LA CONSULTA SEMANAL

CONSULTA

1: Crit Care Med 2001 Oct;29(10):1893-7

Comment in:

Crit Care Med. 2001 Oct;29(10):2025-6.

Symptoms of anxiety and depression in family members of intensive care unit patients: ethical hypothesis regarding decision-making capacity.

Pochard F, Azoulay E, Chevret S, Lemaire F, Hubert P, Canoui P, Grassin M, Zittoun R, le Gall JR, Dhainaut JF, Schlemmer B; The French FAMIREA Group.

Service de reanimation medicale, hopital Cochin, Paris, France.

OBJECTIVE: Anxiety and depression may have a major impact on a person's ability to make decisions. Characterization of symptoms that reflect anxiety and depression in family members visiting intensive care patients should be of major relevance to the ethics of involving family members in decision-making, particularly about end-of-life issues. DESIGN: Prospective multicenter study. SETTING: Forty-three French intensive care units (37 adult and six pediatric); each unit included 15 patients admitted for longer than 2 days. PATIENTS: Six hundred thirty-seven patients and 920 family members. INTERVENTIONS: Intensive care unit characteristics and data on the patient and family members were collected. Family members completed the Hospital Anxiety and Depression Scale to allow evaluation of the prevalence and potential factors associated with symptoms of anxiety and depression. MEASUREMENTS AND MAIN RESULTS: Of 920 Hospital Anxiety and Depression Scale questionnaires that were completed by family members, all items were completed in 836 questionnaires, which formed the basis for this study. The prevalence of symptoms of anxiety and depression in family members was 69.1% and 35.4%, respectively. Symptoms of anxiety or depression were present in 72.7% of family members and 84% of spouses. Factors associated with symptoms of anxiety in a multivariate model included patient-related factors (absence of chronic disease), family-related factors (spouse, female gender, desire for professional psychological help, help being received by general practitioner), and caregiver-related factors (absence of regular physician and nurse meetings, absence of a room used only for meetings with family members). The multivariate model also identified three groups of factors associated with symptoms of depression: patient-related (age), family-related (spouse, female gender, not of French descent), and caregiver-related (no waiting room, perceived contradictions in the information provided by caregivers). CONCLUSIONS: More than two-thirds of family members visiting patients in the intensive care unit suffer from symptoms of anxiety or depression. Involvement of anxious or depressed family members in end-of-life decisions should be carefully discussed.

Publication Types:

Multicenter Study

2: Enferm Intensiva 2000 Jul-Sep;11(3):107-17

[Opinions and attitudes of intensive care nurses on the effect of open visits on patients, family members, and nurses]

[Article in Spanish]

Marco Landa L, Bermejillo Eguia I, Garayalde Fernandez de Pinedo N, Sarrate Adot I, Margall Coscojuela MA, Asiain Erro MC.

Unidad de Cuidados Intensivos Clinica Universitaria de Navarra Avda. Pio XII, 36 31008 Pamplona.

The policy of family visits to patients admitted to the intensive care unit has been liberalized in recent years. This change has been progressive in our unit and family members now spend long periods of time with patients. An analysis was made of the beliefs, opinions and attitudes of nurses toward family visits and the relation between the beliefs of nurses and their attitude toward the effect of an open visiting policy on patients, family members and nurses. A descriptive correlation study was carried out in the Polyvalent Intensive Care Unit. The sample included 46 nurses who completed a self-administered, anonymous questionnaire. This questionnaire contained a Likert type scale analyzing the opinions of nurses regarding the effect of visits and a differential semantic scale analyzing nurses' attitudes toward visits by family members. The opinion that visits had a positive effect achieved a mean value of 3.001 on a scale with a maximum value of 4. The score obtained on the scale of attitudes toward an open visiting policy was 6.005, with a maximum value of 7. The correlation between opinions and attitudes was significant and positive (r = 0.523, p > 0.0001). Comparison of sociodemographic and other variables disclosed no statistically significant differences, except for the variables attitude and having children (t = -2.254, p = 0.03), which obtained a higher score. It is concluded that the opinions of nurses regarding the positive effect of open visits depended on their attitudes. For the most part, they were satisfied with the current visiting policy.

3: Crit Care Med 2001 Feb;29(2 Suppl):N26-33

The family conference as a focus to improve communication about end-of-life care in the intensive care unit: opportunities for improvement.

Curtis JR, Patrick DL, Shannon SE, Treece PD, Engelberg RA, Rubenfeld GD.

