| Peer-Reviewed

Involvement of Patients’ Families in Care of Critically Ill Patients at Kenyatta National Hospital Critical Care Units

Received: 28 October 2017    Accepted: 9 December 2017    Published: 19 January 2018
Views:       Downloads:
Abstract

Patients assess the likely benefits and risks of a recommended treatment or investigation and make a decision to either accept or refuse treatment. When a patient loses the capacity to participate meaningfully in decision making, a means should exist to ensure decisions that represent the patient’s goals, preferences, and interests are made. This means is substitute decision making, and it usually occurs when a spouse, partner, close family member, or friend assumes this responsibility on behalf of the incapacitated patient. Limited involvement in patient care activities at the hospital can lead to distress in the family as well as challenge family members in assuming the likely expected role when the patient returns home. This study aimed at determining the nature and extent of family/substitute decision makers’ involvement in care of the critically ill patients, guiding policies and the perspectives of nurse managers on involvement in Kenyatta National Hospital (KNH) critical care units (CCUs). This was a descriptive cross sectional study with family members and CCU nurse managers as the study participants. Key informants’ interviews and in depth interviews were conducted. The sample size was 52 family members and four nurse managers. Quantitative data was analyzed using Statistical Package for Social Sciences (SPSS) version 21.0 and descriptive content analysis for qualitative data. Family members reported emotional distressed from the admission of a family member to the critical care unit. However their level of satisfaction with the extent of involvement was above average at a mean of 6.5. The activity mostly involved in was sharing of general information at 57.7% (n=30) with 36.5% (n=19) feeling they should have been provided with in depth information regarding the patients care. The key themes from interviews with family members were: limited information involvement, guilt feeling, and appreciation. Nurse Managers reported KNH has a closed visiting policy with none feeling it should be changed to an open policy. They also unanimously agreed that family members should be involved in care of the critically ill patients through information sharing and counseling. Two nurse managers felt primary care nurses should involve families in general nursing activities such as oral care with all agreeing that the nurses don’t involve families in these activities. There was a statistical relationship (p<0.05 at a 95% confidence interval and R2=0.689) between the perspectives of nurse managers and the nature and extent of involvement of family members in care.

Published in American Journal of Nursing Science (Volume 7, Issue 1)
DOI 10.11648/j.ajns.20180701.14
Page(s) 31-38
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Involvement of Family Members, Critically Ill Patients’ Care, Critical Care Unit, Substitute Decision Makers, Kenyatta National Hospital

