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ntensive and Critical Care Nursing (2011) 27, 218—225

a va i la b le at www.sc iencedi rec t .com

jo ur n al homepage: www.elsev ier .com/ iccn

RIGINAL ARTICLE

eeds of American relatives of intensive careatients: Perceptions of relatives, physicians andurses

anice L. Hinklea,∗, Eleanor Fitzpatrickb

The Catholic University of America, 411 Gowan Hall, 620 Michigan Ave NE, Washington DC 20064, USAThomas Jefferson University Hospital, USA

Accepted 6 April 2011

KEYWORDSFamily Needs;Adult Intensive Care;Needs perceptions ofrelatives, physiciansand nurses;Quantitative research

SummaryObjectives: This study investigated differences between the perceptions of American relatives,physicians and nurses concerning the needs of relatives visiting intensive care patients.Design and participants: This was a prospective descriptive study. Perceived needs were mea-sured using the 45 item Critical Care Family Needs Inventory (CCFNI) with 101 relatives visitingas well as 28 physicians and 109 nurses working with the same group of patients.Setting: Data were collected using a convenience sample of patients, their relatives visiting,as well as the physicians and nurses working with the same patients in six adult intensive careunits in a large American tertiary acute care medical centre with over a 900 bed capacity.Results and conclusions: There were significant correlations (p < 0.05) between the relatives,physicians and nurses on eight of the 45 individual items on the CCFNI. Subscale (Information,Proximity, Assurance, Comfort and Support) scores for the needs perceived by relatives, physi-cians and nurses were calculated and there were significant differences in the three groups on

Information (F = 5.90, df = 2, p = .0005), Support (F = 4.12, df = 2, p = .022) and Comfort (F = 5.01,df = 2, p = .010). Relatives and nurses made multiple comments on the surveys. This is importantinformation for all health care workers to consider in setting visiting policies in adult ICUs anddeveloping approaches such as family centred care.

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© 2011 Elsevier Ltd. All rig

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ealth care professionals in most countries recognize thatt is a stressful time for a family when one of its members is

∗ Corresponding author. Tel.: +1 202 319 6451/255 3267;ax: +1 202 319 6485.

E-mail address: hinkle@cua.edu (J.L. Hinkle).

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964-3397/$ — see front matter © 2011 Elsevier Ltd. All rights reserved.oi:10.1016/j.iccn.2011.04.003

served.

ospitalised in an intensive care unit (ICU); some even con-ider this as a time of crisis for families. The response bymerican health care professionals varies widely in typesf visitation policies and the level of family involvementdvocated in adult ICUs. Current practises vary from very

estrictive, allowing two immediate family members overhe age of 12 years at the bedside for 10 minutes on the hourvery 2 hours (Damboise and Cardin, 2003), to liberal withnlimited numbers of visitors and open visitation 24 hours a

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Perception of American relatives visiting Intensive care pati

day with the option for healthcare professionals to ask thefamily to step out as needed (Berwick and Kotagal, 2004;Davidson et al., 2007).

The American College of Critical Care Medicine TaskForce issued clinical practice guidelines that encourage sup-port of the family in patient-centred ICUs (Davidson et al.,2007). Recommendations specified that open visitation inthe adult ICU should allow flexibility for patients and theirfamilies; should be determined on a case-by case basis; andthe patient, family and nurse should determine the visitationschedule collectively taking into account the best interestof the patient. Furthermore, the Institute for HealthcareImprovement (IHI) advocates the liberalising of visiting hoursin American ICUs (Berwick and Kotagal, 2004). It is clearlyimportant for nurses and physicians to have an understand-ing of the perceptions of needs of relatives to be able toprovide the most appropriate visitation policies and the levelof family involvement in adult ICUs.

The purpose of this article is to report on the perceptionsof needs of relatives visiting as well as the physicians andnurses working with the same patients in an ICU setting. Aportion of the data from this study, the perceptions of 101family members visiting and nurses working in adult ICUs,has been reported elsewhere (Hinkle et al., 2009).

