Experiences of ICU Nurses Communicating with Family Members

This research proposal explores the experiences of ICU nurses while communicating with family members of critically ill patients. It highlights the challenges faced by nurses in delivering effective communication and the impact on patient care. The study aims to improve the understanding of health promoting conversations and their role in supporting families in ICU settings.

Running head: RESEARCH PROPOSAL
RESEARCH PROPOSAL
Name of Student
Name of University
Author note

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1. Experiences of an Intensive Care Unit nurse while communicating with
patient’s family members
2. Introduction
Patients affected with traumatic injuries and patient with end of life management are
generally put to intensive care unit. This medical unit is responsible for an intensive care of
the admitted patient’s severe symptoms. End-of-life care (Chan, Webster & Bowers, 2016)
can be defined as being the management that includes a range of supportive services around
an emergency or acutely ill patient and a form of care where the patient’s family takes a
collaborative decision with continuing or withdrawal of a treatment. This decision making
process has to be fostered by a nurse initiated therapeutic and positive communication
process with the patient’s family so as to prevent further physical affections of any other
family members. There are various domains of EOLC which are undertaken in the ICU like:
(1) Family and patient centred joint decision-making, (2) a qualitative nursing (Holloway &
Galvin, 2016) and medical communication with the patient’s family, (3)decision making
about the continuity of a specific care, (4) providing a practical and an emotional support to
the patient’s family and also the patients (5) a definite form of symptomatic management and
palliative care (6) a rare spiritual support (7) developing an emotional framework within the
organisational one for the working ICU specialists. The nurses here are trained well to extend
an additional compassion and treatment comfort to the terminal patient and patient’s family
through the usage of a health promoting conversation but many nurses felt this
communication to be vague and also evasive (Noome et al., 2016). Communication between
the ICU nurses and patient families is critical to a collaborative care and joint decision
making. An empathic verbal discussion with the family members as the nurse puts himself or
herself in the mind-set of the family member who are in anticipation of a trauma is very

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important. A Families of ICU admitted patients have been seen and reported to experience a
deep relationship with the nurses working in ICU especially during the period of end-of-life
(EOL) when a joint decision-making pro-cess is executed.
Inversely though, there has been a possibility that the physician stands in opposition
and against a nurse’s perception of the right EOL care and this is where the nurse can have
major problems while applying a prescribed curative as instructed by the doctor when he or
she knows that a preferred form of care has to be palliative care. Family members on the
other hand, who has seen their family member suffering from a critical illness over a period
of life becomes emotionally guarded as well as charged. Inside the ICU, they face an
emotional and demandingly challenging, ICU driven life change which affects the normal
dynamics of patient’s family. As a matter of fact though, nurses can promote positive family
relations by having qualitative family-centered conversations discussions. Families that have
experienced issues of stroke have been reported for going through an acute emotional trauma
(such is the nature of the disease) and health-promoting conversations have assisted them
improve their family relationships and overall emotional turmoil. They also felt less lonely
and helpless and these heath promoting discussions were then transferred to other acute
health situations. A good rapport building and using a good form of compassionate
therapeutic communication is a crucial facet of health promoting conversations. These
communication techniques can be very useful during active transitions from a curative to a
patient comfort-centred care. This in turn leads to a shift in ICU nurse’s feeling – as if they
have been ‘torturing the patient’ by using the futile curative method (Adams et al., 2011).
Besides, many ICU nurses do not participate always in family meetings and hence, family
perceived and actually felt that they missed the important situational support of the nurses in
the ICU. Family also appreciated the nursing care of patients that was done physically but the

