I TABLE OF CONTENTS Attestation of Authorship..................................................................... IV Acknowledgements..................................................................................V Abstract.................................................................................................VII CHAPTER ONE: The Background .................................................. - 1 - Reflections ............................................................................................................... - 1 - The Beginning.....................................................................................................................................- 2 - Incidence of Unintentional Injuries to Children....................................................... - 5 - The History of Children’s Hospital Services ........................................................... - 7 - Paediatric Nursing in New Zealand ....................................................................... - 11 - Paediatric nursing education. ............................................................................................................- 11 - Nursing a child after a traumatic accident.........................................................................................- 12 - Choice of Methodology ......................................................................................... - 14 - Summary ................................................................................................................ - 17 - CHAPTER TWO: Literature Review: ........................................... - 18 - Rehabilitation Nursing in the Acute Care Ward .................................................... - 18 - The Impact of Family Functioning on Children’s Progress................................... - 19 - The Need to Assess Family Functioning...........................................................................................- 25 - Acute Care Paediatric Nursing............................................................................... - 27 - Working with Families......................................................................................................................- 28 - Rehabilitation in the Acute Care Ward. ................................................................. - 34 - Summary ................................................................................................................ - 36 - CHAPTER THREE: Research Methodology and Methods......... - 38 - Glossary of Terminology ....................................................................................... - 39 - Grounded Theory Methodology............................................................................. - 41 - Symbolic Interactionism ...................................................................................................................- 42 - Grounded Theory Methods .................................................................................... - 44 - Constant Comparative Analysis ........................................................................................................- 44 - Theoretical Sampling ........................................................................................................................- 45 - Saturation ..........................................................................................................................................- 46 - My Presuppositions Interview................................................................................ - 47 - Demographic Data of Participants ......................................................................... - 47 - My Research Methods Pathway............................................................................. - 48 - Ethical Considerations ......................................................................................................................- 49 - The First Phase..................................................................................................................................- 50 - The Second Phase .............................................................................................................................- 58 - The Third Phase ................................................................................................................................- 65 - The Rigour of the Methodology............................................................................. - 70 - Summary ................................................................................................................ - 71 - CHAPTER FOUR: Building a Working-Relationship ................. - 72 - Beginning a Relationship. ...................................................................................... - 72 - II The Beginning of “Working With”...................................................................................................- 74 - Introduction to the Family.................................................................................................................- 74 - Beginning a Trusting Relationship......................................................................... - 75 - Checking In.......................................................................................................................................- 75 - Getting to Know................................................................................................................................- 78 - Holding All .......................................................................................................................................- 78 - Stepping In ........................................................................................................................................- 80 - Reassuring the Family............................................................................................ - 81 - Giving Hope......................................................................................................................................- 84 - Being Honest.....................................................................................................................................- 85 - Summary ................................................................................................................ - 87 - CHAPTER FIVE: The Art of “Working With” ............................ - 88 - Components of the Art of “Working With”........................................................... - 89 - Re-establishing Parenting..................................................................................................................- 90 - Involving the Parents.........................................................................................................................- 91 - Balancing by Empowering the Other ................................................................................................- 95 - “Working With” a Child ........................................................................................ - 96 - Supporting Family Functioning ............................................................................. - 99 - Summary .............................................................................................................. - 101 - CHAPTER SIX: Promoting Family Independence..................... - 102 - The Process of “Handing Over”........................................................................... - 103 - Stepping in and out of family..........................................................................................................- 104 - Handing Over to the Family............................................................................................................- 106 - Handing Over to the Child ..............................................................................................................- 107 - Family Supporting Each Other........................................................................................................- 108 - Handing Over to the Multidisciplinary Team .................................................................................- 108 - Discharge Planning. ........................................................................................................................- 109 - Summary .............................................................................................................. - 110 - CHAPTER SEVEN: Discussion .................................................... - 112 - The Importance of the Foundation of Trust ......................................................... - 114 - The Affect of Trust on Family Functioning ....................................................................................- 117 - Building trust........................................................................................................ - 118 - Building a Rapport to Trust.............................................................................................................- 122 - Informing to Reassure.....................................................................................................................- 124 - Giving Hope....................................................................................................................................- 125 - Involving and Supporting................................................................................................................- 125 - Building