Care and caring in the intensive care unit: Family members' distress and perceptions about staff skills, communication, and emotional support

doi:10.1016/j.jcrc.2015.01.012

Journal of Critical Care

Volume 30, Issue 3, June 2015, Pages 557-561

https://doi.org/10.1016/j.jcrc.2015.01.012 Get rights and content

Abstract

Purpose

Family members of intensive care unit (ICU) patients are sometimes highly distressed and report lower satisfaction with communication and emotional support from staff. Within a study of emotional responses to traumatic stress, associations between family distress and satisfaction with aspects of ICU care were investigated.

Materials and methods

In 29 family members of trauma patients who stayed in an ICU, we assessed symptoms of depression and posttraumatic stress disorder (PTSD) during ICU care. Later, family members rated staff communication, support, and skills and their overall satisfaction with ICU care.

Results

Ratings of staff competence and skills were significantly higher than ratings of frequency of communication, information needs being met, and support. Frequency of communication and information needs being met were strongly related to ratings of support (rs = .75-.77) and staff skills (rs = .77-.85), and aspects of satisfaction and communication showed negative relationships with symptoms of depression (rs = − .31 to − .55) and PTSD (rs = − .17 to − .43).

Conclusions

Although satisfaction was fairly high, family member distress was negatively associated with several satisfaction variables. Increased understanding of the effects of traumatic stress on family members may help staff improve communication and increase satisfaction of highly distressed family members.

Section snippets

Participants

The study was approved by the institutional review panel for the protection of human subjects, and written informed consent was obtained from participants. Participants were 29 spouses or first-degree relatives of severely injured patients treated at a level 1 trauma center and admitted to a surgical ICU. All participants reported experiencing subjective distress in response to the event. Study participation was restricted to 1 family member per patient.

Measures

Family members completed the Family

Results

The average age of participants was 48 (median, 48.5), and 23 (79%) were female. Twenty-one (72.4%) participants identified themselves as white, 7 (24.1%) identified as Hispanic, and 1 (4%) as Asian. Median years of education was 15; 9 (31.0%) participants had a college degree, followed by 9 (31.0%) with some college, 5 (17.2%) with post baccalaureate education, 5 (17.2%) with a high school diploma, and 1 (3.4%) with less than a high school diploma. Nine (31.0%) participants were the patient's

Discussion

The family members we studied generally expressed high satisfaction with the care provided in the ICU, but relatively lower ratings were given for communication, information, and emotional support among 17% to 20% of participants. Staff competence and skills were most highly rated and were significantly higher than ratings of overall satisfaction, frequency of communication with doctors and nurses, information needs being met, and emotional support. Consistent with prior research [10], [18],

Acknowledgments

This study was supported in part by National Institutes of Health grant MH 69876 awarded to Eve B. Carlson. We wish to thank Abbey Tillery, Marianne Kabour, Rob Wheeler, Donn Garvert, Luma Muhtadie, and Lori Holleran for their work on the research and all of the research participants who generously contributed their time and effort to benefit others.

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Cited by (85)

