New Guidelines Seek to Promote Family-Centered Care in the ICU

Evidence-Based Recommendations Introduced at SCCM 2017

headshots of Linda Franck and Kathleen Puntillo

Critical illness is a stressful and traumatic experience that may have lasting effects on the health of patients and families, even months after discharge from the intensive care unit (ICU). A new set of guidelines for promoting family-centered care in neonatal, pediatric, and adult ICUs were presented at the Society of Critical Care Medicine's (SCCM) 46th Critical Care Congress, taking place January 21 to 25, 2017, at the Hawaii Convention Center, Honolulu. The guidelines also appear in Critical Care Medicine, SCCM's official journal, published by Wolters Kluwer.

UCSF School of Nursing’s Linda Franck, PhD, RN, FRCPCH, FAAN, professor and Jack and Elaine Koehn Endowed Chair in Pediatric Nursing, and Kathleen Puntillo, PhD, RN, FAAN, professor emerita, were the guidelines' co-authors. Franck works with the neonatal/pediatric critical care population, and Puntillo with adult critical care.

“UCSF Benioff Children’s Hospitals have long recognized that families are an integral part of the critically ill child’s care team and have invested in creating a culture of partnership with families and an environment supporting family engagement,” Franck said. “We continue to lead the way – working with families to develop and test new ways to better support families when a child is critically ill so that together we can help children regain and maintain health.”

“These guidelines complement the work being done in the adult medical-surgical ICU here at UCSF,” Puntillo said. “Specifically, the unit has had a Patient Family Advisory Council for several years, ICU clinicians are advancing the engagement of patients’ families in patient care rounds, and families are assisting in the care of patients, such as providing a patient thirst intervention.”

"These guidelines identify the evidence base for best practices for family-centered care in the ICU," comments lead author Judy E. Davidson, DNP, RN, FAAN, FCCM, of the University of California San Diego Health. The new guidelines are based on evidence showing that family-centered care may prevent or lessen the impact of post-intensive care syndrome—lingering physical and mental health effects that can occur in family members as well as patients. The guidelines and supporting work tools are now available on the SCCM and Critical Care Medicine websites. They also are available at the Society's ICU Liberation website at www.ICULiberation.org/Family.

Family-Centered Care in the ICU: Evidence and Recommendations

Based on analysis of more than 450 qualitative and quantitative studies, a multidisciplinary international expert panel developed a series of evidence-based recommendations for family-centered care in the ICU. Defined as "an approach to healthcare that is respectful of and responsive to individual families' needs and values," family-centered care recognizes the central importance of the family to the patient's recovery.

The expert panel followed a rigorous, objective, and transparent approach to evidence analysis, including steps to incorporate the perspectives of former ICU patients and family members. Examples of the 23 recommendations, grouped into five areas, include:

  • Family presence in the ICU. "Open or flexible" family presence in the ICU, along with support and positive reinforcement for staff in partnership with families.
  • Family support. Family education and instruction on how to assist with care.
  • Communication with family members. Family conferences to promote communication and trust between family members and clinicians and lower the risks of anxiety, depression, and post-traumatic stress symptoms.
  • Specific consultations and ICU team members. Palliative and ethics consultations, as well as the roles of psychologists, social workers, family navigators, and spiritual advisors.
  • Operational and environmental issues. Policies and procedures to support family-centered care, for example, considering space for family members to sleep.

The report includes a summary of the supporting evidence for each recommendation. The expert panel highlights areas for further research to strengthen the evidence base." One of the key findings from these guidelines is that there are many important areas of family-centered care where the evidence-base is inadequate. The guidelines highlight key areas for future research," comments senior author J. Randall Curtis, MD, MPH, of the University of Washington, Seattle. The guidelines have been endorsed by nine leading critical care and family-centered care specialty organizations in North America and Europe.

The panel, in collaboration with a task force led by David Y. Hwang MD, of Yale University, has also developed a guide to help in planning and implementing steps to improve family-centered care in ICU settings. This document lists tested resources for translating the recommendations into practice. A gap analysis tool was also developed for use in developing hospital-specific priorities for change to enhance family-centered care. This video offers instruction on how to use the gap analysis tool

At the Critical Care Congress presentation titled "Family-Centered Care: Translating Research into Practice," panel members introduced and discussed the recommendations, including the use of the gap analysis and other work tools. "Family presence, improved communication and family engagement in care may reduce post-intensive care syndrome for both patients and their family members, ultimately improving the health of our community," Judy Davidson comments. "Families in the ICU aren't visitors—they should be an integral part of the care and the care team." The session will be broadcast live at www.sccm.org/live.

Endorsing Agencies: American Association of Critical-Care Nurses, American College of Chest Physicians, American Thoracic Society, British Association of Critical Care Nurses, European Society of Intensive Care Medicine, Institute for Patient- and Family-Centered Care, Pediatric Cardiac Intensive Care Society, Society of Critical Care Anesthesiologists, World Federation of Societies of Intensive and Critical Care Medicine.

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About the Society of Critical Care Medicine: The Society of Critical Care Medicine (SCCM) is the largest nonprofit medical organization dedicated to promoting excellence and consistency in the practice of critical care. With members in more than 100 countries, SCCM is the only organization that represents all professional components of the critical care team. The Society offers a variety of activities that ensures excellence in patient care, education, research and advocacy. SCCM's mission is to secure the highest quality care for all critically ill and injured patients. Visit www.sccm.org for more information. Follow @SCCM or visit us on Facebook.

All of the late-breaking literature releases from the 46th Critical Care Congress are available at www.sccm.org/literature.

About Critical Care Medicine: Critical Care Medicine is the premier peer-reviewed, scientific publication in critical care medicine. Directed to those specialists who treat patients in the intensive care unit and critical care unit, including chest physicians, surgeons, pediatricians, pharmacists/pharmacologists, anesthesiologists, critical care nurses and other healthcare professionals, Critical Care Medicine covers all aspects of acute and emergency care for the critically ill or injured patient. Each issue presents critical care practitioners with clinical breakthroughs that lead to better patient care, the latest news on promising research and advances in equipment and techniques. Follow @CritCareMed.

About UCSF: UC San Francisco (UCSF) is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy; a graduate division with nationally renowned programs in basic, biomedical, translational and population sciences; and a preeminent biomedical research enterprise. It also includes UCSF Health, which comprises two top-ranked hospitals, UCSF Medical Center and UCSF Benioff Children’s Hospital San Francisco, and other partner and affiliated hospitals and healthcare providers throughout the Bay Area. Please visit www.ucsf.edu/news.

About Wolters Kluwer: Wolters Kluwer is a global leader in professional information services. Professionals in the areas of legal, business, tax, accounting, finance, audit, risk, compliance and healthcare rely on Wolters Kluwer's market leading information-enabled tools and software solutions to manage their business efficiently, deliver results to their clients, and succeed in an ever more dynamic world.

 

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