Journal http://jfn.sagepub.com/ of Family Nursing
Family Nursing Is More Than Family Centered Care Janice M. Bell Journal of Family Nursing 2013 19: 411 DOI: 10.1177/1074840713512750 The online version of this article can be found at: http://jfn.sagepub.com/content/19/4/411
Published by: http://www.sagepublications.com
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JFN19410.1177/1074840713512750Journal of Family NursingBell
Editorial
Family Nursing Is More Than Family Centered Care
Journal of Family Nursing 19(4) 411–417 © The Author(s) 2013 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1074840713512750 jfn.sagepub.com
Several articles in this issue of the Journal of Family Nursing focus on family centered care (Coyne, Murphy, Costello, O’Neill, & Donnellan, 2013; Foster, Whitehead, Maybee, & Cullens, 2013; McGavin, 2013). In this editorial, I would like to offer some distinctions between family centered care and family nursing, and declare my belief that family nursing is more than family centered care. I met Colleen McGavin (2013) at a Pre-Forum Deep Dive Session (a.k.a. preconference) in Vancouver called “Patient and Family Centered Care: From Concept to Practice.” I was invited to offer a keynote at the preconference sponsored by the British Columbia Quality and Safety Council. Colleen was a member of the panel who responded to my keynote. The audience was not my usual tribe of family nursing scholars and practitioners. Instead they were an interesting mix of front-line health care providers, legislators, administrators, and patient care advocates (like Colleen) who care about “quality” and “safety” and who have diverse ideas about what “patient and family centered care” is and how it could be done better. For more than half a century, a philosophy of care known as patient and family centered care (which had its origins in child health care) has advocated for a seismic shift in health care from patriarchy and paternalism to partnership, dignity and respect, information sharing, participation, and collaboration with patients and families (Johnson, 2000; Kuo et al., 2012; Wells, 2011). These values extend to viewing families as integral members of the health care team and conceptualizing the family as the unit of care (Shields, Pratt, & Hunter, 2006). Patient and family centered care has been endorsed at the highest policy levels in developed countries and privileged in mission statements of most health care systems which has prompted the creation of numerous institutes for patient and family centered care that provide resources and gather data about implementation (Abraham & Moretz, 2012a, 2012b). Yet, concern and some mystery remain about why patient and family centered care has not yet been successfully implemented and why it is still not uncommon to hear patients and families evaluate their relationships with health care providers as uncaring, difficult, and intimidating (Coyne, O’Neill, Murphy, Costello, & O’Shea, 2011; Shields, 2010).
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For many participants at the preconference, patient and family centered care seemed to be about creating systems and policies to reduce waste and “shadowing” (DiGioia, Lorenz, Greenhouse, Bertoty, & Rocks, 2010) to better understand what patients and families actually experience in a health care setting. For some, it meant changing the policy about “visiting hours” or inviting families to “bedside rounds” in hospitals or hanging whiteboards in hospital rooms to increase communication between families, health care providers, and patients. Some solutions were focused on reducing redundancy and long waiting hours or insuring patients are kept informed about who their care provider team is by posting photos of the staff on the wall of a hospital unit—all very useful and creative ways to insure that patients and their families receive quality care. My keynote address offered a bold assertion that at the heart of patient and family care are particular kinds relationships between patients, families, and health care providers that are shaped, in large measure, by the beliefs of the health care provider (see Slideshare: http://qualityforum.ca/qf2013/2013quality-forum/2013-presentations/keynote-getting-to-the-heart-of-the-matter/). Health care providers who believe that they have more education and expertise (therefore being more “right”) may be less interested in inquiring about or valuing the preferences of patients and family members or entering into collaborative relationships with them. Holding a belief that “I have no time to involve families,” or a belief that “If I talk to families and patients about things that matter to them, I might open a can of worms,” can constrain if and how relationships are established with patients and families and the kinds of conversations that are initiated. If health care providers believe, “I have confidence in my knowledge and skills about how to talk to families,” perhaps they would behave with more confidence to welcome, include, and acknowledge families as partners. Family nurses have developed a variety of practice models to guide generalist and advanced practice with families (for a list of practice models for nursing practice with families see: http://internationalfamilynursing.org/ resources-for-family-nursing/practice/practice-models/). For example, the Calgary Family Assessment and Intervention Models (Wright & Leahey, 2013), the Illness Beliefs Model (Wright & Bell, 2009), and the Trinity Model (Wright, 2005) identify relational family nursing interventions that guide the nurse to explore how illness has impacted their lives and relationships and be curious and vigilant about illness suffering. All family nursing interventions happen in the context of a nurse–family relationship and are enacted primarily through therapeutic conversation (Wright & Bell, 2009). A format for offering a brief therapeutic conversation has been developed by my colleagues Lorraine Wright and Maureen Leahey called the “15 Minute (or shorter) Family Interview” (1999, 2013). Sample interventive questions include, “How can we
