Skip to main content
Article thumbnail
Location of Repository

The Development of Family-Focused Intensive Care Nursing Through Action Research

By Fiona Maree Coyer


Introduction: \ud \ud The purpose of this study was to facilitate an improved understanding by intensive care nurses about their care of family members of critically ill patients. The study aimed to challenge intensive care nurses to reconceptulaise family nursing within the context of the intensive care unit (ICU).\ud \ud \ud \ud Background to the study: \ud \ud Critical illness is not an event that occurs in isolation for the patient and staff. It affects the patient's family in a unique way. A plethora of literature exists identifying the needs of family members in the ICU. However, there are considerably fewer studies which have examined interventions to meet family members' needs and no identified research that discreetly examined the concept of family-focused nursing in the intensive care environment.\ud \ud \ud \ud Design of the study: \ud \ud This study utilised a collaborative action research methodology. It was developed in four phases through the cyclical, dynamic steps of action research.\ud \ud \ud \ud Setting: \ud \ud This study was undertaken in the general intensive care facility of a metropolitan tertiary referral hospital.\ud \ud \ud \ud Phase One: \ud \ud Phase One of the study was the establishment of a collaborative action research group (CARG) with interested registered nurses working in a general intensive care unit. The CARG explored the first two research questions of this study: 1) What are intensive care nurses' perceptions of family-focused nursing? and 2) Is familyfocused nursing appropriate in the intensive care environment? Data were collected through audio taping meetings, flip chart notes and the researcher's reflective diary. Data analysis was undertaken utilising open coding. For the first research question, open coding of the data revealed two categories relating to perceptions of family focused intensive care nursing: partnership in care and maintaining a balance. For the second research question, CARG members agreed unanimously that family focused nursing was appropriate in the intensive care environment. The CARG determined future direction of the action research phases, commencing with a family needs analysis in Phase Two.\ud \ud \ud \ud Phase Two: \ud \ud Phase Two of the study was the utilization of a descriptive survey to determine family member needs in the ICU to determine focuses for interventions during Phase Three. Both family members and staff in the ICU were surveyed utilising the Critical Care Family Needs Index (CCFNI) (Molter & Leske, 1983). Data were analysed by the CCFNI subcategories of assurance, proximity, information, comfort and support, comparing means, rank ordering of means and t-test for statistically significant differences in means between the family members and staff participants. Results indicated that statistically significant differences in means scores between family members and staff participants were in the CCFNI categories of assurance, proximity, information and support. On the basis of these results, a platform for Phase Three of this study arose. The areas for intervention for Phase Three were identified by the CARG as: the provision of staff education seminars to raise staff awareness of family needs and the development of a structured family assessment tool to identify family needs in the ICU.\ud \ud \ud \ud Phase Three: \ud \ud Phase Three of the study addressed research question three: &quotHow can intensive care nurses provide care that is focused toward the family of the critically ill patient?" Phase Three examined practice interventions in two areas. Phase Three Part A was the implementation of nursing staff education seminars. Forty-two nursing staff participated in the family needs education seminars. Data were collected by detailed researcher field notes and completion of a descriptive survey, the CCFNI, post seminar attendance. Thirty-five participants completed the CCFNI. This CCFNI data from nursing participants in the education seminars was compared to family members CCFNI data from Phase Two. Open coding of data from the education seminars revealed codes of family needs, visiting, family presence, encouragement, simple things and boundaries under the theme of &quotestablishing the context" and attitudes, confidence, empathy and culture under the theme of &quotbuilding a partnership". CCFNI results highlighted statistically significant differences in means scores between family members and staff participants were in the subcategories of proximity and support. Results demonstrated that through understanding family members needs that intensive care nurses can provide care that is focused toward the family of the critically ill patient. This is a building process to be achieved over time. Phase Three Part B was the content validity development of a family assessment tool for the Computer Information System (CIS) in the ICU. A family assessment tool (See Figure 6.1) was developed through the literature and in consultation with the CARG. A series of focus groups were organised. All nursing staff in the general ICU were invited to participate. Twenty-nine registered nurses (43.9%, n=66) participated in the family assessment tool focus groups. The five domains of the family assessment tool, family roles, family spokesperson, family perception and coping, family issues and family health needs, were each discussed to determine readability, clarity and applicability. The focus groups agreed on content validity of the family assessment tool. (See Figure 6.2).\ud \ud \ud \ud Phase Four: \ud \ud Finally, Phase Four of the study has addressed research question four: &quotIs action research an appropriate methodology to transform intensive care nursing practice?" Somekh's (1995) framework was utilised to guide this critical evaluation. It is suggested that action research is an appropriate methodology to transform intensive care nursing practice as it enables the development of professional, it is sensitive to the specific nature of intensive care nursing, it acknowledges of attributes of the researcher in the process. It is also an appropriate methodological choice as it provides opportunity for a critical evaluation and a platform for the ongoing nature of the action research journey.\ud \ud \ud \ud Conclusions: \ud \ud Overall the findings achieved the objectives of the study in that organisational, cultural and clinical practice changes were identified to facilitate family-focused intensive care nursing. Collaboration occurred with intensive care nurses to effect change. The action research process involved in the change process was articulated throughout the four phases of the study. An improved understanding by intensive care nurses about their family nursing practice was demonstrated in Phase Three and the efficacy of action research methodology for clinical practice change was demonstrated in Phase Four

