The needs of significant others within intensive care—the perspectives of Swedish nurses and physicians

Intensive and Critical Care Nursing 20 (2004) 22—31

ORIGINAL ARTICLE

The needs of significant others within intensivecare–—the perspectives of Swedish nurses andphysicians

Christina A.S. Takmana,*, Elisabeth I. Severinssonb

a Institute of Nursing Science, University of Oslo, P.O. Box 1120, Blindern, N-0317 Oslo, Norwayb School of Health and Social Work Education, Stavanger University College,P.O. Box 8002 Ullandhaug, N-4068 Stavanger, Norway

Accepted 24 September 2003

KEYWORDSCritical Care FamilyNeeds Inventory;Nurses;Physicians

Summary The aim of this study was to describe and compare the views of registerednurses (RNs, n = 292), enrolled nurses (ENs, n = 232) and physicians (PHs, n = 79)working in intensive care units (ICUs) on the needs of the patients’ significant others.The questionnaire used was the Critical Care Family Needs Inventory (CCFNI). Datawere analysed using descriptive and inferential statistics. Four factors were revealed:(I) the need to meet professionals who are sensitive when informing and listening tosignificant others, (II) the need to take care of themselves, (III) the need to knowwhat is going on, and (IV) the need for continuity as well as information about thehospital staffing structure. RNs and ENs scored higher than the PHs on factors I—III.On the fourth factor, ENs and PHs scored higher than the RNs. The professionals fromsurgical ICUs scored higher on the third factor than the professionals from medicalICUs. In conclusion, to increase the understanding of the complexity of the intensivecare milieu there is a need for further research to illuminate the view of both thehealthcare professionals’ and the critically ill patients’ significant others on theirinteractions with one another, for the purpose of increasing collaboration.© 2003 Elsevier Ltd. All rights reserved.

Introduction

In the highly technical milieu of an intensive careunit (ICU), teams of physicians and nurses providehigh quality care aimed at the recovery of thepatients in their charge. An understanding of theother team members’ perspectives (cf. Oberleyand Hughes, 2001) is an essential component of

*Corresponding author. Present address: Trångsundsvägen22A, SE-142 63 Trångsund, Sweden.

E-mail address: [email protected](C.A.S. Takman).

collaboration. In Sweden, the National Board ofHealth and Welfare’s directives on quality systemsin healthcare state that patients and their signif-icant others are to be treated with concern andrespect, be informed, and be invited to participatein the care (The National Swedish Board of Healthand Welfare, 1996). The individual professionalsin a healthcare team may have contrasting expe-riences from their daily clinical work. Nurses havereported difficulties in performing their dutiesdue to a lack of understanding as well as differ-ing attitudes towards the patient among the teammembers (Beeby, 2000). According to Takman and

0964-3397/$ — see front matter © 2003 Elsevier Ltd. All rights reserved.doi:10.1016/j.iccn.2003.09.003

The perspectives of Swedish nurses and physicians 23

Severinsson (1999), the way in which healthcareprofessionals experience encounters with patientsin acute clinical settings can be understood as theirability to understand the patients’ different waysof communicating experienced suffering.

According to Granberg et al. (1999), patientswhose loved one was at their bedside in ICUs suf-fered fewer hallucinations. In the critical caremilieu, patients are often incapable of making deci-sions regarding their own care (Wasser et al., 2001).The significant others will then be expected, as sug-gested by Oberley and Hughes (2001), to act in theinterest of the patient with regard to medical caredecisions. Pochard et al. (2001) reported that morethan two thirds of the significant others who visitedcritically ill patients in ICUs suffered from symp-toms of anxiety or depression, which could preventthem from acting in the patient’s best interest.

In order to identify and measure the needs andconcerns of families of critically ill patients in ICUs,Molter (1979) developed the Critical Care FamilyNeeds Inventory (CCFNI), a questionnaire consist-ing of 46 items rated on a Likert scale. Leske (1991)examined the internal consistency reliability andconstruct validity. A factor analysis based on datafrom the significant others of critically ill patientsrevealed the following five dimensions: need forsupport, comfort, information, proximity and as-surance (Leske, 1991). The questionnaire has sincebecome one of the most important instruments formeasuring family members’ needs as well as health-care professionals’ views on those needs (Holdenet al., 2002).

