Family needs of critically ill patients in the emergency department

doi:10.1016/j.ienj.2016.05.002

International Emergency Nursing

Volume 30, January 2017, Pages 3-8

https://doi.org/10.1016/j.ienj.2016.05.002 Get rights and content

Highlights

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The communication need was ranked as most important by family members and nurses.
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Nurses ranked the importance of many family needs lower than family members.
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Effective communication is an important link in the process of critical care in emergency departments.

Abstract

Introduction

Family members’ experience a range of physiological, psychological and emotional impacts when accompanying a critically ill relative in the emergency department. Family needs are influenced by their culture and the context of care, and accurate clinician understanding of these needs is essential for patient- and family-centered care delivery. The aim of this study was to describe the needs of Taiwanese family members accompanying critically ill patients in the emergency department while waiting for an inpatient bed and compare these to the perceptions of emergency nurses.

Methods

A prospective cross-sectional survey was conducted in a large medical center in Taiwan. Data were collected from 150 family members and 150 emergency nurses who completed a Chinese version of the Critical Care Family Needs Inventory.

Results

Family members ranked needs related to ‘communication with family members,’ as most important, followed by ‘family member participation in emergency department care’, ‘family member support’ and ‘organizational comfort’; rankings were similar to those of emergency nurses. Compared to nurses, family members reported higher scores for the importance of needs related to ‘communication with family members’ and ‘family members’ participation in emergency department care’.

Conclusions

Family members place greater importance than emergency nurses on the need for effective communication.

Section snippets

1. Introduction

Comprehensive critical care in the emergency department (ED) that embraces a patient- and family-centered approach—that is, one which recognizes the needs of both patients and their families—is central to effective care delivery but is difficult to achieve. Prompt assessment of family needs and actions to meet these needs not only reduces family members’ stress and anxiety (Carlson et al., 2015, Jabre et al., 2014), but also enhances patient recovery and satisfaction with care (Browning and

2.1. Design

A prospective cross-sectional survey was conducted in a medical center in Taiwan with over 3700 beds and approximately 15,000 ED presentations each month. Purposeful sampling was used to recruit family members of critically ill ED patients’ and Registered Nurses (RNs) working in the ED. Family members were identified as potential participants if (1) they were accompanying a patient who had been categorized as level I (Resuscitation), II (Emergent), or III (Urgent) in the five-level Taiwanese

3.1. Demographic characteristics

The characteristics of the family members and ED nurses who participated are presented in Table 1, Table 2. Of the 150 family members, 56.7% were female; nearly three-quarters (74.7%) were aged between 30 and 59 years, and were a child (31.3%) or parent (28.7%) of the patient. Most patients suffered from respiratory diseases (30.7%) or cardiovascular diseases (28.0%), and 70.7% had an assessed triage category of II. As is typical of the nursing workforce in Taiwan, almost all (95.3%) of the 150

4. Discussion

The results of this study indicate that ‘communication with family members’ was the most important need of family members of critically ill patients in the ED, followed by ‘family member participation in ED care’, ‘support’, and ‘organizational comfort’. This is consistent with numerous other studies (AI-Hassan and Hweidi, 2004, Verhaeghe et al., 2005, Yang, 2008). Although previous research suggested that family members might rank the importance of their needs differently in different

5. Conclusions

The study provides a detailed understanding of the most important needs of Taiwanese family members of critical patients who are waiting in the ED for inpatient beds. It also identified a range of needs which family members perceived as not being met well. These findings can facilitate development and testing of strategies to meet family needs, promote patient recovery, strengthen the role and function of families, and increase the level of satisfaction with ED services. The study also

Conflict of interest statement

The author(s) declare that they have no conflict of interests.

Funding statement

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Dr. Han was funded by the Chang Gung Memorial Hospital. Project title: Family needs of emergency patients being inpatient boarding in emergency department. CMRPF1C0141 and BMRPB93.

