Multicultural Intensive Care: A Cross-sectional Study on Family-centered Care in the United Arab Emirates

1. INTRODUCTION

During challenging times when a family member is admitted to an intensive care unit (ICU), the rest of the family often experiences significant stress and uncertainty. Their desire to provide support may be hampered by various factors, including insufficient information about the patient’s condition or how to assist, communication difficulties with healthcare professionals, and the emotional and psychological strain they face. In such circumstances, a lack of knowledge, reassurance, assistance, or support can leave family members feeling helpless, isolated, and insecure, thereby compromising the potential benefits they could provide [1-3].

In the United Arab Emirates (UAE), Arabic and Islamic cultures place a central emphasis on family involvement in healthcare, guided by religious, cultural, and ethical norms. Within the Islamic tradition, caring for an ill relative is deemed both a religious duty and an act of worship, underscoring the importance of family presence and assistance (Saifan et al., 2022) [4]. Families frequently make key healthcare decisions, particularly in critical or end-of-life situations, reflecting sociocultural values that uphold the well-being of the family unit. However, this robust family involvement may also cause practice complexity and ethical challenges regarding patient autonomy and the disclosure of medical information [5], resulting in hesitancy among healthcare professionals to fully adopt Family-Centered Care (FCC). Despite these obstacles, FCC inherently aligns with Islamic and Arabic principles by acknowledging the family’s pivotal role and their need for involvement in their patient's care [6, 7].

Although the UAE has seen a growing acceptance of FCC, its implementation faces additional complexities due to a diverse, multicultural population and reliance on expatriate healthcare providers [8]. While cultural diversity can enrich patient care, it can also introduce language barriers, unfamiliar customs, varied levels of acceptance of some concepts, varied commitment to care development, and disparate religious observances. Consequently, healthcare professionals require specialized training on FCC principles and local cultural norms, including Islamic values, to effectively meet patient and family expectations [8].

Equally important is assessing the needs and experiences of critically ill patients and their families, which is a critical component and the first foundational step of creating a more humanized ICU environment [1-3]. Critically ill patients frequently depend on family members to communicate their preferences and values. Active family participation in ICU settings significantly shapes a patient’s well-being [9-11]. Cagle and Bunting emphasize that families provide vital social and emotional support, contributing to holistic care [10-12]. Meeting these requirements can help reduce patient’s anxiety and cultivate familial trust in the healthcare system [13]. Failing to recognize family needs can lead to dissatisfaction and potentially diminish the quality of healthcare services [14]. Hence, addressing these needs is essential for maintaining patient and family satisfaction and optimizing health outcomes.

Globally, studies have shown that families of ICU patients prioritize different needs, ranging from effective communication to privacy or accommodation [15]. Hospital administrators and staff can enhance critical care outcomes by designing policies and initiatives tailored to the locally identified and prioritized needs of families [16]. Consequently, replicating such studies in the UAE context is vital to ensure that healthcare interventions resonate with the region’s unique cultural and societal nuances. Gaining an in-depth understanding of local family needs, challenges, and preferences will enable the development of culturally sensitive, contextually appropriate healthcare services [16].

2. RESULTS

Table 1 presents the distribution of socio-demographic characteristics of the study sample, consisting of 240 participants. The variables assessed include age, gender, relation with the patient, education level, and type of hospital.

The age distribution of the participants shows the largest proportion (28.3%) of participants in the < 30 years age group. The 30-39 years group is the second largest, representing 27.9% of the sample. The 40-49 years and 50-59 years age groups represent 22.1% and 21.7% of the sample, respectively.

The sample size was more male-dominated, with 54.6% (131) of the participants being male and 45.4% (109) female. The largest group of participants (61.7%) were sons or daughters of the patient, highlighting their primary role as key decision-makers and caregivers in family-centered care, particularly in Middle Eastern and Islamic cultures, where children often assume responsibility for their aging or ill parents, followed by brothers or sisters which account for 20.8% of the participants. Fathers or mothers make up 10.8% of the respondents.

The highest proportion of participants (46.7%) have a Bachelor’s degree, and secondary education follows with 20.8% of respondents.

The majority of participants (62.9%) are associated with public hospitals, and a smaller portion (37.1%) are from private hospitals.

Table 2 presents the mean scores and standard deviations for the five key domains of the Critical Care Family Needs Inventory. These domains encompass emotional support, information, comfort, proximity, and assurance. Here are key observations and implications based on the scores:

The highest mean score is observed for Information (38.8), indicating that families prioritize accurate and timely information about their loved one's condition. This is followed closely by Comfort (37.0), suggesting that families also place considerable importance on the physical environment and their own comfort while in critical care settings. Support (28.0) is also valued but to a slightly lesser extent, indicating that emotional and psychological support is important but may be considered secondary to information and comfort. The domains of Proximity (18.6) and Assurance (18.9) are rated the lowest, suggesting that while they matter, they are less of a priority for families compared to the other needs.

