Nursing has evolved in many ways over the years, in particular is the Florence Nightingale foundation of caring for the whole family and not just the patient. The following case study of Omid’s story: The Power of Family-Centered Care highlights the positive and negative aspects of their family’s healthcare experiences , and models of family nursing and concepts of family-centred care. By comparing the theories and models to what is currently put into practice by today’s nurses and healthcare providers a better outcome for this family is idealized.
Nursing Care has Resounding Effects on a Family
In this case study, a mother recounts her experiences seeking care for her special needs son with healthcare providers as both positive and empowering versus negative and degrading (Raoufian, p. 227, 2003). The positive experiences started from the first moment her son was born prematurely, when she met some helpful and supportive healthcare providers who she says respected her and gave her the confidence to advocate for her son during the difficult times (p.227). She admits that not everyone receives this kind of care, but that it can mean the difference between an early versus late intervention (p.227). This scenario is ideal, the family-centered nursing care resulting in a positive and empowering experience that the mother and family can draw upon for future challenges. The negative experience happened later when the she sought medical referral for a yet undiagnosed condition but was challenged on her parental intuition and observations, which in turn made the family feel degraded and judged. This mother appears to be strong-willed and courageous in her efforts to seek solutions, however for those people who are perhaps uneducated or in-experienced, the long-term effects of a good or bad healthcare experience can either lend hope or hamper a family’s progress.
Family-Nursing is Still Relatively New
Family nursing started long ago in the late eighteen hundreds when Florence Nightingale practiced and encouraged family be included in care needs, but today this foundation of nursing is still a growing and learned practice. Friedman, Bowden and Jones say that family nursing is still relatively new specialty focus, and that there is still a gap between concept and practice (p.36, 2003). As a matter of fact, a definition of family nursing did not even exist in the late seventies to eighties, but today family nursing is defined in many distinct theories and models serving to sharpen our thinking towards the family nursing practice, education, research and theory development (p.36, 2003). The Allen-McGill Model, the World Health Organization’s (WHO) strategic plans for the family-nurse, and five concepts of the family show how the family-nurse can best support the Raoufian family.
Family-Nursing Concepts and Models
Today there are many models and concepts that nursing can employ in order to benefit the Raoufian family. Over one hundred years after Nightingale, Dr. Moyra Allen’s Developmental Model of Health and Nursing was established to engage the patient and family in learning about health (McGill University, 2013). Dr. Allen’s model is meant to complement other professions with the main goal of forming a partnership with the patient and family to foster health (2013). This partnership with family focuses on their strength as opposed to their problems, and encourages members in their current competencies and resources (p.69 2003).
Today, Family Centered Care (FCC) principles enable a model of helping, similar to that of Allen-McGill in that it promotes “self-determination, decision-making capabilities, control, and self-efficacy (Bruce, et al. ). Concepts of family complement the model of nursing, enabling a focus for the nurse to provide goal specific interventions. -Friedman et al., discuss five concepts of family nursing, in which the patient is in different ways; as either an individual in the family in either the foreground, the background, or as a sum of the family unit. Most nursing theories see patients in the Family as Context where the family is the background and the individual is the foreground. In this view, the healthcare provider may include the family in terms of socioeconomic and functional support, but really focus on the patient as an individual (p.36-37, 2003).
Family as Sum of its Members sees each member of the family in the foreground and care is provided to all family members. (p.37, 2003). Family Subsystem looks at the significant relationships in the family; parent-child, marital interactions, caregiving issues, bonding-attachment concerns (p.37, 2003), where Family as Client looks further into family’s internal dynamics, relationships, 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 addresses the family on a broader scale in terms of their contributions, needs and successes like other social systems (eg., educational and healthcare system (p.90, 2003). -A succinct philosophy of family nursing is seen in The Association for the Care of Children’s Health standards stating the expectation for healthcare providers to facilitate family/professional collaboration at all levels of care, and to recognizing family as the constant in the patient’s life whereas the healthcare providers will fluctuate (p.40, 2003).
Helpful in times of stress, such as acute or long-term illness, nursing can engage the family in focusing on their strengths. As people and families perceive illness in differing ways, such as a threat or a challenge, a time where nursing can stear the course, Wright and Bell remind us that healthcare providers need to identify where on this spectrum a family lies so that they can offer support in either grieving the loss of a function or ability or focusing on the positive aspects to master a perceived challenge (as cited by Wright and Bell, 2004).
