (i) diários de itinerância dos enfermeiros que
participaram na implementação da metodologia TP e da (ii) técnica
de grupos focais realizada junto de 10 pais de crianças do grupo de
intervenção. Resultados: os pais consideraram que as sessões TP,
implementadas pelos enfermeiros, contribuíram para: Aquisição de
conhecimentos e competências; Validação de práticas parentais;
Melhoria do comportamento da criança; Confiança parental;
Relacionamento interpessoal; Competências profissionais; Competências
específicas; Satisfação. Os enfermeiros que participaram no estudo
consideraram que a metodologia TP contribuiu para: Mobilização e
aplicação dos princípios TP; Processo de aprendizagem; Interesse
dos pais; Sentimentos/emoções; Satisfação. Implicações Clínicas:
Os enfermeiros que cuidam de famílias devem implementar metodologias
inovadoras que facilitem a adaptação à parentalidade, como os
Touchpoints. A implementação da metodologia TP contribuiu para a
satisfação dos pais e enfermeiros.
Palavras-chave:
Parentalidade; satisfação do cliente; satisfação profissional;
metodologia Touchpoints; Cuidados de enfermagem.
Résumé
Le
soutien aux familles qui vivent la parentalité devrait être basé
sur une relation de confiance entre les infirmières et les parents.
La satisfaction vécue avec le processus de soins, par les parents et
les infirmières, revêt une grande importance et peut être considéré
comme un résultat des soins infirmiers. Objectif: comprendre l'expérience
et signifiant, de participer à la mise en uvre d'une intervention de
soins innovatrice, avec la méthodologie Touchpoints (TP), avec des
infirmières et des parents d'enfants de 11 à 24 mois. Conception de
l'étude et méthodes: étude qualitative utilisant une approche phénoménologique.
La collecte des données a été réalisée grâce à (i) les notes de
terrain des infirmières qui ont participé à la mise en uvre de la méthodologie
TP et (ii) des groupes de discussion technique menées avec 10 parents
d'enfants dans le groupe d'intervention. Résultats: Les parents
estimaient que les séances de TP, mises en uvre par les infirmières,
ont contribué à: Acquisition de connaissances et de compétences;
Validation des pratiques parentales; Amélioration du comportement de
l'enfant; La confiance parentale; Relation interpersonnelle; Compétences
professionnelles; Des compétences spécifiques; La satisfaction. Les
infirmières qui ont participé à l'étude considère que la méthodologie
de TP a contribué à: Mobilisation et application des principes de
TP; Processus d'apprentissage; L'intérêt des parents; Sentiments /
émotions; La satisfaction. Implications cliniques: Les infirmières
qui soignent les familles devraient mettre en uvre des méthodologies
innovatrices qui facilitent l'adaptation à la parentalité, comme
Touchpoints. La mise en uvre de la méthodologie TP a contribué à la
satisfaction des parents et des infirmières.
Mots
Clés: Parenthood;
satisfaction du client; satisfaction professionnelle; méthodologie
"Touchpoints"; Les soins infirmiers..
INTRODUCTION
The investment and attention given to the child at an early age is
essential to promote child health and development. This is a major
concern of national and international institutions as the World Health
Organization (WHO, 2013).
Touchpoints
(TP) are expected periods preceding the motor, cognitive or emotional
child development. These periods can cause predictable disruption in
family relationships. The development affects the child and
caregivers simultaneously and it is characterized by periods of change
that imply adaptation (from child and family). This can cause
disorganization within the family system and relationships. Healthcare
professionals can help the family to experience and cope with these
periods, facilitating the adaptation/transition process.
From
the perspective of a developmental model, child development within the
family context is considered as a discontinuous process, in which
predictable regressions encourage touchpoints to happen. This occurs
because the simultaneous acquisition of skills in different areas may
cause regressions in others, thus resulting in disruption of routines,
feelings and familiar interactive behaviors (Brazelton & Sparrow,
2006).
The
TP approach is a preventive intervention methodology that aims at (i)
supporting the parent-child relationship, (ii) increasing parenting
skills and (iii) strengthening the relations between the family and
the baby. This approach is expected to improve child development,
healthy functional families, and competent and healthy professionals (Brazelton
& Sparrow, 2006).
