Family support in acute care settings: Perspectives of family members on cognitive and emotional support

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The aim of this study was to assess the level of perceived family support (i.e., cognitive, and emotional support for family members) provided by nurses in the context of acute care among family members. Methods A cross-sectional study was conducted among 800 family members, these were recruited from two large hospitals in Uganda. Data collection took place between August 2020 to December 2020. The Icelandic Family Perceived Support Questionnaire (ICE-FPSQ), which measures emotional and cognitive support from the family member´s perspective was used. Analyses were conducted using means, and ANOVA in the R-programming software version 4.0.3 - 2020-10-10. Results : The overall ranking of family support received from nurses by family members was moderate (mean global score on the 14 indicators in the ICE-FPSQ was 45.4 (SD = range 14-70). The perceived cognitive support from nurses by family members was also rated as moderate (mean = 16.3, SD =4.5). Notably, the element “utilizing family rituals to enhance family health” received the lowest scores in the realm of cognitive support. Emotional support offered to family members by nurses received moderate ratings (mean= 32.4, SD=9.36). Within the emotional support category, the element of nurses encouraging the family to take respite from caregiving responsibilities generated the lowest scores (mean = 2.95, SD = 1.43). Conclusion: The findings demonstrated that nurses give the least priority or aren´t aware of the benefits of family rituals or don’t perceive it as important compared to other aspects of cognitive support offered to patient´s families. Nurses may not effectively communicate the importance of encouraging family members to take respite from caregiving responsibilities as an element of emotional support. The moderate perceptible family support scores suggests that the level of support provided by nurses is satisfactory, yet there remains room for sustenance. Ascertaining moderate family perceived support indicates the necessity to improve family support from nurses. Trial registration: A clinical trial number is not applicable to this study. nurses family nursing compliance family-centered care patient-centered care BACKGROUND During the acute care trajectory, families require support, communication with the healthcare team on the patient´s condition as well as operational and environmental issues in the healthcare setting ( 1 ). Families in Sub-Saharan Africa, families play a substantial role in the healthcare system, particularly in providing informal caregiving ( 2 ). The role of family carers is also increasingly acknowledged in High-Income Countries ( 3 ). Of note, despite variations in cultural orientations, and evolution in family structures, families are still expected to create a nurturing environment and offer emotional and cognitive support to their family members ( 4 ). However, family support during the trajectory of care remains poorly defined and operationalized in acute care settings. Yet, family members across different contexts require emotional support and an understanding of support networks ( 5 ). The concept of family support in healthcare settings emphasizes the role of healthcare providers in providing care related to a patient's family member (such as communication, informational needs, and involvement in decision-making) during the illness event in a hospital setting and subsequent post-patient discharge trajectory. Nurses often undertake family support responsibilities ( 6 ), such as mobilizing resources and family education. Scholars in various care settings have consistently articulated definitions of family support provided by nurses. Family support, particularly from nurses, encompasses encouraging families to be present at the bedside, promoting mutual and reciprocal nurse–patient interactions to achieve a mutually beneficial partnership between families, health care team members, and care organizations” ( 7 ). Families need to be informed and require access to information about the patient’s condition ( 8 ). A variety of distinct areas of family support have been reported across studies. Because the concept of family support has different dimensions, it has not been directly measured; instead, several dimensions are used to reflect family support. However, there has been agreement across studies that the nature of support offered by nurses includes cognitive and emotional support ( 9 – 11 ). Sveinbjarndottir et al. (2012) – the original authors of the Icelandic Family Perceived Support Questionnaire (ICE-FPSQ) defined “emotional support as that nurses offer families to handle the burden of emotions around the illness of a family member” (p. 330). Whilst “cognitive support is defined as support that nurses offer to inform or educate the family to help them handle the illness experience” ( 12 ). With respect to cognitive support, informing or educating the family to assist them in coping with the illness experience ( 13 ). In addition, acknowledging family rituals (e.g., religious, and cultural beliefs) – such ritual is considered a crucial element of cognitive support ( 14 ). At the time of discharge, family members require support for continuity of care home, thus, maintaining and guaranteeing resources available in the community fosters cognitive support ( 15 ). With respect to emotional support, scheduled family meetings are appreciated by family members as crucial aspects of emotional support ( 16 ). Objective measures have used the Icelandic Family Perceived Support Questionnaire (ICE-FPSQ) – O´Sullivan et al. (2021) found that family members´ perceived support focused more on the care received by the patient during the illness trajectory rather than on support provided to the family itself ( 17 ). In addition, the element of respect and direct involvement of the family in patient care, as well as drawing forth family strengths, has been emphasized as a crucial component of cognitive and emotional family support ( 3 ). These constructs offer an agenda to develop and implement recommendations for family support, which include policy, practices, and interventions ( 6 ). As a framework to guide assessment of family support from nurses, in this study, Family Perceived Support (FPS) was theorized as the confidence in one´s perception of the action i.e., strategies used to support the patient´s family during hospitalization. This is consistent with the hypothesis that the actions caused the perceived support (outcome effect). This provided a conceptual orientation for exploration of mechanisms that possibly can drive FPS. Previous research utilised the mean score of FPS as indicators of emotional and cognitive support ( 12 ), however, FPS may reflect not only compliance with family nursing, but also family members´ coping and recovery. An acute illness has been defined as “relatively sever disorder with an abrupt onset and brief symptom duration” ( 18 ). Acute care is concerned as prompt management of patients suffering from acute illnesses – often requiring but not limited to emergency care within 48 hours. The acute care trajectory ends in complete recovery or progresses into a chronic phase or death. Acute care settings deal with short-term medical or surgical management of infectious, communicable, and non-communicable diseases ( 18 ). The purpose of this study was to assess the level of perceived family support (i.e., cognitive, and emotional support for family members) provided by nurses among family members. METHODS AND MATERIALS Design and sample A descriptive cross-sectional design was used in this study. This article is a secondary analysis of data collected for a larger study ( 19 ). The data were collected from August 2020 to December 2020 using a survey instrument. Family members were recruited from the largest private for-profit hospital boasting a 100-bed capacity and approximately 150 nursing staff), and the national referral hospital in Kampala, Uganda with a capacity exceeding 1000 beds and approximately 1500 nursing staff. Acute care units providing urgent and short-term care to adult patients with acute illnesses were included in the study. Purposive selection for hospital settings providing acute care considered units providing short-term care or urgent care for critical illness events. These included emergency care units catering for accidents and emergencies; intensive care units, trauma units, short-term medical wards (medical, surgical, obstetrics, and gynaecology wards) and coronary care units. Recruitment Family members aged 18 years or older were eligible to participate in the study. The exclusion criteria considered family members with cognitive or hearing impairment. For patients with more than one family member, we included one participant from the family group. A family member was defined as the person whom the patient identified as their family, including spouse, friends, patients´ children or siblings to the patient. Participants were enrolled in the study using a variety of strategies such as snowballing, and research assistants directly approaching family members in waiting spaces and asking– “would you like to participate in a research study”. Most participants became aware of the study through announcements from department nurses. Measures The Ice-Family Perceived Support Questionnaire (ICE-FPSQ; ( 12 ) was utilised for data collection. Permission to use the ICE-FPSQ tool was obtained from the original authors. The content validity index (CVI; ( 20 ) of the tools was computed from pilot study which was conducted among a convenience sample of 10 family members. Tools distributed to family members were either in English or translated to Luganda (target language). Literacy in either English language or Luganda was considered while recruiting family members. The process of translation and psychometrics of the tool in this study have been described elsewhere ( 19 ). The ICE-FPSQ is a self-administered tool comprising 14 items in two sub-sections assessing: (a) cognitive support (5 items, α = 0.881); (b) emotional support (9 items, α = 0.952). Sveinbjarndottir et al. (2012) – the original authors – defined “emotional support as that nurses offer families to handle the burden of emotions around the illness of a family member” (p. 330). The five items in cognitive construct address intentional nurses’ strategies aimed at fostering the families’ understanding of the patient’s illness, management plans and strengthens the families’ potential to make informed decision making (e.g., Item 1 – the nurses on the unit provided information and their professional opinion). Items within the emotional construct capture nurse-led interventions towards the families’ psychological needs (e.g., Item 7 – the nurses have helped families recognize that their response to the patients’ illness is valid and helped them to normalize their emotional response). The tool has good psychometric properties and has been employed in diverse cultural setting (e.g., Portugal ( 21 ); Norway ( 3 ); and Iceland ( 22 ) to assess family perceived support. It has a total Cronbach’s alpha of 0.961. The scoring of the tool is based on a five-option Likert scale ranging from almost always (score 5) to almost never (score 1). The total score of the tool varies from 14 (minimum) to 70 (maximum), with higher scores reflecting more family perceived support from nurses ( 12 ). The ICE-FPSQ in this study had a total Cronbach’s alpha of 0.89, with 0.87 for the emotional support subscale and 0.74 for the cognitive support subscale. Naef et al (2024) noted “there is no description of what score must be given for a good or insufficient support from nurses” (p. 116), in this study, support was categorized into three categories: low (score of 14–32); moderate (33–51) and high (scores of 52–70). Data analysis Descriptive statistics were employed to depict participants' mean scores on the ICE-FPSQ items, evaluating overall as well as cognitive and emotional perceived family support. We ensured proactive approaches to minimise missing data during the data collection process. Here, research assistants conducted checks immediately after obtaining the questionnaires from the participants to resolve any incomplete data. In addition, missing data with more than 3% of the variables were addressed by deletion of the entire questionnaire. Multivariate analysis was conducted using ANOVA. “ANOVA was used to examine whether support level differed across predefined groups which included participants stratified by