Should we allow children to visit ill parents in intensive care units? Your responses

Should children be allowed to visit ill parents in the intensive care unit? This question was posed in the November/December 2006 issue of Dimensions of Critical Care Nurses. The responses of readers are presented in this article.

Emergency Nurses' Current Practices and Understanding of Family Presence During CPR

PURPOSE

To examine emergency nurses' current practices and understanding of family presence during CPR in the emergency department, Cork University Hospital, Republic of Ireland.

METHOD

A quantitative descriptive design was used in the study. A questionnaire developed by ENA was distributed to emergency nurses working in a level I trauma emergency department at Cork University Hospital. The total sample number was 90, including all emergency nurses with at least 6 months' emergency nursing experience.

RESULTS

Emergency nurses often took families to the bedside during resuscitation efforts (58.9%) or would do so if the opportunity arose (17.8%). A high percentage (74.4%) of respondents would prefer a written policy allowing the option of family presence during CPR. The most significant barrier to family witnessed resuscitation (FWR) was conflicts occurring within the emergency team. The most significant facilitator to FWR was a greater understanding of health care professionals on the benefits of FWR to patients and families, indicating the need for educational development.

CONCLUSION

The findings of the study and previously published studies indicate the need for development of written polices and guidelines on the practice to meet the needs of patients, families, and staff by providing consistent, safe, and caring practices for all involved in the resuscitation process. Recommendations of the study include the development of a written policy and an educational programme on the safe implementation and practices of FWR.

Family members' experiences of the intensive care unit waiting room

AIM

This paper is a report of a study to explore family members' perspectives and experiences of waiting rooms in adult intensive care units.

BACKGROUND

Waiting to visit family members who are hospitalized in intensive care units can be very stressful. Although flexible and or open visiting is practised in many hospitals, family members may spend a great deal of time in the waiting room.

METHOD

A qualitative design using semi-structured interviews was used and the data were collected in 2004. A convenience sample of six visitors was recruited from waiting rooms of three different adult intensive care units. Data collection and analysis were concurrent.

FINDINGS

Six categories emerged from the data that included structural and subjective aspects of waiting: 'close proximity' referred to the importance of a close physical distance to their family member; 'caring staff' captured the comfort family members felt when staff showed caring behaviours towards relative; 'need for a comfortable environment' represented the impact of the design of the waiting room on family members well-being; 'emotional support' referred to the waiting room as a place where comfort was found by sharing with others; 'rollercoaster of emotions' captured the range of emotions experienced by family members; 'information' referred to the importance of receiving information about their relative.

CONCLUSION

Future research should focus on the impact of the interior design of waiting rooms on the comfort and welfare of family members and on identifying needs of family members across different cultures.

Being family: the family experience when an adult member is hospitalized with a critical illness

AIMS AND OBJECTIVES

The purpose of this qualitative study was to understand and interpret the 'family experience' with an adult member hospitalized with a critical illness.

BACKGROUND

Nursing practice in critical care settings has traditionally focused on individual patient needs with only tangential recognition of family needs. Investigation to describe the family experience to illuminate family nursing practice has been lacking. The majority of studies thus far related to critical illness and family are quantitative and reveal constraints to family care and problematic nurse-family interactions. The logical next step is a new kind of family research to enhance nursing of the family as a whole.

DESIGN

Family systems theory and existential phenomenology provided the frameworks guiding the study.

METHODS

Semi-structured 'family as a group' interviews were performed with 11 families. Data were analysed using Van Manen's hermeneutic method. Rigor was addressed with trustworthiness criteria.

RESULTS

The family experience was analysed within Van Manen's framework of lived space, lived relation, lived body and lived time. A constitutive pattern of being family was revealed.

CONCLUSIONS

Being family bonds families and makes them exceedingly strong during the critical illness experience. Being a family unit is what gives most families the ability to endure the emotional upheaval and suffering that come with the critical illness experience.

RELEVANCE TO CLINICAL PRACTICE

Nurses have profound power to help families bear this experience. Family caring is enhanced with the presence of nurses who recognize the importance of 'Being Family' for the family, acknowledge the significance of the nurse-family relationship and act on a commitment to be with and for the family.

Close relatives in intensive care from the perspective of critical care nurses

AIM

The aim was to describe critical care nurses' experiences of close relatives within intensive care.

BACKGROUND

There is a lack of research describing critical care nurses' experiences of the significance of close relatives in intensive care. Knowledge in this area will support critical care nurses to develop good nursing care for the critically ill person and their close relatives.

