Family Presence in ICU: A Critical Component of Patient Care and Safety

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• Family ICU Presence Benefits
• Psychological Support for Patient
• Early Problem Detection by Family
• Nurse-to-Patient Ratios Impact
• The Participatory Medicine Model
• Healthcare Team Collaboration
• Full Transcript

Family ICU Presence Benefits

Dr. Pascal Leprince, MD, emphasizes that allowing family members to stay and even sleep in the ICU room provides immense benefits. This practice, also supported by other leading surgeons like Professor Lawrence H. Cohn, is a cornerstone of modern patient-centered care. The advantages extend beyond simple comfort, offering tangible clinical and safety improvements for the critically ill patient.

Psychological Support for Patient

A primary reason for family presence is the profound psychological support it offers the patient. Being in a vulnerable state in the ICU can be terrifying and isolating. The familiar face of a loved one provides comfort, reduces anxiety, and can significantly improve the patient's mental and emotional well-being during a highly stressful medical crisis. This support is a non-pharmacological intervention that complements medical treatments.

Early Problem Detection by Family

Dr. Pascal Leprince, MD, highlights a crucial, often overlooked advantage: families can detect emerging problems before the clinical staff. Because family members are intensely focused on their loved one, they may notice subtle changes in condition, breathing, or responsiveness that a busy nurse might miss during rounds. This early detection allows for faster intervention, potentially preventing complications and improving patient safety in the intensive care environment.

Nurse-to-Patient Ratios Impact

The value of family as an extra set of eyes is magnified by variations in nursing staff levels. Dr. Leprince contrasts the one nurse per patient model common in some US ICUs with the European reality, where one nurse may be responsible for two or three critically ill patients. In these scenarios, the family member becomes an indispensable partner in monitoring, as the nurse cannot be physically present with every patient every minute of the day.

The Participatory Medicine Model

This approach aligns perfectly with the "P4 Medicine" model, where one "P" stands for "participatory." Dr. Anton Titov, MD, and Dr. Leprince agree that when a patient is sedated, unconscious, or too weak to communicate, family participation becomes their voice. The family actively participates in the care process, ensuring the patient's needs and preferences are represented and integrated into the treatment plan.

Healthcare Team Collaboration

Dr. Pascal Leprince, MD, advocates for breaking down the traditional wall between the clinical care team and the family. The ideal model is a true teamwork approach where physicians, nurses, and family members are all united partners working toward the single goal of patient healing. This collaboration moves away from a paternalistic system where physicians unilaterally direct care, instead creating a supportive ecosystem that benefits the patient from every angle.

Full Transcript

Dr. Anton Titov, MD: You highlight something very important. It is the ability of the patient's family to stay in the room with the patient, even at the ICU care level. This is something that Professor Lawrence H. Cohn mentioned in our conversations some time ago. You have confirmed that.

Yes, yes. That is very important—to stay and to sleep in the room with your relative. I think this is very important.

There are two reasons for that. The first reason is the psychological help you give to your relative when you stay in the same hospital room with the patient. The other reason, which may be less known, is that if you stay in the room with your relative, particularly in the ICU, you can look at problems before the nurses find them.

Because you are very focused on your relative. In France, it is different than in the US. I remember in the US we had one nurse for one patient in the ICU. It was easy for the nurse to look at the patient.

In many countries, in Europe at least, we have one nurse for two or three patients. The nurse is not with each patient every single minute. I think it is quite important to have the relative in the room.

The relative can say that something is happening to the patient and alert the nurse. Because patients sometimes cannot alert the nurse themselves. This is another reason why it is pretty helpful to have relatives in the room with the patient.

Dr. Anton Titov, MD: This is very interesting what you are saying. Because patients discuss P4 medicine. One of those "P"s is "participatory." That is the participation in patient care by the patient's family.

I agree that participation is important.

Dr. Pascal Leprince, MD: We don't have a clinical care team anymore on the one hand and the family on the other hand, with some wall in between. Everyone is trying to do the best to get the patient to heal.

We know that participation of the patient in treatment is very important. But if a patient cannot participate because he is asleep, or because he is in the ICU, even if the patient is in a ward but is very tired to move around, I think the family's participation is very important, as is the work of the care team.

It is true teamwork. Patients, physicians, are all part of the team together, as opposed to physicians unilaterally directing patient's treatment. It goes both ways. I agree it is very important.