their perceived level of engagement in care e.g., almost never, rarely, sometimes, usually and always.” For modelling purposes, some variables were mean-centered and scaled to unit variance. Imputation of missing values was also executed. Analyses were conducted using the R-programming software version 4.0.3–2020-10-10 ( 23 ). A level of significance level of 0.05 was deemed statistically significant. Regarding individual items, a minimum of 51 participants per individual response on each item completed the ICE-FPSQ questionnaire. RESULTS Out of the 850 participants that were recruited in the study, 810 returned questionnaires of which 10 had more than five incomplete responses. Ultimately, 800 participants were included in the final analysis. yielding a response rate of 95%. Table 1 provides a summary of the characteristics of the participants. The mean age of the participants was 26 years (SD=7.4; Range 18-72 years). The highest percentage of participants were siblings of the patient (45.8%), most were female (n = 504), and had attained vocational or university-level of education (73.7%, n = 590; Table 1). With respect to the two settings where data collection was conducted, most respondents (75%, n =600) were from a public funded healthcare provider. Table 1. Characteristics of the participants Variable n % Gender Female Male 504 295 63.1 36.9 Education levels No formal education Primary Secondary Post-secondary (vocational or university) 16 35 158 590 2.0 4.4 19.8 73.7 Employment status In a working relationship Unemployed Retired 342 441 10 43.1 55.6 1.3 Family member’s relationship to the patient Parent (mother/father) Sibling Spouse (wife/husband) Friend Caretakers Grandparent Child of the patient Other relative 124 366 38 113 20 21 73 43 15.6 45.9 4.7 14.2 2.6 2.6 9.1 5.4 Marital status Single In a recognized relationship Separated/widowed 522 240 35 65.5 30.1 4.4 Overall perceived family support Indicators of family perceived support from nurses are summarised in table two –family members indicated that their perceived support from nurses was moderate – the mean global score on the 14 indicators (Table 2) in the ICE-FPSQ was 45.4 (SD = range 14-70). With respect to the extent of family support, most participants indicated moderate support (55.1%, n= 441), followed by those that reported high support (33.4%, n=267), the least number of participants (11.5%, n=92) reported that family support was low. When considering overall family support, the majority (n =441, 55.1%) of scores fell within the median quartile (considering a range of 14 – 70). Slightly over a third of family members´ reported scores (n = 267, 33.4%) were in the highest quartile while 11.5% (n=92) were in the lowest quartile. Overall family perceived support from nurses correlated positively with perceived cognitive, [ r (800) =.86 , p=<0.001] and emotional support [ r (800) =.96 , p=<0.001]. Regarding indicators of family perceived support, participants within the lowest quartile of perceived family support (range 0 -30) reported significantly least responses to each item on the ICE-FPSQ. Within the lowest quartile of overall family perceived support, 48.7% indicated almost never offered information compared with 7.9% within the highest quartile of overall family perceived support. Table 2. Indicators for measuring family members´ perceived support from nurses on the ICE-FPSQ Measured indicators Responses 5 n(%) 4 n(%) 3 n(%) 2 n(%) 1 n(%) Offered information and professional opinion 239(29.9) 224(28.1) 170(21.3) 89(11.2) 76(9.5) Provided available and easy-to-read literature about the health problem 173(22.1) 198(25.3) 188(24) 128(16.4) (95)12.1 Provided ideas, information and thoughts in a manner which allowed us to learn from them and think about them. 195(25) 188(24) 208(26.6) 114(14.6) 77(9.8) Informed my family about the resources available in the community that helped families in similar situations. 154(19.6) 217(27.6) 207(26.3) 79(10) 130(16.5) Highlighted the use of family rituals (act/prayers) to promote our health 127(16) 213(26.8) 166(20.9) 121(15.2) 167(21) Offered us family discussion 200(25.4) 146(18.5) 162(20.6) 101(12.8) 179(22.7) Helped family members recognize that our emotional response is acceptable and helped us to normalize family members´ emotional response 156(19.6) 251(31.6) 220(27.7) 85(10.7) 82(10.3) Encouraged family to become involved with the health care team in the care of our family member and have offered us support 229(29) 182(23) 202(25.6) 87(11) 90(11.4) Encouraged family members to share their illness stories -not only stories of illnesses and suffering, but also stories of strength and ability to tolerate illness 182(23.3) 252(32.3) 104(13.3) 140(17.9) 103(13.2) Drew out our family strengths 120(15) 197(24.6) 213(26.6) 133(16.6) 137(17.1) Helped family members understand how our emotional response is related to the family member’s illness 225(28.3) 169(21.3) 202(25.4) 93(11.7) 105(13.2) Encouraged my family to take a break from caregiving sometimes 141(17.9) 179(22.7) 148(18.8) 137(17.4) 183(23.2) Understand how family members affect one another, the patient’s health, and illness 186(23.9) 253(32.6) 153(19.7) 134(17.2) 51(6.6) Looked for the family’s strengths and opportunities to commend when strengths have been revealed 197(24.6) 199(24.9) 152(19) 138(17.3) 114(14.2) Note: 5 = almost always; 4 = Usually; 3 = Sometimes; 2 = Rarely; 1 = Almost never Family perceived cognitive support from nurses Family members´percieved cognitive support from nurses was evaluated across five items revealing a moderate level (M = 16.3, SD =4.5). Table three provides a summary of the items on the ICE-FPSQ. Comparatively, the item concerning “nurse(s) highlighting the use of family rituals to promote our health” received significantly lower scores (M =3.02, SD = 1.38, t(794), =61.5, P<0.001) on the cognitive subscale. The highest percentage of family members (n =239, 29.9%) indicated that nurses provided information and their professional opinion on the illness to family members. This item received the highest scores (M = 3.6, SD = 1.28; table 3) on the cognitive support subscale and among all items on the ICE-FPSQ. Among other items on the cognitive subscale, literature about health problems was occasionally (n=188, 24%) or frequently (n=198, 24.8%) provided by nurses to family members. Furthermore, a quarter of family members reported that nurses regularly (n=217, 27.6%) provided information about community resources beneficial to families in similar situations. Most family members further indicated that nurses occasionally (n=208, 26.6%) provided ideas, information, and insights conducive to learning. Whilst most (n=213, 26.8%) reported that nurses less frequently highlighted the use of family rituals such as prayers to promote health of patients or family members. Emotional support from nurses: The overall emotional support from nurses gained modest scores (M=, 32.4, SD=9.36), with the item “nurse(s) encourage the family to take a break from caregiving” receiving the lowest scores (M = 2.95, SD = 1.43; table 4). A substantial proportion of family members (179, 22.7%) indicated that nurses almost never facilitated family meetings. Notably, family members who are not offered family meetings by nurses had significantly lower overall perceived emotional support (M=24.1, SD =9.2, F(788)=120.1, p<0.001 ) compared to those who were rarely (M=29.7, SD=7.9), sometimes (M=31.4, SD=5.1), or usually (M=37.7, SD=4.5). Conversely, family members who reported always being offered family meetings (M=38.8, SD=8.04) experienced higher perceived emotional support. Additionally, family members who indicated always being provided with an opportunity to share their illness stories (N=182,22.8%) had significantly higher overall perceived support from nurses (M=55.7, SD=9.7). Regarding family engagement with the healthcare team during patient care, most family members reported always being encouraged (N=229, 29%) to participate in care and decision making for their patients. Of note, post-hoc analyses using the Bonferroni correction indicated a statistically significant differences were revealed in mean perceived emotional (M=32, SD=9.4, F(789)=267.1, p<0.001 ) and overall family perceived support (M=45, SD =11.9, F(785)=244.6, p<0.001 ) across categories of family engagement in care (e.g., almost never, rarely, sometimes, usually and always). Despite the majority of family members indicating they were almost never encouraged to take a break from caregiving roles (N=183, 23.2%), a significant difference in overall perceived emotional support was revealed concerning nurses´ encouragement for family members to take respite from caregiving. Specifically, post-hoc analyses using the Bonferroni correction indicated that family members who indicated that they were almost always encouraged by nurses to take breaks from caregiving experienced significantly higher perceived emotional support (M =40.6, SD=6.6, F(788)=132.8, P<0.001 ). Similarly, post-hoc analyses using the Bonferroni correction indicated that overall family perceived support was highest among family members who reported that they were always encouraged to take respite from caregiving (M =55.7, SD=9.6, F(788)=106.8, P<0.001 ). Table 3 : Descriptive response to the items related to Cognitive support from nurses Indicators of cognitive support within the ICE-FPSQ Mean (SD) The nurse offered us information and their professional opinion 3.6 (1.28) The nurses provided ideas, information and thoughts in a manner which enabled us to learn from them and reflect on them 3.4 (1.3) The nurse provided accessible and easy-to-read literature about the health problem 3.3 (1.31) The nurse informed my family about the resources available in the community that have proven to be helpful for families in similar situations 3.2 (1.32) The nurses emphasized the use of family rituals to promote family members´ health 3.0 (1.38) Note. SD= Standard Deviation Table 4. Descriptive responses on emotional support from nurses Indicators of emotional support within the ICE-FPSQ Mean (SD) The nurses on the unit have been aware of the impact family members can have on one another, on the patient’s well-being, and on the illness itself 3.50 (1.2) The nurses on the unit have encouraged my family to become involved with the healthcare team in the care of our family member and have offered us caregiver support 3.47 (1.3) The nurses on the unit have helped family members recognize that our response is valid and helped us to validate and/or normalize family members´ emotional response 3.40 (1.2) The nurses on the unit have helped family members understand how our emotional response is related to the family member’s illness 3.40 (1.3) The nurses on the unit have encouraged family members to share their narratives – not only stories of illnesses and suffering, but also stories of strength and resilience 3.35 (1.3) The nurses on the unit have looked for the family’s strengths and opportunities to commend family members when their strengths were revealed 3.28 (1.3) The nurses on the unit have offered us family meetings 3.11 (1.5) The nurses on the unit have drawn out our family strength 3.04 (1.3) The nurses on the unit have encouraged my family to take a respite from caregiving 2.95 (1.4) DISCUSSION In this study, we explored the extent of perceptive family members´ cognitive and emotional support described as a set of actions taken by nurses that promote family members´ support during acute illness. The ICE-FPSQ provided reliable and valid measures of family-perceived cognitive and emotional support. The findings demonstrated that family members perceived emotional and cognitive support from nurses was moderate. This implies that nurses and other healthcare professionals need to work towards enhancing the support provided to patients´ family members during acute illnesses. Moderate scores on perceived family support indicate that the level of support offered by nurses is adequate, with potential for further enhancement over time. Ascertaining moderate family perceived support in the study setting, however, results indicate the necessity to improve family support from nurses. The finding in the current study is consistent with that from a study in a Nigerian hospital setting ( 24 ). Family support in healthcare settings is multidimensional, these generate variation in family members´ perspectives on indicators of cognitive and emotional support. Evidence from a similar study ( 3 ) confirms that family members in mental health settings had lower scores compared to this study. In the current study setting, family members´ discourse tends