ICU nurse-family engagement from a global perspective: A qualitative multi-site exploration

Journal article


Naef, R., Brysiewicz, P., McAndrew, N. S., Beierwaltes, P., Chiang, V., Clisbee, D., De Beer, J., Honda, J., Kakazu, S., Nagl-Cupal, M., Price, A. M., Richardson, S., Richardson, A., Tehan, T., Barnard-Towell, A. and Eggenberger, S. 2021. ICU nurse-family engagement from a global perspective: A qualitative multi-site exploration. Intensive and Critical Care Nursing. https://doi.org/10.1016/j.iccn.2021.103081
AuthorsNaef, R., Brysiewicz, P., McAndrew, N. S., Beierwaltes, P., Chiang, V., Clisbee, D., De Beer, J., Honda, J., Kakazu, S., Nagl-Cupal, M., Price, A. M., Richardson, S., Richardson, A., Tehan, T., Barnard-Towell, A. and Eggenberger, S.
Abstract

Background: Critical illness is distressing for families, and often results in negative effects on family health that influence a family's ability to support their critically ill family member. Although recent attention has been directed at improving care and outcomes for families of critically ill patients, the manner in which nurses engage with families is not fully understood.

Objectives: To describe nurses’ perceptions and practices of family engagement in adult intensive care units (ICUs) from a global perspective.

Design: A qualitative-descriptive multi-site design using content analysis.

Settings: The study was conducted in 24 ICUs of 12 urban, metropolitan, academic medical centers in ten countries, spanning five continents.

Participants: A total of 65 registered nurses (77% women, age of M=39.5, SD=11.4 years) participated. Most held an ICU certification (72%) and had worked on average 10 (SD=9.6) years in
the ICU.

Methods: Semi-structured, individual interviews (M = 38.4 minutes, SD=12.0) were held with ICU nurses at the hospital (94%) or their home using an interview guide. Qualitative interview data were analysed using inductive content analysis.

Results: We found that nurse-family engagement was an ebb and flow of relational power thatneeded to be carefully negotiated and balanced, with nurses holding and often exerting more power than families. Constant fluctuations in nurses’ practices of engagement occurred in day-to-day practice from shift-to-shift and from nurse-to-nurse. Family engagement was dependent on individual nurses’ attitudes and perceptions of family, the patient’s condition, and workload. Lastly, family
engagement was shaped by the ICU context, with team culture, collaborative relationships, unit structures and organizational resources either enabling or limiting nurses’ ability to engage with families.

Conclusions: This global study provides an in-depth understanding of the way nurses engage with families in ICU and reflects many different cultures and health systems. We found that nurse-family engagement was marked by a shifting, yet often unequal power distribution in the nurse-family relationship, inconsistent nurse engagement practices, both of which resulted in variable family engagement in ICU care. Our research contributes a detailed description of engagement as practiced in the everyday delivery of health care. A more concentrated team effort, based on a shared culture and defined framework of family care is needed to ensure that families of critically ill persons are fully engaged in all aspects of ICU care.

