TNAI JOURNAL

The admission of a family member into
a critical care unit can be a frightening experience for family members. Often, the combination of a patient’s condition and an initial perception by relatives of a high tech, intimidating area can cause a great deal of stress for them.

Traditionally, nurses carry out a wide variety of functions. Some of these can be seen as primary to nurse’s role and some are secondary to nurse’s role – namely care and cure functions. Today’s concern is “family centered care” where health personnel are in a position to provide care not only to the patient but also to family as a whole.

Health care provider who recognizes the influence of family will have a powerful role in healing. Critical care nurses who do not assist visiting relatives may be ignoring valuable contribution to patient’s recovery.

Therefore the investigator undertook a study of needs of family members of patients admitted in ICU and the extent to which these needs were met at St. Johns Medical College Hospital, Bangalore in view of developing an informational booklet.

Objectives
To study the needs of family members

The author is a Junior Lecturer at St. Johns College of Nursing, Bangalore.

of patients admitted in ICU as perceived by the family members and caregivers.

To assess the extent to which these needs have been met as perceived by the family members.

To compare the needs of family members with selected baseline variables.

To develop an informational booklet for family members based on the identified needs.

The conceptual framework adopted for this study was based on Sr. Calista Roy’s adaptation model. This framework highlights the needs as coping mechanisms and causes changes in all four adoptive modes. This adaptation helps the family members to focus their attention on the critically ill patients.

Methodology
A descriptive study design was used to conduct the study. A purposive sampling technique guided by inclusion criteria was used to select 100 family members of patients admitted in intensive care units and 50 care givers.

Data collection tool consisted of

Family needs inventory guide to assess family members’ perception of their needs
(a) Demographic and clinical profile of the patients and family members.

(b) Family needs inventory guide to assess the needs of family members and their satisfaction level. This semi structured interview guide included 30 need statements, which were categorized as Cognitive needs (1-9); Emotional needs (10-12); Spiritual needs (13-16); Physical needs (17-23); and Social needs (24-30).

Instrument for caregivers:
(i) Demographic profile of caregivers.

(ii) Self administered family needs inventory guide to assess caregivers’ perception of family member’s needs.

Data collection
The data collection was carried out for six weeks from 03-07-2006 to12-08-2006. One or two family members of patients admitted consecutively in ICU were selected as per inclusion criteria. Family members were approached after 24 hours of patients’ admission to ICU and tool was administered to them after obtaining their consent.

The need statements were read to the family members and asked to respond to each statement by rating its importance on a scale of 0-(not important) -3 (very important). After marking the importance, they were asked to rate their satisfaction level of that need on a scale of 0- (not satisfied)- 3 (very satisfied). To assess the caregivers’ perception of family members’ needs,

the self-administered family needs inventory guide was given to the caregivers after brief explanation of the purpose of the study.
The data was analyzed and interpreted in terms of

With regard to satisfaction level, cognitive (67%) and physical (63.3%) needs were highly satisfied than spiritual, emotional and social needs. As a whole,

Ranking of needs by both the groups showed the ‘need for explanation’ as top most important need. Caregivers considered the ‘need to know the cost of treatment’ as

Needs of family members of patients admitted in ICU must be included in curriculum of critical care nursing courses. Thought nurses have knowledge of family needs, regular study by staff members will improve their insights.

objectives using descriptive and inferential statistics like frequency, percentage, mean, S.D, range, mean%, ‘t’ test and ANOVA.

Findings of the study
In cognitive need category 92% of family members identified the need to have explanation about patient’s condition as top priority need, followed by need to have questions answered honestly (90%).
Majority of family members (83%) rated physical and cognitive needs as very important needs.

majority of family members (81%) were moderately satisfied with their needs met.

There was no significant relationship between needs and baseline variables at 0.05 levels.

Highest number of caregivers (88%) identified the need to have explanation in an understandable language in cognitive need category as most important need. Caregivers considered the social needs as least important need among five categories of needs.

second important need of family members whereas family members rated the ‘need to have honest answer’ as second important need among 30 need statements.

Recommendations
An experimental study can be conducted by using any intervention to meet family needs (pamphlet, information board, volunteers).
A study can be done to evaluate the overall satisfaction level of ICU care for patients and relatives.

Top ten needs identified by family memebers and caregivers:

Family Members

To have explanation in easily understandable language
To have my questions answered honesty
To have waiting room nearby
To discuss with the doctor and nurse everyday
To be assured of best possible care
To know what is wrong with patient
To know bathroom and toilet nearby
To know probable outcome of the treatment
To have one more person to stay
To know probable length of stay

Caregivers

To have explanation in understandable language
To know the cost of treatment
To have waiting room nearby
To discuss with the doctor and nurse everyday
To be assured of best care
To have clear, gentle infprmation
To have bathroom toilet nearby.
To know ancillary services.
To know the probaly outcome
To have questions answered honestly.

A similar study could be made to compare expectations and needs of family members of patients in an ICU as opposed to general ward, postoperative ward etc.

Conclusion
The needs of family members of patients admitted in ICU must be included in curriculum of critical care nursing courses. Though nurses have knowledge of family needs, regular study of staff members will improve their insights.

Holistic care can only be implemented when the entire family is included in total patient’s care. Adequate information provided to family members will reduce their anxiety and in turn they will be able to involve themselves in the care of the patients.

Bibliography
1. Lee Iym, Mackenzie AE.( 1999): ‘Needs of Chinese families with relative in ICU’. Journal of clinical Nursing, 8, pp. 762.

2. Kirchhoff KT, Song MK, Khel K. (2004): ‘Caring for the family of critically ill patient’. Critical Care clinic,20 (3), pp.453-66.

3. Hardicre J. (2003): ‘Meeting the needs of families of patients in ICU’. Nursing Times, 99(27),pp26-7.

4. Lee LYK, Lau YL.( 2003). ‘Immediate needs of adult family members of adult ICU patients in Hong Kong’. Journal of Clinical Nursing, 12, pp. 440-450.

5. Heyland HK, Rocker Gm, Dodek PK, Kutsogiannis DJ, Konopad E, cook EJ etal. (2002), ‘Family satisfaction with care in the ICU’ – Results of Multi-center study. Critical care medicine,30(7), pp. 413-418.

6. Takman S, Severinsson E. (2005). ‘A description of health care providers perception of the needs of significant others in ICU’. Intensive critical care nurse, Dec, pp.30.