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  1. FAMILY-CENTERED CARE Spring, 2010

  2. Learning Outcomes: • The student will be able to: • Identify elements of family-centered care. • Apply elements to the practice setting. • Describe how to incorporate core concepts into care. • Discuss the definition of “family” as well as various types of families.

  3. Reading Assignment: • Required: None. • Recommended: • Hockenberry, pgs 13-14.

  4. “Technology should support your practice, not define it…”

  5. Family-Focused Care: • Health professionals provide care from the position of being an expert. • As an expert, they direct care, tell the family what to do, and intervene for the child and family. • Not really teaching and building on strengths. Families usually come back because they weren’t prepared.

  6. Family-Centered Care:Focus on all family’s needs and not just the patient’s • A mutually beneficial partnership that develops between families and the nurse, and other health professionals. • Focuses on the needs of all family members, not just the child’s needs.

  7. Why Family-Centered Care? • History shows that when parents were allowed to stay with hospitalized children, they were quieter, happier, and recovered sooner.

  8. Research has confirmed that children had decreased anxiety during procedures, needed less pain medication following surgery, and coped better during hospitalization when parents were allowed to stay with their child.

  9. Gradually, it has become recognized that parental presence during certain medical procedures, and sometimes resuscitation, is also beneficial to children and their families.

  10. Family As The Center • Always remember: They know their child better than anyone. • Families have important knowledge to share about their child, their child’s health condition, and how their child responds to various actions and events.

  11. Illness or injury affects all members of the family system (including siblings). • *Respect – Acknowledges the expertise of the family. • *Strengths– Recognizing & valuing family strengths and needs

  12. Practice Examples: • Providing comfortable places for the family to stay (promote sibling visitation) • Providing hygiene facilities for families who spend long hours at the facility or travel great distances.

  13. Offering parent’s the opportunity to participate in care and promote development of expertise • Collaborative care conferences

  14. 3:30 *Collaboration2nd most important • Seeking a “partnership” role • Characterized by several features: • Communication- children pay more attention to non verbal communication. • Open ended questions start with: what, how, and tell me about. • Closed ended Q’s start w/: Does, did, and is • Make sure to explain/communicate w/ parents, but be able to listen as well. • Active Listening • “Knowledge has never been known to enter the head through an open mouth” • Negotiation – Implies discussion

  15. 13:30 Words That We Should Avoid: • Words like “policies”, “allowed”, and “not permitted” imply that hospital personnel have authority over matters concerning their child.

  16. All Visitors: Please pick up the wall phone and dial 1 for permission to enter the room

  17. Words That We Should Use: • Words like “guidelines”, “working together”, and “welcome”, communicate an openness and appreciation for families.

  18. 15:20 Are These The Same? • “Guidelines for Family Members” • Most children hospitals have guidlines for each. • “Guidelines for Visitors”

  19. Practice Examples: • Assure that parents are integral in the decision-making process • That parents have 24 hour access to their child • Family Advisory Councils • Family Evaluation of Care, including attitudes of the health professionals

  20. Sharing *Information • Sharing complete and unbiased information to the family. • *Empowerment – Sharing knowledge & skills to achieve the goal of the family caring for their child.

  21. They will need access to information that will make it possible for them to fully participate in planning and decision making. • Give information on the child’s problem, prognosis, and needs.

  22. Provide information to siblings at a developmentally appropriate level and answer questions honestly.

  23. 24:00 Practice Examples: • Eliciting vital information about their child. • Temperament and pain • Providing pertinent information in writing if possible.

  24. 24:55 Respect for Cultural Diversity • Understanding cultural and religious beliefs – respect and sensitivity. • Differences in food vs culture • A simple change in menu can prevent malnutrition problems • Understanding coping differences.

  25. 27:15 Practice Examples: • Providing translators / interpreters • Written information should be in family’s primary language. • Learning about a family’s cultural healing practices. • Explaining terminology.

  26. 28:15 Broad Array of *Supports

  27. Practice Examples: • Help families build on their strengths. • Offering referrals.

  28. 29:10 Family-to-family Supports • Parent-to-parent and family support resources. • Mentors to families entering the healthcare system for a new chronic condition. • Mentors- Family who’ve had some of the same promblems as the new family and guide them and offer support.

