Experiences and Needs of Families With a Relative Admitted to an Adult Intensive Care Unit

The objective of this review was to synthesize research studies on the experiences and needs of families with a relative in an adult intensive care unit (ICU).Having a family member admitted to the ICU can be a stressful and traumatic experience.1 The associated stressors can create coping challenges for the family, and there is even evidence that poor family coping may affect the patient's recovery.2,3 Nurses play a unique supportive role for such families through their ongoing presence and communication. This communication is highly valued by patients and family members, who struggle to assimilate all the relevant data for their own understanding and their ability to make necessary care decisions.4 Family-centered care in the ICU is not a new concept, with published clinical practice guidelines dating back to 2007.5 Nevertheless, our understanding of how families experience having a relative in the ICU and what their needs are can still be improved. Thus, a qualitative systematic review can provide a valuable summary of the available and applicable qualitative research.The systematic review conducted by Kynoch et al6 explored qualitative studies including those based on phenomenology, grounded theory, ethnography, and action research. The review included studies focusing on family members' experiences and needs when they had a relative in the ICU for any length of time. The review followed the Joanna Briggs Institute (JBI) methodology for qualitative synthesis, including an a priori protocol (published before the review was conducted), a comprehensive search strategy, critical appraisal, and data synthesis, among other required elements.7 Each eligible study meeting the inclusion criteria was critically appraised for quality using the standardized JBI checklist for qualitative research by 2 independent reviewers.7 Any disagreements about the assessed quality were resolved through internal discussion or consultation with a third reviewer. The process of pooling the eligible research findings together was performed with the JBI SUMARI (System for the Unified Management of the Assessment and Review of Information) software by means of a meta-aggregation approach, which uses the primary findings of individual studies, without reinterpretation, to provide recommendations to guide clinical care.7After a comprehensive search and a critical appraisal, Kynoch et al6 included 20 qualitative studies for the systematic review, with a combined total of 112 qualitative findings. These 112 findings were then aggregated into 12 categories based on their similarities. From there, 4 synthesized findings (overall summaries) were created.This systematic review highlights the stressful and impactful experiences individual family members have when one of their relatives is in the ICU. From the 4 synthesized findings, 3 main recommendations were identified. The first was about providing supportive care to families as they cope with the impact of having a relative in the ICU. This type of care includes having a welcoming waiting room, exploring the possibility of extending visiting hours, finding creative methods for families to connect with the patient (eg, video), and addressing families' spiritual and emotional needs.The second recommendation related to how nurses and the health care team deliver information to the family. This topic includes how communication occurs (eg, frequency, duration, use of language that families can understand) as well as understanding that each family member has individual information needs.The third recommendation addressed how families can feel overwhelmed and traumatized in an unfamiliar ICU environment. Strategies to help support families with this experience include orienting family members to the unit and the general routine, taking the time to explain different equipment and technology if a family member seems curious, and helping them feel like a part of the care team. Providing family members with a choice regarding how they would like to be involved can help them feel seen and heard. It is important to remember that different family members have individual needs and preferences; for example, some do not want to be involved at all or receive any detailed information.The evidence from this systematic review can affect the decisions of clinical care team members when they are creating patient- and family-centered treatment plans for patients in critical care. Deliberate consideration is needed of how information is communicated, what the visiting policies and practices are, and how support is provided to the families.As nurses caring for critically ill patients, we must regard advocating for the best evidence-based treatment as an important part of our role. We must always consider the best available evidence and understand the feasibility, appropriateness, meaningfulness, and effectiveness of any intervention to determine whether it is most appropriate to implement in our individual context.