Family Involvement in the Hospital - From a Nursing Perspective
By Elna Osso, RN, MPH
Achieving a balance between creating a safe therapeutic environment for hospitalized patients and allowing family involvement for support is a challenge, here in the US and in developing countries. As nurses we may serve as facilitators and advocates, both at the bedside and in developing hospital policies.
In contrast to what I have seen as a staff nurse in US hospitals, patients are often accompanied by family when they come to hospitals in rural parts of developing countries. Siblings, parents, spouses, children, or other companions are at the bedside taking turns throughout the hospitalization. They sleep at the bedside, on the floor next to the bed or by the ward’s door or camp nearby in the open air on hospital grounds. They sit vigil, bathe their loved ones, run to the pharmacy to find medicine if they can afford it, make meals and feed them to the patient. That meal may be that same chicken that ran loose on the grounds of the ward a few hours before. It is what people have learned to do when they know hospitals struggle to provide care and seldom provide the services we assume are basic to hospital care.
Involvement from family in that setting is often ignored or it is taken as a necessary nuisance; people can help as long as they don’t get in the way, don’t ask questions and remain in a submissive role. I have seen families asked to leave a room in the way cattle is chased away by hospital staff.
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. As nurses, we have the potential to influence this attitude towards families/companions by our own actions, taking advantage of the fact that we spend most of our time at the bedside. Involving a family member while we provide care to the patient while explaining why what we are doing will benefit the patient could be an effective way. At the policy level, we can provide documentation and anecdotal evidence of the benefits of companions at the bedside (such as fewer falls, less anxiety, extra help lifting, to name a few), and we can model the behavior we would like to see from families and other health care professionals.
It should be noted that, in our emphasis to create a controlled, clean, private space at US hospitals, we have created unwelcome places for companions. Busy work schedules and family responsibilities don’t always coincide with visiting hours for example. The amount of time patients spend alone in our hospitals is tremendous; rare are the cases of a patient with extensive involvement from the family.
I don’t see family involvement as a negative for patient care. It is often a huge burden to the families. They put their lives on hold to care for their sick. Children are left unattended at home, fields not worked, household items sold for cash. While we strive to create hospitals where high quality services are provided and the burden on the family is significantly decreased, family contributions could be recognized in the hospital and channeled in the best way.
-Have others encountered similar situations?
-How can nurses influence change by taking advantage of the fact that we work in parts of the world where improvement in hospital services is still in process?
-How do we adapt to local perceptions of privacy and support?