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From Kiribati to the Bedside: Making Family Caregivers Partners in Healing®

Thursday, November 01, 2018
Geri Lynn Baumblatt & Michelle Van De Graaff, RN, BSN

By Geri Lynn Baumblatt & Michelle Van De Graaff, RN, BSN
While we all look forward to the day when a family member is told they can go home from the hospital, taking someone home and feeling you can take care of them well is daunting.
And it’s often on that last day that family caregivers are told what they need to do and shown how to do it. So, while people are anxious, their minds crowded with questions and concerns, and working memory is less than ideal, we try and tell them what to do.
Michelle Van De Graaff’s experiences led her to pilot a way to involve families in care at the hospital. When in the Peace Corps in the Republic of Kiribati, she noticed that family members provided much of the care for their loved ones while in the hospital. After returning from the Peace Corps, when caring for her own child with a congenital heart problem, she noticed how calmly the baby tolerated treatments when she or her husband held the child. As parents, they actually provided a sort of palliative care the clinicians couldn’t.

Michelle in the Republic of Kiribati

Inviting Family Members to Learn and Help at the Bedside
Many family members want to help, but often feel intimidated by doing hands on care. Michelle began a program called “Partners in Healing” to invite family members to become part of the care team. Most accept, then get training on things like monitoring fluids, understanding why and how often to use an incentive spirometer, or in the ICU they may help apply lotion. They get a badge and a checklist where they can help record what they do (like helping with passive motion exercises). They’re also shown where things like ice and pillows are, so they can help themselves.
Families feel involved and included, and less like furniture. They get a chance to learn and practice care, build competency, and they become comfortable and confident in their ability to continue care at home. As families and patients explain:
“We (wife and I) thank you for allowing us the dignity to be part of each other’s lives.”
“I really appreciated being given the authority to assist in my husband’s recovery.”
"This program helped me [the caretaker] feel the confidence that I would be able to do what is needed once we arrive home.”
This process also gives family caregivers a chance to ask questions they may not know they have until they start caring for a loved one. When home is the first place family caregivers do hands on care, they often have a lot of questions and no one at hand to guide them.

In a study of the Partners in Healing® pilot working with families of cardiothoracic surgery patients, there was a 65% reduction in 30 day readmissions. And 92% of families said it “greatly enhanced” their transition home. A patient experience study from 2012-2016 on 7 acute care units showed significant improvements:

  • They felt their preferences were taken into account by the staff:(+9.1)
  • They understood how to manage health (+7.9)
  • They felt nurses explained things understandably (+8.6)
Family members often experience time in the hospital as endless waiting and anxious watching. They are present, but often don’t know how to help or when to chase down a nurse. Utilizing this time in the hospital to train family caregivers, changes those interactions. And it gives them agency both at the hospital and as they bring their family member home.
Hear from a Nurse and a couple that experienced Partners in Healing (3 minutes)
Read the article in Chest
Van De Graaff M, Beesley SJ, Butler J, et al. Partners in Healing. CHEST. 2018;153(2):572-574. doi:10.1016/j.chest.2017.09.046.

Michelle Van De Graaff RN, received her BSN from Brigham Young University.  She has worked with cardiac patients for 31 years and is the Practice Chair on the Acute Cardiovascular Unit at Intermountain Medical Center.  She sits on the hospital, regional and corporate Nurse Practice Councils for Intermountain Healthcare and in the Peace Corps in the Republic of Kiribati. @IntermtnMedCtr

Geri Lynn Baumblatt MA, For the last 20 years, Geri has worked to help people understand health conditions and procedures, orient them to their diagnoses, make more informed decisions about their care, and partner with their care teams.  She oversaw the creation of the Emmi program library, and she regularly speaks and serves on patient engagement, patient experience, health literacy, shared decision making, health design, family caregiving, and heath communication panels for organizations like AHRQ, the Brookings Institute, Stanford Medicine X, and the Center for Plain Language. She serves on the editorial board for the Journal of Patient Experience, is on the board of the Society for Participatory Medicine, and published a chapter in Transformative Healthcare Practice through Patient Engagement (IGI Global). She currently consults on patient engagement, family caregiving, and health communication. Follow her on Twitter @GeriLynn

Catch up with Geri Lynn November 9-10 at the National Caregiving Conference in Chicago. She’s cohosting 2 panels and a participatory lab at the Family Caregiving & the Workplace Summit.

Nurse family caregivers, CNOs and CXOs will discuss the impact on nurses and the organizations that employ them. If you’re a nurse, nurse manager, director, CNO or work in hospital leadership, you can participate in the surveys here.

Tags: communication, family caregiver, engagement, experience
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