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communication while delivering the bad and sad news were highly deficient. This is where a
therapeutic and reflective communication comes to play.
The health care facilities present in ICU which includes problems lack of privacy at
patients’ bedside and during regular farewell between the patient and his family after the
visiting hours. Follow up meetings with family along with formation of support groups,
initiated by the nurse is an important strategy to develop a productive relationship with the
family of EOL or deceased patient. Post-intensive care syndrome is the response of patient’s
family to an EOLC condition or to the death of their patient. This syndrome includes anxiety,
posttraumatic stress and depression. Effective nursing communication and then involving the
family within the patient care can affect the long-term goals and outcomes in a good way.
Health promoting conversations improved their caring behavior within the family and
facilitated emotional engagement and feelings of closeness in the family, which may be
considered to be significant for family interaction and well-being Families which experience
critical illness and acute injury are at greater risk and has to be handled with a qualitative and
compassionate communication. Multicultural patients and their families are reported to suffer
from a double-stress inside the hospital. Raw emotions can be also triggered by the previous
history of traumatic experiences as those of immigrants (Høye & Severinsson 2010). Family
centred counselling with relational approach is vital to the care of these families.
Family members who come to see their critically ill patient are often confronted by
the alien environment of hospital especially when they visit an ICU - intensive care unit.
Dignity and rights should be respected and this is where the nursing care must practice with
cultural safe clinical principles. The patient’s family should be rightfully treated with
compassion, kindness and above all – respect and this kind nursing behaviour should be
irrespective of gender, creed, colour, language or social background.

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Highly effective biomedical equipment(s) are often used nowadays to treat the
patients with complicated and acute conditions. This is done mainly in the ICU of hospitals
and this setting provides a major barrier to family -patient communications (Cypress, 2011).
Analyzing the different facets of patient family- nurse relationships within the premises of
ICU - it is very important to note that if a patient family relationship is hindered by a patient’s
pathophysiological state. Nurses working in ICU, need to feel and understand the vitality of
family’s experiences.
3. Background
The medical admission of the very critically sick patient to an intensive care unit is
universally known as a great crisis for the concerned patients and also their families. The
family members of these critically ill patients can experience deep emotional turbulence.
They have many emotional needs to be fulfilled during the course of patient’s illness. Nurses
are in the best position to meet the patient families' needs (Stayt, 2007). There exist a huge
number of evidences about the family needs but comparatively less is known regarding the
ICU nurses' related experiences of emotionally and affectionately handing these families.
Nurses working in ICU care for critically sick patients on a daily basis. There are
some patients who do not get treated well from the intervention and tend to die after a period
of apparent suffering (Hov, Hedelin & Athlin, 2007). A global trend has bought withdrawal
of curative treatments into practise and instead starting a palliative care. Physicians are very
much responsible for the decisions made concerning the necessary medical treatments of a
patient but as the ICU nurses must carry out the physicians’ prescriptions while being
attached with patient’s feelings on the other side, they tend to land in a dilemma.
Admission to an ICU is a major cause of mental as well as physical stress for the
patients and also their families. This experience can lead to a long-term development of

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psychological issues. Post stress traumatic disorder is common in trauma affected patients as
well their emotionally entangled family members. A ICU diary is great way of explaining and
clarifying covert thoughts and the events happening in the ICU. Maintaining a diary also the
fills the memory gap which can assist them in making sense of ICU stay (Griffiths and Jones,
2001). An Intensive Care Unit diary is actually a notebook which the family members and
nurses write using an everyday common language. This ICU diary starts with a specific
summary which includes the main reason for patient admission which is then followed by the
hospital events. This album also contains photographs.
Family members’ assistance is critical to the ICU admitted patient’s healing. It
signifies the crucial assistance during the concerned patient’s recovery process. ICU patient’s
health state is a subtle summation of emotional pain, anxiety, family burden and constant
worrying for the dependable and loved family members (Haugdahl, 2018). As a health
promoting conversation is a two way process – the family members always make a constant
effort to encourage and stabilize their patient’s healing. The conversation has to be initiated
by the ICU nurse. Showing concern and strengthening the family’s emotional framework is a
vital ingredient of health enhancing communication. There are certain guidelines for the
family centred care used in daily ICU practices which highlights- that a support from family
members can enhance the patient’s health outcome and also consequently, lower the length of
hospital stay.
Involving the family members as the very informants and also spokespersons on
behalf of their patient is an extremely challenging thing. In order to ease a decision-making
process, the nurses need to deliver detailed information regarding the patient’s prognosis
(Lind et al., 2011) .

