Actual and Ideal Professional Support for African American Family Members(1).

The sudden hospitalization of an acutely ill relative to the intensive care unit (ICU) for any reason is a source of stress for many family members (Kleiber et al., 1994) and critical care nurses (MacNeil & Weisz, 1987). Because critical care nurses' primary concern is the immediate care of the critically ill relative, nurses frequently delay, forget, or avoid interactions with family members (Chesla & Stannard, 1997). Some of the reasons cited for this inconsistent lack of familial support have been related to nurses' uncertainty about the restoration and preservation of the client's life and their feeling inadequate to convey concerns about critically ill relatives to family members (MacNeil & Weisz, 1987). In consequence, the provision of professional nursing support given to family members is often haphazard, inconsistent, or absent (Chesla, 1996). Adding to the complexity of this acute situation is the different response pattern of family members from diverse cultural, socioeconomic, and educational backgrounds (Waters, 1997). People often have distinctive needs and coping styles for managing stress associated with health and illness (Dilworth-Anderson & McAdoo, 1988; Lawton, Rajagopal, Brody, & Kleban, 1992).

Within this multicultural society, there is an increased likelihood that health care professionals will interact with ethnic minority persons. Of the 2.2 million registered nurses in the United States, approximately 90% are non-Hispanic Whites, 4% are African Americans; 3.4% are Asians or Pacific Islanders; 1.4% are Hispanics; 0.4% are Native Americans or Native Alaskans; and the remaining 0.7% are unknowns (Bureau of Health Professions, personal communication, September 2, 1997). These statistics are startling given that ethnic minorities are among the fastest growing groups of the U.S. population. Projections are that the U.S. population will be half ethnic minority by the year 2050 (National Center for Health Statistics, 1996).

Culturally Relevant Family-Centered Professional Nursing Support

The literature addresses three major interactional concerns of the client-nurse-family triangle in the critical care milieu: the benefits of providing immediate, technological quality care to critically ill clients (Chesla, 1996; Fairman, 1992); the importance of identifying the needs of family members and viewing them and critically ill clients as essential components of holistic, family-centered professional nursing care (Hickey, 1988, 1990; Leske, 1986, 1992a; McClowry, 1992; Molter, 1979; Simpson, 1989); and the positive effects of providing time and availability of professional nursing support to address family members' identified needs and coping strategies (Chavez & Faber, 1987; Chesla & Stannard, 1997; Heise, 1991; Kirchoff, 1993; Kleiber et al., 1994; O'Keefe & Gilliss, 1988).

A meta-analysis of critical care family-need studies conducted by 27 nurse investigators in 15 states over a period of 10 years (1980-1989) was completed by Leske (1992b). In this recta-analysis, ratings of need importance by family members within 24 to 72 hours following the admission of the critically ill relative to the ICU were compared. The findings of this compilation of various studies revealed family members needed and wanted professional nursing support. Five major themes of familial needs were identified: information, comfort, assurance, proximity, and support. A significant limitation of these studies was the homogeneity of their almost exclusive focus on White family members. Another limitation of the adult critical care family studies was the paucity of investigations that gave attention to the variations between family members' perceptions of their needs and nurses' perceptions of what they believed were family members' needs. To address perceptual differences between nurses and family members of critically ill adult clients, Norris and Grove (1986) asked predominantly White nurses and White family members to rate the importance of familial psychosocial needs. Findings revealed there was a significant difference between the perceptions of the ethnically homogeneous groups of nurses and family members, suggesting that nurses needed to become more sensitive to the cues of family members' needs. Lynn-McHale and Bellinger (1988) went beyond Norris and Grove's (1986) study by comparing the need satisfaction levels of predominantly White family members visiting a relative in the ICU to the accuracy of predominantly White nurses in perceiving family members' satisfaction. Findings of the study indicated family members were more satisfied than dissastified, and nurses were moderately successful at identifying the level at which family members' perceived needs were met.

One study was found in the literature that systematically examined the influences of cultural affiliation on the professional nursing support needs of family members of critically ill adult clients (Waters, 1997). In this study, a comparison of family members' perceptions of expected (ideal) professional nursing support was examined among African American, Hispanic and White family members. Family members were not asked about the professional nursing support they received (actual). The nurses' perceptions were not described. Similar to the other culturally homogeneous studies, findings revealed that family members were aware of and desired nurses' primary focus to be the immediacy of care to the critically ill relative. In addition, family members believed nurses should provide unsolicited and systematic support on a continual basis to help family members feel a sense of connectedness to the critical care experience. Although general findings demonstrated more universality than differences across cultural groups, additional findings indicated a need to examine within cultural group patterns and support-tailoring interventions that are unique. Post hoc comparisons demonstrated that the statistical differences between the statistically significant items were mostly with the African American family members. The least statistical differences were between Hispanic and White family members. African American family members had significantly higher expectations for professional nursing support than White and Hispanic family members. No explanations were given for why the differences between groups were mostly with the African American group or why African American family members' expectations for professional nursing support were significantly higher than the other two cultural groups.

African Americans have been subject, historically, to a long account of oppression (Robinson & Tidwell, 1995). Resilient boundaries and strong kinship and social bonds were …