Supporting families in the ICU: A descriptive correlational study of informational support, anxiety, and satisfaction with care

Iranian families' experience of receiving support during their patients' surgical process: qualitative study

BACKGROUND

The time spent waiting through the surgery of a loved one is stressful for family members because of their worries regarding the procedure and potential outcomes. In Iran, the attention and support of healthcare professionals focus almost exclusively on the patient. No studies have explored the related support experiences of family members. Understanding these experiences may facilitate the development by healthcare professionals of support strategies to alleviate the surgery-related stresses of patients' family members.

PURPOSE

This study elucidates the support experiences of the Iranian families of patients undergoing surgery.

METHODS

A qualitative design using a content analysis approach was used to gather and analyze the support experiences of 16 Iranian families awaiting the conclusion of their relative's surgical operation. The study was conducted at a university medical center hospital in an urban area in Iran. After employing a purposive sampling method to select participants, semistructured interviews were used to collect data.

RESULTS

Data analysis led to the development of two main themes: "interaction:" and "physical proximity." One significant finding was the role of productive interactions among family members to facilitate the passing of time and to provide a buffer. These interactions may take place among family members as well as among other companions.

CONCLUSIONS

The findings of this study may be used to guide nursing practices and may help change nursing attitudes toward the family members of surgical patients. By better understanding the experience of families, nurses may improve their professional actions and reduce the stress experienced by family members while waiting for the conclusion of surgery.

Informational support to family members of intensive care unit patients: the perspectives of families and nurses

Introduction:

The receiving information about the patients hospitalized in the intensive care unit is classified among the most important needs of the family members of such patients. Meeting the informational needs of families is a major goal for intensive care workers. Delivering honest, intelligible and effective information raises specific challenges in the stressful setting of the intensive care unit (ICU). The aim of this qualitative study was to explain perspectives of families of Intensive Care Unit patients and nurses about informational support.

Method:

Using a conventional content analysis approach, semi-structured interviews were conducted with participants to explore their perspectives of providing informational support to families of ICU patients. A purposeful sampling method was used to recruit nineteen family members of thirteen patients hospitalized in the ICU and twelve nurses from three teaching hospitals. In general, 31 persons participated in this study. Data collection continued to achieve data saturation.

Findings:

A conventional content analysis of the data produced three categories and seven sub-categories. The three main categories were as followed, a) providing information, b) handling information and c) using information. Providing information had three sub-categories consisting of “receiving admission news”, “receiving truthful and complete information” and receiving general information. Handling information had two sub-categories consisting ‘keeping information” and “gradual revelation”. Lastly, using information has two sub-categories consisting of “support of patient” and “support of family members”.

Conclusion:

The results of this study revealed perspectives of families of Intensive Care Unit patients and nurses about informational support. It also determines the nurses’ need to know more about the influence of their supportive role on family’s ICU patients informing. In addition, the results of present study can be used as a basis for further studies and for offering guidelines about informational support to the families of the patients hospitalized in the ICU.

[Measuring the satisfaction of patients admitted to the intensive care unit and of their families]

OBJECTIVE

To determine the level of satisfaction of family members with the care and decision making process, and to know the level of satisfaction of patients discharged from ICU.

DESIGN

A prospective, observational and descriptive study with a duration of 5 months was carried out.

SETTING

The ICU of Marqués de Valdecilla University Hospital, Santander (Spain).

SUBJECTS

Family members of adult patients admitted to the ICU and patients discharged to the ward.

INTERVENTION

INSTRUMENT

Family Satisfaction Intensive Care Survey (FS-ICU 34) of family members of patients discharged to the ward. We adapted the FS-ICU 34 in relation to care for application to the patients.

RESULTS

A total of 385 questionnaires were obtained: 192 from families of survivors and 162 from patients, and 31 from relatives of non-survivors. The majority of relatives were satisfied with overall care and overall decision making (survivors: 83.46 ± 11.83 and 79.42 ± 13.58, respectively; non-survivors: 80.41 ± 17.27 and 79.61 ± 16.93, respectively). Patients were very satisfied with the care received (84.71 ± 12.85).

