Caring for relatives in intensive care – an exemplar of advanced practice - editorial

URL:

http://www.blackwell-synergy.com/doi/abs/10.1111/j.1478-5153.2006.00201.x

Keywords:

family care

Abstract:

When a patient is admitted to the intensive care unit (ICU), the central focus is 'on patients' life-threatening pathophysiological states and on stabilizing interventions' (Benner et al., 1999, p. 294). Secondary to this role is caring for the patient's family, and it is suggested that nurses working in general (adult) ICUs have much to learn about family-centred care from paediatric intensive care unit nurses (Latour, 2005).

Full Text:

When a patient is admitted to the intensive care unit (ICU), the central focus is 'on patients' life-threatening pathophysiological states and on stabilizing interventions' (Benner et al., 1999, p. 294). Secondary to this role is caring for the patient's family, and it is suggested that nurses working in general (adult) ICUs have much to learn about family-centred care from paediatric intensive care unit nurses (Latour, 2005). Benner et al. (1999) suggest that it requires 'astute clinical judgment, wisdom, skill and coming to terms with the human significance of critical illness and injury to care for family members of the critically ill' (p. 294). Caring for the family is described as difficult and stressful for many critical care nurses (Leske, 2000), creating 'emotional labour' for nurses (Smith, 1992); however, it is suggested that family support (visiting) for the critically ill patient can have benefits in terms of instilling a sense of hope (Hupcey, 2000), reduced heart rate (Schulte et al., 1993) and higher patient and family satisfaction (Roland et al., 2001). While there is limited research examining the specific times when family need critical care nurses' support and care, understanding these 'critical junctures' from the relatives' perspective will help nurses to prioritize care for families.A study conducted in two Australian critical care units, one in a large teaching hospital and the other in a smaller regional hospital, examined these issues from the perspectives of families and nurses. Families of patients in the critical care unit participated in informal interviews and completed a Professional Support Questionnaire (adapted from Waters, 1999). Nurses also participated in informal interviews and completed questionnaires related to their communication skills and team climate. Family members were asked when they needed most support from the critical care nurses and to rank critical junctures in the priority when they felt support was required. Nurses were also asked when they perceived family most needed their support and to rank these times identified as critical junctures for family requiring support. Findings revealed an interesting contrast in perspectives: nurses believed family would need to have most support when the family member was dying followed by ICU admission, and family said they needed most support when the patient was admitted, then if the patient was likely to die or was dying. The third critical juncture family said they needed support was when their family member required interventions or procedures.Benner et al. (1999) highlight three central aspects of family care in ICU: (1) ensuring the family can be with the patient, (2) providing the family with information and support and (3) encouraging family involvement in caregiving activities. The study reported above focuses particularly on the second of these. However, findings of a recent study suggest that relatives can also contribute to patient management in the early stages of intensive care admission (Green et al., 2005). Relatives completed a questionnaire to assess the patient's premorbid psychological profile; results demonstrated that premorbid psychological profile (in particular, the patient's 'desire for control') independently predicted sedation requirement in critically ill, mechanically ventilated patients. The researchers suggest that early identification of such a profile (shortly after the patient's admission to ICU) may help in sedation management (Green et al., 2005).The difference in perspectives of relatives and nurses outlined above (Berry et al., 2006) provides a salutary reminder: (1) not to make assumptions about relatives' needs, (2) to periodically review the aspects of practice that may seem routine, (3) and perhaps most importantly, to consider how we facilitate others to acquire the expertise (Scholes, 2006) required to identify those times when relatives need additional support.In the current cost-cutting climate, it would be foolhardy to deny the value of sound evidence for the impact of nursing interventions on patient outcomes. However, we must not lose sight of the fact that many of our interventions do not have outcomes that are easily measurable. Equally it is essential that we do not lose the 'heart' of expert critical care nursing (providing care for patients and families) in our striving to take on new challenges and demonstrate improved outcomes.

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