Digital Repository Masters Theses Spring 2026 Family Involvement in Patient Care and Associated Health Outcomes Donna Cassidy Weber State University Follow this and additional works at: https://dc.weber.edu/collection/wsudoctoral Cassidy, D.. 2026.Family Involvement in Patient Care and Associated Health Outcomes. Weber State University Doctoral Projects. https://cdm.weber.edu/digital/collection/WSUDoctoral This Project is brought to you for free and open access by the Weber State University Archives Digital Repository. For more information, please contact archives@weber.edu. WSU REPOSITORY MSN/DNP Family Involvement in Patient Care and Associated Health Outcomes Project Title by Donna Cassidy Student’s Name A project submitted in partial fulfillment of the requirements for the degree of MASTERS OF NURSING Annie Taylor Dee School of Nursing Dumke College of Health Professions WEBER STATE UNIVERSITY 4/25/2026 Ogden, UT Date Donna Cassidy 4/16/26 Student Name, Credentials (electronic signature) Date 5/28/26 MSN Project Faculty (electronic signature) Date 6/9/25 (electronic signature) DNP, N, CNE MSN Program Director Note: The program director must submit this form and paper. Date 1 Family Involvement in Patient Care and Associated Health Outcomes Donna Cassidy Annie Taylor Dee School of Nursing Weber State University Amber Fowler MSN Project 3/29/26 2 Abstract Purposes/Aims: This project aims to involve the family in patient care through a head-to-toe assessment to improve patient health outcomes and nursing teaching skills. Rationale/Background: Family inclusion is an important aspect of patient care, though oftentimes they are excluded from care. Excluding family from patient care can compromise care quality and leave both the patient and family in the dark about updates and changes. The lack of family inclusion can be detrimental to patient care. Methods: A head-to-toe assessment was developed to provide nurses with an educational tool for families, intended to guide them through the specifics of the patient's diagnosis and potential complications. Lewin's Change Model framework is utilized to develop the project. The project involved researching interventions for including family in patient care. The intervention selected was a head-to-toe assessment tailored to each patient and family. Results: Three themes were identified regarding family involvement. 1) Significance of family exclusion from patient care, 2) the effects of family involvement regarding patient care, and 3) family inclusion teaching methods and teach-back approaches. A pre- and post-knowledge survey was provided to assess patients' understanding of nurse teaching, and nurses were instructed to use the teach-back method to ensure teaching was understood. Conclusions: By involving families in patient care, patient health will improve by reducing missed care, readmissions, and lengths of stay. Nursing skills will also be developed, including greater compassion. Family involvement has additionally been known to reduce stress among patients. Keywords: Family inclusion, family exclusion, effects of family involvement, and family interventions 3 Family Involvement in Patient Care and Associated Health Outcomes Families play a crucial role in care in all aspects of nursing. However, this importance is not acknowledged. According to Smith et al. (2022), healthcare professionals often prioritize their jobs, neglecting family inclusion. Not only does this decrease trust in healthcare professionals, but it can also have a detrimental impact on patient health (Gwaza & Msiska, 2022). To improve family involvement in patient care, a policy will be implemented that encourages health professionals to slow down, facilitates open questions, and supports active participation. Family involvement can improve patient outcomes in many ways. In Krewulak et al.'s (2020) study, they found that educating family members about the signs and symptoms of delirium increased the rate at which delirium was detected early. Catching delirium early allows for early treatment and reduced adverse outcomes. Another study, conducted by Bloemberg et al. (2025), found that patient outcomes were improved, with decreased readmission rates and complications. These studies emphasize the importance of family involvement in patient outcomes. The proposed implementation policy is to provide comprehensive education for families, including head-to-toe assessments, required post-surgical teaching, and a teach-back method to ensure family understanding. The head-to-toe method may be applied to surgical patients by teaching the family all specifics related to the specific surgery or condition, from head to toe (if applicable). The specifics include any conditions or treatments involved in the patient's admitting diagnosis. The head-to-toe method means that everything related to the surgery will be thoroughly thought out and taught in its entirety. The purpose of this intervention is to increase family involvement in patient care and improve the family's confidence in their involvement. 