Across the country, hospitals and other medical institutions are acknowledging the importanceof including the family in critical medical and mental health decisions.
Gone are the days where the clinician makes decisions without the patient's and family's input. In essence, there has been a paradigm shift, where the cultures of many health care organizations are not only inclusive of families, but also are actively recruiting their involvement.
The goal is to empower families to ask direct and courageous questions by giving them access to medical information and placing more emphasis on the importance of human interactions among all health care providers (3).“Family-centered care within the nursing profession is not a new trend, with roots dating back as early as the 1950s” (4). However, it did not receive national recognition until 1987, when former Surgeon General Koop made it a primary initiative (5). These initiatives broadened the definition of family and acknowledged the diverse cultural backgrounds that make up families in our nation.
Smith, Terrel, and Conant (6) state in their article “Making family-centered care a reality,” that “Children get better faster when their emotional and social needs are met along with their medical needs—a hospitalized child is still first and foremost a child.”
While this statement may ring true for most children and families, the literature also suggests that providing family-centered care may be daunting for some practitioners. For example, Newton (7) states, “There is no consensus as to how much and what form of parental involvement should exist and how far that participation should extend.” Barriers such as balancing parental involvement and participation need to be addressed honestly and openly with the health care team. Keeping the child's medical condition in the forefront of decision making will allow a positive experience for all participants.
In an effort to gain a better understanding of family-centered care, Eichner and Johnson and The American Academy of Pediatrics have defined seven core principles (8) for the practitioner to incorporate into their interactions with families during each encounter to improve outcomes. Each principle is based on a collaborative relationship between family and health care practitioner.
1. Respect
2. Honoring racial, ethnic, cultural, and socioeconomic diversity and its effect on the families' experience and perception of care
3. Recognizing and building strengths of each child and family, even in difficult and challenging situations
4. Supporting and facilitating choices for the child and family about approaches to care
5. Ensuring flexibility in organizational policies and procedures so services can be tailored to meet the needs, beliefs, and cultural values of the family
6. Sharing honest and unbiased information with families on an ongoing basis in ways that are useful and affirming
7. Providing and/or ensuring formal and informal support for the child and parent/caregiver during each developmental phase
While patient satisfaction is the primary goal, the author also describes several benefits for the pediatrician (and other health care providers) as well (8). These include but are not limited to improved clinical decision-making from better information and a collaborative process; improved follow-through, as the family has been consulted; improved communication among health care team members; and greater child and family satisfaction with the health care team.
Family-centered care also recognizes that institutional leadership and policies must promote the family's best interests and support the activity of the direct care clinician. Although family satisfaction has increased from such initiatives as specialty meals, access to technology, and more inclusive visitor policies (eg, younger siblings), economic considerations exist. “Health care decision makers, providers, and third- party payers require evidence that family-centered care is not only effective but cost-effective” (9).