Voices in Crisis: An Ethnographic Study Uncovering Family Caregivers’ Experiences with their Involvement in Ghanaian Emergency Care.

Voices in Crisis: An Ethnographic Study Uncovering Family Caregivers’ Experiences with their Involvement in Ghanaian Emergency Care. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Voices in Crisis: An Ethnographic Study Uncovering Family Caregivers’ Experiences with their Involvement in Ghanaian Emergency Care. Olivia Nyarko Mensah, Pius Koduah Dwumah, Gabriel Oti-Amankwaa, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8275348/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Background Family involvement is increasingly acknowledged as an important component of patient-centered emergency care. However, in Ghana, limited research has explored how families perceive their roles, experiences, and challenges during relatives’ emergency care. This study sought to explore the perspectives of family members regarding their involvement in emergency care at the AngloGold Ashanti Health Foundation and Obuasi Government Hospital in Ghana. Research Design/Methodology: This was qualitative research with an ethnographic, contextually grounded design, guided by the COREQ checklist. Ghanaian participants were purposively sampled, and semi-structured interviews were conducted with 10 family members of patients admitted to the emergency unit. The data were transcribed verbatim, and a thematic analysis was conducted through open coding using Braun and Clarke's six-step thematic framework in the ATLAS-ti version 24.0 software. Findings: The study found that families were largely excluded from direct caregiving but contributed through logistical and financial support. Participants experienced strong emotional reactions, including fear and anxiety, which were eased after patient stabilization. Communication was a major concern, with many reporting delays and negative staff attitudes, though few received adequate updates. Institutional restrictions, congestion, and privacy issues limited involvement, while supportive staff facilitated participation. Conclusion The findings of this study conclude that while families desire meaningful involvement in emergency care, systemic, institutional, and interpersonal barriers limit their participation. Also, participants' emotional well-being is strongly tied to communication. Family-care givers Perspectives Involvement Emergency care ethnographic design Introduction The integration of patients’ family members into care and decision making, particularly when they are in the hospital for acute and serious illnesses, is a prerequisite for family-centred care [1]. As the healthcare system continues to shift from provider-centred to patient- and family-centred models, the active participation of family members is now recognized as a key component of high-quality, ethical care [2.3]. Family presence or involvement during emergency care, specifically, is a relatively new and unestablished practice. Family involvement denotes the presence of one or more family members in an area that permits visual and or physical contact with the patient as procedures are being performed in the emergency units and partake in planning, delivering and evaluation of care [4] Thus, the presence of family members during an emergency provides emotional support to the patient, which significantly reduces anxiety and stress [3]. Globally, studies have shown that patients who have family members present during critical interventions report feeling more secure and comforted, which can positively influence their overall experience in the emergency department [3]. Also, studies highlighted that several family members desire to be present during critical interventions, such as resuscitation, and wish to participate in end-of-life care decisions. For instance, a cross-sectional study conducted in 2024 found that approximately 61% of family members wanted the option to be present during resuscitation, with nearly half expressing a preference to participate in both resuscitation and end-of-life care [3,5,6]. Several barriers hinder effective family involvement in emergency settings. Healthcare professionals often face challenges balancing the urgency of care with the inclusion of family members. A qualitative evidence synthesis revealed that while some healthcare providers view family presence during resuscitation as ethically appropriate, concerns about potential interference and emotional distress persist [5]. In Ghana, families play a vital role in healthcare, rooted in cultural values that highlight shared responsibility, social unity, and support for one another. It is customary for families to take care of their sick members and make important decisions during critical illnesses or hospital stays. However, in emergency healthcare situations, where quick decisions and urgent interventions are crucial, this expectation can sometimes conflict with hospital protocols that focus on clinical efficiency, patient confidentiality, and infection control [6]. Recent research in Ghanaian hospital settings has demonstrated that while healthcare providers acknowledge the importance of family-centered care, the actual integration of families into decision-making and care processes is inconsistent. A recent study found that in neonatal intensive care units (NICUs), both families and clinicians expressed a need for improved communication, emotional support, and clearer role definitions [7]. These findings are reflective of a broader issue across hospital departments, including the emergency unit, where family involvement is often informal, unstructured, and dependent on individual providers' attitudes and the immediate pressures of clinical care. Another Ghanaian study found that in emergency settings, family members often feel emotionally distressed because they don't receive timely information and feel excluded from the care process [8]. This lack of communication not only diminishes their satisfaction but can also erode their trust in the healthcare system. There is an increasing understanding that enhancing family involvement in emergency care can lead to lower family anxiety and more effective decision-making, especially when patients cannot speak for themselves. However, there is a notable scarcity of research that examines the views of families in Ghana, particularly in emergencies where the urgency of clinical care often takes precedence over personal relationships. This study aims to fill this gap by exploring the lived experiences, expectations, and challenges faced by families involved in the emergency care of their relatives. Methodology We utilized the Consolidated criteria for Reporting Qualitative Research (COREQ) [9] was followed for procedures and reporting (supplemental data 1). Study Design This study employed a qualitative research approach with an ethnographic contextualized design to explore the lived experiences, perceptions, and meanings that family members attach to their involvement in emergency care. Ethnography was deemed appropriate for this research because it seeks to understand the social and cultural dynamics of people in a community and allows researchers to immerse themselves in a particular culture, sub-culture environment. We engaged participants in in-depth interviews to gain insights into the perspectives, behaviors, and practices of individuals within the studied context. Study Area This study was conducted in the AngloGold Ashanti Health Foundation (AGAHF) and Obuasi Government Hospitals (OGH)., both in Obuasi Municipality. Study population The study focused on family members whose relatives were seeking care at the emergency department of AngloGold Ashanti Health Foundation (AGAHF) and Obuasi Government Hospitals (OGH). The eligibility criteria for participation included family members 18 years or older who were able to provide informed consent, family members who were present at the emergency department during the care of their relative and the collection of data, and family members who were willing to participate in the study Sampling Technique and Sample Size We used the purposive sampling method to select family caregivers who met the inclusion criteria to participate in the study because they had relevant experiences and could provide detailed information. Approaching the participants, two gatekeepers, each working in the two selected hospitals, were contacted per the hospital's protocol to assist researchers in identifying participants who met the inclusion criteria and were willing to participate voluntarily in the study. The gatekeepers introduced the researchers to the participants. Initially, those who agreed were thirteen. However, before data collection, two declined, with one giving the reason that it would affect his emotions. The other gave no specific reason, but based on the fact that researchers assured her she can step down at any point in the research, with or without giving anybody reasons. The sample size was not predetermined, as data collection continued until saturation on the 10th participant. The number of samples was guided by the principle of data saturation, where new interviews no longer generated new insights. Therefore, 10 participants took part in the study. Data Collection Tools and Methods A semi-structured interview guide was used to collect data for the study. An interview guide, composed of open-ended questions, was drafted by the researchers; PKA and GOA who are both undergraduates. The tool was revised, validated and approved by a senior researcher, ONM, PhD(c), MPhil, female thesis supervisor with 12 years of experience in qualitative inquiries and an expert in qualitative and mixed researches, and EGE, (PhD), male with experience in both qualitative and mixed-methods studies over 15 years. Both validated the draft interview guide and handed over to other qualitative experts for their inputs to finalise and validate the tool before data collection. The tool was pretested using three participants from the study area. The initial participants used for the pretest were not used in the main study. The interview was formulated based on the following research questions; How do family members perceive their roles during the emergency care of their relatives? What emotional experiences do family members go through during their relative’s emergency treatment? What are the expectations of family members regarding communication and access during emergency care? What barriers influence the involvement of family members in emergency care? Data Collection and Analysis Data collection and analysis were conducted simultaneously through one-on-one, face-to-face interviews with an interview guide within an hour. The process was conducted between 18th August 2025 and 20th September 2025. Before data collection, participants' consent was sought. Researchers PKD, a male with a BSN, and GOA, a male with a BSN in nursing, were trained by ONM, a female PhD (c) with an MPhil, and have expertise in qualitative research. Researcher, ONM was supported by EGE, PhD with expertise in qualitative and mixed-methods studies. The Interviews were conducted in quiet and comfortable mini-conference rooms at the hospitals with “Do Not Disturb, there is a Meeting” signs placed at the doors. The interview guide included questions on perceived roles, experiences, involvements, and family expectations in their relatives’ emergency care. All interviews were conducted in English and /or Twi within an hour, audio-recorded, and transcribed verbatim for analysis in the English language. All participants were given pseudonyms during the interviews and in the transcripts, ensuring anonymity. Permissions were sought to audio-record the interview session, and all participants agreed to the request before interviews were conducted. The transcribed data