family centered care
DESCRIPTION
Family centered careTRANSCRIPT
Family Centered Care: Family Centered Care: Strategies for SuccessStrategies for Success
Jocelyn Farrar RN, MS, CCRN CRNPJocelyn Farrar RN, MS, CCRN CRNPDoctoral Student, University of Doctoral Student, University of
Maryland School of NursingMaryland School of NursingBaltimore, MarylandBaltimore, Maryland
Robyn Schaffer MARobyn Schaffer MACarine McLaughlin LCSWCarine McLaughlin LCSW
Lara Klick BALara Klick BASinai Hospital of BaltimoreSinai Hospital of Baltimore
Baltimore, MarylandBaltimore, Maryland
Why Design This Course?Why Design This Course?• Adoption of a culture of Family Centered Adoption of a culture of Family Centered
CareCare• Nursing SurveyNursing Survey
– Strong desire to adopt Family Centered Care Strong desire to adopt Family Centered Care conceptsconcepts
– Little to no Family Centered Care content in Little to no Family Centered Care content in Schools of NursingSchools of Nursing
– Learning needsLearning needs• Impact of hospitalization of family membersImpact of hospitalization of family members• Communication strategiesCommunication strategies• Developing partnerships with familiesDeveloping partnerships with families• Caring for challenging familiesCaring for challenging families• Dealing with out of control situationsDealing with out of control situations
• Recommendations from literatureRecommendations from literature• Recommendations from families 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 CommitteeCourse Planning Committee
• PatientsPatients• Family membersFamily members• Direct Care RNDirect Care RN• Chairperson of the Family Centered Care Chairperson of the Family Centered Care
Advisory CouncilAdvisory Council• Director of Social WorkDirector of Social Work• Director of Nursing EducationDirector of Nursing Education• Organization Effectiveness Development Organization Effectiveness Development
SpecialistSpecialist• Safety and SecuritySafety and Security
Course ObjectiveCourse Objective
• To provide the participant with the To provide the participant with the knowledge and skills to enhance the knowledge and skills to enhance the development of clear communication development of clear communication and positive partnerships with and positive partnerships with patients patients
and familiesand families
Participant Learning Participant Learning ObjectivesObjectives• Articulate the conceptsArticulate the concepts of Family Centered Care of Family Centered Care• Discuss the impactDiscuss the impact of hospitalization on family of hospitalization on family
membersmembers• Identify interventionsIdentify interventions to optimize culturally to optimize culturally
sensitive family care and facilitate positive sensitive family care and facilitate positive partnering with patients and familiespartnering with patients and families
• Utilize the knowledgeUtilize the knowledge of differing temperaments of differing temperaments to provide optimal interventions for family to provide optimal interventions for family membersmembers
• Analyze personal biases and beliefs that influence Analyze personal biases and beliefs that influence interpersonal relationshipsinterpersonal relationships
• Demonstrate effective communicationDemonstrate effective communication techniques techniques when interacting with family memberswhen interacting with family members
• Implement appropriate interventionsImplement appropriate interventions for families for families exhibiting anger, aggression, and crisisexhibiting anger, aggression, and crisis
• Identify resourcesIdentify resources to assist in difficult or out of to assist in difficult or out of control situationscontrol situations
Family Centered Care: Family Centered Care: Strategies for SuccessStrategies for Success
Course OverviewCourse Overview• Flexible, adapt to various education Flexible, adapt to various education
venuesvenues
• 4 Modules4 Modules– One computer-based learning moduleOne computer-based learning module– Three interactive education modulesThree interactive education modules
Module 1: Computer – Based Module 1: Computer – Based Learning ModuleLearning Module
• Introduction to the Philosophy of Introduction to the Philosophy of Family Centered CareFamily Centered Care– Set the stage for the journeySet the stage for the journey– What to expectWhat to expect– ImpactImpact
• Prerequisite to other modulesPrerequisite to other modules• 30 minutes to complete30 minutes to complete• CEUs providedCEUs provided
Modules 2, 3, 4:Modules 2, 3, 4:Interactive Education ModulesInteractive Education Modules
• Use as single modules or as a 4 – hour courseUse as single modules or as a 4 – hour course– Module 2: Families in Crisis – 1 hourModule 2: Families in Crisis – 1 hour– Module 3: “It’s All About Me” – 45 minutesModule 3: “It’s All About Me” – 45 minutes– Module 4: Working with Families in Crisis – 1 hour Module 4: Working with Families in Crisis – 1 hour
30 minutes30 minutes• Teaching strategiesTeaching strategies
– LectureLecture– Interactive discussionInteractive discussion– Role playingRole playing– Group activitiesGroup activities– Case study analysisCase study analysis– CEUs providedCEUs provided
Pre Course EvaluationPre Course Evaluation