References
[1] Santiago, C., Lazar, L., Jiang, D. and Burns, K., E., A. (2014) A survey of the attitudes and perceptions of multidisciplinary team members towards family presence at bedside rounds in the intensive care unit. Intensive and Critical Care Nursing, 30, 13-21.
[2] Kitto, S., Olding, M., McMillan, S., E., Reeves, S., Schmitt, M., H., and Puntillo, K. (2015) Patient and family involvement in adult critical and intensive care settings: a scoping review. Health Expectations. 1-20.
[3] Liu, V., Read, J., L., Scruth, E., and Cheng, E., (2013) Visitation policies and practices in US ICUs. http://ccforum.com/content/17/2/R71 (Accessed 18/12/2016).
[4] Gentry, S., McArthur, R., Millegan, J., Morris-White, E., Scott, S., and Williams, L. (2014) A Study to Evaluate the Needs of Family Members of Critically Ill Patients in the ICU. Nursing journal.
[5] Hinkle, J. L., and Fitzpatrick, E. (2011) Needs of American relatives of intensive care patients: Perceptions of relatives, physicians and nurses Intensive and Critical Care Nursing. Australian journal of advanced nursing. 27, 218—225.
[6] Nelms, T., P. and Eggenberger, S., K. (2010). The Essence of the Family Critical Illness Experience and Nurse–Family Meetings Journal of Family Nursing. 16, 462–486.
[7] Bond, A. E., Draeger, C., R., L., Mandleco, B. and Donnelly, M., (2003) Needs of family members of patients with severe traumatic brain injury. Implications for evidence-based practice. Critical Care Nursing, 23, 63-72.
[8] Omari, F. (2012) Jordanian nurses’ perceptions of their roles toward the families of hospitalized critically ill patients. Journal of Research in Nursing, 18, 669–680.
[9] Ngui, M., L. (2006) Determination of families’ needs of patients admitted in the intensive care unit (ICU) and the extent to which these needs are met as perceived by the family members and the ICU nurses at Kenyatta National Hospital. University of Nairobi College of Health Sciences Digital Repository 2006. (accessed 10/10/2016).
[10] Umani, K., O. (2014) A survey of ICU setups in the republic of Kenya. www.google.com (accessed on 3/11/2016).
[11] Fateel, E., E., and O’Neill, C., S. (2015) Family members’ involvement in the care of critically ill patients in two intensive care units in an acute hospital in Bahrain: The experiences and perspectives of family members’ and nurses’ - A qualitative study. Clinical Nursing Studies, 4, 57-69.
[12] Zampieron, et al., 2008. Access to intensive care units: A survey in North-East Italy. Intensive Critical Care Nursing. 24(6), 366–374.
[13] Banh, M., A. (2013) A closer look at visitation hour policies in intensive care units. The Journal of Undergraduate Nursing Writing. vol 6, issue 1 (http://archie.kumc.edu/2271/237).
[14] Khaleghparast, S., Joolaee, S., Ghanbari, B., Maleki, M., Peyrovi, H. and Bahrani, N. (2015) A Review of Visiting Policies in Intensive Care Units. Global Journal of Health Science. 8(6): 267–276.
[15] Hunter, J. D., Goddard, C., Rothwell, M., Ketharaju, S., and Cooper H. (2010) A survey of intensive care unit visiting policies in the United Kingdom. Anaesthesia. 65(11), 1101-1105.
[16] El-Masri, M., M., and Fox-Wasylyshyn S., M., (2007) Nurses’ roles with families: Perceptions of ICU nurses. Intensive and Critical Care Nursing 23, 1, 43–50.
[17] Tomnay, J. E., Kinrade, T., and Jackson, A, C. (2009) The psychosocial needs of families during critical illness: comparison of nurses’ and family members’ perspectives. Australian journal of advanced nursing. 27, 82-88.
