**2. Our experience and discussion**

#### **2.1. New communication approach**

Since 2013, as we have recently published, we developed a new communication approach addressed to relatives of patients admitted to the intensive care unit (ICU) ([18], with permission]). It consists of a patient/relative-centered approach, in which doctors, nurses, psychologists and volunteers support relatives throughout the care process. First, they try to acquire information on the family's social and cultural background and adjust the communication accordingly and second, they aim to understand the patient's will, a task that can be challenging in the intensive care context. When the patient first enters the ICU, the physician must give priority to treatment and can only speak briefly to the relatives. He reassures them that there will soon be time to acquire information and ask questions. As soon as the patient's conditions allow an interview with the relatives is performed so as to establish a relationship between the physician and the family. The physician who followed the patient's acute phase, the nurse who is in charge of him or her and a psychotherapist or a psychologist conducts it in a dedicated room. The staff also takes note of the relatives' phone numbers. The following interviews take place in the patient's room. During the first interview, the medical staff harmonizes on the needs and feelings of the family and retraces the patient's history and the recent acute event. This interview also aims to identify the main caregivers and establish the timetable and program for the following days. We applied a well-defined model, which can be divided into several steps:

trauma center. Relatives of brain-dead patients were approached according to an internal protocol, inspired by NICE guidelines, which temporarily distinguishes two phases: communicating brain death and proposing organ donation. These guidelines deal with delivering the end-of-life communication and developing a supportive relationship with potential beating-heart donors' families [19]. Often, patients who develop brain death did not express their opinion on organ donation during their lifetime. In our ICU all patients and relatives including relatives of brain-dead patients have been approached by the medical staff to establish a relationship since 2013, aiming at making them feel better and understood. The number of acceptances to organ donation in our intensive care was observed before and after the implementation of two major interventions: the opening of the intensive care (project called "OpenICU") to relatives and the introduction of the innovative communication approach mentioned above. Opening ICUs should come about not so much in answer to pressure generated by a growing social awareness, or in simple recognition of a right, but because this policy addresses more comprehensively the issue of respect for the patient, as well as providing more appropriate responses to many needs of both patients and families. It is a decision which requires doctors and nurses to rethink their relationships with patients and their families, which calls for original solutions for each individual situation and which should be subject to periodic checks. Psychotherapists support the relatives in finding a meaning to their experience and to understanding their own reaction and attitude. Further elements could

Family-Centered Care to Improve Family Consent for Organ Donation

http://dx.doi.org/10.5772/intechopen.74781

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have positively influenced the decline in organ donation, such as:

**3.** The enhancement of giving information in the patient's room.

as psychologists and volunteers;

**1.** Increased attention to the initial welcome to the patient and his family;

**2.** The creation of a multidisciplinary team, giving a new value to non-medical figures, such

The Open ICU is realized when the whole team aims to abolish all of the unnecessary limitations at a temporal, physical and relational level. Opening the ward to family members allows patients and their relatives to be actively involved, fueling the healing process through affection and contact with their beloved. Besides, it helps patients to better tolerate hospitalization. When the Open ICU first opened, an innovative concept was introduced: interview with relatives no longer took place in a separate and impersonal "medical staff room." It was moved into the patients' room. This gave the opportunity for relatives to be physically close to their beloved while receiving bad news. This physical nearness soothes the relatives' grief. Being in the patients' room means sharing the environment with him or her: they hear the same sounds, feel the same temperature and see the same colors. The patient, his family and the physician now share the same scene. The relationship is still asymmetrical as the physician decides what to do and is trusted. However, the patient and his family are now considered as central elements of the scene. In fact, during the interview, there is an exchange of information between the physician and the family; the former is open to questions and doubts expressed by relatives, reducing errors related to a subjective interpretation of reality. Rather than speaking to the patient's family, the physician speaks with the patient's family. Conducting the interview in the patient's room also facilitates questions on machines and therapies with

