Jennifer de Beer Enhancing family care during critical illness

BACKGROUNDThe process of hospitalization.The impact of hospitalization forfamily members.(Eggenberger and Nelms,2007).Family dynamics adverselyaffected. (Kanervisto, Paavilanen and Heikkila,2007).

PROBLEM STATEMENT Sudden hospitalization is a catastrophicevent for family members (Söderström et al.,2009). Psychological crisis (Chien, Chiu, Lam et al.,2006). International studies: quantitative versusqualitative. Studies in South Africa limited. Internationally developed models inresource constraint South Africa.

PURPOSE AND OBJECTIVES The purpose -to explore family care duringcritical illness and develop a theory for theenhancement of such care in ICUs in Durban,KwaZulu-Natal, South Africa. To explore family members’ experiences offamily care in the intensive care units; To explore the perceived needs of familymembers in the intensive care units; To explore the current practices of intensivecare nurses and doctors in providing familycare in the intensive care units;

OBJECTIVES CONT. To distinguish between the limiting and theenabling practices as experienced by intensivecare nurses and doctors in providing family care inthe intensive care units; To explore the meaning of family care asperceived by intensive care nurses, doctors andfamily members. To develop a middle range theory towards theenhancement of family care in the intensive careunits.

METHODOLOGYQualitative -Grounded theory- Strauss and Corbin’s(1990) versionParadigm model of Grounded theory

SETTING , PARTICIPANTS ANDSAMPLING Intensive care units of the two hospitals inKZN Private versus public Participants: critical care nurses, doctorsand family members Sampling: convenient → theoreticalsampling

DATA COLLECTION Covert Observations: two monthsintermittently Document analysis: policies, memos,nursing and doctors notes In-depth interviews Field notes Memos

Adapted from Gorra (2007).DATA ANALYSIS

SUMMARY OF FINDINGS Realization of sample of participants. 9 Family members- majority female 16 Nurses 7 Doctors

FINDINGS Conceptualization of the meaning family care: Ubuntu (togetherness): Ukubambisana (partnership): Ukuhlonipha (respect and dignity)“FC in South Africa means, togetherness, people first,ubuntu, also keeping people informed, where you takea total outsider as your family. When visitors enter theICU, they shouldn’t be regarded as visitors but be partof the family, the ICU family because we all help eachother to cope…. We deal with the critical illness of thepatient together ….you treat each other as equalindividuals, creating a sense of harmony”

FINDINGS Sub concepts: Information sharing, Proximity Garnering of resources Cultural and religious co-operation Core concepts of theory: empowerment

INFORMATION SHARING Exchange of information Patient’s condition, treatment, prognosis,outcome. Technical milieu Honest factual, consistent Written information: pamphlets, familyinformation booking.

PROXIMITY Flexibility in access to patient Physical and psychological closeness be mindful of the fact this should not betiring and draining for the patients andFMs.

GARNERING OF RESOURCES Material and non material Material : comfort, nutritional and privacyneeds Non- material: need to maintain hopeand need to share feelings of "suffering”with other.

CULTURAL AND RELIGIOUSCO-OPERATION Awareness, respect and acceptance Cultural context of families as well as ofthe ICU. Cultural biases and prejudices Professional and cultural conflicts Cultural knowledge and skill

EMPOWERMENT Of family members Health care professionals

PURPOSE OF THE THEORY Knowledge and guidance in the processof providing FC Enhance family care Shift from biomedical approach Family is acknowledge for their expertise Collaborative reciprocal relationships Promote cultural appropriate care Not restricted to critical care

Theory of Family Care During CriticalIllness

RECOMMENDATIONSNursing practice: Access to information. Conducting a family needs assessment. Family care coordinator.Nursing education Education regarding the theories andconcepts related to the phenomenon offamily care. Culturally competent care.

RECOMMENDATIONS Nursing research: The Theory of Family Care During Critical Illnessshould be implemented and evaluated. Further, an investigation into the alternate supportservices available to FMs during critical illnessespecially within resource constraintsenvironments. An investigation in the cultural competence ofICNs. Exploring health care teams and communicationpatterns within the ICU setting.

THANK YOU