were uploaded into ATLAS-ti 24.0.0 to perform the thematic data analysis. Analysis was performed by two researchers independently (PKD, GOA) under the supervision of ONM, by transcription verbatim, reading and re-reading to familiarize, after which the codes were generated, compared, and discussed with two other researchers (WWA and EGE) to reach consensus for each transcript. Subsequently, code groups were formed combining codes regarding the same topic. Through discussion with the research team (PKD, GOA, ONM, WWA and EGE) the code groups were further categorized into four main and subthemes. The process is elaborated following Braune and Clarke [10,11] six-step reflexive thematic analysis framework in ATLAS ti version 24.0. Step 1: Familiarization with the data Authors, ONM, PKD and GOA imported transcribed data into a new project. Read and re-read the transcripts multiple times within the software, listening to audios. We then use the comment function for documents to write down initial impressions and potential ideas or patterns. Step 2: Generating initial codes ONM PKD and GOA systematically worked through the dataset. ONM highlighted relevant segments of text (quotations) and used the "Apply Codes" function (often via right-click) and created concise labels or "codes" that described the content. We created our own descriptive labels with EGE. Phase 3: Searching for themes ONM and EGE review all your generated codes in the Code Manager. We looked for broader patterns of meaning and grouped related codes together to form main themes. The software allowed organizing codes into Code Groups Phase 4: Reviewing themes In the iterative process, we revisited the themes in the Code Groups and checked for coherent meaning and their distinctiveness from other themes. We read the data extracts associated with each theme (by double-clicking the code) to ensure they accurately represent the overall dataset and answer your research questions. Step 5: Defining and naming themes We described each theme within the software using the code's comment function and then articulated what story each tells with assigned narratives and pseudonyms with participant numbers. Step 6: Producing the report We generated the findings in the form of reports from the narrative, using compelling quotes to support our analysis and contextualizing them. Trustworthiness of the Study The researchers ensured the trustworthiness of this study by employing Lincoln and Guba’s Framework of Qualitative Criteria as elaborated by [12] for developing the trustworthiness of a qualitative inquiry: credibility, dependability, confirmability, and transferability. The inclusion criteria were strictly adhered to. Verbatim transcription of the data ensured that the exact narrations of the participants were kept intact. Member checking was done by playing back and allowing participants to confirm transcripts, and also to ensure that the transcribed data was what the participant actually said or meant. The researcher used the same interview guide to collect data from the study participants. Questions were only rephrased to convey the same meaning of questioning. Furthermore, a detailed description of the study setting, methodology, data analysis, and backgrounds of the informants was done to ensure the potential applicability of the data in a similar context as well as for other researchers to be able to replicate the study. Ethical Considerations This study adhered to the principles of the Declaration of Helsinki (World Medical Association [13]. Therefore, ethical approval was first obtained. An introductory letter was also obtained from KNUST, Obuasi campus, which was added to the supervisors’ support letter to seek approval from the study area, the AngloGold Ashanti Health Foundation, and Obuasi Government Hospital. These documents were then used to seek ethical approval from the Committee of Human Research Publication and Ethics [CHRPE], KNUST, and were obtained with reference number CHRPE/AP/831/25. Participants were given a participant information leaflet that outlined the study's purpose, benefits, and risks. The purpose of the study was explained to all participants, and their consent was sought before participating in the study. Confidentiality and anonymity were strictly maintained by replacing personal identifiers with codes. Ethical standards were upheld, ensuring integrity and preventing any form of research misconduct. Findings Table 1 outlines the sociodemographic characteristics of the participants. Table 1 provides characteristics of the study participants. More than half of the participants were female, and the rest were male, with ages ranging from 25 to 66 years. The study population was heterogeneous, including participants with different occupational backgrounds, and the participants also varied in social, educational, and employment status. The summary is found in Table 1 . Table 1 Participant’s Demographic Information Participants (Family Caregivers) Occupation Number of days spent at the Emergency Caregiver-Patient Relation PA Trader 3days Mother PB Hairdresser 1day Grandmother PC Mechanical Technician 1 day Father PD Teacher 1day Father PE Soaper 1day Brother PF Teacher 1day Mother PG Teacher 1day Son PH Farmer 2days Daughter PI Trader 2 days Brother PJ Mason 1 day Son Four main themes and 10 sub-themes were derived from participants' responses (Refer to Table 2 ) Table 2 Emerged Themes and Subthemes No. Themes Sub-themes 1. Perceived roles. • Perceived exclusion from direct caregiving. • Assumed supportive roles through logistical and financial support. 2. Emotional experiences. • Fear, sadness, and anxiety. • Inconsistent emotional support from staff. • Relief after patient stabilization 3. Communication and information sharing. • Absence or delay of updates. • Mixed staff attitudes towards communication. • Adequate communication 4. Barriers to family involvement. • Institutional restrictions. • Privacy and congestion Description of Major Themes and Sub-Themes From the data analysis, four overarching and thirteen subthemes emerged. Each of the subthemes elaborated on participants' narratives described as follows: THEME 1: PERCEIVED ROLES Family members described different levels of involvement in the emergency care of their relatives. Many of them were excluded from direct caregiving, while others engaged in supportive roles such as running errands, providing patient information, or being present in the ward. The following sub-themes were identified: I) Exclusion from direct caregiving and II) Indirect involvement through logistical and financial support Sub-Theme I: Exclusion from Direct Caregiving Restriction of family members from direct caregiving tasks was a common experience among participants. Most were denied entry into the emergency unit and prevented from assisting with activities such as feeding, bathing, or sitting with relatives. This left families feeling sidelined and dependent on staff for all aspects of patient care. A participant stated that, “I wasn’t allowed to enter the emergency room upon arrival…I would be lying if I say I have participated in providing care such as feeding or even bathing my mom. The nurses do all of it.” (P.A). Another participant also stated that, “We haven’t been allowed to enter to see how my grandmother is doing…I feel we were sidelined in the care because… they did not request for our assistance for example to bed-bath my grandmother” (P.B). This sense of exclusion was not physical but also emotional as families often remained outside the ward with no visibility of their relative’s condition. Sub-Theme II: Assuming supportive roles through logistical and financial support Although families were excluded from clinical tasks, some assumed an indirect supportive role, particularly in financial and logistical matters. Participants describe being called upon to purchase medications, settle bills, provide food, or run errands on behalf of their relative. As Participant A explained: “... all this while I’ve been sitting outside waiting to be called upon to either buy some medicines or settle some bills so I can do it (P.A). Another participant also stated that: “The only thing that I expect the health professionals to be doing is…and also requesting for things they would need to complement their care process before it's urgent; we are on standby to get it for them” (P.C.) Participant E also stated that, I was allowed to enter the ward to ask my brother of the things he would need so that I could get them for him. It was one of the nurses who asked me to do that exercise. (P.E) This role, though less visible than direct caregiving, was perceived as essential to complementing professional care. THEME 2: EMOTIONAL EXPERIENCES Participants reported a wide range of emotional and psychological reactions to their relatives’ admission to the emergency unit. These experiences were shaped by uncertainty, restricted access, and the conduct of healthcare providers and the progress of their relatives' condition. Three sub-themes emerged from the interview: I) Fear, sadness, and anxiety II) Inconsistent emotional support from staff, and III) Relief after stabilization. Sub-theme I: Fear, sadness, and anxiety The initial stages of the emergency experience were marked by fear and sadness. Families described feelings of distress when they were unable to see their relatives or receive updates on their condition. One participant said: “I was very sad at first when I brought my mom here…” (P.A) Another participant also stated that: “...the feeling wasn’t easy, and I didn’t know what would happen to my son ” (P.J) Participant D also described her anxiety, knowing that her father’s pre-existing health status: “The thought I had was unexplainable as my dad has this persistent BP issue ” (P.D). These accounts reflect the emotional vulnerability families experience in emergency contexts, especially when faced with uncertainty and limited access. Sub-theme II: Inconsistent emotional support from staff Participants reported mixed experiences with emotional support from healthcare providers. While some received comfort and reassurance, others felt neglected or even dismissed. For example, Participant B described how a nurse attended to her mother who was panicking: “One of the nurses came out to support my mom emotionally because she was sad and panicking.” (P.B) Participant C on the other hand expressed disappointment at the absence of support: “I haven’t been supported emotionally since I arrived here…” (P.C.) Participant D also stated not only the lack of emotional support but also negative staff attitudes: “...a male nurse was rude to me…I didn’t feel emotionally supported during the care as some of the staff shouts at me anyhow” (P.D) This inconsistency suggests that emotional support was dependent on individual staff behaviors rather than a standardized practice within the emergency department. Sub-Theme III: Relief After Patient Stabilization Although initial experiences were emotionally overwhelming, most participants reported feeling calmer and reassured once their relatives were stabilized. This sense of relief often occurred independently of staff support. Participant F explained: “I was sad when I came but when she was stabilized, I calmed down, the nurses had no contribution to me calming down.” (P.F) Participant I also stated: “I became okay after my brother is being catered for” (P.I) These accounts demonstrate that while healthcare providers play a role in communication and reassurance, families emotional states are strongly tied to perceptions of their relative’s stability and recovery. THEME 3: COMMUNICATION AND INFORMATION SHARING Communication between families and healthcare providers emerged as a central issue across participant’s accounts. While few described positive interactions, the