Family centred care - Essay Example

Family Centered Care Patient care by nurses has been the norm in medical practice for the longest time. However, in recent years, there is more focus around the involvement of family members in the care of relatives, both inside the hospital and after they have been discharged (Mitchell et al. 2009). The family plays a vital role in the nursing of the patient. Since the discovery of this fact, there has been vast interest on the topic of family-centered care. This essay examines the role of the nurse in planning a patient’s discharge, and the considerations they have to make in order to ensure that family –centered care is made possible. For purposes of establishing the role of the nurse in family centered care, the essay has its basis on a case study. The patient, Joan, who is in hospital, has been diagnosed with Alzheimer’s disease. It is evident that she has a family, a husband. In planning the discharge of this patient, the nurse has to consider a number of issues. Some of these issues are the feelings that her husband has, and the fact that he may be unable to cope with her condition, managing Joan’s agitation, assessing the risk that the disease brings about to Joan. In addition, the nurse should consider the stress that Joan’s disease puts on the relationship between the members of the family and the possibility that the family might have limited knowledge on the disease and may need guidance on how to cope. The paper will focus on four major topics with regard to family centered care. The first of these is the risk posed by Alzheimer’s. Secondly, the paper will look into the issue of the stress that Joan’s sickness could cause on the relationship between members of her family. The third topic entails the possible reasons for Joan’s agitation and the best way to manage it. The last issue to be discussed is the feelings that the family members may have towards Joan, and with regard to her condition and the part they play in caring for her. Family Care plan Family centered care according to the Institute for Family Centered Care (2005) is an approach to caring for patients that involves building mutually beneficial relationships among the patients, the families of the patients, and those in charge of providing healthcare to the patients themselves. This kind of care, the institute adds, is applicable to patients of all age groups, and is recommended in all settings that deal with health care. This would mean that for the sake of quick recuperation of patients, the family would have to be heavily involved in the process of nursing, while acquiring relevant and vital information on what steps to take from the nurse in charge of their sick relatives. In the case study, Joan has dementia. Joan is set for discharge from the health facility where she has been. Family centered care begins from within the hospital. This means that the family is also heavily involved in the decision to discharge. At this point, the family needs to get reassurance that Joan is in a stable enough condition to go home. In addition, the dependent state of the patient warrants their involvement for purposes of establishing whom her primary caregivers will be and where she will be living (Davidson et al. 2007). Before the nurse releases her into the care of her family, it is important that they come up with a family care plan that will aid in assessing the situation at home (Gulanick & Myers 2011). An example of the nurse’s family care plan is as shown. Table 1: Family care Plan for Joan with dementia Family Problem Goal of care Objectives of Care Intervention Measures Method of nurse-family contact Resources Evaluation -little knowledge on risks posed by Alzheimer’s . - possible source of stress for family - patient agitated - To put the patients at ease -Prevention of self-harm by patient Enabling the family to empathize with the situation and learn the understand the sickness -provide health teachings to the family on Alzheimer’s -Introduce the family to professional aid -provide emotional and medical support to enhance coping -encourage active participation by family. -regular clinical visits by patient and family -occasional home visit -books on Alzheimer’s -medication to ease agitation The family care plan outlined should aid the nurse to cover more ground in an organized manner in educating the family on how to cope with having a relative diagnosed with dementia. The next part of the discussion outlines four possible issues in the care and management of Joan following her discharge from hospital. 1. Assessment of risk as a result of Alzheimer’s Having been diagnosed with Alzheimer’s, Joan faces a few challenges unique to Alzheimer’s patients. The nurse has to consider these risks and make them known to the patient’s family. The most common risks that Alzheimer’s poses to the patient stem from the loss of memory, faulty reasoning, loss of their ability to communicate, regular disorientation, problems with balance or gait, neglecting their personal care safety and general care, and hallucinations coupled with paranoia and agitation (Brodaty et al. 2013). These symptoms, as the nurse in charge of Joan’s health ought to point out to the family, make it impossible for her to be responsible for her own personal care. Joan, like all Alzheimer’s patients will be indisposed to carry out her daily activities on her own. For example, if she drove herself to certain destinations, it would be unwise to suffer her to continue doing this on her own because she is prone to disorientation (Alzheimer’s Australia n.d.). Allowing her to drive might end up in her as the victim of a car crash or just simply getting lost if she suddenly cannot remember her whereabouts or identity. Unaccompanied, it is possible for Joan to wander off into harmful territory and constantly end up in potentially harmful situation, completely unaware of the risk that she in. Another risk posed by allowing Joan to continue to live on her own or expecting her look out for her own health is in the fact that dementia patients have no regard for their personal hygiene and health (Brodaty et al. 2013). This would mean that her disorientation might lead her to starve to death if she is left to carter to her own needs. In addition, she is prone to forgetting to take a shower or carry out any activity towards enhancing her personal hygiene. The family has to be abreast with risks of this nature in order to make necessary arrangements to protect Joan from ending up in harm’s way. 2. The stress that Joan’s sickness may put on the relationships in the family The presence of a patient that is almost fully dependent on the support of those around them is a strenuous affair in many instances. This is aggravated if the support system