Volver a:  "Los familiares en la UCI"

1.    Aeschlimann A, Steinmann E. [The intensive care patient and his family physician]. Schweiz Rundsch Med Prax 1985; 74(40):1073-1074.

2.    Appleyard ME, Gavaghan SR, Gonzalez C, Ananian L, Tyrell R, Carroll DL. Nurse-coached intervention for the families of patients in critical care units. Critical Care Nurse 2000; 20(3):40-48.
Abstract: Providing support to family members of critically ill patients is a significant responsibility for critical care nurses because patients' families are important factors in patients' illness experience and recovery. This article presents a study that measured the effectiveness of a nurse-coached volunteer in satisfying the needs of families and the effects on attitudes of staff nurses toward patients' family visitors

3.    Azoulay E, Pochard F, Chevret S, Lemaire F, Mokhtari M, Le Gall JR et al. Meeting the needs of intensive care unit patient families: a multicenter study. Am J Respir Crit Care Med 2001; 163(1):135-139.
Abstract: Intensive care unit (ICU) caregivers should seek to develop collaborative relationships with their patients' family members, based on an open exchange of information and aimed at helping family members cope with their distress and allowing them to speak for the patient if necessary. We conducted a prospective multicenter study of family member satisfaction evaluated using the Critical Care Family Needs Inventory. Forty-three French ICUs participated in the study. ICU characteristics, patient and family member demographics, and data on satisfaction were collected. Factors associated with satisfaction were identified using a Poisson regression model. A total of 637 patients were included in the study, and 920 family members completed the questionnaire. Seven predictors of family satisfaction were found: one family-related factor, namely, family of French descent and six caregiver-related factors, namely, no perceived contradictions in information given by caregivers; information provided by a junior physician; patient to nurse ratio </= 3; knowledge of the specific role of each caregiver; help from the family's own doctor; and sufficient time spent giving information. Predictors of satisfaction are amenable to intervention and deserve to be investigated further with the goal of improving the satisfaction of ICU patients' family members

4.    Azoulay E, Pochard F, Chevret S, Jourdain M, Bornstain C, Wernet A et al. Impact of a family information leaflet on effectiveness of information provided to family members of intensive care unit patients: a multicenter, prospective, randomized, controlled trial. Am J Respir Crit Care Med 2002; 165(4):438-442.
Abstract: Comprehension and satisfaction are relevant criteria for evaluating the effectiveness of information provided to family members of intensive care unit (ICU) patients. We performed a prospective randomized trial in 34 French ICUs to compare comprehension of diagnosis, prognosis, treatment, and satisfaction with information provided by ICU caregivers, in ICU patient family representatives who did (n = 87) or did not (n = 88) receive a family information leaflet (FIL) in addition to standard information. An FIL designed specifically for this study was delivered at the first visit of the family representative: it provided general information on the ICU and hospital, the name of the ICU physician caring for the patient, a diagram of a typical ICU room with the names of all the devices, and a glossary of 12 terms commonly used in ICUs. Characteristics of the ICUs, patients, and family representatives were similar in the two groups. The FIL reduced the proportion of family members with poor comprehension from 40.9% to 11.5% (p < 0.0001). In the representatives with good comprehension, the FIL was associated with significantly better satisfaction (21 [18 to 24, quartiles] versus 27 [24 to 29, quartiles], p = 0.01). These results indicate that ICU caregivers should consider using an FIL to improve the effectiveness of the information they impart to families

5.    Azoulay E, Pochard F. Meeting the needs of intensive care unit patients' family members: beyond satisfaction. Crit Care Med 2002; 30(9):2171.

6.    Baquedano Fernández, Blas Pérez Pérez, M Ángeles Molina Santiago, Andrés Maurici Díez, M Carmen y Serrano Gutiérrez, Concepción. Evaluación del protocolo de información a familiares y control de calidad asistencial en cuidados intensivos. Garnata. 3:39-47.

7.    Beck, Carme Lucía Colomé. O processo de viver, adoecer e morrer vivências com familiares de pacientes internados em terapia intensiva. Texto Contexto Enferm. 10(3):118-137.

8.    Bernat Adell, MD Tejedor López, R y Sanchís Muñoz, J. ¿Cómo valoran y comprenden los familiares la información proporcionada en una unidad de cuidados intensivos? Enferm Intensiva. 11(1):3-9.

9.    Bernat i Bernat, Ramona López Ruiz, Julia y Fontseca Roselló, Joan. Vivencia de los familiares del enfermo ingresado en la unidad de cuidados intensivos. Un estudio cualitativo. Enferm Clínica. 10(1):19-28.

10.   Bijttebier P, Delva D, Vanoost S, Bobbaers H, Lauwers P, Vertommen H. Reliability and validity of the Critical Care Family Needs Inventory in a Dutch-speaking Belgian sample. Heart & Lung: Journal of Acute & Critical Care 2000; 29(4):278-286.
Abstract: OBJECTIVE: The purpose of the study was to provide psychometric evaluation of the Dutch version of the Critical Care Family Needs Inventory. SETTING: The study took place in an intensive care unit of a university hospital. PARTICIPANTS: The participant group included 200 adult family members visiting a patient within the 72-hour interval after admission to the intensive care unit. RESULTS: Principal factor analysis with varimax rotation resulted in a 5-factor solution distinguishing 5 need types: need for information, need for comfort, need for support, need for assurance and anxiety reduction, and need for proximity and accessibility. The internal consistency of the resulting subscales ranged from 0.80 to 0.62, and all factors were significantly related to each other. The Critical Care Family Needs Inventory subscales were found to be clearly related to the demographic variables age, sex, and education level. CONCLUSION: The reliability and validity of the Dutch-language Critical Care Family Needs Inventory as a diagnostic tool in family needs assessment are supported

11.   Bisaillon S, Li-James S, Mulcahy V, Furigay C, Houghton E, Keatings M et al. Family partnership in care: integrating families into the coronary intensive care unit. Can J Cardiovasc Nurs 1997; 8(4):43-46.
Abstract: Since the introduction of Family Partnership in Care in the CICU and other pilot units, many changes have been made. Education sessions are now unit specific rather than in groups with multiple units. This facilitates the discussion of unit-specific educational and implementation needs. In addition, unit-specific sessions allow for some case scenario/role playing activities to facilitate learning and application of the FPCP elements to the unique culture of the unit. Finally, less emphasis is placed on the documentation, while greater emphasis is placed on the philosophy behind the program and the nurses values and attitudes towards families. Overall, the implementation of the FPCP in CICU has had a positive impact on staff and patients. Staff awareness regarding the importance of involving family in the patient's care and the benefits of this has been heightened. Staff who were initially very skeptical have become strong advocates for the program. The successful shift with families in "doing for" to "working with" has enhanced the professional practice of many nursing staff and contributed to the overall unit functioning. Finally, the feedback from patients and their care partners and the independence and informed decision-making fostered by designing a plan of care with staff validates the importance of this program in a critical care area

12.   Bouley G, von Hofe K, Blatt L. Holistic care of the critically ill: meeting both patient and family needs. Dimens Crit Care Nurs 1994; 13(4):218-223.
Abstract: Holistic care of the critically ill includes meeting the needs of both the patient and the patient's family. The critical care nurse needs to be prepared to deal with the family's special needs during a time of crisis, including making decisions about the withdrawal of life support. This article addresses such issues, and includes care of the family once technological support has been withdrawn and the patient is transferred from the Intensive Care Unit

13.   Boyle M, Kwasha D, Morris RW. Do intensive care nurses consider intensive care less useful than their patients or patient's family? Confed Aust Crit Care Nurses J 1991; 4(2):22-27.
Abstract: Do Intensive Care Nurses feel that Intensive Care (IC) treatment is worthwhile for their patients? Can they speak for their patients, when considering how useful IC would be, in the event of life-threatening illness? And, do quality of life (QOL) considerations affect IC nurses', and patients', and patients' family perceptions of the usefulness of IC treatment? To determine how useful they perceived IC treatment to be 44 ex-patients (or their family if the patient had died) were asked how willing they would be to return to IC (or have their relative return to IC) if again threatened by critical illness. 16 Registered Nurses (RNs) were asked how useful they considered IC would be for patients they had nursed, if those patients' treatment in IC could be done all over again. RNs were also asked how useful they considered IC to be if they themselves required it. Patient (or family) responses were matched with the corresponding RN responses and compared (39 matched pairs). The comparison showed, 1--Patients and families did not consider QOL effected their judgement of the usefulness of IC; 2--Patients and families considered IC useful for all periods of survival; 3--RNs considered IC much less useful than patients and families; 4--QOL was a significant consideration for RNs when assessing the usefulness of IC for their patients. These results have implications for RNs who attempt to represent the patients' view when assessing the usefulness of IC

14.   Brown R, Deeny P, McIlroy D. Family needs in critical care settings: a comparison of the perceptions of nurses and family members. All Ireland Journal Nursing Midwifery 2000; 1(3):108-115.
Abstract: While the needs of families in critical care settings are identified clearly by previous research there is ongoing recognition of the importance of assessing the perceptions of need by family members and nurses. Such perceptions provide valuable feedback on the accuracy of nursing care in meeting family needs and also provide foci for change and improvements in the quality of care and the education of nurses in critical care settings. Using an exploratory descriptive approach the researchers used Molter's Critical Care Family Needs Inventory (CCFNI) Molter, 1979) to determine the perceptions of family members and nurses (Molter, 1979) in two intensive care units. Follow-up open-ended interviews with family members provided the opportunity to gain greater insight regarding their psychosocial need patterns. Results of the study indicate that there are a number of similarities between nurses and family members in their responses to the 30 items in the CCFNI and tests of differences reveal significant results in five items. These differences demonstrate that nurses are more concerned about issues related to important instructions and about eliciting family members feelings. In contrast, family members' priorities appear to be related to issues concerning receiving care and acceptance by hospital staff. Emerging from follow-up interviews were key themes concerning informational, educational, environmental and emotional needs. It has been concluded that the use of qualitative and quantitative methods to complement each other added another important dimension to the overall analysis. It is suggested that the methodology could be improved further in a larger study through the use of a newly constructed seven-point Likert Scale to allow respondents greater variation in their choice

15.   Burck R. Family satisfaction surveys to improve the fit between the intensive care unit and its concept. Crit Care Med 2002; 30(7):1650-1651.

16.   Burden JM, Freedman B, Gelb AW. Ethical and family management problems in the intensive care unit--an illustrative case. Can J Anaesth 1987; 34(3 ( Pt 1)):274-279.

17.   Burr G. Contextualizing critical care family needs through triangulation: an Australian study. Intensive Crit Care Nurs 1998; 14(4):161-169.
Abstract: Family needs and concerns within the critical care context have been thoroughly explored from the quantitative perspective utilizing the Critical Care Family Needs Inventory (CCFNI). Nursing interventions have been designed on the basis of the findings from these studies. However, while the CCFNI would seem to encompass all the possible needs of families with a critically ill loved one, at no time were the family members themselves consulted at length in regard to the development of the instrument, or in any subsequent validation studies. Individual reality generates the variables that are measured in a needs analysis, and the family member experiences encompass dimensions that are not easily assessed by quantification. In fact the unique experiences of family members underpin their perception of need. Methodological triangulation formed the basis for this study to determine the degree of confirmation (or otherwise) between family member respondents to the CCFNI (n = 105) and those participating in an interview (n = 26) designed to explore needs and experiences. The qualitative data served the purpose of completeness by providing a more contextual representation of needs and therefore greater depth of understanding of the whole construct. The results indicate that, while there were many areas of convergence between the two samples, there were also areas of diveregence. Two major needs emerged from the interviews that are not represented on the CCFNI: the need of family members to provide reassurance and support to the patient; and their need to protect (others as well as the patient). A more complete understanding of family needs was obtained through the contextualization of their experiences

18.   Campbell M.L. Management of the patient with do not resuscitate status:  compassion and cost containment. Heart & Lung 1991; 20(4):345-348.

