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.     

The needs of the family of critically ill neurosurgical patients: a comparison of nurses' and family members' perceptions.

In this study, researchers identified the important needs of family members of critically ill neurosurgical patients and explored the relationship between needs and unmet needs as perceived by nurses and family members. A total of 52 family members and 36 nurses in three neurosurgical special care units in Hong Kong were asked to complete the Chinese version of the 45-item Critical Care Family Needs Inventory. The rank order of most important needs reported by family members indicates that the majority of needs are related to assurance; needs for support and comfort were much less important. When rating needs, nurses underrated most of the needs considered important by family members. Needs for proximity were also underrated in importance by nurses when compared to family ratings, and needs for support were heavily overrated by nurses. The needs for proximity were least met. An inverse relationship between nurses' ratings of importance and the frequency of unmet needs was demonstrated. The most important need that was also largely unmet was having a specific person call when unable to visit. The findings of this study indicate areas of unmet need that require additional 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.     

Close relatives in intensive care from the perspective of critical care nurses

Aim. The aim was to describe critical care nurses’ experiences of close relatives within intensive care. Background. There is a lack of research describing critical care nurses' experiences of the significance of close relatives in intensive care. Knowledge in this area will support critical care nurses to develop good nursing care for the critically ill person and their close relatives. Design and method. The design of the study was qualitative. Data collection was carried out through focus group discussions with 24 critical care nurses in four focus groups during spring 2004. The data were subjected to qualitative thematic content analysis. Results. The focus groups discussions showed that the presence of close relatives was taken for granted by critical care nurses and it was frustrating if the critically ill person did not have any. Information from close relatives made it possible for critical care nurses to create individual care for the critically ill person. They supported close relatives by giving them information, being near and trying to establish good relations with them. Close relatives were important. Critical care nurses lacked forums for reflection and discussion about the care given. Relevance to clinical practice. This study indicates that close relatives are a prerequisite for critical care nurses to give good nursing care to meet the needs of the critically ill person. A communication based on mutual understanding is necessary if critical care nurses are to be able to support close relatives. Dealing constantly with situations that were ethically difficult without any chance to reflect was an obstacle for critical care nurses to improve their work with close relatives.     

Needs of family members of intensive care unit patients.

To identify important needs of families of critically ill patients, and the degree to which these needs were being met, 64 family members and 58 nurses were asked to complete a modified version of the Critical Care Family Needs Inventory (Molter & Leske, 1983). Family members and nurses identified many similar important needs, such as the need to have questions answered honestly, the need to be called at home about changes in the patient's condition, and the need to know why things were done for the patient. However, family members indicated that some needs were both more important and less satisfactorily met than the nurses perceived: the need to know the occupational identity of staff members, directions as to what to do at the patient's bedside, and having friends for support.     

重症监护室危重患者家属需求的调查与分析

目的了解重症监护室患者家属的需求，为临床护理工作提供依据。方法采用Molter的“急危重患者家庭需要量表”中文版，对47例ICU患者的家属进行调查。结果患者家属认为最需要的项目是了解患者的治疗与预后、知晓患者病情变化等，认为最不需要的项目是与自身有关的需求；人口学分析结果显示，部分需要与患者家属的年龄、性别、文化水平和人均月收入有关。结论ICU护士必须正确认识患者家属的需要，根据其性别、年龄、文化水平和家庭收入等因素满足患者家庭需要，以帮助其应对家庭危机状态。     

Family-focused interventions

CATs are interventions that should be considered by critical care nurses when planning interventions for meeting the needs of families of critically ill patients. More research is needed on the effect of family members providing CAT to critically ill patients and what forms of CAT are most effective. Comparison studies of CAT being provided by certified providers versus family members are needed. Using CAT for family members may be useful in reducing their levels of stress and anxiety and therefore reducing negative physiologic and psychologic responses to stress.     

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.     

急诊危重患者家属病情保证需求和护士对其认知的研究

目的 了解急诊危重患者家属对病情保证(AS)的需求,以及护士对家属需求的认知.方法 采用危重患者家属需求量表(CCFNI)对100例急诊抢救间/急诊监护室(EICU)的患者家属和100名急诊科护士进行涮查.结果 在7个条目中,家属组对AS的需求与护士组对其认知有4个条目差异无统计学意义(P>0.05),如实回答家属问题、家属能知道病情变化的具体情况、让家属能感到病情有望好转等3个条目差异有统计学意义(P<0.05).结论 急诊科护理人员对危重患者家属的需求大部分都能满足,但仍有需要进一步改善、提高的问题.     

