Family Support
Crit Care Nurs Q Vol. 35, No. 3, pp. 299–313 Copyright c 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Experiences and Needs of Families Regarding Prognostic Communication in an Intensive Care Unit
Supporting Families at the End of Life
Karen M. Gutierrez, PhD, RN
This article reports the results of a study designed to explore the experiences and needs of family members for prognostic communication at end of life in an intensive care unit (ICU). Subjects in this qualitative study included 20 family members of patients at high risk for death in 1 adult medical/surgical ICU. All subjects were interviewed once utilizing a semistructured interview format, with approximately half interviewed multiple times during the ICU stay. Families described 5 themes of information-related “work”: (1) hearing and recalling, (2) accessing, (3) interpreting, (4) retaining, and (5) utilizing information for decision making. Barriers, including accessing physicians and cognitive issues from high levels of stress, made this work difficult. Families described a need for prognostic information, especially if the prognosis was poor. Because hearing this news was difficult, they needed it communicated with respect, sensitivity, and compassion. Suggestions for clinical practice to support families in their information-related work are presented. Overall, the importance of providers approaching communication from a holistic perspective, extending beyond simply passing on information, is emphasized. Viewing communication as a therapeutic modality, and communicating with compassion, sensitivity, and a genuine sense of caring, can help provide both the information and the emotional support and comfort families desperately need. Key words: communication, critical care, end of life, family support, intensive care unit
Author Affiliation: Department of Nursing and Health Sciences, Metropolitan State University, St Paul, Minnesota. This work was done at the University of Minnesota.
Experiences and Needs of Families Regarding Prognostic Communication in an Intensive Care Unit
Supporting Families at the End of Life
Karen M. Gutierrez, PhD, RN
This article reports the results of a study designed to explore the experiences and needs of family members for prognostic communication at end of life in an intensive care unit (ICU). Subjects in this qualitative study included 20 family members of patients at high risk for death in 1 adult medical/surgical ICU. All subjects were interviewed once utilizing a semistructured interview format, with approximately half interviewed multiple times during the ICU stay. Families described 5 themes of information-related “work”: (1) hearing and recalling, (2) accessing, (3) interpreting, (4) retaining, and (5) utilizing information for decision making. Barriers, including accessing physicians and cognitive issues from high levels of stress, made this work difficult. Families described a need for prognostic information, especially if the prognosis was poor. Because hearing this news was difficult, they needed it communicated with respect, sensitivity, and compassion. Suggestions for clinical practice to support families in their information-related work are presented. Overall, the importance of providers approaching communication from a holistic perspective, extending beyond simply passing on information, is emphasized. Viewing communication as a therapeutic modality, and communicating with compassion, sensitivity, and a genuine sense of caring, can help provide both the information and the emotional support and comfort families desperately need. Key words: communication, critical care, end of life, family support, intensive care unit
Author Affiliation: Department of Nursing and Health Sciences, Metropolitan State University, St Paul, Minnesota. This work was done at the University of Minnesota.
References: 1. Verhaeghe S, Defloor F, Van Zuuren F, Duijnstee M, Grypdonck M. The needs and experiences of family members of adult patients in an intensive care unit: a review of the literature. J Clin Nurs. 2005;14:501509. 2. Pochard F, Azoulay E, Chevret S, Kentish-Barnes N. Symptoms of anxiety and depression in family members of intensive care unit patients: ethical hypothesis regarding decision-making capacity. Crit Care Med. 2001;29(10):1893-1897.