“Mind the gap”: Exploring pediatric nurses‘ perceptions of the theory and practice of caring for children and families

Purpose: To investigate how pediatric nurses interpret and conceptualize theoretical underpinnings and daily practice scenarios pertaining to their role in pediatric care. Design and methods: 139 pediatric nurses completed a survey in which they were asked to endorse to what extent practices related to pediatric concepts are expected from their role (“Expected”) or are actually implemented in their clinical work (“Actual”). Survey items were derived from a nursing textbook that outlines the theoretical tenets of the “art of pediatric nursing”, along with scenarios and conflicts encountered in everyday practice, covering family-child centered care, child growth and development, and emotional boundaries. Results: In both Expected and Actual practices, the highest level of endorsement was for items focused on core elements of family-centered care (80–96%), and moderate-low endorsement levels were observed for items related to therapeutic relationship management and emotional boundaries. A factor analysis yielded 12 factors representing themes related to pediatric nursing. However, the division of items per factor indicated diffusion between key concepts and a discrepancy between theory and practice, especially in regard to maintaining emotional separateness and objectivity, advocacy, managing conflicts within the nurse-child-family triad, and navigating oneself boundaries. Conclusions: Nurses' ability to manage and contain various types of unclear boundaries is crucial for optimal care provision when working with children and families. Practice implication: Variability in nurses' theoretical role-perception and practical care provision is largely attributed to the way they navigate various ambiguous boundaries in practice and this could be a focal point in educational programs and on-the-job training.