Patient-family Centered Care Research Articles

Instrumen Discharge Planning Berbasis Patient Family Centered Care

This study aims to develop a discharge planning instrument through an inpatient family centered care approach, to improve service quality. The method used was systematic review, a systematic search through the Scopus, Science Direct, and Pub Med databases published between 2018-2023. The results showed that discharge planning based on patient family centered care helps prepare patients and families for home care, increase knowledge and skills, and collaborate with other health workers. The conclusion of this study is that discharge planning has an influence on the success of patient care after being at home. The implementation of discharge planning is important in preparing patients and families with education by nurses related to the disease and patient care so as to increase knowledge and skills for home care. Improved quality of service at home and patient and family satisfaction. Keywords: Discharge Planning, Instrument Development, PFCC, Hospitalization, Hospital.

임상간호사의 임종간호수행에 미치는 영향요인

The purpose of this study was to examine the effects of clinical nurses’ positive psychological capital, terminal care stress and perception of patient-family centered care on performance of terminal care. Data were collected from 198 nurses, and analyzed using descriptive statistics, independent t-test, one-way ANOVA, Pearson’s correlation coefficient, and stepwise multiple regression analysis. There were significant differences between clinical nurses’ performance of terminal care and working experiences in current unit (F=3.60, p=.015), work unit (t=2.36, p=.019), number of terminal care provided to dying patients within 1 year (F=2.76, p=.044), and experience of patient-family centered care education (t=-2.26, p=.025). The factors affecting clinical nurse’s performance of terminal care were positive psychological capital (β=.38, p<.001), perception of patient-family centered care (β =.23, p=.001), work unit (β=.15, p=.014), and experience of patient-family centered care education (β=.14, p=.026), explaining 29.0% of the variance. Therefore, the effective education program is needed to enhance clinical nurses’ positive psychological capital as well as to increase their education experience and awareness of patient-family centered care in order to better perform terminal care.

Development of Discharge Planning Instruments Based on Patient Family-Centered Care in the COVID-19 Inpatient Room, Universitas Airlangga Hospital, Surabaya

Introduction: The current era of the COVID-19 pandemic requires innovation in the provision of discharge planning by involving family members through the media safely and effectively. This study aimed to develop a discharge planning instrument based on patient family-centered care. Method: Research design Research and Development. The sampling technique used purposive sampling with a total sample of 110 medical record documents, 23 focus group discussion participants, and 2 experts (expert consultation). Data were collected through observation sheets, focus group discussions, and expert consultations. Data analysis using descriptive analysis, and validity test using I-CVI. Results: Development of a patient family centered care-based discharge planning instrument at the beginning of the patient’s admission (admission), namely sorting and adding assessment items to the level of knowledge of the disease, information and education needs, values, and beliefs, cultural background as well as physical and psychological. During treatment, namely arranging and sorting discharge planning items, providing information and education according to the assessment results using a media approach and the method according to the COVID-19 pandemic protocol. Towards home that is adding items; readiness or environmental conditions (environment), referral plans (Outpatient referral), and continued treatment while at home (Medication). Conclusion: The developed instrument tested is valid. As a result of this development, the new instrument can be tested and applied, and researched in the next stage on the outcomes of patient family-centered care.

Utilization of Family as Faculty: A Patient Directed Simulation Education to Improve Patient and Family Communication during Patient-Family Centered Rounds (PFCR).

