Progressively engaging: constructing nurse, patient, and family relationships in acute care settings

Nurse-Client Engagement: A Concept Analysis Through a Spiritual Lens

ABSTRACT

Engaging clients is central to nurses' work across all practice settings. This concept analysis seeks to better understand engagement as seen by the participants. Data from 15 qualitative studies conducted between 1982 and 2020 illustrate engagement from the perspective of nurse and client. Five defining attributes emerged: genuine concern and hopeful persistence, authenticity, trusting, time, and mutuality. The purpose of this concept analysis is to make the process of engagement visible, quantifiable, and valid.

Rapport between nurses and adult patients with cancer in ambulatory oncology care settings: A scoping review

BACKGROUND

Although the importance of the nurse-patient relationship in oncology is established, a consolidated body of research describing nurse-patient rapport, especially in ambulatory care, is lacking.

OBJECTIVES

This scoping review aimed to explore knowledge about rapport between adult patients with cancer and their nurses in ambulatory oncology care, including nurse, patient, nurse-patient dyad, and system-level factors that influence rapport.

METHODS

A scoping review was conducted to explore sources of evidence and gaps in knowledge pertinent to future research. The Joanna Briggs Institute methodology for Systematic Reviews was used with searches in MEDLINE, CINAHL, and ProQuest Dissertations and Theses Global databases. Experimental, descriptive observational, and qualitative study designs that focused on patients with cancer and their nurses within an ambulatory care setting were included. Results were reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews.

RESULTS

The search strategy collected 4538 studies of which 10 met study criteria after screening. Forward and backward citation tracking of included articles resulted in 4 additional studies. In total, 14 studies were extracted and analyzed. Synthesis of results from the individual sources resulted in three key observations: (a) there is an absence of studies that focus directly on nurse-patient rapport; (b) the majority of extracted data on rapport-related factors described aspects of nurses' attitudes; and (c) there was minimal information on patient, nurse-patient dyad, and system-level factors reported in these studies.

CONCLUSIONS

The lack of studies focused specifically on nurse-patient rapport in oncology ambulatory care indicates a notable gap in our empirical understanding of relationship-based care, a hallmark of cancer care provision.

TWEETABLE ABSTRACT

Nurse-patient rapport in oncology ambulatory care requires additional research @paula_koppel.

Crossroads of parental decision making: Intersections of hope, communication, relationships, and emotions

Parents of children born with complex life-threatening chronic conditions (CLTCs) experience an uncertain trajectory that requires critical decision making. Along this trajectory, hope plays an influential but largely unexplored role; therefore, this qualitative descriptive study explores how parent and provider hope may influence decision making and care of a child born with CLTCs. A total of 193 interviews from 46 individuals (parents, nurses, physicians, and nurse practitioners) responsible for the care of 11 infants with complex congenital heart disease (CCHD) were analyzed to understand how hope features in experiences related to communication, relationships, and emotions that influence decision making. Overall, parental hope remained strong and played a pivotal role in parental decision making. Parents and professional healthcare providers expressed a range of emotions that appeared to be integrally linked to hope and affected decision making. Providers and parents brought their own judgments, perceptions, and measure of hope to relationships, when there was common ground for expressing, and having, hope, shared decision making was more productive and they developed more effective relationships and communication. Relationships between parents and providers were particularly influenced by and contributory to hope. Communication between parents and providers was also responsible for and responsive to hope.

Rapport: A conceptual definition from the perspective of patients and families receiving palliative care

OBJECTIVE

To explore patient and family perceptions of rapport in interactions with health professionals and use the findings to develop a conceptual definition of rapport.

METHODOLOGY

We undertook a qualitative Interpretive Description study; semi-structured interviews were conducted between November 2020 and May 2021. Participants included 18 patients and 11 family members recruited using a random approach from four hospice locations in Aotearoa, New Zealand. Interviews were audio recorded, transcribed, and analysed to develop a conceptual definition of rapport using guidelines (Podsakoff et al., (2016). A COREQ checklist was completed.

RESULTS

Four dimensions of rapport were identified which formed the basis of a conceptual definition: 1) the type of relating, 2) the essence of rapport experienced, 3) key communication characteristics, and 4) the effect on interactions.

