Critical Ilness

It is very difficult for a patient to have a critical illness as this case affects the patient's family because their well being and their quality of life differ when having a critical illness patient. The sudden occurrence of the disease and its complicated requirements leave hard effects on the family members. This imposes them to be there with the patient in the critical care unit to provide help and support to the patient but the stressors they are liable to affect their stay negatively as they are not accustomed to stay in the critical care environment. (Schmidta and Azoulay 2012). According to what was confirmed by McAdamet al (2010), nurses' support is highly asked by the family members as they feel lost in the care environment and need nursing advice about the patient's condition, treatment, costs of stay and other information. Nurses have to be skillful and bearing the initiation ability to provide information and support for the family members according to the differences between each family of a specific patient in order to provide them with the holistic care through the nursing interventions in the critical care environment. Andersonet al (2008) analyzed the stressors that the patient's family members are encountered to in the critical care unit and stated that these stressors can vary from simple ones to very sever ones as, for example, decision making may bother the family members if they don’t have enough information about the patient's case so when the patient is admitted to hospital, the family should receive enough information about the patient. Stress, anxiety and panic are among the stressors that affect the family members and they can be a result of the environment of the care unit. The assignment is a presentation and a discussion for the impact left on the family members of a critical illness patient regarding their well being and quality of life and the role of the nursing staff in supporting the family members of a critical illness patient.

According to Davidson et al (2012), critical illness is a disease which is serious and it forces the patient to live a difficult life due to the conditions of the disease that requires the patient to be under control, monitoring and support from the family members and from health caregivers. Critical illness can affect the patient's health and cause cases such as coma or stroke and other cases that may lead to ending the patient's life. Such cases and disease conditions make the patient in a need for critical care that can help in improving the quality of life of the patient. Critical care was defined by Abuatiq et al (2012) to be a kind of healthcare that targets certain types of patients with critical illness or with an illness condition which is unstable and causes physiological difficulties to the patient that makes healthcare is critical too and includes continuous monitoring and observing for the patient by special care providers who understand the condition of the patient deeply and the way it is developing. The patient whose health is affected by a critical illness usually reflects the condition of the critical illness on the family members who suffer as long as the patient suffers. According to McLain and Dashiff(2008), a family is a group of related members forming a social unit with known parents who are considered the source of care. The stressors found where a critical illness patient stays can result in disturbing the patient and the family. Laveeet al (2013) defined well being as a case of illness absence and a feeling of satisfaction with life, work and health and it helps in having better social engagement and psychological stability.  

Today's life is full of stressors that affect everyone differently according to the individual's conditions and the surroundings around each person. Hickmanand Douglas (2010) referred to hospital experiences where there are lots of stressors and that these stressors increase when the patient stays long periods with the family members or some of them who are accepted to stay I the critical care unit as stressors then are reflected on the family members as well as the patient and sometimes reflected on the health caregivers themselves. Dodge et al (2012)discussed how the family members can be prone to many stressors which can take many various aspects such as the financial and economical stressors, social ones, emotional and psychological and or physical stressors; these stressors come from what may be confronted by the family members of severe experiences in the critical care unit. It is critical illness that confuses the life of the patient and the family as the patient needs the family members to stay for help and support in the hospital and this can last for long periods affecting each one's life, career and social activities in addition to the financial burdens the family affords as this may be more than their financial capabilities.  Novaes et al (2009) confirmed that the stressors the family suffers can include psychological stressors as they watch one of them in a critical health condition and in need for treatment, care and support. Another stressor is the physiological stressors that affect the body functions as a result of standing, providing help for the patient while eating or having a bath, not having good sleep and feeling pain. Leske(2008) said that the care environment itself can be a source for stressors affecting the family as it includes strong lights, strange devices' sounds, equipment for therapy uses and odors of medicines and other medical substances, there are also the emotional stressors that result from fears and decisions to be taken regarding the patient's therapy and this becomes more difficult when the family lacks proper information about the patient's condition and needs of therapy. Leske and Jiricka(2011) states that the family members endure many social stressors in their communities as they are asked to engage in the social activities and meetings while they are spending their time with the patient in hospital which makes them away from applying the social needs. Members of the family may also suffer having bad relations with the health care givers because they don't give them the needed information to help them decide about the patient's case which raises their stressful feelings and anxiety. Delva et al (2012) reported that the family of the patient usually suffers emotional stressors due to what they face of difficult family situations and less family conversations in addition to their fears towards the life of the patient and being uncertain if he or she is going to complete life or die which causes great disturbance and emotional or psychological problems to them.   