19.   Chartier L, Coutu-Wakulczyk G. Families in ICU: their needs and anxiety level. Intensive Care Nurs 1989; 5(1):11-18.
Abstract: In the course of their care-giving activities nurses deal with family members as well as with patients. The dimension of family involvement becomes even more crucial when patients are hospitalised in the Intensive Care Unit (ICU). The purpose of this study was to identify: 1. The perceived needs and anxiety levels of adult family members of ICU patients; 2. The relationship between perceived needs and situational anxiety levels; and 3. The sociodemographic factors having an influence on the needs and anxiety level of family members. Over a 10-week-period, a convenience sample of 207 subjects was formed from the total adult population of immediate family members visiting a patient in a 9-bed ICU of a 388-bed university hospital. The data were gathered by a face to face interview, a self-report questionnaire of the French version of the Critical Care Family Needs Inventory (Molter & Leske, 1983), and the A-Scale of the State Trait Anxiety Inventory (Spielberger, 1970). The major variables investigated were: family needs; situational anxiety; on-site sources of worry; level of knowledge with respect to the ICU setting from experience or pre-surgery education; and finally, sociodemographic data. The sample was predominantly female (75%) and the mean age was 45.43 s.d.-15.19, ranging from 18 to 91 years. The average number of respondents per family was 2.3 with a range of 1 to 5. The Situational Anxiety Scale of the STAI yielded a mean score of 47.88 +/- 12.02 ranging from 21 to 76.(ABSTRACT TRUNCATED AT 250 WORDS)

20.   Chavez CW, Faber L. Effect of an education-orientation program on family members who visit their significant other in the intensive care unit. Heart Lung 1987; 16(1):92-99.
Abstract: An education-orientation program given to family members may be an effective initial intervention technique for alleviating familial stress. The findings suggest that the intervention program had a positive effect on the experimental group. A comprehensive, ongoing program is needed to ensure that each family is given the attention they require to promote and maintain family function and integrity during the hospitalization crisis. Future research is needed to identify stressors perceived by family members and to identify effective nursing interventions that would decrease familial stress and promote and maintain the family integrity during the hospitalization crisis. Future research should be time-sequenced to examine the effect of an intervention program as initial coping mechanisms begin to diminish. Finally, research is needed to determine whether family intervention alleviates stress in the stricken family member

21.   Chow SM. Challenging restricted visiting policies in critical care. CACCN 1999; 10(2):24-27.
Abstract: The need for family members to visit their loved ones when they have been admitted into the critical care unit was identified in 1979 by Molter in the critical care family needs inventory (CCFNI). This need has been the centre of controversy for critical care units for many years. This article provides an overview of literature that refutes some of the rationales that have been used to restrict family visiting in the critical care unit. An overview of a liberalized (open, contract, inclusive or structured) visiting policy is discussed as an option to the restricted visiting policy

22.   Circo A, Mangiameli S, Lombardo D, Lisi F, De Luca A, Genovese G et al. [Presence of the nuclear family in the coronary intensive care unit in the immediate post-infarct period]. Boll Soc Ital Cardiol 1979; 24(7):789-794.

23.   Clarke C, Harrison D. The needs of children visiting on adult intensive care units: a review of the literature and recommendations for practice. J Adv Nurs 2001; 34(1):61-68.
Abstract: AIM: The purpose of this paper is to review the current literature and research available and to identify specific, nursing interventions to meet the needs of child visiting within the ICU setting. BACKGROUND: According to recent surveys children are still restricted from visiting their critically ill family and friends on many adult intensive care units (ICUs) within the United Kingdom (UK). Imposing restrictive visiting policies does not respect the rights of patients and their families to be together and to support each other during a period of stress and crisis. METHOD: The motivation to undertake the study was derived from a critical incident involving a small boy who was not allowed to visit his critically ill mother. She subsequently died. Reflection on the available literature identified the value and role of intuition in expert clinical judgement, but the need to support this with evidence based knowledge. CONCLUSION: The implications for practice are discussed and recommendations for further research are made

24.   Clarke CM. Children visiting family and friends on adult intensive care units: the nurses' perspective. J Adv Nurs 2000; 31(2):330-338.
Abstract: Recent surveys show that children are still restricted from visiting their critically ill family and friends on many adult intensive care units throughout the country. The purpose of this small-scale exploratory pilot study was to examine and describe the experiences and perceptions of trained nurses towards children visiting within this setting. The aim of the study was to gain greater insight and understanding into the reason why, despite evidence to support the benefits to children of visiting their critically ill family and friends, they remain discouraged and restricted. It is hoped that the study will act as an initial enquiry to generate themes and further research questions. A qualitative research approach was adopted and in-depth focused interviews used as a method of data collection. The participants of the study were trained nurses working on an adult intensive care unit in a district general hospital in England . A total of 12 individual interviews were conducted which were audiotaped in full and analysed using a method of thematic content analysis. The value of the research is to promote family-centred care within an adult intensive care environment to meet the neglected needs of the well children of the critically ill person. The findings suggest that the participants in the study attempted to offer valuable support to children visiting their critically ill family and friends, but, despite an open visiting policy, children rarely visited within this setting. The desire of the well parent to protect and shield the child from the crisis of critical illness was perceived by the participants to be the main reason why they did not visit. To provide family-centred care within an adult intensive care setting has many implications for practice and several of these important issues are discussed. These include the educational and training needs of nursing staff and the importance of adopting a collaborative team approach to providing care for the critically ill person and their family. The need to generate research and literature from within the United Kingdom 's health care system has also been identified and recommendations for further studies are proposed

25.   Coulter MA. The needs of family members of patients in intensive care units. Intensive Care Nurs 1989; 5(1):4-10.
Abstract: This study investigated the needs of family members of patients in intensive care units (ICUs) from the families' perspective. A qualitative research methodology was chosen and a 'Grounded Theory' type of approach after Glaser and Strauss was used. The fieldwork comprised informal in-depth interviews with 11 relatives of patients in one general adult intensive care unit in a teaching hospital in the north of England . Previously identified topic areas guided the fieldwork and these were expanded, and new topics included, as appropriate. A tape recorder was used and the interviews were subsequently analysed. Six conceptual categories were developed. The strong theme which emerged was that of 'Retaining Hope'. The study gives some indication of the viewpoint of relatives in ICU and what they perceive to be their major needs. Suggestions for future nursing practice have been presented

26.   Coutu-Wakulczyk G, Chartier L. French validation of the critical care family needs inventory. Heart Lung 1990; 19(2):192-196.
Abstract: This study is a contribution to the French validation of Molter and Leske Critical Care Family Needs Inventory (CCFNI). The importance of this validation study is based on the presumption that evaluation of family needs relies on the use of measures that are reliable and valid for a specific population. The preliminary validation of the French text of the CCFNI was carried out by back translation method of the French form into English by three translators. Then the final French version was selected. The study was conducted in the surgical intensive care unit of the University Hospital in Sherbrooke , Canada . The sample consisted of 207 voluntary subjects selected from adult members of the immediate family visiting a patient in the intensive care unit. The data collection was spread over a 10-week period. The French version of the CCFNI was given to subjects for self-reporting at the end of a 15-minute face-to-face interview. The reliability of the French version yielded 0.91 as Cronbach alpha coefficient. The Spearman-Brown split-half coefficient was 0.89, and the Guttman split-half coefficient was 0.88. Principal-component analysis and factorial matrices were used to examine the clustering structure of the French version of this instrument

27.   Cray L. A collaborative project: initiating a family intervention program in a medical intensive care unit. Focus Crit Care 1989; 16(3):213-218.
Abstract: Common needs of family members of critically ill patients were identified. Each member of the family may react differently to the stress caused by hospitalization of a loved one. Dealing with families in crisis requires the coordination of the health care team. A clinical nurse specialist can act as a coordinator and continue to integrate the efforts of the nursing staff to ensure a team approach in providing a structured yet individual way to deliver emotional support to families of the critically ill. The purpose, design, implementation, and evaluation of a family intervention program in an MICU as well as suggestions for its continuation were described. Evaluations of the program revealed positive responses by the majority of families participating in the program. Findings indicated that a structured and well-planned family intervention program can increase the staff nurse's knowledge and sensitivity to the needs of families who are in a crisis situation. Further research is necessary to identify needs of a family when they are faced with an acute illness of a family member and the required nursing interventions to assure the desired outcome of care. Replication and reporting of similar intervention programs, such as the family intervention program, would help nurses plan and implement appropriate interventions to support the family during critical illness of a family member

28.   Crozilhac N. [Myocardial infarction--admission of the patient and his family to the intensive care unit]. Rev Infirm 1990; 40(4):41-44.

29.   Curry S. Identifying family needs and stresses in the intensive care unit. Br J Nurs 1995; 4(1):15-19.
Abstract: This article explores the effect that the intensive care unit has on patients' families and examines ways for nurses to identify and cope with family needs and stresses in the intensive care environment

30.   Curtis JR, Patrick DL, Shannon SE, Treece PD, Engelberg RA, Rubenfeld GD. The family conference as a focus to improve communication about end-of-life care in the intensive care unit: opportunities for improvement. Crit Care Med 2001; 29(2 Suppl):N26-N33.
Abstract: The intensive care unit (ICU) represents a hospital setting in which death and discussion about end-of-life care are common, yet these conversations are often difficult. Such difficulties arise, in part, because a family may be facing an unexpected poor prognosis associated with an acute illness or exacerbation and, in part, because the ICU orientation is one of saving lives. Understanding and improving communication about end-of-life care between clinicians and families in the ICU is an important focus for improving the quality of care in the ICU. This communication often occurs in the "family conference" attended by several family members and members of the ICU team, including physicians, nurses, and social workers. In this article, we review the importance of communication about end-of-life care during the family conference and make specific recommendations for physicians and nurses interested in improving the quality of their communication about end-of-life care with family members. Because excellent end-of-life care is an important part of high-quality intensive care, ICU clinicians should approach the family conference with the same care and planning that they approach other ICU procedures. This article outlines specific steps that may facilitate good communication about end-of-life care in the ICU before, during, and after the conference. The article also provides direction for the future to improve physician-family and nurse-family communication about end-of-life care in the ICU and a research agenda to improve this communication. Research to examine and improve communication about end-of-life care in the ICU must proceed in conjunction with ongoing empiric efforts to improve the quality of care we provide to patients who die during or shortly after a stay in the ICU

31.   Daley L. The perceived immediate needs of families with relatives in the intensive care setting. Heart Lung 1984; 13(231).

32.   Daly K, Kleinpell RM, Lawinger S, Casey G. The effect of two nursing interventions on families of ICU patients. Clinical Nursing Research 1994; 3(4):414-422.
Abstract: Although much research has addressed family needs of ICU patients, only a few studies have examined interventions aimed at meeting these family needs. Therefore, the purpose of this study was to examine the effects of two interventions, a family information pamphlet and a family group session, on 60 family members of ICU patients. Results revealed no statistically significant differences between the family member groups on Critical Care Family Needs Inventory scores (p=.45), which assessed important needs, or State Trait Anxiety scores (p=.61). Consistent with previous research on families' needs, the majority of the needs identified as most important by all family members related to receiving information. Small sample sizes may have contributed to nonsignificant differences between family member groups, and study replication with larger sample sizes is recommended

33.   Danis M, Jarr SL, Southerland LI, Nocella RS, Patrick DL. A comparison of patient, family, and nurse evaluations of the usefulness of intensive care. Crit Care Med 1987; 15(2):138-143.
Abstract: As patient advocates, critical care nurses need to be cognizant of which treatments the patients and their families prefer. Therefore, we conducted a study to compare how nurses, their critically ill patients, and their families evaluate the usefulness of intensive care. A group of former medical intensive care patients (n = 72), or their family members if the patient had died, were asked how willing they would be to undergo (or to subject their relative to) intensive care again, if necessary. All nurses (n = 15) caring for these patients were asked a parallel, hypothetical question about the usefulness of intensive care to these patients and to themselves, were they to become sick. Analysis of matched pairs of patient (or family member) and nurse questionnaires (n = 38) revealed that: nurses underestimate the usefulness of intensive care as evaluated by their patients and families; and patients believe that quality of life is a less important factor in judging the usefulness of intensive care than do their nurses

34.   De Jong MJ, Beatty DS. Family perceptions of support interventions in the intensive care unit. Dimens Crit Care Nurs 2000; 19(5):40-47.
Abstract: Family needs of critically ill patients have been well documented in nursing literature. However, few researchers have examined support interventions intended to meet these needs. This study examines which interventions provide the greatest benefit to critically ill patients' families and recommends nursing actions to meet families' support needs

35.   Delva D, Vanoost S, Bijttebier P, Lauwers P, Wilmer A. Needs and feelings of anxiety of relatives of patients hospitalized in intensive care units: implications for social work. Soc Work Health Care 2002; 35(4):21-40.
Abstract: INTRODUCTION: This study explores the needs and anxiety levels of relatives faced with the stress of a family member's critical care hospitalization in relation to the relatives' age, gender, educational level and type of kinship with the patient and in relationship to the characteristics of the admission and the condition of the patient. METHODS: Participants were 200 relatives of 120 different critical care patients. Family needs were measured by means of the Critical Care Family Needs Inventory. Anxiety was measured by means of the State version of the State-Trait Anxiety Inventory. RESULTS AND CONCLUSION: Relatives' needs and anxiety levels are found to be significantly related to demographic variables and type of kinship with the patient. The implications for clinical practice are discussed

36.   Díaz Chicano, J.F. Cuidados a familiares de pacientes críticos. Enfermería científica 1997; 184(185):26-30.
Abstract: Revisión bibliográfica en la que se señala que partiendo de una concepción holística del paciente es necesaria la aplicación de cuidados a su s familiares, además enfermería tiene la obligación de prestar estos cuidados porque es competencia suya, por motivos ético-legales, por reconocimiento de la profesión y sobre todo por conseguir un efecto positivo en la familia , el enfermo y los propios profesionales.  En la revisión efectuada señala la coincidencia de los autores en el reconocimiento de las necesidades de información y seguridad como las más importantes.
Defienden que tras una identificación previa de necesidades deben implantarse en los planes de cuidados acividades del tipo:
Mejor y más información.
Mas numero de visitas e implicación en los cuidados de los familiares.
Apoyo emocional.
Estimulación del auto cuidado.

