Critical Conversations: Navigating Nurse-Family Communication in the ICU

Introduction: The high-acuity, fast-paced nature of Intensive Care Units (ICUs) demands clear and effective communication. While prior research has focused on interprofessional communication, communication between nurses and family members, who often play key roles in patient care, remains underexplored. National data report high satisfaction with patient-provider communication, yet up to 30% of ICU family members express dissatisfaction, signaling a need for improvement. This study investigates nurse-family communication methods, perceived challenges, and potential improvements in ICU settings.


Methods: We conducted semi-structured interviews with 18 ICU nurses across three major hospitals in Texas. Interviews focused on four domains: nurses’ perceptions of family members’ situational awareness, their communication experiences, barriers and solutions to effective communication, and the impact of emotional distress on both nurses and families.


Results: Only 11% of nurses believed family members had good awareness of patient status; 72.2% said it varied, and 16.7% said family members were generally unaware. Influencing factors included health literacy (61.1%), family engagement (55.6%), and provider communication (38.9%). Nearly all nurses (94.4%) said communication served primarily to inform, with just 5.6% emphasizing emotional comfort. Communication frequency varied, with 55.6% of nurses initiating contact. Regarding training, 22.2% had none, 55.6% had informal exposure, and 22.2% received formal training. One-third lacked defined communication methods. Reported barriers included limited family presence, inconsistent messaging among relatives, language and literacy gaps, heavy workloads, and emotional strain. Suggested improvements included assigning a primary family contact, using simplified language, scheduled updates, interpreter services, and emotional support resources.


Conclusions: ICUs require structured, empathetic communication strategies due to the critical nature of care and complex family dynamics. Findings highlight the need for formal communication training, defined protocols, and support resources to improve nurse-family interactions and enhance the overall ICU experience.