Family INvolvement in inTensive care: A qualitative exploration of critically ill patients, their families and critical care nurses (INpuT study).

Abstract

AIMS AND OBJECTIVES\nTo understand the different factors that impact on the involvement of adult family members in the care of critically ill patients from the perspective of patients, families and nurses, with the aim to inform the enactment of a patient and family-centred care (PFCC) intervention to support the patient-family-nurse partnership in care involvement.\n\n\nBACKGROUND\nExisting evidence lacks theoretical underpinning and clarity to support enactment of patient and family-centred care and involvement of families in the care of the critically ill patient.\n\n\nDESIGN\nQualitative exploratory design using thematic analysis.\n\n\nMETHODS\nThis study was conducted at two adult intensive care units (ICU) in two tertiary University Hospitals in the central belt of Scotland. Between 2013 and 2014, we conducted semi-structured interviews with critically ill survivors (n\xa0=\xa019) and adult family members (n\xa0=\xa021), and five focus groups with nurses (n\xa0=\xa015) across both settings. Data were digitally recorded, transcribed verbatim, and uploaded in NVivo10. Data were analysed thematically using a constructivist epistemology. Ethical approval was obtained prior to data collection. Data are reported according to the Consolidated Criteria for reporting qualitative research (COREQ) checklist.\n\n\nRESULTS\nFamily s situational awareness; the perceived self in care partnership; rapport and trust; and personal and family attributes were the main factors that affected family involvement in care. Two key themes were identified as principles to enact PFCC in adult ICUs; Need for Doing family and Negotiations in care involvement .\n\n\nCONCLUSIONS\nNegotiating involvement in care requires consideration of patients and family members values of doing family and the development of a constructive patient-family-nurses partnership.\n\n\nRELEVANCE TO CLINICAL PRACTICE\nFuture policy and research should consider patients and family s needs to demonstrate family bonds within a negotiated process in care participation, when developing tools and frameworks to promote PFCC in adult intensive care units.