Semin Respir Crit Care Med 2019; 40(05): 648-654
DOI: 10.1055/s-0039-1697957
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Family-Centered Care in the Intensive CareUnit—What Does Best Practice Tell Us?

Jonathan Ludmir
1   Cardiology Division, Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Giora Netzer
2   Division of Pulmonary and Critical Care Medicine, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
› Author Affiliations
Further Information

Publication History

Publication Date:
11 December 2019 (online)

Abstract

Families in the intensive care unit (ICU) experience high-stress levels and are at risk of developing psychological symptoms including depression, anxiety, and posttraumatic stress disorder (PTSD). Family-centered care defines an approach that encompasses respect, compassion, and support for families. By alleviating stress and anxiety, this approach can increase family satisfaction, improve communication with staff, and decrease ICU length of stay. Family-centered care relies on an interdisciplinary approach. Its components include daily family-centered rounds, frequent family meetings, and ensuring an adequate family support environment. Each of the components of family-centered care depend on adequately trained clinical staff who are champion in empathetic communication and constantly support family member throughout an ICU stay.

 
  • References

  • 1 Davidson JE, Aslakson RA, Long AC. , et al. Guidelines for family-centered care in the neonatal, pediatric, and adult ICU. Crit Care Med 2017; 45 (01) 103-128
  • 2 Goldfarb MJ, Bibas L, Bartlett V, Jones H, Khan N. Outcomes of patient- and family-centered care interventions in the ICU: a systematic review and meta-analysis. Crit Care Med 2017; 45 (10) 1751-1761
  • 3 Johnson CC, Suchyta MR, Darowski ES. , et al. Psychological sequelae in family caregivers of critically-ill intensive care unit patients: a systematic review. Ann Am Thorac Soc 2019; 16 (07) 894-909
  • 4 Bolosi M, Peritogiannis V, Tzimas P, Margaritis A, Milios K, Rizos DV. Depressive and anxiety symptoms in relatives of intensive care unit patients and the perceived need for support. J Neurosci Rural Pract 2018; 9 (04) 522-528
  • 5 Schmidt M, Azoulay E. Having a loved one in the ICU: the forgotten family. Curr Opin Crit Care 2012; 18 (05) 540-547
  • 6 Alfheim HB, Småstuen MC, Hofsø K, Tøien K, Rosseland LA, Rustøen T. Quality of life in family caregivers of patients in the intensive care unit: a longitudinal study. Aust Crit Care 2018; S1036-7314(18)30165-6
  • 7 Pochard F, Azoulay E, Chevret S. , et al; French FAMIREA Group. Symptoms of anxiety and depression in family members of intensive care unit patients: ethical hypothesis regarding decision-making capacity. Crit Care Med 2001; 29 (10) 1893-1897
  • 8 Ullman AJ, Aitken LM, Rattray J. , et al. Diaries for recovery from critical illness. Cochrane Database Syst Rev 2014; (12) CD010468
  • 9 Egerod I, Christensen D, Schwartz-Nielsen KH, Agård AS. Constructing the illness narrative: a grounded theory exploring patients' and relatives' use of intensive care diaries. Crit Care Med 2011; 39 (08) 1922-1928
  • 10 Jones C, Bäckman C, Griffiths RD. Intensive care diaries and relatives' symptoms of posttraumatic stress disorder after critical illness: a pilot study. Am J Crit Care 2012; 21 (03) 172-176
  • 11 Nielsen AH, Angel S, Egerod I, Lund TH, Renberg M, Hansen TB. The effect of family-authored diaries on posttraumatic stress disorder in intensive care unit patients and their relatives: a randomised controlled trial (DRIP-study). Aust Crit Care 2019; S1036-7314(18)30191-7
