Family Support Program for ICU Patient Relatives Essay

Evidence has shown that family members of Intensive Care Unit (ICU) patients develop anxiety, depression, or post-traumatic stress syndrome -like symptoms. Paparrigopoulos (2006), Joint Commission on Accreditation of Healthcare Organizations (JCAHO) (2006) and the Society of Critical Care Medicine recommend family-centered care, but few studies demonstrate successful interventions to “decrease the ad­verse psychological effect of critical illness on the family.^“ (Azoulay, 2005) Family Support Program for ICU Patient Relatives Essay

This project served to examine the feasibility of such interven­tions, and as a pilot program to investigate research procedures before the design of a controlled trial. Derived from business leadership models, “Facilitated Sensemaking,” provided the theoretical framework for the interventions: family members experience a disruption in their lives when a loved one is admitted to the ICU; they adjust with a compensatory process that may be influenced by nursing interventions. Family Support Program for ICU Patient Relatives Essay

2. Methods

The ‘Family Support Pro­gram’ was developed consisting of personalized instructions delivered a clinical nurse specialist, and a family visiting kit in zip-locked plastic bag consisting of: a workbook including program introduction and instructions, cognitive recovery activities, activities to perform at the bedside including passive range of motion exercises, and personal care items. The program was offered to 30 consecutive families in a 32 bed “mixed-use” ICU. All participants were English-speaking adult family members of mechanically ventilated adult ICU patients. To evaluate feasibility, data was collected on program acceptance, time of personal instruction, use of items in the family visiting kit, and family perception of program usefulness. In piloting the research procedure: a Family Sup­port Program evaluation, and adapted Critical Care Family Needs Inventory (aCCFNI) was administered and psychometric properties of the instrument — the reliability and validity of the questioner and scoring method — were assessed. Family Support Program for ICU Patient Relatives Essay

A convenience sample is a study of subjects taken from a group that is conveniently accessible to a researcher. One advantage of this is that it is easy to access, requiring little effort and time. This sampling method suffers from a major disadvantage in that it is not an accurate representation of the population, which can skew results quite radically. Use of a convenience sample is quite popular and prevalent, however, and it can be valid under certain conditions. Family Support Program for ICU Patient Relatives Essay

Biases and Flaws

Any number of biases can occur in a convenience sample. By selecting from a specific population such as students enrolled in Sociology 101, people visiting a mall between 10:00 am and 2:00 pm on Saturdays, or library patrons, the study inadvertently excludes a great deal of the population. Choosing only students in a particular classroom at a certain university can easily exclude certain portions of the general populace, such as children or those without the financial means to attend the school.

Such exclusions are not always a problem. For example, a study on library patrons could easily take a convenience sample of people at a certain library and generalize the results. On the other hand, a study on social attitudes toward people with disabilities should not use only the students in a sociology class, which does not necessarily represent an accurate cross-section of the population. This inability to accurately generalize the results of such a group makes it ineffective for many studies. Family Support Program for ICU Patient Relatives Essay

Researchers who want more valid results typically take a “probability sample,” which attempts to get an accurate representation of the population. It is not generally possible to study everyone, but it is possible to randomly assign people to a study with an eye toward retaining a balance of characteristics seen in the population in general. For example, organizations that conduct political polling usually try to draw on a large database of people and select subjects randomly. This randomization increases the chances of a more accurate pool forming to produce results that can be better generalized.Family Support Program for ICU Patient Relatives Essay

If a convenience sample is used, researchers typically disclose this fact. Good research usually includes a detailed overview of the sampling techniques used, so that people reading about it have a better understanding of how it was conducted. When revealing that a convenience sample was used, the researcher may also present justifications for its use and defend its accuracy.

3. Evaluation / Analysis

Standard statistical methods were applied using SPSS. Each aCCFNI item was ranked in order of importance using a weighted average analysis to measure “the importance of the need and how well that need was met” (Davidson 2010). The Family Sup­port Program evaluation questioner was in the same way analyzed with descriptive statistics. Family Support Program for ICU Patient Relatives Essay

4. Results

Of the thirty family members approached for the Family Support Program, all consented to participate. 22 surveys were returned. Quantitative analyses of the aCCFNI results determine all 45 needs had some importance. Likewise, all items offered within the family visiting kits were found useful to some fam­ily members. 42 Referrals to ancillary services were made for the 30 family members.

5. Discussion / Conclusion

Like previous research, this study demonstrated the importance of each of the 45-aCCFNI needs. A list of top 10 needs was also identified and corresponds with work by other researchers. Several non-generalizable opportunities for unit-specific performance improvement, including parking and other transportation related areas of stress were identified. Family Support Program for ICU Patient Relatives Essay

27% of family members who participated in the study did not to complete the surveys. The authors speculate that, “the early critical care period may be too stressful to concentrate on writing.” Only two family members were observed writing in the provided workbook even though the workbook was reported as helpful on the program evaluation questioner. The authors point-out similar phenomenon demonstrated in the literature (Kloos 2008). The small sample size was identified as a study limitation. Results of this study are “also limited to English-speaking adult family members of mechanically ventilated patients” (Davidson 2010).

