Relationships Among Climate of Care, Nursing Family Care and Family Well-being in Intensive Care Units

Abstract

Family inclusion in health care delivery is vital for family well-being. However, intensive care (ICU) nurses experiencing frequent ethical conflict, low levels of organizational support and high levels of burnout may not be able to adequately care for families. The purpose of this study was to explore the relationships among variables related to the climate of care, nursing family care and family well-being in the ICU setting. A conceptual model derived from nursing, family, and organizational theories guided the study. A cross-sectional, correlational design was used with a convenience sample of nurses (n= 115) and family members (n = 44) from 5 ICUs at a Midwest hospital. The Ethical Conflict Questionnaire-Critical Care Version, Maslach Burnout Inventory-Human Services Survey and Hospital Ethical Climate Scale were used to measure the climate of care. The Family-Centered Care-Adult Version and Nurse Provided Family Social Support Scale were family measures of nursing family care, and the Family Well-being Index was used to measure family well-being. There was an indirect effect of organizational resources on family-centered care through nurse depersonalization, indicating a possible mediation effect of nurse burnout. Nursing years in the current ICU had a direct effect on family well-being and family-centered care. Nurse years in the ICU had a negative relationship with family-centered care, suggesting family-centered care decreases as nurse years in the ICU increase. In contrast, there was a positive relationship between family well-being and nursing years in the current ICU, indicating experienced ICU nurses may enhance family well-being. Organizational resources and depersonalization were significant predictors of family-centered care. There were weak, nonsignificant relationships between nurse provided family support and family well-being and family-centered care and family well-being. This study highlights the importance of organizational resources, as well as the negative influence burnout may have on the delivery of family-centered care. Nursing experience was related to family-centered care and family well-being, supporting the need for educational and practice-based interventions to enhance nursing family care. Further research is needed to examine the relationships among the ICU climate of care, nursing family care and family outcomes.