Research article
The needs of families of trauma intensive care patients: A mixed methods study

https://doi.org/10.1016/j.iccn.2018.08.009Get rights and content

Abstract

Objective

To identify the needs of families of trauma patients in the Intensive Care Unit and to assess nurses’ perceptions of those needs.

Methodology

A sequential mixed-methods study was utilised combining survey data and semi-structured interviews.

Setting

A tertiary Intensive Care Unit in Australia.

Outcome measures

The Critical Care Family Needs Inventory assessed the needs of families of general and trauma patients. Nurses were also surveyed for their perspectives on the needs of trauma patients’ families. Interviews with families were analysed using an inductive thematic analysis technique.

Results/findings

214 surveys were completed (50 family members of trauma patients; 53 family members of general patients; 111 nurses). No statistically significant sub-scale differences in survey responses between the family groups were found. However, differences on four of the five survey sub-scales (p ≤ .001) were identified between families of trauma patients and nurses. Three themes emerged identifying unique needs of families of trauma patients from the interviews and included: Personal Distress and Adjustment, Guidance, and Care.

Conclusion

This mixed methods study identified that families of trauma patients have different needs to families of general patients and the nurses rated the needs of the families of trauma patients as less important than the families rated their own needs. Through a collaborative partnership with these families, nurses can assist and better meet their needs. The provision of individualised patient/family-centred care is likely to have a positive influence.

Introduction

Traumatic injuries can have lasting psychological and physical impacts requiring a lengthy hospital stay which may include an admission into intensive care. Intensive Care Unit (ICU) health care professionals and patients rely heavily on family members for substitute decision-making, psychological support and ongoing care (Azoulay et al., 2001, Hupcey, 1999, McKinley et al., 2002). The families of trauma patients are likely to be ill-prepared for the sudden, frequently life-changing events that occur as a result of traumatic injury. This together with the uncertainty of short and long term outcomes can result in emotional distress for families (Bandari et al., 2015). The importance of the patient’s family in the ICU journey is well recognised as family members frequently provide ongoing care and support throughout the illness and recovery trajectory (Wetzig and Mitchell, 2017).

One clear focus in the literature is the recognition that families of ICU patients have needs and nurses are well positioned to support many of these needs (Bandari et al., 2015, Leung et al., 2000, Takman and Severinsson, 2005, Verhaeghe et al., 2005). The premise is that by meeting a family’s needs, they are better able to cope with the ICU experience and critical illness (Bandari et al., 2015, Kosco and Warren, 2000, Molter, 1979, Titler et al., 1995). The needs of families of general ICU (GICU) patients have been extensively examined over the decades and are described as having five dimensions including the need for support, comfort, information, proximity and assurance (Leske, 1986, Molter, 1979). The needs of families of trauma ICU (TICU) patients are less well reported and may differ to other families in ICU. These patients and their families are not experiencing planned admission, but rather emergency and/or unexpected ICU admission. This in association with their propensity to long term implication for employment and returning to their pre-injury roles, potentially have a significant impact on both patients’ and their families’ requirements for care (Bandari et al., 2015), unlike other non trauma ICU patients and families. There are limited studies which examine the needs of families of TICU patients (Wetzig and Mitchell, 2017). However, two ICU trauma sub-groups do emerge in the literature and include the needs of families of patients with a traumatic brain injury (TBI) (Bond et al., 2003, Engli and Kirsivali-Farmer, 1993, Keenan and Joseph, 2010, Mathew et al., 2015, Rotondi et al., 2007, Schaaf et al., 2013, Verhaeghe et al., 2007, Verhaeghe et al., 2010a, Verhaeghe et al., 2010b) and the needs of families of burns patients (Gullick et al., 2014, Thompson et al., 1999). The recent integrated review on the needs of families of ICU trauma patients found that the need for protecting their critically ill relatives was strongly identified across the studies of families of TBI and burns patients due to the sudden and devastating nature of traumtic injuries (Wetzig and Mitchell, 2017). However, the application of these findings to families of TICU patients, inclusive of all types of injuries, has not been investigated. There were only two reviews where the researchers planned to examine the needs of families of multitrauma patients, however, due to the paucity of research with multitrauma patients, they were limited to studies that drew from patients with a diagnosis of TBI (Friedemann-Sánchez et al., 2008, Griffin et al., 2009). The authors highlighted the need for more research as extrapolating findings from TBI studies to other forms of trauma patients and their families is unwise due to differences in the type and number of injuries (Friedemann-Sánchez et al., 2008, Griffin et al., 2009).

The manner in which nurses structure and tailor ICU family care is related to their perceptions of families’ needs, which depends on how nurses can incorporate patient-family centered care (Institute for Patient- and Family-Centered Care, 2012). With limited understanding and knowledge regarding this area, critical care nurses may not be well informed to meet the actual needs of families of TICU patients. Importantly, nurses’ perceptions of the actual needs of families of GICU patients have not always aligned, thus highlighting the need to have families clearly identify their needs (Kosco and Warren, 2000, Tin et al., 1999). The objective of this study was to identify and understand the specific needs of families of TICU patients and to assess nurses’ perceptions of those needs.

The project aims included: identifying the needs of families of ICU patients determining the differences and similarities of families of TICU and GICU patients and identifying the perceptions of nurses about the needs of families of TICU patients.

