Outcomes of a Comprehensive Patient and Family-Centered Program in an Adult Intensive Care Unit

摘要

Background: Intensive care unit (ICU) admission is often life threatening, and may cause severe anxiety within the family system. Anxiety can impair decision-making ability. A majority of ICU patients cannot direct their own treatment; therefore, family members are often required to make major decisions under stressful conditions. Patient and family-centered care (PCFF) has been shown to reduce anxiety, improve decision-making, and improve outcomes for patients and their families. However, no published study has examined outcomes of a comprehensive PFCC program in the ICU. Purpose: The study purposes were to evaluate a comprehensive program to improve PFCC within an adult ICU, and to determine the usefulness of specific PFCC interventions. Methods: An exploratory comparative design was used. Data from ICU patients' family members and ICU nurses, before and after implementation of a PFCC program, were compared using the 30-item combined Critical Care Family Needs Inventory/Needs Met Inventory (CCFNI/NMI). Convenience samples of 49 adult family members of patients admitted to the ICU for at least 36 hours and 85 nurses employed in the ICU full-time for at least six months were recruited from an adult ICU in a 337-bed tertiary care hospital in the southwestern region of the United States. The program was conducted in 3 stages: baseline assessment, program development and implementation, and evaluation. Results: After the PFCC implementation statistically significant differences between nurses' and family members' responses were reported for18 items on the CCFNI and 20 items on the NMI. Five of the10 items family members ranked highest at baseline remained in the top 10 after PFCC implementation, and 3 needs ranked lowest at baseline moved up to the top 10. Conclusions: The results show that the nurses' education was likely the most efficacious program intervention. There may be a hierarchy of needs specific to ICU patients' family members, similar to those described by Maslow. Further study is needed to determine the effectiveness of the CCFNI/NIM in measuring outcomes before and after a PFCC intervention.