Touchpoints
methodology allows parents to identify, rationalize and anticipate the
childs behavior, recognizing the transitional moments in the emotional
development and child behavior. Evidence shows that TP methodology
contributes to the promotion of parenting skills, increasing
self-esteem, confidence and parental power, allowing parents to
respond assertive and contingently to the childs needs, assuming an
active role in his/her development (Stadtler, Brandt, Novak, &
Beauchesne, 2013). This methodology allows professionals to act
preventively, strengthening and facilitating their relationship with
the parents (Percy, 2006). Moreover, it decreases the risk of
professional burnout and increases vitality and motivation (Stadtler
et al., 2013).
Touchpoints
methodology includes 8 guiding principles (Table
1). Promoting childrens health and parental competences is of
foremost relevance and anticipatory care is paramount (Brazelton &
Sparrow, 2006; Portugal, 2013). The succession of touchpoints in a
child development is like a map that can be identified and anticipated
by both parents and care providers. They are much more focused on care
provision of topics of interest to parents (eg., food, discipline)
than in traditional milestones (e.g., crawling, walking). Negotiations
with the child in connection with these touchpoints can be seen as a
source of satisfaction and encouragement for the family system. Prior
knowledge of these touchpoints and strategies to cope with them can
help parents by reducing the negative interaction that otherwise could
harm the course of child development and result in problems in
different areas (e.g., sleep, food and toilet training) (Brazelton
& Greenspan, 2005; Brazelton & Sparrow, 2006). Besides
assuming a developmental model, Touchpoints methodology is grounded in
a relational model and therefore associated to establishment of
interpersonal relationships. The latter is a central concept in
nursing care (Portugal, 2015) that facilitates the identification of
children and parents needs, care planning and the implementation of
interventions.
Table
1 – Touchpoints principles (adapted from Brazelton
& Sparrow, 2006)
Principles
|
Description
|
-
Recognize what you bring to the interaction
|
Professional
influence and is influenced by the families, his behaviors and
emotions elicit his reactions and feelings. He should develop
a third ear that helps him to develop self-reflection and
maturity.
|
-
Look for opportunities to support mastery
|
Professional
highlights parents competence and self-esteem for example
through observations of the child development progress and
parental skills.
|
-
Use the behavior of the child as your language
|
Child
brings together the professional and the parents and both can
see what the childs does. His behavior is the means by which
they work together and tells to the professional where he must
go next.
|
-
Value disorganization and vulnerability as an opportunity
|
Development
is characterized by periods of normal disorganization that
affect other infant systems and, simultaneously, family
system. The professional use this opportunity to help
parents to understand that disorganization means an
anticipation of infant development progression.
|
-
Value and understand the relationship between you and the
parent
|
Professional
enters to the family system so, he must reflect about what he
represents to the family, how is distributed the power in the
relationship, the professional is only an expert or also a
partner?
|
-
Be willing to discuss matters that go beyond your traditional
role
|
Professional
needs to open up their experience as a human being in relation
to the families he works with to be truly effective in
supporting a familys overall well-being
|
-
Focus on the parent-child relationship
|
The
babys demands elicit expectations and responses from parents
based on their own infancy and present relationships
experiences. So, observe and understanding the relationship
and interaction between parent and child is one of the best
tools to work with the family.
|
-
Value passion wherever you find it
|
The
passion of parents for children is energy, both, negative and
positive that moves in the parenting process with all its
challenges and joys inherent in creating and caring for a
child. Therefore, the professional must find that passion and
facilitate falling in love between parents and children.
|
Family-centered
care is essential to create a true partnership of care between health
professional/patient (Jolley & Shilds, 2009). Combined with the TP
methodology, it contributes to the effectiveness and quality of
children and family care and (Stadtler et al., 2013). Patients
perception of satisfaction is an indicator of quality care (Yagil,
Luria, Admi, Moshe-Eilon, & Linn, 2010; Pinto, & Silva, 2013)
and is influenced by the personal background and previous experiences
related to healthcare, emotional support (Yagil et al., 2010; Liu,
Avant, Aungsuroch, Zhang, & Jiang, 2014), health information (Eriksson
& Svedlund, 2007), decision control (Campos & Graveto, 2009),
technical and professional competences (Liu & Wang 2007).
