1. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 03: The Family’s Experience With Critical Illness

2. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins The Definition of Family The family is defined as any people who share intimate and routine day-to-day living with the critically ill patient. Anyone who is a significant part of the patient’s normal lifestyle is considered a family member. The term “family” describes the people whose social homeostasis and well-being are altered by the patient’s entrance into the arena of critical illness or injury.

3. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Potential Impact of Critical Illness or Trauma on the Family Stress and anxiety, which may lead to crisis situation Disorganization of the family unit Role confusion and strain Financial strain Social, spiritual, and cultural impact Grieving process Caregiver strain

4. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Potential Impact the Critical Care Environment Has on the Family Limited visitation Limited communication Foreign environment full of noisy, sophisticated equipment Nurses busy caring for the patient and not meeting the family’s needs Sense of loss of control and feeling helpless in the environment

5. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Key Aspects to Include When Assessing the Family Cultural background: country of birth, languages spoken, diet, social structure, religious and recreational activities Social support system: informal and formal Family structure: who is in charge and makes the decisions, family roles, presence of unresolved family conflict, and system of communication and travel Family’s beliefs about health and illness, who makes the legal and health-related decisions in the family, stressors, coping styles, and needs for healthcare professionals to address

6. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following is the best definition of family? A.Group of persons related by blood B.Any people who share intimate day-to-day living with the critically ill patient C.Group of persons living in the same home D.Any people who are a significant part of the critically ill patient’s life

7. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. Any people who share intimate day-to-day living with the critically ill patient Rationale: For the purposes of this textbook, family is defined as “any people who share intimate day-to-day living with the critically ill patient.” Family is defined by the patient, and that family should be welcomed by the critical care nurse through open visits, and supported through ongoing communication as the patient wishes.

8. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Interventions With the Family in Crisis

9. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Considerations for the Older Patient

10. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Palliative Care and the Critical Care Environment Provide liberal visitation Involve the family in the patient’s care Provide physical, emotional, and spiritual support for the family Keep the family informed on an ongoing basis Guide the family with the decision-making process

11. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following best describes the main purpose of palliative care? A.To restore function and ability to perform activities of daily living B.To provide support for a long-term chronic illness C.To prevent and relieve suffering through comforting care D.To prevent infection or disease through primary prevention

12. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer C. To prevent and relieve suffering through comforting care Rationale: The purpose of palliative care is to prevent and relieve suffering by providing comforting care. Restoring function and ability to perform activities of daily living is the purpose of rehabilitative care. Providing support for a long-term chronic illness is the goal of medical management. Preventing infection or disease through primary prevention is one purpose of health promotion.

13. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Components of the Critical Care Family Assistance Program

14. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Diagnoses Appropriate to Family Members of a Critically Ill Patient See Box 3-1.

15. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Case Study The patient’s significant other informs you that he can’t sleep at night because he is so worried about his partner. He has trouble falling asleep and sleeps in short intervals of 1 or 2 hours and gives up after 4 hours of trying to rest. He has to ride the bus to the hospital, and he can only see his partner in the afternoon when he gets off from his daytime job. This is the only time that he finds out what is going on with his loved one. Choose one nursing diagnosis from Box 3-1 and develop a care plan.

16. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Case Study 2 The patient’s wife tells you that she knows that her husband is going to live: she believes the doctor is mistaken about the cancer, and her husband is not dying. She does not want anyone to tell her husband that he is going to die because if they did, then he would give up and die. She refuses to talk with clergy or the social worker about end-of-life issues. She is planning a trip to Europe with her husband and has paid for the trip already. Choose one nursing diagnosis from Box 3-1 and develop a care plan.

17. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Case Study 3 The patient’s significant other was recently diagnosed with diabetes and hypertension. She refuses to leave the patient’s room to eat or to get rest and relaxation breaks. She has worn the same outfit for 3 days. She has not filled her prescriptions. She tells you that she is too busy caring for her loved one to care for herself. Choose one nursing diagnosis from Box 3-1 and develop a care plan.

18. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question The patient’s husband tells you that their 7-year-old son wants to visit his mother in the ICU. The mother is newly diagnosed with bacterial meningitis. The nurse should do which of the following? A.Allow the child to see the mother, but he must wear a mask. B.Have the child talk to the mother by telephone. C.Wait until the mother is transferred to the step-down unit. D.Ask if the child’s immunizations are up to date.

19. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. Have the child talk to the mother by telephone. Rationale: The best way to protect the child from being exposed to disease while allowing him to talk with his mother is by telephone. Waiting until the mother is transferred to the step-down unit increases patient/family stress because they will not be able to communicate and support each other.