Division of Pulmonary and Critical Care Medicine, School of Medicine, University of Washington, Seattle, WA, USA.

The intensive care unit (ICU) represents a hospital setting in which death and discussion about end-of-life care are common, yet these conversations are often difficult. Such difficulties arise, in part, because a family may be facing an unexpected poor prognosis associated with an acute illness or exacerbation and, in part, because the ICU orientation is one of saving lives. Understanding and improving communication about end-of-life care between clinicians and families in the ICU is an important focus for improving the quality of care in the ICU. This communication often occurs in the "family conference" attended by several family members and members of the ICU team, including physicians, nurses, and social workers. In this article, we review the importance of communication about end-of-life care during the family conference and make specific recommendations for physicians and nurses interested in improving the quality of their communication about end-of-life care with family members. Because excellent end-of-life care is an important part of high-quality intensive care, ICU clinicians should approach the family conference with the same care and planning that they approach other ICU procedures. This article outlines specific steps that may facilitate good communication about end-of-life care in the ICU before, during, and after the conference. The article also provides direction for the future to improve physician-family and nurse-family communication about end-of-life care in the ICU and a research agenda to improve this communication. Research to examine and improve communication about end-of-life care in the ICU must proceed in conjunction with ongoing empiric efforts to improve the quality of care we provide to patients who die during or shortly after a stay in the ICU.

Publication Types:

Review

Review, Tutorial

4: Heart Lung 2001 Jan-Feb;30(1):74-84

Family-provider relationships and well-being in families with preterm infants in the NICU.

Van Riper M.

Ohio State University College of Nursing, 1585 Neil Ave., Columbus, OH 43210, USA.

OBJECTIVE: The purposes of this study were the following: (1) to describe maternal perceptions of family-provider relationships in the neonatal intensive care unit (NICU) and (2) to examine associations between maternal perceptions of family-provider relationships in the NICU and well-being in families with preterm infants. DESIGN: The study's design was descriptive and correlational. SETTING: The study took place in 5 NICUs in midwestern United States. PARTICIPANTS: The study included 55 mothers of preterm infants hospitalized in the NICU. MEASURES: Self-report measures: the Family-Provider Relationships Instrument-NICU, Ryff's measure of psychologic well-being, and the General Scale of the Family Assessment Measure. RESULTS: Mothers of preterm infants who depicted their family's relationship with their child's primary health care providers in the NICU as positive and family-centered reported more satisfaction with the care received. In addition, these mothers expressed a greater willingness to seek help from health care providers. When mothers reported a discrepancy between what they wanted the family-provider relationships to be like and what they believed the relationship was like, they were less satisfied with care received. Mothers who wanted and believed they had positive family-centered relationships with providers were more satisfied with the care received and they reported higher levels of psychologic well-being. CONCLUSION: The nature of the relationships that families develop with health care providers in the NICU may have a profound influence on how individuals and families respond to the experience of having a preterm infant. Health care providers who incorporate the key elements of family-centered care into their practice can have a positive influence on well-being in families of preterm infants.

Publication Types:

Multicenter Study

5: J Palliat Care 2000 Oct;16 Suppl:S40-4

Withdrawal of life support: how the family feels, and why.

Keenan SP, Mawdsley C, Plotkin D, Webster GK, Priestap F.

Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada.

The objectives of this study were to develop an instrument to assess the satisfaction of family members with withdrawal of life support (WLS), and to determine which factors are associated with greater levels of satisfaction. To do this, we developed a self-administered questionnaire that was sent to the next-of-kin of intensive care unit (ICU) patients dying following WLS. Over a six-month period, 69 patients died following WLS in the ICU. Three letters were returned "address unknown", 33 did not respond, and 33 responded, of whom 29 agreed to participate (29/66 = 44% of those contacted). Of these, 24 (83%) strongly agreed with the patient's death being compassionate and dignified, one moderately agreed, one mildly agreed, one was neutral and two strongly disagreed. Items associated with greater satisfaction included: the process of WLS being well explained, WLS proceeding as expected, patient appearing comfortable, family/friends prepared for the decision, appropriate person initiating discussion, adequate privacy during WLS, chance to voice concerns. The study suggests factors that are important to consider in ensuring family comfort with the process of withdrawing life support.

6: Heart Lung 2000 Jul-Aug;29(4):278-86

Reliability and validity of the Critical Care Family Needs Inventory in a Dutch-speaking Belgian sample.

Bijttebier P, Delva D, Vanoost S, Bobbaers H, Lauwers P, Vertommen H.

