LEC 2: Family-Centered Care Flashcards

1
Q

Family-Centered Care

A
  • A philosophy embraced by most health care organizations globally and promoted by policy makers and nurse leaders.
  • Has been unclear how this philosophy is enacted in practice.
    • Not BPGs and other literature provices recommendations
  • Current environment migh cause a disconnect between the expectations of a family and the ability of the nurse to meet these expectations
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2
Q

RNAO 2015 BPG patient and Family-Centred Care

A
  • Establishing a therapeutic relationship for true partnership, continuity of care, and shared decision making
  • Care is organized around and respectful of the person
  • Knowing the whole persone (holistic care)
  • Communication, collaboration, and engagment
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3
Q

RNAO: Practice Guidelines Recommendation: Assessment

A
  • Establish a therapeutic relationship with the person using verbal and non-verbal communication strategies to build a genuine, trusting, and respectful partnership
  • Build empowering relationships with the person to promote the person’s proactive and meaningful engagment as an active partner in their healthcare
  • Listen and seek insight into the whole person to gain an understanding of the meaning of health to the person and to learn their preferences for care
  • Document information obtained on the meaning and experience of health to the person using the person’s own words
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4
Q

RNAO: Practice Guidelines Recommendation: Planning

A
  • Develop a plan of care in partnership with the person that is meaningful to the person within the context of their life
  • Engage with the person in participatory model of decision making, respecting ther person’s right to choose the preferred interventions for their health by:
    • Collaborating with the person to identify their priorities and goals for healthcare
    • Sharing information to promote an understanding of available options for healthcare so the person can makre an informed decision
    • Respecting the person as an expert on themselves and their life
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5
Q

RNAO: Practice Gidelines Recommendations: Implementation

A
  • Personalize the deliver of care and services to ensure care is not driven from the perspective of the healthcare provider and organization by collaborating with the person on:
    • Elemetns of care
    • Roles and responsibilities in the delivery of care
    • Communication strategies
  • Partner with the person to tailor strategies for self-managment of care that are based on the person’s characterisitcs and preferences for learning
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6
Q

RNAO: Practice Guidelines Recommendations: Evaluation

A

Obtain feedback from the person to determine the person’s satisfaction with care and whether the care delivered was person-centred and family-centred

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7
Q

RNAO: Practice Guidelines Recommendations: Education

A
  • Educate healthcare providers at a minimum of the following attributes of person-centred and family-centred care to improve the person’s clinical outcomes and satisfaction with care:
    • Empowerment
    • Communication
    • Shared decision making
  • Educational institutions incorporate this Guideline into the curricula for nurses and, as appropriate, for other healthcare providers
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8
Q

RNAO: Practice Guidelines Recommendations: System, Organization, and Policy

A
  • Create an organizational culture that exemplifies its commitment to person-centred and family-centred care by:
    • Demonstrating leadership and commitment to this approach to care
    • Involving the person in co-designing health programs and services
    • Building health work environments for all healthcare provider
  • Design an environment that demonstrably improves the person’s experience of healthcare by:
    • Creating healing environments
    • Being flexible and partnering to personalize care routines
    • Improving access to care and services
    • Enhancing the continuity and coordination of care and services during transitions
    • Providing continuity of caregivers
  • Collect continuous feedback from the person to determine whether their experience with healthcare and services was person- and family-centred, and utilize this feedback to make improvements at all levels of the health system
  • Government agencies and regulatory bodies must monitor, measure, and utilize information from organizations regarding the person’s experience of health care to improve health-system performance
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9
Q

Family

A
  • A term used to refer to individuals who are realted (biologically, emotionally, or legally) to and/or have close bonds (friendships, commitments, shared households and chold rearing responsibilites, and romantic attachments) with the persone receiving healthcare.
  • A person’s family includes all those whom the person identifies as significant in their life (parents, caregivers, friends, substitute decision makers, groups, communicites, and propulations)
  • The person receiving care determines the importance and level of involvment of any of these individuals in their care based on their capacity
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10
Q

Patient-and-Family-Centred Care

A
  • An approach to care that recognizes the importance of family and in a patient’s life and the importance of their active involvment in planning and making decisions on healthcare, services and treatment, and health system reform
  • This approach to care provides respectful, compassionate, culturally safe, and responsive care that meets the needs, values, belifes, and preferences of the patient, their family, and others identified as significant to their life from dicers backgrounds and settings
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11
Q

What are the 8 dimensions of patient centered care (RNAO)?

A
  1. Patient’s preferences
  2. Emotional support
  3. Physical comfort
  4. Information and education
  5. Continuity and transition
  6. Coordination of care
  7. Access to care
  8. Family and friends
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12
Q

What are the 8 principles of patient-centered care?

A
  1. Respect for patient’s values, preferences, and expressed needs
  2. Coordination and integration of care
  3. Information and education
  4. Physical comfort
  5. Emotional support and alleviation of fear and anxiety
  6. Involvment of family and friends
  7. Continuity and transition
  8. Access to care
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13
Q

What are the common themes in person and family centered care?

A
  • Establishing a therapeutic relationship for true partnership, continuity of care, and shared decision making
  • Care is organized, and respectful of the person
  • Knowing the whole person
  • Communication, collaboration, and engagement
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14
Q

What are the three partnerships for care?

