The essence of the family critical illness experience and nurse-family meetings

Nursing care of families is essential to strong family support and maintenance of family health during a critical illness. Secondary data analysis of interviews conducted with 11 families with a family member in the intensive care unit revealed two essences: the family critical illness experience and the family vision for the kind of care families required and desired from nurses. The purpose of this article was to explicate the essence of these phenomena and their implications for family nursing practice. Findings affirm the need for a family intervention described in the literature, that of regularly scheduled nurse-family meetings. Although developed for work with families experiencing a chronic illness, bringing families together and inviting meaningful conversation about their experiences is appropriate for families experiencing critical illness. Nurse-family meetings acknowledge suffering and vulnerability of families when a loved one is critically ill and afford families an opportunity for honest sensitive communication with nurses.     

Professional nursing support for culturally diverse family members of critically ill adults

Family members' perceptions of professional support expected of critical care nurses were examined for differences related to cultural affiliation using the "Professional Support Questionnaire for Critical Care Nurses Working with Family Members" (PSQ). The PSQ was administered face-to-face to family members waiting to visit a critically ill relative admitted to the intensive care unit. ANOVA and post hoc tests were computed to compare 90 family members' expectations for professional nursing support during a relative's critical illness across three cultural groups-African American, Hispanic, and White. There were significant differences in family members' responses on certain PSQ items across cultural groups. Despite these differences, family members' expectations of professional support from critical care nurses were generally universal-suggesting equitable care, dignity, and respect should be universal values. There is a need for critical care nurses to develop interventions that respect some cultural uniqueness as well as address the universal needs of family members coping with the ICU admission of a critically ill family member.     

A family nursing educational intervention supports nurses and families in an adult intensive care unit

The family experience of critical illness is filled with distress that may have a lasting impact on family coping and family health. A nurse can become a source of comfort that helps the family endure. Yet, nurses often report a lack of confidence in communicating with families and families report troubling relationships with nurses. In spite of strong evidence supporting nursing practice focused on the family, family nursing interventions often not implemented in the critical care setting. This pilot study examined the influence of an educational intervention on nurses’ attitudes towards and confidence in providing family care, as well as families’ perceptions of support from nurses in an adult critical care setting. An academic–clinical practice partnership used digital storytelling as an educational strategy. A Knowledge to Action Process Framework guided this study. Results of pre-intervention data collection from families and nurses were used to inform the educational intervention. A convenience sample of family members completed the Iceland Family Perceived Support Questionnaire (ICE-FPSQ) to measure perception of support provided by nurses. Video, voice, and narrative stories of nurses describing their experiences caring for family members during a critical illness and family members’ experiences with a critically ill family member also guided education plans. When comparing the pre and post results of the Family Nurse Practice Scale (FNPS), nurses reported increased confidence, knowledge, and skill following the educational intervention. Qualitative data from nurses reported satisfaction with the educational intervention. Findings suggest that engaging nurses in educational opportunities focused on families while using storytelling methods encourages empathic understandings. Academic–clinician teams that drive directions show promise in supporting families and nurses in critical care settings. Plans are moving forward to use this study design and methods in other critical care settings.     

Nursing interventions for families of cardiac surgery patients

Caring for the cardiac surgery patient includes intervening with the patient's family members. It is important for the nurse to acquire the knowledge base to implement appropriate interventions with family members. An intervention program was designed to meet the needs of family members of cardiac surgery patients based on a compilation of previous research data. This program included providing educational classes for the nursing staff as well as giving written information and support to the family member while visiting in the intensive care unit. A visiting intervention checklist was given to each nurse to initiate for each family member at all visits. Family members who received the intervention program reported higher satisfaction of needs and lower anxiety levels than those family members who did not receive the program.     

