This document provides a summary of Kathryn E. Barnard's parent-child interaction model. It discusses Barnard's background and credentials in maternal healthcare. The model proposes that a child, mother and environment interact in overlapping systems that influence each other. It is applicable to research through studies examining interactions under stressful conditions and the impact of socioeconomic factors. In practice, it guides assessment using Barnard's Feeding Scale to identify risks and provide preventative care through encouraging positive communication between mothers and children. The model focuses on maternal healthcare but its generalizability is unclear for other caregivers.

1. Running head: THE PARENT-CHILD INTERACTION MODEL
1
THE PARENT-CHILD INTERACTION MODEL
2
The Parent-Child Interaction Model
Student Name
Florida National University
Abstract
The present paper provides an analytical review of Kathryn
E. Barnard’s parent-child interaction model. The purpose is to
define the main concepts of the discussed theory and identify its
connection to the author’s credentials. Moreover, the goal is to

2. explore applicability of the parent-child model within maternal
health care setting by defining its contribution to the research
and practice in nursing. The given analysis bases on the recent
studies that provide conceptual insights developed by Barnard.
In particular, this paper discusses the applicability of Barnard’s
Feeding Scale. Moreover, it derives examples from studies of
mother-child interactions at early childhood under stressful
conditions of the repetitive separation and reunion. In addition,
the paper provides examples obtained from a study that focuses
on adapting to environmental factors while developing maternal
identity. It is detected that Barnard’s parent-child interaction
model has considerable implacability for in the planes of
research and practice.
Key words: Barnard’s parent-child interaction model,
adaptation, maternal identity, Barnard’s Feeding Scale, maternal
healthcare.
The Parent-Child Interaction Model
Introduction
Kathryn E. Barnard was the person who developed the
parent-child interaction model in 1978. This model emerged as a
result of Barnard’s scholarly and practical performance. In other
words, this scholar had strong credentials in the field of early
child development. Specifically, Barnard has received her
master’s degree in nursing along with the certificate of
Advanced Graduate Specialization in Nursing Education
(Masters, 2015).This was the first step to becoming a teacher of

3. nursing. After graduation, Barnard became a teacher of maternal
healthcare. To be more precise, she specialized in child and
mother healthcare.
The parent-child interaction model suggests the three
planes: a child, a mother, and the environment; beginning from
the woman’s pregnancy, these three fields overlap and influence
one another. In order to ensure successful interaction within
these overlapping circles, mother needs to modify constantly
her mentality to meet and cope with the changes and challenges
of the other planes. The same refers to a child: the process of
development means the need for constant adjustment and re-
adjustment (adaptation) to external stimuli. Simultaneously with
the development of a child’s psyche, it is necessary to adjust his
or her internal stimuli to the external factors. However, this
process is ongoing and highly volatile due to constant
accommodation to the variables that alter within the time.
Reviewing parent-child-environment interactions, one
should stress that the plane ‘parent’ refers to a concept of a
caregiver in general. In other words, there are cases, when
interactions between a child, environment, and a parent include
a father or other significant person as the main care-giver.
Hence, it is clear that in the prevailing majority of cases, this
model implies interaction between a child and a mother.
According to the discussed theory, the interaction of these three
systems depends on the unique characteristics of each plane. To
be more precise, Kathryn E. Barnard educates that the main
characteristics of a child “include physical appearance,
temperament, feeding and sleeping patterns, and self-
regulation” (Masters, 2015, p. 274). At the same time, the
important assets of a care-giver include a range of bio-psycho-
social qualities that are being constantly changed to adapt to a
child’s needs and environmental factors, simultaneously causing
a child’s system to accommodate accordingly.
Finally, the environmental factors include socio-economic
factors (financial well-being, social roles, educational
healthcare establishments, religion, politics, cultural events,

4. etc.). The role of a nurse is to help a mother set realistic
expectations, develop a positive maternal identity, and connect
to benevolent environmental factors. This complex purpose
prepares favorable conditions for healthy child’s development
and growth, provides a care-giver with pleasure from parental
interactions, and delivers healthy members to social
environment.
Relevance
Personal Relevance
Striving to continue ongoing improvement of professional
skills, this scholar headed a research project that was aimed to
develop the method of assessment of early childhood
development and well-being. In overall, Barnard participated in
22 scientific studies (Masters, 2015). Further, she would
become a professor in child-parent nursing. Scholarly activity
strongly related to collecting practical evidence. In particular,
the scholar provided consultations, conducted public lectures,
and released a number of academic publications that related to
the maternal healthcare and early child development (Masters,
2015). In addition, she was working with mentally impaired
children, which resulted in gaining considerable experience
from delivering patient-centered care. Barnard acquired enough
first-hand evidence to make an assumption about the importance
of child-mother-environment interactions (Masters, 2015).
Further, that assumption turned into conceptual patterns that
took a place in the field of nurse science as the theory of
parent-child interaction.
Relevance to Healthcare and the Client Discussed
The name of the theory itself implies the population that
Barnard addressed. The parent-child interaction model functions
to deliver patient-centered and evidence-based maternal health
care as well as ensures that early child development occurs at a
normal rate in positive conditions. In order to provide a
particular example showing how this scientific theory serves the
purpose of collecting the new evidence about mother-child
interactions, and according to these observations, increases the

