Patient and Family Centered Care PDF

**DAY 1** - **PATIENT AND FAMILY CENTERED CARE** **Why have a course dedicated to Patient and Family Centered care?** 1\. Everything we do is about the patient and their family. 2\. Everything comes back to dignity and respect for the patient. 3\. Everything is about family wishes. **Patients i...

**DAY 1** - **PATIENT AND FAMILY CENTERED CARE** **Why have a course dedicated to Patient and Family Centered care?** 1\. Everything we do is about the patient and their family. 2\. Everything comes back to dignity and respect for the patient. 3\. Everything is about family wishes. **Patients in Canada have the Following Rights:** - To receive appropriate and timely care - To be treated with dignity and respect - To receive health services without discrimination - To have their personal and health information protected from disclosure - To have access to their health information unless, in the opinion of a relevant health professional, the disclosure could result in immediate and grave harm to the patient's health or safety - To refuse consent to any proposed treatment - To receive information relating to any proposed treatment and options - To the recognition of your Representative or Substitute Decision-Maker - To a second opinion - To pain and symptom management **Respectful, Patient-Centred Care** It is an expectation that patients receive care which is "respectful of and responsive to individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions". **Respect and Cultural Safety** Accepting "others\' points of view and to adapt your attitude without judgment requires continual conscious effort". **Respect and Culture** - Multiculturalism is integrated into The Canadian Charter of Rights and Freedoms. - The Canadian Charter of Rights and Freedoms "guarantees individual rights and freedoms to all Canadians and stipulates that those rights must be interpreted in the context of cultural diversity". Patient-centred care is foundational in the doctor-patient relationship: - "It considers a patient\'s values, beliefs, and wishes in the formulation of a treatment plan". - "It requires that physicians understand how a patient\'s socio-cultural background affects beliefs and behaviours". **How to Integrate Culture and Respect -- (show interest)** - Being respectful includes providing "patient-centred care by being culturally curious". - This can be achieved by having "polite and genuine interest in someone\'s cultural background". - This "opens the door to discussion and understanding". **CASE: Background Information** - A plastic surgeon is seeing a child about a fingertip injury. - The patient\'s mother is veiled -- only her eyes are visible. - The surgeon asks the mother to remove her veil so he can see who he is speaking with. - The mother took offence to this and complained to the regulatory authority (College) that the plastic surgeon had tried to frighten her and made inappropriate comments. **CASE: Result** - The College required the plastic surgeon to undertake sensitivity training. **Respect is Integrated into the Code's 6 Principles:** - Nurses respect the dignity of patients and treat them as individuals. - Nurses work together to promote patient well-being. - Nurses maintain patients' trust by providing safe and competent care. - Nurses work respectfully with colleagues to best meet patients' needs. - Nurses act with integrity to maintain patients' trust. - Nurses maintain public confidence in the nursing profession. **Fundamental Commitments of the Medical Profession** - Always treat the patient with dignity and respect the equal and intrinsic worth of all persons. - Always respect the autonomy of the patient. - Never exploit/taking advantage the patient for personal advantage. - Never participate or support practices that violate basic human rights. **What is Dignity?** - Being treated with respect, regardless of the situation, and preserving a sense of self-esteem - For example: having a sense of self-worth and being accepted as one is, regardless of age, health status, and so on - Being appreciated for life accomplishments - Being respected for continuing role and contributions to family, friends, community, and society Being treated as a worthy human being and a full member of society **What is HealthHub Patient Engagement Solutions?** - Originated in 1967 - In 1968, the company started with developing and implementing patient entertainment system in hospitals and health care facilities across Canada. - The system grew to serve more than 33,000 beds in over 200 hospitals across the country, making it an industry leader. - Today, they provide digital health care engagement solutions -- integrated bedside terminal. **Who is VOYCE?** - Voyce gives "access to on-demand Video Remote Interpreters on a variety of devices". - ***How does it work?*** Live interpreters can be requested when required. - ***Result:*** Communication across a variety of languages and cultures can improve outcomes and increase patient satisfaction. **Partnerships in Health Care in Canada** - ***Goal:*** Eliminate language barriers between hospital staff and patients. - ***Target:*** Canadian hospitals - HealthHub Patient Engagement Solutions and Voyce will expand access to virtual language interpretation services. - The integration of Voyce software to myHealthHub will offer health care providers and patients easy access to interpreters 24/7 in over 235 languages and dialects on a platform that\'s encrypted and secure. - Digital health technology in Canada is transforming the way hospitals operate and we have witnessed this evolution accelerate by the COVID-19 pandemic. - A study by Health Canada found that, \"those facing language barriers also face increased risk of medication errors and complications, and adverse events. - The rights of limited English proficient patients to informed consent and confidentiality are often not protected." **What is Shared Decision-Making (SDM)?