Investigating a Critical Practice Question Through a Literature Review
Family involvement in a patient’s treatment plan, and the effect of that involvement on treatment outcomes and recovery has been an issue of much debate. This issue has been significantly highlighted by the treat of Covid-19 pandemic, and public health advice on social isolation to curb the spread of the pandemic. In fact, the social isolation of family members has made it difficult for the family to establish connections with the health care team so that they are minimally involved in the treatment plan. The involvement of family members in treatment is well established: a qualitative study by Kentish-Barnes et al. (2021) revealed that with family visits to hospitals either being restricted or highly banned, the family involvement in decision making has been compromised. However, the study further reveals that while family cannot be present in person, technology can be leveraged by modifying distance communication so that family still provide a sense of support and information, although the quality of communication would be compromised Investigating a Critical Practice Question Through a Literature Review.
ORDER YOUR PAPER HERE
Family involvement in patient care is increasingly advocated for in the redesign of health care services. In fact, family involvement is perceived as allowing family to contribute to discussions and decisions involve the planning and development of health care services. Such involvement is associated with patients reporting improved quality of life and health. In this case, family involvement entails providing feedback based on the valuable perspectives, insights, expertise and experience that they can inform health care changes regardless of whether the feedback is positive or negative. For that matter, family involvement entails sharing information, transparency and partnership that is applied at the decision making levels thereby giving the family a voice in planning the treatment strategy and designing patient care changes and improvements. The involvement of family results in a co-led health care design in which clinical, patient and family perspective come into play for shared decision making (Prior & Campbell, 2018).
Wiig et al. (2020) explains that family involvement in decision making and as a source of information is not a new concept. Rather, it is a recommended strategy high in health policy agenda. There has been increasing efforts to involve family at multiple decision making levels: at the policy, organizational and individual levels. This is intended to achieve two benefits: they are effected by health care decisions and are being offered an opportunity to influence the decisions that affect them; and there is an expectation that involving family will result in a better understanding of the patient’s case and result in better quality decisions across all levels thus ensuring patient-centered care of high quality is delivered Investigating a Critical Practice Question Through a Literature Review.
Rous, Tengah and Zolkefli (2021) add to the discussion by reporting that family involvement offers significant benefits. It ensures that the health care plan and services meet the needs of the patient and improve health outcomes. Providers practice medicine because of the patient, with a focus on taking care of people. However, unintentionally, providers face pressure to manage more complex health concerns, see more patients and produce more, with these pressures cause them to miss care opportunities. When family is actively involved in care, there are measurable improvements in safety and quality, with even more efficient care and fewer malpractice claims. Also, family involvement improves the satisfaction levels of the patients, family and providers. Besides that, it improvement communication, and with better communication comes more accountability and transparency (Naef et al., 2021)Investigating a Critical Practice Question Through a Literature Review.
These benefits can be summarized as three reasons for family involvement. First, it allows the providers to gain patient-centered credit for shared decision making and other collaborative activities. Second, it improves provider/clinician satisfaction, a significant concern in the face of high provider burnout rates. Building relationships with patients and family members is a very satisfying experience and can help boost provider morale. When the family trusts the provider, the patient is likely to have better care outcomes, because they feel empowered to contribute where they can and less likely to file a malpractice claim or fail to pay the medical bill. These are things that alleviate the burdens placed on the providers on a daily basis. Third, it improves care outcomes for patients. Patients can feel frustrated when the provider does not understand how the medical condition affects their daily lie and there are other barriers that hinder them from improving. The providers are likely to become frustrated if the patient does not improve. Involving the family helps in finding a common ground where improved outcomes of mutual goals can be achieved. When the patient and family feel involved and are part of the solution, they are likely to trust the providers and become more motivated to succeed (Kydonaki, Kean & Tocher, 2020)Investigating a Critical Practice Question Through a Literature Review.
Soklaridis et al. (2019) similarly reports that family involvement offers significant benefits in psychiatric care. The family provides information that may be unavailable through other avenues and could be overlooked as they have unique expertise and skills, and bring in their lived experiences. The family have in-depth knowledge of the patient receiving care and are a consistent support system. In addition, the family is often the first to recognize if the patient has problems, such as relapse, and can connect the patient to the providers in emergency situations outside scheduled care interactions. While family involvement is beneficial, it has been hindered by a range of factors. First, fears about being unable to establish a therapeutic alliance and family interfering with informed care plans. The family involvement could cause the provider to be over reliant on the family for information while ignoring the therapeutic relationship with the patient. Second, lack of health literacy could result in the family being unaware of how they should be involved, such as not knowing what information to provide and being unable to contribute to decision making. Third, the family can be overburdened so that it become more resentful, and less appreciative, of the involvement. This can make the family involvement counterproductive as they may withhold information and become less supportive of the patient. Fourth, there are fears about losing control and power. Family involvement introduces a new locus of control and power that interferes with other loci so that decision making becomes more difficult. Fifth, there are privacy concerns. The patient may not necessarily want the family to have access to his/her private medical information, and yet family involvement would allow the family members to have access to that information (Soklaridis et al., 2019). These are barriers that must be addressed if the benefits of family involvement are to be derived Investigating a Critical Practice Question Through a Literature Review.
