Cape Breton Regional Hospital intensive care unit embraces family presence

Cape Breton Regional Hospital ICU embraces family presence
Seated (l to r): Laurie Madinsky, RN and Dorothy MacAskill, Director, Critical Care/Acute Medicine-Intensive Care Unit, Cape Breton Regional Hospital Standing (l to r): Shannon Ranni, RN; Krystal MacDonald, RN; Rose Harrietha, RN; Dr. David Brake, Internal Medicine and Marie AuCoin, clerical

Several years ago, Dorothy MacAskill drove all night to see a loved one who’d been admitted to an intensive care unit (ICU) in the province. When she arrived, she was told she couldn’t visit. As manager of an ICU herself, and now interim director, it hit home for MacAskill that restricting family access to loved ones wasn’t serving the patient or family. 

“All of the literature says family presence works,” said MacAskill. “We just weren’t doing it. It’s those personal experiences that change your mind.”

As a result of MacAskill’s experience and a commitment to patient- and family-centred care, the ICU at Cape Breton Regional Hospital introduced family presence three years ago. Nova Scotia Health Authority (NSHA) formalized its commitment to family presence in 2017 with the introduction of a Family Presence policy. This means that instead of observing strict visiting hours, designated close family members can spend as much time as they like with the patient, in addition to attending rounds if they wish.

“We encourage families to come to daily rounds,” said MacAskill. “We get information from them as well – very important information. We invite them to ask questions. We ask them if they have any concerns. They are part of the care plan for their loved one, which is hugely important.”

Family members are able to stay overnight, too, although few choose this option.

“We encourage families to take care of themselves – get some sleep, eat well. Rarely do they stay the night.” 

With the adoption of family presence at the Cape Breton Regional Hospital ICU came an immediate increase in trust among families and staff. “When you don’t get information, you automatically go to a place of mistrust. Just by opening up our visiting hours, we gained a whole lot of trust.”

Benefits of family presence include decreased anxiety and confusion for the patient, improved emotional health, decreased risk of falls, better medication adherence and lower readmission rates.

Satisfaction has also increased, said Joanne Boutilier, interim manager of CBRH's ICU. “Families are seeing that everything is being done for their loved one that that can be done. There is less misinformation. They are hearing right from the doctor. It really cuts back on their anxiety.”

Now that family members are welcome and feel informed, “we have absolutely no complaints about care in ICU,” said MacAskill. 

The most compelling evidence of change came from a family member directly.

MacAskill explained, “a patient recently stopped me and said, ‘what happened here? My mother was in five years ago and we were never allowed here. What a difference! We feel like we’re part of her care now.’”

For more information about Family Presence at NSHA, see NSHA’s Family Presence policy