Unequal partners? A critical realist ethnographic study of fathers’ experiences during their child’s admission to hospital for acute illness

Background: Children’s nurses claim to practice family-centred care in which care is centred on the needs of the whole family and to work in partnership with parents to care for the sick child. Fathers of acutely ill children have been overlooked in prior research on parents’ experiences in which samples have been predominantly mothers, yet recent years have seen an increasing focus in other professional fields on the significance of fathers’ involvement in their children’s lives. Aim: To understand how fathers experience their child’s hospitalisation and explore relationships between children’s nurses and fathers in the acute in-patient setting. Method: An ethnographic study took place on two children’s wards consisting of participant observation (150 hours) and interviews with both n resident and non- resident fathers (n=12) and nurses (n=7). Thematic analysis yielded understanding of the complexities of fathers’ experiences. Findings: Nurses had no specific preparation for working with fathers and yet had clear expectations of how a good father would act on the ward, based on their experiences with mothers. Fathers, whether resident on the ward or not, played significant roles in their child’s care, yet were largely overlooked by health professionals unless the mother was not present. Fathers also experienced maternal, institutional and structural barriers to partnership in the care of their sick children in hospital. Conclusions and implications: The study begins to redress gaps in knowledge about parents in hospital. Children’s nurses need to recognise that parents are in reality fathers and mothers and that they may therefore have different needs and respond to their child’s illness in different ways