Das Angehörigengespräch in der Intensivmedizin
Zusammenfassung
Auf der Erwachsenenintensivstation (ITS) sind Angehörige Partner des Behandlungsteams. Angehörige tragen wesentlich dazu bei, eine patientenzentrierte Versorgung auf der ITS und darüber hinaus zu gewährleisten. Gleichzeitig sind Angehörige selbst belastet und benötigen Unterstützung durch „angehörigenzentrierte Versorgung“. Dies geschieht vor allem durch das Gespräch mit Angehörigen. Der Umgang mit Angehörigen sollte stets respektvoll sein und ihre akute Stresssituation berücksichtigen. Empfohlen werden schriftliche Festlegungen oder Standard Operating Procedures (SOP) für das Behandlungsteam, eine strukturierte Kommunikation unter Verwendung besonderer Gesprächstechniken sowie Broschüren und ein Gesprächsleitfaden für Angehörige. Die Dokumentation der strukturierten Angehörigenkommunikation ist ein anerkannter intensivmedizinischer Qualitätsindikator.
Schlüsselwörter
Kritische Erkrankung Akute Stressbelastung Mitarbeiter-Angehörigen-Beziehung Kommunikation Qualitätsindikatoren in der GesundheitsversorgungCommunicating with families in the ICU
Abstract
Family members of adult intensive care patients are partners of the interdisciplinary team. Family members provide important contributions to patient-centered care in the intensive care unit (ICU) and beyond. At the same time, family members are stressed and are themselves in need of support (“family-centered care”). This is mainly provided through family conferences. Family members must always be treated respectfully and with consideration for their acute stress syndrome. A structured communication is recommended as well as written standard operating procedures (SOPs) or guidelines for the ICU team and brochures and written guidelines for relatives. Documentation of structured family conferences is an established quality indicator of intensive care.
Keywords
Critical illness Acute stress disorder Professional-family relations Communication Quality indicators, health careNotes
Einhaltung ethischer Richtlinien
Interessenkonflikt
C. S. Hartog, S. Jöbges, O. Kumpf und U. Janssens geben an, dass kein Interessenkonflikt besteht.
Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.
Supplementary material
Literatur
- 1.Davidson JE, Aslakson RA, Long AC et al (2017) Guidelines for family-centered care in the neonatal, pediatric, and adult ICU. Crit Care Med 45:103–128. https://doi.org/10.1097/CCM.0000000000002169 CrossRefPubMedGoogle Scholar
- 2.Neitzke G, Burchardi H, Duttge G et al (2016) Grenzen der Sinnhaftigkeit von Intensivmedizin Positionspapier der Sektion Ethik der DIVI [Limits of the meaningfulness of intensive care medicine : Position paper of the Ethics Section of DIVI]. Med Klin Intensivmed Notfmed 111:486–492. https://doi.org/10.1007/s00063-016-0202-8 CrossRefPubMedGoogle Scholar
- 3.McAdam JL, Arai S, Puntillo KA (2008) Unrecognized contributions of families in the intensive care unit. Intensive Care Med 34:1097–1101. https://doi.org/10.1007/s00134-008-1066-z CrossRefPubMedGoogle Scholar
- 4.Matt B, Schwarzkopf D, Reinhart K et al (2017) Relatives’ perception of stressors and psychological outcomes – results from a survey study. J Crit Care 39:172–177. https://doi.org/10.1016/j.jcrc.2017.02.036 CrossRefPubMedGoogle Scholar
- 5.Netzer G, Sullivan DR (2014) Recognizing, naming, and measuring a family intensive care unit syndrome. Ann Am Thorac Soc 11:435–441. https://doi.org/10.1513/AnnalsATS.201309-308OT CrossRefPubMedPubMedCentralGoogle Scholar
