Obstacles to Shared Expectations in a Burn Intensive Care Unit

Abstract

Critical care patients are dependent on the health care team and their family members to effect care goals that are consistent with their core values and wishes. This study aimed to identify and understand how obstacles to communication affect these two disparate groups. Ten burn intensive care unit (BICU) care team and 20 family members participated in in-depth semistructured interviews. A two-cycle coding, inductive analytical approach was used to derive three obstacle metathemes: family engagement, information exchange, and process transparency and standardization. However, care team and family members' themes within each metatheme were different. Although the thematic structure was derived inductively, our findings in retrospect appeared to be consistent with Law's four resistances associated with actor-networks. From this perspective, actor-network theory provides a plausible explanation for perceived obstacles and may, in the future, guide the development of interventions to improve shared agency across networks.

The experiences of ‘significant others’ supporting people with severe burn injury: An integrative literature review

“…26 Although not reflected in this review, it is interesting that research examining communication in the burns ICU cautioned that there may be inherent difficulties for SOs taking on the role of a communicator and relaying information between healthcare professionals, family, and friends. 11 The authors explained that vicarious trauma can impact SOs' memory and their ability to understand the critical care environment, which may lead to delayed decisions and may negatively impact mental health and wellbeing of the SO. 11 Not surprisingly, the studies in this review support evidence from previous observations that SOs supporting patients with SBI are exposed to vicarious trauma as a result of witnessing painful wound care and procedures and anxiety related to appearance (disfigurement), body functioning, societal acceptance, and survival.…”

“…11 The authors explained that vicarious trauma can impact SOs' memory and their ability to understand the critical care environment, which may lead to delayed decisions and may negatively impact mental health and wellbeing of the SO. 11 Not surprisingly, the studies in this review support evidence from previous observations that SOs supporting patients with SBI are exposed to vicarious trauma as a result of witnessing painful wound care and procedures and anxiety related to appearance (disfigurement), body functioning, societal acceptance, and survival. 32,33 This often left them feeling powerless, and therefore, taking on a role as the communicator within the relationship provided SOs with a sense of control.…”

An Integrated Framework for Effective and Efficient Communication with Families in the Adult Intensive Care Unit

“…There are different versions of family-centered rounds described in the literature, but they share several core elements: families are invited to be at the bedside when multidisciplinary team rounds are conducted; they are provided a brief lay summary of the patient's condition and allowed to listen in as the patient is discussed; and they are permitted a brief opportunity to ask questions. Family-centered rounds were first described in the pediatric setting (25,37,38), and then in the adult trauma ICU setting (24,39), and have expanded to other general and specialty adult ICU settings (26,27)…”

“…In addition, it is difficult to consider how family deliberation about difficult decisions could occur during time-pressured multidisciplinary rounds. Not all family members report feeling comfortable participating in family-centered rounds; and some express uncertainty regarding how to participate in this clinician-centric activity (26). Without a comfortable, private space where participants are giving their full attention to the larger picture of the patient and his/her situation, the deliberation process is shortchanged.…”

“…Finally, attendance at family-centered rounds is not feasible for all family members. Families express dissatisfaction with needing to be at rounds at a specific time (24), as this can interfere with work or caregiving responsibilities (26,28).…”