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Family centered care is a program of care designed by health planners which attempts to correct for the deficiencies in health service delivery by creating a system which was decentralized and provided targeted services to the people at whom it was directed. It is defined as an approach to planning, evaluation and delivery of healthcare that is driven by mutually beneficial partnerships which exist between families and health care providers (IPFCC, n.d).
Although the concept was developed in the United States and the UK, varying degrees emanating from the initially formed tenets are in practice all over the world A significant amount of literature exists on the subject, which look at it from various perspectives and target audiences. This paper will attempt to examine the literature that exists on family centered care with special emphasis on those that place children at their center.
The family is the oldest and most fundamental unit of the society, and every social action or agenda that does not factor in the family and its influence might not have the full desired impact. Over time the definition ad constitution of the family has changed or evolved.
Due to various societal influences. Traditionally the family unit comprised of grandparents, uncles, aunts and numerous cousins and children. This unit defined in this way provided numerous advantages and benefits to its constituents, the family served as the main the main support structure for its members.
However with the breaking of up of that particular system following the effects of urbanization, there has now become a breakdown of that traditional structure to one that reflects the greater independence of the family members namely the nuclear family.
The consequence of this however is that the support framework that was guaranteed in the former structure is now lost. (Cowen & Sbarbaro, 1972)Thus with regards to health and illness of whatever kind physical, emotional or otherwise, the support which family members enjoyed has now been removed.
This development consequently led the authorities in the state of Denver, Colorado in 1966 to develop pilot teams of health professionals that would provide targeted family centered, comprehensive care to families that lived within the counties in which they were, these teams comprised of a General practitioner a nurse and asocial worker with other support staff.
These people in the team served specific roles and were rated by the initial teams that they served based on the separate roles they were perceived to play. The team members were to develop a customized active plan for the family that was receiving care at the time. And this brought with it some peculiar problems.
For example the transfer of patients/families who had previously worked with specific teams proved somewhat difficult because even though the paper work could be transferred the existing relationships were not as mobile (Cowen & Sbarbaro, 1972). This was the premise around which what we know today as family centered care developed.
The application of the family centered care with special care to its application was developed by Shelton in 1987, and included or factored in several elements mainly, the realization and acknowledgement of some important factors like the fact that the family is a constant in the child’s life, that the collaboration between the parents of the child and the health care professionals is essential, that individual families had their own cultures and preferences and by the same measure their own peculiar coping mechanism.
All this were geared to words providing a culturally competent yet flexible specific care for families. In any case family centered care in the practice of pediatrics worked on the fundamental truth the that the family unit in whatever form it took was the supporting structure that the child had (MacKean, Thurston & Scott, 2005).
Following the patient protection and affordable care act (PPACA) the medical home and primary care were seen as essential components of the health care delivery infrastructure the idea behind it was to provide near universal access to maternal child health services which were designed following evidence based models with the aim of improving the service delivery to the patients.
In the field of pediatrics the term medical home was designated as the repository of medical records which also included a physician who provided community based coordinated family centered care to families in the vicinity where he was working.
In this module a lot of emphasis is placed on the type and quality of care that is available to the child based on the understanding that the child has peculiar characteristics and needs which must be reflected in the kind of care the characteristics are conceptualized as demography, differential epidemiology, dependency and developmental change (Laraque & Sia, 2010).
The instance of a child adopted from an orphanage who has been in foster care gives a poignant example of how the family centered approach can offer tailored care for a child. For this particular child who has been a victim of sexual abuse, the demography and epidemiological peculiarities of their care are going to be vastly different from the care that will be provided for a typical adult.
There will be a pressing need to establish this child in the care of a family that will provide for the emotional and social needs of the child, to provide this child with love and some form of stability to ensure that the neuro-mental development of this child will not be significantly impaired by the previous experience of the child all this in addition to evidence based treatments (Laraque & Sia, 2010).
The above example is quite unique, but having said so the care of sick is not exclusively the responsibility of the medical personnel, the practice of family centered care recognizes that the care of the sick is as much the responsibility of the doctor/nurse team as it is that of the family.
This is especially true in the field of pediatrics as alluded to earlier one of the peculiarities of child care is the fact that the child is exclusively dependent on its parents and its development and response to any kind of medical intervention is a function of the reception granted to the medical personnel by the family of the child.
