UCQ Nursing Journal of Academic Writing, Winter 2010 http://www.qatar.ucalgary.ca/acwr/w2010 Ahmad Dorri, R. (2010). Family‐centered care. UCQ Nursing Journal of Academic Writing, Winter 2010, 61‐69. FAMILY‐CENTERED CARE by Roqaia Ahmad Dorri Family‐centered care has become an essential part of patient care in many countries in the world. This means that health care providers do not just concentrate on the patient, but that family members also should be involved. Because of my experiences in my own life and as a health care professional, I will argue that family‐centered care should be implemented throughout the health care system in Qatar. From that point, I would like to share one of my experiences in the hospital setting and how it changed my concept of the importance of family members' roles in fostering patient treatment and health. In 2005, when I was 25 years old, I was hospitalized for four days post cesarean. I was in a room with three other women. I was lonely and scared because I was in a women’s unit where men and children were not allowed to visit. My mother could visit me, but when other patients needed treatment, she had to leave. During that time, I felt bad and always looked to the door, hoping for anybody to enter the room. The nurses gave me unknown medications without any explanation, which greatly increased my fear. Whenever my mother was with me, I felt better. However, when she was not there, my pain became worse. And when she was with me, she tried to help me as much as possible, but it did not always work well because no health care providers involved her in my care. She was not supported to be a good caregiver. My entire family was anxious during this time and their self‐esteem was very low. On the very last day, one kind nurse who was like an "angel" to me came to my room and before giving me medication and discharge papers, she talked with me and my mother about our feelings and needs. Within that short period of time, she engaged us in a strong relationship. We felt relieved and more comfortable. Because of this experience, 61 UCQ Nursing Journal of Academic Writing, Winter 2010 http://www.qatar.ucalgary.ca/acwr/w2010 although I believe in medicine for the relief of pain, I also believe pain will be relieved faster by offering emotional support to both the patient and the patient's family. Do you think family involvement in patient care can influence and foster the patient‐
healing process? There is a strong relationship between the family and its members` illnesses because the family influences individuals' perceptions about their diseases. Family members bring strengths and resources to their relationship with health care providers. The family has a significant impact on the illness and wellness of its members. Family‐centered care becomes a major part of nursing practice in order to maintain family strengths and foster the patient healing process. When it comes to the topic of family‐centered care, most of us will readily agree that family involvement is very important in patient care. Where this agreement usually ends, however, is in the question of how to implement family‐centered care. Many are convinced that nursing intervention in family‐centered care has a strong impact on patient care. Despite this, there is difficulty in implementing it in Qatar, where it is less well‐known. Accordingly, I will argue here for the importance of family involvement in patient care in Qatar. First, this paper will define family centered care. Then, I will introduce the goals of family‐centered care, and I will discuss nursing perceptions of and interventions in family‐centered care. Next, I will explain some challenges of practicing family‐centered care. Finally, I will provide some recommendations about family‐centered care in hospital rules and regulations. A therapeutic and trusting relationship is one of the most important aspects of the care process. In patient‐centered care the health care provider treats the patients with dignity and respect, and involves them in making decisions and expressing their needs regarding their health care (Pelzang, Wood & Black, 2010). However, I believe that the family also should be considered in the patient's care, a point that needs emphasizing since 62 UCQ Nursing Journal of Academic Writing, Winter 2010 http://www.qatar.ucalgary.ca/acwr/w2010 so many people believe that health care delivery is limited to the patient only. According to Nelson & Polst, "Family centered care typically refers to the expansion of total patient care to include the patient's family in the planning and implementation of the patient's plan of care" (2008, p.110). In other words, they believe that the family should actively be engaged in each step of patient care by being included in the planning and provision of the patient's care. So, both the patient and their family should participate in any decision‐making related to their health. Essentially, family‐centered care has developed over the past four decades through legislation by national leaders to concentrate on children with special needs. Then, in 1960 it was expanded to include education and family support in health care. Later, women in the health care profession began to seek and advocate for more family control over care, such as in making policies in hospitals, and less restriction on visiting time. Also, these women believed that during childbirth fathers might be allowed in the delivery room. These women formed an organization called Children in Hospital which began in 1973. After that, between 1970 and 1980 family‐centered care changed to be more supportive of families' active participation in their children's education and healthcare. Today it has been expand to