Introduction
Parents are frequently separated from caring for their children, which leads to additional pressure on staff and trust issues. Patient-and family-centered care (PFCC) is applied to overcome the barrier between family and health workers to benefit patients, facilitate recovery, and enhance all members of the process’s satisfaction. In addition, such practice even reduces risks to patients’ health because medical errors become highly probable to be prevented. Practical strategies for collaborating with patients and their family members include but are not limited to Patient/family-centered communication and patient/family-centered multidisciplinary rounds.
Patient/family-centered communication can be considered a core of the caring process that improves overall satisfaction and helps achieve greater results in a shorter time. Park et al. (2018) emphasize the necessity of applying this strategy and its efficiency: “Diversity and flexibility of approaches made the provision of patient information one of the most popular interventions that can be relatively easy to implement with reliable outcomes” (p. 81). The other effective strategy is engagement in multidisciplinary bedside family-centered rounds (FCR). By becoming participants in the rounds, parents obtain a greater understanding of the patient’s plan of care and a feeling of working as a team. Park et al. (2018) state that this intervention effectively encouraged and motivated the patient and family members to participate in his/her care process actively. In addition, specific effects on patients indicated improving knowledge about their health, performing self-care behaviors, enhancing satisfaction with practitioners, reducing admissions, readmissions, and the length of hospital stays (Park et al., 2018). The mentioned evidence states that patient/family-centered communication and multidisciplinary bedside family-centered rounds are practical strategies for collaborating with patients and their family members to achieve the desired health outcomes.
The Aspects of Change Management that Directly Affect Patient Experience
Change management in medicine is considered an approach to transferring patient-centered care areas from a current state to an improved future condition. It is possible to distinguish the variety of aspects that directly affect the patient’s experience from the process of caring. According to the CAHPS survey (that is a national, standardized, publicly reported survey of patients’ perspectives of hospital care), nine main critical aspects should be identified (Kumah, 2017). These include communication with nurses, communication with doctors, hospital staff responsiveness, pain management, communication about medicines, hospital discharge, cleanliness and quietness of the clinic environment, and overall hospital rating (Kumah, 2017). It is necessary to stick to the mentioned aspects to enhance high-quality, patient-centered care to conduct changes successfully.
Considering change management, it is worth distinguishing the difference between patient experience and patient satisfaction. These indicators of the quality of healthcare are related but not equal, as it is possible to track to what extent certain aspects of patient experience refer to patient satisfaction. According to pairwise correlations of CAHPS reported dimensions of hospital experience and overall patient satisfaction, the highest correlation coefficient (0.793 and 0.765 respectively) showed communication with nurses and Responsiveness of hospital staff (Kumah, 2017). Simultaneously, the less valuable aspect was hospital discharge (0.544 correlation coefficient) (Kumah, 2017). The mentioned evidence shows what aspects of patient-centered care should be respected the most as change management using the noticeable difference between them may distribute efforts according to their values.
The Rationale for Coordinated Care Plans Based on Ethical Decision Making
The significant role of coordinated care plans in the process of patient care is inevitable. They outline the accessible way to meet all personal and medical needs of a patient on an ethical decision-making base to facilitate both a practitioner and a patient even in the most complicated terminal diseases cases. However, the ethical approach is complicated because of the necessity to balance rational and empathetic choices. Doctors who counsel, for instance, parents about choices for a sick baby are responsible for being aware of the ethical complexity of their role as choice architects (Lantos, 2018). According to Lantos (2018), “parents of critically ill babies generally do not make decisions by carefully calculation the likelihood of achieving various specific outcomes” (p. 1856). As family members are usually in the grip of emotions and cannot obtain an unbiased insight, a practitioner should identify the optimal coordinated care plan and convince them to accept it. Following the mentioned statement and evidence, the logical positive implications and consequences of an ethical approach to caring are persuasions on a rational treatment. At the same time, the adverse outcomes lead to the deterioration of a case.