Topics: Family Members, Intensive Care, Action Research, General Systems Theory, Family Member Needs, Education, Assessment, Family Focused Care
Publisher: Queensland University of Technology
Year: 2004
OAI identifier:

Suggested articles


  1. (1997). 2 nd Edition. Gerontological Nursing – concepts and practice.
  2. (1991). A familycentred critical care unit.
  3. (1995). A hermeneutic study of the experiences of relatives of critically ill patients.
  4. (1995). A qualitative study to establish the self-perceived needs of family members of patients in a general intensive care unit. Intensive and Critical Care nursing,
  5. (1999). A study of postdiagnosis breast cancer concerns for women living in rural and remote Queensland. Part 1: Personal concerns.
  6. (1991). a). Internal Psychometric Properties of the Critical Care Family Needs Inventory.
  7. (1995). Action research and communicative action: Changing teaching practices and the organisation of educational work. Paper presented for the Innovative Links Project,
  8. (1946). Action research and minority problems.
  9. (1993). Action research and quality of care: a mechanism for agreeing basic values as a precursor to change.
  10. (1996). Action research as a professionalising strategy: issues and dilemmas.
  11. (1995). Action Research as Professional Development. Australian Government Publishing Service,
  12. (1991). Action Research for Educational Change.
  13. (1998). Action research for health and social care; a guide to practice.
  14. (2000). Action research in health care.
  15. (1994). Action research, evaluation and health care.
  16. (1994). Action research: a few details, a caution and something new.
  17. (1999). Action Research. Chapter 12, pp 247-270. In
  18. (2003). Action Research”, in
  19. (1998). Acutely ill children and their families. In
  20. (1999). All in the family. Family coping: issues and challenges for cancer nursing.
  21. (1978). An assessment of the scientific merits of action research.
  22. (1991). An evaluation of the validity, reliability and readability of the Critical Care Family Needs Index. Heart and Lung,
  23. (2002). An introduction to qualitative research. 2 nd Edition.
  24. (2002). An overview of three different approaches to the interpretation of qualitative data. Part 1: theoretical issues.
  25. (2002). An overview of three different approaches to the interpretation of qualitative data. Part 2: practical illustrations.
  26. (1991). b). Family Member Interventions: Research Challenges.
  27. (1986). Becoming critical: Education, knowledge and action research.
  28. (1996). Cancer Nursing – a comprehensive textbook. 2 nd Edition.
  29. (1991). Caring and the family in the critical care unit.
  30. (1987). Caring, Courtesy, Understanding in Critical Care Units.
  31. (1998). Changing practice through action research.
  32. (1993). Chapter 10 Action research: philosophy, methods and personal experience. In A. Kitson (Ed.) Nursing: Art and science.
  33. (1998). Children and families in health and illness.
  34. (1998). Children and their families – the continuum of care.
  35. (1999). Clinical wisdom and intervention in critical care – A thinking in action approach.
  36. (1999). Communicating the processes and outcomes of practitioner research: an opportunity for self-indulgence or a serios professional responsibility?
  37. (1990). Comparison of perceived needs of family members between registered nurses and family members.
  38. (1992). Comparison ratings of need importance after critical illness from family members with varied demographic characteristics.
  39. (1991). Comprehensive Assessment of Families of the Critically Ill.
  40. (1997). Constructions of family nursing; a critical exploration.
  41. (1998). Contextualizing critical care family needs through triangulation: an Australian study.
  42. (1997). Council for Healthcare Standards).
  43. (1997). Creating meaning, responsibility and choice: the lived expereince of family carers in nursing homes. Unpublished Doctor of Philosophy thesis,