The contents of the family visiting kits were re­fined with feedback received from family members during the study. It was suggested to build a ‘family supply cart’ to wheeled around the unit and offer supplies to family members. Family Support Program for ICU Patient Relatives Essay

Operational issues

During the study, many unit-specific issues arose regarding current practice and were for­warded to the leadership team for action. For example, while screening patients for inclu­sion into the study, the investigator discovered that many patients did not have family mem­bers or visitors. A visiting ministry to meet the social needs of those patients has been suggested. Family Support Program for ICU Patient Relatives Essay

Nurses and families alike were unaware of the hospital’s family room in the medical li­brary equipped with an Internet-connected computer and handy hot-linked Web sites as well as novels. Because of study refer­rals, the librarian reported an increased use in the family room (M. Robinson, personal oral communication, September 30, 2007). An informational sheet of family-friendly med­ical information sites was prepared for in­clusion in the visiting kit and later use. A note card explaining library services was de­veloped, printed, and stocked in the waiting areas. Family Support Program for ICU Patient Relatives Essay

As found in studies by Lautrette et al,³¹ Melnyk et al,¹⁴ Jones et al,¹³ and Kloos and Daly,³³ family members appreciate supportive interventions that are multimodal in nature, both verbal and written. In this study, families also self-reported and it was observed that tac­tile interventions using common household items for hands-on bedside activities were a welcome addition to the family support services. Family Support Program for ICU Patient Relatives Essay

CONCLUSION

The Family Support Program based on the model of facilitated sensemaking is not only feasible but also helpful to family members of mechanically vented, adult ICU patients. The demonstrated reliability of the aCCFNI supports its continued use in identifying im­portant needs and evaluating whether those needs are met for families of ICU patients. An overall score weighting importance and needs-met for each item aided in ranking op­portunities for improvement. Future research is warranted to continue evaluation of the Fa­cilitated Sensemaking theory and measure ef­fect of these interventions on outcomes (eg, anxiety, depression, symptoms suggestive of risk for posttraumatic stress). Inclusion of this nursing intervention is warranted to assist family members in communicating with the patient as part of the list of bedside activi­ties. Future study design should be expanded to other cultures or patient groups. Educa­tional programs targeted to provide instruc­tion for nurses on how to include family mem­bers into daily practice are also warranted. The time the lead investigator spent per fam­ily in supportive interactions appeared rea­sonable for inclusion into the bedside nurse’s practice. Family Support Program for ICU Patient Relatives Essay

Feasibility was further supported in that family members accepted and used the inter­ventions that were based on concepts of the Facilitated Sensemaking model. Information to assist with decoding by explaining equip­ment, alarms, and surroundings was notably accepted. Instructions for interacting with or assisting ICU patients were appreciated. The provision of personal care supplies was found to be most helpful and useful. Verbal instruc­tions and hands-on activities were preferred over journaling activities. Family Support Program for ICU Patient Relatives Essay

References

Azoulay, E., Pochard, F., Kentish-Barnes, N. et al. (2005). Risk of post-traumatic stress symptoms in family members of intensive care unit patients. American Journal of Respiratory and Critical Care Medicine .171 (9): 987-994

Paparrigopoulos, T., Melissaki, A., Efthymiou, A. et al.(2006).Short-term psychological impact on family members of intensive care unit patients. Journal of Psychosomatic Research.61 (5):719-722

Critical Care Unit (CCU) or Intensive Care Unit (ICU) is designed to meet the special needs of acutely and critically ill patients in a hospital setting. In many acute care setting, the concept of ICU care has expended from delivering care in a standard unit to bringing ICU care to patients wherever they might be. The electronic or virtual ICU is designed to augment the bedside ICU team to monitoring the patient from a remote location. The ICU staff includes critical care physician, respiratory therapist team, critical care nurses, and advanced practice nurses (APN). The capability exists to continuously monitor ECG, blood pressure, oxygenation saturation, mechanical ventilation, cardiac output, intracranial pressure, and temperature. More advanced monitoring devices allow for the measurement of cardiac index, stroke volume, ejection fraction, end-tidal carbon dioxide (CO2), and tissue oxygen consumption (Lewis et al., 2007). Family Support Program for ICU Patient Relatives Essay

Intensive care settings are designed to assist and care for patients with complex, multiple or life threatening heath problems. Many of the patients are ventilated and/or chemically paralyzed and sedated. The emphasis in ICUs is on technology and short stays. The environment is often noisy, technical and fear inducing to many patients (Usher& Monkley, 2001).