provided by the family is already weak before the diagnosis of a patient with a disease of this nature (Webster & Jonson 1999). In Joan’s case, she has is married and has sisters. According to Alzheimer’s Australia (n.d.), feelings of anger and sadness are possible from the members of the family. They point out that this can ensue from witnessing the deteriorating health of a loved one that was once very capable by themselves. Different individuals react to this differently. Some family members care about the patient but feel incapable of making them comfortable. These people tend to want to take a backseat in the care of the patient. For others in the family, it could mean dedicating all their free time to try to make Joan comfortable. Both of these groups experience the stress of having a terminally ill loved one. It could manifest in the emergence of drifts between some of the family, hence straining the relationship. The health care provider could provide emotional support and counseling to these families to alleviate the stress placed of their relationships (Webster & Jonson 1999). 3. Management of Joan’s agitation Agitation in dementia patients is common. It can present itself through constant fiddling and pacing, sometimes it is in the way the patient keeps repeating certain phrases or cries and screams (Brodaty et al. 2013). These kinds of behaviour is annoying and irritating to the members of the family and other involved parties. One of the most causes of agitation in dementia patients is a change of routine. Alzheimer’s causes changes in the brain and some of these changes mean that the patient is uncomfortable when there are new factors in their environment. Another cause for agitation is the complexity of performing certain tasks, for example tying one’s own shoelaces. Physical discomfort could also be a cause for agitation, since these patients are unable to articulate their feelings verbally. To deal with Joan’s agitation, the nurse must help the family to understand the factors that could lead up to angry episodes. The family should also empathize with her, since another cause is frustration over being unable to carry out intimate functions such as dressing up on their own. Joan’s anger may come from her inability to comprehend her environment, fear, and the need for attention. One of the methods of managing Joan’s agitation according to Verhaeghe et al. (2005) is establishing a routine for her and remaining consistent as much as possible. Another way in which her family can keep her comfortable is to avoid putting unnecessary pressure on her to perform certain tasks. The family can also consult with the relevant healthcare providers. 4. The feelings of the family towards Joan Joan’s family members may experience changes psychologically, socially and physically due to following her return home. This is because they are suddenly not receiving as much help from the nurses with their sick relative. In addition, the presence of Joan at home implies a change of routine in the lives of her relatives to help her cope with her new lifestyle (Maxwell, Stuenkel & Saylor 2007). For, example, some of the family members could find that they have to spend more time at home looking out for her safety. These members of the family could experience frustration, especially if they are not sure how to manage the agitation in their relative or embarrassment in instances where Joan’s unreliable judgment leads her to engage in humiliating activities in public. Socially, the relatives may feel isolated due to the amount of time they have to spend with Joan as they purpose to establish a routine for her. These negative feelings can be negated when the family teams up to share responsibility, and if they can afford it, they could hire professional help to help with some of the work. Caregiver burnout is common among those helping terminally ill relatives (Maxwell, Stuenkel & Saylor 2007). With Joan, for example, after a while, the family could begin to experience feelings of frustration and fatigue. In order to curb this occurrence, there is a range of services available to Alzheimer’s patients and their families. The first of these is taking the patient to adult daycare. In this setting, the patient gets to interact socially with other people away from home under supervised conditions before returning home at the end of the day. Another service available is the in-home respite care, where one gets a licensed professional to come to their home and engage the patient in constructive activities. One must keep in mind that Alzheimer’s patients have deteriorating mental capacity. For this reason, there has to be a system that clarifies who to consult in a situation whereby the patient is indisposed to make decisions on health or financial decisions (Azoulay et al. 2003). In Joan’s situation, her husband is best placed to make important decisions affecting her life. The decisions made on her behalf must be the best possible, given the situation. Joan’s Alzheimer’s is an alteration to her life and to the lives of her family. Dementia patients require those in charge of healthcare must reiterate maximum supervision of the patients. One of the conclusions drawn from this analysis is that survival of dementia in a relative requires cooperation from the members of the family. In addition, for purposes of their own mental health, there are effective services available to the families of dementia patients, allowing them to take small breaks from care giving. Finally, routine is important in the lives of the diagnosed in order to put them at ease and make them easier to manage. The importance of family centered care in Alzheimer’s patients cannot be overstated. References Alzheimer’s Australia n.d, Agitated Behaviour in Dementia Patients: Fight Alzheimer’s save Australia. [Accessed 11 May 2013]. Pochard, F, Azoulay, E, Chevret, S, Lemaire, F, Hubert, P, Canoui ,P, Grassin, M, Zittoun, R, le Gall, JR, Dhainaut, J & Schlemmer, B 2003, Family participation in care to the critically ill: opinions of families and staff”, Intensive Care Med, vol. 29 no. 9, pp. 1498-1504. 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Mitchell, M, Chaboyer, W, Burmeister, E & Foster, M 2009, “Positive Effects Of A Nursing Intervention On Family-Centered Care In Adult Critical Care”, American Journal Of Critical Care, vol. 18 no. 6, pp. 543-552. Verhaeghe, S, Defloor, T, Van Zuuren, F, Duijnstee, M & Grypdonck, M 2005, “The needs and experiences of family members of adult patients in an intensive care unit: a review of the literature”, J Clin Nurs, vol. 14 no.4, pp. 501-509. Webster, D & Johnson, H 1999, Developing Family-Centered Vision, Mission, and Philosophy of Care Statements, Bethesda, MD, Institute of Family-Centered Care. Read More