Goals for Family-Nursing
-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 in “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 in achieving this goal by caring for them collectively rather than individually, the outstanding goal is for the government to achieve. Examples of family health nursing include caring for family where the mother has cancer, care of a diabetic woman who now requires residential care, etc. (2004).
The Gaps Between Theories and Practice
-The Raoufian’s negative experience relates to the breakdown of FCC as happening at the crux between perception and practice as reported in the article A multisite study of health professional’s perceptions and practices of family centered care” (Bruce, et al., p. 409, 2000).
-Bruce et all discuss an interesting disparity between the FCC model of helping versus the medical model of the healthcare provider assuming the control of treatment interventions; this latter model forces parental dependence on the healthcare system rather than a FCC model of independence with support from the healthcare system (2000).
-The gap between the philosophy of family-centred care and the practice may be caused by the healthcare provider’s struggle to relinquishing power to the family; meaning well in their educated experience, but perhaps negatively influencing the family by not allowing the family’s personal experience and intuition to be incorporated. A drastic change in society in the last few decades has shifted the goals of healthcare to a primary care focus due to a greater value being placed on quality of life. This combined with the influx of the internet and plethora of information available to self-diagnose and treat, consumerism has driven society to demand control over their healthcare services.
-Some perceived barriers to FCC as identified by Bruce et al., include non-supportive health professionals and their lack of time and conflicting perceptions (p.412).
-Healthcare professionals complain about the barriers being lack of education in terms of interpersonal relationship and negotiation skills, suggesting a need to improve in these categories in order to better facilitate FCC (2000).
-In this day and age of Google searching medical diagnosis, healthcare providers find it challenging to trust patients and parents as their web search of information can term up a plethora of valuable but also extremely dangerous information. This may contribute to the healthcare professional’s inability to collobate with parents as the risk of the parents running amok with mis-information is a risk the healthcare professional may not want to take. -The findings of Bruce et al. study implies a need for more education in the practice of FCC (2000). Ultimately, Bruce et al. believe that health professionals favour the helping role over the collaboration role (2000).
The Devastation of a Frustrating Nursing Experience
-what was a degrading and frustrating experience:
-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 experience left the family feeling as though they were incompetent.
The Power of Family-Centered Care
There is a stark change from power-struggle to partnership, which is seen in this family’s experience from one physician to another. The dynamics changed from control to support when the family’s pediatrician listened and respected her feelings and concerns, an assessment, diagnosis and treatment was established. Raoufian reflects on a sentiment by Carl Buechner that mirrors her feelings, that ‘they may forget what you said, but they will never forget how you made them feel’ (2003).
Wright and Bell talk encourage nurses to make the effort to engage family in the process; by being available to answer questions, listen and discuss their feelings about the illness, this way the family toolbox is prepared to deal with the illness (p. 6). -Furthermore, they say that just the nature of the nurse-patient-family relationship may be more important than the
actual information presented. -Wright and Bell stress the importance of a supportive family and healthcare relationship as they say “it may not be change itself, but the context in which the change occurs that makes the event stressful, creating a ripple effect and affecting other important relationships” (p.9.). Furthermore, a number of studies suggest that families can even prolong an illness (cited by Wright and Bell, p.9).
-Bruce et al., cite many studies that show parents of children with special health care needs have benefited from FCC because when they are involved in the care plan, they learned and acquired the necessary functional skills, making them less anxious and stressed, which also improved overall family satisfaction with their care (p.411). Moreover, the patient’s physical and psychological health improves (2000). Interesting fact; physicians report being the least experienced with FCC whereas nurses and social workers are the most experienced (as cited by Bruce et al, 2000).
-Wright and Bell have witnessed an evolution in nursing over twenty years; from just caring for the patient to the whole family unit (p.4). They say that while this change may still be slow, the practice is indicative of the recognition that illness to one member is consequential to the unit, categorically defined as the general systems theory (p.4).
-Wright and Bell remind us that “Nursing needs to be more cognizant that all families with a hospitalized family member need information and support. The family literature indicates that families have a capacity to care for their members in times of crisis. However, the arrival of the illness seems to fracture the unity of some families with the result that some lose this ability (Peck, 1974). The nurse may be able to provide support directly to families or indirectly by assisting them to support their own members” (p.4).