title: Nurses' communication with families in the intensive care unit - a literature review.
abstract: OBJECTIVE
  This review examined the literature across 12 years that explored nurses' perceptions of their role when communicating with families in adult intensive care units (ICUs). The objectives were: (1) to describe how ICU nurses facilitated communication with families; (2) the perceived barriers to that communication; (3) strategies to improve their skills.
  
  
  BACKGROUND
  Evidence demonstrates that effective communication by health care providers can improve families' understanding of their situation and decrease their psychological burden. The continuous presence of ICU nurses, combined with the use of effective empathic communication skills, can impact on families' ICU experience in a positive way. Nevertheless, research continues to demonstrate that communication with families in ICU is inadequate and of poor quality.
  Eight databases were systematically searched to identify peer reviewed studies published in English between 2002 and 2014. The results are presented via a thematic literature review.
  
  
  RESULTS
  Four major themes emerged from a synthesis of the review findings: 'Nurses as information and communication facilitators', 'Nurses as family support providers', 'Nurses' non-supportive behaviours' and 'Improving nurses' communication skills'.
  
  
  CONCLUSIONS
  Most ICU nurses considered communicating with families a vital part of their role, and described supportive behaviours. However, they perceived significant barriers to effective communication; some as a result of active decisions on their part, and some beyond their control. These barriers often resulted in nurses believing that families received suboptimal information and support. Peer support and formal training were identified as key strategies to overcome inadequacies.
  
  
  CONCLUSIONS
  This review summarizes nurses' perceptions of the means and barriers for communicating with families in ICUs. Intensive care nurses need skills and knowledge in how to communicate effectively with families. This skill can be learnt formally, or acquired from role modelling of more experienced peers.
authors.affiliation: MNg, University Hospital of Northern Norway, Intensiv avdeling, 9038 Tromsø, Norway.
authors.forename: Amn
authors.initials: A
authors.lastname: Adams
authors.affiliation: School of Nursing and Midwifery, Flinders University, Adelaide, GPO Box 2100, Adelaide, South Australia, Australia.
authors.forename: T
authors.initials: T
authors.lastname: Mannix
authors.affiliation: School of Nursing and Midwifery, Flinders University, Adelaide, GPO Box 2100, Adelaide, South Australia, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Harrington
mesh_terms: D003142:Communication; D064648:Critical Care Nursing / Q000379:methods*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D008297:Male; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D011368:Professional-Family Relations; D058996:Quality Improvement
keywords: Communication in ITU/CCU; Family care in critical care; Family-centred care; Intensive care nursing; Psychological support for patients/carers; Role of health care professionals