Susan Salmond will never forget finding her 22-year-old daughter unresponsive and in status epilepticus, nor the eight months of her recuperation. During that time, she realized that her nurse identity and her role as nurse family member are intertwined.
Although Ive always believed that nurses make a difference, when my daughter was sick I saw firsthand the powerful influence that RNs have on both patient and family well-being either positive or negative depending on the nurses competence, advocacy role, communication skills, and their relationship with the family member, says Susan Salmond, RN, EdD, interim dean, UMDNJ School of Nursing, Newark, N.J.
Search and research
While her daughters health improved, Salmond reflected on her experiences as a nurse family member (NFM) of a loved one with a critical illness. She began research that developed into the qualitative study, When the Family Member Is a Nurse: The Role and Needs of Nurse Family Members During Critical Illness of a Loved One.
Initially, Salmond researched the literature to compare her experience with that of others. Because she was not a typical family member, Salmond speculated that there were differences, but she found no studies that examined the experiences of NFMs. She decided to explore this unique occurrence and describe how NFMs view their role, what strategies they use to carry out this role, and how they cope with their loved ones critical illnesses.
Findings reveal role conflict
The 22 NFMs Salmond interviewed described the impact of critical illness on a loved one as causing panic, fear, and acute anxiety. Because of their nursing knowledge, the NFMs grasped the nature of the physiologic instability and were aware of what could go wrong, both from a disease perspective and iatrogenic, or hospital-induced error, says Salmond. Some wished for less knowledge, because ignorance is bliss. Others said that without nursing knowledge, the nurses and physicians would not have responded as quickly.
You cant separate the nurse from the NFM the nurse identity is intertwined with the family role identity, said Salmond.
The NFMs identified their primary role as maintaining guard to protect the patient and family member. Each suppressed his or her emotions so that the nurse self could respond and be in control. Despite an innate tension between nursing staff and NFMs, NFMs used any way they could to partner with nursing staff to benefit the care of their loved ones and advocate for them, said Salmond. For example, NFMs said they brought in food for the staff, hoping to ease the strain between them.
NFMs found themselves in a state of constant assessment and surveillance, comparing the care they saw with their own standards. What NFMs valued most was detailed information about their loved ones from nursing staff, even more than from the physicians. They needed to be part of the team and maintain guard to protect the patient. If these goals were accomplished, the NFMs could resume their own roles and those within their families.
How staff view NFMs
On the other side of the nursing station, nurses viewed NFMs with mixed reactions. Although some saw an NFM in ICU as a collaborative opportunity and entered into dialogue with the NFM, others felt threatened and wished the NFM would go home so they could just do their jobs. They saw NFMs as more active and demanding than other family members and therefore more challenging.
Some ways to help
To provide family-centered care and to ease the emotional turmoil felt by NFMs as found by her study, Salmond encourages critical care nurses to try to do the following
Demonstrate empathy for NFMs
Acknowledge the vulnerability NFMs feel and their need to feel in charge
Recognize NFMs knowledge
Partner with the NFM to advocate for the patient
and acknowledge that NFMs have a special place
Include NFMs as part of the team by sharing physicians orders and nursing plans of care and seeking
out and clarifying information
Enable flexible visiting hours in the ICU
Introduce team members to the NFM; for example, tell the nurse on the next shift (in front of the NFM) the role the NFM can play to help with care
Focus on the normal aspect by referring to patient preferences for example, types of music the patient enjoys or things he or she did before becoming ill
Facilitate ongoing observation and monitoring; for example, have NFMs call the unit for patient status
Certainly, all NFMs are not the same, and each needs
to be cared for and interacted with in a unique way, says Salmond. We can use the data from this study to better our nursing practice.
Editors note: For more information about the study, contact Susan Salmond, RN, EdD, at [email protected]