ABSTRACT & COMMENTARY
Synopsis: A structured communication program for family members of patients in an ICU reduced incoming calls without decreasing satisfaction with care or need for information.
Source: Medland JJ, et al. Am J Crit Care 1998;7: 24-29.
Although it is recognized that family members need to be kept informed about patient status, few studies have tested interventions to meet this need. The purpose of this study was to determine whether the use of a structured communication program for family members would increase satisfaction with care, better meet information needs, and decrease incoming telephone calls to the ICU nursing staff.The sample consisted of 30 family members who participated in a usual care (n = 15) or intervention group (n = 15). The family member was the individual closest to the patient or the one who assumed responsibility for decisions. One medical ICU was used with the study conducted in two phases (control, then intervention). Pre-test data were obtained in less than 24 hours of patient admission. Post-test data were obtained on the day of discharge from the ICU or two weeks after admission if the patient still remained in the ICU. The program consisted of three parts: 1) a discussion with the nurse approximately 24 hours after admission; 2) a pamphlet given to the family member at the time of the discussion; and 3) daily telephone calls from the nurse caring for the patient.
The number of incoming calls from family members was significantly lower in the intervention group (0.33 + 0.49) compared to the usual care group (3.26 + 1.87). Satisfaction with care increased significantly in the intervention group, as did family members' perceptions of how well their information needs were being met.
COMMENT BY LESLIE A. HOFFMAN, RN, PhD
Findings of this study show that a simple intervention can reduce incoming calls from patients' families without compromising satisfaction with care or the need for information. The ability to achieve these outcomes most likely resulted from the structure required by the intervention. The nursing staff discussed issues at the time of admission, made daily phone calls, and provided additional details via a pamphlet. The pamphlet contained information about the ICU and its policies, suggestions on how to communicate effectively with the critical care team, visiting hours, explanations of common equipment, and services available in the hospital. Nurses called the family member at an agreed upon time and, using a checklist that outlined the information to be shared, communicated changes in vital signs, mentation, status during the night, changes in condition, and plans for the day. Family members were encouraged to ask all their questions during the daily call and to limit other calls to the ICU.Findings of this study encourage testing in other units and settings.
In today's busy ICUs, it is important to maintain communication, but this
takes time. Telephone calls from family members can come at inopportune
moments, causing staff to resent these interruptions. Family members also
have many demands on their time but need to be kept informed. The intervention
tested is simple, fits well into the daily routine of the ICU, and appears
to have benefits for the staff and families. In support of its use, Medland
and colleagues report that, after the study was completed, the intervention
was adopted as standard practice for ICUs in their hospital.
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