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be most helpful to you and your family during your hospitalization?” or “If you could have just one question answered in our time together, what would that question be?” or “Who in your family is suffering the most?” Patients and families are asked these questions based on a belief of the nurse that “illness is a family affair” (Wright & Bell, 2009, p. ix). The patient is only half of the patient, the other half is the family. As a member of the panel who responded to my keynote, Colleen was invited to represent the “patient’s perspective.” She offered a compelling and reflective illness narrative about how serious illness has invaded her life and that of her family. The room became very quiet as she spoke. Colleen did not shy away from talking about her grueling experience of serious illness nor from offering her recommendations for what health care providers did that was helpful or could have done to show more patient and family centered care. Later, Colleen told me that when she has opportunities to influence positive change in patient and family centered care through her writing and speaking, her sense of well-being increases and her pain is less. Advocating for change, she has learned, can be healing. The family nursing interventions offered within brief therapeutic conversations are easy to learn and mentor. Recent research findings from the carefully designed Landspitali University Hospital Family Nursing Implementation Project in Iceland found that families and nurses benefit from therapeutic conversations with families (Halldorsdottir & Svavarsdottir, 2012; Kamban & Svavarsdottir, 2013; Sigurdardottir, Svavarsdottir, Rayens, & Adkins, 2013; Svavarsdottir, 2008; Svavarsdottir & Sigurdardottir, 2013; Svavarsdottir, Tryggvadottir, & Sigurdardottir, 2012; Sveinbjarnardottir, Svavarsdottir, & Saveman, 2011; Sveinbjarnardottir, Svavarsdottir, & Wright, 2013). Families reported higher cognitive and emotional support from nurses following the intervention and nurses reported a positive shift in their attitudes about families and in their understanding that they could make a difference with families. However, it seems that there are still very few nurses in practice settings who know about these useful ways of talking with patients and families or who have seen the value of this kind of brief therapeutic conversation. They say that the diffusion of innovation takes 17 years. Wouldn’t it be interesting to examine if a link exists between brief therapeutic conversations with patients and families and the quality and safety metrics in health care. My hypothesis is that if patients and family members felt like they mattered and their illness suffering was acknowledged by health care providers, there may be fewer errors made by health care providers and greater satisfaction with care reported by families. We need to gather more data about how therapeutic conversations influence these variables. Scholars in our family nursing community have been creating and disseminating knowledge about how to care for families
Downloaded from jfn.sagepub.com at University of Waikato Library on May 25, 2014
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over the past 30 years. I can hardly wait for a tipping point in health care to occur where brief therapeutic conversations would be usual practice offered to all patients and families in our care. It is clearer to me than ever that all this “buzz” about patient and family centered care is very timely (Abraham & Moretz, 2012a, 2012b). It is important to recruit family participation and leadership to insure that health care policies, resources, and physical space are family friendly. However, families who are suffering in their experience of serious illness are not likely ready or able to participate in committees and hospital planning meetings. Family nursing is more than family centered care. We need institutional endorsement and support to systematically teach nurses to address and soften illness suffering in individuals and families through brief therapeutic conversations. For examples of this kind of legitimization and valuing of family nursing practice see position statements developed by the Registered Nurses Association of Ontario (2006) and Victorian Order of Nurses (2012). The added benefit that family nursing theory and practice offers needs more documented evidence through case reports and carefully designed research so as to consistently appear on agenda of larger systems planning to change the culture of health care delivery. When you read Colleen’s panel response in this issue (pp. 418-430) about her lengthy and arduous illness journey, you will note that no health care professional ever asked about her illness suffering nor was she and her family members ever offered an opportunity to have a conversation about their experience of being a husband, a wife, and young daughters living with serious illness. Here are some questions I wish a nurse had asked Colleen and her family. These questions are derived from the “Calgary Family Nursing Models” and could be asked routinely of every patient and family (Wright, 2005; Wright & Bell, 2009; Wright & Leahey, 2013): •• We routinely invite families to a family meeting to learn more about your experience of this illness and how we can be most helpful to you. What are you most worried about right now? What do you need most from me as I care for you today? In our time together if you could just have one question answered, what would that question be? •• What has been the biggest impact of this illness on you? On your family? On your marriage? On your children? •• Who in your family has been most affected by this illness? •• What have you come to appreciate most about your family during this illness experience? About your marriage? About your children or other significant others? •• Who you do think in your family is suffering the most?