Department of Psychology, University of Leuven, Belgium.

OBJECTIVE: The purpose of the study was to provide psychometric evaluation of the Dutch version of the Critical Care Family Needs Inventory. SETTING: The study took place in an intensive care unit of a university hospital. PARTICIPANTS: The participant group included 200 adult family members visiting a patient within the 72-hour interval after admission to the intensive care unit. RESULTS: Principal factor analysis with varimax rotation resulted in a 5-factor solution distinguishing 5 need types: need for information, need for comfort, need for support, need for assurance and anxiety reduction, and need for proximity and accessibility. The internal consistency of the resulting subscales ranged from 0.80 to 0.62, and all factors were significantly related to each other. The Critical Care Family Needs Inventory subscales were found to be clearly related to the demographic variables age, sex, and education level. CONCLUSION: The reliability and validity of the Dutch-language Critical Care Family Needs Inventory as a diagnostic tool in family needs assessment are supported.

7: Rev Esc Enferm USP 1999 Mar;33(1):39-48

[Guiding patients' family members through an intensive care unit: difficulties of lack of systematization?]

[Article in Portuguese]

Domingues CI, Santini L, da Silva VE.

Escola de Enfermagem da USP.

The purpose of this study was to analyse the problematic situation experienced by nurses at the moment of guiding the relatives of patients in an ICU. Therefore, seven (7) nurses who worked in this unit, which belonged to a general, public and training hospital in the city of Sao Paulo, were interviewed. The results have shown that the period of guiding brings anxiety and stress to the nurses, originated by the critical patient's condition, as well by the deficiency of conduts and in the systematization of this activity in the unit. Based on the results it was proposed the creation of na assistance plan. That includes the guiding to the family and the elaboration of a written instrument of orientation.

8: Crit Care Med 2000 May;28(5):1660-1

Comment on:

Crit Care Med. 2000 May;28(5):1347-52.

Pain assessment in the seriously ill patient: can family members play a role?

Devlin J.

Publication Types:

Comment

Editorial

9: Issues Compr Pediatr Nurs 1999 Jan-Mar;22(1):27-47

Identification of nurse-family intervention sites to decrease health-related family boundary ambiguity in PICU.

Tomlinson PS, Swiggum P, Harbaugh BL.

University of Minnesota School of Nursing, Minneapolis 55455, USA. Tomli001@tc.umn.edu

The most common explanation of parental stress associated with hospitalized children is based on individual stress theory. Using a family stress and family systems approach with an emphasis on examining family integrity, this qualitative study selected families in the Pediatric Intensive Care Unit (PICU) with high boundary ambiguity in the caregiving environment and identified potential sites for nursing actions that impede or assist families in maintaining family integrity. Within three days of admission of their child to a major tertiary children's hospital PICU, 29 families were recruited and screened with a Health-Related Family Boundary Ambiguity Scale. High scoring families (n = 11) were interviewed using an open-ended method. Data were analyzed using a content analysis method, and results were interpreted within a family systems framework. The following three potential areas of intervention to encourage family integrity during acute illness of a child were identified: fostering family normalcy, respecting family rights, and strengthening the family boundary. Implications for initiating or improving family centered care in the PICU are discussed.

10: J Clin Nurs 1999 May;8(3):253-62

Looking out for the patient and ourselves--the process of family integration into the ICU.

Hupcey JE.

School of Nursing, College of Health and Human Development, Pennsylvania State University, Hershey 17033, USA. jxh37@psu.edu

As more intensive care units (ICU) are adopting the policy of unrestricted family visiting, families are playing an increasing role in the unit. This role may be restricted to being involved in discussions and decisions related to the patient or may entail a caregiving role. This study examined how families and nurses interact to increase or decrease the family's involvement in the ICU, how nurses maintain control, how families remain on guard, endure and find their niche in the ICU. The techniques of grounded theory were used to develop a model of the process of family integration into the ICU. This model was developed around the core variable of 'looking out for the patient-looking out for ourselves'. The perspectives of ICU nurses, families and ICU patients in the process of looking out for the patient while they look out for themselves are discussed, as well as nurses maintaining the position of power and families remaining on guard and enduring the ICU experience.

11: Arch Pediatr Adolesc Med 1999 Sep;153(9):955-8

Family presence during invasive procedures in the pediatric intensive care unit:a prospective study.

Powers KS, Rubenstein JS.

