Effective Communication With Families Of Critically Ill Patients

This author’s personal perceptions concerning patients facing a lingering terminal illness, have been shaped by over 20 years of critical care nursing experience. Facing death and illness on a daily basis requires self-examination and a high degree of comfort with one’s own mortality, limits and values. Constant exposure to the fragility of life forces respect for the whole person and the people who love them. A general approach to patients who are actively dying is to allow them to define what they want and need during this time. The nurse’s role

Including the client as an expert member of the team creates an enhanced quality of care (Coad, Patel & Murray, 2014). In pediatrics, parents are often at the center of the child’s care. When asked to define what made the client care experience positive, parents stated that sensitivity, empathy and honesty were key factors (Coad, Patel & Murray, 2014). Working in healthcare, nurses can become desensitized to difficult experiences because they deal with them daily. Integrating the client and family as part of the healthcare team, allows the nurse to see the patient and family as a people first. By avoiding using illness as context, and instead using person as context, care will be more holistic (Coad, Patel & Murray, 2014). A family-focused approach helps to ensure that the whole family feels a part of the experience and is valued. In the case of bereavement, family centered care is particularly important. If the family is not included in the care from the start, it can provide barriers for grieving and impact how the family deals with loss (Jones, Contro & Koch, 2014). Nurses have an opportunity to help support the family through the grief process (Jones, Contro & Koch, 2014). Families have a significant impact on how the client heals, so by caring for the family’s needs, the nurse is indirectly caring for the patient. It is in the client’s best interest for the care to be holistic for the patient as well as the family (Jones, Contro & Koch, 2014). All

For this study patient families were randomly assigned to the intervention or control group. In the control group the interactions between the family and ICU staff, including the end-of-life conference, occurred according to the usual practices and policies in the hospital; whereas in the intervention group, the research study was conducted according to specific guidelines. A bereavement information leaflet was given to each surrogate decision maker. In this research, the independent variable can be the type of family conference received by the surrogates and the dependent variables were the level of stress, anxiety, and depression levels indicated in the 90-day follow-up interview.

Death is inevitable. It is one of the only certainties in life. Regardless, people are often uncomfortable discussing death. Nyatanga (2016) posits that the idea of no longer existing increases anxiety and emotional distress in relation to one’s mortality. Because of the difficulty in level of care for end-of-life patients, the patient and the family often need professional assistance for physical and emotional care. Many family caregivers are not professionally trained in medicine, and this is where hospice comes into play. Hospice aims to meet the holistic needs of both the patient and the patient’s family through treatment plans, education, and advocacy. There is a duality of care to the treatment provided by hospice staff in that they do not attempt to separate the patient’s care from the family’s care. Leming and Dickinson (2011) support that hospice, unlike other clinical fields, focuses on the patient and the family together instead of seeing the patient independent of the family. Many times in hospitals, the medical team focuses solely on the goal of returning the patient back to health in order for them to return to their normal lives. They do not take into account the psychological and spiritual components of the patient’s journey and the journey that the family must take as well. For treatment of the patient, Leming and Dickinson agree that hospice does not attempt to cure patients, and instead concentrates solely

Communication is key to effective healthcare practices. According to American Journal Of Critical Care (2014), Patient-centered care starts with “effective communication, being empathetic and available, avoiding personal prejudges, and listening therapeutically are integral parts of patient-centered care” (Riley, White, Graham, Alexandrov, 2014, p. 320). This will improve communication; promote patient involvement in care, which creates a positive relationship with the healthcare provider and medical team. This results in improved adherence to treatment plan. Clinical practice guidelines need to be implemented for the patient and family members to be able to be involved in informed decision-making regarding healthcare needs. The fundamental core of nursing is to have a partnership with the patient and their family regarding the patient’s outcome.

1.1 Caring for patients at the end of life is a challenging task that requires not only the consideration of the patient as a whole but also an understanding of the family, social, legal, economic, and institutional circumstances that surround patient care.

Caring for patients at the end of life is a challenging task that requires not only the consideration of the patient as a whole but also an understanding of the family, social, legal, economic, and institutional circumstances that surround patient care.

