¿Qué perspectiva tienen las enfermeras de unidades de cuidados intensivos de su relación con los familiares del paciente crítico?

Perspectives of intensive care nurses on open visits in an ICU

OBJECTIVE

To determine the attitude of the nursing professionals of an Intensive Care Unit regarding the effects of open visiting on the daily activities of the patient, their family and professionals, and also to determine their contribution to the current open visiting policy.

METHOD

A cross-sectional descriptive study was performed, with a non-probabilistic discretionary sampling. The sample comprised nursing professionals of the aforementioned Unit. They were given a questionnaire with 26 items and an open question to evaluate their suggestions.

RESULTS

101 nursing professionals took part in the study, of the 120 working in the Unit under study. Seventy-five point two percent state that the nursing team has to postpone or modify their work due to the presence of the family and 89.9% that their presence produces a physical and psychological burden on the staff. Eighty percent think that the visit exhausts the family and 84.2% that the family feels obliged to remain with the patient. Ninety-four percent think that the effect of the presence of the family depends on the patient and the family.

CONCLUSIONS

Most of professionals have a negative opinion about the policy of open visits, showing some reluctance when it comes to flexible visiting hours, although they admit that an unrestricted schedule in this type of units implies some benefit for the patient and the family.

Perspectives of intensive care nurses on open visits in an ICU

OBJECTIVE

To determine the attitude of the nursing professionals of an Intensive Care Unit regarding the effects of open visiting on the daily activities of the patient, their family and professionals, and also to determine their contribution to the current open visiting policy.

METHOD

A cross-sectional descriptive study was performed, with a non-probabilistic discretionary sampling. The sample comprised nursing professionals of the aforementioned Unit. They were given a questionnaire with 26 items and an open question to evaluate their suggestions.

RESULTS

101 nursing professionals took part in the study, of the 120 working in the Unit under study. Seventy-five point two percent state that the nursing team has to postpone or modify their work due to the presence of the family and 89.9% that their presence produces a physical and psychological burden on the staff. Eighty percent think that the visit exhausts the family and 84.2% that the family feels obliged to remain with the patient. Ninety-four percent think that the effect of the presence of the family depends on the patient and the family.

CONCLUSIONS

Most of professionals have a negative opinion about the policy of open visits, showing some reluctance when it comes to flexible visiting hours, although they admit that an unrestricted schedule in this type of units implies some benefit for the patient and the family.

Experience of care through patients, family members and health professionals in an intensive care unit: a qualitative descriptive study

BACKGROUND

A patient's stay in an intensive care unit (ICU) can lead to psychological and social alterations in patients and their nearest family circle. Healthcare staff and patients' family members strongly influence patients' stays in ICU.

AIMS

To explore the perceptions about the experiences of patients in the ICU, their family members and nurses who attend them.

METHODS

A descriptive phenomenological design was used to guide the research. A purposive sample of 27 male and female participated. Nine hospitalised patients, nine nurses and nine family members were interviewed in 2016 using a semi-structured, face to face interview. Steps of Giorgi phenomenological method were used to analyse the qualitative data.

FINDINGS

Among the three categorised groups, there is a common point that is the constant of humanization in care and it is very clear on the part of the patient, the patient's family and the nurses whom they attend. In addition, both in the group of patients and in the group of families allude to the fear and anguish that responds to patients, this problem does not appear in the speeches of nurses, who are torn between excessive technology and the performance of their work correctly for better patient welfare.

CONCLUSIONS

A stay in an ICU implies emotional expense for both patients and their families, which leads to a series of changes in their affective and social sphere, manifested by a set of requirements that must be responded by the multidisciplinary team that attends to patients. It would be fundamental to inform the health authorities about these requirements in order to modify the usual conduct habits displayed in ICU, which would help improve all levels for patients, their families and nurses.

