VANDAL –WALKERAND CLARK “IT START WITHACCESS,AGROUDED THEORY OF
FAMILY MEMBER WORKIN TO GET THROUGH CRITICAL ILLNESS”
This crisis for FM often describe as an emotional roller-coaster. FM of critically ill patient
reported stress was high as that of patient admitted for posttraumatic stress disorder. However
FM reported to mobilize a large range of coping strategies and scored higher than the national
norm for coping. Optimism for FM was comparable to those of a control adult nonpatients.
Many family get through this crisis but with a cost in energy time and emotion. The old view of
FM suggests that they were more passive bystander at the bedside grateful when the nurse met
their needs. The NEW view suggested that were significant contributors to the psychological
well-being of patient, affecting both patient satisfaction and health outcomes.
“What constitute family members work to get through the critical illness of a relative, from their
For each studies in 4 hospital in Canadian cities notices were posted in seven waiting rooms
serving 10 adult critical care unit.
Study 1: also recruited by word-of-mouth from nurses, staff and other participant= convenience
Study 2 = purposive theoretical sample based on the developing analysis
Unit of analysis for both study was the individual family member rather the family unit. in 3
instance family member were interview together to get family unit data.
All first interview in both study was done face-to-face, second interviews were conducted by
phone with those family member from ICU to a medical ward, or no longer in hospital or
deceased. Length -of-stay ranged from 24h to 270 days.
Family member work “working to get through”
Study 1 revealed: Family member were engaged to get through the situation of having critically
Study 2: explore the phenomenon
Both studies revealed that the most significant influence on family members work was their need
to be that at the bedside. this permit them to gaining access to accomplish patient related work,
nurse physician related work and self-related work
The need to be there: simply as witnesses to the experience, was a demonstration of their love to
the patient and reassure them to see what was happening. Family member believed they were
essential to patient welfare. Family took pride of their involvement and interpreted their need to
be there as their work. Work of gaining access: family member work to gain access to the patient bedside, to critical
care staff and to information.(first step was gaining access to the unit)this was accomplish by
negotiation and renegotiation with medical staff.
Waiting and worrying:work of gaining access can be passive and invisible .Protracted waiting
and worrying can result in higher level of anger and frustration. Family member can expend time
and energy enduring long wait time and suffering for uncertainty and fear.
Watching and listening: family member assess each staff member approachability and were
responsive to cues that revealed opportunity for access to info . Determine who and how to
approach in medical staff.
Asserting vs acquiescing: the work of FM in gaining access is visible and active which could
lead medical staff label them as difficult and eventually info access to bedside, staff and info
could be harder to achieve. So FM knows how risky this assertive behavior is.
Negociating: what was frustrating to all family a member was the recurrent need to