  44. (1991). Critical care family needs in an urban teaching medical center.
  45. (1983). Critical care family needs inventory. Copyright. Available from author.
  46. (1990). Critical care family needs: Nurse family confederate pairs.
  47. (1993). Critical care family support sessions.
  48. (1991). Critical care nurses perceptions of family needs.
  49. (2000). Critical care nurses’ perceptions of family needs as met. Critical Care nursing
  50. (1988). Critical care nurses’ role with families: A descriptive survey.
  51. (1998). Critical Care nursing – a holistic approach. 7 th Edition.
  52. (1998). Critical Care Nursing; a history.
  53. (1996). Critical collaborative action research as a means of curriculum inquiry and empowerment.
  54. (1997). Current practices regarding visitation policies in critical care units.
  55. (1995). Developing family-focused care.
  56. (1990). Effect of family support groups on anxiety of family members during critical illness.
  57. (1992). Empathy of intensive care nurses and critical care family needs assessment.
  58. (1998). Establishing the nurse-family relationship in the intensive care unit.
  59. (1997). Explorations in family nursing.
  60. (2003). Facing challenges to Family-Centered Care 1: Conflicts over visitation.
  61. (1991). Families – a link or liability?
  62. (1988). Families and Intensive Care nurses: Comparisons and perceptions.
  63. (1998). Families in pediatric critical care: The best option. Pediatric Nursing,
  64. (1983). Families in the intensive care unit: their effect on staff.
  65. (2002). Families of critically ill patients and the effect of nursing interventions.
  66. (1992). Families: An Essential Element in the Care of the Patient with Cancer.
  67. (2001). Family advocates: Caring for families in crisis.
  68. (1982). Family Coping With the Crisis of a Heart Attack.
  69. (1992). Family functioning during a critical illness.
  70. (1992). Family life; Process and practice. Jones and Bartlett Publishers,
  71. (1997). Family nursing in Intensive Care. In
  72. (1990). Family perceptions of care.
  73. (1992). Family responses to critical care of the geriatric patient. In
  74. (1984). From novice to expert – Excellence and power in clinical nursing practice.
  75. (1978). Fundamental patterns of knowing in nursing.
  76. (2000). Gerontological Nursing. (2 nd Ed).
  77. (1998). Historical overview of health promotion for children and families in late 19 th and 20 th century America. In
  78. (1998). Historical overview of responses of children and their familes to acute illness. In
  79. (1990). Humanity in Intensive Care.
  80. (1995). Identifying family needs and stresses in the intensive care unit.
  81. (2003). Immediate needs of adult family members of ICU patients in Hong Kong.
  82. (1991). Impact of adult critical care hospitalisation: Perceptions of patients, spouses, children and nurses.
  83. (2002). Impact of prolonged surgical critical illness on patient’s families.
  84. (1996). Implementation and evaluation of a liberalised visiting policy.
  85. (1983). Importance of visiting needs as perceived by family members of patients in the intensive care unit.
  86. (1992). Interventions related to family.
  87. (1986). Investigation of the selected psychosocial needs of family members of critically ill patients.
  88. (1995). Involving families in the intensive care environment – a descriptive survey.
  89. (1978). Involving the family in patient care – the Castledine Column. Nursing Mirror,
  90. (1995). Issues of validity in action research.
  91. (1998). Keeping above the surface in an action research study.
  92. (1989). Learning from experience.
  93. (2001). Learning to nurse the family.
  94. (1999). Looking out for the patient and ourselves – the process of family integration into the ICU.
  95. (1991). Meeting the needs of visitors – a practical approach.
  96. (1992). Need for information; interventions for practice.
  97. (1991). Needs and anxiety levels in relatives of intensive care patients.
  98. (1992). Needs of families of critically ill patients – State of the science and future directions.