CONCLUSIONS

The level of satisfaction of the relatives of patients admitted to the ICU is high, in the same way as the degree of patient satisfaction. Still, there are several points that should be improved, such as the waiting room environment and the atmosphere of the ICU in terms of noise, privacy and lighting. In relation to the decision making process, there are also some aspects that may be improved, such as the provision of hope regarding recovery of the critically ill relative.

Relatives' perspectives on the quality of care in an Intensive Care Unit: the theoretical concept of a new tool

OBJECTIVE

To examine the potential of a questionnaire (CQI 'R-ICU') to measure the quality of care from the perspective of relatives in the Intensive Care Unit (ICU).

METHODS

A quantitative survey study has been undertaken to explore the psychometric properties of the instrument, which was sent to 282 relatives of ICU patients from the Erasmus MC, an academic hospital in Rotterdam, the Netherlands. Factor-analyses were performed to explore the underlying theoretical structure.

RESULTS

Survey data from 211 relatives (response rate 78%) were used for the analysis. The overall reliability of the questionnaire was sufficiently high; two of the four underlying factors, namely 'Communication' and 'Involvement', were significant predictors. Two specific aspects of care that needed the most improvement were missing information about meals and offering an ICU diary. There is a significant difference in mean communication with nurses among the four wards in Erasmus MC.

CONCLUSIONS

The CQI 'R-ICU' seems to be a valid, reliable and usable instrument. The theoretical fundament appears to be related to communication.

PRACTICE IMPLICATIONS

The newly developed instrument can be used to provide feedback to health care professionals and policy makers in order to evaluate quality improvement projects with regard to relatives in the ICU.

Important quality aspects in the transfer process

Purpose

– Admission to and transfer from an intensive care unit affects not only the patient but also his or her relatives. The authors aimed to investigate relatives' perceptions of quality of care during a patient's transfer process from an intensive care unit to a general ward.

Design/methodology/approach

– The study had a mixed method design that included quantitative data and answers to open questions. The participants were 65 relatives of patients who received care in an ICU. They were recruited from two hospitals in Sweden.

Findings

– A majority perceived the transfer process as important, but analysis also showed that the participants rated it as an area for improvements. The relatives wanted participation, personal insight and control, respectful encounters, proximity, reassurance, continuous quality, reconnection and feedback. The relatives' participation in the transfer process was perceived as inadequate by 61 per cent, and the support that was received after the ICU discharge was perceived as inadequate by 53 per cent. The patients' length of stay in the ICU affected the relatives' perceptions of the quality of care. Overall, the relatives seemed to desire that the transfer process includes a continuous care, a competent staff, available information throughout the transfer process and personal involvement in the care, both before and after the transfer from the ICU.

Research limitations/implications

– The conclusion of this study is that relatives' needs and seeking for a well-planned ICU transitional process organisation with continuous quality before and after transfer, informational strategies that encourage the relatives to be involved and an organisation with competence throughout the healthcare chain are vital for quality.

Practical implications

– The conclusion of this study is that relatives' needs and seeking for a well-planned ICU transitional process organisation with continuous quality before and after transfer, informational strategies that encourage the relatives to be involved and an organisation with competence throughout the healthcare chain are vital for quality.

Originality/value

– The findings have important implications for nursing and nursing management. A relative's perception of the quality of care before and after transfer from ICU may be a valuable source to evaluate the ICU transitional care.

Factors affecting the nurse-patients' family communication in intensive care unit of kerman: a qualitative study

INTRODUCTION

The communication between nurses and patients' families impacts patient well-being as well as the quality and outcome of nursing care, this study aimed to demonstrated the facilitators and barriers which influence the role of communication among Iranian nurses and families member in ICU.

