Nursing Inquiry 2014

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Bourdieu at the bedside: briefing parents in a pediatric hospital Karen LeGrow,a,b Ellen Hodnett,c Robyn Stremler,c Patricia McKeeverc,d and Eyal Cohenb,e aDaphne Cockwell School of Nursing, Faculty of Community Services, Ryerson University, Toronto, ON, Canada, bThe Hospital for Sick Children, Toronto, ON, Canada, cLawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada, dBloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada, eHealth Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada Accepted for publication 20 December 2013 DOI: 10.1111/nin.12063

LEGROW K, HODNETT E, STREMLER R, MCKEEVER P and COHEN E. Nursing Inquiry 2014 Bourdieu at the bedside: briefing parents in a pediatric hospital The philosophy of family-centered care (FCC) promotes partnerships between families and staff to plan, deliver, and evaluate services for children and has been officially adopted by a majority of pediatric hospitals throughout North America. However, studies indicated that many parents have continued to be dissatisfied with their decision-making roles in their child’s care. This is particularly salient for parents of children with chronic ongoing complex health problems. These children are dependent upon medical technology and require frequent hospitalizations during which parents must contribute to difficult decisions regarding their child’s care. Given this clinical issue, an alternative theoretical perspective was explored to redress this problem. Pierre Bourdieu’s theoretical concepts of field, capital, and habitus were used to analyze the hierarchical relationships in pediatric acute care hospitals and to design a briefing intervention aimed at improving parents’ satisfaction with decision making in that health care setting. Key words: Bourdieu, children with complex health problems, family-centered care, parent briefing.

Advances in medical knowledge and technologies have resulted in longer life expectancies for many children with severe congenital or acquired chronic conditions (Gravelle 1997; Kirk 1998; Noyes et al. 1999; Wang and Barnard 2004; Burke and Alverson 2010; Christian 2010). Many of these children have multiple ongoing health and developmental issues such as functional impairments, neurodevelopmental disabilities, and, often, dependence on medical technology (van der Lee et al. 2007; Cohen et al. 2011; Kuo et al. 2011; Elias and Murphy 2012). Their complex needs usually involve reliance on specialty pediatric services and many healthcare sectors and care settings (Perrin et al. 1993; Law and Rosenbaum 2004; Cohen et al. 2008). Although the majority of the time these children are cared for in their homes, the prevalence of children with complex chronic

Correspondence: Dr Karen LeGrow RN, PhD, Assistant Professor, Daphne Cockwell School of Nursing, Faculty of Community Services, Ryerson University, Toronto, ON, Canada. E-mail: © 2014 John Wiley & Sons Ltd

conditions who require frequent and at times lengthy hospitalizations is increasing (Perrin et al. 1993; Horn, Feldman and Ploof 1995; Newacheck and Halfon 1998; Sieben-Hein and Steinmiller 2005; Goldson et al. 2006; Gordon et al. 2007; van der Lee et al. 2007; Burns et al. 2010; Simon et al. 2010; Berry et al. 2011; Elias and Murphy 2012). Pediatric acute care hospitals are bureaucratic organizations consisting of multiple hierarchical structures and resource distributions (Dracup and Bryan-Brown 2006). Having these children admitted to hospital due to acute illness episodes is a highly emotional and stressful event for parents, who are often expected to make decisions regarding their child’s care (Knox and Hayes 1983; Burke, Costello and Handley-Derry 1989; Burke et al. 1991; Horn et al. 1995). Physicians and nurses hold powerful positions because they have specialized medical knowledge, technical skills, and know relevant rules, routines, and policies (Brown and Ritchie 1990; Callery and Smith 1991; Callery 1997; Hawryluck et al. 2002; Lingard et al. 2004), whereas parents’