CONCLUSION

Based on patient and family experiences of rapport, this study formulated a conceptual definition of rapport. This definition will support clinical education and practice and inform future research related to rapport.

PRACTICE IMPLICATIONS

A conceptual definition of rapport can provide clarity for both research and clinical practice. It may be used as a tool for health professionals to reflect upon their experiences with rapport and develop expertise in this area.

3Cs: the experiences of informal caregivers of patients undergoing thoracic surgery

The informal caregiver is pivotal to the postoperative experience of patients. The purpose of this study was to explore the informal caregivers' experience while accompanying patients through thoracotomy surgery. Specifically, and exclusively, the informal carers' personal reactions, needs and views regarding their experience in the patients' surgery trajectory were explored. A convenience sample of eight informal caregivers of patients who had undergone thoracotomy were interviewed approximately 2 weeks following discharge from a general hospital in Malta. The findings revealed knowledge regarding participants' experiences of demands and fears associated with the 3Cs: cancer, challenges and coping. The impact of timely information-sharing and support on the informal caregiver's experience was highlighted. These findings suggest that careful consideration of both a patient's and informal caregiver's needs promotes an enhanced hospitalisation experience, and creates opportunity for a better transition back home. Implications for research and practice are discussed.

The meaning of rapport for patients, families, and healthcare professionals: A scoping review

OBJECTIVE

Rapport is considered fundamental to clinical relationships but is a concept which is rarely defined. This review explores how rapport is defined, characterised, and operationalised in healthcare.

METHODS

A scoping review methodology was used. Data were synthesised using thematic analysis. The review process adhered to the Preferred Reporting System for Meta-Analysis for Scoping reviews (PRISMA-ScR).

RESULTS

Medline, CINAHL, and psychINFO were searched with thirty-four studies meeting inclusion criteria. Results were presented in two themes: The meanings of rapport and the implications for building rapport.

CONCLUSIONS

This scoping review found rapport has no commonly shared definition or conceptualisation in the reviewed research. At the same time rapport is operationalised and characterised. Factors that facilitate, and hinder rapport-building were identified. Having a consistently used definition and conceptualisation will benefit the research that is needed into patient and family experiences and outcomes of rapport.

PRACTICE IMPLICATIONS

It is crucial for health professionals to incorporate simple kind gestures into practice to facilitate rapport. Equally it is necessary for health professionals to review their practice for dismissive, avoiding behaviours that impede rapport-building and consider how they spend their time with patients.

Family Involvement in Caring for Inpatients in Acute Care Hospital Settings: A Systematic Review of Literature

Family members, also known as patients' guardians (PG) are involved in caring for inpatients in acute care hospital settings. The practice is adopted from Family Centred Care (FCC) approach. This literature review aimed to provide an overview of key findings in literature on the practice of involving PGs in acute care hospital settings We used a systematic literature search to select original research articles or systematic reviews published in English between 2008 and 2019 that discussed PGs in acute care hospital settings. Studies that discussed PGs in long-term care hospital or in-home settings were excluded from this literature review. Literature was sought from CINAHL, MEDLINE, and PsycINFO. CASP and JBI checklist was used to appraise the full-text articles for inclusion in the literature review. Twenty-six articles were included. Findings show that there is limited literature on this topic although healthcare institutions involve PGs in their routine inpatient care. Three themes emerged from the review; the FCC approach, roles of PGs in acute care hospitals, and implications of involving PGs in acute care hospitals. PGs offer any care that is left undone by nurses in acute care hospitals to ensure that their patients' needs are met. However, their involvement is not consistent with FCC principles. This leads to physical, psychosocial, and economic implications for PGs. We recommend that nurse practitioners should consistently implement FCC principles to enable PGs to offer meaningful care to their inpatients.

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

BACKGROUND

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

OBJECTIVES

To describe nurses' perceptions and practices of family engagement in adult intensive care units from a global perspective.

DESIGN

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

SETTINGS

The study was conducted in 26 intensive care units of 12 urban, metropolitan, academic medical centers in ten countries, spanning five continents.

PARTICIPANTS

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Timely Family Feedback to Guide Family Engagement in the Intensive Care Unit

BACKGROUND

Organizations motivated to provide high-quality care in the intensive care unit are exploring strategies to engage families in patient care. Such initiatives are based on emerging evidence that family engagement improves quality and safety of care.

