The impact of interventions that promote family involvement in care on adult acute-care wards: An integrative review

Abstract

Background: Healthcare that involves patients and their families in care has been recommended to improve patient safety and quality. With limited direction on care partnerships for adult acute care patients, their families and healthcare teams, there is a need for a review of interventions that have been used to promote family in patient care within adult acute care wards. Aim: The aim of this integrative review was to describe interventions that have been used to promote family involvement in patient care within adult acute care wards. Method: Electronic databases of Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane, PubMed, and PsycINFO were searched between 1994 and 2016 using key search terms and word variations 'family involvement', 'family nursing', family centred care', family interventions', 'family therapies'. Additional literature was sourced from reference lists of relevant original publications. The Mixed Methods Appraisal Tool and Template for Intervention Description and Replication informed study and intervention assessment. Findings: Eleven single centered studies were included with interventions designed to improve functional capacity, cognitive function, and communication. Nurses were involved in intervention delivery for six of the 11 interventions. Outcomes of interest included patient outcomes (n=8) and intervention acceptability and feasibility (n=3). Improved patient outcomes were reported for seven studies. Intervention design and implementation were generally poorly described. Conclusion: Interventions designed to promote family in patient care on adult acute care wards improved patient outcomes in some instances, however, methodological limitations confound the evidence base for family involvement having a direct and positive impact on patient outcomes. Allowing patients and family members to partner in intervention design may enhance uptake and improve outcomes. Process and economic evaluations should also be included in future studies to allow assessment of clinical feasibility.

Obtaining information from family caregivers to inform hospital care for people with dementia: A pilot study

“…The planned conversation with caregivers had a strong focus on the kind of information that would inform care to minimise risk, alongside information to help ensure some understanding of the background, preferences and perspective of the person with dementia. To this extent, the conversation can be criticised as having limited value in terms of being “person‐centred.” However, the conversation is clearly consistent with the PFCC approach as described by Mackie et al (). In effect, this initiative sets person‐centred care within the context of the PFCC approach, which can thus facilitate safer care for the hospitalised person with dementia who is experiencing communication limitations at that time.…”

“…To this extent, the conversation can be criticised as having limited value in terms of being "person-centred." However, the conversation is clearly consistent with the PFCC approach as described by Mackie et al (2018). In effect, this initiative sets person-centred care within the context of the PFCC approach, which can thus facilitate safer care for the hospitalised person with dementia who is experiencing communication limitations at that time.…”

“…The Mackie et al () review identifies research into the PFCC approach for adults in acute care as a newly developing area. When critiquing five studies that aimed to enhance information sharing between the patient, their family and the clinical team, they note that just one, conducted by Berube and colleagues in 2014, included family in the design of the practice change, although engagement of all stakeholders is viewed as the “gold standard.” Our study was guided by a stakeholder reference group that included family caregivers but, in consideration of their caregiving responsibilities, accessed input via email rather than during meetings.…”

Psychometric testing of the revised “Families’ Importance in Nursing Care—Nurses’ Attitudes instrument”

“…Internationally, a growing body of evidence highlights the benefits of involving families in healthcare services, both for patients and family members (Meterko, Wright, Hai, Lowy, & Cleary, ; Mitchell, Burmeister, Chaboyer, & Shields, ; Rukstele & Gagnon, ); however, the implementation of practices which promote and support family participation in patient care has been slow (Berger et al., ). Nurses are uniquely positioned to promote family involvement in patient care, however, the attitudes and beliefs they hold may help or hinder this practice (Mackie, Mitchell, & Marshall, ). Given the importance of this issue, the attitudes nurse's hold towards family involvement in nursing care has been examined in several European studies using the “Families’ Importance in Nursing Care—Nurses’ Attitudes” (FINC—NA) instrument (Benzein, Johansson, Arestedt, Berg, & Saveman, ; Blondal et al., ; Rahmqvist Linnarsson, Benzein, & Årestedt, ).…”

“…and beliefs they hold may help or hinder this practice (Mackie, Mitchell, & Marshall, 2017). Given the importance of this issue, the attitudes nurse's hold towards family involvement in nursing care has been examined in several European studies using the "Families' Importance in Nursing Care-Nurses' Attitudes" (FINC-NA) instrument (Benzein, Johansson, Arestedt, Berg, & Saveman, 2008;Blondal et al, 2014;Rahmqvist Linnarsson, Benzein, & Arestedt, 2015).…”