1. Critical Care and Family
Involvement
By
Angela de Varennes
NURS 609
Athabasca University
Winter 2013
1
Critical Care and Family Involvement

2. Family Members
Should Not Be Considered
Partners In Critical Care
Critical Care and Family Involvement 2

3. Critical Care and Family Involvement 3
WHY NOT???
My opponent would have you believe that
a partnership between health
professionals and patient family members
is a cornerstone to providing effective
patient care when, in fact, nothing could
be further from the truth. This
presentation will argue that limiting
family involvement is, by far, the most
beneficial and ethical approach to patient
recovery in critical care.

4. Confidentiality and Trust
The professional relationship and rapport between the
nurse and the patient is at the core of providing high
quality care that is respectful and responsive to the
individual patient.
Critical Care and Family Involvement 4
The patient MUST be able to trust the ethical conduct of
the health professional. If the patient is unable to
explicitly communicate their desires, often the case
within the critical care setting, the nurse must uphold
the duty to act solely in the best interests of the patient,
ensuring it is the patients values alone that guide clinical
decisions (Wood, 2008) .

5. Key Terms
• Critical Care
• Ethics and
Legalities
• Family
Critical Care and Family Involvement 5

6. What Is Critical Care?
6
Critical Care and Family Involvement
Critical Care is the branch of health that
provides care and support for patients whose
illness or condition is considered acute and
has the potential to be life-threatening. The
term critical care is often used
interchangeably with intensive care or the
ICU (intensive care unit). Critical care
medicine involves a multidisciplinary health
team and specialized equipment and
treatments. Nurses, doctors, therapists,
pharmacists and various medical experts
work together to stabilize and promote
recovery in the patient (Canadian Critical
Care Society, 2009)

7. All health professionals are bound by a
code of ethics, as well as the law, when
treating patients in their care.
Paramount to this ethical conduct is the
primary commitment to the individual
patient (American Nurses Association,
2013). Advocating for the patient to make
informed decisions, respecting the worth
of each patient, maintaining privacy and
confidentiality and upholding human
rights and promoting justice are values
the Canadian Nurses Association (2011),
cites as being intrinsic to the nurse-
patient relationship and competent
nursing practice.
Critical Care and Family Involvement 7
What are Ethics?

8. It is becoming increasingly difficult to
define what constitutes a family unit. As
a result of increased divorce rates and
social acceptance of out-of-wedlock
parenthood, surrogacy and gay marriage,
the 21st century has numerous variances
from the traditional “nuclear” family.
Step-parents, siblings and grandparents,
biological and non-biological family
members, blended families and single
parents. It is this evolution of the family
that makes it nearly impossible to
characterize, other than stating the
diversity of familial forms and dynamics.
(Settles & Steinwetz, 1999)
Critical Care and Family Involvement 8
What is a Family?

9. Points of Issue Regarding
Family as Partners
Critical Care and Family Involvement 9
• Range and Dynamics of
the Family
• Motives of the Family
- Self-serving
- Non-objective
• Family Stress

10. Range of Family
Between the broad definition of family to the further
complication of family systems being in continuous flux
(Wolters Kluwer, 2012), health professionals are unable
to ascertain who is considered privy to sensitive and
private health information. This increases the risk of
confidentiality breach, therefore disrupting the
professional relationship with the patient(Settles &
Steinwetz, 1999).
The patient should be the ONLY source of
disclosure in health matters.
Here is a recent and extreme example
of a hospital confidentiality violation:
Nurse Commits Suicide
Critical Care and Family Involvement 10

11. Implications
Consider the implications of the article:
• The nurse revealed confidential health
information without verification from the
patient, nor verification of the persons
calling as family members.
• The information disclosed did not
compromise the health of the patient but
did result in unwanted publicity.
• Such incidents serve to lessen public
confidence in their health care providers
ability to protect privacy.
• Lack of trust in health care providers
could affect the patients disclosure of
pertinent health related information,
therefore compromising care.
Critical Care and Family Involvement 11

12. Family Dynamics
Even if the patient is medically stable enough to establish
whom is to be considered family, familial relationships
must be acknowledged as subject to complex dynamics,
possibly placing undue stress on the patient and
persuading their course of action.
Any benefit derived from family involvement depends
upon the patient-family dynamics. The health
professional is unequipped to determine family
dynamics and is responsible for the well-being and best
interest of the individual patient.
(Gonzalez, 2004)
“The very presence of family members at the bedside of a
hospitalized patient has a strong intimidating influence
on the decision-making of the patient.”
(McCormik, 2008)
Critical Care and Family Involvement 12

13. Implications
To illustrate the impact of dynamics,
consider the family as a partner in
care. Next, reflect on that family as
belonging to a religious organization
that dictates against blood transfusions
although the patient needs one to
survive. While the family dynamics
may possibly have been supportive
prior to the health crisis, the situation
now presents quite differently. Family
involvement or attendance can
negatively effect both the patients
ability to choose their own care in
addition to the health professionals
ability to remain partial to the patient.
Critical Care and Family Involvement 13

14. Facts
Consider the following:
• 80% of sexual assaults occur in the home with the
attacker being friends or family of the victim (Sex
Assault Canada, 2012).
• 6% of Canadians with a spouse or former spouse have
reported being physically or sexually victimized (Stats
Canada, 2013).
• Lethal violence most often occurs in the home at the
hands of spouse (Stats Canada, 2013).
Given these statistics, the necessity of health
professionals to distance family instead of welcoming them
as partners becomes even more apparent. As nurses, we
are not certain what is happening behind closed doors.
Would you want the input of your assailant in your
medical care?
Critical Care and Family Involvement 14

15. Critical Care and Family Involvement 15
Motives
The thought of family input in patient care as
altruistic is a pleasant thought. Unfortunately,
motives behind input frequently vary from
self-serving to non-objective.
• Self-serving motives may be
externally or internally dictated.
Financial gain, marital stressors,
legalities, cultural norms and values
and religious beliefs are a few
examples of determinants.
• Non-objective motives generally
pertain to emotions and the inability
to rationalize in times of crisis.