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A Cross-Sectional Comparative Study of Nurses’ and Family Members’ Perceptions on Priority and Satisfaction in Meeting the Needs of Family Members at the Emergency Department
2024, Journal of Emergency Nursing
Family members experience considerable physiological, psychological, and emotional pressure when accompanying a critically ill relative in the emergency department. The culture and context of care influence the needs of the family, and a thorough understanding of these needs by health care professionals is essential to providing patient- and family-centered care. This study aimed to compare nurses’ and family members’ perceptions of the priorities of family member needs and their satisfaction with meeting those needs in the emergency department.
A comparative, cross-sectional descriptive study was conducted. Participants were 140 family members of patients receiving care and 122 nurses working in the emergency department in hospitals of Tabriz University of Medical Science, in Iran. The data were collected through Critical Care Family Needs Inventory-ED and analyzed with SPSS Statistics software.
Family members rated their care needs as significantly greater than did nurses (129.45 [31.5] vs 124.45 [24.8], P = .003). Families rated their needs as having been met significantly less than the nurses estimated (103.6 [17.6] vs 110.8 [19.61], P < .05).
The perceived importance of the patient’s family’s needs differed from the viewpoints of the patient’s family members and the nurses. In addition, emergency nurses overestimated the extent to which family members’ needs were met compared with family members. To more adequately gauge and meet the needs of family members, nurses need to acquire more knowledge about patient family needs in the emergency department.
Tools to measure families experience in the emergency department: A scoping review
2021, International Emergency Nursing
Citation Excerpt :
Regarding the rating scale used in the tools, Lozano, García-Cueto and Muñiz [32] suggests that increasing the number of response alternatives in a Likert scale improves reliability and validity, especially when the number is not less than four and not more than seven. Response bias was also noted as a factor as families were excluded from the studies if they had experienced great distress [2,4]. Three studies included open-ended questions and one study conducted an interview in order to supplement the quantitative data by including the power of stories [33].
The aim of this review was to map literature on available tools measuring families experience in the emergency department and to identify domains being measured in the tools. A two-stage screening process was employed to determine eligibility of articles. Articles written in English language were retrieved, and data extracted on design, setting, sample and sampling, tool description and details, as well as data collection point used. From 165 articles initially screened, 8 articles were finally included and three tools identified namely: Critical Care Family Needs Inventory, Critical Care Family Needs Inventory-Emergency Department and one researcher-developed questionnaire. The domains measured, which were common to all tools, were those of communication, comfort, and support. Measuring families experience in the ED appears limited and this might be related to the difficulty around conducting research in an ED environment. This review provides important information for hospitals regarding how they engage with families and how they can influence current practice standards and processes, thus assuring improved quality of care.
COVID-19, the family unfriendly virus: Is the family's experience of the ED relevant within the confines of a pandemic?
2021, International Emergency Nursing
Families’ perceptions of relational practice in the emergency department: A qualitative study
2020, International Emergency Nursing
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Family members reported having been bewildered and fearful during the admission. Previous studies provide similar descriptions of the ED admission as being unsettling and frightening to families [2,30]. Participants stated that the event had disturbed normal family life, consistent with the findings in an Australian study where parents spoke of the tension of being in the ED and simultaneously coping with the demands of life outside the ED [31].
The purpose of this study was to describe families’ perceptions of relational practice when interacting with health care professionals in emergency departments in the South African context.
Relational practice is seen as an approach that amplifies the voices of families through creating meaningful connections with health care professionals. However, the voices of families maybe obliterated by factors in the clinical environment including the pressure to perform and timely patient flow.
The study adopted a qualitative design.
Qualitative data were collected from six family members by means of semi-structured interviews and were analysed using qualitative content analysis.
Four major categories emerged from family members’ perceptions regarding relational practice when interacting with health care professionals in the emergency department, Disrupted worlds; Care is what you see and hear; Powerlessness; Feeling disconnected.
Findings highlighted the need for improved relational practice between families and health care professionals in the emergency department. Pathways need to be created to involve families in decision-making and genuinely engage with them. There is a need to move away from the hierarchical “expert” emergency department culture towards one that seeks to include the voices of families in driving emergency department care.
Time is Brain: Setting Neurologic Patients Up for Success from Emergency Department to Hospital Admission
2019, Nursing Clinics of North America
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Having this information established before transfer from the ED can expedite neurologic interventions. Several studies have correlated strong communication skills such as reassuring the family, providing emotional support, listening, encouraging communication, and providing frequent status updates to the patient and family with increased patient outcomes, reduction in ED resource use, and increased patient satisfaction.16 In addition, as part of the triage assessment, the nurse should ask questions to determine a recent history of falls and last oral intake, and complete a review of current medications including anticoagulants, antiplatelets, and herbal medications to ensure clear documentation is in place, ultimately providing quality care and improved outcomes.
Families’ perceptions of support from health care professionals in the three emergency departments in KwaZulu Natal, South Africa
2019, International Journal of Africa Nursing Sciences
The purpose of this study was to investigate families’ perceptions of support provided by health care professionals in three emergency departments in KwaZulu-Natal, South Africa.
In low- and middle-income countries, engagement with families in emergency departments is often aimed at supplementing manpower for care provision rather than supporting the family. There does, however, need to be appropriate family support, provided through ongoing collaboration and capacity-building with the family.
A quantitative survey of 353 family members of patients admitted to emergency departments was conducted in three emergency departments in the province of KwaZulu-Natal, South Africa. A well validated instrument, the Iceland-Family Perceived Support Questionnaire, was used to collect data on family perceptions of cognitive and emotional support received from health care professionals in the emergency department. Mean scores for overall family support, and cognitive and emotional support subscales were calculated.
Family members gave significantly lower scores average for perceived cognitive and emotional support (8.7; 14.5) respectively, as compared to other studies using the same questionnaire. The mean overall support score for the questionnaire was (22.3, sd 12.4).
Families perceived significantly lower overall support from health care professionals in the emergency department as compared to the findings of international studies using The Iceland-Family Perceived Support Questionnaire. Although emergency care settings can be very busy, health care professionals need to engage with families to provide appropriate support in order to enhance families’ ability to cope effectively.