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•• I would like to learn more about how health care professionals could better support your family. Particularly when you were first diagnosed, or going through a particularly challenging time in your illness, or learning to live alongside of this serious illness—did anyone offer you a family meeting that included you and your significant others? If so, was this helpful? If not, do you think it would have been helpful to your health and healing and/or your family members? And might it still be helpful in the future? The patient and family centered care values of information sharing, respect, and collaboration with patients and families are also central to family nursing (Bell, 2009). How family nursing adds value is through family nursing interventions that identify individual and family strengths and acknowledge and soften illness. Family nursing is more than family centered care. If patient and family centered care is to be truly realized, family nurses need to collaborate with those who are leading cultural transformation in health care to grow capacity at the “heart of the matter”—the facilitating beliefs held by health care providers about families and relational skills for addressing illness suffering that family nurses bring to every encounter with every patient and family. Family nursing as usual care. That’s what I want for Colleen and her family and for all families, everywhere. Janice M. Bell, RN, PhD Editor, Journal of Family Nursing References Abraham, M., & Moretz, J. G. (2012a). Implementing patient- and family-centered care: Part I-Understanding the challenges. Pediatric Nursing, 38, 44-47. Abraham, M., & Moretz, J. G. (2012b). Implementing patient- and family-centered care: Part II-Strategies and resources for success. Pediatric Nursing, 38, 44-47. Bell, J. M. (2009). Family Systems Nursing re-examined [Editorial]. Journal of Family Nursing, 15, 123-129. doi:10.1177/1074840709335533 Coyne, I., Murphy, M., Costello, T., O’Neill, C., & Donnellan, C. (2013). A survey of nurses’ practices and perceptions of family centered care in Ireland. Journal of Family Nursing, 19(4), 469-488. doi:10.1177/1074840713508224 Coyne, I., O’Neill, C., Murphy, M., Costello, T., & O’Shea, R. (2011). What does family-centred care mean to nurses and how do they think it could be enhanced in practice. Journal of Advanced Nursing, 67, 2561-2573. doi:10.1111/j.13652648.2011.05768.x DiGioia, A., Lorenz, H., Greenhouse, P. K., Bertoty, D. A., & Rocks, S. D. (2010). A patient-centered model to improve metrics without cost increase: Viewing all
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care through the eyes of patients and families. Journal of Nursing Administration, 40, 540-546. Foster, M. J., Whitehead, L., Maybee, P., & Cullens, V. (2013). The health care providers’, parents’ and hospitalized child’s perception and experiences of family centered care within a pediatric critical care setting: A meta-synthesis of qualitative research. Journal of Family Nursing, 19(4), 431-468. doi:10.1177/1074840713496317 Halldorsdottir, B., & Svavarsdottir, E. K. (2012). Purposeful therapeutic conversations: Are they effective for families of individuals with COPD? A quasi-experimental study. Vaard I Norden [Nordic Journal of Nursing Research], 103, 48-51. Johnson, B. H. (2000). Family-centered care. Four decades of progress. Families, Systems, & Health, 18, 137-156. doi:10.1037/h0091843 Kamban, S., & Svavarsdottir, E. K. (2013). Does a therapeutic conversation intervention in an acute paediatric setting make a difference for families of children with bronchiolitis caused by respiratory syncytial virus (RSV)? Journal of Clinical Nursing, 22, 2723-2733. doi:10.1111/j.1365-2702.2012.04330.x