37.   Dockter B, Black DR , Hovell MF, Engleberg D, Amick T, Neimier D et al. Families and intensive care nurses: comparison of perceptions. Patient Educ Couns 1988; 12(1):29-36.
Abstract: This study compared family members' and nurses' perceptions on families' needs when a relative was hospitalized in an intensive care unit (ICU). Family members (N = 32) and nurses (N = 23) complete equivalent 44-item questionnaires. Both family members and nurses agreed that the greatest needs of families were anxious at admission (P less than 0.05). Families and nurses seemed satisfied in the Participation/Information and Emotional Support categories, but more disagreements were noted in these areas. More nurses perceived families as not wanting to participate in patient care (P less than 0.003), felt that families did not have enough time to visit (P less than 0.004), believed that families were comfortable expressing their feelings (P less than 0.02) but thought families were uncomfortable asking questions (P less than 0.01). It was concluded that families be prepared for the patient's condition and appearance, and for the hospital milieu in order to cope more effectively with excessive stress in time of crisis. Concordance in perceived needs of family members and care providers may lead to greater need satisfaction and it is advocated that both the patient and the family (rather than the patient alone) be the focus of treatment because of the relationship between social support and patient recovery

38.   Echer IC, Onzi MR, da Cruz AM, Ben GM, Fernandes TS, Bruxel VM. [Visitors' opinion on the system of patient visits in an intensive care unit]. Rev Gaucha Enferm 1999; 20(1):57-67.
Abstract: The objective of this study is to identify whether the current system of visits schedule and patient's information at a Clinical and Surgical Intensive Care Unit (ICU) satisfy the patient's visitors. To do it, two hundred questionnaires were distributed, during a month, and one hundred and sixty returned. The results showed that 70% of the visitors are satisfied with the current schedule; 67% come in daily; 66% are satisfied with the time they have for visiting, 54% asked for access in out of the current schedule, 69% are satisfied with staff information about patients; 88% of the visitors are patient's relatives. The most frequent suggestion was to increase the visit time at this ICU

39.   Engli M, Kirsivali-Farmer K. Needs of family members of critically ill patients with and without acute brain injury. J Neurosci Nurs 1993; 25(2):78-85.
Abstract: A comparative descriptive study was implemented to identify and compare the personal needs of family members of critically ill patients with and without acute brain injury. The study was, in part, a replication of Mathis's study which used Molter's Critical Care Family Needs Inventory (CCFNI) to identify differences in the degree of importance of the perceived personal needs between family members of critically ill patients with and without acute brain injury. Fourteen relatives of critically ill patients completed and mailed a questionnaire adapted from the CCFNI. Results indicated a difference in the degree of importance of the perceived personal needs between the family members of critically ill patients without acute brain injury and family members of critically ill patients with acute brain injury at the 0.001 level of significance (Chi square = 17.70, critical value = 16.27, df = 3). Similarities in the rank ordering of the need statements were found between the two groups in this study and in comparison to the groups in Mathis's study. Family members indicated that most needs were met (78.5%) and nurses and doctors were identified as meeting the majority of these needs (> 80%). Ongoing research is necessary to determine what the needs of the relatives are in order to most effectively use the energies of health care professionals in providing patient care

40.   Fan J. Family needs in critically head-injured patients and related factors [Chinese]. Journal of Nursing Research 1996; 4(3):273-284.
Abstract: The purposes of this study were to identify and describe family needs and to determine what factors were related to the needs of the family members of critically head-injured patients. An instrument developed by Molter & Leske (1983) entitled Critical Care Family Needs Inventory (CCFNI)" was translated into Chinese. The Chinese version of CCFNI, which contains 44 items, was administered to a group of 70 family members. The data were analyzed using descriptive, correlational Pearson, one-way ANOVA, repeated measure ANOVA, t-test, and paired t-test. The top three needs identified by the family members were (1) to know the prognosis; (2) to receive information about the patient every day; (3) to be called at home about changes in the patient's condition. Each need was met at least once among these 70 subjects in this study. There were 16 items met above 90.0% and 7 items met less than 20%. For the 44 need items, nurses were primarily responsible for meeting most of them (54.5%). The factors affecting the identified five dimensions of CCFNI were family members' gender, financial status, occupation, relationship to the patient, whether living with patient with patient or not, previous ICU experiences, and patient's gender and insurance status. This study provides some suggestions for further study, nursing clinical practice, and nursing education

41.   Forrester DA, Murphy PA, Price DM, Monaghan JF. Critical care family needs: nurse-family member confederate pairs. Heart Lung 1990; 19(6):655-661.
Abstract: In this study we explored the relationship between critical care family members' perceived needs and the assessment of these needs by a confederate sample of intensive care unit (ICU) nurses. Family needs were measured by using Molter's revised Critical Care Family Needs Inventory. Data consisted of 92 confederate pairs of Critical Care Family Needs Inventory responses obtained from 92 family members of adult patients hospitalized in a variety of ICUs and 49 ICU nurses providing direct care for these patients. Paired t tests (two tailed) were calculated to detect significant differences between confederate pairs of family members' perceptions and ICU nurses' assessments of the importance of the needs studied. Family members' perceptions and ICU nurses' assessments of the most and least important critical care family needs were identified. Significant (p less than 0.001 to p less than 0.05) differences were detected between confederate pairs of family members' perceptions and ICU nurses' assessments of the importance of 15 (50%) of the critical care family needs studied. Therefore, it appears that these nurses were only moderately accurate in their assessments of critical care family needs. Implications for nursing practice, education, and research were identified and discussed

42.   Foss KR, Tenholder MF. Expectations and needs of persons with family members in an intensive care unit as opposed to a general ward. South Med J 1993; 86(4):380-384.
Abstract: The positive effect of family support on the outcome from serious illness that requires intensive care has been recognized by clinicians for decades. We have all seen that family visitation and an intensive care environment more similar to that of a general ward (sunlight, radio, television) can benefit patients with psychosis related to intensive care. The severity of illness of the individual patient exerts a powerful stress on the family unit, but it has been difficult to measure this effect. We used a 40-question family needs survey with a degree of importance scale to compare the intensive care unit (ICU) with the general ward in terms of impact on the family. Five needs were found to discriminate these two environments. The family members of patients in an ICU considered it very important (1) for staff to give directions on what to do at the bedside, (2) to receive more support from their own family unit, (3) to have a place to be alone as a family unit in the hospital, (4) to be informed in advance of any transfer plan, and (5) to have flexibility in the time allowed for visitation. Family members are willing to accept decreased visitation time if the physicians and nurses can equate this decrease with the complexity of care in the ICU. The results of this survey have helped us modify and individualize our approach based on family expectations especially when patients are transferred from the general ward to the ICU or from the ICU to the ward

43.   Freichels TA. Needs of family members of patients in the intensive care unit over time. Crit Care Nurs Q 1991; 14(3):16-29.

44.   Fuller BF, Foster GM. The effects of family/friend visits vs. staff interaction on stress/arousal of surgical intensive care patients. Heart Lung 1982; 11(5):457-463.

45.   García Aguilar, José Francisco Cámara Hurtado, Francisco Aparicio Ezcurra, A y Cases López, Luis Manuel. Comunicación e información a los familiares en las unidades de cuidados intensivos. Enferm Clínica. 5(3):99-104.

46.   Gretebeck RJ, Shaffer D, Bishop-Kurylo D. Clinical pathways for family-oriented developmental care in the intensive care nursery. J Perinat Neonatal Nurs 1998; 12(1):70-80.
Abstract: The physiologic and neurodevelopmental benefits of developmentally sensitive nursing care for high-risk infants have been well documented. The remaining challenge is to find ways to introduce developmental care principles into busy intensive care nurseries. The article discusses the development of three clinical pathways designed around five areas for developmental intervention: environmental organization, structuring of nursing care, feeding, family involvement, and family education. Each pathway incorporated developmental principles appropriate for a different level of care; the level III pathway was designed for acutely ill or very premature infants, the level II pathway for infants recovering from acute illness or older premature infants, and the level I pathway for full-term infants. Introduction of the developmental care pathways had an immediate positive impact in the tertiary level intensive care nursery at Allegheny General Hospital

47.   Hammond F. Involving families in care within the intensive care environment: a descriptive survey. Intensive & Critical Care Nursing 1995; 11(5):256-264.
Abstract: A descriptive survey design was utilised within a general intensive care environment, to describe the attitudes of nurses and relatives towards the provision of care by relatives to their critically ill loved one. Triangulation was employed utilising a questionnaire comprising a Likert scale, a checklist of participatory care activities, open questions and biographical questions. The total nurse population of the intensive care unit (ICU) was surveyed. 27 questionnaires were returned (a response rate of 75%). Of a possible 45 relatives surveyed, 20 returned questionnaires (a response rate of 44.4%). A high proportion of both the nurse and the relative samples (96.3% and 85% respectively) indicated their agreement with the concept of involving relatives in the physical care of their critically ill loved one. The results highlighted issues of personal choice for individual lay involvement and adequate information for families to become involved. For the nurse sample the major themes emergent were the problems of role adaptation for nurses and families involved, and building relationships. For the relative sample the categories emergent were adapting to the demanding ICU environment and identifying the parameters of their new caring role. The study suggests benefits, to both nurses and relatives, of lay participation in physical care of critically ill patients on the ICU environment

48.   Harrington L. An evaluation of validity, reliability, and readability of the Critical Care Family Needs Inventory. Heart Lung 1992; 21(2):199-200.

49.   Harvey MA. Evolving toward--but not to--meeting family needs. Crit Care Med 1998; 26(2):206-207.

50.   Henneman EA, Cardin S. Family-centered critical care: a practical approach to making it happen. Crit Care Nurse 2002; 22(6):12-19.