OBJECTIVE

To gather family feedback to guide future nurse-led quality improvement efforts to engage families in the intensive care unit setting.

METHODS

The Critical Care Family Satisfaction Survey, which consists of 20 items rated from 1 (very dissatisfied) to 5 (very satisfied), was paired with open-ended questions and administered to families during the intensive care unit stay from March through December 2017. Content analysis was used to identify themes regarding the family experience.

RESULTS

Responses were collected from 178 family members. The mean (SD) score on the survey was 4.65 (0.33). Five themes emerged regarding the delivery of family care in the intensive care unit: family interactions with the interdisciplinary team, information sharing and effective communication, family navigation of the intensive care unit environment, family engagement in the intensive care unit, and quality of patient care.

CONCLUSIONS

This quality improvement project provided foundational information to guide family engagement efforts in the intensive care unit. Real-time solicitation of feedback is essential to improving the family experience and guiding family-centered care delivery in this practice environment.

The influence of engaging authentically on nurse-patient relationships: A scoping review

The current international healthcare focus on ensuring the perspectives and needs of individual persons, families or communities are met has led to the core tenet of person-centred care for all. The nurse-patient relationship is central to the provision of care, and enhancing this relationship to ensure trust and respect supports optimal care outcomes for those accessing healthcare services. Engaging authentically is one of the recognised key approaches in person-centred practice, and this scoping review of the literature aims to gain an understanding of the role this process plays in developing effective relationships between nurses and the people they care for. A systematic search of databases and grey literature was undertaken, and twenty-one research papers met the inclusion criteria. A thematic analysis revealed four themes: 'getting to know the patient as a person', 'the complexity of relationship building-it takes time', 'the nurse: characteristics and behaviours that support the nurse-patient relationship' and 'the patient voice'. Nurses and patients both benefit from effective relationships, feeling valued and experiencing greater satisfaction with care. Key elements of engaging authentically were revealed as a nurse-patient relational process through this literature review; however, further research is needed to gain a greater understanding of this concept.

Describing healthcare providers' perceptions of relational practice with families in the emergency department: A qualitative study

Background

Emergency departments are regarded as stressful working environments, associated with staff shortages, increased patient numbers and long waiting times. Increased organisational demands for performance can compromise genuine interactions between families and healthcare providers working in emergency departments. A relational practice approach in caring for families can enhance the capability of healthcare providers to simultaneously overcome these difficulties and provide emergency healthcare of high quality.

Objectives

The purpose of the study was to describe healthcare providers’ perceptions of relational practice with families in three emergency departments in KwaZulu-Natal, South Africa.

Method

Using a qualitative descriptive approach data were collected through semi-structured interviews with healthcare providers working in emergency departments. The data were analysed and categorised using qualitative content analysis.

Results

Four categories emerged from data analysis: (1) families and healthcare providers connecting; (2) recognising the uniqueness of families; (3) caring interactions; and (4) taking charge when necessary.

Conclusion

The study elicited that healthcare providers working in emergency departments perceived that despite high patient volumes and resource constraints, collaborative relationships with families were important. However, these collaborative relationships cannot be willed into practice, instead training workshops are needed to develop relational skills of healthcare providers which can facilitate family and healthcare professional collaboration.

Exploring family participation in patient care on acute care wards: A mixed-methods study

BACKGROUND

Patient- and family-centred care practices are a recommended part of contemporary care for the acutely ill hospitalized adult patients. However, how patient- and family-centred care is enacted in an adult hospital setting is not well understood.

AIMS AND OBJECTIVES

The aim of this study is to explore the perceptions of patients, family members and nurses regarding family participation and collaboration in patient care within an acute care setting, including the barriers and facilitators.

DESIGN

This study used a mixed-methods sequential design.

METHODS

Observer-as-participant observations and semistructured interviews were undertaken. Integration of the data was achieved through triangulation.

RESULTS

Triangulation revealed two metathemes. The first metatheme, 'continuum of family involvement', explained the central viewpoint of how family participation and collaboration in the care of acutely ill hospitalized adult patients was enacted. The second metatheme, 'nurses value family involvement', helped to explain and understand the barriers and facilitators to enacting family participation in the acute care setting.

