Debate presentation/NURS609

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Debate presentation/NURS609

  1. 1. Critical Care and Family Involvement By Angela de Varennes NURS 609 Athabasca University Winter 2013Critical Care and Family Involvement 1
  2. 2. Family MembersShould Not Be Considered Partners In Critical CareCritical Care and Family Involvement 2
  3. 3. WHY NOT??? My opponent would have you believe that a partnership between health professionals and patient family members is a cornerstone to providing effective patient care when, in fact, nothing could be further from the truth. This presentation will argue that limiting family involvement is, by far, the most beneficial and ethical approach to patient recovery in critical care.Critical Care and Family Involvement 3
  4. 4. Confidentiality and Trust The professional relationship and rapport between the nurse and the patient is at the core of providing high quality care that is respectful and responsive to the individual patient.The patient MUST be able to trust the ethical conduct of the health professional. If the patient is unable to explicitly communicate their desires, often the case within the critical care setting, the nurse must uphold the duty to act solely in the best interests of the patient,ensuring it is the patients values alone that guide clinical decisions (Wood, 2008) . Critical Care and Family Involvement 4
  5. 5. Key Terms • Critical Care • Ethics and Legalities • FamilyCritical Care and Family Involvement 5
  6. 6. What Is Critical Care? Critical Care is the branch of health thatprovides care and support for patients whose illness or condition is considered acute and has the potential to be life-threatening. The term critical care is often used interchangeably with intensive care or the ICU (intensive care unit). Critical caremedicine involves a multidisciplinary health team and specialized equipment and treatments.Nurses, doctors, therapists, pharmacists and various medical experts work together tostabilize and promote recovery in the patient (Canadian Critical Care Society, 2009)Critical Care and Family Involvement 6
  7. 7. What are Ethics? All health professionals are bound by a code of ethics, as well as the law, when treating patients in their care. Paramount to this ethical conduct is the primary commitment to the individual patient (American Nurses Association,2013). Advocating for the patient to makeinformed decisions, respecting the worthof each patient, maintaining privacy and confidentiality and upholding human rights and promoting justice are valuesthe Canadian Nurses Association (2011), cites as being intrinsic to the nurse- patient relationship and competent nursing practice.Critical Care and Family Involvement 7
  8. 8. What is a Family? It is becoming increasingly difficult to define what constitutes a family unit. As a result of increased divorce rates and social acceptance of out-of-wedlockparenthood, surrogacy and gay marriage, the 21st century has numerous variances from the traditional “nuclear” family. Step-parents, siblings and grandparents, biological and non-biological family members, blended families and single parents. It is this evolution of the family that makes it nearly impossible to characterize, other than stating thediversity of familial forms and dynamics. (Settles & Steinwetz, 1999)Critical Care and Family Involvement 8
  9. 9. Points of Issue Regarding Family as Partners• Range and Dynamics of the Family• Motives of the Family - Self-serving - Non-objective• Family StressCritical Care and Family Involvement 9
  10. 10. Range of Family Between the broad definition of family to the furthercomplication of family systems being in continuous flux(Wolters Kluwer, 2012), health professionals are unable to ascertain who is considered privy to sensitive and private health information. This increases the risk of confidentiality breach, therefore disrupting the professional relationship with the patient(Settles & Steinwetz, 1999).The patient should be the ONLY source of disclosure in health matters.Here is a recent and extreme example of a hospital confidentiality violation: Nurse Commits Suicide Critical Care and Family Involvement 10
  11. 11. Implications Consider the implications of the article:• The nurse revealed confidential health information without verification from the patient, nor verification of the persons calling as family members.• The information disclosed did not compromise the health of the patient but did result in unwanted publicity.• Such incidents serve to lessen public confidence in their health care providers ability to protect privacy.• Lack of trust in health care providers could affect the patients disclosure of pertinent health related information, therefore compromisingCritical Care and Family Involvement 11
  12. 12. Family DynamicsEven if the patient is medically stable enough to establish whom is to be considered family, familial relationships must be acknowledged as subject to complex dynamics, possibly placing undue stress on the patient and persuading their course of action. Any benefit derived from family involvement depends upon the patient-family dynamics. The health professional is unequipped to determine family dynamics and is responsible for the well-being and best interest of the individual patient. (Gonzalez, 2004)“The very presence of family members at the bedside of a hospitalized patient has a strong intimidating influence on the decision-making of the patient.” (McCormik, 2008) Critical Care and Family Involvement 12
  13. 13. ImplicationsTo illustrate the impact of dynamics, consider the family as a partner in care. Next, reflect on that family as belonging to a religious organization that dictates against blood transfusions although the patient needs one to survive. While the family dynamics may possibly have been supportive prior to the health crisis, the situation now presents quite differently. Family involvement or attendance can negatively effect both the patients ability to choose their own care in addition to the health professionals ability to remain partial to the patient.Critical Care and Family Involvement 13