** - Process: Clinicians collaboratively help patients to reach evidence-informed and value-congruent medical decisions. - Important when assessing for conditions which could result in benefits or harm as a result of the screening. - Patients will make screening decisions based on their values. **SDM CASE: You are John's Physician...** - John is 66 years old; you've known him and his family for years. - John takes a daily statin and a baby aspirin for primary prevention of coronary artery disease. - Since the age of 18, he has smoked a pack a day. - At a recent office visit, he tells you about another recent attempt to quit. - This time, a nicotine patch was of no help and so he now asks you to prescribe varenicline. - In conversation about this prescription, he reminds you that his father died of lung cancer. - You recall that the College of Family Physicians of Canada endorsed a recommendation on screening for lung cancer. **SDM CASE: Recommendation** - For those aged 55 to 74 years with at least a 30 pack/year smoking history who currently smoke or quit fewer than 15 years ago, the recommendation is annual screening with low-dose computed tomography (CT) of the chest, up to 3 consecutive times. - Screening should only be carried out in health care settings with expertise in early diagnosis and treatment of lung cancer (weak recommendation; low-quality evidence). **SDM CASE: Your Conversation with John** ***JOHN:*** Before this visit, I didn't have an opinion about screening for lung cancer, and I didn't know this type of screening was possible. ***PHYSICIAN:*** --- The low-dose CT chest screening is available in your community. --- Are you aware of this option? --- What are your views? --- You must decide whether you want to be screened or not. --- I will support you as you work through the options. **SDM CASE: Conclusion** The physician's role is to ensure that John is informed and understands the benefits and harm of following through with the screening. ***PHYSICIAN:*** --- John, according to recent statistics, 16 smokers per 1000 die from lung cancer over a median follow-up of 6.5 years. --- Please take this into consideration as you weigh the harms and benefits of screening for lung cancer. **Core Elements of Shared Decision Making** **Risk Communication:** The attempt to communicate the benefits and harms of interventions based on evidence. **Values Clarification:** Clarifying what matters most to the patient and his or her family. **Shared decision-making (SDM):** Becomes embedded within a process in which a health care provider and a patient relate to and influence each other as they collaborate in making a choice about health care. --- The choice must align with what matters to the patient. --- His or her values and preferences are to be incorporated into the decision. **Steps of Shared Decision Making** 1\. Identify a clear decision: *Is the patient aware of options?* 2\. Provide information about the clinical problem and options at the decision point. 3\. Elicit the patient perspective: *Assess the patient's view on what matters most* 4\. Guide the patient toward a final decision. 5\. Assess comfort level of the patient with their decision. **Key Points about Shared Decision-Making** - SDM offers a structured process to incorporate evidence as well as patient values and preferences into screening decisions. - SDM is most relevant when there is a close trade-off between the harms and the benefits of a screening decision that could be altered by individual patient values and preferences. - The core elements of SDM are ***risk communication*** and ***values clarification***. **SDM and Knowledge Translation Tools** - Individuals may need help understanding the details. - Individuals might need more than one office visit to decide about screening. - How can you help them understand? - **Knowledge Translation** (KT) tools are resources and products that are meant to facilitate shared decision-making between patients and clinicians (decision aids). - Tools can be clinician-centred (clinical practice guidelines) or more patient-oriented (plain-language videos). **Culture and Canadian Health Care** - "Culture incorporates a mix of beliefs and behaviours that define the values of communities and social groups." - Health practitioners in Canada will have a series of patients who are from various cultures. **Visible Signs of Culture** - Language - How one dresses - Food - Practices/rituals **Nonvisible Signs of Culture** - Perceptions of time - Values of modesty - Responses to physical space - How one reacts to their emotions **The Unintentional Result** - It is possible to accidentally offend someone by "missing clues or misunderstanding a cultural viewpoint." - There could be trouble understanding the health care provider because of a language barrier. **Culture, Health, and Management of Illness** *Culture can impact care and a response to illness.* **Example:** - Beliefs about what causes disease, whether to engage in certain health promotion activities or seek advice regarding health concerns, as well as whether treatment options are followed. - Culture can also impact a patient\'s approach to attending medical appointments in a timely manner. - Some patients prefer not being informed of a terminal illness or the implications of not following through with a procedure. - First Nations patients may consult a doctor and a traditional healer. - Culture can also influence eating and fasting rituals, even when nourishment is vital to recovery and overall function. **What is Cultural Competence?