Page 180 - ACCCN's Critical Care Nursing

Family and Cultural Care of the Critically Ill Patient 157

OVERVIEW OF MODELS OF CARE healthcare that is governed by mutually beneficial part-
nerships among healthcare providers, patients and fami-
The way that nurses manage their daily activities and lies’. Patient-and-family centred care applies to patients
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patient care is affected by both the critical care unit’s of all ages, and it may be practised in any healthcare
model of care delivery and the nurse’s personal setting.
philosophy of what and how nursing is constructed.
Alternative models of care are examined in this section Family-centred care is founded on mutual respect and
and their use in critical care areas discussed. Nursing partnership among patients, families and healthcare
models define shared values and beliefs that guide prac- providers. It incorporates all aspects of physical and psy-
tice. Various philosophies and models of nursing care chosocial care, from assessment to care delivery and
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delivery have evolved over the decades and contrast with evaluation. Healthcare providers that value the family/
the ‘medical model’, which focuses on the diagnosis patient partnership during a critical illness strive to facili-
and treatment of disease. Models such as primary tate relationship building and provide amenities and
2
nursing and team nursing include organisational or services that facilitate families being near their hospital-
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management properties, whereas client- or patient- ised relative. When a clinical unit’s staff embrace a
centred practice is another model in which a partnership family-centred care philosophy and partner with families
relationship is developed between health professionals and make changes to the physical environment such as
and the patient. Patient empowerment is a key benefit improved privacy and aesthetically pleasing decor, it
3-8
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of this philosophy. However, a shared partnership with can have the added advantage of positive culture changes
the patient may be problematic in critical care, where for the staff. This indicates there is a benefit beyond
critical illness restricts patient involvement in decision the family members for whom the changes were
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making and care planning. In reality, it is generally initiated.
family members who provide the link between the In trying to understand family-centred care, neonatal and
patient and healthcare team. paediatric ICU studies have focused on parents’ percep-
During the 1980s, the role of the family was one focus tion of care in the three key components of family-centred
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of nursing debate and discussion. Friedman believed care: respect, collaboration, and support. In the area
families were the greatest social institution influencing of respect, families rated ‘feeling welcome when I come
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individuals’ health in our society. A worldwide trend to the hospital’ and ‘I feel like a parent, not a visitor’ most
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is for health professionals to value the role of family highly. Within the area of collaboration, feeling well
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members in providing ongoing, post-acute care with the prepared for discharge and being given honest informa-
reality that families provide considerable support during tion about care were rated the highest. The familiarity of
rehabilitation phases of critical illnesses. 12,13 The family nurses with the special needs of patients was rated highest
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is strongly incorporated within the philosophies of the in the area of support.
professionally-centred model and family-centred model. Strategies to improve family-centred care within adult
The professionally centred model is patient- and family- critical care areas include involving family members in
focused, but the nurse or doctor decides on what is partnering with the nursing staff to consider the involve-
needed rather than involving the family and patient in ment they would like which may include providing fun-
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identifying their actual needs. The professionally- damental care to their sick relative. Family members can
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centred model retains a component of paternalism, as decide in consultation and negotiation with the bed-side
health professionals act from their own perspective, nurse the care that they want, and are able to provide;
rather than as a result of a shared decision-making this may vary from moisturising their relative’s skin to a
process. The emphasis of this model, when used in the full sponge and will require negotiation. This act of caring
context of nursing, centres on autonomous nursing deci- allows family members to connect in what they see as a
sion making, albeit in an environment of collaboration meaningful way with their sick relative. In addition, it can
with other healthcare providers. It espouses the require- also improve communication with critical care nurses
ment for accountable practice and respect for individuals and facilitate close physical and emotional contact with
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and their right to make decisions. In contrast, the their relative. An independent nursing intervention such
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family-centred model shares the responsibility with the as partnering with family to provide care provides
family and aims to meet their needs. Whichever model an understanding of how to operationalise a family-
is selected, it must be practical in the clinical setting for centred care model in the clinical setting and assists in
which it is intended. 2 the evaluation of other future interventions directed to
improve an area’s family-centred approach. Further
FAMILY-CENTRED CARE research on the benefits of family-centred care is needed
24,26,27
The family-centred model of care, developed during the in all critical care areas.
early 1990s, primarily in North America, in the area of It is greatly acknowledged that taking care of critically
children’s nursing, considered incorporating the family ill patients requires considerable knowledge and skill.
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was fundamental to the care of the patient. Over the When family members are incorporated into the caring
past two decades, the scope and extent of family-centred paradigm, as advocated within family-centred care,
care has broadened and the Institute for Family-Centered health professionals equally need specific knowledge and
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Care defines family-centred care as ‘an innovative skills. This should be initiated in foundation degrees,
approach to the planning, delivery, and evaluation of postgraduate studies and via ongoing professional