Exploration of Nurse/Social Worker ICU Family Support Group Intervention Satisfying Family Members’ Needs

Abstract

Background: Family members of intensive care unit (ICU) patients are legitimate recipients of nursing care. There is a lack of interventional nursing strategies providing family support while in ICU.

Objective: To demonstrate that a nurse led family support group is tool to fulfill family members’ needs.

Methods: A prospective convenience sample of family members volunteering participation in nurse/social worker led support group. To validate the intervention on family members’ needs, The Critical Care Family needs Inventory was distributed to participants in support group.

Results: 100 relatives participated in the study; Out of the 45 family needs, 21 needs were statistically significantly fulfilled by participation family support group intervention. The findings demonstrated that support group most significantly affected Support and Assurance categories.

Conclusion: Using support group as interventional technique is unique way to build additional avenues of communication, trust, and respect while fulfilling family members essential needs while their loved one is in intensive care.

Introduction

Family members of Intensive Care Unit (ICU) patients are legitimate recipients of nursing care. Family-Centered Care is accepted worldwide as a quality indicator to advance patient care [1]. Providing holistic intensive care including families has been endorsed to improve safety and quality [2]. If family’s needs are met, they are more likely to cope better during and beyond ICU [3]. ICU Family members needs have been clearly identified and validated using the Critical Care Family Needs Inventory tool (CCFNI) [4,5]. Using factor analysis, the 45 needs on the CCFNI have been grouped into five subscales. They are the need for (a) assurance, 7 items (b) proximity, 6 items (c) information, 14 items (d) comfort, 9 items and (e) support , 9 items (8) Family needs have been studied and results reported [6-8] analysis identifying distinguishing elements of satisfaction, usually in one family member. The findings suggest that families want truthful, comprehensible, and timely information; less restricting visiting hour policies; and some way to guarantee that skilled and compassionate people [6-8] care for their loved one. In a published systematic review examining randomized, controlled trials of interventions to improving communications it was found that ICU staffs are capable of implementing interventions effectively, recommending that constant programs targeted at family communication may be the most important element of successfully meeting family needs [9].

The Society of Critical Care Medicine/American College of Critical Care Medicine created recommendations for family support; based on studies describing long-term psychological consequences of family members of critically ill patients [4]. From 66 references of low level of evidence, the following guidelines were published. The ICU staff should receive educational resources to assess and cope with family needs to reduce family stress. The family should receive frequent clearly understandable updates from consistent ICU team members. The ICU staff should provide varied information formats (e.g., verbal, written, and video). Families should be encouraged to partake in patient care as culturally appropriate in cases in which they are comfortable doing so [4]. The guideline [9] was reviewed by the Royal College of Nursing in Australia and further adopted for practice there [10]. The authors commented that one weakness of the guideline was that families [9] did not validate it.

Social support is one resource that can influence fulfilling family’s need and their adaptation to the stress of serious illness and reduce adverse effects [11]. In the ICU setting physicians nurses, and social workers, have the task of managing support to relatives of patients who are gravely ill. One-way to enrich social support for the goal of fulfilling family’s’ needs could be nurses providing a platform for a support group while families are in ICU [11].

There is a lack rigorous, large-scale evaluation of interventional strategies which nurses undertake providing a platform for family support while hospitalized in the ICU [10]. A few recent published studies discuss family and ICU team communication interventions in a private setting to satisfy family needs [12], however, no published papers were found regarding using family support groups as a strategy for providing psychosocial care to families of sick ICU patients while hospitalized.

The most all-inclusive investigation of support groups found that the foremost motive for involvement in groups of any kind was the experience of physical illness [13].

Nurse led support groups are practiced in a multitude of clinical settings, as a way to meet family needs [11,14]. Support groups are designed to provide information, unique sense of community and unconditional acceptance, in contrast to experiences outside a peer support group where feelings of isolation or even rejection may occur [14]. Rappaport has recommended that collective narratives generated during group meetings form a kind of group account that establishes a social uniqueness, differentiating the “group therapy” from any kind of formal psychotherapy [15]. It is important to note that support groups are not suitable for every person and do not replace private discussions between ICU staff and individual family members. Therefore, participation should be voluntary, and in those cases where individuals sit in the group but do not actively partake in discussion, they should be accepted as members of the group regardless of individual participation [13].

