Prehospital Providers' Perceptions on Providing Patient and Family Centered Care

Figures & data

Table 1. Principle themes on barriers to and strategies for providing family centered prehospital care

Themes	Codes	Quotes	Ref^*
Barriers	Interference in Delivering Patient Care	“She was kind of hovering, so it was kind of hard to work, when a parent is hovering.”“My distraction was her [caregiver] because I was trying to help out with the team, but then she got more in the way … and so I had to get her out of the way, so they could do the job.”“Absolutely, so when you are taking care in critical situations, your focus has to be the medical care. Part of that, though, is you want to make sure you are creating a situation or atmosphere that's not going to be disruptive to your medical care. Sometimes if you don't update the family, they can start to become more disruptive than they already might be.”“To let them hold their hand could be good, but as things progressed with the patient and things get worse, that can make the parent that much more aggressive too and impede what we are trying to do. I've had that happen numerous times and the best thing to do at that point in time is to get that parent out of the room.”	33
	Manpower and Multitasking	“Yeah that's not going to happen, in a real world situation, you can get some information, but everybody's got something going on, so you are going to end up feeling like you are being left out. That's just real world truth.”“Everybody's got a job … I have had that parent … you can give them a brief description, but the reality is that everybody's got something to do.”	12
	Unfamiliar Environment	“You have to realize that we are in somebody else's home and we are on their turf. A lot of times I've found, when you start talking to people it calms people down, especially those that are very upset. It gives the impression that 1: you are including them; 2: you know what you are doing; 3: you can get a take on who your friends or your foes are.”	4
Providing Emotional Support to Caregivers	Empowerment	“[Make] them a part of what's going on, utilizing that particular resource. The more you ask questions [you] empower them by putting them in on some of the decision making. Explaining each step.”“It's always a feeling of empowerment to the family to have some type of close [proximity to the patient].”	18
	Calming Energy	“Y'all were actually very calm in the scenario. There wasn't a lot of useless conversation, but because I saw that y'all were calm, I in turn was calm. It translated trust for me; because y'all were collected and organized, I felt you were better taking care of my child.”“I felt very well taken care of … I do tend to react to energy in the room. So you were being very calm.”	17
	Providing Comfort and Empathy	“And I think originally when you came over first, you put a hand on my shoulder for just a moment, so I would know you were there, and that was comforting.”“One person was talking to me … you had a hand on my back the entire duration that you were talking to me which was empathetic … It played into my maternal instinct. It reminded me to breathe and relax.”“I have kids too, to feel like, oh, we're allies. That's a good way to be an ally to someone. I'm a Dad too; I know what that's like. If this were my kid, this is the way I would want to be treated. So I understand you're scared, just relating you understand as a parent.”	12
Strategies for Effective Communication	Designate Roles: The Family Point Person	“I guess somebody could be there from the word go … Be with her from the time we get there until it's over with … so she's not having to ask questions and get frustrated … If you have the resources and manpower … have somebody designated to update the caregivers.”“Sometimes we need to be directed. I've been on calls where everyone is going in different directions, and we forget all about the family; somebody has to step up.”“Someone needs to be delegated to the parent. At the same time you've got make sure that they're aware of everything that's going on, as long as they're not disrupting patient care, they need to be there, where they can see everything. Someone has to take that role.”	33
	Utilize Lay Language	“When you were talking to me, you started giving me what was going on, but it was all in medical terms, I didn't understand a word of it.”	12
	Utilize Downtime and First Impression	“You have done what you thought you could, and you were waiting for ALS to arrive, and I noticed you were doing something very nice … you were explaining everything to mom.”“Communication with the parents is key. A lot of people don't do that at the beginning, because they are just trying to figure out the scenario, but it help to calm them down.”	5
	Narration	“So it's like give you a play by play … The baby's heart rate is going too slow, so we are going to beat it for them to make it go faster … And we are going to put a tube it their throat so that we can breathe for them, because they stopped breathing.”	4
Tactics to Overcome PFCC Barriers	Line of Sight	“For us, trust me, I work out in the field. I understand. I think what we fail to realize, if you have a child, say it's your child, your baby, not so much take the parent out of the room; put them maybe at the front of the bed, because I guarantee if it's anyone of us, you aren't leaving the room.” “You took her around, because it seemed like she was getting in the way [and said], ‘I'm going to take you over here where you can still see what is going on.’ That line of sight is important, you want them out of the way, but you still want them to be able to see. It helps them still feel somewhat in control even though they aren't in control.”	33
	Situational Awareness	“It's a matter of self-preservation; you have to maintain a sense of professionalism. Hey guys, let's load and go … everybody knows if you say load and go, that means trauma.”“Anything outside of the realm that facilitates patient care, you should probably let it stay in its own lane. When you are in that situation you can be direct without being accusatory; control your emotions. It's not about you or how you feel. You are not the police; you are there to provide patient care … Proceed in a professional and controlled manner.”	4
	Time-out	“She wasn't being disruptive, so sometimes taking them out of the room could cause them to do that. And they are a source of information; having her there could be an asset.”“Just because you take someone out of the room doesn't mean you can't bring them back in.”	3

^* Number of times a coded sub-theme was referenced in audio transcript.

Figure 1. Conceptual framework of barriers and strategies to facilitate PFCC.