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report being placed in subordinate roles and having to struggle for position, power, and, ultimately, a voice when their children are hospitalized (Knox and Hayes 1983; Robinson 1987; Thorne and Robinson 1988; Brown and Ritchie 1990; Callery and Smith 1991; Callery 1997; Balling and McCubbin 2001; Clark and Carter 2002; Dudley and Carr 2004; Gatrell, Popay and Thomas 2004; Mello et al. 2004; Ygge and Arnetz 2004; Miceli and Clark 2005; Carnevale et al. 2007; Gooding et al. 2011; Lotze, Bellin and Oswald 2010; Macdonald et al. 2012). Dealing with uncertainty, communication problems, and conflict with members of healthcare teams, services, and programs have been central concerns in parents’ reports of their children’s hospitalizations (Thorne and Robinson 1988, 1989; Burke et al. 1989; Brown and Ritchie 1990; Burke et al. 1991; Callery and Smith 1991; Bain, Rosenbaum and King 1995; Horn et al. 1995; Dixon 1996; Dodgson et al. 2000; Studdert et al. 2003; Mello et al. 2004; Sieben-Hein and Steinmiller 2005; Coffey 2006; Carnevale et al. 2007; Gooding et al. 2011). Family-centered care (FCC) is a philosophy that was introduced in the 1980s in an effort to recognize and support partnerships between families and staff to plan, deliver, and evaluate healthcare services for children (Shelton, Jeppson and Johnson 1987; Johnson, Jeppson and Redburn 1992; Ahmann and Johnson 2000; Franck and Callery 2004). FCC is an approach to pediatric care that encompasses parental participation in health-care, collaborative relationships between healthcare providers and families in decision-making, and healthcare policies and environments that support family functioning in healthcare settings (Ahmann and Johnson 2000; Franck and Callery 2004). This philosophy has been adopted by many pediatric hospitals in North America. However, despite the wide-spread adoption of this care philosophy over the past 30 years, parents’ reports of their experiences during their child’s hospitalizations indicate that the collaborative activities that are central to FCC are inconsistently upheld (Knox and Hayes 1983; Robinson 1987; Thorne and Robinson 1988, 1989; Brown and Ritchie 1990; Carnevale 1990; Burke et al. 1991; Callery and Smith 1991; Callery 1997; Espezel and Canam 2003; Franck and Callery 2004; Carnevale et al. 2007; Hughes, Bamford and May 2008; Goldfarb et al. 2010; Harrison 2010; Gooding et al. 2011; Kenney et al. 2011; Macdonald et al. 2012). Consequently, the occurrence of parents’ dissatisfaction with communication and decision-making processes during children’s hospitalization motivated us to explore an alternative conceptual orientation that would possibly explicate why FCC is not being fully enacted in pediatric hospitals. The conceptual orientation we choose was Pierre 2

Bourdieu’s, The Logic of Practice (1990). This theoretical perspective was chosen as it allows for a critical analysis of structure and agency in understanding practices in various social contexts. In this paper, we explore the key concepts in Bourdieu’s theory and describe how these ideas were applied to help us explicate the influences on communication and decisionmaking practices between players (i.e. physicians, nurses, and parents) in a pediatric hospital inpatient unit and analyze the social organization of structures and/or processes that shape these practices in this unique setting. We posited that this new perspective could lead to the development of innovative interventions that could possibly address parents’ dissatisfaction with communication and decision-making practices in an acute care setting. These insights subsequently led us to develop a Bourdieusian-informed communication intervention referred to as a ‘parent briefing’. In the second paper in this series, we report the results of a phase I single group post-test study (LeGrow, Hodnett, Stremler and Cohen, submitted for publication) evaluating the feasibility and acceptability of the ‘parent briefing’ intervention to physicians, nurses, and parents of children with complex health care needs admitted to an acute care pediatric hospital inpatient unit.

A BOURDIEUSIAN CONCEPTUAL ORIENTATION The late French sociologist and philosopher Pierre Bourdieu postulated that human behavior is governed by a sense of how to behave in social contexts that is acquired through socialization processes (Swartz 1997). In one of his major works, The Logic of Practice, Bourdieu outlined a ‘general science’ of human behavior (Swartz 1997, 52). His theory is based on three key concepts – habitus, capital, and field – that are said to determine the positioning of individuals in various social contexts (Swartz 1997). He posited that individuals’ or groups’ predispositions for certain behaviors, beliefs, and attitudes are a function of the resources available to them in specific social environments or fields. Thereby, the term practices conceptualizes the outcome of the relationship between his key concepts to describe behaviors that flow from individuals’ positions relative to others in the hierarchies that form in these social spaces. Even though his three concepts are presented separately in this paper, they are not intended to be static. Bourdieu posited that practices cannot be reduced to any one of them; rather, they grow out of the inter-relationship between all three (Swartz 1997).