Although
nurses satisfaction is associated to patient satisfaction, it is also
influenced by autonomy and involvement in clinical decision making (Campos
& Graveto, 2009), quality of nursing care (Tourangeau, McGillis
Hall, Doran, & Petch, 2006), personal and professional achievement
and organizational performance and professional/patient relationship
(Castro et al., 2011).
Despite
the important role nurses have in infant and young people health,
little is known about the implementation of TP methodology by nurses,
even less in outermost regions frequently prevented from participating
in research projects. Therefore, this study aims to understand the
experience and meaning given by parents of children at the age of 11
and of 24 months and by nurses to the experience of participating in
the implementation of the TP methodology in Terceira Island, Azores,
Portugal.
STUDY DESIGN AND METHODS
A qualitative study was conducted using a phenomenological approach in
order to obtain an in-depth understanding of the experience and
meaning given by parents and nurses to their participation in the
implementation of a quasi-experimental design to test the TP
methodology by nurses. This type or research methodology is
particularly useful to understand the meaning people build on their
life experiences, permitting the comprehension of the insiders
perspective. The objective of phenomenology is the direct
investigation and description of phenomena as consciously experienced,
without theories about their causal explanations or their objective
reality.
The
study was conducted by nurses trained in the TP methodology, in a
Primary Care Health Center, Terceira Island, Azores, Portugal, a
context where population meets specific conditions of insularity and
remoteness that make this context peculiar and unique. The
experimental study is described in another article (Soares, Fuertes
& Santos, 2015).
A
major focus was given to the views, feelings and sense of satisfaction
experienced both by the participant parents and nurses.
Data
collection was performed using (i) the field-notes (FN) written by the
two nurses who implemented the TP methodology and (ii) transcripts of
focus groups (FG) recordings with the parents who were part of the
intervention group (Table
2). Two diverse instruments were used for data collection (FN and
FG) to adjust the best strategy for each group of participants (nurses
and parents, respectively). As the number of nurses who participated
in the intervention was only two, FN were more suitable than FG.
Furthermore, FN are widely used in the implementation of innovative
approaches aimed at changing current practices. This type of
instruments allows the regular monitoring and self-assessment of
experiences, feelings, and self-awareness about the development of
knowledge through the intervention (Coutinho, 2011), The FN were
essentially reflective, showing the experience that the two nurses
lived in each TP session with the participant parents and children.
The FG allowed us to gather several perspectives on the same situation
as the participants were able to share the meanings attributed to the
experience of participating in the implementation of the TP
methodology. The two FG were conducted with 10 parents of 8
children that were part of the intervention group. Participant parents
and children were recruited considering the following inclusion
criteria: being healthy and clinically normal, with no sensory or
motor neuron disabilities, serious illness or congenital anomalies.
All parents were healthy, with no mental problems or known drug or
alcohol addiction. Two fathers participated in this study. Table
2 illustrates the characteristics of the
participants.
Table
2 – Sociodemographic data of the participants and
technical data collection.
|
|
Parents
n=
10
|
|
Nurses
n=
2
|
|
|
n
|
|
n
|
Gender
|
Male
|
2
|
|
0
|
Female
|
8
|
|
2
|
Age
|
27-32
|
3
|
|
0
|
33-38
|
5
|
|
1
|
39-44
|
1
|
|
1
|
45-50
|
1
|
|
0
|
Years of formal education
|
1-4
|
1
|
|
0
|
5-9
|
1
|
|
0
|
10-14
|
2
|
|
0
|
15-19
|
6
|
|
2
|
Technical data collection
|
|
Focus groups
|
|
Field-notes
|
Theoretical
saturation was reached after conducting 2 FG, each one with 5 parents,
including a total of 10 participants.
FN
were written by the two participant nurses during the implementation
of TP methodology (from March 2012 to August 2013). The two FG took
place in August 2013, each one lasting for about 60 minutes; the FG
sessions were audio-recorded and transcribed verbatim.
The
full content of the transcripts of the FG sessions and the complete FN
of both participant nurses were analyzed inductively. A combination of
both narrative and thematic analysis was used.
Ethical
approval was obtained from the director of the primary healthcare
institution where it was conducted. Furthermore, the two nurses and
the parents gave their written consent in participating in the
implementation program of the TP methodology and inherent data
collection (FG). Results are presented anonymously with full respect
for confidentiality of all participants.
