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Resources for Culture Change in Family Focused Care

Family Health & Healing | Dr. Janice M. Bell, RN, PhD | Resources
Credit: National Academy of Medicine

As a family nursing scholar, my greatest desire is to shift the emphasis of health care from the individual to the FAMILY and from tasks and technology to RELATIONSHIPS.

I am delighted there are many organizations and individuals around the world who share my mission, including the International Family Nursing Association.

I don’t think family nursing and “patient and family centred care” (PFCC) are one in the same. My belief is that family nursing includes nursing assessment and intervention at generalist and advanced practice levels for systemic “family as the unit of care” that is actually “more” than PFCC.  I tried to articulate this in a Journal of Family Nursing Editorial in 2013. However, PFCC and family nursing share a common vision for expanding the definition of “patient” to include significant others and changing the culture of care to relational care that welcomes and involves families and those who are connected to the individual patient.

I think Family Nursing and PFCC are perhaps “cousins” joined by larger mission and vision for relational health care.

In January 2017, the Patient and Family Leadership Network of the National Academy of Medicine in the USA published A Guiding Framework Patient and Family Engaged Care—notice the shift in the words from “centred” to “engaged”.  Authored by Frampton et al., (2017), this framework beautifully conceptualizes the knowledge translation process needed to shift the culture of health care and includes multiple systems levels for intervention (i.e., Organizational Foundations, Strategic Inputs, Practice Outputs, and Engagement Outcomes) that family nursing colleagues such as Dr. Fabie Duhamel have long been calling for in family nursing knowledge translation research.

This Guiding Framework illustrates  that we need to be taking a larger systems view in family nursing intervention research than only enhancing the family nursing practice of a small group of nurses. In most of the current family nursing intervention research to date, a group of nurses have been offered an educational intervention designed to improve their family nursing knowledge and skills. The outcomes that have measured include nurses’ beliefs about involving families in their care and various family outcomes.  Notice the shopping list of outcome variables identified in the blue area of the Guiding Framework called “engagement outcomes” that could be measured. The Guiding Framework simply puts all of the previous important family nursing intervention research into context in terms of the multiple systems of change that also need to be accounted for in future knowledge translation research. We need to continue to conduct research that explores how knowledge transfer/knowledge translation of family nursing takes place in practice settings and how culture change in family focused care occurs.

Now Planetree, an organization in the US dedicated to integrating PFCC in health care since 1978, has joined this effort by developing two new resources for the general public based on the National Academy of Medicine’s Guiding Framework for Patient and Family Engaged Care:

  1. An Invitation to Engage letter written by patients and families for patients and families.
  2. Harnessing the Evidence for Patient and Family Engage Care – a brief plain language document of the January 2017 National Academy of Medicine publication identified above.

Please share these new resources widely with your nursing and interprofessional colleagues and with families whom you have the honor of caring for.


Frampton, S. B., Guastello, S., Hoy, L., Naylor, M., Sheridan, S., & Johnston-Fleece, M. (2017). Harnessing evidence and experience to change culture: A Guiding Framework for Patient and Family Engaged Care. National Academy of Medicine, 1-38. Retrieved from