Numerous American research studies have examined thefamily members’ perceptions of needs (Molter, 1976, 1979;Leske, 1988, 1991) over the past three decades. Most oftenthis is done using the Critical Care Family Needs Inventory(CCFNI) designed by Molter (1976) and refined by others(Redley and Beanland, 2004). The basic needs of familieshave been summarised in quantitative studies as falling intofour categories; (1) information, (2) reassurance, (3) supportand (4) ability to be near the patient (Damboise and Cardin,2003). One qualitative study reported that family membershad two main goals, to assure their loved one was receivingthe best possible care and to maintain a connection with theperson (Lam and Beaulieu, 2004).

Numerous American studies have also examined thenurses’ perceptions of needs of families of critically illpatients. Many have compared the family members’ andnurses perceptions using the CCFNI (Tin et al., 1999;Lynn-McHale and Bellinger, 1988). Five factors that nursesidentified (Information, Proximity, Assurance, Comfort andSupport) explained 40% of the variance in several studiesassessing the psychometric properties of the CCFNI (Leske,1988, 1991). Research on nurses’ perceptions of needs offamilies of critically ill patients has continued in the UnitedStates (Hinkle et al., 2009; Maxwell et al., 2007) and othercountries (Gunes and Zaybak, 2009). However few studiesreport the perceptions of another important member of thehealth care team, that of the physician.

Physician perceptions of family member needs

Several European studies have reported the physicians’ per-ceptions of the needs of significant others in the ICU. Onegroup included Swedish physicians (N = 79) (Takman and

Severinsson, 2004) and Norwegian physicians’ (N = 29) per-ceptions of the needs of significant others in ICUs using theCCFNI (Takman and Severinsson, 2005). Factors revealedincluded: (1) attentiveness and assurance, (2) taking care

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219

f themselves, (3) involvement and (4) information andredictability (Takman and Severinsson, 2005). The four fac-ors explained approximately 40% of the variance. Olderhysicians and those with extensive professional and ICUxperience had a low score on involvement compared withhysicians with less experience. The group of physicians wasot matched to the same patients and the perceptions of theamily member or significant other were not reported.

Takman and Severinsson (2006) also reported four cat-gories from content analysis of answers to open endeduestions on the CCFNI tool used in the study of health-are provider’s perceptions of the needs of significant othern intensive care units in Norway and Sweden. These fourategories were ‘The need to feel trust in the healthcareroviders’ ability’, ‘the need for ICU and other hospitalesources’, ‘the need to be prepared for the consequencesf critical illness and ‘patients’ needs and reactions in rela-ion to significant others’ (Takman and Severinsson, 2006).hese represented mostly the views of the nurse as only fivehysicians responded to the open ended questions.

A group in Belgium reported the perceptions of physi-ians (N = 38) about the needs of relatives of critical careatients using the Dutch version of the CCFNI. Data werenalysed using Leske’s five factors that nurses identifiedInformation, Proximity, Assurance, Comfort and Support)nd the subscales showed acceptable internal consistenciesCronbach’s alpha 0.62—0.80) (Leske, 1991, Bijttebier et al.,000). Physicians were found to underestimate the relative’seed for information, proximity to the patient and need forssurance (Bijttebier et al., 2001). The group of physiciansas not matched to the same patients.

This study described the individual needs of Americanritically ill patients as identified by relatives, physiciansnd nurses. It also compared and identified the differ-nces in the perceptions on subscale needs (Information,roximity, Assurance, Comfort and Support) of Americanritically ill patients as perceived by relatives, physiciansnd nurses.

ethods

esearch questions

he main research question in this study was: What were theerceptions of needs for American critically ill patients asdentified by relatives, physicians and nurses? One aim waso compare the differences in the perceptions of needs onhe total CCFNI and CCFNI subscales (Information, Proximity,ssurance, Comfort and Support) in a cohort of Americanritically ill patients as perceived by relatives, physiciansnd nurses. An additional aim was to identify if there wereeeds perceived by relatives, physicians or nurses that wereot captured by the CCFNI.

