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As a nurse, you care not only for the patient in the bed, but for the family of the hospitalized patient. Caring for families whose loved ones are in intensive care carries special challenges as the family members deal with the stress of having their acutely ill loved one occupy a terribly unfamiliar setting filled with complex, off-putting medical devices.

To reduce the stress those families experience, nurses should focus their interventions on valuing the role of family members in patient care, improving communication and providing accurate information, according to the results of research published in the February 2021 issue of Critical Care Nurse.

 “Nursing Interventions to Reduce Stress in Families of Critical Care Patients: An Integrative Review” analyzed the literature about family stress in neonatal, pediatric, and adult ICUs. The researchers analyzed the results of 38 studies. They discovered four overall significant stressors: a change in parental role or in family dynamics; the appearance and behavior of the patient; the care setting; and communi­cation and counseling with the healthcare staff. The interventions in each area include:

To reduce stress related to…
  • A change in parental role or family dynamics: nurses should allow family members to be present at any time at the patient’s bedside and on the unit.
  • The appearance and behavior of the patient: nurses should provide information about specific changes observed and encour­age asking questions about them.
  • The care setting: nurses should explain the specific features of the setting, providing reassurance that it is normal for family members to require clarifica­tion and repetition of information.
  • Communication and counsel­ing with the healthcare staff: nurses should establish a communication channel with family members and adapt information to their level of stress and ability to under­stand the situation.
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These interventions relate to the 2017 Guidelines for Family-Centered Care in the Neonatal, Pediatric, and Adult ICU from the Society of Critical Care Medicine. But this research focuses on the interventions specifically for stress.

Adapting to the family

Unlike other research, this paper groups findings together from neonatal, pediatric, and adult ICUs, instead of looking at each setting separately, notes coauthor Valérie Lebel, Ph.D., RN, professor, Department of Nursing, Université du Québec en Outaouais, Quebec, Canada, herself a neonatal intensive care nurse.

What’s more, previous research typically doesn’t define the concept of “family,” she notes in an interview.  “As nurses, you have to adapt your intervention to the type of family,” she says. For instance, a nurse can ensure that a family who might be socioeconomically disadvantaged could have free hospital parking or tickets for a meal. “If you don’t adapt your intervention to your family, it’s really hard to make sure that you really have a partnership with them,” Lebel says.

With COVID, the interventions discovered by the paper, which was done before the pandemic, might be difficult to execute, Lebel notes. “It’s really hard right now to make sure to apply all those interventions,” she says. Still, the nurse needs to find a way to team with the family “no matter what.” If the family cannot be with the patient because of COVID restrictions, the nurse “should find a way to team up with them anyway, to give them information, and to make sure they understand what’s going on.”

Louis Pilla
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