Guidelines for Family-Centered Care in the Neonatal, Pediatric, and Adult ICU:

What challenges of family-clinician conversations in the intensive care unit can teach us: A cross-sectional survey study

OBJECTIVES

To explore the perspectives of intensive care unit personnel and patients' family members on challenges of family-clinician conversations and corresponding learning needs.

RESEARCH METHODOLOGY/DESIGN

Cross-sectional survey study.

SETTING

Two medical intensive care units of a German academic tertiary care hospital.

MAIN OUTCOME MEASURES

Data were collected using an investigator-designed online survey with open- and closed-ended questions. Descriptive statistics were conducted to determine frequencies, free-text responses were analysed using directed qualitative content analysis.

FINDINGS

The responses of 94 family members, 42 nurses, and 28 physicians were analysed (response rate: 45%). Regarding the clinicians' perspective, three main themes of challenges were deduced: ICU setting, Staff-related challenges, and Family-related challenges. Conversely, the majority of participating family members reported challenges both cognitive and affective in nature, e.g., remembering provided information or discussing the patient's prognosis. Most clinicians stated their need for a corresponding communication skills training to successfully navigate those challenges in clinical practice, particularly regarding conveying complex information, handling strong emotions, and managing family-clinician conflicts.

CONCLUSION

The identified communication challenges underline the issues of family-clinician conversations that require improvement, making it possible to determine corresponding strategies to attain the desired outcome. Further research is needed to elicit best-practices of communication skills trainings for family-clinician conversations and its implementation in critical care settings.

IMPLICATIONS FOR CLINICAL PRACTICE

These findings invite clinicians to engage in self-reflection to identify individually perceived communication challenges and learning needs. Faculty and healthcare institutions may further use these findings to conceptualise tailored communication skills trainings to contribute to the advancement in nursing and medical education.

The person-centered medical care in pediatrics: A scoping review

INTRODUCTION AND OBJECTIVES

The medicine development demonstrates that the traditional bioethical medical care model is not the most adequate. On the other hand, the person-centered clinical method has been winning more space in the medical practice, since it is a humanized method of care that allows best results. In pediatrics, the patient-centered care works a little bit different, since it requires not only the physician-patient relation, but also the integration of the physician-family-patient relation. Thus, the patient-centered care in the pediatric area is understudied, as well as little practiced. In this context, this review has the objective to exposure the actual scenario of the patient-centered care in pediatrics.

MATERIALS AND METHODS

This is a scoping review carried out from the standards of Jonna Briggs Institute (JBI). The database PubMed, Science Direct and BVS were used to search studies between 2012 until 2024. The research was performed with the descriptors "Medicine", "Shared DecisionMaking", "Pediatrics", "Physician-PatientRelations" and "Patient-CenteredCare".

RESULTS

The research identified 27,272 articles, along with 79 met the criteria and were included. Each article was analyzed and allocated in the four pillars of the patient-centered care, which was described and related with the pediatric clinic.

CONCLUSIONS

The patient-centered care brings benefits to medical care, especially in the pediatric area. Among them, stands out the increased adherence to treatment, the lowest rates of medical errors, the greater integration of the interprofessional team, the more individual and patient-sensitive investigation, as well as the respect of beliefs and desires, making the results obtained better.

Understanding crisis needs among family caregivers of patients in critical care: A qualitative analysis

BACKGROUND

Family caregivers often experience shock and disorientation when a patient is admitted to critical care. Developing interventions to assist caregivers during this crisis requires a more in-depth understanding of their needs.

OBJECTIVE

Our aim was to understand family caregivers' needs during a patient's critical care admission and early hospitalisation and differences in needs by caregiver anxiety level.

METHODS

We conducted a descriptive mixed-method study. Forty semistructured interviews were conducted with family caregivers of mechanically ventilated critical care patients. The Hospital Anxiety and Depression Scale was also administered. Crisis theory was used to guide this analysis. The data were analysed by content analysis and then stratified by anxiety level to examine differences across groups. Consolidated Criteria for Reporting Qualitative Research were followed.

SETTING

Two intensive care units at a large, tertiary academic medical centre were a part of this study.

FINDINGS

Caregivers at all anxiety levels described needs involving information and emotional processing, social support, and self-care, with differences across anxiety groups. Caregivers with anxiety and borderline anxiety expressed limited capacity to think past the current moment, whilst caregivers with low anxiety actively used information to consider next steps and prepare others. Emotional processing appeared more limited in the anxiety and borderline-anxiety groups. Whilst most caregivers reported receiving some degree of social support, some caregivers with anxiety noted family tension, whilst caregivers with borderline and low anxiety had a wider variety of supportive relationships. Caregivers with anxiety reported distress influenced their self-care, whilst caregivers with borderline and low anxiety received tangible help from other family members for self-care.

CONCLUSION

Family caregivers of critical care patients experience needs during early hospitalisation, although the specific needs differ by caregiver anxiety level.

Effectiveness of interventions to prevent or treat prolonged grief symptoms among families of patients who die in intensive care units: a systematic review protocol

OBJECTIVE

The objective of this review is to evaluate the effectiveness of interventions to prevent or treat prolonged grief symptoms among families of patients who die in the intensive care unit (ICU).

INTRODUCTION

Up to 52% of families of patients who die in an ICU may be at risk of experiencing prolonged grief symptoms. This psychological morbidity should be addressed as early as possible through effective interventions.

INCLUSION CRITERIA

Studies of adult family members (≥18 years) of adult patients (≥18 years) who died in the ICU after a treatment withdrawal or withholding decision will be considered for inclusion. Family members must be exposed to tailored interventions to prevent or treat prolonged grief symptoms before, during, and/or after the patient's death. Randomized and non-randomized controlled trials; before and after studies; and interrupted time-series, cohort, and case-control studies will be considered.

METHODS

The JBI methodology for systematic reviews of effectiveness will be followed. Databases to be searched include CINAHL, Academic Search Complete, Psychology and Behavioral Sciences Collection, Cochrane Central Register of Controlled Trials, and APA PsycINFO (all via EBSCOhost), as well as PubMed, Web of Science Core Collection, and Scopus. Two independent reviewers will perform the study selection, critical appraisal, and data extraction. Studies will be pooled in meta-analysis, if possible. Heterogeneity will be assessed using the standard χ 2 and I 2 tests. Statistical analyses will be performed using the random-effects model. The fixed-effects model will be used if fewer than 5 studies are included. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach will be used to grade the certainty of evidence, and a Summary of Findings will be presented.

REVIEW REGISTRATION

PROSPERO CRD42024528308.

Prehabilitation to mitigate postintensive care syndrome in surgical patients: The rationale for a peri-critical illness pathway involving anaesthesiologists and intensive care physicians

The post-intensive care syndrome (PICS) refers to the long-term physical, psychological and cognitive impairments experienced by intensive care unit (ICU) survivors, while PICS-Family (PICS-F) affects their family members. Despite preventive strategies during the ICU stay, PICS remains a significant concern impacting survivors' quality of life, increasing the healthcare costs, and complicating recovery. Prehabilitation offers a promising approach to mitigating PICS and PICS-F, especially when the ICU stay can be anticipated, such as in the case of major surgery. Recent literature indicates that prehabilitation - interventions designed to enhance patients' functional capacity before critical illness - may mitigate the risk and severity of PICS. Studies have demonstrated that prehabilitation programs can improve muscle strength, reduce anxiety levels and enhance overall quality of life in ICU survivors. Family prehabilitation (prehabilitation-F) is also introduced as a potential intervention to help families to cope with the stress of critical illness. This article aims to explore the role of multimodal prehabilitation and post-ICU follow-up in preventing and managing PICS and PICS-F, focusing on improving patient outcomes, supporting families and optimising healthcare resources. Combining prehabilitation with post-ICU follow-up in peri-critical care clinics could streamline resources and improve outcomes, creating a holistic care pathway. These clinics, focused on both pre-ICU and post-ICU care, would thus address PICS from multiple angles. However, the heterogeneity of patient populations and prehabilitation protocols present challenges in standardising the interventions. Further research is necessary to establish optimal prehabilitation strategies tailored to individual patient needs and to demonstrate their utility in terms of patient outcome.

Family-centred care research in paediatrics: A scoping review

Family-centred care (FCC) is central to care of children and families across healthcare settings. Research exploring FCC is increasing, so there is a need to identify clinical and research priority areas. This review aimed to describe FCC research for children and families in the 21st century. Studies were sourced from CINAHL, Ovid Medline, and Embase and underwent two-stage screening, guided by a published protocol. Data were extracted on study authorship, author discipline, funding, study methodology, study findings, and use of 'FCC'. Analysis included descriptive statistics, Pearson's Chi-Squared tests, and content analysis. Five hundred and seventy-nine articles were included. Most used quantitative methodologies and were published from 2010, predominantly by authors from nursing or medical disciplines. Most studies were conducted in acute care settings, typically in North America, and primarily included nurses or mothers as participants. FCC was typically defined using multiple references, with several key authors identified. Future research should focus on historically underrepresented clinical and geographical areas and include multidisciplinary team members. Increasing cultural and familial diversity in FCC research is also necessary to ensure inclusive FCC practices that are transferrable within and between clinical and geographical settings.

Enhancing shared decision-making for infants in the intensive care unit: lessons from parents

BACKGROUND

Understanding parent preferences and experiences of decision-making can guide interventions to improve shared decision-making. We aimed to characterize how parents (1) incorporated values into decision-making, (2) evaluated clinician recommendations, and (3) experienced their decisional role.