DESIGN AND METHOD

The design of the study was qualitative. Data collection was carried out through focus group discussions with 24 critical care nurses in four focus groups during spring 2004. The data were subjected to qualitative thematic content analysis.

RESULTS

The focus groups discussions showed that the presence of close relatives was taken for granted by critical care nurses and it was frustrating if the critically ill person did not have any. Information from close relatives made it possible for critical care nurses to create individual care for the critically ill person. They supported close relatives by giving them information, being near and trying to establish good relations with them. Close relatives were important. Critical care nurses lacked forums for reflection and discussion about the care given.

RELEVANCE TO CLINICAL PRACTICE

This study indicates that close relatives are a prerequisite for critical care nurses to give good nursing care to meet the needs of the critically ill person. A communication based on mutual understanding is necessary if critical care nurses are to be able to support close relatives. Dealing constantly with situations that were ethically difficult without any chance to reflect was an obstacle for critical care nurses to improve their work with close relatives.

[Intensive therapy unit hospitalization: the patients' relatives experience]

The objective of this qualitative study was to understand the meaning of Intensive Care Unit (ITU) hospitalization for the patients' relatives. From April to December 2003, 16 relatives of patients admitted in the ICU of a teaching hospital in the state of Rio Grande do Sul, were interviewed. Front the thematic analysis emerged the following categories: the admission to the ICU; the impact of separation and family feelings of impotence; lack of consideration and reduced number of visits; patient's lack of privacy. Neglect and lack of consideration towards the patients' relatives by intensive care professionals were observed.

Family members' needs at intensive care units: comparative analysis between a public and a private hospital

This cross-sectional study proposed to analyze the needs of adult ICU patients' family members at a public and a private hospital, regarding their level of importance and satisfaction. Ninety-one family members were interviewed, 47 from the public hospital and 44 from the private one, using the Brazilian adaptation of the Critical Care Family Need Inventory (INEFTI). There was no significant difference between the groups in the total score of importance attributed to the needs (p=0.410). The satisfaction score was higher in the private hospital than in the public one (p=0.002). Multiple linear regression analysis allowed us to establish a hierarchy of importance and satisfaction of the family members' needs in each group. The differences observed between the groups suggest that the fulfillment of their needs requires interventions directed at the specificity of each type of hospital.

Anticipatory mourning in parents with a child who dies while hospitalized

Even when prognosis is poor and death appears imminent, care of the dying child typically focuses on achieving cure. Parents are often ill-prepared to cope with the grief they experience as their child is dying. Anticipatory mourning allows time to begin grief work prior to the death of a loved one. An exploratory design was used to answer questions in focused semistructured interviews to determine the presence and the role of anticipatory mourning, and to describe the themes expressed by parents. Parents' descriptions of their experiences surrounding the death of their child reveal an environment and a health care team that are often ill-prepared to deal with the impending death of a child. Also described are instances that reflect a compassionate process that positively affects the experience while facilitating appropriate grief work. Offered are recommendations for health care professionals that may assist parents in coping with the death of their child.

How does information influence hope in family members of traumatic coma patients in intensive care unit?

AIMS

To assess the interplay between hope and the information provided by health care professionals.

BACKGROUND

Earlier research learned that hope is crucial for relatives of traumatic coma patients. Also it has been reported that the need for information is extremely important for relatives of critically ill patients.

DESIGN

A qualitative approach according to the 'grounded theory' method with constant comparison was used.

METHOD

We held 24 in-depth interviews with 22 family members of 16 patients with traumatic coma. Data processing and data analysis took place in a cyclic process wherein the induction of themes was alternated by confrontation with new material.

RESULTS

Family members of traumatic coma patients want information that is as accurate as possible, provided by doctors and nurses in an understandable manner and leaving room for hope. At first, family members can do no more than passively absorb the information they receive. After some time, they actively start working with information and learn what to build their hope on. In this way, concrete hope evolves and seems to be strongly determined by information. Information that is more positive than warranted is not appreciated at all. It leads to false hope and once its real nature becomes apparent, to increased distress and loss of trust in the professionals.

CONCLUSION

The process of hope is crucial in coping with traumatic coma and information can facilitate this process.

RELEVANCE TO CLINICAL PRACTICE

If professionals, especially nurses, keep the process in mind that family members go through in handling information, they can not only facilitate this process but also help them to establish realistic hope.

Listening to the Voices of Hospitalized High-Risk Antepartum Patient

OBJECTIVE

To explore the needs of high-risk antepartum patients while hospitalized and to generate recommendations from the patients' perspective.

DESIGN

Qualitative descriptive.

