Family Centered Care: Strategies for Success

1. 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

2. 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

3. No one ever told me grief felt so much like fear.-- C. S. Lewis (1898-1963) www.6seconds.org/hwc/online/grief.html

4. ANGER

5. 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

6. 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

7. 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

8. Family Centered Care: Strategies for SuccessCourse Overview • Flexible, adapt to various education venues • 4 Modules • One computer-based learning module • Three interactive education modules

9. 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

10. 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

11. 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 Pre Course Evaluation

12. Module 1: Computer – based Learning Module

13. Family Centered Care Initiative………………………………… Advancing the Practice of Family Centered Care. . . Making Families Partners in Care

14. 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.

15. FAMILY CENTERED CARE IS A TOTAL CHANGE IN PHILOSOPHY AND THE WAY WE DO BUSINESS

16. Family Centered Care is a paradigm shiftand a profound change in culture for many health care organizations • Family Centered Care challenges the traditionalapproaches 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 healthcareprofessionals and the system

17. Family Centered Care helps us clearly understand that. . . and these are VISITORS . . .this is FAMILY. . .

18. With that being said, we realize this concept may bring a multitude of emotions….

19. 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?

20. 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 Regulatory and Specialty Care Organizations That Support Family Centered Care

21. 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

22. Where are we now??

23. Patient and family satisfaction surveys give a measure of where we are now: Overall Assessment of Hospital

24. Patient Personal Issues

25. Visitor and Family Issues

26. Where we want to be for the future!

27. Mutual respect Patient and family choice Focus on strengths Flexibility in health care delivery Information sharing Patient and family support Mutual collaboration Patient and family empowerment The Core Concepts of Family Centered Care give us a vision of where we want to be

28. According to experts, the key phrase we like to work around is:Families are not visiting,they are“Family-ing”

29. 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”

30. Family Centered Care facilitates collaboration between the patient, family and health care team at all levels. STUDER PRINCIPLES MAGNET RECOGNITION FAMILY CENTERED CARE PRESS GANEY SERVICE EXCELLENCE BASICS

31. 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

32. 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

33. 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

34. 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 inculture 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

35. Other goal enhancingorganizational 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

36. 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 The following challenges to Family Centered Care are being addressed as we move forward:

37. 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

38. Family Centered Care: What have you learned?

39. 1) In the Family Centered Care model, visiting is driven by the PATIENT'S choices and requests. True or False

40. 2) In understanding the concept of Family Centered Care, staff are defined as “visitors”. True or False

41. 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

42. 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

43. 5) Through the Family Centered Care initiative, patient or family advocates will serve on unit-based committees, bringing their expertise as patients and families to the table. True or False

44. Congratulations! You have successfully completed the introductory course of Family Centered Care!

45. Module 2:Families In Crisis • Case study analysis and application of concepts • Interactive lecture and group discussion • One hour module

46. 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

47. 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

48. Module 3“It’s All About Me” • Lecture and interactive discussion • Case study analysis

49. 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

50. 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