• I can clearly discuss the I can clearly discuss the impact of hospitalization impact of hospitalization on the patient’s familyon the patient’s family
• I can identify the personal I can identify the personal beliefs and biases that beliefs and biases that influence my influence my interpersonal interpersonal relationshipsrelationships
• I can apply my knowledge I can apply my knowledge of the impact of different of the impact of different temperaments to provide temperaments to provide optimal interventions for optimal interventions for family membersfamily members
• I can develop effective I can develop effective partnerships when caring partnerships when caring for familiesfor families
• I am able to demonstrate I am able to demonstrate proactive negotiation and proactive negotiation and contracting skillscontracting skills
ScoringScoring
• 4 = highly 4 = highly agreeagree
• 3 = agree3 = agree• 2 = disagree2 = disagree• 1 = highly 1 = highly
disagreedisagree
Module 1: Computer – based Module 1: Computer – based Learning ModuleLearning Module
Family Centered Care Family Centered Care InitiativeInitiative……………………………………………………………………
Advancing the Practice of Advancing the Practice of Family Centered Care. . .Family Centered Care. . .
Making Families Partners in Making Families Partners in CareCare
What is Family Centered What is Family Centered Care?Care?• A A philosophy and approach to healthphilosophy and approach to health care that care that
places the patient and family at the center of places the patient and family at the center of the institutional and professional purposesthe institutional and professional purposes
• Patients and families are Patients and families are involved involved in all in all aspects of planning, implementation and aspects of planning, implementation and evaluation of health servicesevaluation of health services
• It involves patients and families in It involves patients and families in polices,polices, programs, facility design, and staff day-to-day programs, facility design, and staff day-to-day interactions. interactions.
• Family Centered Care facilitates Family Centered Care facilitates collaborative collaborative relationships between and among consumers relationships between and among consumers and health providers. and health providers.
Family Centered Care is a Family Centered Care is a paradigm shiftparadigm shift and a profound change in culture for many and a profound change in culture for many health care organizationshealth care organizations
• Family Centered Care Family Centered Care challenges the challenges the traditionaltraditional approachesapproaches that: that:– Focus on patient and family Focus on patient and family deficitsdeficits– DisempowerDisempower patients and families patients and families– Rely heavily on Rely heavily on technology technology and and
biomedical science biomedical science – UndervalueUndervalue the importance of human the importance of human
interactions in the health care experienceinteractions in the health care experience– Are driven by the Are driven by the needs of the healthcareneeds of the healthcare
professionalsprofessionals and the system and the system
Family Centered Care helps Family Centered Care helps us clearly understand that. . 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 But….for the sake of perspective…..just imagine if your loved one was now “the imagine if your loved one was now “the patient”….patient”….
How would you like him/her to be treated? As the family member, how
would youyou like to be treated?
Regulatory and Specialty CareRegulatory and Specialty Care Organizations That Support Organizations That Support
Family Centered CareFamily Centered Care• JCAHOJCAHO
• Healthcare Healthcare Advisory BoardAdvisory Board
• Institute for Institute for Healthcare Healthcare ImprovementImprovement
• Society of Critical Society of Critical Care MedicineCare Medicine
• American Hospital American Hospital AssociationAssociation
• American American Association of Association of Critical Care NursesCritical Care Nurses
• Institute of MedicineInstitute of Medicine
• Institute for Family Institute for Family Centered CareCentered Care
Why Is Family Centered Care Why Is Family Centered Care Important to Sinai Hospital?Important to Sinai Hospital?• PATIENT SAFETY IS ENHANCED WHEN PATIENTS AND PATIENT SAFETY IS ENHANCED WHEN PATIENTS AND
FAMILIES PARTNER WITH THE HEALTH CARE TEAMFAMILIES PARTNER WITH THE HEALTH CARE TEAM• Patients and families are becoming more aware of Patients and families are becoming more aware of
their rights and are their rights and are advocatingadvocating more vigorously for more vigorously for increased accessincreased access
• JCAHOJCAHO and others are looking for increased patient and others are looking for increased patient and family involvement in the development and and family involvement in the development and implementation of the plan of careimplementation of the plan of care
• ComplaintsComplaints have been received from patients and have been received from patients and their familiestheir families
• ConfrontationsConfrontations have occurred between visitors and have occurred between visitors and staffstaff
Where are we now??
