Patient and family centred care
in the intensive care
Jos M. Latour
Professor in Clinical Nursing
No conflict of interest
Jos M. Latour
nothing about family
"On the Fringe of Anaesthesia" was chosen
because it offered an opportunity to highlight some
important aspects of our various commitments
which have arisen as the speciality has matured
and we have been accepted in the profession as
properly trained, broadly based consultants.
On the fringe of ICU:
what we have not yet improved
Family and friends’ involvement in the
patient's critical care journey
Keep People Integrated
People Integrated in ICU
DoctorsNurses
Admin
staff AHPs
Other
patientsPatients
Family Friends
Pets are good Meds
Vos et al. Pets or meds: how to tackle misery
in a paediatric intensive care unit. Intensive
Care Med 2007:33;1492-1493
Risk minimisation through proper communication with relatives
https://www.esicm.org/education/educational-initiatives/patient-safety-training-research-programme/
And suddenly…
you see this?
I have experienced
disagreement by
family members
about care decisions
Yes, many times
Sometimes
No, never
Risks of ‘failed’ communication
with relatives
Tension, distrusts, conflict, legal
implications
Distress among all stakeholders
Influence decision-making
Risks of ‘failed’ communication with relatives
Thus…
Focus on early identification of needs
Focus on effective and compassionate communication
EMPATHY, a definition
The healthcare professionals’ skills to understand the feelings of
others, identify emotional situations, and respond effectively to
patient' needs (Zhai et al., 2015)
EMPATHY
Empathy is a special skill of communication and has an impact
on interpersonal relationships (Percy et al., 2018)
Someone may need to have a certain level of empathy before
they are able to feel compassion
EMPATHY, can we learn this?
PubMed search: conflict family ICU
In 2019 alone
58 new articles
Topics:
Barriers Family-Centred Care in ICU
Family satisfaction
Family needs
Family visitation
PICS-F
Respectful care
Healthcare Conflict scale
ICU climate of care predict quality of
nursing family care and family wellbeing
Effects of climate of care on quality of
nursing family care and family wellbeing
• 111 nurses + 44 family members
• Ethical Conflict Questionnaire-Critical Care
Version
• Maslach Burnout Inventory
• Hospital Ethical Climate Scale
• Family-Centered Care-Adult Version
• Nurse Provided Family Social Support Scale
• Family Wellbeing Index
So what?
Implications
for practice Resources for (ethical) conflict
resolution
Family integration in patient
care and decision-making
Education and training for
interactions with families
Patient and family engagement
in ICU vision and mission
Keep People Interested
Patient and Family Centred Care
In the last 40 years
1984
What’s
next?
Patient and Family Centred Care
In the last 40 years
1984 2005
What’s
next?
Patient and Family Centred Care
In the last 40 years
1984 2005 2007
What’s
next?
Patient and Family Centred Care
In the last 40 years
1984 2005 2007 2014
What’s
next?
Patient and Family Centred Care
In the last 40 years
1984 2005 2007 2014
What’s
next?2022
Keep People Informed
Keep People Involved
I always involve family members in
patient care and decisions
Yes, always
Sometimes; some care/decisions are too difficult
for family
No, (I have no time, family do not want, etc, etc)
Challenge of assessing symptoms in ICU
patients
Puntillo et al Crit Care Med. 2012; 40(10):2760–2767
Determine levels of agreement among proxy reporters (patients, family, nurses,
physicians) regarding ICU patients’ symptom characteristics (intensity, distress)
for 10 symptoms
Pain Tiredness
shortness of breath Restlessness
Anxiety Sadness
Hunger Fear
Thirst Confusion
2 ICUs
245 ICU patients, 243 family members, 103 nurses, and 92 physicians
10-item checklist including physical and psychological symptoms
Reporters were asked to rate if the symptom was present in the patient and,
if present, its intensity and distress
Challenge of assessing symptoms in ICU
patients
Puntillo et al Crit Care Med. 2012; 40(10):2760–2767
Ordinal logistic regression analyses showed that the odds of
higher pain intensity rating were two times greater among family
members, nurses, and physicians than among patients.
Challenge of assessing symptoms in ICU
patients
Puntillo et al Crit Care Med. 2012; 40(10):2760–2767
Still with me?
Keep people Inspired
Experienced
Aim: To improve the ICU experience of patients, their relatives, and healthcare
professionals, including the perspectives of industry
Post Intensive Care Syndrome
PICS-p, Manning et al PCCM 2018 Davidson et al CCM 2012, Lobo-Valbuena et al 2020
Grab it back
Patient- and Family-Centred Care
in ICU
What we must consider to improve
patient- and family-centred care in ICU
Collaborate with all stakeholders
Explore factors contributing to increase patient and family satisfaction
Develop pathways to guide patients and family beyond the ICU
Develop strategies to support ICU staff well-being when caring for patients
AND families
Family and friends are not visitors
Thank you
jos.latour@plymouth.ac.uk