51.   Heyland DK, Tranmer JE. Measuring family satisfaction with care in the intensive care unit: the development of a questionnaire and preliminary results. J Crit Care 2001; 16(4):142-149.
Abstract: PURPOSE: To develop and test the feasibility of administering a questionnaire to measure family members' level of satisfaction with care provided to them and their critically ill relative. MATERIALS AND METHODS: To develop the questionnaire, existing conceptual frameworks of patient satisfaction, decision making, and quality of end-of-life care were used to identify important domains and items. We pretested the questionnaire for readability, clarity, and sensibility in 21 family members and 16 professionals. To assess validity, we measured the correlation between satisfaction with overall care and satisfaction with decision making. To assess the reliability of the questionnaire, we administered the questionnaire to next of kin of surviving patients on discharge and 7 to 10 days later. RESULTS: Questionnaires were mailed out to 33 family members of nonsurvivors; 24 were returned completed but only 22 (66%) were usable.Twenty-five family members of eligible surviving critically ill patients participated in the test-retest part of this study. Of the 47 respondents, 84% were very satisfied with overall care and 77% were very satisfied with their role in the decision making.There was good correlation between satisfaction with overall care and satisfaction with decision making (correlation coefficient =.64). The assessment of overall satisfaction with care was shown to be reliable (correlation coefficient =.85). CONCLUSIONS: This questionnaire has some measure of reliability and validity and is feasible to administer to next of kin of critically ill patients

52.   Heyland DK, Rocker GM, Dodek PM, Kutsogiannis DJ, Konopad E, Cook DJ et al. Family satisfaction with care in the intensive care unit: results of a multiple center study. Crit Care Med 2002; 30(7):1413-1418.
Abstract: OBJECTIVE: To determine the level of satisfaction of family members with the care that they and their critically ill relative received. DESIGN: Prospective cohort study. SETTING: Six university-affiliated intensive care units across Canada . METHODS: We administered a validated questionnaire to family members who made at least one visit to intensive care unit patients who received mechanical ventilation for >48 hrs. We obtained self-rated levels of satisfaction with 25 key aspects of care related to the overall intensive care unit experience, communication, and decision making. For family members of survivors, the questionnaire was administered while the patient was still in the hospital. For family members of nonsurvivors, the questionnaire was mailed out to the family member 3-4 wks after the patient's death. MAIN RESULTS: A total of 891 family members received questionnaires; 624 were returned (70% response rate). The majority of respondents were satisfied with overall care and with overall decision making (mean +/- sd item score, 84.3 +/- 15.7 and 75.9 +/- 26.4, respectively). Families reported the greatest satisfaction with nursing skill and competence (92.4 +/- 14.0), the compassion and respect given to the patient (91.8 +/- 15.4), and pain management (89.1 +/- 16.7). They were least satisfied with the waiting room atmosphere (65.0 +/- 30.6) and frequency of physician communication (70.7 +/- 29.0). The variables significantly associated with overall satisfaction in a regression analysis were completeness of information received, respect and compassion shown to the patient and family member, and the amount of health care received. Satisfaction varied significantly across sites. CONCLUSIONS: Most family members were highly satisfied with the care provided to them and their critically ill relative in the intensive care unit. Efforts to improve the nature of interactions and communication with families are likely to lead to improvements in satisfaction

53.   Higgins I, Cadd A. The needs of relatives of the hospitalised elderly and nurses' perceptions of those needs. Geriaction 1999; 17(2):18-22.
Abstract: This paper presents the findings of a study designed to explore the needs of the relatives of elderly people hospitalised for acute care and nurses' perceptions of the relatives' needs. The first phase of this study, presented previously in this journal, explored the experiences of elderly people during acute hospitalisation (Higgins, Fiveash, Parker, Lay, Wamsley, Nancarrow and Henderson, 1997). The findings of the Higgins et al. study highlighted the important role played by the relatives of elderly people during acute hospitalisation and the need to consider their needs. In this study, the Critical Care Family Needs Inventory (CCFNI, Molter, 1979) was used to determine the needs of the relatives of elderly patients as perceived by both nurses and the relatives themselves. The CCFNI has proven validity and reliability in the critical care context, however it has not been used with other populations in the acute hospital setting. Findings from this study showed that information and communication were important needs perceived by both groups, however, nurses underestimated the extent of information required by relatives. Findings also highlighted significant differences related to other needs including the need for support and amenities

54.   Hodovanic BH, Reardon D, Reese W, Hedges B. Family crisis intervention program in the medical intensive care unit. Heart Lung 1984; 13(3):243-249.

55.   Holden J, Harrison L, Johnson M. Families, nurses and intensive care patients: a review of the literature. J Clin Nurs 2002; 11(2):140-148.
Abstract: 1. Nurses striving to give holistic care to provide quality care for their patients, need to recognize the importance of caring for patients' families. 2. A detailed review of the literature examining the relationships between nurses and intensive care patients' families was undertaken to examine its strengths and weaknesses as a basis for further study. 3. Studies show that although nurses are often in the best position to meet families' needs, their needs are not always met. 4. The building of good relationships with families is essential for nurses, and yet evidence shows that some nurses have difficulties in this area. 5. Good practice is identified and obstacles nurses face in forming relationships with families are explored. 6. Strategies for improving the interaction process between intensive care nurses and patients' families are systematically evaluated

56.   Hupcey JE. Establishing the nurse-family relationship in the intensive care unit. West J Nurs Res 1998; 20(2):180-194.
Abstract: The nurse-family relationship in the intensive care unit (ICU) may replace the traditional nurse-patient relationship due to the patient's compromised state. As a result, the nurse-family relationship becomes extremely important. Nurses and families may develop a relationship in which they work together to benefit the patient, or an inadequate relationship may develop. In this study, strategies used by nurses and families to either develop or inhibit the development of the nurse-family relationship were identified. Using unstructured interviews with ICU nurses and family members of ICU patients, categories of strategies were identified and behaviors described. Nurses and families perceived that they each displayed only positive behaviors yet identified inhibiting behaviors of the other. Once the behaviors were shown to nurses as secondary informants, they were able to identify with their negative behaviors. An understanding of these strategies will help nurses to reevaluate their practice and enhance their understanding of the behaviors of family members

57.   Jacono J, Hicks G, Antonioni C, O'Brien K, Rasi M. Comparison of perceived needs of family members between registered nurses and family members of critically ill patients in intensive care and neonatal intensive care units. Heart Lung 1990; 19(1):72-78.
Abstract: Using the Norris and Grove (1986) questionnaire of perceived needs of families of critically ill patients, 11 registered nurses working in the neonatal intensive care unit and 19 registered nurses working in the intensive care unit of two mid-northern community hospitals provided their perceptions of family needs. Their responses were compared with responses of family members of patients in the intensive care unit (n = 25) and the (n = 24). Results suggest that regardless of unit, registered nurses' perceptions of family needs are congruent. Family members collectively and by unit ranked their needs consistently higher and in some areas differently than did the registered nurses

58.   Jamerson PA, Scheibmeir M, Bott MJ, Crighton F, Hinton RH, Cobb AK. The experiences of families with a relative in the intensive care unit. Heart Lung 1996; 25(6):467-474.
Abstract: OBJECTIVE: To describe the experiences of families with a relative in the intensive care unit (ICU). DESIGN: Retrospective, descriptive, and qualitative. SETTING: The surgical-trauma ICU in a midwestern university-affiliated tertiary medical center. PARTICIPANTS: Eighteen women and 2 men with relatives in a surgical trauma ICU. OUTCOME MEASURES: Focus group and individual unstructured interviews. RESULTS: A group interpretive process was used to code, categorize, and identify themes found in the transcribed interviews. Four categories of experiences were identified: hovering, information seeking, tracking, and the garnering of resources. Hovering is an initial sense of confusion, stress, and uncertainty. Information seeking is a tactic used both to move out of the hovering state and to identify the patient's progress. Tracking is the process of observing, analyzing, and evaluating patient care and status and the family's own satisfaction with the environment and with care givers. The garnering of resources is the act of acquiring what family members perceive as needed for themselves or their relative. CONCLUSIONS: Families experience a sense of uncertainty that is eventually resolved by seeking information and resources. Health care professionals can minimize the stress associated with hospitalization of relatives in the ICU by anticipating and addressing the family's needs for information and resources

59.   Johnson D, Wilson M, Cavanaugh B, Bryden C, Gudmundson D, Moodley O. Measuring the ability to meet family needs in an intensive care unit. Crit Care Med 1998; 26(2):266-271.
Abstract: OBJECTIVE: To measure the ability to meet family needs in an intensive care unit (ICU). DESIGN: Descriptive survey. SETTING: University hospital ICU. SUBJECTS: Ninety-nine next of kin respondents and 16 secondary family respondents were recruited. INTERVENTIONS: A modified Society of Critical Care Medicine Family Needs Assessment instrument was used. MEASUREMENTS AND MAIN RESULTS: Demographic variables included patient age, gender, diagnosis, Acute Physiology and Chronic Health Evaluation (APACHE) II score on admission, Therapeutic Intervention Scoring System (TISS) score on the date of interview, cumulative TISS of the ICU on the day of interview, number of patients in the ICU at time of interview, nurse/patient ratio for the patient, average nurse/patient ratio of the entire unit, day of the week of the interview, timing of the interview, number of ICU attending physicians who cared for this patient (scheduled for a period of seven consecutive days), number of nurses who cared for the patient, if a nurse was assigned the same patient on two consecutive days worked, length of stay in the ICU, and length of hospital stay. Demographic information concerning the family member included gender, age, commuting time to the hospital, visiting time in the hospital per day, number in family group, relationship to the patient, ethnic background, and education level. The additive score of all questions in the needs assessment instrument was calculated and used as the dependent variable. The independent variables were demographic information concerning patients, ICU, and respondents. The model coefficient of determination (R2adj) was 0.20 with a p = .0079. Greater family dissatisfaction (i.e., higher score) was present if there were more than two ICU attendings per patient (p = .048), or if the same nurse was not assigned on two consecutive days (p = .044). Family satisfaction increased if the respondent was female (p = .006), if the patient had a higher APACHE II score (p = .007), and if the patient's relationship with the most significant family member was brother/sister (p = .012). The family needs instrument was reliable and demonstrated a high degree of concordance with a second respondent in the same family surveyed. CONCLUSIONS: Communication by the same provider was important when measuring the ability of an ICU to meet family needs. Instrument scores and the ability to meet family needs differed depending on the gender and the relationship to the patient of the most significant family member. We speculate that this instrument may be a useful adjunct in assessing quality of critical care services provided

60.   Johnstone M. Children visiting members of their family receiving treatment in ICUs: a literature review. Intensive & Critical Care Nursing 1994; 10(4):289-292.
Abstract: Occasionally people ask if children can visit members of their family who are patients in our intensive care unit (ICU). To allow us to devise a unit policy based on research, the author felt it necessary to review literature concerning child visitors to ICUs, more specifically the reasons why they should or should not be allowed to visit. Unfortunately very little has been written about the effects of visits to ICU on children; so it was felt that it would be beneficial to review the literature concerning child visitors to wards other than ICUs, as well, and also review the reasons behind hospital visiting policies for adults. The literature reviewed suggested that no reasons have been found not to allow children to visit but that advice should be given to the parents allowing them to come to the final decision. If the parents then decide to allow the child to visit, further support for all the family should be given

61.   Kelly S, Walser-Vonlanthen L. [The family and intensive care]. Krankenpfl Soins Infirm 1995; 88(3):52-58.

62.   Kleinpell RM, Powers MJ. Needs of family members of intensive care unit patients. Appl Nurs Res 1992; 5(1):2-8.
Abstract: To identify important needs of families of critically ill patients, and the degree to which these needs were being met, 64 family members and 58 nurses were asked to complete a modified version of the Critical Care Family Needs Inventory (Molter & Leske, 1983). Family members and nurses identified many similar important needs, such as the need to have questions answered honestly, the need to be called at home about changes in the patient's condition, and the need to know why things were done for the patient. However, family members indicated that some needs were both more important and less satisfactorily met than the nurses perceived: the need to know the occupational identity of staff members, directions as to what to do at the patient's bedside, and having friends for support

63.   Koller PA. Family needs and coping strategies during illness crisis. AACN Clin Issues Crit Care Nurs 1991; 2(2):338-345.
Abstract: This descriptive study was conducted to explore family needs and coping behaviors when faced with the stress of a family member's critical illness. Family systems, crisis, and coping theories provided the conceptual frameworks for this study. A convenience sample of 30 family members of 22 critically ill patients completed the Critical Care Family Needs Inventory and the Jalowiec Coping Scale and responded to a seven-item semi-structured questionnaire. The need to know the patient's prognosis was identified as most important on the basis of item mean scores. The top ten identified needs centered around the need for assurance, information, and proximity. Hope was the most frequently used method of coping. Seven of the top ten coping methods most frequently used were also identified by family members as being most effective. Coping styles labeled confronting and optimistic were found to be most useful and effective overall. Nursing interventions described by family members as helpful included: the provision of information, emotional support, and competence and manner of the nurse

64.   Kosco M, Warren NA. Critical care nurses' perceptions of family needs as met. Critical Care Nursing Quarterly 2000; 23(2):60-72.
Abstract: In this descriptive, exploratory study, nurses' perceptions of family needs as met during the critical care experiences of an adult member were correlated to the families' perception of those same needs as being met. The population consisted of 45 family members in a large county hospital designated as a Level 3 trauma center. Family members of adult patients and registered nurses who were assigned to care for them completed a three-part instrument, which consisted of the Demographics Data Questionnaire, the Critical Care Family Needs Inventory (CCFNI), and the Needs Met Inventory (NMI). Data were analyzed using descriptive and inferential statistics. The top 10 needs perceived by the family members and registered nurses were reported in order of importance during the first 18-24 hours on the CCFNI and NMI. Data were analyzed on all 45 need statements to determine the top 10 needs perceived as important on the CCFNI and perceived as being met on the NMI. A one-way analysis of variance (ANOVA) test was performed op the data and yielded significant differences on three of the items. Linear regression was performed using t test which supported a significant difference on five statements based on critical care nursing years of experiences in critical care. Self-reported or open-ended comments from the family members and nurses were presented. Copyright (C) 2000 by Aspen Publishers, Inc

65.   Krozen, Charles F. Ayude a la familia del paciente ingresado en una UCI. Nursing. 9(9):18-22.

66.   Krumberger JM. Linking critical care family research to quality assurance. AACN Clin Issues Crit Care Nurs 1991; 2(2):321-328.
Abstract: The Joint Commission on Accreditation of Health Care Organizations standards require the inclusion of all major clinical functions performed by nurses in the nursing quality assurance (QA) program. To achieve this goal, nurses must first define the scope of care, which includes articulating the specific activities performed in the critical care unit, who provides the care, where and when nursing care is provided, and to whom nursing care is provided. Interventions directed toward families are recognized as falling within the scope of nursing practice. This article addresses how family research was used to develop a QA tool to evaluate family satisfaction with nursing interventions to meet their identified needs in an intensive care unit setting

67.   Labiano, J Huarte Carrión C Ruiz San Pedro, E y Asiain, MC. Problemática de los familiares de pacientes ingresados en UCI. Rev ROL Enferm. Año X(102):19-22.