METHODS

In this qualitative study, we longitudinally interviewed parents of infants with neurologic conditions about their experiences making decisions for their child. Infants were eligible if they were (1) hospitalized in a critical care unit, (2) < 1 years old, (3) diagnosed with a neurologic condition and (4) expected to have a family conference to discuss goals of care or neurologic prognosis. Data were analyzed using a conventional content analysis approach.

RESULTS

In total, 123 interviews were conducted with 52 parents (n = 37 mothers, n = 15 fathers) of 37 infants. We identified 3 themes: (1) Clarifying and communicating values: Parents characterized challenges weighing multiple decision-relevant values. (2) Evaluating clinician recommendations: Parents appreciated clinician recommendations that incorporated their values. (3) Understanding decision-making roles: Parents typically preferred an active role; poor alignment between preferred and actual decision-making role sometimes precipitated conflict with the team.

CONCLUSION

We identified parent-informed opportunities to support shared decision-making for critically ill infants. Future interventions should target strategies to help parents clarify and communicate values, ensure that clinician recommendations acknowledge parent values, and identify parent-preferred decisional roles.

IMPACT

Existing data suggest gaps in how parents and clinicians partner in making decisions for critically ill infants. In this descriptive qualitative study, we characterized the parent experience of decision-making amidst critical illness. Parents shared challenges associated with weighing and communicating multiple, sometimes competing, decision-relevant values. Parents appreciated when clinicians offered recommendations that acknowledged their values. Parents preferred an active decision-making role; poor alignment between preferred and actual decision-making role sometimes led to conflict with the team. Future decision-making interventions should target strategies to help parents communicate and clarify values, ensure that clinician recommendations integrate parent values, and identify parent-preferred decisional roles.

Family-centered care in neonatal and pediatric critical care units: a scoping review of interventions, barriers, and facilitators

INTRODUCTION

The Family-Centered Care (FCC) model has been linked to improved clinical outcomes and family satisfaction. However, implementing this model can be challenging, especially in neonatal and pediatric critical care units. This review aims to map the literature on FCC in neonatal and pediatric critical care units, identify barriers and facilitators of effective interventions, and suggest a practical step-by-step approach for implementing FCC interventions.

METHODS

This scoping review was guided by the PRISMA-ScR guidelines and followed the Arksey and O'Malley 5-step scoping review framework. We accessed the databases on the 28 th of April, 2024, and included all prospective and randomized controlled trials (RCT) implementing FCC interventions from PubMed and Web of Science databases. Data were organized, tabulated, and described narratively.

RESULTS

Out of 1,577 potentially relevant citations after duplicate removal, 17 articles met our eligibility criteria (4 RCTs and 13 prospective studies). Nine of these studies were conducted in neonatal intensive care units (NICU) and eight in pediatric intensive care units (PICU). Three NICU interventions were single-type interventions, while six were part of comprehensive programs; in the PICU, seven were single-type interventions and one was part of a comprehensive program. All interventions incorporated elements of FCC principles (respect, information sharing, collaboration, and participation). Barriers included institutional factors, provider attitudes, cultural issues, communication challenges, environmental constraints, training needs, and emotional stress. FCC facilitators included enhanced environment, empowerment and training, supportive Infrastructure, collaborative communication, parental Involvement, adaptive interventions, and continuous feedback.

CONCLUSION

Effective implementation of FCC interventions requires careful planning and needs assessment. It ensures management support, regular staff training, family orientation, and a continuous feedback loop. Incorporating FCC principles and delivering culturally acceptable interventions is key while acknowledging possible barriers and utilizing available facilitators. FCC interventions can help foster a healthcare culture that values partnerships with families and can transform the neonatal and pediatric critical care experience for patients, families, and providers alike.

Post-Intensive Care Syndrome and Caregiver Burden: A Post Hoc Analysis of a Randomized Clinical Trial

Importance

Understanding the reciprocal association between post-intensive care syndrome (PICS) and caregiver burden is crucial for optimal care of patients and caregivers following critical illness.

Objective

To evaluate the associations between patient post-intensive care impairments and caregiver burden.

Design, Setting, and Participants

This secondary analysis of the MIND-USA study, a multicenter randomized clinical trial, which enrolled patients admitted to intensive care units (ICU) from 16 academic medical centers across the US (December 2011 to August 2017), included 148 patient-caregiver dyads. Patients were adults aged 18 years or older with ICU delirium randomized to receive haloperidol, ziprasidone, or placebo. A caregiver who provided unpaid assistance to the patient was identified at enrollment. PICS and caregiver burden were assessed at 3 months and 12 months after randomization. Statistical analysis was performed from March 2023 to April 2024.

Main Outcomes and Measures

ICU survivors were assessed for PICS domains, including physical and cognitive function, and posttraumatic stress disorder using the Katz Activities of Daily Living, the Functional Activities Questionnaire, the Telephone Interview for Cognitive Status, and the Posttraumatic Stress Disorder Checklist-Civilian version, respectively. Caregiver burden was assessed using the Zarit Burden Interview. The associations between patient PICS and caregiver burden at 3 and 12 months were examined using structural equation modeling.

Results

Of 148 patients included in this study with a median (IQR) age of 58 (48-65) years, the majority identified as male (79 patients [53.4%]), and there were 16 (10.8%) Black, 139 (93.9%) non-Hispanic, and 127 (85.8%) White patients. PICS and caregiver burden at 3-month follow-up was positively associated with these outcomes at 12-month follow-up (PICS: β = 0.69; 95% CI, 0.50 to 0.88; P < .001; caregiver burden: β = 0.68; 95% CI, 0.53 to 0.82; P < .001). However, contrary to the study hypotheses, significant associations between 3-month PICS and 12-month caregiver burden and between 3-month caregiver burden and 12-month PICS were not observed (PICS→caregiver burden: β = 0.82; 95% CI, -0.02 to 1.66; P = .09; caregiver burden→PICS: β = 0.00; 95% CI, -0.03 to 0.03; P = .95). There was significant covariance between PICS and caregiver burden at each time point.

Conclusions and Relevance

In this secondary analysis of a randomized clinical trial of ICU survivors and their caregivers, patient PICS and caregiver burden were associated at concurrent time points but were not associated with each other longitudinally.

Trial Registration

ClinicalTrials.gov Identifier: NCT01211522.

Perspectives on Implementing a Communication Facilitator Intervention From a Critical Care Setting

CONTEXT

Critically-ill patients and their families often experience communication challenges during their ICU stay and across care transitions. An intervention using communication facilitators may help address these challenges.

OBJECTIVES

Using clinicians' perspectives, we identified facilitators and barriers to implementing a communication intervention.

METHODS

Using purposive sampling, we conducted semi-structured interviews with 17 clinicians from an intensive care unit at an academic health center that participated in a randomized trial of communication facilitators. We used the Consolidated Framework for Implementation Research (CFIR) to guide data collection and analysis.

RESULTS

CFIR constructs of relative advantage, communication, and critical incidents facilitated the intervention's implementation. CFIR constructs of access to knowledge and information, relational connections, and clinician knowledge and belief hindered its implementation. Clinicians reported that facilitators provided continuity to patients and families, support in a trusting and proactive manner over transitions of care, and bridged communication between families and clinicians particularly during the Covid-19 pandemic. Limited information about the intervention prevented clinicians from working with facilitators earlier in the course of the intervention. Differences in beliefs regarding facilitator involvement during family meetings also hampered the intervention's implementation.

CONCLUSIONS

Future studies should incorporate implementation strategies that help connect facilitators to clinicians early in the intervention period which may improve role clarity and enhance collaboration.

Improving Outcomes for ICU Family Members: The Role of Spiritual Care

Having a family member hospitalized in the intensive care unit (ICU) can be a stressful experience for family members, encompassing both psychological and spiritual distress. With over 5 million ICU admissions annually in the United States, it is imperative to enhance the experiences and coping mechanisms of ICU family members. In particularly challenging situations, some family members even face psychological effects known as post-intensive care syndrome-family, which includes anxiety, depression, and posttraumatic stress. The distress may be worsened when patients and families experience poor communication or medical care, which has been shown to be more common among minoritized populations including Black and Hispanic patients and families. Family members' emotional and spiritual distress also has an effect on the medical decisions they make for the patient. While research has delved into the impact of spiritual care for ICU family members, further investigation is still needed to determine the most effective approaches for delivering such care. This narrative review will describe a conceptual model aimed at guiding future research in this endeavor. The model proposes that chaplains provide emotional, spiritual, and information support to ICU family members. This affects both their ICU experience, decision making, and outcomes for the patient and family. This process is also affected by characteristics of the family such as race, ethnicity, and economic status. This model helps identify gaps in research, including the need for randomized trials of spiritual care that identify mechanisms underlying outcomes and demonstrate impact of spiritual care, and consider race, ethnicity, and other characteristics.

Position Statement of ISCCM on Intrahospital Transport of Critically Ill Patients

Background and purpose

Intrahospital transport (IHT) of critically ill patients is essential for diagnostic and therapeutic indications, requiring thorough assessment and careful preparation of patients, staff, and equipment throughout the process. Variability in practices among hospitals can affect patient safety and may result in adverse events (AEs). This position statement is designed to provide guidance to multidisciplinary critical care teams in the adoption of evidence-based recommendations aimed at mitigating risks and improving safety during patient transport.

Method

This position statement has been drafted by an expert committee on IHT constituted by the Indian Society of Critical Care Medicine. The process involved thorough review of literature from electronic database using PubMed services. Recommendations made are tailored with considerations for Indian setting; the units may further modify these as per local needs and equipment and staffing available. The final manuscript was written after achieving consensus among members, and final draft was accepted by all the committee members.

Results

This position statement offers a compilation of 38 strategic recommendations, which are comprehensive and deal with all aspects of IHT of the critically ill. Recommendations provided in this document are, therefore, applicable for routine use during the IHT. They cover all phases of transport and answer questions pertaining to pre-, intra-, and post-transport considerations. It will help to achieve uniformity, minimize AEs, and enhance safety.