CONCLUSION

Promoting family participation in the acute care setting requires supporting multiple levels of engagement. Developing a relationship, clear communication and open sharing of information amongst patients, family members and nurses is critical to supporting family involvement.

Family experience living with advanced neoplasm: a glance at the rural population

OBJECTIVES

to understand the experience of rural families living with advanced cancer, from Family Management Style Framework's perspective.

METHODS

a qualitative research conducted in seven cities of the northern of state of Rio Grande do Sul in homes of 11 families (27 people). Data collection took place in 2014, using the genogram and narrative interview. Analysis followed Family Management Style Framework's theoretical model.

RESULTS

the results were organized into three categories based on conceptual components of the referred model: no more normal life: situation definition; attempt to reconcile care and work: management behavior; imminence of the finitude of life: perception of consequences.

FINAL CONSIDERATIONS

living in rural context gives families specific ways of dealing with advanced cancer. Understanding the movements undertaken by rural families throughout the experience can guide nursing professionals in planning interventions collaborating with this population's health.

Understanding and managing depression in older people

Clinicians do not always recognise depression in older people as they attribute symptoms to the ageing process and the effects of failing health. Similarly, older people do not always appreciate that their symptoms relate to their mood. Understanding how depression affects older people can improve access to support, thereby improving overall health and quality of life. To ensure these outcomes we need a workforce with excellent communication skills that supports therapeutic relationships, promotes recognition of symptoms, and enhances assessment, diagnosis, treatment and management.

Relationships among Climate of Care, Nursing Family Care and Family Well-being in ICUs

BACKGROUND

Frequent exposure to ethical conflict and a perceived lack of organizational support to address ethical conflict may negatively influence nursing family care in the intensive care unit.

RESEARCH AIMS

The specific aims of this study were to determine: (1) if intensive care unit climate of care variables (ethical conflict, organizational resources for ethical conflict, and nurse burnout) were predictive of nursing family care and family wellbeing and (2) direct and indirect effects of the climate of care on the quality of nursing family care and family wellbeing.

RESEARCH DESIGN

A cross-sectional, correlational design was used.

PARTICIPANTS AND RESEARCH CONTEXT

Convenience sample of 111 nurses and 44 family members from five intensive care units at a Midwest hospital in the United States.

INSTRUMENTS

The Ethical Conflict Questionnaire-Critical Care Version, Maslach Burnout Inventory-Human Services Survey and Hospital Ethical Climate Scale were used to measure climate of care. The Family-Centered Care-Adult Version and Nurse Provided Family Social Support Scale were family measures of the quality of nursing family care. The Family Wellbeing Index was used to measure family wellbeing.

DATA ANALYSIS

Hierarchical regression and mediation analysis were used to answer the study aims.

ETHICAL CONSIDERATIONS

The study was approved by the Institutional Review Board at the study site.

FINDINGS

In separate regression models, organizational resources for ethical conflict (β = .401, p = .006) and depersonalization (β = -.511, p = .006), a component of burnout, were significant predictors of family-centered care. In simple mediation analysis the relationship between organizational resources for ethical conflict and family-centered care was mediated by depersonalization (β = .341, 95% confidence interval (.015, .707)).

DISCUSSION

Inadequate organizational resources and depersonalization may be related to family care delivery, and present obstacles to family-centered care in the intensive care unit.

CONCLUSION

Further research to explicate the relationships among organizational resources, ethical conflict, burnout, and family-centered care is needed to guide the development of effective interventions that enhance the quality of nursing family care in the intensive care unit.

Patient and family members' perceptions of family participation in care on acute care wards

BACKGROUND

Hospital leaders, policymakers and healthcare professionals are realising the benefits of delivering care that promotes family participation because it is known to enhance the quality of care, and improve patient satisfaction.

AIM

The aim of this study was to explore, from the perspective of patients and family members within an adult acute care ward: (a) their beliefs and attitudes towards family participation in patient care and (b) staff behaviours that support or hinder family participation in patient care.

DESIGN AND METHODS

A naturalistic approach with an exploratory sequential design was used in a medical assessment and planning unit of a regional referral hospital in Australia. Purposeful maximum variation sampling was used to recruit patients and family members who differed in age, ethnicity, relationship to patient and gender. Observer-as-participant observation data and semi-structured interviews were undertaken. Following separate inductive content analysis, data were triangulated.

