ICU nurses’ perceptions of communication with patients’ families : roles, facilitators, and challenges

Abstract

Background: Effective communication between intensive care unit (ICU) nurses and patients’ families is a central element of family-centred care. Families depend on nurses for information, reassurance, and emotional support when patients are critically ill or unable to communicate. Despite its significance, communication in the ICU remains complex and emotionally demanding. Organisational pressures, role ambiguity, and emotional strain often hinder the process. Within the Maltese context, research on nurses’ perceptions remains limited. Aim: This study aimed to explore ICU nurses’ perceptions and experiences of communication with patients’ families, focusing on their perceived roles, facilitators, challenges, and the strategies used to sustain effective and compassionate communication. Design and Methods: A qualitative descriptive design was adopted. Semi-structured interviews were conducted with seven registered ICU nurses were recruited through purposive sampling from a general adult ICU (20 beds) in Malta. Data were analysed thematically using Braun and Clarke’s (2021) framework, and Symbolic Interactionism was employed as an interpretive lens during data analysis to explore how meaning is created and negotiated through everyday communicative exchanges. Findings: Five interconnected themes emerged. Communication as a Strategic and Adaptive Practice describes how nurses adjusted tone, timing, and delivery to meet families’ needs. Emotional Navigation in Clinical Communication emphasises the emotional intensity and the importance of empathy, composure, and self-regulation. Navigating Role Boundaries and Team Dynamics addresses interprofessional overlap and the mediating role nurses take between families and physicians. Structural and Organisational Barriers include time constraints, staffing pressures, and restrictive visitation policies. Lastly, Communication as a Professional and Humanising Practice reflects nurses’ views on compassionate, honest, person-centred communication as essential to preserving trust and connection in care relationships. Conclusion: ICU nurses perceive communication with families as a dynamic, relational, and humanising process that lies at the heart of their professional role. While adaptability, empathy, and teamwork are perceived to enhance communication, organisational and emotional barriers continue to limit its consistency. Structured communication training, interdisciplinary collaboration, and supportive institutional policies are essential to strengthen family-centred care in intensive care settings.