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Nursing & Healthcare International Journal Research Article 8 min read

The Patient in Intensive Care: Communication with the Critical Patient and His Family Members - A Narrative Review

Chiara G* and Lucia G*
* Corresponding author
ISSN: 2575-9981  10.23880/nhij-16000134  Received: December 02, 2017  Published: January 03, 2018
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Keywords
&lt p&gt Intensive Care Unit Communication Family Care in Critical Care&lt /p&gt
Abstract

<p style="text-align: justify;">The study intends to investigate fundamental elements of effective communication between health professionals and patients and/or family members, in a particular context such as intensive care.</p>

Introduction

The critical area is defined as “the set of high-intensity care structures and the set of situations characterized by the criticality - vital instability of the sick person and by the complexity of the nursing and medical approach and nursing intervention [1]. The situation that the patient lives in a resuscitation or intensive care center, given the complexity of the clinical situation, requires a multidimensional and multidisciplinary evaluation. Likewise, nursing care is challenging and difficult, precisely because of the situation in which the patient finds himself, from the physiopathological, environmental, psychological and isolation point of view; all variables that characterize this event as critical and although they are in relation to each other must be studied and analyzed separately to be addressed and resolved. The nursing management of these patients is therefore very delicate and multi-faceted: “we are immersed in complexity in all our fields of action. Complexity among other things does not imply that if the action is small, the effect will be proportionally small, and even if the action is good, the result will necessarily be good” [2]. Patients who experience an accident or a sudden crisis that alters their vital functions are often overwhelmed by anxiety and experience with the disease an experience of fear, mutilation, immobilization and in general of non- knowledge that represents an attack on their personality and the integrity of their bodies. In these situations, next to the patient there is always the family who, in the same way, needs support and encouragement. In these cases, nursing care should be a methodological process for solving problems in a short time and pressing situations, recognizing problems, establishing priorities, governing the situation, always keeping the person and his family at the center. The fundamental and distinctive elements of assistance in critical areas are the critical situation as a life- threatening situation that requires the rapid and safe commitment of all operators; in this event the doctor plays an important role, instability, as a situation in which Nursing & Healthcare International Journal

life-threatening events may not always be precociously predictable; the nurse with advanced skills has a role relevant, the intensity, which defines a medical-nursing curative process characterized by a constant, continuous and systematic care commitment [3]. Linking the assistance complexity to the assistance process itself means thinking in terms of care intensiveness, or rather the healing process with constant, intensive and systematic commitment, even with the use of complex equipment. The poor quality of interpersonal communication is the main reason for intensive care dissatisfaction patients and often also for their family members [4]. Interpersonal communication must therefore be considered an essential part of therapy as it is an important means of transmitting information, providing psychological support and preventing conflicts that may arise when communication is ineffective and information is misinterpreted. Good communication is therefore an essential part of therapy.

The purpose of the literature review is to analyze the communication between health professionals and patients and / or family members of the same, going to investigate the basic elements of effective communication in a particular context such as intensive care [5]. The project is developed in the form of a literature review, thus summarizing the results of the studies in the literature and described without the use of statistical analyzes [6].

Methodology

The studies included in the research are essentially of two types: -study studies: randomized controlled trials, non- randomized experimental studies, observational studies, case-control studies, case series. - Secondary publications: journalistic articles, volumes The unit of analysis of the elaborate is based on primary studies. Criteria for inclusion of the studies analyzed: - Language: italian and english; - Period: from 1-2014 to 8-2017; - All ages; - All health professionals; - Type of selected studies: primary studies and survey.

Exclusion Criteria

Other types of studies Databases consulted: Medline (Pubmed); Embase; Cinahl; Cochrane Library The work was carried out in July 2017 and has followed the following steps: -Acquisition of the relevant studies and analysis of the literature concerning the chosen theme. -Subsequent reading of selected articles and extraction of data of interest. Seven studies have been selected that correlate the communication between health professionals and patients / families of patients in intensive care and the relative outcomes of health services. These studies have been summarized in a graphical schematization (Table 1).

StudiesSampleCommunication operator contextResults
1)Christopher G.
Slatore, et al.
(2014) Survey		315 hours of
intensive care
interactions
were analyzed
and 53 interviews
with 53 nurses
were developed		The study was conducted in a 26-bed
cardiac intensive care center in an
academic hospital and a general 26-
patient intensive care unit in a
veteran hospital in Portland, OR.
Service domains analyzed:
biopsychosocial area; patient
as a person; sharing of power and
responsibility; therapeutic alliance;
clinical area		Most of the communications at the nursing
level occurred in the biopsychosocial,
"patient as a person" and "clinical as a
person" domains. Nurses have approved the
importance of shared power and
responsibility and therapeutic alliance
domains, but have had relatively few
communication interactions in these areas.
Communication was strongly influenced by
the roles of the nurse as a translator of
information between doctors and patients /
families.

