Table 5.

The Three Overarching Themes Drawn From Family Caregivers’, Older Adult Patients’, and Nurses’ Responses (N=67) on Barriers to Participation in the Fam-HELP

Theme	Barrier	Example		Recommendations for Practice
Partnership (n=55, 82%)	Not involving patients and families in the plan of care Poor follow through Inflexibility	“As the main caregiver for my mom, I wanted to be respected as a member of her plan of care. The nurses and doctors told me they would involve me in decisions, but never asked for my input. This is not how I viewed being part of a team.”		Adopting an inpatient culture of family-centered care including: Importance of communication to family caregivers Acknowledging vital role of family caregivers in patient’s recovery
		(Family caregiver)
Therapeutic Relationships (n=56, 84%)	Poor listening Not being responsive to patient and family needs	“I’m sure this happens at other hospitals too….The nurses get distracted by other things they have to do. We would get interrupted for a time when the nurse was trying to answer our questions. It would have been nice if the nurse could have sat there when the request for support was made without any distractions or interruptions, but on the unit this was quite difficult.”		Patient and family communication strategies: Allow time to address both patient and family needs Foster opportunities for patients and families to express their concerns Provide accurate information
		(Family caregiver)
Environment (n=50, 75%)	Excessive noise Close quarters Frequent interruptions	“My wife and I were trying to read the newspaper out loud together. The noise coming from outside in the hall drowned us both out. It was too loud and too cramped for me to even carry on a conversation more than a few seconds. I wish that there was more privacy and noise control….”		Implement environmental strategies Noise and clutter control Maximize existing space to support privacy Cluster nursing care and minimize distractions
		(Older adult patient)