Implementing Evidence Based

Practice: Caring For Pediatric Patients

Zainah Mohamed
 Caring For
Document- Pediatric
ation
Patients Patient
Patient-and Safety
Etc.
Family- Effective Pain
Empathy Centered Care Patient Communication Mx.
Parental Justice Education
Continuity
rights Accessibility
Integrity of Care
of Care
 Caring For
Document- Pediatric
ation
Patients Patient
Patient-and Safety
Etc.
Family- Effective Pain
Empathy Centered Care Patient Communication Mx.
Parental Justice Education
Continuity
rights Accessibility
Integrity of Care
of Care
What is Patient- and Family-Centered Care (PFCC)?

“…an approach to the planning, delivery, and evaluation of

healthcare grounded in mutually beneficial partnerships
among health care providers, patients, and families.”

Institute for Family-Centered Care

 History of Patient-and Family- Centered Care (PFCC)

• Developed after WW II
• Children were admitted to the
hospital without their parents
• Not allowed to visit
• Limited visiting hours
• Hospitalized for long period for
chronic illness e.g. TB
• Resulted in Psychological trauma
 The Convention on the Rights of the Child (1989)
Article 7 The child’s right “to know and be cared for by his or her
parents”

Article 9 Child’s right “not to be separated from his or he parents against

their will, except when competent authorities subject to judicial
review determine… that such separation is necessary for the
best interests of the child”

Article 18 Recognition that both parents have common responsibilities

and “the best interests of the child will be their basic
concern.”
 Video:
The Human Connection to Patient Care

By Cleveland Clinic
https://www.bing.com/videos/search?q=cleveland+clinic+empat
hy+video+youtube&view=detail&mid=474C42E5C5E5155A20
CC474C42E5C5E5155A20CC&FORM=VIRE
Patient- and Family-Centered Care : Redefines Roles in Healthcare

Places emphasis on collaborating with patients and

families of all ages, at all levels of care, and in all
healthcare settings

Recognizes that families are essential to patients’

health and well-being and are crucial allies for
quality and safety within the healthcare system
PFCC helps us clearly understand that…
 Dignity &
Respect

Collaboration
Concepts of
Patient-and
Family-Centered
Care

Information
Participation Sharing
 Paradigm Shift
System or Health Care Patient & Family
Provider Centered Patient or Family Focused Centered

Paternalistic Empowered
• Families allowed to participate
• Families as visitors. • Families as partners
when deemed appropriate by staff.
• Professional • Families & staff share
• Decisions made by staff based on
expertise & decision- expertise &
their perceptions of family needs or
making . collaborate in
priorities.
• Gate-keeping of decision-making
• The patient is the focus or unit of
information. • Transparency of
care. Interventions are don to & for
• The priorities of the information
him/her instead of with the patient.
system (hospital) and • The priorities &
• The patient is not viewed within
those who work choices of patients &
the context of family or
within it drive the families drive the
community.
delivery of care. delivery of care
Delivering Care in partnership with Parents
• Respect parents’ role as child’s main caregiver
• Encourage parents’ presence to minimize separation
 Wards dedicated to
children, with family- Appropriate
friendly areas (e.g. communication
resources/facilities for
children at different
development stages)
Care that Addresses
Children’s
Psychological, Social
& Developmental Support coping
Needs with anxiety &
pain

Support opportunities for

play (for self-expression, Staff have
distraction, and pediatric
continued development) qualifications &
experience
 Sibling Support
• Facilitate sibling visitation
• Prepare siblings for what they’ll see or
experience in the hospital. Give honest and
developmentally appropriate information and
encourage questions and expression of
feelings
• Engage siblings in play and expressive
activities
 All families are different and
The well-being of function best when their unique
families depends on the values and preferences are
quality of their informal acknowledged and incorporated
and formal social into the plan of care
support systems

Core Features of
Patient-Family-
Parents know their
Centered Care children and their
family best and want
The well-being and the best for them
development of
children depends on
All families have
the well-being of the
strengths and
family
competencies
 Improved satisfaction for patient/family and
service provider.
-FCC approach have positive r/ship with patient recovery,
emotional health, physical function and physiologic
outcome & Rx satisfaction

Decreased litigation.
Improved adherence.
- Behave like devaluing
patients/families views, delivering The Benefit of - Pts. more likely to take
information poorly, failing to be Patient-Family- their medications, show
attentive to patients/ families
perspective
Centered Care up for appointment

Patient/ family-centered Functional outcome

communication skills. improvement.
-Patient/ family-centered -Fewer limitations imposed (Baird et al.
communication skills promote by the disease on patient 2015; Hill 2019)
adherence functional ability
What action should we take?
CHALLENGES & EXPECTATION IN FCC
 “It’s not Lack of
my job” ‘geographical
space’
Perceived -ve
impact on
recovery & Staff
healing shortage
Barriers to Family-
Centered Care

Lack of Staff
time convenience
Fear of ‘being
watched’
(Baird et al. 2015; Foster & Whitehead
2017; Phiri et al. 2017; Hill 2019)
 Patients & families will
collaborate with the health
care team in the planning,
implementation & evaluation
of care
Mission, Vision & Philosophy
of Care Statements will
address family-centered care &
set the organizational tone

