Within the first hour that Peggy Elliott and husband John arrived at MCG Health System in Augusta, Ga., she knew something was different. John was taken to radiology to have several scans taken of his brain to determine the cause of his intense headaches and seizure episodes. As Peggy made her way back to Johns room, she was stopped in the hallway by the neurosurgeon who had reviewed the scans who asked if they could discuss Johns diagnosis in private.
John had glioblastoma multi-form one of the most deadly forms of brain cancers. He prepared me for the diagnosis and what it would mean for John and me so I wouldnt have to hear it for the first time with John in the room, says Peggy. This allowed me to get my act together before I had to face it as a couple.
When they stepped into Johns room, the neurosurgeon explained everything plainly and thoroughly to Peggy and John, but this time Peggy was prepared. He looked at both of us, she recalls. He provided options, spelled them out, provided the percentages and likelihoods and then allowed us time to do some additional research and think things through on our own before we decided what route we wanted to take.
This was the beginning of a patient care experience that Peggy says she and John had never experienced before. After intricate surgery to remove the tumor, Peggy was allowed to stay with John in MCGs neuro ICU, to hold his hand, to provide a calming voice, and to be by his side should his condition change. Nurses explained medications to Peggy, coached her on how to care for John at home, and even consulted with her on day-to-day care decisions. They treated us as if we were part of the treatment and recovery process, says Peggy. This was so important to me. When someone you love is this ill, you want to know what is happening. No one wants to sit behind a curtain.
MCG is part of an emerging trend in health care in which hospitals are integrating patients and family into the patient-care process. Instead of being restricted to limited visiting times and overcrowded waiting areas with no privacy, families are invited to stay with their loved ones and be a part of the care team.
We dont have visitors, says Sandra McVicker, RN, MSN, senior vice president of patient care services and chief nursing officer at MCG. Families are considered a part of the care team.
A growing body of research shows numerous benefits to patient- and family-centered care, including fewer medication errors, shorter lengths of stay, fewer return visits to emergency rooms, and less stress on the patient and family, says Joanna Kaufman, RN, MS, resource and information specialist for the nonprofit Institute for Family-Centered Care.
The movement is getting support throughout the healthcare industry. The Joint Commission and the Society of Critical Care Medicine endorse the model. In addition, the American Hospital Association has partnered with the Institute for Healthcare Improvement to develop tools to help healthcare providers accelerate their efforts to provide more patient- and family-centered care.
According to the Institute for Family-Centered Care, the model is grounded in several key principals:
Dignity and respect: Healthcare practitioners listen to and honor patient and family perspectives, choices, values, and beliefs.
Information sharing: Healthcare practitioners communicate and share complete, timely, and unbiased information with patients and families and allow for active participation in care and decision-making.
Participation: Patients and families are encouraged and supported in participating in care and decision-making at the level they choose.
Collaboration: On an institution-wide basis, healthcare leaders collaborate with patients and families in areas such as policy and program development, facility design, professional education, as well as the delivery of care.
MCGs Neuro ICU, which was undergoing an expansive remodeling and redesign last year, presented the perfect opportunity to incorporate the family model. The hospital consulted with former patients and families as well as staff members for recommendations on how to provide the best patient and family experience. With these suggestions in hand, the hospital transformed the ICUs shared patient rooms into private rooms with family living areas and soon began to see a transformation in the quality of care as well.
Patient satisfaction increased from the 10th to the 99th percentile, length of stay
decreased by 50%, discharge volume increased by 15.5%, medical errors were reduced by 62%, and staff vacancy dropped from 7.5% to 0. Our turnover rate in the neuro ICU was constant before, says McVicker. Now theres a waiting list for nurses and staff to work in the unit.
The rooms include two pull-out beds, private bathrooms, flat-screen TVs, and dry-erase boards for communication between nurses and family members. There is also a family resource center with computers, a commons area with sofas for larger family gatherings, and small alcoves that offer quiet and privacy space.
Jill Williams, RN, BSN, a neuro ICU nurse for about 22 years, says the culture change was bigger than the physical change. Once nurses adapted, they realized that it actually made their job easier, she says. They no longer had to spend much of their time fielding phone calls for updates because family members are by the bedside allowing the nurses to teach and explain as they provide care.
Families are also present when physicians and nurses make rounds on their loved ones. They can ask questions, make recommendations, and take part in the decision-making. Theres an immediate trust that develops because they can see that we are doing everything possible for the patients and we are not hiding information from them, says Williams.
Who better to get information about a patient than a spouse or other family member, says Ray Quintero, RN, MSN, CCRN, unit director for the neuro ICU at Emory University Hospital in Atlanta, which recently reorganized into a family-friendly and healing environment. We consider the families partners in care. It just makes good sense.
Communication is a critical component of this partnership, so much so that the nurses have become artists at dealing with family dynamics, notes John Scala, RN, unit nurse at Emorys neuro ICU.
To prepare for this new care model, neuro ICU nurses at Emory participated in a full-day communication class that walked nurses through the nuances of patient- and family-centered care, the importance of respecting the values and beliefs of patients and families, and ways to communicate sensitive information.
We used to practice in a fish bowl, says Scala. Now our goal is to develop a synergy between the families, nurses, doctors, and other members of the healthcare team. And by working together, we hope to arrive at a different place than we would have otherwise, one that is better for the patient and the family.
It has long been believed that overstimulation of a patient in critical condition could cause adverse affects. However, according to hundreds of observational studies, patients actually do better when they are exposed to family stimulation. For instance, a study in the Aug. 11, 2004, issue of the Journal of the American Medical Association, Restricted Visiting Hours in ICUs: Time to Change, found that family visits actually lowered patient stress levels, as measured by blood pressure, heart rate, and intracranial pressure.
Anecdotally, weve found that when families start touching and talking, weve seen vital signs change in a positive way, says Quintero. Families do better as well. Many of their fears and stresses are allayed when they are a part of the care process.
When it comes to adopting patient- and family-centered care, health care is years behind the times, says Quintero. Nursing is as much an art as it is a science, he says. The community demands it, the evidence proves it, and health care needs to step up and do it.
Susan Meyers is a freelance writer for Gannett Healthcare Group.