METHODS

This study is a qualitative study with content analysis. Participants were eight registered nurses and ten of patients' families. Patients were admitted to the ICU of two large university hospitals in Kerman, Iran. We used non-structured interviews for data collection. All interviews were transcribed verbatim with a simultaneous, constant comparative analysis of the audio tapes.

RESULTS

According to data analysis, facilitative factors between nurses and families' communication consisted of spiritual care, emotional support, Participation, notification and consultation and barriers that were misunderstandings regarding treatment, job and patient difficulties.

CONCLUSION

The findings led into the recognition of the important barriers and facilitators in communication between ICU team and the family of the patients. By identification of the barriers and facilitators of communication, establishing new rules and using creative methods in education and establishing the communication of ICU team especially using patient-based approach we can have effective communication.

Development of the Chinese family support scale in a sample of Chinese patients with hypertension

Background

Despite strong recommendations to involve family social support in hypertension control, few questionnaires have been designed to measure family support in Chinese patients. The Chinese Family Support Scale is a self-rated questionnaire that assesses family support over a 6-month period.

Methods

A total of 282 patients with hypertension participated in this study and 136 of them completed the questionnaire twice within an interval of two to three weeks. Exploratory factor analysis was conducted to assess the structural validity of the scale. Concurrent validity was determined by measuring the correlation between the Chinese Family Support Scale, and Hospital Anxiety and Depression Scale using the Sperman’s Correlation Coefficient. Cronbach’s alpha and intraclass correlation coefficients were employed to evaluate the internal and test-retest reliability of the scale.

Results

Exploratory factor analysis revealed a three-factor solution accounting for 62% of the total variance. The three underlying sub-scale dimensions were kinship, nuclear family, and social resources. Significant correlation (r=-0.266; p<0.01) was found between the depression subscales of the Hospital Anxiety and Depression Scale and the extent of support perceived by the patients as measured by the Chinese Family Support Scale. The Chinese Family Support Scale had an acceptable internal consistency (Cronbach’s alpha = 0.84) and test-retest reliability (intraclass correlation coefficient = 0.82).

Conclusion

The study provides preliminary evidence that the12-item Chinese Family Support Scale is acceptable, valid and reliable for measuring the perceived family support in hypertension patients. It is a promising tool which can be easily incorporated into epidemiological surveys.

Health consumers' experiences in Australian critical care units: postgraduate nurse education implications

AIM

To explore critical care patients and families experiences and seek their input into nurses' postgraduate educational preparation and practice.

BACKGROUND

There is an inconsistency in the expected standard of practice to 'qualify' Australian critical care nurses. There has also been a lack of health consumer input in the development of postgraduate course curriculum and content.

METHOD

Following institutional ethics committee approval, purposive sampling was used to select participants for focus groups and individual interviews who had experienced intensive care or coronary care.

FINDINGS

Seventeen participants provided data which created two main thematic categories; the role of the critical care nurse and; minimum practice standards for postgraduate critical care course graduates. Both physical patient care and socio-emotional support of patients and family were identified as important for the critical care nurse role. The level of socio-emotional support provided by nurses was reported to be inconsistent. Components of socio-emotional support included communication, people skills, facilitating family presence and advocacy. These components were reflected in participants' concepts of minimum practice standards for postgraduate critical care course graduates; talking and listening skills, relating to and dealing with stressed people, individualizing care and patient and family advocacy.

CONCLUSION

Health consumers' views emphasize that socio-emotional skills and behaviours need to be explicitly described in postgraduate critical care nursing course curricula and instruments developed to consistently assess these core competencies.

Families' stressors and needs at time of cardio-pulmonary resuscitation: a Jordanian perspective

Background:

During cardio-pulmonary resuscitation, family members, in some hospitals, are usually pushed to stay out of the resuscitation room. However, growing literature implies that family presence during resuscitation could be beneficial. Previous literature shows controversial belief whether or not a family member should be present during resuscitation of their relative. Some worldwide association such as the American Heart Association supports family-witnessed resuscitation and urge hospitals to develop policies to ease this process. The opinions on family-witnessed resuscitation vary widely among various cultures, and some hospitals are not applying such polices yet. This study explores family members’ needs during resuscitation in adult critical care settings.

