This study employs a qualitative phenomenological approach to explore the perceptions of healthcare professionals and patients in the Intensive Care Unit (ICU) toward the family-centered visitation system. The perspectives of physicians, nurses, patients, and their families are shaped by their distinct cultural backgrounds, traditions, family environments, and socioeconomic circumstances. It is therefore essential for participants to articulate their own views and lived experiences, necessitating that the researcher engage deeply with them to understand these firsthand accounts.

A purposive sampling technique was used to recruit doctors, nurses, patients, and family members from a tertiary care hospital in Lanzhou City between January and June 2024. Following approval from the Ethics Committee of [REDACTED], the researcher communicated the study objectives and significance to potential participants. Individuals who voluntarily agreed to participate were selected, and their informed consent was obtained prior to data collection.

The sample size was determined in accordance with the principle of data saturation, a common criterion in qualitative research. Saturation refers to the point at which data collection ceases, when no new information or emergent themes are identified in subsequent interviews.

A semi-structured interview guide (see Appendix) was utilized for data collection during in-person interviews. The guide was developed by the research team based on the study objectives and a comprehensive review of relevant domestic and international literature. The initial version was refined through consultations with experts in qualitative nursing research and was subsequently piloted with three individuals from each stakeholder group (physicians, nurses, patients, and family caregivers). The final guide was adjusted based on insights from this pilot phase.

All interviews were conducted by graduate students formally trained in qualitative research methods, assisted by research assistants tasked with documenting non-verbal cues (e.g., tone of voice, facial expressions, body language). Prior to each interview, written informed consent was obtained. Sessions were audio-recorded in their entirety using iFlytek recording software.

Each interview session commenced with a brief overview of the study background. The conversation then followed the semi-structured guide, allowing flexibility for probing and follow-up questions. To ensure privacy and an environment conducive to open discussion, all interviews were conducted in quiet, private consultation rooms. Each participant was interviewed once, with sessions lasting between 30 and 50 min (mean duration: 35 min).

Data analysis adhered to Colaizzi’s seven-step phenomenological method. All interview recordings were transcribed verbatim within 24 h, with contextual annotations added during transcription. The textual data were then imported into NVivo 14.0 software to facilitate systematic management and analysis. The analytical procedure included the following steps:

This study received ethical approval from the Ethics Committee of the Lanzhou University School of Nursing (Ethics Code: LZUHLXY20200015). Prior to each interview, written informed consent was obtained from all participants after a detailed explanation of the study’s purpose and procedures. Participants were explicitly informed of the voluntary nature of their involvement and their right to withdraw at any time without affecting their clinical care.

It was acknowledged that the primary interviewer’s dual role as an ICU nurse could introduce bias, due to her pre-existing professional relationships and the inherent power dynamics with fellow nurses, patients, and their families. The study incorporated specific strategies in its design to mitigate these risks. At the outset of each interview, the interviewer explicitly clarified her role as a “researcher” distinct from a “care provider,” ensured confidentiality, and emphasized that their responses would not influence their clinical treatment. Accordingly, the interviews were structured to focus solely on listening to and understanding participants’ personal experiences and perspectives, without any form of clinical assessment.

Furthermore, to ensure analytical rigor and minimize individual bias, the research team held regular collaborative discussions during the data analysis phase. These discussions aimed to critically examine emerging interpretations, ensuring that the findings were grounded in the data and not merely reflective of the interviewer’s pre-existing clinical assumptions.

Thematic analysis was conducted, informed by the core principles of patient- and family-centered care, to analyze the data and synthesize themes. This process culminated in the identification of three primary themes and eleven corresponding sub-themes, which are presented in Table 1.

