Putting the patient and their family at the heart of all healthcare decision-making may seem like a natural and obvious approach to nursing. But it’s actually a radically disruptive idea that goes against traditional, top-down methods of clinical care, where professional caregivers such as nurses and physicians assume absolute responsibility and authority for the treatment and wellbeing of a patient.
Shared decisions
A family-centered approach to nursing considers the patient in the context of a family unit and includes family members in decision-making and the provision of care, to a degree agreed upon by everyone involved. In cases of disability, chronic illness, developmental issues or other conditions requiring long-term care, family members, friends and neighbors are usually the primary caregivers. While the patient may have regular appointments with medical professionals, either at a clinic or hospital or in the form of home visits, it is the family members who assume the burden of everyday care and who therefore best know the patient’s needs, feelings and aspirations.
Providing support
Without proper support, however, the family members providing care will suffer in terms of their own physical, emotional and mental health. Providing full or part-time care will also impact upon their finances and social life. These caregivers are unpaid and don’t have professional training. Family-centered nursing is not about shifting care responsibilities onto family members but about providing full support to the family, recognizing their contributions and involving them fully in the decision-making process.
History and context
The family-centered approach was originally developed in the context of pediatric care. Young children with developmental disabilities or other long-term conditions will spend most of their time with the families that look after them. Those families are given appropriate support and information to help them take care of their children’s health and wellbeing as effectively as possible. Treatment plans are created collaboratively between professionals and parents, or other primary caregivers at home.
Wider benefits
The benefits of family-centered nursing are now being recognized in other areas. The field of gerontology is one example. Family-centered care can help the elderly to live more independent lives, with the support of their families, rather than being institutionalized. An aging population means a greater need for adult-gerontology primary care nurse practitioners, and the University of Indianapolis offers an MSN-AGPCNP online degree that is designed for working nurses who want to continue their professional development.
Equal partnership
With a family-centered approach to nursing, healthcare is planned around and with the whole family. In a partnership-based model, the family become active decision-makers and are recognized as both caregivers and care recipients. Information is shared, and cultural, linguistic and other differences are respected. Families can choose their level of involvement, but as far as possible, nurses, physicians and families work together towards outcomes that are medically appropriate and meet the needs, abilities and values of all those concerned.
Respect for diversity
All families are unique and have different stories, dynamics, traditions, perspectives and circumstances. Family-centered nursing recognizes and respects this, while empowering families to ask questions, share information and access the support they need. This collaborative, holistic approach may also involve education and social support.
Improved care
From the point of view of nurses and other healthcare professionals, a family-centered approach allows for more informed decision-making, greater efficiency and more effective communication. Patient assessment and pain management are both improved, and there is a focus on empathy and inclusivity. Appreciating the lived experience of care, for both patients and families, is central to this way of working.
Advice and guidance
Family members are able to advise the patient and act as their advocates with the healthcare providers. Qualified nurses will still provide guidance and authoritative information, but inevitably some degree of control is relinquished. By treating patient care as a collaborative process, treatment plans can be streamlined, optimized and personalized, leading to more satisfying results for all parties.
Family first
It’s essential that families are given the information they need to make decisions affecting patient care, and the support they need in terms of physical assistance, equipment, financial help, counselling or other services. Most crucially, the family should always feel fully supported by healthcare professionals and able to choose their own level of participation.
Putting the family first doesn’t mean shifting the burden of responsibility entirely onto family members. Nurses should also monitor for disagreements or conflicts of interest between the patient and their families. In some cases, professional mediation may be necessary, but the individual autonomy of the patient should prevail in most cases.
Considering the family’s needs and involving them in the decision-making process reduces stress and increases the chance of a favorable outcome for everyone concerned.
