Improving family-centered care in intensive care units: participatory action research to design and implement changes in nursing care

Abstract

Background: It is imperative to take care of the critically ill patient's family and meet their needs. Although there are evidence-based recommendations for doing so, their implementation is not widespread because changing the culture of care is difficult. Aim: To implement evidence-based changes in care for family members of critically ill patients in a tertiary hospital using a reflexive and participatory process and to assess their effects. Study Design: Participatory action research. A homogeneous theoretical sample of nurses from three intensive care units in a tertiary care hospital, with ≥ 5 years' experience and willingness to reflect on and critique their practice. Data were gathered through participant observation, documentary analysis, multilevel discussion groups and field diaries and a thematic analysis was performed. Results: Based on the identification of the causes and consequences of a variable and non-generalised approach to family care, a multicomponent, evidence-based set of strategies was designed and implemented. Subsequently, participants perceived important benefits: family members appeared more satisfied, collaborative and less anxious; patients reported feeling safer, emotionally supported and experiencing reduced stress, agitation or disorientation; and nurses perceived greater visibility of nursing care alongside enhanced professional satisfaction. Conclusions: Reflexivity, consensus and the active participation of healthcare professionals facilitated the change that ultimately enabled the genuine implementation of evidence-based recommendations. The training of the care team, the contextualisation of the strategies and the progressiveness of the process were key in generating change, reducing the variability of practice and leading to key benefits. Relevance to Clinical Practice: The interventions provide an adaptable guide for ICUs to implement and evaluate a multifocal approach to family-centred care, enhancing its benefits.