PARTICIPANTS/SETTING

Thirteen female patients in a high-risk antepartum unit of a large tertiary hospital, Edmonton, Alberta.

DATA ANALYSIS

A qualitative data analysis process was followed.

RESULTS

The major themes and subthemes that emerged from interviews with participants included stressors associated with loss of control and feelings of being a burden. The need for privacy and sensitivity to family members was expressed. Participants' recommendations included being treated as a family unit, setting up accommodation for visiting family members, and wanting more organized activities to relieve boredom.

CONCLUSIONS

An understanding of the needs of high-risk antepartum patients while hospitalized from their perspective will help the primary caregiver such as the registered nurse improve the quality of the women's care, provide guidance about the management of stressors, and plan interventions to reduce stress and to involve their families.

[Can children visit their relatives in an adult ICU?]

For the last three years, our oncology ICU (intensive care unit) has been opened to visiting children between 0 and 18 years. Our objective was to attempt to decrease the psychological burden in critically ill cancer patients and their children. We report here the evaluation of this new policy. Encouraged by the child psychologists in our hospital, we first recorded the opinions of the nursing staff, patients and relatives about this innovative approach. As our preliminary findings were favourable, a liberalised greeting and education policy for visiting children was implemented. A dedicated procedure was followed in order to provide children with a better understanding of their parent's disease, to alleviate any traumatic experience the visit might cause and to create an environment where mutual confidence would reign. After 2 years, each visiting child, patient, accompanying parent and the nursing staff were directly questioned using a specifically designed questionnaire. The daily lives of the staff, children, families and patients themselves appeared to be dramatically improved, even in the most difficult medical situations. Based on these promising results, the new policy has definitively been adopted in our unit. We propose that children ought to be allowed to visit a parent in the ICU and that this policy warrants evaluation in other types of units.

Factors related to family visits to nursing home residents in Japan

This study examined factors related to the frequency and duration of family visits to elderly residents of nursing homes in Japan. Data were collected using a self-administered questionnaire from 299 family members of residents of three nursing homes in Tokyo. Almost all family members visited residents more than once a month, and more than three quarters stayed for more than 1h during each visit. These findings confirm that family involvement with the elderly is maintained even after admission to a nursing home. Multiple regression analysis revealed the variables related to a higher frequency and duration of visits. Some factors related to frequent or long visits such as the requirement of higher care or the ability to remember family visits were similar to the findings of other studies conducted in western countries, yet the results need to be understood in a Japanese cultural context. Other factors such as the gender of the visitors, distance to the nursing home, and sentiment about placement were thought to be related to the unique cultural norms of family caregiving in Japan. These findings will be useful for developing effective methods to assist nursing home residents and their families in Japan.

Promotion of family integrity in the acute care setting: a review of the literature

The acute illness of 1 family member can then negatively affect all family members and lead to the disruption of family functioning and integrity. During the patient's hospitalization, nurses are in a key position to support family members, maintain family integrity, and ready them for assuming the role of caretaker during the patient's recovery and management of health at home. This article reviews current research findings that provide empirical support for activities that promote family integrity. Strategies for nurses to support family members during the hospitalization of an adult family member and suggestions for future research are provided.

Perceived needs of critical care family members: a phenomenological discourse

A phenomenological study with Heideggerian hermeneutic contextual analysis was used to illuminate the perceived needs of family members who were in the critical care waiting room. Family members freely expressed their perceptions of perceived needs, and thick descriptions supported 4 explicit needs expressed by all participants. These needs were seeking information, trusting the professionals, being a part of the care, and maintaining a positive outlook. The dialogues of the participants were presented to develop awareness and stimulate conversation regarding the needs of family members in the critical care waiting room who are an integral part of the healing process of patients in the critical care unit.

Should families be present during resuscitation?

Weigh the pros and cons of family presence during a crisis, then tell us what you think.

Attitudes toward and beliefs about family presence: a survey of healthcare providers, patients' families, and patients

BACKGROUND

Although some healthcare providers remain hesitant, family presence, defined as the presence of patients' family members during resuscitation and/or invasive procedures, is becoming an accepted practice. Evidence indicates that family presence is beneficial to patients and their families.

OBJECTIVES

To describe and compare the beliefs about and attitudes toward family presence of clinicians, patients' families, and patients.

METHODS

Clinicians, patients' families, and patients in the emergency department and adult and neonatal intensive care units of a 300-bed urban academic hospital were surveyed.

