Chapter 104
Family-Centered Care and Communication with Families of Intensive Care Unit Patients
Family-centered rounds are a component of the broader concept of family-centered care, the key elements of which are an authentic partnership between the health care providers and the patient/family based on mutual respect, trust, open communication and information sharing, collaboration, and shared decision-making. Developed initially in the context of care for chronically ill pediatric patients, family-centered care has now been widely endorsed as a core competency for health care providers by numerous health care organizations and institutions including the Institute of Medicine, professional nursing and physician societies, and accrediting agencies for health care organizations and graduate medical education. Other resources and skills to provide family-centered care include palliative and end-of-life care (see Chapter 102), teamwork and ICU organization focused on patient and family care (see Chapter 103), cultural competency (see Chapter 105), and family-friendly practices such as liberal visitation policies.
Having the family join daily work rounds provides a structure and process that can enhance effective communication between health care providers and the patient and the patient’s family. This approach has a number of important potential benefits (Box 104.1) that contribute to the goal of promoting high-quality, patient-centered, and family-centered care as well as minimizing the long-term neuropsychological distress incurred by family members of critically ill patients.
BOX 104.1 Objectives of Having the Family Join Daily ICU Work Rounds
Demonstrate respect and foster trust.
Affirm and support the family.
Enable timely opportunities to learn of the concerns and fears of the family.
Ensure the family has accurate and current information about the patient.
Provide a consistent message to the family.
Facilitate timely and appropriate end-of-life conversations.
An Overview of Family-Centered Rounds
Family-centered rounds, initially introduced into pediatric care in the early 2000s, are now increasingly more common in adult critical care medicine. However, the proportion of adult ICUs in the United States to have adopted this approach is unknown. Likewise, relatively few studies have examined the effects of family-centered rounds on patient outcomes or family satisfaction, with most of the data being drawn from the pediatric experience. Consequently, it is important to exercise caution when extrapolating the published data to the practice of adult critical care, particularly in light of the fact that ICU mortality is substantially lower in pediatric populations. Despite these limitations, one can conclude that the family’s participation in rounds often provides new and relevant information about the patient without significantly lengthening the duration of rounds, improves communication between clinicians and family members, and is associated with higher levels of family and staff satisfaction. Further, the data suggest that family members, when appropriately coached, are able to accept and adjust to the expectations and culture of multidisciplinary ICU rounds. A number of elements have been reported to enhance the quality of the family’s experience while participating in rounds, and these have been incorporated into the recommendations in Box 104.2.
BOX 104.2 Recommendations for Conducting Family-Centered Rounds
Each day, before beginning, invite family members who are present to join rounds.
If this is the first time the family is participating in rounds, do the following:
Describe the structure of rounds: presentation of medical data, followed by a formulation of the assessment and plan. Then inform the family that at the conclusion of the assessment and plan, the facts will be summarized for them, followed by an opportunity for the family to ask questions or make comments.
Intentionally solicit needed information from the family.
Related posts:
Full access? Get Clinical Tree
