Facing challenges to family-centered care. I: Conflicts over visitation

Policies and practices related to parental presence and participation in the care of a hospitalized child can be a source of tension between nurses and families. Tensions often revolve around "visiting" hours, who may visit, the number of visitors allowed at the bedside at a time, and inconsistent enforcement of existing visitation policies. A family-centered framework for evaluating these policies and practices can provide direction that will help reduce these tensions. Visitation policies that are flexible and offer guidelines, not rules, will usually best meet the needs of families. Some nurses may need education, mentoring, skill-building, and role-playing opportunities to work comfortably with flexible guidelines and increased family presence and participation.     

Strategies for family-centered care in the critical care setting

Family-centered care (FCC) for critically ill or injured infants and children must be a priority for nurses and other health care professionals in the 1990s. Eight essential elements of FCC provide the basis for devising strategies for implementing FCC in the critical care setting.     

Medication safety challenges in the palliative care setting: Nurses' perspectives

AimTo explore medication safety issues faced by general and palliative care community nurses working in rural and remote palliative care domiciliary settings.MethodAn online survey for nurses working in rural communities was conducted across the South East region of rural Victoria, Australia. Nurses from 18 community based health care organisations across the region were invited to participate in an anonymous survey addressing medication safety issues in the palliative care settings. Qualitative data obtained from the open-ended survey questions were analysed inductively.ResultsA total of 29 nurses completed the survey (response rate 28% from potential respondents). Most of the nurses were working in a rural practice providing a mixed model of community palliative care and community nursing. Medication safety issues raised by the nurses included; errors associated with dose administration aids, frequency of medications reviews undertaken by clinical pharmacists of clients’ medications, high occurrence of medications error reporting, lack of awareness of medications initiated by nurses and cytotoxic medications handling.ConclusionTargeted interventions addressing the identified issues raised by community general and palliative care nurses have the potential to improve medication safety in the domiciliary palliative care setting.     

School nurses' perceptions of family-centered services: commitment and challenges.

Family-centered service is a service delivery model that recognizes the central role of families, builds on their strengths, and seeks to fully involve them in all aspects of their child's health, learning, and development. Family-centered service has been associated with positive outcomes in health and education and has been viewed as best practice. This study examined school nurses' perceptions of their work practices with families and the implementation of family-centered services in the school health setting. An established instrument, the Measure of Processes of Care for Service Providers, was used to survey a convenience sample of school nurses practicing in California. Quantitative and qualitative results indicated that school nurses value family-centered service and use the core elements regularly in their work with families. Qualitative data further illustrated school nurses' solid commitment to families even in the face of challenges such as high student-nurse ratios, lack of time, and limited support. Suggestions for overcoming these barriers include development of parent centers, employment of school social workers/case managers, and advocating for changes in legislation to support the hiring of more school nurses.     

A journey to family-centered maternity care

This article highlights the journey taken by the nursing staff of a traditional maternity care unit in a moderately sized Pennsylvania hospital as they moved to a new single-room maternity care (SRMC) unit and transformed their model of care to family-centered maternity care (FCMC). The steps of the journey are described, including the process undertaken, the road blocks encountered, and the factors that contributed to a successful outcome.     

Patient approaches to clinical conversations in the palliative care setting

AIM: The aim of this paper is to report a study exploring patients' understanding of their discussions about end-of-life care with nurses in a palliative care setting. BACKGROUND: It is assumed that nurses are central players in patients' major decisions about their care, yet minimal information is available about the complexity of patient-nurse interaction in palliative care, and patients' views of the impact of such interactions on decisions that are made. METHOD: A modified version of grounded theory was used to collect and analyse interview data collected in 2001-2002 with a convenience sample of 11 patients in a palliative care setting. Interviews focused on each patient's selection of two decisions they had made in the past 6 months that had involved nurses in the decision-making process. FINDINGS: Processes were identified between nurses and patients that facilitated or blocked open discussion and discernment of patients' preferences for care. Six approaches that patients used in their conversations with nurses about their care: wait and see, quiet acceptance, active acceptance, tolerating bossiness, negotiation and being adamant. These approaches are described in terms of how they assisted or impeded autonomous decision-making. CONCLUSION: Palliative care patients often adopt passive roles and tend not to engage in important decision-making, for various reasons. Professionals need to be made aware of this, and should facilitate an open, trusting relationship with patients in order to ensure that important information passes freely in both directions. Professionals should learn to prioritize patient participation and negotiation in their work. With further research, it should be possible to identify the factors that will allow patients to take a more pro-active role in making decisions about their care, where desired.     

Promoting family-centered care with foster families.

There has been a tremendous increase in the need for foster families since the 1980s largely because of the effects of drug abuse on the child and the biological family. As many as 500,000 children are currently living with foster families. Many children living with foster families were exposed to drugs before birth. Even those not exposed before birth demonstrate the effects of having lived with drug-abusing family members. Family life for these children is very often chaotic and unpredictable. There are increased health care needs for foster children due to drug-exposure and neglect. Yet, research suggests that the health care needs of foster children are often neglected. Foster families report that their concerns and needs are, frequently, neither recognized nor addressed by health professionals. Pediatric nurses can improve health care by increasing their awareness of the special needs of foster families and foster children.     

The challenges of diagnosing erectile dysfunction in the primary care setting

Erectile dysfunction is present in approximately half of all men between the ages of 40 and 70. Patients are often reluctant to discuss this problem with their practitioner; therefore, unless the practitioner is able to initiate the discussion, the diagnosis will not be made and successful treatment will not be started. Primary care practitioners have previously received little training in taking the sexual history of their patients. In addition, primary care practitioners are under increasing pressure to see more and more patients in less and less time. Erectile dysfunction is a condition that is relatively easy to diagnose using history, physical examination, and laboratory tests at the disposal of the primary care practitioner. Although referral to an urologist may be necessary, most patients can be successfully treated in the primary care setting.