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Nehrir B, Ebadi A, Mokhtari Nouri J, Nehrir B. Family-Centered Care Approach: A Systematic Review Study. JPMed 2022; 11 (1) : e30
URL: http://jpmed.ir/article-1-1096-en.html
1- Department of Nursing, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran , rnehrir1739@yahoo.com
2- Department of Nursing, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
English Extended Abstract:   (1102 Views)
… [1]. Due to the lack of information related to the disease, the lack of understanding of the patient's needs and the lack of knowledge about how to care for the patient, the families of the patients do not have the necessary efficiency in providing adequate care [2]. … [3]. Education with a family-centered approach is a process in which family members are trained to increase their skills and abilities to help the sick family member [4]. ... [5, 6]. Different texts have other multiple consequences for the implementation of family-centered care including improving the psychological conditions of children and families, attachment increase, reducing the hospitalization time of patients, increasing the satisfaction of families, patients and healthcare personnel, reducing stress and restlessness, reducing negative effects of hospitalization, reducing stay in intensive care units as well as hospitals, and increasing satisfaction in the family [3, 7, 8]. A clinical trial study in France showed that improving relationships and support of family members in intensive care units can significantly reduce depression, anxiety and post-traumatic stress disorder [9]. ... [10]. In a review of parental participation in the care of hospitalized children, Power Frank stated that nurses usually have a good attitude towards parents' participation in care. However, due to the limitations of professional rules, they are reluctant to hand over some routine daily tasks [11]. With numerous advantages, this approach has been neglected in Iran, and less emphasis and attention has been paid to it. ... [12, 13].
The present study was conducted to review recent studies in the field of family-centered care approach.
This research is a review study.
The statistical population of this review study was the articles of 2000-2021 that investigated the approach of family-centered care.
Searching in Persian articles was done using the keywords family-centered approach and family-centered care and using the keywords Family-centered approach, Family-based centered, and Family-centered care in English articles. English articles were searched in Google Scholar, PubMed, Science Direct, Scopus, and Persian ones were searched in SID and Magiran databases. Repeated and unrelated cases after the initial screening were excluded from the studies in the next step. The screening criteria included the lack of relationship between the article to the topic and removing articles that were published in both Persian and English versions. All the articles containing the mentioned keywords in their titles or abstracts were included in the initial list in the next step. Then a checklist of the necessary information of the study, including the name of the author, the time of the study, the sample size, and the results of the study was prepared for the final evaluation. After reviewing the articles that met the inclusion criteria, the final articles obtained were reviewed by researchers. To select related articles, the article quality tool called Prisma Checklist was used [14] (Diagram 1).
Ethical permission was observed at all levels of the research, and no seizure was made by the researchers while conducting the research. The code of ethics related to this study was also received from Baqiyatllah University of Medical Sciences as IR.BMSU.REC.1400.05.
