Nursing: Family Centered Care

Introduction

The information should be accurate between the patient, family members, and the care providers to ensure that quality service is offered.

The care providers need to learn about family background and culture and traditions. This will enable them to create a conducive environment for the health care workers

Much attention can be given to patients in critical conditions if they are near their family members. They will also enjoy the freedom to follow their taste and preferences unlike in hospital-based care where the management determines the diet

It will also enable the care providers to identify the possible barriers that can hinder effective service delivery

It is different from the traditional health care system in that it involves both the patient and the family in deriving a solution to the medical problem (Sisterhen et al 2007, p2).

Literature review

The practice of FCC ensures that both the patient and family are considered as the units of health care (Mitchell, Burmeister, and Foster 2009, p3). The health assurance and well-being of the patients in a critical care environment are affected by the good relationships obtained through the partnership between the family and the professionals.

The strengths, culture, and traditions in a given family will directly impact how a patient relates to the family

These barriers could be those that prevent the patients and families from enjoying such services. They could be those preventing the care providers from effectively delivering their services, e.g. a strange culture and tradition

Sharing the information among the family, the patients, and the professionals will enable health assurance since an appropriate resolution can be made that suits everyone.

The care given under partnership will help reduce the burden that would be put on the health care providers.

There is a need to outline the kind of care that is to be given to the patient and give a description of the delivery process

There is also a need to examine the possible interventions that can be made to meet the needs of both the patients and their families

Family-centered care should be given the necessary precautions to achieve its desired objective. A well-delivered FCC shall ensure that the intended quality services are given to the patients and their families.

Fundamentals of FCC philosophy

There are various key elements of Family-centered care (Cooley & McAllister 1999, p120). The elements can be broadly grouped into these three categories. These are the fundamental principles that govern an effective family-centered care practice. Each of the parties involved should respect and recognize the roles that each has in providing the needed care ( Marshall et al 2002, p2). There should be no overdependence on one party and neither should a party, particularly the staff, consider it wrong for the other to be involved.

The information on the medical history of the patients as well as the economic needs of the family will greatly affect the course of treatment to be provided. Such information should therefore be welcomed by the hospital staff and the family should also be willing to provide it

The care, especially in an ICU environment, should be considered a collective responsibility that requires the services of both parties.

Learning Model

The learning model outlines how the learning process shall be conducted and what is required of the instructor and the learner

The learners should understand the necessities in a learning environment and ensure that they comply with such provisions.

The Adult Learning Theory

The Adult Learning Theory assumes that the learners are very mature people, and who have gained some knowledge in the past. The basics are therefore not very necessary

Interactive learning enables the instructor to identify what the learners are not getting correctly and make clarification appropriately.

The adult learners often have other engagements and it will be very necessary that the learners, as well as the instructor, keep time.

There is a need to have penalties for non-compliance with the learning principles like time management. Specify the consequences of lateness and stress on the dangers of being a passive learner

Interventions to Meet the Needs of the Patients

A patient in a critical condition may lose the courage to ever get better. Words of encouragement from the family members may not sound like truth to such a patient who may have been bedridden for long or underwent amputation in the leg. The nurses are responsible for restoring this lost confidence in the patients

In a situation where there are conflicts in the course of action to be taken about the patient’s care, the nurses should have an upper say to protect the patient. This is because they understand the physiological needs of the body better than the families do

Interventions to Meet the Needs of the Families of the Patient

An important need by the family that should be addressed is the assurance that their patient would recover (Gavaghan & Carroll 2002, p3). The nurses should help the families in identifying their strengths and weaknesses and the possible causes of barriers that can be encountered in providing FCC services. The next move is to assist them to develop these strengths while attempting to alleviate the weaknesses

The assessment of how the family understands the physiological and physical bodily mechanisms will enable the nurses to make an appropriate decision in response to the information that is obtained from the family.

The family of the patient is often interested in knowing the condition of the patient and whether an improvement is recorded or not Gavaghan & Carroll 2002, p3).

Teaching the family the normal physiological functioning of the body will enable them to make an informed decision. They shall be taking a course of action whose purpose and ultimate consequences are well known to them.

The family members should be aware of the important role that they should play in ensuring that their patient receives quality care services.

The beliefs and culture in a given area can affect the people’s perception of the practice of FCC. The nurses should therefore examine such cultural practices and educate the families on the dangers of being stuck to them, especially in a situation that requires crucial medical attention.

Barriers to the Family-Centered Care

The delivery of family-centered care has several challenges that it faces and still allows for the adoption of the traditional system of care. Some of these obstacles stem from within the healthcare center while others are from the families of the patients

The factors could be obstacles to either the professionals who would wish to provide quality services or to the patients and families who would want to obtain the quality services.

