Involvement of Patients’ Families in Care of Critically Ill Patients at Kenyatta National Hospital Critical Care Units

Abstract

Patients assess the likely benefits and risks of a recommended treatment or investigation and make a decision to either accept or refuse treatment. When a patient loses the capacity to participate meaningfully in decision making, a means should exist to ensure decisions that represent the patient's goals, preferences, and interests are made. This means is substitute decision making, and it usually occurs when a spouse, partner, close family member, or friend assumes this responsibility on behalf of the incapacitated patient. Limited involvement in patient care activities at the hospital can lead to distress in the family as well as challenge family members in assuming the likely expected role when the patient returns home. This study aimed at determining the nature and extent of family/substitute decision makers' involvement in care of the critically ill patients, guiding policies and the perspectives of nurse managers on involvement in Kenyatta National Hospital (KNH) critical care units (CCUs). This was a descriptive cross sectional study with family members and CCU nurse managers as the study participants. Key informants' interviews and in depth interviews were conducted. The sample size was 52 family members and four nurse managers. Quantitative data was analyzed using Statistical Package for Social Sciences (SPSS) version 21.0 and descriptive content analysis for qualitative data. Family members reported emotional distressed from the admission of a family member to the critical care unit. However their level of satisfaction with the extent of involvement was above average at a mean of 6.5. The activity mostly involved in was sharing of general information at 57.7% (n=30) with 36.5% (n=19) feeling they should have been provided with in depth information regarding the patients care. The key themes from interviews with family members were: limited information involvement, guilt feeling, and appreciation. Nurse Managers reported KNH has a closed visiting policy with none feeling it should be changed to an open policy. They also unanimously agreed that family members should be involved in care of the critically ill patients through information sharing and counseling. Two nurse managers felt primary care nurses should involve families in general nursing activities such as oral care with all agreeing that the nurses don't involve families in these activities. There was a statistical relationship (p<0.05 at a 95% confidence interval and R 2 =0.689) between the perspectives of nurse managers and the nature and extent of involvement of family members in care.

Family’s Supportive Behaviors in the Care of the Patient Admitted to the Cardiac Care Unit: A Qualitative Study

“…This supportive role continues even when the person is hospitalized. 4 Family members are faced with a variety of challenges against life-threatening illnesses that may either break their power of maintaining and deteriorating health or ultimately lead to their acceptance of and reconciliation with the problem. Different life-threatening conditions, such as myocardial infarction, cerebrovascular accidents, are examples of acute medical crises for family members.…”

“…6 The anxiety becomes double particularly when the patient is admitted to stressful areas such as the emergency department. 4 Nurses often work with family members who feel frustrated, feared, angry, failed, or confused. They usually do a lot of work to maintain and improve the health of the family members.…”

Family satisfaction with involvement in decision making in the intensive care unit: A scoping review

“…In addition, a Canadian study by Henrich et al [37] revealed that family members believe that they were able to handle the honest information about their patient and that full and realistic information about the situation enables them to make better treatment and end-of-life decisions and to cope with the patient's situation. A Kenyan study [38] on family involvement in the provision of care to critically ill patients revealed that family members were not satisfied with the depth of information about the patient care, and families reported build-up of anxiety levels due to withholding of information by nurses.…”

The Empowerment of Child and Family in Pediatric Intensive Care Units

“…Ebeveynler çocuklarını ilk kez görecekleri zaman çocuğun dış görünüşü ve vücudunda yer alan sondalar, serumlar, monitörler vs. nedeniyle daha fazla anksiyete yaşamaktadır (6,10) . Yapılan çalışmalara bakıldığında; çocuğu yoğun bakımda yatan ebeveynlerin çocuğun gereksinimleri, tıbbı tedavi ve süreci hakkında bilgi almak istedikleri ve bu konuda daha fazla anksiyete yaşadıkları görülmektedir (15)(16)(17)(18) . Bu nedenle hemşire ebeveynlerin çocuklarını ilk kez görecekleri zaman yanlarında olmalı, çocuğun sağlık durumu ve gerçekleştirilen işlemler hakkında bilgi vermeli ve sorularını yanıtlamalıdır.…”