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ata were collected prospectively over a one year period

sing a convenience sample of relatives visiting as well ashysicians and nurses working in 6 units within the criti-al care division of a large American tertiary acute careedical centre with over 900 bed capacity. Approximately

2 J.L. Hinkle, E. Fitzpatrick

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Table 1 Medical diagnosis of patients.

Diagnosis Frequency Percent Cumulativepercent

Trauma 12 11.0 11.9Stroke 15 13.8 26.7Brain tumour 7 6.4 33.7Spine surgery 10 9.2 43.6Mastoidectomy 1 .9 44.6Craniotomy 1 .9 45.5Cancer 8 7.3 53.5Seizure disorder 4 3.7 57.4Carotid endarterectomy 2 1.8 59.4Abdominal surgery 8 7.3 67.3Small bowel obstruction 8 7.3 75.2Transplant 4 3.7 79.2Pneumonia/sepsis 4 3.7 83.2Non healing diabetic

foot ulcer1 .9 84.2

Pulmonary nodules 1 .9 85.1Ruptured cyst 1 .9 86.1Cardiac surgery 2 1.8 88.1Shunt revision 2 1.8 90.1Upper extremity

embolism1 .9 91.1

GI Bleed 1 .9 92.1Hernia repair 3 2.8 95.0Suicide Attempt 1 .9 96.0Amputation 1 .9 97.0AAA repair 1 .9 98.0Cholecystitis 2 1.8 100.0

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12 individuals were approached, some relatives (10)ecided, after reviewing the materials, not to fill out theurvey and one survey was not useable. The surveys werell completed whilst the patient was still an inpatient in theCU. Relatives were given as much time as they needed toomplete the survey but the majority took about 30 minuteshilst sitting at the bedside of the patient.

The six ICUs used in the study provide care for adult,eriatric and adolescent patients with complex medical, sur-ical and neurosurgical problems. Critically ill patients wereefined as those patients who had spent at least 24 hoursn one of the ICUs. Relatives were adults who were fam-ly members or significant others whom the patient sharedn established relationship with and who visited the patienthilst in one of the 6 units.

thical approval

he study received expedited Institutional Review BoardIRB) approval and all relatives gave written informed con-ent prior to inclusion in the study. Once the relative gaveonsent the patients’ notes were reviewed for pertinentemographic information whilst the relative completed theurvey. The physicians and nurses caring for the patientere approached and they could volunteer or decline toarticipate. The IRB determined there was no need for theealthcare professionals to give written informed consentue to the minimal level of risk to participants.

nstrument

emographic data were collected on patients, family mem-ers, physicians and nurses who consented to participatesing an investigator devised form. The Critical Care Familyeeds Inventory (CCFNI) was designed in 1976 (Molter, 1976),as been refined and used in multiple studies in the lastour decades. Needs were measured using the 45 item CCFNIhich has the responder rate their perception of importancef individual needs on scores of one (not important) to fourvery important). Internal consistency reliability has beeneported as ranging from 0.85 to 0.98 (Hickey, 1990). Sepa-ate versions of the CCFNI filled out by relatives, physiciansnd nurses had Cronbach alphas of .92, .93 and .93 respec-ively, which indicates high levels of internal consistencyeliability is all forms of the instrument.

Space was left on the questionnaire for relatives, physi-ians and nurses to write comments. All participants werencouraged to add comments about any areas of importanceo them regarding visiting in the ICU that were not includedn the inventory.

ata analysis

he data were analysed with SPSS version 17 using descrip-ive and inferential statistics. The mean scores on each ofhe 45 CCFNI items were rank ordered for relatives, physi-

ians and nurses. Spearman Rho correlations were used tonvestigate the similarities between the ratings of relatives,hysicians and nurses. Five subscales (Information, Prox-mity, Assurance, Comfort and Support) of the CCFNI were

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Total 101

alculated for relatives, physicians and nurses. Analysis ofariance was used to investigate differences in the threeean subscale scores.