4 The hoped-for outcome is an improvement in patient condition and a decrease in stress for both the family and the patient (Smith et al., 2022). The care team will maintain the intervention by adding an admission charting assessment that requires the nurse to answer specific questions regarding education and family participation that have been completed in the patient's chart. Statement of Problem Families have become more neglected as healthcare has become more standardized and managed. This neglect of families includes being excluded from education and patient care (Ghosh et al., 2025). Family deterioration in patient care can be evidenced by nurses' frustration with family members and their frequent exclusion from care. Family involvement in patient care enhances patients' recovery and provides psychological and emotional support (Liu et al., 2025). Without family involvement, stress disorders are increased (Dijkstra et al., 2023). Additionally, Bloemberg et al. (2025) found that cardiac patients without family involvement were 11.4 times more likely to experience readmission; however, family involvement reduced length of stay. The intended outcome of this project is to increase family involvement and improve patient health, as measured by the number of nurses implementing the change and by evaluating the difference in family understanding before and after education and the teach-back process. Nurses will achieve this outcome by implementing comprehensive education policies and utilizing teach-back methods. Head-to-toe education for families will help increase family understanding and involvement, and teach-back methods will encourage family participation and questions in patient care (Smith et al., 2022). Significance of the Project This project is significant because a lack of family care can negatively impact a patient's health. Even if the nurses are caring professionals, they have a lot on their minds and may more 5 often miss or overlook aspects of a patient's care (Gwaza & Msiska, 2022). However, family members can ensure that the patient receives the care they need (Gwaza & Msiska, 2022). The presence of family has also been known to improve the patient's condition (Liu et al., 2025). Improving patient conditions involves providing comfort and reducing stress (Liu et al., 2025). An increase in the amount of stress patients experience can interrupt and slow recovery, underscoring the importance of family involvement. Families can offer comfort in ways that no professional caregiver can. Another reason family involvement is important is that it allows family members to catch changes in condition quickly. Krewulak et al. (2020) conducted a study in which family members educated on delirium significantly increased the rate of early detection and prevention. A lack of family involvement can lead to increased patient stays and a decline in their health (Bloemberg et al., 2025). However, family involvement could lead to earlier detection and higher-quality care. Review of the Literature This literature review aims to explore current literature on interventions to promote family involvement and the necessity of family involvement in patient care. Family involvement in patient care has been found to improve patients' conditions and reduce readmission rates (Bloemberg et al., 2025). Providers and nurses may exclude family from care, and family may remain uninformed about their role in the healthcare team (Ghosh et al., 2025). Family involvement can be enhanced by standardized head-to-toe teaching from nurses and the utilization of the teach-back method (Smith et al., 2022). Family inclusion in patient care has historically been minimal. This lack of involvement has been reflected in families' different preferences for how they would like to be involved, as 6 little effort has been made to ensure that those who would like to be involved are (Liu et al., 2025). Additionally, nurses' perspectives indicate hesitancy to incorporate family into patient care due to policies that prohibit or hinder family involvement (Shibily et al., 2021). Framework The framework for this project is Lewin's Change Management Model. This model is suitable for the project because it enables analyzing and researching the problem, discovering and implementing solutions, and maintaining that solution as a standard of care to prevent regression, a process referred to by Lewin as unfreezing, moving, and freezing (Endrejat & Burnes, 2022). This framework also facilitates the participation and unification of other team members, as it rallies their support for the change (Kump, 2023). The first step in Lewin's Model is unfreezing (Endrejat & Burnes, 2022). Unfreezing refers to the process of improving family involvement in patient care by allowing time to conduct research and develop solutions. The research for this project focuses on the head-to-toe and teach-back methods. The next step in Lewin's Model is moving (Endrejat & Burnes, 2022). To enact moving, this project aims to implement policies based on the proposed solution. These policies involve creating an assessment form in the chart to be completed on every shift, with families involved. The last step in Lewin's Model is freezing (Endrejat & Burnes, 2022). Freezing is implemented in this project by evaluating results and creating a policy based on assessments and educational materials, ensuring that families are considered in patient care. The solution will also require the nurses' willingness and participation. Getting nurses involved in family involvement will require teaching them the head-to-toe assessment and ensuring they know how to gather information for different patient diagnoses. Additionally, the nurses will 7 need to know the benefits of implementing these family involvement changes. Implementing the head-to-toe policies will help sustain the change and prevent regression. Strengths and Limitations The strengths of the proposed framework include the unity it requires to effect change and its encouragement of deeper thinking (Endrejat & Burnes, 2022). To effect change, people must collectively acknowledge the issue and recognize the need for change, which can bring them closer together. Additionally, Lewin encouraged extraordinary thinking (Endrejat & Burnes, 2022). This way of thinking enables new solutions to be proposed that might otherwise have remained undiscovered. Some limitations to the model suggest that peer-pressure reactions may be more prevalent than unity in response to the proposed changes (Kump, 2023). A change driven by peer pressure or intimidation will not foster a healthy change and may create more resentment toward the person proposing the change, as well as resistance to it. Giving team members more voice and choice in the change process may help decrease this resentment (Kump, 2023). These strengths and limitations apply to this project, allowing nurses to work together not only with each other but also to involve families in the change process. However, some families may not be willing to participate, and forcing the change on them should not be encouraged. Search Strategies A literature search was conducted to identify current evidence using Weber State University's Stewart Library's OneSearch. Only articles dated from 2020 to 2025 were included to ensure the information remains current. The search included the keywords teaching methods, family-centered care, family involvement, family inclusion, effects of family involvement, and 8 family interventions in patient care. Various Boolean combinations were created with the keywords for a broader search. Synthesis of the Literature Three themes were identified in the literature: a) exclusion of family members from patient care, b) family involvement improving patient condition, and c) nurses' teaching with teach-back methods improving family involvement. These themes support the project of incorporating family into patient care by examining the risks and benefits of involvement, as well as opportunities for improvement. Family Exclusion from Patient Care Family has historically been excluded from patient care for the following reasons: facility/hospital policies, nurses' perceptions, family discomfort with involvement, family being unaware of their right to be involved, and patient preference (Ghosh et al., 2025; Gwaza & Msiska, 2022; Liu et al., 2025; Shibily et al., 2021). Facility and hospital policies are problematic when they hinder family involvement in patient care and necessitate changes to implement effective family engagement (Shibily et al., 2021). These hospital policies are primarily due to a greater focus on patient volume rather than quality (Conway et al., 2023). Unfortunately, this often means families are left out of the picture. These policies are also problematic in shaping nurses' perspectives on patient care, leading to a more negative view of family involvement (Shibily et al., 2021). There is also the perspective that some families are uncomfortable with involvement, and that some patients may not want family involved (Liu et al., 2025). This case is not critical to the project, as patients and their families should not be forced to participate. However, one of the more alarming barriers is that families often do not know they have the right to participate and 9 are left out of care due to high nursing demands (Ghosh et al., 2025). This deterrent to participation is harmful, more stressful for patients and their families, and is caused by nurses monopolizing conversations and failing to encourage questions (Ghosh et al., 2025). A policy change, along with a shift in perspective, may help nurses become more open to family involvement. Effects of Family Involvement Family involvement has had many beneficial effects on patient health outcomes. This involvement includes identifying complications early, reducing readmissions, minimizing safety incidents, and ensuring that all necessary care has been provided (Bloemberg et al., 2025; Ghosh et al., 2025; Gwaza & Msiska, 2022; Krewulak et al., 2020). Bloemberg et al. (2025) found that family involvement is associated with improved health outcomes, including reduced lengths of stay and readmissions. Family involvement has also been shown to reduce patient distress (Bloemberg et al., 2025; Gwaza & Msiska, 2022). Krewulak et al. (2020) found that educating families about