Implementing Evidence Based Practice: Caring For Pediatric Patients

Zainah Mohamed

Patient-and Family-

Centered Care

Caring For Pediatric Patients

Effective Communication

Pain Mx.

Patient Safety

Integrity

Parental rights

Patient Education

Continuity of Care

Justice

Document-ation

Accessibility

of Care

Empathy

Etc.

Patient-and Family-

Centered Care

Caring For Pediatric Patients

Effective Communication

Pain Mx.

Patient Safety

Integrity

Parental rights

Patient Education

Continuity of Care

Justice

Document-ation

Accessibility

of Care

Empathy

Etc.

What is Patient- and Family-Centered Care (PFCC)?

“…an approach to the planning, delivery, and evaluation of

healthcare grounded in mutually beneficial partnerships

among health care providers, patients, and families.”

Institute for Family-Centered Care

History of Patient-and Family- Centered Care (PFCC)

• Developed after WW II

• Children were admitted to the

hospital without their parents

• Not allowed to visit

• Limited visiting hours

• Hospitalized for long period for

chronic illness e.g. TB

• Resulted in Psychological trauma

The Convention on the Rights of the Child (1989)

Article 7 The child’s right “to know and be cared for by his or her parents”

Article 9 Child’s right “not to be separated from his or he parents against their will, except when competent authorities subject to judicial review determine… that such separation is necessary for the best interests of the child”

Article 18 Recognition that both parents have common responsibilities and “the best interests of the child will be their basic concern.”

Video: The Human Connection to Patient Care

By Cleveland Clinichttps://www.bing.com/videos/search?q=cleveland+clinic+empat

hy+video+youtube&view=detail&mid=474C42E5C5E5155A20

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Patient- and Family-Centered Care : Redefines Roles in Healthcare

Places emphasis on collaborating with patients and families of all ages, at all levels of care, and in all healthcare settings

Recognizes that families are essential to patients’ health and well-being and are crucial allies for quality and safety within the healthcare system

PFCC helps us clearly understand that…

Concepts of Patient-and

Family-Centered Care

Dignity & Respect

Information SharingParticipation

Collaboration

Paradigm Shift

System or Health Care Provider Centered

Paternalistic• Families as visitors.• Professional

expertise & decision-making .

• Gate-keeping ofinformation.

• The priorities of thesystem (hospital) andthose who workwithin it drive thedelivery of care.

Patient or Family Focused

• Families allowed to participatewhen deemed appropriate by staff.

• Decisions made by staff based ontheir perceptions of family needs orpriorities.

• The patient is the focus or unit ofcare. Interventions are don to & forhim/her instead of with the patient.

• The patient is not viewed withinthe context of family orcommunity.

Patient & Family Centered

Empowered • Families as partners• Families & staff share

expertise &collaborate indecision-making

• Transparency ofinformation

• The priorities &choices of patients &families drive thedelivery of care

Delivering Care in partnership with Parents• Respect parents’ role as child’s main caregiver• Encourage parents’ presence to minimize separation

Care that Addresses Children’s

Psychological, Social & Developmental

Needs

Staff have pediatric

qualifications & experience

Appropriate communication

Support coping with anxiety &

pain

Support opportunities for play (for self-expression,

distraction, and continued development)

Wards dedicated to children, with family-

friendly areas (e.g. resources/facilities for

children at different development stages)

Sibling Support

• Facilitate sibling visitation

• Prepare siblings for what they’ll see or experience in the hospital. Give honest and developmentally appropriate information and encourage questions and expression of feelings

• Engage siblings in play and expressive activities

Core Features of Patient-Family-Centered Care

The well-being of families depends on the quality of their informal

and formal social support systems

All families are different and function best when their unique

values and preferences are acknowledged and incorporated

into the plan of care

Parents know their children and their

family best and want the best for them

All families have strengths and competencies

The well-being and development of

children depends on the well-being of the

family

The Benefit of Patient-Family-Centered Care

Improved satisfaction for patient/family and service provider.

-FCC approach have positive r/ship with patient recovery, emotional health, physical function and physiologic

outcome & Rx satisfaction

Improved adherence.

- Pts. more likely to take their medications, show

up for appointment

Functional outcome improvement.

-Fewer limitations imposed by the disease on patient

functional ability

Patient/ family-centered communication skills.

-Patient/ family-centered communication skills promote

adherence

Decreased litigation.

- Behave like devaluing patients/families views, delivering

information poorly, failing to be attentive to patients/ families

perspective

(Baird et al. 2015; Hill 2019)

CHALLENGES & EXPECTATION IN FCC

What action should we take?

Barriers to Family-Centered Care

“It’s not my job”

Staff shortage

Lack of time

Fear of ‘being watched’

Staff convenience

Perceived -veimpact on recovery &

healing

Lack of ‘geographical

space’

(Baird et al. 2015; Foster & Whitehead 2017; Phiri et al. 2017; Hill 2019)

Organizational Changes

Patients & families will collaborate with the health care team in the planning,

implementation & evaluation of care

Patients & families will be given choices

in care

Patients & families will participate in

hospital-wide & unit based committees

The leadership group & staff will adopt a

change in culture to one of patient &

family- centered care

Mission, Vision & Philosophy of Care Statements will

address family-centered care & set the organizational tone

(Cliff 2012; Phiri et al. 2017)

Parents have a right to make decisions about their child

Parents need to have information about their child’s condition, Rx & nursing care

Implementing PFCC – Paradigm ChangeFamilies are not visitors, but

part of the team.

