Högskolan i Skövde

Background: Family involvement in the intensive care unit (ICU) is recognized as important, yet its implementation is complex and varies across contexts, including Scandinavian settings.

Aim: This integrative review aimed to synthesize and integrate the evidence on family involvement in Scandinavian ICUs across the perspectives of family members, patients, and healthcare professionals. Findings are presented thematically rather than by perspective to capture shared and contrasting dimensions within overarching concepts.

Design: An integrative review was conducted following Whittemore and Knafl's framework.

Methods: A systematic search was conducted in five databases (PubMed, PsycINFO, and CINAHL) covering January 2010–October 2023, with an update in January 2025. A systematic search strategy was applied, and reporting adhered to PRISMA guidelines. Peer-reviewed studies published between 2013 and 2024 in English, Danish, Swedish, or Norwegian were included.

Findings: Fourteen studies met the inclusion criteria: nine qualitative (including one case-oriented) and five cross-sectional surveys. The review highlights the critical role of family involvement in the ICU, emphasizing its positive impact on patient care and family wellbeing. Active participation by family members provides both practical assistance and emotional support, fostering a patient-centred approach that improves patient outcomes. However, integrating families into care also presents significant challenges. Healthcare professionals' attitudes and behaviours, along with institutional policies and resource limitations, strongly influence the experience of family involvement. Families often face emotional stress and uncertainty, which can affect their engagement and lead to varying levels of participation. These findings underscore the need for strategies that balance collaboration with sensitivity to contextual and individual factors.

Conclusions: Family involvement in Scandinavian ICUs is a complex, context-dependent phenomenon shaped by relational, emotional, and organizational factors. It requires healthcare teams to balance challenges with the benefits for patients and families.