Methods:

This is a part of larger study. The study was conducted in six hospitals in two major Jordanian cities. A purposive sample of seven family members, who had experience of having a resuscitated relative, was recruited over a period of six months. Semi-structured interview was utilised as the main data collection method in the study.

Findings:

The study findings revealed three main categories: families’ need for reassurance; families’ need for proximity; and families’ need for support. The need for information about patient’s condition was the most important need. Updating family members about patient’s condition would reduce their tension and improve their acceptance for the end result of resuscitation. All interviewed family members wanted the option to stay beside their loved one at end stage of their life. Distinctively, most of family members want this option for some religious and cultural reasons such as praying and supplicating to support their loved one.

Conclusions:

This study emphasizes the importance of considering the cultural and religious dimensions in any family-witnessed resuscitation programs. The study recommends that family members of resuscitated patients should be treated properly by professional communication and involving them in the treatment process. The implications concentrate on producing specific guidelines for allowing family-witnessed resuscitation in the Jordanian context. Finally, attaining these needs will in turn decrease stress of those witnessing resuscitation of their relative.

Needs and experiences of intensive care patients' families: a Saudi qualitative study

AIM

To identify the perceived needs of Saudi families of patients in Intensive Care in relation to their culture and religion.

BACKGROUND

Admission of a family member to an intensive care unit (ICU) is a deeply distressing and often unexpected life event to the family. Families of critically ill patients have needs that should be acknowledged and met by the ICU team. Literature is virtually silent on the issue of recognizing the ICU family needs in relation to the influence of their cultural values and religious beliefs.

DESIGN

A descriptive exploratory qualitative study.

METHOD

Individual, semi-structured interviews of a purposive sample of 12 family members were carried out between November 2011 and February 2012. The closest family members were recruited to participate in the interviews with a mean age of 44·25 years in eight mixed medical-surgical ICUs of eight major trauma hospitals in Saudi Arabia.

RESULTS

The family needs and experiences are described via six major themes: looking for information, maintaining reassurance, spiritual healing, maintaining close proximity, involvement in care and support not being facilitated. The results indicated that family members sought to access information readily to diminish their anxiety. They also needed to be reassured that the best care was being delivered to their loved one and to feel supported during this critical time. Saudi families have cultural and spiritual healing beliefs and practices including faith in God and that God is the ultimate healer, reading of the Qur'an, prayer and charity. These lessen their stress and connect them to hold on to hope. In addition, maintaining proximity to their ill family member was considered of the greatest importance to the families.

CONCLUSION

The study provided an in-depth understanding of the family members' experience of having a relative in Intensive Care and focussed on a range of unmet needs, particularly those related to culture and religion. The ICU team need to work collaboratively with family members to improve their experience.

RELEVANCE TO PRACTICE

The recognition of family needs, experiences and situations can enhance the care provided by the critical care team to patients and families.

Families' needs of critical care Muslim patients in Saudi Arabia: a quantitative study

AIM

To identify the needs of families of adult intensive care unit (ICU) patients in Saudi Arabia as perceived by family members and health care providers.

BACKGROUND

Family members of critically ill patients are likely to have specific needs that should be addressed by the critical care team and which, if unmet, may produce stress for patients' families and health care providers. The literature has yet to identify the needs of Muslim families in relation to religious beliefs and cultural values in critical care settings in Saudi Arabia.

DESIGN

A cross-sectional survey design.

METHOD

A total of 176 family members and 497 intensive health care providers were recruited from eight adult mixed medical-surgical ICUs between November 2011 and February 2012 utilizing a four-point Likert type scale self-administered questionnaire.

