Elsevier

Intensive and Critical Care Nursing

Volume 43, December 2017, Pages 123-128
Intensive and Critical Care Nursing

Research article
The needs of the relatives in the adult intensive care unit: Cultural adaptation and psychometric properties of the Chilean-Spanish version of the Critical Care Family Needs Inventory

https://doi.org/10.1016/j.iccn.2017.07.006Get rights and content

Abstract

Introduction

The admission of a patient to an intensive care unit is an extraordinary event for their family. Although the Critical Care Family Needs Inventory is the most commonly used questionnaire for understanding the needs of relatives of critically ill patients, no Spanish-language version is available. The aim of this study was to culturally adapt and validate theCritical Care Family Needs Inventory in a sample of Chilean relatives of intensive care patients.

Methods

The back-translated version of the inventory was culturally adapted following input from 12 intensive care and family experts. Then, it was evaluated by 10 relatives of recently transferred ICU patients and pre-tested in 10 relatives of patients that were in the intensive care unit. Psychometric properties were assessed through exploratory factor analysis and Cronbach’s α in a sample of 251 relatives of critically ill patients.

Results

The Chilean-Spanish version of the Critical Care Family Needs Inventoryhad minimal semantic modifications and no items were deleted. A two factor solution explained the 31% of the total instrument variance. Reliability of the scale was good (α = 0.93), as were both factors (α = 0.87; α = 0.93).

Conclusion

The Chilean-Spanish version of theCritical Care Family Needs Inventory was found valid and reliable for understanding the needs of relatives of patients in acute care settings.

Introduction

Admission to the Intensive Care Unit (ICU) is an event that significantly impacts the life of the patients and their family. This uncertain and life-threatening situation alters the normal family routine, it’s lived in an unfamiliar environment that is often unwelcoming and involves a healthcare team that primarily focusses on the medical treatment of the patient, leaving the family on the sidelines. In this context, families suffer high levels of anxiety, stress and depression that can last even after the patient is released (Cameron et al., 2016, Haines et al., 2015).

One way to address this issue is to know the needs of the family members and to what degree these needs have been met. Research in the last decade has found that the most important needs of family members of critical care patients are related to assurance and information (Paul and Rattray, 2008, Verhaeghe et al., 2005). Based on this, some interventions centered on the needs of patient family members in the ICU have positively impacted in their satisfaction and, even, decreased psychological impact (Chien et al., 2006, Kynoch et al., 2016).

While there are a number of instruments existing to determinate family needs in the ICU, the most commonly used is the Critical Care Family Needs Inventory (CCFNI) (Olano and Vivar, 2012). This instrument was created to allow patient family members to hierarchically classify a group of needs related to assurance, information, support, comfort, and proximity (Leske, 1991). The CCFNI has been validated in several languages and the original version is available in English (Leske, 1991), French (Coutu-Wakulczyk and Chartier, 1990), Chinese (Chien et al., 2005), Farsi (Bandari et al., 2014), and German (Bijttebier et al., 2000). Currently, only a short version of CCFNI is available in Spanish-language (Gómez Martínez et al., 2011).

Although family needs have been systematically evaluated with the CCFNI (Al-Hassan and Hweidi, 2004, Chatzaki et al., 2012, Prachar et al., 2010), there is currently no published research in Spanish-speaking countries in Latin American. This point is of particular importance, as cultural and geographic contexts could become important factors in determining the importance of the family needs and influence how these needs are categorized by the family members (Al-Hassan and Hweidi, 2004, Chien et al., 2006, Wang et al., 2004).

The objective of this study was to culturally adapt and validate a Spanish-language version of the CCFNI in family members of critical care patients at the ICU of a teaching hospital.

Section snippets

Design and participants

This study was carried out in a group of 251 family members of patients hospitalised in the ICU of a teaching hospital in Santiago, Chile. The inclusion criteria for family members were as follows: (1) to be a direct family member, including non-blood relationships, such as spouses and partners; (2) to be older than 18 years; (3) to have at least an 8th-grade educational level; (4) have visited the patient at least once time before the invitation; and (5) length of stay in the ICU > 48 hrs.

