Registed Nurses' Association of Ontario

Facilitating Family Involvement in Patient Care: Development and Implementation of a Family Education Program in Complex Continuing Care

Linda Emslie
Grand River Hospital

knowledge of client self-management, adult education principles, program development, and client centred-care; improve my patient and family communication skills; become a more effective mentor to other front-line nurses; and improve my practice with respect to the care of complex patients.The intention was to improve my skills and knowledge through the development of a family education program in Complex Continuing Care. Additionally, the program was designed to meet the educational needs of family caregivers, increase the focus on the role of the family as experts in care and to facilitate improved communication among the staff, family and patients.

The early steps in the fellowship process involved meetings with staff members including nursing staff, respiratory therapists, family members and patients.

An extensive literature review was completed seeking other models of care on which to base the program.This review revealed a lack of information with respect to models of family education programs in acute or complex care with the exception of a few programs aimed at parents of chronically ill children. While the grey literature revealed significant educational material for individual skills (e.g., suctioning or position changes), no comprehensive education program was found.

In addition, other facilities were contacted to seek out similar models of client centred care. Twelve facilities were contacted with 8 facilities respond to the request for an interview. None of the facilities contacted had a formal education program with most doing the teaching on an “as needed” bases. It was discovered that the majority of facilities only do this type teaching as the patient comes close to discharge or if at the time of a readmission the family care givers had a history of providing this type of care in the home.

The next weeks were spent in preparing the learning tools for the successful delivery of the education program to caregivers. A brochure, introducing the program, as well as instructions for setting up tube feeds, mouth care, the use of a mechanical lift, and repositioning patients were developed. In addition a learning checklist was prepared to assist the clinical staff to identify learning needs.

Prior to approaching family, I reviewed the prepared materials with frontline staff (6 nurses and 1 respiratory therapy) for feedback. Minor changes to the materials were made based on input from these individuals. The program and materials were then presented to staff through a series of small group presentations using a poster board. Additionally, two family members of patients who were currently engaged in providing care for their family member were asked to review the teaching materials and provide feedback. The materials were positively received and only minor changes were suggested.
Next family members of other patients on the unit were interviewed to determine what level of involvement they currently had in the care of their family members and what, if any, additional education or support they required.Of the eight families approached four requested a review of care procedures (e.g., suctioning, using the ceiling lift and tube feed flushes).

The developed teaching resources were collated into a manual that will assist the nursing staff with teaching skills to caregivers and enhance their knowledge of client centered care. The unit nursing staff have been provided with the tools to embrace a culture change, which includes increased knowledge of family centered care, an approach patient/family teaching and an awareness of the benefits of enhancing their practice. The clinical staff nursing and respiratory therapy staff have been very positive in the acceptance of this program. They have stated that it will be excellent to have the family involved in the care of their loved ones in that it will foster better patient outcomes, and satisfaction with care. The availability of these teaching materials along with the provision of the brochure to all newly admitted patients on the unit will help to sustain this project after my fellowship. In addition, both the Unit Manager and Clinical Nurse Specialist are invested in seeing this program continue.

During the readings I did on family centred care I came to realize that hearing and respecting an individual’s choices improves not only his/her health but also his/her experiences. That goes as well for clinical staff in that a positive life experience and working environment needs to promote respect, recognition, opportunities to share knowledge and skills opportunities for professional development. Also, advocating for the client and respecting their autonomy, voice and participating in care is essential to their care.

The knowledge I have gained during this fellowship experience include the following: all team members need to work toward facilitating client goals and those goals can be more precise if family members are included in both the planning and the care. Client centred care should guide the practices of those involved. Providing care that is respectful of and responsive to the individuals clients preferences needs and values and ensuring that clients guide all clinical decisions. It does not mean giving the client whatever they want rather giving them guidance from their care team about options, benefits and risks.

This fellowship has also afforded me the opportunity to develop my skills in Power Point presentations, literature searches, poster and checklist development and I have established the beginnings of a community of practice with colleagues both within and outside my facility.

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