Care project: involving family members in post-operative care
Proposer: Amsterdam UMC, AMC site
At the Amsterdam University Medical Center, AMC site, care of cancer patients who have undergone major abdominal surgery is shared between nurses and carers.
These patients require highly complex care. Following discharge, care continues at home with family members. Family members are not usually well-prepared for this active role. A programme was therefore developed for actively involving family members in care, during the stay in hospital. This programme fits in well with the current trend for patient and family-centred care. Family members get involved in precisely those activities that are known to have a preventive effect against complications arising. Examples include: early exercise, oral hygiene, breathing exercises or cognitive activities reducing the risk of episodes of sudden confusion. The programme was devised at a multidisciplinary level, and includes the following elements: rooming-in (optional), attending a doctor's round, written information, training by nurses, hands-on participation in care activities. Depending on the patient’s care needs and the carer’s skills, they can also help with other care activities such as dealing with wounds, running enteral feeds or injecting fraxiparin. An app has also been developed, where carers can look up information and keep track of their activities. Nurses were trained prior to the project, to involve carers actively in healthcare. To facilitate the family's presence in the hospital, two special informal care rooms were set up in the department. These rooms have a homely feel to them, and there is also a bed for the carer.
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The programme proved to be viable following an initial test on patients undergoing oesophageal or pancreatic resection, and their carers. The activities proved to be feasible and the carers did not find them too difficult. Patients indicated that they got a lot of support from having their relatives around and were more satisfied with the hospital stay than patients in a control group. Patients with carers were also found to implement exercise, breathing exercises, oral hygiene and cognitive activities more than the control group. These results are already promising, and as a next step, the AUMC wants to investigate the impact of the programme on patient clinical outcomes (readmissions and complications).
Impact on the healthcare professional
During the assessment, doctors and nurses expressed a positive attitude towards involving carers. For nurses, time needs to be invested during the initial post-operative days, but that pays off later in the hospital stay if the carer takes on more activities. The morning rounds take doctors some extra time, but also provide them with information. Fewer additional family meetings were required, as the family were provided information directly. It was important to document the division of assigned activities properly between informal carer and nurse and it was sometimes necessary to screen potential carers for suitability.
Impact on healthcare institution
This project is having a positive impact on how hospitalisation is perceived by patients and family members. The hospital distinguishes itself through patient friendliness and quality.
Building plans take into account the need for informal care rooms as part of the large-scale renovation that will be taking place at the AUMC.
Amsterdam UMC, AMC site
Afdeling chirurgie (G6-noord en G6-zuid)
Project contact person:
Marthe Schreuder (surgical registrar)
Other project team members:
Anne Eskes (research nurses)
Els Nieveen van Dijkum (surgeon)
Chris Bakker (nurse)
Rosanna van Langen (physician associate)