| 1.Narrative review |
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Literature focusing on adult patients admitted to the hospital (first search up to March 2015, and updated in July 2017) |
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Limited evidence on effective interventions to promote family involvement in care on adult acute wards [21,22]
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Focusing on complications which are known to be responsive to fundamental care [3,8,23]
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| 2. Drafting the program |
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Selection of a minimum set of fundamental care activities known to have an effect on postoperative complications.
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Selection of several tasks to encourage family caregivers to provide fundamental care activities: (1) information about basic care activities; (2) goal setting with the patient, family caregiver and nurse; (3) task-oriented training; (4) hands-on participation in basic care; (5) presence of family caregivers during medical ward rounds; (6) rooming-in (at least 8 h a day).
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| 3. Focus group meetings |
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Nurses' needs and expectations regarding active family involvement
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Nurses' perceived competence in involving family carers in fundamental activities
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Nurses' preferences regarding educational strategies
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Three focus group meetings, totalling 23 participants |
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Positive effects of family presence on outcomes, but this may be more time-consuming
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Nurses needed to be flexible, but as one nurse said: ‘how flexible can you be as you need to finish your within a certain time’
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Some had negative personal experiences with managing patients and family caregivers who exbitit aggressive behaviour
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There should be clearly defined responsibilities among patients, family caregivers and healthcare professionals
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Most important competency mentioned is adequate communication to build trusted relationships and stimulate the involvement of family caregivers
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Important communication skills are: persuasiveness, being honest, listening carefully, self-reflection and able to negotiating.
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The majority of the nurses mentioned that they have an adequate communication style, and adapt their communication to align with patients and family caregivers.
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Nurses had specific preferences for a number of training courses, preferably focusing on self-reflection and conflict management
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| 4. Group discussion with physicians |
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Discussion was led by one of the project leaders, and 63 participants attended the meeting |
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Positive effects of family presence on outcomes, but this may be more time-consuming
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They feel that it adds value to the decision-making process
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There should be a clear definition of who is a family caregiver
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Patient is top priority: patient preferences are prioritised over the preferences of family caregivers
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Hidden agenda of family caregivers.
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Physicians have some privacy concerns constrain information sharing
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Family caregivers should receive adequate education
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It is essential that any changes does not influence hospital bed capacity
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| 5. Surgeon opinion survey |
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Physicians response rate = 75/125; 60%
Male: 45 (61%)
Female: 29 (39%) |
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Family caregivers are seen as respected partner in healthcare team (n = 40/71; 56%)
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Family caregivers' preferences are taken into account in the decision-making process (n = 39/69; 57%)
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Convinced that family caregivers' preferences are based on patient preferences (36/70; 53%)
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Only supporting the active involvement of family caregivers if the effectiveness on patient outcomes has been demonstrated in scientific research (20/70; 29%)
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Trust in competences and skills of family caregivers to adequately deliver fundamental care activities (44/68; 65%)
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| 6. Redrafting the program |
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