‘Leading Change, Adding Value,’ the new framework for nurses and midwives, announced in May 2016, sets out 10 commitments that embrace patient-centred care, preventative public health and a better experience for staff.
Developed over a nine-month period in consultation with nurses, midwives, other frontline NHS staff, academics and the public, the 10 commitments were launched by Chief Nursing Officer (CNO) Jane Cummings, who described them as a way to tackle variation in prevention services and the efficiency and standards of nursing care.
Retaining a central focus on the 6Cs (care, compassion, courage, commitment, competence and communication), the new nursing strategy which replaces the 2012 Compassion in Practice, includes among its commitments, the pledge that nurses “will work in partnership with individuals, their families, carers and others important to them.”
While the strategy is specific in its approach to working with families - it identifies the referral services Start4Life and Change4Life, says nurses will work with schools to tackle obesity and related issues and involve parents, children, young people, families in the design of interventions - evidence has shown that there are a number of factors that affect the ability to successfully bring a family-centred focus to nursing services. These include the quality and depth of the relationships formed with families, as well as, emotional and educational support for the evolving role of the nurse as a family advocate.
Developing partnerships with families
Research has shown that taking a family-centred approach to healthcare not only improves the quality and cost of care but also delivers greater patient satisfaction with services. When services work, families say that they feel respected, able to communicate openly and that there is a sense of true collaboration and partnership with healthcare providers.
The shape and structure of the family has undergone a dramatic change in the last century, and according to Perri J Bomar in ‘Promoting Health in Families: Applying Family Research and Theory to Nursing’, promoting health in families requires an awareness of these changes, as well as of, diversity, ethnicity, and other determinants of health like social, economic, and political factors.
No two families are the same and services that are family-focused need to be flexible enough to cater to different needs, preferences, cultures and traditions. Nurses are challenged to employ a wide range of communication, observational and intervention skills, in an effort to form relationships and promote wellness with family members as both individuals and as representatives of the family unit.
Establishing mutual respect
The key to successful engagement of families, says the Early Learning Partnership Parental Engagement Group in its report ‘Principles for engaging with families: a framework for local authorities and national organisations to evaluate and improve engagement with families’, is the acknowledgement that both parties bring their own expertise to the partnership. Establishing communication practises that foster mutual knowledge exchange can be challenging for nurses, especially if dealing with families that present as less than competent. One way to meet this challenge is to take a strengths-based/solution-focused approach from the beginning, one that helps each family identify what it does that works and keeps the focus on its ability to make healthy decisions.
The ‘Leading Change, Adding Value’ framework supports this context of empowerment and included in its summary is a set of ‘I-statements’ developed by social care practitioners that “relate to the 10 commitments and the 6Cs.” “I can live the life I want and am supported to manage any risks” and “I have a voice to control the planning and delivery of my care and support” are two of the statements.
For nurses, establishing themselves as a support rather than an authority has the potential to deepen interactions with families and promote positive outcomes.
The nurse as family advocate
A 2013 review of past research studies (1998-2011) into health promotion practises by nurses revealed that when it came to promoting health, nurses were expected to possess a range of competencies. In addition to teamwork, time management and making use of a variety of data sources, nurses were expected to be able to communicate effectively, translate clinical knowledge into health promotion activities, have an awareness of social and cultural issues that influence health and lifestyle, as well as, the skills to respond to varying patient attitudes and beliefs. According to a ‘Nurses' roles in health promotion practice: an integrative review’, effective work with individuals and their families also “requires nurses to adopt a proactive stance and act as an advocate.” There is also the challenge of working with families that have complex dynamics or who have difficulty expressing themselves or making decisions.
With the wide range of competencies that impact effective family health interventions, it is important for nurses who work with families and carers, to recognise when they need extra support. This can sometimes just be in the form of advice but can also take the shape of additional training and the need to draw from the expertise of a wider interdisciplinary team.
Using the Internet as a resource can make it easier to stay abreast of recent research, learn from regional and international colleagues and come up with solutions to combat the lack of time and resources that can sometimes impede efforts.
Championing an organisational approach
At the forefront of the continuous shift towards health services that are more patient-centred and family focused, nurses can champion its development. They can help to promote an organisation-wide attitude that reinforces the importance of families to health outcomes by being willing to communicate the variance between policy and practise and contribute to the existing knowledge on effective practises. This includes prioritising the evaluation of services by families and carers and working with managers to eliminate any conflict in work priorities that could undermine the quality of the services provided.