AJN, American Journal of Nursing:
Those who know the patient best can help bridge the gap between hospital and home.
Susan Frampton is the president of Planetree, Derby, CT, and Carol Wahl is chief nursing officer at Good Samaritan Hospital, Kearney, NE. Contact author: Susan Frampton, email@example.com. The authors have disclosed no potential conflicts of interest, financial or otherwise.
An elderly woman is recuperating in a hospital bed. Her adult daughter is by her side, holding her hand, discussing the family's plan for supporting her mother's recovery once she is discharged. The woman considers her daughter good company, but also a caregiver, advocate, and health coach. What the woman does not consider her daughter is a visitor.
Today, hospitals do themselves and their patients a disservice by limiting the family's role in the patient experience to mere visitation. This is not to discount the profound ways that family and friends can lift patients' spirits and bring companionship and the comforts of home into the hospital. But if family members are only being engaged to provide social support, their potential for improving patient outcomes remains untapped.
The notion of family being integral to healing is hardly groundbreaking. Many hospitals have relaxed visitation policies and have started to offer comfortable accommodations for family members. Changes such as these welcome the family's presence but fall short of forging meaningful and effective partnerships with them. When actively involved (to the extent that they and the patient prefer) through family meetings, bedside shift report, hands-on training in personal care techniques, and patient education, family members (or those considered family by the patient) can become that elusive source of continuity our fragmented health care system lacks.
The prevalence of chronic diseases, shorter lengths of stay, and the availability of home care technologies have all contributed to family members taking on a heightened caregiving role. An essential aspect of partnering with families is providing these informal caregivers with adequate tools, training, and resources. Doing so is good for the patient and can also help to mitigate many of the well-documented emotional and physical pressures experienced by family caregivers.
At many Planetree hospitals, these partnerships are supported through care partner programs that promote an expanded and formalized level of family participation. Identified by the patient, the care partner is typically a family member or close friend who is included as a member of the care team and accepts responsibilities for participating in care. Providing this care for the hospitalized patient—with support readily available from professional caregivers—primes the care partner to continue supporting the patient in meeting wellness goals following hospitalization.
This shift in responsibilities to family caregivers places pressures not only on the family member, but also on nurses. With the size and complexity of patient loads increasing, it can be a challenge to find time during a shift to coach the wife of a patient in changing his dressings or to answer the questions of a patient's son about dad's diagnosis and what to expect.
Ultimately, though, these small investments of time can yield significant results. Patients whose family caregivers thoroughly understand discharge instructions and feel in charge of care plans are less vulnerable to being readmitted because of a failure to manage their care. By fielding a family member's questions, a nurse equips that person with the information needed to serve as the spokesperson for the rest of the family and also avoids redundant requests for information.
These partnerships between professional and family caregivers must be grounded in mutual respect and open communication. Though most family members caring for a loved one don't have health care backgrounds, they do possess specialized knowledge about the patient's health history, lifestyle, and wellness goals. Marrying health care professionals' clinical expertise with the knowledge of the family member (and patient) lays the foundation for patient-centered care planning that is focused on the patient's personal health goals and the necessary steps to attain them.