© 2014 John Wiley & Sons Ltd

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Habitus The concept of habitus allows for an understanding of behavior in the social settings in which it occurs (Bourdieu 1991, 13–14). Accordingly, individuals are born into and socialized within particular fundamental social positions and, hence, internalize the fundamental social conditions of their existence in the form of personal dispositions (Bourdieu 1990). These dispositions shape master patterns of cognitive, normative, and corporeal dimensions of human behavior that are expressed in language, non-verbal communication, tastes, values, perceptions, and modes of reasoning (Swartz 1997; Marcoulatos 2001). Accordingly, Bourdieu states that individual behavior is generated by the interaction between opportunities or constraints presented by situations and the dispositions that individuals bring to situations (Swartz 1997). Therefore, habitus shapes experiences, beliefs, thoughts, attitudes, and behaviors and provides a description of how individuals know or come to know their ‘place’ (i.e. how to think, act, and feel) in various contexts.

Capital Bourdieu conceptualized the resources that individuals and groups draw on to maintain and enhance their positions in various fields as types of capital. Four types of capital said to enhance social status include (i) economic capital (i.e. wealth and property); (ii) cultural capital (i.e. knowledge, goods and services, and credentials); (iii) social capital (i.e. acquaintances and networks); and (iv) symbolic capital (i.e. status and position, Swartz 1997). Bourdieu views linguistic practices, such as language skills and vocabulary, as a form of cultural and/or symbolic capital that is distributed in very similar ways as other forms of capital (Bourdieu 1991). Individuals who have not acquired a certain level of knowledge and learned to master necessary linguistic practices are usually excluded from the social interactions in which this competence is required (Bourdieu 1991). Therefore, successful use of cultural/symbolic capital is an important competency that can enhance an individuals’ social positioning within a social context.

how social relations are subdivided around specific functions and valued resources (Swartz 1997). He described two major competing principles of social hierarchies that shape social positioning and the struggle for power in all fields. These include the distribution of economic capital, such as wealth and property, and the distribution of cultural or symbolic capital, such as knowledge, social status, and credentials. Individuals draw from economic or cultural resources that are accessible to them to maintain and/or enhance their position relative to other players (Swartz 1997). Bourdieu spoke of structural properties that characterize all fields (Swartz 1997; Wacquant 2007). Fields are structured spaces of dominant and subordinate positions based on types and amounts of capital that individuals must acquire or maintain to secure their position in the field. Individuals struggle over what are considered the most valued resources and, as a result, they pursue different strategies to obtain capital that is most accessible and favorable to their own situations in the field. Individuals in dominant positions use conservation strategies such as enforcing the status quo to ensure their power is maintained. New players use succession strategies to gain symbolic capital such as medical information to gain access to more powerful positions in the pediatric hospital. Those whose habitus leads them to believe they will gain very little from more dominant persons use subversion strategies such as vigilant watching to challenge dominant persons’ legitimacy to define standards and acceptable or ‘normal’ behaviors (Swartz 1997; Wacquant 2007). Fields can also impose forms of struggle on individuals (Swartz 1997). Bourdieu likened behaviors that occur within fields to games that are played according to tacit unwritten rules that permanent players formulate and come to understand. Each field has its own specific set of rules that are determined by the possession of certain types and amounts of capital which preceded the individual entering the game. Every field presupposes and produces a belief in/or acceptance of the rules of the game. Bourdieu referred to this as a type of ‘illusion’ because each field’s rules are arbitrary (Bourdieu 1991, 22, 45; Swartz 1997, 125). All players must believe the game or field is worth maintaining and that enhancing their own position is worth pursuing to keep the game going and preserve the field.

Field Critique of Bourdieu’s theory Bourdieu was particularly interested in the ways in which individuals and/or groups attain and maintain positions in different contexts or fields (Bourdieu 1991). Fields are litigious, social, and symbolic institutions that make up the social settings of everyday life such as medicine, education, law, and the family. Bourdieu used this concept to delineate © 2014 John Wiley & Sons Ltd

A main criticism of Bourdieu’s theory is that it is overly deterministic with its strong emphasis on social reproduction that maintains the status quo. Critiques have been focused on his concept of habitus, which tends to reproduce those actions consistent with the conditions under which they were 3

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produced (Bourdieu 1977; Berger 1986; Gartman 1991; Sewell 1992; Swartz 1997; Lau 2004). Thereby, individuals acquire particular dispositions and address situations in habituated ways, portraying an inescapable structural determinism (Swartz 1997; Kontos 2006). However, Bourdieu recognized mismatches between habitus and the opportunities offered in fields as one conceptual possibility for change (Swartz 1997). Scholars supporting the possibility for change have viewed habitus as a mediating concept where practices occur through time and across situations that differ in the structural conditions from which they were formed, thereby, leaving room for change (Swartz 1997). Several authors have postulated that transformations are possible when capital is redistributed and social positions are altered (Swartz 1997; Marcoulatos 2001; Lahire 2003; McKeever and Miller 2004).

