Beyond Bedside Manner: How Family-Centered Care is Revolutionizing Emergency Nursing
"Discover how KwaZulu-Natal emergency nurses are embracing patient- and family-centered care to improve outcomes and create a more compassionate healthcare experience."
The emergency department (ED) can be a chaotic and overwhelming place, not just for patients but also for their families. Imagine the stress of seeing a loved one rushed into emergency care, the uncertainty hanging in the air, and the feeling of helplessness amidst a flurry of medical activity. It’s a situation where anxiety and fear can easily take over.
Traditionally, healthcare has focused primarily on the patient's physical condition. However, a growing movement recognizes the vital role that families play in the healing process. This approach, known as patient- and family-centered care (PFCC), acknowledges that families are not just visitors but essential partners in care. By addressing their needs and involving them in decision-making, healthcare providers can significantly improve both patient outcomes and the overall experience.
Nowhere is this more critical than in the ED, where split-second decisions and high-pressure situations are the norm. This article delves into how emergency nurses in the Durban area of KwaZulu-Natal, South Africa, are implementing PFCC practices to support families during these stressful times, offering insights and practical strategies for creating a more compassionate and effective healthcare environment.
Emergency Care in Context
The CDC’s National Hospital Care Survey collects data on patient care in inpatient, emergency, and outpatient departments to describe patterns of health care delivery and use in the United States. Its National Health Care Surveys dashboards provide preliminary hospitalization and emergency department data on drug use from selected hospitals. The Emergency Nurses Association describes emergency care as a complex setting with fluctuating patient volume and acuity, alongside high health care resource utilization. A 2023 systematic review reports that emergency department nurses use patient-centered interventions to support patient safety and quality of care.
The Patient-Centered Standard
Patient-centered care emphasizes services that respect and meet the needs of patients and caregivers, which the literature-based study links with positive care outcomes and perceptions of quality. In emergency departments, it is described as a holistic approach involving patient participation, communication, access to services, well-trained staff, and an environment responsive to psychosocial and physical needs. A mixed-methods systematic review found that patient-centered care is an emerging priority in health care but remains insufficiently clear in the emergency department. This lack of clarity makes it difficult to determine which patient-centered practices matter most to patients.
From Emergency Nursing to PFCC
Emergency nursing has developed alongside efforts to address workforce and operational pressures in emergency departments. One historical review identifies improving workplace environments, strengthening nurse-to-patient ratios, and avoiding the boarding of admitted patients in the emergency department as strategies for addressing the nursing shortage. A review of patient- and family-centered care describes PFCC as having grown in size and scope since its origins through identifiable milestones and drivers. Another review examines the milestones and pivotal factors that shaped the broader evolution of patient experience across health care.
What is Patient- and Family-Centered Care?
Patient- and family-centered care (PFCC) is more than just a friendly bedside manner; it's a fundamental shift in how healthcare is delivered. It's an approach that actively involves patients and their families in all aspects of care, from planning and decision-making to evaluation. The core principles of PFCC include:
- Respect and Dignity: Valuing the beliefs, culture, and background of each patient and family.
- Information Sharing: Communicating openly and honestly, providing timely and accurate information.
- Participation: Encouraging patients and families to actively participate in care and decision-making.
- Collaboration: Working together with patients and families as partners in care.
Barriers in Fast-Paced Care
Research on implementing person- and family-centred emergency care identifies the department’s fast-paced work environment as a barrier. The challenge is intensified where emergency and primary care are delivered together in the same setting. These findings suggest that family-centred practices must operate within workflows shaped by urgency, changing demands, and multiple forms of care delivery.
Evidence and Uncertainty
A systematic review of patient-centered care in the emergency department used weekly discussions among a research team that included a PCC expert and clinician, a patient engagement expert, and a methodologist to reduce bias and reach consensus. However, evidence concerning family presence during adult resuscitation remains limited: the relevant systematic review rated the evidence as very low or low certainty. It found that high-certainty evidence about the effect of family presence during resuscitation on patient outcomes is lacking. This uncertainty cautions against presenting family presence as a universally proven clinical benefit.
Practice, Outcomes, and Perception
Research on patient-centered care in emergency departments provides a framework for comparing clinical approaches that involve patients and families. In three randomized controlled trials of offering family presence during adult resuscitation, researchers found no differences in resuscitation duration, prehospital or emergency room mortality, or 28-day mortality; the reported odds ratio for prehospital or emergency room mortality was 0.80, with a 95% confidence interval of 0.54–1.19. In emergency departments in KwaZulu-Natal, South Africa, 84% of emergency nurses acknowledged the importance of family participation, 87% reported providing family members with timely information, and 77% said they had the necessary skills to care for family members. A separate quantitative survey included 353 family members of patients admitted to three emergency departments in KwaZulu-Natal.
The Future of Compassionate Emergency Care
The journey towards truly patient- and family-centered care in emergency departments is ongoing. By embracing the principles of PFCC, healthcare professionals can create a more supportive, compassionate, and effective environment for patients and their families during times of crisis. This not only improves the quality of care but also strengthens the vital bonds that connect us all.
The Full Scope of Emergency Nursing
Emergency department nurses care for patients around the clock throughout the year. Their work ranges from direct nursing care to managing patient flow. The setting is characterized by interdependencies among numerous people and processes, placing emergency nursing within a broad operational system rather than limiting it to bedside tasks. This scope helps explain why family-centered care must fit both clinical care and department-wide coordination.
Trauma Care Beyond the Bedside
A 2026 scoping review describes emergency department trauma management as continuing to face clinical, operational, and psychosocial challenges despite advances in trauma care. Its scope covers prehospital, in-hospital, system-level, and psychosocial aspects of trauma care. This framing places family-centered emergency nursing within a wider system that must address more than immediate clinical treatment. It also shows why improvements in emergency care may depend on operational and psychosocial responses alongside medical advances.
Care as Togetherness and Partnership
A study of family care during critical illness in KwaZulu-Natal, South Africa, found that families conceptualize care as togetherness, partnership, respect, and dignity. A patient-centered real-world evidence white paper reports that there are relatively few actual examples of patient engagement in study design or implementation. It argues that understanding patients’ lived experiences can help researchers make studies reflect real-world patient experiences and health care more closely. Interactive nursing case studies likewise present care scenarios in which users choose assessments and interventions and observe patient responses.