Nursing has evolved considerably, with the establishment of the Florence Nightingale foundation prioritizing holistic care for families. The case study, “Omid’s Story: The Power of Family-Centered Care,” showcases both positive and negative aspects of this family’s healthcare journey and delves into various family nursing models and concepts. By examining current nursing theories and practices alongside modern approaches by nurses and healthcare providers, we can strive to enhance outcomes for this specific family.
Nursing care greatly impacts a family.
The text highlights the experiences of a mother seeking care for her special needs son with healthcare providers. These experiences range from positive and empowering to negative and degrading (Raoufian, 2003, p. 227).
The mother’s positive experiences started when her son was born prematurely. Right from the beginning, she encountered healthcare providers who were helpful and supportive, showing respect for her and giving her the necessary confidence to stand up for her son during challenging moments (p. 227). Although not everyone receives such exceptional care, it can significantly impact the timing of intervention, whether it happens early or late (p. 227). Ultimately, this family-centric nursing care contributed to a positive and empowering experience that the mother and her family can rely on when facing future obstacles.
Although there were some positive experiences in the search for medical referral for an undiagnosed condition, there were also negative ones. The challenges faced by the mother’s parental intuition and observations caused the family to feel degraded and judged (p. 227). Even though they made strong-willed and courageous efforts to seek solutions, those who are uneducated or inexperienced in navigating the healthcare system may suffer detrimental long-term effects on their progress.
Family nursing has a rich history, originating in the late 1800s when Florence Nightingale advocated for families to be involved in care. Despite its origins, family nursing is still an evolving practice. According to Friedman, Bowden, and Jones (2003), family nursing is a relatively new specialty with a gap between concept and implementation. In fact, there was no clear definition of family nursing in the late 1970s to 1980s. Today, various theories and models shape our understanding of family nursing in practice, education, research, and theory development (Friedman et al., 2003). The Allen-McGill Model, the World Health Organization’s strategic plans for the role of nurses within families, and five key family concepts all contribute to nurses effectively supporting Raoufian’s family.
Family-Nursing Concepts and Models
Today, the Raoufian family can benefit from various nursing models and concepts. One of these is Dr. Moyra Allen’s Developmental Model of Health and Nursing, which was created over a century after Nightingale. This model aims to involve the patient and their family in learning about health (McGill University, 2013). Dr. Allen’s model complements other professions and focuses on forming a partnership with the patient and family to promote health (2013). Through this partnership, the family’s strengths are emphasized rather than their problems, which encourages their current competencies and resources (p.69 2003).
Today, the principles of Family Centered Care (FCC) enable a helping model similar to that of Allen-McGill. It promotes self-determination, decision-making capabilities, control and self-efficacy (Bruce et al.). The concepts of family complement the nursing model and enable nurses to provide goal-specific interventions. According to Friedman et al., there are five concepts of family nursing that view the patient in different ways: as an individual in the foreground or background, or as a sum of the family unit. Most nursing theories see patients in the Family as Context, where the family is in the background and the individual is in the foreground. In this view, healthcare providers may include families for socioeconomic and functional support but focus on patients as individuals (p. 36-37, 2003).
The concept of Family as Sum of its Members focuses on each member of the family and provides care for all (p.37, 2003). The Family Subsystem examines significant relationships within the family, such as parent-child dynamics, marital interactions, caregiving issues, and bonding-attachment concerns (p.37, 2003). Family as Client delves deeper into the family’s internal dynamics, structure and functions, and its relationship with the outer environment (p.37, 2003). Another concept views the Family as a Component of Society; this structural-functional theory considers the family’s contributions to society and their needs and successes similar to other social systems like educational or healthcare systems (p.90, 2003).
A concise philosophy of family nursing is conveyed in The Association for the Care of Children’s Health standards that require healthcare providers to foster collaboration between families and professionals at all care levels, while acknowledging that families remain a constant presence in patients’ lives even as healthcare providers may change (p.40, 2003).
Nursing is valuable during times of stress, like when someone is experiencing acute or long-term illness. It can help families recognize and utilize their strengths. Since people and families may have different views on illness, either seeing it as a threat or a challenge, nursing plays a role in guiding them. Wright and Bell emphasize that healthcare professionals should determine where a family falls on this spectrum in order to provide the appropriate support. This may involve acknowledging and coping with the loss of a function or ability, or focusing on positive aspects to conquer a perceived challenge (Wright & Bell, 2004).
Family-Nursing objectives:
- The European Region of the WHO has outlined a course for nurses to prepare them for family-health nursing.
- This course is designed to prepare the nurse to achieve the WHO’s twenty-one goals for improving individual and family health in the twenty-first century (2000).
- The WHO states their primary focus is on “promoting and protecting people’s health throughout the course of their lives; and reducing the incidence of and suffering from the main diseases and injuries” (2004).
- The WHO has tasked these nurses with assuming a primary role in achieving twenty of the twenty-one goals to help individuals and families achieve this goal by caring for them collectively rather than individually. The outstanding goal is for governments to achieve.