68.   Lantz I, Severinsson E. The influence of focus group-oriented supervision on intensive care nurses' reflections on family members' needs. Intensive Crit Care Nurs 2001; 17(3):128-137.
Abstract: The aim of this study was to explore intensive care nurses' experiences of focus group-oriented supervision with particular reference to family members' needs. In addition, the aim was to focus on the intensive care nurses' perceived change in their insight into caring for patients and family members in an intensive care unit. Four themes were constructed: increased perception of and response to the family members' needs; increased self-insight related to the therapeutic use of oneself in the relationship with patients and their family members; nurses' reflection on factors that increased their competence; and increased creativity. In conclusion, focus group-oriented supervision increased the intensive care nurses' understanding of their role. This has consequences not only for the family members but also for the teamwork in the intensive care unit, where this type of work is common

69.   Lee IY, Chien WT, MacKenzie AE. Needs of families with a relative in a critical care unit in Hong Kong . J Clin Nurs 2000; 9(1):46-54.
Abstract: The aim of this study is to explore family members' perceptions of their immediate needs following admission of a relative to a critical care unit in Hong Kong . A convenience sample of 30 family members was drawn from those available during the first 96 hours of hospitalization of their relative. Self-reported questionnaires, consisting of a demographic data sheet, a modified Chinese version of the 45-item Critical Care Family Needs Inventory (CCFNI) and semistructured interviews, are the instruments used to examine family members' perceptions of need importance and to ascertain whether or not these needs are met. Doctors and nurses are identified as the most suitable people to meet most immediate family needs. Conclusions are drawn as to the best focus of nursing interventions in order to provide quality care to patients and families

70.   Leith BA. Patients' and family members' perceptions of transfer from intensive care. Heart Lung 1999; 28(3):210-218.
Abstract: OBJECTIVE: To describe patients' and family members' perceptions of transfer from an intensive care unit (ICU). DESIGN: Qualitative component of a descriptive, cross-sectional survey. SETTING: Two university-affiliated tertiary care centres in western Canada . PARTICIPANTS: Fifty-three patients and 35 family members who had been transferred from a medical ICU within the previous 48 hours. MEASURES: Content analysis of responses to 3 open-ended questions relating to transfer from the ICU. RESULTS: Patients and family members had 3 major responses of transfer from the ICU: positive, neutral or ambivalent, and negative. Although some patients and family members perceived the transfer from the ICU as a sign of progress, many individuals expressed concern about the sudden and dramatic change in the level of care after transfer. CONCLUSION: Patients and family members perceived the transfer from the ICU as a significant and sometimes negative event

71.   Leske JS. Selected psychometric properties of the critical care family needs inventory. THE UNIVERSITY OF WISCONSIN - MILWAUKEE ** PH D(129 p) 1988).
Abstract: The Critical Care Family Needs Inventory (1983) was developed for family assessment and self-report of specific needs. The instrument lists 45 need statements to be rated on a scale of 1-4 to indicate degree of importance. Although the instrument has been used widely as a research tool, its psychometric properties have not been determined adequately. Various classifications of family needs during critical illness have been proposed by researchers who have used the instrument. Therefore, exploratory stepwise factor analysis was indicated to examine the underlying dimensions of the items on the Critical Care Family Needs Inventory. A methodological study was conducted to evaluate construct validity and internal consistency reliability of the tool. Family need data on 677 subjects, collected by 21 nurse investigators, in 14 states, over a period of nine years (1980-1988) were used as an aggregate data base. Item analysis was conducted on the tool to identify those items which contribute most to the homogeneity of the measure. Forty-three items on the Critical Care Family Needs Inventory had item-total correlations between 25 and 60 indicating they were relatively homogeneous. No items were eliminated due to redundancy or lack of homogeneity with the construct. The internal consistency alpha coefficient was.92. Factor analysis was used to investigate the construct validity of the instrument. Principal components factor analysis with varimax rotation resulted in a five factor solution as determined by eigenvalues greater than one, lack of trivial factors, scree plot, magnitude of residuals, simple structure, and conceptual clarity. All 45 items had a significant loading (>.30) on one of the five factors. Interpretation and labeling of factors were done by nurse experts. The five dimensions of the Critical Care Family Needs Inventory were labeled as needs for support, comfort, information, proximity, and assurance. The results of the factor analysis suggested that the factors underlying the instrument were relatively distinct dimensions, yet the item-total correlations indicated that all the items related to the overall construct of family needs during critical illness. Sufficient psychometric properties warrant use of the tool in research and clinical practice. (Scientific symbols modified where possible in accordance with CINAHL policy.)

72.   Leske JS. Needs of relatives of critically ill patients: A follow-up. Heart Lung 1986; 15(2).

73.   Leske JS. Internal psychometric properties of the Critical Care Family Needs Inventory. Heart Lung 1991; 20(3):236-244.
Abstract: The aim of this investigation was to examine the internal consistency reliability and construct validity of the Critical Care Family Needs Inventory (CCFNI). Family need data on 677 subjects, collected by 21 nurse investigators in 14 states over a period of 9 years (1980-1988), were used as an aggregate data base. The internal consistency alpha coefficient of the total CCFNI was 0.92. Principal components factor analysis with varimax rotation resulted in a five-factor solution as determined by eigenvalues greater than one, scree plot, magnitude of residuals, simple structure convergence, item loadings, and conceptual clarity. The five dimensions of the CCFNI were labeled as needs for support, comfort, information, proximity, and assurance. Sufficient psychometric properties warrant continuing use of the tool in research and clinical practice

74.   Leske JS. Comparison ratings of need importance after critical illness from family members with varied demographic characteristics. Crit Care Nurse 1992; 4(4):607-613.
Abstract: Estudio descriptivo multicéntrico en el que teniendo en cuenta las siguientes variables con respecto al miembro familiar entrevistado( edad, genero, relación con el paciente, experiencias previas en UCI, diagnostico medico) durante un periodo de diez años destaca las siguientes necesidades como fundamentales:  Soporte, confort, información, proximidad y seguridad.

75.   Lopez-Fagin L. Critical Care Family Needs Inventory: a cognitive research utilization approach. Crit Care Nurse 1995; 15(4):21, 23-21, 26.

76.   Macey BA, Bouman CC. An evaluation of validity, reliability, and readability of the Critical Care Family Needs Inventory.[comment]. Heart & Lung: Journal of Acute & Critical Care 1991; 20(4):398-403.
Abstract: The benefits of caring for the family as well as the patient are well supported in the literature. The Critical Care Family Needs Inventory (CCFNI) has been used by several researchers to identify the needs of family members when a relative is admitted to a critical care setting. However, no research to date has comprehensively evaluated the instrument's content validity, test--retest reliability, or readability. The CCFNI, after review by a panel of 16 experts, was given on two separate occasions to a random sample of 51 family members of adult patients in both medical and surgical intensive care units. Overall content validity was established, but the panel found numerous redundancies among the need statements, suggesting that several items might need to be eliminated or combined. Among family members, a percentage of exact agreement of 70% or greater was calculated for 86.7% of the need statements demonstrating acceptable test--retest reliability. The Gunning Fog Index, used to evaluate readability, was calculated at 9.0, indicating that the CCFNI could be read and understood by those with a ninth grade reading level. Suggestions are made for additional studies to establish the reliability and validity of this widely used instrument

77.   Macey BA, Bouman CC. An evaluation of validity, reliability, and readability of the Critical Care Family Needs Inventory. Heart Lung 1991; 20(4):398-403.
Abstract: The benefits of caring for the family as well as the patient are well supported in the literature. The Critical Care Family Needs Inventory (CCFNI) has been used by several researchers to identify the needs of family members when a relative is admitted to a critical care setting. However, no research to date has comprehensively evaluated the instrument's content validity, test--retest reliability, or readability. The CCFNI, after review by a panel of 16 experts, was given on two separate occasions to a random sample of 51 family members of adult patients in both medical and surgical intensive care units. Overall content validity was established, but the panel found numerous redundancies among the need statements, suggesting that several items might need to be eliminated or combined. Among family members, a percentage of exact agreement of 70% or greater was calculated for 86.7% of the need statements demonstrating acceptable test--retest reliability. The Gunning Fog Index, used to evaluate readability, was calculated at 9.0, indicating that the CCFNI could be read and understood by those with a ninth grade reading level. Suggestions are made for additional studies to establish the reliability and validity of this widely used instrument

78.   Malacrida R, Bettelini CM, Degrate A, Martinez M, Badia F, Piazza J et al. Reasons for dissatisfaction: a survey of relatives of intensive care patients who died. Crit Care Med 1998; 26(7):1187-1193.
Abstract: OBJECTIVE: To describe the reasons for eventual dissatisfaction among the families of patients who died in the intensive care unit (ICU), regarding both the assistance offered during the patient's stay in the hospital and the information received from the medical staff. DESIGN: Cross-sectional descriptive study, which was conducted after a survey using a questionnaire. SETTING: Interdisciplinary ICU (n = 8 beds) at San Giovanni Hospital in Bellinzona (CH). SUBJECTS: Three-hundred ninety families of patients who died in the ICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A postal questionnaire (n = 43 questions) was sent to the families of 390 patients who died in the ICU during 8 yrs (1981 to 1989). The results referred to 123 replies: a) 82.6% of the respondents expressed no criticism of the patient's hospital stay; b) 90% considered the patient's treatment was adequate; c) 17% felt that the information received concerning diagnosis was insufficient or unclear; and d) 30% (particularly close relatives and those relatives who were informed of the death by telephone and not in person) expressed dissatisfaction regarding the information received on the cause of death. CONCLUSIONS: Our survey found that the relatives of patients who died were most dissatisfied with the care received according to: a) the type of death (e.g., sudden death vs. death preceded by a gradual deterioration in the patient's condition); and b) the manner in which the relatives were notified of the death (in person vs. by telephone). The personal characteristics of the people interviewed, such as gender and the closeness of their relationship to the deceased, also seem to have some bearing on the opinions expressed. A high percentage of respondents were satisfied with the treatment received by their dying relative and the information conveyed by caregivers. Nevertheless, the dissatisfaction expressed by some respondents indicates a need for improvement, especially in communicating information to the relatives of these patients

79.   Marco LL, Bermejillo E, I, Garayalde Fernandez dP, Sarrate A, I, Margall Coscojuela MA, Asiain Erro MC. [Opinions and attitudes of intensive care nurses on the effect of open visits on patients, family members, and nurses]. Enferm Intensiva 2000; 11(3):107-117.
Abstract: The policy of family visits to patients admitted to the intensive care unit has been liberalized in recent years. This change has been progressive in our unit and family members now spend long periods of time with patients. An analysis was made of the beliefs, opinions and attitudes of nurses toward family visits and the relation between the beliefs of nurses and their attitude toward the effect of an open visiting policy on patients, family members and nurses. A descriptive correlation study was carried out in the Polyvalent Intensive Care Unit. The sample included 46 nurses who completed a self-administered, anonymous questionnaire. This questionnaire contained a Likert type scale analyzing the opinions of nurses regarding the effect of visits and a differential semantic scale analyzing nurses' attitudes toward visits by family members. The opinion that visits had a positive effect achieved a mean value of 3.001 on a scale with a maximum value of 4. The score obtained on the scale of attitudes toward an open visiting policy was 6.005, with a maximum value of 7. The correlation between opinions and attitudes was significant and positive (r = 0.523, p > 0.0001). Comparison of sociodemographic and other variables disclosed no statistically significant differences, except for the variables attitude and having children (t = -2.254, p = 0.03), which obtained a higher score. It is concluded that the opinions of nurses regarding the positive effect of open visits depended on their attitudes. For the most part, they were satisfied with the current visiting policy

80.   Margall, MA Zazpe, C Perochena, P Labiano, J Otano, C y Asiain, MC. Necesidades de los familiares de pacientes ingresados en cuidados intensivos. Enferm Intensiva. 4(2):40-46.