certain complications, specifically delirium, was beneficial for early detection and rapid treatment. Similarly, families have been essential in identifying and providing care that nurses may miss due to increased workload (Gwaza & Msiska, 2022). Unfortunately, some of these tasks may not be the safest for them to perform because they have not been taught adequately by the nurse (Gwaza & Msiska, 2022). Family involvement has thus been shown to be highly beneficial for patients. Teaching Methods and Teach-Back Teaching methods play a crucial role in enhancing family involvement in patient care. One such approach is to implement a head-to-toe method, which guides the family through all aspects of the patient's condition that may be necessary or complicating (Smith et al., 2022). 10 Kirkland-Kyhn et al. (2022) walk through key components of this method for teaching families about wound care. The educational piece walks through wound care and the specific complications that can arise, such as systemic infection and the risk of wound-healing issues in diabetic patients (Kirkland-Kyhn et al., 2022). Another method mentioned was to assess what the family already knows about the condition, provide education on the condition, and then reassess their knowledge (Krewulak et al., 2020). This educational method was crucial in teaching families to recognize potential complications and in allowing an assessment of areas where they may have needed greater understanding. One of the most effective teaching methods is the teach-back approach, which involves teaching the material to the family and having them repeat their understanding back to evaluate their comprehension (Smith et al., 2022). Many families want to be involved in their patient's care; however, they often do not know how or what to do, and healthcare personnel are not receptive to questions or family involvement (Dijkstra et al., 2023; Ghosh et al., 2025; Gwaza & Msiska, 2022). These interventions will help make patient care more inclusive of families. Summary of Literature Review Findings and Application to the Project Family involvement is essential to reducing patient and family stress and improving patient health outcomes (Bloemberg et al., 2025; Ghosh et al., 2025; Gwaza & Msiska, 2022; Krewulak et al., 2020). Family has hitherto been viewed as just another task for staff to manage, rather than as part of the healthcare team (Conway et al., 2023; Shibily et al., 2021). This attitude depersonalizes patient care and fails to consider the patient's or family's needs. Additionally, effective teaching methods utilize assessments, teach-back, and thorough explanations; these are essential to improving family involvement (Krewulak et al., 2020; Smith et al., 2022). These 11 themes contribute to the proposed solution by examining the problem, highlighting the benefits of resolving it, and exploring potential methods to address it. Project Plan and Implementation The plan for this project is to educate nurses on the importance of family inclusion (including its benefits and the effects of its absence), train nurses in patient-family head-to-toe assessment, and implement an EHR charting section that documents family education and involvement in patient care. Approval of the education provided by the nurse from the patient or the patient's power of attorney (POA) is essential to ensure proper confidentiality and safety. There will be a consent form for the patient or the patient's POA to determine desirability for family involvement, which can be added to the admit paperwork. Utilizing the teach-back method to ensure family understanding of patient care and documentation into the EHR aims to promote family inclusion and understanding. Plan and Implementation Process The plan will begin by educating nurses on the importance of family inclusion in patient care. The education includes both the adverse events that can result from a lack of family involvement and the benefits of family involvement. Informing nurses about the importance of family involvement is crucial to the implementation process, as it unites nurses around a common purpose and helps them understand why family involvement is essential for patient care (Kump, 2023). Without this knowledge, the rest of the implementation may be treated lightly by the nursing staff. The next step is to train the nurses in the head-to-toe assessment and teach-back methods. These methods will be more challenging, as nurses will be dealing with a diverse range of patients with various conditions. To mitigate this challenge, research should be conducted on the 12 most common ailments among the demographic, and the findings should be taught to nurses. In this project, a hip surgery was selected. For rarer or uncommon ailments, doctors may be contacted for input on the education materials. Once the nurses have received training and education on the teaching materials, they can be organized for specific conditions, such as hip surgery. The teaching materials will include all body systems affected by hip surgery in paper form (Smith et al., 2022). Paper copies will provide the family and the patient with