Note from the National Guideline Clearinghouse (NGC): In March 2006, the Registered Nurses Association of Ontario amended the current practice recommendations for this topic. Through the review process, no recommendations were added or deleted, however a number of recommendations were reworded to reflect new knowledge. These have been noted below as "changed" or "unchanged."
The following recommendations grow out of the "Flower (Em)power" framework discussed and illustrated in the original guideline document.
Practice Recommendations
Recommendation 1 (Changed March 2006)
Develop an empowering partnership with families by:
- Recognizing the family's assessment of the situation as essential
- Acknowledging and respecting the important role of family in health care situations
- Determining the desired degree of family involvement
- Negotiating the roles of both nurse and family within the partnership
Recommendation 2 (Changed March 2006)
Assess family in the context of the event(s) to identify whether assistance is required by the nurse to strengthen and support the family. While a family assessment should include information in the following areas, it should be tailored to address the uniqueness of each family through examining:
- Family perceptions of the event(s)
- Family structure
- Environmental conditions
- Family strengths
Recommendation 3 (Unchanged)
Identify resources and supports to assist families address the life event, whether this is expected or unexpected. Resources should be identified within the following three categories:
- Intrafamilial
- Interfamilial
- Extrafamilial
Educational Recommendations
Recommendation 4 (Changed March 2006)
Educate nurses, families, policy-makers, and the public to respond to expected or unexpected life events within the family.
Recommendation 5 (Changed March 2006)
Sustain a caring workplace environment conducive to family-centred practice by:
- Ensuring that nursing staff are oriented to the values and assessment of family-centred care
- Ensuring that nurses have the knowledge, skill and judgement to implement family-centred care
- Providing ongoing opportunities for professional development for nursing staff
Organization and Policy Recommendations
Recommendation 6 (Changed March 2006)
Support the implementation of interdisciplinary family-centred practice in the workplace by:
- Ensuring appropriate resources (e.g., time, staffing)
- Developing and implementing family-centred practices and policies
- Creating and maintaining environments that are conducive to family-centred care
- Developing programs that promote work life balance for employees
Recommendation 7 (Changed March 2006)
Advocate for changes in public policy by:
- Lobbying for public discussion on family caregiving and the development of a public position on what level of caregiving is reasonable to expect from families
- Lobbying for public education about the value and legitimacy of the role of family caregivers and how multiple family members respond to life events
- Lobbying for a full range of adequate and effective programs for family members who are involved in caregiving and other life events within the family
- Lobbying for consistency in funding, availability and delivery of respite care programs and other supports for families across Ontario
- Lobbying for the funding of research projects that examine family as the providers and recipients of care, and the application of lessons learned from this research into public policy and program development
- Lobbying for mechanisms within organizations for families to dialogue with one another in an open forum.
Recommendation 8 (Unchanged)
Nursing best practice guidelines can be successfully implemented only if there are adequate planning, resources, organizational and administrative support, as well as the appropriate facilitation. Organizations may wish to develop a plan for implementation that includes:
- An assessment of organizational readiness and barriers to education
- Involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process
- Dedication of a qualified individual to provide the support needed for the education and implementation process
- Ongoing opportunities for discussion and education to reinforce the importance of best practices
- Opportunities for reflection on personal and organizational experience in implementing guidelines
In this regard, the Registered Nurses Association of Ontario (RNAO) (through a panel of nurses, researchers and administrators) has developed the Toolkit: Implementation of Clinical Practice Guidelines, based on available evidence, theoretical perspectives and consensus. The Toolkit is recommended for guiding the implementation of the RNAO nursing best practice guideline on "Supporting and Strengthening Families Through Expected and Unexpected Life Events."