All participants emphasized the need to uphold the fundamental rights of patients and their families, protect patient privacy, and gain a thorough understanding of the patient’s family dynamics, needs, values, beliefs, and cultural background before implementing family-centered visitation. Both patients and family members unanimously expressed support for extending visiting hours. As Participant F5 stated, “I think twice a day would be ideal—once in the morning and once in the afternoon, with each visit lasting 20 to 30 min.” Similarly, Participant P6 shared, “When I’m awake, there is no one to talk to. I look forward to the short afternoon visits every day and hope visiting hours can be extended so I can spend more time with my family.”

Six interviewees commented on the physical environment and layout of the ICU. Participant D1 noted, “Single-room units could be considered for implementing family-centered visitation, as they help ensure patient privacy and may improve the prevention of nosocomial infections.” Participant N4 suggested, “A disinfection area could be set up before entering the room to allow thorough head-to-toe disinfection, enabling family members to have direct contact with the patient.” Participant N16 proposed, “A family rest area could be established near the ward entrance, equipped with health education materials to serve as a channel for health knowledge dissemination.”

All respondents advocated for incorporating social support—from relatives, friends, peers, counseling services, and hospice care—into the family-centered visitation model. Participant P5 stated, “I wish my family could stay with me longer. Their care and support strengthen my confidence in recovery.” Participant D2 emphasized, “Patients need support not only from family members but also from healthcare professionals. Discussing the condition during visits can aid recovery.” Participant N7 added, “Patients and families may experience psychological distress such as anxiety and depression after ICU discharge. Providing psychological support can help mitigate such distress.”

All interviewees acknowledged the importance of palliative care support. Participant N3 observed, “Currently, there is limited emphasis on palliative care in clinical practice. Given the high mortality rate in the ICU, integrating palliative care into ICU settings will undoubtedly be a future direction of development.”

The rapid advancement of information technology has introduced “big data” into healthcare, facilitating the development of intelligent, multifunctional, and multi-platform information delivery systems for clinical communication. All participants expressed a desire for access to patient information through multiple channels and diverse methods.

Three interviewees raised the idea of an ICU diary. Participant N9 noted, “An ICU diary could record information not directly observable by families, offering them an alternative way to understand the patient’s condition.” Participant D5 commented, “Maintaining an ICU diary for long-stay patients represents a humanized approach. Documenting the patient’s daily progress through photos and narratives can enhance the patient’s confidence in recovery and allow the family to perceive the hospital’s compassion.”

The designation of a family coordinator was highlighted as a key factor in ensuring effective information sharing. Participant D4 stated, “If families are to be deeply involved, a primary caregiver should be designated. Learning to care for a patient takes time, and frequent changes in family caregivers would hinder communication.” Participant D8 added, “Having a primary caregiver allows for targeted training and guided involvement, which also facilitates the patient’s early rehabilitation.”

Several participants indicated that traditional methods of explaining medical conditions remain the primary channel for conveying patient information to families, and that family meetings continue to be the main format for such communication. Participant D9 noted, “The most ideal and effective communication method remains direct conversation with the physician. Although electronic platforms provide families with test results and other information, they often cannot interpret these findings and may turn to online sources, where inconsistent information can heighten anxiety. Family meetings remain an essential communication mechanism.” Participant N10 added, “After each family visit, numerous questions tend to arise. We consistently recommend that families communicate directly with the attending physician.”

All participants provided insights into family involvement in family-centered care. Seven healthcare professionals noted that family members could appropriately assist with activities of daily living (ADL) care, as opposed to specialized clinical procedures. As Participant N15 explained, “I believe family members could assist with ADL such as shampooing, massaging, and sponge bathing. This can help avoid patient embarrassment while allowing them to feel cared for by their relatives.” Participant D5 remarked, “Early mobilization is currently a key focus in clinical research. Guiding patients to get out of bed can reduce ICU length of stay and promote recovery. Under the guidance of medical staff, encouraging primary caregivers to participate in early mobilization is crucial.” Participant F5 expressed, “Being able to do something for the patient is also a comfort to us as family members.” Participant P9 noted, “I would like my family to be involved in care activities, as this allows more time together and enables them to learn some care skills.” Participant D4 emphasized, “For families to participate effectively, relevant training must first be provided through education and guidance. Only when family members possess certain care competencies can family-centered care be fully implemented.”