Comparisons between significant others andprofessionals have been carried out in differentcountries by means of the CCFNI. For example,Burr (1996) in Australia, Mi-kuen et al. (1999) inHong Kong and Bijttebier et al. (2001) in Belgiumcompared significant others’ self-rated needs withnurses’ views, following the patient’s admission toan ICU (Burr, 1996; Mi-kuen et al., 1999) and withnurses’ and physicians’ views (Bijttebier et al.,2001). Significant others in ICUs in Australia, Bel-gium and China reported similar needs, such asfeeling that the healthcare professionals care aboutthe patient and being assured that their loved oneis receiving the best possible care, receiving in-formation once a day, obtaining honest answersto questions, being informed about the patient’sprogress and expected outcome, and finally beinginformed about changes in the patient’s condi-tion (Bijttebier et al., 2001; Burr, 1996; Mi-kuenet al., 1999). In the Belgian study by Bijttebieret al. (2001), the nurses and physicians had almostidentical views on the 10 most important needs ofsignificant others.

Different versions of the CCFNI have recentlybeen developed. For example, Johnson et al.(1998) modified the CCFNI to a 14-item Likertscale questionnaire in order to measure how thepatients’ significant others experience the abil-ity of the healthcare professionals to meet theirneeds in ICUs. In their study, Johnson et al. (1998)found three dimensions: attitude, communicationand comforting skills. Azoulay et al. (2001) con-ducted a multi-centre study of the needs of familymembers in 43 ICUs in France, including both adultand paediatric units, using the Johnson version ofthe CCFNI. The results showed no differences infamily satisfaction between paediatric and adultICUs. Family members preferred a structured careteam, where the role of each professional wasknown to them. They also wanted the healthcareprofessionals to avoid contradictions by providing‘‘effective and intelligible information devoid ofinconsistencies’’ (Azoulay et al., 2001, p. 138).When significant others’ self-rated needs weremeasured, they did not automatically correlatewith the family members’ experiences of satisfac-tion ‘‘because unmet needs do not always translateinto dissatisfaction’’ and ‘‘meeting needs doesnot guarantee satisfaction’’ (Heyland et al., 2002,p. 1413).

Interactions between significant others andhealthcare professionals have been studied.Azoulay et al. (2000) assessed family members’understanding of the medical information providedon ICU admission and concluded that the com-munication from the ICU physicians to significantothers was inadequate. Hupcey (1998) observedthe strategies used by significant others and nursesaimed at developing or inhibiting relationshipswith one another. Most of the nurses’ negative be-haviour was unintentional and occurred as a resultof a heavy workload. In their interaction with thepatient’s significant others, nurses can either assistor hinder them in supporting and making it easierfor their loved one to endure the ICU (cf. Hupcey,1999).

In recent decades, several researchers havecompared self-rated needs of patients’ significantothers in ICUs with the healthcare professionals’views on them (Holden et al., 2002). However,there is a lack of knowledge about the viewsheld by the different members of the profes-sional healthcare team on the needs of signif-icant others in ICUs. The aim of this study is,therefore, to describe and compare the views ofnurses and physicians working in adult ICUs inSweden on the needs of significant others of crit-ically ill patients. The CCFNI questionnaire wasused, and the following research questions were

24 C.A.S. Takman, E.I. Severinsson

formulated:1. What are the healthcare professionals’ views on

the needs of the patients’ significant others inadult ICUs?

2. Are there any differences in the demographicsof registered nurses (RNs), enrolled nurses (ENs)and physicians (PHs)?

3. Are there any differences between surgical andmedical ICU professionals?

Methods and research setting

A descriptive correlational study design was used,and the participants were selected by means ofconvenience sampling (Polit and Hungler, 1999). Alladult surgical andmedical ICUswith sub-specialitiesin five acute care hospitals in an urban area of East-ern Sweden were invited to participate in the study.The chief physicians and head nurses at 12 out of 14ICUs agreed to participate. The units includedwere,nine surgical ICUs (SICU) with sub-specialities suchas thorax, trauma, transplantation, burn, and neu-rosurgery, and three medical ICUs (MICU), includingcardiac ICUs. Respiratory treatment was availablein all nine SICUs and in one of the three MICUs. Inall, 858 healthcare professionals were included inthis self-reported survey (390 RNs, 335 ENs and 133PHs). ICUs are defined as intensive care and treat-ment units where patients are admitted because oflife-threatening or potentially life-threatening al-terations to the physiological life space, and wherethe majority of patients are over 18 years old.

