Critical Care and Family Involvement 1

Critical Care and Family Involvement

By

Angela de Varennes

NURS 609

Athabasca University

Winter 2013

Critical Care and Family Involvement 2

Family Members Should Not Be Considered

Partners In Critical Care

Critical Care and Family Involvement 3

WHY NOT???My opponent would have you believe that

a partnership between health professionals and patient family members

is a cornerstone to providing effective patient care when, in fact, nothing could

be further from the truth. This presentation will argue that limiting

family involvement is, by far, the most beneficial and ethical approach to patient

recovery in critical care.

Critical Care and Family Involvement 4

Confidentiality and Trust

The professional relationship and rapport between the nurse and the patient is at the core of providing high quality care that is respectful and responsive to the

individual patient.

The patient MUST be able to trust the ethical conduct of the health professional. If the patient is unable to

explicitly communicate their desires, often the case within the critical care setting, the nurse must uphold

the duty to act solely in the best interests of the patient, ensuring it is the patients values alone that guide clinical

decisions (Wood, 2008) .

Critical Care and Family Involvement 5

Key Terms

• Critical Care

• Ethics and Legalities

• Family

Critical Care and Family Involvement 6

What Is Critical Care?

Critical Care is the branch of health that provides care and support for patients whose

illness or condition is considered acute and has the potential to be life-threatening. The

term critical care is often used interchangeably with intensive care or the

ICU (intensive care unit). Critical care medicine involves a multidisciplinary health

team and specialized equipment and treatments. Nurses, doctors, therapists,

pharmacists and various medical experts work together to stabilize and promote

recovery in the patient (Canadian Critical Care Society, 2009)

Critical Care and Family Involvement 7

All health professionals are bound by a code of ethics, as well as the law, when

treating patients in their care. Paramount to this ethical conduct is the primary commitment to the individual patient (American Nurses Association,

2013). Advocating for the patient to make informed decisions, respecting the worth of each patient, maintaining privacy and

confidentiality and upholding human rights and promoting justice are values the Canadian Nurses Association (2011),

cites as being intrinsic to the nurse-patient relationship and competent

nursing practice.

What are Ethics?

8

It is becoming increasingly difficult to define what constitutes a family unit. As

a result of increased divorce rates and social acceptance of out-of-wedlock

parenthood, surrogacy and gay marriage, the 21st century has numerous variances from the traditional “nuclear” family.

Step-parents, siblings and grandparents, biological and non-biological family

members, blended families and single parents. It is this evolution of the family

that makes it nearly impossible to characterize, other than stating the

diversity of familial forms and dynamics. (Settles & Steinwetz, 1999)

. Critical Care and Family Involvement

What is a Family?

Critical Care and Family Involvement 9

Points of Issue Regarding Family as

Partners

• Range and Dynamics of the Family

• Motives of the Family - Self-serving - Non-objective• Family Stress

Critical Care and Family Involvement 10

Range of Family Between the broad definition of family to the further complication of family systems being in continuous flux (Wolters Kluwer, 2012), health professionals are unable

to ascertain who is considered privy to sensitive and private health information. This increases the risk of

confidentiality breach, therefore disrupting the professional relationship with the patient(Settles &

Steinwetz, 1999).

The patient should be the ONLY source of disclosure in health matters.

Here is a recent and extreme example

of a hospital confidentiality violation:

Nurse Commits Suicide

Critical Care and Family Involvement 11

ImplicationsConsider the implications of the article:

• The nurse revealed confidential health information without verification from the patient, nor verification of the persons calling as family members.

• The information disclosed did not compromise the health of the patient but

did result in unwanted publicity.

• Such incidents serve to lessen public confidence in their health care providers ability to protect privacy.

• Lack of trust in health care providers could affect the patients disclosure of pertinent health related information, therefore compromising care.

Critical Care and Family Involvement 12

Family DynamicsEven if the patient is medically stable enough to establish

whom is to be considered family, familial relationships must be acknowledged as subject to complex dynamics,

possibly placing undue stress on the patient and persuading their course of action.

Any benefit derived from family involvement depends upon the patient-family dynamics. The health

professional is unequipped to determine family dynamics and is responsible for the well-being and best

interest of the individual patient.

(Gonzalez, 2004)

“The very presence of family members at the bedside of a hospitalized patient has a strong intimidating influence

on the decision-making of the patient.”

(McCormik, 2008)

Critical Care and Family Involvement 13

Implications To illustrate the impact of dynamics,

consider the family as a partner in care. Next, reflect on that family as belonging to a religious organization that dictates against blood transfusions although the patient needs one to survive. While the family dynamics may possibly have been supportive prior to the health crisis, the situation now presents quite differently. Family involvement or attendance can negatively effect both the patients ability to choose their own care in addition to the health professionals ability to remain partial to the patient.

Critical Care and Family Involvement 14

FactsConsider the following:

• 80% of sexual assaults occur in the home with the attacker being friends or family of the victim (Sex Assault Canada, 2012).

• 6% of Canadians with a spouse or former spouse have reported being physically or sexually victimized (Stats Canada, 2013).

• Lethal violence most often occurs in the home at the hands of spouse (Stats Canada, 2013).

Given these statistics, the necessity of health professionals to distance family instead of welcoming them

as partners becomes even more apparent. As nurses, we are not certain what is happening behind closed doors.