Among 265 articles, after searching and screening, the final analysis was done on 100 articles. Many summarized studies related to the family-centered care approach were shown in table 1. Based on this table, the different effects of the family-centered approach can be categorized in different studies. The reviewed studies included nine descriptive-cross-sectional studies, 18 quasi-experimental studies, 60 randomized clinical trial studies, and 13 qualitative research studies. The findings showed that the most important effects of the family-centered approach included increasing the quality of life, the satisfaction of patients and families, improving the clinical outcomes of newborns, reducing anxiety and stress, separating from mechanical ventilation, improving hemodynamic conditions, and increasing the participation of families. Increasing the quality of life: Among the founded studies, 6 investigated the quality of life [15-20]. According to the World Health Organization, quality of life means a person's perception of his/her life situation and attention to the culture in which he/she lives and is related to his/her goals and priorities in life which affects the physical and mental activity of the person and his/her role in society [7]. There is a belief that living well leads to a longer life. For this reason, the concept of quality of life has attracted more attention in recent decades in medical science research. Today, most health-related quality-of-life studies emphasize examining patient care outcomes. After being discharged from the hospital, these patients often experience many problems, such as pain, fatigue, intolerance to activity, sleep disorders, wound care issues, anxiety, depression, and fear of their future condition, which significantly affect their quality of life [21]. Increasing the satisfaction of patients and families: Among the obtained studies, 31 have investigated the satisfaction of patients and their families [22-50, 3]. Patient satisfaction in improving the quality of health care services is one of the most influential factors in the quality of services. Patient satisfaction is evaluated through the recent experience of patients in the hospital. Family satisfaction indicates the extent to which health professionals meet the family's needs and expectations and may be influenced by family-related factors such as attitudes toward life and death and social, cultural, and religious backgrounds as well as patient-related factors such as the severity of the disease, the hospital's infrastructure and the care process [31]. One of the keys to caring is satisfaction with the care provided. Satisfaction is essential not only for patients but also for their families [10]. Improving the clinical outcomes of newborns: Among the founded studies, 13 ones have investigated the clinical outcomes of newborns [51-62]. Underweight and premature babies are at risk and experience many physical and mental problems. Their physiological characteristics require basic care to continue life and achieve normal growth and development. One of these cases is hospitalization in the Neonatal Intensive Care Unit [63]. Since hospitalization is a stressful experience for the baby and parents, special attention has been paid to it in recent years. One of the most effective ways to prevent injuries and damages caused by hospitalization is the active involvement of parents in the care of the baby because it improves parents' ability and reduces the re-hospitalization rate [64]. Family-centered care in Intensive Care Units for newborns has caused the family to be involved in care and decision-making since the baby's birth. So parents are considered primary caregivers and cooperate with health workers [65]. Reducing anxiety and stress: Among the founded studies, 13 have investigated anxiety and stress [9, 25, 76-67]. One of the causes of severe anxiety in the family is facing life-changing conditions such as the hospitalization of one of the family members [25]. Illnesses and accidents that lead to the hospitalization of a patient in the Intensive Care Unit are usually life-threatening and lead to the anxiety of family members. Fear of the patient's death, financial concerns, role changes, and changes in daily life are sources of anxiety for the patients' families [66]. The high level of anxiety in the family of patients admitted to the Intensive Care Unit is due to factors such as not being familiar with the environment and advanced equipment of the hospital, lack of trust in the hospital staff, lack of response to treatment and dissatisfaction with care [44]. Separation from mechanical ventilation and improvement of hemodynamic conditions: Among the founded studies, six investigated hemodynamic conditions in patients with mechanical ventilation [77-82]. The process of isolating the patient from the mechanical ventilator is essential. Because if the patient does not have a stable hemodynamic condition, it will cause adverse effects for the patient. In recent years, many non-pharmacological methods have been recommended to reduce the complications of mechanical ventilation treatment. One of these methods is the family-centered care approach. Increasing the participation of families: Among the founded studies, six studies have investigated the effect of family participation [25, 59, 86-83]. The educational participation of families can provide a suitable basis for improving the clinical condition of patients. Ezzati stated that families' supportive presence and participation in the Intensive Care Unit cause positive patient recovery changes [84].
