Participants to the study expressed different views regarding their understanding of the overall concept of PFCC and its potential value in the peri-operative context. Overall, PFCC was viewed as a collaboration between the management, nurses, patients, and their families in order to promote good interpersonal relationships and implement PFCC in the peri-operative context. Furthermore, applying PFCC means that valuable information could be shared between nurses, patients, and families for improved peri-operative care. The study’s findings emphasized that respectful and dignified care could be rendered to patients and their families by implementing PFCC and that patients and family members may be in a better position to take more responsibility and provide support toward patients’ health and well-being.
These conceptual understandings of PFCC largely correspond with Johnson, Abraham, Conway, Simmons, Edgman-Levitan, Sodomka and Ford’s [40] report about PFCC, comprising four core concepts. These concepts include nurses demonstrating respect and appreciating the dignity of patients and their families; ensuring information sharing between nurses, patients and families; enhancing patients’ and their families’ participation in care; and promoting effective collaboration between nurses, patients, and their families during care.
Furthermore, this study's findings provide a unique contribution to the study of PFCC that has not been adequately captured by existing literature. For instance, it identified the importance of unique cultural needs, values, and roles of patients and families that should be considered, which will allow nurses to support them better throughout the perioperative journey in African countries such as Ghana. These findings are affirmed by another Ghanaian study [17] which explored nurses’ perspectives on the needs of surgical patients during the peri-operative period. Findings from this 2020 study indicate that patient and family values, beliefs, cultural and religious perspectives should be considered and incorporated into the planning and delivery of patient care.
Also, varied views regarding the practice of PFCC in the peri-operative context emerged. Whilst some participants indicated that PFCC is unfamiliar to the Ghanaian perioperative context, and thus, that PFCC is not being practiced at all, others felt that PFCC is being practiced but not to its fullest potential as in Western countries. This variation was also illustrated by a 2019 study in Southern Ghana [3] to assess parents’ perceptions of family-centered care for children hospitalised through road traffic accidents, indicating that PFCC principles, components and dimensions may be less familiar within the Ghanaian context. It may thus be more challenging for nurses to practice PFCC to its fullest potential in the peri-operative context in Ghana.
What also became clear was a number of controversial ideas about the value of PFCC. Concerns that PFCC in the peri-operative context would negatively impact already poor infection control mechanisms, leading to even more infections in patients and families were noted. Other studies [5, 6] support this view by stating that patients and families may not be able to observe infection prevention mechanisms during the care process. This is not a unique stance, as more studies [7, 8] indicate that nurses were also of the view that implementing PFCC in the peri-operative context will affect hospital policies or protocols and might increase infection rates. Such negative views of PFCC in the peri-operative context cause nurses to exhibit poor attitudes toward PFCC implementation, with an unwillingness to engage with PFCC or accept PFCC implementation policies [7, 8].
Those participants who valued the practice of PFCC in the peri-operative context thought that practicing PFCC would contribute to the welfare of patients and their families since they would be actively involved in their care. This corresponds with findings from previous studies which indicated that PFCC helps to calm agitated and disoriented patients during admission to promote active participation in such care [14, 15, 16].
What was further revealed by the present study is that PFCC requires collaboration in order to achieve optimal patient care, similar to previous studies which indicated that collaboration between nurses, patients, and their families in policy and program development, implementation and evaluation as well as in the professional development of nurses are key components to the successful implementation of PFCC [41, 42].
The successful implementation of PFCC in the peri-operative context, as highlighted by the present study, seems to require effective communication between nurses, patients, and families to facilitate the documentation of relevant information that can be used to improve the care process. Similar findings [43, 42, 44] emphasized that effective communication with patients and their families enhances the documentation of relevant information obtained for them in order to effectively plan for ideal care outcomes for both patients and families.
In conjunction with effective communication strategies are nurses’ keen interest in listening to patients and families throughout the care period. Nurses should answer questions asked by the patients and families and respond to the personal preferences of the patients and families. This is in congruence with earlier findings [45, 46, 47] whereby the importance of verbal and non-verbal cues was emphasised for nurses to understand patients and families and assist in overcoming physical, psychological and social barriers affecting their participation.
In addition, effective information sharing between nurses, patients and families was emphasized as fundamental to PFCC practices in the peri-operative context in the present study, as it empowers patients and families in the development of self-care strategies towards independence once discharged. These findings are in tandem with previous findings which revealed that nurses must partner with the patient and family to tailor strategies for self-management of care that are based on the patient and family characteristics and preferences [44, 48].
Patient and Family Centered Care inevitably introduces certain benefits to nurses, patients, families and the overall health system as identified in this study. These findings are corroborated by Clay & Parsh [18] who emphasized that PFCC’s clear objectives, with a focus on the quality of care, are beneficial to patients and families, nurses, and even the health system.
In terms of the benefits of PFCC to nurses, the study indicated that this practice will allow nurses to focus more on patients and their families by showing respect and dignity since they participate in the care. Patient and Family Centered Care thus allows nurses to render care that is tailored to their needs and thus improves patient recovery, leading to nurses’ satisfaction with the care rendered. Through following the processes of PFCC nurses are able to identify the individuality of the patient, their unique needs and preferences, and use this information for the development of a patient centered care plan that is beneficial to the recovery process and resultant increased satisfaction to nurses [20, 21, 22, 23, 24, 19]. Further benefits of PFCC include a decrease in surgical errors during surgery which would lead to a reduction of post-operative wound infection. This will potentially reduce daily wound dressings in the surgical ward. However, contradictory opinions exist, where the idea is that PFCC would result in poor infection control and increased wound infection as a result of patient and family participation in care [5, 6].
Other identified benefits of PFCC include effective education of patients and families during peri-operative care to reduce anxiety and fear amongst patients and families. Similarly, Masry’s study [31] indicates that PFCC improves the education levels of the patient and family and eventually leads to the reduction of fear and anxiety on their part. Furthermore, in the current study, PFCC was seen as a practice that will help reduce mortality post-operatively, increase patients' and families’ satisfaction of care, improve the overall patient outcome and even reduce surgery costs. This view of PFCC corresponds with its benefits as highlighted by Wong, Redley, Digby, Correya & Bucknall’s [33].
Finally, the study identified that, overall, the Ghanian health care system would benefit when PFCC is being practiced because it would create information for the Ministry of Health (MOH) to develop policies to effectively address the patients’ and families’ concerns, leading to an overall improvement of the healthcare system. Such benefits are also confirmed by the observation that PFCC enables management to identify beneficial policies and system regulations following the implementation of PFCC [49, 35].
Management at hospitals will thus benefit from PFCC, as it will help them to diagnose hidden issues in the healthcare system and within families that have not been recognized before but are affecting the provision of care to the patient. Similarly, some studies [11, 34] showed that PFCC implementation would lead to an informal analysis of management, patients’ and families’ expectations towards available or new services needed within the health care system. This implies that PFCC implementation would allow management to assess the cost of care and nurses’ needs to support PFCC and by responding to patients’ and families’ preferences and needs, allowing creativity within the healthcare system, and thus improving the quality of patient care and patient safety.
Limitations of the study
The small sample size at the selected hospitals was identified as a possible limitation and the study’s findings can thus not be generalized. However, the study provided rich qualitative findings that could potentially benefit peri-operative health contexts.