CRITICAL ANALYSIS Bourdieu’s Logic of Practice outlined a general science of human behavior (practice) that was conceptualized as the outcome of the relationship between habitus, capital, and field. Bourdieu believed that in various social fields, individuals struggle over valued resources to maintain or enhance their hierarchical positions (Swartz 1997). This principle provided the foundation for our critical analysis of the application of Bourdieu’s idea in facilitating our understanding of the inter-relationship between healthcare providers’ and parents’ habitus and capital, during communication and decision-making practices for children with complex healthcare needs admitted to hospital, as they are played out in a pediatric hospital on an inpatient unit. It is important to note that while this section is arranged around the three concepts to enhance the presentation of our critical analysis of Bourdieu’s ideas and application to the clinical issue, it is not meant to imply that these concepts are distinct and mutually exclusive of one another. The discussion that follows illustrates how the concepts – habitus, capital, filed – are interrelated in determining practices.

Social organization of a pediatric inpatient hospital unit Many parents of children with complex healthcare needs experience numerous admissions to a pediatric hospital over the course of their child’s life. Parents’ dissatisfaction with their position relative to professional care providers in the healthcare system has been described (Robinson 1987; Thorne and Robinson 1988; Burke et al. 1991; Perkins 1993). The habitus of parents of these hospitalized children is determined through their ability to play the valued rules 4

of the game – in the language, non-verbal communication, perceptions, and behaviors they exhibit. This habitus often predisposes parents to behave in ways that they consider most likely to maintain or enhance their roles as parents based on the resources available to them and past experiences in healthcare fields (Swartz 1997). Parents’ attempts to enhance their positions relative to healthcare providers are evidenced by practices such as maintaining vigilance over hospital routines and cares, negotiating hospital rules, tenaciously seeking information from care providers, and trying to take charge of their children’s care (Thorne and Robinson 1988, 1989; Burke et al. 1991; Perkins 1993). Accordingly, habitus essentially determines how parents know or come to know their place (i.e. how to think, act, and feel) in an acute care hospital inpatient setting. Within the field of pediatric hospital inpatient care, practices based on the dominant discourse of the medical model and knowledge of disease and technologies, and on the acquisition of specific linguistic skills such as language and vocabulary function as cultural/symbolic capital in the subfields of pediatric medicine constituted by children with complex healthcare needs, their parents, and healthcare providers. According to Bourdieu (1991), all communication practices are measured against the practices of those who are in dominant positions. Physicians, who are the gatekeepers of medical knowledge, have the highest weight and distribution of linguistic (symbolic) and knowledge (cultural) capital in this field. Nurses are expected to acquire sufficient amounts of this cultural and symbolic capital to enable them to engage in medical discussions and carry out the children’s care and therapies. Most parents, however, have limited opportunities to acquire a certain level of knowledge or master necessary linguistic practices and therefore hold lower field positions relative to most physicians and nurses. Individuals who have not acquired a certain level of knowledge and learned to master necessary linguistic practices are usually excluded from the social interactions in which this competence is required (Bourdieu 1991). As a result, parents who have not acquired the necessary capital are excluded from social interactions in which these competencies are required. This is evidenced by the multiple discussions among healthcare providers regarding the child’s care that take place without the participation of their parents (Robinson 1987; Burke et al. 1991; Kerr 2002; Kleiber, Davenport and Freyerberger 2006). Higher weight is attributed to medical and nursing knowledge and linguistic styles relative to that of parents, which again speaks to the dominant habitus enjoyed by physicians and nurses compared to parents in this setting © 2014 John Wiley & Sons Ltd