Patient and family satisfaction Patient and family satisfaction surveys give a measure of surveys give a measure of
where we are now:where we are now:Overall Assessment of Overall Assessment of
HospitalHospital
Patient Personal IssuesPatient Personal Issues
Visitor and Family IssuesVisitor and Family Issues
Where we want to be for the future!
The The Core ConceptsCore Concepts of Family Centered of Family Centered Care give us a vision of where we want Care give us a vision of where we want to beto be
• Mutual respectMutual respect
• Patient and family Patient and family choicechoice
• Focus on strengthsFocus on strengths
• Flexibility in health Flexibility in health care deliverycare delivery
• Information sharingInformation sharing
• Patient and family Patient and family supportsupport
• Mutual Mutual collaborationcollaboration
• Patient and family Patient and family empowermentempowerment
According to experts, the key According to experts, the key phrase we like to work around is:phrase we like to work around is:
Families are not visiting,Families are not visiting,they arethey are
“Family-ing”“Family-ing”
We will work to overcome issues that We will work to overcome issues that have historically been have historically been barriersbarriers to to Family Centered CareFamily Centered Care
• Lack of geographic Lack of geographic spacespace
• Incorrectly perceived Incorrectly perceived negative impactnegative impact on on recovery and healingrecovery and healing
• Staff convenienceStaff convenience
• Fear of “Fear of “being watchedbeing watched””
• Lack of Lack of timetime
• Nursing shortageNursing shortage
• ““It’s It’s not my job”not my job”
MAGNETMAGNET RECOGNITIONRECOGNITION
STUDERSTUDERPRINCIPLES PRINCIPLES
PRESS GANEYPRESS GANEY
BASICS
SERVICE SERVICE EXCELLENCEEXCELLENCE
FAMILYFAMILYCENTEREDCENTERED
CARECARE
Family Centered Care facilitates collaboration between the patient, family and health care team at all levels.
Family Centered Care Family Centered Care outcomesoutcomes from three major health care from three major health care organizations across the country organizations across the country include:include:
• Improved nursing Improved nursing staff satisfactionstaff satisfaction scores scores
• Improved Improved patient and family satisfactionpatient and family satisfaction scores and scores and reduced complaintsreduced complaints
• Contributed to Contributed to successful Magnet certificationsuccessful Magnet certification
• Contributed to successful Contributed to successful JCAHO surveyJCAHO survey
• Improved Improved quality and safety scoresquality and safety scores
Potential Potential BenefitsBenefits to Sinai to Sinai
• Improved Improved safety and quality outcomessafety and quality outcomes
• Improved Improved medical & developmental outcomesmedical & developmental outcomes
• Increased Increased organization responsivenessorganization responsiveness to patient to patient and family identified needs and priorities and family identified needs and priorities
• Reduced health care costsReduced health care costs
Potential Potential BenefitsBenefits to Sinai to Sinai
• Enhanced Enhanced patient and family satisfactionpatient and family satisfaction as well as well as staff and faculty satisfaction as staff and faculty satisfaction
• Positions the hospital or clinic more effectively in Positions the hospital or clinic more effectively in the the marketplace marketplace
• Builds a cadre of families able to Builds a cadre of families able to advocate for advocate for qualityquality in health care and the resources to support in health care and the resources to support quality in health care quality in health care
• Enhances Enhances employee prideemployee pride in the hospital in the hospital
Organizational changesOrganizational changes that will that will help us reach our goal include:help us reach our goal include:
• Mission, Vision and Philosophy of Care Mission, Vision and Philosophy of Care StatementsStatements will address family centered care and will address family centered care and set the organizational toneset the organizational tone
• The leadership group and staff will adopt a The leadership group and staff will adopt a change inchange in cultureculture to one of patient and family to one of patient and family centered carecentered care