esults

emographic characteristics

atientshe mean age of the 101 patients in the sample was 58ears (±18) and the mean educational level was 13 years±3). Fifty seven percent were male, 84% Caucasian and 16%ther racial groups. Identified religion was 54% Catholic, 18%rotestant, 8% Baptist, 5% Jewish, 2% Christian, 2% Hindu, 1%uslim and 10% claimed no religion. The medical diagnosesf the patients are listed in Table 1 and the mean length oftay was 11 days (±18) with a range of 2—112 days.

elativeshe mean age of the 101 relatives visiting the patientsas 52 years (±15) and mean educational level was 14

ears (±3). Seventy five percent of visiting relatives wereemale, 85% were Caucasian and 15% were of other racialroups. Religious affiliation included 55% Catholic, 21%rotestant, 7% Jewish, 6% Baptist, 5% Christian, 2% Islam

Perception of American relatives visiting Intensive care patients 221

Table 2 Rank order of items identified by relatives, physicians and nurses.

Relatives Rank,Mean ± SD

Physicians Rank,Mean ± SD

Nurses Rank,Mean ± SD

Be assured that the best care possible is being given to the patient 1, 3.94 (±.28) 3, 3.82(±.39) 2, 3.77 (±.42)Know exactly what is being done for the patient 2, 3.93 (±.29) 15, 3.39(±.62) 10, 3.55 (±.57)Have questions answered honestly. 3, 3.93 (±.30) 1, 3.93 (±.26) 1, 3.77 (±.42)Know why things were done for the patient 4, 3.91 (±.32) 7, 3.57(±.50) 8, 3.59 (±.51)Feel the hospital personnel care about the patient 5, 3.91 (±.41) 2, 3.82(±.47) 3, 3.67 (±.50)Be called at home about changes in condition of the patient 6, 3.90 (±.39) 14, 3.43 (±.63) 9, 3.58 (±.53)Know the prognosis. 7, 3.89(±.38) 4, 3.75(±.44) 4, 3.66 (±.48)Know how the patient is being treated medically 8, 3.88(±.36) 8, 3.57(±.57) 5, 3.65 (±.50)Feel there is hope. 9, 3.87(±.51) 5, 3.75(±.44) 6, 3.64 (±.52)Know specific facts concerning patient’s progress. 10, 3.85(±.41) 33, 3.11(±.88) 11, 3.53(±.57)Have explanations given in terms that are understandable. 11, 3.81(±.47) 6, 3.61(±.57) 7, 3.63 (±.50)Receive information about the patient once a day 12, 3.78 (±.55) 21, 3.36 (±.56) 12, 3.52(±.60)See the patient frequently 13, 3.77 (±.47) 23, 3.36 (±.62) 15, 3.42(±.61)Know what type of staff members are taking care of the patient 14, 3.61 (±.66)* 20, 3.36 (±.68) 25, 3.10(±.74)Be told about transfer plans whilst they are being made 15, 3.60 (±.62) 22, 3.36 (±.62) 14, 3.44(±.60)Have a specific person to call at the hospital when unable to visit 16, 3.57(±.71) 26, 3.25 (±.70) 22, 3.19(±.71)Have someone be concerned with the relative’s health 17, 3.55(±.78) 17, 3.39 (±.69) 13, 3.46(±.66)Talk to the doctor every day 18, 3.53 (±.83)* 29, 3.18(±.67) 16, 3.39(±.61)Feel accepted by hospital staff 19, 3.41(±.74) 9, 3.50 (±.58) 19, 3.33 (±.61)Know which staff member could give what type of information 20, 3.38(±.81) 27, 3.21 (±.63) 31, 2.98 (±.65)Visit at any time. 21, 3.35(±.87) 42, 2.75 (±.97) 39, 2.79(±.88)Have good food available in the hospital 22, 3.34(±.85) 43, 2.71(±.76) 38, 2.83 (±.82)Have visiting hours changed for special conditions 23, 3.31(±.94) 10, 3.50(±.79) 17, 3.38(±.75)Help with the patient’s physical care 24, 3.29(±.83)* 44,2.68(±1.09) 41, 2.78 (±.81)Talk about the possibility of the patient’s death 25, 3.29(±.90) 16, 3.39(±.63)* 26, 3.04(±.79)Have a bathroom near the waiting room 26, 3.27(±.78) 24,3.36(±.68) 37, 2.89 (±.73)Have friends nearby for support 27, 3.22(±.88)* 35, 3.00(±.77) 23, 3.16(±.72)Be told about other people who could help with problems 28, 3.20(±.92) 12, 3.46(±.50)* 21, 3.22(±.77)Have visiting hours start on time. 29, 3.12(±.99) 30, 3.18(±.61) 24, 3.11(±.82)Have comfortable furniture in the waiting room 30, 3.12(±.97) 32, 3.11(±.79) 36, 2.89 (±.80)Be assured it is alright to leave the hospital for a while 31, 3.11(±.97) 11, 3.46(±.58)* 20, 3.29 (±.75)Have the waiting room near the patient 32, 3.09(±1.0) 28, 3.18(±.72) 32, 2.98 (±.72)Talk to the same nurse each day 33, 3.07(±1.0) 38, 2.96(±.79) 43, 2.68 (±.80)Have a telephone near the waiting room. 34, 3.01(±.1.0) 18, 3.36(±.62) 28, 3.01(±.89)Have explanations of environment before going into ICU for the