majority expressed concerns about inadequate updates, mixed staff attitudes and inconsistent communication practices. This theme is presented under three sub-themes: I) Absence or delay of updates, mixed staff attitudes toward communication and III) Reassurance. Sub-Theme I: Absence or Delay of Updates The most common concern was the lack of proactive communication from healthcare providers at the emergency unit. Most participants described waiting outside the emergency ward for long periods without receiving updates on their relative’s condition. Families often remained in suspense until they were either called upon to run errands or when the patient was stabilized. Participant A stated: [...]None of the nurses have come out to inform me of my mom’s current situation…” (P.A) Participant B also stated: “I expected the nurses to update my mom and I regularly but they were not doing that” (P.B) Participant F also stated: “The nurses have not updated me on her status aside being told her sugar level is high…” (P.F) These accounts highlight a communication gap that heightened family’s anxiety and left them dependent on guesswork or informal observation such as: “[…] peeping through the emergency door” (Field note 6). Sub-Theme II: Mixed Staff Attitudes Towards Communication Participants also stated the variability in staff willingness to engage with families. Some of the nurses were approachable while others were described as rude. Participant B stated: “Some of the nurses were open to us when we arrived, others too turned deaf ears to all the questions we asked them indicating they were not willing to give us any updates.” (P.B) Participant D also encountered unprofessional behaviours: “A male nurse was rude to me just moments before my arrival…the challenge I faced was the poor communication between the staff and myself.” (P.D) These inconsistent experiences reveal that communication practices were not standardized leaving families experiences dependent on individual staff attitudes. Sub-Theme III: Adequate communication Although less common, a few participants reported positive and effective communication with staff. In these cases, families felt respected and reassured because their questions were answered and updates were provided. Participant E rated his experience highly: “I would rate my communication with the nurses 9/10 because they responded to all of my questions, which made me calmer” (P.E) Similarly, Participant I appreciated staff efforts to keep him informed: “I felt respected in a way that they explained everything to me.” (P.I) These demonstrate that when communication was clear and respectful, it significantly reduced anxiety and built trust between families and staffs at the emergency unit. THEME 4: BARRIERS TO FAMILY INVOLVEMENT Participants identified some barriers that restricted their involvement in emergency care, while a few described factors that enabled limited participation. These included hospital policies, safety concerns and staff attitudes. This theme is presented under three sub-themes; I) Institutional restrictions II) Privacy and congestion Sub-Themes I: Institutional Restrictions Most participants highlighted hospital policies and procedures as the primary barrier to their involvement in emergency care. Families consistently reported being denied access to the emergency ward unless explicitly called upon, limiting their ability to support or monitor their relatives. Participant F stated: “I was told the emergency ward does not allow relatives inside unless they are needed according to the hospital policies” (P.F ) Such restrictions reinforced feelings of exclusion as their presence was permitted only when staff required logistical support. Sub-Theme II: Privacy And Congestion Some participants rationalized their exclusion by recognizing that practical concerns such as privacy and overcrowding justified restrictions on family presence in emergency units. These individuals accepted the policies as necessary safeguards for patient and healthcare delivery. Participant C stated: “...the emergency ward is not a side ward so it’s not only one patient there, hence family members can’t be allowed inside…it can invade other patient’s privacy and also cause congestion in the ward. I also think the emergency ward can be a source of infection.” (P.C) This perspective demonstrates an awareness that restrictions were not solely punitive but also grounded in broader considerations of safety and confidentiality. Discussion From the findings, exclusion from direct caregiving was a major concern for family members in the emergency unit. Most participants reported that they were not permitted to assist with even simple tasks such as feeding, bathing, or providing emotional comfort to their relatives. To the families, these are natural caregiving roles that they could easily assume in supporting their loved ones. This finding is consistent with existing literature that highlights how relatives in emergency and critical care settings often feel sidelined by institutional protocols that limit their involvement [14]. Similarly, Rance et al. [15] observed that when families are excluded from caregiving roles, their sense of agency, responsibility, and connection with the patient diminishes, which can negatively affect their trust and overall experience of care. The study also revealed that although families were excluded from direct caregiving, they remained actively involved in supporting their relatives through logistical and financial means. They frequently purchased medications, paid bills, and provided basic necessities. This aligns with previous studies that note how, in many low- and middle-income countries, families are indispensable in bridging healthcare resource gaps through financial and logistical contributions [16, 17]. Furthermore, the exclusion of families from caregiving contradicts Ghanaian cultural expectations, where caring for the sick is viewed as both a moral duty and a social obligation [18]. In many African settings, families are traditionally integrated into the care process, offering emotional, physical, and spiritual support [18]. Their exclusion in emergency departments therefore creates tension between cultural norms and institutional practices, often leading to emotional distress and feelings of helplessness [19]. In contrast, studies from high-income countries suggest that structured family inclusion—such as allowing relatives to be present during resuscitation or stabilization—can reduce anxiety, improve communication, and promote transparency [20, 21]. When managed appropriately, involving family members in non-invasive caregiving activities has been shown to enhance patient comfort and foster collaborative care [21]. Therefore, while exclusion policies in Ghanaian emergency units are often justified by privacy, infection control, and space limitations, they inadvertently undermine family-centered care principles. Allowing safe, guided participation of families in simple caregiving or emotional support roles could improve satisfaction, reduce anxiety, and align hospital practices with Ghana’s cultural context. Limitations of the study The use of self-reported data from interviews is one of the limitations. Participants’ emotional states or their propensity to understate their level of involvement and the support they receive from nurses could have affected the accuracy of the results. Additionally, family members’ experiences at a specific moment in time, frequency on their first or second day in the emergency department. This makes it more challenging to understand how family attitudes and participation may alter over the course of their relative’s hospital stay or emergency visits Moreover, the study lacks variables that can affect family experiences. Although they weren’t thoroughly investigated, factors like the participants’ socioeconomic background, occupation, cultural expectations, or previous encounters with the healthcare system might have influenced their stories. It is hard to pinpoint the exact effects of hospital regulations, staff attitudes, or communication procedures on family involvement without taking these factors into consideration. Furthermore, there may be discrepancies between these reports and objective evaluations of medical procedures or staff practices, even when highlighting subjective experiences and opinions provide insightful information. These variations may result in disparities between the implementation of family involvement in emergency care and how it is perceived. Notwithstanding these drawbacks, the study identifies crucial gaps in family involvement, communication and emotional support in emergency care, providing crucial guidance for enhancing family centered procedures. Conclusion The study found out that families see themselves as crucial to emergency care, yet they are primarily excluded from providing direct care, with their duties being restricted to providing logistical and financial support. Poor communication and uneven emotional support from staff exacerbated their feelings of fear and anxiety which were worsened by poor communication and inconsistent emotional support from staff. With polite communication, anxiety and distress will be eased. Cultural expectations in Ghana emphasized family involvement, but hospital policies frequently limit it, resulting in a disconnect between expectations and reality. Better communication, emotional support, and culturally sensitive regulations are required to enhance family-centered care.The findings of the study underlined that families often felt excluded from direct care giving and negatively stressed by the inconsistent communication and emotional support. Anglo Gold Ashanti Health Foundation and Obuasi Government Hospital can make great contributions to improving patient and family care by reinforcing family engagement policies. The hospital should consider creating structured communication protocols that ensure families get regular updates while also training staff to provide regular emotional and psychological support. Families should be involved in non-clinical supportive roles such as providing emotional reassurance, logistical help and advocacy for their relatives, this will enhance trust and reduced anxiety. To add to it, it was keen that some family members lacked adequate knowledge about their roles in supporting emergency care. The Ghana Health Service (GHS) should implement an educational program targeted for families, basing on practical skills such as effective communication with healthcare providers, emotional coping techniques and adherence to treatment plans. Factoring these programs to the needs of different families will strengthen them to participate more meaningfully in care. At national level, the Ministry of Health (MoH) should contribute efforts to establish family-centered care within emergency departments. This involves reshaping hospital policies to balance infection control and patient privacy with cultural expectations of family involvement. The MoH should train staff on family engagement and communication, and establish directions that encourage consistent involvement of family in decision-making processes. Moreover, emotional and motivational support programs such as counseling services and family support groups should be introduced to strengthen both patient and family flexibility. Finally, more research should be conducted to understand the long-term effects of family involvement on emergency care outcomes. A longitudinal study could provide valuable insight into how family participation affects patient recovery, emotional well-being, and satisfaction with care. Such evidence will infuse future interventions and guide the creation of standardized, culturally sensitive approaches to family-centered emergency care. Abbreviations AGAHF