Family-Centered Care and Patient-Centered Care Philosophies in Medical Settings
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[edit] =Definition of family centered care
No concrete consensus exists about the definition of Family Centered care. One suggestion is given by Coyne that states, “family-centered care seems to provide a strong conceptual foundation to the enhancement of care for the child in the context of the family” (739). She came to this conclusion through a concept analysis of the terms: parent, participation, mothers rooming-in with their children, care by parent units, family involvement, quantity measures of care performed, partnership, involvement vs. participation and family-centered care (734-737).
Another definition, offered by The Institute for Family-Centered Care, is an “approach to the planning, delivery and evaluation of health care that is grounded in mutually beneficial partnerships among health care patients, families and providers … [that] applies to patients of all ages, and may be practiced in any health care setting” (Institute). They chose to define “patient and family centered care” this way because they believe the definition allows patients to grow up and mature, allowing them to become more involved with health care decisions (Institute).
For this Wikipedia entry, family centered care will be defined as an approach to planning, delivery and evaluation of health care (Institute) that is beneficial to pediatric patients, their families and medical professionals. This entry focuses on the definition of family centered care in relation to children because most of the research done on family centered care concentrates on pediatric patients. However, information concerning family centered care and adults can be found, but lack of reliable evidence limits this Wikipedia entry.
[edit] Family Participation in Family Centered Care
[edit] Level of Family Participation
The extent to which parents want to participate in their child’s care varies. In a study by Kristensson-Hallstrom, questionnaires asked parents to estimate how much they wanted to participate in their child’s care (Strategies 587). There options were: (1) staying with the child but letting professionals perform the care; (2) participating in care they were familiar with; (3) participating as much as possible, provided they were given guidance; and (4) an open-ended fourth alternative if none of the other options was satisfactory (587). Of the 331 participants, 6.34% (21) of the parents wanted professionals to perform their child’s care, 32.33% (107) of the parents wanted to participate with familiar care, 59.21% (196) of the parents wanted to participate as much as possible, .61% (2) of the parents said none of the alternatives were satisfactory and 1.51% (5) of the parents gave no answer (589). This study provides evidence to families and medical professionals about the different levels of participation that can be chosen from.
It is beneficial to the practice of family centered care to know why families choose a certain level of participation. Kristensson-Hallstrom and Elander conducted an interview with parents to gain knowledge about experiences parents had while in the hospital (362). After analyzing the interviews, three themes of parent security emerged: (1) leaving the child’s care to the staff, (2) obtaining a measure of control over the child’s care, and (3) depending on knowing one’s child the best (363).
These three different themes are similar to the levels of participation described in the previous study, and may explain why parents chose a certain level of participation. Parents who wanted to leave the child’s care to staff members were described as anxious about the hospitalization and the child’s operation (363). These parents said things to interviewers and hospital staff like, “I am so sensitive. I don’t like blood or operations,” and “you take care of him; you know best; I trust you to know what is the best” (363). The parents in the middle category were also anxious during the hospitalization, but thought that they could help their child cope with difficult situations, and be an information provider (364). One parent in this category said, “I feel secure when I know … what is happening to [my son]” (364). The parents in the final category were reported as being calm and unworried, however, for three of the children this was a repeat surgery, which may be why parents were calm (365). These parents made statements such as, “it is natural to participate in the care. I am sure it would have felt unnatural not to do so” and “I want to take care of him myself; I know best how to take care of him” (365).
This evidence allows medical professionals and families to assess how much families should participate in the child’s care. For example, if medical professionals see families that are anxious about the child’s hospitalization, medical professionals may realize these types of families usually like little to no participation in their child’s care. More research needs to be done to determine if medical professionals and families are able to assess the appropriate level of participation. However, discussion between medical professionals and families before health care needs are taken care of can determine the family’s level of participation.
[edit] Medical Professionals Comfort with Family Participation
In an interview with twenty-five pediatric nurses, it was found how comfortable nurses felt with parents performing specific care for children (Brown and Ritchie 31). The results stated that 100% of the nurses felt comfortable with parents feeding the child, changing the child’s diapers, comforting the child, and bathing the child (31). However, 40% or less of the nurses did not feel comfortable with parents giving the child medicine by mouth or injection, taking the child’s temperature, changing the child’s dressing and reporting the child’s pulse (31). This study concludes that nurses are more comfortable with parents performing simple tasks, such as feeding the child, and less comfortable with parents performing complex or important tasks, such as taking the child’s temperature (32).