RESULTS

Thirty-two patients and 26 family members were recruited. Thirty hours of observational data were gathered. Eighteen patients and 15 family members were interviewed. Analysis uncovered two contrasting categories: (a) disconnected communication and (b) family influence quality.

CONCLUSION

The findings of our study demonstrated that most patients and families perceived staff communication as disconnected and inadequate, which constrained them from engaging in care processes or decision-making. However, when family felt empowered and participated in patient care, the quality of health care was enhanced. Healthcare professionals can use these findings to make informed evidence-based changes to the way they practice and communicate to ensure family participation in patient care is optimised in the acute care setting.

Simulation videos presented in a blended learning platform to improve Australian nursing students' knowledge of family assessment

The provision of simulation to enhance learning is becoming common practice as clinical placement becomes harder to secure within Bachelor of Nursing programs. The use of simulation videos within a blended learning platform enables students to view best practice and provides relevant links between theory and practice. Four simulation videos depicting family assessment viewed by a cohort of Australian undergraduate nursing students were evaluated. These videos were professionally developed using actors and experienced family nurses. Surveys were used to explore the students' self-assessed knowledge, confidence and learning preferences before and after exposure to blended learning resources. Students' engagement with the simulated videos was captured via the Learning Management System. Time 1 survey was completed by 163 students and Time 2 by 91 students. There was a significant increase in students' perceived knowledge of family theory Item 1 from a mean 4.13 (SD = 1.04) at Time 1 to 4.74 (SD = 0.89) (Z = -4.54 p < 0.001) at Time 2; Item 2- Knowledge of family assessment improved from mean 3.91 (SD = 1.02) at Time 1 to 4.90 (SD = 0.67) (Z = -7.86 p < 0.001) at Time 2. Also a significant increase in their confidence undertaking family assessment Item 5 from a mean 3.55 (SD = 1.14) at Time 1 to 4.44 (SD = 0.85) (Z = -6.12 p < 0.001) at Time 2. The students watched the videos an average of 1.9 times. The simulated videos as a blended learning resource increases the students' understanding of family assessment and is worth incorporating into future development of courses.

A qualitative investigation of hospital visitors' experiences using the analytic lens of liminality: Informing nursing practice and policy

This research aimed to inform nursing practice and policy by identifying satisfying and problematic experiences of hospital visitors during the hospitalisation episode of a significant other. An extensive contextual review revealed that healthcare systems in advanced economies face multiple pressures and that in England, the government leaves the determination of hospital visiting rules to individual trusts. The analytic lens of liminality provides rich interpretations of visitors' accounts and demonstrates the importance to visitors of structure (hospital rules and systems) and communitas (social bonding among liminal personae). Supportive hospital structures reduce the challenges of liminality and increase satisfaction. The data further suggest an extension to current understandings of liminality. Strong structure and successful communitas permit a safe exit from liminality after the hospitalisation episode for visitors with a close emotional bond with the patient.

How Tanzanian Nurse-Midwives and Obstetricians Develop Postpartum Relationships With Women

Nurse-midwives and obstetricians are the primary postpartum health-care providers for mothers and babies in Tanzania. It is imperative that mothers and babies receive adequate information and support in order to save lives. Feminist poststructuralism and discourse analysis were used to conduct and analyze 13 semi-structured interviews from nurse-midwives and obstetricians at three clinics in Dar es Salaam, Tanzania. Establishing friendly supportive relationships enabled nurse-midwives and obstetricians to work effectively with mothers postpartum. Participants explained the importance of including family members in postpartum care and about the strategies they used in a clinic environment that was not always supportive of including family. Effective relational maternity care focused on families during the postpartum period can facilitate the delivery of information and save lives.

Factors Influencing Active Family Engagement in Care Among Critical Care Nurses

Critical care nurses are vital to promoting family engagement in the intensive care unit. However, nurses have varying perceptions about how much family members should be involved. The Questionnaire on Factors That Influence Family Engagement was given to a national sample of 433 critical care nurses. This correlational study explored the impact of nurse and organizational characteristics on barriers and facilitators to family engagement. Study results indicate that (1) nurses were most likely to invite family caregivers to provide simple daily care; (2) age, degree earned, critical care experience, hospital location, unit type, and staffing ratios influenced the scores; and (3) nursing work-flow partially mediated the relationships between the intensive care unit environment and nurses' attitudes and between patient acuity and nurses' attitudes. These results help inform nursing leaders on ways to promote nurse support of active family engagement in the intensive care unit.

