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Bedside Initiatives Aren't Just for Kids

 |  By Alexandra Wilson Pecci  
   September 03, 2013

Nurses at the University of Pennsylvania Health System take a page from the pediatric playbook to make the hospital experience more patient- and family-oriented for adults, too.

For my four-year-old daughter, trips to the spina bifida clinic at Boston Children's Hospital are—dare I say it?—pretty fun. The hospital's main staircase plays musical notes with every step. The lobby is crowded with kids ogling tanks filled with brightly colored tropical fish and pressing their noses against the glass of a "Bippity Bop Machine" that sends balls bouncing through a complicated maze of levers and cranks.

Volunteers give out stickers near one of the elevators, and on the playground, kids take a break and let off steam between appointments.

If only adult hospital visits could be so comforting. In fact, they should be, argues a new op-ed in the Journal of the American Medical Association. In his piece, "Treat Me Like a Child," Penn Medicine fourth-year medical student Mark Attiah argues that when it comes to creating an environment that's conducive to healing, adult hospitals should take a cue from their pediatric counterparts.

"Adult hospitals, as they begin to fully realize the importance of the environment to a vulnerable patient's well-being, can take a page from the pediatric playbook by creating surroundings that distract and reduce stress, and by making clinical practices more patient- and family-oriented rather than more convenient for the caretakers," he writes.

He points to the University of Pennsylvania Health System as an example, and as it turns out, it's the nurses there who are responsible for implementing and nurturing many of its patient- and family-centered efforts.

"Nurses really are doing so much," says Mary K. Walton MSN, MBE, RN, a nurse ethicist who spent 30 years in a pediatric setting before moving to the Hospital of the University of Pennsylvania (HUP), where she works as the director of Patient/Family Centered Care. "We have that 24/7 presence where we can really see the needs."

She tells me that the hospital in general, and nurses in particular, have been working for several years on patient- and family-centered care, having families present and involved in everything from nurse-to-nurse bedside rounds, to discharge planning, to resuscitation attempts. Such aspects of patient- and family-centered care are taken for granted at pediatric hospitals, but aren't as common at adult hospitals.

For instance, at HUP, family members can stay at a patient's bedside continuously if they want to, sleeping in one of the hospital's hundreds of bedside sleeping chairs. In fact, families aren't simply allowed to stay; "we welcome them. They're important to the patient, and they're important to us," Walton says.

Unit secretaries walk around to patients' bedsides to tell family members they can stay overnight; give out pillows, blankets, and sleeping chairs; and write down the names of anyone who's staying.

"We really start from the premise that in many ways it's the patients right to have someone with them, and we believe that it really improves the care," Walton says. "Family presence is certainly a comfort measure, but it's definitely about patient safety and quality of care."

For example, Walton says a family presence keeps patients safer during handoffs because someone who intimately knows the patient has been monitoring and observing him or her.

"We see them through the clinical lens," Walton says. "A family member knows them in a different way."

Walton says that HUP is always developing programs to make patients and families feel cared for and comforted. For instance, HUP sponsors coffee hours for families in the patient education center and is developing a place where family members can take a shower. And many of these programs are developed and/or led by nurses.

"It's trying to view the experience from the patient/family perspective," Walton says. "Everyone is vulnerable when they're sick, when they're in pain, or in major health crisis—not just children."

Here are a few more nurse-led patient/family-centered initiatives at HUP:

HUP's Pups: It was a nurse who initiated, developed, and implemented this program, which brings volunteer therapy dogs onto units to interact with patients and families. "She loves dogs and she works in a critical care unit where she recognizes the stress of everyone," Watson says of the nurse who started the program. Armed with academic literature to back up the idea that dogs can improve patients' psychological and physiological wellbeing, the nurse vetted the process, engaged stakeholders, worked with multiple departments, and shepherded the program through all needed policies.

Comfort carts: A nurse in the medical ICU saw that family members didn't want to leave patients' bedsides, so she led an initiative to bring necessities to them. Coffee, tea, and snacks are provided to families who are keeping vigil, often before an impending patient death.

The carts also provide blankets, music, tissues, and spiritual or religious items, such as battery-operated candles and copies of the Bible and Koran. "That was a bedside nurse… who works permanent night shift in the medical ICU who launched that program with her colleagues," says Walton.

Musicians On Call brings live music to the hospital. Walton says nurses identify patients or family members who'd like to hear music, and the charge nurse meets with the musicians and tells them which patients would like them to visit. The musicians either go into patients' rooms or simply play on the unit.

Alexandra Wilson Pecci is an editor for HealthLeaders.

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