moving from family centered care to family integrated...
TRANSCRIPT
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1
Moving from Family Centered Care to Family Integrated Care
Clare Raiman FICare Coordinator
Fabiana Bacchini Veteran Parent
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Objectives
• To provide an overview of Family Integrated Care and how it has evolved from the principles of Family Centered Care
• To share information about how the philosophy of family integrated care is based on a partnership between nurses, parents and veteran (graduate) parents
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Estonia
• “The mother and infant should be considered as a closed psychosomatic system. Everyday ward rounds should focus not only on the infant but also on the needs of the
mothers.” - Dr. Adik Levin
Acta Paediatr 1999;88:353-5
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• Dr Levin approach to “Humane Care”
Principles:
• Mother staying with her preterm baby 24 hours/day • With the support of nursing midwife & psychologist • Exercise equipment
• Skin to skin, breastfeeding
Acta Paediatr 1999;88:353-5
Our road to FICare
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Welcoming
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24 hour care
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How could we take this philosophy of true family integrated care from Estonia and include the principles of Family Centered Care into one model?
• Steering committee
• Working groups
• Veteran parents
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Family Centered Care
• Increasing recognition (Helen Harrison)
• Principles 1993 • from visitors to increased participation
• Parents on rounds, redesign of NICU’s, involved in committees, parent education programs, parent to parent support
• Partnerships are the cornerstone of FPCC
Pediatrics. 1993 Nov;92(5):643-50.
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Today parents see things differently
• Are we in line with parent perception and need?
• Family empowerment
• Parental participation
• Communication
• Decision making
• Emotional support
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Inside is as important as outside
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The changing role of nursing
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NICU-“yester”years • “intensivists”
–Focus on safe utilization and interpretation of technology
–Necessary for survival but not sufficient for parent skills & relationship
–l Misconception that only NICU professionals can truly provide care
•“Doer” to “facilitator” •Focusing on strengths
•Support empowerment
• Multidisciplinary health care team
Traditional role
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First steps
• Steering committee • Workgroups, (research, education, veteran parents , physical
space)
– Nurses and veteran parents
• Review of literature – Parental NICU experience
– Parenting a critically ill infant
– Therapeutic nurse-patient relationship
• Concepts gathered – Parent infant dyad, inseparable mutually dependent unit
– Nurses are able to reconnect parent and infant guided by their needs
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Pillars of Family Integrated Care • Parent education, small group
education supported by individual bedside learning
• Nursing education provided nurses with tools to feel comfortable with the model of care
• Environmental support unit policies, physical & environmental (parking)
• Psychosocial supports veteran parents
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Nurse education program
Content based on nursing survey of need • What is Family Integrated Care
• Is this not FCC?
• Implementation specifics
• Communication /Mental Health
• Growth and Development
• Veteran Parent Experience
• Breastfeeding
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FICare Pilot Project • Pilot start date: March, 2011 • Expected length of study: 12 months • Number of patients needed: 40 patients Location • 4 bed spaces reserved in Level II FICare area Time Commitment for Parents • Minimum 8 hours each day - during day
Inclusion Criteria: •< 35 weeks gestation •On low level respiratory support •A primary caregiver parent, willing and able to commit to spending 8 hours per day with their baby between the hours of 0700 and 2000. •Parental consent
Exclusion criteria: •Palliative care •Severe congenital anomaly. •Critical illness (unlikely to survive) •Parental request for early transfer •Parental inability to participate.
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Who were they? • 42 mothers (4 sets of twins)
• 17 (40%) had other children at home
• 22 (55%) were Canadian born; 11 lived in Canada >10 years
• All had at least grade 10 high school education;
• 27 (71%) were employed outside the home
• Varied in age from 23-45 years (mean 33 years)
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Key Outcomes: pilot study • Babies in the family integrated care group
• 9% improved weight gain over the controls
• There was less nosocomial infection
• There was less ROP
• There were fewer incident reports
• Higher breast feeding rates • 85% of the infants went home on >90% breast milk
• Most of those were actually breast fed on discharge
• Decreased parental stress
“A pilot cohort analytic study of Family Integrated Care in a Canadian neonatal intensive care unit”. BMC Pregnancy
Childbirth, Volume 13 Suppl 1:S12, 2013
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• Care provided in accordance with College of Nurses Ontario (CNO) standard
• Nurse to Patient ratio
• Nursing clinical responsibilities and accountabilities
• Nurse charting
What is the same for nurses?
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What was different? • Increased parent
mentoring and education at bedside
• Parents directing their learning/skill acquisition
• Increased skin to skin
• Signing off on parental acquisition of skills
• Parent on rounds
• Parent charting
• Parent education
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Parent education program what is so unique?
• Daily education-curriculum developed
• “small chunks”, regularly reinforced in various topics
• meet multi-disciplinary team
• bedside education
• Incorporates different learning styles, personality traits, cultural practices and information needs
• Medical stability of the infants addressed
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Value of small group education
• Opportunity to talk candidly about self care, postpartum depression, feelings, relationships, loss of full term pregnancy, loss of twin, previous losses
• Share spoken /unspoken fears
• Validate feelings
• Gain perspective and increase independence
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What we see/think…
• Is he in pain?
• Does the tape hurt?
• Will the tape marks scar his skin permanently?
• Intubation? CPAP? Low flow? Who do I talk to about all of this? The doctor we had yesterday isn’t here today. Or was that even a doctor?
• Am I going to ever take this sick baby home?
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What was
unique?
What we see/what they see
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Challenges •Staff- their changing role
•Unit culture-team approach
•Confidentiality
“As the head goes so the tail
wags”
•Consider •Education, follow up
•Invite/participate in parent education
•Champions/advocates
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FiCare - so what does that really mean... • The rumor mill
– Myths and truths • Is our work no longer
valued? • Are we going to lose our
jobs? • Are we going to have
more work? • What about our nursing
license?
• Posters, pamphlets, edu-quicks, muffins & learn
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Applying the philosophy • Staff education
•Commitment
•On going support
•Follow up
•Veteran parents
• Parental Participation • Understanding of their role
• Given a purpose
• Mother’s health, allowances
• Champions
• Won’t happen over night!
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Principles of FICare
Parents are integrated into all aspects of care
• Parents are collaborators in their infant’s care
• The family are invited to participate to the best of their ability and supported to do so
• Parents participate on rounds
• Nurses enable families to be part of the team
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It is NOT only about the organs
• Parenting and role
• Advocacy
• Education and support
• Communication
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“It’s like landing on a cushion before you know you are falling”
-Mount Sinai NICU Dad
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• “Implementing Family Integrated Care in the NICU: A Parent Education and Support Program”
2013 • Vol. 13, (2)
• “Implementing Family-Integrated Care in the NICU: Engaging Veteran Parents in Program Design and Delivery”
2013 • Vol. 13, (4)
• “Implementing Family Integrated Care in the NICU: educating nurses”
2013 • Vol.13, (6)