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