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Department: STUDENT VOICES

Family-centered practice in nursing education

Montiel, Tahani Casameni; Leal, Andrea Ancer BSN, RN, LMSW; Baltazar, Nicole BSN, RN

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doi: 10.1097/01.NURSE.0000668608.92405.0f
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COMMUNICATION, empathy, and inclusion are at the core of nursing, but these qualities do not typically receive dedicated lectures or seminars in undergraduate nursing programs. There is only limited focus on the inclusion of patient families as part of treatment and care plans in nursing curriculums. This article presents a case study from one of the authors' childhood experiences and discusses a five-session elective nursing course focused on the development of professional and personal values through guided reflection and sharing.

Tahani's story

When I was 9, my family traveled from Mexico to Texas for a vacation. In the Houston airport, my 1-year-old brother stopped breathing. A stranger intervened and initiated rescue breathing until the paramedics arrived. He was admitted to the ICU after being stabilized in the ED.

At first, my younger sister and I were not allowed to visit him because hospital policies restricted family access. An exception was made to let us visit, but a child specialist first explained how my brother would look. Nothing she said really prepared us to see him in that condition. That was the first and last time anyone would explain to us what was going on. My brother remained comatose in the ICU for a few months, and we were not allowed to see him again until he was moved to the pediatric ICU (PICU). He was ventilator-dependent and given only 6 months to live, although he lived another 3 years.

After the first few days, the critical care physicians recommended keeping my brother in the US. They wanted to continue investigating, but all tests came back negative and there was never an official diagnosis. My brother was dependent on medical devices and a ventilator for the rest of his life. For years, he went back and forth between the ICU, the PICU, and our home. My father had to find a job in Texas. My sister and I were enrolled in a new school in a new country, and we had to learn a new language. My mother stayed with my brother around the clock, and we saw her on the weekends when we visited them at the hospital. My first Christmas in the US was spent with my father and sister at home, separated from my mother and brother at the hospital.

Fortunately, my brother received most of his care in the PICU, where the nurses grew accustomed to seeing us. Their faces became very familiar to us as well. He had some amazing nurses, as well as some who did not seem to have a calling for it. Even at age 9, I could tell. My sister and I had favorite nurses, those who made an effort to know when we were coming and had stickers and notebooks ready. Although the nurses tried to make us smile, none of them really talked to us about our brother's health status.

Room for improvement

Due to the hustle and bustle of providing the technical aspects of care, nurses may be inadvertently distant with those who surround their patients. As nurses, however, we must remember that a 9-year-old family member may be standing in a quiet corner, devastated by her sibling's condition without a clear picture of what is happening. The last thing we want our patients and their families to experience during difficult times is a sense of isolation and exclusion.

These moments are life-changing, and empathy and responsiveness should be a part of care for all of those involved in patient recovery. By emphasizing the importance of empathy and family-centered care in undergraduate nursing curricula, future nurses may be better prepared to engage in compassionate communication and make sure family members are not forgotten during patient care.1,2

Incorporating affective learning

The Power of Nursing: Embracing the Healer's Art is a five-session elective nursing course that focuses on development of professional and personal values through guided reflection and personal sharing.3 It utilizes affective learning, which enhances students' skills of active listening and self-reflection.3 By incorporating affective learning into the nursing curriculum, students can explore their values in a safe environment without judgment.

The course fills the gap between the didactic and traditional nursing education and develops essential nursing values such as empathy, active listening, and effective communication. Its inclusion in undergraduate nursing education better prepares future nurses for empathetic communication with patients and their families. However, incorporating additional coursework into an already busy nursing curriculum can be challenging.3 An alternative means of incorporating the relevant content within the preexisting curricula may also be considered. For example, providing the opportunity to role-play emotional scenes throughout the nursing curriculum may eliminate the need for additional coursework and provide sufficient affective training.4 Another option is to offer this education as an optional seminar or continuing-education course for ongoing nursing education.3

Family-centered care

The shift toward incorporating family-centered nursing practices into undergraduate nursing curricula has demonstrated a significant impact on patient outcomes.1 Currently, the patient- and family-centered care model is used in pediatrics and obstetrics, but the involvement of families in patient care is relevant across all clinical nursing domains.1

By incorporating family-centered care into the curricula and simulations, nursing programs can help students develop the empathy, compassion, and effective communication necessary to work with patient families for improved outcomes.1 Further, this may help students develop confidence in their ability to support families in times of need.

REFERENCES

1. Meiers SJ, Eggenberger SK, Krumwiede N. Development and implementation of a family-focused undergraduate nursing curriculum: Minnesota State University, Mankato. J Fam Nurs. 2018;24(3):307–344.
2. Koloroutis M, Medeiros M, Giffin Strom M. The voice of the family. In: Advancing Relationships-Based Cultures. Minneapolis, MN: Creative Health Care Management; 2017:76.
3. Day L, Ziehm SR, Jessup MA, et al. The power of nursing: An innovative course in values clarification and self-discovery. J Prof Nurs. 2017;33(4):267–270.
4. Larti N, Ashouri E, Aarabi A. The effect of an empathy role-play program for operating room nursing students. J Educ Eval Health Prof. 2018;15:29.
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