Kuo, D. Z., Houtrow, A. J., Arango, P., Kuhlthau, K. A., Simmons, J. M., & Neff, J. M. (2012). Family-centered care: Current applications and future directions in pediatric health care. Maternal Child Heath Journal, 16, 297-305. doi:10.1007/ s10995-011-0751 McGavin, C. (2013). Colleen’s story: Reflections on the concept of “patient and family centered care.” Journal of Family Nursing, 19(4), 418-430. doi:10.1177/1074840713496114 Registered Nurses Association of Ontario. (2006). Supporting and strengthening families through expected and unexpected life events (Rev. Suppl.). Toronto, Ontario, Canada: Author. Retrieved from http://rnao.ca/sites/rnao-ca/files/Supporting_ and_Strengthening_Families_Through_Expected_and_Unexpected_Life_ Events.pdf Shields, L. (2010). Questioning family-centred care (Models of care). Journal of Clinical Nursing, 19, 2629-2638. doi:10.1111/j.1365-2702.2010.03214.x Shields, L., Pratt, J., & Hunter, J. (2006). Family centred care: A review of qualitative studies. Journal of Clinical Nursing, 15, 1317-1323. doi:10.1111/j.13652702.2006.01433.x Sigurdardottir, A. O., Svavarsdottir, E. K., Rayens, M. K., & Adkins, S. (2013). Therapeutic conversations intervention in pediatrics: Are they of benefit for families of children with asthma? The Nursing Clinics of North America, 48, 287-304. doi:10.1016/j.cnur.2013.01.007 Svavarsdottir, E. K. (2008). Excellence in Nursing: A model for implementing family systems nursing in nursing practice at an institutional level in Iceland. Journal of Family Nursing, 14, 456-468. doi:10.1177/1074840708328123 Svavarsdottir, E. K., & Sigurdardottir, A. O. (2013). Benefits of a brief therapeutic conversation intervention for families of children and adolescents in active cancer treatment. Oncology Nursing Forum, 40, E346-E357. doi:10.1188/13.ONF. E346-E357
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Svavarsdottir, E. K., Tryggvadottir, G. B., & Sigurdardottir, A. O. (2012). Knowledge translation in family nursing: Does a short-term therapeutic conversation intervention benefit families of children or adolescents within a hospital setting? Findings from the Landspitali University Hospital Family Nursing Implementation Project. Journal of Family Nursing, 18, 303-327. doi:10.1177/1074840712449202 Sveinbjarnardottir, E. K., Svavarsdottir, E. K., & Saveman, B. I. (2011). Nurses attitudes towards the importance of families in psychiatric care following an educational and training intervention program. Journal of Psychiatric and Mental Health Nursing, 18, 895-903. doi:10.1111/j.1365-2850.2011.01744.x Sveinbjarnardottir, E. K., Svavarsdottir, E. K., & Wright, L. M. (2013). What are the benefits of a short therapeutic conversation intervention with acute psychiatric patients and their families? A controlled before and after study. International Journal of Nursing Studies, 50, 593-602. Victorian Order of Nurses. (2012). Evidence-informed bereavement care: A primer of interventions towards health systems change. Toronto, Ontario, Canada: Author. Retrieved from http://www.von.ca/en/about/docs/research/ BereavementCarePrimer.pdf Wells, N. (2011). Historical perspective on family-centered care. Academic Pediatrics, 11, 100-102. doi:10.1016/j.acap.2011.01.007 Wright, L. M. (2005). Spirituality, suffering, and illness: Ideas for healing. Philadelphia, PA: F.A. Davis. Wright, L. M., & Bell, J. M. (2009). Beliefs and illness: A model for healing. Calgary, Alberta, Canada: 4th Floor Press. Wright, L. M., & Leahey, M. (1999). Maximizing time, minimizing suffering: The 15-minute (or less) family interview. Journal of Family Nursing, 5, 259-273. doi:10.1177/107484079900500302 Wright, L. M., & Leahey, M. (2013). Nurses and families: A guide to family assessment and intervention (6th ed.). Philadelphia, PA: F.A. Davis.
