Negotiated Care in PICU

suzanne4, RN · Apr 8, 2005

Are you speaking in terms of the family participating in care?

We actually have a family-centered PICU where I am currently working.

wendyw2 · Apr 9, 2005

Are you speaking in terms of the family participating in care?
We actually have a family-centered PICU where I am currently working.

Family Centred care is sort of related but our understanding is that we negotiate the children's management. We've got this document that the parents are supposed to sign when they have 'agreed' to the care for the day. The parents also, if they wish, participate in care. Most of us maintain that we provide ongoing and flexible negotiated care anyway so why do we need another document.

How do you implement your family centred care and how is it measured/evaluated?

Thanks for your response.

suzanne4, RN · Apr 9, 2005

At the moment, the parents can paricipate as much as they want in ADLs, if the child is stable, and it is okay with the nurse. We do not have any document that they sign.............

Some parents want to be very hands on, and others wish to sit in the corner of the room. Depends greatly on the comfort level of the parents, more than anything else.

UK2USA · Apr 10, 2005

Try to locate this article:

Casey, A. (1988). A partnership with child and family. Senior Nurse, 8(4), 8-9.

We used it as a basis to set up negotiated care on the unit I worked in in the UK.

*PICURN* · Apr 10, 2005

We also have a family-centered PICU where the parents are free (and encouraged) to do as much care as they feel comfortable doing.

Right now they are talking about whether or not to allow parents to be present if their child codes in the PICU. As of now, the policy prevents the family from being present. However, my unit director has told us stories about the benefits of having the parents present during a code (as long as there is a staff member available for support). They can see that everything possible is being done for their child, can say their last goodbyes, tell them it is okay to let go, etc.

Of course now I think I'm off topic!

wendyw2 · Apr 13, 2005

We also have a family-centered PICU where the parents are free (and encouraged) to do as much care as they feel comfortable doing.
Right now they are talking about whether or not to allow parents to be present if their child codes in the PICU. As of now, the policy prevents the family from being present. However, my unit director has told us stories about the benefits of having the parents present during a code (as long as there is a staff member available for support). They can see that everything possible is being done for their child, can say their last goodbyes, tell them it is okay to let go, etc.
Of course now I think I'm off topic!

No thats not off the point.

Our parents stay for critical incidences and one of the nurses is doing her PhD on parental presence during the times you mention. On occasions the parents have even been involved in CPR and sometimes they will tell us when to stop. The parents should always have a support nurse to explain and provide acknowledgement.

Concerning parental involvement in care, would you say all nurses are consistent with what they offer the parents? Do you document anywhere about any agreements and assessments you make in PICU?

Cheers and thanks for your info,

*PICURN* · Apr 13, 2005

No thats not off the point.
Our parents stay for critical incidences and one of the nurses is doing her PhD on parental presence during the times you mention. On occasions the parents have even been involved in CPR and sometimes they will tell us when to stop. The parents should always have a support nurse to explain and provide acknowledgement.
Concerning parental involvement in care, would you say all nurses are consistent with what they offer the parents? Do you document anywhere about any agreements and assessments you make in PICU?
Cheers and thanks for your info,

I would say some nurses more than others feel more comfortable allowing parents to be present during procedures (which seems more practical if you have a 3-4 year old screaming when mom/dad leaves). For the most part though, I think our nurses are comfortable enough to allow the parents to participate in a lot of the care. We don't document anywhere about agreements/assessments but I think if a procedure/emergency were to happen, parental presence would most definately be documented on the flowsheet.

wendyw2 · Apr 13, 2005

Try to locate this article:
Casey, A. (1988). A partnership with child and family. Senior Nurse, 8(4), 8-9.
We used it as a basis to set up negotiated care on the unit I worked in in the UK.

Hi,

I located the abstract of the article but can't get the full text yet. There was another book about the Notting Hill Model that came out after that. There has also been subsequent evaluation using the Fawcett Method which seems to be undecided about whether it is a nursing model or a theory. evidently some research needs to be done. It seems very much to be a UK thing. Our situation gets down to where do we document assessment of normal prehospital characteristics and how do we demonstrate consistency with our family centred care?

Although we argue that we all practice FCC, we are being asked to provide evidence of that, which questions a standard practice fundamental to a philosophy of nursing practice against a structured model.

Cheers