My perception of palliative and Hospice care has changed slightly when it comes to communication with the family. I walked into the hospice unit mentally preparing myself to talk with patient families about their loved one and the dying process; this was certainly not the case. The family and the patient did not want to be bothered unless comfort interventions needed to be carried out and there was no conversation to be had about the patient and his situation. This shows that each family is different, each patient is different; and we need to respect and accommodate their unique

An interpretative phenomenology study is titled Family Presence During Resuscitation: A Double Edge Sword (Hassankhani et al., 2016, p.127). Family presence during resuscitation of a loved one can have benefits and risks (Hassankhani et al., 2016, p. 127). According to Hassankhani, Zamanzadeh, Rhmani, Haririan, and Porter (2016), family presence during resuscitation means that the patient’s family arrived or were already present where the resuscitation is taking place, which means that the family members can see and touch the patient (Hassankhani et al., 2016, p. 128). Some of the hesitations that medical staffs have about family being present include environmental, cultural, and social factors (Hassankhani et al., 2016, p. 128). Another factor that can be involved are the previous experiences that the medical staff has had with family presence during resuscitation (Hassankhani et al., 2016, p. 128). These experiences can have a positive or negative affect on the medical staff and affect their allowance of other family members during a resuscitation (Hassankhani et al., 2016, p.128). The study conducted by Hassankhani et al. (2016), included 12 nurses and 9 doctors in Iran that were interviewed about their feelings of family presence during resuscitation for 6 months (p. 128). The participants of this study worked in the most crowded hospitals and worked together during the resuscitation (Hassankhani et al., 2016, p. 128). The nurses in this study had to have at least a bachelor’s degree and the doctors had to have at least a general medical degree; all participants had to have 2 years of clinical experience (Hassankhani et al., 2016, p. 129). Initially, there were 500 codes during the 6 months (Hassankhani et al., 2016, p.129). After the interviews were conducted there were two themes identified: destructive presence and supportive presence (Hassankhani et al., 2016, p. 129). The destructive presence theme included the medical staff experiencing family interruption in their attempt to save the patient (Hassankhani et al., 2016, p. 130). One instance of this involved a family telling the doctor what medications should be given (Hassankhani et al., 2016, p.130). Another occurrence a nurse

The assessments of the patient in an end of life situation must occur frequently as to detect rapid and/or minimal changes in the patient’s condition. It is also the primary nurse’s role to report any and all changes to the multidisciplinary team, including the family members.

Develop an alliance by using caring gestures to the family. Asking caring, sensitive and perceptive questions convey sincere concern for the patient and will help develop trust with the family

Having families present during the resuscitation process has sparked much debate in the medical community because there are strong arguments for both sides. Health care providers tend to shy away from having families present for resuscitation because the process could be considered offensive, cause an increase of tension and pressure, and create distractions (Duran, Oman, Abel, Moziel, & Szymanski, 2007). Holzhauser, Finucane, and De Vries (2006) state family presences during resuscitation assists with coping after an unsuccessful event because they are able to witness the action taken by the team, provides an outlet for decision making, and fosters development of relationships between families and health care providers.

However, often the nurse will find herself dealing with difficult family dynamics with family members having differing expectations of the type of care that the patient should be receiving, staff conflict over treatment methods or strategies and high workloads. These issues can only compound the stresses on the Palliative Care Nurse and to cope

“Improved communication is noted as one of the most important factors in enhancing end-of-life care in a pediatric setting” (Hsiao et al., 2007). These factors are beneficial to maintaining the best care for the child. The relationship between hospital staff, the child, and the child’s family is crucial. “Parents have emphasized the importance of receiving honest and complete information from staff, having ready access to staff, and having continuous, caring relationships with compassionate staff “(Hsiao et al., 2007). Along with the parents’ communication with staff, parents feel it is important to have the child communicate directly with the physician when appropriate. They feel “gaining the child’s perspective is critical if there is to be a cohesive relationship among the child, parent, and health care provider” (Hsiao et al., 2007). Also, children who are able and comfortable enough to communicate with physicians benefit

Usually either patients or families have the legal rights to determine what medical course to take with the patient when it comes to the diagnosis of death, in this case the family's conflict needs be considered. The healthcare staff involved in the patient’s care must communicate with the family members during this difficult time. If the patient is determined to be dead, the family will need support from the health care staff that has been involved in the patients care, all available hospital resources, including medical, nursing, social work, ethics, and pastoral care will be a good resource for the family members. Lawyers will usually advise health care staff to work with the family in the most compassionate way possible, the lawyers should be there to help with any conflict between the family members, and this will also help the organization against any future malpractice suits against the health care staff and organization.