Keeping loved ones at the heart of healthcare during COVID-19: a toolkit of practical ideas | 29 May 2020

The ihub Evidence and Evaluation for Improvement Team (EEvIT) supported the development of a web section dedicated to sharing stories and resources about person-centred care as a single source of information that health and care staff can refer to and gather ideas from as they see how others have tackled similar emerging issues.

Today, EEvIT reflects on a newly published toolkit found during our literature scanning which was created by medical professionals and researchers in the United States. It suggests strategies for staff in acute settings to support their delivery of family-centred care during COVID-19. Below, we also provide innovative stories from NHS staff that relate to these strategies and can provide ideas for others.

The importance of family-centred care
Ensuring personal networks of support (often a network encompassing those beyond traditional family structures) are maintained when someone is unwell and requiring medical treatment is an essential component of person-centred health and care provision.

The involvement of patients and their loved ones throughout the care decision-making process has been linked to positive outcomes both at the patient and system level.

In the current COVID-19 context, family-centred care has become increasingly difficult due to hospital visiting restrictions and the necessity for staff and visitors to wear personal protective equipment (PPE). A recent blog by the Canadian Foundation for Healthcare Improvement highlights how, despite their importance in the patients engagement and care, a change in language used by hospital policy, has reverted loved ones and caregivers to 'visitors' rather than previously acknowledged essential 'partners in care'. Controlling spread of infection and ensuring patient and provider safety is paramount yet strategies to maintain communication and family-centred care are required.

Strategies for using technology to bridge physical distance
As Hart et al. discuss in their paper, technology has been crucial in helping families and staff overcome visitation restrictions. The authors outline four domains of family-centred care staff should consider and provide helpful strategies to enable this process.

In the table below we briefly define each domain and include three additional considerations: accessibility and technology literacy, patient and loved ones with additional needs and end-of-life circumstances.

These encompass barriers and additional concerns discussed by Hart and colleagues as important to consider and from the stories and resources we have gathered from health and social care staff, their importance is evident across the four domains. For each domain and concern we include links to the stories we have collected which illustrate the innovative adapted ways of working currently underway across the healthcare system, providing real-world examples of the strategies suggested by the authors to inform and inspire others facing the same challenges.

Toolkit of strategies and key considerations for delivering family-centred care

Table presenting the four domains of family-centered care (PDF)

Reflections
The article by Hart et al. presents a number of helpful strategies that, as shown in the toolkit table, mirror many of the innovations we are seeing across the healthcare system as staff proactively respond to COVID-19 and a new challenging way of working. We would like to applaud staff worldwide who have tackled communication barriers at pace and continued their commitment to delivering compassionate care.

However, like Hart et al., we urge organisations to ensure that staff are given the support they need as they adjust to their new working environments and learning to provide compassionate care for patients and loved ones with new devices and procedures adds to their work.

Therefore, minimising training and documentation burdens is essential as is the provision of clear and easily accessible guidance and enlisting others to help. Hart et al. suggest medical, nursing or social care students, and community partners could help provide this support.