[18] Gondwe, W. T. M., Bhengu, B. R. and Bultemeier, K. (2011) Challenges encountered by intensive care nurses in meeting patients’ families’ needs in Malawi. Africa Journal of Nursing and Midwifery, 13, 92–102.
[19] Matlakala, M. C. (2015) Sharing the critically ill patient’s information with the family: Reflections and lessons learned. Journal of Nursing Education and Practice, 5, 115-119.
[20] Brysiewicz, P. and Bhengu B. R. (2010) The experiences of nurses in providing psychosocial support to families of critically ill trauma patients in intensive care units. A study in the Durban metropolitan area. South Africa Journal of Critical Care (SAJCC), 26, 42-51.
[21] Foster, M., Whitehead, L., and Maybee, P., (2015)The Parents’, Hospitalized Child’s, and Health Care Providers’ Perceptions and Experiences of Family-Centered Care Within a Pediatric Critical Care Setting: A Synthesis of Quantitative Research. Journal of Family Nursing. 22, 6–73.
[22] Gallo, K., P., Hill, L., C., Hoagwood, K., E., and Olin, S., S., (2015) A Narrative Synthesis of the Components of and Evidence for Patient- and Family-Centered Care. Clinical Pediatrics. 55, 333–346.
[23] Institute for Patient- and Family-Centered Care, (2010) Changing hospital “visiting” and policies and practices: supporting family presence and participation. http://www.ipfcc.org. Accessed December, 2016.
[24] Institute of Family Centered Care, (1992) Institute of Family Centered Care. (www.familycenteredcare.org/pdf/fcc_qa.pdf).
[25] Segaric, C., A., and Hall, W., A. (2014) Progressively Engaging: Constructing Nurse, Patient, and Family Relationships in Acute Care Settings. Journal of Family Nursing. 21, 35–56.
[26] Spreen, A. E., Marieke J. and Schuurmans, M. J. (2011) Visiting policies in the adult intensive care units: A complete survey of Dutch ICUs. Intensive and Critical Care Nursing. 27, 27—30.
[27] Chaboyer, W. and Mitchell, M., L. (2010) Family Centred Care—A way to connect patients, families and nurses in critical care: A qualitative study using telephone interviews. Intensive and critical care nursing journal. 26 (3), 154-160.
[28] Vandall-Walker, V., and Clark, A., M. (2011) It Starts With Access! A Grounded Theory of Family Members Working to Get Through Critical Illness. Journal of Family Nursing. 17, 148–181.
[29] Rippin, A., S., Zimring, C., Samuels, O., and Denham, M., E., (2015) Finding a Middle Ground: Exploring the Impact of Patient- and Family-Centered Design on Nurse–Family Interactions in the Neuro ICU. Health Environments Research & Design Journal, 9, 80-98.
[30] Kingsinger, V. (2015) "Family Centered Care in ICU Settings" Honors Theses. Paper 263.http://scholarworks.wmich.edu/honors_theses. (accessed 18/11/2016).
[31] Azoulay, E., Pochard, F., Chevret, S., Lemaire, F., Mokhtari, M., Le Gall, J. R., Dhainaut, J. F. and Schlemmer, B. (2001) Meeting the needs of intensive care unit patient families. A multicenter study. American Journal of Respiratory And Critical Care Medicine, 163, 135-139.
[32] Kerr, E., M. (2000) “One Family’s Story: A Primer on Bowen Theory.” The Bowen Center for the Study of the Family. http://www.thebowencenter.org.
[33] Ramos, F., J., Fumis, R., R., L., Azevedo, L., C., P., and Schettino, G. (2013) Perceptions of an open visitation policy by intensive care unit workers. Ann Intensive Care; 3: 34
[34] Meert, K., L., Clark, J., and Eggly, S. (2013) Family-centered care in the pediatric intensive care unit. Pediatric clinics of North America. 60(3), 761-772.
[35] Molter, N., C. (1979) Needs of relatives of critically ill patients: a descriptive study. Heart Lung. 8 (2), 332-339. [PubMed].
Cite This Article
  • APA Style

