Holistic Care: Redefining the Role of Family In Critical Care Units
The concept of holistic approach should be kept in mind whenever the aspect of care emerges but unfortunately an important feature of it; that is the involvement of family in the care is not being given much importance especially in the critical care units of the health care setting. Consider a scenario in which a patient was brought to the emergency department of a private hospital by his family with complain of unconsciousness for about half an hour. He was immediately taken to the resuscitation area and family was told by the staff to wait outside.
The staff quickly assessed the patient’s airway, breathing and circulation and found that the patient has compromised respiratory status and he is unable to take breaths of his own. Due to compromised respiratory status, mechanical ventilation was the option left and the patient was transferred to another department of the hospital that is Intensive care unit. Patient’s family was aware about the present condition, treatment modalities and hospital policies. This exchange of information helped to alleviate their anxieties to some extent.
Intensive care unit is considered as one of the critical unit in regards to patients’ condition and a place where outcomes are unpredictable. Patient was left alone in that atmosphere and psychological care was compromised over physiological care by the staff. Family was strictly notified about the visiting timings in the critical care unit and they were not supposed to stay with the patient for a longer period. Why? What is the reason behind this act of insensitivity? What if our loved one is in that situation? During my summer clinical elective, I made quite similar observations while I was working in the critical care unit (i.e. recovery room) that persuaded me to write on the subject that family should be involved in the critical care units.
I argue that family is an integral part of an individual; without whom a person is incomplete and incapable of fulfilling the basic requirements in order to lead a stable life. According to Maslow’s hierarchy of needs (2002) , patients require love and belongingness once their biological, physiological and safety needs are fulfilled. Therefore, this is an identified aspect which needs consideration and it can’t be ignored by the health care professionals and this aspect – that is family centered – care fulfills the concept of holistic care.
According to Barbara (2005)  “family integration into intensive care units (ICUs) and creation of a family-centered approach to care are important in providing holistic care to patients and in helping families decrease their stress levels”. However, some literature supports that involving family in the critical care units is a traumatic experience for them. Olsen, Dysvik and Hansen (2009)  found in their study that several participants describe the situation to see their loved one in critically ill conditions as stressful and some have perceived that this experience would create some psychological problems with them later in their lives.
There is some truth to the argument that involving family in the critical care units is a traumatic experience for them. However, once they are given all the information regarding the disease process and treatment plan they are better able to cope with the situations and they also realize the fact that they have to be strong enough in order to provide support to their loved ones.
I strongly feel that family support in the form of their presence provides strength to the patients in order to cope effectively with the unexpected and unpredictable situations in the critical care units. Critical care unit is the place where uncertainty happens and not a single moment is reliable for any outcome. Williams’ (2005) findings (as cited in Olsen, Dysvik & Hansen, 2009)  indicate that the family provides a vital source of emotional support to patients and seem to make a very valuable contribution to patients’ care and recovery in ICU.
But presence of family might create an anxiety provoking situation for patients which could lead to further deterioration of patient’s health. According to the literature review (as cited in El-Masri & Wasylyshyn, 2006)  it supports that:Hospitalization to an intensive care unit (ICU) triggers a variety of emotional and psychological family responses (Hammond, 1995; Walters, 1995) that often manifest in the form of shock, anxiety, anger, guilt, despair, and/or fear (Fleury and Moore, 1999; Holden et al., 2002). Such responses can impede the ability of family members to exercise effective coping strategies and may lead to family dysfunction. Poor coping strategies and family dysfunction have been reported to have a negative impact on family well-being and patient recovery (Bokinskie, 1992; O’Malley et al., 1991). (p. 43)
While it’s true that involvement of family members might create a negative impact on patients well-being, it is the responsibility of health care professionals to incorporate the concept of holistic care. Priority should be given to address the family needs and to provide them with support so that they can cope up with the situation because there is enough evidences to state that presence of the family makes a positive difference in the prognosis of patients.
Karen, Diane and Coleen (2007)  states that: Family members need support to effectively appraise, cope, and adapt to the stress of having a loved one in the critical care unit (CCU). The challenge for the critical care nurse is to provide care for aggressively managed, critically ill patients while attending to the needs of family members.
I made an argument that the threatening environments of critical care units have devastating effects on the prognosis of patients. Collaboration between health care professionals and families would help to overcome the threatful effects of environment. Mostly the patients are on sedatives so in that case family members become the representatives of the patients when the patients are not feasible to represent themselves due to the course of illness and treatment.
On the other hand, critical care unit is the area of uncertainty and collaboration with the families would be time consuming and might result in delayed interventions. Some researchers suggest that involvement of families would be frustrating the health care professionals. Pryzby (2005) stated that some staff members get frustrated when families are involved in care because they interfere in the care process; obstacles to care in the study included time constraints, staffing shortages, and stress associated with caring for critical patients.
They claim that collaboration with families could be time consuming which might result in decline in the quality of patient’s care but in fact the list of the prime responsibilities of the nurse also includes the collaboration between families and we, as health care professionals, need to build the skills to meet the need of families because without that the concept of holistic care is left unmet. Karen, Diane and Coleen (2007)  analyze that:
Approximately three-quarters of all patients are unable to participate at the time when difficult decisions about the goals of treatment must be made; thus, physicians and nurses must rely on family members to speak for the patient, consent to complicated treatments or procedures, or, when appropriate, approve termination of life support efforts. The family’s needs must be considered alongside those of the patient if holistic care is to be practiced.
In conclusion, families should be allowed in the critical care units in order to enhance the well-being of the patients. As it is an integral part for an individual, it provides strength to cope effectively and it helps to overcome the dreadful effects of critical care unit environments. Health care professionals should draw their attention towards this matter and a change is required to be implemented in the policies and practices. Family involvement should be considered as important as any other treatment modality for the beneficence of the patient.
1. El-Masri, M. M., & Wasylyshyn, S. M. F. (2006). Nurses’ roles with families: Perceptions of ICU nurses. Intensive and Critical Care Nursing, 23, 43-50. Retrieved November 5,
2. Maxwell, K. E., Diane, S., & Coleen, S. (2007). Needs of family members of critically ill patients: A comparison of nurse and family perceptions. Heart & lung, 36(5), 367-376.
3. Maslow’s Hierarchy of Needs. (2002). Retrieved November 24, 2009
4. Pryzby, B. J. (2005). Effects of nurse caring behaviours on family stress responses in critical care. Intensive and Critical Care Nursing, 21, 16-23. Retrieved November 5, 2009.
5. Olsen, K. D, Dysvik, E., & Hansen, B. S. (2009). The meaning of family members’ presence during intensive care stay: A qualitative study. Intensive and Critical Care Nursing, 25, 190-198. Retrieved November 10, 2009.
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