When clinicians facilitate support groups, positive relationships with staff together with other patients’ family members can occur because of venting and legitimatizing feelings, sharing experiences and adopting support strategies have been reported in research preformed in long-term care facilities [16]. The support group platform thus provides a unique sense of community and nonjudgmental acceptance, which facilitates the adoption of improved coping strategies [16]. The United Kingdom has a well-developed nationwide strategy in the ICU STEPS program [17]. This support group intervention focuses on patients and families who have survived ICU and generally join the group six months’ post discharge. The ICU STEPS program is led by ICU nurses however, does not include participation from family during their relative’s ICU stay. No papers were found that described or evaluated support groups during adult ICU admission.

A unique perspective, utilizing nurse and social worker-led support groups for family members during ICU hospitalization have not been investigated or reported and may be of value to families. At the current study site ICU, a 14-bed surgical unit; it was thought that practice could be improved by providing more support to family members while their relative was a patient in the ICU.

To legally conduct a support group in the site country, Israel, one must have specific training. The ICU social worker was certified to do this and was enthusiastic to be included. The support group for family members, led by the nursing staff was intended as an adjunct to bedside nursing and continual routine support provided by the ICU team.

Method

The site ICU has a 1:2 nurse -patient ration, each patient has a room to him/herself and most rooms have outside-looking windows. It is a closed unit with specific visiting hours. The family waiting room is a very large area close to, and outside, of the unit equipped with a full kitchen, scenic view and comfortable seating. The family support group sessions occurred in a comfortable room with beverages, chairs arranged in a circle and ambient lighting, physically located close to the ICU. The objective was to create a space where family members felt comfortable and not threatened to enable the development of a trusting environment, a fundamental aspect in family-centered care delivery [18].

Structure of family support group sessions

Each week all staff nurses would verbally invite visiting family members to the one-hour support group session, relating the time and place held. In addition, family members who attended past sessions encouraged new admission patient families to attend.

In most instances, the head nurse and social worker conducted the support group sessions. Few instances occurred where the assistant head nurse substituted when the head nurse was on vacation.

At the start of every support group session the head nurse introduced herself and the social worker. She assured participants that the ICU staff recognized the families’ importance and how they were integral to the patient’s life and that, they were considered partners in their relative’s care. Ground rules of the session were explained. Specifically, participants were told that any patient details were not discussed, and that the focus was on their [i.e. family members’] thoughts, feelings, and perceptions. The nurse leader emphasized before each support group session the importance of maintaining confidentiality and the fact that the project was to be reported in the literature with aggregate data only and with no names used.

The nurse/social worker provided an overview of what was planned for the session and after answering any questions, requested that family participants provide their consent that the topics discussed be documented. No names were documented and all data were confidential.

Participations were informed that participation in the support group was voluntary and that ethical approval was received from the Institutional review board (0329-13) of the hospital.

To provide a context, each family member introduced themselves by name, their relationship to the patient and how long they have been in the ICU.

Based on principles of developing a support group (14) the nurse proceeded to read a poem, lyrics to a song, or short extract from a book with content about crisis. The family members were asked how this resonated with them. It was anticipated that everyone would be able to identify with some element in the passage which would stimulate discussion of their feelings.

After six months of the nurse/social worker led support group sessions, an evaluation of the intervention occurred with the convenience sample of participating family members.

Data collection and analysis

The data analysis preformed: (1) topics discussed within the support group sessions and (2) the CCFNI results. Demographic data were added and included participants’ gender, age, ethnicity and relationship to the patient. The CCFNI is written in English and translation was necessary into Hebrew. Four bi-lingual Hebrew/ English speakers contributed to the translation of the CCFNI questionnaire. Two independently conducted forward translations from English to Hebrew and then these were back-translated by the two other independent translators to obtain the final version.

The CCFNI instructions to the participate were to complete each of the 45 items immediately after the conclusion of the support group session. A global item was added to the questionnaire “how important the support group was in fulfilling each individual need”. Using SPSS (version23) statistical package, demographic data were calculated using frequencies and proportions. Spearman correlation analysis was used to calculate the association of the perception of the family member in how important participation in the support group was in fulfilling the 45 individual needs of the CCFNI. Responses to each item of the tool was assessed for correlation to the added question (#46) “In general how important is it for you in fulfilling your needs to participate in the support group?”

