Needs and Experiences of Family Members of Patients Admitted in   Intensive Care Unit of B.P. Koirala Institute of Health ...
Introduction:Meeting the needs of their patients’ family members is an essential part of the responsibilities ofintensive ...
Rationale of the study:Having a family member admitted to Intensive Care Unit (ICU) is stressful for the whole family.Stre...
Results:Socio-demographic characteristics of patient’s:- The mean age of patients ware 47.33 with SD21.658 and range 12-83...
The overwhelming need of ICU patients was to feel safe. The perception of feeling safe wasinfluenced by family and friends...
Table 1                Level of satisfaction about ICU services among the family members                                  ...
Table 3                     Needs of the family members of patients admitted in ICU                                       ...
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8. icu family needs article

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8. icu family needs article

  1. 1. Needs and Experiences of Family Members of Patients Admitted in Intensive Care Unit of B.P. Koirala Institute of Health Sciences Nepal 1 2 3 4 Mehta* RS, Basnet* S, Bhattari* BK, Rai* HK B.P. Koirala Institute of Health Sciences, Nepal Email: ramsharanmehta@hotmail.comAbstract:Intensive care unit (ICU) caregivers should seek to develop collaborative relationships with theirpatients’ family members, based on an open exchange of information and aimed at helping 1family members cope with their distress and allowing them to speak for the patient if necessary.The objective of this study was to explore the needs and experiences of family members ofpatients admitted in ICU of BPKIHS.It was hospital based descriptive exploratory study conducted among the family members orcaretakers of the patients admitted in ICU for more than three days at B.P. Koirala Institute ofHealth Sciences during the period of 1st May 2009 to 31st July 2009, i.e. three months. Usingrandom sampling method twice weekly i.e. on Sunday and Wednesday, all the subjects whofulfill the set criteria and give consent was selected for interview using pre-tested interviewquestionnaire.Half of the patient admitted in ICU was on ventilator, male (63.3%), married (80%), and Hindu(90%). Only 20% relatives reported they full understand the explanation given by Doctor/nursesand 73.3% reported partially and 6.7% reported not at all. Most of the relatives ware satisfiedwith the ICU services and information provided to them. The majority of relatives demand fortoilet and bathroom nearby (80%) waiting room (78%) and provision of drinking water (50%).On the basis of study researcher concludes that there is need for explanation to the relatives attheir level of understanding by the Doctor/nurses. The facility of toilet, waiting room anddrinking water is urgent needs of the family members of ICU patients.Note: 1* Ram Sharan Mehta, Associate Professor, Medical-Surgical Nursing Department, Email: 2 3ramsharanmehta@hotmail.com , * Sarsawti Basnet, ICUNurse, * Prof. Dr. Bal Krishna 4Bhattari, HOD, Department of Anesthesia and critical care unit, * Hari Kumari Rai, ICUNursing Incharge. 1
  2. 2. Introduction:Meeting the needs of their patients’ family members is an essential part of the responsibilities ofintensive care unit (ICU) physicians and nurses, who are committed to easing the pain andsuffering of those who have a critically ill relative or close friend. A major task of ICUphysicians is to provide family members with the appropriate, clear, and compassionateinformation they need to participate in making decisions about patients who are unable to speakfor themselves. Evaluations of family needs supply valuable information for improving the 1comprehension, satisfaction, and decision-making capacity of families. 