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Family Centered Care: Strategies for Success. Jocelyn Farrar RN, MS, CCRN CRNP Doctoral Student, University of Maryland School of Nursing Baltimore, Maryland Robyn Schaffer MA Carine McLaughlin LCSW Lara Klick BA Sinai Hospital of Baltimore Baltimore, Maryland. Why Design This Course?.

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Family Centered Care: Strategies for Success

Jocelyn Farrar RN, MS, CCRN CRNP

Doctoral Student, University of Maryland School of Nursing

Baltimore, Maryland

Robyn Schaffer MA

Carine McLaughlin LCSW

Lara Klick BA

Sinai Hospital of Baltimore

Baltimore, Maryland


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Why Design This Course?

  • Adoption of a culture of Family Centered Care

  • Nursing Survey

    • Strong desire to adopt Family Centered Care concepts

    • Little to no Family Centered Care content in Schools of Nursing

    • Learning needs

      • Impact of hospitalization of family members

      • Communication strategies

      • Developing partnerships with families

      • Caring for challenging families

      • Dealing with out of control situations

  • Recommendations from literature

  • Recommendations from families


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No one ever told me grief felt so much like fear.-- C. S. Lewis (1898-1963)

www.6seconds.org/hwc/online/grief.html



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Course Planning Committee

  • Patients

  • Family members

  • Direct Care RN

  • Chairperson of the Family Centered Care Advisory Council

  • Director of Social Work

  • Director of Nursing Education

  • Organization Effectiveness Development Specialist

  • Safety and Security


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Course Objective

  • To provide the participant with the knowledge and skills to enhance the development of clear communication and positive partnerships with patients

    and families


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Participant Learning Objectives

  • Articulate the concepts of Family Centered Care

  • Discuss the impact of hospitalization on family members

  • Identify interventions to optimize culturally sensitive family care and facilitate positive partnering with patients and families

  • Utilize the knowledge of differing temperaments to provide optimal interventions for family members

  • Analyze personal biases and beliefs that influence interpersonal relationships

  • Demonstrate effective communication techniques when interacting with family members

  • Implement appropriate interventions for families exhibiting anger, aggression, and crisis

  • Identify resources to assist in difficult or out of control situations


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Family Centered Care: Strategies for SuccessCourse Overview

  • Flexible, adapt to various education venues

  • 4 Modules

    • One computer-based learning module

    • Three interactive education modules


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Module 1: Computer – Based Learning Module

  • Introduction to the Philosophy of Family Centered Care

    • Set the stage for the journey

    • What to expect

    • Impact

  • Prerequisite to other modules

  • 30 minutes to complete

  • CEUs provided


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Modules 2, 3, 4:Interactive Education Modules

  • Use as single modules or as a 4 – hour course

    • Module 2: Families in Crisis – 1 hour

    • Module 3: “It’s All About Me” – 45 minutes

    • Module 4: Working with Families in Crisis – 1 hour 30 minutes

  • Teaching strategies

    • Lecture

    • Interactive discussion

    • Role playing

    • Group activities

    • Case study analysis

    • CEUs provided


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I can clearly discuss the impact of hospitalization on the patient’s family

I can identify the personal beliefs and biases that influence my interpersonal relationships

I can apply my knowledge of the impact of different temperaments to provide optimal interventions for family members

I can develop effective partnerships when caring for families

I am able to demonstrate proactive negotiation and contracting skills

Scoring

4 = highly agree

3 = agree

2 = disagree

1 = highly disagree

Pre Course Evaluation



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Family Centered Care Initiative patient’s family…………………………………

Advancing the Practice of Family Centered Care. . .

Making Families Partners in Care


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What is Family Centered Care? patient’s family

  • A philosophy and approach to health care that places the patient and family at the center of the institutional and professional purposes

  • Patients and families are involved in all aspects of planning, implementation and evaluation of health services

  • It involves patients and families in polices,programs, facility design, and staff day-to-day interactions.