Acute care nurses' views on family participation and collaboration in fundamental care

AIMS AND OBJECTIVES

To understand the beliefs, attitudes and perceptions of nurses regarding family participation and collaboration in the care of their hospitalized adult relative.

BACKGROUND

Family participation in care is known to enhance the quality of patient care. Nurses are uniquely placed to support such participation, including the delivery of fundamental care. However, nurses' attitudes and beliefs may help or hinder participation.

DESIGN

A mixed methods approach with an exploratory sequential design was used.

SETTING

A regional referral hospital in Australia.

PARTICIPANTS

Nurses were eligible to participate in the study if they were permanent staff of the hospital, and who in their day-to-day work had direct contact with adult patients and their families on acute care wards.

METHODS

Observer-as-participant observation data and semi-structured interviews were undertaken. 30 hr of observational data were gathered, and 14 nurses were interviewed. Data collection occurred between September and December 2016. Following separate analysis, data were triangulated.

RESULTS

Analysis uncovered two contrasting categories: (i) enacting family participation (four themes); and (ii) hindering family participation (five themes).

CONCLUSION

The findings of our study demonstrated that the practices of nurses do not always align with healthcare policies, and strategies to support nurses to enact patient- and family-centred practices are needed.

RELEVANCE TO CLINICAL PRACTICE

Nurses can use these findings to make informed evidence-based changes to the way they practice and communicate with families to ensure fundamental care is delivered.

Experiences of encounters with healthcare professionals through the lenses of families living with chronic illness

AIMS AND OBJECTIVES

To describe and explore the experience of healthcare encounters in families living with chronic illness.

BACKGROUND

Living with chronic illness is a family concern and often includes frequent encounters with healthcare professionals. These encounters affect how persons with illness and family members handle everyday life. Disease-related explanations are perceived by healthcare professionals as being of higher importance than the actual experience of illness, even though patients are concerned with issues involving their everyday life.

DESIGN

A descriptive design with a qualitative approach.

METHODS

Narrative family interviews were conducted with twelve families, using a qualitative content analysis.

RESULTS

One main category was indicated following analysis, specifically "The impact of an accompanying family member." Additionally, three subcategories were revealed; "The importance of collaboration," "Mutual understanding," "A desire to be confirmed in one's illness".

CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE

Having a participating family member increased the sense of power in families during encounters with healthcare professionals. This participation constitutes a level of support, making it easier for families to handle everyday life due to illness. Family members are, in most cases, included in discussions and decisions, both before and after encounters, and it should be a natural for healthcare professionals to invite them to the encounter too. This is an offer that may not fit every family, but the person with illness or the family should at least have the opportunity to choose.

A qualitative study of factors that influence active family involvement with patient care in the ICU: Survey of critical care nurses

OBJECTIVE

Family caregiver involvement may improve patient and family outcomes in the intensive care unit. This study describes critical care nurses' approaches to involving family caregivers in direct patient care.

RESEARCH METHODOLOGY & DESIGN

This is a qualitative content analysis of text captured through an electronic survey.

SETTING

A convenience sample of 374 critical care nurses in the United States who were subscribers to one of the American Association of Critical Care Nurses social media sites or electronic newsletters.

MAIN OUTCOME MEASURE

Critical care nurses' responses to five open-ended questions about their approaches to family involvement in direct patient care.

FINDINGS

Nurse, patient and family caregiver factors intersected in the context of the professional practice environment and the available resources for family care. Two main themes were identified: "Involving family caregivers in patient care in the intensive care unit requires careful ssessment" and "There are barriers and facilitators to caregiver involvement in patient care in the intensive care unit."

CONCLUSION

Patient care demands, the professional practice environment and a lack of resources for families hindered nursing family caregiver involvement. Greater attention to these barriers as they relate to family caregiver involvement and clinical outcomes should be a priority in future research.