It is possible to unite articulates underlying assumptions that guide decision-making into two steps, which allow doctors to help parents make authentic, rational, and ethical choices. According to Lantos (2018), the first step is for doctors to become aware of their own beliefs and unconscious biases. The second step in ethical decision-making is to learn to ask parents questions about their hopes, fears, goals, expectations, and values and then listen attentively for key elements of the answers (Lantos, 2018). After the mentioned steps, a practitioner can sense what parents need and associate it with rational choices that should be implemented to create an optimal coordinated care plan. This attitude allows for determining major preferences that should always be taken into account. However, it is worth remembering that shared and ethical decision-making will not constantly lead to choices that medical staff would prefer.
The Potential Impact of Specific Health Care Policy Provisions
Since medical help should be practical, convenient, satisfying, and accessible for all society segments, specific health care policy provisions are implemented. The opportunity to obtain a high-quality treatment without substantial financial losses significantly improves the patient’s experience and, as a result of the right mindset, improves care outcomes. Affordable Care Act (ACA), accepted in 2010, decreased the number of uninsured individuals through the dependent coverage provision that facilitates the overall situation (French et al., 2016). ACA may positively affect health care areas, and it should be measured by considering its statements.
It is important to outline some key provisions and their definitions, which contain the main intentions and expectations from ACA, to show the potential impact of specific health care policy provisions. Young adults can remain on their parent’s insurance plans until age 26 (dependent coverage provision), which reduces potential expenses and the number of insured individuals (French et al., 2016). Employers are required to offer affordable, comprehensive health insurance to full-time employees (employer mandate) (French et al., 2016). Also, ACA expands Medicaid eligibility to all individuals under age 65 with annual incomes up to 133 percent of the federal poverty level (French et al., 2016). These provisions were established to expand insurance coverage and improve the affordability of insurance plans. Still, they are also noticed to enhance the patient experience from medical care and treatment results due to the absence of irritants related to financial losses.
It is worth appealing to the French et al. (2016) study to summarize effects from an interpretation of relevant and significant policy provisions. It shows that since the year 2012, the percentage of uninsured people in the United States population decreased by half from almost 15 percent to 7.5 percent. French et al. (2016) found significant improvements in access to primary care services and medication, affordability of care, self-reported health, and an increased number of adults reporting problems. The mentioned evidence shows a positive dynamic in the current time and promising expectations in the future. As to outcomes, it is possible to find dependence between simplified access to high-quality care and patient experience since individuals report health issues sooner and receive appropriate treatment in time. The mentioned facts derive from reducing the chances of developing a terminal disease, as individuals are not distracted by financial difficulties from recovering.
The Nurse’s Vital Role in the Coordination and Continuum of Care
In the caring process, nurses pose a particular role due to their unique connection with the patient that arises from the amount of time they spend caring. Their role in the coordination and progression of care cannot be replaced by other medical staff. They watch over both the mentioned processes while ensuring that the patient understood the doctor’s or other healthcare personnel’s information and feedback (Sekse et al., 2018). Throughout the entire continuum of care, nurses are present from prenatal care to elder care and end-of-life care, working around the clock and fulfilling their fundamental needs (Sekse et al., 2018). In the coordination of care, the nurses have key roles in communication with all persons involved. For nurses, being a liaison and a coordinator is seen as essential for continuity of care and the implementation of other pledges regarding the patient’s physical state (Sekse et al., 2018). To conclude, the nurse’s vital role in the coordination and progression of care consists of facilitating clear communication between patients and other medical staff and assisting in fundamental needs at all individual life stages.
References
French, M. T., Homer, J., Gusmus, G. & Hickling Lucas, B. A. (2016). Key provisions of the patient protection and affordable care act (ACA): A systematic review and presentation of early research findings. Health Services Research, 51(5), 1735-1771.
Kumah, E. (2017). Patient experience and satisfaction with a healthcare system: Connecting the dots. International Journal of Healthcare Management, 12(3), 173-179.
Lantos, J. D. (2018). Ethical problems in decision making in the neonatal ICU. The New England Journal of Medicine, 379(19), 1851-1860.
Park, M., Lee, M., Jeong, H., Jeong, M., & Go, Y. (2018). Patient-and family-centered care interventions for improving the quality of health care: a review of systematic reviews. International Journal of Nursing Studies, 87, 69-83.
Sekse, R. J. T., Hunskår, I., & Ellingsen, S. (2018). The nurse’s role in palliative care: A qualitative meta‐synthesis. Journal of Clinical Nursing, 27(1-2), 21-38.