A support group programme for relatives during the late palliative phase

This study describes an intervention where relatives were invited to take part in a support group programme during the late palliative phase of their family member. The purpose was to describe their experiences of the support group programme and the subsequent impact on their lives as relatives of a terminally ill person. Qualitative interviews were chosen as the data collection method. The analysis was inspired by the phenomenological method as described by Giorgi (1989). The relatives' experiences were categorised into six key constituents: confirmation; insight into the gravity of the illness; sense of belonging created by similar experiences; participation in the care system; being able to rest; and strength to provide support for the patient. These six constituents resulted in a sense of safety in relation to the patient, the illness, the nursing staff and the care unit. The study's findings show that interventions of this kind may be integral to the relatives' ability to handle their situation when caring for a terminally ill family member.     

Overview of family needs after critical illness: from assessment to intervention.

Results of numerous independent studies suggest that families of a critically ill hospitalized member have similar needs that they can readily identify as very important. Empirical analysis of results compiled from many studies across patient populations, settings, geographic locations, and over time indicates that families have primary needs for assurance, proximity, and information. These primary family needs provide a research-based framework to guide critical care nurses in implementing and evaluating family-centered nursing interventions.     

Clinical application of family research: a unit-based approach

The needs of family members with a critically ill relative present a significant challenge to nursing professionals in the intensive care unit. Initially, interventions aimed at providing focused information and relieving anxiety take precedence. As the crisis period passes, however, the family may need to reestablish familiar patterns of functioning. Thus, family assessment and intervention is vital throughout the course of the patient's hospitalization. This article examines how a medical-respiratory intensive care unit has applied family need research in designing and implementing an ongoing family-based plan of care.     

Needs of adult family members after critical illness: prescriptions for interventions.

Concerns for family members of critically ill patients are evident in nursing literature; however, assessment parameters and intervention strategies during the critical care experience require further consideration. This article reviews the results of prior published and unpublished nursing research pertaining to needs of adult family members after critical illness. Selected nursing interventions are provided to encourage practitioners and researchers to develop, test, and evaluate those activities that most effectively meet various types of family-member needs.     

Models of family-centered care in one acute care institution

Focus on the emotional responses and needs of critically ill patients has grown to encompass a focus on their families as well. Moos notes that the family as well as the patient faces a number of adaptive tasks in the crisis of serious illness. These include managing the hospital environment, keeping reasonable emotional balance, negotiating relationships with the treatment staff, preserving self-image, preserving a relationship with the patient, and preparing for an uncertain future. The complexity of these tasks and the coping skills needed to master them speaks to the role of the psychiatric clinical nurse specialist in the acute care setting. This article has highlighted some activities of psychiatric clinical nurse specialists working with families in the acute care setting. Included have been support groups, indirect models, contracting, professional families, VIP/VRP families, families in the intensive care setting, and families in transition from intensive care to floor care. All emphasize the importance and needs of the family as well as the patient during hospitalization in an acute care setting.     

Children visiting family and friends on adult intensive care units: the nurses' perspective

Recent surveys show that children are still restricted from visiting their critically ill family and friends on many adult intensive care units throughout the country. The purpose of this small-scale exploratory pilot study was to examine and describe the experiences and perceptions of trained nurses towards children visiting within this setting. The aim of the study was to gain greater insight and understanding into the reason why, despite evidence to support the benefits to children of visiting their critically ill family and friends, they remain discouraged and restricted. It is hoped that the study will act as an initial enquiry to generate themes and further research questions. A qualitative research approach was adopted and in-depth focused interviews used as a method of data collection. The participants of the study were trained nurses working on an adult intensive care unit in a district general hospital in England. A total of 12 individual interviews were conducted which were audiotaped in full and analysed using a method of thematic content analysis. The value of the research is to promote family-centred care within an adult intensive care environment to meet the neglected needs of the well children of the critically ill person. The findings suggest that the participants in the study attempted to offer valuable support to children visiting their critically ill family and friends, but, despite an open visiting policy, children rarely visited within this setting. The desire of the well parent to protect and shield the child from the crisis of critical illness was perceived by the participants to be the main reason why they did not visit. To provide family-centred care within an adult intensive care setting has many implications for practice and several of these important issues are discussed. These include the educational and training needs of nursing staff and the importance of adopting a collaborative team approach to providing care for the critically ill person and their family. The need to generate research and literature from within the United Kingdom's health care system has also been identified and recommendations for further studies are proposed.     

