Nurses play crucial role in helping reduce stress for families of ICU patients

Reviewed by Emily Henderson, B.Sc.Feb 1 2021

Nurses play a crucial role in helping to reduce the stress experienced by family members of critically ill patients, according to an article in Critical Care Nurse (CCN).

Having a family member, regardless of their age, admitted to an intensive care unit (ICU) is a stressful event, and research has documented that such stress may contribute to depression, anxiety, and posttraumatic stress disorder (PTSD).

The Society of Critical Care Medicine (SCCM) recently updated guidelines for family-centered care in ICU settings, which state that part of a nurse's role is to assess stress among family members of a critically ill patient and to intervene to help reduce this stress.

"Nursing Interventions to Reduce Stress in Families of Critical Care Patients: An Integrative Review" responds to the SCCM guidelines by aiming to establish the state of knowledge regarding the stress experienced by families with a loved one in the ICU and to identify specific nursing interventions that may help.

Authors Valèrie Lebel, PhD, RN, and Sylvie Charette, PhD, RN, are professors in the department of nursing, at the Universitè du Quèbec en Outaouais (University of Quebec Outaouais), in Canada.

The COVID-19 pandemic has reinforced that ICU nurses are the main point of interaction between the healthcare team and the family and that they are crucial to supporting the family through the ICU experience. A family-centered approach makes it possible to implement tailored interventions that are flexible and accommodate individual coping strategies."

Valèrie Lebel, PhD, RN, Professor, Department of Nursing, University of Quebec Outaouais

Their literature search of three databases (MEDLINE, CINAHL, and Cochrane) identified 934 research articles with select keywords related to the topic in the abstract or summary. The search covered the period from 2007, when the first SCCM family-centered care guidelines were issued, through 2019.

From there, they removed duplicates and applied inclusion criteria, resulting in a total of 38 articles for the integrative review. Of these, 18 studies dealt with the neonatal ICU setting, nine were in pediatric ICUs, and 11 were in adult ICUs, most of which were medical and surgical ICUs.

The article summarizes the design and findings of all 38 research studies, with principal stressors for families and related nursing interventions. The analysis found that, in all three care settings, the sources of stress fell into four main categories:

• Changes in the relationship between the patient and family
• Altered appearance and behavior of the patient
• Highly specialized care setting with unfamiliar medical equipment and healthcare staff
• Communication and counseling with the healthcare staff

For each stressor, the researchers identified specific nursing interventions, such as using a family-centered approach to care and implementing appropriate stress-reducing interventions. Overall, their findings recommend that nursing interventions focus on valuing the role of family members in patient care, improving communication, and providing accurate information.

Reducing family members' stress during a loved one's ICU stay may also help with efforts to reduce family post-ICU syndrome, with its mental health issues and decreased quality of life. In addition, more research is needed to develop tools to evaluate family members' level of stress and principal stressors, as well as the most effective interventions to improve the family's experience of intensive care.

As the American Association of Critical-Care Nurses' (AACN's) bimonthly clinical practice journal for acute and critical care nurses, CCN is a trusted source of information related to the bedside care of critically and acutely ill patients.