Pediatric nursing versus family nursing; views of professionals and parents of children in San Sebastian de los Reyes (Madrid)

INTRODUCTION

In the past few years there has been disagreement among the collectives of pediatricians and nursing staff as to how child healthcare programs should be developed. At present, pediatricians advocate for the active participation of the nursing staff in the development of this program¹, with the sole requisite that the participating professionals have a level of training fitting the tasks that they perform.

At present, nursing professionals are divided in various groups with regards to their opinion:

• On one hand, there are those who demand working exclusively in pediatrics, matching their specialized training.
• On the other hand, there are those who avoid any work in the child and adolescent field, which feels like an imposition and a struggle to them.
• Last of all, there are those who defend the concept of serving the entire family, with nursing professionals capable of caring for both the senior and the child in the comprehensive field of Family Nursing.

This state of conflict and non-unified criteria in the field of Nursing is even seen at the level of Spain’s various autonomous communities (AC), whose respective Departments of Health maintain different models of healthcare services. Thus, in Spain there coexist some ACs with a clearly defined Pediatric Nursing² (PN) model, others with a mixed model that combines PN and Family and Community Nursing (FCM), others with a defined model of FCM, and yet others where a single nursing professional combines both models, being responsible for PN services and also for a group of adult patients (a model that is increasingly widespread, since the 1:1 nurse-to-physician ratio is disappearing, and the current crisis is widening this gap.)

Adding to this debate, ACs differed in the way they recently enforced the decree on Nursing Specialties (Royal Decree 450/2005, dated April 22 2005)³, as some of them recognized and certified the work of the Nursing professional devoted to Pediatrics; while others never certified this activity and instead recognized for the purposes of certification “excellent” FCN services that were actually never provided by Nursing professionals who had always worked in Pediatrics.

This state of affairs is causing us to lose something that matters in the nursing profession, which is the professional calling and career choices. It used to be that nursing professionals chose to work in the child and adolescent or the adult fields for their personal satisfaction and as it suited their training and inclinations. But now the specific titles and personal choices are fading away to meet healthcare service requirements, which are, needless to say, influenced by the economic situation.

And everyone believes to be in the right in this debate, when studies have yet to be made to support any views on the matter.

The purpose of this text is to learn in a direct manner the preferences for the PN or the FCN model of both the professionals involved in the child healthcare program (pediatricians and nursing staff) and the families served by it.

MATERIAL AND METHODS

In the Spring of 2011 surveys were designed and sent to pediatricians, nurses and parents of children aged 0-14 years in San Sebastián de los Reyes (AC of Madrid). This town has a population of 80,638 people (including 14,222 children aged 0-14 years) and three healthcare centers (HCCs), namely Reyes Católicos HCC, Rosa Luxemburgo HCC and V Centenario HCC. The questionnaires were personally given to and retrieved from:

• All thirty-four nursing professionals working in the aforementioned HCCs.
• All eleven pediatricians working in the three HCCs. Of these, four work in the morning shift with a PN assigned exclusively to them; five work in the afternoon shift, four of them with an exclusive PN and one with a PN that also works with adults; and two work in rotating shifts with PNs whose schedules do not match theirs.
• One thousand and four parents of children attended in the HCCs who participated in the study.

RESULTS

• Results of the survey of the parents: 99.6% of the parents wish to be served by a specialized PN, and only 0.4% would choose a FCN.
• Results of the surveyed pediatricians: all voted in favor of a PN-only model with fixed nurse schedules matching the physicians’.
• Results of the surveyed nurses: see Table 1.

CONCLUSIONS

• Practically all of the parents surveyed (99.6%) want their children to be served by a PN.
• 100% of the responding pediatricians prefer the model where PNs work with them as a team under the same schedule.
• Out of the 34 nurses that serve the population in this town:
  • 71.5% (five out of seven) of the nurses who work as specialized PNs wish to continue with the PN model; the remaining two are open to the possibility of serving adults as well.
  • Out of the 26 nurses that only serve adults (76.5% of the total nursing staff), 77% wishes to continue seeing adults only, and 19% is open to the possibility of serving both adults and children.
• We need to foster teamwork between the different professional groups in HCCs. Pediatricians and PNs must cooperate closely, since their work is complementary.
• It is our understanding that interdisciplinary relationships are very important in doing our work correctly and therefore in helping our patients.

CONFLICT OF INTERESTS

The authors state that they have no conflict of interests in relation to the writing and publication of the current study.

ACRONYMS: AC: autonomous community • HCC: healthcare center • FCN: family and community nursing • PN: pediatric nursing.

BIBLIOGRAFHY

1. Sánchez Pina C, Palomino Urda N, de Frutos Gallego E, Valdivia Jiménez C, Rodríguez Fernández-Oliva CR, Miranda Berrioategortua I, et al. “Puntos negros” de la asistencia a la población infantojuvenil en Atención Primaria en España (primera parte). Rev Pediatr Aten Primaria. 2011;13:15-31.
2. Pedraza Anguera A. Aspectos conjuntos profesionales Pediatría/Enfermería. El equipo pediátrico de Atención Primaria: aspectos formativos y asistenciales. Rev Pediatr Aten Primaria. Supl. 2011;(20):71-80.
3. REAL DECRETO 450/2005, de 22 de abril, sobre especialidades de Enfermería. BOE núm. 108 de 6 de mayo de 2005. p. 15480-6. Disponible en www.boe.es/boe/dias/2005/05/06/pdfs/A15480-15486.pdf

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