The Family Navigator: A Pilot Intervention to Support Intensive Care Unit Family Surrogates

Abstract

Background Although communication problems between family surrogates and intensive care unit (ICU) clinicians have been documented, there are few effective interventions. Nurses have the potential to play an expanded role in ICU communication and decision making. Objectives To conduct a pilot randomized controlled trial of the Family Navigator (FN), a distinct nursing role to address family members’ unmet communication needs early in an ICU stay. Methods An inter-disciplinary team developed the FN protocol. A randomized controlled pilot intervention trial of the FN was performed in a tertiary referral hospital ICU to test the feasibility and acceptability of the intervention. The intervention addressed informational and emotional communication needs through daily contact using structured clinical updates, emotional and informational support modules, family meeting support and follow-up phone calls. Results Twenty-six surrogate/patient pairs (13 per study arm) were enrolled. Surrogates randomized to the intervention had contact with the FN 90% or more of eligible patient days. All surrogates agreed or strongly agreed that they would recommend the FN to other families. Open-ended comments from both surrogates and clinicians were uniformly positive. For both groups, 100% of baseline data collection interviews and 81% of 6–8 week follow-up interviews were completed. Conclusions A fully integrated nurse empowered to facilitate decision making is a feasible intervention in the ICU setting. It is well-received by ICU families and staff. A larger randomized controlled trial is needed to demonstrate an impact on important outcomes, such as surrogate well-being and decision quality.

Nurse–Family Communication During and After Family Meetings in the Intensive Care Unit

“…One approach to empower nurses to participate in conversations is to develop a specialty role for the nurse. Communication facilitators (Curtis et al., ) or family navigators (Torke et al., ) are nurses who receive training in communication and decision making to assist families during the decision‐making process, including during family meetings. However, these additional roles do not attend to the issue of empowering all nurses to fulfill their role in assisting families.…”

Family resilience and flourishment: Well‐being among children with mental, emotional, and behavioral disorders

“…While family navigation interventions are often rated as acceptable by participants (Moody et al, 2019;Torke et al, 2016), parent-based support intervention programs frequently experience disengagement and attrition (Chacko, Wymbs, Rajwan, Wymbs, & Feirsen, 2017;Dadds, Maujean, & Fraser, 2003;Friars & Mellor, 2009). This highlights a po-…”

Effects of the use of interactive E‐books by intensive care unit patients' family members: Anxiety, learning performances and perceptions

“…In the past, the nursing staff gave patients or family members nursing instruction or an introduction to the ICU environment by way of paper‐based instruction, which was often found to cause difficulties (Cypress, ; Torke et al, ). For instance, using conventional paper‐based instruction, it is difficult for the nursing staff to clearly explain the operating procedures of the medical equipment to the patients' families.…”