Implementing family systems nursing through a participatory, circular knowledge-to-action research approach in women’s health

Background: Moving towards more family-centred care cultures in acute settings requires attention to the relational connectedness in which persons who seek acute care are situated. To promote such a family-centred culture and to shift the systemic approach to care from an individual one to a relational one, there is a need to integrate family nursing knowledge and skills into everyday acute care practices. Aim: The aim of this knowledge-to-action project was to create a family-centred care culture by integrating a family system nursing approach into clinical practice within the women’s health division in an acute care hospital. Methods: An action research methodology, using the action cycle of look-think-act, was used to guide knowledge translation and to develop a family-centred practice culture. The ‘think’ phase entailed an ongoing, critical dialogue among the study’s core group members about the meaning of family systems nursing, a shared definition and adaptation of the approach and instruments to the local context, and the development of an action plan for implementation. Lastly, family systems nursing was interprofessionally piloted through education and training activities in neonatal intermediate care. Findings: During the ‘look’ phase, 20 SWOT analyses with 312 health professionals revealed a shared commitment to individualised, participatory care, but a lack of continuity and inconsistent communication. Documentary analysis demonstrated that family engagement was evident in fewer than half of the cases. Conclusions: The use of a participatory, recursive process to tailor and introduce family systems nursing was important in order to gain momentum for change across different units and professions. A shared vision, leadership commitment, participatory collaboration and facilitation were essential for the change process, while the diversity of practice settings and scope of the project were the main challenges to starting the culture change required to achieve family-centred care. Implications for practice: * An early, proactive inclusion of unit-based teams in adopting new knowledge in their particular context is needed * Initiatives around translation of family nursing knowledge into practice should use skilled facilitation and clinical leadership as key enablers of knowledge uptake * The use of a cyclic, recursive and participatory process that engages various stakeholders is required for a shift from individual to relational family systems prac