Background

Being in a hospital can be an unpleasant experience for both patients and their families. Traditionally, families often provide care for their loved ones for the duration of their illnesses. A family might include a wife, husband and children; each of these individuals could potentially be a significant other. A significant other is identified as an individual who is important in someone's life.1,2 They are often individuals who have significant input into their loved one's treatment plan.3 In existing literature, the terms friend, spouse, partner, relative and significant other are used interchangeably. For the sake of consistency, the term "significant other" will be used primarily throughout this protocol.

In an acute-care hospital, patient care is not only provided by healthcare professionals, but also by patients' significant others. Mills and Aubeeluck describe significant others as assuming the role of informal carers.4 This may involve providing both physical and psychological support such as providing assistance with bathing and feeding as well as being emotionally supportive. The need for a significant other's presence alongside a loved one is well documented in literature.5 Therefore, healthcare professionals not only are responsible for providing care for the patients but also need to understand the emotional state of their significant others.

When a healthcare professional's significant other is admitted to an acute-care hospital, the context is quite different. Having a healthcare professional as a family member can impact on the delivery of care to an ill loved one.6-8 The study by Salmond used a qualitative approach using open-ended, focused exploratory interviews to bring to light what a nurse-family member of an ill loved one experienced.6 This experience was described as being different to that of the general public. Issues of role conflict and the burden of expectations were highlighted. Another study by Chen et al. using in-depth, semi-structured telephone interviews clarified the challenge physician-family members face when a significant other becomes ill.9 The researchers specifically explored the experiences of physicians when their significant others were ill. In particular, they explained that when a patient has a physician-family member, the patient's care becomes unique.9 Fromme et al. reported that having a physician-family member was considered as a "good thing" due to the physician's greater familiarity with the current healthcare system as compared with other family members.10 What is more, the physician may be an expert in a relevant area of practice or hold strong views about what care should be provided. Commonly, most physicians are involved in their ill family member's care.11

Schofield explained that being both a nurse and a family member to a loved one, who has been admitted to a hospital, potentially offers additional assistance to staff.12 For instance, the nurse may personally know the staff members they are dealing with, enhancing communication. Scarff and Lippmann highlighted that healthcare professionals exert greater influence on their relative's care because they believe that they are more concerned about the patient's wellbeing than the healthcare staff in charge.11 Other researchers propose that a nurse-family member does not experience the same emotional distress as other relatives due to their increased awareness of the hospital environment.7 Although nurses' familiarity within the clinical setting may be helpful, their professional knowledge may also increase their stress, and they may fear that the worst situation will happen.4,13,14

Often, a healthcare professional who is a significant other is more familiar and knowledgeable about their loved one's health conditions compared with others. For example, they may have increased information about their loved one's medications, medical history and desired form of care. As healthcare professionals, nurses understand how these details can impact on the quality of patient care and influence decision making.4,7 Fromme et al. emphasized that having a physician-family member may provide relief to other family members, provided they are knowledgeable and truthful. When a healthcare professional's loved one is admitted to a different hospital, their need for information would logically be the same or greater compared with other significant others. They may have relevant professional knowledge but not local knowledge about the specific organization.6,15

Alternately, the healthcare professionals may not be versed in the relevant medical areas. This situation may significantly heighten anxiety because the healthcare professionals' families or colleagues may have unrealistic expectations regarding prognosis or patient outcomes. Olivet and Harris stressed that healthcare professionals and other family members place expectations on nurses who have ill loved ones.7 A healthcare professional who is a significant other may experience pressure concerning his or her roles and responsibilities, including being an expert on the field, being a significant other and being part of the decision making process. These roles and responsibilities may lead a healthcare professional into having two conflicting identities: a professional identity and a personal identity. It is likely that multiple factors affect healthcare professionals as significant others when they are caring for loved ones. In almost every study, expectations, conflicting roles and communication are important factors highlighted in the current literature.6-8,14,16

Having a significant other who is a healthcare professional in a relevant clinical area is a special experience for both the staff member and the family members. However, the healthcare system places its own needs, concerns and expectations on healthcare professionals that may limit their ability to care for their loved ones. Increased awareness of these circumstances may help healthcare professionals to make better judgments regarding patient care and the support and care for relatives who are health professionals. Although there have been some investigations into this issue,10,17-19 many have primarily been concerned with family members in the critical-care setting. One qualitative systematic review has been identified that addressed this issue; however, studies were restricted to nurse-family members only whose relatives were critically ill.16 Therefore, this systematic review will have a broader focus: the experience of healthcare professionals as significant others and the factors influencing the unique experiences in any acute-care setting. A synthesis of the qualitative studies regarding the life experiences of healthcare professionals whose significant others have been hospitalized in the acute-care sector will increase our understanding of this issue. The aim of this systematic review is to better inform healthcare professionals, administrators and policy makers about dealing with health professionals as significant others to patients within the acute-care sector.

Inclusion criteria

Types of participants

The review will consider studies that include registered nurses and physicians who have reported their experience as a significant other when a relative has been admitted to an acute-care facility.

Phenomena of interest

The review will consider all studies that explore the experience of healthcare professionals when a significant other has been admitted into an acute-care facility.

Context

The review will consider research conducted in any acute-care setting.

Types of studies

The review will consider all qualitative studies that have examined the phenomena of interest including, but not limited to, research designs such as phenomenology, grounded theory, ethnography, action research and feminist research.

Search strategy

The search strategy aims to find both published and unpublished studies. A three-step search strategy will be utilized in this review. An initial search of PubMed and CINAHL will be undertaken followed by analysis of the text words contained in the title and abstract, and of the index terms used to describe the article. A second search, using all identified keywords and index terms, will then be undertaken across all included databases. Third, the reference list of all identified reports and articles will be searched for additional studies. Only studies published in English will be considered for inclusion in this review. There will be no date restriction.

The databases to be searched will include PubMed, CINAHL, PsycINFO and Embase.

The search for unpublished studies will include Google Scholar, ProQuest Dissertations and Theses. Initial keywords to be used will be (Text word and MeSh terms):

1. Healthcare professional, health personnel, professional-family relations, nurse, nurse-family member, physician and doctors

2. Significant other, family, spouses, partner, loved one, family relations, extended family, immediate family, close relative, family member, family presence, wife, husband, mother and father

3. Life experiences, experience, personal experience, role expectation and dual role

4. Acute care, critical care and intensive care.

Assessment of methodological quality

Qualitative papers selected for retrieval will be assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) (Appendix I). Any disagreements that arise between the reviewers will be resolved through discussion or with a third reviewer.

Data extraction

Qualitative data will be extracted from papers included in the review using the standardized data extraction tool from JBI-QARI (Appendix II). The data extracted will include specific details about the interventions, populations, study methods and outcomes of significance to the review question and specific objectives.

Data synthesis

Qualitative research findings will, where possible, be pooled using JBI-QARI. This process will involve the aggregation or synthesis of findings to generate a set of statements that represent that aggregation, through assembling the findings rated according to their quality, and categorizing these findings on the basis of similarity in meaning. These categories are then subjected to a meta-synthesis to produce a single comprehensive set of synthesized findings that can be used as a basis for evidence-based practice.

Acknowledgements

The review will be part of a research project to fulfil the requirement of a doctoral degree.

Appendix I: QARI appraisal instrument

Appendix II: QARI data extraction instrument

References