Theories in Action and How Nursing Practice Changed

Rogers’ theoretical framework of diffusion of innovation guided the successful infusion of the educational training and implementation of the Magis model of care at a 570 bed hospital in the Chicagoland area. The Magis model of care was derived from several nursing theories along with information from the Institute of Family-Centered Care. By incorporating the components that relate to the institution’s values and Magnet theme, the stages of innovation were readily adopted and sustained over the first year of implementation. The model has spread beyond the original and sister units as demonstrated by another department creating the Magnet poster with the various elements that they have incorporated into daily care delivery. What is so invigorating to the nursing administration is hearing how nursing staff articulates the care they give to the various components of the model and the theory that supports this practice.

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Emancipatory reflection on a nursing practice-based ethical issue about nurses’ paternalistic decision-making for patients

Frontiers of Nursing ◽

10.2478/fon-2019-0005 ◽

2019 ◽

Vol 6 (1) ◽

pp. 19-26

Author(s):

Lian-Lian Tang

Keyword(s):

Decision Making ◽

Ethical Issue ◽

Nursing Practice ◽

Professional Socialization ◽

Nursing Administration ◽

Patient Centered ◽

Socialization Theory ◽

Decision Making Capacity ◽

Centered Care ◽

Policy Work

Abstract Objective This study aimed to demonstrate and promote the skill of critical emancipatory reflection through reflecting on a nursing practice-based ethical issue about nurses’ paternalistic decision-making for patients. Meanwhile, critical awareness will be developed and the underlying issues of paternalism in nursing decision-making will be analyzed. Then, by applying the procedure, improvement in nursing decision-making practice will be expected. Methods Taylor’s model of emancipatory reflection with four steps, including construction, deconstruction, confrontation, and reconstruction, is utilized to guide the author’s reflection. Results Guided by the socialization theory, the author’s personal and professional socialization is seen to be associated with the formation of the value of paternalism. The theory of reflexivity is applied to unearth the related issues, including deeper personal value, work environment, as well as historical and cultural contexts. Moreover, the power derived from policy, work relationship, and nursing administration, which could induce paternalism in the author’s nursing decision-making practice, was critically debated using the hegemony theory. Finally, new insights into paternalism will be achieved, which enable change in terms of how to facilitate patients’ autonomous decision-making. Conclusions The process of refection makes it clear that respecting patients’ right and performing patient-centered caring are the bases to change the paternalism existing in the nursing decision-making practice currently. The reconstruction step assists the author in terms of how to value the patients’ autonomy and balance patients’ safety and choice, rather than being overprotective; carry out risk assessment, and search for strong evidence to counterbalance the positive and negative aspects of risk-taking; communicate with patients appropriately in a manner that they can comprehend; spend more time to explore patients’ preference and choice; make every effort to elevate the patients’ decision-making capacity; implement patient-centered care and shared decision-making in nursing practice; consult with other colleagues and obtain the required support when limitations or challenges exist; try to justify and avoid hidden paternalism behind policy or guidelines; deal with the power in hand well and fairly; and also positively face the powers that constrain the author.

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Best Practice for Family-Centered Health Care

10.1093/med/9780190276201.003.0027 ◽

2017 ◽

Author(s):

Joanna Sturhahn Stratton ◽

Katherine Buck ◽

Allison M. Heru

Keyword(s):

Health Care ◽

Family Involvement ◽

Best Practice ◽

Model Of Care ◽

Patient Centered ◽

Step Model ◽

Essential Components ◽

The Family ◽

Centered Care ◽

Family Centered

The patient-centered medical home is a strong model of care that can be improved by harnessing the power of the patient’s family. This chapter highlights a three-step model of family involvement in patient care: (1) family inclusion, (2) family education and support, and (3) family systems therapy. The model is grounded in evidence-based research and incorporates the essential components of integrated care. A clinical case example illustrates how to involve the family in a stepwise progression. This model of family-centered care is applicable in any health care setting.