to emphasize the interest in knowing about the patient´s illness. It is not surprising, therefore, that the family members´ support indicator “nurse offered us information and their professional opinion” had the highest mean score under cognitive support. Provision of information and nurses´ opinions to family members is thought to precede awareness about the community resources available in the community that have proven to be helpful for families in similar situations. This could explain the closely high scores on both indicators of cognitive support. Whether the provision of information and nurses´ professional opinion worsens family members´ awareness of resources available in the community is consistent with findings from a similar study where scores on the two indicators preceded each other ( 3 ). Opinion on the highest-scored indicators of cognitive support contradicts findings reported from the study in SSA who noted that family members were commonly never and rarely provided information( 24 ). For this study, family members were least supported on the use of family rituals to promote family members´ health. We suspect that opinion on the use of family rituals during illness can be volatile, with opposition from nurses who perceive it as a threat to conventional medical care or less compelling. Although the least supported indicator in the cognitive support domain, family rituals are a plausible strategy that promotes family cohesion and impacts family support during the illness trajectory ( 25 ). Regarding emotional support, areas of improvement are reflected in low scores on some indicators on the ICE-FPSQ. The aspect of encouraging families to take relief from caregiving reflects a psychosocially important domain that can be harnessed to prevent caregiver burden. It has been suggested that social support is essential in family members´ caregiving burden ( 26 ) and healthcare professionals have a substantial role in promoting support structures (27). We observed contradicting findings on the indicator of emotional support least scored by family members from the study in Norway ( 3 ). However, although not the least scored item in our study – offering family meetings was among the three least items in our study. Of note, the data collection was conducted during the COVID-19 era during which there were restricted visiting policies and meetings with healthcare providers. Restricted visitation policies account for the reduced possibility for nurses to offer family meetings in acute care settings ( 28 ). Although it is important to consider the impact of COVID-19 on family meetings in acute care settings, efforts to establish effective intervention packages for offering family meetings in acute care settings are needed. Our findings on emotional support demonstrated that awareness of the impact family members can have on one another, on the patient’s well-being, and on the illness is highly acknowledged by nurses. Like our findings, findings from other studies have highlighted that the essence of a positive attitude toward family importance in care ( 1 , 11 ). This implies that empathy imposes a substantial element of emotional support. Thus, it has the potential to reduce the burden due to illness by expressing empathy. Furthermore, in the Ugandan care setting (the study setting) family members are involved in care as an important part of the patient´s healthcare system. Considering the realm of emotional support, the element “nurses encouraged the family to become involved with the healthcare team in patient care and have offered caregiver support” received the second-highest scores in the current study. There are various compelling reasons why nurses facilitate family engagement in patient care in this study. First, communication in the study setting is linked to nurse-family encounters thus nurses and family members commonly interact and communicate. Secondly, family members in the setting are often involved in decision-making and providers of patients´ needs including medications and nutritional needs. By contrast, this aspect of family emotional support received the lowest score in a Norwegian study ( 3 ). This demonstrates differences in healthcare structures or systems, variations in order of importance assigned to family involvement in care, and cultural differences in how families rank their perceived support from nurses. Strengths and Limitations A pertinent strength of this study lies in its large sample size however the chosen methodology (cross-sectional design) for data collection introduces the potential for recall bias. Secondly, despite the considerably large sample incorporated in the study, two settings considered in the study might not reflect the national overview of family-perceived support in acute care settings across the country. The study did not account for variations in length of stay across acute care units. Indeed, families with short stay may have distinct support needs and interaction possibilities with nurses compared to those in prolonged e.g., those transitioning to other wards. This may potentially influence perceived support levels. Future studies should use longitudinal study approaches to examine how unit-specific care trajectories shape family perceived levels of support from the health care team. However, based on studies conducted on family nursing in Uganda, this study provides important insights into how family-centered acute care settings in Uganda are using the perspectives of family members on cognitive and emotional support. In addition, the tool used for data collection (ICE-FPSQ) was initially validated to capture family members´ perspectives on family support in the setting ( 19 ) – hence, offering accuracy and reliability of the ICE-FPSQ in this study. Conclusion This study examined family members´ perspectives on family support from nurses, particularly, the extent and nature (cognitive and emotional support specific to acute care settings). This study demonstrated that family support from nurses was moderate suggesting a need to enhance the level of family support. Given this consideration, the analyses conducted to identify specific areas for improvement in family support have indicated the necessity for coordinated delivery of support interventions. These interventions could include measures aimed at assisting families in taking respite from caregiving responsibilities. To promote family support during acute care, there is a strong need to address barriers to patient-family-centered care such as critical nursing skills and resources required to support families in hospital settings. Abbreviations ICE-FPSQ Ice-Family Perceived Support Questionnaire SSA sub-Saharan Africa Declarations Ethics approval and consent to participate: The study was conducted according to the Declaration of Helsinki –Ethical Principles for Medical research Involving Human Subject–2013 and the Finnish code of conduct for research integrity based on the Finnish National Board on Research Integrity. Ethical clearance was obtained from the University of Eastern Finland (UEF) Committee on Research Ethics. An ethics approval statement (Statement number: 3/2020) was awarded by the UEF Committee on Research Ethics before conducting the study. Because the study was conducted in Uganda, further ethical clearance in the Ugandan setting was obtained from two separate ethics committees of two Ugandan Hospitals where the data collection process was conducted. Lastly, permission to collect data was sought from the administration of the two Ugandan hospitals. Participation in the study was entirely voluntary and could be terminated at the participant discretion. Participants were given information orally and in writing, using a study information sheet and privacy notice. Before participating in the study, participants provided informed consent, it was also voluntary to participate in the study. Participants were also free to exit from the study at any time. Statement on ethics approval for use or involvement of any animal or human data or tissue: Not applicable Consent for publication: Not applicable. Funding declaration: Research reported in this publication was supported by the grants from the Finnish National Agency for Education and the North Savo Cultural Fund, and the Kuopio University Foundation awarded to the Frank Kiwanuka. Training and capacity Building for Rose Clarke Nanyonga was sup- ported in part by the Fogarty International Center of the National Institutes of Health, U.S. and the Department of States Office of the U.S. global AIDS Coordinator and Health Diplomacy (S/GAC); presidents Emergency Plan for AIDS Relief (PEPFAR) grant number 1R25TW011213. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders. Conflict of interests: The authors have no conflicts of interest to report. Availability of data and materials: the data that supports the findings of this study are available from the first author, but restrictions apply upon reasonable request and with permission from the University of Eastern Finland. Authors contributions: All authors contributed to writing this manuscript. FK contributed to conception, FK, TK, NSD, and RCN contributed to the methodology. FK, TK and JK conducted the data analysis and reporting of the results. Acknowledgement: The authors want to express their gratitude to family members – they were willing to participate in the study. Some expressed the need to be supported during admission of their family member (the patient). They mentioned that participation in the study would prompt nurses, the health organization administrators and other health care providers to sustain and even do better when engaging with family members in health care settings. Author information: Frank Kiwanuka, RN, PhD (Corresponding author) University of Eastern Finland, Department of Nursing Science, Faculty of Health Sciences Kuopio, Finland. Email: [email protected] ORCID: 0000-0001-8178-3120 FK is a Post-Doctoral Researcher at the University of Eastern Finland, Department of Nursing Science, Kuopio, Finland. Juho Kopra, PhD Statistician, Lecturer University of Eastern Finland, School of Computing, Faculty of Science and Forestry Kuopio, Finland ORCID: 0000-0002-2140-8027 Juho Kopra, PhD, is a Statistician and Lecturer at the University of Eastern Finland, School of Computing, Faculty of Science and Forestry, Kuopio, Finland Natalia Sak-Dankosky, PhD, RN Assistant Professor, Medical University of Warsaw, Department of Clinical Nursing Warsaw, Poland ORCID: 0000-0002-2140-8027 Natalia Sak-Dankosky, PhD, RN is an Assistant Professor at the Medical University of Warsaw, Department of Clinical Nursing, Warsaw, Poland Rose Clarke Nanyonga, PhD, RN Vice-Chancellor, Associate Professor, Clarke International University, Uganda Kampala, Uganda ORCID: 0000-0001-7709-5667 Rose Clarke Nanyonga, PhD, RN is the Vice-Chancellor and Associate Professor at Clarke International University, Kampala, Uganda Tarja Kvist, PhD, RN, Professor, University of Eastern Finland, Department of Nursing Science, Faculty of Health Sciences Kuopio, Finland ORCID: 0000-0001-5974-8732 Tarja KVIST, PhD, RN is a full Professor and chair of the Department of Nursing Science, University of Eastern Finland, Faculty of Health Sciences Kuopio, Finland References Imanipour M, Kiwanuka F, Akhavan Rad S, Masaba R, Alemayehu YH. Family members’ experiences in adult intensive care units: a systematic review. Scand J Caring Sci [Internet]. 2019 Sep 1 [cited 2024 Dec 5];33(3):569–81. Available from: https://onlinelibrary.wiley.com/doi/full/ 10.1111/scs.12675 Komuhangi A, Jenkins C, Nakaggwa F, Agaba P, Githinji F, Ewuzie A et al. The needs, challenges, and burden experienced by informal caregivers in Uganda: a scoping review. Discover Social Sci Health. 2022;2(1). Aass LK, Moen ØL, Skundberg-Kletthagen H, Lundqvist LO, Schröder A. Family support and quality of community mental health care: Perspectives from families living with mental illness. J Clin Nurs [Internet]. 2022 Apr 1 [cited 2024 Dec 5];31(7–8):935–48. Available from: https://onlinelibrary.wiley.com/doi/full/ 10.1111/jocn.15948 Hsiao CY, Hsieh MH, Chung FC, Chiu SC, Chang CW, Tsai YF. Changes in family functioning among primary family caregivers of patients with schizophrenia. 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Engagement of Families in the Care of Hospitalized Pediatric Patients: A Scoping Review. https://doi.org/101177/10748407211048894 [Internet]. 2021 Oct 4 [cited 2024 Dec 5];28(2):151–71. Available from: https://journals.sagepub.com/doi/10.1177/10748407211048894 Redley B, Phiri LM, Heyns T, Wang W, Han CY. Family needs during critical illness in the Emergency Department: A retrospective factor analysis of data from three countries. J Clin Nurs [Internet]. 