Challenges Experienced by Intensive Care Nurses in Providing Support to Families of Critically Ill Patients at Kenyatta National Hospital

Abstract

Background: In critical care settings, patients often cannot communicate with the care providers and hence the critical care team heavily relies on their family members to speak on the patient’s behalf including making crucial decisions. Critical care nurses therefore closely interact and work with the intensive care unit (ICU) patients’ families in their care role. Providing support to families of ICU patients, thus, constitutes a critical responsibility of nurses working in intensive care settings. Broad objective: To explore challenges experienced by intensive care nurses in providing support to families of critically ill patients at Kenyatta National Hospital. Methodology: The study design was descriptive cross-sectional employing mixed-methods with qualitative data embedded in quantitative data. The study site was Kenyatta National Hospital’s intensive care units (ICUs). The study’s participants consisted of 112 intensive care nurses and ten ICU nurse managers. The sampling technique for the nurses was stratified random sampling technique and the sampling method for the managers was the census method. Quantitative data was collected using a validated questionnaire which sought data on the nurses’ demographic1information, work-related, capacity-related and psychosocial challenges experienced. Qualitative data was obtained using an interview guide administered on the ICU nurse managers. The study’s quantitative data was analyzed using descriptive measures that included percentages and frequencies using SPSS version 24. Further, association between study variables, based on the quantitative data, was evaluated using chi-square test statistic at 95% confidence-interval. Results were shown in tables. In addition, content analysis by developing relevant themes on the basis of the study-objectives, using NVivo 12, was used in analyzing the study’s qualitative data which was then presented in narrative form. Results:High intensity of ICU work demands (X2 = 11.636, df = 1 and p = 0.000); excessive workload (X2 = 7.723, df = 1 and p = 0.004) and lack of clear family support protocols (X2 = 6.163, df = 1 and p = 0.014) were the leading work-related challenges identified. Nurses’ inadequate training on ICU based family support (X2 = 6.708, df = 1 and p = 0.000) and their poor awareness of family support protocols (X2 = 8.161, df = 1 and p = 0.000) were the leading capacity related challenges identified. Persistent worries and fears over patient’s poor/uncertain prognosis (X2 = 7.118, df = 1 and p = 0.000) and mental distress over possible loss of patients(X2 = 6.702, df = 1 and p = 0.005) were the leading psychosocial challenges identified. Conclusion: Intensive care nurses at KNH experienced a wide range of work-related, capacity related and psychosocial challenges in providing support to families of critically ill patients in the hospital. Recommendations: The management of KNH should also ensure that intensive care nurses working in the hospital are adequately trained, supported and facilitated in their role of offering support to families of ICU patients admitted in the hospital.