Intensive & critical care nursing · 2026
Nurse-led continuity-oriented family support across the adult ICU trajectory: a systematic review and meta-analysis of PICS-F-related outcomes.
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Li Mingyang, Li Chunlin, Zhang Yazhi, Du Meijie, Zhou Yanrong
Аннотация
BACKGROUND: Family members of adult ICU patients are at risk of post-intensive care syndrome-family (PICS-F), but the psychological effects and optimal timing of nurse-led support remain uncertain.
OBJECTIVE: To evaluate nurse-led, continuity-oriented family support for PICS-F-related psychological outcomes and explore differences by intervention phase and nurse type.
METHODS: PubMed, CINAHL, Web of Science, PsycINFO, Embase, and the Cochrane Library were searched from inception to May 2026. Randomized and quasi-experimental studies were eligible if they evaluated nurse-led family support in adult ICUs and assessed at least one family-level PICS-F psychological outcome. Short-term outcomes assessed from 2 weeks to 3 months after ICU discharge formed the primary analyses. Random-effects meta-analyses used Hedges' g standardized mean differences (SMDs). Subgroup analyses were conducted by primary intervention phase and nurse type. Risk of bias and certainty of evidence were assessed using validated tools and GRADE.
RESULTS: Seventeen reports representing 16 independent studies and 3,887 family participants were included. Nurse-led support was not associated with short-term anxiety (SMD = -0.05, 95% CI -0.24 to 0.14; very low certainty), depression (SMD = -0.01, 95% CI -0.23 to 0.21; very low certainty), or post-traumatic stress disorder-related symptoms (SMD = 0.02, 95% CI -0.11 to 0.15; moderate certainty). In-ICU support was associated with lower depression scores (SMD = -0.40, 95% CI -0.67 to -0.12), although phase comparisons included few studies. No ICU transition study contributed an eligible short-term primary outcome. Nurse-type analyses showed no consistent differences.
CONCLUSIONS: Nurse-led, continuity-oriented family support was not associated with improvements in short-term PICS-F-related psychological outcomes. Current evidence does not identify an optimal intervention phase or nurse type.
IMPLICATIONS FOR CLINICAL PRACTICE: Intervention timing should be considered, although the optimal phase remains uncertain. Nurse-led support may strengthen family-centred care, but persistent distress may require tailored psychological support and referral.
OBJECTIVE: To evaluate nurse-led, continuity-oriented family support for PICS-F-related psychological outcomes and explore differences by intervention phase and nurse type.
METHODS: PubMed, CINAHL, Web of Science, PsycINFO, Embase, and the Cochrane Library were searched from inception to May 2026. Randomized and quasi-experimental studies were eligible if they evaluated nurse-led family support in adult ICUs and assessed at least one family-level PICS-F psychological outcome. Short-term outcomes assessed from 2 weeks to 3 months after ICU discharge formed the primary analyses. Random-effects meta-analyses used Hedges' g standardized mean differences (SMDs). Subgroup analyses were conducted by primary intervention phase and nurse type. Risk of bias and certainty of evidence were assessed using validated tools and GRADE.
RESULTS: Seventeen reports representing 16 independent studies and 3,887 family participants were included. Nurse-led support was not associated with short-term anxiety (SMD = -0.05, 95% CI -0.24 to 0.14; very low certainty), depression (SMD = -0.01, 95% CI -0.23 to 0.21; very low certainty), or post-traumatic stress disorder-related symptoms (SMD = 0.02, 95% CI -0.11 to 0.15; moderate certainty). In-ICU support was associated with lower depression scores (SMD = -0.40, 95% CI -0.67 to -0.12), although phase comparisons included few studies. No ICU transition study contributed an eligible short-term primary outcome. Nurse-type analyses showed no consistent differences.
CONCLUSIONS: Nurse-led, continuity-oriented family support was not associated with improvements in short-term PICS-F-related psychological outcomes. Current evidence does not identify an optimal intervention phase or nurse type.
IMPLICATIONS FOR CLINICAL PRACTICE: Intervention timing should be considered, although the optimal phase remains uncertain. Nurse-led support may strengthen family-centred care, but persistent distress may require tailored psychological support and referral.