2Molter in his study reported that, studies suggest that family members want honest, intelligible,and timely information; liberal visiting policies; and the assurance that their loved one is beingcared for by competent and compassionate people. Providing better information was associatedwith better results in terms of meeting the needs and increasing the level of satisfaction of familymembers. Similar study was reported by nelson3.Anyone entering an intensive care unit can feel bombarded by the huge array of sensory stimuli.Family members in ICU are typically in a state of fear and shock. Studies have shown that caringfor the families of patients who are critically ill is believed to be an essential component of thenurses role. However, despite the fact that the critical care nurse is cited as the one who isresponsible for meeting the needs of such families, little is known about how nurses view this 4role.Nursing care must address not only the needs of the patient, but those of the whole family. Theneeds of patients in intensive care and those of their families are especially complicated by thephysical and emotional demands on all concerned. Families experience severe stress and anxiety,and may feel helpless and unable to cope. Accurate assessment of their needs is one of the first 5steps in providing appropriate care to ICU patients and their families.Every year in the United States, approximately 20% of all deaths occur in an intensive care unit(ICU), and more than half of those occur after life-sustaining measures are withdrawn orwithheld. Many of these patients are unable to communicate their wishes because they aresedated, receiving mechanical ventilation, confused, or comatose. The non-communicative stateof such patients places much of the burden of decision making and treatment choices on thepatients’ family members. This type of experience may adversely affect family members by 6increasing their stress levels and increasing their risk for psychological and physical symptoms.In B.P. Koirala Institute of Health Sciences there are 12 bedded ICU services with all the modernfacilities. Insight into the needs and experiences of family members is an initial but necessary 3step in providing appropriate care for both family members and patients. keeping these conceptsin mind investigator has conducted this study.Objectives of the study:The objective of this study was to explore the needs and experiences of family members ofpatients admitted in Intensive Care Unit of BPKIHS. 2
  3. 3. Rationale of the study:Having a family member admitted to Intensive Care Unit (ICU) is stressful for the whole family.Stress can hinder family members coping and thus affect the support that is given to patient. Inorder to lessen the effect of stress, family members immediate needs must be identified and met.Concern for the family members of patients who are at high risk of dying in intensive care unitsis both a necessary and integral part of providing holistic nursing care. When patients are at highrisk of dying, their families experience burdens such as decision making and treatment choicesthat can cause the families psychological and physical symptoms, most commonly stress,anxiety, and depression. These symptoms in turn can affect family members’ general well-being.Family members of dying patients play an integral role in the patients’ care in the ICU. Patientsfamilies are expected to make unprecedented decisions and deal with many difficult situations. Inturn, they may have psychological symptoms such as stress, PTSD-related symptoms, anxiety,and depression, which can affect their general well-being. Researchers have developed aknowledge base on variables associated with an increase in family members’ symptoms.However, additional research is critical to expand our knowledge of symptoms experienced byfamily members of patients in the ICU, especially at the patients’ end of life. This research willhelp clinicians to develop supportive measures to assist patients’ family members during thisdifficult time.Methodology:It was hospital based descriptive exploratory study conducted among the family members of thepatients admitted in ICU of B.P. Koirala Institute of Health Sciences during the period of 1st May2009 to 31st July 2009, i.e. three months. The family members of admitted patients in ICU formore than 3 days constitute the population of the study. Using random sampling method twiceweekly i.e. on Sunday and Wednesday, all the subjects who fulfill the set selection criteria andgive the consent were selected for interview. The informed verbal consent was obtained fromeach subject prior to the interview and assured the relatives that this does not affect on thetreatment of their patients. The interview was taken in a separate room maintainingconfidentiality, using pre-tested interview questionnaire.The questionnaire consists of three parts i.e. Part-I, consists of the socio-demographiccharacteristics of patients, Part–II consists the socio-demographic