Bearing this in mind there is a need for collaboration between the parents of the child and the medical practitioners who have to collaborate to provide care for the child this collaboration is based on; mutual respect, communication that is clear and honest, empathy and understanding on the part of the medical staff , accessibility, shared information and joint evaluation of the medical outcomes.
Because as the evidence shows children who are parts of family centered care programs show significant positive response to medical care(Committee on Hospital Care and Institute For Patient- And Family-Centered Care, 2012).
To properly apply the family centered care program, the care givers (doctors, nurses, social workers etc.) need to have an appreciation for peculiarities of each families cultural, ethnic, social and religious peculiarities this, coupled with understanding the dynamics of the family’s hierarchy enables the care provider to adequately assess the individual members of the family and provide specific support to them in order to achieve the aim of getting the ailing family member back on their feet.
Nowhere is this as important as it is in getting the family history of the child, this proves to be a task that requires a considerable amount of tact and finesse to acquire relevant and important information.
Parent and guardians should be offered the chance to be present during examination and administration of certain procedures to the children and equally as important, the medical personal are encouraged to involve as much as possible the active participation of the children in the process of caring for them.
Additionally the knowledge and experience of other families who have gone through similar situations can be a source of help and support for families who are undergoing some form of medical related distress (Committee on Hospital Care and Institute For Patient- And Family-Centered Care, 2012).
De-rigeur or standard medical practice has made significant advances but at its core is the view that the patient is an single individual with medical needs that bear addressing, the patient is viewed as a whole in themselves and not the part of a sum.
This might at first glance appear to be not so significant, but it bears mentioning that this slight paradigm shift in perspective significantly alters the kind of care available to the patient. In standard medical practice the patient is treated alone by the nurse with directives from the attending physician.
It is important to state here that although this is in more way an attempt to malign standard practice it simply shows the deficiencies and inadequacies that are rife with this kind of practice.
Evidence shows that the patients, in this case children show significant positive responses to treatment under family centered medical care as against standard medical care without the emphasis on involving the family. (Committee on Hospital Care and Institute for Patient- And Family-Centered Care, 2012).
On the other hand the involvement of the family in spite of the benefits brings with it several issues, the most significant of which is how much information the doctors should make available to the patients and where the line should be drawn with regards to family and or parental involvement in the treatment process, given the fact that too much intelligible information can actually hamper the decision making process and speed of parents especially in life threatening decisions.
Furthermore several ethnic and religious beliefs can hamper and endanger the lives of patients for example religions that forbid a man being alone with a female that is not a member of her family can make emergency response quite difficult to administer if the available staff at the time are all male.
Theoretical models of family centered care are designed to guide clinical practice. Despite its sort coming s family centered care is an evidence based approach to patient treatment and should be inculcated and adapted for every societies peculiarities.
This is because it has shown reproducible results and can be adapted to not just physical but the entire spectrum of children’s treatment (frank & Callery, 2004).
COMMITTEE ON HOSPITAL CARE and INSTITUTE FOR PATIENT- AND FAMILY-CENTERED CARE. (January 01, 2012). Patient- and Family-Centered Care and the Pediatrician's Role. Pediatrics, 129, 2, 394-404.
Cowen, D. L., & Sbarbaro, J. A. (January 01, 1972). Family-Centered Health Care--a Viable Reality?. Medical Care, 10, 2.)
Franck, L. S., & Callery, P. (May 01, 2004). Re-Thinking Family-Centred Care Across the Continuum of Children's Healthcare. Child: Care, Health and Development, 30, 3, 265-277.
Institute for Patient and Family-Centered Care (n.d.) Family-Centered Care. Retrieved from: http://www.ipfcc.org/
Laraque, D., & Sia, C. C. (January 01, 2010). Health Care Reform and the Opportunity to Implement a Family-Centered Medical Home for Children. The Journal of the American Medical Association, 303, 23, 2407-8.
MacKean, G. L., Thurston, W. E., & Scott, C. M. (March 01, 2005). Bridging the Divide Between Families and Health Professionals; Perspectives on Family-Centred Care. Health Expectations, 8, 1, 74-85.