t Goryeb Children's Hospital, parents of patients in the pediatric ICU are welcome partners in the healthcare process.
Whether it's listening in on bedside rounds, sitting with their child in recovery or spending the night, it's all part of the patient- and family-centered care (PFCC) culture at the Morristown, NJ, facility. From admission to discharge, everyone on the PICU team views their care through the eyes of the patients and their families. It's an atmosphere where "yes" is the resounding response to questions that frequently begin with "can I" or "may we" from frightened parents, and where trust and respect are cornerstones.
"Our culture has changed a full 180 degrees. Four years ago, we were a locked unit. Parents had to ring a bell and were asked to leave during rounds and procedures," said Liz DuBois, MS, RN, CPN, NE- BC, nurse manager for the PICU. "If you think traditional, which is very patriarchal, we don't believe in that philosophy at all. Parents are on equal ground with us."
Kim Belton, RN, CCRN, clinical coordinator for PICU and pediatrics, couldn't agree more. As a member of the 50-member team, including 30 RNs, she praises everyone for their overall dedication - as well as for bringing its 10 best ideas for PFCC to another hospital in New Jersey.
"We are not only the buzz of our hospital system; we are the buzz of the state," she boasted, and rightly so.
Belton, who has been with the hospital system for 25 years, says it's not hard for her or her fellow team members to keep up the successful momentum, to keep things fresh.
"It's simple, never stray from the PFCC methodology; it will be your North Star and always lead you to transformation."
The PFCC culture is endorsed and recognized through nursing literature, as well as evidence-based practice, and through many professional organizations. Just this year, the Joint Commission integrated PFCC in its standards, and added a section on its website.
FAMILY FIRST:Practicing patient- and family-centered care, Laura Cardona, BSN, RN, reviews the care plan for Bruno Stillo with his mother, Jacel Delgadillo, and sister, Angelene.
Other organizations that have endorsed PFCC include the American Academy of Pediatrics and the American Association of Critical-Care Nurses. The Institute of Medicine, in its 2001 report, "Crossing the Quality Chasm," defined PFCC in part as "care that is respected and responsive to individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions."
Not only are other units within the hospital following suit, other hospitals have reached out to the PICU team for guidance, according to DuBois.
"What we do here in pediatrics should be a model for everything," she said. She questioned rules that prohibit husbands and wives from spending the night with a hospitalized spouse, or parents from observing a procedure as its being performed on their child.
"Here, parents are allowed in the recovery room. Why don't we do that in the adult world?
"Every unit is moving forward with the healing culture throughout the system," DuBois said. "We believe patient- and family-centered care is the icon for the healing culture."
It's not as though the members of the PICU do not experience ups and downs, DuBois said.
"What guides us is our firm belief. We know we are not ever going to be done. The journey is a road that we will continue traveling on.
"We are all committed," she continued. "Everyone is here because they care about kids, and their families." In addition to being part of the team, she said, staff makes it their business to be as supportive to family as they are to the patient.
"We couldn't be here without our team of nurses, doctors and social workers," DuBois said.
Laura Cardona, BSN, RN checks in on Bruno with Jamie Marchiano, BSN, RN, (center) and Jamie Gecz, BS, CCLS.
Noting that any true change must come from the top, DuBois lauded Walter Rosenfeld, MD, chairman of pediatrics, and Frank Drigun, director for Women and Children's Services for the Atlantic Health System, for their unwavering support. "It really was their brain child," she said.
Funded through a $100,000 grant from the R Baby Foundation, the unit began to implement the PFCC culture over the past 4 years. Before Goryeb - which is celebrating its 10th anniversary in October - the PICU was part of Morristown Medical Center for 20 years. (DuBois, Drigun and Rosenfeld collaborated on writing the grant.)
"Our first team initiative, now hard wired, brought change of shift nursing report to the bedside. Patients and parents are always included. This was a big change for us," Belton said. "A driving goal for PFCC in the PICU is to coordinate and improve the critical care patients' course of stay across the entire continuum of care by strengthening the communication between the nurse, patient, family, physician, and support staff. We believe parent participation not only improves quality, but also has demonstrated to reduce errors."
Daily PFCC care rounds, performed by the critical care interdisciplinary team, which includes the physician staff, family member, staff nurses, nursing leadership and ancillary staff like care manager and social worker, are another way to keep lines of communication open.
PICU PRIDE:Team members at Goryeb Children's include (from left) Colin O'Reilly, DO, Jamie Marchiano, BSN, RN, Connie Hauck, MD, Liz DuBois, MS, RN, CPN, NE-BC, Laura Cardona, BSN, RN, Tuesday Cirillo, MA, APN, RN, and Rachel Jeffrey, RN.
"The focus of daily PFCC rounds is to review, discuss and ultimately revise the current plan of care, as well as the long- and short-term patient and family goals," Belton wrote. Those issues might include line/tube necessity, pain management, family needs/family meeting arrangements, DNR status, palliative care, wound/skin care, medication review, discharge/transfer planning, abnormal labs, appropriate feeding orders, and necessary department referrals, to name a few.
"As a result of rounds, parents and staff have experienced an opportunity to clarify daily goals and communicate more effectively as a cohesive team to ensure ongoing positive outcomes," Belton said. "Our families and patients are invited to participate and are encouraged to get involved and give additional feedback regarding the plan of care. We have found by getting the patient and family involved, it has served to strengthen the relationship between them and the caregiver, and to decrease the anxieties that naturally come with being in a critical care environment."
At every bedside is a binder, which includes all up-to-date information. It's among the many accomplishments of the PFCC advisory board committee, which is made up of the PICU team and a parent adviser. "PICU parents find this binder invaluable," according to Belton.
Even in tragedy, the PICU team has found families to be so grateful that they could be with their loved one. "They see the effort," Dubois said.
In the end, she noted, "They are often the first to say, 'OK, enough - stop.' "
DuBois and Belton both agree that it's due to the dedication of PICU colleagues like Jamie Gecz, BS, CCLS, a child life specialist, and Tara Canfield, a licensed clinical social worker, that the family-centered ideals have been so successful.
"Their job is to distract the children," DuBois said. "Nurses could not do what they do without them."
Gecz, who has been at Goryeb for 8 months, said her challenge is to introduce appropriate therapeutic play to the PICU patients. Distractions could be journaling or playing with blocks.
For the intubated patient, she makes certain to bring along an iPad so they can communicate. They also support siblings and their parents.
"Imagine how traumatic this can be," said Canfield, who has been part of the team for 5 years. "We have an appreciation for how terrified and vulnerable they are."
In the past year, 600 patients ranging in age from a few days old to 21 were admitted to the nine-bed unit. Lengths of stay depend on the acuity of each patient.
Belton was reminded of an exchange she had with the newest member of the PICU team, a pediatric intensivist who after years in the field, thought she knew about family-centered care before she arrived at Goryeb.
"I didn't know what I was missing until I got here. You really, truly partner with them," Belton quoted the colleague as saying.
Belton considered it the ultimate compliment.
Rose Quinn is a frequent contributor to ADVANCE.