AngloGold Ashanti Health Foundation COREQ Consolidated criteria for Reporting Qualitative Research CHRPE Committee of Human Research Publication and Ethics GHS Ghana Health Service KNUST Kwame Nkrumah University of Science and Technology MoH Ministry of Health MPhil Master pf Philosophy OGH Obuasi Government Hospitals PhD Doctor of Philosophy Declarations Supplementary information The paper has checklists for readers check Ethical Approval and consent to participate The study adhered to the principles of the declaration of Helsinki (World Medical Association [13] of Scientific Research since it involved human subjects. Therefore, ethical clearance was obtained from the Committee on Human Research, Publications and Ethics (CHRPE) of Kwame Nkrumah University of Science and Technology (KNUST) with reference CHRPE/AP/831/25. Institutional permissions were secured from the participating hospitals and the Department of Nursing and Midwifery, KNUST, Obuasi-Campus. Written informed consent was obtained from all participants before data collection. Consent for publications Not applicable. Data Availability The data pertinent to this study are included in the manuscript. The datasets employed in the analysis of this study can be requested from the corresponding author under reasonable terms. Competing interests The author confirms that there are no conflicts of interest. Fundings This research was self-funded, with all expenses covered by the author's personal savings and pocket money. No external funding or grants were received for this study. Authors Contribution All authors conceived and designed the research; PKD, GOA, and ONM collected data and conducted the research; PKD, GOA, and ONM, EGE analyzed and interpreted the qualitative data and analysis; PKD, GOA, wrote the initial paper ONM, WWA, EGE read, edited, and all approved the final manuscript. Acknowledgements The author would like to express sincere gratitude to all the participants who generously gave them their time and shared their experiences, making this study possible. Special thanks go to the study sites for their cooperation and support throughout the research process. The author also wishes to extend heartfelt appreciation to the Kwame Nkrumah University of Science and Technology (KNUST) for granting the necessary ethical clearance and approving this study, ensuring that the research was conducted with the highest standards of integrity. References Khoshakhlagh F, Elsagh A. A review of challenges associated with the implementation of family-centered care in the NICUs of developing countries: Challenges and solutions. Knowl Nurs, 2024; 1(4), 311–28. Institute for Patient- and Family-Centered Care. Advancing the practice of patient- and family-centered care in hospitals: How to get started. IPFCC. 2021, https://www.ipfcc.org/resources/getting_started.pdf Woldring JM, Paans W, Gans RO. Families’ opinions about their involvement in care during hospitalization: A mixed-methods study. BMC Nurs, 2025, 24(25), 1–8. https://doi.org/10.1186/s12912-024-02664-8 . De Mingo-Fernández E, Belzunegui-Eraso Á, Medina-Martín G, Cuesta-Martínez R, Tejada-Musté R, Jiménez-Herrera M. Family presence during invasive procedures: A pilot study to test a tool. BMC Health Serv Res, 2022, 22(1), 1583. https://doi.org/10.1186/s12913-022-08876-5 . Akman M, Koyuncu S. Family presence during resuscitation and end-of-life care: A cross-sectional study on preferences and ethical concerns. Int J Emerg Med, 2024, 17(1), 12–20. https://doi.org/10.1186/s12245-024-00012-7 . Schuler C, Agbozo F, Bansah E, Owusu R, Ntow GE, Preusse-Bleuler B, Pfister RE. Family involvement along the care continuum for small and sick newborns: Attitudes and skills of healthcare providers in Ghana. J Health Popul Nutr. 2025;44(1):277. https://doi.org/10.1186/s41043-025-01001-2 . Abukari Z, Asiedu A, Boateng E. Family-centered care in Ghanaian neonatal intensive care units: Perspectives from healthcare providers and families. J Pediatr Nurs. 2022;63:55–62. https://doi.org/10.1016/j.pedn.2022.05.003 . Asiedu A, Osei SA, Okyere K. Communication practices in Ghanaian emergency care: Family perspectives. Afr J Emerg Med, 2021, 11(4), 563–70. https://doi.org/10.1016/j.afjem.2021.05.003 . Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19:349–57. Braun V. Using thematic analysis in psychology. Qualitative Res Psychol. 2006;3:77–101. Braun V, Clarke V. Thematic analysis: A practical guide. London: Sage; 2022. Lincoln YS, Guba EG. Natural Inquiry. Newbury Park, CA: Sage; 1985. World Medical Association [WMA] Declaration of Helsinki. 2024 Available from: https://www.wma.net/what-we-do/medical-ethics/declaration-ofhelsinki/.[Last accessed on 2025 July 08]. Palonen K, Kaunonen M, Åstedt-Kurki P. Family participation in emergency care: A systematic review. J Clin Nurs, 2016, 25(19–20), 2858–70. Rance C, Brown T, McDonald S. Impact of excluding families during emergency care on satisfaction and emotional well-being. Emerg Med 2020 J, 37 (8), 471–6. Adejumo PO, Akin-Otiko BO, Omisakin FD. Families’ role in supporting patients in low-resource hospital settings. Afr J Nurs Midwifery, 2019, 21(2), 1–13. Muliira JK, Sendikadiwa VB. Family emotional experiences during emergency care in Uganda: A qualitative study. Afr Health Sci,2020, 20(3), 1104–12. https://doi.org/10.4314/ahs.v20i3.27 . Booysen J, Conradie M. Family experiences in South African emergency units: A qualitative exploration. BMC Nurs, 2021, 20(112), 1–9. https://doi.org/10.1186/s12912-021-00636-7 . Davidson JE, Aslakson RA, Long AC, Puntillo KA, Kross EK, Hart J, Curtis JR. Guidelines for family-centered care in the intensive care unit. Critical Care Medicine , 2019, 45(6), 1039–1046. Kentish-Barnes N, Seegers V, Legriel S, Cariou A, Jaber S, Azoulay. E The experience of families in intensive care: Psychological distress and the need for inclusion. Intensive Care Med, 2019,45(5), 672–81. Wiegand DL, Grant MS, Cheon J. Family participation and communication in emergency and critical care: Implications for practice. Nurs Crit Care, 2020 25(2), 85–93. https://doi.org/10.1111/nicc.12457 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 08 Jan, 2026 Reviewers invited by journal 08 Jan, 2026 Editor assigned by journal 08 Jan, 2026 Editor invited by journal 29 Dec, 2025 Submission checks completed at journal 28 Dec, 2025 First submitted to journal 28 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-8275348","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":571485633,"identity":"ff5faa59-df91-4e05-9510-a74526c30f0f","order_by":0,"name":"Olivia Nyarko Mensah","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA30lEQVRIiWNgGAWjYBADHn5m5gMMjA2kaJFsb0sgTQuDwZkzBsRp0W0//HTDh4o6GYYbOd8kfu6wkWNgP/wArxazM2lmN2ecOczDOCN3m2TvmTRjBp40A/xaDiSY3eZtO8DDLJG7TYK37XBigwQDAS3nn3+7/fdfHQ+bRM4zyb9gLewf8Gu5kWN2m7GBmYeH5wybNMQWHgK23HhTdrPn2GEeCfY2Y2vZtjRjNp6cAgIOS99240dNnb39YeaHN9+22cjxsx/fgFcLMmCRAJFsRKsHAmb83h4Fo2AUjIIRCwDGsUleul+zJAAAAABJRU5ErkJggg==","orcid":"","institution":"1.\tSchool of Nursing and Midwifery, Department of Midwifery, Kwame Nkrumah University of Science and Technology","correspondingAuthor":true,"prefix":"","firstName":"Olivia","middleName":"Nyarko","lastName":"Mensah","suffix":""},{"id":571485635,"identity":"1fa1ec6e-6ced-4582-a6ff-5c3a2a53bbbe","order_by":1,"name":"Pius Koduah Dwumah","email":"","orcid":"","institution":"2. 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As the healthcare system continues to shift from provider-centred to patient- and family-centred models, the active participation of family members is now recognized as a key component of high-quality, ethical care [2.3].\u003c/p\u003e \u003cp\u003eFamily presence or involvement during emergency care, specifically, is a relatively new and unestablished practice. Family involvement denotes the presence of one or more family members in an area that permits visual and or physical contact with the patient as procedures are being performed in the emergency units and partake in planning, delivering and evaluation of care [4] Thus, the presence of family members during an emergency provides emotional support to the patient, which significantly reduces anxiety and stress [3].\u003c/p\u003e \u003cp\u003eGlobally, studies have shown that patients who have family members present during critical interventions report feeling more secure and comforted, which can positively influence their overall experience in the emergency department [3].\u003c/p\u003e \u003cp\u003e Also, studies highlighted that several family members desire to be present during critical interventions, such as resuscitation, and wish to participate in end-of-life care decisions. For instance, a cross-sectional study conducted in 2024 found that approximately 61% of family members wanted the option to be present during resuscitation, with nearly half expressing a preference to participate in both resuscitation and end-of-life care [3,5,6].\u003c/p\u003e \u003cp\u003eSeveral barriers hinder effective family involvement in emergency settings. Healthcare professionals often face challenges balancing the urgency of care with the inclusion of family members. A qualitative evidence synthesis revealed that while some healthcare providers view family presence during resuscitation as ethically appropriate, concerns about potential interference and emotional distress persist [5].\u003c/p\u003e \u003cp\u003eIn Ghana, families play a vital role in healthcare, rooted in cultural values that highlight shared responsibility, social unity, and support for one another. It is customary for families to take care of their sick members and make important decisions during critical illnesses or hospital stays. However, in emergency healthcare situations, where quick decisions and urgent interventions are crucial, this expectation can sometimes conflict with hospital protocols that focus on clinical efficiency, patient confidentiality, and infection control [6]. Recent research in Ghanaian hospital settings has demonstrated that while healthcare providers acknowledge the importance of family-centered care, the actual integration of families into decision-making and care processes is inconsistent.\u003c/p\u003e \u003cp\u003eA recent study found that in neonatal intensive care units (NICUs), both families and clinicians expressed a need for improved communication, emotional support, and clearer role definitions [7]. These findings are reflective of a broader issue across hospital departments, including the emergency unit, where family involvement is often informal, unstructured, and dependent on individual providers' attitudes and the immediate pressures of clinical care. Another Ghanaian study found that in emergency settings, family members often feel emotionally distressed because they don't receive timely information and feel excluded from the care process [8]. This lack of communication not only diminishes their satisfaction but can also erode their trust in the healthcare system. There is an increasing understanding that enhancing family involvement in emergency care can lead to lower family anxiety and more effective decision-making, especially when patients cannot speak for themselves. However, there is a notable scarcity of research that examines the views of families in Ghana, particularly in emergencies where the urgency of clinical care often takes precedence over personal relationships.\u003c/p\u003e \u003cp\u003eThis study aims to fill this gap by exploring the lived experiences, expectations, and challenges faced by families involved in the emergency care of their relatives.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003eWe utilized the Consolidated criteria for Reporting Qualitative Research (COREQ) [9] was followed for procedures and reporting (supplemental data 1).