2019 Aug 1 [cited 2024 Dec 5];28(15–16):2813–23. Available from: https://onlinelibrary.wiley.com/doi/full/ 10.1111/jocn.14857 Dieperink KB, Coyne E, Creedy DK, Østergaard B. Family functioning and perceived support from nurses during cancer treatment among Danish and Australian patients and their families. J Clin Nurs [Internet]. 2018 [cited 2025 Feb 22];27(1–2):e154–61. Available from: https://pubmed.ncbi.nlm.nih.gov/28544339/ Coco K, Tossavainen K, Jääskeläinen JE, Turunen H. The provision of emotional support to the families of traumatic brain injury patients: perspectives of Finnish nurses. J Clin Nurs [Internet]. 2013 May [cited 2025 Feb 22];22(9–10):1467–76. Available from: https://pubmed.ncbi.nlm.nih.gov/23489840/ Freudiger K, Verweij L, Naef R. Translation and Psychometric Validation of the German Version of the Iceland–Family Perceived Support Questionnaire (ICE-FPSQ): A Cross-Sectional Study. J Fam Nurs [Internet]. 2024 May 1 [cited 2024 Dec 5];30(2):114–26. Available from: https://journals.sagepub.com/doi/full/ 10.1177/10748407241234262 Sveinbjarnardottir EK, Svavarsdottir EK, Hrafnkelsson B. Psychometric Development of the Iceland-Family Perceived Support Questionnaire (ICE-FPSQ). http://dx.doi.org/101177/1074840712449203 [Internet]. 2012 Jul 20 [cited 2024 Dec 5];18(3):328–52. Available from: https://journals.sagepub.com/doi/ 10.1177/1074840712449203 Leahey M, Wright LM. Application of the Calgary Family Assessment and Intervention Models: Reflections on the Reciprocity Between the Personal and the Professional. J Fam Nurs [Internet]. 2016 Nov 1 [cited 2025 Feb 22];22(4):450–9. Available from: https://pubmed.ncbi.nlm.nih.gov/27619397/ Santos PM, Dos, Rodrigues K, de Pinheiro S, Santana LA, de Ipólito B, Magro MZ. MC da S. Religious and spiritual support in the conception of nurses and families of critical patients: a cross-sectional study. Rev Esc Enferm USP [Internet]. 2021 [cited 2025 Feb 22];55:e20200508. Available from: https://pubmed.ncbi.nlm.nih.gov/34698760/ Oosono Y, Yokoyama K, Itoh H, Enomoto M, Ishiwata M. Discrepancies Between the Supports Needed for Discharge of Patients With Terminal Cancer to Family Caregivers and What Supports Were Actually Provided in Japan: Assessment of Palliative Care Unit Nurses. Am J Hosp Palliat Care [Internet]. 2018 Apr 1 [cited 2025 Feb 22];35(4):704–11. Available from: https://pubmed.ncbi.nlm.nih.gov/29172637/ Naef R, Massarotto P, Petry H. Family and health professional experience with a nurse-led family support intervention in ICU: A qualitative evaluation study. Intensive Crit Care Nurs [Internet]. 2020 Dec 1 [cited 2025 Feb 22];61. Available from: https://pubmed.ncbi.nlm.nih.gov/32807604/ O’Sullivan A, Alvariza A, Öhlén J, Larsdotter C. Support received by family members before, at and after an ill person’s death. BMC Palliat Care [Internet]. 2021 Dec 1 [cited 2024 Dec 5];20(1):1–12. Available from: https://bmcpalliatcare.biomedcentral.com/articles/ 10.1186/s12904-021-00800-8 El-Gilany AH, Abou-ElWafa H. Acute diseases. Journal of Acute Disease [Internet]. 2023 Jan [cited 2025 Jan 6];12(1):1–9. Available from: https://journals.lww.com/joad/fulltext/2023/12010/acute_diseases__an_epidemiologic_perspective.1.aspx Kiwanuka F, Kopra J, Sak-Dankosky N, Nanyonga RC, Kvist T. Polychoric Correlation with Ordinal Data in Nursing Research. Nurs Res [Internet]. 2022 Nov 1 [cited 2024 Dec 5];71(6):469–76. Available from: https://journals.lww.com/nursingresearchonline/fulltext/2022/11000/polychoric_correlation_with_ordinal_data_in.7.aspx Polit DF, Beck CT. The content validity index: Are you sure you know what’s being reported? critique and recommendations. Res Nurs Health [Internet]. 2006 Oct 1 [cited 2024 Dec 5];29(5):489–97. Available from: https://onlinelibrary.wiley.com/doi/full/ 10.1002/nur.20147 Lemos S, Andrade L, Barbieri-Figueiredo M do, Martins C, Lima T. L. Psychometric Properties of the Portuguese Version of the Iceland-Family Perceived Support Questionnaire in Parents of Children and Adolescents with Chronic Condition. Int J Environ Res Public Health [Internet]. 2022 Jan 1 [cited 2024 Dec 5];20(1). Available from: https://pubmed.ncbi.nlm.nih.gov/36612569/ Gudjonsson SO, Sveinbjarnardottir EK, Arnardottir RH. Recovery of patients with severe depression in inpatient rural psychiatry: a descriptive clinical study. Nord J Psychiatry [Internet]. 2020 Jul 31 [cited 2024 Dec 5];74(6):407–14. Available from: https://www.tandfonline.com/doi/abs/ 10.1080/08039488.2020.1733659 R Core Team. (2020) R A Language and Environment for Statistical Computing. R Foundation for Statistical Computing, Vienna, Austria. - References - Scientific Research Publishing [Internet]. [cited 2024 Dec 5]. Available from: https://scirp.org/reference/referencespapers?referenceid=3064798 Bello CB, Ogunlade OB, Esan DT, Ijabadeniyi OA, Bello AC. Perception of Nurses’ Support among Family Members of Hospitalized Patients in A Tertiary Health Facility in South-West, Nigeria. SAGE Open Nurs [Internet]. 2023 Jan 1 [cited 2024 Dec 5];9:23779608231160480. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9974613/ Santos S, Crespo C, Canavarro MC, Kazak AE. Family Rituals and Quality of Life in Children With Cancer and Their Parents: The Role of Family Cohesion and Hope. J Pediatr Psychol [Internet]. 2015 Aug 1 [cited 2024 Dec 5];40(7):664–71. Available from: https://dx.doi.org/10.1093/jpepsy/jsv013 Liu F, Shen Q, Huang M, Zhou H. Factors associated with caregiver burden among family caregivers of children with cerebral palsy: a systematic review. BMJ Open [Internet]. 2023 Apr 3 [cited 2024 Dec 5];13(4). Available from: https://pubmed.ncbi.nlm.nih.gov/37012010/ Liu Z, Heffernan C, Tan J. Caregiver burden: A concept analysis. Int J Nurs Sci [Internet]. 2020 Oct 10 [cited 2024 Dec 5];7(4):438. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7644552/ Moss SJ, Krewulak KD, Stelfox HT, Ahmed SB, Anglin MC, Bagshaw SM et al. Restricted visitation policies in acute care settings during the COVID-19 pandemic: a scoping review. Crit Care [Internet]. 2021 Dec 1 [cited 2024 Dec 5];25(1). 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5547077","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":453643553,"identity":"19d74278-e5e8-4f2d-bd70-a4c41463ea1c","order_by":0,"name":"Frank Kiwanuka","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAq0lEQVRIiWNgGAWjYBAC9gYGBsYGAxsGBuYDDB8SiNHCcwCsJY2BgS2BcQYJWhgOQ7QQ5TAe6cPPHs4oOJ/YzwbU+oAoLXxp5oYbDG4nzmwDaiHKYfY8DGaSD4BaNtxvYH9AlBYeHvZvQC3nEvcfI9YWHh4eM8kNBgcSN7CRoKVMcoZBsvGMY4yNxGph3ybZ88dOtr+N+WDjD2K0IAFg9IyCUTAKRsEooBIAAAx/MUscK5E9AAAAAElFTkSuQmCC","orcid":"","institution":"University of Eastern Finland","correspondingAuthor":true,"prefix":"","firstName":"Frank","middleName":"","lastName":"Kiwanuka","suffix":""},{"id":453643554,"identity":"c84149bc-129d-469c-aab3-a05031744129","order_by":1,"name":"Juho Kopra","email":"","orcid":"","institution":"University of Eastern Finland","correspondingAuthor":false,"prefix":"","firstName":"Juho","middleName":"","lastName":"Kopra","suffix":""},{"id":453643555,"identity":"9181029f-7973-4643-8b18-a37f540923e0","order_by":2,"name":"Natalia Sak-Dankosky","email":"","orcid":"","institution":"Medical University of Warsaw","correspondingAuthor":false,"prefix":"","firstName":"Natalia","middleName":"","lastName":"Sak-Dankosky","suffix":""},{"id":453643556,"identity":"df591e83-776f-411e-aca2-b3893660ed69","order_by":3,"name":"Rose Clarke Nanyonga","email":"","orcid":"","institution":"Clarke International University","correspondingAuthor":false,"prefix":"","firstName":"Rose","middleName":"Clarke","lastName":"Nanyonga","suffix":""},{"id":453643557,"identity":"7bf3161e-f27b-4afa-b428-79bccbd0d69e","order_by":4,"name":"Tarja Kvist","email":"","orcid":"","institution":"University of Eastern Finland","correspondingAuthor":false,"prefix":"","firstName":"Tarja","middleName":"","lastName":"Kvist","suffix":""}],"badges":[],"createdAt":"2024-11-29 07:38:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5547077/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5547077/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12912-025-03279-3","type":"published","date":"2025-07-01T15:57:15+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":86178939,"identity":"52cd5563-216c-4e44-8fc6-bb39f8a6ed62","added_by":"auto","created_at":"2025-07-07 16:11:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":785501,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5547077/v1/af4aa2dd-49e7-4ca0-bf4e-8f22ae39218f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Family support in acute care settings: Perspectives of family members on cognitive and emotional support","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eDuring the acute care trajectory, families require support, communication with the healthcare team on the patient\u0026acute;s condition as well as operational and environmental issues in the healthcare setting (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Families in Sub-Saharan Africa, families play a substantial role in the healthcare system, particularly in providing informal caregiving (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The role of family carers is also increasingly acknowledged in High-Income Countries (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Of note, despite variations in cultural orientations, and evolution in family structures, families are still expected to create a nurturing environment and offer emotional and cognitive support to their family members (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). However, family support during the trajectory of care remains poorly defined and operationalized in acute care settings. Yet, family members across different contexts require emotional support and an understanding of support networks (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe concept of family support in healthcare settings emphasizes the role of healthcare providers in providing care related to a patient's family member (such as communication, informational needs, and involvement in decision-making) during the illness event in a hospital setting and subsequent post-patient discharge trajectory. Nurses often undertake family support responsibilities (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), such as mobilizing resources and family education. Scholars in various care settings have consistently articulated definitions of family support provided by nurses. Family support, particularly from nurses, encompasses encouraging families to be present at the bedside, promoting mutual and reciprocal nurse\u0026ndash;patient interactions to achieve a mutually beneficial partnership between families, health care team members, and care organizations\u0026rdquo; (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Families need to be informed and require access to information about the patient\u0026rsquo;s condition (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA variety of distinct areas of family support have been reported across studies. Because the concept of family support has different dimensions, it has not been directly measured; instead, several dimensions are used to reflect family support. However, there has been agreement across studies that the nature of support offered by nurses includes cognitive and emotional support (\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Sveinbjarndottir et al. (2012) \u0026ndash; the original authors of the Icelandic Family Perceived Support Questionnaire (ICE-FPSQ) defined \u0026ldquo;emotional support as that nurses offer families to handle the burden of emotions around the illness of a family member\u0026rdquo; (p. 330). Whilst \u0026ldquo;cognitive support is defined as support that nurses offer to inform or educate the family to help them handle the illness experience\u0026rdquo; (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). With respect to cognitive support, informing or educating the family to assist them in coping with the illness experience (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). In addition, acknowledging family rituals (e.g., religious, and cultural beliefs) \u0026ndash; such ritual is considered a crucial element of cognitive support (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). At the time of discharge, family members require support for continuity of care home, thus, maintaining and guaranteeing resources available in the community fosters cognitive support (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). With respect to emotional