Ask your staff to spend time with patient’s family
Ask your staff to spend time with patient’s family
Working with families makes nurse’s job easier
When developing a standard care plan for patients, nurses should make special provisions for working with the patient’s family. Working with relatives will improve the chances of a better, more predictable outcome for the patient.
It’s also good common sense, says Beverly Ann Leith, RN, a staff nurse in the ICU at Montreal Neurological Hospital in Canada. A growing body of evidence points to the effectiveness of working with family members as part of a patient’s treatment plan in critical care.
It may not seem important, but it can be, says Leith, who has studied incidents of family anxiety in ICU patients and determined that much of the anxiety is shared by both the patient and family member in the same way.
The reasons aren’t exactly clear, says Leith. They are manifested, for example, in transfer anxiety, a common emotional instability shown by ICU patients regarding their future. Family members will demonstrate the same level of instability about the future destination of the patient.
Your nursing staff should work closely with the patient’s loved ones as early as admission day to lessen the uncertainty and assure relatives of the patient’s future well-being. "The family should understand that the ICU stay is only temporary, and the patient will be moved to another, equally capable nursing floor," Leith says.
Role of family in treatment now recognized
In recent years, there’s been a growing movement by the nursing profession to provide more emotional support to families of critically ill patients. Most of the progress has been spearheaded by neonatal ICUs, but spread over the years to adult critical care.
"Clinicians are becoming acutely aware of the role that families play in the patients’ progress," says Leith. But in a more practical sense, keeping relatives well-informed pays other dividends.
They tend to require less time and interrupt floor nurses less often when they know what is happening to the patient, says Jane Stover Leske, RN, PhD, associate professor of nursing at the University of Wisconsin/Milwaukee School of Nursing. Here are additional reasons for making the investment:
• Prevents negative exchanges. When family anxiety runs high, relatives may not be able to support the patient, especially during a negative change in the patient’s condition. In those cases, the instability may transfer to the patient, making matters worse, says Leske.
Unmitigated family anxiety may also show in distrust of hospital staff, lack of cooperation, noncompliance with treatment regimen, anger, and even lawsuits, Leske adds. Whether the exchanges are adverse or beneficial depends partially on the type of intervention provided by your staff.
• Answers defined needs. Leske’s research suggests that following the impact of a critical illness, family members exhibit a well-defined, predictable set of needs. They include the need to: 1) receive assurance; 2) remain near the patient; 3) receive accurate, timely information; 4) be comfortable; and 5) have expert support at hand.
The need to remain near the patient reflects a basic desire to link and maintain familial relationships, says Leske. Meeting this need helps families stay close and give support to the patient, which can invariably have a positive influence on outcome.
Family helps smooth discharge
• Helps shape discharge planning. Due to cutbacks in health care funding, patients are being discharged sooner and often directly home from the ICU. Most unit managers know that preparing the patient for an eventual transfer to home or anywhere else should begin as early as possible, says Leith. As recently as a decade ago, critical care nurses gave discharge planning low priority. Some studies indicate that nursing workloads, increased paperwork, higher patient acuity, and inadequate staffing played a role in minimizing discharge planning in the ICU.
Recent changes in viewpoint have raised new opportunities for families to play a vital role in helping nurses prepare patients more adequately for transfer or discharge, Leith adds.
• Fits in with growing consumerism. Patients are demanding more health care information, and providers are accommodating their wishes. Meanwhile, providers have shifted the focus of treatment away from the system to the patient. Patient-centered and focused care have assumed greater emphasis, says Leske.
In critical care, the shift has included families. Nurse managers are pivotal in ensuring that families and patients as a unit get the attention and support they need from the health care system, she adds. "Managers play a key role in creating the desired expectations in families of how well the unit will run and the effect it will have on the patient," Leske notes.
A couple of caveats are also appropriate. Honesty and consistency are paramount in working with families, Leith adds. Nurses frequently tell family members that the unit has an open visiting policy and then appear to reverse themselves when another nurse on duty restricts their schedule. This creates distrust, she says. (See related article, below.)
Furthermore, when assigning a liaison nurse to work closely with family members, it helps if the nurse has had previous training in family nursing. Some advanced practice nurses are good candidates for these responsibilities, says Leith.
They have the flexibility and time to devote to these duties, and their advanced training and education may give them a larger overview in meeting the family’s needs. "Experienced clinical nurse specialists can play a vital role, especially at a time of crisis when the family begins to fall apart," Leith says.
Family Intervention Tips |
|
Activity | Explanation |
• Identify a family spokesperson early | Father, mother, older sibling |
• Assign a primary nursing contact for the family | Nurse acts as liaison for unit |
• Establish mechanism for family access to patient | Open visitations, specific rules, etc. |
• Promote access to patient and ensure consistency | Encourage families to speak with nurses about unit rules and protocols |
• Establish mechanism to contact family | Telephone numbers, pagers, etc. |
• Provide information based on family needs | Videotapes, information booklets |
• Ensure support services are available | Coordinate with social worker, chaplain |
• Explain all procedures using understandable terms | Avoid clinical jargon in conversation |
• Offer tour of the ICU | Get families familiar with surroundings |
• Get family to participate in aspects of care | Activities of daily living, reading, etc.. |
• Include family in end-of-life planning | Prepare family for inevitable |
• Provide comfortable environment | Waiting rooms, access to meals |
• Establish system for daily communication | Telephone updates on changing condition |
Source: Jane Stover Leske, RN, PhD, University of Wisconsin/Milwaukee School of Nursing. |
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