  99. (1992). Needs of family members of intensive care unit patients.
  100. (1991). Needs of Family Members of Patients in the Intensive Care Unit Over Time.
  101. (1979). Needs of relatives of critically ill patients: a descriptive survey.
  102. (1986). Needs of relatives of critically ill patients: a follow up.
  103. (1993). New paradigm research in practice: the trials and tribulations of action research.
  104. (1859). Notes on nursing; What it is and what it is not.
  105. (1994). Nurses and families; A guide to family assessment and intervention. 2 nd Edition.
  106. (1986). Nursing and Social Change. 2 nd Edition.
  107. (1992). Nursing at Burford: a story of change.
  108. (1991). Nursing intervention with the family of the critically ill patient. Videotape: an option for family orientation to the critical care unit.
  109. (1995). Nursing Replay – Researching nursing culture together. Churchill
  110. (1994). Nursing Theory – analysis, application evaluation. 4 th Edition.
  111. (1992). Participation of Informal Caregivers in the Hospital care of Elderly Patients and their Evaluations of the Care Given: A Pilot Study in Three Different Hospitals.
  112. (1998). Participatory action research and the study of practice.
  113. (1986). Patients, relatives and nurses in a technological environment.
  114. (1998). Perceived and unmet needs of critical care family members.
  115. (1993). Perceived needs of the family members in the critical care waiting room.
  116. (1982). Psychological Stress in Intensive Care and Non-Intensive Care Nursing: A Review of the Literature of the Past Decade. Heart and Lung,
  117. (1994). Qualitative data analysis. 2 nd Edition,
  118. (1999). Qualitative research methods: a health focus.
  119. (1988). Reaching out to meet the needs of relatives in Intensive Care Units. Intensive Care Nursing,
  120. (1993). Research partnerships: collaborative action research in nursing.
  121. (1994). Selecting a model to guide family assessment.
  122. (1986). Society of Critical Care Nurses
  123. (1998). Starting out with action research.
  124. (1996). Statewide plan for Intensive Care services in Queensland. Report for Queensland Health.
  125. (1991). Strengthening Nurse-family relationships in Critical Care.
  126. (1975). Stresses Associated with Intensive Care Units Affect Patients, Families and Staff.
  127. (1992). Support and reassurance needs.
  128. (1988). The Action Research Planner. 3 rd Edition.
  129. (1990). The Cancer Experience – nursing diagnosis and management.
  130. (1995). The contribution of action research to the development of social endeavours: a position paper on action research methodology.
  131. (1994). The effect of two nursing interventions on families of ICU patients.
  132. (1996). The experiences of families with a relative in the intensive care unit.
  133. (1989). The needs of family members of patients in Intensive Care Units.
  134. (1996). The needs of relatives visiting adult critical care units as perceived by relatives and nurses.
  135. (1984). The perceived needs of families with relatives in the intensive care setting.
  136. (1994). The power to shape memories: critical care nurses and family visiting.
  137. (1997). The Practice of Nursing Research; conduct, critique and utilisation. 3 rd Edition.
  138. (1997). The role of the nurse with families of patients in ICU: the nurses’ perspective.
  139. (1974). Theory and practice.
  140. (1982). Three modes of action research.
  141. (1996). Unfinished Business: Interviewing family members of critically ill patients.
  142. (1998). Visitation: Policy versus practice.
  143. (1992). Visiting critically ill adults.
  144. (1994). Visiting hospitalised patients.
  145. (1999). Visitor and nurse satisfaction with a visitation policy change in critical care units.
  146. (1985). What are the Needs of Families of Critically Ill Patients? Focus on Critical Care,
  147. (1978). What is action research in schools?

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.