support, scheduled family meetings are appreciated by family members as crucial aspects of emotional support (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eObjective measures have used the Icelandic Family Perceived Support Questionnaire (ICE-FPSQ) \u0026ndash; O\u0026acute;Sullivan et al. (2021) found that family members\u0026acute; perceived support focused more on the care received by the patient during the illness trajectory rather than on support provided to the family itself (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). In addition, the element of respect and direct involvement of the family in patient care, as well as drawing forth family strengths, has been emphasized as a crucial component of cognitive and emotional family support (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). These constructs offer an agenda to develop and implement recommendations for family support, which include policy, practices, and interventions (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). As a framework to guide assessment of family support from nurses, in this study, Family Perceived Support (FPS) was theorized as the confidence in one\u0026acute;s perception of the action i.e., strategies used to support the patient\u0026acute;s family during hospitalization. This is consistent with the hypothesis that the actions caused the perceived support (outcome effect). This provided a conceptual orientation for exploration of mechanisms that possibly can drive FPS. Previous research utilised the mean score of FPS as indicators of emotional and cognitive support (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), however, FPS may reflect not only compliance with family nursing, but also family members\u0026acute; coping and recovery. An acute illness has been defined as \u0026ldquo;relatively sever disorder with an abrupt onset and brief symptom duration\u0026rdquo; (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Acute care is concerned as prompt management of patients suffering from acute illnesses \u0026ndash; often requiring but not limited to emergency care within 48 hours. The acute care trajectory ends in complete recovery or progresses into a chronic phase or death. Acute care settings deal with short-term medical or surgical management of infectious, communicable, and non-communicable diseases (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The purpose of this study was to assess the level of perceived family support (i.e., cognitive, and emotional support for family members) provided by nurses among family members.\u003c/p\u003e"},{"header":"METHODS AND MATERIALS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign and sample\u003c/h2\u003e \u003cp\u003eA descriptive cross-sectional design was used in this study. This article is a secondary analysis of data collected for a larger study (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). The data were collected from August 2020 to December 2020 using a survey instrument. Family members were recruited from the largest private for-profit hospital boasting a 100-bed capacity and approximately 150 nursing staff), and the national referral hospital in Kampala, Uganda with a capacity exceeding 1000 beds and approximately 1500 nursing staff. Acute care units providing urgent and short-term care to adult patients with acute illnesses were included in the study. Purposive selection for hospital settings providing acute care considered units providing short-term care or urgent care for critical illness events. These included emergency care units catering for accidents and emergencies; intensive care units, trauma units, short-term medical wards (medical, surgical, obstetrics, and gynaecology wards) and coronary care units.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eRecruitment\u003c/strong\u003e \u003cp\u003eFamily members aged 18 years or older were eligible to participate in the study. The exclusion criteria considered family members with cognitive or hearing impairment. For patients with more than one family member, we included one participant from the family group. A family member was defined as the person whom the patient identified as their family, including spouse, friends, patients\u0026acute; children or siblings to the patient. Participants were enrolled in the study using a variety of strategies such as snowballing, and research assistants directly approaching family members in waiting spaces and asking\u0026ndash; \u0026ldquo;would you like to participate in a research study\u0026rdquo;. Most participants became aware of the study through announcements from department nurses.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cp\u003eThe Ice-Family Perceived Support Questionnaire (ICE-FPSQ; (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) was utilised for data collection. Permission to use the ICE-FPSQ tool was obtained from the original authors. The content validity index (CVI; (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) of the tools was computed from pilot study which was conducted among a convenience sample of 10 family members.\u003c/p\u003e \u003cp\u003eTools distributed to family members were either in English or translated to Luganda (target language). Literacy in either English language or Luganda was considered while recruiting family members. The process of translation and psychometrics of the tool in this study have been described elsewhere (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe ICE-FPSQ is a self-administered tool comprising 14 items in two sub-sections assessing: (a) cognitive support (5 items, α\u0026thinsp;=\u0026thinsp;0.881); (b) emotional support (9 items, α\u0026thinsp;=\u0026thinsp;0.952). Sveinbjarndottir et al. (2012) \u0026ndash; the original authors \u0026ndash; defined \u0026ldquo;emotional support as that nurses offer families to handle the burden of emotions around the illness of a family member\u0026rdquo; (p. 330). The five items in cognitive construct address intentional nurses\u0026rsquo; strategies aimed at fostering the families\u0026rsquo; understanding of the patient\u0026rsquo;s illness, management plans and strengthens the families\u0026rsquo; potential to make informed decision making (e.g., Item 1 \u0026ndash; the nurses on the unit provided information and their professional opinion). Items within the emotional construct capture nurse-led interventions towards the families\u0026rsquo; psychological needs (e.g., Item 7 \u0026ndash; the nurses have helped families recognize that their response to the patients\u0026rsquo; illness is valid and helped them to normalize their emotional response). The tool has good psychometric properties and has been employed in diverse cultural setting (e.g., Portugal (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e); Norway (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e); and Iceland (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) to assess family perceived support. It has a total Cronbach\u0026rsquo;s alpha of 0.961. The scoring of the tool is based on a five-option Likert scale ranging from almost always (score 5) to almost never (score 1). The total score of the tool varies from 14 (minimum) to 70 (maximum), with higher scores reflecting more family perceived support from nurses (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). The ICE-FPSQ in this study had a total Cronbach\u0026rsquo;s alpha of 0.89, with 0.87 for the emotional support subscale and 0.74 for the cognitive support subscale. Naef et al (2024) noted \u0026ldquo;there is no description of what score must be given for a good or insufficient support from nurses\u0026rdquo; (p. 116), in this study, support was categorized into three categories: low (score of 14\u0026ndash;32); moderate (33\u0026ndash;51) and high (scores of 52\u0026ndash;70).\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics were employed to depict participants' mean scores on the ICE-FPSQ items, evaluating overall as well as cognitive and emotional perceived family support. We ensured proactive approaches to minimise missing data during the data collection process. Here, research assistants conducted checks immediately after obtaining the questionnaires from the participants to resolve any incomplete data. In addition, missing data with more than 3% of the variables were addressed by deletion of the entire questionnaire. Multivariate analysis was conducted using ANOVA. \u0026ldquo;ANOVA was used to examine whether support level differed across predefined groups which included participants stratified by their perceived level of engagement in care e.g., almost never, rarely, sometimes, usually and always.\u0026rdquo; For modelling purposes, some variables were mean-centered and scaled to unit variance. Imputation of missing values was also executed. Analyses were conducted using the R-programming software version 4.0.3\u0026ndash;2020-10-10 (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). A level of significance level of 0.05 was deemed statistically significant. Regarding individual items, a minimum of 51 participants per individual response on each item completed the ICE-FPSQ questionnaire.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eOut of the 850 participants that were recruited in the study, 810 returned questionnaires of which 10 had more than five incomplete responses. Ultimately, 800 participants were included in the final analysis. yielding a response rate of 95%. Table 1 provides a summary of the characteristics of the participants. The mean age of the participants was 26 years (SD=7.4; Range 18-72 years). The highest percentage of participants were siblings of the patient (45.8%), most were female (n = 504), and had attained vocational or university-level of education (73.7%, n = 590; Table 1). With respect to the two settings where data collection was conducted, most respondents (75%, n =600) were from a public funded healthcare provider.\u003c/p\u003e\n\u003cp\u003eTable 1. Characteristics of the participants\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.6109%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.323%;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.0661%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.6109%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.323%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e504\u003c/p\u003e\n \u003cp\u003e295\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.0661%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e63.1\u003c/p\u003e\n \u003cp\u003e36.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.6109%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation levels\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNo formal education\u003c/p\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003cp\u003ePost-secondary (vocational or university)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.323%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003cp\u003e590\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.0661%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003cp\u003e19.8\u003c/p\u003e\n \u003cp\u003e73.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.6109%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment status\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eIn a working relationship\u003c/p\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003cp\u003eRetired\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.323%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e342\u003c/p\u003e\n \u003cp\u003e441\u003c/p\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.0661%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e43.1\u003c/p\u003e\n \u003cp\u003e55.6\u003c/p\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.6109%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily member\u0026rsquo;s relationship to the patient\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eParent (mother/father)\u003c/p\u003e\n \u003cp\u003eSibling\u003c/p\u003e\n \u003cp\u003eSpouse (wife/husband)\u003c/p\u003e\n \u003cp\u003eFriend\u003c/p\u003e\n \u003cp\u003eCaretakers\u003c/p\u003e\n \u003cp\u003eGrandparent\u003c/p\u003e\n \u003cp\u003eChild of the patient\u003c/p\u003e\n \u003cp\u003eOther relative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.323%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e124\u003c/p\u003e\n \u003cp\u003e366\u003c/p\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003cp\u003e113\u003c/p\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.0661%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e15.6\u003c/p\u003e\n \u003cp\u003e45.9\u003c/p\u003e\n \u003cp\u003e4.7\u003c/p\u003e\n \u003cp\u003e14.2\u003c/p\u003e\n \u003cp\u003e2.6\u003c/p\u003e\n \u003cp\u003e2.6\u003c/p\u003e\n \u003cp\u003e9.1\u003c/p\u003e\n \u003cp\u003e5.