以家庭为中心儿科护理模式创建与评价

目的：探索以家庭为中心儿科护理模式,提升患儿及家长的满意度和患儿安全。方法：创建以家庭为中心儿科护理模式,包括制定以家庭为中心儿科护理政策,配备数量充足和资历合格的护理人员,明确总责护士和责任护士的具体职责,对临床护理人员进行以家庭为中心儿科护理理论和实践的培训与考核,研制工具以评价护理人员执行以家庭为中心护理措施的情况,评价以家庭为中心儿科护理模式的实施效果。结果：患儿家长对以家庭为中心儿科护理模式的总体满意度为93.5%,患儿安全指标如给药错误发生率、跌倒/坠床发生率明显下降。结论：把以家庭为中心儿科护理理念转化为行动,深入到儿科护理实践的方方面面是一个长期持久的过程。而在患儿危机时刻,让家长和孩子在一起更是一个巨大的挑战,需要医护人员和患儿家长共同努力。     

The Evolution of a Surgical Liaison Program in a Children's Hospital

Surgical liaison nurses use clear communication to provide timely reports to family members about their loved one during the time the patient is in the OR. The surgical liaison program at the Children's Hospital Boston, Massachusetts, has evolved over time. It began as nurses supervising brief family member visits to the postanesthesia care unit (PACU) and has become a program in which surgical liaison nurses work with OR and PACU staff members to access and provide patient-specific information to families throughout the surgical time period and prepare families for extended visits to the PACU. In addition, we redesigned our surgical department by expanding its size, locating it closer to the OR and PACU, and providing more amenities to family members. A survey conducted to assess family member needs found that most people were satisfied with the services provided, and we were able to make improvements to services based on the survey feedback.     

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.     

Negotiation of parental roles within family-centred care: a review of the research

Aims and objectives. To review research published in the past 15 years about how children's nurses’ negotiate with parents in relation to family‐centred care. Background. Family‐centred care is a basic tenet of children's nursing and requires a process of negotiation between health professionals and the family, which results in shared decision‐making about what the child's care will be and who will provide this. The literature highlights inconsistencies in the degree to which nurses are willing to negotiate with parents and allow them to participate in decisions regarding care of their child. There is need to explore further the extent to which nurses communicate and negotiate shared care with children and their parents. Conclusions. Three themes emerged from this review of the literature relating to whether role negotiation occurred in practice, parental expectations of participation in their child's care and issues relating to power and control. Parents wanted to be involved in their child's care but found that nurses’ lack of communication and limited negotiation meant that this did not always occur. Nurses appeared to have clear ideas about what nursing care parents could be involved with and did not routinely negotiate with parents in this context. Relevance to clinical practice. For family‐centred care to be a reality nurses need to negotiate and communicate with children and their families effectively. Parents need to be able to negotiate with health staff what this participation will involve and to negotiate new roles for themselves in sharing care of their sick child. Parents should be involved in the decision‐making process. However, research suggests that a lack of effective communication, professional expectations and issues of power and control often inhibit open and mutual negotiation between families and nurses.     

The psychiatric liaison nurse's role with families in acute care

The role of the psychiatric liaison nurse with families has been described. In an attempt to differentiate the psychiatric liaison nurse's role from others on the liaison team, the emphasis is on the role in response to problematic interactions between families and nursing staff that revolve around nursing care and management of the patient. Four common problems reflecting family coping behaviors are identified. Case examples illustrate direct and indirect liaison nurse interventions in two of the problem situations as a suggestion of the possible range of creative approaches that may be used in a systems-oriented liaison approach. The key is recognition of the interdependence of the family, patient, and staff within the total environment and the development of approaches that are based on the principles of management for liaison work with families.     

