Patient and Family Centered
Care in Perianesthesia Arena:
WELCOME AND COME ON IN!
Objectives
 Describe and discuss patient and family centered care
in the perianesthesia setting
 Discuss approaches to encourage staff and promote
patient and family centered care
 Identify opportunities to improve Patient and Family
Centered Care by describing missed circumstances
and successful patient stories
DEFINITION:
 Patient and 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 providers, patients, and families. It
redefines the relationships in health care
(Institute for Patient and Family Centered Care,n.d.).
DEFINITION
 Patient and family centered care is an approach to
health care that shapes policies, programs, facility
design and staff day-to-day interactions. It leads to
better health outcomes and wiser allocation of
resources, and greater patient and family satisfaction

(Institute for Patient and Family Centered Care,n.d.).
Core Concepts
 Respect and dignity.
Health care practitioners listen to and honor patient
and family perspectives and choices. Patient and
family knowledge, values, beliefs and cultural
backgrounds are incorporated into the planning and
delivery of care.
Core Concepts
Information Sharing.
Health care practitioners communicate and share
complete and unbiased information with patients and
families in ways that are affirming and useful. Patients
and families receive timely, complete, and accurate
information in order to effectively participate in care
and decision-making.
Core Concepts
Participation.
Patients and families are encouraged and supported
in participating in care and decision-making at the
level they choose
Core Concepts
 Collaboration.
Patients and families are also included on an
institution-wide basis. Health care leaders collaborate
with patients and families in policy and program
development, implementation, and evaluation; in
health care facility design; and in professional
education, as well as in the delivery of care.
Family
Family
 “The word "family" refers to two or more persons who are
related in any way—biologically, legally, or emotionally. Patients
and families define their families.”
 “In the patient- and family-centered approach, the definition of
family, as well as the degree of the family's involvement in
health care, is determined by the patient, provided that he or
she is developmentally mature and competent to do so. The
term "family-centered" is in no way intended to remove control
from patients who are competent to make decisions concerning
their own health care. In pediatrics, particularly with infants and
young children, family members are defined by the patient's
parents or guardians.”

(Institute for Patient -and Family- Centered Care ©)
Family
 A Definition of Family:
 “Families are big, small, extended, nuclear, multi-generational,
with one parent, two parents, and grandparents. Living under
one roof or many, a family can be as temporary as a few weeks
and as permanent as forever. We become part of a family by
birth, adoption, marriage, or from a desire for mutual support. A
family is a culture unto itself with different values and unique
ways of realizing its dreams. Together, our families become the
source of our rich cultural heritage and spiritual diversity. Our
families create our neighborhoods, communities, cities, states,
and our nations.”
( Christiana Care Health System, PFCC Sharepoint)
Family
 Definitions of Family Cont…,
 “When the patient can communicate, the ideal definition
of family is whomever the patient defines as her or his
family. When the patient is unable to communicate, a
practical definition of family is anyone who shares a history
and a future with the patient.”
 ( 2012-2014 Perianesthesia Nursing Standards and
Recommendations)
Caring
Patient Family Centered Care is:
 A philosophy of care
 A culture of care
 A change
ASPAN Practice Recommendation
ASPAN Practice Recommendation
 Pre-op phase~
 1.Pt is informed that family member may visit in immediate
post op phase;
 2.Asked if they would prefer visit and whom would like to
visit;
 3.The designated family member receives info about PACU
environment and expected behavior of visitors
 4. If the family member accepts the invitation to visit, they
are told to wait for contact by PACU staff at appropriate
time

(pg. 63 of Perianesthesia Standards etc., 2012- 2014)
ASPAN Practice Recommendation
 Induction~
 1. Widely accepted and expected by many parents
 2. Premedication effective in reducing child anxiety in
some cases

(pg. 63-64 of Perianesthesia Nursing Standards etc., 2012-2014)
ASPAN Practice Recommendation
 Postoperative Phase ~
 1. Appropriateness of family visitation is based on pt
status/pt wishes/activity of unit/nurse ability to provide
time with pt and family member
 2. Primary nurse available to answer appropriate family
questions and reassure patient and family members
 3. Termination of visitation is at discretion of primary nurse
and based upon patient/visitor/unit circumstances

(Pg. 64 of Perianesthesia Standards etc., 2012-2014)
ASPAN Practice Recommendation
 Evaluation Phase ~
 1. Evaluation of the visitation practice begins when visitors
arrive in PACU and lasts until postoperative phone calls are
made to ambulatory patients or when patients are
assessed for satisfaction related to visitation
 2. Visitation guidelines should be re-evaluated per
institution policy
 3. It is helpful to have posted unit guidelines that specify
expectations concerning family care.

(Pg. 65 of Perianesthesia Standards etc., 2012-2014)
Citations:
 Family visitation in PACU first surfaced in mid 1980’s
aligning with similar issues facing other specialty units
 Nurses personal experiences forced them to consider
the traditional visitation policy of their unit
 One study in the late 1990’s showed that 89% of
patients and 96% of families thought family presence
was beneficial.

Bonifacio and Boschma. Family visitation in the PACU, 1984-2006. Journal of PeriAnesthesia Nursing, April,
2008.
Citations:
 For Pediatrics:
 Pre-op programs began in the 1960’s ~ there are 100’s
of articles on those programs and their benefits
 Parental anxiety has been associated with child
anxiety. Parents need to be active targets of pre-op
education and preparation.