Impact of Interprofessional Relationships from Nurses' Perspective on the Decision-Making Capacity of Patients in a Clinical Setting

Interprofessional relationships may impact the decision making of patients in a clinical setting. The objective of this study was to analyse the decision-making capabilities of patients from nurses' perspectives of interprofessional relationships using Foucauldian ethics. This qualitative study was based on poststructuralist Foucault references with in-depth interviews of nurses working in internal medicine and specialties in a general hospital. The patients constantly appeared in the definition of teamwork, but also as a passive element used by every professional to communicate with others. Nurses continue modelling a type of patient passivity, or what Foucault called passive subjectivity in relation to oneself, because the patient is guided and directed to take charge of a truth provided by professionals. Nurses must break the rigid design of sections or professional skills, and adopt a model of teamwork that meets the needs of the patient and increases their decision-making power. The quality of care will increase to the extent that professionals establish a relationship of equality with the patient, allowing the patient to make real decisions about their care. An egalitarian model of teamwork is beneficial to the patient, abandoning the idea of a team where the patient and family are constantly excluded from decisions about their care.

Humanization in healthcare arises from the need for a holistic approach to illness

Suffering is not only exclusive to patients or their relatives, but also to the health professionals, who feel to be at the center of the depersonalization process. Over-technification and the fact that the disease process is sometimes the only focal point of our activities, together with the ever-increasing influence of institutional power seen in recent times, all cause the health professional to be the first in demanding a change in health institution dynamics. Following initial reflection from one of the most technified medical specialties (Intensive Care Medicine), classically isolated from the rest of the Hospital and from the community, we implemented a project aimed at securing integration and empathy in our approach to patients and their relatives in the Intensive Care Unit (ICU) of Infanta Margarita Hospital. The project was designed to incorporate tools for working on the most important elements of a humanization plan, i.e., the patients, their relatives, the health professionals and the community, attempting to disclose the work done in the ICU over a period of 12 months. This project is referred to as the Project ICU Infanta Margarita: 1 year: 12 months for 12 commitments.

Main information requests of family members of patients in Intensive Care Units

OBJECTIVE

To compile an inventory of information requests prioritized by the family members, to find out which professionals them consider able to respond these requests, and to explore the differences in perception between family members and professionals.

DESIGN

Qualitative analysis of content validation and descriptive cross-sectional study.

SCOPE

41 Spanish ICU.

PARTICIPANTS

Relatives, physicians and nurses of critical patients.

INTERVENTION

From an initial list of questions extracted from literature review, physicians, nurses, and relatives of critical patients incorporated issues that they considered not included. After analyzing content validity, a new list was obtained, which was again submitted to the participants' assessment to evaluate the level of importance that they assigned to each question and which professional they considered appropriate to answer it.

RESULTS

most important questions for the relatives: concern about the clinical situation, measures to be taken, prognosis and information. There was a coincidence between relatives and professionals in the priority issues for families. There were significant differences in the importance given to each question: between doctors and relatives (72/82 questions), and between nurses and relatives (66/82 questions) (P<.05). For the relatives, 63% of the questions could be answered by doctors or nurses, 27% preferably by doctors and 10% by nurses.

CONCLUSIONS

The most relevant issues for families were prognosis and severity, but also the need for information. Healthcare professionals tend to underestimate the importance of many of the questions that concern families. Relatives feel that most of their concerns can be resolved either by doctors or nurses.

[Satisfaction of relatives of the patients admitted to an intensive careunit: Perceptions of relatives and professionals]

OBJECTIVES

To estimate the satisfaction of relatives of critical care patients with regard to the environment, relationship with professionals and visitation and compare it to the perception of professionals.

METHODOLOGY

A descriptive study in two phases. In the first phase validated telephone survey within 15 days of discharge to the relatives of the patients was performed. In the second phase, the same modified questionnaire was self-administered to the professionals. The same variables were studied in both populations.

RESULTS

We interviewed 78 family members and 44 professionals. 95% of professionals vs 67% of the families claimed not to know the name of the nurses (P < .001). Over 70% of professionals and families agreed that the visit protocol is correct and that the information was adequate income. 70% of professionals felt that the information received at admission is not understood by the family although 97% of households claimed to have understood themselves. Statistically significant differences were observed in relation to the location of the unit assessment, the waiting, the aspects of information and comfort, always being the professionals who felt greater dissatisfaction (P < .05).