Cultural adaptation of the Chilean-Spanish version of CCFNI

During the back translation process, the CCFNI had minimal semantic changes related to the ambiguity of some items. Regarding content validity, it was evaluated through expert judgments, with only four of the 45 CCFNI items in the Spanish version having a Lynn Index < 0.8. These items were modified according to the suggestions made by the experts. Similarly, all items were rated as adequate. During qualitative analysis, some verb choices were modified related to verb-linked elements. In this

Discussion

The objective of the present study was to adapt and validate a Spanish-language version of the CCFNI within Chilean population in a teaching hospital. After expert evaluations, the items were considered appropriate and, as such, deemed representative of the needs presented by relatives of ICU patients. As with other validation processes for the CCFNI, no items were deleted. This is a testament to the international importance of family member needs in the ICU (Büyükçoban et al., 2015, Chien et

Strengths and limitations

The strengths of the present study include being the first to culturally adapt and validate the CCFNI in Spanish and in Chile. Similarly, the validation process involved a diverse group of experts which allowed the establishment of a more holistic and complete vision of the studied construct. Limitations include the fact that participants were recruited in a private institution, which might condition the socioeconomic and educational profiles of family members. These factors could also

Conclusion

The present study represents the first investigation directed to culturally adapt validate the original CCFNI in Spanish-language in Chile. The CCFNI adapted to the Chilean population is a valid and reliable instrument for adequately assess the needs of family members of ICU patients. Knowing the needs of ICU family members represents an opportunity for healthcare teams to improve quality by gaining an integrated vision of patient care, which should include and value the experiences lived by

Funding source

This work was supported by the School of Nursing (Pontificia Universidad Católica de Chile) through the “Integracion Docente – Asistencial” program (IDA 2013) and by the Office of the Vice-Rector for Research (Pontificia Universidad Católica de Chile) through the Edition, Translation, or Revision of Articles Competition.

Acknowledgements

The authors thank all of the family members of critical-care patients that participated in this investigation. The authors thank Melissa A. Sutherland, from Boston College and 2017 Fulbright Scholar, for her edits and suggestions.

References (41)

  • H. Carretero-Dios et al.

    Standards for the development and review of instrumental studies: considerations about test selection in psychological research

    Int. J. Clin. Health Psychol.

    (2007)
  • V.H. Cervantes

    Interpretaciones del coeficiente alpha de Cronbach

    Av. En. Medición

    (2005)
  • M. Chatzaki et al.

    Defining the needs of ICU patient families in a suburban/rural Greek population: a prospective cohort study

    J. Clin. Nurs.

    (2012)
  • W.-T. Chien et al.

    Psychometric properties of a Chinese version of the critical care family needs inventory

    Res. Nurs. Health

    (2005)
  • G. Coutu-Wakulczyk et al.

    French validation of the critical care family needs inventory

    Heart Lung

    (1990)
  • K.S. Freitas et al.

    Family members’ needs at intensive care units: comparative analysis between a public and a private hospital

    Rev. Lat. Am. Enfermagem

    (2007)
  • S. Gómez Martínez et al.

    El cuestionario de necesidades de los familiares de pacientes de cuidados intensivos (CCFNI) versión breve: adaptación y validación en población espaíola

    An. Sist. Sanit. Navar.

    (2011)
  • M. Garrouste-Orgeas et al.

    Reappraisal of visiting policies and procedures of patient’s family information in 188 French ICUs: a report of the Outcomerea Research Group

    Ann Intensive Care .

    (2016)
  • K.J. Haines et al.

    Psychosocial outcomes in informal caregivers of the critically ill: a systematic review*

    Crit. Care Med.

    (2015)
  • J.F. Hair et al.

    Multivariate Data Analysis

    (2005)
  • Cited by (7)

    • The enablers and barriers to children visiting their ill parent/carer in intensive care units: A scoping review

      2021, Australian Critical Care
      Citation Excerpt :

      Family life is an integral component of peoples' lives and sustaining links with families when individuals are hospitalised in any context is an essential component of holistic care.1 The admission of a loved one to an intensive care unit (ICU) is traumatic and stress provoking for any adult.2,3 It can be argued however that adult family members by way of their emotional maturity have some insight into the processes that prompted the admission, the intended plan of care, and the potential outcome.

    • Emotional universe of intensive care unit nurses from Spain and the United Kingdom: A hermeneutic approach

      2020, Intensive and Critical Care Nursing
      Citation Excerpt :

      Historically, nurses have primarily focused on the patients (Kvande et al., 2017), but this study highlights patients’ families as being almost as central in their care delivery as the patients themselves. Caring for the family creates the expectation of an empathic attitude, with the information given by the nurses being of great importance (Rojas-Silva et al., 2017). However, when this does not live up to a family’s expectation, negative situations can arise between them and the nurses (Wong et al., 2015).

    View all citing articles on Scopus
    View full text