Shifting focus: A grounded theory of how family members to critically ill patients manage their situation

ObjectivesCritical illness is a life-threatening condition for the patient, which affects their family members as a traumatic experience. Well-known long-term consequences include impact on mental health and health-related quality of life. This study aims to develop a grounded theory to explain pattern of behaviours in family members of critically ill patients cared for in an intensive care unit, addressing the period from when the patient becomes critically ill until recovery at home.Research methodology/designWe used a classic grounded theory to explore the main concern for family members of intensive care patients. Fourteen interviews and seven observations with a total of 21 participants were analysed. Data were collected from February 2019 to June 2021.SettingThree general intensive care units in Sweden, consisting of a university hospital and two county hospitals.FindingsThe theory Shifting focus explains how family members’ main concern, living on hold, is managed. This theory involves different strategies: decoding, sheltering and emotional processing. The theory has three different outcomes: adjusting focus, emotional resigning or remaining in focus.ConclusionFamily members could stand in the shadow of the patients’ critical illness and needs. This emotional adversity is processed through shifting focus from one’s own needs and well-being to the patient’s survival, needs and well-being. This theory can raise awareness of how family members of critically ill patients manage the process from critical illness until return to everyday life at home. Future research focusing on family members’ need for support and information, to reduce stress in everyday life, is needed.Implications for Clinical PracticeHealthcare professionals should support family members in shifting focus by interaction, clear and honest communication, and through mediating hope.     

Accommodation and resistance to the dominant cultural discourse on psychiatric mental health: oral history accounts of family members

Oral history makes a critical contribution in articulating the perspectives of people often overlooked in histories written from the standpoint of dominating class, gender, ethnic or professional groups. Using three interrelated approaches - life stories, oral history, and narrative analysis - this paper analyzes family responses to psychiatric care and mental illness in oral history interviews with family members who experienced mental illness themselves or within their family between 1930 and 1975. Interviews with three family members in Alberta, Canada are the primary focus. These stories provide an important avenue to understand the meaning and transformations of mental health-care from the point of view of families. Family members' stories reveal contradictory responses to the dominant cultural discourse. Using a performative framework of interpretation, the narratives reveal a complex interplay between medical, social and cultural conceptions of mental illness, deepening our understanding of its meaning. The history of mental health-care can be substantially enriched by the analysis of family members' stories, not only revealing the constructed nature of mental illness, but also illustrating the family as a mediating context in which the meaning of mental illness is negotiated.     

ICU family support group sessions: family members' perceived benefits

The purpose of this research was to identify the relationship between attending an ICU family support group and the family's appraisal of stress, social support, and hope. In addition, the family members' perceived benefits of attending an ICU family support family support group session does not significantly change stress levels, feelings of hope, and social support. Analysis of data reconfirms that family members of critically ill patients have a tremendous need for information. Although findings revealed that the majority of the family members who attended the support session would recommend attending again, it is unclear whether the support session method is the most beneficial and cost-effective means to support families of critically ill patients.     

Transitioning to end-of-life care in the intensive care unit: a case of unifying divergent desires

Traditionally, the intensive care unit (ICU) has focused on reversal of life-threatening illness. Patients with incurable cancer admitted to the ICU present unique challenges for clinicians when these patients transition to end-of-life (EOL) care. A dimensional analysis of a single case study from a larger 30-case ethnographic study was used to explore the cancer patient's transition to EOL care in the ICU. Family members and clinicians had different expectations of care, which resulted in divergent treatment goals and desires for the patient, a 62-year-old woman with presumed pneumonia and underlying terminal glioblastoma multiforme. The attending physician and palliative care consultant unified family members' and clinicians' divergent goals and desires through a mediating process of probing the family about the patient's wishes. This process unified those involved and brought them to a place of acceptance. This case illustrates the turning point and rationale for the shift to EOL care in the ICU and the important role that communication plays in the transition. Understanding individual and family processes and family members' need for time to adjust to the transition to EOL is an essential element of practice within ICUs that increasingly manage terminally ill cancer patients.