A
  1. Principles: mutuality and partnership
  2. Focus: places family as central to not only the patient but to the patient’s plan of care
  3. Recognize: the family as an essential part of care
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15
Q

How do you define lip service?

A

An avowal of advocay, adherence, or allegiance expressed in words but not backed by deeds- usually used with pay.

  • Acknowledges and respects the expertise of the family
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16
Q

What does partnership with families depend on?

A
  • Internal factors
  • External factors
  • Duration of the partnership
17
Q

What are the 3 factors affecting person-and-family-centred care partnerships?

A
  1. Internal Factors
  2. External factors
  3. Duration of partnership
18
Q

How does internal factors affect person-and-family-centred care partnerships?

A
  • Characteristics of healthcare providers, and the person, and their family
  • Health states (degree of illness and wellness)
19
Q

How does external factors affect person-and-family-centred care partnerships?

A
  • Determinants of health
  • Types of health systems and organizations (structures and settings)
20
Q

How does the duration of partnership affect person-and-family-centred care partnerships?

A

Length of time knowing the person and their family

21
Q

Integrating Research Into Practice

A

Rapport with families has been identified as a kew element influencing family centred care

22
Q

What influences rapport?

A
  • Having common and relevant goals
  • Reciprocal interchange
  • Narrows the knowledge-competencce gap
  • Clear communication = mutual goals and avoids conflict
23
Q

Communication, Collaboration, and Engagment

A
  • Moving towards person-and-family centred care requires a change in healthcare culture, as well as in the attitudes and behaviours of healthcare providers-specifically their ability to develop relationships, communicate, collaborate, enourage partnerships, and share information related to decisions and healthcare and services.
  • To optomize health outcomes and improve the quality and safety of their services, organizations must support health-care providers to redesign their partnerships with persons receiving care. These partnerships must be supported by true collaborations.
  • Healthcare providers must use effective and therapeutic communication with the persone and promote their active engagment in decisions for their health.
24
Q

Establishing a Therapeutic Relationship for True Partnership, Continuity of Care, and Shared Decision Making

A
  • The existence of a therapeutic relationship between the person and healthcare provider is central to person-and family centred care
  • Continuitu on healthcare providers (i.e the person partnering with the same providers) and the establishmnet of a true collaborative partnership within the context of a therapeutic relationship over time can optimize the person’s health and wellness
  • A therapeutic relationship is required between healthcare providers and the persone seeking health services so they can establish trust, partner, and share decisions on appropriate healthcare and services
25
Q

What does the research show?

A
  • Research demonstrates that the parent-professional interaction gretly influences the quality of healthcare
  • Parents identify establishing rapport and the sharing of care as key
  • Although interactions may be perceived as positive, they may not be seen as collaborative
  • When planning care and services, healthcare providers should engage with the person in a participatory model of shared decision making, respecting their right to choose the preferred interventions for their health.
26
Q

What are the issues and challenges related to implementation?

A
  • Need to also be sensitive to family stress when encouraged to participate more than is desired
  • Some families may not wish to be as involved as required, but may feel/have little choice
  • Ignoring family concerns/feelings will lead to conflict rather than collaboration
  • Botome Line: Need to communicate actovity with the family about their degree of involvment
27
Q

What do important outcomes include?

A
  • Increased autonomy of patient and family
  • Patient and family satisfaction is enhanced
  • Emerging findings from research about the reciprocal, bidirectional influence between families and health/illness
  • The experience is improved
28
Q

Person-Centered-Care Attitudes

A
  • Reflects the healthcare provider’s belief in the importance of coming to know the whole person (biophsychosochial and spiritual) when assessing the person’s condition.
  • They also include a belief in the person’s ability to make a decision; the healthcare provider therefore promotes autonomy and sharing of power.
29
Q

Person-Centered-Care Behaviours

A

Are the observed characteristics of healthcare providers corresponding to person-centered-care attitudes, including verbal behaviours and non-verbal behaviours.

30
Q

How do you provide family-centered care?

A
  • Treat the patient and the family
  • Support the family in their needs
  • Support them in their family roles
  • Listen empathically and actively (values and goals)
  • Facilitate decision making
  • Always consider patient and family experience
    • Use the nursing process with families
31
Q

What is the family nursing process?

A
  • Assessment of the family story
  • Analysis of the family story
  • Design a family plan of care
  • Family intervention
  • Family evaluation
  • Nurse reflection
32
Q

How do you provide family-centered care?

A
  • Teach them and let them teach you
    • They are most knowledgable about their family members and most committed for the lifetime
  • Make appropriate refferals
  • Help ensure that there are supports in place (timely)
  • Contextually respond
    • All family nursing interventions happen in the context of a nurse-family realtionship and are enacted primarily through therapeutic conversation
33
Q

What are the needs of families of critically ill patients?

A
  • Need to be informed
  • Need for assurance (to be respected and to be able to trust)
  • Need to comfort
  • Need to be comforted
  • Need for proximity
  • Need to share what they know
  • Need to feel free to ask
  • Need to feel they can be unique
  • Need to feel valued
34
Q

How can you bring family-centered care to your practice?

A
  • Involves questioning your own beliefs and values
  • Involves questioning patients and families about their narratives
  • Reflecting on your current behavior and opportunities for self discovery
  • Building confidence and communication skills
  • Advocation for and facilitating family interviews, meetings, therapeutic conversations