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Involvement of Patients’ Families in Care of Critically Ill Patients at Kenyatta National Hospital Critical Care Units

Received: 28 October 2017     Accepted: 9 December 2017     Published: 19 January 2018
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Abstract

Patients assess the likely benefits and risks of a recommended treatment or investigation and make a decision to either accept or refuse treatment. When a patient loses the capacity to participate meaningfully in decision making, a means should exist to ensure decisions that represent the patient’s goals, preferences, and interests are made. This means is substitute decision making, and it usually occurs when a spouse, partner, close family member, or friend assumes this responsibility on behalf of the incapacitated patient. Limited involvement in patient care activities at the hospital can lead to distress in the family as well as challenge family members in assuming the likely expected role when the patient returns home. This study aimed at determining the nature and extent of family/substitute decision makers’ involvement in care of the critically ill patients, guiding policies and the perspectives of nurse managers on involvement in Kenyatta National Hospital (KNH) critical care units (CCUs). This was a descriptive cross sectional study with family members and CCU nurse managers as the study participants. Key informants’ interviews and in depth interviews were conducted. The sample size was 52 family members and four nurse managers. Quantitative data was analyzed using Statistical Package for Social Sciences (SPSS) version 21.0 and descriptive content analysis for qualitative data. Family members reported emotional distressed from the admission of a family member to the critical care unit. However their level of satisfaction with the extent of involvement was above average at a mean of 6.5. The activity mostly involved in was sharing of general information at 57.7% (n=30) with 36.5% (n=19) feeling they should have been provided with in depth information regarding the patients care. The key themes from interviews with family members were: limited information involvement, guilt feeling, and appreciation. Nurse Managers reported KNH has a closed visiting policy with none feeling it should be changed to an open policy. They also unanimously agreed that family members should be involved in care of the critically ill patients through information sharing and counseling. Two nurse managers felt primary care nurses should involve families in general nursing activities such as oral care with all agreeing that the nurses don’t involve families in these activities. There was a statistical relationship (p<0.05 at a 95% confidence interval and R2=0.689) between the perspectives of nurse managers and the nature and extent of involvement of family members in care.

Published in American Journal of Nursing Science (Volume 7, Issue 1)
DOI 10.11648/j.ajns.20180701.14
Page(s) 31-38
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2018. Published by Science Publishing Group

Keywords

Involvement of Family Members, Critically Ill Patients’ Care, Critical Care Unit, Substitute Decision Makers, Kenyatta National Hospital

References
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  • APA Style

    Pauline Muthoni Maina, Samuel Kimani, Blasio Omuga. (2018). Involvement of Patients’ Families in Care of Critically Ill Patients at Kenyatta National Hospital Critical Care Units. American Journal of Nursing Science, 7(1), 31-38. https://doi.org/10.11648/j.ajns.20180701.14

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    ACS Style

    Pauline Muthoni Maina; Samuel Kimani; Blasio Omuga. Involvement of Patients’ Families in Care of Critically Ill Patients at Kenyatta National Hospital Critical Care Units. Am. J. Nurs. Sci. 2018, 7(1), 31-38. doi: 10.11648/j.ajns.20180701.14

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    AMA Style

    Pauline Muthoni Maina, Samuel Kimani, Blasio Omuga. Involvement of Patients’ Families in Care of Critically Ill Patients at Kenyatta National Hospital Critical Care Units. Am J Nurs Sci. 2018;7(1):31-38. doi: 10.11648/j.ajns.20180701.14