• Patients and families will participatePatients and families will participate in hospital- in hospital-wide and unit based committees wide and unit based committees
• Patients and families will be given Patients and families will be given choiceschoices in care in care• Patients and families will Patients and families will collaboratecollaborate with the with the
health care team in the planning, implementation health care team in the planning, implementation and evaluation of care and evaluation of care
OtherOther goal enhancing goal enhancing organizational organizational changeschanges include: include:
• Policies and performance evaluationsPolicies and performance evaluations will include a will include a patient and family focuspatient and family focus
• Patient and family Patient and family resourcesresources will be made available will be made available
• SignageSignage will be patient and family friendly will be patient and family friendly
• Clinical Clinical documentation documentation will reflect the philosophy of will reflect the philosophy of Family Centered CareFamily Centered Care
The following The following challenges challenges to Family Centered Care are being to Family Centered Care are being addressed as we move forward:addressed as we move forward:
• Safety and security Safety and security issuesissues
• ParkingParking
• Facility designFacility design
• Attitudes - patient, Attitudes - patient, family, stafffamily, staff
• Staff knowledge and Staff knowledge and skillsskills
• Family support Family support resources resources
• ConfidentialityConfidentiality
• Resuscitations and Resuscitations and other complex other complex clinical eventsclinical events
• Presence of childrenPresence of children
What Is What Is Your Your RoleRole??
• EducateEducate yourself on the yourself on the
philosophy of philosophy of
Family Centered CareFamily Centered Care
• TalkTalk to your peers and leaders to your peers and leaders
• Become Become involvedinvolved on a Family Centered Care unit- on a Family Centered Care unit-based committeebased committee
• Attend Attend education education offeringsofferings
• Incorporate the core conceptsIncorporate the core concepts of Family of Family
Centered Care into your daily practiceCentered Care into your daily practice
Family Centered Care: Family Centered Care: What have you learned?What have you learned?
1) In the Family Centered Care model, 1) In the Family Centered Care model, visiting is driven by the PATIENT'S choices visiting is driven by the PATIENT'S choices
and requests.and requests.
True or FalseTrue or False
2) In understanding the concept of Family 2) In understanding the concept of Family Centered Care, staff are defined as Centered Care, staff are defined as “visitors”.“visitors”.
True or FalseTrue or False
3) With Family Centered Care, patients and 3) With Family Centered Care, patients and families are involved in planning and families are involved in planning and implementing, but not evaluating health implementing, but not evaluating health services. services.
Evaluation is the sole responsibility of the Evaluation is the sole responsibility of the healthcare professional.healthcare professional.
True or FalseTrue or False
4) Family should not be allowed to be 4) Family should not be allowed to be present at the bedside or participate in present at the bedside or participate in rounding due to the time constraints of the rounding due to the time constraints of the physician team and the numbers of physician team and the numbers of questions the patient or family will have.questions the patient or family will have.
True or False True or False
5) Through the Family Centered Care 5) Through the Family Centered Care initiative, patient or family advocates will initiative, patient or family advocates will serve on unit-based committees, bringing serve on unit-based committees, bringing their expertise as patients and families to their expertise as patients and families to the table.the table.
True or False True or False
Congratulations! Congratulations!
You have successfully completed the You have successfully completed the introductory course of introductory course of Family Centered Care!Family Centered Care!