81.   Marsden C. Family-centered critical care: an option or obligation? Am J Crit Care 1992; 1(3):115-117.
Abstract: The patient was dying after undergoing aggressive treatment for a malignancy. Patient and family wanted "everything" to be done and the patient was transferred to the ICU for treatment of acute respiratory failure. The next day the patient's condition deteriorated further. The family decided against chest compressions or defibrillation; however, other aggressive treatment was continued. A "chemical code" was initiated and the patient was ventilated. The family was informed. As they stood in the hall outside the unit, the patient's wife asked if she could be with her husband. A nurse explained what she would see and accompanied her to the bedside. She stood at the head of the bed, stroked her husband's head and spoke softly in his ear. The patient's son came to the bedside and said his last words to his father. The wife was present when treatment was stopped and the patient was pronounced dead. She said to the nurse who had accompanied her, "You have given me the greatest gift possible--you allowed me to be with my husband at the end."

82.   McDonnell M. Reflecting on the knowledge used when caring for an intensive care patient and his/her family. Nurs Crit Care 1997; 2(1):38-42.
Abstract: Carper's four ways of knowing are used to structure a reflection on the knowledge used by an associate nurse in intensive care when caring for her patient, his wife and son. John, the patient, had previously undergone a sex change operation as well as cardiac surgery. His current period in intensive care was due to pancreatitis and involved numerous returns to theatre. He eventually died following multi-organ failure. The reflection focuses on the associate nurse's feelings when trying to act as an advocate for both John and his wife at the time of the patient's pending death

83.   McIvor D, Thompson FJ. The self-perceived needs of family members with a relative in the intensive care unit (ICU). Intensive Care Nurs 1988; 4(4):139-145.

84.   Mendonca D, Warren NA. Perceived and unmet needs of critical care family members. Critical Care Nursing Quarterly 1998; 21(1):58-67.
Abstract: Family members of patients in the intensive care unit (ICU) may experience stress, disorganization, and helplessness which may ultimately result in difficulty in mobilizing appropriate coping resources, thus leading to anxiety. The needs of family members are varied, and critical care nurses must become attuned to these needs and acquire the skills to direct their interventions more appropriately. This article presents the findings from a study that assessed the perceived level of importance of the needs of family members during the first 18 to 24 hours after admission to the ICU using the Critical Care Family Needs Inventory. The study identified which needs were perceived as being met or unmet by the family members using the Needs Met Inventory after 36 to 48 hours had elapsed. Copyright (c) 1998 by Aspen Publishers, Inc

85.   Mendyka BE. The dying patient in the intensive care unit: assisting the family in crisis. AACN Clin Issues Crit Care Nurs 1993; 4(3):550-557.
Abstract: Critically ill patients belong to larger phenomenologic systems, their families. What affects one member affects other system members. Nursing care requires meticulous observation and assessment of family concerns, understanding of clinical events, and practical experience to achieve positive outcomes even if a death occurs. It seems easy to dismiss the family from the clinical and technical matters of the critical care unit, especially when much nursing energy goes into operating peripheral machinery, performing tasks, and pursuing ever-changing patient-centered goals. The following case study attempts to redefine and redirect the focus of what "patient-centered" means to include the nurse, the patient, and the family in the meaning of the core of family-centered care

86.   Mi-kuen T, French P, Kai-kwong L. The needs of the family of critically ill neurosurgical patients: a comparison of nurses' and family members' perceptions. Journal of Neuroscience Nursing 1999; 31(6):348-356.
Abstract: In this study, researchers identified the important needs of family members of critically ill neurosurgical patients and explored the relationship between needs and unmet needs as perceived by nurses and family members. A total of 52 family members and 36 nurses in three neurosurgical special care units in Hong Kong were asked to complete the Chinese version of the 45-item Critical Care Family Needs Inventory. The rank order of most important needs reported by family members indicates that the majority of needs are related to assurance; needs for support and comfort were much less important. When rating needs, nurses underrated most of the needs considered important by family members. Needs for proximity were also underrated in importance by nurses when compared to family ratings, and needs for support were heavily overrated by nurses. The needs for proximity were least met. An inverse relationship between nurses' ratings of importance and the frequency of unmet needs was demonstrated. The most important need that was also largely unmet was having a specific person call when unable to visit. The findings of this study indicate areas of unmet need that require additional nursing interventions

87.   Milholland K. Family participation in the care of patients in the intensive care unit. Heart Lung 1978; 7(5):866.

88.   Molter NC. Needs of relatives of critically ill patients: a descriptive study. Heart & Lung 1979; 8(2):332-339.

89.   Molter NC. Family-centered critical care: an interview with Nancy C. Molter, MS, RN, CCRN. Interview by Jane Stover Leske. AACN Clin Issues Crit Care Nurs 1991; 2(2):185-187.

90.   Morales M, Richards E. Family-centered critical care nursing. Focus Crit Care 1985; 12(4):45-51.

91.   Murphy PA, Forrester DA, Price DM, Monaghan JF. Empathy of intensive care nurses and critical care family needs assessment. [Review] [31 refs]. Heart & Lung: Journal of Acute & Critical Care 1992; 21(1):25-30.
Abstract: In this study we explored the relationship between the empathy of intensive care unit (ICU) nurses and their ability to assess accurately the perceived needs of family members of patients hospitalized in ICU settings. Thirty family needs were studied by using Molter's 1983 revision of the Critical Care Family Needs Inventory (CCFNI). Data consisted of 92 pairs of CCFNI responses obtained from 92 family members of ICU patients and 60 ICU nurses providing direct care for these patients. Multiple regression analysis was performed to determine the extent to which empathy and nursing experience contribute to accurate assessment of the needs of ICU family members. The more emphatic ICU nurses were, the greater their ability to assess ICU family members' needs accurately on six of the needs studied (p less than or equal to 0.05). Length of nursing experience negatively affected the nurse's ability to assess three of the ICU family members' needs accurately (p less than 0.05). [References: 31]

92.   Neabel B, Fothergill-Bourbonnais F, Dunning J. Family assessment tools: a review of the literature from 1978-1997. Heart Lung 2000; 29(3):196-209.
Abstract: Traditionally, nursing practice in critical care settings has been focused on recognizing and addressing the needs of the patient with an acute and serious health problem and individual family members. Little progress has been made in understanding how families manage this hospitalization experience; however, family health has been reported to be a significant factor in the patient's recovery. The purpose of this article is to review the literature from 1978 to 1997 that has examined family assessment tools in a variety of clinical settings. The ultimate goal of the review is to determine their usefulness for critical care environments and their congruence with family systems nursing, which is aimed at the cognitive, behavioral, and affective domains of family functioning. The following characteristics are used to review each of the selected instruments: theoretical framework; purpose; description; the unit of analysis; ease of administration and scoring; reading level; psychometric evaluation; and utility to guide clinical practice and research. Although the instruments have a variety of strengths, none of them are congruent with the philosophy of family systems nursing. Therefore instruments need to be developed that would guide assessment and interventions for nurses in critical care settings

93.   Norheim C. Family needs of patients having coronary artery bypass graft surgery during the intraoperative period. Heart Lung 1989; 18(6):622-626.
Abstract: The purpose of this study was to describe the needs of the spouses and relatives of patients having coronary artery bypass graft surgery during the intraoperative period. Data were collected in a 434-bed Midwestern hospital from a convenience sample of 23 spouses and 45 adult relatives of 30 patients having their first coronary artery bypass graft operation. Using the Critical Care Family Needs Inventory, subjects were asked to rate the importance of 45 needs. On the basis of item means, the 21 highest-ranked needs were rated as very important or important by both spouses and relatives. Of these top 21 needs, 14 concerned the need for obtaining information. The highest-ranking need for both groups was to have questions answered honestly. Eight needs were identified as significantly more important to spouses than to relatives. Nurses were viewed as the most helpful group in meeting the family's needs

94.   O'Malley P. Critical care nurses perceptions of family needs. Heart & Lung 1991; 20(2):189-201.

95.   Oehler JM, Vileisis RA. Effect of early sibling visitation in an intensive care nursery. J Dev Behav Pediatr 1990; 11(1):7-12.
Abstract: In an attempt to assess the effects of early sibling visitation in a neonatal intensive care unit, 31 siblings (ages 3-12) of the hospitalized infant were randomly assigned to either a visit group (during first week of neonatal life) or a comparison group who visited only after the study was completed 3 weeks after birth of the neonate. Parents of both groups of siblings completed the Missouri Behavioral Checklist (MBCL) and Family Environment Scale (FES) in the first few days after birth and, again, 3 weeks after birth. All siblings were interviewed 3 weeks after birth of the neonate. Neither group experienced any increase in negative behaviors following the new sibling's birth. In fact, both groups showed some decrease in negative behaviors. In addition, the visitor group showed a significant decrease in negative behaviors on a specific subset of MBCL items. In addition, the visitor group was significantly more well informed about their sibling than the comparison group

96.   Patricia LM. Family stress in the intensive care unit. Crit Care Med 2001; 29(10):2025-2026.

97.   Perez-San Gregorio MA, Blanco-Picabia A, Murillo-Cabezas F, Dominguez-Roldan JM, Sanchez B, Nunez-Roldan A. Psychological problems in the family members of gravely traumatised patients admitted into an intensive care unit. Intensive Care Med 1992; 18(5):278-281.
Abstract: The aim of these studies was the analysis of the psychological repercussions on the closest members of families of 76 gravely traumatised patients admitted into the Intensive Care Unit (ICU) of the Hospital Universitario de Rehabilitacion y Traumatologia "Virgen del Rocio", Sevilla ( Spain ). An investigation based on social information and the Clinical Analysis Questionnaire was used. The sample of family members was composed of 42 women and 34 men, with an average age of 41.3 years (SD +/- 12.8). Results showed that (a) more than 50% of the family members of gravely traumatised patients admitted into an ICU showed symptoms of depression, (b) the women scored more points in hypochondria, suicidal depression, anxious depression, low-energy depression, guilt-resentment, apathy-withdrawal, paranoia, schizophrenia, psychasthenia and psychological disadjustment, and (c) in general terms, the psychological characteristics of the families were far from the norm of the control group

98.   Pirard M, Janne P, Installe E, Reynaert C. [Patient, family, nurses and intensive care unit: review of the literature and state of a practice "in the field"]. Ann Med Psychol (Paris) 1994; 152(9):600-608.
Abstract: An increasing interest in psychological and interactional aspects of intensive care unit stay is found in the recent literature. On one hand, seriousness and acuteness of the pathology, on the other hand, environment specificity as well as their respective consequences result in the fact that the ICU is a peculiar context for the patient and his family. The patient experiences a stressful event which probably differs from the one experienced in other types of wards. The family and its needs during this critical period are the focus of an increasing number of studies. A corresponding occupational stress for the caregivers is now widely acknowledged

99.   Pochard F, Azoulay E, Chevret S, Lemaire F, Hubert P, Canoui P et al. Symptoms of anxiety and depression in family members of intensive care unit patients: ethical hypothesis regarding decision-making capacity. Crit Care Med 2001; 29(10):1893-1897.
Abstract: OBJECTIVE: Anxiety and depression may have a major impact on a person's ability to make decisions. Characterization of symptoms that reflect anxiety and depression in family members visiting intensive care patients should be of major relevance to the ethics of involving family members in decision-making, particularly about end-of-life issues. DESIGN: Prospective multicenter study. SETTING: Forty-three French intensive care units (37 adult and six pediatric); each unit included 15 patients admitted for longer than 2 days. PATIENTS: Six hundred thirty-seven patients and 920 family members. INTERVENTIONS: Intensive care unit characteristics and data on the patient and family members were collected. Family members completed the Hospital Anxiety and Depression Scale to allow evaluation of the prevalence and potential factors associated with symptoms of anxiety and depression. MEASUREMENTS AND MAIN RESULTS: Of 920 Hospital Anxiety and Depression Scale questionnaires that were completed by family members, all items were completed in 836 questionnaires, which formed the basis for this study. The prevalence of symptoms of anxiety and depression in family members was 69.1% and 35.4%, respectively. Symptoms of anxiety or depression were present in 72.7% of family members and 84% of spouses. Factors associated with symptoms of anxiety in a multivariate model included patient-related factors (absence of chronic disease), family-related factors (spouse, female gender, desire for professional psychological help, help being received by general practitioner), and caregiver-related factors (absence of regular physician and nurse meetings, absence of a room used only for meetings with family members). The multivariate model also identified three groups of factors associated with symptoms of depression: patient-related (age), family-related (spouse, female gender, not of French descent), and caregiver-related (no waiting room, perceived contradictions in the information provided by caregivers). CONCLUSIONS: More than two-thirds of family members visiting patients in the intensive care unit suffer from symptoms of anxiety or depression. Involvement of anxious or depressed family members in end-of-life decisions should be carefully discussed

100.                       Potter PA. Stress and the intensive care unit: the family's perception. Mo Nurse 1979; 48(4):5-8.