Maintaining family connectedness in long-term care. An advanced practice approach to family-centered nursing homes

The decision to place a relative in a long-term care institution is one of the most difficult processes families can go through. Family members often experience conflicting feelings of stress, shock, anxiety, fear, resistance, and guilt. In addition, many individuals, regardless of the amount of previous nursing home experiences, possess misconceptions about nursing home care (Grove, 1997; Mastrian & Dellasega, 1996; Tickle & Hull, 1995). Even after the family realizes the necessity of nursing home placement, achieving a level of comfort with such a decision and maintaining family relationships is a difficult challenge. Unfortunately, family-centered nursing care in long-term care settings is hindered by multiple barriers, including resistance to institutional change, family members' fear and hesitation, institutional rules and protocols, lack of institutional encouragement of family involvement, insufficient programs and activities addressing the social and emotional needs of the family, and ineffective communication between the staff and families. To remedy these barriers, it is suggested the family advanced practice nurse (APN) view the families as clients and initiate family-centered policies to encourage family involvement in the caregiving experience. Ultimately, this will promote individualized care of elderly adults and encourage family processes within the walls of the nursing home.     

家庭参与式护理在新生儿病房优质护理服务中的应用

目的探讨家庭参与式护理在新生儿病房优质护理服务中的应用效果。方法 2015年5月至2016年5月,采用便利抽样法选择在湖南省儿童医院新生儿病房住院的130例新生儿为研究对象,按随机数字表法将其分为观察组和对照组各65例,观察组住院后期在护士的指导下家长参与新生儿的喂养、保暖、沐浴、脐部护理、臀部护理等部分护理工作。对照组住院期间所有的护理工作均由护士完成。比较两组新生儿家长在新生儿出院时对新生儿基本护理知识和护理技能的掌握情况,并比较两组新生儿出院后1个月体质量、身长、头围增长情况、家属满意度及再入院率。结果观察组新生儿家长对新生儿基本护理知识和护理技能的掌握情况及新生儿出院后1个月体质量、身高、头围的增长及家属满意度均明显高于对照组(均P0.05),而新生儿出院后1个月再入院率则明显低于对照组(P0.05)。结论在护士指导下家庭参与新生儿住院期间部分护理工作,能够满足新生儿及其家属的需要,促进新生儿健康成长,减少再入院率,提高新生儿病房家属满意度。     

Measuring intensive care nurses' perspectives on family-centered end-of-life care: evaluation of 3 questionnaires.

BACKGROUND: Attempts to improve end-of-life care increasingly focus on family-centered care, but few validated assessment tools exist. OBJECTIVES: To evaluate 3 new short questionnaires measuring nurses' perspectives on family-centered end-of-life care in the intensive care unit and to show the usefulness of the questionnaires. METHODS: Principal components analysis of data from 141 critical care nurses evaluating care given to families of 218 patients was used to develop domain scores for number of nursing activities with each family, number of barriers experienced, and nurses' satisfaction that the family's needs were met. Random effects models were used to test associations between critical care processes and outcome. RESULTS: Nursing activities fell into 2 domains: general and culture-related communication/support. Barriers consisted of 2 domains: patient/family barriers and system/team barriers. Meeting the needs of patients' families represented a single dimension. In a path model based on domain scores, general activities had significant associations with both nurse communication and meeting families' needs; patient/family barriers, with nurse communication; and nurse and physician communication, with meeting families' needs. In a path model based on total activities and barriers scores, total activities and total barriers had significant associations with nurse communication ratings and meeting families' needs. Patients' and nurses' characteristics were not significant independent predictors of meeting the needs of patients' families. CONCLUSIONS: The 3 questionnaires provide a consistent, valid picture of nurses' perspectives on family-centered critical care and may be useful in evaluating family care processes and outcomes and in targeting areas for improvement.     

Negotiation of care by children's nurses: lessons from research

Parental participation and role negotiation are central elements in family-centred care, but research suggests that such negotiation tends to be ad hoc, depending on the relationships developing between the family and health professionals. Lack of effective communication, professional expectations and issues of power and control often prevent open and mutual negotiation between families and health professionals, especially nurses. This article summarises key lessons from a critical review of relevant research literature (Corlett and Twycross 2006) which suggests that nursing staff often control parental participation leaving parents feeling disempowered and deskilled. Poor communication and lack of information sharing exacerbate the situation. Where parents do not comply with nurses' expectations conflict can arise, resulting in more anxiety for already stressed parents. Current health policy requires that health workers listen to children and their families, to actively involve them in the decision-making process and to plan care around their needs and wishes. Nurses need to be aware of the way they interact with parents and the control they may unwittingly exert. A greater emphasis on communication, interpersonal and negotiation skills within nurse education is also needed.     