CONCLUSIONS

The perceptions of relatives and professionals were mostly uneven, making it necessary to continue exploring the differences through qualitative and participatory methodologies.

[Meaning of family confrontation for nurses of intensive care units for adult people - Medellín 2013]

OBJECTIVE

To comprehend the meaning nurses give to family confrontation, from their experiences while patients are in adult intensive care units in Medellin 2013.

METHOD

A qualitative research study was carried out using a phenomenological approach and theoretical convenience sampling of subjects was used. Interviews with open questions were conducted with nurses that worked in different intensive care units in the city of Medellin, with more than one year of experience in these units. The information was coded and categorised to perform the analysis, and some concept maps were created for the final report.

RESULTS

This study showed that nurses focus their care on the critical patient and not on the patient's family. They considered that there is family confrontation when its members comprehend the processes that are carried out in the intensive care unit, and can contribute to the patient's care, while if families do not have confrontations, it is because they do not understand the process, or feel desperate or are absent. The interventions that nurses consider must be done to help in the family confrontation are: information, interdisciplinary support, visits, and companionship.

CONCLUSION

For the nurses, family confrontation means that family members understand, comprehend, accept, know, bear and go on with the situation; therefore, they can make good decisions regarding the patient's care in the adult intensive care units.

Transforming a conservative clinical setting: ICU nurses' strategies to improve care for patients' relatives through a participatory action research

This study focuses on change strategies generated through a dialogical-reflexive-participatory process designed to improve the care of families of critically ill patients in an intensive care unit (ICU) using a participatory action research in a tertiary hospital in the Balearic Islands (Spain). Eleven professionals (representatives) participated in 11 discussion groups and five in-depth interviews. They represented the opinions of 49 colleagues (participants). Four main change strategies were created: (i) Institutionally supported practices were confronted to make a shift from professional-centered work to a more inclusive, patient-centered approach; (ii) traditional power relations were challenged to decrease the hierarchical power differences between physicians and nurses; (iii) consensus was built about the need to move from an individual to a collective position in relation to change; and (iv) consensus was built about the need to develop a critical attitude toward the conservative nature of the unit. The strategies proposed were both transgressive and conservative; however, when compared with the initial situation, they enhanced the care offered to patients' relatives and patient safety. Transforming conservative settings requires capacity to negotiate positions and potential outcomes. However, when individual critical capacities are articulated with a new approach to micropolitics, transformative proposals can be implemented and sustained.

Factors limiting and facilitating changes in caring for the intensive care unit patients' relatives

AIM

To explore how the intensive care unit (ICU) context influenced receptivity to change in clinical practice, in order to improve the care offered to patients' relatives.

BACKGROUND

Families of critically ill patients have unmet needs that are not being addressed. Lack of attention to these needs is related more to the ICU context than to a lack of scientific evidence.

DESIGN

Participatory action research (PAR), a qualitative study conducted in a Spanish ICU.

METHOD

Eleven participants agreed to represent their teams in all scheduled group discussions. Field diaries were kept by the principal investigator and discussion participants, and five in-depth interviews were conducted. Content analysis was performed.

RESULTS

Four factors limited change: (1) Not acknowledging the legitimacy of scientific evidence regarding the families of critically ill patients. (2) Imbalanced power relationships between the members of multidisciplinary teams. (3) Lack of nurse participation in the information flows. (4) The organization of time and physical space in the unit. Three factors facilitated change: (1) A sense of individual and shared commitment. (2) Leadership in day-to-day matters. (3) A process based on reflection.

CONCLUSIONS

PAR can lead to change in clinical practice, although the process is complex and requires substantial input of time and energy. Contextual factors limiting this change were structural whereas facilitating factors were circumstantial and depended upon individuals' characteristics. Professionals working at the bedside are capable of identifying, developing and introducing changes to the context in which they work.

RELEVANCE TO CLINICAL PRACTICE

Knowing these factors and sharing the experience of a successful change process can help others design processes appropriate to their site.

[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.

