Intensive Care Nurses' Experiences and Attitudes Towards Family Involvement in Delirium Care: A Qualitative Descriptive Study

BACKGROUND: Delirium is a common neuropsychiatric complication among critically ill patients, particularly those who are mechanically ventilated. Evidence suggests family involvement may improve delirium-related outcomes in adult intensive care units (ICUs). However, limited evidence exists on intensive care nurses' (ICNs) experiences and attitudes towards family involvement in delirium care in South Africa. AIMS: The study aimed to explore intensive care nurses' experiences and attitudes towards family involvement in the care of mechanically ventilated patients with delirium in adult ICUs. STUDY DESIGN: A descriptive qualitative study design was utilised. Four focus group discussions were conducted with 32 ICNs from two adult ICUs at a tertiary academic hospital in Johannesburg between April and August 2022. Participants who had at least 2 years of intensive care experience were purposively sampled. Data were analysed using inductive qualitative content analysis. The study adhered to Consolidated Criteria for Reporting Qualitative Studies guidelines. FINDINGS: Three categories were identified: emotional burden and psychological demands of delirium care, communication and psychosocial support for families in delirium care and barriers to effective family involvement in delirium care. While recognising the therapeutic value of family engagement, the nurses reported experiencing emotional stress related to family expectations and anxiety. They adopted strategies such as structured communication, empathetic listening and technology-assisted contact to support families. However, barriers such as time constraints, limited intensive care space, staffing shortages and restrictive policies limited sustained involvement. CONCLUSIONS: This study provides context-specific insight into how ICNs facilitate family involvement in the care of patients with delirium in a public tertiary ICU. ICNs recognise the therapeutic value of family involvement in the care of patients with delirium and are willing to facilitate engagement. However, systemic and environmental barriers limit consistent implementation. Therefore, strengthening institutional policies and supporting nurses through structured training and team-based approaches may enhance sustainable family-centred delirium care. RELEVANCE TO CLINICAL PRACTICE: This study's findings demonstrate the need for ICNs to adopt structured communication strategies, flexible visitation policies and empathy towards families and their patients in the ICU. Perhaps incorporating family-centred care into daily intensive care practices could strengthen family involvement in critical care, particularly for patients with delirium.