FamilyCentered Care: Practice Change Protocol

1
Family-Centered Care Practice Change Protocol

• Meg Dick, Kala Gaydos, Hannah Hudgins, and
• Melody Jacobson

2
PICO

• In hospitalized patients aged 1 day to 18 years,
  does family-centered care when compared to
  conventional care, improve patient and family
  satisfaction scores and decrease the length of
  hospital stay?

3
Introduction

• Nursing staff and hospitals are beginning to see
  the advantages to family involvement.
• Parents want to be involved in providing care,
  monitoring symptoms, and decision-making along
  with the healthcare providers caring for their
  child.

4
Introduction Cont.

• Collaboration and participation recognizes that
  families have been caring for the child at home
  and therefore possess important information
  regarding their child.
• The family should be valued as a partner in the
  childs care and decision-making process.
• The consumer movement in the 1960s opened the
  door for the idea of family-centered care in the
  health-care industry.

5
Definitions

• Family-centered Care
• Philosophy of healthcare service that recognizes
  that family is the constant in a childs life
• Conventional Care
• Families are treated as visitors and not included
  in decisions

6
Review of the Literature

• A Quasi-Experimental Trial on Individualized,
  Developmentally Supportive Family-Centered Care
• Population
• Parents of 114 premature infants ranging from 24
  to 32 weeks gestation
• Results
• No statistical differences between groups on
• Parental perception of NICU experience
• Length of hospital stay
• Parental satisfaction
• Infant stress cues were lower in the
  family-centered care group

Byers, J. F., Lowman, L. B., Francis, J., Kaigle,
L., Lutz, N. H., Waddell, T., et al. (2006).
7
Review of the Literature

• Taking Family-Centered Care to a Higher Level on
  the Heart and Kidney Unit
• Population
• Families, staff, and residents on a heart and
  kidney unit in a childrens hospital
• Results
• Families felt the healthcare team did a better
  job of communicating and were more able to make
  informed decisions about the plan of care after
  implementation

Titone, J., Cross, R., Sileo, M., Martin, G.
(2004).
8
Review of the Literature

• Parents and Professionals Perceptions of the
  Implementation of Family-Centered Practices in
  Child Assessments
• Population
• 50 agencies that provide services to children
  with disabilities aged birth to 5 years
• The family and two of the professionals from the
  team were surveyed
• Results
• Professionals and families agreed that 69 of the
  time family-centered care practices had occurred
  and 81.9 agreed that care was ideal

Crais, E. R., Roy, V. P., Free, K. (2006).
9
Review of the Literature

• Achieving Family-Centered Care Working on or
  Working with Stakeholders
• Population
• 27 Parents and 13 nurses on a participating unit
  implementing family-centered model of care
  completed satisfaction surveys
• Results
• 76 of families were happy with communication
  with the healthcare team and the way the
  healthcare team interacted with their children
• 85 of the families who participated felt they
  were a part of the medical decision- making
  process

Kelly, M. T. (2007).
10
Review of the Literature

• Family-Centered Care in Family-Specific Teams
• Population
• 38 families of children with cerebral palsy, aged
  4-8 years and 204 professionals providing their
  childrens rehabilitation and educational
  services completed surveys
• Results
• Families rated family-centered care higher than
  the staff, but indicated they did not receive
  care they perceived important

Nijhuis, B., Reinders-Messelink, H.A., Blecourt,
A., Groothoff, J., Hitters, W., Nakken, H.,
Postema, K. (2006).
11
Review of the Literature

• Family-Centered Care within an Infant Toddler
  Unit
• Population
• 38 parents and 75 staff completed satisfaction
  surveys in an infant-toddler unit caring for
  infants and toddlers with acute and chronic
  medical needs
• Results
• 80 of parents were satisfied with communication
• 68 satisfied with nursing care and family
  centered interventions
• 61 satisfied with education and discharge
  teaching
• 91 felt they were treated with respect
• 25 felt they were not given the opportunity to
  provide input for the plan of care

Neal, A., Frost, M., Kuhn, J., Green, A.,
Gance-Clevland, B., Kersten, R. (2007).
12
Review of the Literature

• Impact of a Family-Centered Care Initiative on
  NICU Care, Staff, and Families
• Population
• Compares 8 sites who have had all elements of
  NICU family support program, to sites that have
  had some of the elements in place, and sites that
  have had no elements in place
• Results
• 93 of families felt they were directly involved
  in their babies care
• 83 felt a decrease in stress after communicating
  with the NICU family support specialist
• 56 felt they were involved in decision making