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.6109%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003cp\u003eIn a recognized relationship\u003c/p\u003e\n \u003cp\u003eSeparated/widowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.323%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e522\u003c/p\u003e\n \u003cp\u003e240\u003c/p\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.0661%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e65.5\u003c/p\u003e\n \u003cp\u003e30.1\u003c/p\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eOverall perceived family support\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIndicators of family perceived support from nurses are summarised in table two \u0026ndash;family members indicated that their perceived support from nurses was moderate \u0026ndash; the mean global score on the 14 indicators (Table 2) in the ICE-FPSQ was 45.4 (SD = range 14-70). With respect to the extent of family support, most participants indicated moderate support (55.1%, n= 441), followed by those that reported high support (33.4%, n=267), the least number of participants (11.5%, n=92) reported that family support was low. When considering overall family support, the majority (n =441, 55.1%) of scores fell within the median quartile (considering a range of 14 \u0026ndash; 70). Slightly over a third of family members\u0026acute; reported scores (n = 267, 33.4%) were in the highest quartile while 11.5% (n=92) were in the lowest quartile. Overall family perceived support from nurses correlated positively with perceived cognitive, [\u003cem\u003er\u003c/em\u003e(800) =.86 , p=\u0026lt;0.001] and emotional support [\u003cem\u003er\u003c/em\u003e(800) =.96 , p=\u0026lt;0.001]. Regarding indicators of family perceived support, participants within the lowest quartile of perceived family support (range 0 -30) reported significantly least responses to each item on the ICE-FPSQ. Within the lowest quartile of overall family perceived support, 48.7% indicated almost never offered information compared with 7.9% within the highest quartile of overall family perceived support.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e Indicators for measuring family members\u0026acute; perceived support from nurses on the ICE-FPSQ\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMeasured indicators\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 370px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResponses\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003cp\u003en(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003cp\u003en(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003cp\u003en(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003cp\u003en(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003en(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eOffered information and professional opinion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e239(29.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e224(28.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e170(21.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e89(11.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e76(9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eProvided available and easy-to-read literature about the health problem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e173(22.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e198(25.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e188(24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e128(16.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e(95)12.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eProvided ideas, information and thoughts in a manner which allowed us to learn from them and think about them.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e195(25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e188(24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e208(26.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e114(14.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e77(9.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eInformed my family about the resources available in the community that helped families in similar situations.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e154(19.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e217(27.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e207(26.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e79(10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e130(16.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eHighlighted the use of family rituals (act/prayers) to promote our health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e127(16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e213(26.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e166(20.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e121(15.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e167(21)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eOffered us family discussion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e200(25.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e146(18.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e162(20.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e101(12.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e179(22.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eHelped family members recognize that our emotional response is acceptable and helped us to normalize family members\u0026acute; emotional response\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e156(19.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e251(31.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e220(27.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e85(10.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e82(10.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eEncouraged family to become involved with the health care team in the care of our family member and have offered us support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e229(29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e182(23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e202(25.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e87(11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e90(11.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eEncouraged family members to share their illness stories -not only stories of illnesses and suffering, but also stories of strength and ability to tolerate illness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e182(23.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e252(32.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e104(13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e140(17.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e103(13.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eDrew out our family strengths\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e120(15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e197(24.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e213(26.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e133(16.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e137(17.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eHelped family members understand how our emotional response is related to the family member\u0026rsquo;s illness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e225(28.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e169(21.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e202(25.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e93(11.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e105(13.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eEncouraged my family to take a break from caregiving sometimes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e141(17.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e179(22.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e148(18.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e137(17.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e183(23.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eUnderstand how family members affect one another, the patient\u0026rsquo;s health, and illness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e186(23.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e253(32.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e153(19.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e134(17.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e51(6.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eLooked for the family\u0026rsquo;s strengths and opportunities to commend when strengths have been revealed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e197(24.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e199(24.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e152(19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e138(17.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e114(14.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: 5 = almost always; 4 = Usually; 3 = Sometimes; 2 = Rarely; 1 = Almost never\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFamily perceived cognitive support from nurses\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFamily members\u0026acute;percieved cognitive support from nurses was evaluated across five items revealing a moderate level (M = 16.3, SD =4.5). Table three provides a summary of the items on the ICE-FPSQ. Comparatively, the item concerning \u0026ldquo;nurse(s) highlighting the use of family rituals to promote our health\u0026rdquo; received significantly lower scores (M =3.02, SD = 1.38, t(794), =61.5, P\u0026lt;0.001) on the cognitive subscale. The highest percentage of family members (n =239, 29.9%) indicated that nurses provided information and their professional opinion on the illness to family members. This item received the highest scores (M = 3.6, SD = 1.28; table 3) on the cognitive support subscale and among all items on the ICE-FPSQ. Among other items on the cognitive subscale, literature about health problems was occasionally (n=188, 24%) or frequently (n=198, 24.8%) provided by nurses to family members. Furthermore, a quarter of family members reported that nurses regularly (n=217, 27.6%) provided information about community resources beneficial to families in similar situations. Most family members further indicated that nurses occasionally (n=208, 26.6%) provided ideas, information, and insights conducive to learning. Whilst most (n=213, 26.8%) reported that nurses less frequently highlighted the use of family rituals such as prayers to promote health of patients or family members.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEmotional support from nurses:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe overall emotional support from nurses gained modest scores (M=, 32.4, SD=9.36), with the item \u0026ldquo;nurse(s) encourage the family to take a break from caregiving\u0026rdquo; receiving the lowest scores (M = 2.95, SD = 1.43; table 4).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA substantial proportion of family members (179, 22.7%) indicated that nurses almost never facilitated family meetings. Notably, family members who are not offered family meetings by nurses had significantly lower overall perceived emotional support (M=24.1, SD =9.2, \u003cem\u003eF(788)=120.1, p\u0026lt;0.001\u003c/em\u003e) compared to those who were rarely (M=29.7, SD=7.9), sometimes (M=31.4, SD=5.1), or usually (M=37.7, SD=4.5). Conversely, family members who reported always being offered family meetings (M=38.8, SD=8.04) experienced higher perceived emotional support. Additionally, family members who indicated always being provided with an opportunity to share their illness stories (N=182,22.8%) had significantly higher overall perceived support from nurses (M=55.7, SD=9.7).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRegarding family engagement with the healthcare team during patient care, most family members reported always being encouraged (N=229, 29%) to participate in care and decision making for their patients. Of note, post-hoc analyses using the Bonferroni correction indicated a statistically significant differences were revealed in mean perceived emotional (M=32, SD=9.4, \u003cem\u003eF(789)=267.1, p\u0026lt;0.001\u003c/em\u003e) and overall family perceived support (M=45, SD =11.9, \u003cem\u003eF(785)=244.6, p\u0026lt;0.001\u003c/em\u003e) across categories of family engagement in care (e.g., almost never, rarely, sometimes, usually and always).