Page 198 - ACCCN's Critical Care Nursing

Family and Cultural Care of the Critically Ill Patient 175

Research vignette, Continued
Critique units’ results are combined for further analysis which could be
This pilot study focuses on the satisfaction family members experi- problematic if family members rate different items poorly in one
ence when their relative is in a critical care unit. The aim of the unit as opposed to the other. If they were kept separate, no
study is clearly stated as advancing the research in the area of in-depth reporting occurs. Of particular interest for the units is the
overall satisfaction with care from a legitimate surrogate (the items which scored lowest on the survey as this provides direction
family) of critically ill patients. The justification for improving ser- for future interventions and improvements. Family members
vices highlights the different nature of health care in USA com- scored waiting time for results and X-rays lowest and the noise
pared with other countries which have public sector funded care. levels in the unit the second lowest. It may have been more mean-
The authors comment on the need to excel in a market that sees ingful to present Table 3 (which gives the mean scores for each
health care facilities compete for clients. item) with the items listed from the highest score down to the
lowest score rather than as it is listed in order of how the items
The authors give a very good overview of previous research in the occur in the survey. That way the reader can readily see how items
area and provide a useful table that summarises pertinent studies. scored in relation to others. Once again, there may have been unit
It would be helpful for completeness to have the names of all of specific differences that are not apparent in the reported results
the scales used in the research projects incorporated into the table. with the exception of the worst scored item.
For example, the Family Satisfaction–Intensive Care Scale (FS-ICU)
was used in four of the studies but it is not noted in the table or The support subscale had the highest level of satisfaction and the
elsewhere in the paper whereas other scales are mentioned. This comfort subscale the lowest. The items within the comfort subscale
extra information helps the reader become familiar with validated pertain to the waiting room’s cleanliness, appearance and noise.
162
scales for evaluating family satisfaction. The authors justify their Other authors acknowledge that providing a comfortable envi-
choice for using the Critical Care Family Satisfaction Scale (CCFSS) ronment for families is important particularly as they can spend
which they consider is more inclusive. There is no definition given considerable time there during a relative’s critical illness as they
for who constitutes a family member. Some argue that a broad wait to be allowed in to be with their relative.
definition is desirable and that one’s family is made up with whom- The authors suggest a number of useful interventions aimed to
ever they indicate is their family and this may not be based on improve families’ satisfaction and these include the following:
blood or legal relationships and include those with a sustained ● Conduct a root cause analysis to identify reasons for wait time
relationship with the patient. 11 for test results.
● Improve communications with families to ensure both realistic
A survey was distributed to a convenience sample of family
members in two units: one a surgical intensive care unit (SICU) with timeframes and prompt attention when results are received.
10 beds and the other a telementary/intermediate care unit with ● Prioritise critical care tests within the hospital.
14 beds in a community hospital. No description is given in regards ● Patient/family communication board to document questions
to the acuity of the patients in the unit and one assumes that the or concerns.
patients in the SICU are more critically ill than in the other unit. One ● Provide vibrating pagers rather than audible systems to reduce
family member per patient was invited to complete the survey noise levels.
which reduces the potential for skewing the data with many family ● Implement decibel alarm system in unit to identify if noise
members from one patient. Families of dying patients were not levels go above a predetermined acceptable level.
invited to provide feedback. The authors give a humanitarian ratio- ● Play soothing music in unit which may minimise perceptions
nale of not adding to their dire situation, however, it could be of noise levels.
argued that this group is an under-researched and important ● Recognise environment of care is an important part of families’
163 p. 24-25
group in intensive care whose satisfaction with care is equally satisfaction.
161
important to the staff. Sensitivity would be key to their The authors clearly identify the limitations of a small convenience
inclusion. sample with families of patients of unknown acuity levels. The
degree of illness has been found to be associated with low sat-
164
The instrument is described well and the scoring is clearly outlined isfaction levels in a Moroccan study and this patient charac-
with an overall score out of a possible 100 and mean scores calcu- teristic may be worthy of inclusion in future studies. The authors
lated for the five subscales. Thirty-one surveys were returned and highlight the benefit of such a study to provide baseline
analysis was conducted with results showing the participants from measurements against which future interventions can be
both units were satisfied with the care. It appears that the two measured.