Family Centered Care: Strategies for Success Jocelyn Farrar RN, MS, CCRN CRNP Doctoral Student, University of Maryland School of Nursing Baltimore, Maryland Robyn Schaffer MA Carine McLaughlin LCSW Lara Klick BA Sinai Hospital of Baltimore Baltimore, Maryland Why Design This Course? • Adoption of a culture of Family Centered Care • Nursing Survey – Strong desire to adopt Family Centered Care concepts – Little to no Family Centered Care content in Schools of Nursing – Learning needs • Impact of hospitalization of family members • Communication strategies • Developing partnerships with families • Caring for challenging families • Dealing with out of control situations • Recommendations from literature • Recommendations from families No one ever told me grief felt so much like fear. -- C. S. Lewis (1898-1963) www.6seconds.org/hwc/online/grief.html Course Planning Committee • • • • • • • • Patients Family members Direct Care RN Chairperson of the Family Centered Care Advisory Council Director of Social Work Director of Nursing Education Organization Effectiveness Development Specialist Safety and Security Course Objective • To provide the participant with the knowledge and skills to enhance the development of clear communication and positive partnerships with patients and families Participant Learning Objectives • Articulate the concepts of Family Centered Care • Discuss the impact of hospitalization on family members • Identify interventions to optimize culturally sensitive • • • • • family care and facilitate positive partnering with patients and families Utilize the knowledge of differing temperaments to provide optimal interventions for family members Analyze personal biases and beliefs that influence interpersonal relationships Demonstrate effective communication techniques when interacting with family members Implement appropriate interventions for families exhibiting anger, aggression, and crisis Identify resources to assist in difficult or out of control situations Family Centered Care: Strategies for Success Course Overview • Flexible, adapt to various education venues • 4 Modules – One computer-based learning module – Three interactive education modules Module 1: Computer – Based Learning Module • Introduction to the Philosophy of Family Centered Care – Set the stage for the journey – What to expect – Impact • Prerequisite to other modules • 30 minutes to complete • CEUs provided Modules 2, 3, 4: Interactive Education Modules • Use as single modules or as a 4 – hour course – Module 2: Families in Crisis – 1 hour – Module 3: “It’s All About Me” – 45 minutes – Module 4: Working with Families in Crisis – 1 hour 30 minutes • Teaching strategies – – – – – – Lecture Interactive discussion Role playing Group activities Case study analysis CEUs provided Pre Course Evaluation • I can clearly discuss the • • • • impact of hospitalization on the patient’s family I can identify the personal beliefs and biases that influence my interpersonal relationships I can apply my knowledge of the impact of different temperaments to provide optimal interventions for family members I can develop effective partnerships when caring for families I am able to demonstrate proactive negotiation and contracting skills Scoring • • • • 4 = highly agree 3 = agree 2 = disagree 1 = highly disagree Module 1: Computer – based Learning Module Family Centered Care Initiative ………………………………… Advancing the Practice of Family Centered Care. . . Making Families Partners in Care What is Family Centered Care? • A philosophy and approach to health care that places the patient and family at the center of the institutional and professional purposes • Patients and families are involved in all aspects of planning, implementation and evaluation of health services • It involves patients and families in polices, programs, facility design, and staff day-to-day interactions. • Family Centered Care facilitates collaborative relationships between and among consumers and health providers. Family Centered Care is a paradigm shift and a profound change in culture for many health care organizations • Family Centered Care challenges the traditional approaches that: – Focus on patient and family deficits – Disempower patients and families – Rely heavily on technology and biomedical science – Undervalue the importance of human interactions in the health care experience – Are driven by the needs of the healthcare professionals and the system Family Centered Care helps us clearly understand that. . . With that being said, we realize this concept may bring a multitude of emotions…. But….for the sake of perspective…..just imagine if your loved one was now “the patient”…. How would you like him/her to be treated? As the family member, how would you like to be treated? Regulatory and Specialty Care Organizations That Support Family Centered Care • JCAHO • Healthcare Advisory • • Board Institute for Healthcare Improvement Society of Critical Care Medicine • American Hospital • • • Association American Association of Critical Care Nurses Institute of Medicine Institute for