Ethical considerations

The regional ethics committee of the Karolinska In-stitutet in Stockholm approved the study (Reg. no.02-122). In order to safeguard anonymity, while stillmaking it possible for the researcher to send a re-minder, the respondents were given a letter/an en-velope containing information and a slip stating thename of the hospital and ICU, on which they wereasked to write their name. They were requested toreturn the slip in a separate envelope as proof ofinformed consent. The first author asked the con-tact nurses at the 12 ICUs for a checklist containingthe names of all professionals who had receivedquestionnaires. The names on the returned slipswere ticked off the checklist, and one reminderwas distributed via the contact nurse at each ICUto those professionals who had failed to reply. Thequestionnaires were non-coded, and instructionswere given to return them by post in a non-coded,sealed envelope to ensure that the completedquestionnaires did not fall into hands other thanthose of the researchers. When the questionnaires

had been returned to the researcher, they wereassigned a registration number.

Procedure and data collection

A contact nurse who volunteered for the positionwas selected at each unit. He/she was in regu-lar contact with the researcher and distributed thequestionnaires to the participants. All units wereoffered at least one informationmeeting by the firstauthor (C.T.), to be held at the unit. Some unitsrequested separate information meetings for thosehealthcare professionals who worked day shifts andthose who mostly worked at night. The first authorprovided verbal and written explanations of the aimof the study. The participants were informed aboutthe time required to fill in the instrument, the pro-cedure, measures to ensure the confidentiality andanonymity of the questionnaires, and the voluntarynature of participation.

Inclusion criteria (Polit and Hungler, 1999, p. 278)were as follows:

1. Being an EN, a RN or PH (For example, anaes-thetist, surgeon or cardiologist), who providesmedical and/or nursing care, and who has closecontact with the critically ill patient and theirsignificant others in the ICUs as a result ofhis/her professional duties.

2. Being on duty in the intensive care unit for atleast 1 day or night shift during a specific 2-weekperiod.

3. Being on the permanent staff of the intensivecare unit.

Data were mainly collected over a 2-month pe-riod, from the second half of April until the secondweek of June 2002.

Questionnaire

The healthcare professionals received one ques-tionnaire comprising; demographic data and theCCFNI (45 items) for assessing significant others’needs on a 4-point Likert scale, ranging from ‘‘notimportant’’ to ‘‘very important’’. The CCFNI ques-tionnaire also contained one open-ended item,where the healthcare professionals were requestedto describe additional needs not included in thequestionnaire. The data analysis of the resultsfrom the open-ended question will be reportedelsewhere.

The questionnaire were translated from Englishinto Swedish, after which a qualified translatormade a back translation. The translated question-naire was also critically reviewed by a group ofexperienced Swedish ICU nurses. It was found that


the concept of honesty in the item ‘to have ques-tions answered honestly’ could be translated intotwo different concepts ‘honest’ and ‘sincere’. Itwas also found that each interpretation was loadedwith different meanings in the Swedish languageand in the terminology used in Swedish ICUs. Theconcept ‘sincere’ was chosen for the present study.Permission was obtained from Professor Leske inthe USA to use the CCFNI in the present study.

Statistical analysis

SPSS (2000) version 10.0 was employed for thedescriptive and inferential statistical analysesof the returned questionnaires. The healthcareprofessionals’ views on the CCFNI statements wereanalysed by means of principal component analysiswith varimax rotation, in order to condense thenumber of items and to identify related factors(Polit and Hungler, 1999).

