Patient and family involvement in adult critical and intensive care settings: a scoping review

Abstract

BackgroundDespite international bodies calling for increased patient and family involvement, these concepts remain poorly defined within literature on critical and intensive care settings.ObjectiveThis scoping review investigates the extent and range of literature on patient and family involvement in critical and intensive care settings. Methodological and empirical gaps are identified, and a future agenda for research into optimizing patient and family involvement is outlined.MethodsSearches of MEDLINE, CINAHL, Social Work Abstracts and PsycINFO were conducted. English‐language articles published between 2003 and 2014 were retrieved. Articles were included if the studies were undertaken in an intensive care or critical care setting, addressed the topic of patient and family involvement, included a sample of adult critical care patients, their families and/or critical care providers. Two reviewers extracted and charted data and analysed findings using qualitative content analysis.FindingsA total of 892 articles were screened, 124 were eligible for analysis, including 61 quantitative, 61 qualitative and 2 mixed‐methods studies. There was a significant gap in research on patient involvement in the intensive care unit. The analysis identified five different components of family and patient involvement: (i) presence, (ii) having needs met/being supported, (iii) communication, (iv) decision making and (v) contributing to care.ConclusionThree research gaps were identified that require addressing: (i) the scope, extent and nature of patient involvement in intensive care settings; (ii) the broader socio‐cultural processes that shape patient and family involvement; and (iii) the bidirectional implications between patient/family involvement and interprofessional teamwork.

Factors Influencing Active Family Engagement in Care Among Critical Care Nurses

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

“…8 The results can be used to inform nursing leaders how to target educational and training interventions as well as how to assess resource allocation and policies to reduce barriers to promote nurse support of active family engagement in the ICU.…”

“…However, preliminary evidence suggests that family engagement in the ICU can increase family member presence and interaction with the patient; improve the perception of respect, collaboration, and support between family members and health care staff; and reduce family members’ anxiety and stress. 8,14,31 Thus, family outcomes also require further exploration.…”

Recognising the importance of informal communication events in improving collaborative care

“…These encounters involved both members of the healthcare team as well as family members and other patient caregivers (eg, close friend). While family members and caregivers are often not considered in collaboration research, new and emerging research has suggested this is an important avenue for future research exploring patient safety and quality of care 14. In this paper, we share the analysis of our findings to highlight the important information revealed through these events, as well as their significance for improving collaboration and ultimately, quality of care.…”

Care pathways models and clinical outcomes in Disorders of consciousness

“…The difficulty to accept the situation for caregivers as well as the difficulty to define a clear prognosis could explain the negative (or the no evaluation) answer for this item of the questionnaire (DeVoe, Wallace, & Fryer, 2009;Dou, Gao, Lu, & Chang, 2014;Olding et al, 2016;Tsetsou, Oddo, & Rossetti, 2013 However, future studies are needed including a monitoring with standardized clinical scale scores and a larger sample than the one involved for this pilot research in order to compare different models.…”