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Nursing:
doi: 10.1097/01.NURSE.0000445764.18817.d2
Department: CLINICAL QUERIES

Patient- and family-centered care: Not just for kids

Clay, Aaron BSN, RN; Parsh, Bridget EdD, RN, CNS

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Aaron Clay earned his BSN in 2013 from California State University Sacramento in Sacramento, Calif., where Bridget Parsh is an associate professor of nursing. Mr. Clay is starting a new job as a clinical neonatal nurse as this article goes to press.

The authors have disclosed that they have no financial relationships related to this article.

Our hospital administration is promoting patient- and family-centered care (PFCC) throughout the hospital. Isn't that just for pediatrics?—R.M., TENN.

Aaron Clay, BSN, RN, and Bridget Parsh, EdD, RN, CNS, reply: PFCC means more than simply caring for patients' physical health and well-being. PFCC involves families and friends in patient care, using the principles of collaboration, demonstrating dignity and respect, sharing information, and encouraging participation in patient care.1 The Institute of Medicine describes PFCC as making clinical decisions based on individual patient values.2

Including PFCC principles in patient care has become so essential that regulatory agencies such as The Joint Commission have incorporated the tenets of PFCC into their standards and requirements. The Joint Commission considers PFCC fundamental to ensure safety, quality, and equity in patient care.3

PFCC contributes to better patient outcomes and greater patient satisfaction.4 Incorporating families into the patient's care decreases medical errors and lowers costs.5

Spreading rapidly among the nation's top hospitals, PFCC is changing the way nurses provide patient care and increasing staff satisfaction.3 Research suggests patient and family satisfaction during the perioperative period is an essential part of a successful surgical outcome. Implementation of patient-centered care decreased healing time, reduced anxiety, led to earlier discharge, and increased overall efficacy and satisfaction.4

Hospitals define PFCC principles uniquely yet maintain similar core values such as recognizing the family's role, establishing relationships with patients and families, supporting the needs of families, and building on strengths.1,3,6 Ensuring patients have access to at least one support person during their hospitalization is fundamental to PFCC.3

PFCC begins during the admission process and continues throughout the course of care. Within the PFCC framework, patient assessments should go beyond the physical to include patient preferences about language, communication style, spiritual practices and religion, and diet.3 Many elements, such as cultural issues and health literacy needs, can affect communication between healthcare providers and patients.3 Communicating information in a way that's understandable and applicable to the patient and family is essential.7

PFCC extends across the patient spectrum from neonates to older adults with multiple comorbidities and medications.8 Encouraging dialog about procedures and medications, for example, facilitates patient comprehension of the information and involvement in healthcare decisions. Furthermore, PFCC promotes active roles for patients and families, including participation on hospital committees such as quality improvement committees and advisory boards.1 PFCC helps to reduce poor medication adherence by ensuring effective communication with patients and their families about the expected benefits of prescribed medications and potential adverse reactions.8 Providing information in terms that patients and families can understand and encouraging families to participate in the care of their loved one can improve outcomes.7 Providing beds for family members, instituting open visiting hours (no set visiting times), or allowing families to participate in patient rounds are some ways units have implemented PFCC.

Based on experience from mature PFCC organizations, successful adoption of PFCC requires both top-down and bottom-up approaches. Remember, educating staff members about PFCC is the key to their buy-in.9 Designating education days for staff helps to ensure understanding and allows a platform for questions and clarification. Patient and family shadowing is another tool used to help staff members empathize with their patients and to overcome resistance to change. By shadowing, or following a patient and family through a care experience, staff experience the patient perspective.9

Assessment of PFCC is another essential component to implementation on your units. The American Association of Colleges of Nursing (AACN) has a detailed assessment form allowing a rating of 1-to-5 in various categories to provide an accurate assessment of leadership and care. Guides and videos related to shadowing are available at www.pfcc.org as well as information regarding implementation strategies such as establishing a PFCC guiding council and PFCC project improvement teams. Be sure to include participants from different disciplines as well as nurses in these teams and committees.

Empower your patients and yourself with PFCC. Start today by taking time to determine your patients' support persons and how you might facilitate their participation. Talk to your supervisors and inquire about implementing PFCC on your unit. Take the first step to providing care focused on patients and their families!

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REFERENCES

1. American Hospital Association. Strategies for leadership: Patient and Family Centered Care. 2013. http://www.hpoe.org/Reports-HPOE/Patient_Family_Engagement_2013.pdf.

2. Reed P, Conrad DA, Hernandez SE, Watts C, Marcus-Smith M. Innovation in patient-centered care: lessons from a qualitative study of innovative health care organizations in Washington State. BMC Fam Pract. 2012; 13:120.

3. The Joint Commission: Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care: A Roadmap for Hospitals. Oakbrook Terrace, IL: The Joint Commission; 2010. http://www.jointcommission.org/assets/1/6/ARoadmapforHospitalsfinalversion727.pdf.

4. Selimen D, Andsoy II. The importance of a holistic approach during the perioperative period. AORN J. 2011; 93:(4):482–487.

5. Small DC, Small RM. Patients first! Engaging the hearts and minds of nurses with a patient-centered practice model. Online J Issues Nurs. 2011; 16:(2):2.

6. UCSF Benioff Children's Hospital. Family-centered care. http://www.ucsfbenioffchildrens.org/about/family_centered_care/index.html.

7. Ciufo D, Hader R, Holly C. A comprehensive systematic review of visitation models in adult critical care units within the context of patient- and family-centered care. Int J Evid Based Healthc. 2011; 9:(4):362–387.

8. Boyd C. Patient-centered care for older adults with multiple chronic conditions: a stepwise approach from the American Geriatrics Society. J Am Geriatr Soc. 2012; 60:(10):1957–1968. http://www.americangeriatrics.org/files/documents/MCC.stepwise.approach.pdf.

9. Saskatchewan Ministry of Health. Patient- and family-centered care resources and tools. 2011. http://www.health.gov.sk.ca/pfcc-resources-tools.

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RESOURCES

Institute for Patient- and Family-Centered Care. Frequently asked questions. 2010. http://www.ipfcc.org/faq.html.

Institute for Healthcare Improvement and the National Initiative of Children's Healthcare Quality, developed in partnership with the Institute for Family-Centered Care. Patient- and family-centered care organizational self-assessment tool. http://www.aacn.nche.edu/qsen/workshop-details/pittsburgh/KD-Tool.pdf.


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