To compare differences in views between thedifferent groups of healthcare professionals, achi-square test was used, and differences in re-sponses between factors and the three groupsof healthcare professionals were tested by theKruskal—Wallis test. Differences in responses be-tween factors, ICU specialities (MICU and SICU) andgender data were tested by the Mann—Whitney Utest (Siegel and Castellan, 1988).

Cronbach’s alpha was used to test internal con-sistency. The Spearman rank correlation coefficientwas used to calculate the correlation between fac-tors, age and experience. A P value of <0.05 wasregarded as significant.

Results

Six hundred and five (70%) of the 858 questionnaireswere returned duly completed. This figure includesthe questionnaires returned in response to a re-minder (46; 5%). The return rate of each profes-sion was as follows: RN 75%, EN 70% and PH 60%.Sixty-seven percent of the surgical ICUs question-naires were returned, while the response rate frommedical ICUs was 80%.

The respondents’ (n = 605) demographics areshown in Table 1. The ages of the RNs, ENs andPHs were similar, the majority of professionals be-ing between 31 and 45 years. A higher percentageof the respondents worked at surgical ICUs withsub-specialities (RN 75%, EN 76% and PH 77%). Fe-males accounted for 87% of RN and 90% of EN re-sponses. Of the physicians, 66% of the respondentswere male. In all three groups, a high portion ofstaff, 42% of the RNs, 54% of the ENs and 51% of the

Table 1 Demographic characteristics of RNs, ENsand PHs working in ICUs for adults.

Variable RN(n = 292)

EN(n = 232)

PH(n = 79)

Gender (%)Female/male 87/13 90/10 34/66

Age, years (%)21—25 — 7 —26—30 14 7 1031—35 20 18 1136—40 22 23 2241—45 18 16 1846—50 16 9 19

>50 10 20 20

Experience of present profession, years (%)<2 1 4 32—5 12 8 155—10 26 10 1910—15 22 22 2015—20 14 20 13

>21 25 36 30

ICU experience, years (%)<1 8 9 191—3 18 11 93—5 15 12 65—7 9 6 67—10 8 8 9

>10 42 54 51

SICU/MICU (%) 75/25 76/22 77/23

Significant other or self has been an ICU patientYes/no 28/72 34/66 27/73

n = 605; two missing data. SICU: RN, n = 217; EN,n = 177; PH, n = 61. MICU: RN, n = 72; EN, n = 52;PH, n = 18.

PHs, had been working in the ICU area for 10 yearsor more. The majority of the nurses and physicianshad neither been a patient nor a significant otherin an ICU (RN 72%, EN 66% and PH 73%).

Principal component analysis of thehealthcare professionals’ views on theneeds of significant others

A four-factor solution was used, which structureexplains 36.9% of the variance. Each factor had aneigenvalue above 1.4, and the overall alpha coef-ficient was 0.92. Factor I dealt with the healthcareprofessionals’ views on the need of significant oth-ers to meet professionals who are sensitive wheninforming and listening. Factor II concerned theperceived needs of the significant others to takecare of themselves physically, psychologically and


Table 2 Principal component analysis of the healthcare professionals’ views on the needs of significant othersof ICU patients.

Factors and loading Loading on primary factor

Factor I: the need to meet professionals who are sensitive to significant others when informing andlistening (percentage of variance: 10.5, Cronbach’s alpha: 0.84)Q35: to be given explanations that are understandable 0.61Q7: to discuss their feelings about what has happened 0.60Q30: to feel that it is acceptable to cry 0.58Q28: to be assured that it is in order to leave the hospital 0.57Q21: to feel accepted by the healthcare professionals 0.50Q42: to feel that the healthcare professionals care about the patient 0.48Q25: to talk about the risk of the patient dying 0.48Q34: to be given the name of someone who can help with family problems 0.46Q31: to be given the names of other people who can help with problems 0.43Q33: to be allowed to be alone at any time 0.42Q5: to have questions answered honestly 0.41Q6: to have visiting hours changed in special circumstances 0.40Q14: to feel there is hope 0.40