An evidence-based protocol for sensory soothing in paediatric intensive care

In recent years, an increasing body of literature has highlighted the significant sequelae of a paediatric intensive care unit admission for children and their families. More innovative bedside approaches are needed to support children's coping and development and help minimize the use of sedatives, given their known deleterious effects. To support nursing staff in managing agitation in critically ill infants and children, a ‘Sensory Pyramid’ program was built in collaboration with occupational therapists, child life specialists and critical care nursing staff at an academic medical center in the United States. Anchored in evidence-based and developmentally appropriate non-pharmacologic sensory soothing techniques, the protocol outlines escalating comfort interventions nurses can employ that are safe and feasible for implementation by bedside staff and families.     

Circular questions: a family interviewing strategy

Assessment strategies for working with the family of the critically ill typically focus on collecting data from family members in order to determine if the family requires further support or intervention. This article describes using the technique of circular questioning to obtain information from and provide the family with new information. Circular questions are interventions as well as assessment strategies. The authors provide critical care examples of the use of circular questions with families of the critically ill.     

Family functioning during a critical illness: a systems theory perspective.

In this article the effects of critical illness on family functioning are described within a systems theory framework. As identified in the literature, family vulnerabilities and strengths that impede or support family functioning during the time a member has a critical illness are discussed. Strategies that nurses can use to assist families of critically ill patients are explored. A challenge to expand family-centered care across various settings is extended.     

The needs of children visiting on adult intensive care units: a review of the literature and recommendations for practice

AIM: The purpose of this paper is to review the current literature and research available and to identify specific, nursing interventions to meet the needs of child visiting within the ICU setting. BACKGROUND: According to recent surveys children are still restricted from visiting their critically ill family and friends on many adult intensive care units (ICUs) within the United Kingdom (UK). Imposing restrictive visiting policies does not respect the rights of patients and their families to be together and to support each other during a period of stress and crisis. METHOD: The motivation to undertake the study was derived from a critical incident involving a small boy who was not allowed to visit his critically ill mother. She subsequently died. Reflection on the available literature identified the value and role of intuition in expert clinical judgement, but the need to support this with evidence based knowledge. CONCLUSION: The implications for practice are discussed and recommendations for further research are made.     

Shock. Psychosocial needs of the patient and family

This discussion has identified psychosocial needs of the patient and family experiencing shock, a life-threatening illness. Both individuals and families represent constellations of needs, the definitions of which are dependent on situational, familial, and patient-centered variables. Life-threatening illness is a complex phenomenon wherein psychosocial needs and responses can be obscured by a rapidly unfolding clinical picture. Nursing research focusing on critically ill patients and their families has for many years described and quantified psychosocial needs as affected by the dynamics of life-threatening illness. Interventions directed toward meeting individual and family needs have been proposed, implemented, and evaluated. As health care resources become increasingly valuable commodities and as patients and their families become more sophisticated consumers of care, critical care nursing practice must continue to value psychosocial needs and demonstrate commitment to sensitive, individualized intervention. We cannot continue to write about the phenomenon of life-threatening illness without incorporating nursing knowledge into clinical practice.     