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(Brown and Ritchie 1990; Callery and Smith 1991; Callery 1997; Balling and McCubbin 2001). By establishing communication practices related to knowledge of disease and technology as the legitimate language and a rule of the game, hierarchical distinctions between physicians, nurses, and parents are formalized. Parents’ reports of their FCC hospital inpatient experiences are reminiscent of playing a game according to predetermined rules of conduct (Thorne and Robinson 1988; Brown and Ritchie 1990; Burke et al. 1991; Callery and Smith 1991). Their experiences can be interpreted in Bourdieusian terms similar to his concept/analogy of ‘playing a game’ (Bourdieu 1990). During first or new hospitalizations, parents do not know the rules of the game in this field; however, they learn they must abide by the formal and informal rules to gain access to key players such as nurses and physicians, who hold the most cultural and symbolic capital. Over the course of the child’s hospital stay, most parents quickly learn by trial and error the spoken and unspoken rules to maintain or enhance social positioning in the hospital hierarchical structure. Parents reported that they were instructed on how to behave and when they could be present with their child (Rennick 1986, 1995; Robinson 1987; Brown and Ritchie 1990; Ardley 2003; Griffin 2003; Berwick and Kotagal 2004). In the pediatric inpatient unit hierarchy of players, physicians usually occupy the highest positions, parents occupy the lowest ones, and nurses, depending upon their capital, occupy positions somewhere in between. Bourdieu would argue that this arrangement of players is formalized by the structural properties of the field of pediatric medicine that supports its own mechanisms of maintenance (Swartz 1997). These structural properties are reflected in the distinct policies and procedures, processes of care, protocols, and guidelines for behavior that produce and reproduce the hierarchical structures that maintain dominant positions (Davidson et al. 2007). Physicians and nurses implicitly are expected to enforce the rules of the game according to these structural properties. Therefore, physicians’, nurses’, and parents’ relative positions are clearly distinguished and supported by the structural properties that give the illusion of a family-centered care philosophy in the context of pediatric hospital care.

APPLICATION OF BOURDIEU’S IDEAS We believe that Bourdieu’s ideas provide an alternative orientation from which to view clinician and parent practices (behaviors) in an acute pediatric hospital setting © 2014 John Wiley & Sons Ltd

that have not been offered before. His theoretical perspective provided the foundation for our exploration of the inter-relationship between healthcare providers’ and parents’ habitus and capital, during communication and decision-making practices, as they are played out in the field of pediatric medicine within a pediatric inpatient unit. This Bourdieusian analysis of the social organization of pediatric hospitals illustrated how parents’ and healthcare professionals’ resources are not distributed equitably; their habitus differs hierarchically. This may explain why their ability to work collaboratively as partners in a team of equals within the field of pediatric medicine is limited. However, support for the idea that changes in practice can possibly occur through time and across situations by altering the very structures that produced them initially (Swartz 1997; Marcoulatos 2001; Lahire 2003; McKeever and Miller 2004) was an exciting premise upon which to base further inquiry. This postulation was central in justifying the development of an intervention designed to engage clinicians and parents in a structured activity that was different from their present style of interacting that could possibly allow for changes in practices to occur. We, therefore, hypothesized that an intervention aimed at changing the present structure of physician, nurse, and parent communication and decisionmaking practices could possibly lead to increasing parents’ cultural/symbolic capital, enhancing physician, nurse, and parent interactions, and thereby increasing parents’ satisfaction with communication and decision-making processes during an acute care hospital admission.

Parent briefing intervention We used Bourdieu’s key concepts of capital, habitus, and field to frame a structured communication intervention (capital), which was called a parent briefing, to provide one such opportunity for change in practices to occur (habitus) and possibly alter and/or enhance social positions (field). This intervention consisted of a template for physicians and nurses to use to guide a structured communication intervention with parents of their hospitalized child’s health status and care/treatment needs. It was designed to provide parents with opportunities to acquire relevant medical and technological knowledge (cultural capital) about their child’s health-care and to learn a linguistic style (symbolic capital) conducive to participating in physician-directed communication and decision-making practices (symbolic capital) in an acute care hospital setting (field). 5

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INCREASING PARENTS’ CULTURAL AND SYMBOLIC CAPITAL

nurses. Essentially, the rules of the game would change and new rules would be established.