Fig. (1) provides an assessment of the five domains of the Critical Care Family Needs Inventory. The highest mean score is in the Information domain (38.8 ± 5.1), followed by Comfort (37.0 ± 5.6) and Support (28.0 ± 4.0). The Proximity (18.6 ± 3.0) and Assurance (18.9 ± 2.8) domains have the lowest mean scores. Overall, the total score of 141.4 ± 18.8 reflects the cumulative importance of these domains, with a relatively high level of perceived need for emotional and informational support in the critical care setting.

Table 3 emphasizes the critical need for emotional and psychological support among families in intensive care settings. A vast majority prioritize knowing the expected outcome (99.2%) and receiving honest answers to their questions (69.6% very important). While visitation rights are valued, only 17.9% rate them as very important. Support from friends (78.3%) and understanding the roles of medical staff (82.9%) are also significant concerns. Additionally, families express a need for a private space in the hospital, though responses are mixed, with 42.9% considering it important. Financial support emerges as a major concern, with 90% of respondents rating it as important or very important. Emotional expression, such as feeling comfortable while crying, is also valued by 69.6% of families. Lastly, access to family support services is deemed necessary by 74.2% of participants. Overall, these findings highlight the importance of clear communication, financial assistance, and emotional well-being for families navigating the ICU experience.

Table 4 highlights the information needs of families in critical care settings, emphasizing the importance of clear communication and guidance. Families prioritize understanding the ICU environment before entering (83.8%) and expect flexibility in visiting hours for special circumstances (90.5%). Many express a need to discuss their emotions (82.6%) and receive guidance on bedside behavior (85%). Hope is a crucial factor, with 90.5% considering it important or very important. Families also value assurance of quality care (93.8%) and detailed updates on medical procedures (90.9%). While pastoral visits are less prioritized (63.4%), discussions about patient mortality (77.5%) and reassurance about leaving the hospital (77.9%) hold significance. Additionally, families emphasize timely visiting hours (86.2%) and expect regular patient updates (93.7%). These findings underscore the critical role of consistent, transparent, and empathetic communication in supporting families during their loved ones' ICU stay.

Table 5 highlights the physical comfort and environmental needs of families in a critical care setting. Families highly value daily communication with doctors (90%) and a designated contact person at the hospital (91.3%). Understanding staff roles and medical decisions is crucial, with 90.1% wanting clarity on procedures. While good hospital food is important (67.5%), 13.8% find it unnecessary. Comfort in waiting areas receives mixed responses, with furniture (60.8%) and nearby bathrooms (71.7%) seen as moderately important. Support during visits (66.7%) and consistent nurse interaction (62.1%) hold significance, though not top priorities. Family involvement in patient care (91.3%) and feeling hospital staff genuinely care (95%) are among the most valued aspects. Additionally, the proximity of waiting rooms to patients is important for 68.3%. These insights reinforce the importance of clear communication, emotional reassurance, and practical accommodations for families navigating critical care environments.

Table 6 highlights the proximity-related needs of families in critical care settings. The most crucial need is understanding the patient’s medical treatment, with 92.9% rating it as important or very important. Feeling accepted by hospital staff is also significant (89.6%), followed by having someone concerned about their health (65.4%). While being alone at times is moderately important (57.1%), it is not a priority for most. Information about chaplain services is valued by 79.2%, and being informed about transfer plans is a top concern, with 93.4% rating it highly. These findings emphasize the importance of clear communication, emotional support, and transparency in critical care environments.

Table 7 outlines the assurance-related needs of families in critical care. The most critical concerns include being called about changes in the patient's condition (95.8% rated it as important or very important) and receiving understandable explanations (92.9%). Families also prioritize knowing specific facts about the patient’s progress (97.1%) and seeing the patient frequently (88.8%). While learning about other sources of help is valued (70.0%), having a telephone near the waiting room is less critical, with only 56.3% considering it important or very important. These results underscore the need for clear communication, timely updates, and frequent access to loved ones in critical care settings.

