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Appendix 2
Conceptual model of family-centred health care
a different way of thinking,
a different way of practising, and
a different way of working together.
For Family Health Nursing to reach its full potential, it should be located within a health care system committed to family-centred health care. Family-centred health care has a dual health improvement and disease management mandate, and is delivered through an integrated team network. Full implementation of Family Health Nursing entails not only transformation of nurses' roles, but also changes to the other parts of the health care system. This conceptual model describes the process of change required for Family Health Nurses to be able to implement their role as part of family-centred health care (see figure below).
The process depicted in this model is the transformation of the current mode of service delivery in the community into a family-focused system of health care, in which Family Health Nurses play a full role.
Figure 2.2 Conceptual model for family-centred health care (Parfitt et al, 2006).
This model is built on a systems approach where three crucial inputs are required:
- professional expertise underpinned by a portfolio of skills and knowledge on family health approaches that include assessment and health planning
- integrated team working comprising specialist and generalist roles from within nursing and across other professional groups and agencies
- educational culture that takes account of formalised programmes of education and a team ethos of shared learning that embraces the family health approach to care.
These 3 interlocking inputs interact with, build upon, and transform the current mode of health service delivery in the community, in order to produce the output of family-centred care.
The successful implementation of this model requires a process of dynamic change that includes the whole team. If that process does not take place then family-centred health care will not emerge as a distinct way of working. When all parts of the system (3 inputs) are present, Family Health Nurses are enabled to:
- apply knowledge and skills on family health approaches to benefit the service users
- receive and make referrals through a system of clearly defined boundaries of agreed responsibility
- achieve positive outcomes through:
- undertaking clinical care and public health activities with families, with the aim of long term health improvement for all members
- targeting those who do not fall within the remit of a specialist nursing services or acting as the lynchpin for those with multiple needs
- working in collaboration with other nurses and agencies to set up local community initiatives.
Explanation of each component of the model
Introduction
Family-centred health care is the intended result. This is a generalist-based approach, which begins with families and communities as a whole, to identify the health care needs of the collective members of the community, rather than beginning with a set of specialists who work selectively with particular client groups according to age or underlying disease.
To put this into practice requires 3 interlocking key components - (1) a change in education and shared learning to support a generalist-based family oriented approach (2) an organisational change towards more integrated teamwork within and across disciplines, including a clear referral system for generalists, specialists and support staff and (3) expertise in family health approaches.
1. Educational culture
This model requires a culture change for those delivering health services and for those developing programmes of education. It involves a portfolio of skills and knowledge that include - in addition to clinical and public health skills - counselling, negotiation, facilitation, family development, dynamics and interaction, and change management. However for systems change to take effect, learning and behaviour change at different levels within the health service and from all members of the primary care team is needed. In order to support and grow such change, modifications to education at pre and post-registration level, and programmes of continuing professional development ( CPD) for existing team members that incorporate the ethos of family-centred care, are required.
2. Integrated team network
The main conceptual shift to take place is away from thinking in terms of each practitioner having their caseload of individual clients, and towards thinking of the community as the client. This is a 'bottom-up' rather than 'top-down' model of healthcare delivery. This means that the planning, design and delivery of services is driven by community need, rather than by specialists with their individual caseloads. In this way all members of the team have responsibility for the whole community.
For this model to work depends upon an organisational development towards integrated teamwork. Generalists - including the Family Health Nurse and the General Medical Practitioner ( GP) - are the first point of contact for families, and have a thorough understanding of individual families' needs and the resources available to support them. The Family Health Nurse works together with colleagues to plan and deliver community-wide initiatives that address the particular health needs of local families. The success of an integrated team approach depends upon generalist practitioners being supported by a network of specialists and support workers.
Integrated teamwork requires clearly defined boundaries of responsibility. This includes a referral system where individuals and families are allocated to the most appropriate member of the team. This recognises the different skills and talents of all members. The Family Health Nurse as the first point of contact would make a professional judgement on whether they have the required knowledge and skills to deal with the issue themselves, or whether to refer the person on to an appropriate specialist. Family Health Nurses may also receive referrals for families with complex needs or where there is a requirement for clinical intervention and lifestyle change.
3. Expertise in family health approach
Family-centred care requires a high level of expertise in family health approaches. The Family Health Nurse has a portfolio of knowledge and skills to equip them to support families with complex needs. These added skills build on their existing knowledge base. Expertise grows through experience of working with families at different stages in their development. A key aim of this approach to care is moving families away from dependence on health care professionals towards independence within a supportive community.
The expertise of the Family Health Nurse enables them to contribute to the primary care team's 'planning of service' strategy which includes locally developed practice profiles. These profiles detail the health priorities for that community and guide service delivery. The Family Health Nurse can contribute by undertaking risk assessment using their skills of family health assessment to identify health and disease trends. The third area of expertise is their intergenerational approach, working with all generations within family units and using tools such as genograms (family health trees) to help the members identify and respond to health risk factors.
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