Building family resilience: Qualitative perspectives from a multisite experimental study in intensive care units

• Published date: 01 February 2024
• Author: Brigitte S. Cypress,Sarah Allred
• Date: 01 February 2024
• DOI: http://doi.org/10.1111/fare.12893

RESEARCH

Building family resilience: Qualitative perspectives

from a multisite experimental study in intensive

care units

Brigitte S. Cypress

1

|Sarah Allred

2

1

School of Nursing, Rutgers University

Camden, Camden, NJ

2

Department of Psychology, Rutgers

University Camden, Camden, NJ

Correspondence Brigitte S. Cypress, P.O. Box

2205, Pocono Summit, PA 18346, USA.

Email: brigitte.cypress@rutgers.edu

Funding information

Rutgers University Camden Provost

Multidisciplinary Grant with Student

Engagement

Abstract

Objective: We sought to explore how the family resilience

framework may help us understand the relationship between

patient- and family-centered care interdisciplinary rounds and

the stressors, resources, organizational, and systems context

during critical illness of patients, their families, and the health

care professionals providing the care in the intensive care unit.

Background: Family inclusion and engagement in patient-

and family-centered interdisciplinary rounds in the intensive

care unit is a challenging and an under-researched issue in

critical care. Despite evidence thatfamily presence can pro-

vide benefits to patients and family members, current litera-

ture still shows that family members are excluded.

Method: We examined qualitative data from patients, fam-

ilies, and health care professionals involved in a multisite

experimental study using the family resilience framework,

and Braun and Clarke’s (2006) constructionist, con-

textualist approach to thematic analysis.

Results: We learned that the participants’experiences and per-

ception of family engagement during patient- and-family-

centered care interdisciplinary rounds is centered around the

family as the “synchronizer,”achieved with family acting as

“moderator,”as an advocate, and as “therapeutic”that assisted

the patients, family members, and health care professionals to

be “feeling happy,”which also aided in providing “forewarning

and mindfulness of the impermanence of life and imminence of

death.”

Implications: We present and discuss our findings in the

light of theoretical foundations and empirical support for

the use of the Family Resilience Framework in critical care

and propose how the framework can help implement poli-

cies and programs that will address the needs of patients

and their families in this aspect of critical care.

Received: 8 July 2022Revised: 15 January 2023Accepted: 18 January 2023

DOI: 10.1111/fare.12893

© 2023 National Council on Family Relations.

154 Family Relations. 2024;73:154–170.wileyonlinelibrary.com/journal/fare

Over the years, the need for a patient- and family-centered approach to patient care in the inten-

sive care unit (ICU) has been highlighted in research studies. This approach is described asa

mutual partnership—among patients, family members, and health care professionals—who

advocate for family engagement in care (Coombs et al., 2017; Frivold et al., 2021; McAndrew

et al., 2020). Its importance is even greater now due to persistent COVID-19 restrictions on visi-

tation (Ashana & Cox, 2021; Hart & Taylor, 2021).

Patient- and family-centered care (PFCC) is grounded in mutually beneficial partnerships

among health care providers, patients, and families (Cypress & Frederickson, 2017). One spe-

cific technique for PFCC is family inclusion in rounds (Au et al., 2019). Rounds for this study is

defined as an interdisciplinary PFCC activity conducted at the bedside in partnership with

patients, their families, and the health care professionals involved and providing the care. It is a

key component of high-quality critical care, with known benefits for patients, family members,

and the health care team (Ashana & Cox, 2021; Hart & Taylor, 2021). This has been rec-

ommended by the World Federation of Societies of Intensive and Critical Care Medicine,

European Society of Intensive Care Medicine, British Association of Critical Care Nurses,

Institute for Patient- and Family-Centered Care (IPFCC), Institute for Healthcare Improve-

ment, Society of Critical Care Medicine, and the American Association of Critical Care Nurses

(IPFCC, 2021; Strathdee et al., 2019).

However, despite emphasis on and recommendations for engaging families in PFCC inter-

disciplinary rounds (PFCC-IR) in the ICU over the past decade, current literature still shows

that family members are excluded (Frivold et al., 2021). Family members’inclusion during

PFCC-IR is also regarded as a challenging and under-researched issue (Frivold et al., 2021;

Jaberi et al., 2020). Researchers thus continuously emphasize and uphold the need for guide-

lines that promote a culture of family engagement in critical care (Frivold et al., 2021).

Improving patient and family experiences during their ICU admission is important not just

because of the quality of experience during the critical care unit stay, but also because even

short stays can have a long-term impact on patients and their families. A patient’s admission in

the ICU can affect family members during and after discharge. The literature is rich with a myr-

iad research findings about the potential long-term impact of the critical illness of a loved one

on families, from anxiety to delirium (McClay, 2021), depression, and post–intensive care

syndrome—family (PICS-F), to changes in their quality of life (Rose et al., 2021) and social,

financial, role/relationship, and economic situations (Frivold et al., 2021). ICU care involves

not only the patients but the family members as well. Families of critically ill patients are

affected as much as are their loved ones. Active family engagement (Frivold et al., 2021) is fun-

damentally aligned with the family resilience framework for clinical practice.

FAMILY RESILIENCE FRAMEWORK AND CRITICAL CARE

The family resilience framework (Walsh, 2003a), illustrated in Figure 1, was used to conceptual-

ize how stressors, resources, and organizational systems context may influence family resilience

during the critical illness of a loved one in ICU. It is a dynamic, systemic conceptual framework

developed for clinical practice that builds on a body of family systems research on transactional

processes in well-functioning families (Walsh, 1996,2003a,2003b,2016a,2016b,2021). Walsh

(2021) stated, “Family resilience refers to the capacity of the family, as a functional system, to

withstand and rebound from adversity”(p. 256). Thus, a basic premise in this framework is that

crisis and persistent life challenges have an impact on the whole family. Family processes then

mediate adaptation (or maladaptation) for individual members, their relationships, and the

family unit (Walsh, 2021). Family systems refers to the broad relational network, attending to

the ongoing mutuality of influences, and identifying potential resources for resilience through-

out the immediate and extended family (Walsh, 2016b). Key processes in family resilience are

RESILIENCE AND FAMILY INCLUSION IN THE ICU155