Department of Pediatric Critical Care, University of Rochester School of Medicine and Dentistry, NY 14642, USA. karen_powers@urmc.rochester.edu

OBJECTIVES: To determine if allowing 1 or both parents to be present during invasive procedures reduces the anxiety that parents experience while their child is in the pediatric intensive care unit; to evaluate if the parent's presence was helpful to the child and parent; and to determine whether this presence was harmful to the nurses or physicians. DESIGN: A prospective study using surveys (5-point Likert scale) of parents of children requiring intubation, placement of central lines, or chest tubes. Additional surveys were completed by bedside nurses to evaluate the effects of parental presence. SETTING: A 12-bed pediatric intensive care unit in upstate New York. PARTICIPANTS: The study population consisted of the parents of 16 children undergoing 1 or more procedures; 7 had undergone intubation, 11 had central lines placed, and 2 had chest tubes placed. The control population consisted of the parents of 7 children undergoing 1 or more procedures; 7 had undergone intubation, 5 had central lines placed, and 3 had chest tubes placed. RESULTS: Parental presence significantly reduced the parental anxiety related to the procedure (P = .005; Mann-Whitney test), but did not change condition-related anxiety (P = 0.9; Mann-Whitney test). Thirteen of 16 parents found their presence helpful to themselves (10 very, 3 somewhat) and the medical staff (11 very); 14 of 16 found their presence helpful to their child (11 very). Fifteen (94%) of 16 pare nts would repeat their choice to watch. Fifteen (94%) of 16 nurses found parents' presence helpful to the child (9 very) and to the parents (10 very). One nurse found a parent's presence somewhat harmful to nurses and very harmful to the parent. Thirteen (72%) of 18 nurses indicated that allowing parents to observe procedures was an appropriate policy. There were no significant differences noted in response of nurses based on years of experience. CONCLUSIONS: Allowing parental presence during procedures decreases procedure-related anxiety. The implications of such a policy change on physicians and other aspects of pediatric intensive care, including medical education, need further evaluation.

Publication Types:

Clinical Trial

Controlled Clinical Trial

12: Can J Cardiovasc Nurs 1997;8(4):43-6

Family partnership in care: integrating families into the coronary intensive care unit.

Bisaillon S, Li-James S, Mulcahy V, Furigay C, Houghton E, Keatings M, Costello J.

CICU Lab, Toronto Hospital, Ontario. sbisaillon@torhosp.toronto.on.ca

Since the introduction of Family Partnership in Care in the CICU and other pilot units, many changes have been made. Education sessions are now unit specific rather than in groups with multiple units. This facilitates the discussion of unit-specific educational and implementation needs. In addition, unit-specific sessions allow for some case scenario/role playing activities to facilitate learning and application of the FPCP elements to the unique culture of the unit. Finally, less emphasis is placed on the documentation, while greater emphasis is placed on the philosophy behind the program and the nurses values and attitudes towards families. Overall, the implementation of the FPCP in CICU has had a positive impact on staff and patients. Staff awareness regarding the importance of involving family in the patient's care and the benefits of this has been heightened. Staff who were initially very skeptical have become strong advocates for the program. The successful shift with families in "doing for" to "working with" has enhanced the professional practice of many nursing staff and contributed to the overall unit functioning. Finally, the feedback from patients and their care partners and the independence and informed decision-making fostered by designing a plan of care with staff validates the importance of this program in a critical care area.

13: West J Nurs Res 1998 Apr;20(2):180-94

Establishing the nurse-family relationship in the intensive care unit.

Hupcey JE.

School of Nursing, College of Human Development, Pennsylvania State University, USA.

The nurse-family relationship in the intensive care unit (ICU) may replace the traditional nurse-patient relationship due to the patient's compromised state. As a result, the nurse-family relationship becomes extremely important. Nurses and families may develop a relationship in which they work together to benefit the patient, or an inadequate relationship may develop. In this study, strategies used by nurses and families to either develop or inhibit the development of the nurse-family relationship were identified. Using unstructured interviews with ICU nurses and family members of ICU patients, categories of strategies were identified and behaviors described. Nurses and families perceived that they each displayed only positive behaviors yet identified inhibiting behaviors of the other. Once the behaviors were shown to nurses as secondary informants, they were able to identify with their negative behaviors. An understanding of these strategies will help nurses to reevaluate their practice and enhance their understanding of the behaviors of family members.

14: Crit Care Med 1998 Feb;26(2):266-71

Comment in:

Crit Care Med. 1998 Feb;26(2):206-7.

