Family-centered care enhances patient ed

Model takes the focus off the teacher

List the components of patient- and family-centered care and many would think it was the formula for good education. The four core concepts include "dignity and respect," "information sharing," "participation," and "collaboration."

The family-centered care model takes the focus off the teacher, whether the nurse or another discipline, and places it on the learner. Patients and family members are seen as partners rather than as pupils, says Kathy Ordelt, RN-CPN, CRRN, patient and family education coordinator at Children's Healthcare of Atlanta. "It helps us to individualize the teaching a little better," she adds.

With the focus on the patient and/or caregiver, a good learning needs assessment to determine how they would like to be taught and what they would like to know becomes vital, says Linda Broz, RN, MS, patient/family education coordinator at Children's Hospitals and Clinics of Minnesota in Minneapolis. The information gathered from the learning needs assessment is used to individualize the education.

Individualized education is important in all situations, says Broz. Frequently, education is delivered in the same way for everyone, especially during a short length of stay, but that is not ideal.

When patients say reading is not their preferred learning style, yet written materials are used anyway, the educator is being disrespectful, says Broz. There are many ways to make sure the education is delivered in a way that is dignified and respectful.

Visual learners can be taught in a variety of ways including videos or with the aid of models, pictures, or hands-on demonstration.

Providing interpreters for patients and families that do not prefer to learn in English as well as giving out written materials in the appropriate translation shows respect, says Broz.

"It is a mind shift. You are looking at what they need and what is the best way to get that information to them," agrees Ordelt.

During a learning needs assessment, a family member or patient may say he or she learns best with a video but if there isn't a video on that topic then the health care professional must find the next best way to teach and present the information, she explains. If a less effective teaching method is used, the information may need to be repeated or other methods of teaching also incorporated into the process, she adds.

If patients and family members are not learning, one reason may be that the education has not been individualized enough so that learning can take place. Another reason might be that there are barriers prohibiting them from learning. When this is the case, the medical team needs to determine how to address them, says Ordelt.

Patients and family members are part of the actual educational planning process in a family-centered care model. While there are certain skills that must be taught for a safe discharge, the determination of how and when the information is delivered should be collaborative.

Also, patients and family members should be able to request additional information that would be added to the teaching plan. Of course, if their questions require in depth research, they might be referred to the learning center or advised to ask their physician.

Ordelt explains that a nurse may only have the time he or she is on shift to educate a caregiver or patient about a topic; Ordelt tells the family about the time constraints so they can work out the details. While scheduling the teaching session, she also can find out if family members would like any additional information.

"Sometimes in an emergent situation you have to teach immediately, but it is the attitude and the way the information is delivered and the way it is negotiated based on the mutual respect and trust you develop in those relationships; it is also seeing people as partners rather than us as the professional expert telling them what is and what is not going to be," says Ordelt.

To deliver patient education in a respectful and collaborative way, patients and family members need to be a part of the organization-wide planning of educational materials, programs, and processes through committee work, as part of task forces, and other means, says Broz.

When Children's Hospitals and Clinics of Minnesota decided mechanical lifts needed to be used with some children with weight problems, families were involved in determining how these new patient lift procedures would be introduced to families.

"They also helped write an education piece that would be given to families," says Broz.

Sometimes staff members think including patients and families in the planning will slow the process. However, the result is a better product in the end and it better meets the needs of patients and families, she says.

Ordelt says patients and family members can also provide insight into topics for new teaching sheets. "A family member might say 'I would have liked to have had a resource on this topic in the beginning; a teaching sheet would be helpful,'" she explains.

Another key component of patient- and family-centered care — information sharing — is directly related to education.

Many health care institutions have added resource centers, an invaluable resource Ordelt says, because family members can get information there they are not given at the bedside.

"At resource centers they can go on the web and also find different books on various topics. It is supplying a resource that will meet the needs of people who choose to use it to enhance their learning," says Ordelt.

However information sharing is more than providing good educational resources. It also involves good communication between patients, family members and the health care providers. Often family members will wait and wait to get information from the physician and as soon as they leave the patient's room the physician comes, says Broz.

Methods to remedy this problem might be to give family members a pager so the physician can notify them when he is available to see the patient, she adds.

Also it is important that the medical team communicate clearly by defining the medical terms they use and also pausing during the discussion often enough so family members or patients can ask questions.

"In patient satisfaction surveys a lot of the pieces that have to do with satisfaction relate to information sharing and that is a piece of education," says Broz.

[Editor's note: Kathy Ordelt recommends an 18-page "Family Centered Care Self Assessment Inventory," found in the back of a book produced by the Society of Pediatric Nurses and the American Nurses Association (ANA) titled Family-Centered Care: Putting it Into Action. It is published by the ANA.]