Relatives' Experiences of Critical Care.

Aim: The aim of this research was to investigate relatives’ experiences of critical care and staff perceptions of those experiences. Methods: The study examined whether relatives found their experiences of critical care psychologically distressing, and explored the nature of communication processes between relatives and staff. It used a combination of qualitative (Phases I and III) and quantitative (Phase II) methods. All phases were conducted in the UK involving relatives of patients admitted to critical care units and staff working on those units. Phase I used semi structured interviews that were analysed according to grounded theory methodology. Phase II was a nationwide survey of information available to relatives within critical care and policies available to staff concerning care of relatives. Phase III used semi structured interviews and focus groups, which were analysed in accordance with grounded theory. Results and Conclusions: The qualitative findings revealed that, overall, relatives were satisfied with their experiences and staff accurately perceived many aspects of these experiences. Relatives wanted to be kept informed of all stages of their patient’s condition and received a mixture of verbal, factual information and reassurance which they found helpful. It is important that these aspects are not lost amid further improvements and developments. Many relatives suffer from a variety of stress symptoms; the enduring nature of these symptoms is unclear. The process of communication and information giving between staff and relatives appears inconsistent and this was further illustrated by the quantitative findings in Phase II that demonstrated extensive variation of written information available to relatives and a lack of guidelines available to staff. Relatives report irregular contact with doctors and clear guidelines need to be established as to how often relatives should expect this contact. This would aim to allay expectations, largely created by the media, about the desirability of the presence of doctors and would reduce nurses’ feelings of responsibility for the actions of doctors. In addition, relatives reported that they were content to receive the recommended written information examined in Phase II in a verbal format. Cost effective methods of relaying general information to relatives should be considered, for example, notice boards in waiting areas as opposed to information leaflets. Nurses identified a gap in their training. Further training in communication, conveying difficult information and dealing with the responsibilities of relatives’ complex emotional processes could be offered, targeted specifically towards nursing in critical care. There may be a need for employing an additional member of staff, for example, a Health Care Assistant with specific training to deal with advice and welfare issues related to critical care. This may help to address the skills overlap that occurs in critical care due to the nature of the tasks that nurses undertake. Involving relatives in basic patient care, where appropriate, could have beneficial effects for patients, relatives and nurses, particularly in longer stay patients. It could aid relatives coping abilities by making them feel they have a purpose and may also free up nurses time to perform more complex tasks. This research adds a qualitative perspective to existing quantitative literature. It updates previous qualitative studies that have become dated in the fast changing NHS and explores national information provision to relatives, something not attempted previously