Measuring the ability to meet family needs in an intensive care unit.

Johnson D, Wilson M, Cavanaugh B, Bryden C, Gudmundson D, Moodley O. Division of Critical Care, Royal University Hospital, University of Saskatchewan, Saskatoon, Canada.

OBJECTIVE: To measure the ability to meet family needs in an intensive care unit (ICU). DESIGN: Descriptive survey. SETTING: University hospital ICU. SUBJECTS: Ninety-nine next of kin respondents and 16 secondary family respondents were recruited. INTERVENTIONS: A modified Society of Critical Care Medicine Family Needs Assessment instrument was used. MEASUREMENTS AND MAIN RESULTS: Demographic variables included patient age, gender, diagnosis, Acute Physiology and Chronic Health Evaluation (APACHE) II score on admission, Therapeutic Intervention Scoring System (TISS) score on the date of interview, cumulative TISS of the ICU on the day of interview, number of patients in the ICU at time of interview, nurse/patient ratio for the patient, average nurse/patient ratio of the entire unit, day of the week of the interview, timing of the interview, number of ICU attending physicians who cared for this patient (scheduled for a period of seven consecutive days), number of nurses who cared for the patient, if a nurse was assigned the same patient on two consecutive days worked, length of stay in the ICU, and length of hospital stay. Demographic information concerning the family member included gender, age, commuting time to the hospital, visiting time in the hospital per day, number in family group, relationship to the patient, ethnic background, and education level. The additive score of all questions in the needs assessment instrument was calculated and used as the dependent variable. The independent variables were demographic information concerning patients, ICU, and respondents. The model coefficient of determination (R2adj) was 0.20 with a p = .0079. Greater family dissatisfaction (i.e., higher score) was present if there were more than two ICU attendings per patient (p = .048), or if the same nurse was not assigned on two consecutive days (p = .044). Family satisfaction increased if the respondent was female (p = .006), if the patient had a higher APACHE II score (p = .007), and if the patient's relationship with the most significant family member was brother/sister (p = .012). The family needs instrument was reliable and demonstrated a high degree of concordance with a second respondent in the same family surveyed. CONCLUSIONS: Communication by the same provider was important when measuring the ability of an ICU to meet family needs. Instrument scores and the ability to meet family needs differed depending on the gender and the relationship to the patient of the most significant family member. We speculate that this instrument may be a useful adjunct in assessing quality of critical care services provided

15: Am J Crit Care 1998 Jan;7(1):30-6

Family members' experiences with decision making for incompetent patients in the ICU: a qualitative study.

Jacob DA.

University of Michigan, Ann Arbor, USA.

BACKGROUND: Understanding the challenges faced by family members involved in decisions about the use of life-sustaining treatment for incompetent patients in the ICU is necessary for developing empirically based supportive interventions. OBJECTIVES: To describe and explain the experiences of family members who were involved in decisions on behalf of their loved ones in order to promote understanding of such experiences and to suggest areas for effective, supportive intervention. METHODS: The grounded-theory method of qualitative research was used. Data collection involved semistructured interviews of 17 persons who had been involved in decisions about the use of life-sustaining treatment for a family member in the ICU. RESULTS: Family members discussed the need to arrive at a judgment of the patient's condition and to work with caregivers to have the family member's decision about life-sustaining treatment enacted. Data analysis suggests that clinicians can best support family members by helping the members arrive at a judgment about the patient's condition and treatment desires and by connecting with the family members to ensure that treatment goals are mutual. Supporting family members in this way helps them accept and go on in a positive way after the experience. CONCLUSIONS: Family members of patients in the ICU are willing and able to take responsibility for decisions about the use of life-sustaining treatment for their loved ones. The long-term acceptance of the experience and the decisions made depends greatly on the interactions between the family member who makes the decision and nurses and physicians in the clinical setting.

16: Am J Crit Care 1998 Jan;7(1):24-9

Effectiveness of a structured communication program for family members of patients in an ICU.

Medland JJ, Ferrans CE.

Hinsdale Hospital, Ill., USA.

