Self-assessment of family inclusion in institutional policies and practices: nursing team perspective

Botelho, Lilian Rodrigues Martins; Anísio, Nicole de Figueiredo; Cruz, Andréia Cascaes; Santos, Nanci Cristiano; Angelo, Margareth

doi:10.1590/2177-9465-EAN-2018-0207

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RESEARCH • Esc. Anna Nery 22 (4) • 2018 • https://doi.org/10.1590/2177-9465-EAN-2018-0207 copy

Self-assessment of family inclusion in institutional policies and practices: nursing team perspective^a a This article was developed as part of an educative program for the implementation of the Family - Centered Care, which have been conducted in partnership with the School of Nursing of the USP and the University Hospital of the USP - São Paulo - Brazil.

Autoavaliação da inclusão das famílias em políticas e práticas institucionais: perspectiva da equipe de enfermagem

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To compare the evaluation carried out by the nursing teams of pediatric and maternal-infant with adult patient wards on the inclusion of families in institutional policies and practices.

Method:

A cross-sectional and descriptive study carried out in a university hospital with 148 professionals from the nursing team of the maternal and pediatric units and 43 from adult units. The data were analyzed by the program Statistical Package for the Social Sciences 22, using the chi-square test and Fisher's exact test.

Results:

The groups presented distinct perceptions about the differentiation between families and visitors in policies and practices; similar perceptions related to the policies and practices are not favorable to the presence of siblings and children, and to the non-inclusion of the families in aspects related to daily care.

Conclusion and Implications for Practice:

The perception of nursing teams indicates that families are not included in institutional policies and practices. The results of an organizational self-assessment about families' inclusion subsidize a way to improve organizational policies and practices, making it possible to draw up an action plan to implementing Patient and Family Centered Care at the institutional level.

Keywords:
Family Nursing; Organizational Culture; Professional-Family Relations; Nursing team

Professional category	Group I N %		Group II N %
TE/AE^* * TE/AE: Nursing Technicians/Nursing Assistants.	82	55.4	26	60.5
Residents	12	8.1	0	0
Nurses	54	36.5	17	39.5
TOTAL	148	77.5	43	22.5

	Unit	Professional category	N^* * N: Absolute number.	Mean	DP^* * N: Absolute number.	Median	Minimum	Maximum
Age	Group I	TE/AE^* * N: Absolute number.	82	44.35	8.860	44.00	25	63
		Residents	12	23.83	1.642	23.50	22	28
		Nurses	54	41.63	8.090	38.00	30	56
		Total	148	41.70	9.851	41.00	22	63
	Group II	NT/NA	26	44.15	9.242	42.50	28	60
		Nurses	17	39.35	9.340	35.00	30	56
		Total	43	42.26	9.472	41.00	28	60
	Total	NT/NA	108	44.31	8.910	44.00	25	63
		Residents	12	23.83	1.642	23.50	22	28
		Nurses	71	41.08	8.393	38.00	30	56
		Total	191	41.82	9.745	41.00	22	63
Time of profession	Group I	NT/NA	82	19.01	7.075	19.00	7	36
		Residents	12	0.72	0.205	0.58	1	1
		Nurses	54	17.52	7.966	15.00	6	32
		Total	148	16.98	8.629	16.00	1	36
	Group II	NT/NA	26	17.88	6.599	17.50	6	32
		Nurses	17	15.06	7.846	12.00	5	29
		Total	43	16.77	7.164	16.00	5	32
	Total	NT/NA	108	18.74	6.950	18.50	6	36
		Residents	12	0.72	0.205	0.58	1	1
		Nurses	71	16.93	7.952	15.00	5	32
		Total	191	16.94	8.304	16.00	1	36
Time of occupation in the institution	Group I	NT/NA	82	16.98	8.477	17.00	3	35
		Residents	12	0.72	0.205	0.58	1	1
		Nurses	54	16.22	8.469	15.00	4	32
		Total	148	15.38	9.202	15.00	1	35
	Group II	NT/NA	26	14.73	8.619	12.50	4	32
		Nurses	17	12.29	7.192	10.00	5	26
		Total	43	13.77	8.085	12.00	4	32
	Total	NT/NA	108	16.44	8.525	16.50	3	35
		Residents	12	0.72	0.205	0.58	1	1
		Nurses	71	15.28	8.305	13.00	4	32
		Total	191	15.02	8.968	15.00	1	35

