Family-centred care: what works and what does not work

Authors


Family-centred care is strongly advocated in many healthcare settings throughout the world yet is not always operationalized. In some countries, family members routinely provide direct care for a member of the family who is hospitalized. In other countries, however, family members are not allowed to care for the hospitalized family member and may even be barred from being with him or her except for a short time each day, especially if hospitalization is for a critical illness. Thus, Black et al. (2011) challenged prevailing procedures by devising a landmark intervention that involves families in the direct care of hospitalized critically ill patients who are family members. Their study, as reported in their article in this issue of JAN (pp. 1118–1128), is grounded in the Neuman Systems Model – with clear links between the nursing conceptual model and the study variables – and this provides a value-added element to their research (Fawcett 2008). Other special features of their work are the selection of multiple outcomes of the intervention and a longitudinal design, extending from hospitalization in an intensive care unit (ICU) through transfer to a ward to 12 weeks after hospital discharge, to determine whether there were lasting effects of the intervention.

Inasmuch as the Neuman Systems Model focuses on individuals, families and communities as legitimate clients, it directs nurses to include not only the individual patient but also family members as clients. As Black and colleagues explained, the model directed them to use a primary prevention intervention that family members could use to increase the strength of the patient’s lines of defence and resistance to stressors by reducing the patient’s delirium during hospitalization, length of ICU and overall hospital length of stay, and increasing physical and psychological recovery after hospital discharge.

What worked? The intervention had a large effect on physical and especially psychological outcomes, as measured by the Sickness Impact Profile, at 4, 8 and 12 weeks after hospital discharge. These outcomes are noteworthy not only because of large effect sizes but also because improving client well-being after hospital discharge can have a tremendous influence on use of home healthcare resources and caregiver burden.

What did not work? Despite the rigour of the quasi-experimental research design, the intervention was not effective in reducing delirium or length of stay in the ICU or overall length of hospitalization. Perhaps delirium, especially when in an ICU, cannot be prevented without considerable change in the environment and use of drugs that do not produce confusion. Perhaps length of stay cannot be affected by any nursing intervention until nurses have more control over discharge decisions.

The Black et al. study joins several other reports of family-focused research published in JAN that collectively enhance our understanding of how families can and cannot affect physical and psychological outcomes for their ill family members. For example, Tanninen et al. (2009) tested the effects of a family nursing intervention on parents’ and children’s needs for psychosocial support. In addition, Shyu et al. (2010) tested the effects of family needs on the functional recovery of a family member who had experienced a hip fracture. Of course, much more research is needed to fully understand the contributions that the family can make to the care of ill family members and provide the evidence that will convince all nurses that family-centred care does, indeed, work.

Ancillary