Lack of Outcome Measure for Family Satisfaction How do we measure satisfaction at NMH? Staff satisfaction is assessed using the Gallup Survey Q12 measures. Until now, there was no way to directly measure family satisfaction with care given given in the critical care setting. The existing Press Ganey survey only measures satisfaction based on the unit from where the patient is discharged (e.g., to home, to another healthcare facility). Comments from both staff and visiting families have revealed a level of dissatisfaction within both groups. An extensive review of the literature on family systems theory, family needs, visiting and family involvement in care was conducted. Based on this review, it was determined that a change in practice was needed. A new model of care was developed that provides a framework for the sharing of patient care responsibilities between the family and healthcare team. This model has been named the Patient and Family Access Model of Care.

Healthcare Team Connection Trust Connection Trust Community Family ACCESSIBILITY OPENNESS COMMUNICATION INFORMATION Trust Patient Family Defined Healthcare Team MD Nurse Trust Connection Henderson Framework Environment

The Family Side The model consists of 2 intersecting circles. Healthcare Team The Family Side The model consists of 2 intersecting circles. The circle on the left side represents the family, as defined by the patient and the family itself. The family is responsible for nurturing and supporting each of its members, with the family structure based on the interrelationship of its individual parts and unique shared experiences. ACCESSIBILITY OPENNESS COMMUNICATION INFORMATION Patient Family Defined

The Healthcare Team Side The circle on the right signifies the diverse membership of the healthcare team, which supplies specialized expertise in the support of the patient and family during illness and in promoting wellness. ACCESSIBILITY OPENNESS COMMUNICATION INFORMATION Healthcare Team MD Nurse Henderson Framework

At the top intersection of the two circles is the patient, the primary focus for both the family and healthcare team. ACCESSIBILITY OPENNESS COMMUNICATION INFORMATION Patient Nurse Henderson Framework At the bottom intersection is the nurse, who as the coordinator of care, is the primary link between the patient, family and healthcare team. The nurse advocates on the behalf of the patient by fostering a relationship between the family and other members of the healthcare team. The nurse’s practice is grounded in the Henderson Framework, assisting the patient and family to gain independence in their healthcare decisions.

ACCESSIBILITY OPENNESS COMMUNICATION INFORMATION Patient Family Defined Healthcare Team Nurse Included in the middle of the intersection is a two-directional arrow. The arrow indicates accessibility, openness, communication and information that should flow back and forth between the family and the healthcare team, guided by the nurse and inclusive of the patient. Based on the literature on family needs, family members desire access to the patient, openness and transparency with the healthcare team, frequent nurse/physician communication, and information about the ill family member that is easy to understand. Members of the healthcare team also require accessibility, openness, communication and information from the family in order to promote holistic patient care. The healthcare team and family work together with the patient in developing goals and deciding treatment options, always in the best interest of the patient.

Healthcare Team Connection Trust Trust Connection Community Connection ACCESSIBILITY OPENNESS COMMUNICATION INFORMATION Trust Patient Healthcare Team Family Defined MD Nurse Trust Connection Environment When there is a two-way flow of access, openness, communication and information, then a mutual atmosphere of trust and a shared connection should exist between the patient, family and the healthcare professionals, all working together for the benefit of the patient. This is indicated by a dotted line that interconnects each individual. This line is dotted because many things can upset the delicate 2-way balance between trust and doubt for the family and healthcare team. This collaborative effort is accomplished through the utilization of resources within the surrounding community or immediate environment, or that of the patient and family’s home base.

Using the Model to Initiate Change In order for the Patient and Family Access Model of Care to work in the ICU at NMH, several changes to the current nursing practice are required: Family visiting and patient access Based on patient/family request and patient status Improved communication between patient, family and healthcare team Consistent access to verbal/written information, ICU journal Sharing of information between patient, family and team White boards in patient rooms or cork board in waiting areas, family rounds Structured patient and family involvement Participation in family rounds and mutual goal setting, assisting with patient care as desired

Core Concepts for Patient and Family Centered Care Creating an environment that is centered around the patient and family is not unique to Northwestern Memorial Hospital. Other hospitals and organizations across the country recognize the importance of family in patient care. The Institute for Family-Centered Care lists four principles when adopting care practices around patients and their families: Dignity and Respect: “Healthcare providers listen to and honor patient and family perspectives and choices…” Information Sharing: “Healthcare providers communicate and share complete and unbiased information with patients and families in ways that are affirming and useful…” Participation: “Patients and families are encouraged and supported in participating in care and decision-making at the level they choose.” Collaboration: “Patients, families and providers collaborate in policy and program development, implementation and assessment…as well as in the delivery of care.” We need to be attentive to families and involve them because it is the right thing to do!

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