  29. Practice Examples: • One-to-one or group support (parents and / or child). For example: • Anger Management Groups • Parent Support Groups • Sibling Support Groups • Asthma Camps, Diabetic Camps and other diagnosis based camps

  30. 30:55 Flexible Systems of Care • *Choice - Maintain routines established by the family. • *Flexibility – Remember need for respite. • Flexibility w/ treatment (consider families w/ children that have serious health conditions, THEY MAY NEED A BREAK!)

  31. 33:10 Practice Examples: • Flexible scheduling of clinic visits (after 5PM and on Saturdays). • Alternatives such as “Satellite Clinics” at schools. • Smooth transitions between service providers. • Flexible financial support.

  32. 34:50 Appreciating Families • Facilitate “Normalization”.

  33. 35:00 Practice Examples: • Introducing ourselves. • Asking parents their names. Its more appropriate. • Being sensitive to terminology, i.e., “mentally challenged vs. mentally retarded” or “learning difference vs. learning disability”. • Avoid titles like “dad, mom, and sweetie” • Never assume you know who the mom and dad are.

  34. Family Types: Nuclear Family Mom, dad, kids Blended Step parents, siblings w/ other parents Extended Grandparents, grandchildren Single-parent Binuclear Joint custody. Two homes for child. -Heterosexual cohabitating -Gay & lesbian 38:40 Definitions:

  35. Family Is Defined As: • “Whatever the client considers is to be”


  37. Learning Outcomes: • The student will be able to: • Identify child and family stressors. • Discuss principles of Atraumatic care.

  38. Reading Assignment: • Required: None. • Recommended: • Hockenberry, pgs 14-15.

  39. 42:52 Much of what is done to children to cure illness and prolong life is traumatic, painful, upsetting, and frightening.

  40. Atraumatic Care: • Is the provision of therapeutic care in settings, by personnel, and through the use of interventions that eliminate or at least minimize the psychologic and physical distressexperienced by children and their families in the health care system

  41. Identification of Child and Family Stressors Physical Stressors Psychological Stressors Environmental Stressors

  42. Pain and Discomfort Ex: Injections, dressing changes Immobility Ex: restraints Sleep Deprivation Kids like to be active and even when they feel bad don’t want to stay in bed. Can lead to irritability for whole famiy… and staff. Inability to Eat or Drink Consider kids who are NPO. Changes in Elimination Habits Opioids = constipation 44:05 Physical Stressors

  43. Separation from Child Lack of Privacy Inability to Communicate Inadequate Knowledge & Understanding of Situation No idea what’s wrong with your child Severity of Illness Broken arm is different than waiting for the results about leukemia. Parental Behavior- Remind the parents that their kids know “the look” (look of worry) Child Behavior How sick do they act 49:30 Psychological Stressors

  44. Unfamiliar Surroundings Unfamiliar Sounds Unfamiliar People Unfamiliar and Unpleasant Smells Constant Lights Activity Related to Other Patients Sense of Urgency or Lack of Urgency/Concern Among Staff People who give the sense of “who cares” Red Jello story: parents may be reluctant to call for help. Unkind Comments 59:05 Environmental Stressors

  45. 1:06:55, don’t memorize Stressors For Hospital Preschoolers • Intrusive procedures (blood work, rectal exam, dressing change) • Separation (time of surgery) • Postoperative pain • Other events (waiting in the emergency department, severe fluid restriction)

  46. Stressors For Parents With Children in ED • Communication with staff (repeated questioning) • Concern for the child • Length of stay in the ED • Separation from the child • Child’s appearance

  47. Principles of Atraumatic Care:

  48. 1:08:08 Prevent or Minimize Physical Stressors • Avoid or Reduce Intrusive and Painful Procedures • Rectal temp; better Axillary/tympanic • Blood gas; better Pulse Ox • Lube before Foley • Multiple venous punctures; “2 Try Policy” • Topical anesthetics for puncture sticks, IM (Smaller gauge needles) • Avoid or Reduce Other Kinds of Physical Distress • Therapeutic positioning (hugging parent) instead of restraints. • Plan care around naps • Smells, watch for nausea (open tray away from bed) • Avoid excessive tape use • Pedi, rarely NPO so let em’ drink and eat…  • Control Pain