The intensive car unit (ICU) is a place where technology is used to save or enhance the lives of patients and is staffed with clinicians who are skilled at managing physiology and responding to the rapidly changing status of their patients. The clinicians who work in the ICU are able to multitask, set priorities, and constantly assess and manipulate an array of medical machines and vital signs to help improve the patient’s functional status. These clinicians are focused on helping patients get their life back to how it was before the injury or illness landed them in the ICU. Patients are transferred to the ICU to receive an aggressive level of treatment that is not available on other units in a hospital (Treece, 2007). Family Support Program for ICU Patient Relatives Essay

Communication

Communication refers to an organized, patterned system of behavior that may be verbal or nonverbal. Verbal communication includes not only the language or dialect, but also the voice tone, volume, timing, and one’s ability to share thoughts and feelings. Nonverbal communication may take a form of writing, gestures, body movements, posture, and facial expressions. Nonverbal communication also includes eye contact, use of touch, body language, and style of greeting. Other variables to consider include the role of gender, age, acculturation, status, or position on what is considered to be appropriate eye contact. For example, Muslim Arab women exhibit modesty when avoiding eye contact with men other than their husbands and when in public situations (Lewis et al., 2007). Family Support Program for ICU Patient Relatives Essay

Communication regarding end-of-life issues with patients and families has long been recognized as complex and not always done well as judged from all those involved. From the perspective of families, they have indicated that when involved in making decisions at end of life, they feel a sense of comfort and support when they might otherwise feel helpless. A number of studi [€ ] es have identified what families report to be helpful when making end of life decisions for their loved ones. These factors included communicating timely, emotionally supporting families in making decisions, having an advanced directive that provides honor, and having access to the patient before and after death (Liaschenko.J., O’Conner-Von. S., Peden-McAlpine. C, 2009). Family Support Program for ICU Patient Relatives Essay

The importance of effective communication in intensive care settings is well established. However, anecdotal and research evidence suggests that many patients recover from episodes of critical illness that necessitated admission to an intensive care unit (ICU) with a less than favorable view of the nurses’ ability to communicate effectively. Patients often describe how they felt frustrated and alienated by the apparent lack of communication in these settings. Further, just because patients are unconscious, we can never assume they do not perceive attempts to communicate with them (Usher& Monkley, 2001). Family Support Program for ICU Patient Relatives Essay

With increasing focus on improving care in the ICU, the author runs the risk of forgetting the family of patients who survive their ICU stay. There are several reasons to focus on communication with the families of all critically ill patients. First, it is generally not clear whether critically ill patients will survive at time when clinician-family communication should be occurring. Second, although the patient’s death in the ICU is a risk factor for psychological symptoms among family members, even family of patient who survive are at increased risk of these symptoms compared to the general population. Finally, there is evidence that family members of patients who survive are actually less satisfied with communication from ICU clinicians than family of patients who die. If we are to be truly effective in improving clinician-family communication, we must attempt to improve this communication for the family of all critically ill patients (Curtis & white, 2008). Family Support Program for ICU Patient Relatives Essay

Role of the ICU nurse

The nurses who work in critical care units are responsible for providing care to patients who are experiencing or at risk for experiencing life threatening conditions. Patients typically cared for in a critical care unit include patients that have had major invasive surgery, accident and trauma patients, or patients with multiple organ failure. Nurses who work in critical care units must assess and monitor the patient closely in order to identify subtle changes in a patient’s condition that warrant immediate intervention. Patients who admitted to a critical care unit need intensive care in order to maintain their condition, monitoring, and continuous adjustment of treatment, such as changing in doses of multiple intravenous medications, and changes in ventilator support. Critical care nurses must be able to interpret, integrate and respond to a wide array of clinical information because of the critical nature of patients’ conditions (Kozier, Erb, &Berman, 2008). Family Support Program for ICU Patient Relatives Essay

The critical care nurse cares for patients and the families of patients with acute and unstable physiological problems in an environment equipped for technically advanced methods of assessing and managing patient problems. The American Association of Critical Care Nurses (AACN) defines critical care nursing as that specially dealing with human responses to life-threatening problems (Lewis et al., 2007). Family Support Program for ICU Patient Relatives Essay

Nursing staff in ICUs are important facilitators of communication because they provide a link between the patient and the outside world. Nurses are said to provide a conduit for [€ ] initiating and maintaining a modicum of normality in an otherwise alien environment. This is important when many of the patients are unconscious, as is the case in these settings (Usher& Monkley, 2001). Family Support Program for ICU Patient Relatives Essay

Critically ill patient

A patient is generally admitted in ICU for one of three reasons. First, the patient may be physiologically unstable, requiring advanced clinical judgments by the nurse or physician. Second, the patient may be at risk serious complications and required frequent and often intensive assessment. Third, the patient may require intensive and complicated nursing support related to the use of intravenous (IV) polypharmacy such as sedation and thrombolytics drugs. The patient who admitted to ICU are due to a serious conditions such as respiratory distress, major cardiac surgeries, and myocardial ischemic or infarction (Lewis et al., 2007).

