Echoes of isolation: Exploring Arab family perspectives and health care providers' reflections in ICU settings during critical care.

Background
Families are reporting loss of interactions and communication in response to restrict isolation measures. Other tangible losses include income, access to resources, engagement, involvement in decision-making process and other planned activities. Listening to families' needs, concerns and say has been identified as one of the most important and least accomplished health care providers' roles in the intensive care units (ICUs).

Aims
(1) To explore the experiences and concerns of Arab family members and health care professionals facing the challenges during ICU isolation, and (2) to develop recommendations for enhancing family support and improving effective communication to better address the needs of families during ICU isolation.

Study Design
This study utilizes a qualitative descriptive phenomenological design. We analysed data gained from 32 family members' concerns during their ICU patients' stay in isolated room settings and 21 health care providers' reflections through 2 focused groups recruited from Emirati and Egyptian ICUs.

Results
Thematic analysis revealed two main themes. The first theme, Family Members' Perspectives, highlights families' emotional and logistical challenges, including fears about infection, frustration over delayed updates and barriers to advocating for their loved ones. Subthemes include (a) family experiences and emotional challenges and (b) family-derived recommendations, such as implementing regular video calls, providing detailed patient updates and allowing occasional controlled visits to the ICU. The second theme, Health Care Providers' Perspectives, reflects HCPs' professional challenges in balancing family engagement with clinical demands. Subthemes include (a) challenges faced by HCPs, such as time constraints and communication difficulties, and (b) HCP-derived suggestions, including the integration of liaison nurses, social workers and revised visitation policies to enhance family-centred care.

Conclusion
Families expressed concerns regarding the post-ICU discharge plan, prognosis and treatment quality. They proposed regular calls and video conferences as key methods for expressing preferences, emphasizing the importance of their active involvement during isolation. In response, health care providers acknowledged the imbalance in family-centred care and recommended expanding the ICU team to include social workers, psychologists and liaison nurses to better address the holistic needs of patients and families in isolation.

Relevance to Clinical Practice
This study underscores the critical role of family support and involvement in ICU care, specifically highlighting the responsibilities of ICU nurses. It calls for targeted policy modifications, the implementation of structured communication strategies and the establishment of a supportive environment to enhance family engagement. By equipping ICU nurses with the necessary resources, training and tools, these strategies aim to optimize family-centred care, improve the quality of communication and ultimately contribute to better patient outcomes in intensive care settings.