Professional Documents
Culture Documents
Critical Care: A
Practical Approach
to Making It Happen
Elizabeth A. Henneman, RN, PhD, CCNS
Suzette Cardin, RN, DNSc, CNAA
he needs of
f a m i l y
members of
critically ill
patients are
well established: the
need for information, the need for reassurance and support, and the need to
be near the patient. 1-7 Despite a
wealth of evidence supporting
these basic needs, many critical
care units continue to struggle
with implementing or maintaining family-centered critical care.
STEP 2: KNOW
WHAT THE NEEDS
OF FAMILIES
REALLY ARE
As mentioned previously, the
most important needs of families
of critically ill patients are the
need for information, the need for
reassurance and support, and the
need to be near the patient. 1-7
Although seemingly straightforward, these needs can be inter-
STEP 3: INTEGRATE
FAMILY-CENTERED
VALUES INTO YOUR
UNITS STANDARDS
AND POLICIES
Units with family-centered
philosophies incorporate familycentered care into all appropriate
standards and policies for the
units. It is important to translate
this philosophy into concrete messages for patients, their families,
and staff. For example, family
members should be told on their
first visit that the unit has a family
focus. New staff members should
also be made aware of the units
family focus. The nurse recruiter
or manager interviewing potential
employees should emphasize the
role of all staff members in meeting the needs of patients families
(Table 2).
Hospital and unit administrators play a key role in ensuring that
family-centered care is valued in
the organization. Administrators
can serve as powerful role models
by participating in decisions related
to family-centered care and in
valuing and rewarding staff members who demonstrate familyfocused behaviors (Table 2).
STEP 4: USE
HOSPITAL
RESOURCES TO
PROVIDE FAMILYCENTERED CARE
Bedside nurses cannot meet
the needs of patients families and
take care of the patients all by
themselves. The key to effective
family-centered care is to train all
staff members about the needs of
patients families. Programs related
to meeting the needs of patients
family members must include
every member of the healthcare
team.
STEP 5: CREATE
TOOLS TO HELP
A variety of tools such as information booklets and checklists
have been suggested as ways to
meet the information needs of patients families. 11,12 Information
booklets provide family members
with concrete information about
who is who and what to expect in
a unit. Checklists outlining the
specifics of what to say and do
during a family members visit are
especially helpful for new employees and ensure consistency
from one staff member to the
next11 (Table 3). Family-centered
assessment tools and policies are
other examples of structures that
support family-centered care
(Tables 4 and 5).
STEP 6: DO NOT
CONFUSE FAMILY
ISSUES WITH
SECURITY OR
CONFIDENTIALITY
ISSUES
Concern over violence in the
workplace is a frequent deterrent
to establishing a family-centered
environment. Obviously, the safety
of staff members and patients is a
primary concern. All security issues
must be addressed, and steps must
be taken to ensure safety. On the
other hand, the potential for violence should not preclude patients
and families from being together
and having their needs met during
a critical illness.
One approach to attending to
security and family issues is to
include representatives from the
hospital security department in
discussions and planning when
visiting policies are being examined. The expertise of these team
members will be valuable not only
initially but also later as problems
and concerns arise.
Front-line personnel such as
security teams play a critical role
in ensuring that the needs of patients and patients family members are met. As initial responders
or greeters, these personnel set
the standards and expectations
for patients families. The primary
message conveyed to family
members should be that they are
valued and welcome. At the same
time, however, it should be made
clear that there are certain standards (eg, calling before entering
the unit) that must be adhered to.
STEP 7: BE
CONSISTENT WITH
PATIENTS FAMILIES
A frequent concern voiced by
patients and their families is the
inconsistency in the information
they receive. Perhaps the most
classic example of this inconsistency is related to visiting hours.
It is quite typical for individual
nurses to be comfortable letting
patients family members visit
quite liberally, regardless of the
actual visiting policy. When
Friends
Support group
Church group
Other
Would you like your family present during our morning rounds when we review
your condition and plan of care?
Yes
No
What is the best time for your family to communicate with the MICU Team?
Anytime
Mornings
Afternoons
Evenings
Dont know
STEP 8: MAKE
FAMILY-CENTERED
CARE A
MULTIDISCIPLINARY
GROUP ENDEAVOR
Perhaps the biggest mistake a
unit can make is to view familycentered care as solely within the
domain of nursing. All members
of the team who have contact with
patients families play an important role in ensuring that the families needs are met. Among others,
these team members include physicians, nurses, respiratory therapists, physical therapists, pastoral
care, social workers, and dieticians. From the start, leaders
interested in promoting a family
focus must recognize the unique
contribution and expertise of
each member of the team relative
to the patients families in the unit.
When family care is a team func-
STEP 9: RECOGNIZE
THE NEED FOR
ONGOING
ATTENTION AND
SUPPORT
Implementing a family-centered approach to care is only the
beginning of an ongoing institutional commitment. As is the case
with any process of change, the
more preparation that goes into
implementation, the more smoothly the process will ultimately go.
However, regardless of the preparation, new challenges and issues
will inevitably arise in an organization dedicated to family-centered care.
It is unreasonable to expect
that staff members will suddenly
know how to handle every situation simply because a change in
philosophy has occurred. Time
must be devoted at unit staff meetings, conferences, or unit retreats
to discuss challenging cases and
concerns and to solve problems.
Adopting a family-centered
approach also does not mean that
difficult or challenging families will disappear. Despite the
best intentions, philosophies, or
standards, there will always be
patients families with needs different from the norm. However
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CONCLUSION
The time has come to embrace
the practice of family-centered
care. Patients and their families
have basic needs that must be
met if healthcare institutions are
to be successful in addressing
consumers needs and providing
holistic care.
Strategies for ensuring successful family-centered care are not
difficult, but they require embracing a philosophy that recognizes the needs of patients
families and the value of a proactive approach to ensuring that
those needs are consistently met.
References
1. Molter NC. Needs of relatives of critically ill patients: a descriptive study. Heart
Lung. 1979;8:332-339.
2. Daley L. The perceived immediate needs
of families with relatives in the intensive
care setting. Heart Lung. 1984;13;231-237.
3. Leske JS. Needs of relatives of critically
ill patients: a follow up. Heart Lung.
1986;15:189-193.
4. Hickey ML, Leske JS. Needs of families of
critically ill patients: state of the science