Attachment-based interventions are usually aimed at helping parents become more sensitive, responsive, and reflective. (2018). One of the central notions of attachment theory is that the quality of early caregiving is crucial to child development, especially how the parent is sensitive and responsive to the childs cues (Ainsworth etal., 1978; Bell & Ainsworth, 1972). The new PMC design is here! Parents function as attachment figures to children across the early years, preadolescence, and adolescence (Kerns & Brumariu, 2014). Grossmann K., Grossmann K. E., Fremmer-Bombik E., Kindler H., Scheuerer-Englisch H. (2002). government site. (Eds. sharing sensitive information, make sure youre on a federal In the nursing literature, terms such as positive or negative are used when referring to the quality of PCA (Schenk etal., 2005). PMC legacy view Breastfeeding and the motherinfant relationshipA review.

Being separated twice in an unfamiliar (strange) environment activates the childs attachment system and allows for observation of individual differences in attachment patterns (Rosmalen etal., 2014). In Cassidy J., Shaver P. R. Individuals in relationships: Development from infancy through adolescence. Attachment theory as a support for foster carers and adoptive parents. Is insecure parentchild attachment a risk factor for the development of anxiety in childhood or adolescence? A childs committed relationship with at least one attachment figure is central to healthy development (Bretherton, 1992). Measurement invariance across mother/child and father/child attachment relationships, Behavioral styles in infancy and adulthood: The work of Karen Horney and attachment theorists collaterally considered. There is a discrepancy in the description of the patterns of attachment within the psychology and nursing literature, indicating that nurses and psychologists may think differently about PCA. Fatherhood matters: An integrative review of fatherhood intervention research.

The caregiver leaves the room. van IJzendoorn M., Juffer F., Duyvesteyn M. (1995). Bowlby identified the emotional and physical availability of the caregiver as a set-goal of attachment in infancy. Nothing's available: Young fathers experiences with unmet information needs and barriers to resolving them. The capacity for understanding mental states: The reflective self in parent and child and its significance for security of attachment. As children grow, they venture further from the secure base, and for an increasingly extended period of time (Bowlby, 1988). Blurred distinctions between the concepts of bonding and PCA and the subsequent practice recommendations from nursing articles (Goulet etal., 1998; Hill & Flanagan, 2020; Schenk etal., 2005) suggest that a clarification of PCA concept is needed. will also be available for a limited time.

(1999). The uniqueness of the childfather attachment relationship: Fathers sensitive and challenging play as a pivotal variable in a 16year longitudinal study.

O'Connor T. G., Woolgar M., Humayun S., Briskman J. The site is secure. To advance the use of the PCA concept for nursing practice, we propose the definition of the PCA as a bi-directional relationship between a child of 0 to 18 years of age and a primary caregiver, where a child uses the caregiver as a secure base from which to explore and as a haven of safety and source of comfort in times of distress (Ainsworth etal., 1978; Bowlby, 1988). Using a principle-based concept analysis, we clarify how parent-child attachment is understood from a multidisciplinary perspective to advance the use of this concept in nursing practice. During SSP, a caregiver leaves the child twice in an unfamiliar environment (a laboratory room decorated as a playroom) with enticing toys, first with a stranger (an unknown female experimenter) and then alone, before returning (Ainsworth etal., 1978). Nursing diagnoses identified during parent group meetings in a neonatal intensive care unit, International Journal of Nursing Knowledge. Nurses should provide education on ways to increase parental sensitivity and responsiveness (child cue-based interactions, normal child growth, and development). A data file using an Excel spreadsheet was created to aid in the screening and synthesis of the literature. Federal government websites often end in .gov or .mil. The maternal-infant bond: Clarifying the concept. There is often an overlap between concepts of attachment and parenting in the scientific literature (Koehn & Kerns, 2018). Bowlbys (1951) discovery of just how much children depend on their parents for support led to his famous quote that still rings true to this day: if a community values its children it must cherish their parents (p. 84). Bretherton I., Ridgeway D., Cassidy J.

Integration of the concept with related concepts (p. 406). Trust in others, trust in self: you are good and I am good. Learn more Two hallmark ideas of attachment theory are secure base and internal working models. ), Attachment and development: A prospective, longitudinal study from birth to adulthood, Attachment as an organizational construct.