  • Family Centered Care facilitates collaborative relationships between and among consumers and health providers.


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FAMILY CENTERED CARE IS A TOTAL CHANGE IN patient’s family

PHILOSOPHY AND THE

WAY WE DO BUSINESS


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Family Centered Care is a patient’s familyparadigm shiftand a profound change in culture for many health care organizations

  • Family Centered Care challenges the traditionalapproaches that:

    • Focus on patient and family deficits

    • Disempower patients and families

    • Rely heavily on technology and biomedical science

    • Undervalue the importance of human interactions in the health care experience

    • Are driven by the needs of the healthcareprofessionals and the system


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Family Centered Care helps us clearly understand that. . . patient’s family

and these are VISITORS

. . .this is FAMILY. . .


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With that being said, we realize this concept may bring a patient’s familymultitude of emotions….


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But….for the sake of perspective…..just imagine if your loved one was now “the patient”….

How would you like him/her to be treated? As the family member, how would you like to be treated?


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JCAHO loved one was now “the patient”….

Healthcare Advisory Board

Institute for Healthcare Improvement

Society of Critical Care Medicine

American Hospital Association

American Association of Critical Care Nurses

Institute of Medicine

Institute for Family Centered Care

Regulatory and Specialty Care Organizations That Support Family Centered Care


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Why Is Family Centered Care Important to Sinai Hospital? loved one was now “the patient”….

  • PATIENT SAFETY IS ENHANCED WHEN PATIENTS AND FAMILIES PARTNER WITH THE HEALTH CARE TEAM

  • Patients and families are becoming more aware of their rights and are advocating more vigorously for increased access

  • JCAHO and others are looking for increased patient and family involvement in the development and implementation of the plan of care

  • Complaints have been received from patients and their families

  • Confrontations have occurred between visitors and staff


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Where are we now?? loved one was now “the patient”….


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Patient and family satisfaction surveys give a measure of loved one was now “the patient”….

where we are now:

Overall Assessment of Hospital


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Patient Personal Issues loved one was now “the patient”….


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Visitor and Family Issues loved one was now “the patient”….


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Where we want to be for the future! loved one was now “the patient”….


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Mutual respect loved one was now “the patient”….

Patient and family choice

Focus on strengths

Flexibility in health care delivery

Information sharing

Patient and family support

Mutual collaboration

Patient and family empowerment

The Core Concepts of Family Centered Care give us a vision of where we want to be


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According to experts, the key phrase we like to work around is:Families are not visiting,they are“Family-ing”


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We will work to overcome issues that have historically been is:barriers to Family Centered Care

  • Lack of geographic space

  • Incorrectly perceived negative impact on recovery and healing

  • Staff convenience

  • Fear of “being watched”

  • Lack of time

  • Nursing shortage

  • “It’s not my job”


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Family Centered Care facilitates collaboration between the patient, family and health care team at all levels.

STUDER

PRINCIPLES

MAGNET

RECOGNITION

FAMILY

CENTERED

CARE

PRESS GANEY

SERVICE

EXCELLENCE

BASICS


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Family Centered Care patient, family and health care team at all levels. outcomes from three major health care organizations across the country include:

  • Improved nursing staff satisfaction scores

  • Improved patient and family satisfaction scores and reduced complaints

  • Contributed to successful Magnet certification

  • Contributed to successful JCAHO survey

  • Improved quality and safety scores


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Potential patient, family and health care team at all levels. Benefits to Sinai

Improved safety and quality outcomes

Improved medical & developmental outcomes

Increased organization responsiveness to patient and family identified needs and priorities

Reduced health care costs


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Potential patient, family and health care team at all levels. Benefits to Sinai

  • Enhanced patient and family satisfaction as well as staff and faculty satisfaction

  • Positions the hospital or clinic more effectively in the marketplace

  • Builds a cadre of families able to advocate for quality in health care and the resources to support quality in health care

