The vortex: families' experiences with death in the intensive care unit.
BACKGROUND
Lack of communication from healthcare providers contributes to the anxiety and distress reported by patients' families after a patient's death in the intensive care unit.


OBJECTIVE
To obtain a detailed picture of the experiences offamily members during the hospitalization and death of a loved one in the intensive care unit.


METHODS
A qualitative study with 4 focus groups was used. All eligible family members from 8 intensive care units were contacted by telephone; 8 members agreed to participate.


RESULTS
The experiences of the family members resembled a vortex: a downward spiral of prognoses, difficult decisions, feelings of inadequacy, and eventual loss despite the members' best efforts, and perhaps no good-byes. Communication, or its lack, was a consistent theme. The participants relied on nurses to keep informed about the patients' condition and reactions. Although some participants were satisfied with this information, they wishedfor more detailed explanations ofprocedures and consequences. Those family members who thought that the best possible outcome had been achieved had had a physician available to them, options for treatment presented and discussed, andfamily decisions honored.


CONCLUSIONS
Uncertainty about the prognosis of the patient, decisions that families make before a terminal condition, what to expect during dying, and the extent of a patient s suffering pervade families' end-of-life experiences in the intensive care unit. Families' information about the patient is often lacking or inadequate. The best antidote for families' uncertainty is effective communication.
Kirchhoff
Karin T
KT
University of Utah College of Nursing, Salt Lake City, USA.
Walker
Lee
L
Hutton
Ann
A
Spuhler
Vicki
V
Cole
Beth Vaughan
BV
Clemmer
Terry
T
D000293:Adolescent; D000328:Adult; D003643:Death; D005190:Family / Q000523:psychology*; D017144:Focus Groups; D006801:Humans; D007362:Intensive Care Units; D008016:Life Change Events; D008875:Middle Aged; D011368:Professional-Family Relations