Organized, extreme displays of negative emotions and/or helplessness. Van Ijzendoorn M. H., Goldberg S., Kroonenberg P. M., Frenkel O. J. Two reviewers (first author and the scientific writer/methodologist at the Faculty of Nursing, University of Calgary) conducted an inter-rater reliability check (McHugh, 2012) with 97% agreement, and independently screened 1013 abstracts. The concept of PCA is poorly understood in nursing literature due to inconsistencies and confusion of this concept with the concept of bonding. Bowlby (1988) proposed that across the lifespan all of usare happiest when life is organized as a series of excursions, long or short, from the secure base provided by our attachment figure (p. 62).

), https://creativecommons.org/licenses/by/4.0/, https://us.sagepub.com/en-us/nam/open-access-at-sage, https://www.ncbi.nlm.nih.gov/pubmed/5490680, https://www.ncbi.nlm.nih.gov/pubmed/14821768, http://onlinelibrary.wiley.com/doi/10.1111/j.1467-8624.2009.01405.x/abstract?systemMessage=WileyOnlineLibrarywillbeunavailableon2ndDec2017startingfrom0800EST%2F1300GMT%2F21.00SGTfor2.5hoursduetourgentservermaintenance.Apologiesfortheinconvenience, https://www.ncbi.nlm.nih.gov/pubmed/3320116, https://www.merriam-webster.com/dictionary/relationship. Ainsworth M., Blehar M., Waters E., Wall S. (2015). Relationship between parentinfant attachment and parental satisfaction with supportive nursing care, Iranian Journal of Nursing and Midwifery Research, Maternal and infant temperamental predictors of attachment: A meta-analytic review, Journal of Consulting and Clinical Psychology.

Bowlby claimed that a well-loved infant will protest separation from parents, but will later develop more self-reliance (Bretherton, 1992). Models of maternal-infant attachment: A role for nurses, What research does and doesnt say about breastfeeding: A critical review. De Wolff M. S., Van Ijzendoorn M. H. (1997).

Kerns K. A., Aspelmeier J. E., Gentzler A. L., Grabill C. M. (2001). New Directions for Child Development: A Quarterly Sourcebook. Ghadery-Sefat A., Abdeyazdan Z., Badiee Z., Zargham-Boroujeni A.

Careers, University of Calgary, Calgary, Alberta, Canada. An extensive amount of literature focused on the measurement of attachment in infancy and childhood.

OConnor T. G., Rutter M., & English and Romanian Adoptees Study Team.

For example, infants who seek proximity by crawling towards the caregiver at 12 months of age may smile and speak when they are older. (2014). No time limits were set. According to Bowlby (1982), attachment behaviors are rooted in evolution and increase the likelihood of survival by increasing caregiver-child proximity. Psychofunctional symptoms in infants of young mothers: Association with maternal mental health and parental bonding. Describe how concept of PCA is defined in literature. There is much more to parenting than attachment (Lyons-Ruth, 1996). (Eds. Moher D., Liberati A., Tetzlaff J., Altman D. G., Altman D., Antes G., . (father* or paternal* or mother* or maternal* or parent*) N2 child* N2 attachment, Children aged 18 years Parents (mother and/or father) of children aged 18 years, Parent (mother/father)-child (infant) attachment Attachment as defined by Bowlby and Ainsworth, a relationship between a primary caregiver (attachment figure) and a child where a child uses an attachment figure as a safe haven in times of distress and a secure base from which to explore, Parent-fetal attachment Attachment disorders Parent-child bonding Parent-child attachment in adulthood, Literature reviews Discussion or conceptual papers, Primary studies Animal studies Commentaries, opinion articles, books, book reviews, conference abstracts, dissertations. In insecure/ambivalent (Type C) attachment relationships, children exaggerate the display of their emotional needs in a desperate attempt to get the attention of the caregiver, who has typically demonstrated inconsistency in their past responses. Nurse leaders must continue to advocate for the inclusion of attachment theory knowledge in formal nursing programs to help ensure the implementation and sustainability of attachment-based interventions that support optimal child development. Claims regarding the effects of maternal-infant bonding on long-term child health outcomes are not supported by current evidence. Unlike PCA, bonding does not predict socio-emotional and physical health outcomes later in life. do Vale I. N., de Souza S. R., Carmona E. V. (2005). For example, a descriptive nursing study suggested that attachment initially occurs soon after birth in a very important manner through eye contact (do Vale etal., 2005, p. 71).