\u003c/p\u003e\n\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003ch2\u003eStudy Design\u003c/h2\u003e\n\u003cp\u003eThis study employed a qualitative research approach with an ethnographic contextualized design to explore the lived experiences, perceptions, and meanings that family members attach to their involvement in emergency care. Ethnography was deemed appropriate for this research because it seeks to understand the social and cultural dynamics of people in a community and allows researchers to immerse themselves in a particular culture, sub-culture environment. We engaged participants in in-depth interviews to gain insights into the perspectives, behaviors, and practices of individuals within the studied context.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eStudy Area\u003c/h3\u003e\n\u003cp\u003eThis study was conducted in the AngloGold Ashanti Health Foundation (AGAHF) and Obuasi Government Hospitals (OGH)., both in Obuasi Municipality.\u003c/p\u003e\n\u003ch3\u003eStudy population\u003c/h3\u003e\n\u003cp\u003eThe study focused on family members whose relatives were seeking care at the emergency department of AngloGold Ashanti Health Foundation (AGAHF) and Obuasi Government Hospitals (OGH). The eligibility criteria for participation included family members 18 years or older who were able to provide informed consent, family members who were present at the emergency department during the care of their relative and the collection of data, and family members who were willing to participate in the study\u003c/p\u003e\n\u003ch3\u003eSampling Technique and Sample Size\u003c/h3\u003e\n\u003cp\u003eWe used the purposive sampling method to select family caregivers who met the inclusion criteria to participate in the study because they had relevant experiences and could provide detailed information. Approaching the participants, two gatekeepers, each working in the two selected hospitals, were contacted per the hospital's protocol to assist researchers in identifying participants who met the inclusion criteria and were willing to participate voluntarily in the study. The gatekeepers introduced the researchers to the participants. Initially, those who agreed were thirteen. However, before data collection, two declined, with one giving the reason that it would affect his emotions. The other gave no specific reason, but based on the fact that researchers assured her she can step down at any point in the research, with or without giving anybody reasons. The sample size was not predetermined, as data collection continued until saturation on the 10th participant. The number of samples was guided by the principle of data saturation, where new interviews no longer generated new insights. Therefore, 10 participants took part in the study.\u003c/p\u003e\n\u003ch3\u003eData Collection Tools and Methods\u003c/h3\u003e\n\u003cp\u003eA semi-structured interview guide was used to collect data for the study. An interview guide, composed of open-ended questions, was drafted by the researchers; PKA and GOA who are both undergraduates. The tool was revised, validated and approved by a senior researcher, ONM, PhD(c), MPhil, female thesis supervisor with 12 years of experience in qualitative inquiries and an expert in qualitative and mixed researches, and EGE, (PhD), male with experience in both qualitative and mixed-methods studies over 15 years. Both validated the draft interview guide and handed over to other qualitative experts for their inputs to finalise and validate the tool before data collection. The tool was pretested using three participants from the study area. The initial participants used for the pretest were not used in the main study. The interview was formulated based on the following research questions;\u003c/p\u003e\n\u003col\u003e\n\u003cli\u003e\n\u003cp\u003eHow do family members perceive their roles during the emergency care of their relatives?\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eWhat emotional experiences do family members go through during their relative\u0026rsquo;s emergency treatment?\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eWhat are the expectations of family members regarding communication and access during emergency care?\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eWhat barriers influence the involvement of family members in emergency care?\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ol\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003ch2\u003eData Collection and Analysis\u003c/h2\u003e\n\u003cp\u003eData collection and analysis were conducted simultaneously through one-on-one, face-to-face interviews with an interview guide within an hour. The process was conducted between 18th August 2025 and 20th September 2025. Before data collection, participants' consent was sought. Researchers PKD, a male with a BSN, and GOA, a male with a BSN in nursing, were trained by ONM, a female PhD (c) with an MPhil, and have expertise in qualitative research. Researcher, ONM was supported by EGE, PhD with expertise in qualitative and mixed-methods studies. The Interviews were conducted in quiet and comfortable mini-conference rooms at the hospitals with \u0026ldquo;Do Not Disturb, there is a Meeting\u0026rdquo; signs placed at the doors. The interview guide included questions on perceived roles, experiences, involvements, and family expectations in their relatives\u0026rsquo; emergency care. All interviews were conducted in English and /or Twi within an hour, audio-recorded, and transcribed verbatim for analysis in the English language. All participants were given pseudonyms during the interviews and in the transcripts, ensuring anonymity. Permissions were sought to audio-record the interview session, and all participants agreed to the request before interviews were conducted. The transcribed data were uploaded into ATLAS-ti 24.0.0 to perform the thematic data analysis.\u003c/p\u003e\n\u003cp\u003eAnalysis was performed by two researchers independently (PKD, GOA) under the supervision of ONM, by transcription verbatim, reading and re-reading to familiarize, after which the codes were generated, compared, and discussed with two other researchers (WWA and EGE) to reach consensus for each transcript.\u003c/p\u003e\n\u003cp\u003eSubsequently, code groups were formed combining codes regarding the same topic. Through discussion with the research team (PKD, GOA, ONM, WWA and EGE) the code groups were further categorized into four main and subthemes.\u003c/p\u003e\n\u003cp\u003eThe process is elaborated following Braune and Clarke [10,11] six-step reflexive thematic analysis framework in ATLAS ti version 24.0.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eStep 1: Familiarization with the data\u003c/h3\u003e\n\u003cp\u003eAuthors, ONM, PKD and GOA imported transcribed data into a new project. Read and re-read the transcripts multiple times within the software, listening to audios. We then use the comment function for documents to write down initial impressions and potential ideas or patterns.\u003c/p\u003e\n\u003ch3\u003eStep 2: Generating initial codes\u003c/h3\u003e\n\u003cp\u003eONM PKD and GOA systematically worked through the dataset. ONM highlighted relevant segments of text (quotations) and used the \"Apply Codes\" function (often via right-click) and created concise labels or \"codes\" that described the content. We created our own descriptive labels with EGE.\u003c/p\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n\u003ch2\u003ePhase 3: Searching for themes\u003c/h2\u003e\n\u003cp\u003eONM and EGE review all your generated codes in the Code Manager. We looked for broader patterns of meaning and grouped related codes together to form main themes. The software allowed organizing codes into Code Groups\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n\u003ch2\u003ePhase 4: Reviewing themes\u003c/h2\u003e\n\u003cp\u003eIn the iterative process, we revisited the themes in the Code Groups and checked for coherent meaning and their distinctiveness from other themes. We read the data extracts associated with each theme (by double-clicking the code) to ensure they accurately represent the overall dataset and answer your research questions.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n\u003ch2\u003eStep 5: Defining and naming themes\u003c/h2\u003e\n\u003cp\u003eWe described each theme within the software using the code's comment function and then articulated what story each tells with assigned narratives and pseudonyms with participant numbers.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n\u003ch2\u003eStep 6: Producing the report\u003c/h2\u003e\n\u003cp\u003eWe generated the findings in the form of reports from the narrative, using compelling quotes to support our analysis and contextualizing them.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n\u003ch2\u003eTrustworthiness of the Study\u003c/h2\u003e\n\u003cp\u003eThe researchers ensured the trustworthiness of this study by employing Lincoln and Guba\u0026rsquo;s Framework of Qualitative Criteria as elaborated by [12] for developing the trustworthiness of a qualitative inquiry: credibility, dependability, confirmability, and transferability. The inclusion criteria were strictly adhered to. Verbatim transcription of the data ensured that the exact narrations of the participants were kept intact. Member checking was done by playing back and allowing participants to confirm transcripts, and also to ensure that the transcribed data was what the participant actually said or meant. The researcher used the same interview guide to collect data from the study participants. Questions were only rephrased to convey the same meaning of questioning. Furthermore, a detailed description of the study setting, methodology, data analysis, and backgrounds of the informants was done to ensure the potential applicability of the data in a similar context as well as for other researchers to be able to replicate the study.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n\u003ch2\u003eEthical Considerations\u003c/h2\u003e\n\u003cp\u003eThis study adhered to the principles of the Declaration of Helsinki (World Medical Association [13]. Therefore, ethical approval was first obtained. An introductory letter was also obtained from KNUST, Obuasi campus, which was added to the supervisors\u0026rsquo; support letter to seek approval from the study area, the AngloGold Ashanti Health Foundation, and Obuasi Government Hospital. These documents were then used to seek ethical approval from the Committee of Human Research Publication and Ethics [CHRPE], KNUST, and were obtained with reference number CHRPE/AP/831/25. Participants were given a participant information leaflet that outlined the study's purpose, benefits, and risks. The purpose of the study was explained to all participants, and their consent was sought before participating in the study. Confidentiality and anonymity were strictly maintained by replacing personal identifiers with codes. Ethical standards were upheld, ensuring integrity and preventing any form of research misconduct.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u0026nbsp;\u003c/div\u003e"},{"header":"Findings","content":"\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e outlines the sociodemographic characteristics of the participants. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e provides characteristics of the study participants. More than half of the participants were female, and the rest were male, with ages ranging from 25 to 66 years.