include all family members, not just children (Johnson, 2000). Family involvement in patient care is very important as the family members bring strengths and resources to health care. Definitely, the family provides a rich ground of information for the health care provider. The family is able to create a balance between the health and illness of its members. Moreover, the family influences the patient's perception of their condition. Wright & Leahey acknowledge that “illness is a family affair” (2009, p.2). In other words, they believe that when one person in the family experiences an illness, other family members are influenced by the illness too. Because the patient is one of the 63 UCQ Nursing Journal of Academic Writing, Winter 2010 http://www.qatar.ucalgary.ca/acwr/w2010 family members, the family is affect patient recovery and healing. Mitchell and his colleagues agree when they write, "A group of family members of patients who were included in the patient's care perceived more respect ,collaboration, and support than did a group of family members who were not included" (2009, p.550). The essence of Mitchell's argument is that involving family members in basic patient care enhances levels of respect, collaboration, and support. Additionally, incorporating the family in patient care will increase their knowledge and reduce their stress levels. Letourneau & Elliott write, "Enhanced learning and reduced stress have been demonstrated through enabling parents to participate in children's care" (1996, p.160). In other words, they believe that involving the family in patient care and giving them explanations about each step of treatment will help them to understand the situation and will lower their anxiety and stress levels. To achieve an effective relationship with the family, we also have to address the children and young people during patient hospitalization. While children and young people are rarely included, Kean (2010) grants that children of all ages should be involved in their family illnesses. Kean's point is that information should be given to children clearly and honestly by their parents and nurses. If they understand the situation, they will not worry about their relatives. For example, the child who sees his mother in pain because of delivery without any explanation from the health care providers, may start to hate doctors or nurses. As a result of that, he may express his feelings of anxiety by crying and being noisy. And not just children are aggressive; adults also may not follow the hospital's rules and regulations. Family‐centered care has many goals in order to achieve high quality of health care. The essential goal is that patients, their families, and professionals are satisfacted. Jeffries (2009), in his article, says that the family must be treated with dignity and respect. Also, to reach effective outcomes, the health care provider should work collaboratively with the 64 UCQ Nursing Journal of Academic Writing, Winter 2010 http://www.qatar.ucalgary.ca/acwr/w2010 family members. In addition, health care providers' implementation and planning will be based on family priorities. Moreover, family‐centered care encourages family members to be caregivers and encourages nurses to support them. As Wright & Leahey argue, "Caregiver support can be defined as a provision of the necessary information, advocacy, and support to facilitate primary patient care by people other than health care professionals" (2009, p.155). Their point is that the professionals must be aware of how to be protective and offer support to the family and the caregiver in order to achieve desired outcomes. Besides, supporting families empowers them to advocate on their own behalf (Johnson, 2000). Furthermore, family‐centered care's aim is to recognize family members' strengths and to provide them with different methods of coping. Nursing perception of the use of family centered care depends on levels of understanding about the importance of family involvement in patient care. According to Mandell & Murray (2009), the higher the level of administrators' understanding of family‐
centered care practices, the more likely they are to involve families in patient care. So, the hospital setting can improve nurses' experiences and knowledge regarding family centered care by teaching them communication skills and conflict management strategies to enhance their perception in applying that knowledge in practice. As health care providers, nurses are pioneers in establishing family‐centered care. Nursing intervention in family‐centered care requires active listening skills so the nurse will be aware of the family concerns and problems. Nurses can also build on family strengths by offering praise or making comments showing that they appreciate their concern for visit their patients. They can also help the family members to make decisions regarding health issues. The nurse facilitates the family to set goals and solve problems. In addition to that, the nurse must show interest, concern, and respect for each family member. Definitely, the 65 UCQ Nursing Journal of Academic Writing, Winter 2010 http://www.qatar.ucalgary.ca/acwr/w2010 nurse has to involve the family and decrease their stress by providing information and encouraging them to be an active part of their patient’s care, decision making, and well being. Also, the patient requires an explanation about their care, for instance, regarding their medications and treatment. I agree that involving the family in healthcare fosters patients' healing because my experience when I was hospitalized confirms it. For me, it was not medication that I wanted to meet my needs or to achieve a healthy condition. In short, I was broken emotionally and all I