characteristics of the familymembers and Part-III consists of satisfaction level and needs of family members. The interviewquestionnaire is prepared on the basis of “Needs Assessment Questionnaire1” and “ICU patientunderstanding study Interview2” which is widely used for ICU family need assessment worldwide.The prepared questionnaire is pre-tested among 10% subjects i.e. on 4 subjects and fewmodifications in terminology was made to for easy understanding in our setting. The interviewwas obtained from the main family members who spent most of the time with the patients andinvolved in the care of patients. The collected data was entered in Excel software and analyzedusing SPSS-12.5 Software package. The Results obtained was presented in appropriate table,graphs and charts. 3
  4. 4. Results:Socio-demographic characteristics of patient’s:- The mean age of patients ware 47.33 with SD21.658 and range 12-83 years. Majority (63.3%) ware male, educated (76.7%), married (80%)and Hindu (90%). Majority of the patient’s (53.3%) duration of stay in ICU is 3-5 days withmean stay of 8.93, SD = 10.352 and range 3 – 43 days. Most of them (86.7%) were admitted inconscious state, and in 50% patient’s ventilator was used, most of the patients (66.7%) had acutenature of illness.Satisfaction of family members related to ICU services:-All the relatives reported thatdoctor/nurse had talked about the care and condition of patient, 93.3% relatives reported ICUnurses had spoken about the patient’s condition and they spent less than 15 minute to explain thecondition. Most of the nurses (93.4%) reported that they pay the ICU charges by self or with thehelp of relatives and 70% reported it is difficult to pay ICU charges. Regarding the level ofsatisfaction in ten likert scales, most of the family members are satisfied with the informationabout their patient’s condition and the information provided to them. The details are depicted intable 1.Understanding about the patient’s condition by the family members: - Most of the relativesare a ware that their patient is in ventilator, receiving antibiotic, on N-G Tube, on ECU, andhaving Foly’s catheter. The details are in Table 2.Needs of the family members:- Most of the relatives reported in four points liken scale towardspositive side, which is 4 and 3, instead of 2 and 1. Regarding the prognosis of patients theresponses of relatives is differ than the reality of patient i.e. 10% relatives said prognosis is poorwhere as in reality 36.7% patient’s condition is poor. Details are in Table 3.Suggestions for better ICU patient care and welfare of family members: - Most of the family(80%) suggested for needs of toilet and bath room, 78% suggested for waiting room, 50%demands for p0rovision of drinking water and 50% request for round the clock security services.Discussion:Patients spent enormous amounts of energy trying to pull the pieces of the ICU experiencetogether. At times, families were the source of this information. Patients in families that withheldinformation from them said they listened to the nurses and physicians during rounds to try topiece together that were happening to them. Nurses can work closely with family members tobuild trusting relationships with patients and families and they can include family members aspart of the team. Family members in turn can help to provide support for patients.The age distribution of family members were between 12-83 years with mean 47.33 and SD21.658, similarly the age of patient were between 16–70 years with mean 38.48 and SD 16–70.Most of the relatives were female (60%) and patients were male (63.3%). Similar demographiccharacteristics were also reported by the study conducted by Azoulay 1 , Akinci 7 and Colleen 8. 4
  5. 5. The overwhelming need of ICU patients was to feel safe. The perception of feeling safe wasinfluenced by family and friends, ICU staff, religious beliefs, and feelings of knowing, regainingcontrol, hoping and trusting, reported by David 5 which is similar to this study.Most of the relatives were satisfied with the information provided by the Doctor/nurses to them.They are also satisfied with the services of Doctor and Nurses provide in ICU. The satisfactionlevel on various components like: provided best possible care, explanation provided,understanding about therapies, courteousness of staff is high. Similar findings were reported byA Zoulay1, David5 and Akinci7 . David 5 