Visiting/Family Presence
Changing the Concept of Families as Visitors
Viewing families as allies for quality and safety and supporting their presence and participation in care and decision-making requires change in hospital and unit policies and education and support for staff.
Anne Arundel Medical Center Welcomes Family Presence
With valuable input from its patient and family advisors, Anne Arundel Medical Center (AAMC), in Annapolis, Maryland, is now actively promoting family presence. Patients now have the power to choose who they want to stay with them—24 hours a day, seven days a week. According to the AAMC's new policy, the patient determines who is "family." Signs decorated with pineapples and the words "Welcome Families" will replace the old signs displaying the former visiting-hour policy.
The "Revisiting Visiting Task Force," comprised of staff, providers, and patient and family advisors, directly influenced the new family presence policy. In implementing patient- and family-centered care, Anne Arundel is working to include what the patients and their families have to say about everything from visiting hours to changing directory signs around the hospital.
AAMC is also a recipient of a Picker Institute "Always Event" grant. Patients and families, staff, and providers will develop a simple universal checklist of five items as a SMART Discharge Protocolsm. (SMART is an acronym for: Signs, Medications, Appointments, Results, and Talk with Me.) The SMART Team will build on current evidence, create urgency and expectation for use with patients, families, and caregivers, disseminate findings, and promote the protocol as a national standard.
Spectrum Health System: Supporting Family Presence
Spectrum Health, located in Grand Rapids, Michigan, engages patients and families to help improve all aspects of their health care experience. According to Kris White, Vice President of Innovation and Patient Affairs, "Patients and their families are at the center of care continuum—before, during, and after hospitalization."
In 2004, the Spectrum Health Hospital Group executive leadership team designed a culture of excellence committed to improving care from the patient's perspective. The organization is dedicated to empowering patients and families through understanding the experience of care, sharing information, and encouraging true partnerships with caregivers.
In 2006, the health system went one step further and embarked on an astounding culture change. Hospital leadership, with support, advice, and participation from the Patient and Family Advisory Council, established a fifty-member team to move away from "visiting hours" and established policy and processes to encourage and manage "family presence" and participation in care. Read More...
University of Wisconsin Introduces Patients' Primary Supports
Some front-line clinical staff and managers had significant concerns about having family members on units 24 hours a day due to the possibility of infection with immuno-compromised patients and increased demands placed on staff at night. However, nursing leadership believed that family presence and participation were essential to patient- and family-centered care, as well as quality and safety, and wanted to implement a Family Participation Policy based upon experience gained in other hospitals.
Here's how the change was accomplished:
Dianne Danis, Director of Nursing Practice Innovation, planned a design day, bringing together clinical nurses from each inpatient unit, designated to serve as unit-based champions, as well as representatives from other role groups and clinical disciplines and a patient. Everyone came together for one day to review a draft policy, make suggested revisions, learn about the evidence related to family participation (such as no increased infection risk), and hear from a patient about the importance of the issue. The unit champions were brought together again to help plan implementation of the new policy and were key in supporting its acceptance. In addition, a steering committee including management and staff (some in favor of the new policy, some opposed) assisted in working out the operational details such as encouraging units to budget for additional portable cots.
All in all, the policy was implemented without a hitch, and, according to Sue, "having "patients' primary supports' here 24 hours a day is now just how we do things around here!"
NACHRI
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When parents of NICU patients stay overnight, only 15 percent of hospitals indicate parents stay bedside in the unit. |
Children's Hospitals Today is a resource from the National Association of Children's Hospitals and Related Institutions (NACHRI). The Winter 2005 issue featured an article entitled Family-Centered Care in the NICU by Mitch Harris, Associate Director, Child Health and Financing, NACHRI and George Little, M.D., Professor of Pediatric Children's Hospital at Dartmouth, Dartmouth-Hitchcock Medical Center.
Telephone interviews were conducted with NICU nurse managers at 61 institutions. Questions focused on two aspects of family-centered care: visitation policies for parents and other family members, and parent participation in unit activities.
This article is available online, Click Here.
