Patient and Family-Centered Care PDF

**DAY 6 - PATIENT AND FAMILY CENTERED CARE** **Communication Practices\ ** **Respecting Diversity is Very Important** - Culturally sensitive communication is challenging to describe. - Cultural diversity relates to a person's country of birth, "their ancestry, the country of birth of the...

**DAY 6 - PATIENT AND FAMILY CENTERED CARE** **Communication Practices\ ** **Respecting Diversity is Very Important** - Culturally sensitive communication is challenging to describe. - Cultural diversity relates to a person's country of birth, "their ancestry, the country of birth of their parents, languages spoken, Aboriginal descent, religious affiliation, ideas, belief systems, customs, and social behaviour. - Health care providers need to be aware of patients' preferences that are impacted by cultural diversity and the importance of communication to prioritize safety and equity in health care. - Cultural sensitivity requires an awareness of cultural diversity, including how culture may influence patients' values, beliefs, and attitudes, and involves acknowledging and respecting individual differences. - Research suggests that clinicians may not know how to communicate with persons from culturally diverse backgrounds and when communication is not culturally sensitive, there is a potential for it to negatively impact the care provided, and patient and family satisfaction. **Impact of Culturally Sensitive Communication** - Shows "respect for and promotes patient and family satisfaction" - Health care providers try to meet individualized patient needs by using verbal and nonverbal communication. - When communication is not culturally sensitive, patients and families are less likely to be satisfied with their perceptions and experiences of care, there is an increased risk of miscommunication, and cultural disparities may result -- leading to poor adherence to treatment, poorer health outcomes, and an increased prevalence of adverse events. **Definitions of Cultural Sensitivity** 1. Culture 2. Cultural Sensitivity 3. Communication in Health Care **1. Culture** "The knowledge, beliefs, arts, morals, laws, customs, and any other capabilities and habits acquired by a human as a member of society." **2. Cultural Sensitivity** "The ability to recognize, understand, and react appropriately to behaviours of persons who belong to a cultural or ethnic group that differs substantially from one\'s own." **3. Communication in Health Care** - The exchange of information between a patient and their health care provider and includes communications with the family and career - It involves two-way communication (spoken, written and non-verbal) that engages patients in decision making and care planning. - It is tailored, open, honest, and respectful and there is an opportunity for clarification and feedback. **How Do We Use Culturally Sensitive Communication?** - Developing an understanding about one's own cultural beliefs, values, attitudes, and practices and those of others - To describe open and sensitive communication - To describe strategies used to collaborate with the patient and family for optimal care **The Importance of Understanding One's Own Culture** - The essential first step to learning about other cultures is an awareness of one's own cultural beliefs, values, attitudes, and practices. - Important because cultural beliefs have the potential to be very different from a health care provider's own cultural belief. It is important that health care providers realize this and respect the differences. - Being sensitive and adaptive to individual cultural differences rely on clinician self-awareness and reflection and can lead to greater interpersonal cultural awareness and associated patient and family satisfaction. - By increasing one's knowledge and understanding of different cultures, cultural beliefs, values and attitudes, clinicians are more likely to provide individualized care for patients that is culturally sensitive. **The Importance of Open and Sensitive Communication** - This includes active listening and respect of an individual's cultural beliefs and practices. - Active listening and respect relate to interactions that are transparent, and foster a therapeutic relationship built on trust and respect. - Examining ways in which patients and families from diverse cultural backgrounds communicate; including verbal and nonverbal cues, and how this examination may differ within and amongst cultures is necessary for attaining cultural sensitivity. **Collaborating with Patients and Families** - Culturally sensitive communication is also essential for collaborating with the patient and family in decision-making regarding care. - Clinicians who use culturally sensitive communication can demonstrate an understanding of patient and family beliefs, goals, and values. - This approach includes family-centred care, which involves respectful and supportive interactions with the family, fostering partnerships and promoting continuity of care. - Recommended initiatives to increase family participation in patient care include listening to the family and encouraging family members to speak first and to contribute to care planning and decision-making, ahead of clinicians. - Other initiatives include familiarizing the family with the hospital environment to assist family members to interpret the clinical environment in a culturally meaningful way, and decrease any fears and insecurities associated with the hospital environment and care provided. ***Important Attributes for Facilitating Culturally Sensitive Communication*** **Engaging in Open Communication** - Encourage patients and families to participate in communication and decision making to the extent that they feel comfortable doing so. - Health care providers should be encouraged to engage in open communication by encouraging patient and family input, and by promoting