The research, which combined in-depth qualitative interviews with a quantitative survey of one hundred PICU staff members, set out to address a persistent gap in the evidence base. While the impact of family-centred care in adult intensive care settings is well documented, its holistic value in paediatric intensive care units, particularly in low-resource settings such as Ghana, has remained underexplored. The study adopted a four-phase mixed-methods approach grounded in a qualitative, exploratory, descriptive design. First, a literature review informed the development of a semi-structured interview guide. In the second phase, researchers conducted qualitative exploration among families, nurses, and doctors in the PICU. The third phase involved triangulating and mapping the qualitative findings into a four-point Likert scale survey instrument, and the fourth phase was a descriptive quantitative study among PICU staff, with the data subjected to exploratory principal component analysis to obtain a succinct outcome for confirmation.

The setting for the research was two public tertiary PICUs in Ghana, facilities that serve as referral centres for a range of medical-surgical conditions, including aspiration pneumonia and paediatric emergency traumas. These units are equipped with ventilators, cardiac monitors, and electronic vital sign monitors, and staffed by specialists including paediatric nurses, intensive care nurses, paediatricians, intensive care physicians, and dieticians. The researchers used purposive sampling to recruit participants with relevant expertise and experience. For the qualitative phase, they included PICU staff with more than two years of working experience and families whose critically ill children had been admitted to the PICU for at least three weeks. The qualitative participants differed from those recruited for the quantitative study to ensure data variability.

Data collection unfolded through interviews and surveys. Family interviews were held independently of clinician interviews, although all took place in the same PICU setting using researcher-developed interview guides. Each interview lasted roughly forty-five minutes and was audiotaped in a secure room to maintain privacy and confidentiality. The first author conducted six interviews in each PICU — two nurses, two doctors, and two family members, a father and a mother — supplemented by field notes. For the quantitative phase, a purposive sampling strategy recruited PICU staff via an electronic RedCap survey link, achieving a response rate exceeding ninety-five percent. The audiotapes were transcribed verbatim into English text, and the researchers employed thematic analysis, moving through familiarisation, code creation, theme searching, theme assessment, theme definition and naming, and report writing.

Two major themes emerged from the qualitative data: the perceived family value of family-centred care and the perceived facility value of family-centred care. Within the family value theme, six subthemes crystallised. Participants described how the approach promotes family participation and education on childcare, fosters continuity of care and rehabilitation, builds family cooperation and confidence in paediatric care, creates a triangle of bonding between clinicians, family, and the child, helps manage family psychological stress during child illness, and may shorten the length of hospitalisation for critically ill children. One mother described how staff taught her to feed her child, transforming initial challenges into comfortable competence. A paediatrician noted that educating the family on the child’s condition and the care being given helps the family prepare their mind about the outcome of the care process.

The facility value theme yielded four subthemes. Participants perceived that family-centred care promotes the best outcome for early discharge of the critically ill child, reduces paediatric and child mortality in the ICU, reduces workload in the ICU, and improves information sharing to aid decision-making. Nurses and doctors reported that when families assist with basic caregiving tasks such as feeding, cleaning, changing diapers, and dressing, the workload on healthcare professionals lightens, enabling them to devote more attention to complex clinical functions including resuscitation, monitoring, and drug administration. One mother explained that her presence in the ICU allowed her to assist the nurses by feeding and cleaning her child and notifying staff of any sudden changes in the child’s condition. A paediatrician observed that parents who are updated and involved in the care of their children tend to be very cooperative.

The quantitative phase brought statistical rigour to these perceptions. The one hundred respondents were predominantly female, accounting for sixty-nine percent of the sample, with an average age of 31.93 years and an average of 5.67 years of clinical experience. Most were nurses, comprising eighty-one percent of the sample, with the remainder working in medicine, midwifery, and nutrition. Notably, fifty-eight percent were generalists working in intensive care, with only seven percent being paediatricians, four percent paediatric intensive care nurses, and eight percent paediatric nurses. The respondents expressed favourable impressions of family-centred care’s value, with agreement levels of three or higher on every item in the scale. Most respondents — ninety-five percent or more — agreed with the items measuring the value of family-centred care, indicating favourable experiences across the board.