Severe sepsis with associated multisystem organ dysfunction is a leading cause of death in patients hospitalized in intensive care units (ICU). The gastrointestinal tract plays an important role in the pathogenesis of multiorgan dysfunction owing to breakdown of intestinal barrier function and increased translocation of bacteria and bacterial components into the systemic circulation and all those factors lead the patient to become critically ill ( Jacobi, C. A., Schulz. C., Malfertheiner. P, 2011). Family Support Program for ICU Patient Relatives Essay

For many patients, a stay in an intensive care unit can be very frightening and confusing. Some patient may have been prepared for such an eventuality, while others may have been admitted there unexpectedly. In either case, the intensity of the environment and the level of staffing required can be very daunting. In these settings, many patients will have a period of being either intubated or requiring the formation of a tracheostomy, leading to them being unable to talk and therefore asking questions about their health, their care or their prognosis. The lack of control of their own environment can have a significant number of counter effects on the individual’s cognitive and psychological status and potentially can result in misunderstandings. Many studies have demonstrated that the promotion of a suitable means of communication for an individual can improve well being, which may therefore increase compliance with rehabilitation therapies and reduce length of stay (Batty. S, 2009). Family Support Program for ICU Patient Relatives Essay

Ninety percent of deaths in the ICU involve withdrawing or withholding care, but less than five percent of critically ill patients are able to participate in the decision making process leading to treatment limitation (LeClaire, Oakes, & Weinert, 2005).

Most of the critically ill patients do not have decision making capacity, family members frequently become involved with clinicians in discussions about the goals of care and often must represent patients’ values and treatment preferences in these discussions. Therefore, clinician family communication is [€ ] a central component of good medical decision making in the ICU. Prior studies suggest that family members view clinicians’ communication skills as more important than our clinical skills (Curtis & white, 2008). Family Support Program for ICU Patient Relatives Essay

Family

The family is a basic unit of society. It consists of those individuals, male or female, youth or adult, legally or not legally related, genetically or not genetically related, who are considered by the others to represent their significant persons. Family consists of persons (structure) and their responsibilities within the family roles (Kozier, Erb, &Berman, 2008). The definition of family member is the direct family person or significant one who identified as “close relative” (Henderson & Knapp, 2005). Family Support Program for ICU Patient Relatives Essay

Family members of patients in the ICU are exposed to considerable stress. To better help relatives in this situation it is important to gather information about how they experience the information provided by and support from the medical staff. The staff may underestimate relatives’ needs (Myhern, Ekeberg, Langen& Stokland, 2004).

Communication between families and providers in the intensive care unit includes sharing information about illness and prognosis, engaging families in treatment decision making, and offering support. Treatment decisions are complex, and communication is essential for designing treatments that incorporate patient values. Communication also affects patient and family outcomes (Scheunemann, McDevitt, Carson, & Hanson, 2010). Family Support Program for ICU Patient Relatives Essay

However, communication is complicated by time constraints, lack of communication skills training, unclear goals and processes, and challenging family dynamics. Nurses must possess good communication skills in order to provide humane, complete and comprehensive care. Such abilities imply: listening well, honesty, avoiding a conspiracy of silence, fake cheerfulness, never dismissing hope and providing relief of pain. The guidelines of the American Association of Colleges of Nursing State that a nurse must have certain skills to be able to provide a high quality assistance to for example dying patients and their families, such as an effective and compassionate communication ability, when death issues are concerned, among other skills (Trovo de Araujo, M. M., & Paes da Silva, M. J, 2004).

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Family members are becoming an increasing part of care giving for seriously ill patients, whether this is informal support and care in the home or surrogate decision making in the ICU. Informal care and decision making provided by family, partners, and friends constitute a growing portion of the health care provided to seriously ill patients. Furthermore, approximately 20% of deaths in the United States occur in the ICU, and most of these deaths involve family members acting as surrogates for the patient. In the ICU setting, there is an additional reason to focus on the needs of the family. Since family members are often serving as surrogate decision makers, decisions about the care of the patient depend in part on the family. To the extent that family members; distress affect their ability to provide substituted judgment, these burdens of family members can interfere with patient care. Therefore, effective communication with family members that minimizes stress on the family and provides support for the family will improve not only family outcomes but also medical decision making for the critically ill patient (Curtis & white, 2008). Family Support Program for ICU Patient Relatives Essay

To describe nurse’s experiences of communicating with family members of critically ill patients in an ICU setting.

METHOD:

The authors used a literature review method design in their research topic.