Family at the Bedside

Many people have many different definitions of a family. Some include family as the people they live with, some include their entire extended family, and some include friends, neighbors, coaches, and teachers. According to the Vanier Institute (2013), a family is “a combination of two or more persons who are bound together over time by ties of mutual consent, birth, and/or adoption” (para. 2). Whichever way you look at it, families often play a major role in life. It only makes sense that when a person begins to go through a drastic change in life such as illness, the family will be involved. This is why it is important that nurses learn how to provide suitable client and family centered care. They can do this by following the four

Including the client as an expert member of the team creates an enhanced quality of care (Coad, Patel & Murray, 2014). In pediatrics, parents are often at the center of the child’s care. When asked to define what made the client care experience positive, parents stated that sensitivity, empathy and honesty were key factors (Coad, Patel & Murray, 2014). Working in healthcare, nurses can become desensitized to difficult experiences because they deal with them daily. Integrating the client and family as part of the healthcare team, allows the nurse to see the patient and family as a people first. By avoiding using illness as context, and instead using person as context, care will be more holistic (Coad, Patel & Murray, 2014). A family-focused approach helps to ensure that the whole family feels a part of the experience and is valued. In the case of bereavement, family centered care is particularly important. If the family is not included in the care from the start, it can provide barriers for grieving and impact how the family deals with loss (Jones, Contro & Koch, 2014). Nurses have an opportunity to help support the family through the grief process (Jones, Contro & Koch, 2014). Families have a significant impact on how the client heals, so by caring for the family’s needs, the nurse is indirectly caring for the patient. It is in the client’s best interest for the care to be holistic for the patient as well as the family (Jones, Contro & Koch, 2014). All

Emotional Support and encouraging involvement of family and friends- Listening to patient with undivided attention .Providing clear, timely and meaningful information regarding the illness. Providing enough information regarding the patient’s illness. Respecting and acknowledging the family and friends’ support in patient care and providing supportive environment.

Families always affect one another, even when they feel distanced. The family unit can promote health or it can be a source of stress. It is the nurse's task to use family relationships to act as health facilitators for the patient, and, if necessary, treat the family as part of the patient's social environment. The family creates the patient's environment just as much as a clean room or an accessible place to exercise or access to appropriate medication.

The article goes on to address the importance of specifically designing practices related to family centered care in the pediatric setting. Four recommendations are set forth in this guideline: family visitation, family centered rounds, family presence during CPR and invasive procedures, and family conferences. Recurrent themes in these areas are listening to and respect the family. communication of information and answering questions, education, and collaboration in developing treatment. While most of the information in this article is focused on the parents and ill child, many of the suggestions are applicable and adaptable to siblings (Meert, Clark, & Eggly, 2013).

It can be very frustrating at times dealing with the family members of the older patient that I see in the emergency room. I have such limited time to take care of everyone’s needs before the next patient comes in by ambulance that I often forget how the family feels seeing their parent on an emergency room cart in pain and confused. My definition of the comfort I can provide in the emergency room are often very different from the family’s expectations. According to Gerontological Nursing (Tabloski, 2014), the attending nurse needs to understand the patient and family’s goals, wishes and values to attend to their

| |members in bedside handover, it could lead to a collaborative alliance between the |

Family as context is the first approach that focuses on the patient while the family is in background. The family

According to Erlingsson and Brysiewicz (2015), family is considered a core, social institution and is our first interaction with human beings. When viewing the family as a context, the nurse assesses the patient that is in need of care while in the background, there are the family members of the patient. According to Kaakinen, Coehlo, Steel, Tabacco & Hanson (2015), the source of support to the patient is his or her family members. Usually family members are in attendance with the patient. This approach is used when a mother is admitted to the intensive care unit after falling and sustaining head trauma. The patient is the mother. The nurse is focused on the mother and care was directed

The purpose of this paper is to display how such assessment is essential not on an individual basis, but rather on a larger scale in relation to family nursing. Family nursing “centers on the family as a unit of care, addressing family needs in response to a member’s illness or threat to health, rather than focusing on the individual. An understanding of families’ needs at particular developmental stages, how they communicate and function, and an ability to undertake a family assessment is foundational knowledge for family nursing” (St John, 2009, p.6). Often, nurses encounter the families of their individual patients on a daily basis, yet family assessments are not performed. This is because nurses often feel there is little time to engage families effectively, and in fact lack of time, has been identified by nurses as the primary barrier to engaging families (Kaakinen, 2015, p.109). Evidence based practice however, has proven that “a 15 minute, or even shorter, family interview can be purposeful, effective, informative, and even healing” (Wright, 2013, p.264). This 15 minute interview has been adopted in many acute care settings in involves five key components; manners, therapeutic conversation, key questions, commendation, and the genogram. These ideas represent the theoretical underpinning and are a condensed version of the Calgary Family Assessment Model (Wright, 2013). This model is large, but can be customized and adapted to the function of each individual

Develop an alliance by using caring gestures to the family. Asking caring, sensitive and perceptive questions convey sincere concern for the patient and will help develop trust with the family

The study conducted by Mian et al looked at attitudes pre- and post- FWR experience and in both situations found that nurses had a more favorable view of FWR (2007). While there are many potential reasons for this trend, one possible explanation is that nurses have more interaction with the patient and the patient’s family, thus establishing more of a connection which in turn makes nurses feel more comfortable with family members present.

“Family-centered care” is a term heard often in healthcare settings and in nursing practice. Family-centered care has been recognized as being an integral part to patient health, satisfaction and health care quality (Kuo, et al, 2012). Family-centered care is implemented with the goal to increase partnerships between, families, patients and providers; and has been prioritized as a core-concept of quality healthcare (Gallo, Hill, Hoagwood & Olin, 2016) Many professionals, however, would be hard-pressed to state what the term “family-centered care” actually means and how it applies to nursing practice. They would be at a loss for how to implement family-centered care and what is absolutely necessary to have in order for family-centered care to be successful. Advanced practice nurses are faced with the challenge of adhering to family-centered care in their practice. Illness, both chronic and acute, and health does not just affect the patient involved in care. Illness and health affect the patient, their children, their spouses, their parents, their brothers, their sisters, their grandparents and anyone else involved in their life. Research by Davidson (2009) supports the idea that the perceived effectiveness of communication between healthcare providers and the patient’s family is related to the overall satisfaction of care. Advance

Rotman-Pikkielny et al (2007) conducted a longitudinal study on the study of attitude on rounds, Questions were distributed at the end of the rounds to the staff and family members. Family members were excluded in phase 1. Phase 2 excluded family members. The value of parents being inclusive was 53% while that of excluding the family members was 82%. Families expressed strong preference on participating in decision making (73% before being present on rounds), and patients felt strongly that staff attitude towards them improved following family participation on rounds (66.7% vs 91%).

Data was collected over two years in a level one trauma center with trauma patients that had one family member present and were admitted to the surgical intensive care unit after resuscitation. The family member was interviewed two days later for an average of ten to thirty minutes in a quiet room away from the patient. The sample size of the study was twenty eight and the majority of the sample was female. The results showed that the majority of family members that were present felt that there role was to be supportive and protect the patient during the trauma. They felt that being present was comforting to them and the patient, regardless of the outcome. Another common theme was that the family felt comforted knowing that everything possible was done for their family member.