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ICU Culture Key to Nurse Motivation in Family Engagement

ICU units with more culture and protocol for family involvement in care yielded more nurse motivation in family engagement.

ICU culture is important for nurse motivation in family engagement.

Source: Thinkstock

By Sara Heath

- ICUs need to develop a culture around strong family involvement in care to drive nurse motivation in family engagement, according to research published in AACN Advanced Critical Care.

The healthcare industry is increasingly recognizing the role families and other loved ones play in improving care quality and the patient experience. The investigators conducted their research on the supposition that family engagement is good for patient care and continued by looking at the characteristics that will predict nurse motivation in family engagement.

“Effective implementa­tion of active family engagement begins with the endorsement of the bedside nurse,” lead author Breanna Hetland, RN, PhD, CCRN-K, said in a statement. “We must understand how nurses view family engagement and the barriers they face when working to involve family members in patient care.”

Hetland, who is also a postdoctoral fellow at Case Western Reserve University’s Frances Payne Bolton School of Nursing, and colleagues issued a 15-item questionnaire to 433 critical care nurses across the country.

The survey asked about factors that influence family engagement in the ICU, including nurse perceptions of the physical environment and culture of the ICU, the clinical stability of the patient, disruptive workflow, and individual attitude toward family engagement in the ICU.

The survey showed that a nurse’s experience has a significant effect on perceptions of family involvement in care. Nurses who were older, or who had higher degrees, tended to practice more caregiver engagement. Nurses in rural hospitals, pediatric units, or low-staff ratio units also had high engagement scores.

Nurse perceptions that family involvement in care is effective was the strongest predictor of engagement, the survey showed.

Nurses who were planning on leaving their unit within six months, or who worked in a unit that did not value family engagement, tended not to practice meaningful engagement in the ICU. Units that did not have an established protocol for family engagement had the weakest family engagement scores.

The survey also revealed the types of caregiver engagement the nurses practiced. Nurses were more likely to invite families to participate in day-to-day activities, such as applying lotion to patients, feeding patients, washing patients’ hands, and communication. Nurses were less likely to include families in intimate, invasive, or more technically skillful activities.

The findings indicate a need to investigate specific ICU unit staffing, space, and family engagement resources to better cater these elements toward family involvement in care. The researchers also suggested looking into unit culture and specific protocol for family engagement.

As noted above, the researchers worked under the assumption that family engagement is definitively beneficial for patient care. Thus, the team explained that more research needs to go into shaping tailored engagement efforts to various specific cases.

“Additional research is needed to establish criteria to classify caregivers (eg, caregiver knowledge base, previous care experience, motivation, self-efficacy, preparedness) to help nurses tailor their approach to engagement with each family caregiver,” the researchers said. “Additional education and training may be needed for nurses to understand their role in communicating opportunities and safely guiding family involvement within the ICU environment.”

Ultimately, the researchers said ICUs and other healthcare facilities need to emphasize the importance of family engagement to all of their clinicians. Providers – especially nurses – are instrumental in facilitating family involvement in care, and therefore need to be on board for all efforts pertaining to caregiver engagement.

“Effective implementation of active family engagement begins with the endorsement of the bedside nurse,” the researchers concluded. “The results of our study indicate a need look into staffing, space and resources for families, unit culture, and the establishment of policies and procedures that outline the role of family caregivers.”

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