Factor II: the need to take care of themselves (percentage of variance: 10.3, Cronbach’s alpha: 0.82)Q20: to have comfortable furniture in the waiting room 0.67Q23: to have a telephone in the immediate vicinity of the waiting room 0.65Q32: to have a WC near the waiting room 0.64Q45: to have the waiting room near the patient 0.62Q8: to have good food available in the hospital 0.56Q27: to have someone who is concerned about their health 0.52Q18: to have a place to be alone in the hospital 0.52Q22: to have someone who can advise them on financial problems 0.51

Factor III: the need to know what is going on (percentage of variance: 8.4, Cronbach’s alpha: 0.79)Q19: to know exactly what is being done for the patient 0.62Q41: to receive daily information about the patient 0.60Q16: to know what medical treatment the patient is receiving 0.57Q13: to know why the patient has to undergo various procedures 0.54Q43: to know the details concerning the patient’s progress 0.53Q44: to see the patient frequently 0.53Q40: to be phoned about changes in the patient’s condition 0.51Q1: to know the expected outcome 0.48Q3: to talk to the physician every day 0.48

Factor IV: the need for continuity and information about the hospital staffing structure (percentageof variance: 7.7, Cronbach’s alpha: 0.74)Q15: to know which category of staff members take care of the patient 0.59Q4: to have a specific person to contact at the hospital when unable to visit −0.57Q24: to have a clergyman available 0.56Q29: to talk to the same nurse every day 0.54Q37: to be informed about chaplain services 0.53Q38: to help with the patient’s physical care 0.52Q36: to have visiting hours start on time 0.46Q26: to be allowed to have another person present when visiting the

critical care unit0.46

Q11: to know which staff members to ask for different types of information 0.44

Factor loading below 0.40 excluded.

socially. Factor III reflected the need to know whatwas happening to the patient in the ICU. Finally,factor IV concerned the perceived need for conti-nuity and information about the hospital staffingstructure during the patient’s stay in the ICU(Table 2).

Descriptive data, comparisons andcorrelations between the professionals’views on the needs of significant others

Significant differences were found among the threegroups of healthcare professionals in terms of


Table 3 Descriptive data and comparison between RNs, ENs and PHs regarding their views on the needs of thepatient’s significant others in adult ICU (P value tested by means of the Kruskal—Wallis test).

The need for RN (n = 236),mean ± S.D.

EN (n = 200),mean ± S.D.

PH (n = 62),mean ± S.D.

P value

Professionals who show sensitivity � 0.14 ± 0.94 −0.10 ± 1.02 −0.20 ± 1.08 0.01**

Taking care of themselves � 0.07 ± 0.94 0.08 ± 1.03 −0.55 ± 0.96 0.00***

Knowing what is going on −0.00 ± 0.98 0.13 ± 0.99 −0.43 ± 1.01 0.00***

Continuity and information aboutthe hospital staffing structure

∞ −0.20 ± 0.92 0.22 ± 1.10 −0.00 ± 0.73 0.00***

� includes 13 items (range 13—52); � includes 8 items (range 8—32); includes 9 items (range 9—36); ∞ includes9 items (range 9—36).** P < 0.01.*** P < 0.001.

Table 4 Spearman’s correlation of factor scores related to the healthcare professionals’ age.

Age of the healthcare professionals RN (n = 292) EN (n = 232) PH (n = 79) Total (n = 603)

Professionals who show sensitivity −0.11 −0.02 0.05 −0.07Taking care of themselves 0.02 0.10 0.17 0.05Knowing what is going on 0.13* 0.13 0.32* 0.14**

Continuity and information aboutthe hospital staffing structure

0.15* 0.14* 0.21 0.16**

* P < 0.05 (two-tailed).** P < 0.01 (two-tailed).

factors related to age, experience (Tables 3—5),and gender.

Of the healthcare professionals, RNs scored high-est with a mild significance on the first factor;‘the need to meet professionals who are sensitiveto significant others when informing and listening’(P < 0.01), while ENs scored higher than PHs(Table 3). Women in all three professional groupsscored slightly higher on ‘the need to meet pro-fessionals who are sensitive to significant otherswhen informing and listening’, compared to men(P < 0.05).

The scores of both RNs and ENs were higher com-pared to PHs, representing a strong significance,

Table 5 Spearman’s correlation of factor scores related to the RNs, ENs and PHs length of professional experience,and length of ICU experience.

