Positive Parenting
Andrea Seay, RN, MS, PPCNP-BC, Wyona M. Freysteinson, PhD, MN, and Judith McFarlane, RN, DrPH, FAAN
Andrea Seay, RN, MS, PPCNP-BC, is Professor of Nursing, Lone Star College CyFair, Cypress, TX; Wyona M.
Freysteinson, PhD, MN, is Assistant Professor, Texas Woman’s University, Houston, TX; and Judith McFarlane, RN, DrPH, FAAN, is Parry Chair in Health Promotion & Disease Prevention, PI—Mother Child Study To Inform Practice & Policy, Texas Woman’s University, Houston, TX, and Visiting Professor, Aga Khan University, Karachi, Pakistan.
Keywords
Child abuse, child health
promotion, child rearing, concept analysis, parent–child relationship, positive parenting
Correspondence
Andrea Seay, RN, MS, PPCNP-BC, Lone Star College CyFair, Cypress, TX
E-mail: anbishop@twu.edu; abpnp@yahoo.com
AIM. While parenting has been researched and explored in both the
professional and public realms, elements of the current key constructs involving the positive parenting of a child are still missing. The aim of this article is to define the concept of positive or “good” parenting to further extend research toward child health promotion knowledge across disciplines.
METHODS. The Walker and Avant’s concept analysis method was
applied to this analysis.
SOURCES. Published literature and Google search on the worldwide
web.
CONCLUSION. This analysis provides a definition of positive parenting.
The key constructs found within this definition build a foundation for further research to develop measurable outcomes for positive parenting skills. These variables can also assist with research aims geared toward interventions to promote positive parenting.
Introduction
Positive parenting is a concept that may have far-reaching implications and should be adequately defined. Finding the key attributes of positive parent-ing may also hold the key to the possible prevention of child abuse. Child abuse is an unresolved problem and has serious consequences that range from an increased risk of behavioral problems, such as young criminal behavior (Prather & Golden, 2009), to the physical injuries and possible death of a child (Damashek, Nelson, & Bonner, 2013). While the numbers of chil-dren who were reported as victims of child abuse and neglect have declined from 716,000 in 2008 to 686,000 in 2012, child abuse and neglect continues to be a prevalent problem. In 2012, a nationally reported estimate showed 1,640 children died from abuse and neglect (U.S. Department of Health and Human Services, Administration for Children and Families, Children’s Bureau, 2012). Child abuse results in an aftermath of problems, including injuries, death, and/or long-term emotional and health difficulties
for adult survivors (Corso, 2012; Dalton, Greenman, Classen, & Johnson, 2013; Damashek, Nelson, &
Bonner, 2013; Prather & Golden, 2009; U.S.
Department of Health and Human Services,
Administration for Children and Families, Children’s Bureau, 2012; Widom, Czaja, Bentley, & Johnson, 2012). At an estimated consistent rate of approxi-mately 81% in 2009, 2010, 2011, and 2012, parents are the reported perpetrator of this type of abuse each year (U.S. Department of Health and Human Services, Administration for Children and Families, Children’s Bureau, 2012). U.S. statistics are utilized to illustrate the prevalent problem of child abuse and neglect. Sup-porting literature is included from both an interna-tional and interprofessional perspective to comprise a more universal definition ofpositive parentingfor child abuse prevention and for family health promotion research.