There is a general consensus that family involvement is beneficial. However, there is a need to note that these benefits stem from a common approach of family involvement in which the family members act as surrogates for providers, helping them to collect information that improves decision making. In these cases, the family is involved as effectors who seek to change the patient’s behavior and outcomes. These benefits are more perceptible in psychiatric care where family involvement improves their partnership and coping ability so that the focus is centered on the intervention (Gilliss, Pan & Davis, 2019). This awareness raises question about whether there are negative effects associated with family involvement Investigating a Critical Practice Question Through a Literature Review.
ORDER YOUR PAPER HERE
A review of literature reveals that while there are negative effects of family involvement, there is a lack of robust research on this subject. Mayberry and Osborn (2014) reveal that while family involvement can present supportive behaviors, it can also present obstructive behaviors that hinder health care delivery with a negative effect on patient outcomes. Family support is strongly associated with patient adherence as the family provides instrumental support by creating an environment that reinforces adherence, helping and reminding the patient to perform a behavior, and attending medical appointments. Still, family members can intentionally or unintentionally undermine or sabotage care delivery efforts by questioning the need to adhere to the treatment plan, tempting the patient to engage in unhealthy behaviors, and planning activities that should otherwise be avoided (e.g., organizing a home party with alcohol and drugs available when the patient is recovering from alcohol addiction). Also, the family members can argue with or nag the patient in an attempt to support the care plan, only to create family conflict and undermine the patient’s self-efficacy (Mayberry & Osborn, 2014). This makes it clear that family involvement is not unidimensional, as it can be helpful or harmful Investigating a Critical Practice Question Through a Literature Review.
The current state of affairs (Covid-19 pandemic) draws attention to the benefits that can be derived from family involvement. Kentish-Barnes et al. (2021) explains that during covid-19 pandemic, in-person family involvement has been highly restricted. The social distancing requirements have meant that family members no longer accompany patients to hospital visits, so that their participation in decision making is compromised. Gadermann et al. (2021) adds to the discussion by reporting that Covid-19 pandemic may have worsened the situation. As the pandemic raged and surged, there were adopted recommendations for social distancing with public institutions remaining closed and families losing income. These combination of factors creates mental health issues among family members (such as higher incidences of self-harm, suicidality, substance use patterns, emotional resources and stress) so that they may harm instead of helping the patient Investigating a Critical Practice Question Through a Literature Review.
It is evident family involvement can offer significant benefits for treatment outcomes and recovery. These benefits can only be derived when the identified hindrances are eliminated or minimized. In addition, Covid-19 pandemic has created significant challenges for family involvement. To address the Covid-19 era challenges, Hart et al. (2020) suggests that communication technologies be leveraged to facilitate family involvement. Maintaining public health safety in the era of Covid-19 pandemic necessitates that the physical presence of family members be minimized within the health facility. To achieve family involvement, the physical presence restrictions must be circumvented. Communication technologies, particularly the internet and telephones, can help to circumvent the restrictions by allowing the family members to communicate with providers, participate in decision making, and influence health care outcomes. The communication technologies can facilitate structured, predictable and routine communication between the family and provider thus ensuring family involvement (Hart et al., 2020)Investigating a Critical Practice Question Through a Literature Review.
While communication technology is beneficial in facilitating family involvement, it presents unique challenges that may act as a hindrance. First, communication technologies may compromise patient information privacy. While there are a range of protocols and tools that can be applied to secure the patient information, there is always a risk of data breaches, whether intentional or unintentional. The risk to patient information privacy can only be minimized. Second, the use of communication technologies can exacerbate geographic, socioeconomic and racial disparities, especially when a family does not have access to a reliable communication device with internet connection or is not technologically literate. These two challenges can be addressed to ensure communication technologies are leveraged for family involvement even during physical distancing responsive to the current Covid-19 pandemic (Hart et al., 2020) Investigating a Critical Practice Question Through a Literature Review.
Across the reviewed studies, it is clear that although recommended, family involvement has suffered in the face of physical restrictions because of Covid-19 pandemic. There is considerable evidence showing that if done right, family involvement would be beneficial for improvement treatment outcomes and recovery. Towards this end, the reviewed literature suggests that communication technologies should be leveraged to circumvent the physical restrictions and allow for family involvement.