Factor I Factor II Factor III Factor IV

RN, professional experience −0.09 0.08 0.15* 0.11RN, experience of work in ICUs −0.05 0.12 0.07 0.11EN, professional experience 0.04 0.14 0.17* 0.07EN, experience of work in ICUs −0.02 0.17* 0.14 −0.01PH, professional experience 0.17 0.16 0.12 0.22PH, experience of work in ICUs 0.04 0.10 0.31* 0.10

* P < 0.05 (two-tailed).

on the second factor, ‘the need to take care ofthemselves’ (P < 0.00) (Table 3). ENs showed a pos-itive correlation between length of ICU work expe-rience and the need of the significant others to takecare of themselves (P < 0.05) (Table 5). Women inall three professional groups ranked the needs mod-erately significantly higher than men (P < 0.00).

ENs and RNs scored moderately higher than PHs,regarding ‘the need to know what is going on’(P < 0.00) (Table 3). A mild correlation with thefactor score was found between RNs, PHs and age(P < 0.05) (Table 4). ENs and RNs showed a mildcorrelation between professional experience and‘the need to know what is going on’ (P < 0.05)


Table 6 Descriptive data and comparison between MICU and SICU, regarding the healthcare professionals’ viewsof the needs of significant others of critically ill patients (P value tested by means of the Mann—Whitney U test).

The need for MICU (n = 118),mean ± S.D.

SICU (n = 375),mean ± S.D.

P valuetwo tail

Professionals who show sensitivity � 0.06 ± 0.93 −0.01 ± 1.01 0.52Taking care of themselves � −0.49 ± 0.95 0.15 ± 0.97 0.00***

Knowing what is going on 0.04 ± 1.03 −0.00 ± 0.99 0.76Continuity and information about

the hospital staffing structure∞ 0.10 ± 1.06 −0.04 ± 0.98 0.18

� includes 13 items (range 13—52); � includes 8 items (range 8—32); includes 9 items (range 9—36); ∞ includes9 items (range 9—36).*** P < 0.001.

(Table 5). PHs also showed a mild significance(P < 0.05) between the perceived needs and lengthof ICU work experience. Women of all professionshad a higher score, which was moderately signifi-cant, compared to men (P < 0.00).

ENs scored higher than PHs, who in turn scoredhigher than RNs, regarding the fourth factor, ‘theneed for continuity and information about the hos-pital staffing structure’ (P < 0.00) (Table 3). Therewas no difference with regard to experience or gen-der between the three groups. A mild correlationwith the factor score was found between RNs, ENsand age (P < 0.05) (Table 4).

Differences between surgical and medicalICU professionals

The SICU healthcare professionals had a higherscore, which was strongly significant, for the per-ceived need of significant others to take care ofthemselves while present in the hospital comparedto the MICU professionals (P < 0.00) (Table 6). Nodifferences were found between SICUs and MICUsregarding the other factor scores.

Discussion

The aim of this descriptive correlational study wasto describe and compare the views of nurses andphysicians working in adult ICU in Sweden on theneeds of significant others of critically ill patients.Descriptive analysis of the CCFNI questionnaires re-vealed four factors: ‘the need to meet profession-als who are sensitive to significant others when in-forming and listening’, ‘the need to take care ofthemselves’, ‘the need to know what is going on’and ‘the need for continuity and information aboutthe hospital staffing structure’.

There are several limitations in this study thatneed to be addressed. Firstly data collection; the

informants were selected by means of conveniencesampling (Polit and Hungler, 1999) and only profes-sionals on duty in the ICUs over a specific 2-week pe-riod were included. This procedure resulted in dif-ferent sized professional groups, with the physiciangroup corresponding to about 1/3 of the EN groupand 1/4 of the RN group. Secondly, a weakness interms of the validity concerns the instructions tothe healthcare professionals to consider how impor-tant they perceived the CCFNI statements to be to afamily member in the ICU during their hours of duty.The views should be general in character and not re-lated to a specific significant other. This could limitthe study since the needs experienced by individualfamily members in ICUs differ (cf. Twibell, 1998).