101.                       Price DM, Forrester DA, Murphy PA, Monaghan JF. Critical care family needs in an urban teaching medical center. Heart & Lung 1991; 20(2):183-188.
Abstract: This is a descriptive study of the relative importance of needs as reported by 213 family members of 114 patients hospitalized in critical care units of a large, urban, teaching, medical center. In this study we used Molter's Critical Care Family Needs Inventory (revised), an instrument that has been used in other similar investigations, but never before in such a large sample or one with similar demographics. In general, the findings were consistent with those in previous studies using the Critical Care Family Needs Inventory. One striking difference was the relatively low ranking accorded by this sample to the need "to feel there was hope." Parents, spouses, siblings, adult children, and "significant others" ranked their needs in strikingly similar ways. Family members of critically ill patients need two things most: to have honest, intelligible, and timely information and to feel assured that their loved one is being cared for by competent and caring people. Clinical, educational, and research implications are identified and briefly discussed

102.                       Quinn S, Redmond K, Begley C. The needs of relative visiting adult critical care units as perceived by relatives and nurses. Part I. Intensive Crit Care Nurs 1996; 12(3):168-172.
Abstract: This was a descriptive study, aimed at identifying the needs of relatives while they were visiting adult critical care units. A convenience sample of 24 critical care units participated, involving 351 critical care nurses and 255 visiting relatives. Using an adaptation of Molter's Critical Care Family Needs Inventory, the objectives of the study were: To compare (in ranking order) relatives' perceptions of how important their needs were with how important critical care nurses perceived them to be. To identify how satisfied relatives were with how their needs were met, while visiting the unit. To compare who relatives perceived to be the most appropriate person to fulfill each of their needs, with who nurses assessed to be the most appropriate person to fulfill the relatives needs. Relatives highlighted the importance of re-assurance and their need for sufficient information about their family member. Critical care nurses were only moderately accurate in assessing how important relatives' needs were, according to the findings from this relatives' group. Relatives were inverted question marksatisfied' with how the majority of their needs had been met. Only 10 of the 30 needs were considered to have been met to inverted question markvery satisfactory' level by at least 60% of the sample group. Nurses were identified by relatives as being the most appropriate person to fulfil 19 out of the 30 needs. Whereas nurses perceived themselves to be the most appropriate people to fulfill 25 of the 30 needs for relatives. The implications for clinical practice are also discussed

103.                       Reider JA. The relationship of family needs satisfaction and family coping strategies to family adjustment during the critical illness of a family member. THE CATHOLIC UNIVERSITY OF AMERICA ** D N SC (237 p) 1989).
Abstract: The purpose of this study was to describe how family needs satisfaction and family coping strategies relate to family adjustment during the critical illness of a family member. A secondary purpose was to describe the effect of selected demographic variables on family adjustment. A correlational design was used and data were collected from 76 family members of critically ill patients during the 48-96 hour period following the patient's admission to the critical care unit. Family needs satisfaction was measured as the percentage of needs identified as met by family members on the Critical Care Family Needs Inventory (CCFNI). The Family Crisis Oriented Personal Evaluation Scales (F-COPES) measured family coping strategies. Family adjustment was measured with the Family Member Wellbeing Index (FWBI) and the Brief Sympton Inventory (BSI). Data were analyzed using Pearson's product moment correlation coefficients, t tests, and analysis of variance. The findings showed that family needs satisfaction was not related to family adjustment. Family coping strategies and two of the subscale strategies, seeking spiritual support and passive appraisal, were positively related to family adjustment. Of 12 demographic variables tested, four were related to family adjustment. Age of the family member and age of the critically ill family member were positively related to family adjustment. Illness of the critically ill family member and unit where care was received were related to family adjustment with trauma and the Trauma Surgical Intensive Care Unit associated with lower levels of family adjustments. Findings suggest that the use of family coping strategies, particularly seeking spiritual support and passive appraisal, is associated with family adjustment during the critical illness of a family member. Age of the family member, age of the critically ill family member, illness of the critically ill family member, and the unit where care was received are associated with family adjustment. Nurses should assess these items when planning intervention with family members of critically ill patients. Replication of this study using a longitudinal design and an instrument designed specifically to measure family adjustment during critical illness of a family member is suggested

104.                       Rosenfield AG. Visiting in the intensive care nursery. Child Dev 1980; 51(3):939-941.
Abstract: Analyses made of the pattern and frequency of visits to the intensive care nursery by mothers of 78 very low birth weight (< 1,500 grams ) infants found initial visiting rates to be low, averaging less than 1 visit per week. Visits increased during the early part of the infant's hospitalization. However, visits of mothers whose infants received an early stimulation program continued to increase until the infant was discharged. Visiting was found to be uncorrelated with medical, socioeconomic, or demographic variables, but was apparently related to the significantly higher state levels exhibited by stimulated infants

105.                       Rubio Rico, Lourdes Aguarón García, María Jesús Ferrater Cubells, María y Toda Salvall, Dolors. Vivir la UCI : Diferentes perspectivas. Cul Cuid. VI(12):55-66. Investigación cualitativa.

106.                       Rukholm E, Bailey P, Coutu-Wakulczyk G, Bailey WB. Needs and anxiety levels in relatives of intensive care unit patients. Journal of Advanced Nursing 1991; 16(8):920-928.
Abstract: The purpose of this study was to explore the perceived needs and anxiety levels of adult family members of intensive care unit (ICU) patients. The study was conducted over a 3-month period, on a convenience sample of 166 subjects selected from the total adult population of family members visiting an ICU patient in three Sudbury hospitals. Data were gathered using a self-report questionnaire, the Critical Care Family Needs Inventory (CCFNI) and Spielberger's State Trait Anxiety Inventory (STAI). Interviews were conducted in French or English according to the subject's preference. The major variables examined were: family needs; state and trait anxiety; on-site sources of worry; spiritual needs; level of knowledge of ICU from past experience or pre-surgery education; sociodemographic data. The Situational Anxiety Scale yielded a mean score of 45.24 and the Trait Anxiety Scale a mean score of 37.3. Inferential statistics demonstrated that family needs and situational anxiety were significantly related (P < 0.0002). Furthermore, worries, trait anxiety, age and family needs explained 38% of the variation of situational anxiety. As well, spiritual needs and situational anxiety explained 33% of the variation of family needs

107.                       Rukholm EE, Bailey PH, Coutu-Wakulczyk G. Anxiety and family needs of the relatives of cardiac medical-surgical ICU patients. Canadian Journal of Cardiovascular Nursing 1992; 2(4):15-22.
Abstract: The purpose of this study was to seek information on the perceived needs of family members visiting a patient in a critical care unit (ICU) of two hospitals located in Sudbury , Ontario . The sample included fifty-one family members visiting cardiovascular surgical patients (CVS) and forty-four family members visiting cardiovascular medicine patients (CVM). The study was part of a larger project conducted on a convenience sample of 166 subjects visiting an ICU patient. Data was gathered using a self-report questionnaire, the Critical Care Family Needs Inventory (CCFNI) (Molter and Leske, 1983), and Spielberger's (1983) State Trait Anxiety Inventory (STAI). Information was also collected about worries, knowledge, spiritual needs and the distance of subjects' residence from the site of hospitalization. The sample for both groups was predominantly female. The State Anxiety Scale of the STAI yielded mean scores for both groups which were significantly higher than those obtained by Spielberger (1983) (CVS: z = -3.28, p less than .0001; CVM: z = -3.41, p less than .0001)

108.                       Rushton CH. Strategies for family-centered care in the critical care setting. Pediatr Nurs 1990; 16(2):195-199.
Abstract: Family-centered care (FCC) for critically ill or injured infants and children must be a priority for nurses and other health care professionals in the 1990s. Eight essential elements of FCC provide the basis for devising strategies for implementing FCC in the critical care setting

109.                       Rushton CH. Family-centered care in the critical care setting: myth or reality? Child Health Care 1990; 19(2):68-78.
Abstract: Family-centered care (FCC) has been upheld as the standard for providing quality health care for children. However, some professionals question its applicability in the critical care setting. Despite the barriers to FCC, ACCH's eight essential elements of FCC can provide the basis for devising strategies for successfully implementing FCC in the critical care setting

110.                       Scott LD. Perceived needs of parents of critically ill children. Journal of the Society of Pediatric Nurses 1998; 3(1):4-12.
Abstract: PURPOSE. To identify the needs of parents of critically ill hospitalized children as perceived by the parents and critical care nurses, and to identify any differences between the two groups. DESIGN. Descriptive, comparative. SETTING. Pediatric intensive care unit (PICU) in a Midwestern hospital. PARTICIPANTS. A nonprobability convenience sample of parents or primary caregivers of critically ill children (n = 21) and pediatric critical care nurses (n = 17). OUTCOME MEASURES. Critical Care Family Needs Inventory modified for pediatrics and demographic questionnaires. RESULTS. Information, assurance, and proximity to the critically ill child were identified as priority needs of the PCGs in this study. Significant differences on specific needs were identified between PCG/nurse matched pairs; however, no significant differences were found in total scores between the two groups by a two-tailed paired t test. CONCLUSIONS. This study supports the need to investigate interventions to better address parental needs of critically ill children. By consistent identification, prioritization, and incorporation of parental needs into the plan of care, nurses can assist the parents in the recognition and fulfillment of needs that have less perceived importance. Research-based interventions will facilitate improved parental adaptation to their child's critical hospitalization

111.                       Smith K, Kupferschmid BJ, Dawson C, Briones TL. A family-centered critical care unit. AACN Clin Issues Crit Care Nurs 1991; 2(2):258-269.
Abstract: Although care of the family has long been a focus of nursing, there has been an increased emphasis in recent years to provide opportunities for families to be an integral part of the hospitalization experience. This has been difficult for many nurses who perceive themselves as competent to care for a patient in "medical crisis" but feel unqualified to provide family care. This article will address issues related to implementing a family-centered philosophy of care in a critical care unit. Implementation strategies that will be discussed include: formulating a staff-led family support group and family committee, instituting a family visitation contract within open visitation parameters, and developing clinicians with expertise in family care. Tools such as a performance plan for a Clinical Nurse II specializing in family care and the family visitation contract will be shared

112.                       Stillwell SB. Importance of visiting needs as perceived by family members of patients in the intensive care unit. Heart Lung 1984; 13(3):238-242.

