A Theoretical Lens Through Which to View the Facilitators and Disruptors of Nurse-Promoted Engagement With Families in the ICU

Abstract

The theory of nurse-promoted engagement with families in the intensive care unit (ICU) was developed to describe the dynamic and complex interplay between factors that support or impair nurses’ efforts to promote family engagement. Theory construction involved theory derivation and theory synthesis. Concepts and relationships from ecological theory, the Resiliency Model of Family Stress, Adjustment and Adaptation, moral distress theory, and the healthy work environment framework informed the initial formation of the emerging theory. The synthesis of findings from the literature further expanded the scope of the relationships and propositions proposed in the theory. This middle-range theory can set direction for theory-informed focused nursing research that can advance the science of family nursing and guide ICU clinicians in overcoming challenges in family nursing practice. Recommendations are provided for applying this new theoretical lens to guide family nursing curriculum development, practice improvements, and policy changes to support nurses in promoting family engagement.

Giving nurses a voice during ethical conflict in the Intensive Care Unit

“…The theory of nurse-promoted engagement with families in the ICU posits that ethical conflict results from tension between nursing values, organizational priorities, and ICU culture. 42 Similarly, in this study nurses described situations in which organizational priorities did not align with those of nursing as a source of ethical conflict. The theory of nurse-promoted engagement with families 42 also highlights the value of providing resources for critical care nurses experiencing ethical conflict, moral distress, and burnout in order to improve the quality of care.…”

“…42 Similarly, in this study nurses described situations in which organizational priorities did not align with those of nursing as a source of ethical conflict. The theory of nurse-promoted engagement with families 42 also highlights the value of providing resources for critical care nurses experiencing ethical conflict, moral distress, and burnout in order to improve the quality of care. Some support for this proposition was found in this study: nurses reported a need for organizational resources to resolve ethical conflict in the ICU and wanted to be valued by the organization for their contributions to care.…”

Peer Review #1 of "Needs of family members of patients admitted to a university hospital critical care unit, Izmir Turkey: comparison of nurse and family perceptions (v0.1)"

“…For the nurses to fulfill such needs of the family members, it is quite important to define and assess these needs accurately. Family-centered care in the intensive care unit is defined as the assurance, emotional support, decision-making support provided by the nurse and acceptance of the family contributions to care (7).…”

“…Because the family effect is an important component in the patient's response to treatment, and nurses are medical personnel who best meet the emotional and social needs of families having patients treated in intensive care (5). Organizational factors, work environment, nursing culture and the situation of the family affect the provision of family-centered services of nurses (7). Considering that patient-centered care is moving towards family-centered care in the provision of nursing services, it is very important to assess the needs of inpatient families, especially in intensive care units (1).…”

Social Relationships in Nurses’ Caring of Adolescents and Emerging Adults With Life-Limiting Illnesses or Injuries

“…Specifically, nurses’ performance of psychosocial care centers on and emerges from the relationships they have with the people for whom they care (Halldorsdottir, 2008; Li, 2004; Shimoinaba et al, 2013). Within a family-centered care model, nurses additionally care for a person’s “family,” broadly defined as supporters with biological, social, spiritual, or psychological ties (Benoot et al, 2020; McAndrew et al, 2020). Taken together, previous theoretical treatment of relationships in nurses’ caring suggests nurses enact the nurse–patient relationship and fulfill their caring obligations within a person’s larger relational community.…”