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Families Play a Critical Role in Washington Hospitalís ICU

January 28, 2014

In a hospital’s intensive care unit (ICU), patients with the most severe, complicated and life-threatening illnesses and injuries fight for their lives. Attended by highly trained doctors and nurses who specialize in critical care medicine, these patients require constant care and monitoring. Advanced equipment and special machines are in use throughout the unit.

For a patient’s family, the ICU can be a strange, mysterious and even fearful place. Yet, studies show the active involvement of family members in a patient’s care can make a huge difference to the outcome.

"In our ICU, we spend an extraordinary amount of time and attention caring for patients, but we don’t just concentrate on them. We also focus on family members," said Carmen Agcaoili, M.D., medical director of the intensivist program at Washington Hospital in Fremont. "Because no one knows a patient better than their spouse, adult children, parents, siblings and other relatives, we believe family members are an important part of the health care team."

At Washington Hospital, the ICU staff helps families educate themselves about the disease process affecting their loved one. An added benefit is that, when family members understand what’s happening, they tend to experience less anxiety.

"We usually find the families of our patients are anxious for information and reassurance, as well as the opportunity to be closer to their loved one," added Dr. Agcaoili, who helps lead the Hospital’s Family-Centered Care program. "Experience shows care centered on the patient and family tends to be higher in quality and safety because it is based on better communication between families and health care professionals."

For these and other reasons, Washington Hospital’s ICU has adopted a philosophy of Family Centered Care, supporting and encouraging families to be actively involved in the care of their loved one.

Focusing on family

A Family Centered Care committee identifies ways to dramatically improve the critical care experience for patients and families. The group also works to open lines of communication between families and the multidisciplinary health care experts on the team.

Included in the admission packet when patients enter the ICU is a "Getting to Know Me" questionnaire. It is intended to help the staff develop a more personal relationship with the patient by gathering information on the patient’s occupation, favorite hobbies and other interests that might help to cheer them up. The questionnaire also asks about the patient’s fears and stressors, so these topics can be avoided.

At the bedside, families are encouraged to bring in favorite photos to comfort and encourage their loved one. And, they can add a favorite blanket or quilt or play the patient’s favorite music. Family members are also encouraged to get involved in the hands-on care of their loved one by helping with range of motion exercises or daily hygiene, such as oral care.

The unit is also working to hold more family conferences as soon as possible after a patient is admitted, especially for those who are more critically ill.

"The conference is an opportunity to build the relationship between the health care professionals and members of the family, to establish trust and talk about goals and expectations," Dr. Acgaoili explained. "Often, the caregivers’ goals in caring for the patient differ from the family’s goals. With the family conference, we have all the experts in the room—including the family members—and everyone has a chance to share their views and perceptions. Then, we can agree on ways of working together and sharing the decision making. In turn, this leads to better care for the patient."

Sharing information

The ICU is also developing an informative booklet for families to help answer their questions and educate them about practices often followed in caring for critically ill patients, such as the use of a tube to assist with breathing. The booklet will also make families aware of related services at Washington Hospital, such as Palliative Care, a program focused on relieving suffering by addressing the physical, emotional, spiritual and social concerns of patients with advanced illness.

Another program in the development stage at Washington Hospital is "ICU Diaries." Patients and families will be given a notebook so they can describe in their own words what happens with the patient’s care each day and how they progress. Physicians and staff have access to the notebook so that can get a better understanding of the patient’s and family’s perceptions and priorities. If the patient spends some time in an unconscious state, they can learn what happened during that period by reading their family’s entries later on.

The ICU is also working with Washington Hospital’s Volunteer Services department to determine ways to expand the role of volunteers in the unit. The goal is to give volunteers more training so they can provide additional help and support to families and patients.

"Our Family Centered Care philosophy recognizes that family involvement is an important aspect of quality patient care," concludes Dr. Agcaoili. "This takes our Hospital’s Patient First Ethic—the guiding principle for everything we do—to the next level."