reported the majority of respondents were satisfied withoverall care and with over all decision making. The families reported the greatest satisfactionwith nursing skill and competencies (92.4 +_ 14.0). The least satisfaction with waiting roomatmosphere and physician communication. Most of the relatives were suggested for facilities oftoilet (80%), waiting room (78%) and drinking water (50%). Similar Issues were addressed byAkinci7 in his stay as he reported 24% relatives were dissatisfied with waiting room services.Conclusion:Intensive care unit (ICU) caregivers should seek to develop collaborative relationships with theirpatients family members, based on an open exchange of information and aimed at helping familymembers cope with their distress and allowing them to speak for the patient if necessary. On thebasis of study researcher concludes that there is need for explanation to the relatives at their levelof understanding by the Doctor/nurses. The facility of toilet, waiting room and drinking water isurgent needs of the family members of ICU patientsReferences:1. Azoulay E, Pochard F, Chevret S, Lemaire F, Mokhtari M, Fall JL et al. Meeting the needs of intensive care unit patient families: A multicenter study. Am J Respir Crit Care Med. 2002;163: 135- 139.2. Molter NC. Needs of relatives of critically ill patients. Heart Lung. 1979;8: 332-339.3. Nelson JE, Walker AS, Luhrs CA, Cortez TB, Pronovost PJ. J.Clin Nurs.2005; 14(4):501-9.4. Hardcer J. Meeting the needs of families of patients in intensive care units. Nurse Times. 2003; 99(27): 26-7.5. David J, Monique W, Brenda C, Candice B, Debra G, Otto M. Measuring the ability to meet family needs in an intensive care unit: Clinical Investigations. Critical Care Medicine. 1998; 26(2): 266-271.6. Angus DC, Barnato AE, Linde-Zwirble WT, et al. Use of intensive care at the end of life in the United States: an epidemiologic study. Crit Care Med. 2004; 32(3):638–643.7. Akinci SB, Salman N, Kanba KM, Ayparu. Assessement of family satisfaction in the ICU. European Journal of Anesthesiology. 2004 ; 21 :7-8.8. Colleen EG, Diane IC, Jeanne SE, Patricia AF. Heather JV. Visiting presence of patients in the ICU and in a complex, care medical unit. Americal Journal of critical. 2004 ; 13 : 194 – 198. 5
  6. 6. Table 1 Level of satisfaction about ICU services among the family members N= 30 Satisfaction levelSN ICU services 1 2 3 4 5 6 7 8 9 10 Mean* Understanding about 13.1 disease process / 0 0 6.7 13.3 30 20 6.7 3.3 6.7 5.93 3 illness of the patient. Understanding about 23. 23. 13.2 therapies / treatment of 0 3.3 6.7 6.7 3.3 6.7 13.3 6.23 3 3 3 the patient. Communication 13. 23. 23. 10. 16.73 received from ICU 0 3.3 3.3 3.3 3.3 6.83 3 3 3 0 1 nurses. Communication 16. 23. 10.4 received from ICU 0 0 3.3 16.7 13.3 3.3 13.3 6.40 7 3 0 doctors* Full Score = 10 Table 2 Understanding about the patient’s condition by the family members N= 30 Responses of family Chart reality membersSN Information about patient Yes No Yes No (%) (%) (%) (%) 1. Patient on ventilator / breathing machine. 60 40 53.3 46.7 2. Receiving antibiotics. 66.7 33.3 70 30 3. On medication for pain or anxiety. 60 40 60 40 4. Have N-G tube insertion. 60 40 53.3 46.7 5. On N-G tube feeding. 26.7 69.3 16.7 83.3 6. Having EKG / cardiac monitor. 100 0 100 0 7. Receiving dialysis. 26.7 73.3 23.3 76.7 8. Having Foly’s catheter. 66.7 33.3 70 30 6
  7. 7. Table 3 Needs of the family members of patients admitted in ICU N=30 Responses.S Perception needs of the family members. 4 3 2 1 Mean*N (%) (%) (%) (%) Score1. Feeling that best possible care is given to the patient. 23.3 70 0 6.7 3.02. Hospital personnel care about the patients. 23.3 73.3 3.3 0 3.20 Understanding level of explanations given by ICU3. 30 56.7 13.3 0 3.17 personnel.4. Feeling that honest information is given about the patients. 36.7 56.7 6.7 0 3.305. Understanding about patient’s therapies. 40.0 36.7 23.3 0 3.176. Courteousness of the ICU personnel. 13.3 76.7 10 0 3.37. Interest of ICU personnel regarding family members. 13.3 73.3 13.3 0 3.08. Explanations of equipments used to the patient. 33.3 50 16.7 0 3.179. Satisfaction with medical services. 33.3 50 16.7 0 3.1710 Feeling comfortable visiting the patient in ICU. 33.3 23.3 10 0 2.8 .* Full Score= 4, 1= All most all of the time, 2= Most of the time, 3= Only some of the time, 4= None of the time 7

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