Relationship-Based Care® – Patient and Family

When discussing patients and families in the context of healthcare, it refers to the patient and the patient family relationships along with the interactions of the healthcare team with the patient and family to create a healthy environment.

Emphasizing the patient and family role in Relationship-Based Care and Primary Nursing is important to safety, quality, and patient satisfaction.

Embracing Family Involvement in Patient Care

Creative Health Care Management understands the central role of families in healthcare and that the inclusion of a patient’s family is not just beneficial but essential. Families provide critical support and context that can enhance patient care significantly.

Let’s examine family involvement and how it can transform care delivery processes systems and practices.

Intentional Inclusion:

To make the care experience as effective as possible, healthcare teams must actively involve families in the care process. This includes providing them with necessary information and support, and ensuring they are part of the caregiving team.

Proven Benefits:

Studies have shown that when families are engaged in the care process, it not only saves costs but also improves the overall safety, quality, patient satisfaction, and care experience. This engagement enhances the management of illnesses, ensures continuity of care, and reduces the likelihood of hospital readmissions.

Partnership with Families:

In Relationship-Based Care, it’s vital for healthcare providers to work alongside families, respecting their insights and addressing their needs with compassion and attentiveness.

Challenging Biases:

Healthcare professionals need to reflect on their views about family roles in patient care to avoid biases that can impair therapeutic connections.

Positive Family Experiences:

Families feel most satisfied with patient care when caregivers are fully present and communicate effectively, ensuring that all actions are clearly coordinated and aimed at supporting the patient.

Areas for Improvement:

Common factors contributing to family dissatisfaction include poor communication, lackluster teamwork, insufficient individual attention, and a general lack of competence—issues that need addressing to enhance quality and safety in care delivery.

Reflective Practices for Healthcare Providers

Shifting towards a more family-inclusive approach in healthcare isn’t just a nicety—it’s a necessity that can lead to better patient outcomes, more effective care practices, and higher satisfaction rates among all involved.

The inclusion of family members, as defined by the patient, is crucial. They should be encouraged to collaborate with healthcare providers to ensure the safety and well-being of their loved ones. Evidence shows that involving family and friends in the care process not only reduces costs but also improves the overall experience of care, better manages illnesses, ensures continuity of care, and decreases the likelihood of hospital readmissions due to their intimate knowledge of the patient’s health. This collaborative approach is key to transforming the care delivery system into one that is more patient and family-centered, promoting a culture of compassion, integrity, and excellence in care.

Evaluating Language and Attitudes:

Reflect on how you talk about and interact with patients’ families. Identify any negative perceptions and consider how you can change them to improve family relations.

Curiosity Over Reaction:

When faced with potentially negative interactions with family members, take a moment to pause and approach the situation with curiosity rather than defensiveness. What could you learn from this interaction?

Valuing Family Input:

Think about a time when a family member provided essential information that was unavailable from other sources. How did this influence the care provided?

Understanding Non-Ordinary States:

Recognize that the loved ones of seriously ill patients are often under extreme stress, which may affect their behavior and needs. How can this insight shape your approach to care?

Isolating patients from their primary support network during critical times can lead to medical errors, emotional distress, inconsistent care, and unnecessary expenses. Particularly for elderly patients, hospital stays can diminish cognitive and functional abilities, and mobility, which may lead to new disabilities post-discharge.

Family and friends, who are often more aware of the patient’s usual capabilities and changes therein, are invaluable during hospital stays.

The Survey “What Matters Most to Families”

The survey “What Matters Most to Families” was conducted to understand the priorities and concerns of family members whose loved ones recently required medical care. It focused on their overall experiences, the quality of communication and empathy from healthcare providers, and the specific areas needing improvement in caregiving.

Demographics of Respondents:

• Total Responses: 53 individuals
• Background: 37% clinicians, 35% not in healthcare, 28% healthcare but not clinicians
• Care Settings: 73% hospital, 11% ambulatory, 7% long-term care/rehab, 5% hospice, 4% home care
• Relationship to Patient: Mostly daughters (20), mothers (14), and spouses/significant others (11)

Key Survey Insights

1. Overall Satisfaction with Care – 45% were “Very Pleased” with the care when it involved:

• Effective communication
• Caregiver presence and attentiveness
• Respect and dignity towards the patient
• Quick and empathetic response to pain and discomfort

2. Issues and Displeasures – 55% experienced problems with care:

• Inadequate communication and unskilled interactions
• Lack of individualized attention
• Clinical incompetence affecting safety and quality
• Common issues included rudeness, poor information on critical conditions (e.g., terminal illness), and mechanical, impersonal service.

3. Moments of Frustration or Anger – 67% reported frustration or anger due to:

• Lack of compassion and attunement
• Not being listened to or believed
• Poor outcomes without support or clear resolutions

4. Experiences of Appreciation– 86% had moments of deep appreciation when caregivers:

• Treated the patient with compassion and competence
• Were attentive to both patient and family needs
• Provided comfort in critical situations, enhancing the patient and family’s experience significantly

5. Advice to Caregivers– Top requests include:

• Keep families informed: Clarity about the care process and updates were crucial.
• Be present and attuned: Genuine engagement and empathy were highly valued.

6. Suggestions for Improvement:

• Families emphasized the need for better-coordinated care, respectful and thorough communication, and a more caring and personalized approach to caregiving.

Relationship-Based Care “RBC” and Clinical Competence

The survey highlighted the significant impact of communication, empathy, and information transparency on the family’s experience during medical care. Families appreciate when caregivers treat their loved ones with dignity and are actively involved and attentive. Conversely, lack of compassion, poor communication, and inadequate attention lead to frustration and distrust.

The feedback suggests a strong need for healthcare providers to create a more relationship-based, empathetic, and patient-centered care approach to improve both patient and family satisfaction. This involves an operational framework that improves not only individual caregiver efforts but also organizational processes and structure to support these values.

The three relationships included in the basics of Relationship-Based Care and continuous learning will assist the team member’s ability to move past basic concepts and embrace the mission, vision, and values to care for our patients and their families.

Sources:

Koloroutis, M., & Abelson, D. (2017). Advancing Relationship-Based Cultures. Creative Health Care Management. ISBN: 9781886624979.
Available at https://shop.chcm.com/Advancing-Relationship-Based-Cultures.aspx.