UC San Diego
Articles
Title
Guidelines for Family-Centered Care in the Neonatal, Pediatric, and Adult ICU
Permalink
https://escholarship.org/uc/item/8p96j3gd
Journal
Critical Care Medicine, 45(1)
ISSN
0090-3493
Authors
Davidson, Judy E
Aslakson, Rebecca A
Long, Ann C
et al.
Publication Date
2017-12-01
Data Availability
The data associated with this publication are within the manuscript.
Peer reviewed
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University of California
1
Title: Guidelines for Family-Centered Care in the Neonatal, Pediatric and Adult Intensive Care
Unit
Corresponding Author:
Judy E. Davidson DNP RN FCCM FAAN,
jdavidson@ucsd.edu
Authors: (No authors have conflicts to report)
Judy E. Davidson DNP RN FCCM FAAN, University of California San Diego Health, San Diego,
California.
Rebecca A. Aslakson MD PhD FAAHPM, Department of Anesthesiology and Critical Care
Medicine; Department of Oncology and the Palliative Care Program in the Sidney Kimmel
Comprehensive Cancer Center at Johns Hopkins; Department of Health, Behavior, and
Society in the Johns Hopkins Bloomberg School of Public Health; The Johns Hopkins
Hospital, Baltimore, Maryland.
Ann C. Long MD MS, Cambia Palliative Care Center of Excellence, Division of Pulmonary and
Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle,
Washington.
Kathleen A. Puntillo PhD RN FAAN FCCM, Department of Physiological Nursing, University of
California, San Francisco.
Erin K. Kross MD Cambia Palliative Care Center of Excellence, Division of Pulmonary and
Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle,
Washington.
Joanna Hart MD MS Division of Pulmonary, Allergy, and Critical Care Medicine, Fostering
Improvement in End-of-Life Decision Science Program, Center for Clinical Epidemiology and
Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pennsylvania.
Christopher E. Cox MD MPH, Division of Pulmonary and Critical Care Medicine, Program to
Support People and Enhance Recovery, Duke University, Durham, North Carolina.
Hannah Wunsch MD MSc, Department of Critical Care Medicine Sunnybrook Health Sciences
Centre; Department of Anesthesia and Interdepartmental Division of Critical Care Medicine,
University of Toronto, Ontario, Canada
Mary A. Wickline MLIS, M.Ed. University of California, San Diego, California.
Mark E. Nunnally MD FCCM University of Chicago; Chicago, Illinois; Director Adult Critical Care
Services, New York University NY.
Giora Netzer MD MSCE Division of Pulmonary and Critical Care Medicine, University of
Maryland School of Medicine, Baltimore, MD.
Nancy Kentish-Barnes PhD Saint-Louis University Hospital, Paris, France.
Charles L. Sprung MD MCCM JD Hadassah Hebrew University Medical Center, Jerusalem,
Israel.
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Christiane Hartog MD Jena University Hospital, Department of Anaesthesiology and Intensive
Care Medicine, Jena, Germany.
Professor Maureen Coombs PhD RN, Graduate School of Nursing Midwifery and Health,
Victoria University of Wellington; Capital and Coast District Health Board, Wellington, New
Zealand.
Rik T. Gerritsen MD FCCM Center of Intensive Care, Medisch Centrum, Leeuwarden, The
Netherlands.
Ramona O. Hopkins PhD, Brigham Young University, Provo, Utah; Pulmonary and Critical Care
Medicine, Intermountain Medical Center, Murray Utah.
Linda S. Franck PhD RN FRCPCH FAAN Department of Family Health Care Nursing, University
of California, San Francisco.
Yoanna Skrobik MD FRCP(c), MSc McGill University, Montreal, Canada.
Alexander A. Kon MD FCCM, Naval Medical Center San Diego and University of California San
Diego, San Diego, CA
Elizabeth A. Scruth PhD RN CCRN CNS FCCM Quality and Regulatory Services, Kaiser
Permanente, Oakland CA.
Maurene A. Harvey MPH MCCM Critical Care Educator and Consultant, Lake Tahoe, Nevada.
Mithya Lewis-Newby MD MPH Seattle Childrens Hospital, Seattle, Washington.
Douglas B. White MD MAS, Program on Ethics and Decision Making in Critical Illness;
Department of Critical Care Medicine, University of Pittsburgh medical Center, Pittsburgh,
Pennsylvania.