Additionally, PCA can function outside of parent-child relationships, as in cases of securely attached children shown to have less difficulty in building and maintaining social relationships with peers (Sroufe, 1988).

With the support of nurses, fathers can develop parenting competencies and confidence in both play and caregiving contexts which can enhance father-child attachment security. (Eds. Nurses need to identify factors that interfere with PCA, assess available supports, and provide necessary referrals. Verhage M. L., Fearon R. P., Schuengel C., van IJzendoorn M. H., BakermansKranenburg M. J., Madigan S., Roisman G. I., Oosterman M., Behrens K. Y., Wong M. S., Mangelsdorf S., Priddis L. E., Brisch K. H., & Collaboration on Attachment Transmission Synthesis. The relative effects of maternal and child problems on the quality of attachment: A meta-analysis of attachment in clinical samples. (Eds.). Interrater reliability: The kappa statistic. As children grow, they begin to rely more on IWMs than on the actual presence of the attachment figure to guide their daily social interactions (Bowlby, 1982). Attachment behaviors are most likely to be evident when the child is in an unfamiliar environment or feeling ill or in pain (Feeney, 2000). This disposition towards a caregiver was described as an attachment system, with the actions of the infant being termed attachment behavior (Bowlby, 1969/1982). Maia G. N., Frizzo G. B., Levandowski D. C. (2020). Howes C. (1999).

Parent-child attachment and monitoring in middle childhood, Parentchild attachment: Meta-analysis of associations with parenting behaviors in middle childhood and adolescence, Parent to infant bonding: Setting the record straight, The history of research on father involvement: An overview, Training of NANDAI nursing diagnoses (NDs), nursing interventions classification (NIC) and nursing outcomes classification (NOC), in psychiatric wards: A randomized controlled trial. See Table 5 for the description of patterns of attachment. Both mother and father are important in fostering secure attachment (Bretherton, 2010). Theorizing the father-child relationship: Mechanisms and developmental outcomes, A categorical description of infantmother relationships in the home and its relation to Qsort measures of infantmother interaction, Monographs of the Society for Research in Child Development. Integrating infant mental health practice models in nursing. The

PCA does impact health and development over the life span (Puig etal., 2013; Sroufe, 2005; Weinfield etal., 2000). Quality of PCA is best assessed by reference to organization of attachment behaviors concerning the attachment figure and in consideration of the situational context (L. Sroufe & Waters, 1977). Sroufe L. (1988). The majority of included articles were from the discipline of psychology (n=22), three were from the discipline of nursing, and one article was from the medical discipline of medicine. Specifically, the assessment of the PCA should include an assessment of the family context (e.g., parental mental health, social support, socio-economic status) because children are highly dependent on their immediate family environment for their health and development. Mniszak C., O'Brien H., Greyson D., Chabot C., Shoveller J. Thus, multiple attachment behaviors can have a similar meaning, and serve as means of re-establishing contact (Sroufe & Waters, 1977). Once comfort and reassurance in the presence of distress-inducing stimuli are achieved, the attachment figure shifts from being a safe haven to being a secure base from which to explore (Ainsworth etal., 1978, p. 265).

We aimed to review how PCA is described across the disciplines of psychology and nursing to advance the use of this concept for nursing practice.

