Communication With Family Members Of Critically Ill Patients

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).

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).

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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).

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).

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).

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).

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).

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).

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).

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).

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).

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

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 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).

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).

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).

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AIM:

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.

Literature review

This study is a literature review of 15 academic original articles. A literature review discusses published information in a particular subject area within a certain time period. A literature review can be just a simple summary of the sources, but it has an organizational pattern and combines both summary and synthesis of entails information (Polit & Beck, 2008).

Data collection

PubMed and CINAHL

In a general way the MEDLINE Database was developed by U.S. National Library of Medicine (NLM), and is widely recognized as the premier source for bibliographic coverage of the biomedical literature. MEDLINE cover about 5000 medical, nursing, and health journals published in about 70 countries and contain more than 15 million records dating back to the mid-1960s (Polit & Beck, 2008).

MeSH

Medical Subject Headings is to index articles. MeSH terminology provides a consistent way to retrieve information that may use different terminology for the same concepts (Polit & Beck, 2008). The authors searched for scientific articles by using PubMed database. By using MeSH box search to found our key word as follow:

“Communication”[Mesh]) AND “Family”[Mesh]) AND “Nursing Methodology Research”[Mesh], ((“Patients”[Mesh]) AND “Critical Illness”[Mesh]) AND “Intensive Care Units”[Mesh].

Search process in PubMed

Search word PubMed

Numbers of hits

Read abstract

Read article

Chosen articles

Date Time

Patients, Critical illness, Intensive Care Unit.

17

17

10

6

10-15/3/2011

Communication, Family, Nursing experience.

129

20

6

2

10-19/3/2011

Inclusion criteria and limits: PubMed and CINAHL are used in this study to search for the academic articles. PubMed comprises biomedical literature and CINAHL database the cumulative index to nursing and allied health literature, is a resource for nursing and allied health literature. The inclusion criteria for articles will be English language, nursing specialty, original scientific articles, setting Critical Care Unit (CCU) or Intensive Care Unit (ICU). And articles which was published between 2000-2010. It is concerned about human being studies in addition, only primary sources have been taken. The main concern was applied to nursing attitudes and experiences and any study includes other professions besides nursing was considered.

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Data analysis

The articles are all read and are analyzed manually and documented on word office program in the computer. The main concepts were highlights with different colors and are documented in different files. All different aspects are taken in the consideration, and are scheduled according to information correspondence and differences. The studies’ conclusions are read by the authors and included as supportive points in the conclusion of the study.

Quality of the study

In this study the classification and evaluation of the articles scientific quality is based on Sophiahemmet University College criteria.

ETHICAL CONSIDERATIONS:

The author are concern to deal with the results in an honest way and no changes to be made to the facts and finding. The articles which are used all ethically approved. The result will include both information that will support author’s thoughts and those which are not (Polit & Beck, 2008).