The parent-nurse relationship from the perspective of parents of children with cancer

Research to date has overlooked the specific relationship between parents and nurses, particularly in the context of family-centered care for a hospitalized child with cancer. The purpose of this study was to describe how parents perceive the relationship with the pediatric staff nurse necessitated by the hospitalization of their child with cancer. Using a symbolic interactionist framework and a modified grounded theory methodology, this study explored the parent-nurse relationship when a child with cancer is hospitalized. A purposive, theoretical quota sampling method was used to recruit 16 parents. Both parents' and nurses' care were examined from the parents' perspectives; mothers and fathers were interviewed separately. Analysis of the data led to the development of a substantive theory describing parent care (Making it Better), nursing care (Going Through the Motions, Caring Incompletely and Caring Completely), and the parent-nurse relationship (Working Together). Conditions influencing the care provided by parents and nurses and in turn the parent-nurse relationship were also identified. This research describes strategies nurses use to enhance the family-centered care they provide and reveals the effect nursing care has on parents' hospital experiences. Recommendations are made for nursing research, practice, and education.     

Pediatric nursing practice: keeping pace with technological advances

Over the past 25 years, extensive technological and medical advances have had a major impact on the way pediatric nursing is practiced. Pediatric nurses have expanded their nursing roles, established professional organizations and certification standards to ensure clinical competence at the bedside, and tirelessly advocated for the health care needs of children and their families. In addition, pediatric nurses have collaborated with other health care providers to institute family-centered and developmentally appropriate philosophies of care. All of these changes will assist pediatric nurses to remain focused on the most important aspect of their work: Supporting the unique needs of children and their families.     

Determining the impact of a surgical liaison nurse role in the paediatric operating room

A two-group (N = 92) quasi-experimental pre-post test design was used to examine the effects of intra-operative communication by a surgical liaison nurse (SLN) on parental anxiety. Group I received in person progress reports from the SLN. Group II received routine perioperative care. The Speilberger's State-Trait Anxiety Inventory (STAI) Scale and investigator developed family rating scales were distributed to both groups and used as a quantitative as well as a qualitative approach to determine what was helpful for the family members during the operative period. Two hundred and eighty feedback forms were dispersed to various health care professionals including all anaesthetists, surgeons, nurses and other staff in the perioperative care team, including the operating room, day surgery unit and the post anaesthetic recovery room areas. Feedback forms were also circulated to staff from the intensive care unit and the surgical in-patient units. The results showed the anxiety levels were lower for the families who received in person progress reports but the difference by group was not statistically significant. Thematic written responses provided examples of improved care and effective time management behaviours on the part of the health care professionals. Written responses provided validation for the scale scores for both families and health care professionals and were an indication of the support for the role of the surgical liaison nurse. Qualitative findings implied that the surgical liaison nurse facilitated the transfer of necessary information between the perioperative care team and the family thus providing a support mechanism for families under stress.     

Psychological care of children and family in the critical care setting

Admission to the critical care setting can be a traumatic experience for a child and his or her parents. Besides providing physical care, the nurses should assess the psychological and emotional responses of the children and their parents. By integrating the child's psychosocial development and the principles of family-centered care into critical care nursing, the impacts of emergency admission on hospitalized children and their families can be reduced in order to facilitate adaptation on the part of the families.     