•Respect the right of children to have a parent with them.

•Respect the role of the primary caregivers; work with parents so they can care for their child as they would at home.

Good communication is essential - take time to talk

with parents and child in ways they can understand.

•Provide space for families to be together, for children to play, etc.

•Seek regular feedback from families and additional training to develop skills

Facilitate the active participation of parents in the

care of their child:

• give full information regarding the child’s care and about ward routine

• arrange the elements of care they can participate in or take on

• support them in their care and accept their decisions

• discuss changes needed if their care is not helpful to the child’s recovery

Implementing PFCC – Paradigm Change (cont.)

At the Managerial Level : Issues affecting Nursing

• Patient outcomes measurement

• “Routines” appropriate to meet patient needs

• Effective nurse allocation to meet patient needs

• Developing nurses to meet patient needs

(Al-Motlaq et al. 2016)

At Systems/ Institutional Level : Assessment of

Processes

• Nursing Standards

• Accessibility of care (visiting hours, patients records)

• Quality criteria e.g. patient counseling

• Affordability criteria e.g. cost of care

(Al-Motlaq et al. 2016)

Reflection!

• What aspects of PFCC is integrated into your hospital setting?• What would be your priorities for change?• What aspects would you advocate for with colleagues and

administration?• Why and how would you go about it?

What is Your Role as a Nurse?

Orientation

• Introduce yourself to the child & parents

• Show the child & parents aroundthe ward - Tell them about the hospital facilities

• Ask parents if they

• Slept well, had breakfast, etc.

• Explain the care the child will receive that day/night

• Explain what you are going to do, e.g. measure BP, change dressing etc.

• Ask parents what they like to do

• Ask them if they have any questions

Answering questions

• Do not afraid to say “I do not know” when a child/parent asks a question

• Tell child/parents “I do not know but I will get that information for you”

Negotiation

• Helping parents to be involved in their children’s care is important part of FCC

• Nurses & parents need to decide who will perform the care the child will need, e.g.

• Showering the child

• Feeding the child

• How does the nurses’ routine suit the parents’ routine?

(McCann 2018)(Hill et al. 2019; Veal et al. 2017) (Hill et al. 2019; Veal et al. 2017)

Providing Patient-and Family-

Centered Care

Care delivered in partnership with parents to address children’s psychological, social &

developmental needs

Collaborative approach to care giving and decision-making - family is in the

centre of the system

Respect the knowledge, skills, and experience that each party brings to

the healthcare encounter

Family and healthcare team work together collaboratively for the benefit of the patient

Benefits the institution, healthcare workers,

families, and patients.

The Art of FCC

“the process of healing depends on knowing the patient as a person, in

addition to accurately diagnosing their disease” Ronald, M.J. (2000)

REMEMBER

THEREFORE

BUT

THEREFORE

Negotiate with the family what they can do & what they want to do

Nurses must explain to them

Nurses should not expect family to be involved

Family do not know that they can be involved in pt.’s care

References • Al-Motlaq, M., Abuidhail, J., Salameh, T. & Awwad, W. (2016). Development and validation of an instrument to

assess the implementation of family-centred care in traditional open bay Neonatal Intensive Care Units. Early Child Development and Care. 187(1): 168-177.

• Baird, J., Davies, B., Hinds, P. S., Bagott, C. & Rehm, S. (2015). What Impact Do Hospital and Unit-Based Rules Have Upon Patient and Family-Centered Care in the Pediatric Intensive Care Unit? Journal of Pediatric Nursing 30(1): 133-142.

• Foster, M & Whitehead, L. (2017). Family Centred Care in the Paediatric High Dependency Unit: Parents’ and Staff's perceptions. Contemporary Nurse 53(4): 489-502.

• Hill, C., Knafl, K.A., Docherty, H. & Santacroce, S.J. (2019). Parent perceptions of the impact of the PaediatricIntensive Care environment on delivery of family-centred care. Intensive and Critical Care Nursing. 50: 88-94.

• McCann, C.L. (2018). Negotiation Intervention between the Family and the Nurse of a Hospitalized Child. Hampton University, ProQuest Dissertations Publishing, 2018. 10816464.

• Phiri, P.G.M.C., Kafulafula, U. & Chorwe-Sungani, G. (2017). Registered nurses' experiences pertaining to family involvement in the care of hospitalised children at a tertiary government hospital in Malawi. Africa Journal of Nursing and Midwifery. 19(1): 131-143.

• Smith, J., Swallow, V. & Coyne, I. (2015). Involving Parents in Managing Their Child's Long-Term Condition—A Concept Synthesis of Family-Centered Care and Partnership-in-Care. Journal of Pediatric Nursing 30(1): 143-159.

• Veal, G.J., Malik, S., Lupo, M., et al. (2017). Investigating the roles and training of paediatric research nurses working across Europe: a questionnaire-based survey. BMJ Paediatrics Open. 1(1) doi: 10.1136/bmjpo-2017-000170

Thank You.