Healthcare Professionals

As Osso states, “The challenge is then to show we value such involvement and to maintain the support of the family, while creating guidelines that maintain privacy for other patients and effective infection control measures.”(Osso Elna 2012), it is essential in nursing practise to understand the benefits of family involvement, and also predict where and when they can come in handy, before utilising them. The problem faced by the nursing practitioner world-wide is that there are no set rules or policies when it comes to ‘family intervention or involvement’ in nursing care.  It is entirely dependent upon the situation, and revolves around the health care provider and the family of the patient.

What Professional Skills and Values are Required?

Before going into the professional skills required for involving family in nursing care, here is what the experts say about the topic: “Family involvement is a multidimensional construct that entails visiting, socio-emotional care, advocacy, and the provision of personal care” (Gaugler E Joseph).

Family interference, is therefore, related to a whole lot of items, other than the simple care that the members of a household took to save a man from high blood pressure or body weight. Here, it is a comprehensive approach, wherein there exists a harmony between the nursing care professional and the members as in where and when the intervention is appreciated.

There are, however, several cases where we see the care givers, not able to manage the essential ‘care’ that needs to be given to a patient in need. Say, for instance, a family, with a member suffering from dementia, need to go beyond their ways to pacify and keep the patient happy. Here, giving medicines on time (although it matters too) or just having an eye on them to see if they slip back in memory are secondary. What is essential is the psychological support that the family members or one particular care giver can provide. Hence, the family care giver, or a volunteer will require both skill and knowledge to deal with the work and also to lessen their personal distress in an emergency situation. All three skills- the psychomotor, cognitive and psychological skills.

Here is where the professional skills of a nursing provider come into the picture. The requirements of a personal care giver involve: “..monitoring, interpreting, making decisions, taking action, adjusting to changing needs..working with the ill person..” (Schumaker)

The list, as we can see, is huge, and several times, the family care giver needs to put back their requirements, or change their work schedules to deal with the crisis at hand. As for the nursing practitioners, the primary job involved is to identify the person’s capabilities as a personal care giver, and coach them in all the requisite details to ensure they can deal with the job effectively.

It is not always that a family care giver is asked to go beyond the necessary means to deal with an emergency situation or a daily needs. Only in some situations require them to practice their skills to perfection, and also want them to get initial training. For instance, a mother, an ideal person in case of taking care of paediatric issues, should be explained about the risks involved in taking care of an infant with say, Down’s syndrome or irregular heartbeats or a cardiac problem. Unless she is explained about the technicality of involving the infant in an exercise or introducing him or her to a new routine, the primary care giver might not be of use.

Thus, although the involvement of a family care giver can diffuse difficult situations and can ease the patient’s problems, they need to be trained to be of any use to them. The nursing provider, who is in charge, can, to a certain extent, deal with the details. Since the job of a nursing provider is to give essential ‘care’ to the sick person, involving the family member as a secondary care giver can be left to their discretion. However, it is necessary for the nursing provider to:

• Give all details regarding the illness and what it involves treating the sick person
• Teach them the skills required for the job, such as ‘injecting a medicine’, or administering nasal drops or sprays, and so on.
• How to react in an emergency situation – explain, even with the help of an example, the immediate action to be taken in case of an emergency.

To do this, the nursing provider should be able to identify the situation in hand, and also check if the person responsible for acting as a family care giver is suitable for the job. Even if not, it should be left to the discretion of both parties to act according to the present scenario. When all is said and done, as Linda says, “…hearing and respecting an individual’s choice improves not only his/her health, but also his/her experiences” (Emslie Linda)

Hence, it is necessary for the practicing nurse provider to understand individual situations, listen to their requirements, and finally, look into their knowledge of the illness before rendering them suitable as a family care giver.

What areas of conflict arose/or could arise in this partnership and how should this be addressed?

While it is a known fact that involving family as care giver can benefit both the healthcare system and the sick person (as well as the family), there may be some circumstances which might need intervention and diffusion. The fact “The physical and mental health of the caregiver must not be ignored” (Darby Morhardt)” is true, and needs to be addressed.

Problems such as:

• Deciding on which family member is eligible for care giving
• Are the family members receptive to the advice and suggestions given by the nurse practitioner
• Would the family be mentally and physically distressed with the expectations raised as a care giver
• Will the family care giver, picked out either voluntarily or by the nurse is willing to alter the schedules (this might be mandatory in certain cases) and so on.

Similarly, other conflicting situations such as the need for financial assistance, no volunteers to take over the care giving responsibility or not adhering to the suggestions and instructions, can create tensions among the family and the nurse practitioner. However, one needs to understand that each situation is different, and unique. Only the nurse practitioner or any health care professional responsible for the patient can diffuse the tense environment by employing a professional attitude, albeit with kindness needed while dealing with a sick person or his family. Understanding the family and the socio-economic and cultural differences or practices can ensure no feelings are hurt and all are receptive to the advice/suggestions given by the health care provider.

