Transcript Document

TANI FORUM 2014
Exploring Concepts of “Care”
Focus on Children & Families
Ronelle Baker
Allied Health Leader
Child, Women & Family Services
Presentation Outline
1. Define care
2. Explore care obligations for health
professionals, e.g. duty of care
3. Describe Family Centered Care
4. Describe key elements of care planning
5. Discuss some considerations for parents
of children with ongoing, complex health
and/or disability related needs
Defining Care
• Care; to feel concern or interest; provide care for;
be in charge of, act on, or dispose of; be
concerned with
Reference: Dictionary.com
• Care; a socio-cultural value steeped in meaning
• Health professionals have additional obligations:
– Duty to provide care (e.g. In an emergency
situation)
– Professional standards of care (Registration
bodies e.g. Nursing Council etc.)
– Duty of care (Service and individual levels)
Duty of Care
• Ethical and legal obligations
• “the legal obligation to safeguard others
from harm while they are in your care, using
your services, or exposed to your activities”
Reference: Collins English Dictionary
• Service level > duty of care begins on receipt
of referral
Duty of Care cont...
• Professional level > clinician/client
relationship
• Responsibility for providing care is
maintained until formally
transferred
• Can be shared with someone else
Family Centered Care
• FCC is an approach to service delivery which
encompasses planning, delivery and
evaluation of health care for children and
families
• Ensures care is planned around whole
family, not just the child receiving care
Family Centered Care
Key elements of FCC:
– Every family is unique
– Families are the constant in a child’s life
– Parents/families are the experts on their
child (abilities, needs, etc.)
Family Centered Care
• Recognises unique social context of child e.g.
ways of coping, family ability to access resources,
siblings, role of extended family, cultural values,
language spoken, religious beliefs etc.
• Is based on collaboration with families in the
planning of care for their child
• Produces better outcomes
e.g. Improved engagement, planning and goal
attainment
Family Centred Care
• However, some challenges with
implementation and evaluation
• Some evidence does not fully support FCC
model of care in modern context
e.g. Sheilds (2010) notes evidence that parents
can feel pressured to participate in care, there
are role perception issues, workforce
competence requirements, and the availability of
parents who may be working is a factor.
Example of FCC Service
• Example below of implementation
of FCC approach in a perioperative
setting
• The perioperative period covers the
duration of a surgical procedure
• Encompasess admission,
anaesthesia, surgery and recovery
Perioperative Example
Ref: Chorney, J.M. & Kain,
Z.N. (2010).
Family-centered Pediatric
Perioperative Care.
Model of Family Centered Perioperative Care
Family Centered Care Planning
• Must meet service and professional standards
• Integrates all information from family and
multi-disciplinary team members working with
child
• Is developed in partnership with families, as a
result of an assessment of need
• Describes the way services will be provided to
meet identified needs
• Includes goals, actions & a review period
Family Centered Care Planning
• Considers unique family context and needs of
whole family, in addition to the needs of the child
requiring health/disability service
• Workforce requirements: skilled at
communication, negotiation, goal setting,
coordination & the ability to work with diversity
• Adaptability and flexibility to cope with changing
needs
• Empowerment of families & building resiliency
Advance Care Planning
• A process for planning for future health care
• Relevant for permanent and/or palliative conditions
• Includes discussion about:
individual preferences for future care or
treatments
what will happen when a person loses capacity or
competency to make their own decisions
individual beliefs and wishes around death and
dying
Parents as Carers
• Parents – altered role title “family carer”
• Grief / adjustment and coping
• Overwhelming range of health
professionals/services
• Family stress / impact on siblings / parent
wellness / parental separation
• Vulnerability of disabled children
Parents as Carers
• Challenging transitions – e.g.
developmental, educational etc.
• Life planning – e.g. ageing parents
Parents as Carers
• Forms of support include:
Access to health and disability services
Condition specific support groups
Funded out of home or within home
respite
Carer Support subsidy
Child disability allowance
Parents as Carers
• Generic support networks include:
Carers NZ
www.carers.net.nz
Complex Care Group
www.complexcaregroup.org.nz
Parent 2 Parent
www.parent2parent.org.nz
References
Advance Care Planning: A guide for the New Zealand
health care workforce. (2011). Ministry of Health.
www.moh.govt.n.z
CanChild Centre for Childhood Disability Research.
http://canchild.ca/en/
Chorney, J.M. & Kain, Z.N. (2010). Family-centered Pediatric
Perioperative Care. Anesthesiology. 112(3), 751-755.
doi: 10.1097/ALN.0b013e3181cb5ade
Sheilds, L. (2010). Questioning Family centered care. Journal of
Clinical Nursing, 19, 2629–2638.
Writing Good Care Plans: A good practice guide. (2012). Derbyshire
Healthcare. NHS Foundation Trust, United Kingdom.