Interventions to Decrease Family Anxiety

Any illness severe enough to necessitate admission to a critical care unit is life threatening and can precipitate severe anxiety within a family system. Because of the sudden onset of critical illness, anxiety experienced within the family system cannot be prevented. Fear of death, uncertain outcome, emotional turmoil, financial concerns, role changes, disruption of routines, and unfamiliar hospital environments are a few sources of anxiety for family members. Specialized assessment and interventions for families are needed because anxiety may interfere with the family’s ability to receive and comprehend information, maintain patterns of adequate family functioning, use effective coping skills, and provide positive support—for each other and the patient. The family remains the most important social context to consider when determining interventions to positively influence patient outcomes.Q: How do you define “family”?Originally, the term “nuclear family” referred to a family composed of husband, wife, and children. Today, the term “family” also includes couples without children, single parents and children, reconstituted families (second marriages), unmarried couples with or without children, homosexual couples, and people living together. Almost one third of families in the United States are composed of members who are not biologically or legally related. Rather than focus on certain family forms, it may be more beneficial to define “family” as anybody who considers themselves a family member.Q: Why provide interventions for family members?Families appear to have a beneficial impact on the patient’s response to treatment. They act as buffers for patient anxiety and serve as valuable resources for patient care. However, when family anxiety is high, they may be unable to support the patient, and may transfer their anxiety to him or her. Unmitigated family anxiety may manifest itself in distrust of hospital staff, noncompliance with the treatment regimen, anger and dissatisfaction with care, and even lawsuits.As family members struggle to cope with sudden anxiety, the critical nature of the illness may lead to changes within the family unit. Whether these changes are beneficial or adverse depends, in part, on the type of interventions provided by healthcare professionals. Because families’ responses to critical illness have implications for the family, patient, and healthcare staff, everyone involved benefits when professionals assess and intervene to ensure that optimal family functioning is supported.Q: What do families need?The results of numerous studies suggest that following the impact of critical illness, family members exhibit a well-defined, predictable set of needs. These needs are grouped into 5 major areas and are universally experienced by most family members:Q: What interventions are beneficial for family members?Sufficient descriptive research has been conducted on the importance of various family needs after patient admission to critical care. The most effective interventions for meeting family needs are now being tested. Interventions begin on initial contact with family members, continue throughout the critical care period, and extend beyond discharge from the hospital. Professionals and families begin by establishing a relationship that is mutually respectful, trusting, empathetic, and collaborative. The efficacy of further interventions depends on the rapport established between care providers and family members. The interventions offered in the TableT1 are examples from the AACN research-based protocol on family needs and interventions in the acute care environment.F1“Family Needs and Interventions in the Acute Care Environment,” by Jane Stover Leske, RN, PhD, one of AACN’s Protocols for Practice, was sponsored by Hewlett-Packard.