16. Self Serving Motives
A disturbing example of a self serving motive in
critical care can be seen in the following case
Critical Care and Family Involvement 16
Court decides against live-saving measures
for toddler allegedly abused by parents
Ryan Cormier, Edmonton Journal with files from Fletcher Kent, Global News
Friday, September 14, 2012 5:37 AM
In this particular instance, the parents involvement in
the childs’ medical treatment also determines the
charges against them. Removing life support equates
with a murder charge. As stated in the article:
"Even assuming that 'M's' parents think that their decision is
motivated by religious beliefs and love for M," said Justice
June Ross on Friday, "I am left with a concern that their
decision may in fact be affected by self-interest.”

17. Non-Objective Motives
The following example illustrates a non-objective
motive pertaining to family involvement in critical care
of a patient. Families with a loved one needing critical
care are already in a high stress situation, filled with
emotion. If they are considered partners in the care of
the patient, their input toward what is best for the
patient may be based more on feeling than logic.
Consider the battle over Terri Schiavo:
The issue was whether to carry out the
husbands wishes to terminate life support
measures after Terri was diagnosed as
being in a persistent vegetative state and
her parents opposed life support termination.
Wikipedia (2012). Continue Reading…
Critical Care and Family Involvement 17

18. Family Stress
We assume that families of critically ill
patients want to be considered
partners in their care. However, the
responsibility that this entails is often
not welcomed and is plagued with
stress. Family members may feel
obligated to participate in the patients
care, sometimes to their own
detriment. Again, where does this
leave the patient, if persons
participating as partners are only
doing so out of duty or because they
feel they are without any other option.
In this argument both parties suffer,
the patient and the family.
Critical Care and Family Involvement 18

19. Implications
The impact of having a critically ill family
member can be agonizing if also
coupled with the responsibility of
medical decisions. In fact, CNN
Health (2011) recently linked the
situation to post-traumatic stress
disorder and the Canadian Mental
Health Association (2006), states that
caregivers have higher rates of
emotional and anxiety disorders. It
could be argued that in seeking the
partnership of family members in the
care of critically ill patients, health
professionals are facilitating another
health crisis
Critical Care and Family Involvement 19

20. Conclusion
Considering family as partners in critical care has negative
consequences for both the patient and the family. In
addition, ethics dictate the patient as the primary source
of duty to health professionals. Therefore, family
should have involvement only as specifically defined by
the patient and should not be considered a partner in
any medical decisions or matters.
Critical Care and Family Involvement 20

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Critical Care and Family Involvement

22. References
American Nurses Association. (2013). Code of ethics for nurses with interpretative statements.
Retrieved from http://nursingworld.org/MainMenuCategories/
EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf
Canadian Critical Care Society. (2009). About CCCS. Retrieved from
http:www.canadiancriticalcare.org/
Canadian Mental Health Association. (2006). Families as partners in the mental health and
addictions system. Retrieved from http://www.camh.ca/en/hospital/about_camh/
influencing_public_policy/public_policy_submissions/mental_health_and_addictions/
Documents/Caring%20Together%20%20BW%20Final.pdf
Canadian Nurses Association. (2011). Code of ethics. Retrieved from
www.cna-aiic.ca/en/improve-your-workplace/nursing-ethics/
CNN Health. (2011). Families haunted by end-of-life decisions. Retrieved from http://
thechart.blog.cnn.com/2011/03/02/families-haunted-by-end-of-life-decisions/
Critical Care and Family Involvement 22

23. References
Gonzalez, C. E. (2004). Visiting preferences of patients in the intensive care unit and in a
complex care medical unit. American Journal of Critical Care. (13) 3
McCormik, T. R. (2008). Perioperative nursing clinics. Elsevier Inc. digital. Doi:
10.1016/jcpen.2008.04.007
Stats Canada. Government of Canada. (2013). Family violence in Canada: A statistical profile.
Retrieved from http://www5.statcan.gc.ca/bsolc/olc-cel/olc-cel?catno=85-224-
x20050008647&lang=eng
Settles, B. H., & Steinwetz, S. (1999). Concepts and definitions of family for the 21st century.
Haworth Press Inc., Binghamton, N.Y.
Sex Assault Canada. (2012). Sexual assault statistics in Canada. Retrieved from
http://www.sexassault.ca/statistics.htm
Critical Care and Family Involvement 23

24. References
Wolters Kluwer Health. (2012). Involving family systems in critical care nursing: Challenges
and opportunities. (Report 57329). Ovid Technologies .
Wood, D. (2008). Patient-centered care helps hospitals boost patient satisfaction.
Retrieved from http://www.nursezone.com/nursing-news-events/ more-
news.aspx?ID=18618
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