Introduction:Patient-family-centered care (PFCC) is based on the understanding that the family is the child’s source of strength and support. Effective communication between families and providers is an essential component of PFCC. Our interprofessional team designed an initiative to improve medical providers’ communication in partnership with the Patient and Family Advisory Council (PFAC). Strategies included the creation of a competency rubric and simulation curriculum using the family as faculty. The SMART aim was to improve the percentage of respondents who answered “Always” to doctor communication domains from 72% to 75.6% in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) by December 2020.Methods:Pediatric residents, medical students, faculty, nurses, and PFAC members formed a Quality Improvement (QI) team to address PFCR competency. The team created a PFCC checklist to address competency. PFAC volunteers served as standardized parents in an in situ simulation of PFCR scenarios involving interprofessional in-patient teams. Evaluators observed rounds for the pre and postintervention assessment using the checklist. The outcome measure was the percentage of respondents who answered “Always” in the HCAPHS domain for physician communication. The process measure was the PFCR pre and postintervention, using Fisher’s exact test for analysis.Results:Using a statistical process chart (SPC), HCAHPS data from 2018 to 2020 showed that we exceeded our aim of >5% increase in the physician communication performance. Pre-post intervention data showed improvement in PFCR competency.Conclusion:Family as faculty simulation led to improved physician communication, translating to improved performance in the HCAHPS score and PFCR competency communication domains.

Describing Family Needs within Adult Critical Care Units at a Military Hospital in Jeddah, Saudi Arabia

Background: Family members have traumatic experiences when a loved one is admitted into critical care units as they are not psychological prepared for the sudden illness of a loved one. Attending to the needs of family members of critically ill patients is vital in providing appropriate holistic care for both the patient and the family.Methods: A cross sectional descriptive quantitative research design was used. The study was conducted in a military hospital in Jeddah, Saudi Arabia, within 10 critical care units. A total of 25 doctors, 66 critical care nurses and 38 family members were included in the study. Data was collected using the Critical Care Family Needs Inventory (CCFNI), a Likert tool developed by Jane Leske which has established reliability of 0.80-0.97.Findings: The most important need as perceived by doctors was “the “need to know the expected outcome’ regarding the patient’s condition, M= 3.72 (SD = 0.54), while critical care nurses’ perceived the most important family need as “To have explanations of the environment before going into the critical care unit for the first time, M= 3.65 (SD= 0.54). Further to this, family members’ perceived “To be assured that the best care possible is being given to the patient” as the most important family need M= 3.76 (SD= 0.54).Conclusion: Health care professionals have a responsibility towards meeting these needs in order to provide care that is holistic in nature that encompasses the basic tenets of patient-family centered care.

Implementing Patient Family-Centered Care Grand Rounds Using Patient/Family Advisor Narratives.

With the emerging trend of patient family–centered care in health care, it is essential that physicians be exposed to patient and family perspectives of care during medical education and training. Grand Rounds provides an ideal format for physicians to learn about patient family–centered care. At Brigham and Women’s Hospital, we sought to bring the voice of the patient to Patient Family–Centered Grand Rounds in order to expose clinicians to rich narratives describing the medical care received by patients/families and to ultimately change physician practice to reflect patient family–centered principles. We conducted a clinician survey and found promising results indicating that patient/family narratives can be effective at educating physicians about patient family–centered care.

Creating a 24/7 Model for Patient–Family-Centered Care

A major challenge for hospitals is ensuring consistent and standardized patient care across all shifts. In particular, evenings and nights are of concern because most patients are admitted to hospitals during those hours. In 2009, Yale-New Haven Hospital (Y-NHH), a 948-licensed-bed university teaching organization, embarked on a journey to establish a 24/7 leadership model to enhance the culture of safety, provide seamless care delivery, and comply with performance standards. Although care delivery was multidisciplinary and provided a full range of services and coverage from 7 a.m. to 3 p.m., after those prime hours, many departments, nursing included, scaled back resources. Thus, full clinical and managerial coverage was in fact only available one-third of the time, whereas two-thirds of the time, patients and staff were working with fewer resources while caring for the same volume and acuity of patient populations.

Implementation of integrated services networks in Quebec and nursing practice transformation: convergence or divergence?

