Research articleThe 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
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.
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