Conclusions

This is a standard set of 38 evidence-based recommendations to ensure safety for IHT, tailored for implementation in various criticalcare settings across India. Science is ever-changing, and periodic review will be needed to keep it up to date with emerging evidence and standards.

How to cite this article

Zirpe KG, Tiwari AM, Kulkarni AP, Govil D, Samavedam S, Sharma J, et al. Position Statement of ISCCM on Intrahospital Transport of Critically Ill Patients. Indian J Crit Care Med 2025;29(4):291-300.

A Pediatric Interprofessional Cardiac Intensive Care Unit Intervention: CICU Teams and Loved Ones Communicating (CICU TALC) is Feasible, Acceptable, and Improves Clinician Communication Behaviors in Family Meetings

Parents of children in the pediatric cardiac intensive care unit (CICU) are often unprepared for family meetings (FM). Clinicians often do not follow best practices for communicating with families, adding to distress. An interprofessional team intervention for FM is feasible, acceptable, and positively impacts family preparation and conduct of FM in the CICU. We implemented a family- and team-support intervention for conducting FM and conducted a pretest-posttest study with parents of patients selected for a FM and clinicians. We measured feasibility, fidelity to intervention protocol, and parent acceptability via questionnaire and semi-structured interviews. Clinician behavior in meetings was assessed through semantic content analyses of meeting transcripts tracking elicitation of parental concerns, questions asked of parents, and responses to parental empathic opportunities. Logistic and ordinal logistic regression assessed intervention impact on clinician communication behaviors in meetings comparing pre- and post-intervention data. Sixty parents (95% of approached) were enrolled, with collection of 97% FM and 98% questionnaire data. We accomplished > 85% fidelity to intervention protocol. Most parents (80%) said the preparation worksheet had the right amount of information and felt positive about families receiving this worksheet. Clinicians were more likely to elicit parental concerns (adjusted odds ratio = 3.42; 95%CI [1.13, 11.0]) in post-intervention FM. There were no significant differences in remaining measures. Implementing an interprofessional team intervention to improve family preparation and conduct of FM is locally feasible, acceptable, and changes clinician behaviors. Future research should assess broader impact of training on clinicians, patients, and families.

Relationship between perceived stress and health literacy on family satisfaction among family members of critically ill patients: A multicenter exploratory study

BACKGROUND

Intensive care unit (ICU) admission is often a stressful experience that can negatively influence family satisfaction (FS) with patient care, communication, and decision-making. Health literacy (HL) is associated with the patient's ability to obtain, process, and understand health-related information. Few studies have explored the influence of perceived stress and HL on FS simultaneously.

OBJECTIVE

To examine the association of perceived stress and HL with FS among family members of ICU patients.

DESIGN

A multicenter exploratory cross-sectional study.

METHODS

An exploratory, cross-sectional, multicenter study was conducted in three ICUs from different hospitals in Chile. Family members of ICU patients with ≥48 h of stay and respiratory support were eligible. The Family Satisfaction in the Intensive Care Unit-24 questionnaire and the Perceived Stress Scale were used. HL was evaluated using three screening questions. Multiple beta regressions were fit to explore the association between perceived stress, HL, and FS.

RESULTS

A total of 101 family members with 63.4% identified as at risk of low HL were included. Multiple beta regression revealed that low HL was not associated with FS. Conversely, FS was negatively associated with perceived stress, being admitted to the ICU of the central or southern region, and having a close personal relationship with a healthcare provider but positively associated with the number of communications with ICU staff.

CONCLUSIONS

While perceived stress can be detrimental to FS, HL seems not to impact FS levels among family members of ICU patients. Further studies are required to explore the influence of HL on FS.

IMPLICATIONS OF THE CLINICAL PRACTICE

This study advances the knowledge regarding variables affecting FS in the ICU. Evaluating the family members' emotional status may help ICU healthcare providers in the allocation of resources to support family members and to properly assess their satisfaction.

PATIENT OR PUBLIC CONTRIBUTION

Family members of ICU patients participated in this study.

Outcomes associated with family presence at the bedside of critically ill children in the pediatric intensive care unit: a scoping review

OBJECTIVE

The objective of this review is to identify the outcomes of family presence in pediatric intensive care units (PICUs) that have been studied and reported in the literature.

INTRODUCTION

PICU admission can be traumatic for children and their families. While family presence at the patient bedside is recommended to support family participation and engagement in care and is supported in recent family-centered care guidelines, it is not consistently optimized. To guide family presence research, a scoping review is needed to identify outcomes associated with family presence.

INCLUSION CRITERIA

This review included quantitative, qualitative, and mixed methods studies published from 1960 to 2022 in any language that reported outcomes of family presence at the bedside in the PICU for patients, their family members, and PICU health care professionals (HCPs).

METHODS

Following JBI methodology for scoping reviews, we searched MEDLINE (Ovid), PsycINFO (EBSCOhost), CINAHL (EBSCOhost), Embase, as well as 16 sources of gray literature for studies that addressed outcomes of family presence at the bedside in the PICU as they relate to the key players. Two independent reviewers screened titles and abstracts, followed by full texts of selected records according to the inclusion criteria. A priori, we identified categories of outcomes (biologic, psychologic, social, caring behavior) and key groups (HCPs, patients, families) to which the outcomes may apply. Data were extracted by 2 independent reviewers using a data extraction tool developed by the study team. Data were presented in tabular format to address findings related to the review objectives.

RESULTS

We identified 12,411 records through database searches, backward reference chaining, and gray literature searching. We removed 3012 duplicates, excluded 9244 records at the title and abstract review, and excluded 92 reports after full-text review. We extracted data from 62 reports of which 12 were mixed methods, 25 were quantitative, and 25 were qualitative spanning from 1982 to 2022.Of 46 unique outcomes, 39 reports addressed 28 outcomes for family members (psychologic n=13, social n=8, biologic n=5, caring behavior n=2; most common was stress, n=11 reports). Twenty reports addressed 16 outcomes for patients (psychologic n=7, social n=0, biologic n=6, caring behavior n=2, and other outcomes n=1; most common was out-of-bed mobilization, n=4 reports). Eleven reports addressed 9 outcomes for HCPs (psychologic n=3, social n=2, biologic n=0, caring behavior n=3, and other outcomes n=1; most common was procedural performance, n=3). The most frequently studied biologic outcome was sleep (n=7 reports; family members n=6, patients n=1), psychologic outcome was stress (n=13 reports; family members n=11, HCPs n= 2), social outcomes were role changes (n=4 reports; family members n=3, HCPs n=1) and financial challenges (n=4 reports for family members), and caring behavior outcome was out-of-bed mobility (n=4 reports for patients).

CONCLUSIONS

A relatively large, heterogenous body of literature addresses biologic, psychologic, social, and caring behavior outcomes for family members, patients, and HCPs. The review highlights the heterogeneity of available data and identifies a need for a concerted analysis. Important gaps remain, including social and longer-term mental health outcomes for patients, outcomes for siblings, and infection transmission for all key groups.

Delirium in the Acute Care Setting From the Families Perspective: A Scoping Review

AIM

To explore the existing literature on delirium within the acute care setting from the family members' perspective and summarise key findings.

DESIGN

A scoping review guided by Arksey and O'Malley's methodological framework and refined by the Joanna Briggs Institute.

REVIEW METHODS

The Population, Concept, and Context framework recommended by the Joanna Briggs Institute's scoping review protocol identified the main concepts in the primary review question. The inclusion criteria focused on primary research studies from any chronological date that explored the family members' experience of delirium within the acute care setting. Following screening by two independent reviewers, data extraction was conducted and presented in tabular form, detailing the study aim, sample, setting, methods, key findings and recommendations for future research and clinical practice.

DATA SOURCES

A comprehensive search was conducted in January 2025 using CINAHL+, MEDLINE, JBI, Cochrane Library, Web of Science, Scopus and Google Scholar. Citation searching and reference lists supplemented this review to identify relevant studies.

RESULTS

Seventeen studies met the inclusion criteria. Families' experiences of delirium were categorised into (1) lack of awareness and understanding of delirium; (2) communication and informational needs of family members regarding delirium; (3) the emotional impact delirium has on family members, and (4) family desire to participate in their loved one's care.

CONCLUSION

This review highlighted a paucity of literature addressing the experiences of family members who witness delirium in the acute care setting. The existing research underscored the need for clear communication and information regarding delirium to mitigate the negative emotional impact that delirium places on families.

IMPACT

This scoping review provides insights into the challenges facing families witnessing delirium in the acute care setting. A better understanding of family members' experiences can guide the development of a supported family-centred approach to delirium care.

PATIENT CONTRIBUTION

No patient/public contribution.

Direct Observation of Family Engagement Practice in a Cardiovascular Intensive Care Unit

The purpose of this study was to describe family engagement practices in a cardiovascular intensive care unit (CVICU) and to explore their relationship with patient outcomes. Observations were conducted on 104 patients, with most (n = 61; 58%) having family members present. On average, 1.3 ± 0.6 family members were present per observation period per patient, spending 69% of the observation time at the bedside. The most common forms of family engagement included communication (n = 61; 100%), active family presence (n = 36; 59%), and direct contribution to care (n = 35; 57%). Patients with family present were 3 times less likely to be re-admitted to the hospital within 30 days compared to those without family present (5% vs 16%; P = .05). This study offers valuable insights through direct observations of family engagement practices in a CVICU setting, offering a foundational understanding of family engagement patterns and their associations with patient outcomes. These findings establish a basis for developing targeted interventions, policies, and training programs aimed at enhancing family engagement and improving outcomes for both patients and their families in critical care settings.

