Page 181 - ACCCN's Critical Care Nursing

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development opportunities. A feature of family-centred area for further research. 35,40 Meeting the needs of families
care that makes it desirable in the critical care setting is during this stressful and demanding time has the capacity
how it strives to meet the needs of family. 21 to reduce their stress and promote positive coping
strategies.
Needs of family during critical illness
A combined healthcare team approach is needed to meet
Family members of critically ill patients contribute a the family’s needs, as differing perceptions among the
significant and ongoing involvement to patients’ well healthcare team can result in non-unified approaches
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being. Patients need and want their family members with that are potentially confusing. The needs of families with
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them and health care professionals also need their critically ill relatives are complex and multifactorial, rein-
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input. Family members’ satisfaction with the care their forcing the need for an all-of-team approach. Family
relative receives is considered a legitimate quality indi- members’ needs were recognised in Molter’s influential
cator in many areas which routinely assess family study in 1979 where she researched the specific needs of
satisfaction. 31,32 ICU patients’ family members. Although Molter’s sample
On a very practical level within a critical illness situation, was small (n = 40), 45 potential needs of family members
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family members are often the decision makers on treat- were identified and ranked in order of importance.
34,43-48
ment options due to the impaired cognitive state of the Family needs continue to be researched and can
patient. Their contribution to health care decisions is be generally grouped into the need for (a) information,
sought in both acute and ongoing care situations as they (b) reassurance, (c) closeness, (d) support, and (e)
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have insight and knowledge of the patient on an entirely comfort. More specifically, families’ needs include the
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different level to health professionals. In addition, following:
family members provide not only support in the critical ● to know their relative’s progress and prognosis
illness situation, but also continuity of care through reha- ● to have their questions answered honestly
bilitation. This responsibility together with the often ● to speak to a doctor at least once a day
sudden critical illness situation creates stress and anxiety ● to be given consistent information by staff
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for family members. A primary aim of family-centred ● to feel their relative is looked after by competent and
care is to reduce the risk of stress related reactions to caring people
the ICU experience that is often traumatic for family ● to feel confident that staff will call them at home if
members. 35 changes occur in their relative’s condition
● to be given a sense of hope
● to know about transfer plans as they are being made.
Practice tip Meeting information needs

Where appropriate, invite the family to remain by the bedside Families’ needs for information and reassurance are para-
when you might normally ask them to leave. At first it may feel mount during a critical illness, which is often unexpected
daunting, as the family member may seem to watch your every or unexplained. Seven out of the top ten needs of families
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move and action, but if you start doing this when you are are related to information needs. When information is
performing interventions with which you feel confident, provided, it is important to spend sufficient time with
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you will find that having them there seems natural. There is family members. The information has to make sense to
less fuss with family coming and going and talking about what them and it is imperative that health care professionals
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you are doing, and it promotes information sharing and check their understanding. It is not sufficient to think,
understanding. But I told them all that yesterday. Communication is a
two-way process and as such needs to be received in a
meaningful way as well as given appropriately. Repeated
and current information is suggested as it helps to reduce
family members’ anxiety. In a case study report of a
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Stress and anxiety associated with having a critically ill mother with her adult war-injured son, the mother tells
relative can hinder a family’s coping ability, adaptation, how she tried to remember things the staff told her. She
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decision making and long-term health with the possi- said, ‘I loved how my questions would be answered when
bility that post-traumatic stress disorder (PTSD) may we asked (except for the daily one about his brain
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develop in family members of ICU patients. Families damage) and how most people did not take offense at
that experience stress before the critical illness do not me writing down everything. I know that I was scared to
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cope as well, and may need additional assistance. As death most of the entire time’.
34, p. 18
many as half of family members report symptoms of
anxiety and depression, indicating it is a very real Strategies to improve communication with family
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problem. These figures are concerning particularly when members include nurse-led education sessions designed
symptoms continue beyond six months post ICU. 35,39 to identify and meet the needs of family members. Once
In addition, post-traumatic stress symptoms are also the needs have been identified, a specific program can be
reported by family members which is consistent with a developed to meet the needs. This strategy was found to
moderate to major risk of PTSD, resulting in ongoing be effective when two one-hour sessions were conducted
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health-related concerns for the family members. Early with family members who reported significantly lower
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identification and preventions strategies are an important levels of anxiety and higher levels of satisfaction. Other