The stranger and caregiver are in the room (3 minutes or less), 5. Fernandes M., Verssimo M., Santos A. J., Ribeiro O., Vaughn B. E., Gastelle M., Kerns K. A. Articles were excluded if they were (1) primary studies, (2) focused on parental-fetal attachment, (3) focused on attachment disorders, and (4) editorials, letters, books, abstracts, and grey literature (Table 2). A., Scott S. (2019). Ordway M. R., Sadler L. S., Dixon J., Slade A. Sadler L. S., Slade A., Close N., Webb D. L., Simpson T., Fennie K., Mayes L. C. (2013). Guiding Principles (Penrod & Hupcey, 2013) and Application to Concept of PCA. Another key idea of attachment theory, internal working models (IWMs), is defined as cognitive mental structures or mental schemas. The Risky Situation (RS) procedure has been developed to test the following dimensions of father-child attachment in children aged 12-18 months: stimulation (encourage the child to be open to the outside world), and discipline (setting limits for the childs safety). Caregiver leaves again (3 minutes or less), 6. Children with insecure/avoidant attachment (Type A) mask their emotional needs, typically after being consistently rejected by their caregivers in times of past distress. Higher levels of maternal (Stacks etal., 2014) and paternal (Fonagy etal., 1991) RF have been linked to sensitive behavior and a childs attachment security. A childs behaviors coded as D were based on the following indices: (a) sequential and (b) simultaneous display of contradictory behavior, (c) misdirected or incomplete movements, (d) stereotypes and anomalous postures, (e) freezing or stilling, (f) display of apprehension of the caregiver, and (g) signs of disorganization (Granqvist etal., 2017).

Measurement invariance across mother/child and father/child attachment relationships. Attachment disorders of infancy. How well does PCA concept holds its boundaries when integrated with related concepts? (2016). (1992).

IWMs summarize early caregiving experiences and shape expectations about future interactions with significant others (Bretherton, 1992). B., Julion W. A., Bounds D. T., Sumo J. Attachment is a specific type of relationship with distinct goals and behaviors.

However, the parent plays a more important role than the child in shaping the quality of attachment (O'Connor etal., 2019). Frightened of self and others: You are scary, I am scary Unescapable fear originating from within. The caregiver and infant are in the room (3 minutes), 4. (2009). Quality of early maternal-child relationship and risk of adolescent obesity. Letourneau N., Tryphonopoulos P. D., Duffett-Leger L., Stewart M., Benzies K., Dennis C.-L., Joschko J. Moher D., Liberati A., Tetzlaff J., Altman D. G., & Prisa Group. Because attachment-based intervention programs have primarily targeted the mother-child relationship, there are no guidelines for effective father-child attachment programs to date (Henry etal., 2020). IWMs are thought to develop as early as 12 months of age, constructed from a childs actual experiences with the parent (George, 1996), and influence how the children view themselves in relationships with others (Rosmalen etal., 2014). To enhance PAC, nurses can use positive reinforcement of parenting skills, such as modeling appropriate responses (e.g., warm, supportive, sensitive, responsive, and prompt) to the childs behaviors to encourage parents to assume similar responses to promote feelings of security in a child. (2005) claimed that the nature of maternal-child attachment from birth (p. 516) is associated with the childs behavioral disorders. A total of 26 articles were identified as meeting the inclusion criteria of this analysis. Four articles focused on father-child attachment, while the rest examined either mother-child attachment (n=8), attachment between both parents and a child (n=5), or did not specify which parent was the focus (n=9) (Table 3). Nurses in all areas of healthcare should be able to observe the interaction between a parent and a child (e.g., attachment behaviors), and assess the quality of PCA. The development of a standardized procedure to observe and study attachment behavior was a major step in the establishment of an empirical knowledge base regarding the developmental significance of attachment (Ainsworth etal., 1978). Sroufe A., Carlson E., Shulman S. (1993). PCA can be disrupted by conditions that limit childrens behavior, such as neurological disorders, illness, and fatigue, or conditions that can interfere with the parents ability to provide care, such as poverty and mental health problems. The activation relationship theory stipulates that limit-setting and discipline are important in helping children feel safe when exploring their environment (Paquette, 2004).

Implications of attachment theory for developmental psychopathology. Paquette (2004) proposed a new theory of father-child attachment, called activation relationship. van IJzendoorn M., Sagi A., Lambermon M. (1992). (1986). Most of the articles were written in North America (n=20). Narrative and meta-analytic review of interventions aiming to improve maternal-child attachment security, Attachment relationships among children with aggressive behavior problems: The role of disorganized early attachment patterns, Journal of consulting and Clinical Psychology.

Child and family health in the era of prevention: New opportunities and challenges, A representational perspective of child abuse and prevention: Internal working models of attachment and caregiving. The latest research suggests that maternal mental health problems and perception of family support, not the quality of bonding at birth, may influence the development of a child's behavior problems (Maia etal., 2020). (2020). Is PCA concept used consistently and approapriately within the literature? Examining ecological constraints on the intergenerational transmission of attachment via individual participant data meta. A 9-point scale for coding disorganization is used, where observation of five or more disorganized behaviors is sufficient to place a child into the D category (Duschinsky & Solomon, 2017). and transmitted securely.

