Make your ED stand out — trend grows toward family-centered practices
Make your ED stand out — trend grows toward family-centered practices
New study offers 9 tips for family-friendly policies
When a young man died of a congenital cardiac abnormality in the ED at Dartmouth-Hitchcock Medical Center in Lebanon, NH, one of the nurses who had cared for him went out of her way to speak to his father. "His father lived on the West Coast and was not able to come into the ED to be with his son," recalls Lucinda W. Rossoll, RN, MS, CCRN, CEN, charge nurse for the ED. After spending 45 minutes on the telephone describing what had occurred, he was satisfied that everything possible had been done and that his son did not suffer, she recalls. "He was also glad to know that his son’s best friend was here throughout the whole resuscitation, and his son was not entirely with strangers," Rossoll adds.
The above anecdote illustrates the dramatic impact that family-centered care can have in the ED, says Rossoll. A recent study examined the practices of nine EDs and found that all had implemented family-centered interventions or policies. Participants included rural, urban, general, and pediatric EDs.1
"There is an increasing level of awareness of family-centered care practices," says Nancy Eckle, RN, MSN, program manager for emergency services at Children’s Hospital in Columbus, OH, and the study’s principal investigator. "More and more EDs are adopting this philosophy. (To see tips for implementing a family-centered approach, click here. For the Children’s Hospital policy and procedure on family presence during invasive procedures and resuscitation, click here.)
Here are ways to improve the care you provide to families:
1. Perform a self-assessment. Eckle says the first step is to evaluate your current practices. When you do this, she advises considering all aspects of care, including philosophy of care, family involvement in care, availability of information for families, family participation in decision making, policies and procedures, facility design, service coordination and continuity, performance improvement, and community partnerships. (To see excerpt of self-assessment tool to determine family-centered care practices, click here. Also see "Resources" at the end of this article and the table below.)
5 principles you must follow | |
Use the following five principles of family-centered care to evaluate polices and procedures for care in your ED, recommended by Nancy Eckle, RN, MSN, program manager for emergency services at Children’s Hospital in Columbus, OH: | |
1. | Recognizing the family is the constant in a child’s life. |
2. | Facilitating family and professional collaboration at all levels of hospital, home, and community care. |
3. | Recognizing and honoring diversity, strengths, and individuality within and across all families, including ethnic, racial, spiritual, social, economic, educational, and geographic diversity. |
4. | Recognizing and respecting different methods of coping and implementing policies and programs to meet the diverse needs of families. |
5. | Recognizing the range of strengths, concerns, emotions, and aspirations of families and children. |
|
2. Have a patient liaison assist with needs of family members. At Children’s Hospital, a patient liaison is present during the evening shift to help address family needs. "She may sit with a child while a parent takes a break or when the parent has not arrived in the ED yet, help with siblings of the patient, or assist the clinical staff in communicating with the family," says Eckle.
3. Share comments from patients with staff. Eckle suggests compiling comments from patients and family members and sharing them with staff as a morale-booster. "We share them with the nurses who were directly involved, and also post the cards and letters so all the staff can read them," she says.
4. Form a bereavement committee. At Dartmouth Hitchcock’s ED, a bereavement committee consists of chaplains, volunteers, nurses, and laypersons trained in assisting families who are grieving, says Rossoll. When a death occurs in the ED, a referral is sent to the committee. "This referral contains information about who was present in the ED, next of kin who could be contacted, and a brief statement of what occurred," she says. A member of the committee contacts the family and offers to put the family member in touch with a health care provider who was present at the time of death to answer any remaining questions about what occurred, says Rossoll. "Frequently, questions center around what was done in the ED and the comfort of the deceased," she says. A member of the bereavement committee keeps in contact with the family member for as long as needed, usually about a year, she adds.
5. Involve family members in discharge plans. Because sicker patients increasingly are being discharged home from the ED, it is important for family members to be involved with discharge plans, urges Rossoll. "This is particularly important for the elderly population who may be discharged home with injuries such as a fractured arm in a sling," she says. She recommends having a discussion with the patients and family members at discharge. "This helps to evaluate the necessity of assistance with their daily care, such as meal preparation, personal hygiene, the ability to move at home safely, or even how they can get in and out of their home," says Rossoll.
6. Have a dedicated physical therapist. Dartmouth Hitchcock’s ED has a dedicated physical therapist available to help with walker or crutch training, says Rossoll. "She picks out cases that may need further assistance and follows up with patients the nursing staff are concerned about," she says. For example, there is often concern about the safety of elderly patients who have had a limb injury, especially when ED nurses can’t get them to ambulate safely with a walker. "The physical therapist succeeds where we do not and will follow up with them in outpatient physical therapy as necessary," says Rossoll.
