Guidelines For Family-Centered Care In The Neonatal, Pediatric, and Adult ICU

In this 2017 article, specialists from neonatal, pediatric, and adult critical and intensive care medicine and family-centered care convened to analyze Family Centered Care practices in their hospital environments. The researchers completed a meta analysis, as well as family/patient interviews and developed 29 ‘ICU Family-Centered Care Recommendations’. View these recommendations below:

  1. Family presence in the ICU

    1. Family members of critically ill patients be offered open or flexible family presence at the bedside that meets their needs while providing support for staff and positive reinforcement for staff to work in partnership with families to improve family satisfaction.
    2. Family members of critically ill patients be offered the option of participating in interdisciplinary team rounds to improve satisfaction with communication and increase family engagement.
    3. Family members of critically ill patients be offered the option of being present during resuscitation efforts, with a staff member assigned to support the family.

  1. Family support

    1. Family members of critically ill neonates be offered the option to be taught how to assist with the care of their critically ill neonate to improve parental confidence and competence in their caregiving role and improve parental psychological health during and after the ICU stay.
    2. Family education programs be included as part of clinical care as these programs have demonstrated beneficial effects for family members in the ICU by reducing anxiety, depression, post-traumatic stress, and generalized stress while improving family satisfaction with care.
    3. Peer-to-peer support be implemented in NICUs to improve family satisfaction, reduce parental stress, and reduce depression.
    4. ICUs provide family with leaflets that give information about the ICU setting to reduce family member anxiety and stress.
    5. ICU diaries be implemented in ICUs to reduce family member anxiety, depression, and post-traumatic stress
    6. Validated decision support tools for family members be implemented in the ICU setting when relevant validated tools exist to optimize quality of communication, medical comprehension, and reduce family decisional conflict.
    7. Among surrogates of ICU patients who are deemed by a clinician to have a poor prognosis, clinicians use a communication approach, such as the “VALUE” mnemonic (Value family statements, Acknowledge emotions, Listen, Understand the patient as a person, Elicit Questions), during family conferences to facilitate clinician-family communication.

  1. Communication with family members

    1. Routine interdisciplinary family conferences be used in the ICU to improve family satisfaction with communication and trust in clinicians and to reduce conflict between clinicians and family members.
    2. Healthcare clinicians in the ICU should use structured approaches to communication, such as that included in the “VALUE” mnemonic, when engaging in communication with family members, specifically including active listening, expressions of empathy, and making supportive statements around nonabandonment and decision making. In addition, we suggest that family members of critically ill patients who are dying be offered a written bereavement brochure to reduce family anxiety, depression, and post-traumatic stress and improve family satisfaction with communication.
    3. ICU clinicians receive family-centered communication training as one element of critical care training to improve clinician self-efficacy and family satisfaction.

  1. Use of specific consultations and ICU team members

    1. Proactive palliative care consultation be provided to decrease ICU and hospital length of stay (LOS) among selected critically ill patients (e.g., advanced dementia, global cerebral ischemia after cardiac arrest, patients with prolonged ICU stay, and patients with subarachnoid hemorrhage [SAH] requiring mechanical ventilation).
    2. Ethics consultation be provided to decrease ICU and hospital LOS among critically ill patients for whom there is a value-related conflict between clinicians and family.
    3. A psychologist’s intervention be provided to specifically incorporate a multimodal cognitive behavioral technique (CBT)-based approach to improve outcomes in mothers of preterm babies admitted to the NICU; furthermore, targeted video and reading materials be provided in the context of psychological support to mothers of preterm babies admitted to the ICU.
    4. Social workers be included within an interdisciplinary team to participate in family meetings to improve family satisfaction.
    5. Family navigators (care coordinator or communication facilitator) be assigned to families throughout the ICU stay to improve family satisfaction with physician communication, decrease psychological symptoms, and reduce costs of care and length of ICU and hospital stay.
    6. Spiritual support from a spiritual advisor or chaplain be offered to families of ICU patients to meet their expressed desire for spiritual care and the accreditation standard requirements.

  1. Operational and environmental issues

    1. Protocols be implemented to ensure adequate and standardized use of sedation and analgesia during withdrawal of life support.
    2. Nurses be involved in decision-making about goals of care and be trained to provide support for family members as part of an overall program to decrease ICU and hospital LOS and to improve quality of communication in the ICU.
    3. Hospitals implement policies to promote family-centered care in the ICU to improve family experience.
    4. Given the evidence of harm related to noise, although in the absence of evidence for specific strategies, ICUs implement noise reduction and environmental hygiene practices and use private rooms to improve patient and family satisfaction.
    5. Family sleep be considered and families be provided a sleep surface to reduce the effects of sleep deprivation.

 

Davidson, J., Aslakson, R., Long, A., Puntillo, K., Kross, E., Hart, J., Cox, C., Wunsch, H., Wickline, M., Nunnally, M., Netzer, G., Kentish-Barnes, N., Sprung, C., Hartog, C., Croombs, M., Gerritsen, R., Hopkins, R., Franck, L., Skrobik, Y., Kon, A., Scruth, E., Harvey, M., Lewis-Newby, M., White, D., Swoboda, S., Cooke, C., Levy, M., Azoulay, E., Curtis, J. (2017). Guidelines for family-centered care in the neonatal, pediatric, and adult ICU. Critical Care Medicine, 45 (1), 103-128.