Furthering the Understanding of Parent–Child Relationships: A Nursing Scholarship Review Series. Part 3: Interaction and the Parent–Child Relationship—Assessment and Intervention Studies

A relationship is developed and changed through interaction (Hinde, 1976; Hinde & Stevenson-Hinde, 1988). A relationship is distinguishable from interaction by specific motivation (e.g., security regulation) and its qualities. A relationship has endurance over time and is described by qualities of mutuality, reciprocity, responsiveness, and synchrony, and patterns of connection and separation (Hinde, 1976). Interaction, on the other hand, is the activity of the parent–child dyad, including bids for the other’s attention and responses to the bids (Greenspan & Greenspan, 1989). The moment-to-moment interaction between a child and parent and the challenges and opportunities it presents is the fundamental mechanism through which the child develops (Bronfenbrenner, 1996; Bronfenbrenner & Ceci, 1994; Sroufe, Egeland, Carlson, & Collins, 2005). Although nursing research studies of parent–child interaction and relationships are numerous, interaction and relationship are conceptually not well defined. This article is the third in a series of five articles examining the contribution of nursing research to knowledge development about the parent–child relationship (Anderson, Riesch, Pridham, Lutz, & Becker, in press; Lutz, Anderson, Pridham, Riesch, & Becker, 2009; Lutz, Anderson, Riesch, Pridham, & Becker, 2009; Riesch, Pridham, Lutz, Anderson, & Becker, in press). The purpose of this article is to use Hinde’s relationship theory as a context in which to integrate the nursing literature published during the years 1980–2008. The intent is to identify emerging foci and the future goals they suggest for parent–child interaction and relationship studies. Parent–child interaction and relationships are important to nursing science and practice for reasons fundamental to the discipline (Blake, 1954). Of specific interest to nursing is the development of the parent–child relationship through activities central to parent–child functions, for example, care-giving, guiding, playing, socializing, and restoring security. Interaction that occurs during these activities involves goal-directed behavior that increases in complexity as the relationship develops and the child matures (Zeanah, Larrieu, Heller, & Valliere, 2000). A parent’s goal-directed behavior may be supported by nursing practice or deliberately influenced by nursing intervention (Blake, 1954). Qualities of the parent–child relationship are displayed in interactive behaviors, which make the relationship accessible to observation. An understanding of these relationship qualities and interactive behaviors must take into account the knowledge that they are embedded within contextual factors, including personal characteristics and environmental facilitators and barriers. Blake’s scholarly and clinical investigations and those of her students (see Waechter, 1977, for example) supported the analysis of parent–child interaction and relationship in terms of developmental tasks engaged in or accomplished, strengths revealed, or competencies demonstrated. Although most nursing studies of parent–child interaction or relationship involve infants, the young child also has been a subject of nursing research. The review is organized by two research design categories derived from Diers’ (1979) work: Assessment Model and Intervention Model. Discover Model studies were not identified for nursing studies of parent-child interaction and relationships. Assessment and intervention studies reviewed in Part 3 of this series used categories of observable events, conditions, interaction features, or relationship qualities identified a priori of a study. The Assessment Model focuses on child, parent, family, or environmental indicators, correlates, or predictors of parent–child interaction or the parent–child relationship. The Intervention Model involves strategies to support, improve, or otherwise have an effect on parent–child interaction or the parent–child relationship. For each of the two models in this review article, there is a table to summarize the articles reviewed. Prior to 1980, the primary vehicle nurses used to build knowledge relevant to clinical practice with parents and children was in the discovery mode. Concepts of interaction and relationship were explained and developed through case studies, exemplified by Blake’s (1965) study of a young child’s regaining autonomy after surgery to repair a congenital heart defect. The published parent–child interaction and relationship studies identified within the time span of this review, 1980–2008, were either assessment or intervention in type.