The relationship between family members of intensive therapy unit patients and medical staff
*Krystyna Basińska1, Radosław Owczuk2, Janina Suchorzewska1, Magdalena Wujtewicz2, Maria Wujtewicz2
1Department of Ethics, Medical University of Gdańsk
2Department of Anaesthesiology and Intensive Therapy, Medical University of Gdańsk
Background. The satisfaction of family members with the care provided in Polish intensive therapy units has arisen as an important factor in assessing of the overall outcome of treatment. The opinions received from various ITUs were different, but showed a generally low level of satisfaction regarding the availability of physicians for regular discussion. The purpose of this study was to evaluate the levels of satisfaction arising from contact between ITU staff and patients’ families.
Methods. Fifty-nine relatives of ITU patients, treated at the Gdańsk Medical University, were asked to complete questionnaires based on the following: general conditions and privacy during information sessions, the accessibility and quality of information, and the readiness for participation in the care of their relatives.
Results. Families rated the accessibility of information highly (76.3%). The information provided was deemed to be understandable 84.7% of the time, becoming more comprehensive over time (91.5%). In 84.7% of cases, respondents considered that there was consistency in the information given to other members of family. 66% of those questioned were informed by the chief physician, but only 30.5% were able to talk with physicians together with other family members, in a specially designated room. 87% of those questioned were ready to participate actively in the ITU care of their relative.
Conclusion. The study showed that the present system of informing patients’ relatives in the ITU was satisfactory, but only in terms of the accessibility and quality of information. The conditions provided for meetings with ITU physicians were far from being satisfactory, and families received information from too many physicians.
Research into satisfaction of patients and their families is becoming an important factor in assessing the overall outcome of treatment, in ITUs in particular. Numerous studies have indicated that not only survivors but also their families develop symptoms of persistent anxiety, depression and post-traumatic stress disorder (PTSD) [1, 2, 3, 4, 5, 6]. The occurrence and duration of this syndrome were correlated with the relationship between families and medical staff. Likewise, anxiety and depression were rarer in families with good relations with the personnel [1, 2, 6].
According to the families, good relationship with ITU personnel is mainly affected by effective communication characterized by accessibility to full and reliable information, possibility to ask questions and receive answers as well as to participate in the organized care of patients [3, 4, 5, 6, 7]. The data collected from families of patients treated in comparable ITUs, however, show marked differences in the level of satisfaction and permanent lack of satisfaction in communication with physicians [8, 9].
The aim of the study was to assess the rules of communication between the ITU medical personnel and families of patients treated in this unit, including accessibility and quality of information.
The design of this prospective study was approved by the Bioethics Committee. The data were collected from the relatives of patients treated in the Department of Intensive Therapy for minimum 48 h. The authors` questionnaire was used consisting of 17 questions, which was completed anonymously by the families of patients. Beside the two open questions regarding the degree of kinship, the remaining were multiple-choice questions.
The questions concerned:
- accessibility of information about patients;
- ways of obtaining information and general conditions of information sessions;
- quality of the information provided;
- opinions about the readiness to participate in care of their relatives.
The 12-bed ward in which the study was carried out treats internistic and surgical patients. The medical personnel include nurses trained in intensive therapy, min.1 for 2 patients. During the day, patients are attended by four specialists in anaesthesiology and intensive therapy accompanied by at least 2 residents in training. Two specialists are on each duty. The Unit hospitalizes about 350 patients annually; the mean score of severity of their condition is 44 according to the Simplified Acute Physiology Score (SAPS). The mortality reaches 40 %.
Visiting hours and phone calls are not strictly defined. The relatives may visit patients at any time and stay as long as they want provided that their presence does not disturb the treatment process or diagnostic procedures. The information is provided by the chief physician or a physician on duty. If the patient’s condition deteriorates markedly, their families are informed by phone. The Unit is not equipped with a specially designated room for discussions. The information is provided at the chief physician’s office or in the vestibule, if not occupied by third parties.
The questionnaire results were assessed using descriptive statistics – absolute frequency and relative frequency (%) of the respondents` choices.
Fifty-nine respondents completed the questionnaire; the majority of respondents were men (59%). Only two respondents were from the immediate family but not related. In the majority of cases, the respondents confirmed they were authorised to obtain information (Table 1).
The accessibility to information was rated high by the majority of respondents (76.3%) yet only 30.5% could obtain information accompanied by other members of close family (Table 2).
Over twenty-three percent (23.7%) of respondents were informed by the chief physician; the meetings took place mostly in the vestibule (30.5%). In single cases, the information was provided in the presence of third parties (Table 3).