Healthcare providers’ perspectives on factors influencing their critical care decision-making during the COVID-19 pandemic: An international pilot survey

BACKGROUND

Understanding a patient's clinical status and setting priorities for their care are two aspects of the constantly changing process of clinical decision-making. One analytical technique that can be helpful in uncertain situations is clinical judgment. Clinicians must deal with contradictory information, lack of time to make decisions, and long-term factors when emergencies occur.

AIM

To examine the ethical issues healthcare professionals faced during the coronavirus disease 2019 (COVID-19) pandemic and the factors affecting clinical decision-making.

METHODS

This pilot study, which means it was a preliminary investigation to gather information and test the feasibility of a larger investigation was conducted over 6 months and we invited responses from clinicians worldwide who managed patients with COVID-19. The survey focused on topics related to their professional roles and personal relationships. We examined five core areas influencing critical care decision-making: Patients' personal factors, family-related factors, informed consent, communication and media, and hospital administrative policies on clinical decision-making. The collected data were analyzed using the χ² test for categorical variables.

RESULTS

A total of 102 clinicians from 23 specialties and 17 countries responded to the survey. Age was a significant factor in treatment planning (n = 88) and ventilator access (n = 78). Sex had no bearing on how decisions were made. Most doctors reported maintaining patient confidentiality regarding privacy and informed consent. Approximately 50% of clinicians reported a moderate influence of clinical work, with many citing it as one of the most important factors affecting their health and relationships. Clinicians from developing countries had a significantly higher score for considering a patient's financial status when creating a treatment plan than their counterparts from developed countries. Regarding personal experiences, some respondents noted that treatment plans and preferences changed from wave to wave, and that there was a rapid turnover of studies and evidence. Hospital and government policies also played a role in critical decision-making. Rather than assessing the appropriateness of treatment, some doctors observed that hospital policies regarding medications were driven by patient demand.

CONCLUSION

Factors other than medical considerations frequently affect management choices. The disparity in treatment choices, became more apparent during the pandemic. We highlight the difficulties and contradictions between moral standards and the realities physicians encountered during this medical emergency. False information, large patient populations, and limited resources caused problems for clinicians. These factors impacted decision-making, which, in turn, affected patient care and healthcare staff well-being.

Application of family-centered care in cardiac surgery: a scoping review

BACKGROUND

Family-centered care (FCC) has been widely implemented in various medical settings, its application in cardiac surgery remains underexplored. Given the complexity of cardiac surgery and the significant impact on both patients and families, understanding FCC's role in this context is essential to improving patient outcomes and family well-being.

OBJECTIVES

To identify the current state of the application of FCC in the families of cardiac surgery.

METHODS

This study followed Arksey and O'Malley's methodology and the PRISMA extension for Scoping Reviews. A systematic search was conducted across ten databases between July and August 2024. Two researchers independently retrieved literature, extracted data, and cross-checked findings following predefined inclusion and exclusion criteria. The results were organized and synthesized using a structured spreadsheet.

RESULTS

A total of 23 studies were included, 95.65% of which were quantitative, spanning nine countries. FCC interventions focused on collaboration, communication, negotiation, and support, primarily delivered by healthcare professionals. The main intervention formats were training sessions (100.00%), written materials (71.43%), and visual media (42.86%). FCC was linked to improved psychological well-being and greater satisfaction, with anxiety (52.38%) being the most commonly assessed outcome using validated scales. Qualitative findings highlighted the importance of FCC in patient recovery, emphasizing the need for systematic support to alleviate caregiving burden.

CONCLUSIONS

This scoping review highlights the core characteristics and interventions of FCC for cardiac surgery patients, emphasizing the need for a multidisciplinary approach. While FCC has shown benefits in improving emotional well-being and satisfaction, there is a lack of robust longitudinal studies and objective outcome measures. Future research should focus on interactive, personalized interventions, integrate technology, and include a broader range of outcome indicators to better assess FCC's clinical effectiveness.

Preliminary efficacy of the vidatalkTM communication application on family psychological symptoms in the intensive care unit: A pilot study

BACKGROUND

Family caregivers of ICU patients experience difficulty communicating with patients during mechanical ventilation. Little is known about patient-family communication in the ICU and the associated emotional distress.

OBJECTIVES

To examine the preliminary effects of the VidaTalk™ communication app on anxiety, depression, and PTSD-related symptoms among family caregivers.

METHODS

We conducted a prospective study using repeated measures to compare VidaTalk™ to an attention control condition. Twenty-eight family caregivers of nonvocal adult ICU patients participated in this study. The intervention group received VidaTalk™, whereas the attention control group received a standard tablet loaded with MyChart Bedside (EPIC) and game apps during the patient's mechanical ventilation treatment. Family caregiver anxiety and depression (Hospital Anxiety and Depression Scale) were measured at baseline, at extubation/ICU discharge, and 1-, 3-, and 6-months post-ICU discharge. PTSD-related symptoms (Impact of Event Scale-revised) were measured at 1-, 3-, and 6-months. T-tests were used for group comparisons for families' perceived communication difficulty, anxiety, and depression, and Mann-Whitney U tests were used for PTSD-related symptom comparisons.

RESULTS

No statistically significant difference was found between groups in changes in family psychological outcomes, the VidaTalk™ was associated with a small to medium improvement in anxiety symptoms (d = 0.43) at one month. The VidaTalk™ group had lower PTSD-related symptoms than the AC group with a medium effect size (ɳ2=0.07) at one month and a medium-to-large effect size (ɳ2=0.09) at three months.

CONCLUSIONS

The VidaTalk™ demonstrated potential as a family caregiving intervention that may be associated with reduced family psychological symptoms.

Randomized Clinical Trial of the Four Supports Intervention for Surrogate Decision-Makers in Intensive Care Units

Rationale: Individuals acting as surrogate decision-makers for critically ill patients frequently struggle in this role and experience high levels of long-term psychological distress. Prior interventions that were designed solely to improve information sharing between clinicians and family members have been ineffective. Objectives: We sought to examine the impact of a multicomponent family support intervention on patient and family outcomes. Methods: We conducted a patient-level randomized clinical trial at six ICUs in a healthcare system in Pennsylvania. An external interventionist interacted daily with surrogate decision-makers for incapacitated, critically ill patients at high risk of death or severe long-term functional impairment to deliver four types of protocolized support during the ICU stay: emotional support; communication support; decisional support; and, if indicated, anticipatory grief support. The control condition involved usual care plus two brief education sessions about critical illness. Measurements and Main Results: Primary outcome was the surrogates' scores on the Hospital Anxiety and Depression Scale at 6 months (range = 0-42). A total of 444 surrogates of 291 patients were enrolled (233 surrogates in intervention and 211 in control). The Four Supports intervention was delivered with high fidelity (frequency of per protocol delivery of key intervention elements, 97.1%; quality rating of intervention delivery, 2.9 ± 0.2 on a scale ranging from 1 to 3, with higher scores indicating higher quality of intervention delivery). There was no intervention effect on the primary outcome, surrogates' Hospital Anxiety and Depression Scale total scores at 6-month follow-up (β = 0.06; 95% confidence interval, -0.07 to 0.19; P = 0.35), or the prespecified secondary outcomes. Conclusions: Among critically ill patients at high risk of death or functional impairment, a family support intervention delivered by an external interventionist did not reduce surrogates' long-term psychological symptom burden.Clinical trial registered with www.clinicaltrials.gov (NCT01982877).

Bereaved Family Quality of Life Varies With Comorbid Psychological Distress and ICU-Care Quality

CONTEXT

Health-related quality of life (HRQOL) is highly endorsed, but HRQOL studies scarcely investigate the following: ICU family members; modifiable end-of-life (EOL) ICU-care factors; conjoint associations with prolonged grief disorder (PGD), post-traumatic stress disorder (PTSD), and depression; and long-term bereavement outcomes.

OBJECTIVES

Exploratorily investigate associations of PGD-PTSD-depressive-symptom states (resilient, subthreshold-depression dominant, PGD dominant, and PGD-PTSD-depression comorbid) and quality of EOL ICU care with families' HRQOL 6-24 months post loss.

METHODS

This cohort study examined symptoms of PGD (11 items of the PG-13), PTSD (Impact of Event Scale-Revised), and depression (Hospital Anxiety and Depression Scale), and HRQOL (Medical Outcomes Study 36-Item Short-Form Health Survey) among 303 ICU family members. Quality of EOL ICU care was measured by objective process-based care-quality indicators abstracted from medical records and classified by subjective family-assessed quality of patient dying and death (QODD). Associations were simultaneously examined by multivariate hierarchical linear modeling with resilient state and high QODD class as reference.

RESULTS

Physical and mental HRQOL were worse in the 3 more distressed symptom states, especially mental HRQOL which showed an incremental dose-response effect: subthreshold depression-dominant (β [95% CI]=-2.419 [-3.374, -1.464]), PGD-dominant (-8.366 [-10.116, -6.616]), and PGD-PTSD-depression comorbid (-14.736 [-17.772, -11.700]) states. Mental HRQOL was significantly worse in the 3 poorer QODD classes: moderate (-1.085 [-2.138, -0.032]), poor to uncertain (-4.362 [-5.616, -3.108]), and worst (-3.239 [-4.433, -2.045]). HRQOL was not associated with objective care-quality indicators.

CONCLUSION

Bereaved family members' HRQOL was significantly associated with PGD-PTSD-depressive-symptom states and QODD classes-both modifiable through high-quality EOL ICU care.

Society of Critical Care Medicine 2024 Guidelines on Adult ICU Design

RATIONALE

Advances in technology, infection control challenges-as with the COVID-19 pandemic-and evolutions in patient- and family-centered care highlight ideal aspects of ICU design and opportunities for enhancement.

