title: Factors limiting and facilitating changes in caring for the intensive care unit patients' relatives.
abstract: OBJECTIVE
  To explore how the intensive care unit (ICU) context influenced receptivity to change in clinical practice, in order to improve the care offered to patients' relatives.
  
  
  BACKGROUND
  Families of critically ill patients have unmet needs that are not being addressed. Lack of attention to these needs is related more to the ICU context than to a lack of scientific evidence.
  
  
  METHODS
  Participatory action research (PAR), a qualitative study conducted in a Spanish ICU.
  
  
  METHODS
  Eleven participants agreed to represent their teams in all scheduled group discussions. Field diaries were kept by the principal investigator and discussion participants, and five in-depth interviews were conducted. Content analysis was performed.
  
  
  RESULTS
  Four factors limited change: (1) Not acknowledging the legitimacy of scientific evidence regarding the families of critically ill patients. (2) Imbalanced power relationships between the members of multidisciplinary teams. (3) Lack of nurse participation in the information flows. (4) The organization of time and physical space in the unit. Three factors facilitated change: (1) A sense of individual and shared commitment. (2) Leadership in day-to-day matters. (3) A process based on reflection.
  
  
  CONCLUSIONS
  PAR can lead to change in clinical practice, although the process is complex and requires substantial input of time and energy. Contextual factors limiting this change were structural whereas facilitating factors were circumstantial and depended upon individuals' characteristics. Professionals working at the bedside are capable of identifying, developing and introducing changes to the context in which they work.
  
  
  CONCLUSIONS
  Knowing these factors and sharing the experience of a successful change process can help others design processes appropriate to their site.
authors.affiliation: Department of Nursing and Physiotherapy, Critical Health Research Group, University of Balearic Islands, Palma de Mallorca, Balearic Islands, Spain.
authors.forename: Concha
authors.initials: C
authors.lastname: Zaforteza
authors.forename: Ana
authors.initials: A
authors.lastname: García-Mozo
authors.forename: Sylvia M
authors.initials: SM
authors.lastname: Amorós
authors.forename: Eva
authors.initials: E
authors.lastname: Pérez
authors.forename: Mónica
authors.initials: M
authors.lastname: Maqueda
authors.forename: Joaquina
authors.initials: J
authors.lastname: Delgado
mesh_terms: D003422:Critical Care / Q000379:methods*; D004645:Empathy; D005260:Female; D006302:Health Services Research; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D017063:Outcome Assessment, Health Care; D011368:Professional-Family Relations / Q000941:ethics*; D036301:Qualitative Research; D012944:Social Support; D013030:Spain
keywords: Adult intensive care; Change management; Families; Family centered care; Participatory action research; Relatives