RESULTS

The findings revealed that family members and health care providers ranked assurance, information and cultural and spiritual needs as the most important, and support and proximity as least important. There were significant differences in the mean values found between family members and health care providers. A significant finding not identified in other studies was 'The need to have the health care providers handle the body of the dead Muslim with extreme caution and respect' which, under the dimension of cultural and spiritual needs, was perceived by family members to be the most important and by the health care providers as the fifth most important need.

CONCLUSION

The recognition of family needs in the critical care unit informed the development of interventions to meet family needs and improve the care quality.

How do intensive care nurses perceive families in intensive care? Insights from the United Kingdom and Australia

AIMS AND OBJECTIVES

To compare how intensive care nurses in the UK and Australia (AU) perceive families in intensive care units (ICUs).

BACKGROUND

International healthcare research and practice is often based on an underlying assumption of a person- or family-centred ideology. While nurses in ICUs acknowledge the importance of patients' families, a true integration of families as units of care is often not realised.

DESIGN

Data from ICU nurses from two international studies: (1) a constructivist grounded theory study in the UK and (2) a quasi-experimental non-equivalent clinical study in AU. Data were collected in tertiary adult ICUs in the UK and AU. Nurse-to-patient ratio for high-acuity patients was 1:1 in both units.

PARTICIPANTS

Twenty ICU nurses in five focus groups (UK study) and 197 surveys were sent out to ICU nurses in AU (response rate 26%).

RESULTS

Evidence from both studies makes visible the contribution of family care in adult ICUs. Nurses remaining in control and initiating family member care involvement are less likely to perceive families as a burden. The AU study indicated that when nurses partner with families to deliver care, there was a minimal effect on their workload. The nurses concluded that inviting family members to be a part of the patient's care should be usual practice in ICUs.

CONCLUSION

Nurses should promote, facilitate and invite the integration of families in care in today's healthcare system. This is mandatory as families are the caring resource for these patients during an often prolonged recovery trajectory.

RELEVANCE TO CLINICAL PRACTICE

Families are more likely to be successfully integrated into a more active involvement with ICU patients when they are not perceived as a burden. Inviting and supporting family members is not necessarily time-consuming and starts the journey of supporting ICU survivors' recovery journey.

Family needs and involvement in the intensive care unit: a literature review

AIMS AND OBJECTIVES

To understand the needs of critically ill patient families', seeking to meet those needs and explore the process and patterns of involving family members during routine care and resuscitation and other invasive procedures.

METHODS

A structured literature review using Cumulative Index to Nursing and Allied Health Literature, Pubmed, Proquest, Google scholar, Meditext database and a hand search of critical care journals via identified search terms for relevant articles published between 2000 and 2010.

RESULTS

Thirty studies were included in the review either undertaken in the Intensive Care Unit or conducted with critical care staff using different methods of inquiry. The studies were related to family needs; family involvement in routine care; and family involvement during resuscitation and other invasive procedures. The studies revealed that family members ranked both the need for assurance and the need for information as the most important. They also perceived their important needs as being unmet, and identified the nurses as the best staff to meet these needs, followed by the doctors. The studies demonstrate that both family members and healthcare providers have positive attitudes towards family involvement in routine care. However, family members and healthcare providers had significantly different views of family involvement during resuscitation and other invasive procedures.

CONCLUSION

Meeting Intensive Care Unit family needs can be achieved by supporting and involving families in the care of the critically ill family member. More emphasis should be placed on identifying the family needs in relation to the influence of cultural values and religion held by the family members and the organisational climate and culture of the working area in the Intensive Care Unit.

Family Presence in the Adult Burn Intensive Care Unit During Dressing Changes

Objectives

To improve communication, discharge readiness, and satisfaction of burn patients and their families.

Methods

In March 2009, the burn intensive care unit at University of Louisville Hospital, Louisville, Kentucky, incorporated family presence during dressing changes. Adverse family events during observation, measures of patient- and family-centered care according to a standardized patient satisfaction survey, infection rates, and staff members’ response to the intervention were tracked.

