Communication in the intensive care unit: experiences and perspectives of critical care nurses in China

OBJECTIVES: This study was designed to explore intensive care unit (ICU) nurses' experiences communicating with families of critically ill patients, focusing on role perceptions and communication challenges. METHODS: Semi-structured interviews were used in this qualitative descriptive study of purposively sampled critical care nurses from three ICUs (medical, surgical, and liver) at a Hangzhou tertiary hospital. Interviews were audio-recorded, transcribed, and analyzed using descriptive thematic analysis. Rigor was incorporated through the use of independent coding, reflexivity through data collection, analysis and interpretation. This process was captured through an audit trail. FINDINGS: Thematic analysis of interviews with 22 ICU nurses generated two primary themes: (1) ICU nurses' perceived roles in family communication and engagement, encompassing physician-family-patient connector, family emotional support provider, and advocate for patients and families; and (2) Nurse-identified sources of difficulty in family communication, including individual (emotional fatigue and stress, tensions surrounding information disclosure), systemic (time pressure amid family expectations, exclusion from decision-making), and interactional barriers (language and health literacy challenges). These challenges were described as compounding, intensifying communication difficulties and associated psychological stress. Nurses described impaired family interactions with increased risk for burnout. Notably, a majority (82%; n = 18) of ICU nurses were rarely or never included in structured family meetings, highlighting a significant deficit and described frustration regarding underutilized communication competencies and limited opportunities to engage in care decision-making. CONCLUSION: ICU nurses play vital yet underutilized roles in family communication as communicators, emotional supporters, and advocates for patients and families, hindered by systemic, individual, and interpersonal barriers that mirror global challenges, particularly cultural competence gaps and role uncertainty. These barriers converge to form a self-reinforcing cycle that impedes nurse-family communication and exacerbates burnout risk, especially among junior nurses, a pattern likely transferable to high-acuity settings worldwide. IMPLICATIONS FOR CLINICAL PRACTICE: We propose a three-part strategy: (1) structural reforms to formalize nurses' roles in family meetings and decision-making; (2) psychological support systems to boost communication resilience and reduce burnout; (3) culturally adaptive training to address health literacy gaps, language discordance, and cultural script conflicts. This multifaceted approach will empower nurses as effective facilitators of patient- and family-centered care across diverse clinical settings.