\u003c/p\u003e\u003cp\u003eThe study population was heterogeneous, including participants with different occupational backgrounds, and the participants also varied in social, educational, and employment status. The summary is found in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParticipant’s Demographic Information\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipants (Family Caregivers)\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber of days spent at the Emergency\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCaregiver-Patient Relation\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePA\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTrader\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3days\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMother\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePB\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHairdresser\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1day\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGrandmother\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePC\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMechanical Technician\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 day\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFather\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePD\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTeacher\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1day\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFather\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePE\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSoaper\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1day\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBrother\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePF\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTeacher\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1day\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMother\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePG\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTeacher\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1day\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSon\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePH\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFarmer\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2days\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDaughter\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePI\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTrader\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 days\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBrother\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePJ\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMason\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 day\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSon\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eFour main themes and 10 sub-themes were derived from participants' responses (Refer to Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEmerged Themes and Subthemes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThemes\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSub-themes\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePerceived roles.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e• Perceived exclusion from direct caregiving.\u003c/p\u003e \u003cp\u003e• Assumed supportive roles through logistical and financial support.\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmotional experiences.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e• Fear, sadness, and anxiety.\u003c/p\u003e \u003cp\u003e• Inconsistent emotional support from staff.\u003c/p\u003e \u003cp\u003e• Relief after patient stabilization\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCommunication and information sharing.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e• Absence or delay of updates.\u003c/p\u003e \u003cp\u003e• Mixed staff attitudes towards communication.\u003c/p\u003e \u003cp\u003e• Adequate communication\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBarriers to family involvement.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e• Institutional restrictions.\u003c/p\u003e \u003cp\u003e• Privacy and congestion\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003ch2\u003eDescription of Major Themes and Sub-Themes\u003c/h2\u003e\u003cp\u003eFrom the data analysis, four overarching and thirteen subthemes emerged. Each of the subthemes elaborated on participants' narratives described as follows:\u003c/p\u003e\u003ch2\u003eTHEME 1: PERCEIVED ROLES\u003c/h2\u003e\u003cp\u003eFamily members described different levels of involvement in the emergency care of their relatives. Many of them were excluded from direct caregiving, while others engaged in supportive roles such as running errands, providing patient information, or being present in the ward. The following sub-themes were identified: I) Exclusion from direct caregiving and II) Indirect involvement through logistical and financial support\u003c/p\u003e\u003ch2\u003eSub-Theme I: Exclusion from Direct Caregiving\u003c/h2\u003e\u003cp\u003eRestriction of family members from direct caregiving tasks was a common experience among participants. Most were denied entry into the emergency unit and prevented from assisting with activities such as feeding, bathing, or sitting with relatives. This left families feeling sidelined and dependent on staff for all aspects of patient care.\u003c/p\u003e\u003cp\u003eA participant stated that,\u003c/p\u003e\u003cp\u003e \u003cem\u003e“I wasn’t allowed to enter the emergency room upon arrival…I would be lying if I say I have participated in providing care such as feeding or even bathing my mom. The nurses do all of it.”\u003c/em\u003e \u003cb\u003e(P.A).\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAnother participant also stated that,\u003c/p\u003e\u003cp\u003e \u003cem\u003e“We haven’t been allowed to enter to see how my grandmother is doing…I feel we were sidelined in the care because… they did not request for our assistance for example to bed-bath my grandmother”\u003c/em\u003e \u003cb\u003e(P.B).\u003c/b\u003e\u003c/p\u003e\u003cp\u003e This sense of exclusion was not physical but also emotional as families often remained outside the ward with no visibility of their relative’s condition.\u003c/p\u003e\u003ch2\u003eSub-Theme II: Assuming supportive roles through logistical and financial support\u003c/h2\u003e\u003cp\u003eAlthough families were excluded from clinical tasks, some assumed an indirect supportive role, particularly in financial and logistical matters. Participants describe being called upon to purchase medications, settle bills, provide food, or run errands on behalf of their relative.\u003c/p\u003e\u003cp\u003eAs Participant A explained:\u003c/p\u003e\u003cp\u003e“...\u003cem\u003eall this while I’ve been sitting outside waiting to be called upon to either buy some medicines or settle some bills so I can do it\u003c/em\u003e \u003cb\u003e(P.A).\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAnother participant also stated that:\u003c/p\u003e\u003cp\u003e \u003cem\u003e“The only thing that I expect the health professionals to be doing is…and also requesting for things they would need to complement their care process before it's urgent; we are on standby to get it for them”\u003c/em\u003e \u003cb\u003e(P.C.)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eParticipant E also stated that,\u003c/p\u003e\u003cp\u003eI was allowed to enter the ward to ask my brother of the things he would need so that I could get them for him. It was one of the nurses who asked me to do that exercise.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003ch2\u003e(P.E)\u003c/h2\u003e\u003cp\u003eThis role, though less visible than direct caregiving, was perceived as essential to complementing professional care.\u003c/p\u003e\u003ch2\u003eTHEME 2: EMOTIONAL EXPERIENCES\u003c/h2\u003e\u003cp\u003e Participants reported a wide range of emotional and psychological reactions to their relatives’ admission to the emergency unit. These experiences were shaped by uncertainty, restricted access, and the conduct of healthcare providers and the progress of their relatives' condition. Three sub-themes emerged from the interview: I) Fear, sadness, and anxiety II) Inconsistent emotional support from staff, and III) Relief after stabilization.\u003c/p\u003e\u003ch2\u003eSub-theme I: Fear, sadness, and anxiety\u003c/h2\u003e\u003cp\u003eThe initial stages of the emergency experience were marked by fear and sadness. Families described feelings of distress when they were unable to see their relatives or receive updates on their condition.\u003c/p\u003e\u003cp\u003eOne participant said:\u003c/p\u003e\u003cp\u003e \u003cem\u003e“I was very sad at first when I brought my mom here…”\u003c/em\u003e \u003cb\u003e(P.A)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAnother participant also stated that:\u003c/p\u003e\u003cp\u003e \u003cem\u003e“...the feeling wasn’t easy, and I didn’t know what would happen to my son\u003c/em\u003e \u003cb\u003e” (P.J)\u003c/b\u003e \u003c/p\u003e\u003cp\u003eParticipant D also described her anxiety, knowing that her father’s pre-existing health status:\u003c/p\u003e\u003cp\u003e \u003cem\u003e“The thought I had was unexplainable as my dad has this persistent BP issue\u003c/em\u003e \u003cb\u003e” (P.D).\u003c/b\u003e \u003c/p\u003e\u003cp\u003eThese accounts reflect the emotional vulnerability families experience in emergency contexts, especially when faced with uncertainty and limited access.\u003c/p\u003e\u003ch2\u003eSub-theme II: Inconsistent emotional support from staff\u003c/h2\u003e\u003cp\u003eParticipants reported mixed experiences with emotional support from healthcare providers. While some received comfort and reassurance, others felt neglected or even dismissed.\u003c/p\u003e\u003cp\u003eFor example, Participant B described how a nurse attended to her mother who was panicking:\u003c/p\u003e\u003cp\u003e \u003cem\u003e“One of the nurses came out to support my mom emotionally because she was sad and panicking.”\u003c/em\u003e \u003cb\u003e(P.B)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eParticipant C on the other hand expressed disappointment at the absence of support:\u003c/p\u003e\u003cp\u003e \u003cem\u003e“I haven’t been supported emotionally since I arrived here…”\u003c/em\u003e \u003cb\u003e(P.C.)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eParticipant D also stated not only the lack of emotional support but also negative staff attitudes:\u003c/p\u003e\u003cp\u003e\u003cem\u003e“...a male nurse was rude to me…I didn’t feel emotionally supported during the care as some of the staff shouts at me anyhow”\u003c/em\u003e\u003cb\u003e(P.D)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis inconsistency suggests that emotional support was dependent on individual staff behaviors rather than a standardized practice within the emergency department.\u003c/p\u003e\u003ch2\u003eSub-Theme III: Relief After Patient Stabilization\u003c/h2\u003e\u003cp\u003eAlthough initial experiences were emotionally overwhelming, most participants reported feeling calmer and reassured once their relatives were stabilized. This sense of relief often occurred independently of staff support.\u003c/p\u003e\u003cp\u003eParticipant F explained:\u003c/p\u003e\u003cp\u003e \u003cem\u003e“I was sad when I came but when she was stabilized, I calmed down, the nurses had no contribution to me calming down.”\u003c/em\u003e \u003cb\u003e(P.F)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eParticipant I also stated:\u003c/p\u003e\u003cp\u003e \u003cem\u003e“I became okay after my brother is being catered for”\u003c/em\u003e \u003cb\u003e(P.I)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThese accounts demonstrate that while healthcare providers play a role in communication and reassurance, families emotional states are strongly tied to perceptions of their relative’s stability and recovery.