In line with the results of the present study, Qavidel and Shabani have stated in their studies that family-centered education for coronary artery bypass surgery patients has improved their quality of lives [15, 87]. In Lindenfelser's study, music therapy has been introduced as one of the approaches to family-centered care in children who spend their final life levels [17]. Wright and Ferrando stated that factors such as age, ethnicity, relationship with the patient and the number of patient visits affected the satisfaction of the companions and factors such as age, the severity of the disease, the length of the patient's stay in the hospital and invasive ventilation affected the satisfaction of the patients. [31, 45]. Heyland claims that variables related to overall satisfaction include completeness of the information received, respect for the patient and family members, and quality of health care [42]. Karlsson et al. believe that in addition to the mentioned factors, the skill of the ICU personnel and their behavior with the patient and family are important in increasing satisfaction [88]. Some researchers have stated that implementing family-centered programs have increased the satisfaction of patients and their families in the intensive care unit. Therefore, it is useful to implement this approach in the intensive care unit. [22-24, 26, 44, 45]. In general, it can be said that efforts to improve interaction and communication with families, emotional support, providing comprehensible and complete information and coordination in care, most likely lead to improvement of patient and family satisfaction and thus lead to satisfaction with the hospital, which finally, it increases the quality of service. Improvement of clinical results in infants was another effect of this method. Studies by Aliabadi and Ortenstrand have shown that family participation in the neonatal intensive care unit has reduced re-hospitalization and visits to the doctor and significantly reduced the average duration of hospitalization [59, 60]. Skene considered family-centered effects as sharing information with parents, family support, the possibility of parents' participation and improving the competence of supporting parents in care [61]. According to the results of Cooper's study, implementing this approach in the neonatal intensive care unit has made mothers feel less stressed, comfortable, aware and more confident, and more importantly, it has increased parental support in the neonatal intensive care unit by nurses [66]. Simeone et al. have concluded that the implementation of family-centered care before surgery for children with congenital heart has significantly reduced anxiety in parents by explaining the medical equipment and the treatment process [74]. Some researchers believe that this approach has reduced anxiety in the families of patients admitted to the intensive care unit [66, 68, 75]. Shoushi has also stated that this approach has reduced depression, anxiety and stress in the families of open-heart surgery patients [70]. However, Imanipour's study on the families of heart surgery patients found that informational support, orientation tour and provision of educational booklets did not reduce the anxiety of the patient on the day of discharge from the ICU [29], which is not in line with the findings of this study. Also, in Bailey's study, there was no significant relationship between informational support and family anxiety of patients admitted to the ICU [89]. Chien showed in a semi-experimental study in the intensive care unit that the anxiety level in the patient's families in the intervention group decreased compared to the control group and was associated with increased family satisfaction. However, it caused anxiety in family members [33], which is inconsistent with the study's results. It can be said that the increase in anxiety and stress resulting from this approach is because the family does not have enough information about the disease, the treatment process, the department's environment and the ward's complex equipment, and they feel anxious when they are asked for an opinion. Therefore, the participation of family members of patients hospitalized in the intensive care unit in the care program has an effective role in reducing the anxiety of family members and improving the process of caring for patients. Early separation from mechanical ventilation and improvement of hemodynamic conditions are other effects of this approach. Safaeipour stated in his thesis that family-centered care reduced the time of isolation from mechanical ventilation in patients who had coronary artery bypass surgery [77]. Some researchers have reported that the fear of the unknown caused an increase in hemodynamic indicators, including blood pressure, heartbeat, and breathing. At the same time, implementing this approach improved hemodynamic symptoms and reduced hospitalization in the intensive care unit. The reason for this could be the lower anxiety of patients in the intervention group compared to the control group [4, 80, 82]. Also, Azimi Lolati has shown that visiting family members and friends led to a decrease in a heartbeat, breathing and more oxygen saturation in patients hospitalized in CCU. Also, meeting with family and friends can improve the feeling of well-being in MI patients and reduce their anxiety [82]. Hosseini Azizi et al. stated about the effect of family support on the recovery process of concussion patients in the intensive care unit that this approach has accelerated the recovery process of the patient. Also, solving the concerns among nurses and correcting their beliefs has provided the basis for using the benefits of family presence [90].
The limitation of the study was the impossibility of accessing the full text of some articles, so they were not included in the study.
Due to the frequency of studies in this field, it is vital to conduct a meta-analysis study in this regard. It is suggested that nursing managers implement family-centered care, especially in children's and Intensive Care Units. It is also necessary that its various dimensions be studied and evaluated in universities and research centers; according to Iranian culture and society, and its hidden symptoms be identified, and the field for applying this approach in public and private medical centers be provided.