7. Allow families to stay with patients. Family members should be encouraged to stay with patients throughout their visit, argues Rossoll. "This includes procedures such as suturing, conscious sedation for reduction of fractures, and resuscitations," she says. (For more information about family presence, see "Family presence update: What parents want," in ED Nursing, January 2000, p. 33.)
8. Help families find housing if needed. ED staff put family members in touch with an organization called David’s House that houses families of severely ill children for as long as there is a need, says Rossoll. "The stay is at no cost and is supported by community and family donations," she adds. Information also is provided about a hostel where family members can stay for a nominal charge, she notes. "Maps to locate area motels, where discounts are provided for family members of hospitalized patients, are available," she says.
9. Allow parents to accompany children during transport. The transport team at Riley Children’s Hospital in Indianapolis has adopted several family-centered practices, reports Barbara Coffel, RN, MSN, the facility’s lead transport nurse. "From initiation of our contact with the family, we include them as the primary source of information about their child. This allows them to feel they are contributing to making their child better," says Coffel. The team has begun to allow one parent to accompany the child in an ambulance to the hospital. "This has been a major stress reducer for parents in crisis," she says. The team has eliminated stopping at admitting first, she adds. "Instead, we instruct parents to go directly to their child’s admitting unit and allow them to take care of paperwork later, after they are reunited with their child," says Coffel.
As an "extension of the ED," transport teams are very important in setting the tone for the child’s whole admission, Coffel stresses. "A negative or confrontational first impression of the facility could cloud the impression of the care provided throughout the entire stay," she says.
Reference
1. Eckle N, MacLean SL. Assessment of family-centered care policies and practices for pediatric patients in nine U.S. emergency departments. J Emerg Nurs 2001; 27:238-245.
Sources
For more information on family-centered care in the ED, contact:
• Barbara Coffel, RN, MSN, Riley Hospital for Children, Clarian Health Partners, 702 Barnhill Drive, Room 1960, Indianapolis, IN 46202-5210. Telephone: (317) 274-4386. Fax: (317) 274-4354. E-mail: [email protected].
• Nancy Eckle, RN, MSN, Emergency Services, Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205. Telephone: (614) 722-4353. Fax: (614) 722-6890. E-mail: [email protected].
• Lucinda W. Rossoll, RN, MS, CCRN, CEN, Emergency Department, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756-0001. Telephone: (603) 650-7000. E-mail: [email protected].
Resources
• The Institute for Family-Centered Care offers numerous publications and resources, including Developing Family-Centered Vision, Mission, and Philosophy of Care Statements (Item No. 32098, $15). Developing and Sustaining a Patient and Family Advisory Council (Item No. 32085, $30) includes sample materials and forms from established councils. Designing for Family-Centered Care (Item No. 3208, $75) is a videotape profiling innovative design projects. Family-Centered Care: Changing Practice, Changing Attitudes is a set of training and planning modules designed to facilitate the process of change. Modules may be purchased separately or as a package (Item No. 32040, $150). All materials can be ordered at the Institute for Family Centered Care web site (www.familycenteredcare. org). For more information or to order products, contact: The Institute for Family-Centered Care, 7900 Wisconsin Ave., Suite 405, Bethesda, MD 20814. Telephone: (301) 652-0281. Fax: (301) 652-0186. E-mail: [email protected].
• Emergency Medical Services for Children National Resource Center can provide Family-Centered Pediatric Care in the Emergency Department: A Self-assessment Inventory is designed to help ED staff work with families to improve quality of pediatric care and includes strategies for designing and evaluating programs and services. It can be downloaded at no charge at the Emergency Medical Services for Children web site (www.ems-c.org). Click on "Family Information" and scroll down to "Working with Families to Enhance Emergency Medical Services for Children." The self-assessment tool can be found in Appendix D of this publication.
One paper copy of the publication is available at no charge. To order, contact the EMSC Clearinghouse at (703) 902-1203, e-mail: [email protected]. Orders also can be placed on-line at www.ems-c.org/cfusion/OnlineOrder.cfm. For more information, contact: Emergency Medical Services for Children National Resource Center, 111 Michigan Ave., N.W., Washington, DC 20010-2970. Telephone: (202) 884-4927. Fax: (202) 884-6845. E-mail: [email protected]. Web: www.ems-c.org.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.