[Limiting and facilitating factors of changes in the care of families of the critically ill patient]

INTRODUCTION

Participatory action research (PAR) was conducted in an intensive care unit (UCI), with the general purpose of fostering change in clinical practice so as to improve the care offered to families of critically ill patients. As a result of this process, four change-related initiatives were introduced. One specific additional objective was to explore how the unit's background context limited or facilitated change. This paper presents findings based on this objective.

MATERIALS AND METHODS

Qualitative methodology.

DESIGN

Participatory-action research (PAR). DATA GATHERING TECHNIQUES: 11 discussion groups incorporating professionals, 5 in-depth interviews with professionals, field diaries kept by the participants, and field diary kept by the lead researcher. Eleven professionals took part in the discussion groups (each one conveyed information made known to them by 3-5 colleagues), 5 professionals were involved in the interviews, and 11 professionals filled in a field diary. A content analysis was performed.

RESULTS

Factors limiting change included: 1) Not acknowledging the legitimacy of scientific evidence regarding the families of critically ill patients; 2) Imbalanced power relationships among the members of multi-disciplinary teams; 3) Nurses' lack of involvement in information flow; 4) The organization of time and physical space in the unit. Factors facilitating change: 1) A sense of individual and shared commitment; 2) Leadership in day-to-day matters; 3) A process based on reflection.

CONCLUSIONS

A process of participatory action research can lead to change in clinical practice, although this is complex and requires substantial input in terms of personal energy. Contextual factors limiting this change are related to the actual structure of the unit, while factors facilitating it are circumstantial ones and are dependent upon individual people. In this sense, professionals working at the bedside are capable of introducing changes to the context in which they work.

[Needs of the family in the intensive care units: a review of the literature]

Admission to the Intensive Care Units (ICU) is perceived by both patients and their family as a stressful experience. This situation can cause shock, skepticism and anxiety in the patient's setting.

OBJECTIVE

To analyze and present the needs of the family members of the critical patient.

METHODOLOGY

A review was made of the literature in the following data bases: Pubmed, CINAHL, Cuiden and Cochrane Library. Furthermore, three journals specialized in Intensive Cares were reviewed.

RESULTS

After including the articles that met the screening criteria, 30 articles were finally selected. Of these, 11 were reviews of the literature, 7 qualitative studies and 12 more were quantitative investigations. Four groups of needs in the families were identified after the analysis of these articles, these being cognitive, emotional, social and practical.

DISCUSSION

One of the main needs of the family is to receive better information from the professionals followed by the need for closeness with the ill family member. This review proposes that, in order to cover these needs, the information should be protocolized and the visiting hours should be made flexible. Furthermore, incorporation of two familial evaluation tools, the genogram and ecomap, is proposed.

CONCLUSIONS

This work has revealed the importance of having the Intensive Care nurses identify the needs of the family during the admission of the patient in the ICU in order to be able to provide help, support and counseling care that relieves the suffering of the families.

"What families want - an assessment of family expectations in the ICU"

Introduction

Families of patients admitted in the intensive care units (ICUs) experience high levels of emotional stress. Access to information about patient's medical conditions and quality relationships with healthcare staff are high priority needs for these families and meeting these needs of the family members is a primary responsibility of ICU physicians and nurses.

Methodology

Our objectives were to assess the expectations of ICU patients' families that can be fulfilled by physicians and nurses. The design was a descriptive, exploratory questionnaire based study over 6 months in the multidisciplinary ICU of a tertiary care hospital.

Results

Of 205 interviews, the median age of the patient was 28 years. One hundred and nineteen (58%) were male and Eighty six (42%) patients were female. 163 (79.5%) of the relatives were Next of kin, and 133 (64.9%) were male members. Of the family members, 20 (9.8%) were spouses. One hundred and forty two (69.3%) belonged to Middle income group. Ninety nine (48.3%) were Graduates of high school or above. Relation to patient, sex of relative, DNR status of patient and age of relative were statistically significant to make a difference to the satisfaction score. The majority of the relatives reached a score of 22-25.