113.                       Tin MK, French P, Leung KK. The needs of the family of critically ill neurosurgical patients: a comparison of nurses' and family members' perceptions. J Neurosci Nurs 1999; 31(6):348-356.
Abstract: In this study, researchers identified the important needs of family members of critically ill neurosurgical patients and explored the relationship between needs and unmet needs as perceived by nurses and family members. A total of 52 family members and 36 nurses in three neurosurgical special care units in Hong Kong were asked to complete the Chinese version of the 45-item Critical Care Family Needs Inventory. The rank order of most important needs reported by family members indicates that the majority of needs are related to assurance; needs for support and comfort were much less important. When rating needs, nurses underrated most of the needs considered important by family members. Needs for proximity were also underrated in importance by nurses when compared to family ratings, and needs for support were heavily overrated by nurses. The needs for proximity were least met. An inverse relationship between nurses' ratings of importance and the frequency of unmet needs was demonstrated. The most important need that was also largely unmet was having a specific person call when unable to visit. The findings of this study indicate areas of unmet need that require additional nursing interventions

114.                       Tracy MF, Ceronsky C. Creating a collaborative environment to care for complex patients and families. AACN Clin Issues 2001; 12(3):383-400.
Abstract: Today's critical care environment is increasingly complex due to technological advancements, greater intensity of interventions, and a myriad of healthcare providers. Critically ill patients and their families can feel overwhelmed with the stress of the environment in addition to the acute illness. This stress affects the patients' and families' ability to function, cope, and understand complex information. For some families, this experience precipitates distrustful relationships with care providers. The resulting impact on quality of care, staff morale, length of stay, and cost is high. The purpose of this article is to describe issues encountered by one medical center in caring for complex patients and families. A representative case outlines the types of issues the staff in the adult intensive care units faced. Use of a comprehensive problem-solving model to address concerns resulted in structured approaches to guide healthcare providers in caring for complex patients and families. The goal of these approaches was to support all parties involved in the care of complex patients, improve communication, and avoid crises that resulted from distrustful relationships and lack of skill in resolving conflict

115.                       Walters AJ. A hermeneutic study of the experiences of relatives of critically ill patients. J Adv Nurs 1995; 22(5):998-1005.
Abstract: This paper describes a hermeneutic study of experiences of relatives of critically ill patients in the context of a large tertiary referral hospital in Sydney , Australia . The participants were 15 female family members of critically ill patients. Taped conversations between the researcher and participants were conducted and interpreted using Reinharz's hermeneutic method. Two themes emerged from the participants' experiences and are described as 'being-with' and 'seeing'. 'Being-with' focused on the desire of the participants to 'be-with' their relatives, in a physical and emotional sense. The theme 'seeing' highlighted the importance of actually seeing the patient. Ontological concepts relating to the themes are described with reference to Taylor 's concept of being human

116.                       Ward K. Practice applications of research. Perceived needs of parents of critically ill infants in a neonatal intensive care unit (NICU). Pediatric Nursing 2001; 27(3):281-286.
Abstract: Purpose: To identify the perceived needs of parents of infants in a neonatal intensive care unit (NICU). Method: A convenience sample of 52 parents of NICU infants completed the NICU Family Needs Inventory that was modified from the Critical Care Family Needs Inventory (CCFNI). Data were analyzed using descriptive statistics. The differences between mother and father responses were analyzed by ANOVA. Findings: The ten most important and least important need statements were identified. The participants reported assurance and information-related needs as the most important, while support needs were ranked as least important. An ANOVA revealed a significant difference between mother and father responses. Fathers ranked support, information, and assurance needs as significantly less important than mothers did. Conclusions: The findings suggest the need to inform parents of the infants treatment plan and procedures, answer parents' questions honestly, actively listen to parents' fears and expectations, assist parents in understanding infant responses to hospitalization, and other effective nursing interventions to help meet the needs of parents of NICU infants

117.                       Warren NA. Perceived needs of the family members in the critical care waiting room. Critical Care Nursing Quarterly 1993; 16(3):56-63.
Abstract: Family needs during the critical care experience of an adult member was the focus of this descriptive exploratory study conducted with 94 family members. The study describes the perceived needs of family members during the first 18 to 24 hours after admission of a patient to the critical care unit. The article further identifies the order in which the family perceived those needs to be met 36 to 48 hours after admission of that patient. Family members of adult patients completed a three-part instrument, which consisted of the Demographics Data Questionnaire, the Critical Care Family Needs Inventory (CCFNI), and the Needs Met Inventory (NMI). Items with which the family strongly agreed are discussed. The correlation between the CCFNI and the NMI is explicated. Also, the unusual finding of an inverse relationship between education and comfort/support statements is presented

118.                       Wasser T, Matchett S. Final version of the Critical Care Family Satisfaction Survey questionnaire. Crit Care Med 2001; 29(8):1654-1655.

119.                       Wasser T, Pasquale MA, Matchett SC , Bryan Y, Pasquale M. Establishing reliability and validity of the critical care family satisfaction survey. Crit Care Med 2001; 29(1):192-196.
Abstract: OBJECTIVE: To develop and validate the Critical Care Family Satisfaction Survey as a proxy for patient satisfaction. DESIGN: Instrument validation study. SETTING AND TIME FRAME: The Medical Intensive Care, Shock Trauma, Acute Coronary Care, Central Nervous System, Surgical Intensive Care, and Special Care units of Lehigh Valley Hospital (Allentown, PA), for the period December 1997 through September 1998. PATIENTS/PARTICIPANTS: One family member for each of 237 critical care patients. INTERVENTION(S): Content and construct validity were examined on 37 items and 6 constructs thought to measure family satisfaction with the quality of critical care in hospitals. Initially, 14 items and 1 construct were removed from the questionnaire based on this analysis. It was then administered to 237 family members. MEASUREMENTS AND MAIN RESULTS: Factor analysis and confirmatory factor analysis using path models were performed. Internal consistency using Pearson correlations and Cronbach's alpha, and discriminant validation were also calculated. Factor analysis yielded a single eigenvalue >1 (3.712), whereas confirmatory factor analysis led to the final instrument being reduced to 20 items and 5 subscale constructs. One subscale ("Comfort") performed poorly, indicating the possible need for a four-factor model. Subsequently, internal consistency assessed by Cronbach's alpha was 0.9101 for the five-factor model and 0.9327 for the four-factor model. Subscale correlations were no lower than 0.750 for the five-factor model and 0.856 for the four-factor model. CONCLUSIONS: This study provides support that the Critical Care Family Satisfaction Survey-which yields five subscales, "Assurance," "Information," "Proximity," "Support," and "Comfort"--is reliable and valid. Using five constructs rather than four is recommended because of the following: a) the internal consistency loss of 0.0226 for the "Comfort" subscale is not enough to warrant its removal, b) a four-factor questionnaire can be administered and totaled independently of this subscale, c) the need for the fifth construct is indicated by this study's results, and d) including the extra data may allow for more detailed analysis

120.                       Waters CM. A description of professional support provided by critical care nurses to culturally diverse family members of critically ill adult clients. UNIVERSITY OF MIAMI ** PH D(299 p) 1993).
Abstract: Since the time of the antebellum era (1861-65) and the Crimean War (1854-56), nursing's involvement with health care has gone through many stages and changes. In the critical care setting there has been a change from a dyadic (client-nurse) model of nursing care to a family systems (client-nurse-family) model of nursing care. The purposes of the study were (a) to examine what family members describe as professional support provided by critical care nurses following the admission of a critically ill adult relative to the intensive care unit, and (b) to determine if culture influences family members' descriptions of professional support. The sample consisted of 90 family members from three cultural groups: (a) African-American, (b) Hispanic, and (c) White, non-Hispanic. The Professional Support Questionnaire for Critical Care Nurses Working With Families and a demographic form were administered verbally to family members waiting to visit clients in the intensive care units. Crosstabulations by cultural group and descriptive statistics were computed to describe the demographic characteristics of family members and their responses to the items. Individual Kruskal-Wallis one-way ANOVA by ranks and Mann-Whitney tests were computed to determine if the distribution of responses to the items differed among cultural groups and among demographic variables. Preliminary validity and reliability measurements were computed for the questionnaire. Family members' comments were examined for themes. Findings of the study revealed the description of professional support among family members was unique and was influenced by culture, religion, education, occupation, income, gender, relationship to client and hospital setting. Conclusions of the study were (a) regardless of the presence of their social support network, critical care nurses can support professionally all family members, irrespective of cultural differences and similarities, via the three dimensions of professional support: information, comfort and assurance, and (b) specifically, critical care nurses can best support White, non-Hispanic family members by providing information to maintain their independence, by providing comfort to Hispanic family members to maintain family connectedness, and by providing comfort and assurance to African-American family members to promote connectedness with the critical care milieu

121.                       Watson LA. Comparison of the effects of usual, support, and informational nursing interventions on the extent to which families of critically ill patients perceive their needs were met. UNIVERSITY OF ALABAMA AT BIRMINGHAM ** D S N(122 p) 1991).
Abstract: The purpose of this experimental study was to compare the effects of usual, support, and informational nursing interventions on the extent to which the family members of critically ill patients perceive their needs were met. The independent variable in this study was the nature of the nursing intervention. The dependent variables were the extent to which families perceived their needs were met in the categories of support, comfort, information, proximity, and assurance. Sixty family members were randomly assigned into three groups. The control group received the usual staff nursing intervention. Families in one experimental group received the support nursing intervention and families in the other experimental group received informational nursing intervention. The conceptual framework for this study is based on concepts from Family Systems Theory and the Neuman Systems Model. Both theories are applicable to family reaction to stress and to the factors of reconstitution or adaptation that may be utilized by families. The literature review revealed numerous research studies identifying the needs of family members. However, very little research has been directed toward identifying the effectiveness of nursing interventions in meeting those needs. Data were collected by use of the Critical Care Family Needs Inventory (CCFNI) (Molter & Leske, 1983) and an adapted version of the CCFNI to measure the extent to which the family member perceived needs were met between the group receiving the usual nursing intervention and the combined groups receiving support and informational nursing interventions. No significant differences were noted in the extent to which the family member perceived needs were met between the support and informational groups. Means and standard deviations were determined to identify a hierarchy of needs and how families rated needs were met. This analysis was done to determine if nursing interventions were meeting the needs families rated as most important

122.                       Weiss BD. Family physicians in university hospital intensive care units. J Fam Pract 1983; 17(4):693-696.
Abstract: Although physicians in most family practice residency programs hospitalize their patients at community hospitals, those in 21 programs in the United States hospitalize patients exclusively at university hospitals. Through a questionnaire mailed to directors of each of these programs, it was learned that family practice residency faculty have medical intensive care (ICU) privileges at 38 percent of these university hospitals. No family physicians had ever been denied ICU privileges at any of these hospitals. Mandatory consultations were reported by only a minority of programs. At 62 percent of these university hospitals, family physicians do not have ICU privileges. However, no family physician had every made a formal application for them. Intensive care patients at these hospitals were generally cared for by specialists and house staff in internal medicine or critical care

123.                       Wilkinson P. A qualitative study to establish the self-perceived needs of family members of patients in a general intensive care unit. Intensive Crit Care Nurs 1995; 11(2):77-86.
Abstract: Admission to an intensive care unit (ICU) invariably causes a considerable degree of distress and anxiety to both patient and family. If we profess to deliver holistic care then it is essential that intensive care nurses are able to identify the specific needs of family members and provide appropriate supportive interventions. This small study was designed to gain the perspectives of the families. Through unstructured interviews participants were invited to discuss their experiences of visiting a critically ill relative, particularly in relationship to their own needs. Interviews were tape-recorded with permission and subsequently transcribed. Thematic content analysis adapted from Glaser & Strauss' 'grounded theory' approach (1967) by Burnard (1991) occurred, with formation of six categories, exemplified by verbatim quotations. The study may contribute towards a framework for preventative, supportive and therapeutic intervention with family members in the intensive care setting

124.                       Wincek JM. Promoting family-centered visitation makes a difference. AACN Clinical Issues in Critical Care Nursing 1991; 2(2):293-298.
Abstract: Promoting parental and sibling visitation of the critically ill child can positively influence the resolution of a crisis when a child is admitted to the pediatric intensive care unit. There are many benefits as well as barriers to incorporating family-centered visitation into the plan of care. Understanding the needs, stressors, and coping styles of the entire family will help the nurse provide a positive experience when parents or siblings visit the critically ill child

125.                       Zazpe C, Margall MA, Otano C, Perochena MP, Asiain MC. Meeting needs of family members of critically ill patients in a Spanish intensive care unit. Intensive Crit Care Nurs 1997; 13(1):12-16.
Abstract: A descriptive study was carried out to ascertain how well the needs identified by relatives of patients admitted to an intensive care unit (ICU) were met and what measures could be implemented to improve the care for patients' family members. Eighty-five relatives of patients were studied using a needs questionnaire as developed by Molter (1979) and modified in accordance with our setting, with needs classified into four groups: information, confidence, comfort of the ICU environment and emotional support. Family members were asked to identify their needs and then to score how well each had been met on a 5-point Likert scale. Results showed that the most frequently identified needs were related to information and confidence. Overall, 94% of the needs of all groups were found to be adequately met. Those needs which relatives felt were least well met were related to certain aspects of information and the comfort of the ICU environment. The conclusions based on the results are that more than one channel of communication should be used to transmit the desired information, and that hospital managements should be informed of the importance that back-up services (waiting rooms, restaurants, etc.) have for the relatives of patients

126.                       Zazpe Oyarzun, MC. Información a los familiares de pacientes ingresados en una Unidad de Cuidados Intensivos. Enferm Intensiva. 7(4):147-151.