Christy Rae Lee and Dr. A. Elaine Bond, Nursing

In the intensive care unit (ICU), family members of severe traumatic brain-injured (STBI) patients struggle with the possibility of future dysfunction or untimely death. This is a vulnerable and precarious time for the families. In this crisis time, nurses must be able to provide holistic nursing care that includes the family as well as the patient. To determine and react to the family’s ongoing needs, nurses could return some stability to the family, aiding the patient’s recovery.

In this quantitative and qualitative study, seven family members completed the Critical Care Family Needs Inventory (CCFNI) (1) and were interviewed daily about their needs regarding their relatives’ hospitalization. Results indicate all seven family members have the same needs for information, communication, and emotional support, regardless of relationship to patient or length of stay. A general trend of the family’s needs during the ICU experience was elucidated from interviews with families.

Results

(1) The need to know the patient’s prognosis and other information (Day One). Family members preferred to be told the truth about the situation, even if it conflicted with or compromised their need for hope, which Molter (1979) classified as the number one family need. One family member’s comment poignantly summarized the feelings of all families: I need a resolution. I need a doctor not to say all the things they are supposed to say [meaning, the doctors need to avoid diplomacy and must begin speaking candidly about the situation]. I need to hear what they [the doctors] are saying to each other. I need to meet with the doctors privately in order to obtain this information, because they won’t say it in front of the whole family. I need to know because I am the support system.
(2) Inconsistent information from physicians, nurses, and staff (Days Two and Three). Inconsistencies included information shared by doctors, nurses, technicians, and other hospital staff. One family member reported, “You get so much personality from them [the doctors] that you are unable to know what is real and what is just opinion.” Exacerbating this discrepancy of information was the fact that the entire family was usually not present at one time, resulting in additional familial problems: Each doctor said something different. And since not all of us were there together, each person heard something different. When we came together as a family, it was very confusing and very problematic. We almost started fighting. We had conflicting information. More harm was done than should have been.
(3) Environmental conditions and inconveniences in the hospital and waiting room (Days Three through Six). Family members began to notice surrounding environmental conditions as they began to feel the effects of spending 18-20 hours a day at the hospital. One participant reported the ICU waiting rooms as “dark and dreary with no place to lay down”; another family member said, “It’s hard to sit in here all day long, waiting for something.”
(4) Need for/hesitancy with involvement in patient care (Days Six and greater). One family member remarked about the lack of information regarding patient care by the family, and recalled the nurse giving a bath to her relative: Now I could have easily and gladly done that. But she [the nurse] told us to wait outside. So I asked her if she would come tell us when she was done, so that we could come right back into the room. But she forgot and we sat and sat and sat. I know that the nurses are busy, but we were just sitting there. I guess we have nothing better to do, but we want to spend as much time with her as we can. But even when we are in the room, we don’t know what to do or what not to do. We just sit and stare at her [the patient] and each other. And what good is that doing [the patient]?
Families wanted to be involved in the care of their loved one, but were intimidated by the complexities of the ICU equipment, and did not feel welcomed or comfortable asking the nurses about the responsibilities they could share.

Suggestions

Molter’s qualitative data (1979) suggested that since many relatives of the patient have similar needs, the use of group process, allowing for sharing and support among the relatives, and having one staff member work with the family should be investigated. Additionally, considering the Inconsistency theme in the interviews, it is suggested one family member be the family’s representative. Thus, there would be a staff member-family member dyad involved in communication about the patient’s care, reducing errors and inconsistency in information.

Nursing interventions put into effect must be studied to see what differences families notice in nursing care while in the ICU. While further and more extensive studies are indicated, information regarding daily needs could improve the quality of life if acknowledged by the ICU nurse. Knowledge of a general trend of family needs is valuable to the nurse in his or her assessment of what kind of care to provide for the family. Implementing truly holistic nursing care of the STBI patient and family will allow the nurse to function more effectively with the family, which may aid them in their crisis and may ultimately change their perception of the experience.

References

• Molter, N. C. (1979). Needs of relatives of critically ill patients: A descriptive study. Heart and Lung, 8(2), 332-339.