5. quality of maternal healthcare, one should refer to the Barnard’s
Feeding Scale (BFS). Beel-Bates et al. (2012) conducted a study
that aimed at tracking mealtime interactions between a care-
giver and a child. To measure the level of development of
maternal identity and its relevance to the stage of a child’s
growth, the scholars applied to the Barnard’s Feeding Scale.
BFS is a tool that was elaborated to collect evidence about
caregivers’ verbal and non-verbal responses to a child’s
mealtime behavioral patterns. For example, these reactions
include facial mimics, gestures, posture, language, and signs
that a care-giver performs while feeding a child. Beel-Bates et
al. (2012) assume that it is possible to interpret the reactions as
the indicators of the internal elements in a parent’s system.
Thus, obtaining this data is essential for understanding the
patterns of interaction between a mother and a child.
Applying to the parent-child interaction model, BFS can be
useful for learning the system of a mother. One may utilize this
knowledge in order to make several important assumptions.
Firstly, it indicates to which extent the maternal identity is
evolved. Secondly, “parent–child interaction has been found to
be a bidirectional system where both partners are shaped by
each other’s state and signals” Guo et al. (2015, p. 258). Thus,
this data suggests the kind of impact, which a child’s system
makes on a care-giver. Thirdly, this information helps making
an approximate prognosis about the future development of
parent-child interactions. Consequently, BFS is a valuable
instrument that is important in anticipating potential health
problems related to the defects of a care-giver’s adaption to the
environmental circumstances and the needs of a child.
Moreover, it is possible to mitigate already existing issues. In
this regard, one can use the theory of parent-child interaction as
a theoretical background to create the new conceptual patterns
in accordance with the evidence obtained while utilizing BFS.
This example illustrates the significance of Barnard’s parent-
child interaction model and its appropriateness to nursing, in
particular, in a maternal healthcare setting.

6. Application to Research and Practice
It is possible to characterize Kathryn E. Barnard’s parent-
child interaction model by great implacability. One example is
the study of meal-time interactions between a child and a care-
giver conducted by Beel-Bates et al (2012), which was depicted
below. Another example of implacability is the research of Guo
et al. (2015) who studied positive and negative interactions
between a mother and a child in stressful situations. In early
childhood, separation from the main care-giver is an extremely
stressful event. The same concerns the process of reuniting,
especially when one of the participants reacts with the hostility,
rejection, or indifference (Guo et al., 2015). Utilizing parent-
child model as a background, the researchers identified that
long and frequent separations between a mother and a child
resulted in the disrupted concept of parenting. In addition, such
inconsistency in the availability of the attachment figure
stipulated the development of coping mechanisms in a child that
might have negative implications if being applied to other
individuals. Moreover, such interactions strengthened the
feeling of insecurity, which had a negative impact on a child’s
self-concept. These examples illustrate applicability of the
discussed theory to the research.
It is possible to depict the applicability of a parent-child
interaction model to practice referring to the study by Vallotton
(2012). Valloton explored the impact of environment on the
parent-child interactions. The study reveals that socio-economic
position is linked to the quality of mother-child communication.
In particular, it affects maternal identity, which forces a child to
adapt to the mother’s attempts of adjusting her inner
disturbance to the environmental factors and child’s
characteristics. Vallotton (2012) educates that the care-givers
who belong to vulnerable population (the poor) perform less
verbal and non-verbal communication with offspring. This fact
may result in the retarded development of children, predefine
emergence of cognitive and emotional issues, deteriorate
relations between a child and care-givers, as well as between a

