Crisis Center
ICU and Families
Last Updated:
Perhaps the greatest challenge for those with loved ones in ICU (Intensive Care Unit) is accepting a realistic view of the situation. A person is in ICU because they’re in danger of death. But typically, families don’t want to believe the severity of diagnosis and prognosis and are very skeptical about what the physician says. Still, families have a vital role in this acute phase of treatment and the patient’s interests will be best served if the medical team and the family can work together.
As in any partnership, the basis for a good relationship within the medical setting depends on honesty, communication, courtesy and a willingness to give the other person the benefit of the doubt. However, in ICU, there are issues that may place extraordinary strain on the relationship:
The priority the team must give to the injured person’s immediate medical crisis. Of necessity, the medical team’s most important job is to care for the patient. Yet when facing a trauma such as brain injury, family members need attention also and tend to look to the medical staff for comfort. However, the medical staff may be unavailable. This can cause disappointment, even anger in family members who already stressed. It may be helpful for families to remember that one reason ICU personnel may fail to pick up on the family’s needs is that they are busy with the task of addressing the life-threatening problems of their loved one.
The emotional trauma the family is experiencing. Some families find it hard to avoid the “shoot the messenger” syndrome if the physician must convey news that is painful to hear. But part of a doctor’s job is to offer an honest and realistic assessment of their loved one’s situation. The family should expect the doctor to give potential options. He may say, “If he lives, this is what we may see.” It may be necessary to discuss what the medical team should do if the person arrests and you may be asked if the person signed an Advance Directive. Harsh realities create stress but families should know such discussions, though difficult for both physician and family, are necessary.
Lack of communication. Some doctors are very good physicians but very poor communicators. They may seem abrasive, insensitive or “too busy.” Yet families still have a right to be informed about their loved one’s condition regardless of their physician’s communication skill level. Changing doctors is not always possible or advisable. What may be needed is another option for having critical information communicated to the family.
Accurate information and a family member with a calm, clear, mind are both needed for families to make informed decisions regarding their loved one’s medical care. These are hard to come by in a medical crisis but there are things the family can do to better equip themselves to meet the challenges.
- Ask for outside support. A family in crisis does need care and while family members tend to gather at such times, it may be helpful for someone besides family (perhaps a close friend, pastor or priest) to be present also. A person less emotionally impacted by the event is often better able to lend strength and perspective to the situation. If the family does not have a support system, many hospitals have chaplains and other support persons who are available and want to help.
- Appoint a family spokesperson to communicate with the physician. Doctors get overwhelmed too. If seventeen family members are all asking questions he’ll want to get away as soon as possible. Instead, choose one person who is calm, communicates well, and if possible, has some medical knowledge. Let that person interface with the physician and the family.
- Be present when the doctor makes rounds. Most doctors visit hospitalized patients at approximately the same time each day. This face-to-face time with the physician is a good opportunity for family members to ask questions, report changes or communicate information about their loved one’s condition. Determine who is the best communicator on the medical team. Look for a person who has access to the medical information but is also a compassionate communicator. It may not be the doctor, but a nurse or case manager. Once identified, develop a relationship with that person. He/she can become the family’s strongest ally and can help mediate any concerns the family feels are not being adequately addressed by other team members.
- Establish a time for a family medical conference. This is a helpful tool for bringing families up to speed with current and future treatment strategies for their loved one. All family members can gather at one time for the update, though it’s still a good idea to use a family spokesperson. If the hospital uses a team approach to treatment, they will automatically schedule team meetings where all involved doctors, therapists and staff meet together with the family on a regular basis. If this is not the case, ask the doctor when you and the family can meet with him.
The ICU experience is traumatic for all involved but a family that positively interacts with medical personnel in gathering and processing information helps assure the best possible outcome for their loved one.
Shepherd Center, a Center of Excellence Facility
Dr. Donald Leslie is Associate Medical Director of Shepherd Center and an elected member of the Center’s Board of Directors. He is Medical Director of brain injury services at Shepherd, which includes inpatient and post-acute brain injury rehabilitation programs and recently became head of their new geriatric brain injury unit. He is Co-Medical Director of the Georgia Model Brain Injury System. Dr. Leslie has spoken nationally and internationally on spasticity management, and has been involved in intrathecal baclofen research and therapy for the past ten years. Most recently, Dr. Leslie received certification in acupuncture at UCLA in Santa Monica, California.
Karen Moderow is a freelance writer with over ten years experience working in public relations for charitable organizations. As the parent of a son with traumatic brain injury, she has considerable experience dealing with brain injury issues. Her new book, Back Roads Home, chronicles her family’s journey. She is the Director of Content for the Brain Injury Resource Center.