L/O/G/O

FAMILY CENTERED CARE

Septy Nur Aini, S.Kep., Ners
CASE
• Adam, age 5, was referred for a tracheostomy due to
chronic lung disease, vocal cord paralysis, and recurrent
aspiration. After Adam underwent surgery, the
tracheostomy tube dislodged 3 times during the first
night post-op. After the third dislodging, the tube was
sutured in place at the bedside. The suturing caused
Adam considerable pain. When the tube dislodged yet
again, the surgeon and the parents had a team meeting to
discuss possible options. The father suggested to the
surgeon that he would hold the tube in place himself and
keep Adam calm. After some discussion, the surgeon
agreed to place the tracheostomy again. Adam’s father
held the tube in place for 72 h, and the tracheostomy tube
successfully held.
(Kuo et al, 2012)
DEFINITION

• ‘‘Patient-centered care’’ & “Family-centered care”.

• The Institute of Medicine recognizes patient-centered care as
one of the 6 central aims for high quality health care
• PCC described as ‘‘the quality of interactions between
patients and clinicians’’
• However, we believe FCC is the term of choice as it relates to
pediatric care, when families are most involved with their
children. FCC moves beyond patient-clinician interaction
by considering the needs of all family members, not just
the child
(Kuo et al, 2012)
HISTORY
• Rumah sakit eksklusif u/ anak
– 1802 L’Hospital Des Enfants-Malades in
Paris
– 1855 Children’s Hospital of Philadelphia, US
 Orang tua sebagai pengunjung
• Abad ke-20, mulai berlaku rooming-in, jam
kunjungan terbuka, kunjungan saudara, dan
keluarga dapat menemani anak saat operasi
• Pertengahan 1980, Maternal Child Health Bureau
(MCHB) & US Surgeon General mensponsori
beberapa konferensi tentang anak berkebutuhan
khusus
• 1987, “Coordinated, family-centered, community-based
care for Children with special health care needs and their
families” oleh Surgeon General
• 1989, “provide and promoted family-centered,
community-based, coordinated care for children with
special health care needs and to facilitate the
development of community-based systems of services
for such children and their families”, oleh MCHB
• 1980, MCHB giat menggencarkan family nerwork, voice etc
• 2001, Institute of Medicine (IOM) menyebutkan bahwa PCC
merupakan hal penting dalam kualitas pelayanan kesehatan
• 2003, AAP mengintegrasikan FCC dalam setiap kebijakan,
dan FCC merupakan standar dalam perawatan kesehatan
anak
(Kuo et al, 2012)
The Institute for Patient-and Family-Centered Care
(2011) dalam Feeg et al (2015) describes FCC as:

• Recognizing the family is a constant in the child's life;

• Facilitating parent/professional collaboration;
• Recognizing family strengths and individuality;
• Sharing unbiased and complete information with parents;
• Encouraging and facilitating parent-to-parent support;
• Understanding and incorporating the developmental
needs of infants, children and adolescents and their
families;
• Implementing appropriate policies and programs that are
comprehensive;
• Assuring that the design of the health care delivery
system is flexible, accessible, and responsive to family
needs.
PRINSIP FCC
Information
Sharing

Care in context Respect &

of Family & Honoring
Community Differences

Partnership &
Negotiation
Collaboration

(Family Voices, the Maternal and Child Health Bureau (MCHB), the American Academy of
Pediatrics (AAP), and the Institute for Patient- and Family- Centered Care Cit Kuo et al, 2012)
FCC Application
• The inpatient setting (bangsal/ranap)
 family-centered rounds (FCR)
• The ambulatory setting (primary care,
specialty care, emergency care, chronic
care)
 Medical home concept
• FCR  Interdisiplinary work rounds at the bedside in which
patient and family share in the control of management plan.

• Wujud FCC oleh tenaga kesehatan menurut MCHB:

– Apakah tenaga kesehatan memberikan waktu yang
cukup
– Mendengarkan dengan baik
– Sensitif terhadap nilai dan kebiasaan keluarga
– Menyediakan informasi spesifik apabila diperlukan
– Membuat orang tua merasa sebagai partner dalam
perawatan
– Menyediakan Penerjemah Bahasa, jika diperlukan
Penghambat aplikasi FCC
• Adanya gap antara teori dan praktik
• Aplikasi FCC terhambat oleh adanya sikap, nilai dan
persepsi tenaga kesehatan terhadap FCC
• Ketidakjelasan antara peran dan batasan orang tua dan
tenaga kesehatan, dimana dalam praktik professional, tenaga
kesehatan memegang peranan sebagai pengambil
keputusan, penentu perawatan dan pemberi perawatan
• Ketidakadekuatan pengkajian dan dokumentasi
keperawatan terkait dengan negosiasi peran, kurangnya
pengetahuan dan keterampilan dalam hubungannya dengan
implementasi FCC, melakukan sesuatu tanpa pemberian
informasi yang efektif, dan kolaborasi atau negosiasi dengan
keluarga
• Kurangnya dukungan organisasi dan manajerial, panduan
atau kebijakan yang menghambat implementasi dan
konsistensi dalam menerapkan FCC di praktik perawatan
• Desain dan organisasi dari praktik perawatan dapat
memfasilitasi atau menghambat penerapan FCC dalam
praktik
 Fasilitator Hambatan
Praktisi: Praktisi:
Collaborative Preconceived ideas
Open, flexible Resistance to change
Difficulty with shared power &
Persistence & patience control

Klien: Klien:
Expectations Fear
Empowerment Trust
Insight Age
Responsibility Insight
Cultural issues
Reluctance to be involved

Jadi, fasilitator atau penghambat?

System: Medical Model vs FCP
Institution: aturan, regulasi, tradisi

(Sumsion & Law, 2006)

“Parents know their children best and want
the best for their children”
“Orang tua adalah orang yang paling tahu
tentang anaknya dan paling menginginkan
yang terbaik untuk anaknya”

Catatan:
“Idealisme yang baik, tidak selalu sesuai realitas”
 Keperawatan anak berfokus keluarga:
“Orang tua dilibatkan dalam perawatan anak
dan perhatian perawat juga bukan hanya kepada anak
namun orang tua juga”
REFERENCES
• Feeg, VD., Paraszcczuk, AM., Cavusoglu, H., Shields, L.,
Pars, H., Al Mamun, A. (2015). How is Family Centered Care
Perceived by Healthcare Providers from Different Countries?
An International Comparison Study. Journal of Pediatric
Nursing (2015)
• Kuo, DZ., Houtrow, AJ., Arango, P., Kuhlthau, KA., Simmons,
JM., Neff, JM. (2012). Family-Centered Care: Current
Applications and Future Directions in Pediatric Health Care.
Matern Child Health J (2012) 16:297-305
 L/O/G/O

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