7. child and the society.
This research complements the study of a parent’s verbal
and non-verbal responses during the process of feeding a child
because it adds the variable of the environment system to the
studied interactions between a child’s and a care-giver’s
systems. In practice, the healthcare professionals utilize this
insight to detect the risk group for acquiring defecting parental
identities and apply them to preventive care by conducting
educational intervention. For example, to encourage richer
positive emotional expression, a nurse may perform
inspirational conversations with a mother. In this way,
implementing the parent-child interaction model can help a
client gain parental identity, which will also have a positive
impact on a child.
Summary
Strengths
The strength of the parent-child interaction model is that it
is in compliance with the today’s patient-centered approach of
delivering care. Specifically, it is focuses significantly on the
targeted population, namely maternal health-care (care-givers’
and children’s bio-psycho-social well-being at early stages of
development (up to three years)). Moreover, this theory is clear
and concise (Masters, 2015). Thus, Barnard’s model is easy to
comprehend and adapt to the daily nurse practicing. According
to the information provided in this paper, this theory is
characterized by high implacability both in research and
practice.
Limitations
Despite a good focus on maternal healthcare, it is difficult
to decide whether this theory is workable in other strongly
related settings. The parent-child model focuses on “child-
mother-environment interactive process” (Masters, 2015, p.
275). The name of theory and assigned purpose lead to a
confusion regarding the population, to which it can be
generalized. In particular, it is dubious if this model is
applicable to a father, or other significant person who maintains

8. a role of the main care-giver. In case it is possible, one may
assume that there are differences in attitudes and interactions.
Thus, preventive interventions should differ from those applied
to the mother-child interactions.
References
Beel-Bates, C., Stephenson, P. L., Nochera, C. L., & Rogers, J.,
F. (2012). Caregiver-resident interaction with Barnard's feeding
scale. Research in Gerontological Nursing, 5(4), 284-93.
Guo,Y., Szu-Yun Leu, S., Barnard, K. E., Thompson, E. A., &
Spieker, S. J. (2015). An examination of changes in emotion co-
regulation among mother and child dyads during the strange
situation. Infant and Child Development, 24, 256-273.
Masters, K. (2015). Nursing theories:A framework for
professional practice (2nd ed.). Massachusetts, MA: Jones &
Bartlett Learning.
Vallotton, C. D. (2012). Infant signs as intervention? Promoting
symbolic gestures for preverbal children in low-income
families supports responsive parent–child relationships.
Early Childhood Research Quarterly, 27, 401– 415.
1

9. Running Head: NURSING THEORY
Annotated Bibliography
Yitsy Serrano
Florida National University
Deborah Crѐvecoeur, DNP, FNP-BC, ARNP
Nursing Theory
.
Part 1
Pirani, Shahina Sabza Ali. (January 6, 2016). Application of
Nightingale’s Theory in Nursing Practice. Annals of Nursing
and Practice. 3(1): 1040. Retrieved from
https://www.jscimedcentral.com/Nursing/nursing-3-1040.pdf
As the title suggests, this article focuses on applying
Nightingale’s Environmental Theory in nursing practice.
Nightingale’s theory focuses on the environment. The author
claims that theories guide nursing practice by providing a model
for a body of knowledge. This article has examined a clinical
case of Chronic Obstructive Pulmonary disease through
Florence Nightingale’s Environmental theory that focuses on
various aspects of the environment such as light, ventilation,
noise, hygiene, bedding, food and personal cleanliness. Major
assumptions of this theory include natural laws, the idea that
people can become perfect, nursing as a distinct aspect of
healthcare and providing nursing care by altering the
environment that requires education. Nightingale believes that
if the environment of the patient is modified according these
canons, it speeds up recovery. Nightingale has offered a base to

10. provide holistic care to patients and this theory can be applied
today to improve nursing practice. However, people need to be
educated at clinical and community level about basic
environmental hygiene.
Kamau, S & Rotich, R. (August 2015). Application of Florence
Nightingale’s Model of Nursing and the Environment in the
management of Multiple Drug Resistant Tuberculosis Infected
Patients in the Kenyan Setting. Open Access Library Journal.
Retrieved from
https://www.researchgate.net/publication/280882235_Applicatio
n_of_Florence_Nightingale%27s_Model_of_Nursing_and_the_E
nvironment_in_the_management_of_Multiple_Drug_Resistant_
Tuberculosis_Infected_Patients_in_the_Kenyan_Setting
Theories aim at guiding nursing practice. The Heartland
National Tuberculosis Center states that it is challenging for
nurses who are new to Tuberculosis control and prevention to
provide care to patients. A gap between nursing theories for
practice as taught in the classroom and actual nursing practice
was observed. This study aimed to determine if Nightingale’s
theory can be applied to nursing care of drug resistant
tuberculosis infected patients in Kenya. Nurses who work in
resource limited settings have been using the medical model
that could not respond to several of their issues associated with
the care of tuberculosis infected patients. According to
Nightingale’s Theory of Nursing, nurses can alter the
environment of patients to provide the best conditions for
healing. The basic concepts in the theory are ventilation, clean
water, drainage, cleanliness, light, nursing aid, manipulation of
environment and nursing observation. Nursing theories form the
base of evidence-based practice in today’s world thus nurses in
Kenya too should adopt a theory. This study is a review which
applies Nightingale’s theory of Nursing on drug resistant
tuberculosis infected patients in Kenya. Data collection is an
important aspect of a research study because it allows
researchers to test hypotheses and determine outcomes. Data
collection methods may differ but honesty and accurate

