Table 2.

Family influences on comfort

Influence	Operational definition	Subthemes and supporting evidence*†
Family’s unique ability to comfort	Familiarity gives family the unique ability to comfort that complements care provided by staff. From most patients’ perspectives, having loved ones near, connecting with those who know them best and whom they trust, promotes positivity and acceptance of care and provides an important buffer to the unfamiliarity and uncertainty of the clinical environment. Family also comfort through the provision of holistic care and practical support. Patients do not readily relinquish their family role and responsibilities even when facing personal health challenges. Under these circumstances, family-friendly facilities and positive family–staff relationships offset patients’ sense of discomfort about the impact their situation may be having on others. These factors also facilitate family’s ability to comfort. Conflicting views between family and clinical staff can exacerbate doubt in treatment and care among those already feeling vulnerable or uncertain; the most comforting scenario for patients is that family and staff views align. How family is defined and the nature of comforting activities need to be seen in the context of what is culturally important for patients and their family.	The operational definition for the theme ‘Unique ability to comfort’ was generated from data summarised in three subthemes: ‘You always want to see your family – comfort from someone who knows you’ The unique relationship between patient and family underpins family’s ability to comfort. Loved ones can be a buffer to the unfamiliar healthcare setting and a constant comforting presence during times of illness and uncertainty. Patients spoke of hospital life as ‘100% worse without your partner’ (NZE2), the comfort of having someone ‘hold my hand’ (NZE4) and someone ‘to touch’ (M7). ‘… it doesn’t matter how good the nurses, or the doctors are I always want to see my wife or my daughter…I know you give us a lot of helping hands but, in your mind, you always want to see your family.’ (P4). Family also help patients feel safer and more confident about treatment and care decisions. ‘My uncle came and just had a good word to me and sort of put me on track, he sort of made me feel better too you know …he was just more positive you know, like you’re going to be better, have a better life, you’re going to have a longer life … if I didn’t have no family I would have taken off’ (P7). ‘Comfort through practical support and care’ Family provide holistic and practical care that promoted comfort. Examples include back and shoulder rubs, bringing in culturally preferred food, helping with and advocating for care promoting physical comfort (position changes and pain relief). Family also provided practical support that eased patients’ concerns over impending discharge, lifestyle changes and how they would manage at home. ‘I’ve noticed the doctors and nurses take the time to explain things to her [wife] as well as to me which is good. They can probably see I look really spaced out its better to talk to her’ (NZE5). ‘Discomfort, unease related to family’ Even during personal distress, patients did not readily relinquish family roles and responsibilities (as grandmother, mother, father, partner, husband, daughter, family matriarch and so forth). Patients’ concern for their family’s safety and well-being, worry over being a ‘burden’ or ‘scaring’ family sometimes meant denying themselves the comfort of family visits. ‘… My daughter, she’s got her three little children and I don't want her to take them around, I don't want them to get in the car accident, it’s too far for them … I told them not to come back … I’d rather they were safe at home…’ (P2). Strained family relationships or family who did not understand patients’ needs added a layer of distress additional to that arising from their clinical condition. Similarly, differing views between family and staff could undermine patients’ confidence in treatment and care and may require them to make an uncomfortable choice between family and clinical staff recommendations. ‘I don't want to deal with her [wife]. I want to concentrate on the nurses and the doctors… ’ (P6).

* Patient interviews were coded by ethnicity and interview order, that is, M1 is the first Māori interview, P1 for the first Pacific interview and NZE1 is the first New Zealand European (NZE) interview.

†Examples are from stage 2 semistructured interviews of patients undergoing heart surgery.

NZE, New Zealand European.