first time35, 3.01(±.98) 19,3.36(±.73) 18, 3.33(±.73)

Have directions as to what to do at the bedside 36, 3.00(±.97) 31, 3.14(±.65) 33, 2.93 (±.78)Be told about Chaplain services. 37, 2.72(±1.0) 25, 3.36(±.68) 30, 3.01(±.75)Have the pastor visit 38, 2.70(±1.1) 39, 2.89(±1.3) 40, 2.79 (±.61)Be told about someone to help with family problems 39, 2.56(±.1.1) 13, 3.43(±.57) 29, 3.01(±.84)Have another person with relative when visiting in ICU 40, 2.55(±1.2) 41, 86(±.80) 44, 2.68 (±.91)Have someone to help with financial problems 41, 2.49(±1.3) 40, 2.89(±.83)* 35, 2.89 (±.85)Have a place to be alone whilst in the hospital 42, 2.42(±1.2) 36, 3.00(±.82) 34, 2.89 (±.83)Be alone at any time. 43, 2.39(±1.2) 37, 2.96(±.84) 42, 2.75 (±.78)Talk about negative feelings such as guilt or anger 44, 2.10(±1.1) 34, 3.11(±.69) 27, 3.02(±.77)Be encouraged to cry 45, 2.04(±1.1) 45, 2.39(±.73) 45, 2.50 (±.92)

* Indicates significant correlation (p = 0.05).

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and 4% claimed no religion. Forty four percent of rela-tives interviewed were the spouse of the patient, 27% wereadult children. 64% of those interviewed had been living in

the same household as the patient prior to the admissionto the ICU.

18

hysicianshe mean age of the 28 physicians in the sample was 35ears (±12). Eighty two percent were attending physicians

4% residents and 4% interns. Sixteen percent were female,2% Caucasian and 18% Asian. Religion was 61% Catholic,

2 J.L. Hinkle, E. Fitzpatrick

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% Protestant, 14% Jewish, 4% Islam and 17% claimed noeligion.

urseshe mean age of the 109 nurses in the sample was 35 yearsith a range of 22—57 years, 11% had a diploma in nursing,3% had an associate’s degree and 65% had a BSN and 1% aSN as their reported basic level of education. They worked

mean of 36 hours (±5) per week. Seventy seven percentere female, 91% Caucasian and 9% were of other racialroups. Self reported religion was 68% Catholic, 7% Protes-ant, 1% Jewish, 4% Baptist, 7% Christian and 13% claimedo religion.