OBJECTIVES

To provide evidence-based recommendations for clinicians, administrators, and healthcare architects to optimize design strategies in new or renovation projects.

PANEL DESIGN

A guidelines panel of 27 members with experience in ICU design met virtually from the panel's inception in 2019 to 2024. The panel represented clinical professionals, architects, engineers, and clinician methodologists with expertise in developing evidence-based clinical practice guidelines. A formal conflict of interest policy was followed throughout the guidelines-development process.

METHODS

Embase, Medline, CINAHL, Central, and Proquest were searched from database inception to September 2023. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to determine certainty in the evidence and to formulate recommendations, suggestions, and practice statements for each Population, Intervention, Control, and Outcomes (PICO) question based on quality of evidence and panel consensus. Recommendations were provided when evidence was actionable; suggestions, when evidence was equivocal; and practice statements when the benefits of the intervention appeared to outweigh the risks, but direct evidence to support the intervention did not exist.

RESULTS

The ICU Guidelines panel issued 17 recommendations based on 15 PICO questions relating to ICU architecture and design. The panel strongly recommends high-visibility ICU layouts, windows and natural lighting in all patient rooms to enhance sleep and recovery. The panel suggests integrated staff break/respite spaces, advanced infection prevention features, and flexible surge capacity. Because of insufficient evidence, the panel could not make a recommendation around in-room supplies, decentralized charting, and advanced heating, ventilation, and air conditioning systems.

CONCLUSIONS

This ICU design guidelines is intended to provide expert guidance for clinicians, administrators, and healthcare architects considering erecting a new ICU or revising an existing structure.

Intensive care unit diaries-harmful or harmless: A systematic literature review and qualitative data synthesis

OBJECTIVE

The objective of this research was to evaluate the extent of harm for critically ill patients, family members, and healthcare professionals associated with writing and reading intensive care unit (ICU) diaries.

REVIEW METHOD USED

A systematic literature review and a synthesis of qualitative data were performed. The protocol of this study has been registered in the International prospective register of systematic reviews (CRD42022376393).

DATA SOURCES

Databases were PubMed, Cochrane Library, CINAHL, PsychNet, and Livivo.

REVIEW METHODS

The search included qualitative and mixed-methods studies related to harm with an ICU diary. Deductive content analysis was used to create abstractions of quotations. Study quality was assessed with the Critical Appraisal Skills Programme.

RESULTS

Of 12 827 titles, 27 studies with 476 participants were included. Events involving the patients, family members, and healthcare professionals occurred but did not result in harm. A total of 68 quotations from patients, family members, and healthcare professionals were extracted. Those patients, their families, and healthcare professionals who mentioned intense emotions regarding diaries experienced writing and reading diaries as an emotional journey (patients), a help with tears (families), or a question of emotional distance (healthcare professionals).

CONCLUSIONS

Writing and reading ICU diaries can be associated with intense emotions, which are natural reactions when coping with a stressful situation. No study reported harm. Based on uncertain qualitative evidence, the benefits of writing and reading ICU diaries as coping strategies outweigh the potential harm. More research is needed.

REGISTRATION OF REVIEW

The International prospective register of systematic reviews CRD42022376393.

Patients' and family members' dyadic experience of post-operative delirium in the intensive care unit: A qualitative study

BACKGROUND

Post-operative delirium is a complication with long-lasting consequences for both patients and their families. This is particularly true for those transferred to the intensive care unit after surgery, where the incidence of post-operative delirium is high, and patient outcomes are often poor. Despite the acknowledged role of family engagement in delirium management, previous research has mainly focused on patients, with limited exploration of the shared experiences between patients and family members.

AIM

This study aims to explore the experiences of patients and family members during episodes of post-operative delirium in the intensive care unit to better understand their unmet needs.

STUDY DESIGN

A qualitative descriptive study was conducted at a tertiary general hospital. Eighteen pairs of patients, their family members and two other family members were interviewed. Data were collected through face-to-face semi-structured interviews within the first week after patients' discharge from the intensive care unit and analysed using thematic analysis.

RESULTS

Four major themes emerged: (1) the dyadic relationship between patients and family members must be understood in the context of their shared emotional and behavioural experiences; (2) family's history may predispose patients to post-operative delirium; (3) family engagement may prevent the development of post-operative delirium; and (4) inadequate communication between health care providers and patients or families may negatively affect post-operative delirium outcomes.

CONCLUSIONS

Post-operative delirium presents significant emotional and physical challenges for both patients and their families. Addressing these challenges requires improved communication between health care providers and families, as well as strategies that emphasize early family support and collaboration in care.

RELEVANCE TO CLINICAL PRACTICE

Patients and their families should be considered a unit during post-operative delirium management, and earlier family engagement is essential. Health care systems should adapt intensive care unit practices to meet the dynamic needs of families, promoting more comprehensive support during critical care.

Echoes of isolation: Exploring Arab family perspectives and health care providers' reflections in ICU settings during critical care

BACKGROUND

Families are reporting loss of interactions and communication in response to restrict isolation measures. Other tangible losses include income, access to resources, engagement, involvement in decision-making process and other planned activities. Listening to families' needs, concerns and say has been identified as one of the most important and least accomplished health care providers' roles in the intensive care units (ICUs).

AIMS

(1) To explore the experiences and concerns of Arab family members and health care professionals facing the challenges during ICU isolation, and (2) to develop recommendations for enhancing family support and improving effective communication to better address the needs of families during ICU isolation.

STUDY DESIGN

This study utilizes a qualitative descriptive phenomenological design. We analysed data gained from 32 family members' concerns during their ICU patients' stay in isolated room settings and 21 health care providers' reflections through 2 focused groups recruited from Emirati and Egyptian ICUs.

RESULTS

Thematic analysis revealed two main themes. The first theme, Family Members' Perspectives, highlights families' emotional and logistical challenges, including fears about infection, frustration over delayed updates and barriers to advocating for their loved ones. Subthemes include (a) family experiences and emotional challenges and (b) family-derived recommendations, such as implementing regular video calls, providing detailed patient updates and allowing occasional controlled visits to the ICU. The second theme, Health Care Providers' Perspectives, reflects HCPs' professional challenges in balancing family engagement with clinical demands. Subthemes include (a) challenges faced by HCPs, such as time constraints and communication difficulties, and (b) HCP-derived suggestions, including the integration of liaison nurses, social workers and revised visitation policies to enhance family-centred care.

CONCLUSION

Families expressed concerns regarding the post-ICU discharge plan, prognosis and treatment quality. They proposed regular calls and video conferences as key methods for expressing preferences, emphasizing the importance of their active involvement during isolation. In response, health care providers acknowledged the imbalance in family-centred care and recommended expanding the ICU team to include social workers, psychologists and liaison nurses to better address the holistic needs of patients and families in isolation.

RELEVANCE TO CLINICAL PRACTICE

This study underscores the critical role of family support and involvement in ICU care, specifically highlighting the responsibilities of ICU nurses. It calls for targeted policy modifications, the implementation of structured communication strategies and the establishment of a supportive environment to enhance family engagement. By equipping ICU nurses with the necessary resources, training and tools, these strategies aim to optimize family-centred care, improve the quality of communication and ultimately contribute to better patient outcomes in intensive care settings.

A preliminary study of the effectiveness of video visitation on depression and stress in mothers with preterm infants during the pandemic

BACKGROUND AND PURPOSE

Parents of preterm infants experience anxiety and stress in the neonatal intensive care unit (NICU). Visitation restrictions due to COVID-19 have increased maternal pressure and limited bonding opportunities. Little research exists in Taiwan on using video conferencing as a solution. This study investigates depression and stress levels in mothers of preterm infants and evaluates the effectiveness of video visitation during NICU restrictions.

METHODS

This study adopts a cross-sectional design and a qualitative survey. Mothers of premature infants were recruited and they participated in the study. Interventions for video visits were scheduled on the third day of admission to the NICU (T1) and during the second week of the study (T2). After each video visit, participants completed an online survey. The study's online survey used structured questionnaires including demographics, the Edinburgh Postnatal Depression Scale (EPDS) and the Parental Stress Scale (PSS): Infant Hospitalization (IH).

RESULTS

A total of 51 mothers of preterm infants participated in the study. During the T1 and T2 periods, single mothers with lower educational levels and those aged below 30 experienced depression and high levels of stress. Lower birth weight and gestational age were associated with maternal depression. Video visitation intervention led to a significant decrease in depression scores (EPDS, T1: 11.3 ± 5.5 vs. T2: 10.1 ± 5.2, p = 0.039). Positive correlations were observed between EPDS and PSS: IH scores (p < 0 .005).

CONCLUSION

Video visitation intervention can reduce maternal depression in mothers with preterm infants. Since it is practical, video visitation may be applied even after the pandemic.

In-person, virtual visiting and telephone calls in Australia and New Zealand intensive care units: A point prevalence multicentre study mapping daytime and nighttime interactions

BACKGROUND

Family presence, in-person and via virtual visiting (video calls) and the telephone, is an integral part of patient- and family-centred critical care. Previous studies focussed on visiting policies and their effects. Data mapping the frequency and timing of these interactions are not available.

OBJECTIVES

The aims of this study were to describe the prevalence of in-person visiting and the use of telephone or video conferencing in Australia and New Zealand intensive care units (ICUs).

DESIGN

A point prevalence survey was conducted to map visiting policies, hourly family presence at the bedside, telephone or video calls, and reasons for each interaction.

SETTING

The research was conducted in a 24-h study period in October 2020, corresponding to the end of the 2nd COVID-19 pandemic wave in 40 Australia and New Zealand ICUs.