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Family Nursing Is More Than Family Centered Care Janice M. Bell Journal of Family Nursing 2013 19: 411 DOI: 10.1177/1074840713512750 The online version of this article can be found at: http://jfn.sagepub.com/content/19/4/411
Published by: http://www.sagepublications.com
Additional services and information for Journal of Family Nursing can be found at: Email Alerts: http://jfn.sagepub.com/cgi/alerts Subscriptions: http://jfn.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav Citations: http://jfn.sagepub.com/content/19/4/411.refs.html
>> Version of Record - Nov 13, 2013 What is This?
Downloaded from jfn.sagepub.com at University of Waikato Library on May 25, 2014
512750 research-article2013
JFN19410.1177/1074840713512750Journal of Family NursingBell
Editorial
Family Nursing Is More Than Family Centered Care
Journal of Family Nursing 19(4) 411–417 © The Author(s) 2013 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1074840713512750 jfn.sagepub.com
Several articles in this issue of the Journal of Family Nursing focus on family centered care (Coyne, Murphy, Costello, O’Neill, & Donnellan, 2013; Foster, Whitehead, Maybee, & Cullens, 2013; McGavin, 2013). In this editorial, I would like to offer some distinctions between family centered care and family nursing, and declare my belief that family nursing is more than family centered care. I met Colleen McGavin (2013) at a Pre-Forum Deep Dive Session (a.k.a. preconference) in Vancouver called “Patient and Family Centered Care: From Concept to Practice.” I was invited to offer a keynote at the preconference sponsored by the British Columbia Quality and Safety Council. Colleen was a member of the panel who responded to my keynote. The audience was not my usual tribe of family nursing scholars and practitioners. Instead they were an interesting mix of front-line health care providers, legislators, administrators, and patient care advocates (like Colleen) who care about “quality” and “safety” and who have diverse ideas about what “patient and family centered care” is and how it could be done better. For more than half a century, a philosophy of care known as patient and family centered care (which had its origins in child health care) has advocated for a seismic shift in health care from patriarchy and paternalism to partnership, dignity and respect, information sharing, participation, and collaboration with patients and families (Johnson, 2000; Kuo et al., 2012; Wells, 2011). These values extend to viewing families as integral members of the health care team and conceptualizing the family as the unit of care (Shields, Pratt, & Hunter, 2006). Patient and family centered care has been endorsed at the highest policy levels in developed countries and privileged in mission statements of most health care systems which has prompted the creation of numerous institutes for patient and family centered care that provide resources and gather data about implementation (Abraham & Moretz, 2012a, 2012b). Yet, concern and some mystery remain about why patient and family centered care has not yet been successfully implemented and why it is still not uncommon to hear patients and families evaluate their relationships with health care providers as uncaring, difficult, and intimidating (Coyne, O’Neill, Murphy, Costello, & O’Shea, 2011; Shields, 2010).
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For many participants at the preconference, patient and family centered care seemed to be about creating systems and policies to reduce waste and “shadowing” (DiGioia, Lorenz, Greenhouse, Bertoty, & Rocks, 2010) to better understand what patients and families actually experience in a health care setting. For some, it meant changing the policy about “visiting hours” or inviting families to “bedside rounds” in hospitals or hanging whiteboards in hospital rooms to increase communication between families, health care providers, and patients. Some solutions were focused on reducing redundancy and long waiting hours or insuring patients are kept informed about who their care provider team is by posting photos of the staff on the wall of a hospital unit—all very useful and creative ways to insure that patients and their families receive quality care. My keynote address offered a bold assertion that at the heart of patient and family care are particular kinds relationships between patients, families, and health care providers that are shaped, in large measure, by the beliefs of the health care provider (see Slideshare: http://qualityforum.ca/qf2013/2013quality-forum/2013-presentations/keynote-getting-to-the-heart-of-the-matter/). Health care providers who believe that they have more education and expertise (therefore being more “right”) may be less interested in inquiring about or valuing the preferences of patients and family members or entering into collaborative relationships with them. Holding a belief that “I have no time to involve families,” or a belief that “If I talk to families and patients about things that matter to them, I might open a can of worms,” can constrain if and how relationships are established with patients and families and the kinds of conversations that are initiated. If health care providers believe, “I have confidence in my knowledge and skills about how to talk to families,” perhaps they would behave with more confidence to welcome, include, and acknowledge families as partners. Family nurses have developed a variety of practice models to guide generalist and advanced practice with families (for a list of practice models for nursing practice with families see: http://internationalfamilynursing.org/ resources-for-family-nursing/practice/practice-models/). For example, the Calgary Family Assessment and Intervention Models (Wright & Leahey, 2013), the Illness Beliefs Model (Wright & Bell, 2009), and the Trinity Model (Wright, 2005) identify relational family nursing interventions that guide the nurse to explore how illness has impacted their lives and relationships and be curious and vigilant about illness suffering. All family nursing interventions happen in the context of a nurse–family relationship and are enacted primarily through therapeutic conversation (Wright & Bell, 2009). A format for offering a brief therapeutic conversation has been developed by my colleagues Lorraine Wright and Maureen Leahey called the “15 Minute (or shorter) Family Interview” (1999, 2013). Sample interventive questions include, “How can we
