The Nature of Family-Centred Care in Thailand
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The Nature of Family-Centred Care in Thailand: A Case Study Choosak Yuennan A thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy in the School of Health Sciences, Faculty of Medicine and Health Sciences, the University of East Anglia 2015 © This copy of the thesis has been supplied on condition that anyone who consults it is understood to recognise that its copyright rests with the author and that no quotation from the thesis, nor any information derived there from, may be published without the author‘s prior, written consent. Acknowledgements I would like to thank the following people for their help and support in my journey towards completing this thesis. They helped me gain an understanding of the subject area and research methodology and kept me motivated. I really appreciate all their help and support. In particular, I would like to thank the Royal Thai government, the Boromarajonani College of Nursing Chiang Mai and all their staff for sponsoring my study. I hope that I can return my gratitude to my nation and my college one day. I am thankful to my supervisors, Dr Gibson D‘Cruz and Dr Michael Pfeil, for their support, encouragement, guidance, and belief in my abilities and for helping me to gain an understanding of the subject area and research methodology. Their hard work in assisting me, an international student from a non-Western culture who is not a native speaker, is much appreciated. I thank both of them for standing beside me when I needed support and for helping me during the challenging periods of this research. I would like to extend a special thank you to Dr Bruce Lindsay and Dr Janet Reamjeet for their kind support. I would also like to thank all my PhD friends, especially Miriam Bross for her support during a difficult time because she encouraged me to think positive. I would also like to express my gratefulness, praise and love for my wife Siriporn Yuennan and my parents whose help and encouragement was invaluable to bring this thesis to completion. Finally, a special thanks to Buddha for giving me the strength to achieve better things. i Abstract Thalassemia is a long-term condition that is highly prevalent in children in northern Thailand and the management of this disease requires a strong input from families. Family-centred care is a key philosophy in the nursing care of children and their families, especially as parents play a key role in the health and well-being of a child. However, the concept of family-centred care is a western one and there is limited literature on its use in Thailand. The aim of this study is to explore the characteristics of family-centred care in one hospital in Thailand and the factors that influence the nature of the nursing care. Using a qualitative case study approach, data was collected by non-participant observations, semi-structured interviews of five families, four nurses, a medical doctor and a Buddhist monk and the analysis of documentation in 2010. The data was initially analysed deductively using a recognised framework of family-centred care and this was followed by a thematic inductive analysis. The results showed that all the elements of the framework of family-centred care existed in varying degrees although the concept was not recognised as shaping the nature of this care. The nature of this care was influenced by three factors: the family, the hospital and Thai culture with its strong religious traditions. These factors were incorporated into a model of family-centred care that could be applied to other institutions in Thailand. This study has shown that the family-centred care model is practiced but it requires a strong commitment and input from healthcare professionals. Strengthening and formalising the use of this concept can be a very useful strategy to ensure that the needs of the child and family are recognised, valued and met. KEYWORDS: Family-centred care/ Family-centred care/ Case study/ Children with Thalassaemia/ Family participation/ Thailand ii Table of Contents Chapter 1 1 Introduction 1 1.1 Structure of the thesis 1 1.2 General information of thalassaemia 2 1.2.1 Types of thalassaemia ............................................................................. 3 1.2.2 Treatment and prevention of thalassaemia .............................................. 4 1.2.3 Effect of thalassaemia on children and their family .................................. 5 1.2.4 Thalassaemia in Thailand ........................................................................ 9 1.3 The context of the study 12 1.3.1 Location and population ......................................................................... 12 1.3.2 Language and dialect ............................................................................ 13 1.3.3 Political system ...................................................................................... 14 1.3.4 Educational system ................................................................................ 15 1.3.5 Religious beliefs in Thailand .................................................................. 16 1.3.6 Healthcare system in Thailand ............................................................... 17 1.3.7 The profession of nursing in Thailand .................................................... 20 1.3.8 General Information of the Lampang province ....................................... 22 1.3.9 Population and economy of Lampang .................................................... 23 1.4 My rationale for conducting this study 23 1.5 The anticipated contribution of this study to the body of knowledge 28 1.6 Conclusion 29 Chapter 2 30 2.1 History of family-centred care (FCC) and development 30 2.1.1 Framework and Stages of Family-Centred Care .................................... 35 2.1.1.1 Frameworks 35 2.1.1.2 Stages of family-centredness 41 2.1.2 The role of the family and nurse in family-centred care .......................... 44 2.2 Literature search and review 45 2.3 Summary and limitations of the reviewed literature 55 2.4 Justification for conducting this study 58 Chapter 3 60 3.1 Research design and methodology 60 iii 3.1.1 Positivist/quantitative approaches .......................................................... 61 3.1.2 Naturalistic/qualitative approaches ........................................................ 63 3.2 Types of qualitative research 67 3.3 The Case Study 68 3.3.1 Case selection ....................................................................................... 72 3.3.2 Sampling ............................................................................................... 73 3.4 The context of study: General information of the setting in Lampang Hospital 74 3.5 The role of the researcher: The researcher as insider or outsider 74 3.6 Data collection procedures 77 3.6.1 Recruitment and Case Selection ............................................................ 77 3.6.1.1 Children and their families 78 3.6.1.2 Hospital staff 79 3.6.1.3 The nursing instructor 79 3.6.1.4 The monk 79 3.6.1.5 Documents 80 3.6.2 Methods of data collection ..................................................................... 82 3.6.3 Data collection 1: Observation ............................................................... 82 3.6.3.1 Strengths and weaknesses of observation 83 3.6.3.2 Selected method of observation 84 3.6.3.3 Preparation before observation 84 3.6.3.4 Physical setting 85 3.6.3.5 Observational Process 86 3.6.4 Data collection 2: Interviews .................................................................. 90 3.6.4.1 Selected method of interview 91 3.6.4.2 Process of interview 92 3.6.5 Data collection 3: Documentation .......................................................... 94 3.6.5.1 Selected documents 94 3.6.5.2 The process of collecting the documents 95 3.7 Transcription and translation procedures 96 3.7.1 Managing the complex process of translating data ................................ 97 3.7.2 Verification of translation...................................................................... 100 3.8 Analytic procedures 102 3.8.1 Deductive analysis ............................................................................... 103 3.8.1.1 Familiarisation and preparing data 103 3.8.1.2 Identifying a thematic framework 105 3.8.1.3 Indexing 106 iv 3.8.1.4 Charting 107 3.8.1.5 Mapping and interpretation 108 3.8.2 Inductive analysis ................................................................................ 108 3.8.2.1 Coding data 109 3.8.2.2 Grouping and classifying themes and sub-themes 111 3.8.2.3 Reporting 111 3.9 Ensuring quality and trustworthiness of the research study 111 3.9.1 Credibility ............................................................................................. 112 3.9.2 Transferability ...................................................................................... 113 3.9.3 Dependability and confirmability .......................................................... 113 3.10 Ethical issues 114 3.11 Conclusion 116 Chapter 4 118 4.1 Deductive thematic analysis 120 4.1.1 Recognition that the family is the constant in the child’s life while the service systems and personnel within those systems fluctuate ........... 120 4.1.2 Facilitation of parent-professional collaboration at all levels of healthcare .......................................................................................... 122 4.1.3 Sharing of unbiased and complete information with parents about their child’s care on an ongoing basis and in an appropriate