[edit] Medical Professionals’ Participation in Family Centered Care
[edit] Do Medical Professionals Practice Family Centered Care?
This Wikipedia entry suggests that medical professionals do practice family centered care. However, little to no evidence exists about what types of medical professionals (i.e. physicians or nurses, etc.) are likely to practice family centered care or how often (i.e. everyday, every patient, etc.) this technique of care is practiced. More research needs to be done to discover reliable information about these topics.
The degree to which medical professionals perform family centered care varies. In an interview, both parents and health care providers agreed that medical professionals often thought of themselves as being an information provider and supporter, who left decisions about what treatment of care is best for the child up to the family (MacKean, Thurston and Scott 79). After receiving information about her child, one parent said, “the [health care providers] sent [her] afloat in an ocean and said, okay here it is, now go and do something about it” (79). On the other hand, medical professionals see providing information as empowering the parents, not sending them afloat. One professional said, “we want to provide enough information for parents so that they feel empowered [when] making decisions for [the] care [of] their child” (78). This study suggests the degree to which medical professionals practice family centered is limited to giving support to families through information, and leaving the rest up to the families. However, this study also suggests that families feel overwhelmed when medical professionals do this, and therefore more research needs to be done to provide medical professionals with a better way to support and inform parents.
[edit] Families’ View of Medical Professionals’ Participation
The degree to which families want medical professionals to provide care to their children varies. However, little to no evidence on this subject exists, but may be determined by religion, ethnicity, previous experiences, knowledge and level of family participation. More research needs to be done on this topic.
[edit] Patient Participation in Family Centered Care
Pediatric patient participation in family centered care may be beneficial to the patient. However, no research has been done to prove this claim. The reason no evidence exists about pediatric participation could be because many pediatric patients are too young to have knowledge about their care, or they may be too sick to participate in care. More research needs to be done to find out if pediatric patient participation in family centered is beneficial.
[edit] Medical Professionals’ View of Family Centered Care
Many people wonder how medical professionals view family centered care. In a study that interviewed all medical professionals that came in contact with the emergency room, it was found that all medical professionals recognized parents, primary caretakers, and relatives as an important source of information about the child and the child’s condition (Eckle and MacLean 240). Also, it was found that medical professionals viewed family as essential to the pediatric patient (240). This study may be unreliable because it has little evidence to prove these claims, such as the number of participants and specific quotes from medical professionals. Additional research like this needs to be performed to provide reliable evidence about these claims.
One complaint medical professionals have about family centered care is how much of their time it consumes. Callery conducted a qualitative study where interviews were given to nurses and parents (993). Nurses said that the demands of parents for time were unpredictable and presented them with problems managing their work (996). One nurse described the unpredictability of a child’s condition as too demanding of her time. She said, “this morning, I spent quite a bit of my time … with a mom because she was so upset” (996). However, nurses do not agree with each other that spending time with parents is important. One nurse said, “[caring for parents] is part of our role … and it’s an important part” (995). In contrast, a different nurse said, “[spending time with parents] differs between nurses… [some nurses] just see it as…‘we’re here to do a nursing job’” (995). This study suggest that time constraints limit the practice of family centered care and also suggests that the importance of family centered care to medical professionals varies.
[edit] Family Centered Care: Does it Work?
Many families and medical professionals question whether family centered care is beneficial to the patient. In a study by Kristensson-Hallstrom, an experiment was conducted to assess possible benefits of increased parental involvement in the child’s care (Increased 297). A control group of 88 children, and an intervention group of 92 children, was formed (298). The parents of the children in the intervention group received extra information concerning their child, such as what the child could drink and eat, what medicine the child was receiving, how the parents could participate in the child’s care, and extra information about the child’s care after surgery (298).
The two groups were compared to see who would be the first to consume fluid, mobilize, void (urinate) and be discharged from the hospital. The table below shows the average time (and standard deviation) after surgery it took for each group to complete a certain task. The results show that intervention group took less time to drink fluid, mobilize and be discharged from the hospital than the control group, and the control group took less time to void (300).
| Task | Intervention Group | Control Group |
|---|---|---|
| Fluid Intake | 69 (+/- 22) minutes | 84 (+/- 28) minutes |
| Mobilization | 123 (+/- 57) minutes | 183 (+/- 89) minutes |
| Voiding | 263 (+/- 119) minutes | 211 (+/- 95) minutes |
| Discharge from Hospital | 143 (+/- 58) minutes | 261 (+/- 108)minutes |
Table from: Kristensson-Hallstrom. “Increased Parental Participation in a Paediatric Surgical Day-Care Unit” 300
Kristensson-Hallstrom concluded that parental participation in the care of hospitalized children results in benefits for children, parents, and the hospital because for three out of four of the tasks, the intervention group recovered faster (301).