** The Office of Minority Health in the United States defines cultural competence as, ***"a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations."*** **Other terms used are:** **Why is Cultural Competence Important?** - Given Canada's increasingly diverse population, it is important for health care providers to be culturally competent. - Culturally competent care helps to reduce disparities and improve health outcomes in a diverse population by improving communication and helping to effectively manage cultural differences, including beliefs about health and health practices, as part of patient care. - Culture, religion, and ethnicity may influence people's beliefs and values about health and health care, and both patients and providers bring cultural perspectives to each encounter. **Areas where Different Perspectives can Affect Clinical Care** - Birth and early infant care practices - Nutrition and diet - Bedsharing and Sudden Infant Death Syndrome - Developmental disabilities - Parenting and discipline - Adolescent issues, including development, confidentiality, roles within the family and/or extended family, sexuality, substance use, and other risky behaviours, identity development, and acculturation - Accessing health care systems, clinics, and emergency departments - Using traditional medicines and treatments **4 Components of Cultural Competence:** 1\. **Awareness** -- key to cross-cultural success 2\. **Attitude** 3\. **Skills** 4\. **Development** **Defining Cultural Safety** ***Cultural Safety*** is the ultimate goal in a learning process, according to Irihapeti Ramsden, the Maori nurse and educator who developed the concept. It starts with awareness of a patient's ethnicity or community and, in culturally safe practice, growing concerns with social justice \... and nurses' power, prejudice, and attitude. **Cultural Safety Today** Today, the term ***cultural safety*** is used mostly in academic studies and government reports, but it has also been adopted by some Aboriginal communities in Canada. **The LEARN Model** The LEARN model is one framework for teaching cultural competence that is action-oriented and focuses on what health care providers can do: - **L**isten with sympathy and understanding to the patient's perception of a problem. - **E**xplain your perceptions of a problem. - **A**cknowledge and discuss differences and similarities. - **R**ecommend treatment. - **N**egotiate agreement. **Health Care Partnerships** - In 1998, the authors of Partnerships in health care: Transforming Relational Process suggested that the ability to form and sustain true partnerships was the most important competency for health care providers to acquire. - This continues to be the focus of health system reform. - Health care providers who partner and attend to the relational processes of care (for example, information sharing and assisting the person with the decision-making process based on the person's capacity) rather than focusing only on treating the person's disease help the person achieve goals for their health that they cannot achieve alone. - Person and family-centred care must be based on the development of a true partnership within the therapeutic relationship that recognizes, supports, and values the diversity, distinguishing features, and contributions of all participants (the person, the person's family, and health-care providers) and encourages genuine responsive actions and behaviours. - Health care partnerships evolve and are impacted by multiple internal and external factors as well as by the duration of the partnership. **Themes in Person and Family-Centred Care** - Establishing a therapeutic relationship for true partnership, continuity of care, and shared decision making - The existence of a therapeutic relationship between the person and health-care providers is central to person- and family-centred care". - Potentially "optimize the person's health and wellness". - Goal is to "establish trust, partner, and share decisions on appropriate health care and services". - Care is organized around, and respectful of, the person - For a person to be satisfied with health care services, care must be organized with and around the person. - Care must be respectful and reflective of the person's: Voice, Needs, Culture, Values, Beliefs, Changing health states, Life circumstances - Knowing the whole person (holistic care) - A person is not defined by their disease or their illness. - Person and family-centred care includes the philosophy of holism. - Through partnerships and therapeutic relationships, health care providers come to know the whole person, their goals, beliefs and values, culture, experience of health and life circumstances, and care needs. - Communication, collaboration, and engagement - Person and family-centred care requires a change in the health care culture and attitudes and behaviours of health care providers. - They must develop relationships, communicate, collaborate, encourage partnerships, and share information related to decisions on health care and services. - To optimize health outcomes and improve the quality and safety of their services, organizations must support health care providers to redesign their partnerships with those receiving care. - Health care providers must use effective and therapeutic communication with the person and promote their active engagement in decisions for their health.