Relationship Based Care
A family's unique way of being, formulated through social, economic, environmental and political factors, becomes fractured during a loved one's critical illness. Family members experience burdensome physical and emotional symptoms as they transition through the marked uncertainty endemic to high acuity illness. For some, this burden results in long term psychiatric disturbances. Assessment tools and interventions have been proposed for family members experiencing a loved one's critical illness. However, ongoing suffering suggests inherent limitations within these reductionist approaches. The need for a more encompassing disciplinary perspective is suggested. Margaret Newman's (1986, 1994, 2008) theory of Health as Expanding Consciousness (HEC) and its praxis research method was employed to explore relationship based care among intensive care unit (ICU) family members and registered nurses. HEC retains person/environmental integrity through unfolding of unitary knowledge via exploration of meaning. Additionally, its holistic perspective aligns philosophically with the belief in nursing science as the study of caring in the human health experience, endorsing both the mutuality of the nurse/client relationship and pattern recognition's capacity to inspire transformational growth. The study was performed in an eighteen bed medical ICU in the northeast region of the United States. This unit's design includes an integrated critical/palliative care model. Exploration of the study's two research questions was accomplished using the practice and research components of HEC within a sample of eight family members and six registered nurses. Results demonstrated family members' capacity to achieve consciousness expansion within the context of a loved one's critical illness. Registered nurses revealed their ability to steadfastly partner with both patients and families. Repetitive elements distinguished as thematic commonalities were recognized among both family member and registered nurse participants. Additionally, thematic integration between family members and registered nurses was appreciated. HEC was found to offer unique insights into caring relationships between ICU family members and registered nurses.