Perceptions of relatives regarding family centered care at a South African Private Hospital adult intensive care unit

Abstract

Aim: The purpose of this study is to describe the perceptions of family members regarding family-centred care in an adult intensive care unit at a private hospital in the Free State province, South Africa. Setting: The setting for this study was the adult intensive care unit of a private hospital in the Free State province, South Africa. This is a general intensive care unit. Methods: An explanatory sequential mixed method design was utilised for this study; it comprised of both quantitative and qualitative methods. The qualitative data was collected after the quantitative data collection. The sample consisted of 80 family members of patients admitted to adult ICU of the study site from September 2018 to February 2019. Random sampling will be used to select the family member participants. Data was collected using a validated questionnaire: Family Centred Care Survey developed by Mitchell et al. (2009). In addition, semistructured interviews were conducted with a sample of 20 purposively selected family members. The quantitative data analysis was analysed using descriptive summary statistics such as frequencies, percentages, medians and inter-quartile ranges. Also, the qualitative data was analysed using the method of Clarke and Braun (2013). Themes and sub-themes were identified and reported in the narrative. Findings of both quantitative and qualitative methods were reported separately and then integrated to make recommendations for FCC in the adult intensive care unit. Results: In phase 1: quantitative findings indicated that out of 80 relatives who participated in the study, 60% agreed with the existence of respect in ICU as 70% of participants felt welcome to attend in ICU with their relatives. The median response on the aspect of respect was 3 (IQR 2-4) still show average agreement on respect as perceived by relatives. On the collaboration aspect on family centred care from 80 relatives who participated 74% agreed to have perceived collaboration in family centred care as attested by 63.8% of respondents who agree to have received honest information and 72.5% of participants knew the treating Doctor for their loved one. The median response on support scale was 3 (2-4) meaning relatives were on average agreement with adequate support in ICU of South African Private Hospital. Out of 80 participants, 60% agreed with the existence of support in the unit. In phase 2: qualitative study explored the perceptions of relatives regarding familycentred care through semi-structured face to face interviews. Emergent themes that came up from the interviews were communication, partnership, caring environment, Proximity need, religion and cultural practices. These emergent themes were accompanied by sub-themes with the following prevailing issues of lack of updates, health care providers attitude, communication technology, incomplete hand over, involvement in activities, learning opportunities, feeling of relief, respect and dignity, family support, fair treatment, visiting hours, family bonding, cultural and religious inclusion.Communication came up as the main theme; participants were satisfied with communication with the nurses and answers given by nurses at the bedside. Relatives perceived that nurses were treating their relatives with respect and dignity as they communicated with mechanically ventilated patients, sedated and ensuring privacy. Families were not satisfied with communication with treating Doctors as they did not get updates about their loved ones. Relatives described communication with Doctors in ICU as “rushed communication”. The lack of proper communication exacerbates stress and suffering to family members—incomplete handover between health care providers perceived to be disturbing adequate health care service delivery to patients. Family members want to collaborate with health care providers in rendering health care to their loved ones. Most family members are willing to be involved in the plan of care, like bathing, combing hair and cut nails. Families suggested that activities of collaboration with nurses should be under supervision. Other family members felt that they do not want to interfere with health care providers. Families who wish to participate in care feel that they are helping their loved one in ICU. Families reported that being part of care provides the feeling of relief to family members. Relatives voice out concerns about cultural and religious practices that still need improvement in the unit. The ICU should allow them to do their rituals and prayers as they believe it helps and also provides support to patients. Participants want to be treated the same and fair despite religion, colour, gender and race as they visit in the intensive care unit. Most participants appreciated the support received in the unit from health care providers, and they ended up developing a trust relationship with nurses in the unit. Families that required further support emotionally were referred for further counselling and support.