11. collection remain significant. It has been found that
environmental changes such as ventilation, quarantine and
proper administration of drugs improved the health of
tuberculosis patients. Authors have concluded Nightingale’s
nursing theory guides nursing care for patients with drug-
resistant tuberculosis for improving nursing practice and quality
of care.
Medeiro, A.B, Enders, B.C & Lira, A.L.B.D. (July/September
2015). The Florence Nightingale’s Environmental Theory: A
Critical Analysis. Anna Nerry School Journal of Nursing. 19:3.
Retrieved from http://www.scielo.br/scielo.php?pid=S1414-
81452015000300518&script=sci_arttext&tlng=en
This is a theoretical and reflective study which aims to examine
the environmental theory of Florence Nightingale according to
Johnson and Webber’s model. According to this theory, the
environment needs to be balanced to prevent disease or to speed
up the healing process. She stresses that the environment must
be maintained to facilitate healing and living processes such as
cleaning, ventilation, heat, light, noise, smell and food to ensure
recovery. Theory is analyzed on the basis of boundaries,
meaning, concepts, and development of propositions,
assumptions and knowledge for explaining and predicting
concepts that influence nursing practice. Authors have
concluded that the theory has presented clear meaning of ideas,
clear boundaries, 90 percent understanding, fundamental ideas,
developed ideas, hypothesis and variables for understanding and
explaining propositions. Therefore this theory can be applied to
improve the practice of nursing by changing the environment.
Part 2
Nightingale’s Theory of Nursing focuses on altering the
environment to improve patient outcomes. However, people
need to be educated regarding the application of this theory. I
believe Nightingale’s nursing theory will have a strong
influence on my nursing practice. Since I am interested in
family nursing therefore I will be working with families and
communities. Therefore, I will need to understand the

12. environment of patients and the community on the whole to
ensure their well-being. For instance, the biggest issue is
pollution in cities therefore for asthmatic patients; I would
recommend moving to suburbs if the symptoms are too severe or
modify their surroundings in their homes such as removing
carpets or pets and opening windows for ventilation. I will
record the medical history of patients and recommend
modifications according to the nature of their disease. During
the patient’s stay in the hospital, I will observe the influence of
the environment on the patient and create a plan that the patient
will be encouraged to follow after being discharged from the
hospital. This plan will include the use of transportation, eating
and sleeping habits etc. I will educate people about the
influence of environment on their health and how it can be
modified to promote wellbeing. I believe that the application of
this model to nursing practice will allow me to deliver quality
care to people.

13. SCHOLARLY PAPER (30% of final grade)
GUIDELINES: Each STUDENT will hand in one formal paper
about a nurse theorist and the theory. The paper is to be a five
to six (5-6) pages total (double-spaced, 12 font, 1 inch
margins). Papers submitted longer than 6 pages (excluding
references and cover sheet) will not be read. Please less than 15
persent of similarity. It will go thru turning to check plagiarism.
Follow APA guidelines for a cover sheet, headers, pagination,
references, etc.
Use APA format and label each section using the evaluation
outline below.
The criteria guidelines below will be used to evaluate your
paper. Each paper will graded on a 100 point scale.
Components of the Paper and possible points
SECTION
POINTS POSSIBLE
Introduction
• Identification of theorist including
10
a brief background of the theorist
Analysis of basic components/concepts
and major relationships in the theory.
• I suggest you use the two peer reviewed/research
references from your annotated bibliography and
30
perhaps another secondary source from one of
your texts about a selected nursing theorist.
• You must have a minimum of 3 references from

14. nursing literature (only one from a secondary
source/text) to support your discussion in this section.
Relevance
a. Personal relevance of any of the author described
(connect the theorist to the theory)
30
b. Relevance to healthcare and the client discussed
c. Application to research and/or practice provided
Summary
• Include theory strengths and limitation in the
20
summary
Format 10
• Precise APA style and professional writing
Total: 100