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View full text

Family needs of critically ill patients in the emergency department

Highlights

Abstract

Introduction

Methods

Results

Conclusions

Section snippets

1. Introduction

2.1. Design

3.1. Demographic characteristics

4. Discussion

5. Conclusions

Conflict of interest statement

Funding statement

J. Crit. Care

Heart Lung

Intensive Crit. Care Nurs.

Intensive Crit. Care Nurs.

Heart Lung

J. Emergency Med.

Intensive Crit. Care Nurs.

J. Crit. Care

The perceived needs of Jordanian families of hospitalized, critically ill patients

Int. J. Nurs. Pract.

Family needs and involvement in the intensive care unit: a literature review

Br. Assoc. Crit. Care Nurse

Family members’ experiences of their role in hospital: a pilot study

J. Adv. Nurs.

Meeting the needs of intensive care unit patient families: a multicentre study

Am. J. Respir. Crit. Care Med.

Emergency department overcrowding: dying to get in

Med. J. Aust.

Unmet needs of family members in the medical intensive care waiting room

Crit. Care Nurs. Q.

Emergency healthcare of the future

Emergency Med. Australas.

Perceived needs of critical care family members: a phenomenological discourse

Crit. Care Nurs. Q.

Accident and emergency nurses’ perceptions and experiences of caring for families

J. Clin. Nurs.

Critical care nurses’ role with families: a descriptive study

Heart Lung

Relatives’ experiences of critical care

Nurs. Crit. Care

Offering the opportunity for family to be present during cardiopulmonary resuscitation: 1-year assessment

Intensive Care Med.

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Nurs. Crit. Care