Whanau/family meetings in the paediatric intensive care unit: content, process, and family satisfaction : a thesis presented in fulfilment of the requirements for the degree of Master of Philosophy, Social Work, Massey University, Auckland, New Zealand.

Abstract

Family Meetings occur frequently in the Paediatric Intensive Care Unit (PICU) yet little data existed to guide clinicians in the conduct of these meetings. The medical team is required to deliver complex medical information and navigate complex decision-making with a traumatised family during a meeting. The objectives of this study were to describe the content and process of 15 whanau/family meetings in the PICU, identify family meeting characteristics and patient and family attributes that influence family satisfaction and recommend guidelines for health professionals working in the PICU. The study was conducted in a PICU in a university-affiliated children’s hospital in New Zealand (NZ). The process and content of 15 family meetings were analysed using a coding framework previously developed through a qualitative study of family meetings in the adult intensive care unit (Curtis, 2002a). A questionnaire providing a quantitative assessment of family satisfaction drawn from the same study was administered to 30 family members. Demographic data for the study were collected from the patient’s hospital record and these were combined with data relating to the meeting recording and transcript to identify family meeting characteristics and attributes that might influence family satisfaction. The content and process of family meetings in the PICU were described using a framework detailing 28 codes from the six domains: introductions, informational exchange, discussions of the future, decisions, discussions about death and dying, and closings. A comparison of family meeting characteristics and patient and family attributes revealed that longer meetings (40 minutes plus) were associated with lower family satisfaction and should therefore prompt clinicians to consider whether there are unresolved conflicts, difficulties or misunderstandings between the medical team and the family. Recommendations are proposed to guide health professionals in family meetings in the PICU. This is the first study to record and code the content of family meetings in the PICU. The findings from this study will assist clinicians in their meetings with families. The description of the family meeting content will also provide a foundation for future communication training and research in the health environment.