lack of outcome measure for family satisfaction how do we measure satisfaction at nmh? staff...

Lack of Outcome Measure for Family Satisfaction

How do we measure satisfaction at NMH?

Staff satisfaction is assessed using the Gallup Survey Q12 measures. Untilnow, there was no way to directly measure family satisfaction with care givengiven in the critical care setting. The existing Press Ganey survey onlymeasures satisfaction based on the unit from where the patient is discharged(e.g., to home, to another healthcare facility).

Comments from both staff and visiting families have revealed a level of dissatisfaction within both groups. An extensive review of the literature on family systems theory, family needs, visiting and family involvement in care was conducted. Based on this review, it was determined that a change in practice was needed.

A new model of care was developed that provides a framework for the sharing ofpatient care responsibilities between the family and healthcare team. This model has been named the Patient and Family Access Model of Care.

HealthcareTeam

Community

Patient

ACCESSIBILITYOPENNESS

COMMUNICATIONINFORMATION

Nurse

Environment

Henderson Framework

HealthcareTeam

FamilyDefined MD

HealthcareTeam

Patient



FamilyDefined

The Family Side

The model consists of 2intersecting circles.

The circle on the left siderepresents the familyfamily, as

defined by the patientand the family itself.

The family is responsiblefor nurturing and

supporting each of itsmembers, with the

family structure based onthe interrelationship ofits individual parts and

unique shared experiences.



Henderson Framework

HealthcareTeam

Nurse

The Healthcare Team Side

The circle on the rightsignifies the diversemembership of the healthcare teamhealthcare team, which supplies specialized expertise in the support of the patient and family during illness and in promoting wellness.

MD

Patient



Nurse

Henderson Framework

At the top intersection of the two circles is the patientpatient, the primary focus for both the family and healthcare team.

At the bottom intersection is the nursenurse, who as the coordinator of care, is the primary linkbetween the patient, family and healthcare team. The nurse advocates on the behalf of

the patient by fostering a relationship between the family and other members of the healthcare team. The nurse’s practice is grounded in the Henderson Framework,

assisting the patient and family to gain independence in their healthcare decisions.

Patient

Nurse

HealthcareTeam

FamilyDefined

Included in the middle of the intersection is a two-directional arrow. The arrow indicates accessibilityaccessibility, opennessopenness, communicationcommunication and informationinformation that should flow back and forth

between the familyfamily and the healthcare teamhealthcare team, guided by the nurse and inclusive of the patient.

Based on the literature on family needs, family members desire access to the patient, openness and transparency with the healthcare team, frequent nurse/physician

communication, and information about the ill family member that is easy tounderstand. Members of the healthcare team also require accessibility, openness,

communication and information from the family in order to promote holistic patient care.The healthcare team and family work together with the patient in developing goals and

deciding treatment options, always in the best interest of the patient.



HealthcareTeam

Community

Patient



Nurse

Environment

HealthcareTeamFamily

Defined

When there is a two-way flow of access, openness, communication and information, then a mutualatmosphere of trust and a shared connection should exist between the patient, family and the

healthcare professionals, all working together for the benefit of the patient. This is indicated by adotted linedotted line that interconnects each individual. This line is dotted because many things can upset the

delicate 2-way balance between trust and doubt for the family and healthcare team.

This collaborative effort is accomplished through the utilization of resources within the surroundingcommunity or immediate environment, or that of the patient and family’s home base.

MD

Using the Model to Initiate Change

In order for the Patient and Family Access Model of Care to work in the ICU at NMH, several changes to the current nursing practice are required:

Family visiting and patient access Based on patient/family request and patient status

Improved communication between patient, family and healthcare team Consistent access to verbal/written information, ICU journal

Sharing of information between patient, family and team White boards in patient rooms or cork board in waiting areas, family

rounds Structured patient and family involvement

Participation in family rounds and mutual goal setting, assisting with patient care as desired

Core Concepts for Patient andFamily Centered Care

Creating an environment that is centered around the patient and family is not unique to Northwestern Memorial Hospital. Other hospitals and organizations across the country recognize the importance of family in patient care. The Institute for Family-Centered Care lists four principles when adopting care practices around patients and their families:

Dignity and Respect: “Healthcare providers listen to and honor patient and family perspectives and choices…”

Information Sharing: “Healthcare providers communicate and share complete and unbiased information with patients and

families in ways that are affirming and useful…” Participation:

“Patients and families are encouraged and supported in participating in care and decision-making at the level they choose.”

Collaboration: “Patients, families and providers collaborate in policy and program development, implementation

and assessment…as well as in the delivery of care.”

We need to be attentive to families and involve thembecause it is the right thing to do!

References

• American Heart Association. (2006). Patient- and Family-Centered Care: Partnership for Quality and Safety.

• Berwick, D. Institute for Healthcare Improvement. Retrieved from the World Wide Web on March 2, 2009.

• Boss, P. (1992). Primacy of perception in family stress theory and measurement. Journal of Family Psychology,6(2), 113-119.

• Bradbury, N. (2008). Hospitals are no place for sick people. Retrieved from the World Wide Web on March 2, 2009.

• Brown, P. (2008). Patient and Family Access Model of Care. Northwestern Memorial Hospital, Chicago, IL.

• Institute for Family-Centered Care. (2009). Advancing the Practice of Patient –and Family-Centered Care. Retrieved from the World Wide Web on March 2, 2009.

• Jeppson, E. S., & Thomas, J. (1995). Essential allies: Families as advisors. Bethesda, MD: Institute for Family Centered Care.

• Tolbert, G. (2001). Family advocates: Caring for families in crisis. Dimensions of Critical Care Nursing, 20(1), 36.

• Howard, J. (1999). Families. Somerset, NJ: Transaction Publishers.• Levine, C., & Zuckerman, C. (1999). The trouble with families: Toward an ethic of

accommodation. Annals of Internal Medicine, 130(2), 148-152.• Illinois Guardianship and Advocacy Commission. (2009). Healthcare Surrogate Act #755 ILCS

40/1 Short title. Retrieved from the World Wide Web on March 24, 2009.• Molter, N., & Leske, J. (1983). Critical Care Family Needs Inventory.

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