We Try to Provide Family-Centered Care

…but does our environment?

Read about the importance of family included at every phase, even in planning the physical environments around us.

We Try to Provide Family Centered Care, But Does Our Environment?

Karen Kelly

I am a registered nurse and work in a pediatric emergency department.  I was at work one day and was talking to a volunteer I knew from my days of working in the NICU.  I asked her why we don’t get volunteers in the Emergency Department and she said, “nobody likes going there because the patients are treated so poorly by the nurses.” When I asked some more questions about what she meant, she went on to say that patients don’t all have pillows and parents are sleeping on chairs or in the beds with the kids.  I couldn’t believe she said that! I thought to myself , I know we do the best we can with what we have.

I went back to work and took a quick look at the patients and the families and everyone looked comfortable and happy.  But as the day progressed and the waiting room started to fill up I noticed a shift. As the patient’s length of stay began to get longer, families started to look more uncomfortable.  Parents were sleeping on chairs meant for sitting and siblings were crying and sitting on the floor watching shows on ipads. And as patients were waiting longer in the waiting room, it became clear, maybe we haven’t been thinking about the patient’s comfort as much as we should. The rooms in the ED are very functional for us (the healthcare team) to do our jobs, but not as functional for our patients and families. And the waiting room can hold a lot of patients, but more like a bus terminal than a room for sick kids waiting to be seen.

A term familiar to most hospitals these days is family centered care.  Even when I teach nursing students, I continually talk about family centered care because it’s a necessity in healthcare. But what is it in practice?  Basically, the Institute for Patient and Family Centered Care describes it as working “with” patients and families rather that doing “to” or “for” them: incorporating family into the healing process.   Terms like dignity, respect, collaboration and family participation are all meant to include the family virtually as part of the healthcare team.

So, when a family is faced with a medical crisis, they are part of the team - at whatever level they choose.  We encourage families to participate in decision-making. In fact, we allow families to be present during most procedures. They are there when we put in IV’s and when we suture lacerations. We allow families to be present in the trauma room to be able to see what is happening and what we are doing to save their child.  We recognize that culture; beliefs; dignity and respect are instrumental in the patients healing and care.

But how can we implement this type of participative, inclusivity into the physical healthcare environment?  Because when I had my “aha” moment I realized, its not just about the care we give, its also the physical environment available to the family. Speaking from an emergency department perspective, we need a place for the families go when they need to walk away – and don’t want to face the chaos in the waiting room.  

Maybe, we include the family at the planning phase.  When we are imagining our walkthrough in the room with nurses and designers and planners, maybe we include family representatives?  Or, maybe we have a family panel BEFORE we all meet – and find out what does healing look like from the perspective of the family who has actually spent time in the hospital.