Cooper, L., Gooding, J., Gallagher, J.,
Sternesky, L., Ledsky, R., Berns, S. (2007).
13
Review of the Literature

• Reducing Premature Infants Length of Stay and
  Improving Parents Mental Health Outcomes with
  the COPE NICU Program A Randomized Controlled
  Trial
• Population
• 247 premature infants ranging from 26 to 35 weeks
  gestation to evaluate the efficacy of
  family-centered care interventions
• Results
• Average length of hospital stay for infants
  receiving family-centered care interventions was
  3.9 days less than control group infants
• Mothers of the infants receiving family-centered
  care reported a significantly lower level of
  stress than control mothers

Melnyk, B. M., Feinstein, N. F., Alpert- Gillis,
L., Fairbanks, E., Crean, H. F., Sinkin, R. A.,
et al. (2006).
14
Review of the Literature

• Parents and Nurses Attitudes to Family-Centered
  Care An Irish Perspective
• Population
• Attitudes of parents and nurses to the model of
  care on an inpatient childrens unit
• Results
• Over half of the parent group admitted they did
  not know what was expected of them
• The nurse group reported they underestimate what
  parents can do for their childs care
• Some parents felt they had to stay with their
  child because the nurse appeared too busy
• The nurses recognize that it is advantageous for
  the child and parent if they could be in resident
  with their child

Hughs, M. (2007).
15
Review of the Literature

• Family-Centered Care A Review of Qualitative
  Studies
• Population
• Review systematically qualitative studies that
  included any health care intervention that aims
  to promote the family-centered model of care
  during a child's hospitalization
• Results
• Negotiations between staff and families and
  perceptions held by both parents and staff roles
  influenced the delivery of family-centered care
• A sub-theme of cost of family-centered care to
  families and staff was discovered including both
  financial and emotional costs
• Further research is needed to generate evidence
  about family-centered care

Shields, L., Hunter, J., Pratt, J. (2006).
16
Comparison of Literature

• All but one of the studies reviewed found that
  patient and family satisfaction increased with
  the use of family-centered care.
• Of the studies reviewed, only two included
  decreased length of stay as an outcome variable.
• One found that family- centered care
  interventions decreased the length of hospital
  stay.

17
Comparison of Literature Cont.

• Common outcome criteria used to determine parent
  and family satisfaction
• Collaboration and partnership with healthcare
  team and inclusion in decision-making process
• Information and education
• Respect and support

18
Family-Centered Care Pros and Cons

• Pros
• Increase patient and family satisfaction
• May decrease the length of hospital stay
• May decrease stress level experienced by the
  hospitalized child and family
• Assists nursing staff with patient care
• Provides open lines of communication between
  staff and family
• Families are a vital resource that augment the
  plan of care

• Cons
• Implementation costs incurred by the hospital
• Room layout
• Fewer allowable beds on the floor
• Inconvenience to Nurses
• More time educating family
• Including the family on the multidisciplinary
  team

19
Family-Centered Care Change in Practice Protocol

• Based on the literature reviewed, both the
  pediatric patient and the family would benefit
  from a change in practice.
• The change of protocol suggestions are based on
  the recommendations made in Clinical Practice
  Guidelines for Support of the Family in the
  Patient-Centered Intensive Care Unit.

20
Practice Change Protocol Guidelines

• Training
• All members of the multidisciplinary team should
  receive training on family-centered care
  protocol.
• Communication
• Collaboration
• Culturally competent care
• Awareness of spiritual and religious issues
• Ability to assess family needs
• Educational needs

21
Practice Change Protocol Guidelines Cont.

• Accommodations
• Open visitation
• Large private rooms
• Fold out couch for a parent to stay overnight
• Private bathroom in the hospital room
• Unit kitchen privileges

22
Practice Change Protocol Guidelines Cont.

• Teaching
• Educate family on patients disease process
• Clearly explain reasonable management options
• Educate family on patient specific care

23
Practice Change Protocol Guidelines Cont.

• Communication and Collaboration
• Keep family informed on patient status and
  prognosis
• Base the medical decision making process on the
  partnership between the family and the
  professionals
• Family presence during multidisciplinary team
  rounds
• Staff assignments remaining as consistent as
  possible

