Developing an evidence-based and theory informed intervention to involve families in patients care after surgery: A quality improvement project

Abstract

ObjectivesIn the post-surgical setting, active involvement of family caregivers has the potential to improve patient outcomes by prevention of surgical complications that are sensitive to fundamental care. This paper describes the development of a theoretically grounded program to enhance the active involvement of family caregivers in fundamental care for post-surgical patients.MethodsWe used a quality improvement project following a multi-phase design. In Phase 1, an iterative method was used to combine evidence from a narrative review and professionals’ preferences. In Phase 2, the logic model underlying the program was developed guided by four steps: (1) confirm situation, intervention aim, and target population; (2) documented expected outcomes, and outputs of the intervention; (3) identify and describe assumptions, external factors and inputs; and (4) confirm intervention components.ResultsPhase 1 identified a minimum set of family involvement activities that were both supported by staff and the narrative review. In Phase 2, the logic model was developed and includes (1) the inputs (e.g. educational- and environmental support), (2) the ultimate outcomes (e.g. reduction of postoperative complications), (3) the intermediate outcomes (e.g. behavioural changes), and (4) immediate outcomes (e.g. improved knowledge, skills and attitude).ConclusionsWe demonstrated how we aimed to change our practice to an environment in which family caregivers were stimulated to be actively involved in postoperative care on surgical wards, and how we took different factors into account. The description of this program may provide a solid basis for professionals to implement the family involvement program in their own setting.

The experiences of family caregivers who participated in a family involvement program after cancer surgery: A qualitative study

“…To prepare families for an active carer role after patients' discharge and to try to reduce the number of postoperative complications, and the number of unplanned hospital readmissions related to these complications, we developed an evidence-based intervention to enhance the active involvement of family caregivers in fundamental care for postsurgical oncology patients during hospitalization (Eskes et al, 2019). It was underpinned by a patient and family centered care (PFCC) approach.…”

“…During hospital admission, the FIP was offered to all adult patients who underwent elective pancreatic or esophageal resection with an expected hospital stay of at least five postoperative days and who have a family caregiver who agreed to participate in care delivery (Eskes et al, 2019). We choose this 5-days cut-off point as it offers nurses the opportunity to train and coach family caregivers adequately under their supervision.…”

Standardization of caregiver and nursing perioperative care on gynecologic oncology wards in a resource-limited setting

“…A few health systems have studied novel programs that specifically involve family members in post-surgical patient care ( Eskes et al, 2019 , Van De Graaff et al, 2018 ). The post-operative environment is unique in that outcomes heavily rely on delivery of fundamental care (e.g., eating, dressing, washing, and mobilizing) that is typically delivered by nursing staff in other countries.…”

“…The post-operative environment is unique in that outcomes heavily rely on delivery of fundamental care (e.g., eating, dressing, washing, and mobilizing) that is typically delivered by nursing staff in other countries. Surgical complications such as pneumonia and urinary tract infections may be preventable and are dependent on adequate fundamental care ( Eskes et al, 2019 ). Recruitment of family members as caregivers represents an opportunity for collaborative care in these settings.…”

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“…A nivel mundial los modelos de práctica de enfermería han sido reconocidos como una estrategia para mejorar la práctica en diferentes escenarios (Hudacek, DiMattio, Turkel, 2017), incrementar el trabajo interprofesional (Bender, 2017), en especial frente a una mejor calidad en el cuidado del paciente Meehan, , Timmins, Burke, 2018); Hagle, Dwyer, Gettrust, Lusk, Peterson, Tennies, 2020) y de sus familiares (Eskes, Schreuder, Vermeulen, Nieveen, Chaboyer, 2019) y para mejorar la visibilidad del aporte profesional en la salud global (Wilson et al, 2016).…”