Family Types in the Neurotrauma Intensive Care Unit

Many healthcare professionals can relate to families who come to the hospital as a unified group. In an intensive care unit (ICU), patients’ families are often present and many are concerned with the immediate health issues of their loved ones. We were interested in how patients’ families are perceived by ICU staff and wondered if certain categories could accurately describe particular qualities of families. Such categorization could help ICU staff communicate with patients’ families by understanding common characteristics associated with certain family types. Structured programs for communication between staff and patients’ families have been successful in the past1; however, specific family types have not been studied.Approval of our study was granted by the ethics committee at St. Michael’s Hospital, Toronto, Ontario. Using a qualitative research design, we asked 40 neurotrauma ICU healthcare professionals structured, open-ended questions about the varieties and characteristics of patients’ families they encountered. Private interviews were conducted outside the ICU. Staff responses were compiled and analyzed for prevalent themes. Staff reported clusters of themes and adjectives associated with their perception of certain family types. We grouped these clusters of themes and adjectives into categories.A total of 6 family types were identified: supportive, culturally diverse/foreign, overbearing, demanding, dysfunctional, and nonexistent.Families in the supportive category were keen to learn about the illness of their relative and actively participate in their relatives’ recovery. These families were described by ICU staff as respectful, accommodating, patient, realistic, and cooperative. Staff reported that these families often used the hospital and ICU educational and support resources.Culturally diverse/foreign families had limited knowledge of the predominantly spoken language (English in this study). Communication was often difficult despite the use of interpreters. ICU staff reported that these families were often frustrated with or passive toward caregivers. Further, cultural differences often complicated decision making related to patients’ care.2Families in the overbearing category were described as having little medical knowledge and minimal experience in hospital settings. ICU staff reported that these families asked many questions yet tended not to comprehend answers; hence many questions were asked again. Overbearing families tended to be anxious, stressed, and needing constant reassurance or emotional support from ICU staff.ICU staff described demanding families as arrogant, entitled, and unrealistic about their relatives’ form of care. These families often demanded that more attention be paid to them or their relatives and often did not listen to information provided by caregivers.The dysfunctional category includes families who were described as belligerent, untrusting, manipulative, threatening, confrontational, rude, and “never satisfied” with care. Staff reported that family infighting in the ICU was common among this group.Finally, nonexistent families were never in contact with either ICU staff or the patients. Patients with nonexistent families were almost always described as being homeless, having a history of psychiatric illness, or being in trouble with the law.The results of this qualitative study indicate broad categories of family types who visited their relatives in an ICU setting. A quantitative study would be beneficial in determining the prevalence of specific family subtypes. Also, additional positive family classifications should be explored to offer a balanced approach to this family classification system. Future studies should explore the impact of psychoeducation and possible interventions that could help staff with transference and countertransference issues that may serve as a stepping stone for improvement in the care of both patients and patients’ families.Like certain patients,3 many families of patients tend to have some predictable qualities that can affect the patients’ care. Most likely, greater understanding of families will result in improved interpersonal management in the ICU.4,5It is important to recognize the benefit of categorizing patients’ families without compromising our understanding of the complexity of the family unit. Although patients’ families can be grouped into convenient categories, the categorization should not be interpreted as a value judgment or a permanent sentence. We hope that through this initial study of family types, support for patients’ families can be improved to further assist the families in their struggles in the ICU.

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