    Pauline Muthoni Maina, Samuel Kimani, Blasio Omuga. (2018). Involvement of Patients’ Families in Care of Critically Ill Patients at Kenyatta National Hospital Critical Care Units. American Journal of Nursing Science, 7(1), 31-38. https://doi.org/10.11648/j.ajns.20180701.14

    Copy | Download

    ACS Style

    Pauline Muthoni Maina; Samuel Kimani; Blasio Omuga. Involvement of Patients’ Families in Care of Critically Ill Patients at Kenyatta National Hospital Critical Care Units. Am. J. Nurs. Sci. 2018, 7(1), 31-38. doi: 10.11648/j.ajns.20180701.14

    Copy | Download

    AMA Style

    Pauline Muthoni Maina, Samuel Kimani, Blasio Omuga. Involvement of Patients’ Families in Care of Critically Ill Patients at Kenyatta National Hospital Critical Care Units. Am J Nurs Sci. 2018;7(1):31-38. doi: 10.11648/j.ajns.20180701.14

    Copy | Download

  • @article{10.11648/j.ajns.20180701.14,
      author = {Pauline Muthoni Maina and Samuel Kimani and Blasio Omuga},
      title = {Involvement of Patients’ Families in Care of Critically Ill Patients at Kenyatta National Hospital Critical Care Units},
      journal = {American Journal of Nursing Science},
      volume = {7},
      number = {1},
      pages = {31-38},
      doi = {10.11648/j.ajns.20180701.14},
      url = {https://doi.org/10.11648/j.ajns.20180701.14},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajns.20180701.14},
      abstract = {Patients assess the likely benefits and risks of a recommended treatment or investigation and make a decision to either accept or refuse treatment. When a patient loses the capacity to participate meaningfully in decision making, a means should exist to ensure decisions that represent the patient’s goals, preferences, and interests are made. This means is substitute decision making, and it usually occurs when a spouse, partner, close family member, or friend assumes this responsibility on behalf of the incapacitated patient. Limited involvement in patient care activities at the hospital can lead to distress in the family as well as challenge family members in assuming the likely expected role when the patient returns home. This study aimed at determining the nature and extent of family/substitute decision makers’ involvement in care of the critically ill patients, guiding policies and the perspectives of nurse managers on involvement in Kenyatta National Hospital (KNH) critical care units (CCUs). This was a descriptive cross sectional study with family members and CCU nurse managers as the study participants. Key informants’ interviews and in depth interviews were conducted. The sample size was 52 family members and four nurse managers. Quantitative data was analyzed using Statistical Package for Social Sciences (SPSS) version 21.0 and descriptive content analysis for qualitative data. Family members reported emotional distressed from the admission of a family member to the critical care unit. However their level of satisfaction with the extent of involvement was above average at a mean of 6.5. The activity mostly involved in was sharing of general information at 57.7% (n=30) with 36.5% (n=19) feeling they should have been provided with in depth information regarding the patients care. The key themes from interviews with family members were: limited information involvement, guilt feeling, and appreciation. Nurse Managers reported KNH has a closed visiting policy with none feeling it should be changed to an open policy. They also unanimously agreed that family members should be involved in care of the critically ill patients through information sharing and counseling. Two nurse managers felt primary care nurses should involve families in general nursing activities such as oral care with all agreeing that the nurses don’t involve families in these activities. There was a statistical relationship (p2=0.689) between the perspectives of nurse managers and the nature and extent of involvement of family members in care.},
     year = {2018}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Involvement of Patients’ Families in Care of Critically Ill Patients at Kenyatta National Hospital Critical Care Units
    AU  - Pauline Muthoni Maina
    AU  - Samuel Kimani
    AU  - Blasio Omuga
    Y1  - 2018/01/19
    PY  - 2018
    N1  - https://doi.org/10.11648/j.ajns.20180701.14
    DO  - 10.11648/j.ajns.20180701.14
    T2  - American Journal of Nursing Science
    JF  - American Journal of Nursing Science
    JO  - American Journal of Nursing Science
    SP  - 31
    EP  - 38
    PB  - Science Publishing Group
    SN  - 2328-5753
    UR  - https://doi.org/10.11648/j.ajns.20180701.14
    AB  - Patients assess the likely benefits and risks of a recommended treatment or investigation and make a decision to either accept or refuse treatment. When a patient loses the capacity to participate meaningfully in decision making, a means should exist to ensure decisions that represent the patient’s goals, preferences, and interests are made. This means is substitute decision making, and it usually occurs when a spouse, partner, close family member, or friend assumes this responsibility on behalf of the incapacitated patient. Limited involvement in patient care activities at the hospital can lead to distress in the family as well as challenge family members in assuming the likely expected role when the patient returns home. This study aimed at determining the nature and extent of family/substitute decision makers’ involvement in care of the critically ill patients, guiding policies and the perspectives of nurse managers on involvement in Kenyatta National Hospital (KNH) critical care units (CCUs). This was a descriptive cross sectional study with family members and CCU nurse managers as the study participants. Key informants’ interviews and in depth interviews were conducted. The sample size was 52 family members and four nurse managers. Quantitative data was analyzed using Statistical Package for Social Sciences (SPSS) version 21.0 and descriptive content analysis for qualitative data. Family members reported emotional distressed from the admission of a family member to the critical care unit. However their level of satisfaction with the extent of involvement was above average at a mean of 6.5. The activity mostly involved in was sharing of general information at 57.7% (n=30) with 36.5% (n=19) feeling they should have been provided with in depth information regarding the patients care. The key themes from interviews with family members were: limited information involvement, guilt feeling, and appreciation. Nurse Managers reported KNH has a closed visiting policy with none feeling it should be changed to an open policy. They also unanimously agreed that family members should be involved in care of the critically ill patients through information sharing and counseling. Two nurse managers felt primary care nurses should involve families in general nursing activities such as oral care with all agreeing that the nurses don’t involve families in these activities. There was a statistical relationship (p2=0.689) between the perspectives of nurse managers and the nature and extent of involvement of family members in care.
    VL  - 7
    IS  - 1
    ER  - 

    Copy | Download

Author Information
  • School of Nursing Sciences, University of Nairobi, Nairobi, Kenya

  • School of Nursing Sciences, University of Nairobi, Nairobi, Kenya

  • School of Nursing Sciences, University of Nairobi, Nairobi, Kenya

  • Sections