THE BACK PAGE

National Priorities Partnership: Engaging Patientsand Family

Vallire D. Hooper, MSN, RN, CPAN, FAAN

Table 1. National Partnership Priorities For Action

1. Engaging patients and families in managing their health and

THIS EDITORIAL presents the third in a series of edito-

rials examining the challenges and goals established by

the National Priorities Partnership (NPP), which is

charged with developing a vision for world-class, afford-

able health care.1 The NPP has identified six priorities

(Table 1) that they believe, if addressed, will have the great-est impact on improving health care at the national level.

For the remainder of this year, I would like to focus on

those priorities on which perianesthesia care can have a di-

rect impact.

Thismonth we will be examining the first goal: Engaging pa-

tients and families in managing their health and making de-

cisions about their care. The NPP envisions patient andfamily engagement as health care that honors the individual

patient and family; offers voice, control, choice, and skills in

self-care; provides total transparency; and adapts readily to

individual and family circumstances, as well as differing

cultures, languages, and social backgrounds. Patient/family

engagement should positively impact health care by

reducing harm, disparities, disease burden, and waste.1

Patient and family engagement is, in many ways, a more

assertive model of patient-family centered care (PFCC).

PFCC is care grounded in mutually beneficial partnerships

that are respectful and responsive to individual/family

preferences, needs, and values.2,3 True engagement, how-

ever, indicates a higher level of involvement by requiring

active participation from all involved parties at all times.

Does the health care provider consider the patient/familywishes in developing the plan of care? Or is the patient/

The ideas or opinions expressed in this editorial are those solely of

the author and do not necessarily reflect the opinions of ASPAN, the

Journal, or the Publisher.

Vallire D. Hooper, MSN, RN, CPAN, FAAN, is a Perianesthesia Consul-

tant, PhD candidate, and Assistant Professor, School of Nursing,

Medical College of Georgia, Augusta, GA.

Address correspondence to: Vallire D. Hooper, MSN, RN, CPAN, FAAN,

10 Park Place Circle, Augusta, GA 30909; e-mail address: vhooper@

mcg.edu.

� 2009 by American Society of PeriAnesthesia Nurses

1089-9472/09/2403-0015$36.00/0

doi:10.1016/j.jopan.2009.04.001

Journal of PeriAnesthesia Nursing, Vol 24, No 3 (June), 2009: pp 211-212

family actively engaged in developing the plan of care in

collaboration with the health care provider?

Engagement is defined as an ‘‘act of engaging’’ or ‘‘state of

being engaged.’’ It can also be defined as a hostile encoun-

ter or a battle.4 In any case, it involves at minimum, theactive involvement of at least two parties. Engaged health

care providers should provide the patient/family with all

available information, including outside resources, in a for-

mat that the consumer can understand. Equally impor-

tant, however, is the engagement of the health care

consumer. Consumers must, and should be encouraged

to seek out independent information about their condi-

tion from multiple independent sources. They shouldhave a clear understanding of all treatment options, to in-

clude non-surgical or less invasive options. Consumers

should have a comprehensive grasp on the risks and ben-

efits associated with any procedure, and take all of these

issues into consideration prior to signing consent for the

procedure.

As you examine your own practice setting, consider yourcurrent model of health care delivery. Do you practice

PFCC, and/or patient/family engagement? My guess is

that the majority of us would consider our care to be pa-

tient-family centered, but is it truly engaged? While most

of us still have work to do, there is a strong movement

making decisions about their care

2. Improving the health of the population

3. Improving the safety and reliability of American’s healthcare

system

4. Ensuring patients receive well-coordinated care within and

across all healthcare organizations, settings, and levels of

care

5. Guaranteeing appropriate and compassionate care for

patients with life-limiting illness

6. Eliminating overuse while ensuring the delivery of

appropriate care

Data from reference 1.

211

212 VALLIRE D. HOOPER

towards family visitation and/or parental presence in all

perianesthesia areas.5-9 The true impact of these actions

on patient and health services outcomes, however, has

yet to be captured due to the dearth of high quality, quan-

titative outcome studies.10-12 Additionally, these measures

are just a small component of true engagement. Are the

patient and family truly engaged in the surgical decision

and consent process? Is that consent truly informed?Do the patient and family have a true grasp on the proce-

dure, anesthesia, risks, and benefits? How does the team

respond when there are questions? Do you blow them

off, giving a brief but reassuring answer, or do you take

the time to truly explain . even if that means delaying

the surgical schedule? As you strive to achieve patient/

family engagement in your health care setting, keep the

following NPP evaluation goals in mind:1

d All patients will be asked for feedback on their

experience of care, which health care organizations

and their staff will then use to improve cared All patients will have access to tools and support

systems that enable them to effectively navigate

and manage their health care

d All patients will have access to information and as-

sistance that enables them to make informed deci-

sions about their treatment options

Lead the charge in your facility to take safe, quality healthcare to a new level. Don’t just respect the patient’s wishes;

engage the patient and family across all phases of peri-

anesthesia care. The results could be immeasurable!

References

1. NPP. National priorities and goals: Aligning our efforts to trans-

form American’s healthcare. Washington, DC: National Priorities Part-

nership; 2008.

2. Institute of Family-Centered Care: Frequently asked questions.

Available at: http://www.familycentercare.org/faq.html. Accessed Octo-

ber 26, 2008.

3. IOM. Crossing the Quality Chasm: A New Healthcare System

for the 21st Century. Washington, DC: National Academy Press;

2001.

4. The American Heritage Dictionary of the English Language. 4th ed.

Available at: http://education.yahoo.com/reference/dictionary/entry/

engagement;_ylt5Aph.3T1KQBGpdBdHlMGNCDKsgMMF. Accessed

April 27, 2009.

5. Bonifacio NC, Boschma G. Family visitation in the PACU, 1984-

2006. J Perianesth Nurs. 2008;23:94-101.

6. Freeman K, Denham SA. Improving patient satisfaction by ad-

dressing same day surgery wait times. J Perianesth Nurs. 2008;23:

387-393.

7. Kamerling SN, Lawler L. Changing practice to promote parental vis-

itation in the pediatric postanesthesia care unit. J Perianesth Nurs. 2008;

23:E9.

8. Kamerling SN, Lawler L, Lynch L, et al. Family-centered care in the

pediatric post anesthesia care unit: Changing practice to promote paren-

tal visitation. J Perianesth Nurs. 2008;23:5-16.

9. Raymond S. PACU patient advocates with family centered care.

J Perianesth Nurs. 2008;23:E20.

10. Chundamala J, Wright JG, Kemp SM. An evidence-based review of

parental presence during anesthesia induction and parent/child anxiety.

Can J Anaesth. 2009;56:57-70.

11. Lewin SA, Skea ZC, Entwistle V, et al. Interventions for providers

to promote a patient-centred approach in clinical consultations [see

comment]. Cochrane Database of Systematic Reviews 2001;(4).

CD003267.

12. Shields L, Pratt J, Davis LM, et al. Family-centred care for children

in hospital. Cochrane Database of Systematic Reviews 2007;(1).

CD004811.