Organizational
Changes
Patients & The leadership group
families will be & staff will adopt a
given choices change in culture to
in care one of patient &
family- centered care
Patients & families
will participate in
hospital-wide & unit
based committees
(Cliff 2012; Phiri et al. 2017)
Parents have a Parents need to
right to make have information
decisions about about their child’s
their child condition, Rx &
nursing care
 Implementing PFCC – Paradigm Change
Families are not visitors, but
part of the team.
•Respect the right of children to
have a parent with them.
•Respect the role of the
primary caregivers; work with
parents so they can care for
their child as they would at
home.
Good communication is
essential - take time to talk
with parents and child in ways
they can understand.
•Provide space for families to
be together, for children to play,
etc.
•Seek regular feedback from
families and additional training
to develop skills
Facilitate the active
participation of parents in the
care of their child:
• give full information
regarding the child’s care and
about ward routine
• arrange the elements of care
they can participate in or take
on
• support them in their care
and accept their decisions
• discuss changes needed if
their care is not helpful to the
child’s recovery
 Implementing PFCC – Paradigm Change (cont.)
At Systems/ Institutional
At the Managerial Level :
Level : Assessment of
Issues affecting Nursing
Processes
• Patient outcomes measurement • Nursing Standards
• “Routines” appropriate to meet • Accessibility of care (visiting hours,
patient needs patients records)
• Effective nurse allocation to meet • Quality criteria e.g. patient
patient needs counseling
• Developing nurses to meet patient • Affordability criteria e.g. cost of
needs care
(Al-Motlaq et al. 2016) (Al-Motlaq et al. 2016)
 Reflection!

• What aspects of PFCC is integrated into your hospital setting?

• What would be your priorities for change?
• What aspects would you advocate for with colleagues and
administration?
• Why and how would you go about it?
 What is Your Role as a Nurse?
Orientation
• Introduce yourself to the child &
parents
• Show the child & parents around
the ward - Tell them about the
hospital facilities
• Ask parents if they
• Slept well, had breakfast, etc.
• Explain the care the child will
receive that day/night
• Explain what you are going to do,
e.g. measure BP, change dressing
etc.
• Ask parents what they like to do
• Ask them if they have any
questions
(Hill et al. 2019; Veal et al. 2017)
Answering questions
• Do not afraid to say “I do not
know” when a child/parent
asks a question
• Tell child/parents “I do not
know but I will get that
information for you”
(Hill et al. 2019; Veal et al. 2017)
Negotiation
• Helping parents to be
involved in their children’s
care is important part of FCC
• Nurses & parents need to
decide who will perform the
care the child will need, e.g.
• Showering the child
• Feeding the child
• How does the nurses’
routine suit the parents’
routine?
(McCann 2018)
 Care delivered in partnership with parents
to address children’s psychological, social &
developmental needs

Benefits the institution,
healthcare workers,
families, and patients.
Collaborative approach to
care giving and decision-
making - family is in the
Providing Patient- centre of the system
and Family-
Centered Care

Respect the knowledge, skills, and Family and healthcare team

experience that each party brings to work together collaboratively
the healthcare encounter for the benefit of the patient
 The Art of FCC

Family do not THEREFORE

know that they THEREFORE Nurses should
can be involved in not expect Negotiate with the
pt.’s care family to be family what they
Nurses must involved can do & what they
explain to them want to do
REMEMBER BUT

“the process of healing depends on knowing the patient as a person, in

addition to accurately diagnosing their disease” Ronald, M.J. (2000)
 References
• Al-Motlaq, M., Abuidhail, J., Salameh, T. & Awwad, W. (2016). Development and validation of an instrument to
assess the implementation of family-centred care in traditional open bay Neonatal Intensive Care Units. Early
Child Development and Care. 187(1): 168-177.
• Baird, J., Davies, B., Hinds, P. S., Bagott, C. & Rehm, S. (2015). What Impact Do Hospital and Unit-Based Rules
Have Upon Patient and Family-Centered Care in the Pediatric Intensive Care Unit? Journal of Pediatric Nursing
30(1): 133-142.
• Foster, M & Whitehead, L. (2017). Family Centred Care in the Paediatric High Dependency Unit: Parents’ and
Staff's perceptions. Contemporary Nurse 53(4): 489-502.
• Hill, C., Knafl, K.A., Docherty, H. & Santacroce, S.J. (2019). Parent perceptions of the impact of the Paediatric
Intensive Care environment on delivery of family-centred care. Intensive and Critical Care Nursing. 50: 88-94.
• McCann, C.L. (2018). Negotiation Intervention between the Family and the Nurse of a Hospitalized Child.
Hampton University, ProQuest Dissertations Publishing, 2018. 10816464.
• Phiri, P.G.M.C., Kafulafula, U. & Chorwe-Sungani, G. (2017). Registered nurses' experiences pertaining to family
involvement in the care of hospitalised children at a tertiary government hospital in Malawi. Africa Journal of
Nursing and Midwifery. 19(1): 131-143.
• Smith, J., Swallow, V. & Coyne, I. (2015). Involving Parents in Managing Their Child's Long-Term Condition—A
Concept Synthesis of Family-Centered Care and Partnership-in-Care. Journal of Pediatric Nursing 30(1): 143-159.
• Veal, G.J., Malik, S., Lupo, M., et al. (2017). Investigating the roles and training of paediatric research nurses
working across Europe: a questionnaire-based survey. BMJ Paediatrics Open. 1(1) doi: 10.1136/bmjpo-2017-
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Thank You.