Perceptions of relatives regarding family centered care at a South African Private Hospital adult intensive care unit
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Date
2020
Authors
Buthelezi, Siyabonga
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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.
Description
A research dissertation submitted in partial fulfillment of the requirements for the degree of
Master of Science in Nursing to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 2020