Last updated January 4, 2022

Family-Centered Care In The Neonatal, Pediatric, And Adult ICU

Recommendations

Family presence in the ICU

Family members of critically ill patients be offered open or flexible family presence at the bedside that meets their needs while providing support for staff and positive reinforcement for staff to work in partnership with families to improve family satisfaction. (Level 2, D)
314262
Family members of critically ill patients be offered the option of participating in interdisciplinary team rounds to improve satisfaction with communication and increase family engagement. (Level 2, C)
314262
Family members of critically ill patients be offered the option of being present during resuscitation efforts, with a staff member assigned to support the family. (Level 2, C)
314262

Family support

Family members of critically ill neonates be offered the option to be taught how to assist with the care of their critically ill neonate to improve parental confidence and competence in their caregiving role and improve parental psychological health during and after the ICU stay. (Level 2, B)
314262
Family education programs be included as part of clinical care as these programs have demonstrated beneficial effects for family members in the ICU by reducing anxiety, depression, post-traumatic stress, and generalized stress while improving family satisfaction with care. (Level 2, C)
314262
Peer-to-peer support be implemented in NICUs to improve family satisfaction, reduce parental stress, and reduce depression. (Level 2, D)
314262
ICUs provide family with leaflets that give information about the ICU setting to reduce family member anxiety and stress. (Level 2, B)
314262
ICU diaries be implemented in ICUs to reduce family member anxiety, depression, and post-traumatic stress. (Level 2, C)
314262
Validated decision support tools for family members be implemented in the ICU setting when relevant validated tools exist to optimize quality of communication, medical comprehension, and reduce family decisional conflict. (Level 2, D)
314262
Among surrogates of ICU patients who are deemed by a clinician to have a poor prognosis, clinicians use a communication approach, such as the “VALUE” mnemonic (Value family statements, Acknowledge emotions, Listen, Understand the patient as a person, Elicit Questions), during family conferences to facilitate clinician-family communication. (Level 2, C)
314262

Communication with family members

Routine interdisciplinary family conferences be used in the ICU to improve family satisfaction with communication and trust in clinicians and to reduce conflict between clinicians and family members. (Level 2, C)
314262
Healthcare clinicians in the ICU should use structured approaches to communication, such as that included in the “VALUE” mnemonic, when engaging in communication with family members, specifically including active listening, expressions of empathy, and making supportive statements around nonabandonment and decision making. In addition, we suggest that family members of critically ill patients who are dying be offered a written bereavement brochure to reduce family anxiety, depression, and post-traumatic stress and improve family satisfaction with communication. (Level 2, C)
314262
ICU clinicians receive family-centered communication training as one element of critical care training to improve clinician self-efficacy and family satisfaction. (Level 2, D)
314262

Use of specific consultations and ICU team members

Proactive palliative care consultation be provided to decrease ICU and hospital length of stay (LOS) among selected critically ill patients (e.g., advanced dementia, global cerebral ischemia after cardiac arrest, patients with prolonged ICU stay, and patients with subarachnoid hemorrhage [SAH] requiring mechanical ventilation). (Level 2, C)
314262
Ethics consultation be provided to decrease ICU and hospital LOS among critically ill patients for whom there is a value-related conflict between clinicians and family. (Level 2, C)
314262
A psychologist’s intervention be provided to specifically incorporate a multimodal cognitive behavioral technique (CBT)-based approach to improve outcomes in mothers of preterm babies admitted to the NICU; furthermore, targeted video and reading materials be provided in the context of psychological support to mothers of preterm babies admitted to the ICU. (Level 2, D)
314262
Social workers be included within an interdisciplinary team to participate in family meetings to improve family satisfaction. (Level 2, D)
314262
Family navigators (care coordinator or communication facilitator) be assigned to families throughout the ICU stay to improve family satisfaction with physician communication, decrease psychological symptoms, and reduce costs of care and length of ICU and hospital stay. (Level 2, C)
314262
Spiritual support from a spiritual advisor or chaplain be offered to families of ICU patients to meet their expressed desire for spiritual care and the accreditation standard requirements. (Level 2, D)
314262

Operational and environmental issues

Protocols be implemented to ensure adequate and standardized use of sedation and analgesia during withdrawal of life support. (Level 2, C)
314262
Nurses be involved in decision-making about goals of care and be trained to provide support for family members as part of an overall program to decrease ICU and hospital LOS and to improve quality of communication in the ICU. (Level 2, D)
314262
Hospitals implement policies to promote family-centered care in the ICU to improve family experience. (Level 2, C)
314262
Given the evidence of harm related to noise, although in the absence of evidence for specific strategies, ICUs implement noise reduction and environmental hygiene practices and use private rooms to improve patient and family satisfaction. (Level 2, D)
314262
Family sleep be considered and families be provided a sleep surface to reduce the effects of sleep deprivation. (Level 2, D)
314262

Family Presence With Patients in the ICU

Given the value family members place on family presence, their dissatisfaction associated with restricted presence, and the benefit of engagement associated with presence, we suggest that family members of critically ill patients be offered open or flexible family presence at the bedside that meets their needs while providing support for staff and positive reinforcement to work in partnership with families. (Level 2, D)
314262
We suggest that family members of critically ill patients be offered the option of participating in interdisciplinary team rounds to improve satisfaction with communication and increase family engagement. (Level 2, C)
314262
We suggest family members of critically ill patients be offered the option of being present during resuscitation efforts, with a staff member assigned to support the family. (Level 2, C)
314262

