Nurses as Intermediaries: How Critical Care Nurses Perceive Their Role in Family Meetings.

BACKGROUND Nurses' involvement in family meetings in the intensive care unit is central to supporting consistent communication and shared understanding within the care team and with patients and patients' family members. Evidence suggests the existence of major barriers to the effective participation and contribution of nurses during family meetings. OBJECTIVES To characterize the nature and extent of nurses' involvement in family meetings in the intensive care unit, including identifying barriers to nurses' participation and opportunities for involvement. METHODS Meetings with focus groups of nurses at a Veterans Affairs medical intensive care unit were recorded, transcribed, and qualitatively analyzed by using the constant comparative method. RESULTS Thirty critical care nurses participated in 6 focus groups. Three major themes describing nurses' involvement in family meetings were identified: nurses can play multiple roles in supporting conduct in family meetings, nurses face critical barriers to fully realizing these roles, and nurses end up as intermediaries in family meetings. Subthemes pertained to being well positioned to act as the patient's advocate, yet feeling undervalued and underempowered to contribute important information in family meetings, often resulting in mixed messages about care preferences, prognosis, or goals of care that nurses did not feel able to address during the meeting. CONCLUSION Nurses are positioned to play essential roles in family meetings, but their full involvement remains unrealized. Communication training and greater attention to nurses' empowerment and to facilitating the nurse-physician relationship in the context of family meetings most likely would increase appropriate involvement of nurses in the meetings.