MEASUREMENTS AND MAIN RESULTS

At the time of survey, 77% of ICUs had restrictions to visiting, median (interquartile range [IQR]) time of 9 (2; 24) hours with permitted visiting per day, a mean of 8 hours less than before the COVID-19 pandemic. There were 532 patients, a median (IQR) of 13 (6; 25) patients per ICU. Two patients had COVID-19. Over 24 h, 65% of patients had at least one in-person visit, median (IQR) of 1 (0; 3) hours with visitors. Telephone calls were received for 52% patients, median (IQR) of 1 (0; 2) calls. Video calls were received for 6% of the patients. In-person visits peaked between 10:00 and 12:00, with a second smaller peak between 16:00 and 17:00. Visiting continued through the evening, and 2% of the patients had visitors overnight. Telephone calls peaked at 10:00, continued through the day and evening, with few calls received overnight. In-person visits were predominantly motivated by family interactions (81%) and telephone calls by clinical updates (51%) and family interactions (47%).

CONCLUSIONS

In a low COVID-19 prevalence period, Australia and New Zealand ICUs had partially reopened to visitors. Most visits happened during the day and evening but persisted overnight. ICU resourcing and visiting policies should take these data into account to facilitate family presence at the bedside, virtual visiting, and obtaining clinical updates via telephone.

Health Care Professionals' Views and Practices Regarding Bereavement Support

BACKGROUND

Because the death of a loved one is distressing for families, bereavement support is recommended for high-quality end-of-life care. Although health care professionals provide support during the death, many do not routinely follow up with bereaved families.

OBJECTIVES

To describe and compare how health care professionals view and provide bereavement support.

METHODS

This prospective, cross-sectional study assessed registered nurses, physicians, social workers, respiratory therapists, and unlicensed assistive personnel working in the intensive care unit, step-down unit, and emergency department. Health care professionals completed a survey assessing their views, practices, and training in providing bereavement support to families. Descriptive statistics and the Kruskal-Wallis test were used to describe and compare the groups.

RESULTS

Among 123 health care professionals, 67.5% were registered nurses and 78% were female. Most (64.2%) supported families at the time of death; however, only 6.5% followed up with bereaved families in the weeks after the death. Physicians, social workers, and registered nurses provided bereavement support more often than unlicensed assistive personnel and respiratory therapists did (P = .001). Only 29.3% were very comfortable providing support to bereaved families. Respiratory therapists were less comfortable than other health care professionals (P = .002). Most health care professionals (54.5%) wanted formal training on providing bereavement support. The main barriers to providing bereavement support included lack of training, time, and resources.

CONCLUSIONS

Understanding health care professionals' views and practices on providing bereavement support may help inform the development of appropriate educational materials, interventions, and protocols around bereavement support.

Electronic Health Records and Family Satisfaction in the ICU: Communication, Care Processes, and Decision-Making

Objectives: To evaluate electronic health records and explore associations with the satisfaction of families of critically ill patients. Methods: Exploratory cohort study. Included 94 patients with severe chronic illnesses or chronic critical illness who were admitted to the ICU and their family members. Family satisfaction was assessed using the Family Satisfaction ICU (FS-ICU 24) questionnaire, through the FS-ICU Care score (perception of care itself), FS-ICU Decision Making score (perception of decision-making), and FS-ICU Total score, and queried about the use of a room suitable for communication. Electronic health records were analyzed for elements of communication with family members, care processes, and decision-making. Results: The scores were FS-ICU Care 91.1 (76.8-98.0), FS-ICU DM 90.0 (77.5-97.5), and FS-ICU total 90.7 (78.0-97.0). In 17 (18.1%) of the medical records, there was a documented family meeting within the first 72 hours, and in 9.6%, there was documentation of communication about functionality, wishes and values, and consultation for palliative care. The use of a suitable room for communication was reported as "never" or "rarely" by 45 (47.8%) of the family members. There was a trend towards greater satisfaction with social support and lower satisfaction among family members of deceased patients, with 9 (25.8%) of these family members feeling that the patient was uncomfortable before death, and the records of meetings and communication of poor prognosis were associated with a lower perception of discomfort (P < .05). Conclusions: The satisfaction of family members of critically ill patients was high and was not significantly associated with the documentation deficiencies found. Deficiencies in communication appear to have influenced the perception of family members. Various perspectives are necessary for analyzing the care provided to patients and families in the ICU.

Improving Commitment to Family-Centered Care in the NICU: A Multicenter Collaborative Quality Improvement Project

OBJECTIVE

Despite evidence demonstrating the positive impact of family-centered care (FCC) in the neonatal intensive care unit (NICU), FCC is not standard of care. This multi-center, quality improvement initiative aimed to increase the percentage of NICUs with FCC committees and Family Partnership Councils (FPCs).

STUDY DESIGN

Participating NICUs were divided into small groups for collaborative mentoring. A key driver diagram and Pareto charts evaluated barriers to FCC and directed interventions. The primary outcome measure was development of an FCC committee and/or FPC. Process measures were views of bi-monthly educational webinars, evaluated using Statistical Process Control charts.

RESULT

Across 22 NICUs, the percentage with FCC committees and FPCs increased from 18% to 59% and 18% to 45%, respectively. Average webinar views increased from 28 to 182 views/webinar with clear signal on XmR chart.

CONCLUSION

A collaborative mentoring model and focused education achieved the goal of increasing NICU FCC committees and FPCs.

Evaluation of Family-Centered Care by Parents and Nurses of Children With Congenital Microtia

BACKGROUND

The family-centered care is widely applied in pediatric nursing; however, there has been no research reflecting its extent of practice in the auricular reconstruction process for families of children with congenital microtia in China.

OBJECTIVE

This study aims to understand the perspectives of parents of children with congenital microtia and nurses at auricular reconstruction centers in Beijing, China, regarding family-centered care practices and specific areas that need improvement.

METHODS

The study utilized the Measure of Processes of Care (MPOC-20) and the Measure of Processes of Care for Service Providers (MPOC-SP) to survey 100 parents and 22 nurses. Scores for each dimension and item with low score (1-4 points, representing for at least 25% respondents) were statistically analyzed, indicated deficiencies in care services. The scores of parents and nurses were compared with international data.

RESULTS

In this study, the dimension scores of the MPOC-20 ranged from 5.34 ± 1.22 (Coordinated and Comprehensive Care) to 5.57 ± 1.22 (Providing Specific Information). The dimension scores of the MPOC-SP ranged from 5.91 ± 1.08 (Showing Interpersonal Sensitivity) to 6.25 ± 1.20 (Providing General Information). Both sets of scores were higher than most previous studies, particularly in Providing General Information.

CONCLUSION

Parents of children with congenital microtia and nurses generally rated family-centered care practices positively. However, improvements are needed in Coordinated and Comprehensive Care and Showing Interpersonal Sensitivity. Future efforts should aim to enhance the care system for microtia by standardizing care service content, increasing auditory and psychological interventions, and strengthening long-term follow-up care.

The effect of family members' communication mode choice on the family's perceptions of care

PURPOSE

Family-centered rounds (FCR) are a multidisciplinary process in which patients and/or family members are present and actively participate in medical rounds. While research has shown that FCR may enhance collaborative information exchange and reduce family anxiety, the impact of the information exchange modality on the experience has been largely unexplored. Medical rounds are typically assumed to be carried out in person at the bedside. In this research, we challenge this perception. We ask whether FCR communication is best conducted at the bedside or if similar communication outcomes are obtained when family members choose the communication mode according to their preferences.

DESIGN/METHODOLOGY/APPROACH

Using a field experiment in which participants choose the communication mode, we empirically analyze perceptions of the resulting communication in terms of information exchange. Three communication modes are available for participants to choose from (i.e. patients' families): face-to-face (FtF), phone and video conferencing. A questionnaire is distributed, and the responses of the patients' family members are analyzed. ANOVA tests are carried out to analyze the effect of communication mode on family perceptions.

FINDINGS

Perceptions following video conferencing or FtF interaction were significantly higher than perceptions following the use of a phone. Thus, our results show clear superiority of video and FtF communication modes as facilitators of effective communication perceptions. There is also marginal evidence that FtF communication is perceived as superior than video conferencing in supporting the receipt of information and understanding but not in the ability to convey information and input to the care team. These results suggest that allowing family members to choose their communication preferences does not always support effective communication. A case can be made for motivating patient family members to use face-to-face or video communication rather than phone if possible.

ORIGINALITY/VALUE

The possible ramifications of allowing family members to choose communication mode with the care team have been largely unexplored. Medical rounds are typically assumed to be carried out in person at the bedside. In this research, we challenge this perception. We ask whether communication is best conducted at the bedside or whether similar communication outcomes are obtained when family members choose the communication mode according to their preferences.

Handoffs and transitions of care in the intensive care unit: an American Association for the Surgery of Trauma Critical Care Committee clinical consensus document

ABSTRACT

Objectives

The American Association for the Surgery of Trauma (AAST) Critical Care Committee chose handoffs and transitions of care in the intensive care unit (ICU) as a clinically relevant topic for review. This clinical consensus document aims to provide practical guidance to the surgical intensivist on the best practices for patient handoffs and transitions of care.

Methods

A working group was formed from the committee-at-large to complete this work. The members of the working group were each assigned a subtopic to review using research to date. The research on which the recommendations are based was compiled at the discretion of the working group. Any topic with discrepant or minimal supporting literature was reviewed by the AAST Critical Care Committee through an anonymous survey.

Results

Recommendations for healthcare handovers include formally recognized handoffs at dedicated times, an interactive verbal exchange including all patients with a focus on what to anticipate or what is needs to be completed, tools to record and maintain information, and training to new providers on the handoff process and technology.

