Dr. M E

Family-Centered Care in the Adult Intensive Care Unit: a concept analysis.

Mohamed Elhakim, M.D.

Disclosure I have NO actual or potential conflict of interest in relation to this activity.

I do not have any relevant financial relationships with any commercial interests.

History of Family-Centered Care  Developed after World War II

 Changing social expectations for the care delivery

 Originate from US and UK

 Research “right time - right place” 

Social readiness for change

Background  “Family” means any person(s) who plays a significant

role in an individual’s life.  During a critical illness, families fulfill an additional

essential role for patients (Granberg, Engberg & Lundberg, 1999).  Family is an acknowledged and accepted essential

component of the patient in Adult critical care units.  Critical Care and intensive care nurses report a

hesitancy to add to the complexity of their work by including family members (Price, 2004)

Background ď‚— Family-centered care is a framework for the delivery

of healthcare that is creating change in healthcare policies, programs, facility design, day-to-day practices of individual practitioners, and professional education.

Role of the Family ď‚— Communication with family members in the ICU

setting is complex, and high-quality communication requires training and collaboration of a wellfunctioning team. This communication also requires a balance between adhering to processes of care that are associated with improved outcomes and individualizing communication to the unique needs of the family.

Role of the Family ď‚— Because most critically ill patients lack decision-

making capacity, physicians often ask family members to act as surrogates for the patient in discussions about the goals of care. Therefore, clinician-family communication is a central component of medical decision making in the ICU,

History Family-Centered Care Patient-Centered Care versus Family-Centered Care Which came first, the chicken or the egg?

Role of Care partners versus family member

ď‚— While specific methods of implementing family-centered care differ from facility to

facility, general procedures are fairly similar.

The University of Virginia Health System in Charlottesville, Virginia, provides an excellent example of this. On admission, the patient usually has one or two people who will serve as their primary "care partners." These individuals are notated in the patient's electronic and physical medical charts, and they are given an orange wristband to wear in order to designate them as a patient's "care partners."

This negates the need for visitor's passes or after-hours registration cards, as the staff can readily identify a patient's "care partners." The admitting staff discuss the reasons for admission with the patient and their "care partners" and what health criteria are required for the patient's discharge.

Role of the Care Partner ď‚— "Care partners" are then involved with the patient's

care by their entire attending healthcare team, including physicians, nurses, nutritionists, social workers, and more. At every stage, "care partners" and patients discuss with healthcare professionals test results, the state of the patient's current health, what type of things to expect throughout the day, and discharge goals.

Role of the Care Partner ď‚— "Care partners" are invited to take part in nursing

interventions, including bathing, feeding, helping the nursing staff with moving the patient, and assisting the patient in exercising or moving about the unit..

ď‚— "Care partners" are also invited to take an active role

in "rounds," providing feedback and asking questions reflective of theirs and the patient's wishes or concerns

ď‚— "Care

partners" are also ifluenced on various elements of hospital operating policy, such as quiet time and visitation rules. The "care partners" are then generally allowed to manage the adherence to these policies in a manner conducive to the patient's healing and common sense—for example, by managing how many visitors are present in the patient's room.

The concept ď‚— The concept of family- centered care in Adult

intensive care unit has changed drastically in protracted years and has been used in various contexts differently. Since we require clarity in our understanding, we aimed to analyze this concept

Research Question

ď‚— What are the changes of family centered care

literature from 1980 to 2013.

METHODS:

ď‚— This study was done on the basis of developmental

approach of Rodgers's concept analysis. We reviewed the existing literature in Science direct, PubMed, and Google Scholar databases from 1980 to 2013. The keywords were family-centered care, family-oriented care, and adult intensive care unit. After all, 59 out of 245 English and Arabic articles and books (more than 20%) were selected.

RESULTS:

ď‚— The attributes of family-centered care in adult

intensive care unit were recognized as care taking of family (assessment of family and its needs, providing family needs), equal family participation (participation in care planning, decision making, and providing care from routine to special ones),

RESULTS:

ď‚— It is recognized also as collaboration (inter-

professional collaboration with family, family involvement in regulating and implementing care plans), regarding family's respect and dignity (importance of families' differences, recognizing families' tendencies), and knowledge transformation (information sharing between healthcare workers and family,

RESULTS:

ď‚— The attributes of family-centered care in adult

intensive care unit were recognized also as complete information sharing according to family learning style). Besides, the recognized antecedents were professional and management-organizational factors. Finally, the consequences included benefits related to adulthood, family, and organization.

RESULTS:

ď‚— family-centered

care was NOT an essential component of A developmental care framework for an intensive care unit from late 1980 to 1999,

Results ď‚— This result affected the outcome of adult intensive

care unit mainly in the form of patient's satisfactions, it also has profound effects on the experiences and long-term mental health of family members.

Results ď‚— literature from 2001 shows the answer of if family

centered care as an essential component of adult intensive care unit ď‚—

It then started to influence and improve the outcome of adult intensive care,

Results ď‚— Discussions between ICU clinicians and family

members about goals of care and medical decision making often take place during ICU family conferences. Conduct of these conferences within 72 hours of ICU admission has been associated with reduced days in the ICU for patients.

Results ď‚— One of the findings have been introduced in family

centered care in 2005, was combined into a mnemonic for five features to enhance clinicianfamily communication: VALUE (value, acknowledge, listen, understand, and elicit) . This mnemonic has been used as part of an intervention to improve clinician-family communication in the ICU that has been shown to significantly reduce family symptoms of anxiety, depression, and posttraumatic stress disorder 3 months after the patient's death.

ď‚— From 2005 to 2013 several research methodology

shows an effective reduced ICU length of stay with effective family – physician communication and knowledge sharing, this affects different factors like cost, effort and quality of care to a larger extent,

CONCLUSION: ď‚— The findings revealed that family centered-care was a

comprehensive and holistic caring approach in adult intensive care. Therefore, it is highly recommended to change the current care approach and philosophy and provide facilities for conducting family-centered care in adult intensive care unit

Future Aim To run the same Family-centered care study in Pediatrics and neonatal intensive care unit and to run a prospective study on the same concept.

Disclosure I have NO actual or potential conflict of interest in relation to this activity.

I do not have any relevant financial relationships with any commercial interests.

THANK YOU!