References
Gadermann, A. C., Thomson, K. C., Richardson, C. G., Gagne, M., McAuliffe, C., Hirani, S., & Jenkins, E. (2021). Examining the impacts of the COVID-19 pandemic on family mental health in Canada: findings from a national cross-sectional study. BMJ Open, 11(1), e042871. https://dx.doi.org/10.1136/bmjopen-2020-042871
Gilliss, C. L., Pan, W., & Davis, L. L. (2019). Family Involvement in Adult Chronic Disease Care: Reviewing the Systematic Reviews. Journal of Family Nursing, 25(1), 3-27. https://doi.org/10.1177/1074840718822365
Hart, J. L., Turnbull, A. E., Oppenheim, I. M., & Courtright, K. R. (2020). Family-Centered Care During the COVID-19 Era. J Pain Symptom Manage., 60(2), e93-e97. https://dx.doi.org/10.1016/j.jpainsymman.2020.04.017
Kentish-Barnes, N., Cohen-Solal, Z., Morin, L., Souppart, V., Pochard, F., & Azoulay, E. (2021). Lived Experiences of Family Members of Patients With Severe COVID-19 Who Died in Intensive Care Units in France. JAMA Network Open, 4(6), e2113355. https://dx.doi.org/10.1001/jamanetworkopen.2021.13355
Kydonaki, K., Kean, S., & Tocher, J. (2020). Family INvolvement in inTensive care: A qualitative exploration of critically ill patients, their families and critical care nurses (INpuT study). Journal of clinical nursing, 29(7-8), 1115-1128. https://doi.org/10.1111/jocn.15175
Mayberry, L. S., & Osborn, C. Y. (2014). Family involvement is helpful and harmful to patients’ self-care and glycemic control. Patient Educ Couns., 97(3), 418-425. https://dx.doi.org/10.1016/j.pec.2014.09.011
Naef, R., Brysiewicz, P., McAndrew, N. S., Beierwaltes, P., Chiang, V., Clisbee, D., … & Eggenberger, S. (2021). Intensive care nurse-family engagement from a global perspective: A qualitative multi-site exploration. Intensive and Critical Care Nursing, 66, 103081. https://doi.org/10.1016/j.iccn.2021.103081
Prior, S. J., & Campbell, S. (2018). Patient and Family Involvement: A Discussion of Co-Led Redesign of Healthcare Services. Journal of Participatory Medicine, 10(1), e5. https://dx.doi.org/10.2196/jopm.8957
Rous, B. X., Tengah, A.,& Zolkefli, Y. (2021). Nurses’ Perspectives on Family Involvement in Intensive Care. International Journal of Care Scholars, 4(1), 3-9. https://doi.org/10.31436/ijcs.v4i1.152
Soklaridis S, McCann M, Waller-Vintar J, Johnson A, Wiljer D (2019) Where is the family voice? Examining the relational dimensions of the family- healthcare professional and its perceived impact on patient care outcomes in mental health and addictions. PLoS ONE, 14(4), e0215071 Investigating a Critical Practice Question Through a Literature Review. https://doi.org/10.1371/journal.pone.0215071
Wiig, S., Rutz, S., Boyd, A., Churruca, K., Kleefstra, S., Haraldseid-Driftland, C., … & van de Bovenkamp, H. (2020). What methods are used to promote patient and family involvement in healthcare regulation? A multiple case study across four countries. BMC Health Services Research, 20, Article number 616. https://doi.org/10.1186/s12913-020-05471-4
Jazieh, A. R., Volker, S., & Taher, S. (2018). Involving the Family in Patient Care: A Culturally Tailored Communication Model. Global Journal on Quality and Safety in Healthcare, 1(2), 33-37. https://doi.org/10.4103/JQSH.JQSH_3_18
ORDER YOUR PAPER HERE
This week you will begin your Module 4 Assignment, which is intended to inform and support your planning for your DNP Project in your program of study. This Assignment has two parts: a literature review in the Walden Library of research to address the critical practice question that you framed in Week 7, and a critical assessment of your search outcomes in which you synthesize the evidence. Both Parts 1 and 2 will be due by Day 7 of Week 10. Plan your time accordingly Analyze your critical practice question from the Week 7 Discussion. Based on feedback from colleagues and your Instructor, revise your question, as necessary, to ensure a clear and relevant focus for your literature search. Review the Learning Resources to support your search. Access the Individual Evidence Summary Tool Template document from the Learning Resources. This is a fillable PDF document that you will complete with at least 10 scholarly articles relevant to your critical practice question. Scan the template to ensure you understand how to enter information for each article you identify. Use the Week 8 Discussion to guide and clarify your search process and to pose any questions related to the template categories, search terms, or others. Part 1: Literature Review (10+ scholarly articles) Using the Walden Library as your source, search to select at least 10 scholarly articles that represent current literature (i.e., published within the previous 5 years) with evidence that addresses your critical question and could inform a practice change initiative for quality improvement. Using the Individual Evidence Summary Tool template document, complete all sections for each article. Part 2: Critical Assessment (7+ pages) In a paper of at least 7 pages, plus cover page and references page, include the following: Investigating a Critical Practice Question Through a Literature Review Write a critical assessment of your search outcomes that synthesizes the evidence from your literature review. Demonstrate clear connections between the practice problem that informs your critical question, your appraisal of evidence that addresses the critical question, and resulting clarification on the need for a practice change initiative focusing on quality improvement. Be specific and provide examples. Practice problem from week 7 that we are trying to address: the issue of concern (problem) is presented as: In outpatient mental health clinic clients (P), how does involvement of family members in the treatment plan (I) compared to not involving them (C) affect treatment outcomes and recovery (O)? Investigating a Critical Practice Question Through a Literature Review