  • Enhances employee pride in the hospital


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Organizational changes patient, family and health care team at all levels. that will help us reach our goal include:

  • Mission, Vision and Philosophy of Care Statements will address family centered care and set the organizational tone

  • The leadership group and staff will adopt a change inculture to one of patient and family centered care

  • Patients and families will participate in hospital-wide and unit based committees

  • Patients and families will be given choices in care

  • Patients and families will collaborate with the health care team in the planning, implementation and evaluation of care


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Other patient, family and health care team at all levels. goal enhancingorganizational changes include:

  • Policies and performance evaluations will include a patient and family focus

  • Patient and family resources will be made available

  • Signage will be patient and family friendly

  • Clinical documentation will reflect the philosophy of Family Centered Care


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Safety and security issues patient, family and health care team at all levels.

Parking

Facility design

Attitudes - patient, family, staff

Staff knowledge and skills

Family support resources

Confidentiality

Resuscitations and other complex clinical events

Presence of children

The following challenges to Family Centered Care are being addressed as we move forward:


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What Is patient, family and health care team at all levels. Your Role?

  • Educate yourself on the

    philosophy of

    Family Centered Care

  • Talk to your peers and leaders

  • Become involved on a Family Centered Care unit-based committee

  • Attend education offerings

  • Incorporate the core concepts of Family

    Centered Care into your daily practice


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Family Centered Care: patient, family and health care team at all levels. What have you learned?


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1) In the Family Centered Care model, visiting is driven by the PATIENT'S choices and requests.

True or False


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2) In understanding the concept of Family Centered Care, staff are defined as “visitors”.

True or False


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3) With Family Centered Care, patients and families are involved in planning and implementing, but not evaluating health services.

Evaluation is the sole responsibility of the healthcare professional.

True or False


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4) Family should not be allowed to be present at the bedside or participate in rounding due to the time constraints of the physician team and the numbers of questions the patient or family will have.

True or False


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5) Through the Family Centered Care initiative, patient or family advocates will serve on unit-based committees, bringing their expertise as patients and families to the table.

True or False


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Congratulations! family advocates will serve on unit-based committees, bringing their expertise as patients and families to the table.You have successfully completed the introductory course of Family Centered Care!


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Module 2: family advocates will serve on unit-based committees, bringing their expertise as patients and families to the table.Families In Crisis

  • Case study analysis and application of concepts

  • Interactive lecture and group discussion

  • One hour module


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Module 2 family advocates will serve on unit-based committees, bringing their expertise as patients and families to the table.Families In Crisis - Objectives

  • Define crisis

  • Discuss a family’s initial response to crisis

  • Describe three areas to include in a family system assessment

  • Outline the top ten needs of families

  • Implement strategies to appropriately care for a family in crisis


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Module 2: Content family advocates will serve on unit-based committees, bringing their expertise as patients and families to the table.

  • Crisis Case Studies

    • Definition of crisis

    • Goals of intervention

    • Families initial reactions

    • Top needs of families in crisis

    • Factors that affect the response to crisis

    • Assessment of the family in an acute care setting

    • What is a “challenging” family

    • Effective staff coping skills

    • What to do in a crisis

    • What not to do in a crisis


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Module 3 family advocates will serve on unit-based committees, bringing their expertise as patients and families to the table.“It’s All About Me”

  • Lecture and interactive discussion

  • Case study analysis


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Module 3: Objectives family advocates will serve on unit-based committees, bringing their expertise as patients and families to the table.

  • Identify personal biases that affect relationships with families

  • Discuss personal triggers/buttons that prevent effective partnering with patients and families

  • Analyze preferences and temperaments that impact the development of partnerships

  • Analyze behaviors that contribute to respect for differences and diversity


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Module 3: Content family advocates will serve on unit-based committees, bringing their expertise as patients and families to the table.