Table 1: The communication between health professionals and patients / families of patients in intensive care Nursing & Healthcar

Nursing & Healthcare International Journal

Intensive therapies belonging to 3

different cities and 6 different hospitals. For data collection, two Questionnaire addressed to 181 The belonging of the physicians studied in different disciplines, associated with different time spent in communication with the family

  • members, influence the communication towards the patient. Furthermore, the study showed that the age of the patient's relatives, the level of education, the doctor's perception created in the context of the study; one for relatives of patients and one for ICU doctors. The
  • Survey intensive care physicians. questionnaire included three subdimensions: information, empathy and the frequency of contact with the patient when he was healthy greatly influences the and trust. doctor's communication attitude.
  • 91.6% of nurses consider communication with patients and their families to be fundamental; 75.9% during the assistance
  • 3)Achury Saldana practice tries to provide physical and psychological assistance during the work shift; 50% are afraid of communicating with
  • 112 nurses
  • Colombian intensive care unit
  • DM at al. (2015) descriptive study
  • (Bogotà) patients and their families; only 53.7% integrate their emotions to the welfare practice.
  • 4) Schubart JR, et
  • Ineffective communication is not a single al. (2015) Semi-
  • 22 health
  • 5 intensive adult therapies in a US problem, but rather different distinct problems that exist at different levels of abstraction and vary in the stability of time. structured interviews workers academic medical center
  • It emphasizes the importance of using support groups for family members of
  • 1 RCT- 10 almost patients admitted to intensive care, structured communication and / or education programs for family members, the
  • Intensive care unit of: Sweden, USA,
  • 5) Kynoch K. et al experimental
  • United Kingdom, Netherlands,
  • France, Hong Kong, Saudi Arabia and
  • 2016 Literature studies - 3 observational review use of flyers or brochures to meet information needs of family members, a diary, changes in the physical environment
  • Iran studies and opening hours or more flexible.
  • Interviews carried out from
  • Communication interventions help promote
  • 6) Wong P, et al.
  • (2015) Qualitative
  • 2009 to 2011 with 12 family members of 11 family involvement in caring for the family member in ICU and facilitate their decision-
  • Metropolitan hospital mixed intensive care unit - Australia study making skills, as well as improving interaction with health professionals. hospitalized patients
  • Most ICU nurses find communication with families a vital part of their role. However, they have perceived significant barriers to
  • 8 databases were consulted to identify studies
  • 7) Adams A, et al.
  • (2017) Literature
  • Analysis of the communication role effective communication. These barriers conducted in
  • English published of nurses with the families of adult often led nurses to believe that families review intensive care units. received non-optimal information and support. Equal support and formal training between 2002 and 2014. have been identified as key strategies to overcome inadequacies.

Table 2: The communication between health professionals and patients / families of patients in intensive care

Contents of Selected Studies

Christopher G. Slatore et al. (2014) [7]: Care in intensive care, including communication, is a collaborative effort. Understanding how nursing staff are committed to implementing patient-centered communication in the intensive care unit can guide future interventions to improve patient [8]. Faruk Cicekci et al. (2015) [9]: This study demonstrates the mutual expectations and the substance of the messages in the information, empathy and confidence of the communication process between the patient's relatives and the doctors of the intensive care unit. Communication between relatives and doctors can be strengthened through a series of training programs to improve communication skills. Achury Saldana DM et al. (2015): This study demonstrates the mutual expectations and the substance of the messages in the information, empathy and confidence of the communication process between the patient's relatives and the doctors of the intensive care unit. Communication between relatives and doctors can be strengthened through a series of training programs to improve communication skills. Schubart JR, et al. (2015) [10]: Ineffective communication is not a single problem, but rather different distinct problems that exist at different levels of abstraction and vary in the stability of time. These results provide a framework for designing interventions to improve the well-being of patients and family members Wong P (2015) [11]: Facilitating communication and interacting in a sustainable way should help alleviate the anxiety and disgrace experienced by the families of critically ill patients in the intensive unit care. Kynoch K, et al 2016 [12]: Communication interventions help promote family involvement in caring for the family member in ICU and facilitate their decision-making skills, as well as improving interaction with health professionals [13]. The need for further research in this area is also highlighted. It is hypothesized that future intervention studies focusing on family needs could include the use of technologies such as DVD (Digital Versatile Discs) and SMS (Short Message Service) to inform families and interventions specifically designed to improve family comfort [14].