Barriers to the patient and family

In practicing family-centered care, there may be a resolution that the family members be close to the patient if the latter has to be hospitalized. The space that is available in the hospital may not allow for that, hence this shall be a barrier.

The infrastructural facilities in the hospital, as well as the entire region, will greatly affect the delivery of family-centered care services. If the patients are being nursed at home, poor conditions of the roads may not allow the professionals who have limited time to assess the patients’ progress effectively. Other facilities like water and electricity will greatly affect the necessary care given to the patients, especially in critical conditions.

Some professionals find it professionally unethical to involve the opinions of the patients and their families in addressing the issues that concern the patient’s health. The patients and family needs will thus not be considered in decision making posing challenges to an effective FCC

The patients and families are maybe not aware of the need to have such a kind of care system. They then adopt the traditional system that it is the professional who knows what to do and should be fully responsible for the steps to be taken.

They may also be unaware of the services even though they may be practiced in a given center.

Lack of enough resources in the patients family can be of absolute threat to effective family-centered care

Barriers to the Professionals

The ratio of physicians to patients is growing smaller and smaller with the increasing number of patients that need attention. The average physician time per patient is thus a scarce resource that may not allow for family-centered care. Financial constraints may also not allow for the physicians to effectively deliver the services at home.

Barriers on the Professionals Cont’

A care provider would be positively willing to practice FCC, however, if such a program is not supported by the management then the professional may not effectively deliver the services. It is the responsibility of the management of a health institution to ensure that such services are instituted and supported

The nurses should be conversant with the cultural beliefs and practices in a given community from which the patient hails. Some communities do not believe in medical treatment. An important guideline is to help the family and patient understand and appreciate the effectiveness of health care systems (MacDougall 2007, p1)

A care provider may fail to collaborate with a given family due to the conflicting cultural beliefs and practices that exist between them

The data about the lab results, admission and discharge dates, and chart reviews are not easy to keep in practice family-centered care. This will eventually pose a problem when attempting to evaluate how such practices progress to make the necessary improvements.

Creating Conducive Environment

Creating a conducive environment for the delivery of family-centered care is mainly concerned with the management of the health institution. They are the interventions that the staff need to make to ensure the effective delivery of FCC (Bowden & Greenberg 2009, p10) They need to have a positive attitude towards the service.

They should do away with what is referred to as ‘latent conditions’ characterized by the poor environment with the administration not intending to make changes (Reiling, Hughes & Murphy n.d, p1).

The expansion of accommodation facilities will allow for more members of the family to be present at the patient’s bedside when there is a need for it.

Alternating the visiting hours will also allow for more members of the family to be present at a patient’s bedside during the visiting time.

The family members who are accommodated to support their patient should be provided with incentives to make him feel at home. Involvement in the activities like sports will enable the family to overcome the stress of nursing their beloved member

The conferences shall enlighten the family on the health matters and enable them to make an informed decision concerning their patient’s needs.

Consistent means of communication will ensure that the family and the hospital are in touch all the time. Any emergency case can then be dealt with immediately.

The family needs to be introduced into the institution. They should be made to feel part of the institution for whatever period it will turn out to be.

It is important to understand that the families that shall be met come from different cultural backgrounds. The nurses should be conversant with the cultures and allow them as long as they are consistent with the regulations of the institution on such issues. Religious culture should not be discouraged since a kind of divine intervention is often required in a critical health condition

It is however important to note that some families may have uncontrolled emotions that may distort the whole practice if they are tolerated (York 2004, para8).

The independent body will easily identify the needs of the family and advise the hospital on the necessary course of action

Expansion of the hospital staff will increase the time that a nurse will have for each of his/her patients.

Evaluation of Family-Centered Care Practices

Evaluation of how the practice of Family-centered care is necessary after such a system has been adopted (Hanson & Randall, 1999, para.1).

It is an integrated process that requires drawing information from various sources and involving the families with ICU patients. The information should be drawn from different sources and over a long period.

The purpose for Evaluation of FCC Practices

In as much as it might appear as a test to the performance of the nurses, evaluation of Family-Centered care can be advantageous if properly carried out. The evaluation mainly focuses on the practices that are going on currently and can help in identifying the possible reinforcements to be made

Much of the patient and family needs will be identified only in an evaluation process. The kinds of questions that are often designed relevant to the objectives of evaluation enable the care providers to learn more about the needs of their patients

The exercise will also enable the care providers to learn how their services are perceived in the given area by different groups of an individual.

Assessing the progress that the practices have shown can be a good indicator of performance and often cultivates in the spirit of hard work in the care providers. The poor result is supposed to alert them to have the required corrective measures.