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4. Research question:
What are the experiences of nurses communicating with family members in ICU?
5. Research design
A qualitative phenomenological method will be used in this study to describe the
various experiences of ICU nurses in treating critical illness and communicating with the
family members of EOL patients. Improving the family situation towards a better
collaborative patient care applies the following points – to enhance the substance of the
health promoting conversation. Van Manen (2007) describes phenomenological research as a
dynamic interplay between : (1) transforming the clinical or experienced phenomenon which
triggers our seriously interests (2) investigation of personal experiences as one lives through
it rather than just conceptualising it from the outside (3) reflection on many essentially
derived themes that constitutes the concerned phenomenon (4) description of the
phenomenon with art of analytical writing (5) maintenance of a heavy pedagogical relation
(6) creating a balance between the fragmented logic and holistic understanding. This method
will help develop a ‘healing’ conversation with the patient family and can redress their
tumultuous situation in a spiritual way as well. Family health can be explained as being a
holistic, interactional comprising of psychological, biological, sociological, cultural and
spiritual aspects of well-being at an individual and family level. Hence a conversational and
discussion type communication including all the mentioned aspects is critical in improving
family health and mental distress. The qualitative exploration of ICU nursing experiences
will the family members will be done in order to understand the subtle planes of a clinically
correct health promoting conversation . This findings of this proposed study will promote the
existing nursing knowledge globally on its successful outcome and this ‘knowledge’ will be
transferred to the clinical framework to help better the concept and practise of health
promoting conversations.

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5.1Participant selection and sampling method
The proposed research design will use a snowball sampling method to select 20
participants from a mixed gender sample size. All the nurses participating have to be
registered ICU nurses with more than 5 years of experience in the same unit.
5.2Data collection
Data will be collected by a focused and semi structured interviewing. Semi structured
interviews will give the nurse’s – a freedom to explore their own ideas on the experiences and
what changes in patient family – nurse communication would be critical to an improved EOL
care. The interviews will be recorded and an independent code will provided to each
interview after completion. Transcribed verbatim will be applied (Sutton & Austin, 2015)
The moderator and observer will guide the participant through open ended questions
(Bryman, 2017)
5.3Data analysis
Data analysis will be done by a systematic, holistic and detailed approach. Code
applied (English et al., 2017)to the interviews will be analyzed until they reach a consensus
on the coding tree. The perception of nursing experiences pertaining to the communication
used in and around ICU, with the patient’s family members will be primarily taken into
consideration. The codes (Stuckey2015) will be further analyzed and reviewed by authors to
determine the major research themes. Further forms and techniques of a detailed
phenomenological thematic analysis (Nowell et al., 2017) will be done in an effort will be
undertaken to illuminate the gray shades of nursing experiences with patient family
communication. Triangulation of found data will be done to achieve the research goals and

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findings. Each theme containing descriptors will be considered vital to achieve the
understanding of phenomenon.
Reliability and Validity
During the interpretation of interviews, the true meaning of family members’ sayings
will be deciphered without any personal bias and would be checked further for another
meaning afterwards when and if findings coincides or differs with or from the analysis. The
transcribed interviews will be verified by randomized comparing components of an
audiotape. Each interview will be independently scrutinized by two researchers for check the
similarity or heterogeneity and the fairness in analysis. Finally the interview will be reviewed
the third researchers for validity. A consensus and peer review will be devised as well.
Validity scales will be used to assess the convergent or divergent as well as face validity.
This research process will go through a triangulation process to check for reliability.
The transparency in the analytical process will be thoroughly checked and verifiability of this
research will be assessed as well using reliability parameters. The participants will be
explained about the procedure completely and ethical barriers (Morrison et al., 2019) will be
managed strictly. Participant’s voluntary participation and protection of their ‘anonymity and
privacy’ (Lancaster, 2017) will be followed as an ethical procedure thoroughly. The research
resources will be distributed equally amongst the participants and no personal bias towards a
specific candidate will be encouraged nor practiced. In a quantitative research, reliability
actually refers to an exact replicability of research processes with the desired results. Diverse
paradigms like definition of reliability, is often challenging and also epistemologically very
counter-intuitive. Hence, to preserve the essence of very reliability in a qualitative research –
consistency has to be assessed. A fine margin of result variability is generally tolerated in
qualitative research due to the perceptual, observation, personal, psychological and

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behavioral differences between the participants, between the observers or between the
researcher and the participants.
Conclusion
The proposed research should be able to decipher the minute folds of a qualitative
nursing communication with the patient’s family so as to achieve a turning point in
improvement of family health. Based on the findings of the research study, further steps to
transfer the knowledge to various health care settings will be taken. The results will be set
forth to further research and testing.

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