BackgroundEven though nurses are expected to play a key role in implementing integrated services networks, up to now their practice in this regard has received very little research attention. The aim of this study is to describe the extent to which the evolution of nursing practice in Quebec in recent years has converged with the requirements and efforts involved in services integration.MethodsThis descriptive study was carried out with 107 nurses working an integrated network of healthcare services in Quebec in four different care pathways: chronic obstructive pulmonary disease, autonomy support for the elderly, palliative oncology care, and mental health. Development model for integrated care (DMIC) was used, first, to examine the prevalence in each pathway of integrative activities, grouped into nine practice dimensions, and then to position each pathway in relation to the four phases of development for any integration process, as defined by the DMIC.ResultsOnly one pathway had reached Phase 3, which involves expansion and monitoring of integration, whereas the others were still in the preliminary Phases 1 and 2 characterized by initiative and experimentation. Only two dimensions out of nine (‘quality of care’ and ‘interprofessional teamwork’) were prevalent in all the pathways; two others (‘transparent entrepreneurship’ and ‘performance management’) were in none of the pathways, and the remaining five (‘patient–family centered care’, ‘result-focused learning’, ‘delivery system’, ‘commitment’, ‘roles and tasks’) were present to varying degrees.ConclusionsThese results suggest that particular efforts should be made to bridge the significant gap between the pace of nursing practice transformation and the objectives of service integration. These efforts should focus, among other things, on the deployment of organizational, clinical, human, and material resources to support practice renewal and continuing education for nurses to prepare them for the requirements of integration.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-0720-8) contains supplementary material, which is available to authorized users.

The interaction between lived experiences of older patients and their family caregivers confronted with a cancer diagnosis and treatment: A qualitative study

BackgroundDespite the growing incidence of cancer among older people, little is understood about how older patients and their family caregivers experience receiving a cancer diagnosis and treatment and how their experiences mutually influence each other. Such knowledge is needed to provide meaningful support for both the older person and family caregivers. ObjectivesExploring lived experiences of older cancer patients, family caregivers and their interaction. DesignQualitative interview design. SettingSix outpatient oncology departments at a University Hospital. ParticipantsThirty-two patients (age range 70–86) and 19 family caregivers (age range 42–83). MethodsSemi-structured interviews with a fairly open framework were conducted and analyzed using the constant comparative method inspired by a grounded theory approach. ResultsOlder patients and family caregivers experience important demands when confronted with cancer. Patients feel the inherent need to search for hope, and the majority are able to do so by employing coping strategies. Because of their older age, patients anticipate getting a serious illness such as a cancer diagnosis. Family caregivers become ‘a family member of an older person with cancer’ and feel responsible for the patient's well-being and for providing care. If patients are able to maintain a ‘positive’ story, family caregivers support this ability. If not, they search for a ‘positive’ story and point this out to the patient. Most family caregivers perceive their care-giving as a normal process and find it difficult to request professional help for themselves. Nevertheless, knowing that professional help is available whenever they need it reassures them. Overall, life continues during the illness experience: the interaction between patients and family caregivers goes on, their relationship proceeds, the coping and care patterns continue. ConclusionsThe cancer diagnosis has a major impact on patients and family caregivers. This study offers a framework for understanding what is it like to have cancer in old age and outlines the importance of listening actively to the life stories of patients and family caregivers in order to comprehend coping strategies. This may result in better tailored patient–family centered care.

Does the Type and Frequency of Palliative Care Services Received by Patients with Advanced Heart Failure Impact Symptom Burden?

