Rahel Naef1, Petra Brysiewicz2, Natalie S Mc Andrew3, Patricia Beierwaltes4, Vico Chiang5, David Clisbee6, Jennifer de Beer7, Junko Honda8, Shota Kakazu9, Martin Nagl-Cupal10, Ann M Price11, Sandra Richardson12, Anna Richardson13, Tara Tehan14, Amanda Towell-Barnard15, Sandra Eggenberger16. 1. Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Universitätstrasse 84, 8006 Zurich, Switzerland; Centre of Clinical Nursing Science, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland. Electronic address: rahel.naef@usz.ch. 2. School of Nursing & Public Health, University of KwaZulu-Natal, King George Mazisi Kunene Road, Glenwood, Durban 4041, South Africa. Electronic address: brysiewiczp@ukzn.ac.za. 3. College of Nursing, University of Wisconsin-Milwaukee, Cunningham Hall, 1921 East Hartford Avenue, P.O. Box 413, Milwaukee, WI 53201-0413, USA; Froedtert & the Medical College of Wisconsin, Froedtert Hospital, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA. Electronic address: mcandre3@uwm.edu. 4. College of Allied Health and Nursing, School of Nursing, Minnesota State University, 360 Wissink Hall, Mankato, MN 56001, USA. Electronic address: patricia.beierwaltes@mnsu.edu. 5. School of Nursing, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Kowloon, Hong Kong. Electronic address: vico.chiang@polyu.edu.hk. 6. College of Science, Engineering and Technology, Computer Information Science Department, Minnesota State University, 273 Wissink Hall, Mankato, MN 56001, USA. Electronic address: david.clisbee@mnsu.edu. 7. College of Nursing-Jeddah, King Saud bin Abdul Aziz University for Health Sciences-Jeddah, Makkah Highway, Al Haramain Road, Mail Code 65 65, PO Box 9515, Saudi Arabia. Electronic address: jbeer@kfshrc.edu.sa. 8. Child Health Nursing, College of Nursing Art and Science, University of Hyogo, 13-71, Kitaoji-cho, Akashi, Hyogo 673-8588, Japan. Electronic address: junko_honda@cnas.u-hyogo.ac.jp. 9. Child Health Nursing, Graduate School of Nursing Sciences, St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044, Japan. Electronic address: shota@slcn.ac.jp. 10. Department of Nursing Science, University of Vienna, Alser Strasse 23/12, 1080 Vienna, Austria. Electronic address: martin.nagl-cupal@univie.ac.at. 11. School of Nursing, Midwifery and Social Work, Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent CT1 1QU, United Kingdom. Electronic address: ann.price@canterbury.ac.uk. 12. School of Health Sciences, College of Education, Health and Human Development, University of Canterbury, 276 Antigua Street, Christchurch 8011, New Zealand; Emergency Department, Christchurch Hospital, Canterbury District Health Board, 2 Riccarton Avenue, Christchurch 8011, New Zealand. Electronic address: sandra.richardson@canterbury.ac.nz. 13. Bachelor of Nursing Programme, Department of Health Practice, Manawa, Ara Institute of Canterbury Ltd, 276 Antigua Street, Christchurch 8140, New Zealand. Electronic address: Anna.richardson@ara.ac.nz. 14. University of Massachusetts Medical School, Graduate School of Nursing, 55 Lake Ave North, Worcester, MA 01655, USA. Electronic address: tara.tehan@umassmed.edu. 15. School of Nursing & Midwifery, Edith Cowan University, 270 Joondalup Drive, Western Australia 6027, Australia; Sir Charles Gairdner Hospital, Centre for Nursing Research, Hospital Avenue, Nedlands, Western Australia 6009, Australia. Electronic address: a.towell-barnard@ecu.edu.au. 16. College of Allied Health and Nursing, Glen Taylor Nursing Institute for Family and Society, Minnesota State University, 360 Wissink Hall and 351 7700 France, Mankato, MN 56001, USA. Electronic address: sandra.eggenberger@mnsu.edu.
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 from a global perspective. DESIGN: A qualitative-descriptive multi-site design using content analysis. SETTINGS: The study was conducted in 26 intensive care units 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 intensive care certification (72%) and had worked on average 10 (SD = 9.6) years in the ICU. METHODS: Semi-structured, individual interviews (M = 38.4 min, 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 that needed 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 intensive 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 intensive care.
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 illpatients, 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 from a global perspective. DESIGN: A qualitative-descriptive multi-site design using content analysis. SETTINGS: The study was conducted in 26 intensive care units 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 intensive care certification (72%) and had worked on average 10 (SD = 9.6) years in the ICU. METHODS: Semi-structured, individual interviews (M = 38.4 min, 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 that needed 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 intensive 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 illpersons are fully engaged in all aspects of intensive care.
Keywords:
Critical care nursing; Family engagement; Family involvement; Family nursing; Family-centered care; Intensive Care Units; Qualitative content analysis
Authors: Lisa A Cranley; Simon Ching Lam; Sarah Brennenstuhl; Zarina Nahar Kabir; Anne-Marie Boström; Angela Yee Man Leung; Hanne Konradsen Journal: J Fam Nurs Date: 2021-09-08 Impact factor: 3.818