Table 8 explores the association between socio-demographic characteristics (age, gender, relation with the patient, education level, and type of hospital) and the Critical Care Family Needs Inventory domains and total score. The table presents the mean scores for five domains (Support, Information, Comfort, Proximity, and Assurance) based on socio-demographic groups, along with statistical analyses (ANOVA and Student’s t-test). Here’s an interpretation of the findings:

Age emerged as a significant factor in determining families’ needs, with older participants (40–49 years) reporting higher requirements across most domains, particularly for

information, comfort, proximity, and assurance. By contrast, gender did not show statistically significant differences in any of the domains (p > 0.05). Similarly, the participant’s relationship with the patient whether as a parent, sibling, child, or aunt/uncle—did not influence reported needs (p > 0.05). Education level, however, played a notable role: those holding a Bachelor’s degree consistently indicated higher needs across all domains. In addition, the type of hospital (public vs. private) significantly affected the Proximity domain (T=2.188, P=0.030), with families in public hospitals expressing a slightly greater need (18.9) to remain near their loved one than those in private hospitals (18.1).

3. DISCUSSION

This study provides a critical foundation for the advancement of Family-Centered Care (FCC) in critical care units (CCUs) within the United Arab Emirates (UAE). By identifying the needs of families with relatives in intensive care, these findings offer clear direction for initiatives that are more focused, organized, and ultimately more likely to succeed. Meeting these needs is not only essential for minimizing the psychological stress families face but also crucial for tapping into their ability to contribute positively to patient care and outcomes. A CCU encompasses both intensive care units (ICUs) and high-dependency units (HDUs)—settings where families commonly experience tension, anxiety, and sadness [20]. In the UAE, male family members often serve as the main caregivers and hospital companions, in contrast to the cultural norms of other regions where women typically fulfill this role [21-25]. This difference underscores the importance of tailoring FCC strategies to local cultural contexts and ensuring that they align with the roles that family members naturally assume.

The current findings highlight the specific ways in which family needs in the UAE diverge from international norms, such as emphasizing the importance of accurate information and suitable physical amenities like lodging. These observations align with previous research indicating that when information needs remain unmet, families may feel overlooked or poorly utilized in the care process [21, 26-28]. Conversely, when they receive sufficient support and timely updates, families can become active partners in care, ultimately improving patient outcomes. Participants strongly voiced a desire for clear communication regarding the health status of their critically ill relatives and the procedures being performed. Related studies [26, 27] confirm that families experience additional distress when the diagnosis, prognosis, and plan of care are insufficiently explained and that comprehensive information-sharing can empower families to act effectively as patient advocates [28, 29]. Another significant area of concern in this study was the provision of physical resources. Consistent with Hsieh et al. [30], families emphasized the need for comfortable waiting areas, adequate nutrition, and rest, particularly since many travel from distant regions to access specialized facilities. Meeting these environmental needs can lessen stress and improve the overall experience for both families and patients.

Strong psychosocial needs also emerged, encompassing emotional support, reassurance, and close proximity to the patient. High levels of worry, stress, or sadness are common in CCUs [20, 22, 31, 32], and addressing these emotional burdens through open communication, empathy, and psychological services can help both families and patients cope more effectively. Being able to identify healthcare professionals—by having staff wear clear identification—was highlighted as a simple but impactful step to reduce confusion and anxiety [29]. Families also viewed proximity as an integral aspect of care monitoring. Extended or more flexible visiting hours could allow families to stay closer to their relatives, which not only reduces their anxiety but also enhances their trust in the care provided [20-35].

Public hospital families, in particular, reported higher needs for proximity, suggesting that policies limiting visiting times should be revisited to accommodate these needs. Sociodemographic factors further influenced family perspectives: older participants (40–49 years) registered greater needs for information, comfort, proximity, and assurance, possibly reflecting a combination of increased life experience and more active roles within the family. Meanwhile, families with higher education were more likely to demand detailed information and supportive measures, aligning with Bandari et al. [27], who argue that education fosters greater awareness of critical care processes and the desire for increased involvement.

CONCLUSION

This study highlights the critical role of the FCC in meeting the diverse needs of families in multicultural ICU settings in the UAE. While proximity and assurance were valued, significant gaps remained in emotional support, timely information, and comfort. Addressing these unmet needs through enhanced communication, culturally sensitive support services, and flexible visitation policies can improve family experiences and contribute to better patient outcomes. Implementing tailored FCC strategies will be essential in fostering a more inclusive and supportive ICU environment.

LIMITATIONS

Although this study’s sample size was sufficient for the quantitative surveys conducted at multiple hospitals, the representation of participants from specific facilities and localities may limit the applicability of findings to all regions of the United Arab Emirates. Family needs could vary across different cultural and geographic contexts, and a more extensive, regionally diverse sample in future research would provide a more comprehensive understanding of family requirements throughout the UAE.

REFERENCES