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Family Centered Care

Giora Netzer, MD, MSCE, Tom Robertson, MD, and Mizuho Morrison, DO
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When we treat patients, whether in the hospital or outpatient setting, involving their family members can lead to improved outcomes. Tom and Miz discuss the engagement of family members with Dr. Giora Netzer, who literally wrote the book on family centered care. 

 

Pearls:

  • Family Centered Care is an approach that collaborates with a patient’s family in the care of that patient.

  • Practical tips in the hospital for family centered care:

    • 1. Introduce yourself

    • 2. Take a seat

    • 3. Let the family talk

    • 4. Consider bedside rounding with the family

 

  • Why is this important?

    • To take the best care of people, we have to be supporting their families

    • In the ICU setting, families have high levels of stress, anxiety, depression and even PTSD before they even leave the hospital

  • What is family centered care?

    • Approach to taking care of patients that collaborates with families in the care of a patient. Acknowledges that families may often be the decision-maker and that health is a community issue

    • Benefits: reduce delirium if engaged, help mobilize, help take care of patient at home. May reduce burnout among staff

  • How do we facilitate family centered care?

    • Start with respect for the patient and family

    • Determine who is considered “family” - not narrowly defined as people related to each other but rather as a group of people that care for one another and define among themselves what family is

      • If the patient has named a legally appointed representative, take cues from that person

      • If no legally appointed representative, familiarize yourself with state laws that oftentimes define that person

    • Set the stage by coming to an understanding how information will be disseminated

  • Tips:

    • 1. Introduce yourself:

      • 1. #Hello, My Name is: campaign started in the UK by gerontology fellow after she fell ill and experienced so many people coming into her care, no identifying themselves and then expecting to lay hands on her

    • 2. Take a seat

      • Patient and family actually think you spent longer in the room than you did

    • 3. Let the family talk by asking open-ended questions:

      • “What do you understand about what’s going on so far?”

    • 4. Consider rounding at the bedside to create an open culture

      • Data shows it does not take more time

      • Improves family satisfaction

      • Improves nursing satisfaction

 

REFERENCE:

  1. Netzer G, Ed. Families in the Intensive Care Unit: A Guide to Understanding, Engaging, and Supporting at the Bedside. New York: Springer Publishing, In Press.

  2. Davidson JE, Aslakson RA, Long AC, Puntillo KA, Kross EK, Hart J, Cox CE, Wunsch H, Wickline MA, Nunnally ME, Netzer G, Kentish-Barnes N, Sprung CL, Hartog CS, Coombs M, Gerritsen RT, Hopkins RO, Franck LS, Skrobik Y, Kon AA, Scruth EA, Harvey MA, Lewis-Newby M, White DB, Swoboda SM, Cooke CR, Levy MM, Azoulay E, Curtis JR. “Guidelines for Family-Centered Care in the Neonatal, Pediatric, and Adult ICU.” Critical Care Medicine. 45(1):103-128, 2017. PMID: 27984278.

  3. Netzer G, Sullivan DR. “Recognizing, Naming, and Measuring a Family Intensive Care Unit Syndrome.” Annals of the American Thoracic Society. 11(3): 435-441, 2014. PMID: 24673699.

  4. Netzer G, Iwashyna TJ. “Fair is Fair: Preventing the Misuse of Visiting Hours to Reduce Inequities.” Annals of the American Thoracic Society. 14(12):1744-1746, 2017. PMID: 29019704.

  5. Leiter N, Motta M, Reed RM, Adeyeye T, Wiegand DL, Shah NG, Verceles AC, Netzer G. “Numeracy and Interpretation of Prognostic Estimates in Intracerebral Hemorrhage Among Surrogate Decision Makers in the Neurologic ICU.” Critical Care Medicine. 46(2):264-271, 2018. PMID:29215368.

  6. Sullivan DR, Liu X, Corwin DS, Verceles AC, McCurdy MT, Pate DA, Davis JM, Netzer G. “Learned Helplessness Among Families and Decision-makers of Patients Admitted to Medical, Surgical, and Trauma Intensive Care Units.” Chest. 142(6): 1440-1446, 2012. PMID: 22661454.

  7. Verceles AC, Corwin DS, Afshar M, Friedman EB, McCurdy MT, Shanholtz C, Oakjones K, Zubrow MT, Titus J, Netzer G. “Half of the Family Members of Critically Patients Experience Excessive Daytime Sleepiness.” Intensive Care Medicine. 40(8): 1124-1131, 2014. PMID: 24898893.

  8. Glick DR, Motta M, Wiegand DL, Range P, Reed RM, Verceles AC, Shah NG, Netzer G. “Anticipatory grief and impaired problem solving among surrogate decision makers of critically ill patients: A cross-sectional study,” Intensive and Critical Care Nursing. ePub ahead of press. PMID: 30057337.

Owens RL, Huynh TG, Netzer G. “Sleep in the Intensive Care Unit in a Model of Family-Centered Care.” AACN Advanced Critical Care. 28(2):171-178, 2017. PMID: 28592477.

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