title: Nurses as Intermediaries: How Critical Care Nurses Perceive Their Role in Family Meetings.
abstract: BACKGROUND
  Nurses' involvement in family meetings in the intensive care unit is central to supporting consistent communication and shared understanding within the care team and with patients and patients' family members. Evidence suggests the existence of major barriers to the effective participation and contribution of nurses during family meetings.
  
  
  OBJECTIVE
  To characterize the nature and extent of nurses' involvement in family meetings in the intensive care unit, including identifying barriers to nurses' participation and opportunities for involvement.
  
  
  METHODS
  Meetings with focus groups of nurses at a Veterans Affairs medical intensive care unit were recorded, transcribed, and qualitatively analyzed by using the constant comparative method.
  
  
  RESULTS
  Thirty critical care nurses participated in 6 focus groups. Three major themes describing nurses' involvement in family meetings were identified: nurses can play multiple roles in supporting conduct in family meetings, nurses face critical barriers to fully realizing these roles, and nurses end up as intermediaries in family meetings. Subthemes pertained to being well positioned to act as the patient's advocate, yet feeling undervalued and underempowered to contribute important information in family meetings, often resulting in mixed messages about care preferences, prognosis, or goals of care that nurses did not feel able to address during the meeting.
  
  
  CONCLUSIONS
  Nurses are positioned to play essential roles in family meetings, but their full involvement remains unrealized. Communication training and greater attention to nurses' empowerment and to facilitating the nurse-physician relationship in the context of family meetings most likely would increase appropriate involvement of nurses in the meetings.
authors.affiliation: Sangeeta C. Ahluwalia is a policy researcher, RAND Corporation, Santa Monica, California, and an adjunct assistant professor, Fielding School of Public Health, University of California Los Angeles. Hannah Schreibeis-Baum is a health science specialist, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California. Thomas J. Prendergast is a clinical professor of medicine, Oregon Health Sciences University, and section chief, Pulmonary and Critical Care Medicine, Portland Veterans Affairs Medical Center, Portland Oregon. Lynn F. Reinke is an investigator, Veterans Affairs Puget Sound Healthcare System, and a clinical associate professor, University of Washington School of Nursing, Seattle, Washington. Karl A. Lorenz is a core investigator and staff clinician, Veterans Affairs Greater Los Angeles Healthcare System, and an associate professor of medicine, School of Medicine, University of California Los Angeles. sahluwal@rand.org.
authors.forename: Sangeeta C
authors.initials: SC
authors.lastname: Ahluwalia
authors.affiliation: Sangeeta C. Ahluwalia is a policy researcher, RAND Corporation, Santa Monica, California, and an adjunct assistant professor, Fielding School of Public Health, University of California Los Angeles. Hannah Schreibeis-Baum is a health science specialist, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California. Thomas J. Prendergast is a clinical professor of medicine, Oregon Health Sciences University, and section chief, Pulmonary and Critical Care Medicine, Portland Veterans Affairs Medical Center, Portland Oregon. Lynn F. Reinke is an investigator, Veterans Affairs Puget Sound Healthcare System, and a clinical associate professor, University of Washington School of Nursing, Seattle, Washington. Karl A. Lorenz is a core investigator and staff clinician, Veterans Affairs Greater Los Angeles Healthcare System, and an associate professor of medicine, School of Medicine, University of California Los Angeles.
authors.forename: Hannah
authors.initials: H
authors.lastname: Schreibeis-Baum
authors.affiliation: Sangeeta C. Ahluwalia is a policy researcher, RAND Corporation, Santa Monica, California, and an adjunct assistant professor, Fielding School of Public Health, University of California Los Angeles. Hannah Schreibeis-Baum is a health science specialist, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California. Thomas J. Prendergast is a clinical professor of medicine, Oregon Health Sciences University, and section chief, Pulmonary and Critical Care Medicine, Portland Veterans Affairs Medical Center, Portland Oregon. Lynn F. Reinke is an investigator, Veterans Affairs Puget Sound Healthcare System, and a clinical associate professor, University of Washington School of Nursing, Seattle, Washington. Karl A. Lorenz is a core investigator and staff clinician, Veterans Affairs Greater Los Angeles Healthcare System, and an associate professor of medicine, School of Medicine, University of California Los Angeles.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Prendergast
authors.affiliation: Sangeeta C. Ahluwalia is a policy researcher, RAND Corporation, Santa Monica, California, and an adjunct assistant professor, Fielding School of Public Health, University of California Los Angeles. Hannah Schreibeis-Baum is a health science specialist, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California. Thomas J. Prendergast is a clinical professor of medicine, Oregon Health Sciences University, and section chief, Pulmonary and Critical Care Medicine, Portland Veterans Affairs Medical Center, Portland Oregon. Lynn F. Reinke is an investigator, Veterans Affairs Puget Sound Healthcare System, and a clinical associate professor, University of Washington School of Nursing, Seattle, Washington. Karl A. Lorenz is a core investigator and staff clinician, Veterans Affairs Greater Los Angeles Healthcare System, and an associate professor of medicine, School of Medicine, University of California Los Angeles.
authors.forename: Lynn F
authors.initials: LF
authors.lastname: Reinke
authors.affiliation: Sangeeta C. Ahluwalia is a policy researcher, RAND Corporation, Santa Monica, California, and an adjunct assistant professor, Fielding School of Public Health, University of California Los Angeles. Hannah Schreibeis-Baum is a health science specialist, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California. Thomas J. Prendergast is a clinical professor of medicine, Oregon Health Sciences University, and section chief, Pulmonary and Critical Care Medicine, Portland Veterans Affairs Medical Center, Portland Oregon. Lynn F. Reinke is an investigator, Veterans Affairs Puget Sound Healthcare System, and a clinical associate professor, University of Washington School of Nursing, Seattle, Washington. Karl A. Lorenz is a core investigator and staff clinician, Veterans Affairs Greater Los Angeles Healthcare System, and an associate professor of medicine, School of Medicine, University of California Los Angeles.
authors.forename: Karl A
authors.initials: KA
authors.lastname: Lorenz
mesh_terms: D003142:Communication; D064648:Critical Care Nursing; D003430:Cross-Sectional Studies; D017144:Focus Groups; D006126:Group Processes; D006801:Humans; D007362:Intensive Care Units; D024802:Nurse's Role / Q000523:psychology; D010344:Patient Advocacy; D010465:Perception; D019555:Physician-Nurse Relations; D011209:Power, Psychological; D011368:Professional-Family Relations; D036301:Qualitative Research