Developing a theory of family care during critical illness

Abstract

Critical illness of a loved one and subsequent admission into the critical care unit (CCU) have notable effects on family members (FMs). Many studies have acknowledged the importance of identifying the needs of FMs during this difficult period in an attempt to ease the effects of this crisis. [1-4] Molter's seminal work [5] that explored the needs of FMs led to the development of the Critical Care Family Needs Inventory, which categorises family needs into five domains, namely assurance, proximity, comfort, support and information. [6] The admission of a loved one into the CCU may result in FMs experiencing symptoms of a psychological nature, both during and after the critical illness, such as generalised anxiety and depression, acute stress and post-traumatic stress. [7] A survey by Lemiale et al. [8] showed that 36% of FMs of patients admitted to the CCU were taking antidepressants or anxiolytic drugs, with 8% of FMs using psychotropic drugs after the discharge or death of a loved one. In addition, Pochard et al., [9] who conducted a study among 544 FMs using the Hospital Anxiety and Depression Scale, found that depression and anxiety were evident in 73.4% and 35.3% of respondents, respectively. Presently, more attention is being directed towards family nursing in the critical care setting worldwide. [10] Current family-centred interventions in CCUs include improving care that focuses on quality of life, symptoms of psychological distress and end-of-life care. [11] The situation is complicated in resource-constrained settings such as South Africa (SA). SA's healthcare system comprises private (medical insurance) and state health sectors, with the focus on service delivery evolving from a curative, hospital-based service to a comprehensive primary healthcare approach. This redistribution of resources to primary healthcare has led to reduced resources being available for critical care. [12] Although the state health sector has become a comprehensive, integrated national service, failure in leadership and stewardship and poor management have led to a struggle in handling major challenges associated with issues such as effective and efficient management of human resources, moonlighting, and ill discipline and absenteeism among staff. There has also been a tendency to retain incompetent staff or managers, and as a result 'loyalty rather than ability to deliver' has been rewarded for many years, with no climate of accountability. [13] The CCU admission profile in SA is different from that of international CCUs. The majority of patients are typically male (65%) and traumatic injuries (motor vehicle accidents, gunshots and stabbings) account for a large part (53%) of admissions. The remainder comprises

Perception of Nurses’ Support among Family Members of Hospitalized Patients in A Tertiary Health Facility in South-West, Nigeria

“…Also, a study conducted in Ghana ( Ohene et al, 2017 ) among parents of road traffic accidents in the emergency unit reported that health workers supported family belief and inspired them to engage in prayers and rituals to support the medical care they are receiving. Beer and Brysiewicz (2019) in development of a theory to guide caring for family members when their loved ones are suffering from critical health conditions, emphasized the importance of the concept of religious and cultural collaboration in family care. According to health belief model, belief that people hold may influence behavior; perceived benefits of rituals/prayers may influence positive coping behavior of families ( Tsai et al, 2021 ).…”

The risk factors of the functional status, quality of life, and family psychological status in children with postintensive care syndrome: A cohort study

“…The complete comprehension of the family about the patient's condition was also crucial to prevent the psychological problem, which could be achieved by involvement of the close family in their children nursing and good communication between health professionals and the family throughout and after the intensive care. [ 19 ] None of the internal and external risk factors evaluated in this study had a significant impact on the family psychological condition. It showed that clear continuous communication and the involvement of the family, as not evaluated in this study, were the key aspects to maintain the good psychological condition of the family.…”

Actividades de enfermería para la satisfacción de necesidades familiares en cuidado intensivo adulto: una revisión integrativa

“…Actividades para suplir la necesidad de proximidad: De acuerdo con De Beer 36 la proximidad se refiere a ser flexible con respecto al acceso de la familia al entorno del paciente y hacer que sea más fácil (tanto física como psicológicamente) el estar cerca de su ser querido; dicha cercanía le permite a los miembros de la familia monitorear la situación, rastrear la atención brindada y desarrollar confianza con el personal que brinda atención; esto también es acorde con lo encontrado por Shorofi et al 37 donde se encontró que la proximidad es una de las principales necesidades de la familia en la UCI adulto.…”