Caring for the cardiac transplant patient

The care of a child after cardiac transplantation is similar to the care of any child after cardiac surgery. In this article, the program at The Children's Hospital in Boston and the nursing management have been discussed. The focal points of nursing care are: (1) to continually monitor and assess the child's cardiovascular stability; (2) to prepare the child and family for the first endomyocardial biopsy and subsequent care; (3) to begin teaching about denervation and heart function, dietary modification, medications, infection, and rejection; and (4) to prepare the child and family for transfer from the CICU. The nursing care of a child who had a cardiac transplant is an exciting challenge for critical care nurses. As advances in the various aspects of transplantation are made, critical care nurses will assume more responsibility and actively participate in these advances. It is the art and science of critical care nursing that will contribute to the family integrity and the healthy lifestyle of the child.     

A collaborative project: initiating a family intervention program in a medical intensive care unit

Common needs of family members of critically ill patients were identified. Each member of the family may react differently to the stress caused by hospitalization of a loved one. Dealing with families in crisis requires the coordination of the health care team. A clinical nurse specialist can act as a coordinator and continue to integrate the efforts of the nursing staff to ensure a team approach in providing a structured yet individual way to deliver emotional support to families of the critically ill. The purpose, design, implementation, and evaluation of a family intervention program in an MICU as well as suggestions for its continuation were described. Evaluations of the program revealed positive responses by the majority of families participating in the program. Findings indicated that a structured and well-planned family intervention program can increase the staff nurse's knowledge and sensitivity to the needs of families who are in a crisis situation. Further research is necessary to identify needs of a family when they are faced with an acute illness of a family member and the required nursing interventions to assure the desired outcome of care. Replication and reporting of similar intervention programs, such as the family intervention program, would help nurses plan and implement appropriate interventions to support the family during critical illness of a family member.     

Family and staff perceptions of the role of families in nursing homes

Family and staff perceptions of the role of families in nursing homes Admission to a nursing home is generally regarded as the termination of family care and the commencement of institutional care. Research suggests that following placement families are often expected to relinquish their dependent older relative to the bureaucracy of the institution. The aim of this study was to investigate family and nursing home staff perceptions of the role of families caring for residents in nursing homes. A convenience sample of 44 family carers and 78 nursing home staff completed questionnaires, and interviews were conducted with 10 family carers and 10 nursing home staff. The results suggest that family carers perceived themselves to have a greater role in caring for relatives than that perceived by the nursing home staff. Either families overestimated their involvement, or staff underestimated family involvement in caring for residents in nursing homes. Families were mostly satisfied with their role and with the care provided in nursing homes. They perceived nurses as providers of technical care and they perceived themselves as having an important role in providing social and emotional care. Families trusted the clinical judgement of the staff but the staff were reluctant to trust family carers, especially in situations where care involved an element of risk. Family roles were limited by members' own ability to care and the dependency of the resident, while professional responsibility and accountability discouraged nurses from sharing some caring roles. The results indicate that families in this study were more willing to help in nursing home care and were perhaps under-valued as a resource within the nursing home setting.     

Nurses' beliefs about family involvement in a children's hospital.

Children's hospitals throughout North America have implemented many changes during the past 15 years. In recognition of the central role of parents in the lives of their children, policies and procedures have been implemented to enable parents to participate in various aspects of their children's care. However, the extent to which attitudes of nurses have changed to support a more active parental role is less evident. In a project to formulate a philosophy of nursing for a children's hospital, 22 nurses were asked a wide range of questions about nursing and family-centered care. Although all nurses expressed explicit support for the concept of family-centered care, some of their practices and beliefs suggested otherwise. This article describes their responses and suggests recommendations for future research, education, and nursing practice.     

Bridging the gap in care for children through the clinical nurse leader

Care coordination has been identified as a gap in the nursing care of children and families who experience an encounter within the health care system. The educational preparation of the clinical nurse leader (CNL) enables the CNL to address many gaps found in health care. Current evidence suggests various gaps in care, as reported by patients, families, nurses, and other health care providers. Identified gaps in care include problems with communication, coordination, education, research, advocacy, psychological and social support, and the needs of siblings. The CNL may improve quality of care for children through efficient care coordination by acting as a liaison and advocate between the patient, family, and health care team to bridge gaps in the current practices of care.