  • Beliefs and biases

    • Ladder of Inference

    • Personal communication filters

    • Triggers and buttons

  • Effective listening skills in difficult times

  • Personal preferences and temperaments

    • Absorb new information

    • Make decisions

  • Respecting differences and diversity


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Module 4: family advocates will serve on unit-based committees, bringing their expertise as patients and families to the table.Working With Families in Crisis

  • Lecture and interactive discussion

  • Group work

  • Role play

  • Scripting


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Module 4: Objectives family advocates will serve on unit-based committees, bringing their expertise as patients and families to the table.

  • Recognize proactive techniques to establish collaborative guidelines for partnerships

  • Demonstrate proactive contracting and negotiating skills

  • Identify key words for communicating a caring response to patients and families

  • Identify behaviors indicating escalating dissatisfaction in patients and families

  • Demonstrate proactive positive de-escalation techniques for working with angry patients and families

  • Identify resources available to assist in out of control situations, when to access them and how to access them


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Module 4 - Content family advocates will serve on unit-based committees, bringing their expertise as patients and families to the table.

  • Proactive patient preference discussion

    • Establishing patient focused guidelines for care

  • Establishing partners in care

    • The responsibility of the patient, family and health care provider

  • Contracting

    • Ensuring that “rules” are not a mystery

    • Negotiating

    • Red, Yellow and Green light rules

  • Disagreements: Defining the Real Issues

    • When is the issue not the issue?

    • Addressing the real issue

    • What does it sound like (scripting)

    • When do you need help

  • Anger and aggression

    • De-escalation techniques

    • Danger signs

    • Getting help


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The Tipping Point family advocates will serve on unit-based committees, bringing their expertise as patients and families to the table.

  • Behavior of staff on the unit

    • Integrating concepts into care

    • Questioning the status quo

    • Refusing to accept “non-family centered behaviors

  • Managers appreciate the

    value of the course

    • Enhanced patient safety

    • Nurse retention = $$$ saved

    • Less problems = Time savings

    • Patient and Family satisfaction =

      • Better patient outcomes

      • Congruent with mission and vision

      • Hospital of choice

      • Positive financial impact


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I can clearly discuss the impact of hospitalization on the patient’s family

I can identify the personal beliefs and biases that influence my interpersonal relationships

I can apply my knowledge of the impact of different temperaments to provide optimal interventions for family members

I can develop effective partnerships when caring for families

I am able to demonstrate proactive negotiation and contracting skills

Scoring

4 = highly agree

3 = agree

2 = disagree

1 = highly disagree

Post Course Evaluation


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Course Evaluation patient’s family

  • “This is the best course I have ever taken”

  • “The physicians need to learn about this”

  • Improved Press Ganey Scores and positive patient and family comments

  • Absence of staff and family conflict

  • Improved nurse satisfaction

  • Collaborative relationships with patients and families


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Evidence of Success patient’s family

  • The baptism in a bucket

  • Family presence at a Code

  • Removal of the “family presence prohibited” sign in the CCU

  • Patient centered visiting in almost all units

  • Unit – based family hospitality centers

  • Staff training of staff

  • Collaboration with Child Life Specialists in the Adult ICU

  • Nurse Managers deem the course to be mandatory training for staff

  • Resident education coordinators integrate the course into resident training


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Attendees to Date patient’s family

  • Over 700 registered nurses

  • Patient care techs and unit receptionists

  • Radiology staff

  • All Social Work staff

  • All Clergy

  • All Physical Therapy and Occupational Therapy staff in the Rehabilitation Center

  • All Guest Relations staff

  • University of Maryland senior nursing students

  • Sinai and Johns Hopkins medical residents


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Future of the Course patient’s family

  • Hearing the Voice of the Patient and Family

    • Development of a training video by patients and families for staff

  • Required education for all physician residents

  • Incorporation into School of Nursing curriculum

  • Development of a course for ancillary staff

    • Transporters, dietary hostesses, security staff


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Questions? patient’s family

jfarrar20@yahoo.com