\u003cu\u003e\u0026nbsp;\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eDespite the majority of family members indicating they were almost never encouraged to take a break from caregiving roles (N=183, 23.2%), a significant difference in overall perceived emotional support was revealed concerning nurses\u0026acute; encouragement for family members to take respite from caregiving. Specifically, post-hoc analyses using the Bonferroni correction indicated that family members who indicated that they were almost always encouraged by nurses to take breaks from caregiving experienced significantly higher perceived emotional support (M =40.6, SD=6.6, \u003cem\u003eF(788)=132.8, P\u0026lt;0.001\u003c/em\u003e). Similarly, post-hoc analyses using the Bonferroni correction indicated that overall family perceived support was highest among family members who reported that they were always encouraged to take respite from caregiving (M =55.7, SD=9.6, \u003cem\u003eF(788)=106.8, P\u0026lt;0.001\u003c/em\u003e).\u003cu\u003e\u0026nbsp;\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e: Descriptive response to the items related to Cognitive support from nurses\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 520px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndicators of cognitive support within the ICE-FPSQ\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 520px;\"\u003e\n \u003cp\u003eThe nurse offered us information and their professional opinion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e3.6 (1.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 520px;\"\u003e\n \u003cp\u003eThe nurses provided ideas, information and thoughts in a manner which enabled us to learn from them and reflect on them\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e3.4 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 520px;\"\u003e\n \u003cp\u003eThe nurse provided accessible and easy-to-read literature about the health problem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e3.3 (1.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 520px;\"\u003e\n \u003cp\u003eThe nurse informed my family about the resources available in the community that have proven to be helpful for families in similar situations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e3.2 (1.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 520px;\"\u003e\n \u003cp\u003eThe nurses emphasized the use of family rituals to promote family members\u0026acute; health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e3.0 (1.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote. SD= Standard Deviation\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4.\u003c/strong\u003e Descriptive responses on emotional support from nurses\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 510px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndicators of emotional support within the ICE-FPSQ\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 510px;\"\u003e\n \u003cp\u003eThe nurses on the unit have been aware of the impact family members can have on one another, on the patient\u0026rsquo;s well-being, and on the illness itself\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e3.50 (1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 510px;\"\u003e\n \u003cp\u003eThe nurses on the unit have encouraged my family to become involved with the healthcare team in the care of our family member and have offered us caregiver support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e3.47 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 510px;\"\u003e\n \u003cp\u003eThe nurses on the unit have helped family members recognize that our response is valid and helped us to validate and/or normalize family members\u0026acute; emotional response\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e3.40 (1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 510px;\"\u003e\n \u003cp\u003eThe nurses on the unit have helped family members understand how our emotional response is related to the family member\u0026rsquo;s illness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e3.40 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 510px;\"\u003e\n \u003cp\u003eThe nurses on the unit have encouraged family members to share their narratives \u0026ndash; not only stories of illnesses and suffering, but also stories of strength and resilience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e3.35 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 510px;\"\u003e\n \u003cp\u003eThe nurses on the unit have looked for the family\u0026rsquo;s strengths and opportunities to commend family members when their strengths were revealed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e3.28 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 510px;\"\u003e\n \u003cp\u003eThe nurses on the unit have offered us family meetings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e3.11 (1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 510px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 510px;\"\u003e\n \u003cp\u003eThe nurses on the unit have drawn out our family strength\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e3.04 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 510px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 510px;\"\u003e\n \u003cp\u003eThe nurses on the unit have encouraged my family to take a respite from caregiving\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e2.95 (1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn this study, we explored the extent of perceptive family members\u0026acute; cognitive and emotional support described as a set of actions taken by nurses that promote family members\u0026acute; support during acute illness. The ICE-FPSQ provided reliable and valid measures of family-perceived cognitive and emotional support. The findings demonstrated that family members perceived emotional and cognitive support from nurses was moderate. This implies that nurses and other healthcare professionals need to work towards enhancing the support provided to patients\u0026acute; family members during acute illnesses. Moderate scores on perceived family support indicate that the level of support offered by nurses is adequate, with potential for further enhancement over time. Ascertaining moderate family perceived support in the study setting, however, results indicate the necessity to improve family support from nurses. The finding in the current study is consistent with that from a study in a Nigerian hospital setting (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFamily support in healthcare settings is multidimensional, these generate variation in family members\u0026acute; perspectives on indicators of cognitive and emotional support. Evidence from a similar study (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) confirms that family members in mental health settings had lower scores compared to this study. In the current study setting, family members\u0026acute; discourse tends to emphasize the interest in knowing about the patient\u0026acute;s illness. It is not surprising, therefore, that the family members\u0026acute; support indicator \u0026ldquo;nurse offered us information and their professional opinion\u0026rdquo; had the highest mean score under cognitive support. Provision of information and nurses\u0026acute; opinions to family members is thought to precede awareness about the community resources available in the community that have proven to be helpful for families in similar situations. This could explain the closely high scores on both indicators of cognitive support. Whether the provision of information and nurses\u0026acute; professional opinion worsens family members\u0026acute; awareness of resources available in the community is consistent with findings from a similar study where scores on the two indicators preceded each other (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Opinion on the highest-scored indicators of cognitive support contradicts findings reported from the study in SSA who noted that family members were commonly never and rarely provided information(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). For this study, family members were least supported on the use of family rituals to promote family members\u0026acute; health. We suspect that opinion on the use of family rituals during illness can be volatile, with opposition from nurses who perceive it as a threat to conventional medical care or less compelling. Although the least supported indicator in the cognitive support domain, family rituals are a plausible strategy that promotes family cohesion and impacts family support during the illness trajectory (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRegarding emotional support, areas of improvement are reflected in low scores on some indicators on the ICE-FPSQ. The aspect of encouraging families to take relief from caregiving reflects a psychosocially important domain that can be harnessed to prevent caregiver burden. It has been suggested that social support is essential in family members\u0026acute; caregiving burden (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) and healthcare professionals have a substantial role in promoting support structures (27). We observed contradicting findings on the indicator of emotional support least scored by family members from the study in Norway (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). However, although not the least scored item in our study \u0026ndash; offering family meetings was among the three least items in our study. Of note, the data collection was conducted during the COVID-19 era during which there were restricted visiting policies and meetings with healthcare providers. Restricted visitation policies account for the reduced possibility for nurses to offer family meetings in acute care settings (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Although it is important to consider the impact of COVID-19 on family meetings in acute care settings, efforts to establish effective intervention packages for offering family meetings in acute care settings are needed.\u003c/p\u003e \u003cp\u003eOur findings on emotional support demonstrated that awareness of the impact family members can have on one another, on the patient\u0026rsquo;s well-being, and on the illness is highly acknowledged by nurses. Like our findings, findings from other studies have highlighted that the essence of a positive attitude toward family importance in care (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). This implies that empathy imposes a substantial element of emotional support. Thus, it has the potential to reduce the burden due to illness by expressing empathy. Furthermore, in the Ugandan care setting (the study setting) family members are involved in care as an important part of the patient\u0026acute;s healthcare system. Considering the realm of emotional support, the element \u0026ldquo;nurses encouraged the family to become involved with the healthcare team in patient care and have offered caregiver support\u0026rdquo; received the second-highest scores in the current study. There are various compelling reasons why nurses facilitate family engagement in patient care in this study. First, communication in the study setting is linked to nurse-family encounters thus nurses and family members commonly interact and communicate. Secondly, family members in the setting are often involved in decision-making and providers of patients\u0026acute; needs including medications and nutritional needs. By contrast, this aspect of family emotional support received the lowest score in a Norwegian study (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). This demonstrates differences in healthcare structures or systems, variations in order of importance assigned to family involvement in care, and cultural differences in how families rank their perceived support from nurses.