Chorney and Kain. Family centered pediatric perioperative care. Anesthesiology, March 2010
Citations:
 Pre-Op phase:
 Multimodal approach providing sensory and
procedural information for parents and child
 Anxiety reduction= distraction, education, adding
parents, no excessive reassurance, coaching

Chorney and Kain. Family centered pediatric perioperative care. Anesthesiology, March 2010
Citations:
 Intra-Op phase:
 Facilitate and collaborate between families and
healthcare professionals
 Major interventions include pre-medication with
sedative and parental presence at induction
 Must be agreement between parent/family
member/anesthesiologist

Chorney and Kain. Family centered pediatric perioperative care. Anesthesiology, March 2010
Citations:
 Post-op phase:
 Most hospitals have a policy to allow parents in PACU
 Utilizing parental presence, distraction, instruction of
coping skills are associated with less distress
 Studies show pain management and recovery at
home is less than optimal

Chorney and Kain. Family centered pediatric perioperative care. Anesthesiology, March 2010
Citations:
 Staff preferences and family preferences:
 Units that supported open visitation had increased
job satisfaction of their nurses
 Study showed close family member preferred one
single visit with verbal updates while distant family
member preferred verbal update only

DeWitt and Albert. Preferences for visitation in the PACU. Journal of PeriAnesthesia Nursing. October, 2010
Citations:
 Randomized control trial (RCT) evaluated impact of
PACU visitation on anxiety levels of the family
members, using a pre and post test design, and a
convenience sample at a 400 bed community hospital
 Visits lasted 10 minutes
 Standardized Adult Anxiety Survey was used
 Conclusion~ brief visit can be beneficial to family
member and increases patient/family satisfaction

Carter, et al. Postanesthesia care unit visitation decreases family member anxiety. Journal of Perianesthesia
Nursing. February, 2012.
Citations:
 Descriptive study:
 Staff feelings regarding visitation
 83% of staff would want visitation of their family
member before surgery
 73% of staff would want family to visit after surgery

Walls. Staff attitudes and beliefs regarding family visitation after implementation of formal visitation policy
in the PACU. Journal of PeriAnestheisa Nursing. August, 2009.
Citations:
 Descriptive study:
 Conclusion ~education for family was needed ; education
for the staff to interact and communicate with family in
PACU

Walls. Staff attitudes and beliefs regarding family visitation after implementation of formal visitation policy
in the PACU. Journal of PeriAnestheisa Nursing. August, 2009.
Citations:
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Our patients are saying:
“Family members are the eyes and ears of the patient”
“Visiting hours are behind the time”
“Exam rooms should have an extra chair for the family
member”
 “There should be a support group for families”
 “There should be a family bill of rights”

W. Leebov. Heartbeat on the quality patient experience. www.quality-patient-experience.com
“Yes, I am part of the medical team.
Without me, you have nothing.”
Benefits of PFCC
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Trust and partnership
Communication
Patient and family satisfaction
Staff satisfaction
Improvement in patient safety
Christiana Care’s Journey
At Christiana Care:
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Perioperative Services Journey
Envisioning a philosophy of PFCC within
Periop Services
Creating a Periop PFCC Steer Group
Formation of the Perioperative PFCC Advisory
Council represented by patients, families,
physician partners, and CCHS employees
Patient Experience Teams
At Christiana Care:
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Organizational Restructuring to Patient Experience
Christiana Care Way
Leadership Development
Employee Engagement
Implementation of AIDET
No Pass Zone
Quiet time
Rounding
Sharing Experiences
A Positive Outcome…
Opportunity for growth…
Questions?
References:
 Bonifacio, N. and Boschma, G. (2008, April) Family visitation in the PACU, 19842006. Journal of PeriAnesthesia Nursing. Vol. 23, No. 2; 94-101
 Carter, A. et al. (2012, February) Postanesthesia care unit visitation decreases
family member anxiety. Journal of PeriAnesthesia Nursing. Vol. 27, No. 1; 3-9.
 Chorney, J. and Kain, Z. (2010, March) Family centered pediatric perioperative
care. Anesthesiology. Vol. 112, issue 3; 751-755.
 DeLeskey, K. (2009, April) Family visitation in the PACU: the current state of
practice in the United States. Journal of PeriAnesthesia Nursing. Vol. 24, No. 2; 8185.
 DeWitt, L. and Albert, N. (2010, October) Preferences for visitation in the PACU.
Journal of PeriAnesthesia Nursing. Vol. 25, No. 5; 296-301.
 http://depts/PFCC/default.aspx. Patient family centered care. Christiana Care
Health Systems, I-Net, Newark, DE.
References:
 http://www.ipfcc.org
 Kamerling, S. and others. (2008, February) Family – centered care in the pediatric
post anesthesia care unit: changing practice to promote parental visitation.
Journal of PeriAnesthesia Nursing. Vol. 23., No. 1; 5-16.
 Leebov, W. HeartBeat on the quality patient experience. (2013) www.qualitypatient-experience.com
 TripleAim@ihi.org
 Walls, M. (2009, August) Staff attitudes and beliefs regarding family visitation
after implementation of a formal visitation policy in the PACU. Journal of
PeriAnesthesia Nursing. Vol. 24, No. 4; 229-232.
 2012-2014 Practice Recommendation #9: Visitation in the perianesthesia care unit.
PeriAnesthesia Nursing Standards, Practice Recommendations, and Interpretive
Statements. (©2012) American Society of PeriAnesthesia Nurses, Cherry Hill, new
Jersey; 63-66.