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Family Care before and after Bereavement

OMEGA - Journal of Death and Dying ◽

10.2190/om.56.1.c ◽

2008 ◽

Vol 56 (1) ◽

pp. 21-32 ◽

Cited By ~ 18

Author(s):

David Kissane ◽

Wendy G. Lichtenthal ◽

Talia Zaider

Keyword(s):

Hospice Care ◽

Controlled Trial ◽

Family Care ◽

Model Of Care ◽

The Family ◽

Before And After ◽

Centered Care ◽

Therapy Model ◽

Family Centered

Distress reverberates throughout the family during palliative care and bereavement, inviting consideration of a family-centered model of care. Targeting families thought to be “at risk” has merit. The Family Focused Grief Therapy model was tested in a randomized controlled trial of 81 families (353 individuals) and bereavement outcome is reported here for treatment completers compared to controls. There were no significant baseline differences between treatment completers and non-completers. Significant reduction in distress occurred at 13 months post death for the families completing treatment, with further improvements for the 10% of individuals most distressed at baseline. A preventive model of family-centered care applied to those at greatest risk is meritorious and in keeping with the aspirations of Cicely Saunders for improving the quality of hospice care.

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115 An Evidence-Based Model of Care for Newcomer Children with Special Health Care Needs

Paediatrics & Child Health ◽

10.1093/pch/pxaa068.114 ◽

2020 ◽

Vol 25 (Supplement_2) ◽

pp. e47-e48

Author(s):

Ayesha Rizwan ◽

Shazeen Suleman

Keyword(s):

Chronic Illnesses ◽

Health Care Needs ◽

Model Of Care ◽

Care Needs ◽

Special Health Care ◽

Centered Care ◽

Canadian City ◽

Evidence Based Model ◽

Family Centered ◽

Special Health

Abstract Background In 2018, Canada resettled the most refugees in the world, in response to the greatest migration crisis in global history. The refugee and resettlement experience at critical stages of children’s development places children at risk for a number of chronic illnesses. Newcomer children with chronic illnesses or special health care needs (NCSHCN) require services and care providers across many systems, but face greater barriers to healthcare access and are at an increased risk of unmet needs, yet no research has been done to identify best practices for this vulnerable population. Objectives To develop an evidence-based model for high-quality, patient-centered care for NCSHCN and identify areas of need in a large Canadian city with a high density of newcomers. Design/Methods Using formative research design, a literature review and thematic analysis was performed to develop a conceptual model of care for NCSHCN. Next, a local environmental scan was conducted to identify and evaluate current clinics serving newcomers in a large urban Canadian city. Variables collected included the constructs identified in the conceptual model, and information about population served, providers and services offered including access to paediatrics. Results 326 studies were identified, of which 43 studies underwent full-text review and 21 were included in the final synthesis. Six key components were identified to best support NCSHCN: access to interpreters and appropriately translated resources; delivery of culturally competent care; access to care coordination and system navigation; longer appointment times; family-centered care through medical homes and home-based services; and an enhanced knowledge and understanding of health insurance processes. The environmental scan identified 50 clinics and programs serving newcomers, with 88% providing referrals to paediatric services but only 12% with a paediatrician on-site. Eighty-eight percent offered some form of interpreter services and while 71% offered patient navigation/care coordination services, only one program was specific to navigating child health services and programs. Conclusion We propose a data-driven model of care for NCSHCN that can reduce the intersecting disparities these families face by promoting equitable access to health and community services, thereby improving child outcomes and quality of life. While many programs for newcomers exist, access to paediatric services remains elusive and training in cultural competency and insurance processes is variable. More programs that integrate paediatric services into the community to make quality care more accessible and family-centered are required.