RESULTS AND DISCUSSION
Parents who participated in the study acknowledged that the TP
sessions implemented by the nurses contributed considerably to the
development of the following 8 aspects: Acquisition of knowledge and
skills; Validation of parental practices; Improvement of child
behavior; Parental confidence; Interpersonal relationship;
Professional competences; Specific competences; Satisfaction.
The
two nurses who implemented the abovementioned TP methodology perceived
their experience as follows: Mobilization and application of TP
principles; Learning process; Parents interest; Feelings/emotions;
Satisfaction.
These
concepts will be defined and further discussed as follows.
Figure
1 illustrates
the perceptions of both the participant parents and nurses.
Figura
1- Diagram of categories and subcategories founded in the study
Experience
of parents during the implementation of the touchpoints approach
Participant
parents considered that the implementation of the TP methodology by
nurses contributed mostly to their acquisition of knowledge and skills,
namely in terms of the following aspects: the development of their
child, ways to stimulate his/her development, strategies to deal with
tantrums, toilet training, importance of the educational process,
discipline and love in the exercise of parenting, and the opportunity
to make questions. This facilitated the learning of parental role and,
consequently, a better exercise and experience of parenting.
Using
those techniques that the nurse taught me, made me able to know my
daughter better and this was a way to see her development clearly
or to correct what she was doing wrong. (P8); Thereafter I tried
to teach him more, see what he's doing… there were things I never
paid attention to my other children; now I'm more attentive and
help him to learn new things (P2); we had a teaching session that
pleased us and functioned very well, which is how to deal with the
tantrum (P5); start going to the potty (referring to the sphincter
training) was also something that we talked about (...) I was very
distracted(P6); we explain to him what is wrong to see if he
understands (P5); the no is essential, no exists and should be a
persistent no (…) if no becomes yes easily, doesnt make
sense (P7); Give lots of love, it is with love we should educate,
changed deeply our approach (P4); there were things I had doubts
and I could clarify (P7).
Being
parenting a transition process, those who experience it can be more
vulnerable to risk (e.g., vulnerability to stress, illness,
insufficient parenting role) (Meleis, 2011). Moreover, this transition
is distinguished from others because it is a changing process that
requires the acquisition of new competences, continuous learning and
adaptation to the childs development. Understanding the childs
behavior, knowing and promoting his/her development through adequate
stimulation is a parents need and interferes with the quality of the
interaction between the dyad parents-child (Bryanton, Gagnon, Hatem,
& Johnston 2009). Therefore, nurses need to be aware of the
familys needs and find strategies to prepare and help parents to feel
competent, secure and satisfied in the exercise of the parental role.
This contributes to the well-being of the family and the promotion of
child development and health.
In
the parents speech, participating in the TP sessions contributed to
the improvement of child behavior and was an opportunity to validate
the parental practices, increasing parental confidence.
It
was spectacular and helped us a lot, dealing with his tantrums, it
decreased very much (...) was excellent (P4); always helps, or, if
only, confirms something we already were doing and was correct.
Often, we do instinctively what we think best for them (P6); to
hear and talk about important things (referring to TP sessions)
made me go home and reflect, also think: maybe I'm not doing wrong
or I have to change it (P7).
The
improvement of child behavior as a result of using the TP methodology
was shown elsewhere (Brandt et al., 2010). Parents confidence is
related to the perception of self-efficacy, investment and performance
of the role (Grossklaus & Marvicsin, 2014), thus resulting in
parental satisfaction and in the quality of the interaction with the
child. The purpose of the TP methodology is to act preventively in
order to increase the capacities of parents and their self-esteem.
This increases their confidence to deal with the challenges that arise
in the different stages of child development (Brazelton & Sparrow,
2006). Moreover, professionals using this methodology emphasize a
positive and supportive approach focusing their intervention on the
strengths and potentials of the parents.
In
our study, parents felt that the nurses who applied the TP methodology
presented specific competences at personal, relational and
communicational levels..
