Patient- and family-centered care (PFCC) is often mentioned when discussing quality outcomes for care recipients. The theoretical framework of PFCC proposes that family influence and presence impacts each patient’s strength and resilience. Incorporation of the knowledge, priorities, and beliefs of the patient and their family affirms and fosters their participation in decision-making. The Institute for Patient- and Family-Centered Care put forward the core concepts of PFCC, which include respect and dignity, information sharing, participation, and collaboration.
A key point to consider is that each patient defines their family, and each patient determines the family’s level of participation in the patient’s care. Nurses and other clinicians must listen to patients and families and incorporate care recipients’ choices and beliefs into the plan of care. Although a plethora of published literature about PFCC exists, important questions may persist. For example, does engaging family members in a patient’s healthcare management aid the healing process?
Not just for pediatrics
Historically, the concept of family-centered care has been a priority in the pediatric setting. In pediatrics, we recognize that parents and family members are more knowledgeable about the child’s condition and responses to care than healthcare professionals. Parents and family are acknowledged as an indispensable part of their child’s illness experience. Consequently, during a child’s hospitalization and illness, one goal of pediatric nurses is to minimize stress for the child by encouraging parent-child contact and by maintaining the child’s familiar routines and rituals.
Despite this focus on the care of children, family-centered care also is appropriate as patient-focused or person-centered care across the lifespan and across all settings. For example, clinicians providing healthcare services to older adults must implement developmentally appropriate approaches to this population that communicate cultural sensitivity and humility. Person-centered care for older adults must prioritize reducing health disparities, leveraging technology as appropriate, engaging end-of-life resources for holistic care, and embracing chronic disease models that optimize quality of life and functioning.
Significance of PFCC
PFCC care is a collaborative approach that includes patient and family preferences and perspectives in all aspects of care management. Respect for the patient’s family is integral to the development of the healthcare management plan. Nurses facilitate a collaborative relationship with the patient by seeking out and actively listening to the patient and family members. Thus, an individualized plan of care is created and implemented jointly with the patient and family members. Becqué and associates noted that as family members frequently perform caregiving roles for their loved ones, the family’s perspective in the plan of care is essential.
The social and emotional needs of families also are a critical part of care. Supporting and meeting the needs of the family minimizes the likelihood of negative outcomes for the patient. Strategies to address the social and emotional needs of the patient and family include administering a questionnaire during a healthcare encounter, identifying family strengths as coping strategies, and incorporating the patient’s and family members’ cultural values and preferences into the healthcare plan to ensure honesty, transparency, and respect.
Role of the nurse
Delivery of integrated care requires that nurses and other members of the healthcare team develop therapeutic interpersonal relationships with patients and their families. A report by Younas and associates found that patients expect nurses to be knowledgeable about living situations and social care needs. However, the only way to obtain accurate information is to ask and show interest and concern for patients from a holistic perspective. Nurses are expected to interact with patients and families in a genuine, honest, transparent, and ethical manner and to empathetically understand and care for their basic psychological needs.
PFCC can help improve communication and build relationships, which is perceived by patients as spending sufficient time with them, attentively and patiently listening, and exchanging information. Patients and families need to sense that healthcare professionals care about them and demonstrate empathy in their interactions.
The nurse demonstrates that the patient is known and seen by addressing the patient and family members by name without the need to constantly look at the medical record. Information reported previously by patients and families should be reviewed before entering the room where the patient encounter will occur. Families feel known and cared about when the nurse or provider includes previously discussed stories or preferences in their discussions. Families’ perceptions of common understanding with healthcare providers is key to compassionate, culturally sensitive care.
Implications for nursing practice
The nurse’s caring presence as an advocate for patients and families is essential and includes nonverbal actions and positive body language. Eye contact, handshakes, physical touch, unhurried behaviors, and expressions of genuine concern are cultural actions that portray sensitivity, respect, and inclusiveness. The essence of evidence-based quality care is shared responsibility for outcomes. Provision of PFCC results in increased patient satisfaction, closer adherence to care management plans, and improved health outcomes.
Jennifer Coleman PhD, RN, CNE, COI, ANEF and Cynthia G. Cortes DrPH, MSN, MRE, CPNP-PC, COI are professors at Samford University in Birmingham, Alabama.
References
Becqué YN, Rietjens JAC, van der Heide A, Witkamp E. How nurses support family caregivers in the complex context of end-of-life home care: A qualitative study. BMC Palliat Care. 2021;20(1). doi:10.1186/s12904-021-00854-8
Institute for Patient- and Family- Centered Care. ipfcc.org/about/pfcc.html
Institute of Medicine Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001.
Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Press; 2003.
Younas A, Inayat S, Molin AD, Durante A. Nurses’ challenges to developing interpersonal relationships during integrated care for complex patients. West J Nurs Res. doi:10.1177/019394592311897892023;45(10):894-901
