Family Resilience in the ICU: A Concept Analysis

The concept of family resilience is a promising way to improve families' ability to cope with sudden change. However, there is no consensus in the field of intensive care regarding its definition.

The aim of this concept analysis was to develop a deeper understanding of the phrase 'family resilience in the ICU' within the nursing discipline to facilitate its comprehension, implementation and evaluation.

We performed a comprehensive search of Medline (PubMed), Web of Science, OVID, Embase, CINAHL (EBSCO), CNKI (Chinese), Wangfang (Chinese), VIP (Chinese) and SinoMed (Chinese) with MeSH terms and keywords, including critical care/intensive/ICU, family, resilienc* and hardiness. The inclusion criteria were the subject of family resilience in the intensive care unit (ICU), English or Chinese language, and full text. Walker and Avant's approach was used to analyse the concept.

From the 22 studies selected for this analysis, four main attributes of 'family resilience in the ICU' were identified: the characteristics system, belief system, organisation system and support system. We developed four model cases to illustrate how the concept is operationalised. The concept analysis of 'family resilience in the ICU' identified four antecedents: the relatively unexpected admission of a relative to the ICU, disrupted family order, acute stress and positive response. The analysis also identified four consequences: the development of resilience, the psychology of the family, family adaptation and patient support.

According to the concept analysis, we suggest an operational definition to facilitate the implementation of the concept in practice. Furthermore, we propose that implementation should be guided by the following key ideas: (1) identifying family characteristics, (2) helping families establish correct expectations, (3) providing support to help families regain control, (4) promoting family participation in medical decision-making and patient care, and (5) encouraging families to access external resources.

This concept analysis of family resilience in the ICU will advance healthcare professionals' understanding and knowledge and encourage them to pay more attention to patients' families. It can also prepare and educate healthcare professionals to develop policies and guidance to increase family resilience in ICU settings.