Module 2:Module 2:Families In CrisisFamilies In Crisis
• Case studyCase study analysis and analysis and applicationapplication of conceptsof concepts
• InteractiveInteractive lecture and group lecture and group discussiondiscussion
• One hour moduleOne hour module
Module 2 Module 2 Families In Crisis - ObjectivesFamilies In Crisis - Objectives
• DefineDefine crisis crisis
• Discuss a family’s initial Discuss a family’s initial responseresponse to to crisiscrisis
• Describe three areas to include in a Describe three areas to include in a family system family system assessmentassessment
• Outline the Outline the top ten needstop ten needs of families of families
• Implement Implement strategiesstrategies to appropriately to appropriately care for a family in crisiscare for a family in crisis
Module 2: ContentModule 2: Content• Crisis Case StudiesCrisis Case Studies
– DefinitionDefinition of crisis of crisis– GoalsGoals of intervention of intervention– Families initial Families initial reactionsreactions– Top Top needsneeds of families in crisis of families in crisis– Factors that Factors that affect the responseaffect the response to crisis to crisis– AssessmentAssessment of the family in an acute care of the family in an acute care
settingsetting– What is a “What is a “challengingchallenging” family” family– Effective Effective staff copingstaff coping skills skills– What What to doto do in a crisis in a crisis– What What not to donot to do in a crisis in a crisis
Module 3Module 3“It’s All About Me”“It’s All About Me”
• Lecture and Lecture and interactiveinteractive discussion discussion
• Case studyCase study analysis analysis
Module 3: ObjectivesModule 3: Objectives• Identify Identify personal biasespersonal biases that affect that affect
relationships with familiesrelationships with families
• Discuss Discuss personal triggers/buttonspersonal triggers/buttons that that prevent effective partnering with patients prevent effective partnering with patients and familiesand families
• Analyze Analyze preferences and temperamentspreferences and temperaments that impact the development of that impact the development of partnershipspartnerships
• Analyze Analyze behaviorsbehaviors that contribute to that contribute to respect for differences and diversityrespect for differences and diversity
Module 3: ContentModule 3: Content
• Beliefs and biasesBeliefs and biases– Ladder of InferenceLadder of Inference– Personal Personal communication filterscommunication filters– Triggers and buttonsTriggers and buttons
• Effective Effective listening skillslistening skills in difficult times in difficult times• Personal Personal preferences and temperamentspreferences and temperaments
– Absorb new informationAbsorb new information– Make decisionsMake decisions
• Respecting differences and diversityRespecting differences and diversity
Module 4:Module 4:Working With Families in CrisisWorking With Families in Crisis
• Lecture and Lecture and interactive interactive discussiondiscussion
• Group workGroup work
• Role playRole play
• ScriptingScripting
Module 4: Module 4: ObjectivesObjectives
• Recognize Recognize proactive techniquesproactive techniques to establish to establish collaborative guidelines for partnershipscollaborative guidelines for partnerships
• Demonstrate Demonstrate proactive contracting and negotiatingproactive contracting and negotiating skills skills• Identify Identify key wordskey words for communicating a caring response for communicating a caring response
to patients and familiesto patients and families• Identify behaviors indicating Identify behaviors indicating escalating dissatisfactionescalating dissatisfaction in in
patients and familiespatients and families• Demonstrate Demonstrate proactive positive de-escalation techniquesproactive positive de-escalation techniques
for working with angry patients and familiesfor working with angry patients and families• Identify Identify resourcesresources available to assist in out of control available to assist in out of control
situations, when to access them and how to access themsituations, when to access them and how to access them
Module 4 - ContentModule 4 - Content• Proactive patient preference discussionProactive patient preference discussion
– Establishing patient focused guidelines for careEstablishing patient focused guidelines for care
• Establishing partnersEstablishing partners in care in care– The The responsibilityresponsibility of the patient, family and health care of the patient, family and health care
providerprovider
• ContractingContracting– Ensuring that Ensuring that “rules” are not a mystery“rules” are not a mystery– NegotiatingNegotiating– Red, Yellow and Green light rulesRed, Yellow and Green light rules
• Disagreements: Defining the Real IssuesDisagreements: Defining the Real Issues– When is the issue not the issue?When is the issue not the issue?– Addressing the Addressing the real issuereal issue– What does it sound like (What does it sound like (scriptingscripting))– When do you need helpWhen do you need help
• Anger and aggressionAnger and aggression– De-escalation De-escalation techniquestechniques– DangerDanger signs signs– Getting helpGetting help
The Tipping PointThe Tipping Point• Behavior Behavior of staff on the unitof staff on the unit
