Page 182 - ACCCN's Critical Care Nursing

Family and Cultural Care of the Critically Ill Patient 159

units may choose to have a designated critical care nursing Family-friendly policies with few restrictions that centre
position in their unit which focused on family advocacy on genuine patient care issues require the support of criti-
within a family-centred care philosophy. 51 cal care nurses and medical officers for them to work
58
effectively. Flexible visiting policies have been found to
Multidisciplinary patient rounds that meaningfully
include the family show an inclusive and open com- improve quality indicators with higher patient and family
59
munication process that values all contributors as they satisfaction levels and fewer formal complaints. Restric-
34
make an individual plan of care for the patient. Alter- tive visiting policies limit families’ access to their
natively, consider routine family meetings with the relatives and restrict their involvement. Family members
healthcare team aimed at improving communication and are different from other visitors in critical care areas
understanding. 46,47 Frequently, family meetings are called because of their intimate relationship, which helps to
60-62
when the family is needed to make critical decisions form crucial components of the patient’s identity.
about the ongoing care of their relative rather than as a Remember that there are often different meanings or
proactive and positive strategy that allows for patient and interpretations of ‘family’, with it often meaning’s more
family preferences to be integrated into patient care. 47 than just the immediate nuclear family (e.g. the Māori
whānau [extended family]). Negotiation of visiting pro-
It is suggested that a family conference with the inter- cesses that take into account these cultural understand-
disciplinary team should be organised in a staged and ings is imperative.
planned manner with the first occurring within the first There is a genuine concern by some parents or carers
48 hours of admission; the second after three days, and that children should not visit family members who are
a third when there is a significant change in treatment critically ill as they may find the ICU environment and
49
goals. Fundamental topics for the interdisciplinary visit traumatic. This, however, is not the case when chil-
meetings with the family could include the patient’s dren are appropriately supported in visiting a critically
condition and prognosis together with short- and long- ill close family member; they are more likely to be not
31
term treatment goals. Family conferences provide time frightened but rather curious of their surroundings.
28
for discussion amongst the family with the health care Children may have questions and it is recommended that
team as a resource and also for the team to make an they be prepared well with adequate information before,
assessment of the family’s understanding of the situation. during and after their time with their relative in the criti-
In addition, it provides an opportunity to develop cal care area.
an awareness of specific family needs which the team can
31
endeavour to meet. Unhurried family conferencing Patients, however, may want visiting restricted as some
13
allows for opportunities for families to pose questions patients find them stressful or tiring. Contrary to popular
and longer family conferences can result in families belief, unrestricted visiting hours is not associated with
feeling greater support and significantly reduced long visits. In two separate European studies where unre-
53
PTSD symptoms. Although family conferencing has stricted visiting hours were introduced, the number of
been found beneficial, it is advocated that multiple hours family members spent with the patient was low.
modes of communication and information sharing are They stayed for one to two hours per day and usually
required. Leaflets and brochures that have either indi- came during the day. This suggests that when family
vidualised or set information are also helpful. 31,52,53 members have free access to their sick relative they do
not perceive a sense of duty to be there all day and
To promote communication, nurses can discuss with the 63,64
family whether they would like a phone call at night night.
updating them on their relative’s condition. Alternatively, Barriers that restrict family presence require attention as
29
nurses can give them a time to phone before change family attendance is beneficial to the patient and a
36
of shift. This will help to allay their anxiety and promotes primary need for family members. Although some criti-
positive communication and trust. When patients are cal care staff indicate feeling performance anxiety with
transferred from critical care, families and patients may the family present during procedures 29,65 or with extended
13
become anxious or concerned by the reduced level of care family visits, many nurses are comfortable providing
66
in the new ward area. This can be alleviated by providing care with the family present. Staff who do not feel com-
families with verbal and individualised written transfer fortable with this methodology require support and
information as a means to help prepare them for mentoring to facilitate this fundamental aspect of family-
54
transfer. In addition, a structured transferring plan helps centred care.
critical care nurses feel better equipped to ensure they Participating in patient care is one way for family
give families the information they need at this important members to feel closer to their critically ill family
time of transfer. 55
member 57,67,68 and at the same time promote family integ-
67
rity. Most family members, however, will not ask if
Visiting practices they can help with care as this is seen as the nurses’
38
One of the primary needs of families is listed as a need domain in adult critical care areas. 69,70 Nurses therefore
to be physically close to their sick relative. Patient confi- should invite family members to be part of the patient’s
dentiality and privacy remain central and need to be care, with massaging and providing a sponge being
56
balanced with family presence. Patients find that family popular activities. 24,69,70 Providing care allows the family
provides a link with their pre-illness self and provide members to feel connected emotionally with their
support and comfort. 57 relative and provides a means to get to know and