Adams A, et al. (2017) [1]: many intensive care nurses consider communicating with family members a fundamental part of their work, but they perceive significant obstacles to effective communication. These barriers often lead the healthcare provider to think that families do not receive support and optimal information. Peer support and training have been identified as key elements to overcome these barriers.

Conclusions

The analysis of the selected studies, showed a clear correlation between communication and outcomes of the assistance interventions, the health workers also consider of primary importance in the relationship with the patient and his family members elements such as empathy and listening in order to implement personalized assistance for each individual case [15]. Nurses perceive obstacles to communication in their work activity and consider training courses to be fundamental in order to develop specific communication techniques, especially in particular contexts such as intensive care. Often communication is not considered an element as the patient's physiological and clinical conditions, but as emerged from the selected studies, this factor is reflected in the outcomes of the care provided emphasizing the importance of implementing the development of a better communication between health professionals and patients / family members of patients. In the final analysis we can therefore affirm the importance in clinical practice of focusing attention on patient domains as a person and clinician as a person.

References

  1. Adams A, Mannix T, Harrington A (2017) Nurses' communication with families in the intensive care unit - a literature review. Critical care nurse 22(2): 70-80.
  2. Businaro UL (2003) XXII Congresso Nazionale ANIARTI, Bologna.
  3. Coen D (2003) XXII Congresso Nazionale ANIARTI, Bologna Novembre. Nursing & Healthcare International Journal
  4. Miller DC, Mc Sparron JI, Clardy PF, Sullivan AM, Hayes MM (2016) Improving resident communication in the intensive care unit. The proceduralization of physician communication with patients and their surrogates. Ann Am Thorac Soc 13(9): 1624-1628.
  5. Dabaty G (2012) More than half the families of mobile intensive care unit patients experience inadequate communication with physicians. cross selectional study.
  6. Wood GJ, Chaitin E, Arnold RM, Parsons PE, Schwenk TL (2017) Communication in the ICU: holding a family meeting. Literature review.
  7. Rosenblatt L, Meyer FL, Schmader KE, Block SD, Savarese DMF (2017) Psychosocial issues in advanced illness. Literature review.
  8. Slatore CG, Hansen L, Ganzini L, Press N, Osborne ML, et al. (2014) Communication by Nurses in the Intensive Care Unit: Qualitative Analysis of Domains of Patient-Centered Care. Am J Crit Care 21(6): 410- 418.
  9. Silvestro A (2003) Indicatori e standard per l’assistenza infermieristica-“Modello di analisi della complessità assistenziale. Ipasvi, pp: 33.
  10. Faruk Cicekci (2015) “The communication between patient relatives and physicians in intensive care units”, survey.
  11. Schubart JR, Wojnar M, Dillard JP, Meczkowski E, Kanaskie ML, et al. (2015) ICU family communication and health care professionals: A qualitative analysis of perspectives. Intensive Crit Care Nurs 31(5): 315- 321.
  12. Wong P, Liamputtong P, Koch S, Rawson H (2015) Families' experiences of their interactions with staff in an Australian intensive care unit (ICU): a qualitative study. Intensive Crit Care Nurs 31(1): 51- 63.
  13. Kynoch K, Chang A, Coyer F, McArdle A (2016) The effectiveness of interventions to meet family needs of critically ill patients in an adult intensive care unit: a systematic review update. JBI Database System Rev Implement Rep 14(3): 181-234.
  14. Schaefer KG (2013) Physician communication with families in the ICU: evidence-based strategies for improvement. Review 2013.
  15. Sullivan AM, Rock LK, Gadmer NM, Norwich DE, Schwartzstein RM (2016) The Impact of Resident Training on Communication with Families in the Intensive Care Unit. Resident and Family Outcomes 13(4): 512-521.
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@article{chiara2018,
  title   = {The Patient in Intensive Care: Communication with the Critical Patient and His Family Members - A Narrative Review},
  author  = {Chiara G* and Lucia G},
  journal = {Nursing & Healthcare International Journal},
  year    = {2018},
  volume  = {2},
  number  = {1},
  doi     = {10.23880/nhij-16000134}
}
Chiara G* and Lucia G (2018). The Patient in Intensive Care: Communication with the Critical Patient and His Family Members - A Narrative Review. Nursing & Healthcare International Journal, 2(1). https://doi.org/10.23880/nhij-16000134
TY  - JOUR
TI  - The Patient in Intensive Care: Communication with the Critical Patient and His Family Members - A Narrative Review
AU  - Chiara G* and Lucia G
JO  - Nursing & Healthcare International Journal
PY  - 2018
VL  - 2
IS  - 1
DO  - 10.23880/nhij-16000134
ER  -