Patient and Family-Centred Care (PFCC) provided the underlying assumptions for this study where PFCC was defined as a model of care with “an approach to the planning, delivery and evaluation of health care that is grounded in mutually beneficial partnerships amongst health care providers, patients and families” (Institute for Patient- and Family-Centered Care, 2012). The role of the family as a significant participant within PFCC was acknowledged and provided justification for the focus of this study. A family member was broadly defined as someone with a close and continuing relationship with the patient.

Section snippets

Research design

A sequential mixed-methods study was utilised combining quantitative survey data and semi-structured interviews to contextualise and enrich understanding of the needs of families of TICU patients (Creswell and Clark, 2011). Solely qualitative and quantitative methods each provide perspectives and yet have inherent limitations (Creswell and Clark, 2011). Mixed methods offset these limitations to provide a more comprehensive understanding of the needs of the families of TICU patients (Creswell

Results

Surveys were distributed to 98 family members of GICU patients with 53 returned (response rate 54%) and 96 family members of TICU patients with 50 returned (response rate 52%). Of the 338 eligible family members, 120 were ‘failure to capture’ due to family visiting outside research nurse hours of 07:00 hrs to 15:30 hrs, Monday to Friday. Twenty-four family members declined participation. The mean age of the trauma patients was 44.78 years (SD = 19.64) and the mean age of the general patients

Discussion

This is the first study that we have found that distinguishes between the distinct needs of TICU families and those of the families of GICU patients. A further objective was to identify ICU nurses’ perceptions of the needs of families of TICU patients, with the premise being that nurses direct their care to areas they consider being relevant or important. Interestingly, the top need nominated by families of TICU and GICU patients in our study, Item 5. To have question answered honestly, was

Limitations

Families were interviewed at varying times during their relative’s ICU admission. It may be that families have different needs at different points during their ICU experience. However, care was taken to ensure we invited families across the spectrum of time. We also did not ask the nurses to rate the needs of GICU families to make a comparison with the nurses’ perception of the needs of families of TICU patients. Another limitation was that no nurse interviews were completed, which could have

Conclusion

This mixed methods study identified that families of TICU patients have some different needs to families of GICU patients. The well-used CCFNI sub-scale results highlighted that ICU nurses rated the needs of TICU families significantly less than the families of TICU rated their own needs. It is important for nurses to conceptualise and understand the different needs of families of TICU patients. Three important areas were identified as unique needs of families of trauma patients: Personal

Acknowledgements

The authors wish to thank the participating family members and nurses for their valuable input by completing the surveys and interviews. Thanks are extended to Ms Carol Jeffery and Dr Liz Burmeister for advices on the study analysis.

This study was supported by a Trauma and Disaster Management Grant, Princess Alexandra Hospital, Brisbane, Australia.

We recognise the significant contribution to the conception, design and data acquisition made by Prof. Leanne Aitken, City, University of London,

Conflict of interests

The authors declare no conflicts of interests.

Author contributions

Marion Mitchell [MM] conceived the study.

MM and Krista Wetzig [KW] designed the study and the data collection methods.

MM and KW performed data collection.

MM, KW, Toni Dwan [TD], and Mari Takashima [MT] were involved in data management.

All authors were involved in data analysis, drafting and revising the paper. All authors have approved the final version.

References (51)

  • R. Bandari et al.

    Information and support needs of adult family members of patients in intensive care units: an Iranian perspective

    J. Res. Nurs.

    (2015)
  • G.A. Bonanno

    Loss, Trauma, and Human Resilience: Have we underestimated the human capacity to thrive after extremely aversive events?

    Am. Psychol.

    (2004)
  • A.E. Bond et al.

    Needs of family members of patients with severe traumatic brain injury implications for evidence-based practice

    Crit Care Nurse.

    (2003)
  • V. Braun et al.

    Using thematic analysis in psychology

    Qual Res Psychol.

    (2006)
  • J. Cohen

    A power primer

    Psychol. Bull.

    (1992)
  • J. Creswell et al.

    Collecting data in mixed methods research

  • L. DeSantis et al.

    The concept of theme as used in qualitative nursing research

    West. J. Nurs. Res.

    (2000)
  • M. Engli et al.

    Needs of family members of critically ill patients with and without acute brain injury

    J. Neurosci. Nurs.

    (1993)
  • I. Etikan et al.

    Comparison of convenience sampling and purposive sampling

    Am. J. Theor. Appl. Stat.

    (2016)
  • G. Friedemann-Sánchez et al.

    Communicating information to families of polytrauma patients: a narrative literature review

    Rehabil. Nurs.

    (2008)
  • J.M. Griffin et al.

    Families of patients with polytrauma: Understanding the evidence and charting a new research agenda

    J. Rehabil. Res. Dev.

    (2009)
  • J.G. Gullick et al.

    The trauma bubble: Patient and family experience of serious burn injury

    J. Burn Care Res.

    (2014)
  • J.E. Hupcey

    Looking out for the patient and ourselves–the process of family integration into the ICU

    J. Clin. Nurs.

    (1999)
  • IBM Corp. 2013. SPSS Statistics for Windows. 22.0 ed. IBM Corp,...
  • Institute for Patient- and Family-Centered Care. 2012. Patient- and family-centered care....
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