[christvs]

Hi, I'm a med/surg/tele RN who is also a full-time acute/critical care NP student. One of my projects for NP school is to assess/uncover the unmet needs of family members of ICU patients. So far my group has reviewed a lot of the literature on this topic, and pretty soon we will (hopefully) be allowed to interview family members (after we get approval and permission from the hospital) as well as the staff ICU nurses. But I also was hoping some of you here could tell me what you perceive to be the needs, unmet or otherwise, of families of ICU patients (so I can compare what you tell me with what the literature says). Anything you want to tell me would be greatly appreciated. I really do find this topic interesting. Thanks in advance.
-Christine

[cardiacRN2006]

I've worked in 2 ICUs. In the first one, a private hospital, the needs of the families were few. We had a roll out bed, guest trays, open visitation (no visitor hours, no limit on visitors), we gave them pt gowns and pants to sleep in, and we almost never kicked them out of the room, unless it was a sterile procedure. There was a shower in every room and every room was a private one. They would bring us food and eat with us at the nurses station. We knew all their names, and they knew exactly the kind of care that their family member was getting. If they stayed a long time in the ICU, we would even ask if they wanted anything when we ordered out for lunch.

At the ICU I'm at now, we do have visiting hours, and only 2 visitors at a time, which they strictly enforce. It's odd for me to tell a family that they can't come in right now. No guest trays and no chairs in the room, so they are often standing, staring at the pt, hungry and thirsty. Our bathroom is out of the ICU, so they have to leave to go to the bathroom, with the fear that we may not buzz them back in. Our rooms are small, so they feel as if they are in the way (they are), and often times, they are spanish speaking only, so they may not really know what it going on with their family members.

In both hospitals, the families need to see the care that the pt is getting. They need to see that we actually care about the pt, that the room looks clean, that the pt is clean, that the doctors are treating them, and that we are their pt advocate. I always round with the doctors. That can be hard, because there are lots of Drs (teaching hospital), but I want to hear what they are saying, and then translate it out of Dr-speak into normal words for the family. I also want to know what they think is going on with the pt.

When we kick family out when visiting hours close, they just go sit outside or in an empty, dark cafeteria. How sad. They have to sit and wait a few hours before they can come back and wonder what is going on.

[gradcare]

From my perspective the biggest need is information and then reassurance that "it will be all right". Something that we cannot give. Remember the ICU is scary (think back to when you first set foot in one even as a student), noisy and that is without having a person you care about hooked up to strange things with wires coming off them. So even for a "routine" post op admission there is a lot of scary stuff going on. Add to that fear of the unknown (I have rarely seen a relative told that everything will be o.k without some modifier (eg all things being equal, if everything runs to plan etc). Also patient conditions change so rapidly that the condition reports they got this am may not actually reflect what the patient is like now. So I think that information and reassurance are 2 of the most important needs that often are not met for relatives of ICU patients.

[carolCCRN]

I think at the top of my list would be better communication with the MDs. We have some MDs who hide for family members and have to be beaten before they'll talk to anyone. Sure, sometimes the report is going to be "Same", but the stress level of these people is so high, that a word would help. Really, I don't want to talk to some of the family, myself, but not everything is all about me.

Our visiting hours are pretty strict, too. Our unit was just built 1 yr ago, and when it was in the planning stages, administration asked the nurses for suggestions. Knowing that they really like the idea of open visitation, we asked for:
Bigger rooms- didn't get
Visitor shower/bathroom- didn't get
visitor waiting/conference room-didn't get(waiting room and bathroom are on another floor)
So, now, even WHEN we open up visitation, we don't have much to offer the visitors (A TOILET!).
It's a shame, because I believe opening visitation would encourage trust between the families and the medical staff.

[Pompom]

I believe that the physicians should speak to family on a daily basis and in language they can understand. Tell the truth! Do not sugar coat how bad their prognosis is to their faces then come to the nurses station and say I don't think he will make it through the night. Offering false hope is cruel. I also believe all ICU rooms should be private. Visitation hours could be extended but limited to 2 at a bedside due to space issues in the ICU I work in. Family members that think they are at a hotel and we are their maids needs to be discouraged. Perhaps a pamphlet explaining ICU in general terms and that the patients need their REST could ease the families expectations of all day visiting. I have had patients tell me they were so glad the family left so they could rest, I have heard this so many times I can't keep track.

[augigi]

1. Open visiting hours.
2. Scheduled family conferences with the docs, nurses and family members.
3. A plan of care the family can get involved in.
4. Psychological/social work support for the family (from talking about the situation, to getting a parking pass or financial advice).
5. Kindness.

[dfk]

lack of communication/understanding from docs, and regarding hippa, for example, a brother of a patient has to be told to contact spouse for information because 'that's the law'... even if said brother lives far away and has no communication with any family members. i always hated telling phone callers that stuff.