Family-centered care: facing the new millennium. Interview by Elizabeth Ahmann

In an interview with the column editor, Beverley Johnson, President and Chief Executive Officer of the Institute for Family-Centered Care, shares her views on the state of family-centered care (see Table 1). A notable achievement over the past several decades has been the acknowledgment of family-centered care as the standard of care for children with special health care needs. Today there is a growing momentum to more broadly apply the principles of family-centered care in both pediatric and adult care settings, and much work needs to be done to build on the strong foundation that has been laid. Changing attitudes and practice, changing how families are viewed and how care is provided, developing collaborative approaches, and emphasizing the importance of relationships--changing in these ways the very culture of health care--will be necessary to make family-centered care a full reality. Many of these changes need to begin during the process of educating medical and nursing students. Health care institutions can support these changes by incorporating principles of family-centered care into personnel policies and practices, ensuring the hiring and support of individuals with family-centered skills and attitudes, and rewarding family-centered practice. Many of these changes can also be supported by research on the relationships between family-centered care and health care utilization, lengths of stay, and health care outcomes. The interview concludes as follows: "What is good for families and patients is often good for the health care system as well. Family-centered care is a winning proposition for all concerned."     

Family-centered care in the NICU

Family-centered care is a philosophy of care that embraces a partnership between staff and families. Families, patients, and staff benefit in a family-centered care environment and the design of the newborn intensive care unit (NICU) must not interfere with its successful implementation. Unrestricted parental presence in the NICU, parental involvement in infant caregiving, and open communication with parents are basic tenets of family-centered care. By virtue of their continual presence and role in the NICU, nurses are in a unique position to support family-centered care.     

Emergency Departments Treating Veterans for Suicide: Ensuring Quality Care for Veterans Outside of Department of Veterans Affairs Health Care Facilities

IntroductionVeterans die by suicide at higher rates than nonveterans. Given that the emergency department is often the first point of entry to healthcare following a suicide attempt, it would be beneficial for community providers to have knowledge of the characteristics, medical issues, and effective treatments most often associated with those having served in the military to ensure guideline concordant and quality suicide care. This study aimed to identify assessment and referral practices of emergency departments at rural community hospitals related to care for suicidal veterans and explore the feasibility and acceptability of identifying veterans in need of postdischarge aftercare.MethodsThis qualitative exploratory study involved content analysis of semistructured interviews. Ten emergency clinicians from 5 rural Arkansas counties with high suicide rates were interviewed about their experiences working with suicidal patients within the emergency department and perceptions of assessment, management, and referral practices.ResultsAlthough most of the emergency departments had a process for assessing for suicide risk, emergency clinicians did not always feel confident in their knowledge of assessing and caring for suicidal patients. Military history was not included in assessment, treatment, or aftercare planning, nor were brief interventions such as safety planning or lethal means safety education provided.DiscussionBest practices for suicide assessment and management of veterans exist; however, challenges specific to the emergency department regarding staff training and engaging the community to effectively link at-risk veterans to needed care hinder implementation. Veteran-inclusive assessment and intervention practices could enhance the quality of care provided in community emergency departments.     

Optimizing Pediatric Patient Safety in the Emergency Care Setting

This is a revision of the previous American Academy of Pediatrics policy statement titled “Patient Safety in the Emergency Care Setting” and is the first joint policy statement by the American Academy of Pediatrics, the American College of Emergency Physicians, and the Emergency Nurses Association to address pediatric patient safety in the emergency care setting. Caring for children in the emergency setting can be prone to medical errors because of a number of environmental and human factors. The emergency department has frequent workflow interruptions, multiple care transitions, and barriers to effective communication. In addition, the high volume of patients, high decision density under time pressure, diagnostic uncertainty, and limited knowledge of patients’ history and preexisting conditions make the safe care of critically ill and injured patients even more challenging. It is critical that all emergency departments, including general emergency departments who care for the majority of ill and injured children, understand the unique safety issues related to children. Furthermore, it is imperative that all emergency departments practice patient safety principles, support a culture of safety, and adopt best practices to improve safety for all children seeking emergency care. This policy statement outlines the recommendations necessary for emergency departments to minimize pediatric medical errors and to provide safe care for children of all ages.     

Transition to home from the newborn intensive care unit: applying the principles of family-centered care to the discharge process

Increasingly newborn intensive care units (NICUs) are embracing family-centered care principles. Family-centered newborn intensive care requires that families are welcomed as partners in caregiving and decision making. Traditionally, discharge planning has been done without significant family involvement. In fact, parent participation in caregiving may still be limited until discharge is imminent. By increasing parental involvement in caregiving throughout hospitalization and working with families to facilitate the discharge process, parents may emerge from the NICU experience with increased competence and confidence in infant caregiving. This article reviews common discharge practices and processes in the NICU and offers strategies to assist nurses in integrating a family-centered approach into discharge planning.     