Association between psychosocial factors and satisfaction with communication in family members of intensive care unit patients during COVID-19 pandemic: An exploratory cross-sectional study
2023, Intensive and Critical Care Nursing
To investigate the relationship between satisfaction with communication and perceived stress, depressive symptoms and perceived social support among family members of critically ill.
Exploratory, cross-sectional study was conducted.
Private teaching hospital in Santiago, Chile.
Family members of critically ill patients with 3–7 days of stay and respiratory support were approached. Questionnaires were used to assess satisfaction with communication (Family Satisfaction in the Intensive Care Unit-24), perceived stress (Perceived Stress Scale-10), depressive symptoms (Patient Health Questionnaire-9) and perceived social support (Medical Outcomes Study Social Support Survey). The relationship between satisfaction with communication and relevant variables was investigated using bivariate analyses and a beta regression.
The study included 42 family members, with 71.4% being female and 52.4% having prior critical care experience. There was a positive correlation between perceived stress and depressive symptoms (r = 0.32, p = 0.039). According to the beta regression, perceived social support (B; 95% confidence interval, 0.44 [1.05–2.29]) and the number of calls with unit staff (0.17 [1.06–1.32]) were positively associated with satisfaction with communication but negatively with college education (−1.86 [0.04–0.64]) and perceived stress (−0.07 [0.87–0.99]).
Psychosocial factors, such as higher educational level, perceived stress and perceived social support, can influence family members’ evaluation of communication with staff. Current communication practices in acute care settings should be adapted to family members’ psychosocial context to improve their satisfaction with the communication process.
Critical care professionals must be aware of the influence of family member-related factors on the quality and effectiveness of the communication process. Psychosocial features of the family members are likely to impact their satisfaction with communication and should be assessed on admission and during their stay to assist clinicians to adjust and improve their communication practices.
Family experiences and perceptions of intensive care unit care and communication during the COVID-19 pandemic
2023, Australian Critical Care
Citation Excerpt :
Visiting restrictions have kept families and patients apart, causing additional trauma to many.4 Psychological consequences for patients and families resulting from critical illness and ICU admission have been the subject of considerable previous research.5–14 The attendance and inclusion of family members in the ICU has been identified as an important factor in providing patient- and family-centred care,15–17 decreasing the risk of delirium,18,19 and improving patient psychological recovery.19
In 2020, during the first wave of the COVID-19 pandemic in Melbourne, visitor access to acute hospitals including intensive care units (ICUs) was initially barred, followed by a limit of one person per patient for one hour per day. This study explores the care and communication experienced by family members of ICU patients during this time.
This qualitative descriptive study was conducted at an Australian quaternary hospital. Semistructured phone interviews were conducted using an aide-memoire designed to understand participants’ experiences as family of a patient during this time. Interviews were recorded, transcribed, and thematically analysed.
Twenty family members of patients in the ICU participated. Three major themes were identified: ‘impact of restricting visiting procedures’, ‘family experiences of communication’, and ‘care and support’. Inflexible visiting restrictions had a momentous impact on families. Participants objected to having to nominate only two people to visit during the admission and the short visiting time limit. Some family members suffered extreme stress and anxiety during their absence from the bedside. Additional challenges were experienced by rural families, visitors with disabilities, and the young children of patients who were excluded. Communication with clinicians varied. Telehealth was valued by some but not universally embraced. The relationship between staff members and families and involvement in decision-making were unaffected.
Families experienced significant psychological distress from being separated from their critically ill relatives. Patient care and involvement in decision-making appeared to be unchanged, but communication with staff felt to be lacking. Better alternatives to face-to-face communication must be sought to limit the impact of family separation on mental health. Families are a key link between the patient and clinicians and often play a major role in patient support and recovery after discharge. There is an urgent need to support them and facilitate meaningful engagement despite the obstacles.
Factors associated with family satisfaction in the adult intensive care unit: A literature review
2022, Australian Critical Care
Citation Excerpt :
Next, most of the family member–related factors found in this review are nonmodifiable. Future studies could explore factors that are amenable to be modified (or manageable) in both, family members and healthcare providers, such as psychological distress symptoms,24,25,35,36 social support,23 or optimism35 which were explored mostly on low-quality studies. This review has limitations.
The objective of this study was to identify and summarise factors associated with family satisfaction among family members of adult intensive care unit (ICU) patients.
A search was conducted from inception to October 2020 in the following databases: PubMed, Scopus, EMBASE, CINAHL Plus, ProQuest Health Management, PsycINFO, LILACS, and SciELO. Studies reporting the questionnaire's items or dimensions as family satisfaction factors, studies dichotomising family satisfaction outcome, and those involving family members of neonatal, paediatric, palliative, and end-of-life patients were excluded. Quality of the studies was examined through a modified approach to the Consolidated Standards for Reporting Trials (CONSORT). Reported factors were classified as family member, patient, or provider/organisation related.
The search yielded 26 articles reporting factors associated with family satisfaction in the ICU. Regarding study quality, 19.2% were classified as high-quality studies. Family member–related variables such as educational level, gender, and kinship to the patient showed divergent associations with family satisfaction. Within patient-related variables, the severity of illness was positively associated with family satisfaction. Factors related to healthcare providers and organisations were reported only in 26.9% of the studies.
A broad number of factors associated with family satisfaction in the ICU were found in this review. However, few nonmodifiable factors related to the family members and the patient showed a significant and consistent association with family satisfaction. Evidence on factors related to healthcare providers was scarce. Gaps in knowledge regarding family satisfaction in the ICU, including methodological issues that impair the validity of the findings, were identified. Future studies should address these limitations to accurately identify factors that impact family satisfaction in the ICU.
A 6-y retrospective cohort study of family satisfaction with critical care and decision-making in an Australian intensive care unit
2022, Australian Critical Care
Partnering with patients and families to make decisions about care needs is a safety and quality standard in Australian health services that is often not assessed systematically.