JOURNAL OF PALLIATIVE MEDICINE Volume 17, Number 1, 2014 a Mary Ann Liebert, Inc. DOI: 10.1089/jpm.2013.0231 Brief Reports Does the Type and Frequency of Palliative Care Services Received by Patients with Advanced Heart Failure Impact Symptom Burden? Lorraine S. Evangelista, PhD, RN, FAHA, FAAN, 1 Solomon Liao, MD, FAAHPM, 2 Marjan Motie, PhD, 3 Nathalie De Michelis, RN, BSN, 4 Jennifer Ballard-Hernandez, MSN, NP, AACC, 5 and Dawn Lombardo, MD 4 pies, organ and tissue donation, and medical device donation), and worked with participants to develop a treat- ment plan that listed the goals of care. The treatment plan was presented to the interdisciplinary PC team during their weekly meetings, in order to support a team-based approach to providing patient-family centered care that encouraged active involvement of patients and their families in decision making involving their care. Introduction P atients with heart failure (HF) experience a myriad of symptoms that are associated with marked distress and impaired quality of life. 1–3 In light of their high symptom burden and poor prognosis, patients with symptomatic HF are an appropriate population in whom to introduce pallia- tive care (PC). 4–6 However, PC referral early in the course of symptomatic HF is a relatively new practice and few data exist that describe the nature of these encounters. 7 The current study was conducted to describe the nature of outpatient PC services (i.e., type of services and care received, duration, and frequency of visits) used by patients discharged from the hospital with acute HF exacerbation, i.e., New York Heart Association (NYHA) Functional Class II–III, and to describe levels of symptom burden during the initial PC consultation and three months thereafter. Data collection methods The study was approved by the appropriate institutional review board. Participants provided informed consent prior to completing the modified Edmonton Symptom Assessment Scale (ESAS), 8 a nine-item, self-reported visual analog scale numerically rated from 0 (no symptom at all) to 10 (worst possible symptom) at baseline and three months, to assess ratings of each symptom at the time that the survey was completed. 9 The severity of each individual item was cate- gorized as none (0), mild (1–4), moderate (5–7), and severe (8– 10). The reliability (Cronbach’s a) of the ESAS for the current study was 0.86. Data on types of PC services received, the focus of care for each encounter, and medication use over three months were abstracted from the medical records. Methods Study design, setting, and participants This descriptive-exploratory study was conducted at a single university affiliated medical center. Participants were recruited from the inpatient setting through HF provider referrals. Data analyses Palliative care intervention Descriptive summaries of demographic and clinical data, symptom burden scores, and duration and frequency of PC encounters were computed using SPSS 18.0 (SPSS Inc., Chi- cago, IL). The paired Wilcoxon signed-rank test was used to compare symptom burden scores immediately after discharge and three months postdischarge. A symptom response rate (i.e., percentage of participants presenting a reduction of ‡ 2 points on an individual symptom of the ESAS) was computed to determine efficacy of PC in reducing symptom burden; a two-point change in individual symptom scores has been Participants met within seven days of hospital discharge with a PC specialist (e.g., physician or advanced practice nurse) who retained primary responsibility for their PC needs over three months. The PC specialist performed a compre- hensive physical and psychosocial assessment, initiated dis- cussions about advance care planning (e.g., completion of advance directives, options to take in the event of worsening health, family involvement, pain management, hydration is- sues, artificial nutrition, blood transfusions, advanced thera- Program of Nursing Science, University of California Irvine, Irvine, California. Palliative Care Services and Department of Medicine, 4 Clinical Heart Failure Program, University of California Irvine Medical Center, Irvine, California. Pro-HEART, Program of Nursing Science, University of California Irvine, Irvine, California. Hoag Memorial Hospital Presbyterian, Newport Beach, California. Accepted August 30, 2013.

Utilization of a Benchmarking Database to Inform NICHE Implementation

An integral part of NICHE (Nurses Improving Care for Healthsystem Elders) is a benchmarking service that provides member sites with the ability to evaluate staff perceptions of the care environment compared with other NICHE sites. The NICHE Database includes more than 100,000 surveys (Geriatric Institutional Assessment Profile). This study aimed to explain how secondary analyses of this aggregate database can inform effective geriatric programming in hospitals. We found that nurse age and experience influence nurse perceptions of organizational alignment to NICHE guiding principles and that those perceptions improve following NICHE implementation. The NICHE Database addresses knowledge generation in key areas of geriatric nursing practice and assists hospitals' systemic capacity to effectively embed NICHE Guiding Principles: evidence-based geriatric knowledge, patient-family centered care, healthy and productive practice environment, and multidimensional metrics of quality. It contributes to the growing field of implementation science that seeks to promote the uptake of research findings into clinical practice.

