Family engagement as a resilience-building process in adult intensive care: A theory-guided integrative synthesis

Family engagement (FE) is widely endorsed in adult critical care, yet implementation remains inconsistent and insufficiently theorized within health systems.

To develop a theory-guided, systems-oriented conceptualization of FE using the Family Resilience Framework to inform nursing science, leadership, and policy.

A theory-guided integrative synthesis of 52 family studies in intensive care was conducted using Walsh's Family Resilience Framework.

Findings position FE as a systems-level nursing and leadership strategy rather than a discretionary bedside practice. Organizational culture, leadership engagement, and policy structures influenced whether resilience-promoting engagement was sustained or constrained across care settings.

Three interrelated resilience-promoting processes were identified: relational interdependence, co-participation in care, and organizationally mediated connectedness. These aligned with belief systems, communication processes, and organizational patterns. FE was associated with improved communication, trust, and shared decision-making, while leadership, policy infrastructure, and communication culture shaped engagement quality and consistency. FE functioned as a transactional, resilience-building process enacted through interactions among families, clinicians, and healthcare systems.

FE is a system-embedded mechanism through which family resilience is constructed.

This model supports resilience-informed leadership, policy alignment, and equitable family-centered care.