RESULTS

Surveys were completed by 202 clinicians, 72 family members, and 62 patients. Clinicians had positive attitudes toward family presence but had concerns about safety, the emotional responses of the family members, and performance anxiety. Nurses had more favorable attitudes toward family presence than physicians did. Patients and their families had positive attitudes toward family presence.

CONCLUSIONS

Family presence is beneficial to patients, patients' families, and healthcare providers. As family presence becomes a more accepted practice, healthcare providers will need to accommodate patients' families at the bedside and address the barriers that impede the practice.

Methodological aspects of rigor in qualitative nursing research on families involved in intensive care units: a literature review

Rigor has important ramifications for the entire qualitative research process. The aim of this study was to evaluate aspects of methodological congruence by focusing on four dimensions of rigor in qualitative nursing research related to the presence of patients' family members in the intensive care unit. Eight research papers covering the years 1990-2004 were analyzed by means of one of Burns and Grove's standards, methodological congruence, for critique and consistency. The results show that there are varying degrees of focus on procedural rigor, such as limitations and bias. Ethical rigor is described clearly in some papers, while others lack descriptions of confidentiality and the voluntary nature of participation. However, all papers contain descriptions of qualitative data analysis. In conclusion, there were strengths in procedural rigor and auditability, but also some limitations in the identification of theoretical development and the scientific tradition on which the article is based.

Family presence and environmental factors at the time of a patient's death in an ICU

BACKGROUND

In an intensive care unit (ICU), privacy and proximity are reported to be important needs of dying patients and their family members. It is assumed that good communication between the ICU team and families about end-of-life decisions improves the possibilities of meeting families' needs, thus guaranteeing a dignified and peaceful death in accordance with end-of-life care guidelines. The aim of this study was to explore the circumstances under which patients die in Swedish ICUs by reporting on the presence of family and whether patients die in private or shared rooms. An additional aim was to investigate the frequency of end-of-life decisions and whether nurses and family members were informed about such decisions.

METHODS

A questionnaire based on the research questions was completed when a patient died in the 10 ICUs included in the study. Data were collected on 192 deaths.

RESULTS

Forty per cent of the patients died without a next of kin at the bedside and 46% of deaths occurred in a shared room. This number decreased to 37% if a family member was present. Patients without a family member at their bedside received less analgesics and sedatives. There was a significant relationship between family presence, expected death and end-of-life decisions.

CONCLUSIONS

The results indicate the necessity of improving the ICU environment to promote the need for proximity and privacy for dying patients and their families. The study also highlights the risk of underestimating the needs of patients without a next of kin at their bedside at the time of death.

Custodians' viewpoints and experiences from their child's visit to an ill or injured nearest being cared for at an adult intensive care unit

AIMS AND OBJECTIVES

To describe custodians' experiences of their child's visit to an ill/injured nearest being cared for at an adult intensive care unit (ICU), their thoughts about the visit in relation to the child's health/well being and who initiated the visit.

BACKGROUND

Custodians can feel undecided about whether to allow their children to visit the ICU or not. They wonder how important it is for the child to visit, as well as the consequences, and attempt to protect the child from information/experiences that could provoke anxiety or threaten the child's health.

DESIGN

Quantitative and descriptive.

METHOD

Thirty custodians answered a questionnaire.

RESULTS

It was mainly custodians and their children and not staff who initiated the children's visits. Many children were not informed by staff and the responsibility lay instead with the custodians. The importance of giving children adequate information before, during and after the visit was pointed out. The custodians reported that their child's reactions to the visit differed, i.e. reactions reflecting happiness but also sadness; the visit was good for the child, increased awareness of the nearest's condition and appreciation of the hospital staff and their work; if the visit did not take place the child would be left with thoughts and conjectures; their children were not frightened when they saw the equipment and instead they became curious; older children were more focused on the patient while younger children were interested in both the equipment and the patient. Many children asked questions/made comments during the visit. Many custodians were of the opinion that visiting is not a risk to future health and well being.

CONCLUSIONS

This issue must be addressed and discussed and strategies need to be developed to improve the nurses' obligation to involve visiting children in the care that is/should be provided to a member of the patient's family.

RELEVANCE TO CLINICAL PRACTICE

Nurses need to take more initiative when discussing children's visits with the custodians. Nurses also need to discuss how to meet, inform, support and care for visiting children and their custodians in relation to health and well being. Recommendations/guidelines about children visiting that take both the patient's and child's needs into consideration needs to be developed based on scientific knowledge. Findings from this study may draw attention to children visiting ICUs and encourage nurses to discuss children visiting with custodians and to develop family-centred care at the ICU that includes children.