2026/02/11 by Shelly Ashkenazy, Julie Benbenishty · 1 voice
Health Professions · Medicine · #Family and Patient Care in Intensive Care Units #Palliative Care and End-of-Life Issues #Infant Development and Preterm Care
paper · pdf · doi:10.1111/nicc.70375
openalex publication_date 2026/02/11 · openalex created_date 2026/02/13 · openalex updated_date 2026/07/16
Historically, guidelines and protocols for involving families in the care of hospitalised loved ones have shifted over the years [1] from when family and friends were considered as ‘visitors’ [2]. In the early nineteenth century, children's parents' hospital visits were limited to just a few per week [3]. Concerns over safety and infection control prompted clinicians to enforce strict visiting restrictions, significantly limiting family engagement in patient care, including participation in decision-making, especially in the critical care settings [4]. In recent decades, the role of families in the ICU has expanded beyond simply visiting patients [5]. At the beginning of the 20th century, articles began to address the needs of patients and their families in the critical care settings, and nurses recognised the value of family involvement in patient care [6]. In 2004–2005, the American College of Critical Care Medicine published clinical guidelines for supporting patient and family-centred care (PFCC) in the intensive care. The guidelines included 43 recommendations, emphasising areas, such as shared decision-making, open visitation policies, spiritual, religious and cultural support for families, addressing staff stress related to family interactions and participation in rounds and resuscitation efforts [7]. Later, in 2012, Morandi et al. presented the acronym of the multicomponent approach for improving quality of care with ICU patients, the ‘ABCDE’ bundle [8], and introduced the ‘F’ component in 2017 [9] for family engagement and empowerment. The addition highlighted the importance of partnering with family in decision-making and treatment planning. More recently, the Society of Critical Care Medicine published the updated guidelines on family-centred care for adult ICUs, reinforcing the importance of families in the care process [10]. Notably, recommendations to liberalise ICU visitation policies were reaffirmed almost two decades after the initial guidelines, emphasising the continued evolution of family-centred policies in the ICU. PSCC is defined as an approach to health care that is respectful of and responsive to individuals and their families' needs and values [11]. The approach emphasises collaboration, delivery and planning relationships to optimal quality of care and minimises Post-Intensive Care Syndrome—Family (PICS-F) [12]. This approach tends to improve outcomes, satisfaction for patients, families and healthcare providers [11]. However, the challenges of implementing this approach remain. PFCC requires clinicians to centre the families in the care of the patients, collaborating with them while ensuring safe care in an equitable care environment. An additional challenge is identifying if the patient desires and consents to visitors. The complexity of shifting from protocols and guidelines to PFCC in the ICUs can be categorised into ICU clinicians' barriers, family-related barriers and organisational barriers. Language barriers, discomfort with family presence, both families' and clinicians' personalities, and prior negative experience are all part of communication challenges encountered by ICU clinicians [13-15]. Kiwanuka et al. [14] identified communication barriers within ICU teams, including conflicts among clinicians, between doctors and between experienced doctors and nurses. Families may feel psychological distress; cognitive overload of information and diversity of cultural beliefs can lead to disagreement with the plan of care [13]. Moreover, the ICU environment is unpredictable, acute and dynamic, which causes an emotional and physical burden not only for ICU clinicians but certainly for families. Therefore, the engagement of the family in patient care is a challenge. The lack of clear organisational policies or inconsistency in their application presents challenges for both ICU clinicians and families. Environmental conditions within the ICU also impact family engagement, including limited privacy, excessive noise [14], a comfortable waiting room and the absence of a designated area for private discussion. These factors are essential for creating a supportive environment for the families. The added complexities of shifting from policies and guidelines that rely on evidence-based studies to bedside practice involve barriers and challenges to ICU clinicians and families. These barriers can be found globally [15]. The successful implementation of global guidelines into everyday practice is a demanding process. Bridging the gap between guidelines and clinical practice requires organisational culture shifts, strong ICU leadership and effective communication skills among clinicians [15]. The challenge moving forward is to balance between ensuring safety, preventing clinicians' burnout and fostering meaningful family involvement in ICU care. For achieving the optimal balance, a practical recommendation can be adopted. Figure 1 presents a sequential set of recommendations to support effective implementations of the PFCC approach. Encouraging a supportive environment where clinicians feel comfortable raising concerns, prioritising clinicians' well-being by supportive leadership, addressing burnout and moral distress [13]. Adjusting cultural communication and maintaining flexibility as needed to ensure care is humanised and centred for the patients and their families. The authors declare no conflicts of interest. Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.