Enf.ª Isabel Pires

Specialist in Medical-Surgical Nursing
Master's in Nursing Responsible Nurse

Enf.ª Tatiana Neves

Master's student in
Medical-Surgical Nursing 

Enf.ª Joana Russo

Specialist in Medical-Surgical Nursing
Master's in Nursing

The importance of emotional support in increasing client/family satisfaction in the context of an intensive care unit

HPA Magazine 22 // 2024

The concept of health quality can be understood as the provision of health care centered on the individual, taking into account their personal and social characteristics, with its main objective being to improve health outcomes1.
The evaluation of health services is extremely important in demonstrating the effectiveness of the care provided, regardless of the context in which it takes place.
Customer satisfaction is an indicator of quality in healthcare, which is of great importance for evaluating the care provided.
This can be assessed through the implementation of satisfaction surveys to identify the perspectives and needs of clients/families regarding the services provided, also allowing for the collection of improvement proposals².
Assessing the satisfaction of people admitted to an Intensive.
Care Unit (ICU) proves to be a complex task due to the high rate of mortality and morbidity associated with these services, which is why in many situations, it is measured among families2,3.
Several studies have been carried out over the years with the aim of evaluating interventions that increase both client satisfaction and family satisfaction in the ICU context. Firstly, it can be considered that the satisfaction of the client admitted to the ICU regarding nursing care is closely related to the communication established between the nurse and client. Patients reported that the use of communication skills such as active listening, attentive looking, therapeutic dialogue, teaching, responding to doubts and fears, introducing oneself, and saying goodbye in all contacts were interventions that increased their satisfaction with the care provided2,3,4.
Another aspect related to client satisfaction and nursing care is the humanistic profile and technical-scientific skills of nurses. Studies point to a need to combine the two in a constant way, enhancing safety, well-being, comfort, and customer confidence. The nurse, by simultaneously using relational skills and technical-scientific knowledge, demonstrates security in the care provided, enhancing well-being, comfort and satisfaction levels2,3,4.
Caring behaviour proved to be an important factor in increasing customer and family satisfaction related to nursing care. This concept can be understood as the establishment of an interpersonal relationship between the nurse and client/family, focused on attentive care and the implementation of interventions that improve the client's state of mind3.
Regarding family satisfaction, several interventions enhance its increase, namely, a collaborative intervention between the healthcare team and the family, considered a key strategy for increasing family satisfaction2,3,4.
The use of appropriate communication strategies between the team and family members of people admitted to the ICU has been shown to increase family satisfaction with nursing care. The adoption of strategies that reduce noise and light in the ICU and promote privacy were highlighted as essential points for this increase2,3.
Similar to customer satisfaction, family satisfaction is also strongly influenced by communication skills.
It is considered essential to use resources to include family members in care, guiding them throughout the process and providing updated, clear, and honest information related to the client's clinical status. The demonstration of empathy, respect, sensitivity, emotional, and spiritual support to the family are interventions that respond to the family's needs. Therefore, it is important for nurses to meet family members and allow them to express their doubts and fears so that family members feel more confident and understood5.

Holding educational family conferences with the multidisciplinary team, with initial discussions about care objectives, physical structure, equipment, activities carried out in the ICU, prognosis, treatment objectives, and nursing care help improve the family's knowledge and increase their satisfaction2.
At the HPA Alvor ICU, the nursing team, when approaching the client and their family upon admission, strives for personalized and individualized care according to the client's clinical situation. When welcoming the family (first contact with the intensive care unit), the nursing team puts their communication and relational skills into practice, promoting an environment of proximity and availability towards the client and their family. In its initial approach, a small presentation of the operation, structure, and organization of the service is made. It is during this first contact that the nursing team takes the opportunity to also clarify more technical issues, namely the noise caused by monitoring devices, which are normally anxiety-generating factors for both the patient and their family. At this time, all information is also made available in written format, through the delivery of the “Welcoming guide for family members and visitors”.
In our daily clinical practice, one of the most relevant nursing interventions is the clarification of doubts and emotional support provided by the team at all times during the client's hospitalization. Framed in a culture of “proximity,” we promote an environment conducive to communication, which allows the client and their family to express their doubts, fears, and concerns, so that they feel supported, understood, and more confident in the care provided to them.
In short, in their clinical practice, nurses play a central role in the relationship they establish with the client and their family, which is the basis for increasing the satisfaction of the client/family admitted to an intensive care unit.
Referências Bibliográficas // References
1Organização Mundial da Saúde. Quality of care: a process for making strategic choices in health systems. World Health Organization. 2006 [citado 2024 maio 6]. Disponível em: https://iris.who.int/bitstream/handle/10665/43470/9241563249_eng.pdf?sequenc
2 André, T., Pedro A. Intervenções que Promovem o Incremento da Satisfação da Família em UCI: Revisão Integrativa. RIASE. 2021 [citado 2024 maio 5] 7(3): 376-399. Disponível em: http://dx.doi.org/10.24902/r.riase.2021.7(3).495.376-399
3 Mar, M., Esteves, N, Sousa A. Satisfação Familiar em Unidade de Cuidados Intensivos: Revisão Integrativa da Literatura. Revista de Investigação & Inovação em Saúde. 2020 [citado 2024 maio 6] 3(1):66-67. Disponível em: https://doi.org/10.37914/riis.v3i1.61
4Madureira, D., Parreiras, P., Pereira, V., Houri, L. Satisfação familiar nos cuidados intensivos avaliada por meio do FS-ICU 24. Sociedade Brasileira de Psicologia Hospitalar. 2019 [citado 2024 maio 6] 22(1): 195-215. Disponível em:
http://pepsic.bvsalud.org/pdf/rsbph/v22n1/v22n1a11.pdf
5Cabete D., Fonte C., Matos, M., Patrica, H., Silva, A., Silva V. Apoio emocional à família da pessoa em situação crítica: intervenções de enfermagem. Revista de Enfermagem Referência. 2019 [citado 2024 maio 7] 4(20): 129-138. Disponivel em: https://doi.org/10.12707/RIV18062