A “vulnerable child” is one who is dependent on another individual for basic needs and safety, as well as powerless over the condition of his or her environ-ment or circumstances (ACTION for Child Protection, Inc, 2003). Nurses have the ability to intervene and make a difference in the health and well-being of children by aiding parents with the appropriate skills and education to effectively parent their children. The most effective way to protect a child’s safety is to prevent abuse. The most common consequence of child abuse is often the resulting unhealthy adult, assuming that the child survives the abuse (Corso, 2012; Dalton et al., 2013; Prather & Golden, 2009; U.S. Department of Health and Human Services, Health Resources and Services Administration, Mater-nal and Child Health Bureau, 2011; Widom et al., 2012). Widom et al. (2012) conducted a prospective investigation of the physical health outcomes of abused and neglected children in a 30-year follow-up study. These researchers found that children who had suffered from sexual abuse had an increased risk of hepatitis C and oral health problems. Childhood neglect predicted increased hemoglobin A1C, oral health, and vision problems in adulthood. Adult sur-vivors of any type of child abuse were also at risk for unhealthy behaviors (such as smoking), mental health problems, lung disease, and malnutrition. Dalton et al. (2013) depicted the relationship and intimacy difficul-ties for the adult survivor of abuse. According to Corso (2012), our nation will suffer if a large number of abused children become unhealthy and potentially nonproductive adults who suffer from the physical, psychological, and/or sociological effects of abuse. Therefore, the prevention of child abuse should be a priority.
Negativeor badparenting is a primary cause of child abuse. To clarify, parenting is difficult. It is not an easy task. Parenting does not come with instructions. Awareness and teaching of positiveor good parenting can be achieved. Equipping parents with the necessary tools to engage in positive parenting as needed is a necessity to possibly prevent child abuse and its dev-astating effects. Some of the elements within the concept of positive parenting exist currently in pa-renting programs from Child Health Partnerships (Jayaratne, Kelaher, & Dunt, 2010), home visitation programs, and social service programs (Kendrick et al., 2000). However, a review of the literature did not reveal the existence of an instrument specifically designed for the measurement of positive parenting skills. The aim of this article is to create an applicable
definition of positive parenting in order to depict key constructs for the effective measurement of positive parenting outcomes, and to give a foundation for the development of future positive parenting programs to prevent child abuse.
Review of the Literature
The concept of positive parenting was explored through the relevant disciplines of education, nursing, sociology, psychology, and child health and develop-ment. Literature was reviewed in the databases of PubMed, PubMed MeSH, ERIC, Cumulative Index to Nursing and Allied Health Literature, SocINDEX, and EBSCO Host databases. Keywords used were positive parenting, parenting, tools, instruments, and education. There were 120 articles analyzed. Eighteen articles were included in the concept analysis. The inclusion criteria were the articles that included information pertaining to the measurement and/or definition of the key construct(s) of parenting or positive parenting. Articles that discussed child abuse prevention mea-surements, parenting styles, and/or parental risk factors were excluded. As these 18 articles did not contain concrete definitions of parenting, a Google search was also conducted by placingpositive parenting
and definition in the Boolean terms. This search ren-dered 1,350,000 results. Five applicable definitions were revealed and included from reputable and cred-ible sources. The inclusion of these definitions was limited to the first five pages of sources from the Google search in order to avoid redundancy.
Quantitative Research
Six of the articles from the literature review were quantitative research studies that evaluated how par-enting skills and/or the ability to form a bond with the child affected the parent–child relationship. Berry, Cash, and Mathiesen (2003) explained the values of the Strengths and Stressor Tracking Device
assess-ment tool through a literature review. These
mother. If the father was not romantically involved with the mother of the child, then the father did not bond with his child. The father did not display caring behaviors or form an attachment. Therefore, future research needs to focus on improved paternal
bonding with children whose parents are not
involved in a romantic relationship.
This relationship between parent and child was further explored with the remaining four quantitative articles discussed. These articles explored the effect of the relationship and communication of the parents on the health and well-being of their children. Marshall, Golley, and Hendrie (2011) utilized existing parenting tools to assess the relationship between parenting and child dietary intake. In a study of 93 children aged 4–13 years with their parent/caregiver, the findings supported the inclusion of strategies focused on the ability of parents/caregivers to change a child’s or children’s dietary intake. LeCuyer-Maus (2000) con-ducted a study on 60 mothers of healthy 12-month-old infants. Longitudinal data were collected when the infants were 12 months, 24 months, and 36 months of age. The findings suggested that a positive relationship between maternal sensitivity and responsiveness is linked with a teaching-based versus power-based limit setting. McKee et al. (2007) also examined the effect of a positive relationship on discipline/limit setting. The study evaluated 2,582 parents and their fifth- and sixth-grade children. The findings supported the value of parental warmth to lessen the severity of harsh discipline on the child or children. Last, a study on communication styles and the relationship quality of Latino (n = 90) and European (n = 20) mothers and
their teenage children suggested that positive mater-nal responsiveness was related to higher relationship qualities between the dyads. Findings support further research “for a broader definition of positive parent-ing” (Nadeem, Romo, Sigman, Lefkowitz, & Au, 2007, p. 154).