  14. 14. Facts Consider the following:• 80% of sexual assaults occur in the home with the attacker being friends or family of the victim (Sex Assault Canada, 2012).• 6% of Canadians with a spouse or former spouse have reported being physically or sexually victimized (Stats Canada, 2013).• Lethal violence most often occurs in the home at the hands of spouse (Stats Canada, 2013). Given these statistics, the necessity of healthprofessionals to distance family instead of welcoming them as partners becomes even more apparent. As nurses, we are not certain what is happening behind closed doors. Would you want the input of your assailant in your medical care? Critical Care and Family Involvement 14
  15. 15. Motives The thought of family input in patient care as altruistic is a pleasant thought. Unfortunately, motives behind input frequently vary from self-serving to non-objective.• Self-serving motives may be externally or internally dictated. Financial gain, marital stressors, legalities, cultural norms and values and religious beliefs are a few examples of determinants. • Non-objective motives generally pertain to emotions and the inability to rationalize in times of crisis.Critical Care and Family Involvement 15
  16. 16. Self Serving Motives A disturbing example of a self serving motive in critical care can be seen in the following case Court decides against live-saving measures for toddler allegedly abused by parents Ryan Cormier, Edmonton Journal with files from Fletcher Kent, Global News Friday, September 14, 2012 5:37 AMIn this particular instance, the parents involvement inthe childs’ medical treatment also determines thecharges against them. Removing life support equateswith a murder charge. As stated in the article: "Even assuming that Ms parents think that their decision is motivated by religious beliefs and love for M," said Justice June Ross on Friday, "I am left with a concern that their decision may in fact be affected by self-interest.” Critical Care and Family Involvement 16
  17. 17. Non-Objective Motives The following example illustrates a non-objective motive pertaining to family involvement in critical care of a patient. Families with a loved one needing critical care are already in a high stress situation, filled with emotion. If they are considered partners in the care of the patient, their input toward what is best for the patient may be based more on feeling than logic. Consider the battle over Terri Schiavo:The issue was whether to carry out thehusbands wishes to terminate life supportmeasures after Terri was diagnosed asbeing in a persistent vegetative state andher parents opposed life support termination.Wikipedia (2012). Continue Reading… Critical Care and Family Involvement 17
  18. 18. Family Stress We assume that families of critically ill patients want to be considered partners in their care. However, the responsibility that this entails is often not welcomed and is plagued with stress. Family members may feel obligated to participate in the patients care, sometimes to their own detriment. Again, where does this leave the patient, if persons participating as partners are only doing so out of duty or because they feel they are without any other option. In this argument both parties suffer, the patient and the family.Critical Care and Family Involvement 18
  19. 19. ImplicationsThe impact of having a critically ill family member can be agonizing if also coupled with the responsibility of medical decisions. In fact, CNN Health (2011) recently linked the situation to post-traumatic stress disorder and the Canadian Mental Health Association (2006), states that caregivers have higher rates of emotional and anxiety disorders. It could be argued that in seeking the partnership of family members in the care of critically ill patients, health professionals are facilitating another health crisis Critical Care and Family Involvement 19
  20. 20. ConclusionConsidering family as partners in critical care has negative consequences for both the patient and the family. In addition, ethics dictate the patient as the primary source of duty to health professionals. Therefore, family should have involvement only as specifically defined by the patient and should not be considered a partner in any medical decisions or matters. Critical Care and Family Involvement 20
  21. 21. Template Provided By www.animationfactory.com 500,000 Downloadable PowerPointTemplates, Animated Clip Art, Backgrounds and Videos Critical Care and Family Involvement 21
  22. 22. ReferencesAmerican Nurses Association. (2013). Code of ethics for nurses with interpretative statements. Retrieved from http://nursingworld.org/MainMenuCategories/ EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf Canadian Critical Care Society. (2009). About CCCS. Retrieved from http:www.canadiancriticalcare.org/ Canadian Mental Health Association. (2006). Families as partners in the mental health and addictions system. Retrieved from http://www.camh.ca/en/hospital/about_camh/ influencing_public_policy/public_policy_submissions/mental_health_and_addictions/ Documents/Caring%20Together%20%20BW%20Final.pdf Canadian Nurses Association. (2011). Code of ethics. Retrieved from www.cna-aiic.ca/en/improve-your-workplace/nursing-ethics/ CNN Health. (2011). Families haunted by end-of-life decisions. Retrieved from http:// thechart.blog.cnn.com/2011/03/02/families-haunted-by-end-of-life-decisions/ Critical Care and Family Involvement 22
  23. 23. ReferencesGonzalez, C. E. (2004). Visiting preferences of patients in the intensive care unit and in a complex care medical unit. American Journal of Critical Care. (13) 3McCormik, T. R. (2008). Perioperative nursing clinics. Elsevier Inc. digital. Doi: 10.1016/jcpen.2008.04.007Stats Canada. Government of Canada. (2013). Family violence in Canada: A statistical profile. Retrieved from http://www5.statcan.gc.ca/bsolc/olc-cel/olc-cel?catno=85-224- x20050008647&lang=engSettles, B. H., & Steinwetz, S. (1999). Concepts and definitions of family for the 21st century. Haworth Press Inc., Binghamton, N.Y.Sex Assault Canada. (2012). Sexual assault statistics in Canada. Retrieved from http://www.sexassault.ca/statistics.htm Critical Care and Family Involvement 23
  24. 24. ReferencesWolters Kluwer Health. (2012). Involving family systems in critical care nursing: Challenges and opportunities. (Report 57329). Ovid Technologies .Wood, D. (2008). Patient-centered care helps hospitals boost patient satisfaction. Retrieved from http://www.nursezone.com/nursing-news-events/ more- news.aspx?ID=18618 Critical Care and Family Involvement 24

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