The vast majority of respondents were aware that their relatives were in life-threatening condition (96.6%). The information provided was understandable (84.7%) becoming more comprehensive over time (91.5%). The families could ask questions (93.2%) and their knowledge about patient’s condition was consistent with the information provided to other family members (84.7%). Noteworthy, only a low percentage of respondents was informed about the range of information obtainable by phone (Table 4).
The majority of respondents (87.0%) were ready to participate in the ITU care of their relatives.
The studies about satisfaction of families of patients treated in ITUs regard several fields, including the feeling of personnel closeness, confidence in and support provided by the medical staff, comfort in contacts, the feeling of safety and provision of information. The study results are used to elaborate and modify the accepted principles of management. The comparison of findings of multi-centre studies resulted in the formulation of management rules defined as consensus in relationships and communication between the ITU personnel and patients` families [4, 10]; these rules mainly focus on conditions of providing information and quality of information [3, 11, 12, 13, 14].
The accessibility of information is one of the main requirements of families . In our study, the vast majority of families assessed highly the accessibility of information. The majority could receive information at any time of day or night and be informed by phone.
The most common form of communication with the personnel is an individual meeting; the place and number of people participating are equally important. In most cases, the patient’s condition is discussed with one family member, yet their wish to be accompanied by other family members should be considered, although it is obviously more difficult for a physician. Furthermore, some centres organize sessions for several families, but these are rather educational in nature [12, 15].
According to the rules accepted in our centre, information is provided by the chief physician or a physician on duty. Over half of respondents received information from the chief physician and from many physicians; occasionally from the unauthorized personnel. The majority of respondents were not able to talk with the physicians together with other family members. An important element of meetings of families with physicians was the place ensuring privacy and confidentiality. Unfortunately, our unit is not equipped with a specially designated room for meetings with families, which should be considered a great inconvenience; information was provided in various places, in some single cases with the presence of individuals not employed in the unit.
According to literature data, only 50% of families of ITU patients are satisfied with communication with physicians, the lack of time being contributory [16, 17]. Only half of families understand the information concerning the diagnosis, prognosis and treatment, which does not meet the basic criteria of informed consent . Studies regarding expectations of families connected with obtaining the data address comprehensiveness, completeness and consistency of information as well as style of information provision respecting co-participation. The activities aiming at improvement of communication focus mainly on provisions of more information and on the way of supplying it . Another problem is consistency of information under the specific conditions of ITUs. To improve the effectiveness of communication, the health care providers should be encouraged to talk to one another before meetings with families .
The majority of our respondents stated that they were able to ask questions and receive answers; the information received, which were becoming more comprehensible over time, was mostly understandable and consistent with the information provided to other family members. All the involved were aware that the patients were in life-threatening conditions.
The high level of satisfaction of families of ITU patients was also related to other factors, i.e. professionalism in the care of patients, fear management, phone calls regarding changes in health condition and liberal rules of visits with flexible hours, provided they do not disturb the therapy . The system of visits in ITUs, however, is differentiated. The literature contains clear recommendations to organize visits according to the specificity of the unit, experience and conditions of functioning [4, 12]. The differences among units concern not only the duration of visits but also possibilities to participate in the patient’s care [3, 4]. In our study, the families were asked about readiness to participate in care of the relatives. Although this question was added during the study, a vast majority of respondents answered positively.
The improvement in the quality of health care requires assessment of its key dimensions and activities based on that assessment. The dimensions of health care quality include safety, proper care timing, efficiency, honesty and patient-focused management . In ITUs, difficulties in communication with critically ill patients and hence the necessity to communicate with their family members means that the attention is focused on patients as well as their families. To face this problem, family experiences with the treatment of their relatives should be measured [8, 9, 10, 17]. However, such data are not easy to be received due to lack of time of the personnel, scepticism, fears of potential negative experiences of families and lack of preparation for optimal use of the information obtained and lack of interest in such problems among physicians .
It should be stressed that studies assessing satisfaction of families are found extremely relevant considering the serious burden of the personnel associated with care of critically ill patients. If the satisfaction of patients and their relatives is underappreciated, this work-related burden is likely to be perceived as much higherl which may result in higher incidences of professional burnout among the staff of intensive therapy units [10, 16].
1. The majority of families of ITU patients assess highly the accessibility of information, which is provided understandably and concisely.
2. The conditions of meetings with families do not ensure privacy and confidentiality and the information is obtained from various physicians, which is against the accepted rules.
3. The preliminary findings indicate that studies regarding the opinions and needs of families of ITU patients should be continued.
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Zakład Etyki, Gdański Uniwersytet Medyczny
ul. Tuwima 15, 80-210 Gdańsk