Family Centered Care Why Is Family Centered Care Important to Sinai Hospital? • PATIENT SAFETY IS ENHANCED WHEN PATIENTS AND • • • • FAMILIES PARTNER WITH THE HEALTH CARE TEAM Patients and families are becoming more aware of their rights and are advocating more vigorously for increased access JCAHO and others are looking for increased patient and family involvement in the development and implementation of the plan of care Complaints have been received from patients and their families Confrontations have occurred between visitors and staff Where are we now?? Patient and family satisfaction surveys give a measure of where we are now: Overall Assessment of Hospital Patient Personal Issues Visitor and Family Issues Where we want to be for the future! The Core Concepts of Family Centered Care give us a vision of where we want to be • Mutual respect • Patient and family • Information sharing • Patient and family • • • • choice Focus on strengths Flexibility in health care delivery support Mutual collaboration Patient and family empowerment According to experts, the key phrase we like to work around is: Families are not visiting, they are “Family-ing” We will work to overcome issues that have historically been barriers to Family Centered Care • Lack of geographic space • Incorrectly perceived negative impact on • • • • • recovery and healing Staff convenience Fear of “being watched” Lack of time Nursing shortage “It’s not my job” Family Centered Care facilitates collaboration between the patient, family and health care team at all levels. STUDER PRINCIPLES MAGNET RECOGNITION FAMILY CENTERED CARE SERVICE EXCELLENCE PRESS GANEY BASICS Family Centered Care outcomes from three major health care organizations across the country include: • Improved nursing staff satisfaction scores • Improved patient and family satisfaction scores and • • • reduced complaints Contributed to successful Magnet certification Contributed to successful JCAHO survey Improved quality and safety scores Potential Benefits to Sinai • Improved safety and quality outcomes • Improved medical & developmental outcomes • Increased organization responsiveness to patient and • family identified needs and priorities Reduced health care costs Potential Benefits to Sinai • Enhanced patient and family satisfaction as well as staff • • • and faculty satisfaction Positions the hospital or clinic more effectively in the marketplace Builds a cadre of families able to advocate for quality in health care and the resources to support quality in health care Enhances employee pride in the hospital Organizational changes that will help us reach our goal include: • Mission, Vision and Philosophy of Care Statements will • • • • address family centered care and set the organizational tone The leadership group and staff will adopt a change in culture to one of patient and family centered care Patients and families will participate in hospital-wide and unit based committees Patients and families will be given choices in care Patients and families will collaborate with the health care team in the planning, implementation and evaluation of care Other goal enhancing organizational changes include: • Policies and performance evaluations will include a • • • patient and family focus Patient and family resources will be made available Signage will be patient and family friendly Clinical documentation will reflect the philosophy of Family Centered Care The following challenges to Family Centered Care are being addressed as we move forward: • Safety and security • • • • issues Parking Facility design Attitudes - patient, family, staff Staff knowledge and skills • Family support resources • Confidentiality • Resuscitations and other complex clinical events • Presence of children What Is Your Role? • Educate yourself on the • • • • philosophy of Family Centered Care Talk to your peers and leaders Become involved on a Family Centered Care unit-based committee Attend education offerings Incorporate the core concepts of Family Centered Care into your daily practice Family Centered Care: What have you learned? 1) In the Family Centered Care model, visiting is driven by the PATIENT'S choices and requests. True or False 2) In understanding the concept of Family Centered Care, staff are defined as “visitors”. True or False 3) With Family Centered Care, patients and families are involved in planning and implementing, but not evaluating health services. Evaluation is the sole responsibility of the healthcare professional. True or False 4) Family should not be allowed to be present at the bedside or participate in rounding due to the time constraints of the physician team and the numbers of questions the patient or family will have. True or False 5) Through the Family Centered Care initiative, patient or family advocates will serve on unitbased committees, bringing their expertise as patients and families to the table. True or False You have successfully completed the introductory course of Family Centered Care! Module 2: Families In Crisis • Case study analysis and application of concepts • Interactive lecture and group discussion • One hour module Module 2 Families In Crisis - Objectives • Define crisis • Discuss a family’s initial response to crisis • Describe three areas to include in a family system assessment • Outline the top ten needs of families • Implement strategies to appropriately care for a family in crisis Module 2: Content • Crisis Case Studies – – – – – – – – – – Definition of crisis Goals of intervention Families initial reactions Top needs of families in crisis Factors that affect the response to crisis Assessment of the family in an acute care setting What is a “challenging” family Effective staff coping skills What to do in a crisis What not to do in a crisis Module 3 “It’s All About Me” • Lecture and interactive discussion • Case study analysis Module 3: Objectives • Identify personal biases that affect relationships • • • with families Discuss personal triggers/buttons that prevent effective partnering with patients and families Analyze preferences and temperaments that impact the development of partnerships Analyze behaviors that contribute to respect for differences and diversity Module 3: Content • Beliefs and biases – Ladder of Inference – Personal communication filters – Triggers and buttons • Effective listening skills in difficult times • Personal preferences and temperaments – Absorb new information – Make decisions • Respecting differences and diversity Module 4: Working With Families in Crisis • Lecture and interactive discussion • Group work • Role play • Scripting Module 4: Objectives • Recognize proactive techniques to establish collaborative • • • • • guidelines for partnerships Demonstrate proactive contracting and negotiating skills Identify key words for communicating a caring response to patients and families Identify behaviors indicating escalating dissatisfaction in patients and families Demonstrate proactive positive de-escalation techniques for working with angry patients and families Identify resources available to assist in out of control situations, when to access them and how to access them Module 4 - Content • Proactive patient preference discussion – Establishing patient focused guidelines for care • Establishing partners in care – The responsibility of the patient, family and health care provider • Contracting – Ensuring that “rules” are not a mystery – Negotiating – Red, Yellow and Green light rules • Disagreements: Defining the Real Issues – – – – When is the issue not the issue? Addressing the real issue What does it sound like (scripting) When do you need help • Anger and aggression – De-escalation techniques – Danger signs – Getting help The Tipping Point • Behavior of staff on the unit – Integrating concepts into care – Questioning the status quo – Refusing to accept “non-family centered behaviors • Managers appreciate the value of the course – Enhanced patient safety – Nurse retention = $$$ saved – Less problems = Time savings – Patient and Family satisfaction = • Better patient outcomes • Congruent with mission and vision • Hospital of choice • Positive financial impact Post Course Evaluation • I can clearly discuss the • • • • impact of hospitalization on the patient’s family I can identify the personal beliefs and biases that influence my interpersonal relationships I can apply my knowledge of the impact of different temperaments to provide optimal interventions for family members I can develop effective partnerships when caring for families I am able to demonstrate proactive negotiation and contracting skills Scoring • • • • 4 = highly agree 3 = agree 2 = disagree 1 = highly disagree Course Evaluation • “This is the best course I have ever taken” • “The physicians need to learn about this” • Improved Press Ganey Scores and positive patient and family comments • Absence of staff and family conflict • Improved nurse satisfaction • Collaborative relationships with patients and families Evidence of Success • The baptism in a bucket • Family presence at a Code • Removal of the “family presence prohibited” sign in the • • • • • • CCU Patient centered visiting in almost all units Unit – based family hospitality centers Staff training of staff Collaboration with Child Life Specialists in the Adult ICU Nurse Managers deem the course to be mandatory training for staff Resident education coordinators integrate the course into resident training Attendees to Date • • • • • • • • • Over 700 registered nurses Patient care techs and unit receptionists Radiology staff All Social Work staff All Clergy All Physical Therapy and Occupational Therapy staff in the Rehabilitation Center All Guest Relations staff University of Maryland senior nursing students Sinai and Johns Hopkins medical residents Future of the Course • Hearing the Voice of the Patient and Family – Development of a training video by patients and families for staff • Required education for all physician residents • Incorporation into School of Nursing curriculum • Development of a course for ancillary staff – Transporters, dietary hostesses, security staff Questions? jfarrar20@yahoo.com