Improving communication with families in the intensive care unit

Families ('family' will be used in this article to refer to anyone the patient considers significant, whether they are an actual family member or not) of patients who are critically ill have heightened communication needs. Nurses are an important source of information, particularly about day-to-day patient events and progress. Intensive care unit (ICU) nurses are valued by families because they provide clear, jargon-free information about the patient and their condition. However, they have sometimes been criticised for focusing on short-term issues while avoiding potentially difficult conversations about long-term outcomes and prognosis. A family conference or meeting is held when bad news has to be communicated to families, prognosis discussed or major decisions made, particularly about treatment withdrawal or resuscitation. These meetings should involve physicians and ICU nurses. Despite family conferences, family members' understanding of patient prognosis, diagnosis and treatment is often suboptimal. A planned and structured approach for these meetings, using quantitative statements for prognostic information, recording and communicating what has been said, and supporting meetings with written information, can improve their effectiveness. These supportive strategies increase understanding and consensus, and prevent the provision of conflicting information. It is important for nurses to be willing to follow up these meetings by supporting families to clarify their understanding and encouraging them to raise concerns and ask questions.