Even though not explicitly requested, a numberof the returned questionnaires contained commentsconcerning some items in the CCFNI questionnaire.Most of the comments concerned items grouped un-der factor four, ‘the need for continuity and infor-mation about the hospital staffing structure’. Forexample, the item ‘how important do you believeit is to the patients’ significant others to talk to thesame nurse every day? elicited reactions such as,‘‘we do not work 24 h a day’’. This view may re-flect the lack of resources in the present healthcaresystem, where professionals in ICUs have a heavyworkload. Comments on questions concerning theneed for information about the chaplain services ora visit from a clergyman revealed a secularised per-spective, reflecting the view of a multi-cultural andmulti-religious society. However, this is normal inan urban area, such as the one in which this studywas performed. Since the reliability and validity ofthe CCFNI questionnaire were tested (Leske, 1991),the factors revealed in previous studies have beenanalysed based on data from significant others inthe ICUs investigated. In the present study, datafrom the three groups of healthcare professionalswere analysed using principal component analysis,revealing factors that contradict previous research.


The views of healthcare professionals onthe needs of patients’ significant others

The first factor, denoted ‘the need to meet profes-sionals who are sensitive to significant others wheninforming and listening’, can be seen in terms of theSwedish healthcare quality system. The NationalSwedish Board of Health and Welfare (1996) reg-ulations state that the patient’s family membersshould be kept informed and treated with concernand respect. RNs achieved a slightly higher scoreon this factor than ENs (Table 3). RNs have specificnursing competence and are responsible for practi-cal nursing care, which includes high-tech care andsupportive care in existential crises (The NationalSwedish Board of Health and Welfare, 1993). This isin line with Leske (1998), who suggested that nursescan assist significant others to cope by listeningand being responsive. Healthcare professionals whoshow sensitivity can help significant others to feelconfident (cf. Takman and Severinsson, 1999) aswell as strengthening their ability to support theirfamily member, thus benefiting the patient (cf.Hupcey, 2001). Scare resources and high demandsin the high-tech ICUs could provide a basis for amore task-oriented as opposed to interactive ap-proach in today’s healthcare services (cf. Bégat andSeverinsson, 2001). The physicians had the lowestscore on this factor when compared to RNs and ENs.In Sweden, the medical education has been ques-tioned by Holmström (2002), who claims that thestrong focus on biomedical aspects leads to low pre-paredness on the part of physicians in clinical en-counters with clients. It has also been reported froma French study that family members experiencedthat the information received from the critically illpatient’s physician was inadequate (Azoulay et al.,2000). Heyland et al. (2002) suggested educationand training to increase physicians’ communicationskills. In this respect, the structure of focus groupscould be appropriate to teams of healthcare pro-fessionals. Lantz and Severinsson (2001) designedfocus group interventions based on information ob-tained from narratives of family members in ICUs.The interventions were helpful for the nurses whoparticipated, by increasing their self-insight, per-ceptions and responses to the significant others’needs. As the starting point of the caring conversa-tion is the fact that we are all human, the human as-pects of the intensive care situation could form thebasis for healthcare professionals whenmeeting theneeds of significant others to be informed and lis-tened to in a sensitive way (cf. Fredriksson, 1998).

The second factor in the results focused on thesignificant others’ need to take care of themselvesin the hospital, while still having the opportunity of

being close to the patient even if they could not beat their bedside the whole time. When the patientis perhaps undergoing some form of treatment, thesignificant other could take a break, have a snack,wash their face and take a deep breath–—all in or-der to regain some strength to be able to return totheir family member and be supportive. This wasconfirmed by Burr in Australia (1996), who foundthat significant others experienced the need forvigilance irrespective of the length of time spent inthe ICU. In a Canadian study, it was reported thatfamily members were least satisfied with the wait-ing room atmosphere in ICUs (Heyland et al., 2002).In the present study, both ENs and RNs exhibitedsignificantly higher scores for this factor than thephysicians (Table 3). An explanation could be that,since the nurses are responsible for the patients’nursing care, they are more likely to stay close tothe patient’s room and thereby their significant oth-ers. The physicians are responsible for the medicaltreatment of all patients in the unit (The NationalSwedish Board of Health and Welfare, 1993). SICUprofessionals showed a significantly higher scoreon ‘the need to take care of themselves’ than pro-fessionals from MICUs (P < 0.00, Table 6). One ex-planation could be that patients acutely admittedto surgical ICUs are usually more critically ill thanpatients admitted to a cardiac ICU. Only one of thethree medical ICUs included in this study providedrespiratory treatment. This implies that a patientin need of respiratory treatment in a cardiac ICUwould be transferred to a surgical ICU, which isnormally more specialised in such treatment.