Regarding family involvement in rounds, crisis management, and shared decision-making, most participants considered it moderately feasible and important. Participant D2 commented, “We use professional terminology during rounds that families may not understand. Having families present could make us more cautious in our discussions, potentially interfering with the standard rounding protocol.” Participant N4 expressed, “I am uncertain whether every family member has the capacity to assess the patient’s condition. Such differences in perception could potentially exacerbate patient-provider conflicts.” Participant N13 suggested, “If a patient has some medical knowledge, they could be invited to join rounds and participate in shared decision-making.” Participant F1 stated, “Participating in rounds would allow more communication with doctors and provide an additional channel for understanding the patient’s condition.” Participant P8 reflected, “My family lacks medical knowledge. Involving them in rounds and shared decision-making could impose an additional psychological burden on them.”

With the evolution of the medical paradigm, clinical priorities in the Intensive Care Unit (ICU) have expanded beyond a sole focus on patient survival to encompass long-term health outcomes and quality of life. The family-centered visitation model promotes flexible visiting arrangements while being integrated into a structured clinical management framework. This model requires healthcare professionals to develop individualized visitation plans based on patient condition assessments, incorporating the specific needs of both patients and their families. In this process, visitation safety represents an essential prerequisite for the model’s effective implementation.

Internationally, family-centered visitation systems are well-established and have demonstrated efficacy in promoting family involvement in patient care, optimizing resource allocation, improving clinical decision-making, and enhancing satisfaction among patients and families. However, due to differences in national contexts and healthcare systems, certain international practices are not directly applicable to the Chinese setting. Currently, there is a lack of systematic, localized research in China to support the effective implementation of such a model. Therefore, this study aims to explore an ICU visitation system adapted to China’s healthcare environment and cultural background. It seeks to improve the overall quality of life for critically ill patients and their families and to provide an evidence-based foundation for developing relevant policies and practices.

Research on the family-centered care model in China began relatively late. In recent years, domestic studies have primarily focused on visitation models, discharge planning, and hospice care, with most of this research targeting patients in the Neonatal Intensive Care Unit (NICU) or Pediatric Intensive Care Unit (PICU). Domestic studies have shown that involving family members in patient care—assisting with daily living activities and establishing WeChat groups to provide informational support—can effectively reduce the length of ICU stay and the duration of mechanical ventilation for patients (15, 16). Regarding visitation, some domestic researchers have experimented with extending visitation hours in the NICU and guiding family members to participate in daily care activities such as feeding, cleaning, and bathing, as well as in monitoring patient conditions, including nebulization, temperature monitoring, and bowel movements. These interventions have significantly improved family satisfaction (17, 18). However, there is still no systematic application of family-centered care for adult ICU patients in China, and several barriers remain to implementing family-centered care and visitation in domestic settings.

In interviews, healthcare professionals indicated that implementing a family-centered visitation system requires the provision of single-patient rooms to ensure privacy protection. Establishing such rooms is considered effective in reducing the incidence of hospital-acquired infections while providing a comfortable environment for family members (11). It is recommended that units with adequate environmental facilities attempt to implement family-centered visitation and care. Although extensive clinical studies have confirmed that visitation time in the Intensive Care Unit (ICU) is not correlated with the rate of acquired infections (12), healthcare professionals remain concerned about potential increases in ward staffing, which could significantly raise the risk of hospital-acquired infections. Research indicates that the rise in hospital infection rates is primarily attributed to inadequate hand hygiene and insufficient isolation measures (13). Therefore, key strategies for preventing hospital-acquired infections include ensuring that family members wear isolation gowns and follow standard handwashing procedures before entering the ICU, implementing effective contact isolation, maintaining good air circulation in patient rooms, and ensuring thorough and continuous environmental cleaning and disinfection. These measures provide a foundation for the successful implementation of family-centered care and visitation.

