• Registered Nurses Association of Ontario (RNAO). Supporting and strengthening families through expected and unexpected life events supplement. Toronto (ON): Registered Nurses Association of Ontario (RNAO); 2006 Mar. 8 p. [30 references]



• Registered Nurses Association of Ontario (RNAO). Supporting and strengthening families through expected and unexpected life events. Toronto (ON): Registered Nurses Association of Ontario (RNAO); 2002 Jul. 48 p. [77 references]

This is the current release of the guideline.

• Expected life events (birth, schooling, adolescence, aging, and death)
• Unexpected life events (trauma/accidents, chronic illness, developmental delay and disability)

Evaluation
Management

Family Practice
Geriatrics
Nursing
Obstetrics and Gynecology
Pediatrics

Advanced Practice Nurses
Health Care Providers
Nurses

To present nursing best practice guidelines for supporting and strengthening families through expected and unexpected life events

Families in Canada from all health care sectors who are facing expected and unexpected life events

Evaluation/Management

1. Measures to develop an empowering partnership with families
2. Assessment of families in the context of the event(s) to identify whether assistance is required by the nurse to strengthen and support the family
3. Identification of resources and supports to assist families address life events
4. Education, organization, and policy approaches and strategies

Effectiveness of interventions for assessing family needs and promoting family health during expected or unexpected life events

Searches of Electronic Databases

The guideline developers and revision panel conducted an extensive literature search and reviewed articles comprising of research, theoretical papers and other discussion papers.

July 2002 Guideline

Not stated

March 2006 Supplement

Sixty-nine (69) articles were retrieved for review.

Expert Consensus

Not applicable

Review

Not stated

Expert Consensus

July 2002 Guideline

A panel of nurses with expertise in caring for families from practice, research, policy and academic sectors was established by the Registered Nurses Association of Ontario (RNAO). After defining the scope of the guideline; the panel conducted an extensive literature search and articulated values that are the underpinnings of working with families (this work was supported by the literature). The panel then reviewed articles comprising research, theoretical papers, and other discussion papers. Evidence to support the values was identified and specific actions pertaining to nursing was gathered. The panel then identified themes from the literature that led to the development of recommendations in three key areas.

March 2006 Supplement

RNAO has made a commitment to ensure that this guideline is based on the best available evidence. In order to meet this commitment, a monitoring and revision process has been established for each guideline every three years. The revision panel members (experts from a variety of practice settings) are given a mandate to review the guideline focusing on the recommendations and the original scope of the guideline. The revision panel for the Supporting and Strengthening Families Through Expected and Unexpected Life Events guideline consists of original panel members, representatives of organizations who have had experience implementing the guideline, and other recommended experts.

The revision panel reflected on the "Flower (Em)power" Framework and the components of the nurse-family partnership; advocacy activities and policy; founded on the vision, values and principles of respect, recognition, resources, responsibility and results. The framework was used to structure the review/revision discussions to ensure consistency of approach with the original guideline.

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Clinical Validation-Pilot Testing
External Peer Review

An initial draft of the Registered Nurses Association of Ontario (RNAO) "Supporting and Strengthening Families Through Expected and Unexpected Life Events" nursing best practice guideline was reviewed by representative stakeholders and their feedback was incorporated. The stakeholders reviewing this guideline included clients, their families, staff nurses, various formal groups and organizations, and are acknowledged at the front of this document. This guideline was further refined after an eight-month pilot implementation phase in selected practice settings in Ontario. Practice settings for RNAO nursing best practice guidelines are identified through a "request for proposal" process. The guideline was further refined taking into consideration the pilot site feedback and evaluation results.

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."

None provided

In developing this guideline, the development panel drew their evidence from a variety of sources. The evidence was based on not only randomized controlled trials, but also on a number of qualitative sources, including studies that provided in-depth descriptions of family and nurse perceptions of their interactions with one another, and information about the relevance and helpfulness of nursing interventions involving families in care. Expert consensus was also utilized in this guideline when no other more scientifically formalized knowledge was available.

• Guideline implementation is intended to help nurses support and strengthen families through expected or unexpected life events.
• Nurses, other health care professionals and administrators who are leading and facilitating practice changes will find this document valuable for the development of policies, procedures, protocols, educational programs, assessment and documentation tools, etc.

Not stated

• These best practice guidelines are related only to nursing practice and not intended to take into account fiscal efficiencies. These guidelines are not binding for nurses and their use should be flexible to accommodate client/family wishes and local circumstances. They neither constitute a liability nor discharge from liability. While every effort has been made to ensure the accuracy of the contents at the time of publication, neither the authors nor Registered Nurses Association of Ontario (RNAO) give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omission in the contents of this work. Any reference throughout the document to specific pharmaceutical products as examples does not imply endorsement of any of these products.
• The March 2006 supplement to the nursing best practice guideline Supporting and Strengthening Families through Expected and Unexpected Life Events is the result of a three year scheduled revision of the guideline. Additional material has been provided in an attempt to provide the reader with current evidence to support nursing practice. Similar to the original guideline publication, this document needs to be reviewed and applied, based on the specific needs of the organization or practice setting/environment, as well as the needs and wishes of the client/family. This supplement should be used in conjunction with the guideline as a tool to assist in decision making for individualized care, as well as ensuring that appropriate structures and supports are in place to provide the best possible care to families.