A purposeful Yet Nonimposing Approach: How Japanese Home Care Nurses Establish Relationships With Older Clients and Their Families

Relationship development is crucial to nursing practice with families. However, little is known about the process of building relationships with multiple family members in home care settings and in various cultures. The objective of this study was to explore the experiences of home care nurses about how they established relationships with older clients and their families in Japan. Grounded theory was used to guide the research. Twenty-three expert home care nurses participated in semistructured interviews concerning their family nursing practice. The establishment of relationships with clients/family members was based on a purposeful yet nonimposing approach composed of four aspects: keeping a mindful distance from the family, not being a threat to family life, being a comfortable neighbor, and gaining trust as a competent nurse. Through a purposeful nonimposing approach, Japanese home care nurses promoted and nurtured nurse-family relationships and became involved in the life of the family. These findings provide a useful foundation to guide practice with families and grow knowledge about the process of establishing relationships with multiple family members in home settings.

Managing Visitors During the Hospital Stay: The Experience of Family Caregivers of Patients With Traumatic Brain Injury

Family caregivers of patients with moderate-to-severe traumatic brain injury (TBI) regularly visit the patient during the hospital stay and are involved in their care. As impairments caused by the TBI often preclude the patient from stating preferences for visitors, family caregivers often make decisions about visitors on the patient's behalf during the hospital stay. However, limited literature investigates this process. The purpose of this study was to describe family caregivers' experience of visitors while the patient with moderate-to-severe TBI is hospitalized. Authors used grounded theory to conduct 24 interviews with 16 family caregivers. Findings showed family caregivers manage welcome and unwelcome visitors throughout the hospital stay to protect the patient's physical and emotional safety and to conserve their own energy. Staff had limited involvement in management of unwelcome visitors. These findings have practice implications for educating hospital staff about providing family nursing and assisting families to manage unwelcome visitors and about policy implications for improving hospital visiting policies.

Nursing Strategies for Engaging Families of Older Immigrants Hospitalized for End-of-Life Care: An Australian Study

BACKGROUND

Engaging with families of older non-English-speaking background (NESB) immigrants hospitalized for end-of-life (EOL) care can be challenging, especially when their cultures, lifeways, and family decision-making processes are unfamiliar to the nurses caring for them. Despite the recognized importance of family engagement when providing EOL care, the issue of ethnic minority family engagement has received little attention in the field.

AIM

To explore and describe the strategies nurses use to facilitate engagement with families of older immigrant NESB patients hospitalized for EOL care.

METHODS

A qualitative descriptive approach was used. Data were collected via in-depth interviews conducted with 22 registered nurses recruited from 4 Australian health services.

FINDINGS

Using thematic analysis processes, 5 key strategies were identified: listening and understanding families, encouraging family members to speak first, dealing with angst, redressing naive views about the dying process, and managing intergenerational differences. Underpinning these strategies was a profound "will to engage" with the families and their cultural worldviews.

CONCLUSION

Further cross-cultural comparative research is required to inform evidence-based policies, practice, and education on this issue.

Family involvement in emergency department discharge education for older people

AIMS AND OBJECTIVES

To report findings concerning family involvement in emergency department discharge education for older people.

BACKGROUND

The current trend of population ageing in Western countries has caused an increase in emergency department visits. Due to the continuing improvement in the mental and physical status of older people, they are frequently discharged home. Proper discharge education enables older people and their families to better understand how they can cope with the medical issue at home. Given the lack of research, we know relatively little about the significance of family involvement in older people's emergency department discharge education.

DESIGN

A descriptive qualitative design was used.

METHODS

Qualitative thematic interviews of seven older patients, five family members and fifteen nurses were conducted. Data were analysed using content analysis.

RESULTS

Family involvement in discharge education was seen as turbulent. The experiences were twofold: family involvement was acknowledged, but there was also a feeling that family members were ostracised. Families were seen as a resource for nurses, but as obliged initiators of their own involvement.

CONCLUSIONS

Our findings suggest that family members are not considered participants in emergency department care. For a family-friendly approach, actions should be taken on both individual and organisational levels.

RELEVANCE TO CLINICAL PRACTICE

The findings support healthcare providers and organisation leaders in promoting family involvement in discharge education for older people. Families can be encouraged to be involved without feeling responsible for the interaction.