Hospitals shift toward family-centered care in ICUs

Jun 20, 2017

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AACN Advanced Critical Care journal publishes symposium to supplement new family-centered care guidelines

ALISO VIEJO, Calif. – June 20, 2017 – Family members of critically ill patients, once relegated to the waiting room, are increasingly being welcomed into the patient’s room. New guidelines encourage hospitals to engage family members more actively as collaborative participants in patient care.

The shift is part of a growing recognition that critical illness affects other people besides the patient, and critically ill patients and their families can experience persistent negative effects on their health and overall quality of life after patients are discharged from the hospital.

Research published in AACN Advanced Critical Care explores the various perceived elements that influence critical care nurses’ inclusion of family caregivers in the care of critically patients.

The article, “Factors Influencing Active Family Engagement in Care Among Critical Care Nurses,” also examines relationships in the ICU work environment, patient acuity, nurse workflow and attitudes toward family engagement.

Breanna Hetland, RN, PhD, CCRN-K, a postdoctoral fellow at Frances Payne Bolton School of Nursing (FPB), Case Western Reserve University, Cleveland, served as principal investigator and lead author. She worked with FPB faculty Ronald Hickman, RN, PhD, ACNP-BC, and Barbara Daly, RN, PhD, as well as Natalie McAndrew, RN, MSN, ACNS-BC, CCRN, clinical nurse specialist in the medical intensive care unit at The Medical College of Wisconsin-Froedtert Hospital in Milwaukee.

“Effective implementation of active family engagement begins with the endorsement of the bedside nurse,” Hetland said. “We must understand how nurses view family engagement and the barriers they face when working to involve family members in patient care.”

For the study, the researchers developed a 15-item questionnaire on factors that influence family engagement to measure nurse perceptions of the physical environment and culture of the ICU, clinical stability of the patient, disruptive workflow and the attitude toward family engagement in ICU care. A total of 433 critical care nurses completed the online survey.

This is one of the first studies, with a national sample of critical care nurses, to report the patient care activities that nurses invite family caregivers to participate in, as well as those they do not. Nurses were most likely to invite family caregivers to perform or assist with simple daily tasks, such as applying lotion, feeding the patient, washing the patient’s hands and communicating with the patient. They were less likely to include family members in activities that were more intimate, invasive or technically skilled.

The study also explores the impact of nurse and organizational characteristics on the perceived barriers and facilitators to family engagement in the ICU, and the relationships among them.

The researchers found that age, degree earned, years of experience in critical care, hospital location, unit type and staffing ratios influenced the scores. In addition, nursing workflow partially mediated the relationships between the ICU care environment and nurses’ attitudes toward family-centered care and between patient acuity and nurses’ attitudes.

The study findings indicate a need to look into staffing, space and resources for families, unit culture and the establishment of policies and procedures that outline the role of family caregivers.

The National Institute of Nursing Research, a component of the National Institutes of Health, funded the study.

The article is part of a symposium focusing on nurses’ role in moving family-centered care recommendations into practice in the summer 2017 issue of the peer-reviewed journal. Other articles include:

  • A review of outcomes associated with “Project Dispatch: Disseminating Patient-Centered Outcomes Research to Healthcare Professionals”
  • An examination of the potential impact of open and flexible family presence policies on patient and family sleep
  • A discussion of ICU diaries written by staff and family, including how to implement diaries

The symposium supplements “Guidelines for Family-Centered Care in the Neonatal, Pediatric and Adult ICU,” developed by an international group of nursing, medical and academic experts, and recently published by the Society of Critical Care Medicine.

Judy Davidson, RN, DNP, evidence-based practice and research nurse liaison at the University of California, San Diego Health, served as editor for the symposium.

“We now know that family engagement means more than creating satisfaction with the ICU experience,” she said. “Hetland’s work on evaluating barriers to family presence and engagement in care is critical to moving the profession forward with the goal of optimizing the mental health of ICU family members. The best practices, new research and evidence-driven initiatives included in this symposium can help healthcare organizations implement the new guidelines for family-centered care.”

About AACN Advanced Critical Care: AACN Advanced Critical Care is a quarterly, peer-reviewed publication of in-depth articles intended for experienced critical care and acute care clinicians at the bedside, advanced practice nurses, and clinical and academic educators. An official publication of the American Association of Critical-Care Nurses, the journal has a circulation of 4,845 and can be accessed at

About the American Association of Critical-Care Nurses: Founded in 1969 and based in Aliso Viejo, California, the American Association of Critical-Care Nurses (AACN) is the largest specialty nursing organization in the world. AACN represents the interests of more than half a million acute and critical care nurses and includes more than 200 chapters in the U.S. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution.

American Association of Critical-Care Nurses, 101 Columbia, Aliso Viejo, CA 92656-4109; 949-362-2000;;