The experts believe that it is necessary to ensure support is provided in the form on

• Rendering knowledge about care giving and what is involved
• Any form of assistance for gaining access to the services offered for care givers (like seminars, or sessions to impart knowledge)
• Counselling, especially if the care giver is involved with a terminally ill relative and is undergoing mental stress and strain

Although, the support comes only when there is an assurance that the family care giver has agreed to act as ‘secondary health care provider’ and is willing to learn the rudiments of health care for a particular illness (for which he is required to provide care).

What are the important legal and ethical principles that the nurse should consider when performing partnerships?

As many experts vouch for, family interventions and partnerships, earlier considered as a hindrance or unnecessary interruption in care giving, is now becoming essential for health care. The reason behind this is that apart from providing support at home, they also seem to form a bridge between the health care system and the patient, thereby easing communications.

However, there are several legal and ethical issues pertaining to engaging in family partnerships, which needs to be addressed before proceeding.

Ethical considerations-

The patients are the primary concern of any health care provider or the hospital. It is, therefore, essential that the health care provider acknowledge and understand the level of guidance or care the patient might need and if he is willing to go for it. Many patients can take decisions themselves very well, and would like to be involved in the decision making process related to their health issues. Hence, it is essential to get the approval of patients before a family care giver is acknowledged and trained.

Time and again, the hospital or the health care provider should assess the nature and degree of care received by the patient in the hands of care giver. One can either take stock of the situation with regular monitoring, or ask the patient about the nature and level of care given and if they are satisfactory.

The physician dealing with the patient should ensure that the family as well as the care giver at home and patient are all aware of the illness and what it entitles. Encouraging discussions between the family members, patient and health care providers can give an idea about the knowledge level of the individuals involved in providing care to the patient.

The health care provider should intervene in the case of any kind of distress or strain on the family care giver, and suggest an alternative situation or reprisals, if necessary.

Legal implications-

Legal implications for family interventions need to be addressed and understood both by the physician and the health care provider. When a family partnership can be helpful for the patient, it might not be what the patient seeks or want for his treatment. The ‘Decision is making’ should be left to the patient, since he or she is the one who has a legal responsibility towards their health. Unless the patient is not able to decide for himself or comatose, or does not want to take on the responsibility, the health care provider needs to first address the concern to the patient directly before training a care giver within the family.

Also, it is essential for the family care giver to be trained well in the essential care to be given to the patient before they are put to practice. For illnesses which require special care, and which needs the attention of trained personals, the ‘family care giver’ should be given strict instructions to ‘not involve’ in untrained areas.

For instance, administering an IV line, although something simple for a health care and trained professional, might not be easy for a family care giver, despite all the training. It requires an expert nurse or a physician to do it the correct way. On the other hand, giving oral medications, exercising muscles or administering injections (after training has been provided for the same) can be done by a family care giver.

Hence, it is essential to understand the ethical and legal concerns and threats involved in inviting family partnerships in care giving, to make it effective on both sides. Since the legal implications and ethical problems might be serious to handle, it is imperative to consider the above mentioned problems before partnering with the family in care giving.

Conclusion

Family involvement in the patient’s care is a known aspect, and has been practiced in many areas. Since caring for the elders or family members is something that is taken for granted in several cases, forming a family partnership for care giving is not a difficult issue. However, it is essential for the health care providers think about the implications and also look for professional skills of the individual involved, before forming the partnership.

Also, not only are the family care giver and the physician or the nurse involved here, our primary concern is about the patient. Since it is their necessities and health concern that we are worried about, it is important to talk to them before setting up partnerships for care giving. Also, every health care provider should remember that ‘care giving’ without training may not be advisable at all. Identifying the family care provider and training them in the rudiments of health care can work in the favour of both patients and physicians. Only then can they be able to provide home care required for the patient.

Family intervention and partnership is a great way to deal with patient care. However, understanding the implications, both ethical and legal, can work to the advantage of the health care system.

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References

• Angelo, M., Cruz, A.C. et al. 2014.  Nurses’ attitudes regarding the importance of families in pediatric nursing care.  Revista da Escola de Enfermagem da USP, vol. 48, pp. 74-79.
• Olding, M., McMillan, S.E., et al. 2015.  Patient and family involvement in adult critical and intensive care settings: a scoping review.  Health Expectations, vol. 19(6), pp. 1183-1202.
• Reinhard, S.C., Given, B., et al. 2008.  Chapter 14 Supporting Family Caregivers in Providing Care.  Patient Safety and Quality: An Evidence-Based Handbook for Nurses.
• Barbara, G., Paula, S.R., & Charles, G.W. 2008.  Professional Partners Supporting Family Caregivers.  American Journal of Nursing, vol. 108(9), pp. 28-34.
• Schumacher, K.L., et al. 2000.   Family caregiving skill: development of the concept. Res Nurs Health, vol. 23(3), pp. 191-203.
• Morhardt, D. 1999.  Working with the patient and caregiving family.  Galter Health Sciences Library.

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