information on what to do and what to look out for regarding potential complications. Interdisciplinary Team To make this project effective, a variety of people will need to contribute to its implementation. Interdisciplinary teamwork is necessary to create a safe plan of care for patients and to ensure as much understanding as possible among nurses and families. The interdisciplinary team will include nurses and doctors. Nursing Management. Nursing management will be responsible for educating nurses about patients' conditions and ailments. They will have more experience and expectations of what is commonly seen in a rehabilitation setting, and will be aware of the most common complications to watch for. Management approval is also important for advancing the project. Nurses. Nurses will teach the family the head-to-toe assessment and implement the teach-back method to evaluate their understanding. They are responsible for providing quality education to the patient and family, documenting the completion of the task, and documenting what was taught. It is also important to ensure they understand the material and stay up to date with their education. Nurses are also responsible for answering family members' questions and concerns. 13 Doctors. Doctors are an integral part of planning and developing training for nurses and education for families. Doctors are especially important for consulting on conditions or ailments that are not commonly seen in a rehabilitation setting. Their inclusion provides deeper insight into patients' care, potential complications, and the care team's wisdom. They are not responsible for putting together the education materials, but rather for consultation on them. Description and Development of Project Deliverables Pre- and post-knowledge survey. The first deliverable for family inclusion is a pre- and post-knowledge survey to evaluate family understanding. The surveys are essential for evaluating the project's effectiveness because they assess whether the patient's family understood the nurses' teaching and whether it is necessary to revise teaching methods to enhance understanding. The pre-survey also provides the nurse with a sense of the family's baseline knowledge. The test consists of 8 questions for both pre- and post-surveys. The pre- and postknowledge survey method was used in the study by Krewulak et al. (2020) and was effective in improving family knowledge and detecting delirium early (See Appendix A). Flyer. The following deliverable includes a flyer. The purpose of this deliverable is to exemplify the benefits of implementing family inclusion in patient care delivery. The flyer is vital for fostering group unity and a common end goal (Kump, 2023). A flyer sets expectations and a standard to achieve and is responsible for the initial motivation to see the project through (See Appendix B). Head-to-toe assessment. The head-to-toe assessment deliverable focuses on one of the most common diagnoses in rehab: hip surgery. The head-to-toe assessment provides nurses with the education materials necessary to educate family members on hip surgery care and possible 14 complications. The assessment additionally includes preventive care regarding complications (See Appendix C). EHR charting. The last deliverable includes organized EHR charting for documentation. The required documentation helps maintain family involvement and serves as a reminder for family inclusion. The EHR charting includes three sections that need to be addressed: family/patient consent to be involved, details of the education provided, and how the nurse assessed the family's understanding of the education (See Appendix D). Timeline The proposed timeline for this project is one month. The first two weeks of the proposed timeline will be spent on training and education for the nurses and bringing everyone together towards the goal. The benefits of implementation will also be emphasized during this time period. The following two weeks will be spent on implementing and teaching families. Towards the end of the last week, the project will be evaluated for its effectiveness (See Appendix E). The project plans to educate and train nurses on implementing head-to-toe assessments and teachback methods to enhance family involvement in patient care. The plan will also incorporate a policy change and an updated section to the EHR to ensure proper charting. Project Evaluation Formative evaluation occurs as the nurses implement the teach-back method with the family, in which the family teaches back what they have just learned. This method of formative evaluation ensures the family's understanding and the effectiveness of the nurse's teaching. Chen et al. (2024) conducted a similar formative evaluation, facilitating better immediate communication with patients and their families. 