- 6.Davidson JE, Jones C, Bienvenu OJ (2012) Family response to critical illness: postintensive care syndrome-family. Crit Care Med 40:618–624. https://doi.org/10.1097/CCM.0b013e318236ebf9 CrossRefPubMedGoogle Scholar
- 7.Cameron JI, Chu LM, Matte A et al (2016) One-year outcomes in caregivers of critically ill patients. N Engl J Med 374:1831–1841. https://doi.org/10.1056/NEJMoa1511160 CrossRefPubMedGoogle Scholar
- 8.Wendler D, Rid A (2011) Systematic review: the effect on surrogates of making treatment decisions for others. Ann Intern Med 154:336–346. https://doi.org/10.7326/0003-4819-154-5-201103010-00008 CrossRefPubMedGoogle Scholar
- 9.Lautrette A, Darmon M, Megarbane B et al (2007) A communication strategy and brochure for relatives of patients dying in the ICU. N Engl J Med 356:469–478CrossRefPubMedGoogle Scholar
- 10.Guion WK, Mishoe S, Passmore GG, Witter P (2010) Development of a concept map to convey understanding of patient and family-centered care. J Healthc Qual 32:27–32CrossRefPubMedGoogle Scholar
- 11.Hartog CS, Bodechtel U (2018) Umgang mit Angehörigen auf der Intensivstation [Family-Centered Care in the ICU]. Dtsch Med Wochenschr 143:15–20. https://doi.org/10.1055/s-0042-109257 CrossRefPubMedGoogle Scholar
- 12.Riessen R, Celebi N, Weyrich P, Haap M (2011) Die Visite auf der Intensivstation. Intensivmed Notfallmed 48:403–410. https://doi.org/10.1007/s00390-010-0240-z CrossRefGoogle Scholar
- 13.Seaman JB, Arnold RM, Scheunemann LP, White DB (2017) An integrated framework for effective and efficient communication with families in the adult intensive care unit. Ann Am Thorac Soc 14:1015–1020. https://doi.org/10.1513/AnnalsATS.201612-965OI CrossRefPubMedGoogle Scholar
- 14.Jongerden IP, Slooter AJ, Peelen LM et al (2013) Effect of intensive care environment on family and patient satisfaction: a before-after study. Intensive Care Med 39:1626–1634. https://doi.org/10.1007/s00134-013-2966-0 CrossRefPubMedGoogle Scholar
- 15.Ely EW (2017) The ABCDEF Bundle. Crit Care Med 45:321–330. https://doi.org/10.1097/CCM.0000000000002175 CrossRefPubMedPubMedCentralGoogle Scholar
- 16.Wolf A, Mörgeli R, Müller A et al (2017) Delir, Analgesie und Sedierung in der Intensivmedizin : Entwicklung eines protokollbasierten Managements. Med Klin Intensivmed Notfallmed 112:65–74. https://doi.org/10.1007/s00063-016-0251-z CrossRefGoogle Scholar
- 17.Bethge S, Danner M (2017) Impulsbeitrag: Patient First in der Gesundheitsversorgung: Status quo. Z Evid Fortbild Qual Gesundhwes 121:54–57. https://doi.org/10.1016/j.zefq.2017.03.002 CrossRefPubMedGoogle Scholar
- 18.Schaeffer D, Berens E‑M, Vogt D (2017) Health literacy in the German population. Dtsch Arztebl Int 114:53–60. https://doi.org/10.3238/arztebl.2017.0053 PubMedPubMedCentralGoogle Scholar
- 19.Schenker Y, White DB, Crowley-Matoka M et al (2013) „It hurts to know … and it helps“: exploring how surrogates in the ICU cope with prognostic information. J Palliat Med 16:243–249. https://doi.org/10.1089/jpm.2012.0331 CrossRefPubMedPubMedCentralGoogle Scholar
- 20.Schenker Y, Tiver GA, Hong SY, White DB (2012) Association between physicians’ beliefs and the option of comfort care for critically ill patients. Intensive Care Med 38:1607–1615. https://doi.org/10.1007/s00134-012-2671-4 CrossRefPubMedPubMedCentralGoogle Scholar
- 21.Garrouste-Orgeas M, Max A, Lerin T et al (2016) Impact of proactive nurse participation in ICU family conferences. Crit Care Med 44:1116–1128. https://doi.org/10.1097/CCM.0000000000001632 CrossRefPubMedGoogle Scholar
