Barriers and Practices of Intensivists and Nurses in Family Conferences and Ethical Climate in Intensive Care Units

Introduction: The death of a patient can cause families long-term psychological effects. Providing high-quality family conferences (FCs) and fostering an ethical climate are essential to reduce the psychological burden on patients, families, and health care professionals. Aim: To clarify the barriers and practices regarding FCs and the ethical climate in the intensive care unit (ICU) from the perspectives of intensivists and nurses. Methods: We conducted interviews based on an interview guide and analyzed the narrative data of participants using thematic analysis. Participants were intensivists and nurses working in ICUs in Japan who had experience in ICU practice and were involved in FCs. Results: Core themes of lack of communication, lack of education, climate where it is difficult to speak up, differences in opinion and thinking among intensivists and attending physicians, differences in opinion and thinking among professions and individuals, and ethical dilemma were found as barriers for physicians and nurses in FCs and the ethical climate in the ICU. For FC and ethical climate related practices of intensivists and nurses in the ICU, core themes were facilitating communication, promoting education, understanding and respect for other professions and individuals, and addressing ethical matters. Conclusions: This study enabled us to organize the barriers and practices of intensivists and nurses in FCs and the ethical climate in ICUs. These results allow us to consider interventions to build better FCs and ethical climate in ICUs, which may contribute to reducing the psychological burden on patients, families, and health care professionals.