Iran Journal of Nursing

Introduction
The use of family caregivers in providing family-centered care is vital for completing the care and treatment process. Family caregivers are informal caregivers who are usually family members or friends of patients and provide care for the patient daily and support them physically, mentally, and socially, and do not receive any payment for the care they provide. The participation of family caregivers in patient care has a positive impact on patient comfort, communication, increased hope, and reduced anxiety. This participation in patient care is categorized into five areas, ranging from passive to active, including being present at the patient’s bedside, meeting needs, communicating and receiving information, decision-making, and assist in care. The active presence of family caregivers in facilitating the assessment, meeting patient needs, providing training, and completing the care process is important. 
Providing a family-centered care program that meets the needs of patients and families is the main task of the nurse in the intensive care units (ICUs). It is important for nurses to consider the needs of families and involve them in care, and to have a correct perception of their role, which is important for family participation in the ICU patient care. The majority of studies have examined this role from the perspective of family caregivers or have qualitatively examined the experiences of nurses. Only one study used a quantitative method to examine it from the perspective of nurses. There is no study available on the relationship between nurses’ perceptions of their roles towards family caregivers and the factors affecting the participation of family caregivers. Given the important role of family caregivers in completing the treatment or care process, it is necessary to further identify the factors related to the participation of family caregivers of ICU patients. Hence, the present study aimed to survey Iranian nurses’ perceptions of their role towards family caregivers of ICU patients and find the factors affecting the participation of family caregivers in patient care.

Methods
This cross-sectional study was conducted from December 2023 to October 2024. The samples were 150 nurses working in ICUs of hospitals affiliated with Tehran University of Medical Sciences, who had at least one year of experience in providing direct care to patients hospitalized in the ICUs. The nurses were selected using a stratified sampling method. To collect information, three questionnaires were used, including a sociodemographic form, Hickey & Lewandowski’s questionnaire to examine nurses’ role with families, and the Questionnaire on Factors That Influence Family Engagement (QFIFE). The demographic questionnaire recorded variables such as age, gender, marital status, work experience, history of employment in the ICU, employment status (planned, contractual, official), satisfaction with the nursing job, nursing activity score, history of depression and anxiety disorders, and family caregivers’ level of participation (active/inactive). Considering the normal distribution of the data, data analysis was performed using descriptive statistics (mean and standard deviation) and independent t-test, analysis of variance, and Pearson’s correlation test in SPSS v.16 software. All statistical tests were considered significant at P < 0.05.

Results
The nurses participating in the study had a mean age of 34.6±7.88 years, and most of them were female (77.3%) and married (62%). Also, 68.7% had no history of depression, and 67.3% had no history of anxiety disorders. The mean score of nurses’ role with family caregivers was 40.79 ± 6.87 (a moderate perception). The attitude factor obtained the highest score, while the environmental factor obtained the lowest mean score. According to statistical analysis, nurses’ perceptions were significantly different based on family caregivers’ level of participation in patient care (P=0.004). The mean score of family caregivers’ participation in decision-making was significantly higher than that in communication and receiving information. Also, the nurses’ perceptions had a significant positive correlation with age (P=0.004) and nursing work experience (P=0.015). In other words, higher age and work experience improve nurses’ perception of their role with family caregivers. The QFIFE score had no statistically significant relationship with any sociodemographic characteristics, except for the nursing activities, which was a negative correlation (P=0.028). In other words, with increasing nursing activities, the active participation of family caregivers decreases.

Conclusion
According to the findings, the ICU nurses in Tehran have a moderate perception of their roles towards family caregivers. Therefore, they need more motivation and training to improve their perception and meet family needs. Conducting further studies to understand the needs and challenges of family caregivers in Iranian society can be helpful for appropriate planning to address the problems of both family caregivers and patients.

Ethical Considerations

Compliance with ethical guidelines
All ethical principles were considered. The study was approved by the Ethics Committee of Tehran University of Medical Sciences (Code: IR.TUMS.FNM.REC.1403.030).

Funding
This article was extracted from the master’s thesis of Fateme Mahmoudi Lerd, funded by Tehran University of Medical Sciences.

Authors' contributions
Fateme Mahmoudi Lerd: Study design, writing original draft; Elham Navab: writing original draft; Abbas Varvani Farahani: data analysis; Marzieh Sobhani: data collection; Shima Haghani: Data analysis; Mahboubeh Shali: Study design, data analysis, writing original draft. All authors approved the final draft. 

Conflict of interest
 The authors declared no conflict of interest.

Acknowledgments
 The authors would like to thank the Vice-Chancellor for Research of Tehran University of Medical Sciences for providing financial support, and all nurses who participated in this research for their cooperation.




 

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