– Integrating concepts into care Integrating concepts into care – Questioning the status quoQuestioning the status quo– Refusing to accept “non-family centered behaviorsRefusing to accept “non-family centered behaviors
• Managers appreciate the Managers appreciate the valuevalue of the course of the course– Enhanced patient safetyEnhanced patient safety– Nurse retention = $$$ savedNurse retention = $$$ saved– Less problems = Time savings Less problems = Time savings – Patient and Family satisfaction =Patient and Family satisfaction =
• Better patient outcomesBetter patient outcomes• Congruent with mission and vision Congruent with mission and vision • Hospital of choiceHospital of choice• Positive financial impactPositive financial impact
Post Course EvaluationPost Course Evaluation
• I can clearly discuss the I can clearly discuss the impact of hospitalization on impact of hospitalization on the patient’s familythe patient’s family
• I can identify the personal I can identify the personal beliefs and biases that beliefs and biases that influence my interpersonal influence my interpersonal relationshipsrelationships
• I can apply my knowledge of I can apply my knowledge of the impact of different the impact of different temperaments to provide temperaments to provide optimal interventions for optimal interventions for family membersfamily members
• I can develop effective I can develop effective partnerships when caring for partnerships when caring for familiesfamilies
• I am able to demonstrate I am able to demonstrate proactive negotiation and proactive negotiation and contracting skillscontracting skills
ScoringScoring
• 4 = highly 4 = highly agreeagree
• 3 = agree3 = agree• 2 = disagree2 = disagree• 1 = highly 1 = highly
disagreedisagree
Course EvaluationCourse Evaluation
• ““This is the best course I have ever taken”This is the best course I have ever taken”
• ““The physicians need to learn about this”The physicians need to learn about this”
• Improved Press Ganey Scores and positive Improved Press Ganey Scores and positive patient and family commentspatient and family comments
• Absence of staff and family conflictAbsence of staff and family conflict
• Improved nurse satisfactionImproved nurse satisfaction
• Collaborative relationships with patients Collaborative relationships with patients and familiesand families
Evidence of SuccessEvidence of Success
• The baptism in a bucketThe baptism in a bucket• Family presence at a CodeFamily presence at a Code• Removal of the “family presence prohibited” sign in Removal of the “family presence prohibited” sign in
the CCUthe CCU• Patient centered visiting in almost all units Patient centered visiting in almost all units • Unit – based family hospitality centersUnit – based family hospitality centers• Staff training of staffStaff training of staff• Collaboration with Child Life Specialists in the Adult Collaboration with Child Life Specialists in the Adult
ICUICU• Nurse Managers deem the course to be mandatory Nurse Managers deem the course to be mandatory
training for stafftraining for staff• Resident education coordinators integrate the course Resident education coordinators integrate the course
into resident traininginto resident training
Attendees to DateAttendees to Date
• Over 700 registered nurses Over 700 registered nurses • Patient care techs and unit receptionistsPatient care techs and unit receptionists• Radiology staffRadiology staff• All Social Work staffAll Social Work staff• All ClergyAll Clergy• All Physical Therapy and Occupational All Physical Therapy and Occupational
Therapy staff in the Rehabilitation CenterTherapy staff in the Rehabilitation Center• All Guest Relations staffAll Guest Relations staff• University of Maryland senior nursing studentsUniversity of Maryland senior nursing students• Sinai and Johns Hopkins medical residentsSinai and Johns Hopkins medical residents
Future of the CourseFuture of the Course• Hearing the Voice of the Patient and Hearing the Voice of the Patient and
FamilyFamily– Development of a training video by patients Development of a training video by patients
and families for staffand families for staff
• Required education for all physician Required education for all physician residentsresidents
• Incorporation into School of Nursing Incorporation into School of Nursing curriculumcurriculum
• Development of a course for ancillary staffDevelopment of a course for ancillary staff– Transporters, dietary hostesses, security staffTransporters, dietary hostesses, security staff
Questions?Questions?
Our views have increased the Our views have increased the mark of the 20,000mark of the 20,000
Thank you viewers Thank you viewers Looking forward to franchise, Looking forward to franchise,
collaboration, partners.collaboration, partners.
This platform has been started by Parveen This platform has been started by Parveen Kumar Chadha with the vision that nobody Kumar Chadha with the vision that nobody should suffer the way he has suffered should suffer the way he has suffered because of lack and improper healthcare because of lack and improper healthcare facilities in India. We need lots of funds facilities in India. We need lots of funds manpower etc. to make this vision a reality manpower etc. to make this vision a reality please contact us. Join us as a member for please contact us. Join us as a member for a noble cause.a noble cause.