needed were my family members and that one "angel" nurse to be beside me to support and reassure me. While the idea of family‐centered care is generally approved of, there are some limitations in involving the family in patient care. The reason for this is the challenges that family‐centered care is facing. These include a lack of nurses' understanding of patients and family needs, and a lack of knowledge about practicing the concept of family‐centered care. An increase in technology and documentation in the hospital leads nurses to be busier with writing and in danger of ignoring patient needs. Moreover, sharing with the family in a patient's care depends on the nurse's beliefs about working with family members and the patient's beliefs about communicating with the nurse, because the person's beliefs affect his illness and his relationship with others. Also, some policies in the hospital setting are a barrier for successful family engagement with health care providers, such as limitations in visiting time or a restricted number of visitors. To enhance family‐centered care, health care professionals should be provided with adequate education in understanding and practicing the concept of family‐centered care in order to increase their awareness of each family's unique needs. It is important to implement appropriate policies and programs to provide emotional support, specifically, by increasing visiting hours. The hospital can provide training opportunities for staff and family 66 UCQ Nursing Journal of Academic Writing, Winter 2010 http://www.qatar.ucalgary.ca/acwr/w2010 members to build up collaborative and strong therapeutic relationships. Roach et al state, "Research suggests that early care and education programs are most effective when they include strong components of family involvement" (2009), p.865). In making this comment, the researchers argue that strengthening and practicing family‐centered care can be achieved through educational programs for health care provider and family members. Also, teaching the staff good communication skills which are based on trust, respect and understanding will help nurses to engage family members in a successful therapeutic relationship. To provide the best family‐centered care, the nurse should validate each family member's experience and encourage family members to express their own expertise about their illness experience. In addition to that, the nurse should acknowledge patients' and family members' suffering, and keep in mind that family members are an essential part of effective treatment, as they bring strength to the family‐nurse relationship. Consequently, this relationship will help to promote positive involvement and also extensively improve the levels of family‐centered care. Although the implementation of family‐centered care can improve the quality of health care in Qatar, the limitations I have mentioned above are also present in Qatar. Family‐centered care has several advantages which increase patient, family and health care provider satisfaction. Therefore, we need it in Qatar. This goal can be achieved by collaboration between patient and family advisers, leaders, caregivers, medical and nursing staff and the other care providers who are working with families experiencing health problems. In conclusion, although the idea of family‐centered care seems obvious, still health care providers tend to concentrate on illness and disease treatment. To achieve excellence in the care of patients and their families and to provide them with special health care needs, 67 UCQ Nursing Journal of Academic Writing, Winter 2010 http://www.qatar.ucalgary.ca/acwr/w2010 we have to understand and acknowledge the suffering that the patients and their families experience. Also, health care providers and families should work collaboratively in the educational process to support the family‐centered care. Therefore, by practicing family‐
centered care concepts, the nurse will be competent and compassionate in her role of reducing suffering and promoting health. References Jeffries, L. (2009). Within a family‐centered practice, how can family outcomes be identified? Physical & Occupational Therapy in Pediatrics, 29 (2), 129‐132. Johnson, B. (2000). Family‐centered care: four decades of progress. Families, Systems & Health: The Journal of Collaborative Family HealthCare, 18 (2), 137. Kean, S. (2010). Children and young people's strategies to access information during a family member's critical illness. Journal of Clinical Nursing, 19 (1‐2), 266‐274. Letourneau, N., & Elliott, M. (1996). Pediatric health care professionals' perceptions and practices of family‐centered care. Children's Health Care, 25 (3), 157‐174. Mandell, C., & Murray, M. (2009). Administrators' understanding and use of family‐centered practices. Journal of Early Intervention, 32 (1), 17‐37. Mitchell, M., Chaboyer, W., Burmeister, E., & Foster, M. (2009). Positive effects of a nursing intervention on family‐centered care in adult critical care. American Journal of Critical Care, 18 (6), 543‐552. Nelson, D., & Polst, G. (2008). An interdisciplinary team approach to evidence‐based improvement in family‐centered care. Critical Care Nursing Quarterly, 31 (2), 110‐
118. Pelzang, R., Wood, B., & Black, S. (2010). Nurses' understanding of patient‐centred care in Bhutan. British Journal of Nursing (BJN), 19 (3), 186‐193. Roach, M., Kim, Y., O'Connor, C., & Laurion, J. (2009). Impact of a statewide collaborative on strengthening families through early care and education. Early Education and Development, 20 (5), 865‐879. Wright, L. & Leahey, M. (2009). Nurses and Families: A guide to Family Assessment and Intervention, Fifth Edition. Philadelphia, U.S.A: F.A.Davis Company. 68