Page 179 - ACCCN's Critical Care Nursing

Family and Cultural Care of
8 the Critically Ill Patient

Marion Mitchell

Denise Wilson
Vicki Wade

the psychosocial health and wellbeing of patients are
Learning objectives intimately related to their wellness and eventual illness
outcome. There is a tendency, due to the technologically
After reading this chapter, you should be able to: complex nature of nursing in critical areas, for novice
● describe models of care and evaluate how they meet nurses to focus their attention on the management of
patient needs medical treatment regimens. This is an important part
● recognise appropriate resources to enhance communication of their learning trajectory. However, nurses need to be
● develop an understanding of the needs of families and guided to see beyond the waveforms and physical para-
patients who die in the ICU meters to see the patient in the bed as an individual
● evaluate and implement appropriate strategies for working with unique needs. The previous chapter examined
specific aspects of the psychological wellbeing of the
with families from a different culture critically ill with strategies to improve patient outcomes.
● recognise and implement the needs of the critically ill and/ This chapter extends the focus to incorporate the family
or dying patient who is either an indigenous Australian or into the caring paradigm and introduces the concept of
Māori family-centred care. Nursing practices that incorporate
● develop an understanding of Indigenous spirituality as it the patient’s family into the care of the critically ill
relates to Aboriginal and Torres Strait Islander people dying acknowledge the vital part families play in the illness
or have died continuum.
● recognise the various religious considerations for patients
who are dying or who have died. The assessment, understanding and incorporation of the
patient and families’ cultural needs are essential elements
of nursing the critically ill, and involve the entire multi-
disciplinary team. These elements are important for both
the recipients of the care (the patient and family) and the
critical care nurse, as the practice of nursing all aspects of
Key words the patient’s wellbeing brings humanity into critical care
nursing. Cultural factors include social factors and human
models of care behaviours associated with emotional and spiritual
1
communication needs. In this chapter, models of nursing are examined
end of life with particular reference to the philosophy of family-
bereavement centred care, which may be an appropriate nursing model
family care for use within critical care settings. The specific needs of
continuity of care the families of critically ill patients are discussed, also the
cultural care and cultural safety implications for critical care nursing. The differing world
views on health and illness are highlighted for consider-
Indigenous Australians
ation of appropriate care. Effective communication is
crucial to meet both family members’ needs and those of
the patient. The complexity of patient communication
together with the addition of linguistically diverse patients
INTRODUCTION is outlined and suggestions for clinical practice provided.
End-of-life care is discussed in general terms and specific
Care of critically ill patients is complex and multifacto- cultural considerations are highlighted with particular
rial. Although management of the haemodynamic reference to Aboriginal and Torres Strait Islander people
parameters and healthcare interventions is an essential of Australia and New Zealand Māori patients and
156 component of effective care of the critically ill, families.