Involving Relatives in ICU Patient Care: The Barriers and Enablers

Purpose: Relative involvement in ICU patient care has received growing recognition in recent times. However, relative involvement in the care of a critically ill patient remains a controversial issue. Past research has investigated the relatives experience within the intensive care environment, highlighting the benefits of their inclusion in care activities. However, whilst past research has identified the benefits of relative involvement in ICU patient care for the relative, patient and critical care nurse, there has been no investigation as to whether this practice is occurring within Intensive Care Units or if there are any barriers and enablers to this practice. This research study aimed to investigate barriers and enablers that impact on a critical care nurse’s ability to involve relatives in ICU patient care activities and identify possible reasons for their existence. It is of great significance to recognise barriers and enablers to improve the relative’s experience within the intensive care environment and gain the benefits of this practice as outlined in nursing literature.

Methods: A mixed methods methodology consisting of two phases was utilised for this study. To address the diversity of this nursing issue and provide comprehensive answers to the research questions, a mix of both quantitative (Phase 1) and qualitative (Phase 2) data was needed to create a more complete picture of the research problem. An explanatory mixed method design was utilised. An online questionnaire was conducted in Phase 1, in which 70 participants responded to a series of questions related to relative involvement in ICU patient care. The intensive care network was used for questionnaire participant recruitment. As a subset of purposive sampling, a snowball sample approach was used, with third parties emailing the questionnaire link and information sheet to potential participants within the intensive care network. Thirteen interview questions were developed following Phase 1 data analysis and 6 participants were interviewed in Phase 2. Participants were critical care nurses, employed in an Intensive Care Unit at the time of data collection. Although small, the study sample reflected a range of ages and intensive care experience.

 

Results: Descriptive statistics and thematic analysis was used to produce the study’s results. The results of the study demonstrated a range of perspectives demonstrating that relative involvement in patient care is ultimately the personal decision of the gatekeeper critical care nurse. This led to the identification of two distinctive critical care nurses: ‘The Gatekeeper’ and ‘The Facilitator’.  The characteristics of these two types of critical care nurses assisted in the identification of barriers and enablers to this practice. This study fulfilled its aim in determining specific barriers, such as the role of the critical care nurse, critical care nurses expertise, knowing what is best for the patient, time constraints, short term ICU stay, the ‘right’ relative, insecurity, hospital policies and the fear of adverse events. Enablers identified included the relative-patient relationship, the relative as a resource, veracity, care competency, experience, the individual relative, knowledge of benefits and an extended stay in ICU. The researcher also suggests possible reasons for the existence of barriers and enablers.

 

Conclusion: This study has concluded that policies and guidelines to relative involvement in ICU patient care should be produced to assist critical care nurses in their decision making. This practice requires discussion and promotion within the intensive care setting to limit barriers and uphold enablers. Knowledge of barriers and enablers to relative involvement in patient care has the potential to improve the relatives ICU experience. This research has contributed unique findings to the body of knowledge on the topic of relative involvement in ICU patient care, however further investigation is required to identify the ways in which barriers can be reduced and enablers enhanced.