Exploring Implementation Processes of a Multicomponent Family Support Intervention in Intensive Care Units (FICUS)...

Area of Science:

• Critical Care Medicine
• Health Services Research
• Implementation Science

Background:

• Implementing family-centered care in adult intensive care units (ICUs) is crucial for improving patient and family experiences.
• The Family Support Intervention (FSI) was developed to enhance family support within the FICUS trial.
• Process evaluations are essential for understanding the complexities of implementing new interventions in clinical settings.

Purpose of the Study:

• To evaluate the implementation process and progress of the FSI in Swiss ICUs.
• To identify facilitators and barriers to the integration of the FSI into routine ICU care.
• To understand different adoption pathways of the FSI.

Main Methods:

• A mixed-methods process evaluation using a multiple case study design.
• Normalisation Process Theory guided the evaluation framework.
• Qualitative interviews and psychometric questionnaires were administered to 40 ICU key clinical partners across eight ICUs.

Main Results:

• The FSI demonstrated overall desired integration progress with high acceptability and appropriateness.
• Feasibility scores were moderate to high, with study-related barriers (clinical trial context) and implementation barriers (limited family nurse capacity, clinician attitudes) identified.
• Leadership support and interprofessional collaboration acted as key facilitators, leading to two distinct implementation pathways: early and protracted adopters.

Conclusions:

• Implementation feasibility was influenced by the need for standardization within the clinical trial context.
• Successful FSI implementation is contingent upon an interprofessional culture of family care, adequate resources (staff, time), and strong leadership support.
• Findings offer valuable insights for optimizing the implementation of complex health interventions in critical care settings.