Date of Award
12-2024
Document Type
Campus Access Dissertation
Degree Name
Doctor of Philosophy (PhD)
Department
Nursing
First Advisor
Priscilla Gazarian
Second Advisor
Lingling Zhang
Third Advisor
Jennifer Cahill, Christine S. Richie
Abstract
Family engagement is important to safe transition between care setting and providers; and ultimately, as serious illness progresses. The family engagement domains are presence, assessment of family needs, communication, shared decision-making, and contribution to care. Family engagement improves quality and safety and, therefore, patient outcomes in the hospital. Unfortunately, post-Covid visiting policies restricting family access to patients combined with the fact that family engagement is poorly operationalized in the hospital setting makes a description of family engagement in the hospital setting elusive in the literature. This dissertation aimed to contribute to the research on family engagement in the hospital setting with three manuscripts. The first manuscript, an integrated review, describes the domains of family engagement present in the literature with Covid-era hospital visiting policies as the backdrop. The review revealed that presence is recognized as a facilitator of the other domains of engagement and that family engagement is poorly operationalized in the hospital. A second manuscript describes the pre-pilot and pilot stages of a retrospective chart review and the influence these stages had on the abstraction tool. The development of an abstraction tool is a first step in operationalizing family engagement in the hospital setting by providing a framework to assess the family engagement documentation that exists or is absent from the record. The third manuscript, a retrospective chart review, provides an initial description of family engagement in the documentation captured in the electronic health record, a description that is missing in the literature, as well as explores if there are differences in the family engagement documentation related to race, social deprivation index (SDI), and diagnosis of cognitive impairment. This retrospective chart review addresses the literature gap by describing who is documenting the family engagement domains, where it is being documented, and identifying the significant patient, provider, and clinical factors to explore. While there do not appear to be significant differences in the documentation related to race, SDI, and cognitive impairment, without a structured template the existence of disparities may not be obvious. Implications for future work on family engagement in the hospital setting should focus on three areas: research, policy, and education. Further research needs to explore patient and family preferences including perceived facilitators and barriers of family engagement, and provider attitudes toward family engagement. The results of these studies can further inform the description of family engagement in the hospital setting. This work will be used to inform state and institutional policies and the development of a tool to measure family engagement in the hospital setting. Finally, the work will inform interprofessional learning opportunities on family engagement domains how to activate and document family engagement in the hospital setting with a specific focus on shared decision-making. In all, this dissertation, offers foundational work to fill the gap in the literature by describing who is documenting family engagement, where it is being found in the record, and if there are differences between populations.
Recommended Citation
Morgan, Jennifer D., "Family Engagement on Neuroscience Units with Post-Covid Visiting Policies: A Retrospective Chart Review" (2024). Graduate Doctoral Dissertations. 1024.
https://scholarworks.umb.edu/doctoral_dissertations/1024
Comments
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