[edit] Ways To Improve Family Centered Care
[edit] Support
Many families want medical professionals’ support through their child’s hospitalization. A study designed to discover family experiences of support from medial professionals gave questionnaires out to parents and their ill child (Sarajarvi and Haapamaki 206). The results were that 41% of the families felt they received support from the nursing staff (207). Of this 41%, 37% of the families reported that they were supported through discussions, 34 % said it was through listening, 12 % said it was through receiving information, and 11% said it was through the amount of time the nurse gave to the families (207). However, many of the families wished that the staff could have provided them with more support (208). One of the parents stated that, “although you can cope with the child’s care alone, you hope that the nurse would be your companion, because you have a great need for support, like being listened to and talk[ed] to” (208). This study suggests medical professionals support family members, but even more support is needed.
[edit] Hospital Vision and Mission Statements
Having a vision or mission statement that focus on family centered care is beneficial to the practice of family centered care. During the assessment of the policies and practices of family centered care in nine different emergency rooms it was found that all the hospitals had vision or mission statement visible to the public and the staff (Eckle and MacLean 240). All departments also had statements that included core concepts of family centered care, such as respect, dignity, communication and collaboration (240). However, of these nine statements, only two statements articulated the role of the family (240) In conclusion, the study found that the medical professionals in the departments that articulated family centered care believed that family interaction was a priority, and that the staff more consistently identified family strengths (242). This study suggests that vision or mission statements that articulate family centered care will promote medical professionals’ practice of family centered care. However, to conclude this may be unreliable because the authors lack evidence, such as quotes that state the nine hospitals’ vision or mission statement. More research like this one needs to be done to support this claim.
[edit] Actual and Ideal Practices of Family Centered Care
A good way to improve family centered care is to discover the ways families are currently participating in their child’s care, and ideal ways they could be participating. One study had medical professionals and parents use a self-rating tool to discover whether certain family centered practices were performed, and whether these practices were viewed as ideal to include in child assessments (Crais, Roy and Free 368). The results are reported in the table below. The first and third column of the table provides percentages of families and professionals and percentages of professional pairs that agreed a certain practice was performed. The second and fourth columns provide percentages of families and professionals and percentages of professional pairs that agreed a certain practice was ideal. For example, the first practice states that 39% of families and professionals agreed that the family was asked to observe or write down observations of the child before the assessment, and 85% of the families and the medical professionals agreed that this should be an ideal practice. On the other hand, only 23% of professional pairs agreed that the family was asked to observe or write down observations, and 84% of professional pairs agreed this was ideal practice.
| Practice | % Of Family/Professional Pairs Actual | % Of Family/Professional Pairs Ideal | % Of Professional Pairs Actual | % Of Professional Pairs Ideal |
|---|---|---|---|---|
| Family was asked to observe or writed down observations of child before assessment. | 39 | 85 | 23 | 84 |
| Family was asked how they felt about the results of the previous assessment. | 53 | 92 | 38 | 92 |
| Family was asked how they felt about the way the previous assessment was conducted. | 44 | 92 | 31 | 92 |
| Family was asked if the previous assessment gave a good picture of the child. | 63a | 83a | 50 | 92 |
| Family was asked what activities or techniques in the previous assessment were most and least successful. | 11 | 67 | 7 | 62 |
| Family was asked to identify areas for assessment. | 45 | 79 | 37 | 78 |
| Family was asked to identify strategies to use in the assessment. | 21 | 53 | 25 | 63 |