Family health nursing encompasses various situations, such as providing support for a family facing the challenges of a mother with cancer or offering care to a diabetic woman who needs residential assistance (2004).
The disparities between theories and practice
The failure of FCC at the intersection of perception and practice was the cause of Raoufian’s negative experience. This was documented in the article “A multisite study of health professional’s perceptions and practices of family centered care” (Bruce, et al., 2000, p. 409).
Bruce et al. (2000) highlight a significant contrast between the FCC model and the medical model regarding their approach to assisting individuals. The medical model focuses on healthcare providers taking responsibility for treatment interventions, leading to parents relying on the healthcare system. Conversely, the FCC model advocates for independence while also receiving support from the healthcare system.
In practice, the implementation of family-centred care philosophy is often incomplete, potentially due to healthcare providers struggling with relinquishing control to families. Despite their good intentions based on expertise, these providers may inadvertently hinder families by not allowing them to contribute their personal experiences and intuition. Society has witnessed substantial changes over the past few decades that have altered healthcare objectives, giving primary care more importance and emphasizing quality of life. This, coupled with the availability of online information for self-diagnosis and treatment, has encouraged consumerism and a greater desire for individuals to have autonomy in their healthcare services.
Bruce et al. (p. 412) discuss several barriers to FCC, including lack of support from health professionals, their constrained schedules, and differing viewpoints.
Healthcare professionals frequently express concerns about obstacles to successful communication, pinpointing a need for enhanced education in interpersonal relationships and negotiation skills. This is crucial in promoting Family-Centered Care (FCC) (2000).
Medical professionals in the digital era face difficulties in trusting patients and parents due to the prevalence of Google searches for medical diagnoses. While these searches can provide valuable information, they can also lead to dangerous misinformation. Consequently, healthcare providers may be reluctant to engage in collaborative efforts with parents, fearing the potential consequences of misinformation being misinterpreted and misused.
According to Bruce et al. (2000), their study suggests a necessity for further education on FCC. Ultimately, they posit that health professionals prioritize the helping role rather than the collaboration role (2000).
The devastating effects of a frustrating nursing experience
It was both degrading and frustrating.
- When Raoufian believed her son was autistic despite doctors arguing he was not demonstrating the typical signs in the clinical setting, she sought hard for a referral but not without hesitation from his primary care doctors.
- This family went to see specialists and found them to question their judgments and integrity, responding to their autism questions with “oh, you do a lot of research” (2003).
- Further discussion with these doctors led to a patronizing agreement to further test her son, but also a look into her parenting skills and even her history of abuse in adolescence.
- After these tests came back positive for the autistic spectrum disorder, the doctor offered the much-controversial drug Ritalin as an appropriate intervention.
This encounter made the family feel inadequate.
The importance and impact of Family-Centered Care
The family’s experience with various physicians has undergone a significant transformation from a power struggle to a partnership. The shift occurred when their pediatrician started listening to and respecting their feelings and concerns, resulting in the establishment of an assessment, diagnosis, and treatment plan. This change in dynamics reminded Raoufian of a quote by Carl Buechner, which emphasizes the lasting impact of how someone makes others feel rather than what they say (2003).
Wright and Bell (p. 6) advocate for nurses to involve families in the illness process by being accessible to answer queries, be attentive, and discuss their emotions regarding the illness. This ensures that the family is well-prepared to tackle the illness. They further emphasize that the nurse-patient-family relationship’s nature may hold more significance than the actual information conveyed.
According to Wright and Bell, it is crucial to have a supportive family and healthcare relationship. They believe that the stress caused by an event may not come from the change itself, but from the circumstances surrounding the change. This stress can have a ripple effect and impact other significant relationships (Wright and Bell, p. 9). Moreover, research indicates that families can also unintentionally prolong an illness (cited by Wright and Bell, p. 9).
Bruce et al. (2000) state that numerous studies have shown the benefits of Family-Centered Care (FCC) for parents of children with special health care needs. By actively participating in the care plan, parents acquire knowledge and essential skills, leading to decreased anxiety and stress levels. Additionally, this approach increases overall satisfaction with the provided care among families (p.411). Moreover, patients’ physical and psychological well-being also exhibit positive enhancements (Bruce et al., 2000).
Bruce et al. (2000) found that physicians have the least experience with FCC, whereas nurses and social workers are the most experienced.
CONCLUSION
Wright and Bell (p.4) state that nursing has experienced major transformations in the last twenty years. It has evolved from concentrating exclusively on patient care to offering care for the entire family. This transition acknowledges that an illness affecting one family member can have consequences for the whole unit. This viewpoint is consistent with the principles of general systems theory (p.4).
According to Wright and Bell (p.4), it is emphasized that nursing should increase its awareness regarding the need for information and support for families with hospitalized members. The literature on families highlights that they possess the capability to provide care for their members in times of crises. However, certain families may experience a breakdown in this ability when illness occurs, leading to a lack of unity within the family structure (Peck, 1974). Nurses have the option to offer direct support to families or facilitate their efforts in supporting their own members.