I
valued the fact that the sessions were held by someone expert in
child health (...) the sessions were more specific, more
personalized, the nurse X proved to be very competent in what she
does (P6); The nurse X has that ability to (...) is an excellent
person, health services needs people like her, with feelings and
attentive to patients. I think anyone caring by her will be lucky
because it is a very human person, with a vocation to be a great
nurse (...) is one of the best nurses I have ever met(P7); I think
that nurse X is an excellent person (...) making people feel free
to speak of their problems, making diagnoses, with a power of
extreme observation, knowing intervene in certain situations with
the appropriate comments (P6); I liked very much the way the nurse
spoke to my son, the way she asked things. (P2).).
Touchpoints
methodology is grounded on developmental and relational models (Brazelton
& Sparrow, 2006). Holding a higher sphere of child development in
its various dimensions allows the professional who uses this type of
approach to help parents in identifying, streamlining and anticipating
child behavior, improving their understanding about the transitory
moments of the childs emotional behavior. According to Lopes, Catarino
and Dixe (2010), nurses not only need specialized knowledge about
child development and health but also on methodologies that allow an
interactive and positive relationship with parents. This specialized
knowledge gives security to parents (Oommen, Rantanen, Kaunonen,
Tarkka, & Salonen, 2011). In addition to enabling professionals to
obtain an appropriate response to parents needs, parents emphasized
the way this knowledge was shared through personal and professional
skills. Participant parents highlighted the passion transmitted by the
nurses in the way they acted and lived their profession, which
distinguished them from other nurses making them look specials.
The
communication competences and interactive capacities expressed by
nurses in their daily practice are not only associated with their
personal characteristics. These attributes also emerge from the
relational paradigm that underlies the TP model (Brazelton &
Sparrow, 2006), promoting and facilitating the alliance and trustful
relationship with parents. It is interesting to notice that the theme
interpersonal relationship was one of the themes with the highest
number of categories, thus showing the considerable appreciation
parents gave to this dimension of nursing care during TP sessions.
This theme is subdivided into eight sub-themes: Observation
attentive/affection; Person-centered care/approach; Presence;
Friendship; Trust; Tranquility; Dedication; Support..
Most
of the opinions we have are statements that people give and give a
hundred kids; what I noticed here was that the nurse tried to give
appropriate advice to our son in particular in an adapted way
according to our way of dealing with life, our extract, our
profession. She could adapt the advice to our son specifically and
to us and this is something that is really rare because most
people give hints (P4); In addition, we also have a friend (referring
to the nurse who held sessions) (P8); We also noticed, at that
moment, (…) the nurse X, was available and attentive to us and to
our child, reading what was in front, I noticed. (P6); the nurse X
had a very different purpose, she devoted herself to us, to that
child (P6); there were things that the nurse X noted in my son
that even paying to a pediatrician I never saw. She played with
him, watched, evaluated the development and saw what he was able
to do, at the same time managing to be affectionate (P7); nurse X
was there to answer and say exactly what was right, we would not
have to ask someone else, you know that she would say exactly what
should be (P8); that support is very important (P4); that nurse
transmit a peace and I felt this when we met... (P2).).
The
concept of interpersonal relationship is central in nursing care (Portugal,
2015) and it is influenced by communicational competences (Yagil et
al., 2010; Kinder & Allen, 2014). As in the Family Centered Care
philosophy (Kuo et al., 2012), TP methodology focuses on partnership,
support and collaboration with parents and on the assumption that they
are the experts in their child knowledge (Brazelton & Sparrow,
2006).
The
accessibility and proximity with nurses interferes directly in the
quality of the interaction with the family (Lopes, Catarino, &
Dixe, 2010). In addition, nurses availability affects the parents
satisfaction toward nursing care (Magnusson, Lagerberg, & Sundelin,
2012).
The
patients trust in healthcare professionals contributes to a greater
demand for care, adherence to treatment and continuity of care
determining the satisfaction with the care provided (Thom et al.,
2014).
In
our study, parents considered that the TP sessions contributed to
their Satisfaction.
The
sessions were very beneficial for everyone, it makes a big
difference (P6); I loved it, if it were possible I'd like to
continue these sessions (P9
Parents
satisfaction with healthcare and parenting is crucial in the
development of parental competences and abilities to care for their
child (Grossklaus & Marvicsin, 2014). Moreover, this satisfaction
is an indicator of a health gain and care outcome. These findings are
aligned with another study (Soares, et al., 2015) suggesting that the
TP methodology, in this population, was associated to high levels of
parents satisfaction. Table
3 presents the summary of the themes and
subthemes of the dimension Experience of parents during the
implementation of the Touchpoints approach.
