Stakeholders' views and recommendations on active participation of family members in direct ICU care: A qualitative study.

This study aimed to explore the perceptions and recommendations of key stakeholders regarding the development and implementation of care partnerships with families to promote their active participation in the direct care of patients in Intensive Care Units (ICUs). Using a qualitative descriptive design, 16 semi-structured interviews were conducted with 20 participants, including 4 patient-family dyads, 8 clinicians (5 nurses and 3 physicians), and 4 healthcare managers (HMs). The interview guide was informed by conceptual frameworks relevant to enhancing Patient-and Family-Centered Care practices. Descriptive thematic analysis was performed using Miles and Huberman's inductive approach. The analysis identified 4 key themes related to facilitators and barriers for enhancing active family participation in direct patient care, namely: (1) Challenges faced by families regarding active participation; (2) Importance of family education and support; (3) Navigating family active participation within institutional constraints; and (4) Factors shaping family active participation. Specific recommendations for improving active family participation from stakeholders were also documented. All participants view family participation in ICU care positively, but noted obstacles like restrictive visitation policies and the complex, high-acuity ICU environment. Family participation was principally influenced by clinician support, the quality of information provided, and nurses' attitudes. These findings offer actionable recommendations to support family members' active participation in the direct care of ICU patients. Patients value having family members present and appreciate their participation in direct care, while ensuring they do not feel pressured to assume that role. FCs are willing to take an active role in providing direct care to their loved ones in the ICU. However, they need to be invited and supported to develop the skills to do so. Healthcare managers and clinicians can play a role in fostering an open and supportive environment that not only strengthens patient support but also enhances communication, trust, and care continuity. Barriers, such as clinician training gaps, workforce shortages, and limited organizational support, warrant further attention to promote the meaningful integration of families into ICU care processes. Actionable strategies can be applied to strengthen and sustain family participation in ICU settings, including a structured PFCC training program and flexible visitor policies to outline the shared caregiver role.