  • 12 Melnyk BM, Alpert-Gillis L, Feinstein NF. , et al. Creating opportunities for parent empowerment: program effects on the mental health/coping outcomes of critically ill young children and their mothers. Pediatrics 2004; 113 (06) e597-e607
  • 13 Bui M, Thom RP, Hurwitz S. , et al. hospital length of stay with a proactive psychiatric consultation model in the medical intensive care unit: a prospective cohort Analysis. Psychosomatics 2018; 60 (03) 263-270
  • 14 Peris A, Bonizzoli M, Iozzelli D. , et al. Early intra-intensive care unit psychological intervention promotes recovery from post traumatic stress disorders, anxiety and depression symptoms in critically ill patients. Crit Care 2011; 15 (01) R41
  • 15 Ludmir J, Liu X, Gupta A. , et al. Cardiologist perceptions of family-centred rounds in cardiovascular clinical care. Open Heart 2018; 5 (02) e000834
  • 16 Davidson JE, Jones C, Bienvenu OJ. Family response to critical illness: postintensive care syndrome-family. Crit Care Med 2012; 40 (02) 618-624
  • 17 COMMITTEE ON HOSPITAL CARE and INSTITUTE FOR PATIENT- AND FAMILY-CENTERED CARE. Patient- and family-centered care and the pediatrician's role. Pediatrics 2012; 129 (02) 394-404
  • 18 Davidson JE. Family presence on rounds in neonatal, pediatric, and adult intensive care units. Ann Am Thorac Soc 2013; 10 (02) 152-156
  • 19 Rappaport DI, Ketterer TA, Nilforoshan V, Sharif I. Family-centered rounds: views of families, nurses, trainees, and attending physicians. Clin Pediatr (Phila) 2012; 51 (03) 260-266
  • 20 Aronson PL, Yau J, Helfaer MA, Morrison W. Impact of family presence during pediatric intensive care unit rounds on the family and medical team. Pediatrics 2009; 124 (04) 1119-1125
  • 21 Au SS, Roze des Ordons A, Soo A, Guienguere S, Stelfox HT. Family participation in intensive care unit rounds: comparing family and provider perspectives. J Crit Care 2017; 38: 132-136
  • 22 Grzyb MJ, Coo H, Rühland L, Dow K. Views of parents and health-care providers regarding parental presence at bedside rounds in a neonatal intensive care unit. J Perinatol 2014; 34 (02) 143-148
  • 23 Tripathi S, Arteaga G, Rohlik G, Boynton B, Graner K, Ouellette Y. Implementation of patient-centered bedside rounds in the pediatric intensive care unit. J Nurs Care Qual 2015; 30 (02) 160-166
  • 24 Ingram TC, Kamat P, Coopersmith CM, Vats A. Intensivist perceptions of family-centered rounds and its impact on physician comfort, staff involvement, teaching, and efficiency. J Crit Care 2014; 29 (06) 915-918
  • 25 Allen SR, Pascual J, Martin N. , et al. A novel method of optimizing patient- and family-centered care in the ICU. J Trauma Acute Care Surg 2017; 82 (03) 582-586
  • 26 Muething SE, Kotagal UR, Schoettker PJ, Gonzalez del Rey J, DeWitt TG. Family-centered bedside rounds: a new approach to patient care and teaching. Pediatrics 2007; 119 (04) 829-832
  • 27 Yager PH, Clark M, Cummings BM, Noviski N. Parent participation in pediatric intensive care unit rounds via telemedicine: feasibility and impact. J Pediatr 2017; 185: 181-186.e3
  • 28 Phipps LM, Bartke CN, Spear DA. , et al. Assessment of parental presence during bedside pediatric intensive care unit rounds: effect on duration, teaching, and privacy. Pediatr Crit Care Med 2007; 8 (03) 220-224
  • 29 Gupta PR, Perkins RS, Hascall RL, Shelak CF, Demirel S, Buchholz MT. The effect of family presence on rounding duration in the PICU. Hosp Pediatr 2017; 7 (02) 103-107
  • 30 Rea KE, Rao P, Hill E, Saylor KM, Cousino MK. Families' experiences with pediatric family-centered rounds: a systematic review. Pediatrics 2018; 141 (03) 141
  • 31 Singer AE, Ash T, Ochotorena C. , et al. A systematic review of family meeting tools in palliative and intensive care settings. Am J Hosp Palliat Care 2016; 33 (08) 797-806
