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The family in the ICU: needs, flexible visiting, information, family conferences and presence during resuscitation

  • Safe practice

The family of an ICU patient needs clear information, flexible visits, a part in rounds and conferences, and the offer to be present during resuscitation.

Updated

What it is

Between a quarter and a half of the relatives of ICU patients develop acute stress, anxiety, depression or post-traumatic stress, during and after the stay; this is called post-intensive care syndrome-family. How clinicians communicate is linked to those symptoms. Family-centred care treats the family, as defined by the patient, as part of the team: flexible visiting, written information about the unit, the offer to join rounds, regular family conferences with a structured way of communicating, diaries, and the offer to be present during resuscitation with a staff member beside them. The nurse is often the person who makes these things happen.

What it requires

  • In adult trials, offering family presence during resuscitation did not change patient mortality or resuscitation length, and relatives had less anxiety, depression and intrusive memories.
  • Open or flexible visiting is linked to better satisfaction of patients, families and nurses; the visiting rules should follow the patient's needs.
  • Family education programmes and ICU diaries are recommended to reduce family anxiety, depression and post-traumatic stress.
  • When a patient is dying, a written bereavement leaflet for the family is suggested.
  • Ethics consultation is suggested when there is a values conflict between the team and the family.

How it is applied (and why)

  1. On the first day, ask the patient (or the surrogate) who their family is and who speaks for them — the definition belongs to the patient.
  2. Introduce yourself, explain the unit, the devices and the alarms, and give the written leaflet — fear falls when the setting is understood.
  3. Agree with the family flexible visiting times that fit the patient's care and rest — presence comforts the patient and the family.
  4. Invite the family to rounds when the unit offers it, and prepare them for what they will hear — it improves communication and trust.
  5. Attend family conferences, take notes of what was said and check afterwards what the family understood — they may retain little in a crisis.
  6. Listen and name the emotions you see, without false reassurance — empathy and support around decisions lower distress.
  7. During resuscitation, offer one family member the option to be present, with a staff member beside them who explains — it may help them later.
  8. Watch for exhaustion, anxiety or low mood in relatives and refer them to psychology, social work or spiritual care — family members can become ill too.

In nursing practice

  • Clinicians worry that open visiting raises the patient's stress, interrupts care and tires families; agree limits with the family instead of imposing fixed hours.
  • Repeat the same information several times and in simple words: relatives under stress often cannot retain it.
  • When there is a poor prognosis, the nurse links the family with the physician and the palliative care team.
  • Report a conflict between the team and the family early; an ethics consultation can help.

Common mistakes

  • Deciding who is «family» without asking the patient.
  • Sending relatives out during every procedure by habit.
  • Using medical jargon or giving too much information at once.
  • Leaving a relative alone in the room during a resuscitation, without anyone to explain.

Test yourself

Think of the answer, then tap the question to see it.

What did trials find when families were offered to be present during adult resuscitation?

No change in mortality or resuscitation length, and fewer symptoms of anxiety, depression and intrusive memories in the relatives.

Who decides who counts as «family» in the ICU?

The patient, or the surrogate if the patient cannot decide; it need not follow a legal or genetic definition.

What does the VALUE approach include in a family conference?

Value what the family says, acknowledge emotions, listen, understand the patient as a person and elicit questions.

What is needed if a relative stays during a resuscitation?

A staff member assigned to stay with them, explain what is happening and support them.

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Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: New developments in the provision of family-centered care in the intensive care unit (Intensive Care Medicine, 2017); The offering of family presence during resuscitation: a systematic review and meta-analysis (Journal of Intensive Care, 2015); A review of visiting policies in intensive care units (Global Journal of Health Science, 2015).

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