Making family-centered care a reality

Family-centered care means, in the broadest sense, welcoming the family as partners in the care of the child. Family-centered care challenges us to create a new vision of a hospital environment that works in a very different way and that can actually improve clinical outcomes. This report describes one hospital's journey into family-centered care--its accomplishments and its challenges. It should be noted that, although this report describes family-centered care in a children's hospital, the philosophy beautifully adapts to an adult facility.     

An interdisciplinary team approach to evidence-based improvement in family-centered care

Family-centered care has become an integral part of total patient care in today's healthcare setting. Meeting family needs can be challenging for staff nurses already overwhelmed with escalating patient acuity and ever-increasing technical and documentation burdens. In the year 2000, an Interdisciplinary team in a tertiary hospital in the midwest employed a collaborative process to design and pioneer an award-winning nursing role in family-centered care. This article describes the methods used by this hospital to meet the ever-increasing challenge of family needs integrated into holistic patient care.     

以家庭为中心的任务导向性训练计划对痉挛型脑瘫患儿功能独立性和生活质量的影响

目的观察以家庭为中心的任务导向性训练计划对痉挛型脑瘫(SCP)患儿功能独立性和生活质量的影响。方法将符合入组条件的SCP患儿62例采用抽签法随机分为对照组(31例)和TOT组(31例)。对照组患儿按出院指导手册给予家庭康复训练, TOT组则采用家庭为中心的TOT计划进行干预, TOT计划包括训练计划制订和训练质量控制。2组患儿均按要求每日训练1次, 每次训练1 h, 每周训练5 d, 连续训练6个月。于治疗前、治疗3个月后和治疗6个后采用儿科残疾评定量表(PEDI)、儿童功能独立性评定量表(WeeFIM)和儿童生活质量量表(PedsQL)分别评估2组患儿的移动能力、功能独立性和生活质量, 并进行统计学分析。结果治疗6个月后, 2组患儿的移动能力、WeeFIM和PedsQL评分与组内治疗前比较, 差异均有统计学意义(P<0.05), 且TOT组治疗6个月后的移动能力、WeeFIM和PedsQL评分分别为(76.13±6.68)分、(84.32±6.6)分和(72.55±5.90)分, 均显著优于对照组治疗6个月后(P<0.05)。结论采用以家庭为中心的TOT计划进行训练可显著...     

Family-centered care: current realities in parent participation

Family-centered care is currently one of pediatric nursing's most dynamic and challenging philosophies. The concept of parent participation in family-centered practice has become a central tenet of pediatric nursing for the 21st century. Inhospital and home health care interventions have shifted now to recognize families' involvement in care as central to a child's care. Despite roots dating as early as the 1950s, the family-centered care approach still carries with it a myriad of challenges related to parental participation, including issues of role stress, negotiation failure, and power struggles. Although the application of theory in family-centered care practice has been discussed in the literature, implementing parent participation in family-centered care still needs to be refined. Case examples provide an educational strategy for nurses to discuss facilitating effective practice of family-centered care. This strategy also includes developing expertise in communication using models such as the LEARN framework to promote collaborative nurse-family relationships.     

Putting patients and families at the center of care

The authors describe how a patient- and family-centered model of care was introduced and adopted by their healthcare system. Since the model was introduced 2 years ago, it has been embraced by leaders and staff on both hospital campuses; patients and family members routinely consult with hospital committees, departments, and improvement task forces; and numerous clinical programs and units have modified their policies and practices to make them more patient and family centered.     

Missed nursing care in pediatric emergency departments in Turkey: A cross-sectional study

ObjectiveA pediatric emergency department deals with a vast number of patients and a high load of emergent/high-priority healthcare practices. Therefore, at times, it is possible to experience missed nursing care in this department. This study aims to ascertain the types of and reasons for missed nursing care cases in pediatric emergency departments in Turkey.MethodThis is a cross-sectional survey study. Survey data were collected from 155 nurses using the “Introductory Information Form” and the “MISSCARE-Pediatric Emergency Department Survey.”ResultsGastrostomy care, colostomy care, tracheotomy care, and teaching about hospital discharge were the care practices most often missed. The volume of patients, urgent patient situations, an inadequate number of nurses in charge, too many inexperienced nurses in the department, and assignment of work outside the scope of the job are the main reasons for missed care.ConclusionPediatric emergency department patients experience missed nursing care and nurses should be supported more in order for them to provide efficient care to children.     

