Challenges in Nurse and Informal Caregiver Interactions Across Acute Care Settings: A Qualitative Study

To examine how nurses experience and navigate the emotional and interpersonal demands of working with informal caregivers in acute care settings and to identify opportunities for institutional and policy-level support.

Informal caregivers play an essential role in patient and family-centered care, yet their involvement often creates emotional and relational strain for nurses. Nurses frequently become the primary outlet for caregiver distress while receiving little preparation or organizational support. Limited research has explored these dynamics from the nurse's point of view.

A qualitative descriptive design was used, guided by relational cultural, emotional labor, and organizational role theories. Semi-structured interviews were conducted with registered nurses working in diverse acute care environments. Data were analyzed using reflexive thematic analysis to identify patterns in how nurses interpret and manage caregiver interactions.

Nurses encountered two primary challenges. First, caregiver distress often escalated into hostility or intense emotional expression, creating significant emotional strain and moral tension alongside clinical responsibilities. Second, nurses described persistent ambiguity around caregiver roles, driven by limited training, inconsistent workflows, and the absence of institutional guidance. Nurses used individualized communication strategies, improvised boundaries, and interdisciplinary collaboration to support caregivers and reduce conflict.

Caregiver engagement is a hidden dimension of nursing work that places substantial emotional and relational demands on nurses. These demands reflect systemic gaps rather than isolated interpersonal problems and require structured organizational responses.

Supporting nurses in caregiver engagement requires clearer role expectations, standardized caregiver onboarding, simulation-based communication and de-escalation training, and routine opportunities for reflective debriefing.

Nursing education and hospital policy should formally integrate caregiver engagement into curricula, orientation, and unit protocols. Health policy must include guidance on caregiver roles, workplace safety, and interdisciplinary resources to strengthen family-centered care and reduce the emotional burden on nurses.