Sandra M. Swoboda MS RN FCCM Johns Hopkins University Schools of Medicine and Nursing,
Baltimore, Maryland.
Colin R. Cooke MD MS, University of Michigan Hospitals, North Campus Research Complex,
Ann Arbor, Michigan.
Mitchell M. Levy MD MCCM FCCM, The Warren Alpert School at Brown University, Providence,
Rhode Island.
Elie Azoulay MD PhD, Saint-Louis University Hospital, Paris, France.
J. Randall Curtis MD MPH Cambia Palliative Care Center of Excellence, Harborview Medical
Center, University of Washington, Seattle, Washington.
Acknowledgements:
Sarah A. Kraus MPH Society of Critical Care Medicine, Mt. Prospect, Illinois
Patricia G. Graham MS RN CCRN University of California, San Diego, San Diego, California
Scot Halpern MD, University of Pennsylvania School of Medicine, Division of Pulmonary and
Critical Care Medicine, Philadelphia, Pennsylvania
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Miachael Quasney MD, University of Michigan, Ann Arbor, Michigan
Kathleen M. Kelly MD FACS FCCM, Janssen Research and Development, Morristown, New
Jersey
Dan R. Thompson MD MCCM MA FACP, Alden March Bioethics Institute, Albany, New Jersey
David Y. Hwang MD, Assistant Professor of Neurology; Division of Neurocritical Care and
Emergency Neurology; Yale School of Medicine; New Haven, Connecticut
Heather M. Bullard PharmD, BCCCP, Clinical Pharmacy Specialist, Cardiothoracic Surgery;
Department of Pharmacy; The University of Chicago medicine; Chicago, Illinois
LeeAnn Christie MSN RN Dell Children’s Medical Center of Central Trexas; Austin, Texas
Meg Frizzola DO, Division of Critical Care Medicine; Medical Director, Pediatric Intensive Care
Unit; Assistant Professor of Pediatrics; Sidney Kimmel Medical College; Thomas Jefferson
University, Philadelphia, Pennsylvania
Serena A. Harris PharmD, BCPS, BCCCP; Department of Pharmacy; Eskenazi health;
Indianapolis, Indiana
Mathhew E. Lissauer MD, Surgical Critical Care; Rutgers-Robert Wood Johnson Medical
School; New Brunswick, New Jersey
Appreciation is sent to the patients and family members who volunteered their time to validate
the PICO questions and outcomes of interest.
Keywords:
"Family"[ Mesh]
"Patient-Centered Care"[ Mesh]
"I ntensive Care"[ Mesh]
"I ntensive Care, Neonatal"[ Mesh]
"Critical Care"[ Mesh]
"Critical Care Nursing"[ Mesh]
Family-centered care
Family Nursing
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Abstract
Objective:
To provide clinicians with evidence-based strategies to optimize support of the family
of critically ill patients in the ICU.
Methods: We used the Council of Medical Specialty Societies principles for the development of
clinical guidelines as the framework for guideline development. We assembled an international
multidisciplinary team of 29 members with expertise in guideline development, evidence
analysis and family-centered care to revise the 2007 Clinical Practice Guidelines for Support of
the Family in the Patient-Centered Intensive Care Unit. We conducted a scoping review of
qualitative research that explored family-centered care in the ICU. Thematic analyses were
conducted to support Population, Intervention, Comparison, Outcome (PICO) question
development. Patients and families validated the importance of interventions and outcomes. We
then conducted a systematic review using the Grading of Recommendations, Assessment,
Development and Evaluations (GRADE) methodology to make recommendations for practice.
Recommendations were subjected to electronic voting with pre-established voting thresholds
.
No industry funding was associated with guideline development.
Results: The scoping review yielded 683 qualitative studies; 228 were used for thematic
analysis and PICO question development. The systematic review search yielded 4158 reports
after de-duplication and 76 additional studies were added from alerts and hand searches; 238
studies met inclusion criteria. We made 23 recommendations from moderate, low and very low
level of evidence on the topics of: communication with family members, family presence, family
support, consultations and ICU team members, and operational and environmental issues. We
provide recommendations for future research and work-tools to support translation of the
recommendations into practice.
Conclusions:
These guidelines identify the evidence base for best practices for family-centered
care in the ICU. All recommendations were weak, highlighting the relative nascency of this field
of research and the importance of future research to identify the most effective interventions to
improve this important aspect of ICU care.
