Heightened emotional vulnerability and regaining control : a grounded theory of family resilience in an Australian ICU

Introduction: Families are at risk of Post Intensive Care Syndrome-Family when a relative is admitted to an Intensive Care Unit (ICU). The families' experiences of their interactions in ICU have the potential to enhance or minimise this risk. The value of encouraging positive relationships with families is well recognised; however, it is argued that a lack of theoretical frameworks to guide practice in this area may be a barrier to improving Patient and Family-centered Care (PFCC). Objectives: To understand families' experiences of their interactions when a relative is admitted unexpectedly to an Australian ICU, and to generate a substantive theory that represents families' interactions that can be used to guide critical care nursing practice when caring for patients' families in this context. Methods: A qualitative grounded theory methodology was adopted for the study. Data was collected using in-depth interviews with 25 family members of 21 critically ill patients admitted to a tertiary-level ICU in Australia. Results: The core category Regaining control represents the families' journey towards resilience when in ICU. The findings from this study offer a grounded theory that represent facilitators for, and barriers to regaining control. Regaining control is facilitated when families are able to make sense of their circumstances; experience meaningful engagement with staff and are able to receive and provide social support to their own, and other family members. Conclusions: This study offers a framework to improve PFCC in ICU by facilitating families' ability to manage their situation more effectively. Although some of these themes have been previously identified in the literature in isolation, the interrelationships of these categories within a theoretical framework to represent family resilience in the context of an ICU situated in the Australian healthcare system are novel findings.