Table
3 - Summary of themes, subthemes and dimension: Experience of parents
and nurses during the implementation of the Touchpoints approach
DIMENSION
|
Theme
|
Subtheme
|
EXPERIENCE
OF PARENTS DURING THE IMPLEMENTATION OF THE TOUCHPOINTSAPPROACH
|
Acquisition
of knowledge and skills
|
Knowing
the development of the child
|
Tantrums
|
Educational
process
|
Love
/ affection
|
Clarify
doubts
|
Discipline
|
Development
stimulation
|
Toilet
training
|
Interpersonal
relationship
|
Attentive
observation and affection
|
Person-centered
care/approach
|
Presence
|
Friendship
|
Trust
|
Tranquility
|
Dedication
|
Support
|
Parental
confidence
|
|
Improvement
of child behavior
|
|
Professional
competences
|
|
Validation
of the parental practices
|
|
Specific
competences
|
Personal
competences
|
Relational
competences
|
Communicational
competences
|
Satisfaction
|
|
EXPERIENCE
OF NURSES DURING THE IMPLEMENTATION OF THE TOUCHPOINTSAPPROACH
|
Mobilization
and application of Touchpoints principles
|
Recognize
what you bring to the interaction
|
Look
for opportunities to support mastery
|
Use
the behavior of the child as your language
|
Value
disorganization and vulnerability as an opportunity
|
Value
and understand the relationship between you and the parent
|
Be
willing to discuss matters that go beyond your traditional
role
|
Focus
on the parent-child relationship
|
Value
passion wherever you find it
|
Learning
process
|
|
Parents
interest
|
|
Negative
feelings/emotions
|
Anxiety
|
Difficulty
|
Nostology
|
Discomfort
|
Positive
feelings/emotions
|
Motivation
|
Gratifying
and rewarding sensation
|
Satisfaction
|
|
Experience
of nurses during the implementation of the touchpoints approach
The
participant nurses considered that the experience of participating
actively in the implementation of the TP methodology allowed them to
fully Mobilize and apply the TP principles. From the 8 TP principles
the one that emerged more expressively in the FN was: Recognize what
you bring to the interaction. This principle highlights the relevant
contribution this methodology gives to personal and professional
development as a result of the process of reflection and
self-awareness it generates.
Parental
words do not come out from my mind. There is indeed to change
behaviors, however difficult it may be. A whole relationship can
be compromised with the first impact we give and receive (...) the
judgments must stay outside the service. (E2).
This
is aligned with Yagil et al. (2010) who emphasized the need for nurses
to develop self-knowledge. This is of foremost relevance as it helps
nurses to become aware of the stereotypes they have and that may harm
the relationship with patients.
According
to the nurses own words, the implementation of TP methodology was
associated with positive and negative Feelings/emotions.
The
positive feelings/emotions referred to: Motivation and Gratifying and
rewarding sensation.
I
felt an urge to talk to the mother, playing with the child and be
attentive to all was happening around me (E2); The mother
expression of interest and surprise made me feel rewarding and
useful, probably, I could help her (…) to interpret her daughter
behavior making her feel secure, confident and knowledge empowered
(E1).
Professionals
sense of effectiveness contributes to a higher investment of time in
these tasks (e.g., vaccination, perform physical exams and health
histories, provide health promotion, counseling and education) being
associated to professional empowerment and to the quality of care (Hernandez-Marrero,
2006). Consequently, these professionals will have more work-related
satisfaction, thus feeling rewarded, empowered and engaged (Bandura,
1997 cited by Grossklaus & Marvicsin, 2014).
Although
much less expressively, the theme negative feelings/emotions was also
found in the FN namely in terms of: Anxiety, Difficulty, Discomfort
and Nostalgia..
It
is, indeed, difficult to follow the mother or both parents, the
child and the whole surroundings of the moment. (E2); In this
session I felt very upset when mom and dad said that health
professionals (nurses) did not treat users equally, and if they
dont enjoy their profession shouldnt be there, father said yet
that in many nursing visits he held back for not explode. (E2); Im
already beginning to miss these families because I know next month
is the last one I will be with children and families, it is clear
that they will be in my memory, and anybody can strip it by my
mind. I found that I really love and want to be with families,
with the children (E1).
