Empowering Families to Create Better Patient Outcomes
July 23, 2013
By Mary Griffin Strom, MSN, RN, Consultant, Creative Health Care Management
Empowerment: definition from Wikipedia
to give or delegate power or authority to; authorize
to give ability to; enable or permit
A Great Family Empowerment Experience
My 14-old-daughter had a surgical procedure for a pilonidal cyst at the local hospital where I work, and from the beginning, the rules on family involvement were broken. I was allowed to be with her in the pre-op area until she was wheeled through the door to the OR, and I was brought back to post-op immediately upon her arrival there. I was not only welcomed, but involved in helping her drink fluids, go to the bathroom, manage her embarrassment, etc. She was able to complete all the necessary milestones for discharge much quicker due to my presence and my assistance.
A Not-So-Great Family Empowerment Experience
Fast forward a couple of years—I had my own surgical experience, a major thoracic surgery for a malignancy at a large academic medical center, where I knew very few people. My family was often treated like visitors at best, and intruders at worst. They were not allowed to stay with me in pre-op through the meeting with anesthesia or the epidural and art line placement, both painful and scary procedures. How I hated that they had to stay in the waiting room during the two-hour prep time, while I worried about them and they worried about me.
The surgery was long and complicated, and I lost a couple of days of consciousness while in the ICU. My family spent much more time in the waiting room than they were allowed to spend with me, due to the strict enforcement of the 10-minutes-every-two-hours visiting rule.
Now that this episode is behind me, I find myself wondering, “Would it have been different if I had worked there? If they knew me? If I had a relationship with the staff?” Then I wondered why that should matter. Don’t all of our patients/families deserve the very best care that we seem, in my experience, to reserve for only a select few?
The Importance of Family in Healthcare
As a facilitator of Relationship-Based Care sessions with healthcare providers, the discussions/dialogues/exercises are intended to rekindle and reawaken the caring, compassionate side of healing and health, and I am often struck by how often participants talk about how important their family is to their balance in life, and that it is family that matters the most in the world.
When one is sick, injured, fearful, who would you want by your side helping you? Holding your hand? Guiding, asking questions, nurturing, and supporting? The answer for most of us is family, of course. Yet, when I challenge participants in my workshops to explore how an organization’s policies, procedures, practices, and behaviors impede family involvement and inclusion, they are often reluctant to take action to eliminate some of the obstacles and barriers that get in the way for families. They like having the rules to “lean on” when they have to deal with a difficult family. It’s important to realize, however, that the people we’ve been calling “difficult families” may be responding to the fact that we have treated them like “visitors” versus an instrumental part of the whole experience.
Why do we post visiting hours signs for family? They are not visitors, are they? Are they not allowed to come earlier in the day and stay later at night if that works for the patient and family schedule? Why don’t we ask them? What would be the outcome of individualizing rest/activity/procedure times in ICU? What would happen if we invited families to participate in daily/shift rounds and hand-off reports? How would they feel if we turned to them and asked, “Do you have any questions, or do you have anything to add?”
Empowering Families Can Lead to Better Care Outcomes
We need to empower families to be partners with us, not visitors to the room. This is true patient/family empowerment in their care—inviting their input so that we design the best care for that individual and help them to be a healing presence for their loved one. We need to give them permission, to authorize them, to delegate to them that they are the experts, and that they have lots to teach us about what matters to their loved ones. This is empowerment for families, and I dare say, it is also indicative of an empowered health care team.
Throughout her career, both as a nurse at the point of care and as an administrator, Mary has seldom used the word “patient” without the word “family” following right behind it. Currently, Mary is a consultant at Creative Health Care Management, where she partners with health care organizations on team building, patient safety and quality, leadership development at all levels, physician engagement, and patient experience. Mary can be contacted at firstname.lastname@example.org