KeywordsFamily nursing; Family engagement; Family involvement; Family-centered care; Intensive Care Units; Critical care nursing; Qualitative content analysis
Year2021
JournalIntensive and Critical Care Nursing
PublisherElsevier
ISSN0964-3397
Digital Object Identifier (DOI)https://doi.org/10.1016/j.iccn.2021.103081
Official URLhttps://www.sciencedirect.com/science/article/pii/S0964339721000707
FunderBritish Association of Critical Care Nurses
Publication dates
Online09 Jun 2021
Publication process dates
Accepted05 Apr 2021
Deposited12 Apr 2021
Accepted author manuscript
License
File Access Level
Open
Publisher's version
License
Output statusPublished
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Price, A. M. 2010. Interpretation of blood gases. in: Smith, S., Price, A. M. and Challinor, A. (ed.) Ward-Based Critical Care: A Guide for Health Professionals Keswick M&K Update. pp. 333-340
Neurogenic shock
Price, A. M. 2010. Neurogenic shock. in: Smith, S., Price, A. M. and Challinor, A. (ed.) Ward-Based Critical Care: A Guide for Health Professionals Keswick M&K Update. pp. 241-246
Altered level of consciousness and confusion
Price, A. M. 2010. Altered level of consciousness and confusion. in: Smith, S., Price, A. M. and Challinor, A. (ed.) Ward-Based Critical Care: A Guide for Health Professionals Keswick M&K Update. pp. 233-240
Compartment syndrome
Price, A. M. 2010. Compartment syndrome. in: Smith, S., Price, A. M. and Challinor, A. (ed.) Ward-Based Critical Care: A Guide for Health Professionals Keswick M&K Update. pp. 229-232
Acute abdomen
Canavan, R. and Price, A. M. 2010. Acute abdomen. in: Smith, S., Price, A. M. and Challinor, A. (ed.) Ward-Based Critical Care: A Guide for Health Professionals Keswick M&K Update. pp. 163-170
Chest pain
Budack, K. and Price, A. M. 2010. Chest pain. in: Smith, S., Price, A. M. and Challinor, A. (ed.) Ward-Based Critical Care: A Guide for Health Professionals Keswick M&K Update. pp. 157-162
Sepsis
Price, A. M. and Smith, S. 2010. Sepsis. in: Smith, S., Price, A. M. and Challinor, A. (ed.) Ward-Based Critical Care: A Guide for Health Professionals Keswick M&K Update. pp. 113-120
Participant observation: how useful is it in an acute hospital setting?
Price, A. M. 2009. Participant observation: how useful is it in an acute hospital setting?
Caring and technology: can we separate them in ITU?
Price, A. M. 2009. Caring and technology: can we separate them in ITU?
Measuring cardiac output using the PiCCO system
King, D. and Price, A. M. 2008. Measuring cardiac output using the PiCCO system. British Journal of Cardiac Nursing. 3 (11), pp. 512-518. https://doi.org/10.12968/bjca.2008.3.11.31555
Developing a high dependency unit from a ward
Price, A. M. 2008. Developing a high dependency unit from a ward.
Applying interprofessional learning to a pre-registration health professions programme: the challenges for adult nursing
Felstead, I., Levine, A. and Price, A. M. 2008. Applying interprofessional learning to a pre-registration health professions programme: the challenges for adult nursing.
Exploring caring practice within the technological setting of a critical care unit
Price, A. M. 2008. Exploring caring practice within the technological setting of a critical care unit.
Using a high-flow respiratory system (Vapotherm) within a high dependency setting
Price, A. M., Plowright, C., Makowski, A. and Misztal, B. 2008. Using a high-flow respiratory system (Vapotherm) within a high dependency setting. Nursing In Critical Care. 13 (6), pp. 298-304.
Vascular surgery
Price, A. M. 2007. Vascular surgery. in: McArthur-Rouse, F. and Prosser, S. (ed.) Assessing and Managing the Acutely Ill Adult Surgical Patient Oxford Wiley-Blackwell. pp. 107-120
The joys and frustrations of being a part-time nursing student
Price, A. M. 2006. The joys and frustrations of being a part-time nursing student.
Pre-registration education: making a difference to critical care?
Collins, T., Price, A. M. and Angrave, P. 2006. Pre-registration education: making a difference to critical care? Nursing In Critical Care. 11 (1), pp. 52-57.
Implementing an adult nursing pathway within an inter-professional framework
Price, A. M. 2005. Implementing an adult nursing pathway within an inter-professional framework.
Caring and technology: time to redress the balance?
Price, A. M. 2005. Caring and technology: time to redress the balance?
Pre-registration education: making a difference to critical care?
Price, A. M. 2004. Pre-registration education: making a difference to critical care?
Intensive care nurses' experiences of assessing and dealing with patients' psychological needs
Price, A. M. 2004. Intensive care nurses' experiences of assessing and dealing with patients' psychological needs. Nursing In Critical Care. 9 (3), pp. 134-142. https://doi.org/10.1111/j.1362-1017.2004.00055.x
The reality of critical incident technique in small scale research
Price, A. M. 2003. The reality of critical incident technique in small scale research.
To high flow or not high flow CVVH
Price, A. M. 2003. To high flow or not high flow CVVH.
Using information technology to enhance critical care education
Price, A. M. 2003. Using information technology to enhance critical care education.
Nursing care of the acute head injury: a review of the evidence
Price, A. M., Collins, T. and Gallagher, A. 2003. Nursing care of the acute head injury: a review of the evidence. Nursing In Critical Care. 8 (3), pp. 126-133. https://doi.org/10.1046/j.1478-5153.2003.00019.x
The nurses' perspective of psychological care given to patients in ITU: what helps or hinders
Price, A. M. 2002. The nurses' perspective of psychological care given to patients in ITU: what helps or hinders.
Implementing a nurse-led ventilatory weaning protocol for long-term patients
Price, A. M. 2001. Implementing a nurse-led ventilatory weaning protocol for long-term patients.
Psychological care in intensive care: the nurses' view
Price, A. M. 2001. Psychological care in intensive care: the nurses' view.
Nurse-led weaning from mechanical ventilation: where's the evidence?
Price, A. M. 2001. Nurse-led weaning from mechanical ventilation: where's the evidence? Intensive and Critical Care Nursing. 17 (3), pp. 167-176. https://doi.org/10.1054/iccn.2001.1557
Alteration in cardiovascular function: care of the patient with septic shock
Price, A. M. and Kavanagh, D. 2001. Alteration in cardiovascular function: care of the patient with septic shock. in: Cox, C. and Reyes-Hughes, A. (ed.) Clinical Effectiveness in Practice Basingstoke Palgrave Macmillan. pp. 59-68
Nurse-led weaning from mechanical ventilation: where's the evidence?
Price, A. M. 2000. Nurse-led weaning from mechanical ventilation: where's the evidence?
Our journey with clinical supervision in an intensive care unit
Price, A. M. and Chalker, M. 2000. Our journey with clinical supervision in an intensive care unit. Intensive and Critical Care Nursing. 16 (1), pp. 51-56. https://doi.org/10.1054/iccn.1999.1475
Implementing clinical supervision in a district general hospital
Price, A. M. 1999. Implementing clinical supervision in a district general hospital.