A Synthesis of Family-Focused Care Research in Acute Care Settings in Africa

In family-focused care, health professionals are viewed as providing care from the position of an "expert" by assessing, assisting and providing recommendations for the family as a unit to follow. Much of the research work in this area has been developed in the western world and thus it is often questioned as to whether it is appropriate and transferable to a resource constrained, multi-cultural environment such as that found in many countries in Africa.

Purpose: This presentation will provide a synthesis of findings from a targeted body of research directed towards family focused care in the acute care setting within Africa. Acute care is a comprehensive system based approach to time sensitive diseases, encompassing all health system components and care delivery platforms used to diagnose, manage and treat injury and illness that may lead to death or disability without timely intervention. This term includes a range of clinical health-care functions, including emergency medicine, trauma care, pre-hospital emergency care, acute care surgery, critical care, urgent care and short-term inpatient stabilization.

Methods: A synthesis of research findings from seven collaborative research studies conducted in South Africa, Rwanda and Sweden was undertaken in order to answer the following;

• Who is the family?
• What do the families experience?
• What can nurses do to improve their experiences?

The research settings included various acute care areas (neonatal ICU, trauma/surgical ICU) and involved families and nurses within these areas. 

Results: There is much confusion regarding the term "family" as it can mean different things to different people and it was for this reason that an international research collaboration between South Africa and Sweden was conducted to compare and contrast descriptions of “family” amongst Swedish and South African university nursing students (Erlingsson & Brysiewicz, 2015). This qualitative content analysis study established that families can be seen as people who are connected to one through Ties of Kinship, Love, Influence, Everyday Life, and by being Tied by Slipknots (this emphasised the fluidity and flux of families). The definitions were very similar between the two countries however there were a number of differences in that the South Africans placed much emphasis on family being someone who had the same surname, was linked by having the same ancestors and was someone who was an important resource - both physically and emotionally. Awareness of what is meant by the term family can assist nurses in their daily work through increasing understanding of the complexities surrounding this issue and encouraging cultural sensitivity and openness to patients’ and families’ views about who is a family member.

Family members interviewed in two qualitative studies in South Africa described their experiences of feeling invisible, avoided and neglected by the health workers within the acute care areas of the hospital. The families also appeared to have a fairly negative attitude of the health professionals, who they described as being “unfeeling” and “cold” (Brysiewicz, 2008).  One of these studies using grounded theory to enhance family care during critical illness, highlighted that family focused care is a collaborative effort between health workers and families and is characterized by partnership and trust. This study reinforced the fact that strategies to enhance family care can only be successful if strategies to support the health worker are also considered (De Beer & Brysiewicz, 2012).These studies also highlighted the fact that caring for families can be made visible using small, simple gestures that do not necessarily require a great deal of resources or finances. 

In exploring the needs of family members admitted into an ICU in Rwanda, using the Critical Care Family Needs Inventory, this quantitative study found that the most important need identified was the need for assurance, followed by the need for comfort, information, proximity and lastly support. In this study three additional needs related to resource constraints present in the hospital (and common elsewhere in Africa) were also identified (Munyiginya & Brysiewicz, 2014). 

Having a new-born infant hospitalised in the neonatal intensive care unit (NICU) is an unexpected and stressful event for a family and a study in Rwanda described and analysed parental perception of stress. The Parental Stress Scale: Neonatal Intensive Care Unit was the tool used and the most stressful events for parents were found to be the appearance and behaviour of the baby, as well as the sights and sounds of NICU. This study concluded that parents needed to be prepared and educated by the staff regarding these issues (Musabirema, Brysiewicz & Chipps, 2015). 

Two systematic reviews, undertaken to establish the current status quo regarding in hospital interventions to address the psychosocial needs of families of critically ill patients, illustrated that research within this area is limited and reflected a paucity of interventional studies, which are methodologically rigorous, to evaluate the effectiveness of these interventions. There was some support regarding the vaule of providing written communication to families.

Synthesis of the data from the seven studies spanning three different countries thus highlighted the information needs (concerning a variety of issues) as well as the importance of attending to the psychological needs of the family. A family intervention has been developed which includes written and culturally appropriate information as well as the implementation of a psychological first aid (PFA) programme. PFA is a supportive response to a person following a traumatic event, such as having your loved one admitted into an acute care area of the hospital, and it takes strives to provide support to the person suffering from the event.

Conclusion: Providing family focused care within the acute care setting is challenging and addressing the needs of the family within this time constrained, and often, resource constrained environment while remaining sensistive to cultural nuances adds to the difficulties. Interventions need to be simple, time limited, cost effective as possible, culturally sensitive, informative and supportive.