tem scores

he mean, standard deviation and rank order of the 45 CCFNItems are displayed in Table 2. The top five needs identifiedy relatives were first to be assured that the best care pos-ible is being given to the patient, second to know exactlyhat is being done for the patient, third to have questionsnswered honestly, fourth to know why things were doneor the patient and fifth to feel the hospital personnel carebout the patient. The five top needs identified by physi-ians were first to have questions answered honestly, secondo feel the hospital personnel care about the patient third toe assured that the best care possible is being given to theatient, fourth to know the prognosis and fifth to feel theres hope. The five top needs identified by nurses were first toave questions answered honestly, second to be assured thathe best care possible is being given to the patient, third toeel the hospital personnel care about the patient, fourtho know the prognosis and fifth to know how the patient iseing treated medically.

Relatives and physicians agreed on the rank order of 7%three of the 45 needs). The item ‘to be encouraged to cry’anked last amongst the 45 items. There were significantorrelations (p < 0.05) between the relatives, physicians andurses on eight of the individual items on the CCFNI as indi-ated in Table 2.

ubscale scores

he mean scores, standard deviations, ranges, item meannd Cronbach alphas for the three groups on the fiveubscales are listed in Table 3. There were significant dif-erences in the mean scores for the needs perceived byelatives, physicians and nurses on the Information (F = 5.90,f = 2, p = .0005), Support (F = 4.12 df = 2, p = .022) and Com-ort (F = 5.01, df = 2, p = .010) subscales. On the Informationubscale the item mean was higher for relatives comparedo Physicians and nurse. On both the Support and Comfortubscales the Physicians had a higher item mean comparedo the relatives and nurse.

urvey comments

elatives and nurses made multiple comments on the sur-eys. Tables 4 and 5 contain the comments from relativesnd nurses respectively. The one physician survey comment

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Perception of American relatives visiting Intensive care patients 223

Table 4 Visitation survey written comments by relatives.

Item Comments by relatives

Be assured that the best care is being given to the patient Plus the family is updated and understands that the patient isgetting the best possible care. Compassion and empathy seemto be very much missing at this Hospital. Also communicationis very, very poor!

Talk to the same nurse each day With updatesTalk to the physician every day and prn (as needed)Visit at any time One relative wrote ‘within reason’Second rated this item a ‘5’Be told about other people who could help with problems e.g. rehabilitationHave visiting hours start on time I would prefer 24 hours a day visiting hours with the

understanding that medical staff could ask me to leave theroom (temporarily) at any time

Have friends nearby for support Confusing question I personally do not need friends nearbythe ICU to support me, but I like my mother’s friends to benearby to support her

Receive information about the patient once a day Once a day minimumHave comfortable furniture in the waiting room Bed or couchesTalk about the possibilty of the patients death if applicableBe assured it is alright to leave the hospital for a while Rated this item a ‘5’Know exactly what is being done for the patient Rated this item a ‘5’Feel there is hope Rated this item a ‘*’Be called at home about changes in the condition of the

patientIf it is a decline in condition

Further comments at the end of survey not related to specific items: when family is given information about the patient that is notgood news, a private place is needed to console the family Every patient in this hospital is very important to someone and they want tomake sure they are getting the best care. Sometime I think Doctors forget that every patient is special to someone. Communication isvery important. I started to get upset because I was trying to get an answer and was told the Doctor would be in. I waited 24 hours forthe Doctor. When I asked the Doctor why was not my mother a candidate for a certain procedure. She could not answer me. This is mymother and this is what needs to be remember by the Doctors. So far I am not 100% happy with this hospital and it is Doctors. I want tobe 100% that my Mother is receiving the best of care. We have been very pleased with the level and quality of care in this hospital. Ithas been a long twelve days, but with each day we have become more confident and ‘‘at ease’’ as we become familiar with and trust

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was about the need for better patient family educationmaterials as a mechanism for communication.