The objective of this study was to retrospectively evaluate satisfaction with care and involvement in decision-making among family members of patients admitted to the intensive care unit (ICU).
A retrospective cohort analysis of a satisfaction survey administered to family members of patients admitted to an ICU in an Australian metropolitan tertiary care hospital from 2014 to 2019 was conducted. The Family Satisfaction in the Intensive Care Unit questionnaire (FSICU) questionnaire was used to assess overall satisfaction, satisfaction with care, and satisfaction with decision-making on a scale from “poor” (0) to “excellent” (100).
In total, 1322 family members fully completed the survey. Respondents were typically direct relatives of ICU patients (94.2%) with an average age of 52.6 years. Most patients had an ICU length of stay <7 d (56.8%), with most patients being discharged to the ward (96.8%). The overall mean satisfaction score was high among respondents (90.26%). Similarly, mean satisfaction with care (93.06%) and decision-making (89.71%) scores were high. Satisfaction with decision-making scores remained lower than satisfaction with care scores. Multivariable modeling indicated that those younger than 50 years reported higher satisfaction scores (p = 0.006) and those with prolonged lengths of stay in the ICU were associated with lower overall satisfaction scores (p = 0.039). Despite some criticism of waiting times and noise levels, responses showed sincere gratitude for patients’ treatment in the ICU and appreciation for the care, skill, and professionalism of the staff.
Very high satisfaction levels were reported by family members during this study. Routine, prospective evaluations of family member satisfaction with ICU experiences are feasible and can be leveraged to provide insight for clinicians and administrators seeking to improve family satisfaction with decision-making and care in ICU settings and meet national standards.
Impact of a nurse-led family support intervention on family members' satisfaction with intensive care and psychological wellbeing: A mixed-methods evaluation
2021, Australian Critical Care
Families of critically ill persons face uncertainty and experience distress during and after their close other's stay in an intensive care unit (ICU). Proactive nurse engagement and support is recommended to meet families' needs in the ICU, but little is known about its impact on quality of family care. We introduced a family support intervention that consisted of an interprofessional family support pathway and a new role of an advanced practice family nurse.
The aim of the study was to examine the effect of an advanced practice nurse–led family support intervention on family members' satisfaction, wellbeing, and psychological distress.
We conducted a quasi-experimental before-and-after study with embedded qualitative interviews in a Swiss University Hospital from March 2018 to July 2019 using a questionnaire (Family Satisfaction in the ICU-24 Survey, Hospital Anxiety and Depression Scale, and Impact of Event Scale-Revised-6) and qualitative interviews (n = 19) after patient discharge.
Families in the intervention group (n = 75) showed a trend for increased overall satisfaction (difference of 5.544, 95% confidence interval [CI]: −0.11 to 11.20), a statistically significant increase in satisfaction with decision-making (7.258, 95% CI: 0.89 to 13.63), and a nonsignificant increase in satisfaction with care (4.178, 95% CI: −1.53 to 9.89). Psychological distress was higher in the intervention group, with depression reaching statistical significance (difference of 1.706, 95% CI: 0.16 to 3.25), which may be explained by longer ICU stays and higher proportion of deaths in the intervention group. Families receiving the intervention reported to be feeling cared for, well informed, and better able to cope. Data integration suggests that early onset, fit to need, and quality of intervention were the most important intervention characteristics impacting family wellbeing.
Our study found that family members experience a nurse-led support intervention as beneficial for their wellbeing. It increased their satisfaction, but was unable to demonstrate a favourable impact on psychological distress.
Satisfaction of patients and family caregivers in adult intensive care units: Literature Review
2021, Enfermeria Intensiva
Las unidades de cuidados intensivos son lugares hostiles que se deben acondicionar a las necesidades de los pacientes y familiares, para esto se deben conocer los factores que influyen en la satisfacción de estos.
Actualizar el conocimiento sobre la satisfacción de los pacientes ingresados en una Unidad de Cuidados Intensivos (UCI) de adultos y la de sus cuidadores familiares descritos en la literatura científica.
Se realizó una revisión bibliográfica sistematizada en las bases de datos PubMed, Scopus, Cinahl y WOS. Estrategia de búsqueda: «Personal Satisfaction» and (patients or caregivers) and «Intensive Care Units». Criterios de inclusión: Estudios publicados entre 2013-2018, población entre 19-64 años, idioma inglés y castellano.
Se localizaron 760 estudios y se seleccionaron 15. Los factores que generan satisfacción son: Buena comunicación con los profesionales (n = 5), calidad de cuidados (n = 4) y limpieza y ambiente de la unidad (n = 2). Los factores que producen insatisfacción son: Infraestructura de las salas de espera (n = 5), inadecuada comunicación (n = 4) y la implicación de familiares y pacientes en la toma de decisiones (n = 4). Como estrategias de mejora encontramos el entrenamiento de los profesionales (n = 5), inclusión familiar durante el proceso (n = 2) y rediseño de las salas de espera (n = 2).
Entre los factores generadores de satisfacción hallamos los relacionados con los profesionales y con el ambiente y limpieza. Los que causan insatisfacción se relacionan con una mala infraestructura, falta de implicación en la toma de decisiones de pacientes y familiares y mala comunicación con los profesionales. Las estrategias para mejorar la satisfacción de los pacientes y familiares están relacionadas con la organización, los profesionales, los familiares y con la infraestructura y ambiente.
Intensive care units are hostile places, which must be conditioned to the needs of patients and families, and therefore the factors that influence their satisfaction must be known.
To update the knowledge on the satisfaction of the patients admitted to an adult intensive care unit and that of their family caregivers as described in the scientific literature.
A systematized literature review was carried out in PubMed, Scopus, Cinahl and WOS databases. Search strategy: “Personal Satisfaction” and (patients or caregivers) and “Intensive Care Units”. Inclusion criteria: studies published between 2013-2018, population aged between 19-64 years, english and spanish language.
760 studies were located and 15 were selected. The factors that increased satisfaction are: good communication with professionals (n=5), the quality of care (n=4), and the cleanliness and environment of the units (n=2). The factors that produced dissatisfaction are: the infrastructure of the waiting room (n=5), inadequate communication (n=4), and the involvement of families and patients in decision-making (n=4). Training of professionals (n=5), inclusion of the family during the process of hospitalization (n=2) and redesigning the waiting room (n=2) are some of the suggestions for improvement.
Factors related to professionals, environment and cleanliness of the units are satisfaction-generating factors. Factors generating dissatisfaction related to poor infrastructure, a lack of involvement in decision-making and poor professional communication. Strategies to improve patient and family satisfaction relate to the organization, professionals, family members, and infrastructure and environment.

