The visitors' book as a family-centered care tool: A corpus-based, multi-site study on the implementation of a narrative care practice in ICU

Abstract

Objectives: Hospitalization in an Intensive Care Unit (ICU) is a profound disruption of the taken-for-granted flow of everyday life, for both the patient and their relatives. While narrative-based tools to address the patients' traumatic experience in the ICU have been implemented and analyzed, research fails to address ways of dealing with the relatives' experience in order to align with the Patient & Family-Centered Care framework. This study aims to preliminarily observe the narrative-based care practice implemented in three Italian ICUs by means of a visitors' book (VB).

Design: Qualitative study.

Methods: Thematic analysis of a corpus of naturally gathered texts written by inpatients' relatives in the VB.

Results: The semantic analysis, i.e., what relatives write about or refer to in their texts, suggests that the VB is interpreted by users mainly as a way to 1) establish a state of intersubjectivity with the staff, 2) talk into being the disruption they lived as a consequence of ICU hospitalization of a family member, and 3) transform it into an object of thought. The prevalence of references to visitors' experience indexes the users' appropriation of the VB as a family-centered care tool.

Conclusions: The VB demonstrably works as a communicative and relational tool, a reflexivity-enabling device enacting and displaying the ward's orientation toward patient and family-centered care.

Implications for clinical practice: Overcoming the limitations of family-centered care relying only on the staff's individual competences, attitudes, value-orientation, and time constraints, implementing the VB appears to be a sustainable way for the ward to respond to family members' needs.

Keywords: Intensive Care; Narrative-based medicine; Patient and family-centered care; Thematic analysis; Visitors’ book.