Barriers to patient and family-centred care in adult intensive care units: A systematic review.
Frank Kiwanuka, Shah Jahan Shayan, Agbele Alaba Tolulope
PMID 31367389WHAT IT FOUND
Clinicians and families in adult ICUs reported barriers to patient and family-centred care: lack of understanding, heavy workloads, poor teamwork, restrictive visiting policies, and limited time to communicate.
Key findings
01Barriers to patient and family-centred care in adult ICUs were grouped into four categories: lack of understanding, organizational barriers, individual barriers, and interprofessional barriers.
02Organizational barriers included nurse shortages, workload, overcrowded hospitals, burnout, poor ICU design, and lack of guidelines or tools for patient and family-centred care.
03Individual barriers included lack of motivation, lack of holistic view of care, and lack of time, while interprofessional barriers included tension between discussing likely patient outcomes and uncertainty about predicting them.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only seven studies were included, and one study contributed 334 participants, so the review rests on a small evidence base. The search was limited to English-language publications, and most included studies were from developed countries, with only one from a middle-income country. No studies from Africa were found, and the authors recommend more work in low- and middle-income countries. The included studies used different designs, so the authors did not combine results statistically. The reported participant counts list family members, nurses, physicians, and researchers, and do not give a separate count of patients. The review describes barriers through narrative and thematic synthesis, so it does not show how common each barrier is.
Declared interests
The authors declared no conflict of interest.
The easy way to misread this
Do not conclude that specific changes such as more family visitation or teamwork training will improve ICU care. This review describes barriers reported in seven studies; it does not test interventions.