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be most helpful to you and your family during your hospitalization?” or “If you could have just one question answered in our time together, what would that question be?” or “Who in your family is suffering the most?” Patients and families are asked these questions based on a belief of the nurse that “illness is a family affair” (Wright & Bell, 2009, p. ix). The patient is only half of the patient, the other half is the family. As a member of the panel who responded to my keynote, Colleen was invited to represent the “patient’s perspective.” She offered a compelling and reflective illness narrative about how serious illness has invaded her life and that of her family. The room became very quiet as she spoke. Colleen did not shy away from talking about her grueling experience of serious illness nor from offering her recommendations for what health care providers did that was helpful or could have done to show more patient and family centered care. Later, Colleen told me that when she has opportunities to influence positive change in patient and family centered care through her writing and speaking, her sense of well-being increases and her pain is less. Advocating for change, she has learned, can be healing. The family nursing interventions offered within brief therapeutic conversations are easy to learn and mentor. Recent research findings from the carefully designed Landspitali University Hospital Family Nursing Implementation Project in Iceland found that families and nurses benefit from therapeutic conversations with families (Halldorsdottir & Svavarsdottir, 2012; Kamban & Svavarsdottir, 2013; Sigurdardottir, Svavarsdottir, Rayens, & Adkins, 2013; Svavarsdottir, 2008; Svavarsdottir & Sigurdardottir, 2013; Svavarsdottir, Tryggvadottir, & Sigurdardottir, 2012; Sveinbjarnardottir, Svavarsdottir, & Saveman, 2011; Sveinbjarnardottir, Svavarsdottir, & Wright, 2013). Families reported higher cognitive and emotional support from nurses following the intervention and nurses reported a positive shift in their attitudes about families and in their understanding that they could make a difference with families. However, it seems that there are still very few nurses in practice settings who know about these useful ways of talking with patients and families or who have seen the value of this kind of brief therapeutic conversation. They say that the diffusion of innovation takes 17 years. Wouldn’t it be interesting to examine if a link exists between brief therapeutic conversations with patients and families and the quality and safety metrics in health care. My hypothesis is that if patients and family members felt like they mattered and their illness suffering was acknowledged by health care providers, there may be fewer errors made by health care providers and greater satisfaction with care reported by families. We need to gather more data about how therapeutic conversations influence these variables. Scholars in our family nursing community have been creating and disseminating knowledge about how to care for families
Downloaded from jfn.sagepub.com at University of Waikato Library on May 25, 2014
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over the past 30 years. I can hardly wait for a tipping point in health care to occur where brief therapeutic conversations would be usual practice offered to all patients and families in our care. It is clearer to me than ever that all this “buzz” about patient and family centered care is very timely (Abraham & Moretz, 2012a, 2012b). It is important to recruit family participation and leadership to insure that health care policies, resources, and physical space are family friendly. However, families who are suffering in their experience of serious illness are not likely ready or able to participate in committees and hospital planning meetings. Family nursing is more than family centered care. We need institutional endorsement and support to systematically teach nurses to address and soften illness suffering in individuals and families through brief therapeutic conversations. For examples of this kind of legitimization and valuing of family nursing practice see position statements developed by the Registered Nurses Association of Ontario (2006) and Victorian Order of Nurses (2012). The added benefit that family nursing theory and practice offers needs more documented evidence through case reports and carefully designed research so as to consistently appear on agenda of larger systems planning to change the culture of health care delivery. When you read Colleen’s panel response in this issue (pp. 418-430) about her lengthy and arduous illness journey, you will note that no health care professional ever asked about her illness suffering nor was she and her family members ever offered an opportunity to have a conversation about their experience of being a husband, a wife, and young daughters living with serious illness. Here are some questions I wish a nurse had asked Colleen and her family. These questions are derived from the “Calgary Family Nursing Models” and could be asked routinely of every patient and family (Wright, 2005; Wright & Bell, 2009; Wright & Leahey, 2013): •• We routinely invite families to a family meeting to learn more about your experience of this illness and how we can be most helpful to you. What are you most worried about right now? What do you need most from me as I care for you today? In our time together if you could just have one question answered, what would that question be? •• What has been the biggest impact of this illness on you? On your family? On your marriage? On your children? •• Who in your family has been most affected by this illness? •• What have you come to appreciate most about your family during this illness experience? About your marriage? About your children or other significant others? •• Who you do think in your family is suffering the most?