Qualitative Research
Qualitative articles were also reviewed to further explore the key attributes needed for the concept of positive parenting. Each article included information on the reasons why a person makes a choice to be a parent. Coulson, Oades, and Stoyles (2012) explored the concept of a callingto a parent, and explored the cultural, religious, and freewill standpoint of this
callingthrough 11 qualitative interviews with mothers
and fathers. The research supported how acallingto a parent was associated with positive outcomes in par-enting. The authors suggested future research should strive to enhance this concept in parents through interventions. In Inanda, South Africa, Meyiwa (2011) used a qualitative secondary analysis approach to evaluate how a person does not have to be a child’s biological parent in order to effectively parent the child. Participants of the study parented orphan chil-dren who were infected with human immunodefi-ciency virus (HIV) or acquired immunodefiimmunodefi-ciency syndrome (AIDS), and/or had a deceased parent due to HIV or AIDS. Findings showed that a strong sense of commitment to the well-being of the child correlated with participants’ ability to parent and to cope in par-enting. Davis-Sowers (2012) conducted a qualitative analysis of children being raised by an African Ameri-can aunt rather than by their biological parent(s). The total comprised 35 participants. Findings revealed several themes of deciding to parent: “perceptions of a crisis, fulfillment of family obligations, personal iden-tities, faith in God, gendered expectations, and the role of the Black aunt” (p. 231). All of the qualitative articles focused on how the strength of a parenting relationship from a nonbiological mother or father was correlated with a sense of commitment and/or a sense of acallingto parent the child.
Literature Review
quality parent–child relationship in every interaction and communication between the parent and the child, especially in adolescents.
Leon’s (2002) literature review also focused on the positive parent–child relationship. However, his focus was on the relationship between a parent and an adopted child. The review concluded that the strength of a parenting relationship is not deter-mined by a biological relationship. Jones, Zalot, Foster, Sterrett, and Chester (2007) added a further foundation to this premise with their literature review on the co-parenting relationships of single African American mothers. These findings suggested that children and mothers experience increased favorable outcomes when they are able to co-parent
with another adult (i.e., grandmother, father of the child, aunt, etc.).
Call to Action
Last, three papers selected for this analysis were calls to action due to the detrimental effects of nega-tive parenting, and targeted suggested methods for strengthening parenting skills for positive child out-comes. These calls to action were not limited to the United States, but also occurred in Russia and the United Kingdom. In the United Kingdom, Gambles (2010) explored the meaning of parenting with the
popular show Supernanny and the “Raymond
Wil-liams’ (1961, 1977) structure of feeling approach” (p. 698). He analyzed New Labour policy documents related to parenting, an interactive parenting Web site, the showSupernanny, and 23 interviews of first-time parents. Gambles’ analysis revealed that parenting skills are necessary for effective nurturing to occur and for the positive development of children. Kuchmaeva, Maryganova, and Petriakova (2009) evaluated the social policy on child rearing in Russia to monitor the “family’s upbringing potential.” Their evaluation revealed that the basis for the implementation of a family social policy is the health and well-being of the child and the outcome of a healthy adult. Schor (2003) reported on a task force for the family in a journal from the American Academy of Pediatrics. He called to action pediatricians, as they are the parent’s first call for help when there is a need or difficulty with parenting a child. Schor concluded that a child’s physi-cal health, emotional health, and cognitive functions are all related to the family’s health and ability to function successfully.
