Nurse-Family Communication During and After Family Meetings in the Intensive Care Unit.

PURPOSE: To explore nurse-family communication during and after family meetings.

DESIGN: A cross-sectional study in which 36 family meetings were audio-recorded in two intensive care units in an urban, community hospital.

METHODS: Data were analyzed using conversation analysis, a qualitative method.

FINDINGS: Nurses spoke during 10 (28%) of the family meetings. During the family meetings, nurses mostly self-selected to take a turn by interrupting a physician or family member, finishing their sentences, responding to questions, and, in one instance, asking a question. Nurses were mostly selected as the next speaker to address logistical issues, but were also asked questions. Most of nurses' turns were short and simple, and aimed to provide clarification, reassurance, and information regarding the patient's status. Immediately after the family meetings, nurses offered to provide family members clarification or gestures of empathy, but these offers were met with resistance from family members.

CONCLUSIONS: Despite calls for nurses to take a more active role in surrogate decision making, nurses minimally participated during family meetings. Empowering nurses to share their expertise is one solution for nurses to contribute during family meetings. Further research is needed to explore nurse-family bedside interactions to improve our understanding of the nurse's role in the surrogate decision-making process.

CLINICAL RELEVANCE: Findings from this exploration of nurse communication during and after family meetings can inform how nurses may best assist families during surrogate decision making in the intensive care unit.