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•• I would like to learn more about how health care professionals could better support your family. Particularly when you were first diagnosed, or going through a particularly challenging time in your illness, or learning to live alongside of this serious illness—did anyone offer you a family meeting that included you and your significant others? If so, was this helpful? If not, do you think it would have been helpful to your health and healing and/or your family members? And might it still be helpful in the future? The patient and family centered care values of information sharing, respect, and collaboration with patients and families are also central to family nursing (Bell, 2009). How family nursing adds value is through family nursing interventions that identify individual and family strengths and acknowledge and soften illness. Family nursing is more than family centered care. If patient and family centered care is to be truly realized, family nurses need to collaborate with those who are leading cultural transformation in health care to grow capacity at the “heart of the matter”—the facilitating beliefs held by health care providers about families and relational skills for addressing illness suffering that family nurses bring to every encounter with every patient and family. Family nursing as usual care. That’s what I want for Colleen and her family and for all families, everywhere. Janice M. Bell, RN, PhD Editor, Journal of Family Nursing References Abraham, M., & Moretz, J. G. (2012a). Implementing patient- and family-centered care: Part I-Understanding the challenges. Pediatric Nursing, 38, 44-47. Abraham, M., & Moretz, J. G. (2012b). Implementing patient- and family-centered care: Part II-Strategies and resources for success. Pediatric Nursing, 38, 44-47. Bell, J. M. (2009). Family Systems Nursing re-examined [Editorial]. Journal of Family Nursing, 15, 123-129. doi:10.1177/1074840709335533 Coyne, I., Murphy, M., Costello, T., O’Neill, C., & Donnellan, C. (2013). A survey of nurses’ practices and perceptions of family centered care in Ireland. Journal of Family Nursing, 19(4), 469-488. doi:10.1177/1074840713508224 Coyne, I., O’Neill, C., Murphy, M., Costello, T., & O’Shea, R. (2011). What does family-centred care mean to nurses and how do they think it could be enhanced in practice. Journal of Advanced Nursing, 67, 2561-2573. doi:10.1111/j.13652648.2011.05768.x DiGioia, A., Lorenz, H., Greenhouse, P. K., Bertoty, D. A., & Rocks, S. D. (2010). A patient-centered model to improve metrics without cost increase: Viewing all
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care through the eyes of patients and families. Journal of Nursing Administration, 40, 540-546. Foster, M. J., Whitehead, L., Maybee, P., & Cullens, V. (2013). The health care providers’, parents’ and hospitalized child’s perception and experiences of family centered care within a pediatric critical care setting: A meta-synthesis of qualitative research. Journal of Family Nursing, 19(4), 431-468. doi:10.1177/1074840713496317 Halldorsdottir, B., & Svavarsdottir, E. K. (2012). Purposeful therapeutic conversations: Are they effective for families of individuals with COPD? A quasi-experimental study. Vaard I Norden [Nordic Journal of Nursing Research], 103, 48-51. Johnson, B. H. (2000). Family-centered care. Four decades of progress. Families, Systems, & Health, 18, 137-156. doi:10.1037/h0091843 Kamban, S., & Svavarsdottir, E. K. (2013). Does a therapeutic conversation intervention in an acute paediatric setting make a difference for families of children with bronchiolitis caused by respiratory syncytial virus (RSV)? Journal of Clinical Nursing, 22, 2723-2733. doi:10.1111/j.1365-2702.2012.04330.x