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Crit Care Nurse 2002 Dec; 22(6): 61-65
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Protocols for Practice
Applying Research at the Bedside

Interventions to Decrease Family Anxiety

Jane Stover Leske, RN, PhD

Jane Stover Leske is an associate professor in the School of Nursing, University of Wisconsin, Milwaukee, Wis.

This article is based on the protocol "Family Needs and Interventions in the Acute Care Environment," (published August 1998) by Jane Stover Leske, RN, PhD, from the Creating a Healing Environment series of AACN’s Protocols for Practice. It can be obtained from AACN, 101 Columbia, Aliso Viejo, CA 92656, (800) 899-AACN, (949) 362-2000. $11.01, AACN members; $12.95, nonmembers.

This column is designed to provide the latest research findings in patient care in a format that is easy to understand and integrate into clinical practice. The information is drawn from individual protocols in the various Protocols for Practice series available from AACN, which cover research-based practice protocols in detail.

Any illness severe enough to necessitate admission to a critical care unit is life threatening and can precipitate severe anxiety within a family system. Because of the sudden onset of critical illness, anxiety experienced within the family system cannot be prevented. Fear of death, uncertain outcome, emotional turmoil, financial concerns, role changes, disruption of routines, and unfamiliar hospital environments are a few sources of anxiety for family members. Specialized assessment and interventions for families are needed because anxiety may interfere with the family’s ability to receive and comprehend information, maintain patterns of adequate family functioning, use effective coping skills, and provide positive support—for each other and the patient. The family remains the most important social context to consider when determining interventions to positively influence patient outcomes.

Q: How do you define "family"?

Originally, the term "nuclear family" referred to a family composed of husband, wife, and children. Today, the term "family" also includes couples without children, single parents and children, reconstituted families (second marriages), unmarried couples with or without children, homosexual couples, and people living together. Almost one third of families in the United States are composed of members who are not biologically or legally related. Rather than focus on certain family forms, it may be more beneficial to define "family" as anybody who considers themselves a family member.

Q: Why provide interventions for family members?

Families appear to have a beneficial impact on the patient’s response to treatment. They act as buffers for patient anxiety and serve as valuable resources for patient care. However, when family anxiety is high, they may be unable to support the patient, and may transfer their anxiety to him or her. Unmitigated family anxiety may manifest itself in distrust of hospital staff, noncompliance with the treatment regimen, anger and dissatisfaction with care, and even lawsuits.

As family members struggle to cope with sudden anxiety, the critical nature of the illness may lead to changes within the family unit. Whether these changes are beneficial or adverse depends, in part, on the type of interventions provided by healthcare professionals. Because families’ responses to critical illness have implications for the family, patient, and healthcare staff, everyone involved benefits when professionals assess and intervene to ensure that optimal family functioning is supported.

Q: What do families need?

The results of numerous studies suggest that following the impact of critical illness, family members exhibit a well-defined, predictable set of needs. These needs are grouped into 5 major areas and are universally experienced by most family members:

{blacksquare} To receive assurance, reflecting a need to maintain or redefine hope about the patient’s outcome. Meeting this need promotes confidence, security, and freedom from doubt.
{blacksquare} To remain near the patient, reflecting a desire to link and maintain familial relationships. Meeting this need helps a family remain emotionally close and give support to the patient. (See the protocol "Family Visitation and Partnership in the Critical Care Unit," by Marita Titler, RN, PhD, from the Creating a Healing Environment series of AACN’s Protocols for Practice for further information on visitation in the critical care environment.)
{blacksquare} To receive information, reflecting the goal of understanding the patient’s condition. Meeting this need lays the foundation for family decision making and coaching the patient. Family anxiety is reduced and a sense of control is promoted.
{blacksquare} To be comfortable, reflecting a need to reduce distress. When comfortable, energy is conserved and anxiety is reduced.
{blacksquare} To have support available, reflecting a need for expert help, assistance, or aid. Meeting this need assists coping with anxiety, augments family resources, and maintains strengths to support the patient.

Q: What interventions are beneficial for family members?

Sufficient descriptive research has been conducted on the importance of various family needs after patient admission to critical care. The most effective interventions for meeting family needs are now being tested. Interventions begin on initial contact with family members, continue throughout the critical care period, and extend beyond discharge from the hospital. Professionals and families begin by establishing a relationship that is mutually respectful, trusting, empathetic, and collaborative. The efficacy of further interventions depends on the rapport established between care providers and family members. The interventions offered in the TableGo are examples from the AACN research-based protocol on family needs and interventions in the acute care environment.


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  		Useful interventions for families in the acute care environment

 
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Acknowledgment

"Family Needs and Interventions in the Acute Care Environment," by Jane Stover Leske, RN, PhD, one of AACN’s Protocols for Practice, was sponsored by Hewlett-Packard.

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Suggested Reading

Danielson CB, Hamel-Bissell B, Winstead-Fry P, eds. Families, Health, and Illness: Perspectives on Coping and Intervention. St Louis, Mo: Mosby; 1993.

Feetham SL, Meister SB, Bell JM, Gilliss CL, eds. The Nursing of Families: Theory/Research/Education/Practice. Newbury Park, Calif: Sage; 1993.

Vaughan-Cole B, Johnson MA, Malone JA, Walker BL, eds. Family Nursing Practice. Philadelphia, Pa: Saunders; 1998.

Wright LM, Leahey M, eds. Nurses and Families: A Guide to Family Assessment and Intervention. Philadelphia, Pa: FA Davis; 1994.




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