Abstract Rationale Although family engagement is a core principle in the Society of Critical Care Medicine’s (SCCM) 2024 family-centered care guidelines and the ICU Liberation Bundle (A-F), the term lacks conceptual clarity. “Family engagement” and “family involvement” are used interchangeably, leading to inconsistent implementation and hindering standardized measurement, intervention development, and evaluation across intensive care units (ICUs). This concept analysis sought to clarify the defining attributes, antecedents, and consequences of family engagement in adult ICUs, providing a unified theoretical foundation for nursing research and practice. Methods Guided by Walker and Avant’s eight-step method, we analyzed published uses and definitions of family engagement in adult ICUs (≥18 years). Comprehensive searches of CINAHL, PubMed, Web of Science, Google Scholar and Scopus (2000-24 July 2025) identified 2,134 records, of which 18 publications met inclusion criteria. Two researchers independently extracted and coded data on all identified uses applying constant comparative analysis to identify defining attributes, antecedents, consequences, and empirical referents of family engagement, as well as illustrative cases and verified findings, to ensure rigor. Results Seven defining attributes emerged: reciprocal partnership; open communication; mutual trust and respect; shared decision-making; educational support; meaningful participation; and technology support. Role negotiation and delegation; mutual trust and respect; and open communication were identified as recurrent features evident across multiple dimensions of family engagement. Antecedents occurred at three levels: organizational (e.g., visitation policies, infrastructure and resources), clinician (e.g., attitudes, communication skills), and family (willingness, health literacy). Consequences included improved teamwork; higher family satisfaction; goal-concordant care; and potential reductions in delirium and readmissions, along with system-level cost efficiencies and challenges such as workload and the digital divide (Figure 1). Empirical referents that measured/demonstrated the occurrence of family engagement included validated tools (e.g., Family Engagement Measure (FAME), Family Satisfaction-ICU (FS-ICU)) and observation-based process metrics. The model case depicted hybrid (in-person/virtual) engagement across the ICU trajectory, while contrast cases clarified that engagement extends beyond involvement, reflecting an active partnership grounded in mutual trust and shared decision-making. Conclusions Family engagement in adult ICUs is best conceptualized as a reciprocal partnership grounded in trust, communication, education, shared planning, and meaningful participation, and is supported by technology. This clarified construct distinguishes engagement from simple visitation or information delivery, supports the development of valid measures, guides implementation efforts aligned with the ICU Liberation Bundle (A-F), and offers a theoretical foundation for future ICU nursing interventions. Keywords: Family engagement; Concept analysis; ICU Liberation Bundle (A-F) This abstract is funded by: Leslie A. Hoffman Research Award FY26
Shamsizadeh et al. (Fri,) studied this question.