Would you want the input of your assailant in your medical care?

Critical Care and Family Involvement 15

MotivesThe thought of family input in patient care as altruistic is a pleasant thought. Unfortunately, motives behind input frequently vary from

self-serving to non-objective.

• Self-serving motives may be externally or internally dictated. Financial gain, marital stressors, legalities, cultural norms and values and religious beliefs are a few examples of determinants.

• Non-objective motives generally pertain to emotions and the inability to rationalize in times of crisis.

Critical Care and Family Involvement 16

Self Serving Motives

A disturbing example of a self serving motive in critical care can be seen in the following case

Court decides against live-saving measures for toddler allegedly abused by parentsRyan Cormier, Edmonton Journal with files from Fletcher Kent, Global News

Friday, September 14, 2012 5:37 AM

In this particular instance, the parents involvement in the childs’ medical treatment also determines the charges against them. Removing life support equates with a murder charge. As stated in the article:

"Even assuming that 'M's' parents think that their decision is motivated by religious beliefs and love for M," said Justice June Ross on Friday, "I am left with a concern that their

decision may in fact be affected by self-interest.”

Critical Care and Family Involvement 17

Non-Objective Motives The following example illustrates a non-objective motive pertaining to family involvement in critical care of a patient. Families with a loved one needing critical care are already in a high stress situation, filled with

emotion. If they are considered partners in the care of the patient, their input toward what is best for the patient may be based more on feeling than logic.

Consider the battle over Terri Schiavo: The issue was whether to carry out the

husbands wishes to terminate life support

measures after Terri was diagnosed as

being in a persistent vegetative state and

her parents opposed life support termination.

Wikipedia (2012). Continue Reading…

Critical Care and Family Involvement 18

Family StressWe assume that families of critically ill

patients want to be considered partners in their care. However, the responsibility that this entails is often

not welcomed and is plagued with stress. Family members may feel

obligated to participate in the patients care, sometimes to their own

detriment. Again, where does this leave the patient, if persons

participating as partners are only doing so out of duty or because they

feel they are without any other option. In this argument both parties suffer,

the patient and the family.

Critical Care and Family Involvement 19

ImplicationsThe impact of having a critically ill

family member can be agonizing if also coupled with the responsibility of

medical decisions. In fact, CNN Health (2011) recently linked the situation to post-traumatic stress

disorder and the Canadian Mental Health Association (2006), states that

caregivers have higher rates of emotional and anxiety disorders. It could be argued that in seeking the

partnership of family members in the care of critically ill patients, health

professionals are facilitating another health crisis

Critical Care and Family Involvement 20

ConclusionConsidering family as partners in critical care has negative

consequences for both the patient and the family. In addition, ethics dictate the patient as the primary source of duty to health professionals. Therefore,

family should have involvement only as specifically defined by the patient and should not be considered a

partner in any medical decisions or matters.

Critical Care and Family Involvement 21

Template Provided By

www.animationfactory.com

500,000 Downloadable PowerPoint Templates, Animated Clip Art, Backgrounds

and Videos

Critical Care and Family Involvement 22

References American Nurses Association. (2013). Code of ethics for nurses with interpretative statements.

Retrieved from http://nursingworld.org/MainMenuCategories/

EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf

Canadian Critical Care Society. (2009). About CCCS. Retrieved from

http:www.canadiancriticalcare.org/

Canadian Mental Health Association. (2006). Families as partners in the mental health and

addictions system. Retrieved from http://www.camh.ca/en/hospital/about_camh/

influencing_public_policy/public_policy_submissions/mental_health_and_addictions/

Documents/Caring%20Together%20%20BW%20Final.pdf

Canadian Nurses Association. (2011). Code of ethics. Retrieved from

www.cna-aiic.ca/en/improve-your-workplace/nursing-ethics/

CNN Health. (2011). Families haunted by end-of-life decisions. Retrieved from http://

thechart.blog.cnn.com/2011/03/02/families-haunted-by-end-of-life-decisions/

Critical Care and Family Involvement 23

References

Gonzalez, C. E. (2004). Visiting preferences of patients in the intensive care unit and in a

complex care medical unit. American Journal of Critical Care. (13) 3

McCormik, T. R. (2008). Perioperative nursing clinics. Elsevier Inc. digital. Doi:

10.1016/jcpen.2008.04.007

Stats Canada. Government of Canada. (2013). Family violence in Canada: A statistical profile.

Retrieved from http://www5.statcan.gc.ca/bsolc/olc-cel/olc-cel?catno=85-224-

x20050008647&lang=eng

Settles, B. H., & Steinwetz, S. (1999). Concepts and definitions of family for the 21st

century. Haworth Press Inc., Binghamton, N.Y.

Sex Assault Canada. (2012). Sexual assault statistics in Canada. Retrieved from

http://www.sexassault.ca/statistics.htm

Critical Care and Family Involvement 24

References

Wolters Kluwer Health. (2012). Involving family systems in critical care nursing:

Challenges and opportunities. (Report 57329). Ovid Technologies .

Wood, D. (2008). Patient-centered care helps hospitals boost patient satisfaction.

Retrieved from http://www.nursezone.com/nursing-news-events/ more-news.aspx?

ID=18618