GPS Devices in a Simulated Mass Casualty Event

Objective: The aim of this study was to assess the staff perception of a global positioning system (GPS) as a patient tracking tool at an emergency department (ED) receiving patients from a simulated mass casualty event. Methods: During a regional airport disaster drill a plane crash with 46 pediatric patients was simulated. Personnel from airport fire, municipal fire, law enforcement, emergency medical services, and emergency medicine departments were present. Twenty of the 46 patient actors required transport for medical evaluation, and we affixed GPS devices to 12 of these actors. At the hospital, ED staff including attending physicians, fellows and nurses working in the ED during the time of the drill accessed a map through an application that provided real-time geolocation of these devices. The primary outcome was staff reception of the GPS device as assessed via Likert scale survey after the event. The secondary outcomes were free text feedback from staff and event debriefing observations. Results: Queried registered nurses, attending physicians, and pediatric emergency medicine fellows perceived the GPS device as an advantage for patient care during a disaster. The GPS device allowed multiple-screen real-time tracking and improved situational awareness in cases with and without EMS radio communication prior to arrival at the hospital. Conclusion: ED staff reported that the use of GPS trackers in a disaster improved real-time tracking and could potentially improve patient management during a mass casualty event.     

Family-centered theory: origins, development, barriers, and supports to implementation in rehabilitation medicine

Bamm EL, Rosenbaum P. Family-centered theory: origins, development, barriers, and supports to implementation in rehabilitation medicine.The concept of family-centered care was introduced to the public more than 4 decades ago, stressing the importance of the family in children's well being. Since then, family-centered values and practices have been widely implemented in child health. The purpose of this article is to offer an overview of the development and evolution of family-centered theory as an underlying conceptual foundation for contemporary health services. The focus includes key concepts, accepted definitions, barriers, and supports that can influence successful implementation, and discussion of the valid quantitative measures of family-centeredness currently available to evaluate service delivery. The article also provides the foundation, and proposes questions, for future research.     

Communication between residential aged care facilities and the emergency department: A review of the literature

BackgroundWestern countries have encountered an increase in elderly patients transferred from residential aged care facilities to emergency departments. This patient cohort frequently experiences impaired physical and cognitive function. Emergency department staff require important clinical and personal patient information to provide quality care. International studies show that documentation and handover deficiencies are common.ObjectiveThe purpose of this literature review was to explore transitional communication practices, and to consider the specific patient information deemed essential for the management of residents in the emergency department.MethodsA literature review was conducted to examine the studies exploring the documentation accompanying elderly people who were transferred from residential aged care facilities to emergency departments. Scopus, OVID Medline and Cinahl Plus data bases were searched using combinations of the following key words: ‘nursing home’, ‘long-term care’, ‘skilled nursing facility’, ‘aged care facility’, ‘communication’, ‘documentation’, ‘emergency department’, ‘emergency room’, ‘hospital’, ‘acute’, ‘transfer’, and ‘transition’. Additional data was located with the use of Google Scholar. Review of titles and exclusion of duplicates identified 69 relevant studies. These 69 papers were independently reviewed by three members of the research team for eligibility for inclusion in the review, and seven papers were retained.ResultsThere is currently no consensus regarding what information is essential when residents are transferred from aged care facilities to emergency departments, and practices vary. Key information which should accompany the resident has been reported by various authors and include the reason for transfer, past medical history, current medications, cognitive function and advance directives. Some authors also suggest that facility contact details are essential. Without agreement by key stakeholders as to what constitutes ‘essential transfer information’, clinical practices will continue to vary and resident care will be affected.ConclusionThis paper identifies frequent communication deficits in the information provided to the emergency department from aged care facilities. There is an imperative to identify suitable items of information which health care professionals agree are essential. Future research should focus on methods to improve the transfer of information between facilities, including consensus regarding what information is essential transfer data.     

Development of a family liaison model during operative procedures.

The essence of family-centered care is the provision, by all health professionals, of psychosocially supportive care that fosters family integrity and functioning. Data from a hospital-based satisfaction survey at The Children's Hospital of Philadelphia (CHOP) indicated that the primary reason for parents being "less than completely satisfied" was lack of communication. A search of recent literature suggests also that breakdown in family-centered care in intensive care units is neither new nor unique. The purpose of this article is to describe how efforts to improve communication with parents and families led to the development of a family liaison program and an expanded role for staff nurses in the Cardiac Intensive Care Unit (CICU). The goals of this family liaison program were three-fold: to facilitate establishment of a relationship between CICU nursing staff, parents, and families at the earliest possible point in time; to ensure communication with parents and families at regular intervals during their child's surgery; and to promote practice that incorporates principles of family-centered care within the CICU. The design and implementation of such a program presented nurses in the CICU with both a challenge and an opportunity to take an innovative approach to meeting the fundamental need for information reported by parents and families, and echoed throughout nursing literature. This family liaison program serves to educate parents and families, communicate updates, provide physical and emotional support, and establish continuity of care for the patient and family. Additionally, nurses involved in the program have given positive feedback regarding their expanded role in this family-centered care model.