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160 P R I N C I P L E S A N D P R A C T I C E O F C R I T I C A L C A R E

TABLE 8.1 Family participation in patient care

Principle Procedure
Consent Gain patient consent beforehand where possible.
Building of trust Introduce the concept of family members’ involvement in care after a period during which a
rapport is developed.
Individualise for patient and family Offer suitable options from which family members can choose: for example massaging feet and
hands, cleaning teeth and feeding may be appropriate options for short-term patients, whereas
additional options may exist for long-term patients.
Safety The registered nurse should remain physically close by at all times.
Promote achievement of goals Provide sufficient information to the family member to support successful completion of the care.
Reflect on outcomes Provide feedback to family members on how they performed the task.
Continuity of care Document the care the family members participated in and any relevant information.

communicate with the nurses which families consider unconscious patients can hear and recall some verbal
important. Family members appreciate invitations from communication once they regain consciousness. 81,82
nurses as this allows them to feel more in control in Meeting information needs builds trust between the
24
a situation where family members do not often experi- nurse and patient and their family as a relationship devel-
ence this. 71,72 ops. The nurse’s understanding of the person behind
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For family participation to work effectively and safely, the patient is important to families, and can be achieved
a number of guiding principles should be incorporated, by talking to the family about the patient’s life before the
as outlined in Table 8.1. It is useful for critical care nurses illness. 83
to explore their beliefs and practices concerning family Good communication is a prime patient need and
participation, as many support family participation inspires patient confidence, making patients feel safe.
84
but do not always implement these beliefs in their When nurses reassure patients they provide a sense of
practice. 73 hope and a feeling of safety, which is further supported
by family members’ presence and the patients’ religious
COMMUNICATION beliefs. 77,84 Constructive strategies should be identified
The ability to communicate effectively is an underlying to overcome difficulties with patient communication.
tenet of nursing practice and a fundamental need for This is worthwhile pursuing as it reduces both nurse
75
people. As mentioned previously in the context of caring and patient frustration and improves nursing care. The
for family members, for communication to occur, there following methods of communication may be used
needs to be a two-way passage of ideas or information. individually or together to enhance communication,
In the patient context the inability to communicate and should be readily employed in critical care
causes, or adds to, anxiety, frustration and stress 74-76 as settings: 74,85
77
they lose control over their life and decisions. It is ● body language
therefore imperative for health care professionals to find ● lip reading
ways to communicate with patients. Critically ill patients ● writing
commonly have communication difficulties due to either ● alphabet boards
74
mechanical devices (e.g. endotracheal tubes), cognitive ● communication boards
impairment from the disease and/or pharmacological ● pictures
78
medications or language difficulties. Therefore, effec- ● gestures, including nodding and blinking of the eyes.
tive communication is challenging, and nurses need
additional knowledge and understanding of these Although electronic voice output communication aids
complex situations to meet medicolegal obligations and are used with disabled children and adults, they have not
to assist in meeting the key information needs of patients been evaluated sufficiently with an ICU population.
79
and families. As many critically ill patients are These aids use prerecorded digitalised voice messages or
unconscious, it is important to understand the need for synthesised speech, with the phrases accessed by the
85
verbal communication to continue. Such communication patient via a computer screen or keyboard. This device
did not occur in one Jordanian setting where in-depth would be restricted to those patients who are dexterous
interviews and observations used in three critical care and able to select an appropriate key, which limits its
areas identified that nurses communicated less with utility in the ICU setting. However, some patients in a
80
unconscious patients than with conscious patients. small study found electronic voice output beneficial, par-
It has been known for decades that sedated and ticularly when communicating with family. 85