University of Tennessee at Martin: Ripley Center
Nursing 350, Spring 2013: Transition to Professional Nursing
When loved ones are admitted to a critical care area, the effect on the family as a unit can be serious and long term. Traditional rules for this area have not been advantageous to meeting the needs of the client with inclusion of the family and significant others, but have served as a shield for the healthcare staff. Research shows barriers in meeting the needs of family members that require solutions based on evidence rather than tradition.
Critical Care Family Needs
Families of critical care patients experience loss that has not routinely been a part of the patient care plan, yet plays a significant role in the recovery process. Nurses have been the profession that interacts most consistently with the family and as such have the responsibility of addressing the needs of the patient and their loved ones. Customarily the family is excluded from the bedside except under limited visitation. This practice denies the value of family support and prevents nursing interventions in meeting the family needs. Providing support and ensuring a positive outcome for the family should be included in the critical care pathway. Review of Literature
A review of journal articles that address the needs of critical care family members reveals ongoing research on this subject. Evidence of needed change in the routine of critical care is revealed in multiple research projects. From the perspective of nursing practice, a more open communication with the family would be a step in resolving emotional stress experienced with the hospitalization of a significant other.
The research of Siddiqui, Sheikh, and Kamal (2011) attempted to determine what the family of intensive care unit (ICU) patients expected and were the expectations fulfilled. An open-ended questionnaire was created to explore the uniqueness of the location, Pakistan, of the study. The questions were presented in interviews with 205 adult family members of ICU patients in a tertiary care hospital. Previous research of this type in developing nations was not located. The critical care family needs survey (CCFNI) (Molter and Leske, 1995) was reviewed, but not used. Western studies were difficult to apply due to the differences in culture, education, socioeconomic status, and payment issues. Results of the study may not be representative of a majority of the population based on the use of a convenience sample in a limited setting. Communication with the family was considered a key issue to satisfaction. Within the critical care atmosphere, healthcare workers may tend to neglect this as a priority. The focus is primarily on the severity of the patient. Inclusiveness of adequate and effective communication decreased misunderstandings and frustration and increased the ability of the family to act as surrogates in decision-making and protect patient autonomy.
Chronic critical illness (CCI) effect on the psychological well-being of family members was explored by Hickman and Douglas (2010). Advances in resources and technology have increased the life-sustaining capabilities of healthcare in chronic critically ill patients. Exposure to the often protracted, uncertain, and expensive course of CCI posed the possibility of overwhelming stress on the patient and family. Psychological risks included depression, anxiety, and acute/post-traumatic stress disorder (PTSD). Risk for depression remained in some family members even one year after the patient’s discharge. Contributing factors for the continued risk of depression were the family members’ view of their physical health status and their estimation of caregiver burden. Anxiety levels were associated with uncertainty, absence of information, and transition of care delivery. Acute stress disorder experienced by family members of critically ill...