Developing a Conceptual Framework of Nurse–Family Communication in the ICU: a Narrative Review

Abstract

Background: Communication between nurses and family members is a fundamental component of family-centered care in intensive care units (ICUs). While previous studies have examined communication practices, barriers, and interventions, limited attention has been given to understanding how family experiences of nurse communication may contribute to theoretical development in critical care nursing. Aim: This review aimed to synthesize evidence on family experiences of communication with nurses in adult ICUs and to identify conceptual dimensions that may inform the development of a theory of nurse–family communication in critical care. Methods: A theory-informed narrative review was conducted using systematic search procedures guided by SANRA recommendations and reported in accordance with relevant PRISMA principles. Literature published between 2015 and 2025 was searched across major healthcare databases. Studies were included if they explored communication between nurses and family members in adult ICU settings. Findings from qualitative, quantitative, and mixed-methods studies were synthesized using thematic narrative analysis to identify recurring concepts and higher-order themes. Results: The synthesis revealed five interconnected dimensions of nurse–family communication: (1) information exchange, (2) emotional presence, (3) trust building, (4) family empowerment, and (5) shared decision-making. Families consistently valued communication that was timely, honest, compassionate, and inclusive. The sequence of these dimensions was derived inductively from recurring patterns across the reviewed studies and represents an interpretive progression from foundational communication processes toward increasingly participatory family involvement. Information exchange provided the basis for understanding; emotional presence addressed families’ relational and emotional needs; these experiences contributed to trust, which facilitated family empowerment and, ultimately, meaningful participation in shared decision-making. The dimensions were considered interconnected and potentially reciprocal rather than strictly linear. Conclusion: Nurse–family communication in critical care extends beyond information delivery and functions as a dynamic relational process that shapes family experiences and outcomes. The proposed conceptual framework provides a foundation for future theory development, empirical testing, and the design of communication-focused interventions aimed at strengthening family-centered critical care nursing.