Curranet al (2006) discussed the stressors to find out that they are multi- faceted through the body, financial state, emotions and psychological state of the family members which reduces the efficiency of their daily functions and decreases the quality of life. Another study by Chien et al (2006) confirmed this because the stressors are having features that are severe and hard on anyone being in the critical care unit and are difficult to be coped with by the family members staying with the patient whose case is usually serious and may be facing the last days of life. This can affect the patient as well as the family members and cause great pain physically and psychologically. A big stressor is the family's sufferings with the financial needs of the patient as they may be unable to pay what they have to and this may cause troubles and fights among the family members especially when they are surprised with these unexpected costs. This can also make the family unable to provide the patient with the support they are staying for and this reflects on the well being of the patient also. Jee et al (2012) discussed the psychological consequences resulting from the critical care unit stressors and affecting the patient and the family members and that they can cause varied psychological problems such as depression, grief, despair, anxiety or worry feelings. When the family stays with the patient for long times that appear not to end, these psychological problems increase especially when there aren't enough and effective nursing interventions aimed at helping the family members not to be liable to have such problems and this may lead the patient to have negative health outcomes and decrease the effectiveness of therapy. Curley (2010) stated that when nurses tend to neglect their role towards the patient's family member, this will lead to all the problems the family members suffer and decrease the success chances in treating the patient or raising his quality of life and well being so the nursing interventions are very important for preventing any complications to occur to the family members due to their stay with the patient. Miles (2009) added that weak compatibility issues are usually causes by the shortage in information in addition to adding more stressors to the family members because they feel not welcomed and feel as aliens in the care environment then when they asked to provide therapeutic decisions, they don't know exactly what to do and their decisions may be wrong ones. Their weak knowledge about the patient makes them uncertain about what is good and what is bad for the patient so they can't be correct in their decisions as the case of the patient is mysterious and vague to them so their fears of death and difficulty of the patient's recovery make them hesitate regarding what steps to be taken for helping the patient. Coyne (2011) added also that the family members' dissatisfaction with the service and care provided for the patient can also affect the health care providers and let them suffering stressors which retards the case of the patient and decrease the treatment effectiveness. 

Leske and Jiricka(2009) confirmed that nurses are well acquainted with what the family members really need and that they are considered a tool of the critical care tools and that they are under pressures of psychological sufferings which may be complicated and require special dealing with them especially when they spend long time with the patient in the hospital. Nurses have to get a clear identification of the family members' requirements and needs in order to arrange them according to their importance and include them within the care plan provided to the patient because these needs may differ from a family to another according to many measurements such as the conditions of the patient and the condition of the family members themselves. This was also asserted by Warren(2014) when he mentioned that the family's most important need is having a good knowledge background about their patient's case and to be aware that the healthcare provided for the patient is well planned and is suitable for the case. The family members have to learn all about the care costs, expenses and financial requirements in order to prepare themselves and not to be surprised by such costs and this can decrease the stressors the family suffers due to financial burdens. According to Kinradeet al (2009), nurses are responsible for helping the family members psychologically in order to prevent any negative emotions from affecting them where they stay in the care environment and it is better to make them familiar with the strange devices and the medical equipment in the room to avoid their being disturbed by them or fear them. Molter (2010)added that health education is very necessary to be provided for the patient's family members in order to help them support the patient and raise his psychological and emotional status to be at its best. Chartierand Coutu-Wakulcyzk(2011) commented on the five basic needs that the family members of the patient often have and mentioned that these five needs are the need to be informed about the patient's case and the care environment components, the need for receiving organized regular nursing interventions for the patient and for the family members, the need to have some relaxing and resting time to relieve pains and sufferings, the need for psychological aid by nurses in their interventions and the need for discussions with healthcare providers about the patient's progress and recovery plan and this increases the patient's ability to receive treatment and medical examinations. Koscoand Warren(2012)referred to the needs of the patient's family to be classified into main categories such as the psychological needs, physical needs, social needs and knowledge needs and that nurses have to meet their needs through their organized interventions that should include all needs' categories as this is considered a part of treating the patient.

