This is the first set of guidelines that defines standards for incorporating families into decision-making and care for ICU patients. “The guidelines attempt to define evidence-based best practices for support of families in the delivery of patient-centered care in the ICU,” says Judy E. Davidson, RN, FCCM, chairperson of the American College of Critical Care Medicine task force and the lead author of the guidelines. “It is now known that up to 80% of family members of ICU patients develop anxiety, depression and/or post-traumatic stress response related to their experience.”
“The task force concluded that including and embracing the family as an integral part of the multiprofessional ICU team is essential for timely restoration of health or optimization of the dying process for critically ill patients,” comments Charles G. Durbin, Jr., MD, who is president of the Society of Critical Care Medicine. “Support for the psychological and spiritual health of the family is an essential component of patient-centered care for the critically ill.”
Historically, families have played a crucial role in the care of the injured or critically ill. The advanced technology and training required to care for critically ill patients has had the consequence of limiting family participation in healthcare decision-making and care of loved ones.
“To correct this problem we must acknowledge the important role that family members and other surrogates play in patient care and embrace their participation,” explains Dr. Durbin, an intensivist with the University of Virginia Health System in Charlottesville.
The guidelines were developed to assist healthcare providers in supporting the families of the critically ill in adult, pediatric and neonatal patient-centered ICUs. The guidelines were written by a multidisciplinary task force of experts assembled by the American College of Critical Care Medicine of the Society of Critical Care Medicine and are based on medical literature supplemented by the expertise and experience of members of the task force.
According to the task force, the Institute of Medicine (IOM) strongly recommends that healthcare delivery systems become patient-centered rather than clinician- or disease-centered, with treatment recommendations and decision-making tailored to patient preferences and beliefs. The task force also cites several studies that have demonstrated that patient-centered care is associated with improved clinical outcomes.
“Nowhere is the need for patient-centered care greater than in the ICU, where patient and family involvement can profoundly influence both clinical decision-making and patient outcomes,” says Davidson, who is a clinical nurse specialist at Scripps Mercy Hospital in San Diego. “Not only is it morally important to tend to family needs, but the family, when included, may prove to be helpful in the restoration of health and appropriate goal setting for the patient. We, as healthcare providers, are obligated to provide a structure for family support to minimize the impact of critical illness on family health.”
One of the greatest family needs described in the medical literature is the desire to be present. “There is no evidence that family presence will delay healing or be harmful,” continues Davidson. “However, not being present is highly dissatisfying and may cause distress. This guideline endorses family presence via open and flexible visitation, and presence on rounds and at resuscitation when desired.”
The guidelines also address decision-making, family coping, staff stress related to family interactions, cultural support, spiritual/religious support, open and flexible family visitation, family presence during rounds, family presence at resuscitation, family environment of care, and palliative care.
“Critical care professionals should seek the participation of families as we strive to improve all aspects of the ICU experience for the critically ill,” said Joseph E. Parrillo, M.D., editor-in-chief of Critical Care Medicine. “The new guidelines published in this month’s issue are a good example of critical care’s pursuit of excellence.”
The American College of Critical Care Medicine, which honors individuals for their achievements and contributions to multiprofessional critical care medicine, is the consultative body of the Society of Critical Care Medicine and possesses recognized expertise in the practice of critical care. The College has developed administrative guidelines and clinical practice parameters for the critical care practitioner. New guidelines and practice parameters are continually developed, and current ones are systematically reviewed and revised.
Critical Care Medicine is the official journal of the Society of Critical Care Medicine. It is the premier peer-reviewed, scientific publication in critical care medicine. Each issue presents critical care practitioners with clinical breakthroughs that lead to better patient care, the latest news on promising research, and advances in equipment and techniques.
The Society of Critical Care Medicine is the leading professional organization dedicated to ensuring excellence and consistency in the practice of critical care medicine. With more than 13,000 members worldwide, the Society is the only professional organization devoted exclusively to the advancement of multiprofessional intensive care through excellence in patient care, professional education, public education, research and advocacy. Members of the Society include intensivists, critical care nurses, critical care pharmacists, clinical pharmacologists, respiratory care practitioners and other professionals with an interest in critical care, including physician assistants, social workers and dietitians.
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For more information, please contact Amanda Mannina at +1 847 827-7095 or amannina@sccm.org or Thomas Joseph at +1 847 827-7282 or tjoseph@sccm.org.