effective interactions to overcome communication barriers. **Prioritizing Cultural Considerations in Care** ***Can be achieved by:*** - Showing respect for the culture of the patient and their family by inquiring about the patient's and family's values, beliefs, and practices - Obtaining information about the patient's perceptions and beliefs associated with their presenting illness - Assessing the individual's psychological, physiological and sociocultural needs, secondary languages, non-verbal communication techniques, religion, and food preferences - Results need to be shared with other health care providers sharing in the care for the patient, verbally, and in writing in the medical record, and integrated into a care plan **The Importance of Trusting Relationships** - Trusting relationships are achieved through using open and non-threatening body language that demonstrates a willingness to help and learn. - Trusting relationships are critical to the communication process between clinicians, the patient, and family. - Use communication strategies that demonstrate an interest in the patient's cultural practices. - Imperative actions to develop trust are active listening, using appropriate body language, using the patient's actual words to communicate, and being flexible and respectful to the needs, beliefs and practices of the patient and their family. **Use an Interpreter** - An interpreter is trained professional who participates in the dialogue between the patient, family and health care provider, to address language, cultural, and communication difficulties. - The use of a professional interpreter is ideal instead of staff or family members, to ensure accurate, unbiased information is being communicated. - Accurate interpretation is crucial to clinician-patient and clinician family interactions, as it demonstrates respect for the other person's language and input, contributing to the development of a trusting therapeutic relationship. **These Foundational Aspects Support and Impact Culturally Sensitive Communication:** 1. Environment and Culture 2. Organizational Structure and Policies 3. Education and Communication Experience of the Health Care Provider 4. Sociocultural Characteristics of Patients, Families, and Health Care Providers **1. *Environment and Culture*** - The environment and culture of the unit impacts the communication experience for health care providers, patients and families. - The design of the clinical area, the accessibility of family spaces within patient rooms, and the private areas assigned for sensitive conversations, differ within health care facilities and may impact a provider's capacity to prioritize cultural considerations and participate in culturally sensitive communication. - A strategy to foster interdisciplinary collaboration for effective culturally sensitive communication includes implementation of interdisciplinary simulation-based training. - Teams are better equipped than individual practitioners to provide holistic care to patients and families with complex needs, as there is a larger group of individuals with a range of cultural knowledge and skills. - Fostering a culture of interprofessional collaboration is essential to delivering culturally sensitive communication. **2. *Organizational Structures and Policies*** - Organizational structures, including hierarchy and significant power differences between physicians and other health care professionals, and health care policies influence the outcomes and satisfaction of patients and families. - Organizations need to ensure policies are supportive of and enable culturally sensitive communication. - An environment that fosters effective communication practices requires organizational support through policy, resources and professional development opportunities to enhance critical skills and knowledge related to culturally sensitive communication. **3. *Education and Communication Experience*** - The availability of education---to the health care provider--- on culturally sensitive communication directly impacts the quality of culturally sensitive communication. - Undergraduate programs that have been implemented using guidelines for culturally sensitive communication skills with nursing students, have been associated with increased patient satisfaction. **4. *Sociocultural Characteristics*** - Culturally sensitive communication may be influenced by the sociocultural characteristics of patients, families, and clinicians, if they differ in their beliefs regarding decision making, supportive care, and active treatment. - Shared decision making is recognized as a prerequisite for optimal patient and family outcomes. - Sociocultural characteristics that influence culturally sensitive communication include the languages spoken at home, cultural values, religious beliefs, and socioeconomic background. ***MODELING: Results of a Scoping Review on Patient and Family Centred Care*** **Context: Patient and Family-Centred Care (PFCC)** - Families are foundational in caring for individuals with health issues. - A caregiver is defined as an unpaid family member, close friend, or neighbour who helps with daily activities. - The definition of family is "the patient, caregivers and other family members". **Definitions of PFCC** - Family-centred care addresses the needs of the patient and their family. - The Institute for Patient- and Family-Centred Care (IPFCC) defines family-centered care as "mutually beneficial partnerships between health care providers (HCPs), patients, and families in health care planning, delivery, and evaluation. - Perrin and colleagues define family-centred care as an organized system of health care, education and social services offered to families, that permits coordinated care across systems. - In palliative care, family-centred care is defined by Gilmer as a seamless continuity in addressing patient, family, and community