Conclusion

As clinicians, we strive to provide the best evidence-based care to our patients. It is essential to study these high states, ICU handoffs to enhance the safety, efficiency, and effectiveness of patient care transitions, ultimately leading to better patient outcomes and provider satisfaction.

Level of evidence

V.

Effect of an intensive care unit virtual reality intervention on relatives´ mental health distress: a multicenter, randomized controlled trial

BACKGROUND

Relatives of intensive care unit (ICU) patients often endure symptoms of post-traumatic stress, anxiety, and depression during and after treatment of a family member's hospitalization. The aim of this study was to evaluate the effect of ICU-specific virtual reality (ICU-VR) on mental health among relatives, 6 months after patient's ICU discharge.

METHODS

This multicenter, randomized controlled trial included relatives of ICU patients who were assigned to receive either standard care or standard care plus ICU-VR, by randomizing the ICU patients. Relatives were assessed up to 6 months after patient discharge from the ICU for post-traumatic stress, anxiety, depression, quality of life, relatives' understanding of ICU care, and appreciation of ICU-VR.

RESULTS

One hundred relatives of 81 patients and 89 relatives of 80 patients were randomized to the intervention and control groups, respectively. Relatives' median age was 48 years and 53% were female. Compared to the control group, relatives who received ICU-VR did not experience a decrease in post-traumatic stress (23% vs. 18%; p = 0.99), anxiety (22% vs. 30%; p = 0.35), or depression (17% vs. 23%; p = 0.44). There was no significant difference between median mental quality of life (50.2 vs. 52.6; p = 0.51), physical quality of life (56.1 vs. 54.3; p = 0.16), or understanding of ICU care between groups. Patients in the intervention group highly endorsed ICU-VR (90%), favoring it over traditional informational brochures and the majority (82%) stated it improved their understanding of ICU treatment.

CONCLUSION

ICU-VR did not significantly improve mental health distress symptoms among relatives 6-months after a patient's discharge. Relatives highly endorsed ICU-VR and self-reported that it improved their understanding of ICU treatment.

Objective assessment of nursing workload in an intermediate care unit: A prospective observational study

OBJECTIVES

To systematically assess the nursing workload in an Intermediate Care Unit.

DESIGN

Single-centre prospective observational study. The nursing activities within the initial 72 h of hospitalization were recorded on a prespecified chart and standardized as activities/5 min/patient/day.

SETTING

This study was conducted at the Intermediate Care Unit of the Altovicentino Hospital (Italy) from September 1 to December 31, 2022.

MAIN OUTCOME MEASURE

We considered working overload as an average number of nursing activities/5 min/patient/day higher than the 85th percentile and investigated independent risk factors associated with it.

RESULTS

A total of 183 patients were included. During their hospital stay, the average number of nursing activities per patient was 30 per 5-minute interval per day (range: 22-40). On the first day of hospitalization, the primary activities were predominantly administrative and managerial tasks. In contrast, on the second day, activities related to therapeutic management and primary care predominated. Various scores related to the patient's condition, including comorbidity, functionality, frailty, intensity, and severity, were analyzed for their association with nursing workload using multivariate analysis. However, only the National Early Warning Score was found to be an independent risk factor for nursing workload overload (OR 1.399, 95 % CI 1.205-1.624, p < 0.001).

CONCLUSION

The study results demonstrated a significant variation in nursing workload within the same department. Subsequent studies are necessary to confirm the ability of the National Early Warning Score in predicting nursing over workload.

IMPLICATION FOR CLINICAL PRACTICE

This study provides a detailed analysis of nursing workload in intermediate care settings, emphasizing the need for adequate resource allocation due to the potential for rapid deterioration in patients' conditions. By correlating nursing activities with patient severity indices, such as the National Early Warning Score, the findings support more effective organizational strategies to enhance care for patients at high risk of health decline.

A Quality Improvement Initiative to Implement Focused Family Meetings in the Surgical Intensive Care Unit: Does It Matter?

Introduction: Communication with families is essential to improve satisfaction, especially in the critical care setting. We sought to identify patients who were not recovering as expected and to improve communication with their families.Methods: We implemented a novel algorithm, incorporating clinical and social criteria, to determine which patients could benefit from additional communication. Patients who qualified were randomized to the intervention of a structured interdisciplinary family meeting or to standard communication in the Intensive Care Unit at the discretion of the attending. Surveys were administered to both groups to determine the primary outcome of satisfaction with communication. Wilcoxon rank-sum, chi-square, or Fisher's exact test as appropriate was used to compare baseline characteristics and survey items between groups.Results: There was no difference between the intervention (n = 25) and non-intervention groups (n = 33) in demographic or clinical characteristics (P-value >.05). Surveys were able to be completed for 76% of the intervention group and 51% in the non-intervention group. There was no difference in the responses to the survey between the groups (P-value >.05), signifying that families were satisfied with communication regardless of whether they had a structured interdisciplinary family meeting.Conclusion: Our results are contrary to the traditionally held belief that structured family meetings improve communication. A possible explanation is that implementing an algorithm to identify patients in need of additional communication predisposes providers to be more cognizant of family needs in the Surgical Intensive Care Unit. Future research should focus on qualitative research to elucidate what aspects of communication are most useful to families.

Society of Critical Care Medicine Guidelines on Family-Centered Care for Adult ICUs: 2024

RATIONALE

For staff in adult ICUs, providing family-centered care is an essential skill that affects important outcomes for both patients and families. The COVID-19 pandemic placed unprecedented strain on care of ICU families, and practices for family engagement and support are still adjusting.

OBJECTIVES

To review updated evidence for family support in adult ICUs, provide clear recommendations, and spotlight optimal family-centered care practices post-pandemic.

PANEL DESIGN

The multiprofessional guideline panel of 28 individuals, including family member partners, applied the processes described in the Society of Critical Care Medicine Standard Operating Procedures Manual to develop and publish evidence-based recommendations in alignment with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Conflict-of-interest policies were strictly followed in all phases of the guidelines, including panel selection, writing, and voting.

METHODS

The guidelines consist of four content sections: engagement of families, support of family needs, communication support, and support of ICU clinicians providing family-centered care. We conducted systematic reviews for 15 Population, Intervention, Control, and Outcomes questions, organized among these content sections, to identify the best available evidence. We summarized and assessed the certainty of evidence using the GRADE approach. We used the GRADE evidence-to-decision framework to formulate recommendations as strong or conditional, or as best practice statements where appropriate. The recommendations were approved using an online vote requiring greater than 80% agreement of voting panel members to pass.

RESULTS

Our panel issued 17 statements related to optimal family-centered care in adult ICUs, including one strong recommendation, 14 conditional recommendations, and two best practice statements. We reaffirmed the critical importance of liberalized family presence policies as default practice when possible and suggested options for family attendance on rounds and participation in bedside care. We suggested that ICUs provide support for families in the form of educational programs; ICU diaries; and mental health, bereavement, and spiritual support. We suggested the importance of providing structured communication for families and communication training for clinicians but did not recommend for or against any specific clinician-facing tools for family support or decision aids, based on current available evidence. We recommended that adult ICUs implement practices to systematically identify and reduce barriers to equitable critical care delivery for families and suggested that programs designed to support the wellbeing of clinicians responsible for family support be developed.

CONCLUSIONS

Our guideline panel achieved consensus regarding recommendations and best practices for family-centered care in adult ICUs.

Strategies for Coping With Complicated Grief in Relatives of Patients Who Are Critically Ill: An Observational Single-Center Cohort Study

BACKGROUND

Relatives of patients who are critically ill who die are at high risk for symptoms of complicated grief (CG) with potential individual and social burdens. The prevalence and predictors of CG, and in particular the involvement of individual facets of relatives' coping strategies, are not well understood.

RESEARCH QUESTION

How high is the prevalence and what are the predictors of CG, and how are coping strategies associated with CG symptoms?

STUDY DESIGN AND METHODS

In this observational single-center cohort study, relatives of patients who are critically ill who died while in the ICU were surveyed 6 months later, using the Inventory of Complicated Grief (ICG) and the Brief Coping Orientation to Problems Experienced questionnaire, to assess CG symptoms and coping strategies, respectively. Patients' and relatives' characteristics were obtained. The primary outcome was the ICG sum score.

RESULTS

Relatives of 89 of the 298 patients who died in the ICU during the study period were included. The mean ± SD ICG sum score was 41.6 ± 10.9. Eighty-four relatives (94.4%) had an ICG score ≥ 25. Multivariable analysis revealed that being a partner significantly affected the ICG sum score (coefficient, 4.9; 95% CI, 1.8 to 8.0; P = .003), as did the coping strategies of self-distraction (coefficient, 4.4; 95% CI, 2.5 to 6.3; P < .001), acceptance (coefficient, -4.4; 95% CI, -6.3 to -2.5; P < .001), and self-blame (coefficient, 3.8; 95% CI, 1.4 to 6.3; P = .002).

INTERPRETATION

Almost all relatives of deceased patients who are critically ill exhibit symptoms of CG. Relatives' functional and dysfunctional coping strategies may be associated with their CG symptoms. Knowledge of individual relatives' coping strategies may be helpful in supporting them. Adequate supportive interventions should be developed.