Kuo, D. Z., Houtrow, A. J., Arango, P., Kuhlthau, K. A., Simmons, J. M., & Neff, J. M. (2012). Family-centered care: Current applications and future directions in pediatric health care. Maternal Child Heath Journal, 16, 297-305. doi:10.1007/ s10995-011-0751 McGavin, C. (2013). Colleen’s story: Reflections on the concept of “patient and family centered care.” Journal of Family Nursing, 19(4), 418-430. doi:10.1177/1074840713496114 Registered Nurses Association of Ontario. (2006). Supporting and strengthening families through expected and unexpected life events (Rev. Suppl.). Toronto, Ontario, Canada: Author. Retrieved from http://rnao.ca/sites/rnao-ca/files/Supporting_ and_Strengthening_Families_Through_Expected_and_Unexpected_Life_ Events.pdf Shields, L. (2010). Questioning family-centred care (Models of care). Journal of Clinical Nursing, 19, 2629-2638. doi:10.1111/j.1365-2702.2010.03214.x Shields, L., Pratt, J., & Hunter, J. (2006). Family centred care: A review of qualitative studies. Journal of Clinical Nursing, 15, 1317-1323. doi:10.1111/j.13652702.2006.01433.x Sigurdardottir, A. O., Svavarsdottir, E. K., Rayens, M. K., & Adkins, S. (2013). Therapeutic conversations intervention in pediatrics: Are they of benefit for families of children with asthma? The Nursing Clinics of North America, 48, 287-304. doi:10.1016/j.cnur.2013.01.007 Svavarsdottir, E. K. (2008). Excellence in Nursing: A model for implementing family systems nursing in nursing practice at an institutional level in Iceland. Journal of Family Nursing, 14, 456-468. doi:10.1177/1074840708328123 Svavarsdottir, E. K., & Sigurdardottir, A. O. (2013). Benefits of a brief therapeutic conversation intervention for families of children and adolescents in active cancer treatment. Oncology Nursing Forum, 40, E346-E357. doi:10.1188/13.ONF. E346-E357
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Svavarsdottir, E. K., Tryggvadottir, G. B., & Sigurdardottir, A. O. (2012). Knowledge translation in family nursing: Does a short-term therapeutic conversation intervention benefit families of children or adolescents within a hospital setting? Findings from the Landspitali University Hospital Family Nursing Implementation Project. Journal of Family Nursing, 18, 303-327. doi:10.1177/1074840712449202 Sveinbjarnardottir, E. K., Svavarsdottir, E. K., & Saveman, B. I. (2011). Nurses attitudes towards the importance of families in psychiatric care following an educational and training intervention program. Journal of Psychiatric and Mental Health Nursing, 18, 895-903. doi:10.1111/j.1365-2850.2011.01744.x Sveinbjarnardottir, E. K., Svavarsdottir, E. K., & Wright, L. M. (2013). What are the benefits of a short therapeutic conversation intervention with acute psychiatric patients and their families? A controlled before and after study. International Journal of Nursing Studies, 50, 593-602. Victorian Order of Nurses. (2012). Evidence-informed bereavement care: A primer of interventions towards health systems change. Toronto, Ontario, Canada: Author. Retrieved from http://www.von.ca/en/about/docs/research/ BereavementCarePrimer.pdf Wells, N. (2011). Historical perspective on family-centered care. Academic Pediatrics, 11, 100-102. doi:10.1016/j.acap.2011.01.007 Wright, L. M. (2005). Spirituality, suffering, and illness: Ideas for healing. Philadelphia, PA: F.A. Davis. Wright, L. M., & Bell, J. M. (2009). Beliefs and illness: A model for healing. Calgary, Alberta, Canada: 4th Floor Press. Wright, L. M., & Leahey, M. (1999). Maximizing time, minimizing suffering: The 15-minute (or less) family interview. Journal of Family Nursing, 5, 259-273. doi:10.1177/107484079900500302 Wright, L. M., & Leahey, M. (2013). Nurses and families: A guide to family assessment and intervention (6th ed.). Philadelphia, PA: F.A. Davis.
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