School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK.
School of Health in Social Science, The University of Edinburgh, Edinburgh, UK.
J Clin Nurs. 2020 Apr;29(7-8):1115-1128. doi: 10.1111/jocn.15175. Epub 2020 Jan 21.
To understand the different factors that impact on the involvement of adult family members in the care of critically ill patients from the perspective of patients, families and nurses, with the aim to inform the enactment of a patient- and family-centred care intervention to support the patient-family-nurse partnership in care involvement.
Existing evidence lacks theoretical underpinning and clarity to support enactment of patient- and family-centred care and involvement of families in the care of the critically ill patient.
Qualitative exploratory design using thematic analysis.
This study was conducted at two adult intensive care units in two tertiary university hospitals in the central belt of Scotland. Between 2013-2014, we conducted semi-structured interviews with critically ill survivors (n = 19) and adult family members (n = 21), and five focus groups with nurses (n = 15) across both settings. Data were digitally recorded, transcribed verbatim, and uploaded in NVivo 10. Data were analysed thematically using a constructivist epistemology. Ethical approval was obtained prior to data collection. Data are reported according to the Consolidated Criteria for Reporting Qualitative Research checklist.
Family's situational awareness; the perceived self in care partnership; rapport and trust; and personal and family attributes were the main factors that affected family involvement in care. Two key themes were identified as principles to enact patient- and family-centred care in adult intensive care units: "Need for 'Doing family'" and "Negotiations in care involvement."
Negotiating involvement in care requires consideration of patients' and family members' values of doing family and the development of a constructive patient-family-nurses' partnership.
Future policy and research should consider patients' and family's needs to demonstrate family bonds within a negotiated process in care participation, when developing tools and frameworks to promote patient- and family-centred care in adult intensive care units.
从患者、家属和护士的角度了解影响成年家属参与危重症患者护理的不同因素，旨在为实施以患者和家庭为中心的护理干预提供信息，以支持患者-家庭-护士伙伴关系在护理参与中的作用。
现有证据缺乏理论支持和清晰度，无法支持以患者和家庭为中心的护理以及家属参与危重症患者的护理。
使用主题分析的定性探索性设计。
这项研究在苏格兰中部两个三级大学医院的两个成人重症监护病房进行。在 2013-2014 年期间，我们对 19 名危重症幸存者（n=19）和 21 名成年家属（n=21）以及两个环境中的 15 名护士（n=15）进行了半结构化访谈。数据以数字形式记录、逐字转录，并上传到 NVivo 10 中。使用建构主义认识论对数据进行主题分析。在数据收集之前获得了伦理批准。根据定性研究报告的统一标准清单报告数据。
家庭的情境意识；在护理伙伴关系中感知到的自我；融洽和信任；以及个人和家庭属性是影响家庭参与护理的主要因素。确定了两个主题作为在成人重症监护病房实施以患者和家庭为中心的护理的原则：“需要‘做家人’”和“在护理参与中的协商”。
协商参与护理需要考虑患者和家属的家庭价值观，并建立建设性的患者-家庭-护士伙伴关系。
在制定工具和框架以促进成人重症监护病房以患者和家庭为中心的护理时，未来的政策和研究应考虑患者和家属在护理参与中协商过程中展示家庭关系的需求。