Conclusion

We conclude that families of critically ill patients were generally satisfied with communication in the ICU; however, our limitations are the cohort in our urban based tertiary care hospital may not adequately represent the majority of our population which is poor and illiterate and many other factors such as misunderstanding of medical knowledge and a more patriarchal attitude of physicians may affect family needs and satisfaction scores.

[The nurse expert in the care of the critical patients according to Patricia Benner]

INTRODUCTION

When discussing care, the individual cannot be considered separate from their most immediate context, that is, the family. Including the family in the cares for a critically ill patient requires a skill that is not developed until the nursing professional is competent in Benner's terms. The skill that a nurse can have to become involved in caring for patients and the family is acquired over time and through experience.

OBJECTIVE

To explore the behavior and clinical judgment of a nurse qualified in areas of critical care, according to Patricia Benner, identifying the responses provided by the nurse for patient and family needs.

METHOD

Maria, an expert nurse in an intensive care unit, was selected to report on a significant clinical episode related to caring for the family. Her narration was read, and analysis and conclusions were carried out, within the field of caring for the family and according to the six aspects of clinical judgment and expert behavior outlined by Benner.

RESULTS

It reveals how the expert skills and know-how of the nurse bring about a significant change in the practice.

CONCLUSIONS

Encouraging the family to take part in the care promotes union, decreases impotence and anxiety and helps to assimilate the loved one's situation, aspects which form part of the nursing skill to provide complete care. Using Maria's clinical practice as a base, aspects of the clinical judgment and behavior that Benner identifies in an expert nurse can be observed.

[Improving the care of critical patient family members: Agreed on strategies]

INTRODUCTION

Within the context of participatory action research (PAR), a 4-stage process was established with the general aim of promoting improvements in the care offered to families of patients in the Intensive Care Unit (ICU). The 4 stages consisted of a situational diagnosis, proposals for change, the design and implementation of the proposals, and an evaluation. This paper presents the first 2 stages.

OBJECTIVES

To define the attention given to families of patients in the Intensive Care Unit. To reach a consensus on areas for action/intervention in the unit.

MATERIALS AND METHOD

A qualitative methodology.

DESIGN

PAR. Data-collection technique: 4 focus groups made up of 10 professionals, and consensus with support groups made up of 30 members. Content analysis was performed. The theoretical saturation point was reached.

RESULTS

Two documents were drawn up: 1) A situational diagnosis, describing the current situation of the attention given to families and 2) 10 proposals for change, 5 of which were given priority. They were: a session to familiarize professionals with evidence concerning families of patients in the ICU and the handing out of informative leaflets, the improvement of (nurse-family and intra-team) informative procedures, more privacy for patients and a reduction in environmental noise, a training plan for professionals, and change in the visiting policy.

CONCLUSION

By using consensus-based methodologies, strategies for change can be prioritized and designed, adapted to the context in which they will be applied.

[Opening the intensive care unit to families: what do the professionals think?]

AIM

A participatory action-research was conducted in an intensive care unit (ICU). A consensus was reached on four proposals for change regarding how to deal with the relatives of the critically ill patients, extending their visiting hours being one of these proposals. This study has aimed to ascertain the contributions of the unit professionals to a new proposal regarding visiting hours.

PARTICIPANTS AND METHODS

The sample included 93 ICU professionals out of 205. A qualitative methodology study that included a two-item open survey was used: 1. Yes, I agree with the proposal (explain how you would improve it); 2. No, I do not agree with the proposal (explain why and how you would improve it). Content analysis and triangulation of researchers and participants were performed. The theoretical saturation point was reached.

RESULTS

Five categories emerged: 1) Modify the initial proposal; 2) Agreement with the proposal; 3) Doubts; 4) Barriers to implementation; 5) Flexibilization.

CONCLUSIONS

ICU professionals are reluctant to open their units, but accept the extension of current visiting hours. The physical structure of the unit is perceived as a major barrier.

[Identity of gender and intensive care: influence of masculinity and femininity in the perception of nursing care]

INTRODUCTION

Nursing has essentially been the work of women. The increase in men incorporating into nursing makes us think about whether there are different ways of expressing and practicing a profession in relationship to gender.