Furthermore, to successfully carry out family-centered care and visitation, policy support is essential. Ensuring an adequate number of healthcare professionals is a prerequisite for facilitating family involvement.

The critical condition of ICU patients, coupled with the limited clinical experience of newly appointed nursing staff, can complicate care delivery. In contrast, primary caregivers are often more adept at communicating the patient’s condition and, over time, become capable of participating in shared decision-making and ward visits. Familiarity between healthcare providers and primary caregivers can enhance mutual trust and foster mutual understanding.

Family-centered visitation constitutes a novel multidisciplinary bedside model, the core of which involves actively engaging ICU patients’ families (9). The inclusion of family members in medical visits facilitates surrogate decision-making and strengthens their involvement in patient care (19). Some studies suggest that a lack of medical knowledge or insufficient family engagement may prolong hospital stays and increase the risk of medical disputes, thereby hindering the implementation of the family-centered visitation model (20). However, international nursing research indicates that family participation does not reduce the efficiency of clinician–patient interactions; rather, it can shorten the duration of family meetings and enhance the effectiveness of medical discussions (21).

Shared decision-making in the ICU is a collaborative process that involves healthcare professionals, patients, and their families in reaching consensus on treatment plans based on the principles of family-centered care (22). This approach prioritizes the needs and values of patients and their families, supports evidence-based evaluation of treatment benefits and risks, and ensures through structured dialogue that the patient’s best interests are fully considered (23). Research shows that shared decision-making between families and clinicians can alleviate the decision-making burden on families and improve the quality of decisions (24).

Although clinical guidelines advocate for shared decision-making, empirical evidence in the domestic context suggests that only a small proportion of physicians actively integrate patient values and preferences into clinical practice (25). In reality, clinical decisions remain largely clinician-led. Therefore, it is recommended that domestic physicians recognize the critical role of primary caregivers, guide their participation in appropriate clinical activities, provide structured support to families, and promote positive health outcomes for both providers and patients.

The family-centered visitation model promotes family involvement in patient care and early rehabilitation. Research indicates that in the high-stress ICU environment, family members are frequently exposed to significant pressure, which may impair their capacity to provide effective care (26). Multiple studies have confirmed the feasibility and effectiveness of the involvement of families in patient care (27). Moreover, ICU healthcare teams implement supportive interventions and targeted training programs to enhance family members’ caregiving skills, and thus promote their active engagement in the care process. Such involvement not only empowers families but also enhances their comprehension of communication and family-centered healthcare services (28).

This study found that most patients expressed a desire for family companionship and care within the ward, as this helps alleviate psychological distress. Additionally, most medical staff supported family involvement in patients’ daily care, emphasizing the need for proactive health guidance provided in diverse formats. This approach demonstrates strong feasibility and significant potential for development in the domestic context. However, regarding family presence during resuscitation, both international research and this study indicate predominantly cautious or negative attitudes among healthcare professionals and families, reflecting persistent disagreements and barriers to family involvement in critical care.

In China, the family-centered visitation system remains exploratory, with existing research primarily focused on neonatal and pediatric wards. This study aims to investigate the applicability of the family-centered visitation model in adult ICUs and to elucidate the prevailing perceptions of this approach among ICU medical staff, patients, and their families.

The external validity of the findings from this study is limited by its single-center design. Future multi-center research is warranted that would enhance the robustness and generalizability of the conclusions.

Additionally, the limited sample size in this investigation precluded a thorough examination of the relationships between demographic characteristics and study outcomes. Subsequent studies should therefore utilize larger and more diverse cohorts to validate these preliminary findings.

Future research must prioritize clinical trials adapted to China’s specific healthcare context and institutional realities to evaluate the implementation outcomes and address the practical challenges of the family-centered visitation system. Such research is essential for establishing a robust evidence base to inform national policies and clinical guidelines, and thereby facilitate the effective dissemination of this model across ICUs in China.