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Active Involvement of Families in ICU Care Improved Satisfaction with Care Provided
Abstract & Commentary
By Leslie A. Hoffman, RN, PhD, Department of Acute/Tertiary Care, School of Nursing, University of Pittsburgh, is Associate Editor for Critical Care Alert.
Dr. Hoffman reports no financial relationship to this field of study.
Synopsis: Partnering with families to provide basic care to the patient significantly improved ratings of respect, collaboration, and support.
Source: Mitchell M, et al. Positive effects of a nursing intervention on family-centered care in adult critical care. Am J Crit Care 2009;18:543-552.
Generally, families of critical care patients are not actively involved in patient care in a consistent or meaningful way. This study, conducted in two ICUs in Australia, was designed to determine if more active family involvement was feasible and positively received by those involved. Prior to beginning the study, the research team held focus group discussions with critical care nurses to discuss study goals and identify basic care activities that families could provide, such as hair combing, massage, and bathing. One facility was designated as the control site and the second as the intervention site. Subjects were a convenience sample of 174 family members (75 control, 99 intervention). At baseline, there were no significant between-group differences in the selected family members with respect to age, gender, or relationship with the patient. However, patients in the intervention group were younger (45.5 ± 18.1 years vs 52.1 ± 17.9 years; P = 0.03) and had lower APACHE III scores compared to controls (52.8 ± 26.2 vs 63.6 ± 28.3; P < 0.01). Families in the intervention group were more likely to perceive greater respect (P = 0.04), collaboration (P = 0.001), and support (P = 0.001) from members of the critical care team.
Although the role of the patient's family is widely recognized as important in making decisions vital to the patient that range from providing consent for procedures to decisions about withdrawing life support, families are infrequently involved in providing care to patients. There are many reasons for this practice, including care routines that focus on bathing and hygiene during nighttime hours when families are less likely to visit to preferences of critical care nurses who may be hesitant to disrupt routines to actively involve families. This limited involvement contrasts with the role families are expected to assume when the patient returns home and they assume the role of primary caregiver.
Findings of this study are not unexpected. Families who were more actively involved perceived a higher level of respect, more collaboration with the health care team, and more support from the critical care team. Each family member was allowed to decide what care he or she would provide by consulting with the bedside nurse and the patient, if possible. Most selected fundamental or basic care needs, e.g., massage, bathing, eye care, combing the hair, mouth care, shaving, and/or limb exercises. These decisions required discussion, collaboration, and cooperation from the bedside critical care nurse, which likely facilitated communication. The study would have been more enlightening if it included "debriefing" sessions designed to identify more detailed information regarding benefits and barriers to providing such care from the perspective of the family and critical care nurse. Nevertheless, the study provides interesting supportive data regarding the benefits of more active family involvement in the care of critically ill patients.