\u003c/p\u003e\u003ch2\u003eTHEME 3: COMMUNICATION AND INFORMATION SHARING\u003c/h2\u003e\u003cp\u003eCommunication between families and healthcare providers emerged as a central issue across participant’s accounts. While few described positive interactions, the majority expressed concerns about inadequate updates, mixed staff attitudes and inconsistent communication practices. This theme is presented under three sub-themes: I) Absence or delay of updates, mixed staff attitudes toward communication and III) Reassurance.\u003c/p\u003e\u003ch2\u003eSub-Theme I: Absence or Delay of Updates\u003c/h2\u003e\u003cp\u003eThe most common concern was the lack of proactive communication from healthcare providers at the emergency unit. Most participants described waiting outside the emergency ward for long periods without receiving updates on their relative’s condition. Families often remained in suspense until they were either called upon to run errands or when the patient was stabilized.\u003c/p\u003e\u003cp\u003eParticipant A stated:\u003c/p\u003e\u003cp\u003e \u003cem\u003e[...]None of the nurses have come out to inform me of my mom’s current situation…”\u003c/em\u003e \u003cb\u003e(P.A)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eParticipant B also stated:\u003c/p\u003e\u003cp\u003e \u003cem\u003e“I expected the nurses to update my mom and I regularly but they were not doing that”\u003c/em\u003e \u003cb\u003e(P.B)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eParticipant F also stated:\u003c/p\u003e\u003cp\u003e \u003cem\u003e“The nurses have not updated me on her status aside being told her sugar level is high…”\u003c/em\u003e \u003cb\u003e(P.F)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThese accounts highlight a communication gap that heightened family’s anxiety and left them dependent on guesswork or informal observation such as:\u003c/p\u003e\u003cp\u003e \u003cem\u003e“[…] peeping through the emergency door” (Field note 6).\u003c/em\u003e \u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003ch2\u003eSub-Theme II: Mixed Staff Attitudes Towards Communication\u003c/h2\u003e\u003cp\u003e Participants also stated the variability in staff willingness to engage with families. Some of the nurses were approachable while others were described as rude.\u003c/p\u003e\u003cp\u003eParticipant B stated:\u003c/p\u003e\u003cp\u003e \u003cem\u003e“Some of the nurses were open to us when we arrived, others too turned deaf ears to all the questions we asked them indicating they were not willing to give us any updates.”\u003c/em\u003e \u003cb\u003e(P.B)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eParticipant D also encountered unprofessional behaviours:\u003c/p\u003e\u003cp\u003e\u003cem\u003e“A male nurse was rude to me just moments before my arrival…the challenge I faced was the poor communication between the staff and myself.”\u003c/em\u003e\u003cb\u003e(P.D)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThese inconsistent experiences reveal that communication practices were not standardized leaving families experiences dependent on individual staff attitudes.\u003c/p\u003e\u003ch3\u003eSub-Theme III: Adequate communication\u003c/h3\u003e\u003cp\u003e Although less common, a few participants reported positive and effective communication with staff. In these cases, families felt respected and reassured because their questions were answered and updates were provided.\u003c/p\u003e\u003cp\u003eParticipant E rated his experience highly:\u003c/p\u003e\u003cp\u003e\u003cem\u003e“I would rate my communication with the nurses 9/10 because they responded to all of my questions, which made me calmer”\u003c/em\u003e\u003cb\u003e(P.E)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eSimilarly, Participant I appreciated staff efforts to keep him informed:\u003c/p\u003e\u003cp\u003e \u003cem\u003e“I felt respected in a way that they explained everything to me.”\u003c/em\u003e \u003cb\u003e(P.I)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThese demonstrate that when communication was clear and respectful, it significantly reduced anxiety and built trust between families and staffs at the emergency unit.\u003c/p\u003e\u003ch2\u003eTHEME 4: BARRIERS TO FAMILY INVOLVEMENT\u003c/h2\u003e\u003cp\u003eParticipants identified some barriers that restricted their involvement in emergency care, while a few described factors that enabled limited participation. These included hospital policies, safety concerns and staff attitudes. This theme is presented under three sub-themes; I) Institutional restrictions II) Privacy and congestion\u003c/p\u003e\u003ch2\u003eSub-Themes I: Institutional Restrictions\u003c/h2\u003e\u003cp\u003eMost participants highlighted hospital policies and procedures as the primary barrier to their involvement in emergency care. Families consistently reported being denied access to the emergency ward unless explicitly called upon, limiting their ability to support or monitor their relatives.\u003c/p\u003e\u003cp\u003eParticipant F stated:\u003c/p\u003e\u003cp\u003e \u003cem\u003e“I was told the emergency ward does not allow relatives inside unless they are needed according to the hospital policies”\u003c/em\u003e \u003cb\u003e(P.F\u003c/b\u003e\u003cem\u003e)\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eSuch restrictions reinforced feelings of exclusion as their presence was permitted only when staff required logistical support.\u003c/p\u003e\u003ch2\u003eSub-Theme II: Privacy And Congestion\u003c/h2\u003e\u003cp\u003eSome participants rationalized their exclusion by recognizing that practical concerns such as privacy and overcrowding justified restrictions on family presence in emergency units. These individuals accepted the policies as necessary safeguards for patient and healthcare delivery.\u003c/p\u003e\u003cp\u003eParticipant C stated:\u003c/p\u003e\u003cp\u003e \u003cem\u003e“...the emergency ward is not a side ward so it’s not only one patient there, hence family members can’t be allowed inside…it can invade other patient’s privacy and also cause congestion in the ward. I also think the emergency ward can be a source of infection.”\u003c/em\u003e \u003cb\u003e(P.C)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThis perspective demonstrates an awareness that restrictions were not solely punitive but also grounded in broader considerations of safety and confidentiality.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eFrom the findings, exclusion from direct caregiving was a major concern for family members in the emergency unit. Most participants reported that they were not permitted to assist with even simple tasks such as feeding, bathing, or providing emotional comfort to their relatives. To the families, these are natural caregiving roles that they could easily assume in supporting their loved ones. This finding is consistent with existing literature that highlights how relatives in emergency and critical care settings often feel sidelined by institutional protocols that limit their involvement [14]. Similarly, Rance et al. [15] observed that when families are excluded from caregiving roles, their sense of agency, responsibility, and connection with the patient diminishes, which can negatively affect their trust and overall experience of care.\u003c/p\u003e \u003cp\u003eThe study also revealed that although families were excluded from direct caregiving, they remained actively involved in supporting their relatives through logistical and financial means. They frequently purchased medications, paid bills, and provided basic necessities. This aligns with previous studies that note how, in many low- and middle-income countries, families are indispensable in bridging healthcare resource gaps through financial and logistical contributions [16, 17].\u003c/p\u003e \u003cp\u003eFurthermore, the exclusion of families from caregiving contradicts Ghanaian cultural expectations, where caring for the sick is viewed as both a moral duty and a social obligation [18]. In many African settings, families are traditionally integrated into the care process, offering emotional, physical, and spiritual support [18]. Their exclusion in emergency departments therefore creates tension between cultural norms and institutional practices, often leading to emotional distress and feelings of helplessness [19].\u003c/p\u003e \u003cp\u003eIn contrast, studies from high-income countries suggest that structured family inclusion\u0026mdash;such as allowing relatives to be present during resuscitation or stabilization\u0026mdash;can reduce anxiety, improve communication, and promote transparency [20, 21]. When managed appropriately, involving family members in non-invasive caregiving activities has been shown to enhance patient comfort and foster collaborative care [21].\u003c/p\u003e \u003cp\u003eTherefore, while exclusion policies in Ghanaian emergency units are often justified by privacy, infection control, and space limitations, they inadvertently undermine family-centered care principles. Allowing safe, guided participation of families in simple caregiving or emotional support roles could improve satisfaction, reduce anxiety, and align hospital practices with Ghana\u0026rsquo;s cultural context.\u003c/p\u003e\n\u003ch3\u003eLimitations of the study\u003c/h3\u003e\n\u003cp\u003eThe use of self-reported data from interviews is one of the limitations. Participants\u0026rsquo; emotional states or their propensity to understate their level of involvement and the support they receive from nurses could have affected the accuracy of the results. Additionally, family members\u0026rsquo; experiences at a specific moment in time, frequency on their first or second day in the emergency department. This makes it more challenging to understand how family attitudes and participation may alter over the course of their relative\u0026rsquo;s hospital stay or emergency visits\u003c/p\u003e \u003cp\u003eMoreover, the study lacks variables that can affect family experiences. Although they weren\u0026rsquo;t thoroughly investigated, factors like the participants\u0026rsquo; socioeconomic background, occupation, cultural expectations, or previous encounters with the healthcare system might have influenced their stories. It is hard to pinpoint the exact effects of hospital regulations, staff attitudes, or communication procedures on family involvement without taking these factors into consideration. Furthermore, there may be discrepancies between these reports and objective evaluations of medical procedures or staff practices, even when highlighting subjective experiences and opinions provide insightful information. These variations may result in disparities between the implementation of family involvement in emergency care and how it is perceived.\u003c/p\u003e \u003cp\u003eNotwithstanding these drawbacks, the study identifies crucial gaps in family involvement, communication and emotional support in emergency care, providing crucial guidance for enhancing family centered procedures.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe study found out that families see themselves as crucial to emergency care, yet they are primarily excluded from providing direct care, with their duties being restricted to providing logistical and financial support. Poor communication and uneven emotional support from staff exacerbated their feelings of fear and anxiety which were worsened by poor communication and inconsistent emotional support from staff. With polite communication, anxiety and distress will be eased. Cultural expectations in Ghana emphasized family involvement, but hospital policies frequently limit it, resulting in a disconnect between expectations and reality. Better communication, emotional support, and culturally sensitive regulations are required to enhance family-centered care.The findings of the study underlined that families often felt excluded from direct care giving and negatively stressed by the inconsistent communication and emotional support. Anglo Gold Ashanti Health Foundation and Obuasi Government Hospital can make great contributions to improving patient and family care by reinforcing family engagement policies. The hospital should consider creating structured communication protocols that ensure families get regular updates while also training staff to provide regular emotional and psychological support. Families should be involved in non-clinical supportive roles such as providing emotional reassurance, logistical help and advocacy for their relatives, this will enhance trust and reduced anxiety.