Family-Led Coaching of Patients During Weaning From Sedation and Mechanical Ventilation in the ICU

Background: ICU patients are weaned from sedation and mechanical ventilation through spontaneous awakening trials (SATs) and spontaneous breathing trials (SBTs). Weaning can be distressing for patients and their families. Family-led coaching could reassure patients and reduce stress for families by engaging them in patient care. This study developed and piloted a family-led coaching tool to support patients undergoing SATs/SBTs. Methods: Patient and family member dyads were recruited from 2 medical-surgical ICUs in Calgary, Canada (February 3-August 1, 2023). Surveys were administered to collect family (1) demographics, (2) anxiety and satisfaction with ICU care, (3) feedback on the tool, and (4) attitudes about family presence during SATs/SBTs (also collected from clinicians). Tool feasibility was determined by calculating the proportions of (1) eligible patients who were recommended for participation in the study by clinicians and (2) families approached who consented to participate in the study. Results: One thousand one hundred fifty patients were admitted to the study ICUs during the study period of which 819 received mechanical ventilation, and 42 were recommended by bedside clinicians for participation in the study. Twenty-five dyads were approached, 21 dyads consented to participate, and one withdrew consent before data collection. Of the enrolled families, 12 (60%) reported the coaching tool to be useful, and 5 (25%) recommended minor suggestions such as "shortening" the tool. Fourteen (70%) families reported positive experiences (through open-ended feedback) with being present for the SAT/SBT. State-Trait Anxiety Inventory (Y1) scores (scale range 20-80 points) significantly decreased in families from the first (pre coaching) to the second (post coaching) measures (mean decrease 8.2 points, SD 10.3, P = .001). All clinicians indicated they were comfortable with family presence and/or coaching during SATs/SBTs. Conclusion: Family-led coaching of patients during SATs/SBTs appears to be feasible, favorably perceived by families and clinicians, and potentially associated with lower family anxiety.

Patient-Centered Communication: Incorporating Principles of Dialogic Practice and Family Centered Rounds on an Inpatient Psychotic Disorders Unit

This study examined the impact of Patient-Centered Communication (PCC), Open Dialogue-inspired changes to rounding practices and culture, on patient perceptions of care on an inpatient psychotic disorders unit. A retrospective cohort analysis was conducted based on medical records, restraint and seclusion records, and hospital Perceptions of Care (PoC) surveys. The analysis compared data from 6-month periods before and after implementation of PCC to quantify whether the implementation of PCC was associated with more positive care ratings. There were trends toward improvement suggestive of an effect on patients' perception that their care was adequately explained, that they felt involved in care, that they felt respected, and that they were supported during hospitalization, although improvements did not achieve statistical significance. Greater improvement was observed for teams that incorporated a greater number of interventions. Dialogic practice-inspired changes on an acute inpatient unit may improve patient perceptions of inclusion and respect in their care.

Patient and Family Experience: Targets for Improvements in Care and Communication in the ICU

This process improvement project sought to further explore the experience of patients and family members within an intensive care unit (ICU) hospital setting to develop specific interventions that can be executed to provide better patient-centered outcome. We surveyed 103 family members using the satisfaction with care subscale of Family Satisfaction with the ICU survey (FS-ICU) (validated ICU experience survey). 103 patients also completed FS-ICU subscale with a modification to make it applicable to patients. Additional questions explored their interest in supportive services and factors contributing to distress with the goal of understanding the gaps in multidisciplinary care and supportive services. Overall, the findings of this project emphasize the importance of (1) understanding patients' experience and satisfaction with care, in addition to families', (2) gathering data with measurement tools that is specific enough to the care environment allowing for unique feedback and areas for improvement, and (3) identifying psychological needs and faith-based support to intervene on challenging experiences.

[Chinese expert consensus on diagnosis, treatment and management of critically ill patients in hematology intensive care unit (2025)]

Recently, survival rates for patients with hematological malignancies (HMs) have improved, but severe complications have also risen accordingly, and can escalate quickly. Establishing a hematology intensive care unit (HCU) is crucial for early detection and centralized monitoring of critically ill hematological patients, as well as the enhancement of diagnosis, treatment and prognosis and minimizing medical disputes. Based on the guidelines of intensive care unit and hematology department, combined with clinical operation experience of domestic HCU, this consensus is participated by several leading hematology centers in China. It outlines the necessity, configuration, admission standards, management, treatment principles, and strategies of HCU. An expert agreement on managing critically ill HCU patients was achieved. It is suggested that the blood centers with eligible critieria should actively establish HCU, aiming to further lowering the mortality rate of critically ill hematology patients.

Post-Intensive Care Syndrome-Mental Health

Intensive care unit (ICU) survivors experience longstanding psychological impairments that persist in the months to years following ICU discharge, regardless of severity of illness or extent of physical recovery. Risk factors for psychological problems following critical illness have been identified including early symptoms of acute stress. Assessment of psychological symptoms in ICU patients and survivors remains inconsistent and many do not receive appropriate psychological evaluation, diagnosis, or treatment. Screening patients for psychological impairments early and serially following hospitalization is crucial to addressing patients' needs and mitigating long-term distress, as is connecting patients to outpatient mental health follow-up for treatment.

Family involvement in preventing delirium in critically ill patients: A systematic review and meta-analysis

BACKGROUND

Humanized care is a novel concept in the prevention of delirium, with family involvement being a crucial component. Currently, there is controversy regarding the effectiveness of family involvement in preventing delirium among critically ill patients, and the impact of varying levels of family involvement on delirium prevention remains unclear.

OBJECTIVE

The purpose of this study is twofold: (a) to investigate the influence of family involvement on delirium among critically ill patients, and (b) to explore the effectiveness of different levels of family involvement in preventing delirium in these patients.

DESIGN

A systematic review and meta-analysis.

METHODS

From database inception to July 2024, a comprehensive search was conducted across PubMed, EMBASE, CINAHL, Web of Science, and the Cochrane CENTRAL database. Randomized controlled trials that examined family involvement were included in the review.

RESULTS

This review included a total of 11 randomized controlled trials, encompassing 3113 critically ill patients. Family involvement was found to significantly reduce the incidence of delirium among critically ill patients (RR = 0.46, 95%CI = 0.31 to 0.69), decrease the duration of delirium (WMD = -2.18, 95 % CI = -4.14 to -0.22), and shorten the length of Intensive Care Unit (ICU) stay (WMD = -1.46, 95%CI = -2.43 to -0.50). Three different levels of family involvement-direct participation in care (RR = 0.37, 95%CI = 0.26 to 0.51), family visits and companionship (RR = 0.56, 95 % CI = 0.25 to 1.25), and indirect participation (RR = 0.77, 95 % CI = 0.29 to 2.07)-varies in their effectiveness for delirium prevention.

CONCLUSIONS

Family involvement significantly impacts delirium prevention in critically ill patients. The effectiveness of delirium prevention varies depending on the level of family involvement, with direct participation of family members in caregiving demonstrating a more pronounced effect in reducing delirium incidence among critically ill patients.

REGISTRATION

The review protocol has been registered in the PROSPERO International prospective register of systematic reviews (CRD42024563095).

Developing conceptual guidelines for Family-Centered Care for standard ICU practice: A constructivist grounded theory

PURPOSE

To explore the constructs of family-centered care (FCC) from the perspectives of nurses, doctors, and families in the intensive care units (ICU) and to develop FCC guidelines for ICUs.

DESIGN

A constructivist grounded theory (CGT) design was employed.

METHODS

We conducted 12 individual interviews and triangulated the data with 12 focus group discussions (FGDs) using an interview guide from February to December 2020. The interviews and the FGDs were conducted face-to-face. Data was analyzed using CGT analysis. The data analysis was assisted by MAXQDA version 2020 plus. The study was guided by the 32-COREQ checklist.

RESULTS

The participants (72) were nurses (n = 28), doctors (n = 8), and family (n = 36). Four themes were generated: respect, family support, participation, and collaboration. Each theme had subthemes to illuminate the participants' perspectives of the FCC constructs.

CONCLUSION

This study revealed that nurses and doctors had positive perspectives of FCC in the ICU and are willing to accept and implement it into standard ICU practice. Four main constructs of FCC emerged from this CGT study: respect, family support, participation, and collaboration and were used to develop a conceptual guideline.

PRACTICE IMPLICATION

FCC implementation in the ICU may be facilitated by designing family-inclusive ICUs with spacious subunits, kangaroo rooms, family areas, provision of counselling, as well as adopting regular and effective communication guidelines, and adequate staff training. Conceptual guidelines for FCC have been developed to promote FCC in standard ICU practice.

Exploring critically ill patients' functional recovery through family partnerships: A descriptive qualitative study

BACKGROUND

Early mobilisation interventions play a role in preventing intensive care unit-acquired weakness in critically ill patients and may contribute to improved recovery. Patient-and-family-centred care includes collaborative partnerships between healthcare professionals and families and is a potential strategy to promote early mobilisation in critical care; however, we currently do not know family member preferences for partnering and involvement in early mobilisation interventions.

OBJECTIVES

The objective of this study was to explore family member perspectives on the acceptability and feasibility of partnering with healthcare professionals in early mobilisation interventions for adult critically ill patients.

METHODS

A descriptive qualitative design. Semistructured interviews were conducted with family members of adult critically ill patients admitted to an intensive care unit. Data were collected through individual audio-recorded interviews. Interview data were analysed using the six phases of thematic analysis described by Braun and Clark. This study is reported following the Consolidated Criteria for Reporting Qualitative Research guidelines.

RESULTS

Most family members of critically ill patients found the idea of partnering with healthcare professionals in early mobilisation interventions acceptable and feasible, although none had ever considered a partnership before. Participants thought their involvement in early mobilisation would have a positive impact on both the patient's and their own wellbeing. Themes uncovered showed that understanding family-member readiness and their need to feel welcome and included in the unfamiliar critical care environment are required before family member and healthcare professional partnerships in early mobilisation interventions can be enacted.

CONCLUSIONS

Family members found partnering with healthcare professionals in early mobilisation interventions acceptable and feasible to enact, but implementation is influenced by their readiness and sense of belonging.