Involving Families in Healthcare – Danish and Spanish perspectives 2014-15
It has been estimated that in England and Wales there are around six million carers (White, 2013) and most of these are family carers. This figure equates to approximately one in ten of the UK population are unpaid carers supporting a friend or family member (ONS, 2011) and is forever growing. In response UK government policy has placed an emphasis and priority upon integrated approaches to identifying, involving and supporting carers (DH 2010a, DH 2012, DH 2013a, DH 2013b), with every health professional having a responsibility and role to play. The ways in which patients and families experience health care is of fundamental importance (e.g. NHS England 2013) and impacts upon recovery patterns and notions of wellbeing. Nurses play a key role and for decades have sought to ‘reach out’ and work with families and carers.
A priority in undertaking my study was to place an emphasis upon families as carers and as knowledge holders in working with nurses. In addition, a prime concern was to be able capture meaning and have insights into the culture of care pertaining to the ‘norms’ of family involvement across a range of care settings. Thus the overarching aim of this travel scholarship was to explore how patients and families are involved and supported in care to enhance their recovery and wellbeing.
Objectives: I wanted to learn about, and have insights into family involvement in caregiving.
a) To learn about the ‘norms’ of family involvement
b) To see how families are involved across a range of care settings
c) To understand what is expected and how meaningful activities with healthcare staff are created
d) To gather information to both understand and learn from, these differences towards patient and family experiences than are seen in the UK.
I choose to visit Denmark and Spain as both countries compare differently to the UK in healthcare approaches but have a history of respect and values for involving families and accounting for patient experiences in healthcare.
Synthesis of my travel scholarship into my practice has been an integral feature from the outset. For example as part of my teaching of undergraduate student nurses I have and will continue to share the knowledge that I have obtained in the context of supporting families and carers. Specifically, as module lead for a dedicated under-graduate module: ‘Supporting Families and Carers’, I have shared my insights and findings within my teaching about the importance of involving families and building relationships in order to enhance recovery and wellbeing.
In my leadership role for service users and carers the process of conveying my findings with the user and carer group (members of the public) alongside colleagues continues to take place. Interestingly, I have featured key learning points on twitter (a social media platform) via @JuWray and @userscarersSU resulting in followers and direct contacts requesting further information. For example I have been approached by NHS England and interviewed in regard of hospitals visiting hours and the Royal College of Midwives (RCM) have sought information about patient hotels.
Lessons to be learnt
During this wonderful study tour I have extended my learning above and beyond the intended aim and objectives; with absolute clarity that the ‘human pull’ (Benner et al, 1999) remains at the core of nursing practice. My experience and findings show that families as carer givers and nurses ‘reach out’ together, mostly in harmony for the benefit of loved ones whom become patients. I was inspired by how in both Denmark and Spain family centeredness (even if it this term was not used) was embedded into every aspect of healthcare provision and notably in promoting self-care. Individual family carers, support groups and patients affirmed this ethos from their own experiences. Despite what could be regarded as pragmatic visitation strategies in hospitals, people understood, respected and complied with the expectations. I found this mutuality towards visitation in particular to be refreshing. We in the UK could learn a great deal about visitation processes that serve to respect place and space for all those involved. The UK could explore the benefits of triage to identify primary carers; criterion to enable and support primary carer’s involvement in care giving as part of on-going health and wellbeing of patients.
In comparison to the UK both countries have strikingly different cultures and cultural ‘norms’. And yet their accepted practices were rooted in building mutual respect and trust in encounters with families and carers. There was a palpable collective pride for the health service in both countries this was evident amongst healthcare staff, patients and families that I met. They expressed concern and anxiety about ‘loosing what they had’ and it was clear that everyone felt a sense of responsibility to nurture and care for what they had. We could learn from this shared responsibility in the UK.
I also learnt how digital health, tele-health and IT systems enhanced communication at all levels and across place and space. For example texting, sykpe or facetiming family carer givers and patients was usual practice; not just to prevent re-admission but to support self-care wellbeing.
My learning, knowledge and findings attained from this travel scholarship are featured strongly in the authored book Braine and Wray (2016) and Professor Elizabeth Robb was invited to write the foreword. This book, a first from a nursing perspective and is seeking to align theory to practice and become a core text for nurses.
For the most part we all have a responsibility to stop and think about the potential and real long-term gains from good assessments and discharge planning, compliance with care and treatments, and more involved caregivers and patient’s (Braine and Wray, 2016). By practising in this context we are likely to be promoting saltugenesis, as achieving wellbeing at this level should be our goal as nurses.
Overall, I learnt that through understanding how families are involved in meaningful ways and what is expected with healthcare staff; we as nurses can be confident that saltugeneis is enabled.
This report of the findings and lessons learnt is not a research study but a synthesis of different perspectives influenced by an ethnographic values of learning from people rather than studying people (Spradley, 1979). In visiting Córdoba a bio-ethics committee approved my study travel as part of their University requirements.
Note: Throughout the travel scholarship I used Twitter to tweet information and pictures (with permission) as a way to promote the Florence Nightingale Foundation but also my experiences and insights obtained during the study travel visits. See: @JuWray and @FNighingaleF