Integrating a family support intervention in intensive care units: A mixed-methods summative evaluation with health professionals

Background: Effective integration of family-focused nurse interventions in critical care is crucial for improving quality of family care, reducing family distress, and mitigating adverse long-term health outcomes. However, knowledge on how to effectively integrate these interventions in dynamic settings, such as intensive care units, remains underexplored. This study addresses this knowledge gap by examining the implementation of a nurse-led, multi-component family support intervention, which was introduced using a tailored implementation strategy as part of the Family in Intensive Care UnitS (FICUS®) cluster-randomized trial. It aims to evaluate the integration from health professionals' perspective and to understand how implementation outcomes are associated with the intervention's integration and clinical benefit. Methods: A Normalization Process Theory-guided, multi-center, mixed-methods study was conducted in eight Swiss adult intensive care units. All health professionals (n = 518) were invited at the end of the active 18-month implementation period (September 2023 to April 2024) to complete an online survey, which included the German version of the Normalization MeAsure Development questionnaire and measures of the family support interventions' acceptability, appropriateness, feasibility, benefit, and sustainability. Eight focus group interviews (6–11 health professionals each) were conducted. Ten regression models were performed using mixed linear effects and logistic models to determine associations between implementation outcomes (acceptance, appropriateness, feasibility), integration (normalization, sustainability) and benefit for families, patients, team collaboration and individual work. Qualitative content analysis was used to identify themes regarding health professionals' perceptions of implementation. Findings: A total of 228 participants (44 %) completed the survey, 64 were interviewed. The level of intervention normalization was high and associated with its acceptability, appropriateness, feasibility and perceived benefit for families and health professionals (p < 0.05). While feasibility predicted integration, conceptualized as normalization and perceived sustainability (p < 0.001), the benefit for teams and families was predicted by the family support intervention's acceptability and appropriateness (p < 0.05). Key facilitators for integration were clear roles, structured workflows, and team engagement. Overall, the family support intervention was valued for supporting families and strengthening team collaboration. Conclusion: Study findings demonstrate that the nurse-led family support intervention is acceptable, appropriate, feasible and beneficial from the perspective of health professionals. Further research is needed on how to best scale and integrate this intervention across an entire health system.