  • 32 Curtis JR, White DB. Practical guidance for evidence-based ICU family conferences. Chest 2008; 134 (04) 835-843
  • 33 Nelson JE, Walker AS, Luhrs CA, Cortez TB, Pronovost PJ. Family meetings made simpler: a toolkit for the intensive care unit. J Crit Care 2009; 24 (04) 626.e7-626.e14
  • 34 White DB, Angus DC, Shields AM. , et al; PARTNER Investigators. A randomized trial of a family-support intervention in intensive care units. N Engl J Med 2018; 378 (25) 2365-2375
  • 35 Lautrette A, Darmon M, Megarbane B. , et al. A communication strategy and brochure for relatives of patients dying in the ICU. N Engl J Med 2007; 356 (05) 469-478
  • 36 Sviri S, Geva D, vanHeerden PV. , et al. Implementation of a structured communication tool improves family satisfaction and expectations in the intensive care unit. J Crit Care 2019; 51: 6-12
  • 37 Breisinger L, Macci Bires A, Cline TW. Stress reduction in postcardiac surgery family members: implementation of a postcardiac surgery tool kit. Crit Care Nurs Q 2018; 41 (02) 186-196
  • 38 Cox CE, White DB, Hough CL. , et al. Effects of a personalized web-based decision aid for surrogate decision makers of patients with prolonged mechanical ventilation: a randomized clinical trial. Ann Intern Med 2019
  • 39 Mistraletti G, Umbrello M, Mantovani ES. , et al; http://www.intensiva.it Investigators. A family information brochure and dedicated website to improve the ICU experience for patients' relatives: an Italian multicenter before-and-after study. Intensive Care Med 2017; 43 (01) 69-79
  • 40 Wilson ME, Krupa A, Hinds RF. , et al. A video to improve patient and surrogate understanding of cardiopulmonary resuscitation choices in the ICU: a randomized controlled trial. Crit Care Med 2015; 43 (03) 621-629
  • 41 Pham K, Thornton JD, Engelberg RA, Jackson JC, Curtis JR. Alterations during medical interpretation of ICU family conferences that interfere with or enhance communication. Chest 2008; 134 (01) 109-116
  • 42 Thornton JD, Pham K, Engelberg RA, Jackson JC, Curtis JR. Families with limited English proficiency receive less information and support in interpreted intensive care unit family conferences. Crit Care Med 2009; 37 (01) 89-95
  • 43 Kagawa-Singer M, Blackhall LJ. Negotiating cross-cultural issues at the end of life: “You got to go where he lives”. JAMA 2001; 286 (23) 2993-3001
  • 44 Seltz LB, Zimmer L, Ochoa-Nunez L, Rustici M, Bryant L, Fox D. Latino families' experiences with family-centered rounds at an academic children's hospital. Acad Pediatr 2011; 11 (05) 432-438
  • 45 Sharma RK, Dy SM. Cross-cultural communication and use of the family meeting in palliative care. Am J Hosp Palliat Care 2011; 28 (06) 437-444
  • 46 American Academy of Pediatrics. Committee on hospital care. child life services. Pediatrics 2000; 106 (05) 1156-1159
  • 47 Committee on Hospital Care and Child Life Council. Child life services. Pediatrics 2014; 133 (05) e1471-e1478
  • 48 Ludmir J, Small AJ. The challenge of identifying and addressing psychological comorbidities. J Am Coll Cardiol 2018; 71 (14) 1590-1593
  • 49 Gursky B, Kestler LP, Lewis M. Psychosocial intervention on procedure-related distress in children being treated for laceration repair. J Dev Behav Pediatr 2010; 31 (03) 217-222
  • 50 Wolfer J, Gaynard L, Goldberger J, Laidley LN, Thompson R. An experimental evaluation of a model child life program. Child Health Care 1988; 16 (04) 244-254
  • 51 Sutter C, Reid T. How do we talk to the children? Child life consultation to support the children of seriously ill adult inpatients. J Palliat Med 2012; 15 (12) 1362-1368
  • 52 Bruce JE, McCue K. Child life in the adult ICU: including the youngest members of the family. In: Netzer G. , ed. Families in the Intensive Care Unit: A Guide to Understanding, Engaging, and Supporting at the Bedside. Switzerland: Springer; 2018