BACKGROUND: In ICUs, an essential component of caring for patients' families is providing information about the patient's status. Nevertheless, interruptions by family members requesting information create an additional burden for nursing staff. OBJECTIVES: To test a structured communications program for family members to determine whether the program would increase family members' satisfaction with care, meet their needs for information better, and decrease disruption for the ICU nursing staff caused by incoming telephone calls from patients' family members. METHODS: The study used a two-group, pretest-posttest quasi-experimental design. The sample consisted of 30 family members of patients in a medical ICU (experimental group, n = 15; control group, n = 15). The intervention consisted of a structured communication program consisting of three components: (1) a discussion with a nurse approximately 24 hours after admission of the patient, (2) an informational pamphlet given at the time of the discussion, and (3) a daily telephone call from the nurse who was caring for the patient that day. RESULTS: The number of incoming calls from family members was significantly lower in the experimental group than in the control group. In the experimental group, satisfaction with care increased significantly from pretest to posttest, as did the members' perception of how well their information needs were being met. CONCLUSIONS: The intervention reduced the number of incoming calls from family members, without compromising family members' satisfaction with care or how well their information needs were met.

Publication Types:

Clinical Trial

Controlled Clinical Trial

17: Intensive Crit Care Nurs 1997 Apr;13(2):111-8

Meeting the informational, psychosocial and emotional needs of each ICU patient and family.

Wesson JS.

Cardiothoracic Intensive Care Unit, Southampton General Hospital, Shirley, UK.

The acquisition of counselling skills and a review of current practice within a cardiothoracic intensive care unit (ICU) have revealed the need for a nursing development that will focus on meeting the informational, psychosocial and emotional needs of patients and their families. The findings from a literature search suggest that these needs are not always adequately met. Difficulties may be encountered by patients and their families whilst trying to adjust to a stay in the ICU, to transfer to the ward, and following discharge home. Providing a client-driven service that effectively meets these complex needs could be achieved by developing a specialist role in intensive care nursing. The patients and their families could be offered provision of information and supportive strategies that extend from admission to the ICU, through transfer to a ward, and beyond. The aim of the service would be to provide patient- and family-centred continuity of care throughout the acute and rehabilitative stages of the crisis (Turner 1992). The utilization of counselling skills could help to facilitate the service, and help each client to feel supported (Tschudin 1995, p 33).

Publication Types:

Review

Review, Tutorial

18: Crit Care Nurs Clin North Am 1997 Mar;9(1):107-14

Family decision making for incompetent patients in the ICU.

Jacob D.

University of Michigan School of Nursing, Ann Arbor, USA.

Insight into the experience of family-member decision making regarding treatment of incompetent ICU patients can be gained through an exploration of the literature regarding the ICU environment, normative bioethics, and the decision-making process (see Fig. 1). The review of these relevant bodies of literature has suggested the challenges faced by family members who are expected to be involved in these difficult decisions. Nurses, by virtue of their professional commitment to patient and family advocacy, have a responsibility to develop empirically based knowledge that can be used to assist family members as they face these challenges.

Publication Types:

Review

Review, Tutorial

19: Intensive Crit Care Nurs 1997 Feb;13(1):12-6

Meeting needs of family members of critically ill patients in a Spanish intensive care unit.

Zazpe C, Margall MA, Otano C, Perochena MP, Asiain MC.

University School of Nursing, University of Navarra, Pamplona, Spain.

A descriptive study was carried out to ascertain how well the needs identified by relatives of patients admitted to an intensive care unit (ICU) were met and what measures could be implemented to improve the care for patients' family members. Eighty-five relatives of patients were studied using a needs questionnaire as developed by Molter (1979) and modified in accordance with our setting, with needs classified into four groups: information, confidence, comfort of the ICU environment and emotional support. Family members were asked to identify their needs and then to score how well each had been met on a 5-point Likert scale. Results showed that the most frequently identified needs were related to information and confidence. Overall, 94% of the needs of all groups were found to be adequately met. Those needs which relatives felt were least well met were related to certain aspects of information and the comfort of the ICU environment. The conclusions based on the results are that more than one channel of communication should be used to transmit the desired information, and that hospital managements should be informed of the importance that back-up services (waiting rooms, restaurants, etc.) have for the relatives of patients.

20: Pediatr Nurs 1997 Jan-Feb;23(1):64-6

The value of a family-centered approach in the NICU and PICU: one family's perspective.

Sweeney MM.

Partners in Intensive Care, Bethesda, MD 20824-1043, USA.

A family-centered approach in the NICU and PICU can make a tremendous difference to parents, providing the basis for systematic support. One family's story of a high-risk twin pregnancy, long hospitalizations, and ultimately the deaths of both daughters illustrates the kind of support system that families need. Positive examples from their experiences show the value of a family-centered approach, while negative examples show how difficult the intensive care environment can be for parents when family-centered care is missing. Parents and staff working together in partnership can improve the intensive care experience for all involved.