Family Centered Care - Advantages and Disadvantages

Advantages and Disadvantages

Family-centered care emerged as an important concept in health care at the end of the 20th century; but the implementation of Family Centered care was met with a variety of snags. Prior to the early 1990s, the relationship between care providers and patients was distant. The traditional model of care centered around physicians, and an expectation that patients and their families would assume a passive role as an observer, rather than a participant. Healing was treated largely as an abstract or business-like affair. Special requests by the patient were seen as interfering with the provision of their care or even as being a detriment to their health. Modern ideas like open visitation or care partners were almost unheard of and were generally dismissed as impossible to accomplish. This was compounded by the implementation of Health Maintenance Organizations, which successfully reigned in the rising healthcare costs of the 1970s at the cost of the patient-healthcare worker relationship.

Much of the early work on Family Centered care emerged from the pediatric and geriatric medicine fields; for example, as research came to light about the effects of separating hospitalized children from their families, many healthcare institutions began to adopt policies that welcomed family members to be with their child around the clock. As awareness increased of the importance of meeting the psychosocial and holistic needs of not only children, but all patients, the family-centered care model began to make serious headway as a bond fide intervention model. In the United States, this was further encouraged by Federal legislation in the late 1980s and early 1990s that provided additional validation on the importance of family-centered principles.

Beginning in the mid-90's (although elements of family-centered care began appearing in the early 1980s), however, this situation began to change. Studies began to show that many of the supposed detriments to family-centered care were negligible, not supported by research, or untrue. A study conducted in 2001 showed that open visitation had little to no effect on physiologic parameters such as heart rate, blood pressure, respiratory rate, cardiac arrhythmias, and intercranial pressure. Indeed, evidence suggested anxiety levels and general cardiovascular health were positively affected after the implementation of family-centered care, leading to fewer medical interventions being required (physical or chemical therapies in particular). Another area of concern, septic and infection control, found that as long as a patient's visitors were educated in the proper aseptic procedure (such as hand washing and use of hand sanitizer gel), infection control outcomes were not negatively affected by unrestricted visitation.

Patient care was also positively affected. Decubidation rates in facilities with family-centered care dropped significantly. In one study, it was found that patients receiving family-centered care were far more likely to have met the criteria of medical and nursing care plans (such as drinking x amount of fluids every eight hours, moving from NP suctioning to bulb suctioning, or the measurement of patient's intake/output), as the patient's family took it upon themselves to encourage or assist the patient in accomplishing these goals. Family and close friends were more likely to identify slight variations in the patient's mental or physical health that health care professionals largely unfamiliar with the patient may miss. Furthermore, while health care professionals are very talented at their work, their jobs are generally limited by the walls of the health care facility, whereas a patient's family is not. Enlisting a patient's family as a part of their health care team helps enable their ability to assist, manage, and assess the patient's healing after their discharge from a health care facility.

A study undertaken at the University of Virginia's Children's Hospital showed that sharing information and involving family in a patient's care (via the family-centered care model described previously) had the following effects:

• A rise in staff satisfaction due to reduced phone calls by security at night;
• Improved consistency of information given to family members;
• A decrease in clinical workload; and
• A significant rise in patient satisfaction scores on the Press-Ganey scale in the areas of Accommodations and Comfort of Visitors (93 to 98), Information Provided to Family (87 to 99), Staff Attitudes Towards Visitors (62 to 75), and Safety and Security Felt at the Hospital (86 to 88).