The intervention is a process that structures time for the physician, nurse, and parent to engage in real time faceto-face communication during the daily patient care rounds. The briefing template includes the following elements to enhance parents’ cultural and symbolic capital in the field: (i) medical and nursing updates that would provide parents with a summary of the child’s current condition (i.e. medical/technical knowledge); (ii) review of the goals and plan of care for the next 12–24 hours (i.e. medical/technical knowledge); (iii) discussion about related medical terms, jargon, abbreviations, and acronyms used in healthcare practitioners’ communication practices (i.e. linguistic style); and (iv) time for physicians and nurses to listen to and answer/address parents’ questions and concerns (i.e. medical/technical knowledge and/or linguistic style).

PARENT BRIEFING INTERVENTION: PLAN, RULES, AND THE GAME

HABITUS: REDUCING SOCIO-SPATIAL DISTANCE BETWEEN HEALTHCARE PROVIDERS AND PARENTS Most health care providers have been socialized into a habitus that positions them hierarchically above parents in social spaces within a pediatric inpatient unit. The physical manner and style of an interaction are the results of the internalization of objective structures in the hospital setting that become incorporated into bodily form, which Bourdieu referred to as bodily hexis (Swartz 1997, 107–108). Healthcare providers typically stand while engaging in daily discussions with parents. This signifies the planned brevity of the ensuing encounter to parents and represents the healthcare providers’ ‘busyness’ and their need to get to other important things they have to do. Bourdieu would argue that this dominant, powerful position is reflected in healthcare providers’ behavior and linguistics practices. For the designed intervention, chairs are to be placed in each child’s hospital room. Physicians, nurses, and parents are required to sit to conduct the briefing. This is an important and integral component of the intervention. We posited that the act of sitting to engage in the parent briefing intervention would signify time for important communication practices to take place and physically position the parent, the physician, and the nurse on the same horizontal plane (Marcoulatos 2001). Therefore, the act of sitting to engage in communication practices with parents would change the physical manner and style, or bodily hexis, of physicians and 6

The parent briefing was designed as a communication tool to be used by physicians, nurses, and parents on a daily bases or as needed/requested. The briefing was designed to allow structured time for the physician, nurse, and parent to engage in real time face-to-face communication related to the child’s acute hospital admission. These briefings only would take place during the usual bedside patient care rounds process if all three were present and were not meant to replace the end of shift report but augment regular communication practices and activities. The briefing is designed to begin with the attending physician and nurse greeting the parent and sitting down. The physician and nurse then complete the key components of the briefing in discussion with the parents. Then, the attending physician proceeds with their usual patient bedside round duties, and the parent and nurse complete the briefing. At this point in time, the nurse reviews with the parent the information that has been presented. As needed, the nurse repeats medical and technical information, provides clarification, adds additional information, and translates medical terminology (i.e. cultural capital). He/she reviews the plan of care for the child, which includes relevant tests and procedures, and explains any jargon, abbreviations, and acronyms used (i.e. cultural capital), answers any questions and/or addresses any concerns the parents have (i.e. cultural capital), discussed the use of medical terminology in communication practices with physicians and nurses (i.e. symbolic capital).Finally, the nurse completes documentation in the hospital record for each briefing, highlighting parents’ expressed questions and concerns. This information is available for the attending staff physician to view.

CONCLUSION We posit that Bourdieu’s theory of human behavior provides a useful orientation from which to view clinician–parent behaviors that currently are not captured by the rhetoric of family-centered care guiding acute care in pediatric hospital settings. Using his key concepts to understand the social organization of a pediatric inpatient unit and explicating why family-centered care may not always be achieved, provided new insights into physician/nurse-parent communication and decision-making practices that had not been © 2014 John Wiley & Sons Ltd

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previously explored in this manner. This new understanding of physician/nurse–parent practices led to the design of the parent briefing intervention. There is theoretical evidence to suggest that a parent briefing intervention may have benefits for parents of children with complex healthcare needs, as well as for physicians and nurses providing their care. Empirical research, however, is required to further explore Bourdieu’s concepts – capital, habitus, and field – and their application to hierarchical structures within healthcare settings. The feasibility and acceptability of the parent briefing we designed needs to be investigated from physicians’, nurses’, and parents’ perspectives. In addition, the use of chairs during structured communication practices warrants study to determine if their use has an effect on clinicians’ and parents’ attitudes and behaviors and on parents’ satisfaction with decision-making processes during their children’s hospitalizations.

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Bourdieu at the bedside: briefing parents in a pediatric hospital.

The philosophy of family-centered care (FCC) promotes partnerships between families and staff to plan, deliver, and evaluate services for children and...
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