A view from the other side*

Abstract

The environment in our intensive care units (ICUs) often serves the convenience of the staff who work in the ICU, rather than the critically ill patients and their loved ones who are, as a family unit, the objects of our care. Critically ill patients, especially those with high acuity, require close bedside attention. Continuous monitoring, frequent physical evaluations, invasive procedures, and other demands of bedside care are just some of the processes in the ICU that require heightened attention from ICU clinicians. But the fact that we "have a lot to do" at the bedside of critically ill patients has led to an unfortunate environment in many ICUs, one in which the needs of families are not only considered secondary to the convenience of ICU personnel, but are frequently dismissed as burdensome, unreasonable, and even counter to good-quality patient care. Perhaps this is why there are reports in the literature of family concerns about less than satisfactory interactions with ICU clinicians. The attitude we have toward families is an important part of the care we offer to patients in the ICU, and it can have a profound effect on the health of our patients' families. In palliative care circles, it has long been understood that the "unit of care" is both the patient and the family. Although we are moving in that direction in critical care, many ICUs may not always reflect an appreciation of the therapeutic potential or devastating consequences of the attitudes in the ICU. The evolution of our understanding of care for critical illness should include a different approach to families and visiting hours in the ICU. One that balances the need of family members to be with their loved ones at a time of critical illness and the need of ICU clinicians to conduct efficient bedside care.