OBJECTIVE

To describe if there are different ways of perceiving and assessing ICU work from a gender perspective.

METHODOLOGY

A qualitative phenomenological study.

SAMPLE

6 male nurses and 6 female nurses from the ICU of the Hospital Universitario de Bellvitge (HUB).

DATA COLLECTION

In-depth semi-constructed interview. Content analysis.

RESULTS

Male nurses describe ICU work in terms of autonomy in making decisions and professional competence. They claim responsibility for their identity as nurses and stress the low social recognition of the profession. They prioritize the responsibility of decision making over the final outcome and evaluate family satisfaction in terms of prestige and competence. They are more practical. Female nurses describe the work in terms of control and follow-up of the patient's evolution. They emphasize the final care outcome and evaluate satisfaction in terms of a relationship of confidence and warm patient care. They are more meticulous.

CONCLUSIONS

There are differences in how they classify their ICU work, in the self-evaluation of professional identity, behavior in the development of the nursing care and in perception of family satisfaction. No differences are observed regarding problem solving with the technology.

[Development of an attention guideline for the critical patient's family]

INTRODUCTION

Within the context of participatory action research (PAR) at an Intensive Care Unit (ICU), 4 proposals for change were agreed by consensus to improve the attention given to families of critical patients. One proposal was the creation of a guideline for attending to family members, inspired by the participants' desire to improve the attention given to this group of users.

OBJECTIVES

1) To design a guide that would meet the needs of professionals and users. 2) To reach an agreement on the minimum requirements for attention given to families of critical patients.

MATERIALS AND METHODS

Qualitative methodology, based on PAR. For each of the initiatives, a working group was created, composed mainly of professionals from the ICU coordinated by a researcher. In the case of the guide, an online community was also created as a working tool to speed up communications among the participants, reducing the number of face-to-face sessions. Participation was voluntary. To draft the guideline, a Clinical Practice Guideline for support the family was made available, which had been translated into Spanish, together with an up-to-date bibliography.

RESULTS

Twenty four professionals were involved. We developed a guide that contained the following sections: introduction, objectives, the experiences and needs of families of patients in the ICU, strategies for action, specific procedures, and hospital resources. We designed strategies for the diffusion and implementation of the guide.

CONCLUSIONS

The guide is a useful tool that offers the professionals greater assurances and unifying criteria for action. During subsequent stages of the PAR project, an assessment will be made of the impact on professionals and users.

[Needs of the families in a Critical Care Unit]

OBJECTIVES

To identify the needs of the family of admitted patients in the Critical Care Unit (CCU), and their level of satisfaction with the attention that they received.

DESIGN

Cross-sectional, observational study.

SETTING

Critical Care Unit, Virgen Macarena University Hospital, Seville. SUBJECTS OF THE STUDY: Two-hundred and sixty-eight families were selected through a random sampling system.

INSTRUMENTS

A survey was developed using bibliography as reference.

RESULTS

According to information, it was observed that receiving information after visiting hours and its access was difficult in regards to unforeseen changes in the patient's course. On the other hand, there were high levels of satisfactions with the attention received and with the nursing cares. Nevertheless, several deficiencies were observed in the identification of all the professionals, the visiting hours, the physical conditions of the waiting room, and privacy within patient's care environment.

CONCLUSIONS

One of the principal needs of the relatives was to spend more time with the patients. Regarding to the information, access after visiting hours, and on that regarding unforeseen changes in the patient's evolution should be reviewed. Regarding satisfaction, in general, families were highly satisfied with the attention received, especially with the nurse's care. Nevertheless, these professionals should encourage the participation of the families in the patient's care. Moreover, all the areas of improvement observed should be dealt with urgently, mainly the visiting hours.

[Analysis of the literature on the relatives of the critical patient: research in effective care needs to be performed]

AIM

To explore the nature of studies on families and the Intensive Care Unit context and the issues they deal with.

DESIGN AND METHODS

This is a qualitative, methodological study that makes a documental analysis of 24 articles (between 1993-2004) located by descriptors in journals and databases. A double analysis was conducted: quality assessment and content analysis.