Discussion

In this study relatives of patients in critical care unitswere able to identify their needs and indicated that manyresources were available and used to meet their needs.Often the resources were the relative’s own inner strengthand religious beliefs and many hospital workers other thanthose giving direct care were utilized. These finding aresimilar to results of previous studies (Molter, 1976, 1979).

The patient population in the study represents a widerange of medical diagnoses (Table 1). With a mean length ofhospital stay of 11 days this does suggest a fairly criticallyill group of patients.

Whilst there was little exact agreement on individualrankings by relatives, physicians and nurses, three of theneeds most highly rated did occur amongst the top fiveof all three groups. The three included to have questions

answered honestly, to be assured that the best care possibleis being given to the patient and to feel the hospital person-nel care about the patient. A comparable study by Bijttebieret al. (2001) found that four of the five most highly ranked

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eeds appeared in the rankings by relatives, physicians andurses. The two overlapping items between this study andhat of Bijttebier et al. (2001) included having questionsnswered honestly and being assured the best possible cares being given. Health care workers in all countries clearlyeed to make time to answer the questions posed by rela-ives honestly and assure relatives visiting in the ICU thatheir family member is receiving the best care possible.

This study found significant differences in the mean sub-cale scores for the needs perceived by relatives, physiciansnd nurses for Information, Support and Comfort. Otheresearch has found Physicians underestimate the relative’seed for information (Bijttebier et al., 2001). Our findingsf the overestimation of the needs of relatives by Physiciansn Support and Comfort may be explained by the fact thatur study was unique in that it matched the relatives visitingnd the physicians and nurses caring for the same group ofatients.

The majority of the comments by relatives were furtherlarification of what the individual items meant to them.here was only one comment written in response to an item

hat fell into the most highly rated category leading us topeculate that overall the most highly rated items may alsoave been those items that were the most clear to rela-ives. The clarifying responses to four of the items indicate

224 J.L. Hinkle, E. Fitzpatrick

Table 5 Visitation survey comments written by nurses.

Item Comments by nurses

Have a telephone near the waiting room First nurse comment: Unable to answerSecond nurse comment: N/A

Visit at any time First nurse comment: Unable to answerSecond nurse comment: N/A

Have the pastor visit First nurse comment: priest;Second nurse comment: when needed

Talk to the doctor everyday First nurse rated this item: 4 plusSecond nurse comment: N/A

Have someone to help with financial problems Social Work?Talk to the same nurse each day Perhaps Clinical Nurse Specialist or Nursing Care Coordinator

Second nurse comment: N/AHelp with patient’s physical care if important to familyTalk about the possibility of the patient’s death First nurse comment: if applicable

Second nurse comment: N/ATalk about negative feelings such as guilt or anger N/AHave visiting hours changed for special conditions N/AHave another person with the relative when visiting in ICU N/ABe alone at anytime N/AHave a place to be alone whilst in the hospital N/AHave friends nearby for support N/AHave comfortable furniture in the waiting room N/AB e told about Chaplain Services N/AHave directions as to what to do at the bedside N/AHave visiting hours start on time N/AHave the pastor visit N/AHave good food available in the hospital N/AHave a bathroom near the waiting room N/AFeel accepted by hospital staff N/AReceive information about the patient once a day N/AKnow specific facts concerning the patient’s progress N/A

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Feel there is hope

hat perhaps the one—four likert scale may be inadequateo capture the depth of the response to some items onhe CCFNI. There were only a few negative comments andhese were counterbalanced by other positive commentsnd highly rated items.

No research is without limitations and this study is noxception. A convenience sample was used and no measuresf severity or co-morbidity of illness were used. There waso exploration of whether families’ needs were met and whoas responsible for meeting their needs. There was a low

esponse rate by the physician group to the survey.

ractice implications

he main conclusion was that families of critically illatients would be better served by having more open vis-tation policies in ICUs. Visiting hours vary from ICU to ICU

ut discussions in our institution and across the US are ongo-ng as physicians and nurses continue to work together toest serve the needs of our critically ill patients and theiramilies.

/A

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