Family engagement in intensive care: perceptions, barriers, and facilitators among nurses in Saudi Arabia

BACKGROUND: Family engagement is a core component of patient- and family-centered intensive care. In Saudi Arabia, its implementation is shaped by cultural expectations, resource availability, and the preparedness of nursing staff. Despite its recognized significance, research examining intensive care nurses’ perspectives on family involvement in this context remains limited. AIM: This study examines intensive care nurses’ perceptions of family engagement and identifies factors that facilitate or impede its implementation. METHODS: A descriptive cross-sectional design was utilized across 17 intensive care units in three tertiary hospitals in Western Saudi Arabia. Cluster random sampling was used to select 372 nurses. Data collection involved the Questionnaire on Factors That Influence Family Engagement (QFIFE) (α = 0.70–0.87), which evaluates the ICU environment, patient acuity, workflow, and attitudes. Five open-ended questions were included to further explore nurses’ experiences. Quantitative data were analyzed using SAS, and qualitative data were subjected to content analysis. RESULTS: The participating nurses had a mean age of 36 years. The majority were women (88.7%), ICU-certified (62.5%), and originated from the Philippines, Saudi Arabia, or Malaysia. Overall, nurses reported positive attitudes toward family engagement (mean = 4.0) and perceived their environments as supportive (means 3.8–4.2). Concerns were noted regarding workflow (means 3.3–3.8), and nurses expressed greater caution about family involvement in high-acuity cases (means 2.9–3.4). Nurses with family-nursing training demonstrated greater awareness of relevant policies and perceived more benefits in symptom assessment. Non-ICU-certified nurses were more receptive to family involvement in unstable or life-sustaining situations. Open-ended responses identified facilitators, including patient- and family-centered care, decision-making, staffing, policies, education, and communication. Reported barriers included knowledge and communication gaps, limited time and space, infection-control protocols, and family emotional distress. CONCLUSION: The findings indicate that nurses generally support family engagement; however, they encounter challenges due to heavy workloads, patient acuity, and families’ emotional and psychological needs. Enhancing policies, staffing, and training, in conjunction with culturally sensitive approaches, is essential for establishing family engagement as a safe and sustainable component of intensive care. CLINICAL TRIAL NUMBER: Not applicable.