RESULTS

The articles analyzed were mainly descriptive and reviews of the literature. Six categories were found: environment hostility, family needs, design of interventions, nursing care, experience of the families, and decision making autonomy.

CONCLUSIONS

The nursing staff wants to establish care aimed at the patient's family. To do so, they need to be trained in psychological aspects such as handling of emotional stress, strategies and skills for coping and communication strategies and skills. Research should change its focus from being description to proposing and evaluating intervention strategies. Research findings should translate into recommendations for this change.

[What is important for the family of patients in the intensive care unit?]

The abundant bibliography shows us that the family plays a fundamental paper in the recovery of the hospitalized patients, and the patients in the intensive care units (ICU) are no exception. Several authors have demonstrated that a stress-free and calm setting helps in the care process. Thus, the family needs must be considered to improve their well-being. In this way, their attitude will help in the patient's recovery. Health care personnel must be aware of these needs and make up for their deficit as far as possible. The first study that evaluated this question used the CCFNI questionnaire (Critical Care Family Needs Inventory) that measures the degree of importance given by the relatives to the needs of safety, support, information, comfort and proximity. This study has aimed to detect the degree of importance given by the relatives of the patients in the ICU of the Hospital Dr. Josep Trueta of Girona, using the CCFNI questionnaire. All the relatives of the patients in said unit during the autumn of the year 2003 were interviewed and the needs considered to be most important were compared with the sociodemographic variables of the relatives. The total sample was made up of the 132 people interviewed. The need considered to be most important was safety with 50.3% followed by need for support with 47.2%. In the results, some differences were observed depending according to age and studies of those surveyed and according to the diagnosis and the origin of the hospitalization. The collected data did not differ with the reviewed bibliography. All the study was very valuable for the health care professionals of the unit and was taken into account to improve the deficiencies of the ICU of the hospital of Girona.

[Organization of visits in Spanish ICU]

It is a fact that visits in the intensive care units (ICU) have always been very restrictive due to diverse criteria. Nowadays, some of them have been progressively liberalized, giving to the relatives more satisfaction and a better cover to their necessities. In our country there are no surveys about the organization of these visits at the present time, apart from some exceptional cases which commentate the situation in a particular center.

OBJECTIVE

Know how are visits organized in the intensive cares units in Spain.

MATERIAL AND METHOD

DESIGN

cross-sectional study; scope: 98 ICU of different Spanish hospitals; studied variables: the number of visits, their duration, the number of relatives in each visit, the number of relatives visiting the patients at the same time, the amount of information each day, the professional that informs, the use of written information and information by telephone, preventive measures taken before the entry in the unit, how relatives take part in the cares, location of the waiting room and use or not of a protocol of attention to relatives.

INSTRUMENTATION

The information has been obtained by a questionnaire placed in a web site of the Internet and directed to professionals of different Intensive cares units.

RESULTS

The ninety and eight evaluated units represent 37 Spanish provinces from all the autonomous communities. The most frequently noticed pattern for the organization of visits shows a restrictive character of the visits in Spain.

CONCLUSIONS

There are clear differences in the organization of visits between the studied ICU and no connection between the most common practice and what the survey, after evaluating the necessities of the relatives, recommends. These recommendations are: more visits, more flexibility of schedules, more integration of the relatives in the patients cares, broach the information from diverse disciplines, washing hands as the only necessary measure to be taken by the relatives.

The process of giving information to families of critically ill patients: a field of tension

We conducted research to study nurses' views on factors that influence their relationship with patients' relatives in intensive care units in three hospitals in Mallorca (Balearic Islands, Spain). This article focuses on the findings related to the process of giving information to the family. We used a post-structuralist theoretical framework and data were collected through observations and interviews. The analysis revealed that nurses thought information eases relatives' worries, but they felt that in order to avoid conflicts with physicians they should restrain themselves from providing it. We propose that the existing power relationships in intensive care units should be challenged if we expect health care professionals to offer patients' relatives a planned information process.