| Family given the option to choose the time of day for the assessment. | 39a | 59a | 48 | 79 |
| Family given the choice to complete an assessment tool or checklist. | 34 | 71 | 10 | 60 |
| Family given the choice to write down observations of their child during the assessment. | 0 | 32 | 0 | 31 |
| Family given the choice to comment on ways to get their child to perform assessment tasks. | 69a | 91a | 57 | 90 |
| Purpose of all activities or assessments explained to family before being used. | 59 | 89 | 62 | 95 |
| If family wrote down observations before the assessment, they were asked to describe what they saw. | 4 | 68 | 6 | 56 |
| Family was asked to talk about their child's behaviors observed during the assessment. | 57 | 89 | 50 | 94 |
| If the family completed an assessment tool or checklist, they were asked to talk about what they noticed. | 10 | 64 | 6 | 73 |
| Family given a choice about when and where the assessment results would be discussed. | 55 | 80 | 54a | 76a |
| If a diagnosis was made, family was asked whether they agreed with the diagnosis. | 37 | 93 | 30 | 88 |
| Family was asked to help identify future goals for their child. | 53 | 89 | 60 | 86 |
| Family was asked to help determine how goals for their child could be accomplished. | 43 | 86 | 54 | 82 |
| Family given the choice to review the written report and suggest changes. | 21 | 64 | 33 | 60 |
Note. Percentage of pairs who agreed the practice actually occurred or was ideal. a These percentages do not represent a 25% or greater difference within the pair. Crais et al. “Parents’ and Professionals’ Perceptions of the Implementation of Family-Centered Practices” 373
These results give family members and medical professionals ideas on the areas of improvement, and important practices of family centered care. For example, if it was agreed that families were only asked to write down child observations 23% or 39% of the time, and about 85% of families and medical professionals agreed this is an ideal practice, then medical professionals and families should find a way to use this practice in family centered care. For more information about improvement to family centered care, analyses like this one can be done for every practice in the table.
[edit] Refrences
Brown, Janis and Ritchie, Judith A. “Nurses’ Perceptions of Parent and Nurse Roles in Caring for Hospitalized Children.” Children’s Health Care 19.1 (1990): 28-36. EBSCOhost. McIntyre Lib., UW Eau Claire. 20 Nov. 2006.
Callery, Peter. “Caring For Parents of Hospitalized Children: A Hidden Area of Nursing Work.” Journal of Advanced Nursing 26 (1997): 992-998. EBSCOhost. McIntyre Lib., UW Eau Claire. 20 Nov. 2006
Coyne, Imelda T. “Parent Participation: A Concept Analysis.” Journal of Advanced Nursing 23 (2006): 733-740. EBSCOhost. McIntyre Lib., UW Eau Claire. 15 Nov. 2006.
Crais, Elizabeth R. and Roy, Vicky Poston and Free, Karen. “Parents’ and Professionals’ Perceptions of the Implementation of Family-Centered Practices in Child Assessments.” American Journal of Speech-Language Pathology 15 (2006): 365-377. EBSCOhost. McIntyre Lib., UW Eau Claire. 26 Nov. 2006.
Eckle, Nancy and MacLean, Susan. “Assessment of Family-Centered Care Policies and Practices for Pediatric Patients in Nine US Emergency Departments.” Journal of Emergency Nursing 27.3 (2001): 238-244.
Kristensson-Hallstrom, Inger. “Increased Parental Participation In A Paediatric Surgical Day-Care Unit.” Journal of Clinical Nursing 6 (1997): 297-302. EBSCOhost. McIntyre Lib., UW Eau Claire. 20 Nov. 2006.
Kristensson-Hallstrom, Inger. “Strategies For Feeling Secure Influence Parents’ Participation in Care.” Journal of Clinical Nursing 8 (1999): 586-592. EBSCOhost. McIntyre Lib., UW Eau Claire. 15 Nov. 2006.
Kristensson-Hallstrom, Inger and Elander, Gunnel. “Parents’ Experience of Hospitalization: Different Strategies for Feeling Secure.” Pediatric Nursing 23(1997): 361-366. EBSCOhost. McIntyre Lib., UW Eau Claire. 15 Nov. 2006.
Institiue For Family Centered Care. 15 Nov. 2006 <http://www.familycenteredcare.org/faq.html>
MacKean, Gail L and Thurston, Wilfreda E. and Scott, Catherine M. “Bridging the Divide Between Families and Health Professionals’ Perspectives on Family-Centered Care.” Health Expectations 8(2005): 74-85. EBSCOhost. McIntyre Lib., UW Eau Claire. 22 Nov. 2006.
Sarajarvi, A and Haapamaki, Paavilainen. “Emotional and Informational Support for Families During Their Child’s Illness.” International Nursing Review 53.3 (2006): 205-210. EBSCOhost. McIntyre Lib., UW Eau Claire. 15 Nov. 2006.