Methods
Walker and Avant’s (2010) method of analyzing concepts was applied to this concept analysis. The necessity of the concept of positive parenting was identified by the scarcity of literature containing an applicable definition of the concept and through the undeniable evidence of child abuse in our society. The prevention of child abuse and the health promo-tion of families can be achieved through positive par-enting education programs and/or a developed tool to measure the positive parenting skills obtained through this analysis. Through Walker and Avant’s applicable methodology, defining attributes, a model case, a borderline case, a related case, a contrary case, an invented case, an illegitimate case, antecedents along with consequences, and empirical referents were utilized to create a new definition of positive parenting.
Definition
An initial step in the evaluation of the concept of positive parenting was a review of the definition. Invest in Kids, a national organization in Canada, found that 30% of all children had social, emotional, or intellectual problems as a result of a lack of positive parenting. Kulkarni (2010), as a part of Invest in Kids, defined positive parenting through five defining prin-ciples: loving through warmth and nurturing, under-standingof a child’s temperament with flexibility of the child,reasonablewith clear limits and discipline, protec-tiveby providing a safe environment, ateacherthrough providing learning opportunities, and amodelthrough demonstrating appropriate behavior and knowing himself/herself. The Centers for Disease Control and Prevention (2014) does not specifically define positive parenting. However, the agency does offer “positive parenting tip” handouts for each specific age group that incorporate anticipatory guidance for safety, edu-cation, development, and the establishment of a caring and understanding relationship with one’s child. Posi-tive parenting was defined in Europe as:
behaviour, setting clear rules, taking time to listen, working as a team, and of course, using positive
disciplining instead of physical punishment.
(Daphne, 2009)
Positive parenting definitions from national organiza-tions included key concepts such as teaching, under-standing, leading, listening, providing safety, and giving clear and consistent discipline while respect-ing the child (Centers for Disease Control and Prevention, 2014; Daphne, 2009; Kulkarni, 2010). Through the incorporation of the above definitions with a review of the literature, Walker and Avant’s (2010) process for concept analysis to develop a more applicable definition was applied to the concept of positive parenting.
Defining Attributes
To contribute to the defining attributes of this concept, it is important to note the interchangeable terms ofparenting,caretaking,mothering, andupbringing
found in the literature review. Another important consideration is that many persons identified as parents of the child were nontraditional parents. The traditional two-parent household consisting of a bio-logical mother and father was not always the norm.
The literature suggested that adoptive parents
(Meyiwa, 2011), aunts (Davis-Sowers, 2012), other extended family members (Jones et al., 2007), gay/ lesbian couples, or stepparents may also be good parents (Schor, 2003).
Numerous terms are applicable to the concept of parenting, and many variations of who may be a parent exist. In order for any parent to engage in positive parenting, the parent must display an interest in the child and must maintain a continual relation-ship with the child. This relationrelation-ship is one of the defining attributes of parenting. Leon (2002) stated that the parenting relationship with the child is “ulti-mately arbitrated by the child’s attachments rather than the priori pre-eminence of biological parent-hood” (p. 659). A parent who is unable to have this relationship is at risk for negative parenting, which may lead to child abuse. As a preventive measure, the health promotion of positive parenting should be addressed. The defining attributes of positive parent-ing, as determined from the literature, are that the parent must have a relationship with a child that embodies the following characteristics:
Caring
Care for the child in a responsive relationship sym-bolizing attachment (Bentley et al., 2011; Gavin et al., 2002), love (Davis-Sowers, 2012; Jones et al., 2007; Kuchmaeva et al., 2009), compassion (Duncan et al., 2009), warmth (Kulkarni, 2010; McKee et al., 2007; Schor, 2003), and affection (LeCuyer-Maus, 2000).
Leading
Lead the child by setting developmentally appropri-ate boundaries or limits with discipline (Berry et al., 2003; Davis-Sowers, 2012; McKee et al., 2007; Schor, 2003). This was also labeled in the literature as shaping, modeling (Marshall et al., 2011), and regulating a child’s behavior (Duncan et al., 2009; Kulkarni, 2010).
Providing
Provide by giving the child adequate food (Marshall et al., 2011; Walker & Kirby, 2010), shelter (Kuchmaeva et al., 2009), hygiene, medical care, and financial support (Gavin et al., 2002; Meyiwa, 2011) within a safe environment (Berry et al., 2003; Schor, 2003).