Effects of a needs-based education programme for family carers with a relative in an intensive care unit: a quasi-experimental study

Critical illness and subsequent hospitalisation of a relative to an intensive care unit (ICU) can result in many physiological and psychosocial problems for patients and their family members. Caring for the anxiety and frustration of these families is an integral part of critical care nursing. The purpose of this study was to examine the effect of a needs-based education programme provided within the first 3 days of patients' hospitalisation, on the anxiety levels and satisfaction of psychosocial needs of their families. This was a quasi-experimental study with pre- and post-test design. A convenience sample was recruited over a period of three months, consisting of one primary family carer of each critically ill patient who had been admitted to an ICU in Hong Kong. Conducted by an ICU nurse specially assigned for the purpose, family carers in the experimental group (n=34) received an individual education programme based on the results of a literature review and an individual family needs assessment carried out at the time of patient admission, using the Critical Care Family Needs Inventory. The subjects in the control group (n=32) received the usual orientation and explanation given by the ICU nurses. Anxiety and need satisfaction were measured in the two groups at pre- and post-test and their mean scores were compared. Of the ten most important statements identified by the family carers in the two groups, the statements regarding the needs for information and assurance were found to predominate. After the needs-based intervention, the experimental group reported significantly lower levels of anxiety and higher levels of satisfaction of family needs than the control group at the post-test. The findings support the effectiveness of providing families of newly admitted critically ill patients, with a needs-based educational intervention to allay anxiety and satisfy immediate psychosocial needs. The formulation of a family education programme should be based on the results of a needs assessment, in order to meet family carers' individual needs.     

The COPE program: a strategy to improve outcomes of critically ill young children and their parents

Critically ill young children and their parents are subjected to multiple stressors during hospitalization, which may predispose them to short- and long-term negative outcomes. Nurses who care for children who are critically ill and their families during and following their intensive care unit stay must be knowledgeable of the impact of a child's critical illness on the family and factors influencing adjustment to the stressful experience. Knowledge of these issues is essential in planning effective intervention strategies to enhance coping outcomes in this population. This article (a) discusses how young children and their parents are affected by critical illness; (b) outlines major sources of stress for families; (c) identifies factors influencing coping outcomes; and (d) describes the COPE program, a newly devised early intervention program for critically ill young children and their parents.     

Social support and the chronically ill individual

Nurses caring for the chronically ill need to be alert for the problems of social isolation and social impairment. Families often respond initially to serious illness by becoming over-protective and fostering dependence and a sense of impaired competence in the ill person. As the illness continues, families often experience exhaustion because of the demands of new roles, depleted finances, and other aspects of a changed lifestyle. Feelings of anger, guilt, and helplessness occur in the network, often leading to withdrawal of support--especially as the ill person's ability to reciprocate support is impaired. Nursing interventions in situations of social isolation focus on reducing isolation by promoting social interaction as appropriate, and by directly or indirectly mobilizing or expanding the social network. The problem of impaired social interaction may occur secondary to the personality changes that often accompany chronic illnesses, or as a function of the chronic illness or disability itself, as in the case of mental illnesses. Social impairment is an appropriate nursing diagnosis in abusive families. Nursing interventions range from educational programs for social skill development to reduction of the amount of contact within the network to involvement of protective and psychotherapy services. Chronic illness has profound effects on social support and the social network of both the ill person and his or her family. As both long-term illnesses and family involvement in care giving increase, nursing care in situations of chronic illness must include attention to issues of social support. Nursing diagnosis provides a framework for nurses to include social support in their care of the chronically ill patient. Social isolation and social impairment can be reduced by nursing interventions.     

The perceived needs of Jordanian families of hospitalized, critically ill patients

The purpose of this study was to identify needs of Jordanian families of hospitalized, critically ill patients. The Critical Care Family Needs Inventory was introduced to 158 family members who were visiting their hospitalized, critically ill relatives. The findings revealed that > or = 80% of the family members perceived 16 need statements as important or very important. The participants ranked order needs for assurance, information and proximity the highest and needs for support and comfort the lowest. Specifically, the most important needs of the families were to receive information about the patients, to feel that the hospital personnel care about the patients and to have the information given in understandable terms. Results of this study indicated that Jordanian families had specific and identifiable needs. Providing families of critically ill patients clear, simple and updated information about the patients, and assuring them about the quality of care the patients receive, should be essential components of the critical care nursing delivery system.