Results

Through December 2011, no adverse family events occurred, patients’ satisfaction scores increased, and infection rates did not increase. Staff members responded positively to the project.

Conclusions

Allowing family presence during dressing changes provides an opportunity to educate and include patients’ family members in care delivery.

[Benefits of flexible visitation in the intensive care units for the family of critical patients]

AIM

To identify, analyze and summarize the main effects that may be related to flexible visitation policies for the relatives of critically ill adults.

METHOD

A review of the literature was conducted in the following databases: PubMed, CINAHL, PsycINFO, Cochrane Library and CUIDEN. Thematic content analysis was used to evaluate selected articles.

RESULTS

Fifteen articles were included in this review. Four main themes emerged from the thematic content analysis. Themes included the main effects of flexible visitation policies for the family of the critical patients such as: improvement of satisfaction, reduction of anxiety and stress, satisfaction regarding their own family needs, and the role of the family in the patient's care.

CONCLUSION

According to the existing evidence, flexible visitation policies appear to be both beneficial and decisive. It seems to be necessary to favor the participation of the family in the care of the intensive patient as well as the acquisition of a more prominent role the visitation context and in their relationship with the patient.

Jordanian nurses’ perceptions of their roles toward the families of hospitalised critically ill patients

The primary purpose of this study was to identify Jordanian nurses’ perceptions of their roles toward the families of hospitalised critically ill patients. Second, to examine the relationship between nurses’ role expectations and perceived role performance toward the families of hospitalised critically ill patients. A descriptive, correlational design was used. A convenience sample of 127 intensive care unit (ICU) nurses was recruited from ICUs located in four different hospitals in Jordan. Data were collected using a demographic data form, a Role Performance Subscale with 19 items and a Role Expectation Subscale with 14 items. Results indicated that Jordanian ICU nurses expected and performed interventions that required more time, emotion and communication skills less than interventions that required less time, emotion and communication skills.

Participation and support in intensive care as experienced by close relatives of patients: a phenomenological study

AIM

The aim of this study was to explore participation and support as experienced by close relatives of patients at an intensive care unit (ICU).

METHOD

This study used the phenomenological approach as developed by Dahlberg et al. (2008) as a method for reflective lifeworld research. Seven close relatives of critically ill patients cared for at an ICU were interviewed. The data were analysed with a focus on meanings.

RESULTS

Being allowed to participate in the care of critically ill patients at an ICU is important for close relatives to the patients. Their experiences can be described as having four constituents: participation in the care of and being close to the patient; confidence in the care the patient receives; support needed for involvement in caregiving; and vulnerability.

CONCLUSION

Participation with and support from health-care professionals are important for the relatives' well-being and their ability to contribute to the patients' care. Health-care professionals, especially critical care nurses, need to create an atmosphere that invites relatives to participate in the care provided at an ICU.

Social workers' perspectives on the psychosocial needs of families during critical illness

This article reports the needs of relatives whose family member is unexpectedly admitted to an Intensive Care Unit. The Critical Care Family Needs Inventory (CCFNI) was used to measure and rank a series of need statements by family members (n = 25) and social workers (n = 42). Comparative analysis reveals that there were need statements that showed a significant difference in mean scores. Minor differences in both the rank order of individual need statements and the five-factor analysis categories were found. Implications for clinical social work practice are discussed.

Implementing small tests of change to improve patient satisfaction

The Institute of Medicine supports proposed changes in the overall delivery of healthcare and the nurses' work environment to achieve improved patient outcomes and protect the public from unnecessary harm. Allowing nurses to have a voice in decision making and influence over their practice, in an environment that fosters autonomy and interdisciplinary collaboration, enhances nurse satisfaction while improving the quality of patient care. The authors describe how a pediatric medical unit engaged in small tests of change to improve communication and patient satisfaction on an inpatient unit.