Breann Brady and Dr. Joan Baldwin, College of Nursing
When a patient enters the Intensive Care Unit (ICU), the experience is stressful and traumatic, for both the patient and their family members. The fast paced environment may seem scary to those unfamiliar with it. Families are left in a waiting room, only to enter and see their loved one in a strange environment full of equipment and beeping machinery. The family is sometimes left confused and unsure of what is happening in the care of their loved one. Nurses need to be aware of families’ needs. By meeting their needs, nurses can be invaluable to families of ICU patients.
The purpose of the pilot study conducted was to assess family members’ satisfaction of nursing care while a loved one was a patient in an ICU of a local hospital on the Wasatch Front. In order to assess family satisfaction in the ICU, a non-experimental survey research design was employed. The instrument used in this study was the Critical Care Family Satisfaction Survey (Matchett & Wasser, 2001). This survey yields data in five areas: Assurance (the need to feel hope for a desired outcome); Proximity (the need for personal contact and to be physically and emotionally near the patient); Information (the need for consistent, realistic, and timely information); Comfort (the need for personal comfort); and Support (the need for resources, support systems, and ventilation) (Matchett & Wasser, 2001). Hospital and university IRB approval and informed consent were obtained. Surveys containing twenty questions and a space for written suggestions were distributed in the ICU waiting room. A convenience sample of fifteen family members was surveyed. Descriptive statistics, such as frequencies, were used to analyze the demographic and survey findings. Reporting of qualitative comments was done with summaries of the quoted data received.
Demographics collected from the subjects included age, number of days loved one was in the critical care unit and relationship to the patient. Twelve of the fifteen surveys collected (80%) were completed by 35-59 year old subjects. One person (6.7%) was over age 60; one (6.7%) was in age range 18-24; and one person did not respond. Six (40%) of subjects’ loved ones were in the critical care unit for 0-3 days; six (40%) were in the unit 3-7 days; and two (13.3%) were in the unit 10 or more days. The majority of respondents were sons or daughters of the patient. I found two areas that caused concern: Waiting time for test results and x-rays, where seven subjects (46.7%) did not give a top score, and, Peacefulness of the waiting room, seven (46.7%) gave a satisfied score and 2 subjects (13.3%) indicated a not satisfied score. I found many areas of high satisfaction, including Clear answers to my questions, Quality of care given to my family member, Flexibility of visiting hours and Noise level in the critical care unit. In the area of Preparation for family member’s transfer out of the ICU, there were a large number of answers (26.7%) in the not certain category.
Seven of the fifteen (50%) subjects surveyed responded to the question, “What else would you like us to know so we can take better care of our patients and their families?” Four of the seven voiced satisfaction and appreciation for good care. Three had areas of concern. The first stated, “some of the nurses maybe could be more forthcoming. I’m sure they were just trying to protect us, but sometimes we got false hope because of it.” Another person expressed dissatisfaction with “giving out voluntary information to others without consent of me (the wife) or his parents regarding drugs.” The third voiced concern with why they decided to transfer a loved one out of the ICU, the level of noise and laughter at the ICU nurses station, and not being told about rehab or transitional care available. Dissatisfaction with the volunteers not taking care of the flowers that were delivered but couldn’t be taken to the rooms was noted, as well as families being loud in the waiting room and a lack of volunteers at the waiting room desk.
A limitation to this pilot study is that the sample size was small. The limits of the quantitative questions include only getting a level of satisfaction, instead of the answers as to why the level of satisfaction is what they scored it to be. More qualitative questions may have elicited more answers about the problems instead of just finding out where some problems might exist.
Results of this research study show two areas of concern including waiting time of tests and xrays and peacefulness of the waiting room. The large number of not certain responses in the area of preparation to transfer patient out of the ICU may be because many patients may not have reached the stage where transfer was being considered. The written comments helped determine why peacefulness of the waiting room scored poorly. I learned through this study the importance of doing both quantitative and qualitative research. Quantitative work is important so that numbers can be used to back up conclusions drawn. But without qualitative work, we may never know what a patient is truly trying to tell a researcher by not allowing them to express themselves in their own words. While conducting this study I was not convinced I would receive any conclusive evidence, due to the small sample size and the fact that many outlying factors seem to go into the satisfaction of each family depending on the specific condition of their patient. I also did not expect the many written comments which were interesting and helpful.
Nurses need to be aware of the time it takes for test results and x-rays. Realistic time frames can be given to keep the patient’s family well informed as to the progress of tests. Clear explanations of the procedures will assist families to understand why they take so long. We need to be aware of families needs and make personal contact to define problems that may exist.
This study provides implications for future research. A large qualitative research study could be conducted, focusing on all aspects of the waiting room phenomena. A quantitative study of larger numbers focusing in some of the areas of concern found would yield interesting results. The placement of a chapel near a waiting room so families could pray or meditate could be examined for future hospitals, as many are afraid to leave an ICU waiting room to spend time in a chapel in another location, feeling they may miss some important development in their family member’s condition.
Though this was a small study, it served a valuable purpose. I learned about different types of research and the results they yield. If I were to do this study differently, I would have included more qualitative questions to yield richer and more data relating actual perceptions of participants. I offer thanks to the ORCA Scholarship for making this experience possible.