\u003c/p\u003e \u003cp\u003eTo add to it, it was keen that some family members lacked adequate knowledge about their roles in supporting emergency care. The Ghana Health Service (GHS) should implement an educational program targeted for families, basing on practical skills such as effective communication with healthcare providers, emotional coping techniques and adherence to treatment plans. Factoring these programs to the needs of different families will strengthen them to participate more meaningfully in care.\u003c/p\u003e \u003cp\u003eAt national level, the Ministry of Health (MoH) should contribute efforts to establish family-centered care within emergency departments. This involves reshaping hospital policies to balance infection control and patient privacy with cultural expectations of family involvement. The MoH should train staff on family engagement and communication, and establish directions that encourage consistent involvement of family in decision-making processes. Moreover, emotional and motivational support programs such as counseling services and family support groups should be introduced to strengthen both patient and family flexibility.\u003c/p\u003e \u003cp\u003eFinally, more research should be conducted to understand the long-term effects of family involvement on emergency care outcomes. A longitudinal study could provide valuable insight into how family participation affects patient recovery, emotional well-being, and satisfaction with care. Such evidence will infuse future interventions and guide the creation of standardized, culturally sensitive approaches to family-centered emergency care.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAGAHF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAngloGold Ashanti Health Foundation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCOREQ\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConsolidated criteria for Reporting Qualitative Research\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCHRPE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCommittee of Human Research Publication and Ethics\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGHS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGhana Health Service\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eKNUST\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eKwame Nkrumah University of Science and Technology\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMoH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMinistry of Health\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMPhil\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMaster pf Philosophy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOGH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eObuasi Government Hospitals\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePhD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDoctor of Philosophy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eSupplementary information\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe paper has checklists for readers check\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study adhered to the principles of the declaration of Helsinki (World Medical Association [13] of Scientific Research since it involved human subjects. Therefore,\u0026nbsp;ethical clearance was obtained from the Committee on Human Research, Publications and Ethics (CHRPE) of Kwame Nkrumah University of Science and Technology (KNUST) with reference\u0026nbsp;CHRPE/AP/831/25.\u0026nbsp;Institutional permissions were secured from the participating hospitals and the Department of Nursing and Midwifery, KNUST, Obuasi-Campus. Written informed consent was obtained from all participants before data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data pertinent to this study are included in the manuscript. The datasets employed in the analysis of this study can be requested from the corresponding author under reasonable terms.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author confirms that there are no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFundings\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was self-funded, with all expenses covered by the author's personal savings and pocket money. No external funding or grants were received\u0026nbsp;for\u0026nbsp;this\u0026nbsp;study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors conceived and designed the research; PKD, GOA, and ONM collected data and conducted the research; PKD, GOA, and ONM, EGE analyzed and interpreted the qualitative data and analysis; PKD, GOA, wrote the initial paper ONM, WWA, EGE read, edited, and all approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author would like to express sincere gratitude to all the participants who generously gave them their time and shared their experiences, making this study possible. Special thanks go to the study sites for their cooperation and support throughout the research process. The author also wishes to extend heartfelt appreciation to the Kwame Nkrumah University of Science and Technology (KNUST) for granting the necessary ethical clearance and approving this study, ensuring that the research was conducted with the highest standards of integrity.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKhoshakhlagh F, Elsagh A. A review of challenges associated with the implementation of family-centered care in the NICUs of developing countries: Challenges and solutions. Knowl Nurs, 2024; 1(4), 311\u0026ndash;28.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eInstitute for Patient- and Family-Centered Care. Advancing the practice of patient- and family-centered care in hospitals: How to get started. 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Newbury Park, CA: Sage; 1985.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Medical Association [WMA] Declaration of Helsinki. 2024 Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.wma.net/what-we-do/medical-ethics/declaration-ofhelsinki/.[Last\u003c/span\u003e\u003cspan address=\"https://www.wma.net/what-we-do/medical-ethics/declaration-ofhelsinki/.[Last\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e accessed on 2025 July 08].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePalonen K, Kaunonen M, \u0026Aring;stedt-Kurki P. Family participation in emergency care: A systematic review. J Clin Nurs, 2016, 25(19\u0026ndash;20), 2858\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRance C, Brown T, McDonald S. Impact of excluding families during emergency care on satisfaction and emotional well-being. 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BMC Nurs, 2021, 20(112), 1\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12912-021-00636-7\u003c/span\u003e\u003cspan address=\"10.1186/s12912-021-00636-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDavidson JE, Aslakson RA, Long AC, Puntillo KA, Kross EK, Hart J, Curtis JR. Guidelines for family-centered care in the intensive care unit. \u003cem\u003eCritical Care Medicine\u003c/em\u003e, 2019, 45(6), 1039\u0026ndash;1046.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKentish-Barnes N, Seegers V, Legriel S, Cariou A, Jaber S, Azoulay. E The experience of families in intensive care: Psychological distress and the need for inclusion. Intensive Care Med, 2019,45(5), 672\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWiegand DL, Grant MS, Cheon J. Family participation and communication in emergency and critical care: Implications for practice. Nurs Crit Care, 2020 25(2), 85\u0026ndash;93. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/nicc.12457\u003c/span\u003e\u003cspan address=\"10.1111/nicc.12457\" targettype=\"DOI\" 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":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"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":"Family-care givers, Perspectives, Involvement, Emergency care, ethnographic design","lastPublishedDoi":"10.21203/rs.3.rs-8275348/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8275348/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eFamily involvement is increasingly acknowledged as an important component of patient-centered emergency care. However, in Ghana, limited research has explored how families perceive their roles, experiences, and challenges during relatives\u0026rsquo; emergency care. This study sought to explore the perspectives of family members regarding their involvement in emergency care at the AngloGold Ashanti Health Foundation and Obuasi Government Hospital in Ghana.\u003c/p\u003e\u003ch2\u003eResearch Design/Methodology:\u003c/h2\u003e \u003cp\u003eThis was qualitative research with an ethnographic, contextually grounded design, guided by the COREQ checklist. Ghanaian participants were purposively sampled, and semi-structured interviews were conducted with 10 family members of patients admitted to the emergency unit. The data were transcribed verbatim, and a thematic analysis was conducted through open coding using Braun and Clarke's six-step thematic framework in the ATLAS-ti version 24.0 software.\u003c/p\u003e\u003ch2\u003eFindings:\u003c/h2\u003e \u003cp\u003eThe study found that families were largely excluded from direct caregiving but contributed through logistical and financial support. Participants experienced strong emotional reactions, including fear and anxiety, which were eased after patient stabilization. Communication was a major concern, with many reporting delays and negative staff attitudes, though few received adequate updates. Institutional restrictions, congestion, and privacy issues limited involvement, while supportive staff facilitated participation.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe findings of this study conclude that while families desire meaningful involvement in emergency care, systemic, institutional, and interpersonal barriers limit their participation. Also, participants' emotional well-being is strongly tied to communication.\u003c/p\u003e","manuscriptTitle":"Voices in Crisis: An Ethnographic Study Uncovering Family Caregivers’ Experiences with their Involvement in Ghanaian Emergency Care.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-12 11:10:57","doi":"10.21203/rs.3.rs-8275348/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-08T12:35:09+00:00","index":"","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-08T08:25:54+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-08T08:16:05+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-29T11:11:48+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-29T00:00:55+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-12-28T23:55:50+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":"12fc6595-6e5d-4d2e-9ab9-45e7f650105f","owner":[],"postedDate":"January 12th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-06T05:53:29+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-12 11:10:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8275348","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8275348","identity":"rs-8275348","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}