Even
if Nostalgia can be considered a negative feeling/emotion, in this
particular case it may also reflect something positive associated with
the bond, depth, nature and quality of the relationship nurse/family
established in the interaction process with families. Indeed, it is to
remember with joy and fulfillment times and experienced relationship
processes, wishing to experience them again. In our view, the depth,
nature and quality of the relationship developed and lived with the
other and the impact and importance it had in the life of both are
essential and reflects the components for the construction and
development of a true therapeutic relationship
Nurses
also highlighted the learning process associated with the
implementation of TP methodology. Ingredients
I
learned a lot from all families, each with its own style, each
with different skills but, all made me see there are no perfect
families but all parents want the best for their children (E1).
The
conceptual framework of the TP methodology and its principles guide
the professional and the relationship established with families. This
triggers the professional to open-up to others (e.g., parents),
questioning, reflecting on his/her actions and on him/herself as human
being. The richness of this experience provides opportunities for
learning and personal development.
Parents
interest was also valued by the participant nurses.
Parents
consider information provided very pertinent and saying that
should always be given, they left the room thanking the
accompaniment available (E2).
Patient
interest and recognition of the quality of care is an aspect that
greatly influences the motivation and gratification experienced by
nurses. Although conducted in different contexts, evidence shows that
the recognition by the healthcare beneficiaries contributes to
feelings of fulfillment among health professionals (Pereira, Fonseca
& Carvalho, 2012; Smart et al., 2014).
Finally,
nurses highlighted the Satisfaction related with the completion of the
TP sessions.
I
loved to make this assessment because Z is a child who exudes
tranquility, love and good humor, demonstrates - Happiness - in
the presence of parents, he feels security to explore, imitate and
interact with me. (E2).
As
suggested by Stadtler et al. (2013), nurses using TP methodology in
their practices feel satisfaction and this is an important outcome of
this approach. Table
3 presents the summary of themes and subthemes
of the dimension Experience of nurses during the implementation of the
Touchpoints approach.
STRENGTHS AND LIMITATIONS
As far as we know, this is the first study focusing on the
implementation of TP methodology by nurses in the outermost region of
Azores. This is of relevance as people living in this region are often
excluded from relevant research, which may increase their sense of
isolation and vulnerability. Furthermore, it relates nurses
perceptions and satisfaction to the ones of the parents. Nevertheless,
a few limitations need to be mentioned: (i) The experiences and
meanings among parents and professionals were obtained using different
instruments (FG vs. FN); however, tools and data collection techniques
had to be adapted to specificity of environment and participants.
(ii) A mixed-methods approach could have reinforced the findings. Our
findings refer only to qualitative data and could have been
complemented by the use of a satisfaction scale for professionals and
parents.
Despite
these limitations, it is relevant to emphasize the novelty of the use
of TP by nurse. This is also a relevant feature, which may contribute
to the effective implementation of this methodology in practice,
without additional costs to the healthcare system. Moreover, the
combination of perspectives and techniques focusing on the experience
of the participants, meaning and satisfaction, brings a better yield
to this subject.
CLINICAL IMPLICATIONS
This study addresses the experience of implementing the TP methodology
by nurses, focusing on parents who are in a transition process, i.e.,
parenting, in the conviction that it can be a relevant contribution to
nursing practice, health promotion and care. This can be achieved
through the integration of this methodology in practice, which
requires the interaction and relational dimension that are nuclear in
nursing, contributing to the development of parental skills through a
preventive approach based on the familys strengths.
Based
on our findings we can assume that the implementation of the TP
methodology in practice contributes not only to the development of
parenting skills, facilitating their transition process of parenthood,
but it also contributes to parental and professional emotional
well-being and satisfaction.
The
results of this study suggest that the use of this methodology
contributes to professional and costumers satisfaction which can be
considered a care outcome. In fact, we can assume that satisfied
professionals and satisfied customers may be synonymous of high and
good quality care. Therefore, based on our findings we recommend the
integration of TP methodology in nursing education at undergraduate
and post-graduate levels.
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