“I Will Never Forget”: What We Learned from Medical Student Reflections on a Palliative Care Experience

To use reflective writing to evaluate a new required palliative care experience for third year medical students. The authors used a constant comparison method based on grounded theory to conduct a thematic analysis of reflective writings produced by third-year medical students completing a mandatory week-long clinical rotation in palliative care during academic year 2010 at the University of Louisville. Two broad thematic categories were identified: what the students learned and what the students experienced. Student writings revealed learning about palliative care (pain management, family meetings, goals of care, patient-family centered care, timing of palliative care, and delivering bad news); being a doctor (knowledge, communication, presence, empathy, not giving false hope, and person-focused care); the patient (importance of family, the experience of dying, and the uniqueness of each patient); and themselves (need to be non-judgmental, ability to do palliative care, self-limitations, becoming a better physician, and dealing with death). Student reflections centered on encounters with patients and families, internal emotional responses, and self-transformation. Systematic analysis of reflective writing provides educators with valuable data about students' learning experiences. These results may inform the design and modification of the curriculum.

“He Got His Last Wishes”—Next-of-Kin Ways of Knowing Patient's End of Life Preferences and Affirming Clinical Conformity (726)

Result. Two broad thematic categories were identified: what the students learned and what the students experienced. Student writings revealed learning about palliative care (pain management, family meetings, goals of care, patientfamily centered care, timing of palliative care, and delivering bad news); being a doctor (knowledge, communication, presence, empathy, not giving false hope, and person-focused care); the patient (importance of family, the experience of dying, and the uniqueness of each patient); and themselves (need to be non-judgmental, ability to do palliative care, self-limitations, becoming a better physician, and dealing with death). Student reflections centered on encounters with patients and families, internal emotional responses, and self-transformation.

Patient-Family Centered Care: Are We There Yet?

AS THE HOLIDAYS rapidly approach, much of our focus will soon turn away from the daily grind of work and professional activities, and re-center on renewing relationships with our closest family and friends. Many of us are currently spending much of our time sending out Holiday cards, buying just the right gift, and meticulously planning gatherings with family and friends. These gatherings and relationships are, after all, a primary focus of the holiday season. We strive to remain familyand relationship-centered in the midst of the chaotic holiday rush. As we turn our focus on this ‘‘family centered’’ season, I thought it would be appropriate to also explore the meaning of patient-family centered care (PFCC).

Development, Testing, and National Evaluation of a Pediatric Patient-Family–Centered Care Benchmarking Survey

This study provides evidence for reliability (the Cronbach alpha of .76-.94) and construct validity of the Patient-Family-Centered Care Survey developed by the researchers in collaboration with FKP Architects, used to measure and benchmark practice within pediatric institutions. The survey evaluates progress of integrating patient-family-centered care over time and can be triangulated with measurements of desired patient and institutional outcomes.

Family Presence in Emergency Medical Services for Children

The presence of family at the bedside during a cardiopulmonary resuscitation is uncommon in most institutions and has generated strong debates within the healthcare community during the past decade. However, the time-honored practice of banning families from the bedside during emergency procedures appears to be grounded by tradition rather than by evidence based on the outcomes of actual family presence (FP) events. Family presence is explored within the framework of patient-family–centered care and from the context of resuscitation outcomes. The focus of this review examines research findings investigating the effects of FP during cardiopulmonary resuscitation and invasive procedures on family members, patients, and providers. The process of developing FP programs based on models of evidence-based practice to promote quality patient care is described. Finally, the application of FP to the prehospital environment is explored.