As critically ill patients are often unable to participate in ICU treatments decisions, substitute decision makers (SDMs), most of the time, family members, have an important role in decision-making. This demands a high information exchange with key healthcare providers, especially attending physicians, but time constraints and restrained availability limit the frequency of family meetings.
Family presence during ward rounds, already perceived as beneficial in paediatric intensive care units, could positively impact communication between ICU staff members and patients´family, and even patient outcome. Despite this fact, in general, ICU heathcare providers seem to express an ambivalence regarding this practice.
In ESICM´s website was published yesterday this study conducted by C. Santiago and his team. In a 24-bed Medical Surgical Intensive Care Unit in Toronto, Canada, explores the attitudes and perceptions of multidisciplinary staff members (including Medical Doctors, Registeres Nurses, Allied Health Discipline members and ICU Managers) towards family presence at bedside rounds through a cross sectional, self-administered survey.
72.4% individuals responded. Over 50% of the respondents perceived strongly or somewhat that their presence prolonged rounds, reduced medical education and constrained delivery of negative medical information. The study revealed also significant differences between groups concerning the opportunity to propose family members to participate in bedside rounds; among them, the more experienced nurses expressed the greatest reservation to their presence, while most doctors, HD and managers agreed to it.
This study highlights the difficulties in the implementation of some interventions, which remain undesirable despite being widely recommended and already successful in units at other hospitals. The study also stresses the importance of providing a clear framework for participants; this point is extremely relevant and could be more widely developed, as nurses’ expectations and difficulties at bedside rounds should be explored and respected. We cannot neglect the fact that, after rounds, nurses are often alone when confronted with the questions and doubts of patients’ families.
Therefore, in order to ensure a smooth implementation of this intervention, prior to the introduction of family members at the bedside during routine rounds in the ICU, a thorough training and education of all staff must ensue.
And I think, why not making a protocol or Clinical Practise Guideline?
Santiago C, Lazar L., Jiang D, Burns K. E. A. 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. 2014 (30): 13-21