title: Barriers to regaining control within a constructivist grounded theory of family resilience in ICU: Living with uncertainty.
abstract: OBJECTIVE
  To discuss families' experiences of their interactions when a relative is admitted unexpectedly to an Australian intensive care unit.
  
  
  BACKGROUND
  The overwhelming emotions associated with the unexpected admission of a relative to an intensive care unit are often due to the uncertainty surrounding the condition of their critically ill relative. There is limited in-depth understanding of the nature of uncertainty experienced by families in intensive care, and interventions perceived by families to minimise their uncertainty are not well documented. Furthermore, the interrelationships between factors, such as staff-family interactions and the intensive care unit environment, and its influence on families' uncertainty particularly in the context of the Australian healthcare system, are not well delineated.
  
  
  METHODS
  A grounded theory methodology was adopted for the study.
  
  
  METHODS
  Data were collected between 2009-2013, using in-depth interviews with 25 family members of 21 critically ill patients admitted to a metropolitan, tertiary-level intensive care unit in Australia.
  
  
  RESULTS
  This paper describes the families experiences of heightened emotional vulnerability and uncertainty when a relative is admitted unexpectedly to the intensive care unit. Families uncertainty is directly influenced by their emotional state, the foreign environment and perceptions of being 'kept in the dark', as well as the interrelationships between these factors.
  
  
  CONCLUSIONS
  Staff are offered an improved understanding of the barriers to families' ability to regain control, guided by a grounded theory of family resilience in the intensive care unit.
  
  
  CONCLUSIONS
  The findings reveal in-depth understanding of families' uncertainty in intensive care. It suggests that intensive care unit staff need to focus clinical interventions on reducing factors that heighten their uncertainty, while optimising strategies that help alleviate it. Families are facilitated to move beyond feelings of helplessness and loss of control, and cope better with their situation.
authors.affiliation: School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Vic., Australia.
authors.forename: Pauline
authors.identifier: http://orcid.org/0000-0002-6396-0338
authors.initials: P
authors.lastname: Wong
authors.affiliation: School of Science and Health, Western Sydney University, Penrith, NSW, Australia.
authors.forename: Pranee
authors.initials: P
authors.lastname: Liamputtong
authors.affiliation: Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.|University of Sydney Medical School, Hornsby Ku-ring-gai Hospital, NSW, Australia.
authors.forename: Susan
authors.initials: S
authors.lastname: Koch
authors.affiliation: School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Vic., Australia.
authors.forename: Helen
authors.identifier: http://orcid.org/0000-0001-5363-729X
authors.initials: H
authors.lastname: Rawson
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001315:Australia; D003422:Critical Care / Q000523:psychology*; D064648:Critical Care Nursing; D016638:Critical Illness / Q000523:psychology; D005190:Family / Q000523:psychology*; D005260:Female; D066296:Grounded Theory; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D011368:Professional-Family Relations; D013315:Stress, Psychological / Q000523:psychology; D035501:Uncertainty
keywords: critical care; critical care nursing; families; grounded theory; professional-family relations; qualitative studies; uncertainty