24
Practice Change Protocol Guidelines Cont.

• Basic Needs
• Nurse builds rapport with both the patient and
  the family
• Families cultural, spiritual, and religious needs
  assessed and met
• Allow the family the opportunity to step away
  from the stressful hospital environment and feel
  confident that their child will be properly cared
  for

25
Method for Evaluation

• Patient and family satisfaction surveys
• Distributed at the time of discharge
• Should include a Likert scale that measures
• Accommodation
• Education
• Communication and collaboration
• Basic needs of the family

26
Method for Evaluation Cont.

• Decrease length of hospital stay
• Compare average length of stay before and after
  family-centered care interventions

27
Suggestions for Further Study

• More research is needed on the effects of
  family-centered care on
• Length of hospital stay
• Cost to the organization
• Physiological outcomes for the patient
• Larger sample sizes are needed in future studies
• Compare institutions with and without
  family-centered care
• More research is needed for special populations

28
Suggestions for Further Study Cont.

• What are the long term effects of family-
  centered care on patient and family satisfaction
  scores, the institution, and the health care team?

29
References

• Melnyk, B. M., Feinstein, N. F., Alpert- Gillis,
  L., Fairbanks, E., Crean, H. F., Sinkin, R. A.,
  et al. (2006). Reducing premature infants length
  of stay and improving parents mental health
  outcomes with the creating opportunities for
  parent empowerment (COPE) neonatal intensive care
  unit program A randomized, controlled trial.
  American Academy of Pediatrics , 118 (5),
  e1414-e1427.
• Byers, J. F., Lowman, L. B., Francis, J., Kaigle,
  L., Lutz, N. H., Waddell, T., et al. (2006). A
  quasi- experimental trial on individualized,
  developmentally supportive family- centered care.
  JOGNN Clinical Research , 35 (1), 105-115.
• Cooper, L., Gooding, J., Gallagher, J.,
  Sternesky, L., Ledsky, R., Berns, S. (2007).
  Impact of a family-centered care initiative of
  NICU care staff and families. Journal of
  Perinatology , 27, S32-S37.
• Crais, E. R., Roy, V. P., Free, K. (2006).
  Parents' and professionals' perceptions of the
  implementation of family-centered practices in
  child assessments. American Journal of
  Speech-Language Pathology , 15, 365-377.

30
References

• Davidson, J. E., Powers, K., Hedayat, K. M.,
  Tieszen, M., Kon, A. A., Shepard, E., et al.
  (2007, February). Clinical practice guidelines
  for support of the family in the patient-centered
  intensive care unit American college of critical
  care medicine task force 2004-2005.
• Hockenberry, M. J., Wilson, D. (2007). Wong's
  nursing care of infants and children. St. Louis
  Elsevier.
• Hughs, M. (2007). Parents and nurses attitudes
  to family-centered care an Irish perspective.
  Journal of Clinical Nursing, 16, 2341-48.
• Hunter, J., Pratt, J., Shields, L. (2006). Family
  centered care a review of qualitative studies.
  Journal of Clinical Nursing, 15, 1317-1323.
• Kelly, M. T. (2007). Achieving family-centered
  care Working on or working with stakeholders?
  Neonatal, Paediatric, and Child Health Nursing ,
  10 (3), 4-11.

31
References

• Melnyk, B. M., Feinstein, N. F., Alpert- Gillis,
  L., Fairbanks, E., Crean, H. F., Sinkin, R. A.,
  et al. (2006). Reducing premature infants length
  of stay and improving parents mental health
  outcomes with the creating opportunities for
  parent empowerment (COPE) neonatal intensive care
  unit program A randomized, controlled trial.
  American Academy of Pediatrics , 118 (5),
  e1414-e1427.
• Neal, A., Frost, M., Kuhn, J., Green, A.,
  Gance-Clevland, B., Kersten, R. (2007). Family
  centered care within an infant-toddler unit.
  Pediatric Nursing , 33 (6), 481-487.
• Nijhuis, B., Reinders-Messelink, H., Blecourt,
  A., Hitters, W., Groothoff, J., Nakken, H., et
  al. (2007). Family- centered care in
  family-specific teams. Clinical Rehabilitation ,
  21, 660-671.
• Titone, J., Cross, R., Sileo, M., Martin, G.
  (2004). Taking family- centered care to a higher
  level on the heart and kidney unit. Pediatric
  Nursing , 30 (6), 495-497.