Crucial conversations: Perceptions of staff and patients' families of communication in an intensive care unit

The purpose of this study was to answer the question What are the challenges to communication in an intensive care unit (ICU) between staff members (including physicians) and ICU patient family members? My goal was to understand the aids and barriers to communication in this difficult setting. This qualitative study sought to increase understanding of the factors that contribute or detract from effective communication between ICU staff members, and between ICU staff members and families.;This study applied grounded theory methodology through the use of observations and in-depth interviews to learn what difficulties ICU staff encounter when they communicate with families and with one another and to learn what helps or hinders families' understanding of the ICU communication process.;The purposefully selected sample was comprised of 11 ICU staff members, 4 ICU physicians, 1 patient and 9 ICU patient family members. Three categories: (a) adaptation, (b), organizational culture, and (c) collaboration, emerged from the data as influential to 1 the ICU communication process. Based on these findings, two broad based conclusions are presented: (1) Family members of patients hospitalized in the ICU have physical and psychosocial needs that must be addressed in order for them to feel that they can effectively represent their loved one. (2) Intensive care unit staff work under difficult, stressful conditions to provide the best possible care for critically ill patients. ICU staff members understand and embrace the interdisciplinary approach to ICU medicine, but find it difficult to collaborate effectively with each other.;Recommendations are offered for hospital administration and intensive care unit management, for ICU staff, for educators, and for those interested in conducting further research.