Toolkit: Implementing Clinical Practice Guidelines

Nursing best practice guidelines can be successfully implemented only where there are adequate planning, resources, organizational and administrative support, as well as the appropriate facilitation. In this regard, Registered Nurses Association of Ontario (RNAO) (through a panel of nurses, researchers and administrators) has developed "The Toolkit for Implementing Clinical Practice Guidelines," based on available evidence, theoretical perspectives and consensus. The "Toolkit" is recommended for guiding the implementation of any clinical practice guideline in a health care organization.

The "Toolkit" provides step by step directions to individuals and groups involved in planning, coordinating, and facilitating the guideline implementation. Specifically, the "Toolkit" addresses the following key steps:

1. Identifying a well-developed, evidence-based clinical practice guideline
2. Identification, assessment and engagement of stakeholders
3. Assessment of environmental readiness for guideline implementation
4. Identifying and planning evidence-based implementation strategies
5. Planning and implementing evaluation
6. Identifying and securing required resources for implementation

Implementing guidelines in practice that result in successful practice changes and positive clinical impact is a complex undertaking. The "Toolkit" is one key resource for managing this process.

The Registered Nurses' Association of Ontario and the guideline panel have compiled a list of implementation strategies to assist health care organizations or health care disciplines who are interested in implementing this guideline. A summary of these strategies follows:

• Provide organizational support such as having the structures in place to facilitate family-centred practices. For example, having an organizational philosophy and vision that reflects the value of best practices through policies and procedures. Develop new assessment and documentation tools.
• Identify and support designated best practice champions on each unit to promote and support implementation. Celebrate milestones and achievements, acknowledging work well done.
• Establish a process to facilitate the cultivation of positive family-nurse relationships. This process may include adequate time and resources, documentation of family care transactions, and family-centred care as a component of staff performance reviews. These approaches may help to sustain a family-centred approach to care and to achieve partnerships between families and nurse.
• Organizations implementing this guideline should adopt a range of self-learning, group learning, mentorship and reinforcement strategies that will over time, build the knowledge and confidence of nurses in providing family-centred care. Mentorship of nursing staff leaders may help to foster family-centred practices.

For other specific recommendations regarding implementation of this guideline, refer to the "Major Recommendations" field.

Evaluation and Monitoring

Organizations implementing the recommendations in this nursing best practice guideline are recommended to consider how the implementation and its impact will be monitored and evaluated. A table in the original guideline document illustrates some indicators for monitoring and evaluation. It is based on a framework outlined in the RNAO Toolkit: Implementation of Clinical Practice Guidelines (2002).

End of Life Care
Getting Better
Living with Illness
Staying Healthy

Effectiveness
Patient-centeredness

• Registered Nurses Association of Ontario (RNAO). Supporting and strengthening families through expected and unexpected life events supplement. Toronto (ON): Registered Nurses Association of Ontario (RNAO); 2006 Mar. 8 p. [30 references]



• Registered Nurses Association of Ontario (RNAO). Supporting and strengthening families through expected and unexpected life events. Toronto (ON): Registered Nurses Association of Ontario (RNAO); 2002 Jul. 48 p. [77 references]

Not applicable: The guideline was not adapted from another source.

2002 Jul (addendum released 2006 Mar)

Registered Nurses' Association of Ontario - Professional Association

Funding was provided by the Ontario Ministry of Health and Long Term Care.

Not stated

Revision Panel Members

Catherine Ward-Griffin, RN, PhD
Co-Team Leader
Associate Professor
University of Western Ontario
London, Ontario

Claire Mallette RN, PhD
Co-Team Leader
Chief Nursing Officer
Worker's Safety and Insurance Board
Toronto, Ontario

Holly Quinn RN, BScN
Director of Clinical Programs
Bayshore Home Health
Mississauga, Ontario

LeeAnne Rankin-Greene, RN, BScN(c)
Staff Nurse
Royal Victoria Hospital
Barrie, Ontario

Maria Rugg RN, BScN, MN, ACNP, CHPCN(c)
Clinical Nurse Specialist
The Hospital for Sick Children
Toronto, Ontario

Heather McConnell, RN, BScN, MA(Ed)
Program Manager
Nursing Best Practice Guidelines Program
Registered Nurses' Association of Ontario
Toronto, Ontario

The Registered Nurses Association of Ontario (RNAO) received funding from the Ministry of Health and Long-Term Care (MOHLTC). This guideline was developed by a panel of nurses and researchers convened by the RNAO and conducting its work independent of any bias or influence from the MOHLTC.

This is the current release of the guideline.

This NGC summary was completed by ECRI on December 17, 2003. The information was verified by the guideline developer on January 16, 2004. This NGC summary was updated by ECRI on June 22, 2006.

With the exception of those portions of this document for which a specific prohibition or limitation against copying appears, the balance of this document may be produced, reproduced, and published in its entirety only, in any form, including in electronic form, for educational or non-commercial purposes, without requiring the consent or permission of the Registered Nurses Association of Ontario, provided that an appropriate credit or citation appears in the copied work as follows:

Registered Nurses' Association of Ontario (2006). Supporting and Strengthening Families Through Expected and Unexpected Life Events. (rev. suppl.) Toronto, Canada: Registered Nurses' Association of Ontario.