Exploring Implementation Processes of a Multicomponent Family Support Intervention in Intensive Care Units ( <scp>FICUS</scp> ) Study: A Mixed‐Methods Process Evaluation

We read with great interest the recent article by Oesch et al. 2025 entitled “Exploring Implementation Processes of a Multicomponent Family Support Intervention in Intensive Care Units (FICUS) Study: A Mixed-Methods Process Evaluation”. This study represents a significant contribution to the growing body of implementation science in critical care, particularly in the under-researched area of family-centred interventions. The authors' use of Normalisation Process Theory (NPT) to guide a mixed-methods, multiple-case study design offers a robust and nuanced understanding of the implementation process of a complex nursing intervention. The study highlights several key findings with profound implications for practice. The high acceptability and appropriateness of the Family Support Intervention (FSI) across eight Swiss ICUs underscore the relevance of structured family support in critical care. However, the moderate feasibility scores and the identification of two distinct implementation pathways—early versus protracted adopters. This reveals the profound impact of situational factors such as leadership support, cross-professional cooperation and staffing. We wish to offer the following reflections to further enrich the discourse on implementing family-focused interventions in complex care environments. First, the role of interprofessional leadership cannot be overstated (Cypress et al. 2024). The study rightly identifies leadership support as a key facilitator. In our own context, we have observed that nurse and physician leaders who actively model family-centred behaviours and allocate protected time for family communication significantly accelerate the normalisation of new interventions. Future implementation strategies should explicitly include leadership coaching and role modelling as core components. Second, the adaptability of interventions within clinical trials deserves greater emphasis (Brahim et al. 2025). The tension between protocol adherence and real-world flexibility, stemming from the lower feasibility ratings, necessitates that future trials incorporate adaptive implementation designs. Such approaches are key to allowing tailored timing and delivery of intervention components without compromising fidelity to core functions. Third, we support the authors' call for post-trial summative evaluation. Understanding the long-term sustainability of the FSI beyond the research context is essential. We also encourage the inclusion of broader stakeholder perspectives, including non-participating clinicians, hospital administrators, and importantly family members themselves, to capture a more comprehensive picture of implementation success. Oesch et al.'s study not only advances the science of implementing family support in ICUs but also serves as a methodological exemplar for process evaluations in nursing research. We commend the authors for their rigorous and transparent approach and look forward to future work that continues to bridge the gap between evidence-based interventions and real-world practice in critical care settings. The authors have nothing to report. The authors have nothing to report. The authors declare no conflicts of interest. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.