15 Summative evaluation occurs when the pre- and post-knowledge surveys are completed to evaluate family understanding. The steps taken to ensure the survey is a reliable method of evaluation are through research on common surgical complications and education from Kirkland-Kyhn et al. (2022). This summative evaluation method is similar to that of Krewulak et al. (2020), who used a post-test to assess the family's retained knowledge after education. These methods of evaluation will determine the effectiveness of the head-to-toe assessment and the effects on family involvement. Ethical Considerations Family members who are not comfortable participating in the patient's care ought not to be required to do so. The right to refuse is part of the American Nurses Association (ANA) Code of Ethics (Haddad & Geiger, 2023). Similarly, patients who are not comfortable with family involvement should not be required to allow family members to participate in their care, as this also involves the right to refuse (Haddad & Geiger, 2023). The family or the patient can sign a declination form refusing education and teaching, and it is charted in the family involvement section of the EHR. No one will be excluded from participation in the project, except by their own declination, patient refusal, or by law (e.g., due to family being a safety issue for the patient, such as abuse). Patient and family privacy will be maintained by not discussing the education and teaching provided to those outside the care team and by documenting in a secure EHR. A secure EHR includes encryption and passcodes to ensure that information is accessed only by authorized users (Office for Civil Rights, n.d.). Family involvement may be different for each individual, and it is important to consider patient and family preferences in each circumstance. 16 Instances of bias may be present in nurses' self-reporting of teaching patients' families, particularly if the nurse is in a rush or does not value family inclusion (Havaei & MacPhee, 2020). Not respecting patient and family involvement in care can constitute disrespect for patient rights and dignity (Papinaho et al., 2021). Failing to inform patients or family about changes in care or conditions constitutes a violation of patients’ rights. Discussion The following sections will discuss dissemination methods for evidence-based solutions, the project's significance in advancing nursing practice, the implications of the results, and recommendations for moving forward. Dissemination includes describing what will be disseminated and why it is important. The significance of the project in advancing nursing practices will be described in terms of its improvement in family involvement. The implications section will discuss the project's strengths and weaknesses, and the recommendations section will examine the next steps. Evidence-Based Solutions for Dissemination This project will be disseminated as a poster. The poster will include how family involvement in patient care reduces hospital readmissions and lengths of stay, educates families on prevention techniques, and highlights the significance of the head-to-toe assessment and its implementation (Bloemberg et al., 2025; Krewulak et al., 2020; Smith et al., 2022). The poster will also include the timeline, flyer, education piece, and knowledge survey. The poster will highlight the importance of including family and aim to improve their involvement. Dissemination can impact unity and support for the project (Kump, 2023). Dissemination to those not directly involved in the project is important because it builds unity and advocacy for the change. It gains support and can provide different perspectives and ideas that can help 17 improve the project. Because they come from different backgrounds and skill sets, they can offer more focused perspectives on certain aspects of the project. Significance to the Advancement of Nursing Practice This project improves family involvement by increasing family knowledge and awareness of patient care. It will demonstrate how adding head-to-toe teaching will improve patient health and well-being (Smith et al., 2022). The addition to the literature will further support that family involvement in patient care is a necessary component of healthcare and encourage further practices that are family-inclusive. Family involvement benefits the nursing profession in several ways. One way this is achieved is by reducing the heavy workload on nurses (Gwaza & Msiska, 2022). In turn, this gives nurses a less rushed sense and helps prevent mistakes. Additionally, when nurses involve family in patient care, this has been shown to improve nurses' compassion (Anthonysamy et al., 2025). Compassion is one of the most critical parts of nursing. Compassion is associated with improved patient outcomes, and nursing staff's lack of compassion negatively affects patients and their families (Manookian et al., 2025). Since family involvement is connected to increased compassion, it further supports the advancement of nursing practice by improving patient care. Implications A strength of this proposed project is that it lays a foundation for including family in patient care. While it is a start toward improving family inpatient care, there is still much more to be done to increase family involvement. One possibility is to have an educator specifically for teaching families and addressing their concerns, given that nursing staff are low and often lack time (Havaei & MacPhee, 2020). An educator’s specialty may also help nurses in this area by 18 increasing the time they have to care for patients and keep patients more up-to-date on the care plan and the patient’s condition. Recommendations While this project formulates a structure that allows for family involvement, the environment will still need to be changed to improve nursing perceptions of family involvement. Hawkins & Morse (2022) state that the expectation can be present without the means to attain that standard. The recommendation for moving forward is to ensure that nurses have the means to involve families compassionately in patient care. Whether that is increasing staffing or providing the necessary materials, the means must be provided to meet expectations. Additionally, the project can expand to more diagnoses in patient care to increase the range of family involvement. To achieve this, the rehabilitation facility's accepted patients can be reviewed for diagnoses, and additional head-to-toe assessments may be created (Smith et al., 2022). The facility may also examine readmission rates of discharged patients to the ER and determine whether these rates have decreased to assess project success (Bloemberg et al., 2025). Seeing improvements in patient health and care may encourage the project to continue and incorporate facility feedback. Conclusions Family involvement is crucial to patient care. Without family involvement, patients have been known to experience more extended hospital stays, readmissions, missed care, and increased stress (Bloemberg et al., 2025; Ghosh et al., 2025; Gwaza & Msiska, 2022). The headto-toe assessment involves evaluating the entire patient, including diagnosis and potential complications (Smith et al., 2022). The diagnosis and potential complications are then taught to the family to include them in patient care. Teaching is done to improve patient outcomes and 19 family knowledge of patient care, thus improving their involvement. Family involvement in patient care can enhance nursing compassion and further improve patient care, leading to better health outcomes (Anthonysamy et al., 2025; Manookian et al., 2025). In the future, resources may be allocated to better meet expectations for including family (Hawkins & Morse, 2022). Overall, the project will help nurses increase family involvement among patients residing in a rehabilitation facility. 20 References Anthonysamy, C., Vasudevan, V. M. K., Rajendran, S. S., Anbalagan, M., Lakshmanan, J., Narayanasamy, M., Azhagirisamy, S. (2025). Enhancing emotional care: The power of nurse-led interventions in cultivating compassion and family engagement in mental health caregiving in India. Bioinformation, 21(8), 2737–2739. https://doi.org/10.6026/973206300212737 Barbanti-Brodano, G., Griffoni, C., Halme, J., Guisuppe, Tedesco, G., Terzi, S., Bandiera, S., Ghermandi, R., Evangeslisti, G., Girolami, M., Pipola, V., Gasbarrini, A., Falavinga, A. (2020). Spinal surgery complications: an unsolved problem—Is the World Health Organization Safety Surgical Checklist an useful tool to reduce them? European Spine Journal, 29(5), 927-936. https://doi.org/10.1007/s00586-019-06203-x Bloemberg, D., van Zuylen, M. L., Musters, S. C. W., de Jong, D., Schreuder, A. M., Jamaludin, F. S., Preckel, B., van Dijkum, E. N., Eskes, A. M. (2025). Is the active involvement of family caregivers in adult hospital care effective to improve patient outcomes? A systematic review. Journal of Clinical Nursing. https://doi.org/10.1111/jocn.70059 Chen, Z. , Guo, Q. , Geng, H. , Xi, L. , Lin, J. Chochinov, H. (2024). Development and formative evaluation of the family-based dignity therapy protocol for palliative cancer patients and their families. Cancer Nursing, 47(3), 180-188. 10.1097/NCC.0000000000001174. Conway, S. J., Kuye, I. O., Yeatts, J., Jaffery, J., Berkowitz, S. A. (2023). Transforming health care from volume to value: Moving the needle through population health. The American Journal of Medicine, 136(9), 874-877. 10.1016/j.amjmed.2023.04.031 Dijkstra, B. M., Felten-Barenstz, K. M., Van der Valk., M. J. M., Pelgrim, T., Van der Hoeven, H. G., Schoonhoven, L., Ebben, R. H. A., Vloet, L. C. M. (2023). Family participation in 21 essential care activities: Needs, perceptions, preferences, and capacities of intensive care unit patients, relatives, and healthcare providers—and integrative review. Australian Critical Care, 36(3), 401-419. https://doi.org/10.1016/j.aucc.2022.02.003 Endrejat, P. C., Burnes, B. (2022). Draw it, check it, change it: Reviving Lewin’s topology to facilitate organizational change theory and practice. The Journal of Applied Behavioral Science, 60(1). https://doi-org.hal.weber.edu/10.1177/002188632211228 Ghosh, M., O'Connell, B., Nguyen, H. T., Coventry, L., Towell-Barnard, A., Gallagher, O., Gullick, K., Gent, L., Saunders, R. (2025). Patient and family involvement in nursing bedside handover: A qualitative descriptive study of consumer perceptions of nursing care. Nursing Reports, 15(2), 51. https://doi.org/10.3390/nursrep15020051 Gwaza, E., Msiska, G. (2022). Family involvement in caring for inpatients in acute care