Families in the ICU: Addressing Their Needs and Yours

The considerations of patients and their families are important in the critical care setting as more hospitals move toward allowing families into the intensive care unit (ICU) to play a greater role in patient care. Kay Lawrence, a staff nurse in the pediatric ICU for the Medical College of Georgia, addressed the issue of families in the ICU as they affect positive outcomes in patient care and create challenges for nursing staffs in yesterday’s session, “Families in the ICU: We Let Them In, Now What Do We Do With Them?”

Family Needs

“What is patient- and family-centered care all about?” Lawrence said. “It should be about partnering with the patient and the family for the best possible outcome. We need to listen to and honor our patients and our families’ perspectives, values and beliefs.”

In addition to helping families and patients feel more at ease, Lawrence said that reports in the literature indicate that these partnerships often result in shorter hospital stays and fewer medication errors.

Families should be encouraged to participate in care and decision-making and should be given the necessary support in these potentially stressful time, she said. However, the level of support needs to be considered on a case-by-case basis as each family and even each family member will bring a unique set of experiences into the ICU. Healthcare providers need to consider the following aspects as they relate to patients and families to build a positive working relationship with them: resiliency, vulnerability, stability, complexity, resources available to the family, their desired level of participation in care and their predictions in terms of the course of critical care.

“The way I decide what I can say is I think about it in terms of medical diagnosis versus nursing diagnosis,” Lawrence said.

She urged nurses to use a compassionate yet honest approach when working with families, which allows them the chance to express genuine concern without making any medical inferences.

Provider Needs

How do you effectively engage families without disrupting a healing environment or violating HIPAA regulations?

Family systems are complex, so it is important to determine what relationship each visitor has to the patient to ensure that you are giving information regarding that patient to the appropriate person, Lawrence said. An additional HIPAA concern arises when trying to discuss the course of care for patients in a unit where families are walking the halls in larger numbers than ever before.

Lawrence acknowledged the challenge of effectively working “in a fishbowl” and offered attendees some tips on how to handle this high pressure environment. She suggested performing a self-check before walking into any room to stabilize yourself and what might be going on in your own life before handling the problems of the patient and family. Lawrence also recommended fostering a supportive environment among professionals and not overlooking personal needs.