|dc.description.abstract||The principles of patient- and family-centred care (PFCC) have been adopted by healthcare services internationally, and position patients and their families in their rightful place at the centre of care. Further, these principles emphasise that patients and families should be treated with dignity and respect, be active partners in all aspects of their care, and contribute to the development and improvement of health care; yet how this is enacted in an adult acute hospital setting is not well understood. Therefore, to promote PFCC practices in the adult hospital setting, it is vital to understand how family participation is enacted and what helps or hinders the adoption of this approach in practice.
The purpose of this research was to examine the beliefs, attitudes and perspectives of patients, family members and acute care nurses relating to PFCC practices in hospitals. To achieve this, a mixed-method, exploratory, sequential two-phase study design guided by naturalistic inquiry was used. It included interviews and observations of practice. Potential barriers and facilitators were also explored to identify ways in which the practice of family participation in patient care within hospitals could be supported. The setting for this study was a medical assessment and planning unit of a regional referral hospital in Australia. The selection of this ward was guided by the results of a hospital-wide survey using the Families’ Importance in Nursing Care – Nurses’ Attitudes (FINC-NA) survey and reflected a unique case sampling approach. Observer-as-participant observations were conducted in Phase 1 to describe the existing situations and patterns of behaviours related to family participation in patient care within an adult acute care ward. Analysis of Phase 1 data informed questions that were used in semi-structured interviews in Phase 2. Thirty hours of observational data were gathered. Eighteen patients, 15 family members and 14 nurses were interviewed. Following separate inductive content analysis, data were triangulated.
Findings from the discrete analysis of patient, family and nurse data revealed that most patients and families perceived staff communication as disconnected and inadequate, which constrained them from engaging in care processes or decision-making. However, when families felt empowered and participated in patient care, patients and families believed the quality of care was enhanced. Furthermore, analysis of nurse participant data revealed that nurses’ practices do not always align with healthcare policies. Nurses’ attitudes and beliefs towards involving family in care were perceived to either help or hinder family engagement in patient care planning and decision-making. Consequently, strategies should be implemented to support nurses to enact patient- and family-centred practices that align with national and international standards.
Methodological triangulation of the discrete data was paramount and revealed that supporting meaningful family participation in the acute care setting requires supporting multiple levels of engagement. Further, these different levels of engagement are all legitimate depending on the goals, wishes, time frames of care and capabilities of patients and their families. Patients and family members expressed a shared view that family participation in care was vital because it helped nurses to keep the patient safe. Both patients and nurses stated family had a rightful role in making sure the correct treatments were given because their family often undertook a carer’s role and thus knew the usual healthcare routine.
Finally, a contribution of this study is a preliminary conceptual framework that suggests contextual factors, nurses’ views towards family members and interpersonal communication influence the level of family participation. This framework and its description provide insights into understanding key elements of family participation in an acute care setting. This has the potential to benefit patients and their families as nurses and researchers further explore supporting family participation in the clinical practice setting with consideration of the contextual factors identified in this study.||