Family needs and involvement in the intensive care unit in Saudi Arabia: mixed methods study

Aim The aim of this study was to identify the perceived needs of Saudi families with a critically ill family member admitted to the Intensive Care Unit as perceived by family members and healthcare providers. The study explains how family needs were being met and who were the most appropriate healthcare providers to meet their needs. The study also compares the families’ perceptions of their needs being met to those of healthcare providers’. It also describes the healthcare providers’ attitudes towards family involvement during routine care and family presence during resuscitation, or other invasive procedures. Background Admission of a family member to an intensive care unit often occurs without any warning, leaving the family in a very stressful situation. Families of intensive care patients have specific needs that should be acknowledged and met during this time. If unmet, the stress for the patients’ families may be increased and also produce stress for the healthcare providers. Further, the literature is virtually silent on the issue of recognizing the ICU family needs of Saudi or Muslim families in relation to religious beliefs and cultural values in intensive care settings. Knowledge about health professional’s attitudes towards family involvement during routine care and family presence during resuscitation or other invasive procedures can inform intensive care practice for holistic family centred care. Design A mixed method two phase sequential explanatory design was utilised for the study. In Phase One, a convenience sample of 644 participants (167 family members and 477 healthcare providers) was recruited and a closed-ended questionnaire was administered. Participants were invited from ICUs located in eight hospitals in six major cities in Saudi Arabia. Phase Two involved face-to-face semi-structured interviews with 12 close family members at the same participating hospitals. Results Family members and ICU healthcare providers perceived assurance, information and cultural and spiritual needs as the most important needs, and proximity and support needs as least important. The findings indicated that family members considered their needs of assurance as being met but their needs for support as not being met. Moreover, they considered needs related to information, proximity and cultural and spiritual needs as not always met. Despite this, the healthcare providers identified all the families’ needs as being successfully met. Family members recognized doctors as the most appropriate person to meet most of their needs, followed by nurses, then hospital administration. Healthcare providers perceived doctors as the most appropriate person to meet most of the family needs, followed by the hospital administration and then nurses. The healthcare providers had positive attitudes towards family involvement during routine care, but negative attitudes towards family presence during resuscitation or other invasive procedures. A deeper understanding of Saudi family needs was obtained through the qualitative results. Family members described their experiences of having a critically ill relative in the ICU. The analysis of the interview transcripts revealed six explicit themes. These themes were: 1) looking for information; 2) maintaining reassurance; 3) spiritual healing; 4) maintaining close proximity; 5) involvement in the care and 6) support not being facilitated. Conclusion This study builds upon previous work and contributes important new nursing knowledge about the needs of Saudi families with a relative in the ICU. In Saudi Arabia, it is recommended that ICU nurses be prepared to recognize family needs, and support and facilitate family involvement and caregiving. An emphasis should be placed on the recognition of family needs in relation to the influence of cultural values and religion. In the 21st century, models of nursing care should not just focus on the patients’ needs but should also be focused on of the needs of the families.