The written policies (in documents) of the hospital:		Group I		Group II
The written policies (in documents) of the hospital:	Answer	N	%	N	%	P-value
a) Recognize the importance of the families in the patients' assistance, comfort and safety?	Yes	110	74.3%	26	61.9%	0.018
	No	24	16.2%	5	11.9%
	Don't know	14	9,5%	11	26,2%
b) Refer to the families as essential partners and not as visitors?	Yes	85	57.4%	19	45.2%	0.015
	No	45	30.4%	10	23.8%
	Don't know	18	12.2%	13	31.0%
c) Encourage the patients and their families to define who will be involved in the care and in the decision making?	Yes	97	65.5%	24	57.1%	0.005
	No	32	21.6%	4	9.5%
	Don't know	19	12.8%	14	33.3%
d) Encourage the patients and their families to declare their preferences of how will be involved in the care, care planning and in the decision making?	Yes	70	47.9%	20	47.6%	0.002
	No	52	35.6%	6	14.3%
	Don't know	24	16.4%	16	38.1%
e) Make distinction between families and visitants?	Yes	70	47.6%	9	21.4%	0.001
	No	58	39.5%	19	45.2%
	Don't know	19	12.9%	14	33.3%
f) Consider the families as visitors?	Yes	57	38.8%	25	59.5%	0.006
	No	68	46.3%	8	19.0%
	Don't know	22	15.0%	9	21.4%
g) Consider the families as companions?	Yes	116	78.9%	28	66.7%	0.217
	No	16	10.9%	7	16.7%
	Don't know	15	10.2%	7	16.7%
h) Are favorable to the presence of brothers and children of all the ages in accordance with the preferences of the patient and the family?	Yes	37	25.2%	5	11.9%	0.074
	No	96	65.3%	29	69.0%
	Don't know	14	9.5%	8	19.0%

The nursing team's practices of its work unit:		Group I		Group II
The nursing team's practices of its work unit:		N	%	N	%	P-value
a) Recognize the importance of the families in the patients' assistance, comfort and safety?	Yes	123	83.1%	38	88.4%	0.404
	No	25	16.9%	5	11.6%
	Don't know	0	0.0%	0	0.0%
b) Encourage the patients and their families to define who will be involved in the care and in the decision making?	Yes	121	81.8%	38	88.4%	0.682
	No	22	14.9%	4	9.3%
	Don't know	5	3.4%	1	2.3%
c) Encourage the patients and their families to declare their preferences of how will be involved in the care, assistance planning and in the decision making?	Yes	81	56.3%	29	69.0%	0.332
	No	43	29.9%	9	21.4%
	Don't know	20	13.9%	4	9.5%
d) Make distinction between families and visitors?	Yes	81	55.5%	15	35.7%	0.050
	No	61	41.8%	26	61.9%
	Don't know	4	2.7%	1	2.4%
e) Make distinction between families and companions?	Yes	67	45.3%	13	30.2%	0.121
	No	80	54.1%	29	67.4%
	Don't know	1	0.7%	1	2.3%
f) Are favorable to the presence of brothers and children of all the ages in accordance with the preferences of the patient and the family?	Yes	32	21.8%	9	20.9%	0.519
	No	104	70.7%	33	76.7%
	Don't know	11	7.5%	1	2.3%

The families are welcome 24h a day, 7 days a week by the team's practices as a whole in:		Group I		Group II
		N	%	N	%	P-value
a) Clinic visits (discussion of cases)	Yes	39	26.7%	11	26.2%	0.322
	No	88	60.3%	29	69.0%
	Don't know	19	13.0%	2	4.8%
b) Passages of duty	Yes	47	32.2%	9	21.4%	0.348
	No	93	63.7%	30	71.4%
	Don't know	6	4.1%	3	7.1%
c) Emergency situations	Yes	48	32.7%	18	41.9%	0.245
	No	91	61.9%	25	58.1%
	Don't know	8	5.4%	0	0.0%
d) Realization procedures	Yes	67	45.3%	19	45.2%	0.553
	No	75	50.7%	23	54.8%
	Don't know	6	4.1%	0	0.0%

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[1] Corresponding author: Andréia Cascaes Cruz. E-mail: deiacascaes@gmail.com