Hannemanand Cardin(2010) reported that the patient and the family both need to relieve stressors in order to be able to endure life in the hospital and this can happen using some strategies to relieve stressors and reduce their impact and can have stability during their stay in the critical care unit. These strategies can be applied by the health caregivers and especially nurses who should be trained to perform them well in order to help the family cope with difficult situations and hard times they suffer in the hospital. Miracle(2011) discussed how nurses can use the strategies prepared for helping the family through using behavioral strategies and cognitive strategies for managing stress and provide solutions for difficult situations for enabling the family members to have stable emotional status. Kinradeet al (2009) added that the strategies used for helping the family during the time they spend with the patient in the hospital can be categorized to four major important ones such as using newsletters as a means of providing information to the family members and communicating with the family members based on having a strong therapeutic relationship with the patient and the family members depending on exchanging information, answering questions and applying needs of them through discussing their troubles and learning all about the health history of the family in order to enable them help the patient and provide all possible aids to the healthcare staff and to the patient without being upset or nervous and having improved relations with nurses specifically and solving the emotional and psychological problems of the family through having a clear idea about their emotional sufferings and discussing them to find solutions for them. This can help them overcome any stressors they may suffer and can be as obstacles to health caregivers. Baileyet al (2010) stated that there is a successful strategy to be used to help the family members which is inviting them to spend extra time with the patient to help the patient have mind peace and be stable during the hospital stay. Azoulayet al (2011), presented a discussion for nurses' role in using the techniques that help the family members have high levels of confidence in the nursing team and all healthcare providers and a confidence in what doctors and other care providers present for the patient through the set care plans that aim at improving the status of the patient and in making the family acknowledged with what is prepared for them of means to make them cope with the care environment such as the nursing interventions prepared to provide them with information and answers for any enquiries they may have about the patient or the care environment. Ahrens et al (2012) stated that there are many ways to provide information for the family by nurses such as using leaflets and magazines and inviting the family members to be in the meetings the doctors and nurses have about the patient's condition and the care plan set for helping the patient. This helps the nursing staff get the best benefits from the family members by using them as tools to help the patient and not to disturb him. 

Conclusion

Critical illness requires many care measurements and many procedures of keeping the patient healthy through the critical periods of his life. Critical illness is dangerous that the patient needs to be staying in the hospital with the family members in many cases. This makes it important for the health caregivers to understand the needs of the family members in order to be careful while dealing with them and to apply their needs in the critical care environment. The family members may be bothered by many stressors found in the critical care unit such as their feelings towards the patient, death fears, misunderstanding of the care providers' role and the existence of many unusual devices and equipment in the care unit. The care environment can also work against the rest of the family members with the lights, sounds and disturbance effects it has so it is important to care for the family members' needs and enquiries by a skillful trained cooperative staff of nurses who provide special interventions for the family members. There are strategies that were found by researchers to be effective with the family members such as newsletters, leaflets and meetings with the family members so as to recognize what they think of, what they are in need for and what questions they need answers for. Applying the strategy of building a nurse family therapeutic relationships found to be successful in helping families of the critical illness patient cope with all stressors they find while they are staying with the patient during treatment periods. A nurse has to understand the roles and responsibilities that should be done with the patient's family in order to reach to the main goal of care which is improving the patient's condition and well being and employ the family energies to serve the healthcare staff and not to disturb them while they are doing their jobs of providing care for the patient with critical illness.