Family Support

We suggest that family members of critically ill neonates be offered the option to be taught how to assist with the care of their critically ill neonate to improve parental confidence and competence in their caregiving role and improve parental psychological health during and after the ICU stay. (Level 2, B)
314262
We suggest that family education programs be included as part of clinical care as these programs have demonstrated beneficial effects for family members in the ICU by reducing anxiety, depression, post-traumatic stress, and generalized stress, while improving family satisfaction with care. (Level 2, C)
314262
We suggest that peer-to-peer support be implemented in NICUs to improve family satisfaction, reduce parental stress, and reduce depression. (Level 2, D)
314262
We suggest that ICUs provide family with leaflets that give information about the ICU setting to reduce family member anxiety and stress. (Level 2, B)
314262
 We suggest that ICU diaries be implemented in the ICU to reduce family member anxiety, depression, and post-traumatic stress. (Level 2, C)
314262
We suggest that among surrogates of ICU patients who are deemed by a clinician to have a poor prognosis, clinicians use a communication approach, such as the mnemonic “VALUE,” during family conferences to facilitate clinician-family communication. (Level 2, C)
314262

Evaluation of Interventions Focused on Improving Communication

We suggest routine interdisciplinary family conferences be used in the ICU to improve family satisfaction with communication and trust in clinicians and to reduce conflict between clinicians and family members. (Level 2, C)
314262
We suggest healthcare clinicians in the ICU use structured approaches to communication such as that included in the “VALUE” mnemonic when engaging in communication with family members, specifically including active listening, expressions of empathy, and making supportive statements around non-abandonment and decision making. In addition, we suggest that family members of critically ill patients undergoing withdrawal of life support be offered a written bereavement brochure to reduce family anxiety, depression and post-traumatic stress and improve family satisfaction with communication. (Level 2, C)
314262
Based on the existing evidence of patient and family burdens associated with poor communication, as well as improved clinician-reported skills and comfort following communication training, we suggest that ICU clinicians receive family-centered communication training as one element of critical care training. However, no recommendation can be made to suggest the use of any of the specific communication training programs that have been evaluated based on the existing evidence. (Level 2, D)
314262

Evaluations of the Use of Specific Consultations and Team Members

We suggest proactive palliative care consultation be provided to decrease ICU and hospital LOS among selected critically ill patients (e.g., advanced dementia, global cerebral ischemia after cardiac arrest, patients with prolonged ICU stay, and patients with SAH requiring mechanical ventilation). (Level 2, C)
314262
We suggest that ethics consultation be provided to decrease ICU and hospital LOS among critically ill patients for whom there is a value-related conflict between clinicians and family. (Level 2, C)
314262
We suggest a psychologist’s intervention be provided to specifically incorporate a multimodal CBT-based approach to improve outcomes in mothers of preterm babies admitted to the NICU. Furthermore, we suggest that targeted video and reading materials be provided in the context of psychological support to mothers of preterm babies admitted to the ICU. (Level 2, D)
314262
We suggest social workers be included within an interdisciplinary team to participate in family meetings in order to improve family satisfaction. (Level 2, D)
314262
We suggest that family navigators (care coordinator or communication facilitator) be assigned to families throughout the ICU stay to improve family satisfaction with physician communication, decrease psychological symptoms, and reduce costs of care and length of ICU and hospital stay. (Level 2, C)
314262
Given the consistency of expression of family values for availability of spiritual care, the accreditation standard requirements, and the association with increased satisfaction, we suggest that families be offered spiritual support from a spiritual advisor or chaplain. (Level 2, D)
314262

Operational and Environmental Issues

We suggest that protocols be implemented to ensure adequate and standardized use of sedation and analgesia during withdrawal of life support. (Level 2, C)
314262

We suggest that nurses be involved in decision making about goals of care and trained to provide support for family members of critically ill patients as part of an overall program to decrease ICU and hospital LOS and to improve quality of communication in the ICU.

(Level 2, D)
No recommendation can be made about how to accomplish this goal due to lack of supporting evidence.
314262
We suggest hospitals implement policies to promote family-centered care in the ICU to improve family experience. (Level 2, C)
314262
Given evidence of harm related to noise, although in the absence of evidence for specific strategies, we suggest ICUs implement noise reduction and environmental hygiene practices and use private rooms to improve patient and family satisfaction. (Level 2, D)
No recommendation can be made for family space. However, it is noted that the SCCM guidelines for ICU design recommend designing new ICUs with family space based upon consensus statement.
314262
We suggest that family sleep be considered and families are provided a sleep surface to reduce the effects of sleep deprivation. (Level 2, D)
314262

Recommendation Grading

Overview

Title

Family-Centered Care In The Neonatal, Pediatric, And Adult ICU

Authoring Organization

Publication Month/Year

January 1, 2017

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

To provide clinicians with evidence-based strategies to optimize the support of the family of critically ill patients in the ICU.

Target Patient Population

Family of critically ill patients

Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Infant, Older adult

Health Care Settings

Home health, Hospice, Hospital, Outpatient

Scope

Counseling, Management

Diseases/Conditions (MeSH)

D003422 - Critical Care, D016638 - Critical Illness, D003376 - Counseling, D064648 - Critical Care Nursing, D003423 - Critical Period, Psychological, D005196 - Family Therapy

Keywords

critical care

Source Citation

Critical Care Medicine: January 2017 - Volume 45 - Issue 1 - p 103-128
doi: 10.1097/CCM.0000000000002169