- 22.Anderson WG, Puntillo K, Boyle D et al (2016) ICU bedside nurses’ involvement in palliative care communication: a multicenter survey. J Pain Symptom Manage 51:589–596e2. https://doi.org/10.1016/j.jpainsymman.2015.11.003 CrossRefPubMedGoogle Scholar
- 23.Janssens U, Graf J (2010) Angehörigenkonferenz. Intensivmed 47:35–42CrossRefGoogle Scholar
- 24.Nelson JE, Walker AS, Luhrs CA et al (2009) Family meetings made simpler: a toolkit for the intensive care unit. J Crit Care 24:626. https://doi.org/10.1016/j.jcrc.2009.02.007 CrossRefPubMedPubMedCentralGoogle Scholar
- 25.Baile WF, Buckman R, Lenzi R et al (2000) SPIKES‑A six-step protocol for delivering bad news: application to the patient with cancer. Oncologist 5(4):302–311CrossRefPubMedGoogle Scholar
- 26.Curtis JR, White DB (2008) Practical guidance for evidence-based ICU family conferences. Chest 134:835–843. https://doi.org/10.1378/chest.08-0235 CrossRefPubMedPubMedCentralGoogle Scholar
- 27.Janssens U, Burchardi H, Duttge G et al (2013) Therapiezieländerung und Therapiebegrenzung in der Intensivmedizin: Positionspapier der Sektion Ethik der Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin. Med Klin 108:47–52. https://doi.org/10.1007/s00063-012-0190-2 CrossRefGoogle Scholar
- 28.Curtis JR, Back AL, Ford DW et al (2013) Effect of communication skills training for residents and nurse practitioners on quality of communication with patients with serious illness: a randomized trial. JAMA 310:2271–2281. https://doi.org/10.1001/jama.2013.282081 CrossRefPubMedPubMedCentralGoogle Scholar
- 29.Carson SS, Cox CE, Wallenstein S et al (2016) Effect of palliative care-led meetings for families of patients with chronic critical illness: a randomized clinical trial. JAMA 316:51–62. https://doi.org/10.1001/jama.2016.8474 CrossRefPubMedPubMedCentralGoogle Scholar
- 30.Kumpf O, Braun JP, Brinkmann A et al (2017) Quality indicators in intensive care medicine for Germany – third edition 2017. Ger Med Sci 15:1–29. https://doi.org/10.3205/000251 Google Scholar
- 31.Neitzke G, Böll B, Burchardi H et al (2017) Dokumentation der Therapiebegrenzung. Med Klin Intensivmed Notfallmed 112:527–530. https://doi.org/10.1007/s00063-017-0321-x CrossRefGoogle Scholar
- 32.Warrillow S, Farley KJ, Jones D (2015) Ten practical strategies for effective communication with relatives of ICU patients. Intensive Care Med 41:2173–2176. https://doi.org/10.1007/s00134-015-3815-0 CrossRefPubMedGoogle Scholar
- 33.Fassier T, Darmon M, Laplace C et al (2007) One-day quantitative cross-sectional study of family information time in 90 intensive care units in France. Crit Care Med 35:177–183. https://doi.org/10.1097/01.CCM.0000249834.26847.BE CrossRefPubMedGoogle Scholar
- 34.Curtis JR, Treece PD, Nielsen EL et al (2016) Randomized trial of communication facilitators to reduce family distress and intensity of end-of-life care. Am J Respir Crit Care Med 193:154–162. https://doi.org/10.1164/rccm.201505-0900OC CrossRefPubMedPubMedCentralGoogle Scholar
- 35.Aslakson RA, Bridges JF (2013) Assessing the impact of palliative care in the intensive care unit through the lens of patient-centered outcomes research. Curr Opin Crit Care 19:504–510. https://doi.org/10.1097/MCC.0b013e328364d50f CrossRefPubMedGoogle Scholar
- 36.Aslakson R, Cheng J, Vollenweider D et al (2014) Evidence-based palliative care in the intensive care unit: a systematic review of interventions. J Palliat Med 17:219–235. https://doi.org/10.1089/jpm.2013.0409 CrossRefPubMedPubMedCentralGoogle Scholar