needs related to terminal conditions through interdisciplinary collaboration. - In the broadest scope, the notion of family-centred care embraces the view of the care-client as the patient and their family, rather than just the patient. **Themes in PFCC models** - Overall objective of family-centred care models is to create and support patient care plans that are developed addressing each family scenario. - Patients, families, and health care providers (HCPs) are "key partners who should contribute to the clarification of care plan goals". - Care plans should consider the day-to-day ways of living for patients and families by encouraging the maintenance of home routines. - Potential goals identified included achieving family and patient identified functional milestones like a new motor skill (for example, running); decreasing delays, or complications at hospital discharge; improving patient and family satisfaction with care; and improving caregiver support. - From the initial diagnosis, the models championed that all members of the patients care team should elicit families' perspectives regarding priorities, families' needs and concerns, and their abilities to provide care. - Understanding families' needs and priorities was deemed important and as contributing to realistic and better-defined outcomes, as well as important to enhance families' abilities to support the plan and optimize patient outcomes. - The models also emphasized that HCPs and family members should share in the implementation of the care plan. - Care delivery starts when everyone agrees with the care plan - Family members should be encouraged to communicate any issues or priorities they have regarding care to HCPs. **Model Components There are many parts that are consistent to patient and family-centred care models:** 1. Collaboration 2. Communication 3. Education 4. Family Support Needs 5. Policies and Procedures **1. Collaboration** - Foundational in the creation of care plans - Trusting, caring, and collaborative relationships between families and HCPs were identified as key and efforts should be undertaken to cultivate them. - In this collaborative relationship, HCPs were encouraged to relinquish their role as a single authority. **2. Communication** - Support improved "communication and exchange of information and insights among family members, patients and HCPs related to the development and delivery of care plans". - Communication is encouraged to be "open, timely, complete and objective". - HCPs should "use a variety of strategies to communicate with and support caregivers and patients, including interdisciplinary care and diagnostic reports, community follow-up in-person or by virtual meetings, and resource notebooks listing community supports to help care for the patient". - HCPs were also encouraged to communicate disease-specific information to help patients and family members make appropriately informed disease-related decisions. **3.** **Education** - Models advocated for training of HCPs to effectively elicit information and communicate with patients and family members. - This was believed "to decrease anxiety and increase control for patients and caregivers". - Information should be presented at a language level that is understandable to the family and patient. - Education is believed to foster a sense of trust and help patients and family members become more knowledgeable. - Leads to patients and families developing the capacity to make informed treatment decisions - When patients share their experiences with other patients, it has been seen to empower other patients. **4. Family Support** - Family members may experience a negative impact on their own well-being as part of the ongoing demands of caregiving. - Recognizing that families are often psychologically stressed and can have difficulties coping, family-centred care models emphasized support for family members' well-being. - Supporting families often included emotional support and providing education and training on care delivery that considers caregiver needs. - Family-centred care models emphasized that care recipients function best in a supportive family environment. - Identifying the impact of the illness on the patient and the family is crucial to providing emotional support. - Information about support needs should be gathered from both patient and family. - Organizational support should make existing health service community resources more family-centered to support ongoing care when the patient is discharged. - Areas of support to families "included, mental health, home care, insurance/financing, transportation, public health, housing, vocational services, education, and social services". **Family Strengths** - Families have unique strengths that should be identified, enhanced, and utilized. - Examples of family strengths in care delivery including resilience, coping strategies, competence, and skill in providing care and motivation. **Cultural Values** - Families were thought to contribute to a culturally sensitive care plan by discussing their specific cultural needs, as well as their strengths related to personal values, preferences, and ideas. - Caregivers' social, religious, and/or cultural backgrounds can influence the provision of care to their family member. **5. Policies and Procedures to Support Implementation** - Family-centred care models should be accompanied by dedicated and easily accessible policies and procedures. - Policies should be included at the national, provincial, and municipal levels as well as with physicians\' offices, schools, transportation and more. - Examples include "incorporating families in nation-wide policy making and program development, incorporating family members and patients in decision-making for local community organizations, the implementation of health programs and care policies at regional hospitals, as well as in HCP education".