Leading the Way for Change: Engaging Nurses in Family-Centred Adult Critical Care Practice

There are over 30 years of compelling evidence of the value and importance of Family-centred Adult Critical Care (FcACC), yet there has been slow uptake of these findings in practice. What are the contributing factors to this very evident knowledge-practice gap? How is it that some nurses consistently and effectively support families in adult critical care environments thereby providing family-centred care, while others do not? We conducted a qualitative descriptive study to critically examine the supports and barriers to FcACC, through focus groups and interviews held with 20 registered nurses (RNs) working in urban and regional adult critical care facilities in Alberta, Canada. Using constant comparison of data we developed a taxonomy illustrating the two primary domains of people and structures (with multiple sub-domains for each). Incongruent policies and practices related to FcACC, staff shortages, and time management were often described as barriers to enacting FcACC for some but not all. RNs’ lack of education and knowledge and their attitudes about FcACC were also barriers to enacting FcACC. In contrast, we found that the presence of formal leaders (i.e. those holding management or clinical leadership positions) in clinical practice made a significant difference in whether FcACC was an established practice, priority, and/or expectation. In the absence of formal leadership, clinical instructors and staff nurses who subscribed to FcACC were often the informal leaders who challenged the status quo and role modeled best practices. We found that the RNs in this study highly respected these leaders for their tenacity in modeling, fostering, and establishing FcACC practices in critical care. Building on Kouznes and Posners’ (2012) five practices of exemplary leadership, we found that some clinical instructors and critical care RNs in Alberta have demonstrated at the very least, two out of the five practices by modeling the way and challenging the status quo when enacting family-centred care. By applying this leadership model to education about, and practice in, adult critical care, we have the potential to bridge the knowledge to practice gap and to influence a much-needed change so that we can consistently and effectively provide FcACC to patients and families.

            Keywords: family-centred care, adult critical care, leadership