ICU revamps relations between staff, families

Innovative program includes families in rounds

Two years ago, communication between the intensive care staff and patients’ families at St. Joseph Health Center in Kansas City, MO, was rocky at best.

"The families weren’t involved in the patients’ care as much as I’d like," recalls Twila Buckner, RN, BSN, manager of the progressive care and cardiac care units. "We brought them in when it was convenient for us — not when they needed it. That didn’t make for a smooth relationship."

Visiting hours were highly restrictive, there was no real liaison between the staff and families, and the volunteers who staffed the waiting room were little more than "greeters and gatekeepers," says Buckner.

"They were pretty much just there to make the coffee," adds Rita Laws, manager of volunteer services. They were not informed of a patient’s condition or about any procedures being performed. Volunteers weren’t providing much of a service, so they weren’t sticking around. Laws was finding it difficult to get volunteers for the hospital.

Remove barriers, change the rules

As for the families waiting for news of their loved ones, there was a big barrier, says Laws. "There were signs everywhere saying ‘Do not do this,’" she says.

Only two family members were allowed into the patient’s room every two hours — and only for 10 minutes at a time. These rules and the volunteers’ lack of information added to the frustration for family members.

But things have changed. Armed with a small grant and a lot of initiative, the staff have developed a program that includes families in daily rounds, helps them find temporary housing in the area, and even provides them with beepers. (See related story, above.)

"It all comes down to the word communication," says Laws. Families want to know what is going on, and they want to be as comfortable as possible while they are waiting.

When changes were being considered, Buckner drew on her experience with the local chapter of the American Association of Critical-Care Nurses (AACN). She had helped create a survey to determine what families at several area ICUs thought about the services. She found that they wanted to be able to spend time with their loved ones and have a comfortable place to wait.

"These needs were the same regardless of the type of hospital," says Buckner.

She resurrected a committee there to look at needs of families. It found that the facility "did not offer a lot of space or opportunity for quiet time," she says. The committee also realized that one way to improve the relationship between staff and the families was to get the volunteers more involved.

Thus was born a two-pronged movement to make families visiting St. Joseph’s ICU more comfortable. It consisted of physically redesigning the waiting room and using what Buckner calls "the softer touch."

The program, dubbed the Family Support Program, was kicked off in spring 1995 with a trial run of open visiting hours.

"There’s no way we could have any support of the family with such a closed ICU," says Buckner.

Although physicians initially balked at the idea, Laws says they have been very supportive of the whole program.

Physicians also were not happy about a decision to include families in the doctors’ rounds. In the past, if the family happened to be in the patient’s room when the doctor came by, that was fine. But no one made an effort to notify them that the doctor was in the unit. Now, a nurse will tell the volunteer when the doctor comes in. Instead of having to spend extra time with the family in the waiting room, the doctor talks to the family while making the evaluation.

Communication in the center

Communication is the core of the program. In the past, waiting room volunteers often were not told of significant changes in a patient’s condition, which led to tense situations involving not only the patient’s family but other families in the waiting room.

"The families get so emotionally entwined — the whole waiting room gets involved in it," says Buckner. "We thought it would be nice for the volunteers to know what’s going on."

Since the Family Support Program has been implemented, the volunteers are notified of pertinent changes, and they keep a log to record these special conditions so the next shift can keep up-to-date. And, since volunteers only come in once or twice a week, the log allows them to track patients’ progress.

The volunteers are much happier now that they have some structure to their jobs, Laws says. When families first come into the waiting room at the critical care unit, they are met by a volunteer who gives them a questionnaire and makes them aware of the services available to them — such as the serenity room. (For a list of other services, see box on p. 8.)

Also, a facilitator, usually one of the students in chaplain services, is notified of the family’s arrival. The facilitator gives the family an orientation and explains where they can touch the patient and what they can do safely to help the patient. "The volunteers are really a resource for the families," says Buckner.

Ardith Ubben, a volunteer at St. Joseph for the past 21¼2 years, says the program has done a lot to put families more at ease.

"Overall, it just gives them a warm feeling that not only does the hospital care for the patient but for the family as well," she says.

Buckner advises colleagues interested in implementing a similar program — or any program — to first establish a need. This is why the initial survey she conducted became so important.

"Any time you have data, you have the upper hand," Buckner says. "Even if you only have 15 people, and seven of them say you need to do something — that’s still important."

Find a partner in the community

The other keys to making a program successful are to have a partner in the community and to have a multidisciplinary team. In spring 1996, Buckner applied for the InnoVision grant from the AACN. The grant helps to fund "creative things, which fall outside the norm of what is usually budgeted," says Phyllis Reading, RN, MN, director of professional development for the AACN. To qualify for the AACN grant, a project must include participants from a health care provider institution, a community group, and at least one AACN member.

The St. Joseph Health Center Auxiliary is the community partner in this program. It provided money raised through bazaars, a gift shop, and craft sales. It has contributed considerably more than the $2,500 AACN grant. Buckner says the program so far has cost between $6,000 and $7,500.

Several departments are involved in the effort, Buckner says. For example, chaplain services has been a huge supporter of the program; the well-life coordinator chairs the committee, along with Buckner and Laws. Social work services is also sporadically involved, says Buckner. "With certain key partners," she says, "you can move mountains."

[For information on the InnoVision grant program, contact Phyllis Reading at the American Association of Critical-Care Nurses, 101 Columbia, Aliso Viejo, CA 92656-1491. Telephone: (800) 899-2226. E-mail:]