Family Centered Care
Family Centered Care
Family Centered Care
SUBMITTED TO
Assistant professor
kurnool
FAMILY CENTERED NURSING CARE
FAMILY
“Family” means any person(s) who plays a significant role in an individual's life. This
may include a person(s) not legally related to the individual who act as advocates. Members
of “family” include spouses, domestic partners, and both different-sex and same-
sex significant others. “Family” includes a minor patient's parent or parents, regardless of
the gender of either parent. Solely for purposes of visitation policy, the concept
of parenthood is to be liberally construed without limitation as encompassing legal
parents, foster parents, same-sex parent, stepparents, those serving in loco parentis (in
place of the parent), and other persons operating in caretaker roles.
"Care partners" are then intricately involved with the patient's care by their entire
attending healthcare team, including physicians, nurses, nutritionists, social workers, and
more. At every stage, "care partners" and patients discuss with healthcare professionals test
results, the state of the patient's current health, what type of things to expect throughout
the day, and discharge goals. "Care partners" are invited to take part in nursing
interventions, including bathing, feeding, helping the nursing staff with moving the patient,
and assisting the patient in exercising or moving about the unit. "Care partners" are also
invited to take an active role in "rounds," providing feedback and asking questions reflective
of theirs and the patient's wishes or concerns.
Patient care was also positively affected. Decubidation rates in facilities with family-
centered care dropped significantly. In one study, it was found that patients receiving
family-centered care were far more likely to have met the criteria of medical and nursing
care plans (such as drinking x amount of fluids every eight hours, moving from NP suctioning
to bulb suctioning, or the measurement of patient's intake/output), as the patient's family
took it upon themselves to encourage or assist the patient in accomplishing these goals.
[12]
Family and close friends were more likely to identify slight variations in the patient's
mental or physical health that health care professionals largely unfamiliar with the patient
may miss. Furthermore, while health care professionals are very talented at their work, their
jobs are generally limited by the walls of the health care facility, whereas a patient's family
is not. Enlisting a patient's family as a part of their health care team helps enable their
ability to assist, manage, and assess the patient's healing after their discharge from a health
care facility
Family-centered maternity care, a concept based on the fact that having a baby
involves all members of the family, implies thinking of human beings as individuals. It calls
for caring for the significant others in a mother’s life as well as the mother herself, and it
encourages the nursing and medical professions to prepare expectant couples physically,
emotionally, and intellectually for labor, delivery, and parenthood. Family, it should be
noted, does not refer exclusively to husbands or to blood relations. Rather, it refers to any
system of relationships in which the related persons are deeply involved with each other.
When evaluating the kind of maternity care given today in most hospitals, questions can be
raised about whether nursing care is even patient centered, much less family centered. Give
thought to what is provided. In many instances, mothers bear their pain in loneliness, their
helplessness in fear. Fathers, grandparents, and other significant people spend hours alone
in waiting rooms with little word about what is happening on the other side of the labor
room door. While mothering and fathering behaviors are known to be learned, many nurses
are content with bringing babies to mothers for 30 minutes every 4 hours. Fathers are
relegated to viewing their offspring through a glass window. Responses to parents’
questions often reflect neither care nor concern for the people being served, with little
provision being made for preparing parents for the adjustments that will take place at
home. At the end of approximately 48 hours, parents are discharged as supposedly well-
functioning and skilled mothers and fathers.
Family-centred care
Family-centred care is a multifaceted concept that has evolved over the past 60 years and
remains a significant concept for children’s nursing in the 21st century. The concept
embraces caring for the child in the context of the family and therefore nurses recognise the
central role of the family in the child’s life.
Different definitions and theoretical frameworks have been used to explain the evolving
concept of family-centred care. These definitions and frameworks are all still reflected to
some extent in the family-centred care approaches that are currently used by children’s
nurses in practice. This is because some children’s nurses, using their professional
judgement, will select the most appropriate family-centred care framework to meet the
needs of individual children and their families. Conversely, other children’s nurses have not
adopted contemporary theoretical family-centred care frameworks for implementation in
practice and their approach to care is based on earlier theories. This may be due to choice
or because of a lack of knowledge, skills or willingness to adopt new ways of working in
practice. Bruce & Ritchie (1997) identify a need for skill development in areas of
communication that involve negotiation and the sharing of information with children and
their families. These areas of communication are defining characteristics of contemporary
family-centred care theoretical frameworks. Bruce et al (2002) advocate the need for
continuing education for healthcare professions working with families to further develop
these communication skills.
The practice continuum tool was synthesised from available research and theoretical
material, as well as practice experience, and therefore incorporates all the elements of the
theoretical frameworks already discussed. Children’s nurses should be familiar with the
terms contained within the tool but because these terms are sometimes used
interchangeably to mean the same thing, and because using the practice continuum tool
provides practitioners with a dialogue through which to articulate family-centred care in a
meaningful and achievable way, it is important to understand what we mean by the
following terms:
• Nurse-led care, no family involvement: this may occur in situations where the family is not
able or willing to be involved for a particular reason for a period of time. This is still family-
centred care because the nurse still uses a family-centred focus in care delivery in the
family’s absence.
• Nurse-led care, family/child involvement in care: this may occur when the family is
involved in some basic care, such as feeding, hygiene and/or emotional support. The nurse
takes the lead in care management at this stage.
• Equal status, family/child partnership in care: this is exemplified by the change in the
nurse’s role to becoming more of a supporter and facilitator. As families become more
empowered they resume their role as primary care givers and the relationship with the
nurse is much more equal in nature.
• Parent/child-led care, nurse-consulted care: the family is now expert in all aspects of the
child’s care. There is a mutual, respectful relationship with the nurse, who is used in a
consultative capacity from time to time. Although this is expressed explicitly as parent-led
care, the implicit notion is that children are involved in their care and can lead their care in
some instances.
No matter where the family is on the practice continuum, it is family-centred care; family-
centred care is not only achieved by reaching an ‘end stage’. Parents negotiating with the
nurse choose where they wish to be on the continuum. For some this may be a progression
along the continuum, particularly for those families with a child with an ongoing illness,
whereas others may prefer to be involved differently, providing normal childcare and
emotional support only.