“It’s all about setting the stage.” The nurse facilitator trial: perceived outcomes and implementation issues. A qualitative study among ICU clinicians and nurse facilitators

• Published in: Intensive care medicine Vol. 50; no. 10; pp. 1657 - 1667
• Main Authors: Renet, Anne, Azoulay, Elie, Reignier, Jean, Cariou, Alain, Renault, Anne, Huet, Olivier, Pochard, Frédéric, Engelberg, Ruth A., Kentish-Barnes, Nancy
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2024; Springer Nature B.V
• Subjects: Adult; Anesthesiology; Attitude of Health Personnel; Communication; Content analysis; Continuity of care; Critical Care Medicine; Decision making; Emergency Medicine; Families & family life; Female; France; Humans; Intensive; Intensive care; Intensive Care Units - organization & administration; Interviews as Topic - methods; Male; Medicine; Medicine & Public Health; Middle Aged; NCT; NCT04133753; Nurse specialists; Original; Pain Medicine; Pediatrics; Pneumology/Respiratory System; Qualitative Research; Teams; France; Communication facilitator; Qualitative research; Intervention implementation
• ISSN: 0342-4642; 1432-1238; 1432-1238
• DOI: 10.1007/s00134-024-07589-z

Purpose For the first time in France, a randomised controlled trial was conducted to evaluate the impact of a nurse facilitator on family psychological symptoms. We sought to explore the implementation of the intervention, how it was experienced by clinicians, as well as the barriers and facilitators to implementing the change. Methods We conducted qualitative semi-structured interviews with intensive care unit (ICU) clinicians and facilitators involved in the trial. Interview questions focused on participants’ perceptions of the intervention and its outcomes, including the effect of the intervention on patients, families and the health care team, and barriers and facilitators to its implementation. Interviews were conducted by two social science researchers, audio recorded, transcribed, and analyzed using thematic content analysis. Results Twenty-three clinicians were interviewed from the five participating ICUs. Three themes emerged, capturing clinicians’ perspectives on implementing the intervention: (1) improved communication and enhanced care for families and the ICU team, albeit with some associated risks; (2) active listening and support, both for families and ICU clinicians but with certain limitations; (3) barriers to implementation including lack of organizational readiness, exclusion of under-represented groups, and facilitator challenges including role ambiguity and the need for role support. Conclusion Participants believed the facilitator intervention potentially improved families’ experience. However, they also highlighted emotional difficulties and tensions with some members of the participating teams, due to competing territories and ambiguous role definitions. Facilitators' failure to affect decision-making suggests their role in enhancing goal-concordant care was inadequate within the setting.