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and Limitations\u003c/h2\u003e \u003cp\u003eA pertinent strength of this study lies in its large sample size however the chosen methodology (cross-sectional design) for data collection introduces the potential for recall bias. Secondly, despite the considerably large sample incorporated in the study, two settings considered in the study might not reflect the national overview of family-perceived support in acute care settings across the country. The study did not account for variations in length of stay across acute care units. Indeed, families with short stay may have distinct support needs and interaction possibilities with nurses compared to those in prolonged e.g., those transitioning to other wards. This may potentially influence perceived support levels. Future studies should use longitudinal study approaches to examine how unit-specific care trajectories shape family perceived levels of support from the health care team. However, based on studies conducted on family nursing in Uganda, this study provides important insights into how family-centered acute care settings in Uganda are using the perspectives of family members on cognitive and emotional support. In addition, the tool used for data collection (ICE-FPSQ) was initially validated to capture family members\u0026acute; perspectives on family support in the setting (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) \u0026ndash; hence, offering accuracy and reliability of the ICE-FPSQ in this study.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study examined family members\u0026acute; perspectives on family support from nurses, particularly, the extent and nature (cognitive and emotional support specific to acute care settings). This study demonstrated that family support from nurses was moderate suggesting a need to enhance the level of family support. Given this consideration, the analyses conducted to identify specific areas for improvement in family support have indicated the necessity for coordinated delivery of support interventions. These interventions could include measures aimed at assisting families in taking respite from caregiving responsibilities. To promote family support during acute care, there is a strong need to address barriers to patient-family-centered care such as critical nursing skills and resources required to support families in hospital settings.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eICE-FPSQ\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIce-Family Perceived Support Questionnaire\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSSA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003esub-Saharan Africa\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate: \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted according to the Declaration of Helsinki \u0026ndash;Ethical Principles for Medical research Involving Human Subject\u0026ndash;2013 and the Finnish code of conduct for research integrity based on the Finnish National Board on Research Integrity. Ethical clearance was obtained from the University of Eastern Finland (UEF) Committee on Research Ethics. An ethics approval statement (Statement number: 3/2020) was awarded by the UEF Committee on Research Ethics before conducting the study. Because the study was conducted in Uganda, further ethical clearance in the Ugandan setting was obtained from two separate ethics committees of two Ugandan Hospitals where the data collection process was conducted. \u0026nbsp;Lastly, permission to collect data was sought from the administration of the two Ugandan hospitals. Participation in the study was entirely voluntary and could be terminated at the participant discretion. Participants were given information orally and in writing, using a study information sheet and privacy notice. Before participating in the study, participants provided informed consent, it was also voluntary to participate in the study. Participants were also free to exit from the study at any time.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStatement on ethics approval for use or involvement of any animal or human data or tissue: Not applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding declaration:\u003c/strong\u003e Research reported in this publication was supported by the grants from the Finnish National Agency for Education and the North Savo Cultural Fund, and the Kuopio University Foundation awarded to the Frank Kiwanuka. Training and capacity Building for Rose Clarke Nanyonga was sup- ported in part by the Fogarty International Center of the National Institutes of Health, U.S. and the Department of States Office of the U.S. global AIDS Coordinator and Health Diplomacy (S/GAC); presidents Emergency Plan for AIDS Relief (PEPFAR) grant number 1R25TW011213. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interests:\u003c/strong\u003e The authors have no conflicts of interest to report.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e the data that supports the findings of this study are available from the first author, but restrictions apply upon reasonable request and with permission from the University of Eastern Finland.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors contributions:\u003c/strong\u003e All authors contributed to writing this manuscript. FK contributed to conception, FK, TK, NSD, and RCN contributed to the methodology. FK, TK and JK conducted the data analysis and reporting of the results.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement:\u003c/strong\u003e The authors want to express their gratitude to family members \u0026ndash; they were willing to participate in the study. Some expressed the need to be supported during admission of their family member (the patient). They mentioned that participation in the study would prompt nurses, the health organization administrators and other health care providers to sustain and even do better when engaging with family members in health care settings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor information:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrank Kiwanuka, RN, PhD (Corresponding author)\u003c/p\u003e\n\u003cp\u003eUniversity of Eastern Finland, Department of Nursing Science, Faculty of Health Sciences\u003c/p\u003e\n\u003cp\u003eKuopio, Finland. Email: [email protected]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eORCID: 0000-0001-8178-3120\u003c/p\u003e\n\u003cp\u003eFK is a Post-Doctoral Researcher at the University of Eastern Finland, Department of Nursing Science, Kuopio, Finland.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eJuho Kopra, PhD\u003c/p\u003e\n\u003cp\u003eStatistician, Lecturer\u003c/p\u003e\n\u003cp\u003eUniversity of Eastern Finland, School of Computing, Faculty of Science and Forestry\u003c/p\u003e\n\u003cp\u003eKuopio, Finland\u003c/p\u003e\n\u003cp\u003eORCID: 0000-0002-2140-8027\u003c/p\u003e\n\u003cp\u003eJuho Kopra, PhD, is a Statistician and Lecturer at the University of Eastern Finland, School of Computing, Faculty of Science and Forestry, Kuopio, Finland\u003c/p\u003e\n\u003cp\u003eNatalia Sak-Dankosky, PhD, RN\u003c/p\u003e\n\u003cp\u003eAssistant Professor,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMedical University of Warsaw, Department of Clinical Nursing\u003c/p\u003e\n\u003cp\u003eWarsaw, Poland\u003c/p\u003e\n\u003cp\u003eORCID: 0000-0002-2140-8027\u003c/p\u003e\n\u003cp\u003eNatalia Sak-Dankosky, PhD, RN is an Assistant Professor at the Medical University of Warsaw, Department of Clinical Nursing, Warsaw, Poland\u003c/p\u003e\n\u003cp\u003eRose Clarke Nanyonga, PhD, RN\u003c/p\u003e\n\u003cp\u003eVice-Chancellor, Associate Professor,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eClarke International University, Uganda\u003c/p\u003e\n\u003cp\u003eKampala, Uganda\u003c/p\u003e\n\u003cp\u003eORCID: 0000-0001-7709-5667\u003c/p\u003e\n\u003cp\u003eRose Clarke Nanyonga, PhD, RN is the Vice-Chancellor and Associate Professor at Clarke International University, Kampala, Uganda\u003c/p\u003e\n\u003cp\u003eTarja Kvist, PhD, RN,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eProfessor,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUniversity of Eastern Finland, Department of Nursing Science, Faculty of Health Sciences Kuopio, Finland\u003c/p\u003e\n\u003cp\u003eORCID: 0000-0001-5974-8732\u003c/p\u003e\n\u003cp\u003eTarja KVIST, PhD, RN is a full Professor and chair of the Department of Nursing Science, University of Eastern Finland, Faculty of Health Sciences Kuopio, Finland\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eImanipour M, Kiwanuka F, Akhavan Rad S, Masaba R, Alemayehu YH. 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Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/34563234/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/34563234/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"nurses, family nursing, compliance, family-centered care, patient-centered care","lastPublishedDoi":"10.21203/rs.3.rs-5547077/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5547077/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eFamily support\u003cstrong\u003e \u003c/strong\u003eduring acute illnesses is both a care quality indicator and\u003cstrong\u003e \u003c/strong\u003ea goal to deliver value-based care that is respectful of patients and their families’ needs. The aim of this study was to assess the level of perceived family support (i.e., cognitive, and emotional support for family members) provided by nurses in the context of acute care among family members.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods \u003c/strong\u003eA cross-sectional study was conducted among 800 family members, these were recruited from two large hospitals in Uganda. Data collection took place between August 2020 to December 2020. The Icelandic Family Perceived Support Questionnaire (ICE-FPSQ), which measures emotional and cognitive support from the family member´s perspective was used. Analyses were conducted using means, and ANOVA in the R-programming software version 4.0.3 - 2020-10-10.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: The overall ranking of family support received from nurses by family members was moderate (mean global score on the 14 indicators in the ICE-FPSQ was 45.4 (SD = range 14-70). The perceived cognitive support from nurses by family members was also rated as moderate (mean = 16.3, SD =4.5). Notably, the element “utilizing family rituals to enhance family health” received the lowest scores in the realm of cognitive support. Emotional support offered to family members by nurses received moderate ratings (mean= 32.4, SD=9.36). Within the emotional support category, the element of nurses encouraging the family to take respite from caregiving responsibilities generated the lowest scores (mean = 2.95, SD = 1.43).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe findings demonstrated that nurses give the least priority or aren´t aware of the benefits of family rituals or don’t perceive it as important compared to other aspects of cognitive support offered to patient´s families. Nurses may not effectively communicate the importance of encouraging family members to take respite from caregiving responsibilities as an element of emotional support. The moderate perceptible family support scores suggests that the level of support provided by nurses is satisfactory, yet there remains room for sustenance. Ascertaining moderate family perceived support indicates the necessity to improve family support from nurses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration:\u003c/strong\u003e A clinical trial number is not applicable to this study.\u003c/p\u003e","manuscriptTitle":"Family support in acute care settings: Perspectives of family members on cognitive and emotional support","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-09 12:55:12","doi":"10.21203/rs.3.rs-5547077/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-13T03:36:45+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-12T13:19:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"53594082742813518662427917834421241690","date":"2025-05-12T13:03:13+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-08T07:38:30+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-08T07:19:28+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-05-05T06:32:43+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"12797bf2-b06f-4637-bf6f-68d578a902c4","owner":[],"postedDate":"May 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-07-07T16:00:58+00:00","versionOfRecord":{"articleIdentity":"rs-5547077","link":"https://doi.org/10.1186/s12912-025-03279-3","journal":{"identity":"bmc-nursing","isVorOnly":false,"title":"BMC Nursing"},"publishedOn":"2025-07-01 15:57:15","publishedOnDateReadable":"July 1st, 2025"},"versionCreatedAt":"2025-05-09 12:55:12","video":"","vorDoi":"10.1186/s12912-025-03279-3","vorDoiUrl":"https://doi.org/10.1186/s12912-025-03279-3","workflowStages":[]},"version":"v1","identity":"rs-5547077","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5547077","identity":"rs-5547077","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}