140520P - THE FAMILY AS HONORED GUESTS OF THE HOSPITAL-WORD SLIDES

Presented at the Saudi Health 2014 Conference held in Riyadh May 20-21, 2014 under the theme 'Patient First: Bridging the Gap from Rhetoric to Reality’ by Professor Omar Hasan Kasule Sr MB ChB(MUK), MPH (Harvard), DrPH (Harvard) Faculty of Medicine and Chair of the Ethics and IRB committees at King Fahad Medical City, Riyadh.

INTRODUCTION

·         The paper argues for a new paradigm that requires hospitals to treat family members as honored guests who are an indispensable component of the psycho-social-physical modalities of the therapeutic process.

·        Families played this role in the pre-hospital home-centered care but lost it when care shifted to high-technology hospitals based on the biomedical and not the holistic model.

·        The paradigm of holistic care requires that this role be reactivated and be recognized in modern hospitals.

FAMILY ROLES

·      Family presence (FP)

·         -Family support (FS)

·         -Family-centered care (FCC)

·         -Fulfilment of the obligatory social duties of visiting the patient (‘iyadat al mariidh)

·         -Joining kindred relations (silat al rahim).

FAMILY ROLES

·         -FP during various hospital activities has benefits and no adverse impact on care-

·         -FS for the patient is associated with better compliance and better outcomes

·         -FCC is associated with high satisfaction, and is a form of health education.

CHANGE OF PARADIGM

·         -The paper calls for a change of policies, procedures, and attitudes to enable the family play its role as welcome guests of the hospitals and not just be tolerated intruders.

·         -The families are guests of the hospital and not of the patient; the hospital should honor them as guests (ikram al dhaif) with all the related legal rights.

·         -The family welcome should not exceed limits and affect adversely the hospital routines or disturb other patients and their families whose right of neighborhood (haqq al jaar) should be respected.

FAMILY PRESENCE (FP)- ATTITUDES OF HEALTH CARE PROFESSIONALS

·         -Research has shown that some healthcare professionals (HCPs) have negative attitudes to family presence during resuscitation (FPDR) while others have negative ones[1]^,[2].

·         -Negative attitudes may be due to Health Care Professionals’ (HCP) concern that family members may see resuscitation as chaotic and may sue[3] or that FP may lead to shorter visits and less patient centered communication by HCPs[4].

FAMILY PRESENCE (FP)- ATTITUDES OF HEALTH CARE PROFESSIONALS

·         -Negative HCP attitudes are behind the failure to implement recommended FP protocols that are recommended at many hospitals[5].

·         -Policy changes, education, training have been shown to change negative attitudes to, perceptions of, and acceptance of FPDR[6].

FAMILY PRESENCE (FP)- RISKS AND BENEFITS

·         -FPDR has benefits and risks[7] but the benefits outweigh the risks.

·         -Besides psychological benefits[8] including less post-traumatic stress in the families[9].

·         -FP during dressings in a burn unit had educational benefits[10]

·         -FP was found beneficial to child, family and healthcare workers[11] in invasive procedures.

·         -FP had no adverse effects on pediatric trauma resuscitation[12]

·         -FP has been described in resuscitation in the OR[13], brain death testing[14], cutting off of life support[15], bedside teaching during ward rounds[16].

FAMILY SUPPORT (FS)

·         -A paradigm shift is needed in the concept of family support (FS) from giving support to the family of the patient to[17]^,[18],[19] to empowering the family to support the patient.

·         -Family caregivers suffer psychological and spiritual distress[20] and may need use of mental health services[21] and other forms of social support[22], programs[23], and interventions[24].

·         -Despite their stress, family members are able to give support to the patients with beneficial results for cancer patients[25].

FAMILY SUPPORT (FS)

·         -FS for pregnant women with pre-existing diabetes helped in the management of the pregnancy[26].

·         -FS helped in weight loss for the obese[27].

·         -FS for general nutritional support for diabetics whether general[28] or diet-specific[29] improved metabolic outcomes. 

·         -FS improved physical activity[30], led to higher adherence to treatment regimens[31], and access to digital health information[32].

FAMILY CENTERED CARE (FCC)

·         -The doctrine of family centered care (FCC) under which the family can be involved in the therapeutic process finds more acceptance in home care than in hospital care.

·         -FCC leads to accommodating values and priorities of families in therapeutic decisions[33] such as professionals respect family expertise in care for children with special needs[34].

·         -Family members can be involved in ICU decision making[35], advance planning for adolescents with cancer[36],  pediatric ICU palliative care[37], and family-centered ward rounds[38].

FAMILY CENTERED CARE (FCC)

·         -The benefits of FCC are not confined to the hospital, family members can learn health lessons such as education on infectious diseases[39].

·         -FCC is considered so important by some hospitals that patient and family advisors are involved in its execution[40].

·         -Special scales have been developed to measure FCC[41] and social support for patients[42]

TOWARDS A NEW PARADIGM

·         -A holistic approach motivates inclusion of the family in the hospital’s therapeutic team. The family are honored as guests of the hospital according to the rules and etiquette of honoring guests, ikram al dhaif[43]. 

·         -The family should not abuse the hospitality by interrupting unnecessarily the operations of the hospital just as a house guest should not overstay beyond the customary three days[44]

·         -The family should not violate the welfare and rights of other patients and families and should treat them well, ihsan ila al jaar[45]. 

TOWARDS A NEW PARADIGM

·         -Presence of the family in the hospital has religious and social consequences: joining kindred relations, silat al rahm[46]

·         -Fulfilling the duty of visiting the sick enjoined by the prophet[47] [48] as having a lot of merit[49],and considered one of the 5 duties of brotherhood[50]

TOWARDS A NEW PARADIGM

·         -The family can make dua for the patient[51]

·         -The family encourages the patient to take medication except if considered futile[52]

·         -The family encourages the patient to eat pleasure-causing food[53]

·         -The family helps by saying good things, kalimat taibat, when visiting the patient[54]

NOTES

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[43] Sahih Bukhari No 6019

[44] Sahih Bukhari No 6135

[45] Sahih Muslim No 48 .

[46] Sahih Bukhari No 6138

[47] Sahih Bukhari No 5175

[48] Sahih Bukhari No 5650

[49] Sahih Muslim No 2568

[50] Sahih Bukhari No 1240

[51] Sahih Muslim No 2191

[52] Sahih Bukhari No 6897

[53] Sahih Bukhari No 5689

[54] Sahih Muslim No 919