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Enhancing Nursing Practice and the Patient Experience in the BMT Program Using the Principles of Patient- and Family-Centered Care

Biology of Blood and Marrow Transplantation ◽

10.1016/j.bbmt.2012.11.584 ◽

2013 ◽

Vol 19 (2) ◽

pp. S366

Author(s):

Amy E. Patterson ◽

Nancy W. Newman ◽

Debbie Phillips ◽

Rebecca Ray ◽

Theresa Papa-Rodriguez ◽

...

Keyword(s):

Patient Experience ◽

Nursing Practice ◽

Family Centered Care ◽

Centered Care ◽

Family Centered

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Oncologists' attitudes towards patient and family-centered care.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.29_suppl.111 ◽

2015 ◽

Vol 33 (29_suppl) ◽

pp. 111-111

Author(s):

Timothy K. Nguyen ◽

Glenn Bauman ◽

Christoper J Watling ◽

Karin Hahn

Keyword(s):

Patient Autonomy ◽

Care Delivery ◽

Family Centered Care ◽

Structured Interviews ◽

Roles And Responsibilities ◽

Continued Education ◽

Creative Solutions ◽

Centered Care ◽

Physician Support ◽

Family Centered

111 Background: Patient and family-centered care (PFCC) represents an evolution from traditional models of provider-focused and patient-focused care that places a strong emphasis on optimal patient communication, patient autonomy, and shared decision-making within care teams. A shift towards PFCC requires participation across all provider groups. Despite the importance of physician buy-in, research examining physicians’ perspectives on PFCC is lacking. We sought to explore oncologists’ familiarity with the principles of PFCC and perceived barriers to implementing principles of PFCC. Methods: In this qualitative exploratory study, we conducted semi-structured interviews with 18 oncologists (8 radiation, 4 medical, 4 surgical, 2 hematologist-oncologists) at a single Canadian academic cancer institution. Interview data were analyzed using coding principles drawn from grounded theory. Constant comparisons were used to identify recurring themes. Results: We identified 3 dominant themes related to physicians’ interpretations of PFCC: 1) Physicians expressed a limited understanding of the formal principles of PFCC, 2) Physicians identified patient autonomy as essential to PFCC and 3) Disparities between patient and physician objectives exist and result in compromises that may affect the quality of PFCC delivered. Oncologists perceived that spending more time with patients improved PFCC, but also recognized that it would leave less time for other necessary activities. Participants also identified a number of ‘system’ barriers to PFCC, including limited staff and clinical space, excessive case load, a lack of physician support and input into operational decisions, and funding constraints. Many felt that PFCC was challenged by inefficiencies in the system of care delivery, and that progress might lie in reorganization to more clearly match health care staff’s roles and responsibilities to their credentials and skills. Conclusions: Advancing PFCC in our institution will require continued education of physicians regarding the principles of PFCC, acknowledgement and preservation of the PFCC behaviors already in practice and creative solutions to address the system issues that may hamper their abilities to enact PFCC.

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Family Presence in the Adult Burn Intensive Care Unit During Dressing Changes

Critical Care Nurse ◽

10.4037/ccn2013116 ◽

2013 ◽

Vol 33 (1) ◽

pp. 14-24 ◽

Cited By ~ 14

Author(s):

Sarah M. Bishop ◽

Mandi D. Walker ◽

I. Mark Spivak

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Care Delivery ◽

Infection Rates ◽

Family Presence ◽

Staff Members ◽

Discharge Readiness ◽

University Of Louisville ◽

Centered Care ◽

Family Centered

ObjectivesTo improve communication, discharge readiness, and satisfaction of burn patients and their families.MethodsIn March 2009, the burn intensive care unit at University of Louisville Hospital, Louisville, Kentucky, incorporated family presence during dressing changes. Adverse family events during observation, measures of patient- and family-centered care according to a standardized patient satisfaction survey, infection rates, and staff members’ response to the intervention were tracked.ResultsThrough December 2011, no adverse family events occurred, patients’ satisfaction scores increased, and infection rates did not increase. Staff members responded positively to the project.ConclusionsAllowing family presence during dressing changes provides an opportunity to educate and include patients’ family members in care delivery.

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