The SSP is normally only used during infancy and toddlerhood because as the children grow, the goals of attachment shift from proximity-seeking to co-constructing of cooperative partnerships with their attachment figure to ensure parents' ability and availability to act in child's best interests (Fernandes etal., 2020). Shah P., Strathearn L. (2014). This is important to know because attachment outcomes can be altered by changes in the immediate environment, such as changes in parenting behaviors (Belsky & Fearon, 2002). Solomon J., George C. (1999). official website and that any information you provide is encrypted There is a decreased need for proximity to the attachment figure in the absence of distress as the child grows and develops. Children with insecure/disorganized (D) attachment, fail to develop and organized pattern and display contradictory and incoherent behaviors with caregivers.

Eckardt P., Culley J. M., Corwin E., Richmond T., Dougherty C., Pickler R. H., . During the visit to a healthcare setting, a frightened child may crawl to the parent, looking to be picked up and comforted (George, 1996). Bonding is not attachment (Benoit, 2004; Redshaw & Martin, 2013). (2000).

DeVon H. A.

The relative effects of maternal and child problems on the quality of attachment: A metaanalysis of attachment in clinical samples, A secure base from which to explore close relationships. Trust in self, distrust in others: I will do this on my own, I fear closeness. (1992). Accessibility The infant is alone in the room (3 minutes or less), 7. The .gov means its official.

This article aimed to describe how the concept of PCA is understood from a multidisciplinary perspective. Is it usefull to the discipline of nursing? In Cassidy J., Shaver P. In the first volume of his trilogy, Attachment, and Loss, Bowlby (1969) considered the antecedents of attachment, such as maternal sensitivity to an infants cues.

The https:// ensures that you are connecting to the Letourneau N., Tryphonopoulos P., Giesbrecht G., Dennis C. L., Bhogal S., Watson B. To address association between attachment security and maternal social-marital support, stress, and depression. Parental RF refers to a parent's capacity to reflect on their own childhood experiences, and make meaning of their childs thoughts, feelings, and behaviors (Slade, 2005). The founder of attachment theory, British psychoanalyst John Bowlby (1944, 1951), studied how the childs early experiences with the caregiver impacted the childs future mental health. Ainsworth used the term organization to describe the way a childs attachment behaviors are brought together to form a coherent pattern of security or insecurity (Duschinsky & Solomon, 2017). A review of attachment theory in the context of adolescent parenting. To conclude, the concept of PCA can be measured by validated tools and is useful to nursing practice because nursing practice is concerned with child mental health (Gordon etal., 2020).

.

Focuses on the disciplines distinction of concept within the knowledge base (p.405). Fuemmeler B. F., Behrman P., Taylor M., Sokol R., Rothman E., Jacobson L. T., Wischenka D., Tercyak K. P. (2017). applicability to explaining or describing phenomeonon encountered within disciplinefrom the perspective of usefulness (p. 405).

This disposition towards an attachment figure is described as an attachment system, with the actions of the child being termed attachment behaviors (Bowlby, 1969/1982). (1978) and/or Bowlbys (1988) definitions of PCA (see Table 3), with an exception of a nursing article by Goulet (1998), where the definition of PCA by Bowlby (1996) was mixed with the definition of maternal-infant bonding by Klaus and Kennell (1983). (2009). (2000). The child decides which behaviors to use to maintain the proximity to the caregiver based on the situational context (Sroufe & Waters, 1977). Fathers in attachment theory and research: A review. Attachment is different from other aspects of parenting such as feeding, teaching, playing, and disciplining (Benoit, 2004). Nurses work closely with families of young children, and parents often approach nurses for advice on their childrens health (Ordway etal., 2014). (Eds.). Early caregiving predicts attachment representations in adolescence: Findings from two longitudinal studies, Journal of Child Psychology and Psychiatry.

(2010). Numerous studies have replicated these findings, exploring how maternal capacity to organize thoughts was linked to the ability to sensitively respond to her infant (van Ijzendoorn, 1995).


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