Teaching
Teach by providing developmentally appropriate activities and play (LeCuyer-Maus, 2000) for cognitive stimulation (Gavin et al., 2002), appropriate expecta-tions for learning activities (Kulkarni, 2010), socializa-tion with friends (Kuchmaeva et al., 2009; Schor, 2003; Walker & Kirby, 2010), and the child’s atten-dance at school (Jones et al., 2007).
Communicating
Communicate with the child through verbalization (Gavin et al., 2002), active listening (Duncan et al., 2009; Kulkarni, 2010), and respect (Nadeem et al., 2007; Schor, 2003).
Model Case
Lisa has a continual relationship with her 5-year-old daughter, Mikayla. Her caring is evident when she embraces Mikayla before leaving her each day at school. She provides for Mikayla by ensuring she has sufficient food, a safe environment, is well groomed and neatly dressed, and has appropriate medical care. Lisa also leads Mikayla by acting as a role model for her daughter by modeling appropriate behavior. This is further accomplished as she provides Mikayla with a consistent set of boundaries and with developmen-tally appropriate consequences when necessary. She teaches Mikayla by reading developmentally appropri-ate books, providing her socialization through her peers, and being actively involved in her learning activities. Lisa also communicates with her daughter in a responsive manner through both nonverbal and verbal communication, allowing Mikayla to feel lis-tened to and respected as a child. The model case includes all of the defining attributes of parenting: having a relationship with the child that includes caring, leading, teaching, communicating, and provid-ing for the child.
Borderline Case
A borderline case, on the other hand, contains many but not all of the attributes of the concept of study (Walker & Avant, 2010). The following is an example: Lisa displays a loving relationship with her 5-year-old daughter, Mikayla. She cares for her through her loving attachment, as seen by her gentle embrace each day prior to dropping Mikayla off at school. Lisa pro-vides learning opportunities through school and socialization activities with Mikayla’s friends. Lisa allows Mikayla to do whatever she pleases because she loves her so much. This includes playing in the street unsupervised, hitting her friends when she is angry, and eating whatever she wants. Lisa communicates with Mikayla in a loving manner, and provides food and shelter, and ensures Mikayla is always well groomed and neatly dressed. This meets the attributes of a loving relationship that embodies caring, commu-nicating, and providing. However, the breakdown in the borderline case occurs as Lisa fails to lead her child by appropriate discipline with boundaries and by failing to provide a safe environment.
Related Case
A related case is similar to the concept. However, it lacks many of the defining attributes (Walker & Avant,
2010). Parenting and caretaking are two related con-cepts that are similar, but differ. Caretaking may involve the care of any individual, regardless of age or relationship. It also does not involve the same defining attributes as parenting. The following is an example of this related concept:
Susie cares for her elderly mother, Dawn. She loves her mother, which is why she provides food, shelter, medical care, and a safe living environment. Susie communicates with her mother in a loving manner both verbally and nonverbally. When her mother feels the need to talk, Susie listens to her patiently and without judgment. While caretaking is a similar con-cept to parenting, it is different in that it does not involve the care of a child with the additional attri-butes of leading and teaching.
Contrary Case
A contrary case is a very clear example of what the model case is not (Walker & Avant, 2010). An example of a contrary case is an actual case found utilizing a Google search withchild neglectas the search term. The contrary case is based upon the story of a young girl named Danielle in the Tampa Bay Times (DeGregory, 2008):
She lay on a torn, moldy, mattress on the floor. She was curled on her side, long legs tucked into her emaciated chest. Her ribs and collarbone jutted out; one skinny arm was slung over her face; her black hair was matted, crawling with lice. Insect bites, rashes and sores pocked her skin. Though she looked old enough to be in school, she was naked – except for a swollen diaper. The mother’s statement was: “I’m doing the best I can.”
This is clearly not a case of positive parenting. The parent did not have a relationship with the child that included any degree of caring, teaching, communicat-ing, providing for, and leading the child.