Role of an Acute Care PNP in FCC. A case study

The role that an acute care pediatric nurse practitioner has is very essential in family-centered care. Diabetes is often a disorder caused by abnormal synthesis of sugar. The amount of sugar to be consumed is therefore restricted by a medical specialist

It is important to understand the medical history of a patent as this may help the nurse and the physician to quickly identify the cause of the problem

The period that the wound had taken to dry out was essential as it gave a hint on the possible cause of this ailment

Hemophilia is a blood disorder where blood takes too long to clot following a deficiency in clotting factors. The kind of diagnosis done to a hemophiliac is not the same as that given to a bleeding non-hemophiliac, the latter requires weaker clotting agents. The first physician had not enquired into this possibility

The fact that John’s father was a hemophiliac gives a possibility that he could be a hemophiliac as well.

The bacterium Clostridium tetani is a rapidly multiplying species and gets into the body through a wound. It invades the muscles there as it fights its way into the nervous system

It is important to understand the extent that an infection has gone. Diagnosis will often depend on the stage that disease is in when it is reported for medication

It is important to have an open consultation between the patient, family, and medical practitioners. It is also important to examine first the patient and family’s understanding of the health problem that has been identified and the necessary course of action.

Do not forget to get the patient’s point of view especially in a critical situation like an amputation.

The PNP intervened here to meet the family needs of the mother. This mother had a career that could not allow her to attend to her son in the hospital. Her other children were still in the educational institution while the father had died two years before. They were very free to share their information, which is an integral part of family-centered care (Kitchen 2005, p2). The nurse offered to take John as her own even after the arrival of John’s aunt. This was particularly necessary because John had no immediate family member. In a critical situation where he had undergone an amputation, he needed to receive support, comfort, and assurance from a specialist. He had to be close to a care provider (Davidson 2009, para10).

The mother needed to leave her number so that she would be consulted during emergencies. John also required special meals following the previous directions from the physician.

Both John and her aunt were provided with the necessary and conducive environment that allowed for quick recovery. This would see him be discharged two weeks before the anticipated period.

Conclusion

The care that has been traditionally adopted does not provide for the consideration of the needs of the patients and families. It gave a lot of dependence on the health care specialists, and the families were in many cases denied their roles as the primary care providers.

It is important to consider the needs of the patients and families to provide a full health care service. The hospital staff should not consider it as an intrusion by the family if the latter are intervening, rather they should share the emerging information to be able to adopt the appropriate treatment procedures.

All the parties should adhere to the philosophies involved in the FCC practices. Both the family and the hospital staff need to recognize and respect the role that each of them has in providing the necessary care services. They should collaborate by sharing the necessary information regarding the medication history of the patient as well as the economic status of the family. This can often determine the appropriate measures to be taken. The care provider should be considered as teamwork requiring the participation of both the family and the hospital staff.

References

Putting family-centered care into practice: a response to the adaptive practice model. Developmental and Behavioral Pediatrics, 20(2), 120-122.

Bowden, V. and Greenberg, C. (2009) Children and Their Families: The Continuum of Care. 2nd ed. Philadelphia: Lippincott Williams & Wilkins.

Cooley, W. C., & McAllister, J. W. (1999). Putting family-centered care into practice: a response to the adaptive practice model. Developmental and Behavioral Pediatrics, 20(2), 120-122.

Davidson, J. E. (2009). Family-centered care: meeting the needs of patients’ families and helping families adapt to critical illness. Critical Care Nurse, 29(3), 28-34. Web.

Gsavaghan, S. R., & Carroll, D. L. (2002). Families of critically ill patients and the effect of nursing interventions. Dimensions in Critical Care Nursing, 21(2), 64-71. Web.

Hanson, J. L., & Randall, V. F. (1999). Evaluating and improving the practice of family-centered care. Pediatric Nursing, 25(4), 445-449. Web.

Johnson, B. H. (2000). Family-centered care: four decades of progress. Family Systems and Health, 18, 137-156.

Kitchen, B. (2005). Family-centered care. Journal for Specialists in Pediatric Nursing, 10(2), 93-97. Web.

MacDougall, d. (2007). Incorporate family members in the care of ICU patients: New Guidelines Provide First Evidence-Based Standards. Web.

Marshall, M., Fleming, E., Gillibrand, W., and Carter, B (2002). Adaptation and negotiation as an approach to care in pediatric diabetes specialist nursing practice: a critical review. Web.

Mitchell, M., Chaboyer, W., Burmeister, E., & Foster, M. (2009). Positive effects of a nursing intervention on family-centered care in adult critical care. American Journal of Critical Care, 18(2), 543-552. Web.

Reiling, J., Hughes, R. & Murphy, M. (n.d). The Impact of Facility Design on Patient Safety. Web.

Sisterhen, L. L., Blaszak, R. T., Woods, M. B., & Smith, C. E. (2007). Defining family-centered rounds. Teaching and Learning in Medicine, 19(2), 319-322.

York, N. L. (2004). Implementing a family presence protocol option. Dimensions of Critical Care Nursing, 23(2), 84-88.