The evidence base of nurse-led family interventions for improving family outcomes in adult critical care settings: A mixed method systematic review.
Frank Kiwanuka, Natalia Sak-Dankosky, Yisak Hagos Alemayehu and 2 others
PMID 34736074WHAT IT FOUND
Nurse-led ICU family interventions sometimes improved satisfaction, communication and decision-making, but benefits were modest and several studies showed no improvement.
Evidence is mixed and not enough for strong conclusions.
Key findings
0115 studies were included; 11 showed improved family outcomes and one showed deterioration.
02An ICU family diary did not increase family satisfaction or decision-making on a 0 to 100 scale; satisfaction scores were 90.5 before and 91.2 after, and decision-making scores were 90 before and 89.7 after.
03A nurse-delivered SMS information intervention improved family satisfaction with care with a medium effect (Hedges' g = 0.6).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Most included studies were quasi-experimental or before-and-after designs, so they cannot show that the nurse-led intervention caused the outcome. Sample sizes varied, and several studies were small, including 14 parents in one booklet study and 8 family members in one qualitative study. Only two randomised studies were included, and conclusions about family rounds were based on only two original studies. The review included only English-language studies, which may have missed relevant evidence. Cost and length-of-stay outcomes were rarely assessed, and cost reporting was inadequate. Bundled interventions combined several elements, so the contribution of any single nurse-led component cannot be separated. The review did not fully integrate mixed data across all intervention categories. Many outcomes were family quality-of-care measures such as satisfaction.
Declared interests
The authors declare no conflict of interest.
The easy way to misread this
Do not treat this review as proof that nurse-led family interventions reduce anxiety or depression. The multicomponent study of nurse-driven emotional support, relationship building and re-engineered ICU teams found no significant difference in surrogates' anxiety or depression, and diary and family-round studies did not improve satisfaction.