The development of family resilience in intensive care unit settings: A grounded theory study integrating perspectives of healthcare professionals and families

BACKGROUND: Families of intensive care unit (ICU) patients face significant crises during their relatives' critical illness. Family resilience plays a vital role in overcoming these challenges, yet theoretical frameworks for ICU family resilience remain understudied, limiting clinical interventions. OBJECTIVES: The objectives of this study were to explore the development of family resilience in ICU settings from the perspectives of healthcare professionals and families and to construct a theoretical framework. DESIGN: A grounded theory study was conducted using Glaser and Strauss' traditional approach. SETTINGS: The study was conducted in 10 ICUs across nine provinces/municipalities in China, including Beijing, Liaoning, Shandong, Zhejiang, Sichuan, Chongqing, Xizang, Hainan, and Guangdong, representing diverse geographical and cultural regions. PARTICIPANTS: Data were collected from 21 ICU healthcare professionals (seven physicians and 14 nurses) and 36 members of 14 patient families. Healthcare professionals had 3-25 y of ICU experience. METHODS: Data were collected via in-depth or focus group interviews (both face-to-face and telephone). The constant comparative method was applied simultaneously to data from both groups to develop an integrated theoretical framework. RESULTS: The core issue identified was the development of ICU family resilience. There were nine conceptual codes and nine subconceptual codes. The theoretical framework integrates five theoretical codings: conditions (patient illness severity and family characteristics), processes (adaptive behaviour, interactive behaviour, and cultural factors), covariance (disease duration and economic burden), and consequences (adaptation vs. breakdown). Key adaptive behaviours included environmental, psychological, and functional adjustments. Interaction with professionals, patients, and social resources facilitated resilience. Cultural values and regional norms significantly influenced decision-making. CONCLUSION: This study constructs a theoretical framework of ICU family resilience by integrating the complementary perspectives of healthcare professionals and families, modelling the roles of adaptive processes, professional-family interaction, and cultural context. The framework offers a holistic understanding of the phenomenon and has global applicability for guiding family-centred interventions in critical care.