Family Centered Care: A Productivity Issue
Monique Van Dooren
Submitted in Partial Fulfillment for NUSC: 5763: Personnel in Management, for Dr. Barbara Pate, Clinical Associate Professor at the University of Arkansas for Medical Sciences, College of Nursing, Master of Nursing Science Degree Program
Identify Problem and symptoms
Family-centered care or more specifically, open visitation in a critical care unit, is something more and more hospitals are moving towards, specifically at the University of Arkansas for Medical Sciences (UAMS). Healthcare providers are being asked to strive towards a more consumer oriented role in their practice (Livesay, et al 2005). In addition to this new focus on family-centered care, changes in the reimbursement system has forced hospitals to encourage managers to make decisions about how to increase productivity while keeping costs down. Healthcare delivery today is more transitional than it has ever been.
Physical environment is an important component in the acute care setting that can affect nursing productivity as any inadequacy in the physical environment can contribute to staff fatigue, stress, and burnout. An area of health care that is often overlooked, but can have significant effect on patientoutcomes, is the process of care. “The way we practice, the culture we work in, the climate that our professional demeanor creates can all dramatically impact on outcome measures” (Moreno, Rhodes, & Donchin, 2009, p. 1668). Time spent comforting and explaining specific care to the family adds drastically to the time taken away from care of the patient. Add into that mix, a teaching institution where many aspects of care are difficult to coordinate, a poorly organized work environment or layout of the unit, and not enough ancillary support to assist with the lesser complex tasks, leaves a nurse carrying the majority of the work load. Within a nursing department, productivity is calculated as a relationship between the type and hours of nursing care provided and the units of service delivered, adjusted for acuity.
There are two sides to any coin. Imagine for a moment that a loved one is in the Intensive Care Unit (ICU) with multiple tubes coming from their body. Their senses are bombarded with the sight of family members as they wake, smells of disinfectant and blood, sounds of monitor alarms ringing, and scary looking machines/tubes are connected or attached to them. In addition, this hospitalization stems from an unforeseen traumatic event, a motor vehicle accident. Imagine a family that is given limited information and access to their loved one. Visits are small pre-selected time intervals, and even then they are asked to leave frequently while the nursing staff performs procedures or bathes the patient. There is definite apprehensive as to what is going on, worried the loved one may take a turn for the worse, and worse, feel neglected by the medical staff. You are afraid your loved one may wake up any minute, and it will be during the time of no visitation. Would the outcome be better if a loved one is allowed to stay in the room with the patient, given more access to the information concerning the diagnosis, and allowed to be the continuity of care.
Now imagine that you are the nurse caring for that patient. The stress of manipulating multiple drips to keep the patient with a blood pressure, working with different teams and different residents that are giving contradictory orders, and trying to make the patient comfortable at the same time. The family is anxious and angry because no one has come out and told them what is going on. The patient was in a motor vehicle accident and has numerous problems requiring many different teams. When family is in the room the nurse is overwhelmed with questions concerning each number on...