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  • @article{10.11648/j.ajns.20180701.14,
      author = {Pauline Muthoni Maina and Samuel Kimani and Blasio Omuga},
      title = {Involvement of Patients’ Families in Care of Critically Ill Patients at Kenyatta National Hospital Critical Care Units},
      journal = {American Journal of Nursing Science},
      volume = {7},
      number = {1},
      pages = {31-38},
      doi = {10.11648/j.ajns.20180701.14},
      url = {https://doi.org/10.11648/j.ajns.20180701.14},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajns.20180701.14},
      abstract = {Patients assess the likely benefits and risks of a recommended treatment or investigation and make a decision to either accept or refuse treatment. When a patient loses the capacity to participate meaningfully in decision making, a means should exist to ensure decisions that represent the patient’s goals, preferences, and interests are made. This means is substitute decision making, and it usually occurs when a spouse, partner, close family member, or friend assumes this responsibility on behalf of the incapacitated patient. Limited involvement in patient care activities at the hospital can lead to distress in the family as well as challenge family members in assuming the likely expected role when the patient returns home. This study aimed at determining the nature and extent of family/substitute decision makers’ involvement in care of the critically ill patients, guiding policies and the perspectives of nurse managers on involvement in Kenyatta National Hospital (KNH) critical care units (CCUs). This was a descriptive cross sectional study with family members and CCU nurse managers as the study participants. Key informants’ interviews and in depth interviews were conducted. The sample size was 52 family members and four nurse managers. Quantitative data was analyzed using Statistical Package for Social Sciences (SPSS) version 21.0 and descriptive content analysis for qualitative data. Family members reported emotional distressed from the admission of a family member to the critical care unit. However their level of satisfaction with the extent of involvement was above average at a mean of 6.5. The activity mostly involved in was sharing of general information at 57.7% (n=30) with 36.5% (n=19) feeling they should have been provided with in depth information regarding the patients care. The key themes from interviews with family members were: limited information involvement, guilt feeling, and appreciation. Nurse Managers reported KNH has a closed visiting policy with none feeling it should be changed to an open policy. They also unanimously agreed that family members should be involved in care of the critically ill patients through information sharing and counseling. Two nurse managers felt primary care nurses should involve families in general nursing activities such as oral care with all agreeing that the nurses don’t involve families in these activities. There was a statistical relationship (p2=0.689) between the perspectives of nurse managers and the nature and extent of involvement of family members in care.},
     year = {2018}
    }
    

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  • TY  - JOUR
    T1  - Involvement of Patients’ Families in Care of Critically Ill Patients at Kenyatta National Hospital Critical Care Units
    AU  - Pauline Muthoni Maina
    AU  - Samuel Kimani
    AU  - Blasio Omuga
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    N1  - https://doi.org/10.11648/j.ajns.20180701.14
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    T2  - American Journal of Nursing Science
    JF  - American Journal of Nursing Science
    JO  - American Journal of Nursing Science
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    PB  - Science Publishing Group
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    UR  - https://doi.org/10.11648/j.ajns.20180701.14
    AB  - Patients assess the likely benefits and risks of a recommended treatment or investigation and make a decision to either accept or refuse treatment. When a patient loses the capacity to participate meaningfully in decision making, a means should exist to ensure decisions that represent the patient’s goals, preferences, and interests are made. This means is substitute decision making, and it usually occurs when a spouse, partner, close family member, or friend assumes this responsibility on behalf of the incapacitated patient. Limited involvement in patient care activities at the hospital can lead to distress in the family as well as challenge family members in assuming the likely expected role when the patient returns home. This study aimed at determining the nature and extent of family/substitute decision makers’ involvement in care of the critically ill patients, guiding policies and the perspectives of nurse managers on involvement in Kenyatta National Hospital (KNH) critical care units (CCUs). This was a descriptive cross sectional study with family members and CCU nurse managers as the study participants. Key informants’ interviews and in depth interviews were conducted. The sample size was 52 family members and four nurse managers. Quantitative data was analyzed using Statistical Package for Social Sciences (SPSS) version 21.0 and descriptive content analysis for qualitative data. Family members reported emotional distressed from the admission of a family member to the critical care unit. However their level of satisfaction with the extent of involvement was above average at a mean of 6.5. The activity mostly involved in was sharing of general information at 57.7% (n=30) with 36.5% (n=19) feeling they should have been provided with in depth information regarding the patients care. The key themes from interviews with family members were: limited information involvement, guilt feeling, and appreciation. Nurse Managers reported KNH has a closed visiting policy with none feeling it should be changed to an open policy. They also unanimously agreed that family members should be involved in care of the critically ill patients through information sharing and counseling. Two nurse managers felt primary care nurses should involve families in general nursing activities such as oral care with all agreeing that the nurses don’t involve families in these activities. There was a statistical relationship (p2=0.689) between the perspectives of nurse managers and the nature and extent of involvement of family members in care.
    VL  - 7
    IS  - 1
    ER  - 

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Author Information
  • School of Nursing Sciences, University of Nairobi, Nairobi, Kenya

  • School of Nursing Sciences, University of Nairobi, Nairobi, Kenya

  • School of Nursing Sciences, University of Nairobi, Nairobi, Kenya

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