Essay Archive
BACK TO LIST

Professional Perspectives On Family- Centered Care

(Excerpted from materials prepared by the Communications Consortium Media Center, Washington, D.C.)

After years of stagnation, construction and renovation of health care facilities are booming, according to industry reports. Hospital administrators, physicians, nurses, and health care consumers have an opportunity to shift the way they view hospitals, and each other. Instead of treating families as strangers in a system designed primarily for the convenience of staff, many hospitals are asking what patients and families want and need - and then involving them in planning teams with architects, administrators, doctors and nurses to provide it.

From the perspective of many healthcare professionals who support family-centered care, this approach makes good sense both for the quality of life of patients and families, and for the financial bottom line of health care facilities. Families who are empowered to help manage their health care are more likely to follow through with treatment and are less likely to continue their reliance on hospital staff and resources. And, a health care system that values relationships increases the job satisfaction of health care providers, and improves a facility's overall marketability.

In both new construction and remodeled facilities across the country, healthcare professionals are working with architects and interior designers to incorporate elements of the physical environment that can be used as tools for transforming care. Many are designing their inpatient units to integrate views of the outdoors, which promote relaxation and a sense of well-being among both patients and staff. Common areas more resemble living rooms than waiting rooms with fireplaces, bookshelves, interactive activities for children and comfortable furniture.

More and more hospitals are creating single rooms to provide greater privacy for patients and families, with beds or sleeper sofas where family members can spend the night. Nurses' stations are being located more centrally and designed to be more accessible, so that families can find and interact with caregivers. Lighting has been softened, colors made more cheerful, and equipment fixtures concealed behind sliding wood panels when not in use. What virtually all of these changes have in common, besides their visual appeal, is that the physical environment supports a focus on the patient's needs for physical comfort, emotional support and the presence of family and friends.

But creating environments that are truly "family-centered" is more complex than merely beautifying the physical space of a facility. It requires a profound shift in the relationship between patients and providers - and long-established attitudes, practices and perceptions about their roles in health care do not change overnight. Plans to incorporate new ways of doing business are often met with resistance from staff members who already feel overburdened and fear changes will hinder rather than facilitate their work.

This was the case at Blank Children's Hospital in Des Moines, Iowa, which completed a major renovation and expansion in August 2001. The hospital's medical director, Dr. David Alexander, said that families were invited to be a part of the redesign from the beginning stages of planning. With respect to specific design elements, families encouraged administrators and hospital staff to rethink the ways in which the design of the existing building discouraged rather than supported the involvement of families in a child's care.

For example, in the neonatal intensive care unit (NICU), families were encouraged by doctors and nurses to participate in their child's care, but in reality there was nowhere for them to be in the large unit where infants were grouped together without privacy or space at the bedside for family members. Dr. Alexander says that families were crucial in the planning phase, because "they opened our eyes to the stress" caused by this situation.

Based on the families' concerns, the hospital administration supported the idea of private rooms for all infants in the redesigned NICU. The NICU staff, however, "had to take a couple of deep breaths," says Dr. Alexander. Whereas they were used to being able to see and monitor many babies at once in the large, one-room setting, moving to private rooms would require staff to reorient themselves to their jobs - not to mention require more walking. The new design plans tripled the amount of space in the NICU without increasing the total number of beds.

But the NICU staff became very supportive of private rooms when the unit was forced to relocate to temporary quarters when the renovation of the new space got underway. The temporary NICU had semi-private rooms, to which the staff adapted easily, allowing them to see the benefits of what the families had proposed to patients, families and staff alike. Having sufficient room for parents at each bedside, and not treating them as "visitors," meant that physicians and nurses were able to communicate more regularly with them and integrate them in the specifics of their child's care from the start, as well as address their questions and concerns. Staff also noticed that the lengths of stay became shorter and discharge planning was made smoother.

For the full article, and more information on family-centered care, go to http://news.ccmc.org/topic.php?topic=103.