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Clinical PotpourriCare and caring in the intensive care unit: Family members' distress and perceptions about staff skills, communication, and emotional support

Abstract

Purpose

Materials and methods

Results

Conclusions

Section snippets

Participants

Measures

Results

Discussion

Acknowledgments

Soc Sci Med

J Crit Care

Int J Nurs Stud

J Crit Care

J Affect Disord

Intensive Care Nurs

Heart Lung

Ann Emerg Med

Int J Nurs Stud

Intensive Care Nurs

Lancet

Behav Res Ther

Intensive Crit Care Nurs

Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine Task Force 2004-2005

Crit Care Med

Directly observed patient-physician discussions in palliative and end-of-life care: a systematic review of the literature

J Palliat Med

Psychosocial and professional characteristics of burnout in Swiss primary care practitioners: a cross-sectional survey

Swiss Med Wkly

Symptoms of anxiety and depression in family members of intensive care unit patients: ethical hypothesis regarding decision-making capacity

Crit Care Med

Family satisfaction with care in the intensive care unit: results of a multiple center study

Crit Care Med

Determinants of family satisfaction in the intensive care unit

Anaesth Intensive Care

Patients' family satisfaction with needs met at the medical intensive care unit

J Adv Nurs

Risk of post-traumatic stress symptoms in family members of intensive care unit patients

Am J Respir Crit Care Med

Family satisfaction in the intensive care unit: a quantitative and qualitative analysis

Intensive Care Med

Clinical Potpourri
Care and caring in the intensive care unit: Family members' distress and perceptions about staff skills, communication, and emotional support