  • 53 Committee on Hospital Care. American Academy of Pediatrics. Family-centered care and the pediatrician's role. Pediatrics 2003; 112 (3, Pt 1): 691-697
  • 54 Owens RL, Huynh TG, Netzer G. Sleep in the intensive care unit in a model of family-centered care. AACN Adv Crit Care 2017; 28 (02) 171-178
  • 55 Verceles AC, Corwin DS, Afshar M. , et al. Half of the family members of critically ill patients experience excessive daytime sleepiness. Intensive Care Med 2014; 40 (08) 1124-1131
  • 56 Stremler R, Dhukai Z, Pullenayegum E, Weston J, Wong L, Parshuram C. Sleep, sleepiness, and fatigue outcomes for parents of critically ill children. Pediatr Crit Care Med 2014; 15 (02) e56-e65
  • 57 Day A, Haj-Bakri S, Lubchansky S, Mehta S. Sleep, anxiety and fatigue in family members of patients admitted to the intensive care unit: a questionnaire study. Crit Care 2013; 17 (03) R91
  • 58 Stremler R, Dhukai Z, Wong L, Parshuram C. Factors influencing sleep for parents of critically ill hospitalised children: a qualitative analysis. Intensive Crit Care Nurs 2011; 27 (01) 37-45
  • 59 Huynh TG, Owens RL, Davidson JE. Impact of built design on nighttime family presence in the intensive care unit. HERD 2019; ; (e-pub ahead of print)
  • 60 Thompson DR, Hamilton DK, Cadenhead CD. , et al. Guidelines for intensive care unit design. Crit Care Med 2012; 40 (05) 1586-1600
  • 61 Serrano P, Kheir YNP, Wang S, Khan S, Scheunemann L, Khan B. Aging and postintensive care syndrome- family: a critical need for geriatric psychiatry. Am J Geriatr Psychiatry 2019; 27 (04) 446-454
  • 62 Covinsky KE, Goldman L, Cook EF. , et al; SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. The impact of serious illness on patients' families. JAMA 1994; 272 (23) 1839-1844
  • 63 Griffiths J, Hatch RA, Bishop J. , et al. An exploration of social and economic outcome and associated health-related quality of life after critical illness in general intensive care unit survivors: a 12-month follow-up study. Crit Care 2013; 17 (03) R100
  • 64 Cameron JI, Chu LM, Matte A. , et al; RECOVER Program Investigators (Phase 1: towards RECOVER); Canadian Critical Care Trials Group. One-year outcomes in caregivers of critically ill patients. N Engl J Med 2016; 374 (19) 1831-1841
  • 65 Franck LS, Oulton K, Nderitu S, Lim M, Fang S, Kaiser A. Parent involvement in pain management for NICU infants: a randomized controlled trial. Pediatrics 2011; 128 (03) 510-518
  • 66 O'Brien K, Robson K, Bracht M. , et al; FICare Study Group and FICare Parent Advisory Board. Effectiveness of Family Integrated Care in neonatal intensive care units on infant and parent outcomes: a multicentre, multinational, cluster-randomised controlled trial. Lancet Child Adolesc Health 2018; 2 (04) 245-254
  • 67 Markin A, Cabrera-Fernandez DF, Bajoka RM. , et al. Impact of a simulation-based communication workshop on resident preparedness for end-of-life communication in the intensive care unit. Crit Care Res Pract 2015; 2015: 534879
  • 68 Sullivan AM, Rock LK, Gadmer NM, Norwich DE, Schwartzstein RM. The impact of resident training on communication with families in the intensive care unit. resident and family outcomes. Ann Am Thorac Soc 2016; 13 (04) 512-521
  • 69 Gustin JL, Way DP, Wells-Di Gregorio S, McCallister JW. Validation of the family meeting behavioral skills checklist. an instrument to assess fellows' communication skills. Ann Am Thorac Soc 2016; 13 (08) 1388-1393
  • 70 Seaman JB, Arnold RM, Scheunemann LP, White DB. An integrated framework for effective and efficient communication with families in the adult intensive care unit. Ann Am Thorac Soc 2017; 14 (06) 1015-1020