Invented Case
An invented case consists of taking the case out of its ordinary context into an invented one (Walker & Avant, 2010). The following is an example of an invented case of positive parenting:
through various learning activities. Robots can also communicate with your child verbally and non-verbally. Although robots cannot actually listen, your child will not know the difference. Your child will also have a real relationship with your robot. This is the solution to “actual” parenting. Robots can be a time-saver so you can do all the things you had sacrificed prior to this innovative invention. This case represents positive parenting; however, it is not with a parent. Therefore, it is an invented case.
Illegitimate Case
In an illegitimate case, the concept is used incor-rectly and its meaning is distorted (Walker & Avant, 2010). For example, Dan loved his 4-year-old daugh-ter, Elizabeth. However, he did not always agree with how her mother parented her. Dan felt her mother was not a good leader and did not discipline her enough. As Elizabeth approached her dad, she held her head down, wringing her hands, as she whis-pered, “Hi, daddy.” He told her mother, “See, she respects me. That’s called parenting.” Dan felt he exhibited good or adequate parenting by being a harsh disciplinarian. However, this is not what posi-tive parenting entails. It encompasses a loving rela-tionship between the parent and the child. This relationship is one where the child feels cared for by her father, while he shapes her behavior with positive reinforcement and modeling ideal behaviors. On the contrary, harsh discipline does the opposite and creates fear through negative reinforcement. This is an example of positive parenting used out of context and is an illegitimate case.
Antecedents and Consequences
The antecedents of a case must be present in order for the concept to occur (Walker & Avant, 2010). The antecedent of positive parenting is a relationship between two or more people where at least one person is in the role of a parent and at least one individual is in the role of a child, regardless of age. According to Walker and Avant (2010), a conse-quence is an event or incident occurring as a direct result of the concept. Dumas, Lawford, Tieu, and Pratt (2009) indicated that a consequence of positive parenting is the emotional health and well-being of a young adult.
Empirical Referent
An empirical referent for the concept is an “actual phenomena that by their existence or presence dem-onstrates the occurrence of the concept itself” (Walker & Avant, 2010, p. 168). Empirical referents for the concept of positive parenting include the following:
1. A parent–child relationship that is “responsive to child’s needs and feelings and combines warmth and thoughtful, firm limit setting consistently over time” (Schor, 2003, p. 1567).
2. Children have developmentally appropriate oppor-tunities for socialization, learning, and play (Daphne, 2009).
New Definition
A new definition of positive parenting was created through a careful review of the existing literature and through a concept analysis utilizing Walker and Avant’s (2010) format. The definition is as follows: Positive parenting is the continual relationship of a parent(s) and a child or children that includes caring, teaching, leading, communicating, and providing for the needs of a child consistently and unconditionally. In the current literature, the instruments that exist for parenting program outcome measurement identify that at least one of the key constructs within this new definition must exist. For example, one article dis-cussed the necessity ofprovidingnutrition for the child (Bentley et al., 2011), while another article depicted
the importance of communicating with the child
(Nadeem et al., 2007). There were also several studies that concentrated on the importance of a positive rela-tionship with the child (Duncan et al., 2009; Leon, 2002; Walker & Kirby, 2010). However, in order for an instrument to effectively measure positive parenting skills, all of the key constructs within this relationship found in the new definition should be addressed.
Conclusion
positive parenting skills. This may be achieved by developing a method of measuring the key constructs of caring, teaching, leading, communicating, and pro-viding found within the new definition. Parents who are educated and skilled in the key constructs of posi-tive parenting may still fail to exemplify these con-structs at all times. This does not mean that the parent is abusive. However, parents must strive to meet the key constructs of positive parenting at all times in order to avoid becoming potentially abusive to their child or children and causing devastating effects. Negative parenting, the inability to have a relationship with a child or children that includes the key con-structs of positive parenting, is one of the root causes of child abuse. Providing parents with education on how to engage in positive parenting combined with the ability to measure these outcomes with a devel-oped instrument will provide the tools necessary to reduce and/or prevent child abuse.
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