hospital settings: A systematic review of literature. SAGE Open Nursing, 8, 23779608221089541. https://doi.org/10.1177/23779608221089541 Haddad, L. M., Geiger, R. A. (2023). Nursing ethical considerations. StatPearls. Havaei, F., MacPhee, M. (2020). The impact of heavy nurse workload and patient/family complaints on workplace violence: An application of human factors framework. Nursing open, 7(3), 731–741. https://doi.org/10.1002/nop2.444 Hawkins, S. F., Morse, J. M. (2022). Untenable expectations: Nurses' work in the context of medication administration, error, and the organization. Global Qualitative Nursing Research, 9, 23333936221131779. https://doi.org/10.1177/23333936221131779 Kump, B. (2023). Lewin’s field theory as a lens for understanding incumbent actors’ agency in sustainability transitions. Environmental Innovation and Societal Transitions, 46, 100683. https://doi-org.hal.weber.edu/10.1016/j.eist.2022.11.008 22 Krewulak, K.D., Bull, M.J., Wesley E. E., Davidson, J. E., Stelfox, H.T., Fiest, K. M. (2020). Effectiveness of an intensive care unit family education intervention on delirium knowledge: A pre-test post-test quasi-experimental study. Canadian Journal of Anaesthesia, 67(12), 1761-1774. https://doi.org/10.1007/s12630-020-01810-5 Kirkland-Kyhn, H., Generao, S. A., Teleten, O., Young, H. (2022). Teaching wound care to family caregivers: An overview of methods to use to promote wound healing. Home Healthcare Now. Liu, S., Yang, X., Xie, W., Huang, S., Xiao, W., Deng, Y., Zhang, C. (2025). Identifying family experiences and perspectives on involvement in care of adult ICU patients under familycentered care: A systematic review of qualitative studies. Intensive and Critical Care Nursing, 90, 104059. https://doi.org/10.1016/j.iccn.2025.104059 Manookian, A., Palese, A., Chiappinotto, S., Dashti, S., Shahmari, M., Poorceraghi, H. (2025). Understanding the ethics of compassion in nursing: A qualitative exploration. Nursing Forum. https://doi.org/10.1155/nuf/9241724 Office for Civil Rights (n.d.) Privacy, security, and electronic health records. https://www.hhs.gov/sites/default/files/ocr/privacy/hipaa/understanding/consumers/privac y-security-electronic-records.pdf Papinaho, O., Häggman-Laitila, A., Kangasniemi, M. (2021). Unprofessional conduct by nurses: A document analysis of disciplinary decisions. Nursing Ethics, 29(1), 131–144. https://doi.org/10.1177/09697330211015289 Shibily, F. M., Aljohani, N. S., Aljefri, Y. M., Almutairi, A. S., Almutairi, W. Z., Alhallafi, M. A., Alsharif, F., Almutairi, W., Badr, H. (2021). The perceptions of nurses and nursing 23 students regarding family involvement in the care of hospitalized adult patients. Nursing Reports. 11(1), 133–142. https://doi.org/10.3390/nursrep11010013 Smith, T. S., de Oca, M. A. M., James, L. K., Loehr, A. B. (2022). Standardized postoperative cardiac surgery educational process: Improving family-centered care. Pediatric Nursing, 48(4), 187+. https://link-galecom.hal.weber.edu/apps/doc/A718115599/ITOF?u=ogde72764&sid=summon&xid=c956 71f7 Summit Orthopedics (2025). Common complications after hip surgery and how to avoid them. https://www.summitortho.net/blog/archive/2025/04/28/common-complications-after-hipsurgery-and-how-to-avoid-them/ 24 Appendix A Pre and Post-Surveys Pre-survey 1. What are some complications that can come from reduced mobility (Kirkland-Kyhn et al., 2022)? 2. True or false: Using antiseptics on surgical wounds prevents infection and promotes healing, and needs no instruction from the health care provider (Kirkland-Kyhn et al., 2022). 3. What are 2 signs and symptoms of infection (Kirkland-Kyhn et al., 2022)? Post-survey 1. What are some complications that can come from reduced mobility (Kirkland-Kyhn et al., 2022)? 2. True or false: Using antiseptics on surgical wounds prevents infection and promotes healing, and needs no instruction from the health care provider (Kirkland-Kyhn et al., 2022). 3. What are 2 signs and symptoms of infection (Kirkland-Kyhn et al., 2022)? 25 References Kirkland-Kyhn, H., Generao, S. A., Teleten, O., Young, H. (2022). Teaching wound care to family caregivers: An overview of methods to use to promote wound healing. Home Healthcare Now. https://1drv.ms/w/c/80b7ad0dd70dbd5e/IQDxfO6N8IEMQLBA9KXRgW71AfKdpWbiffZX9er s4N2Gaow 26 Appendix B Unit Flyer/Infographic https://new.express.adobe.com/id/urn:aaid:sc:US:75bca8b7-c371-5501-a8e9c71f875c354e?invite=true&accept=true&promoid=Z2G1FQKR&mv=other 27 Appendix C Head-to-Toe Assessment https://new.express.adobe.com/id/urn:aaid:sc:US:5ca9eaae-9ca5-44ba-b7c278dbd8b56bfb?invite=true&accept=true%3Fpreload%3Dsharesheet&promoid=Z2G1FQKR&m v=other 28 Appendix D EHR Charting System https://new.express.adobe.com/id/urn:aaid:sc:US:7254ae1e-86ca-4ffb-a52cfbdc44c0f55d?invite=true&accept=true&promoid=Z2G1FQKR&mv=other 29 Appendix E Timeline Begin educating patient families using the headto-toe assessment and teach-back method. Introduce the plan to the staff. Create onboarding and training of staff for implementation. Create educational handouts for teaching patient families and add a charting section to the EHR Evaluate project effectiveness.