The current research showed that implementing family-centered approach increases the quality of life, and satisfaction of patients and families, improves the clinical results of newborns, reduces anxiety and stress, separates them from mechanical ventilation, and increases the participation of families. According to the findings and positive effects of this approach as a valuable and low-cost solution, it can be used as a scientific solution for more participation of patients and families in Iran's rehabilitation and treatment centers. Therefore, according to the mentioned materials, with a little expense, using different specialties, supporting the family, and involving the patient, the conditions for empowering the family can be provided
Teaching the principles of family-centered care creates group motivation, increases the quality of life, creates independence, and makes patients and families of the armed forces not dependent on health care providers.
This article results from a part of the Ph.D. dissertation in the Faculty of Nursing of Baqiyatallah University of Medical Sciences. The financial and moral support of the Research and Technology directorate of Baqiyatallah University of Medical Sciences and the Research Center of the Health and Treatment directorate of the Police Headquarters of the Islamic Republic of Iran are gratefully acknowledged for this project.
The authors state that the present study has no conflict of interest.
This article was written with the financial support of the directorate of Research and Technology of Baqiyatallah University of Medical Sciences and the Research Center of the directorate of Health and police Headquarters of the Islamic Republic of Iran.


Figure 1) The process of reviewing and selecting the articles included in the study

Information about some used articlesTable 1) 
Authors (year) Year Type of research Aim Data collection method Conclusion
Verma A et al [53] 2017 Clinical trial Investigating the effect of family-centered care on the rate of hospital infection in infants educational videos By implementing the principles of family-centered care, the rate of breastfeeding improved before the discharge
Safaeipour et al. [77] 2017 Clinical trial Determining the effect of family-centered care on the duration of isolation from mechanical ventilation in patients undergoing CABG The researcher-made tool includes: demographic information and a form related to the intubation and extubation of patients Family-centered care reduced the duration of isolation from mechanical ventilation in patients undergoing coronary surgery.
Farnia F et al. [23] 2014 Clinical trial The effect of family-centered care on family satisfaction of patients hospitalized in special adult care A researcher-made questionnaire including demographics and family satisfaction with the quality of care Family-centered care led to an increase in family satisfaction.
Lv B et al [51] 2019 semi experimental Investigating the effect of family-centered care on the clinical outcomes of low birth weight infants Parents demographic questionnaire The weight of babies and the amount of breastfeeding increased in the intervention group at the time of discharge (p<0.001).
Nohi, Karbalaizadeh and Abazari [25] 2015 Clinical trial Investigating the effect of participation and family-centered care on the anxiety of mothers of children with gastrointestinal infection Demographic information questionnaire and Spielberger standard anxiety questionnaire After the intervention, the mean score of overt anxiety significantly decreased in the test group compared to before the intervention (p>0.015).
He S-W et al. [52] 2018 Before and after intervention Evaluation of the effect of family-centered care on the clinical outcomes of premature infants Questionnaire and implementation of family-centered care interventions The study results show that family-centered care improved the clinical outcomes of preterm infants.
Shushi et al. [70] 2017 Semi-experimental Investigating the effect of family-centered care program implementation on depression, anxiety and stress of family caregivers of open heart surgery patients DASS21 questionnaire Family-centered care program reduces depression, anxiety and stress of patient caregivers
Karimi et al. [79] 2017 Clinical trial The effect of family orientation program on hemodynamic indicators Questionnaire of demographic information and clinical characteristics, hemodynamic status form and hospitalization data After the intervention, the hemodynamic indices and hospital stay in the intervention group were lower than the control group (p<0.001).
Ghavidel et al. [15] 2015 experimental and length of hospitalization in patients with coronary artery disease SF-12 quality of life questionnaire After the intervention, the quality of life scores of the test group increased significantly compared to the control group (p<0.0001).

Article number: e30
Full-Text [PDF 879 kb]   (1103 Downloads)    
Article Type: Systematic Review | Subject: Police Health
Received: 2022/04/15 | Accepted: 2022/07/31 | Published: 2022/09/26

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