Relationships among Climate of Care, Nursing Family Care and Family Well-being in ICUs. Nurs Ethics 2019;26(7-8):2494-2510
Date
03/06/2019Pubmed ID
30832534DOI
10.1177/0969733019826396Scopus ID
2-s2.0-85062441751 (requires institutional sign-in at Scopus site) 18 CitationsAbstract
BACKGROUND: Frequent exposure to ethical conflict and a perceived lack of organizational support to address ethical conflict may negatively influence nursing family care in the intensive care unit.
RESEARCH AIMS: The specific aims of this study were to determine: (1) if intensive care unit climate of care variables (ethical conflict, organizational resources for ethical conflict, and nurse burnout) were predictive of nursing family care and family wellbeing and (2) direct and indirect effects of the climate of care on the quality of nursing family care and family wellbeing.
RESEARCH DESIGN: A cross-sectional, correlational design was used.
PARTICIPANTS AND RESEARCH CONTEXT: Convenience sample of 111 nurses and 44 family members from five intensive care units at a Midwest hospital in the United States.
INSTRUMENTS: The Ethical Conflict Questionnaire-Critical Care Version, Maslach Burnout Inventory-Human Services Survey and Hospital Ethical Climate Scale were used to measure climate of care. The Family-Centered Care-Adult Version and Nurse Provided Family Social Support Scale were family measures of the quality of nursing family care. The Family Wellbeing Index was used to measure family wellbeing.
DATA ANALYSIS: Hierarchical regression and mediation analysis were used to answer the study aims.
ETHICAL CONSIDERATIONS: The study was approved by the Institutional Review Board at the study site.
FINDINGS: In separate regression models, organizational resources for ethical conflict (β = .401, p = .006) and depersonalization (β = -.511, p = .006), a component of burnout, were significant predictors of family-centered care. In simple mediation analysis the relationship between organizational resources for ethical conflict and family-centered care was mediated by depersonalization (β = .341, 95% confidence interval (.015, .707)).
DISCUSSION: Inadequate organizational resources and depersonalization may be related to family care delivery, and present obstacles to family-centered care in the intensive care unit.
CONCLUSION: Further research to explicate the relationships among organizational resources, ethical conflict, burnout, and family-centered care is needed to guide the development of effective interventions that enhance the quality of nursing family care in the intensive care unit.
Author List
McAndrew NS, Schiffman R, Leske JAuthors
Natalie McAndrew PhD, RN, ACNS-BC, CCRN Assistant Professor in the College of Nursing department at University of Wisconsin - MilwaukeeRachel Schiffman BS,MS,PhD Associate Dean for Research in the College of Nursing department at University of Wisconsin - Milwaukee
MESH terms used to index this publication - Major topics in bold
AdultAttitude of Health Personnel
Cross-Sectional Studies
Family Health
Family Relations
Female
Humans
Intensive Care Units
Job Satisfaction
Male
Middle Aged
Nursing Care
Organizational Culture
Surveys and Questionnaires
Wisconsin