This correlation analysis was used to draw a line of best fit through effectiveness of the family group and family needs.

Results

There were 147 surveys distributed over the six-month period (from January to July 2015) and 100 returned-a response rate of 68%. Participants in the support group were predominantly females (61%), who were either daughters or spouses of hospitalized husbands or fathers. The average age was 49.3 years (SD 20.6); with 83% with Jewish ethnicity and the remainder 17% Arab (Muslim or Christian) (Table 1).

  

    
Demographic variables
    
ICU patients (n= 83 )
    
Family members (n= 89 )
  
  

    
Females
    
46%
    
61% spouse or daughter, sons and fathers
  
  

    
Mean Age in yrs (SD)
    
53.3 ( 22.4)
    
49.3( 20.6)
  
  

    
Age over 60
    
57%
    
50%
  
  

    
Ethnicity
      

        
Jewish
        
Arabic
      
    
 
      
71%

        29%
    
 
      
83%

        17%
  

Table 1: Gender, age and ethnicity of patients and their family members.

  

    
Item
    
N
    
Paired differences; Mean (SD)
    
Correlation T value (P value).
    
Sub scale
  
  

    
To have explanations of the environment before going into the critical    care unit for the first time
    
100
    
-.056

      3.81 (0.744)
    
0.369

      (<.001)
    
Support
  
  

    
To have a religious leader visit
    
93
    
-1.277

      3.49 (1.119)
    
0.327

      (0.003)
  
  

    
To feel it is alright to cry
    
94
    
-.798 3.81

      (1.119)
    
0.293

      (0.007)
  
  

    
To talk about feelings about what has happened
    
95
    
-0.705

      3.64(0.886)
    
0.406

      (<.001)
  
  

    
To be told about other people that could help with problems
    
97
    
-0.299

      3.87 (0.966)
    
0.227

      (0.035)
  
  

    
To be alone at any time
    
96
    
-0.616

      3.02(2.823)
    
-.308

      (0.004)
  
  

    
To be told about religious services
    
92
    
-1.390

      2.84 (1.119)
    
.333

      (.002)
  
  

    
To know why things were done for the patient
    
98
    
0.25

      2.37 (0.731)
    
.332

      (0.002)
    
Information
  
  

    
To know why things were done for the patient
    
96
    
0.27

      3.67 (0.653)
    
.392

      (<.001)
  
  

    
To know about the types of staff members taking care of the patient
    
100
    
-0.011

      2.81 (0.746)
    
.445

      (<.001)
  
  

    
To know how the patient is being treated medically
    
100
    
0.284

      3.57 (0.726)
    
.475

      (<.001)
  
  

    
To be assured that the best care possible is being given to the    patient
    
100
    
0.348

      2.79 (0.693)
    
.366

      (<.001)
    
Assurance
  
  

    
To have explanations given that are understandable
    
97
    
0.115

      3.71 (0.799)
    
.343

      (<.001)
  
  

    
To talk to the doctor every day
    
100
    
0.258

      3.76 (0.716)
    
.344

      (0.001)
  
  

    
To have questions answered honestly
    
100
    
0.315

      3.54 (0.717)
    
.313

      (0.003)
  
  

    
To feel that the hospital personnel care about the patient
    
100
    
0.386

      3.82 (0.668)
    
.402

      (<.001)
  
  

    
To know specific facts about the patient’s progress
    
100
    
-0.299

      3.90 (0.966)
    
.316

      (0.003)
  
  

    
To be told about transfer plans while they are being made
    
100
    
0.159

      2.95 (.786)
    
.317

      (.003)
    
Proximity
  
  

    
To receive information about the patient at least once a day
    
100
    
0.261

      3.81 (0.735)
    
.309

      (0.003)
  
  

    
To see the patient frequently
    
97
    
0.092

      2.83 (0.816)
    
.267

      (0.012)
  
  

    
To have the waiting room near the patient
    
98
    
0.000

      3.28 (0.788)
    
.384

      (<.001)
  

Table 2: Mean and standard deviation for the paired differences, T Test Correlations and significance.

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Citation: Benbenishty J, Kirshbaum-Moriah D and Harel C. Exploration of Nurse/Social Worker ICU Family Support Group Intervention Satisfying Family Members’ Needs. Ann Nurs Res Pract. 2021; 6(2): 1044.

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