The psychometric properties of the survey instrument proved robust. Cronbach’s alpha coefficient exceeded 0.82, indicating high internal consistency among the items. The Kaiser–Meyer–Olkin measure of sampling adequacy reached 0.85, well above the 0.65 threshold considered suitable for factor analysis, and Bartlett’s test of sphericity was significant, confirming the data were adequate for the analysis. In the exploratory principal component analysis, only one component was retained according to the scree plot and the eigenvalue greater than one rule. This single component, with an eigenvalue of 3.200, explained 53.337 percent of the total variance, confirming a unidimensional structure for the family-centred care value construct in PICUs. The retained items all loaded above the 0.50 threshold: educating families loaded at 0.744, reducing anxiety at 0.773, promoting bonding at 0.832, promoting recovery at 0.728, providing timely information at 0.665, and reducing workload at 0.619.

The item-level statistics revealed striking consensus among PICU staff. One hundred percent of respondents agreed or strongly agreed that family-centred care practices serve as education for families, especially new families, empowering them to continue appropriate childcare at home after discharge. Ninety-nine percent agreed that such practices reduce anxiety and motivate psychologically stressed families to support and participate in the care of critically ill children. Ninety-nine percent agreed that the practices promote bonding and initiate good parenting for critically ill children. Ninety-four percent agreed that the practices promote early recovery and shorten the length of hospitalisation of children and families in intensive care. Ninety-six percent agreed that family-centred care plays significant roles in providing timely information and resources to support clinical care, and ninety-five percent agreed that the practices reduce workload as families become well involved in the care processes.

The findings from this Ghanaian study resonate with international evidence. Prior research in Denmark found that family-centred care implementation led to the early discharge of newborns from intensive care. Studies in Italian PICUs associated family involvement and support with increased family satisfaction, increased weight gain in preterm children, and enhanced recovery. A study in the Netherlands found that seven of seventeen intervention studies demonstrated significant reductions in ICU stay duration due to effective implementation of family-centred care. The American Academy of Paediatrics has stated that integrating the approach can reduce job-related fatigue among healthcare providers, improve medical record accuracy and completeness, and increase overall job satisfaction. Earlier research in South Africa advocated for implementation in South African PICUs, citing its significant contribution to the development of early parent-infant bonding and attachment with positive long-term psychosocial outcomes.

The researchers acknowledge important limitations. The data came from only two PICUs, which may not be sufficiently representative for generalisation, although triangulation was used to address this constraint. The quantitative stage excluded families, whose inclusion could have added data variability, though family perspectives were more deeply represented in the qualitative phase. No subgroup analysis of perceived value was performed because the dataset was too small for stratification. Differences in role and professional training among the included professionals could have led to variations in how the holistic value of family-centred care was perceived. The researchers recommend that future research apply confirmatory factor analysis to isolate and confirm the holistic value of the approach in their setting and in other contexts with similar characteristics, thereby enabling broader generalisability.

Nevertheless, the implications for policy and practice are substantial. The researchers propose that nurses and doctors should undergo additional in-service training on integrating family-centred care into the PICU setting, and that unit heads could modify the physical set-up to create space for easier integration. They call for structured training modules developed through partnerships between the Nursing and Midwifery Council, academic institutions, and regulatory bodies including the Ghana Health Service, the Ghana College of Nurses and Midwives, the Health Facility Regulatory Authority, and the Ministry of Health. From a healthcare policy standpoint, they argue there is an urgent need to develop regulatory guidelines and infrastructure standards, including designing PICUs with dedicated family spaces, privacy for special cases, and protocols for active family participation in clinical discussions. In resource-constrained environments, they suggest, family-centred care can catalyse the redistribution of caregiving responsibilities, reducing the strain on overburdened ICU nurses and doctors while improving workflow and quality of care for the most vulnerable patients in the health system.

Subject of Research: Perceived holistic value of family-centred care in Ghanaian paediatric intensive care units

Article Title: Evaluating the Holistic Value of Family‐Centred Care in Paediatric Intensive Care Units: A Mixed Methods Study

Article References: Abukari, A. S., Schmollgruber, S., & Korsah, E. K. (2026). Evaluating the Holistic Value of Family‐Centred Care in Paediatric Intensive Care Units: A Mixed Methods Study. Nursing Open, 13(10), Article e70752. https://doi.org/10.1002/nop2.70752

Image Credits: AI Generated

DOI: 10.1002/nop2.70752

Keywords: family-centred care, paediatric intensive care, Ghana, mixed methods, principal component analysis, parental anxiety, nursing workload, child health, low-resource settings, qualitative research, PICU, family involvement