‘The need to know what is going on’ was the thirdfactor revealed by the analysis. The need of signif-icant others to watch over the care provided to thepatient by the ICU professionals has been reportedby Hupcey (2000). The need to know what is goingon can be seen in the light of Antonovsky’s (1998)‘sense of coherence’, as an important part of mak-ing what is happening intelligible and manageable.ENs scored higher than the other professionals onthis factor. This can be interpreted to mean that,while looking after the patient in the ward, the ENsare aware of the family members’ questions. Thelength of experience (due to age–—RNs and PHs,length of professional experience–—RNs and ENsand length of professional experience in ICUs–—PHs)could imply that increased experience makes theprofessionals more sensitive to significant others’needs to know what is going on (Tables 4 and 5).

The fourth and final factor was ‘the need for con-tinuity and information about the hospital staffingstructure’. This factor can be seen in the lightof Hupcey’s studies (1998, 1999), where familymembers tried to develop relationships with those


nurses who were in charge of the patient’s care(Hupcey, 1998). This was done both to help thepatient and to allow the significant other to be in-volved in the care. Some nurses made subjectivedecisions regarding, for example, how long the sig-nificant others were allowed to be with the patient(Hupcey, 1999) or how many visitors were allowedto be present at a time (Hupcey, 1998). The ENsscored higher on this factor than the physiciansand RNs (Table 3). As the ENs often performedpractical nursing tasks for the patients, they hadthe opportunity to develop closer contact with thepatients’ significant others, who thereby becamemore familiar with the ICU environment.

Implications for practice

The findings in this study indicate that the profes-sional team members are sensitive to the needs ofcritically ill patients’ significant others. However,differenceswere found between the perspectives ofthe ENs, RNs and PHs. All healthcare professionalswho have contact with family members can ensurethat their needs are met, but different perspectivesamong the professionals may result in different ac-tions. Professionals need to understand how theiractions may influence significant others’ ability tosupport their critical ill family member (cf. Hupcey,1999).

To avoid inadequate communicationwith patients’significant others, there is a need for a formalexchange of information among the professionalteam members about the significant others’ needs(cf. Azoulay et al., 2000; Bijttebier et al., 2001).Through multidisciplinary training such as clinicalsupervision, both nurses and physicians could de-velop their self-insights about their own and otherteam members’ perspectives on the significantothers’ experiences and needs.

Conclusion

Two dimensions of information were identified inthis study: (1) an inter-subjective dimension, whichincludes sensitivity on the part of nurses and physi-cians in meeting the significant others’ need forinformation (factors I and III) and (2) an informa-tional dimension concerning contextual knowledgeabout the surrounding environment (factors II andIV). There is a need for further research in orderto increase the understanding of the complexity ofthe intensive care milieu. Semi-structured inter-views, for example, could illuminate the differentdimensions of the professionals’ and the significantothers’ views on their interactions with one another

and with the critically ill patient, for the purposeof increasing team collaboration.

Acknowledgements

The authors are grateful to the nurses and physi-cians who participated in this study. We also wishto thank the registered nurses; Elisabeth Lerndal,Anna Blommengren, Katarina Karlsson, Rose-MarieHallin, Britta Lahti, Ann Hultman-Cadring, ThorleifRosander, Christel Westerlund, Pia Andersson, Gu-nilla Lindberg, Bernhard Backhaus and Marina Häggfor acting as contact persons at the ICUs, to VibekeHorstmann for statistical support and Gullvi Nilssonfor reviewing the English.

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The needs of significant others within intensive care—the perspectives of Swedish nurses and physicians