From positive attitudes to limited implementation: A mixed-methods study of family-centered care in a Turkish pediatric intensive care unit

Azak M., Cafri I., Yorur N., Korkmaz N.

JOURNAL OF PEDIATRIC NURSING-NURSING CARE OF CHILDREN & FAMILIES, vol.91, pp.146-154, 2026 (SCI-Expanded, SSCI, Scopus)

Abstract

Purpose: Family-centered care (FCC) is a key approach in the pediatric intensive care unit (PICU), yet limited research has examined the gap between nurses' positive attitudes toward FCC and its implementation in practice. This study explored PICU nurses' attitudes toward FCC and factors influencing its implementation using a mixed-methods approach. Design and methods: This mixed-methods study was conducted in a tertiary hospital PICU in T & uuml;rkiye. Quantitative data were collected using a demographic form and the Family-Centered Care Attitude Scale (FCCAS), and qualitative data through semi-structured interviews. Quantitative data were analyzed using descriptive and nonparametric statistics, and qualitative data using thematic analysis. Results: Forty-six nurses participated in the quantitative phase and 15 in the qualitative phase. Nurses demonstrated highly positive attitudes toward FCC, with a mean total FCCAS score of 4.41 +/- 0.45 and similarly high subscale scores. Qualitative findings revealed six themes: communication and trust, education and support, family participation and attitudes, implementation barriers, workload and professional satisfaction, and improvement needs. Integrated findings showed that, despite positive attitudes, FCC was not systematically embedded in routine practice. Conclusion: Although nurses expressed positive attitudes toward FCC, these attitudes were not consistently reflected in clinical practice. Integrated findings indicated that this gap was primarily associated with organizational factors, including lack of training, absence of protocols, and workload constraints. Practice implications: The absence of formal FCC training and institutional protocols places responsibility for implementation on individual nurses, resulting in inconsistent care. Unit-level protocols, structured training, and practical guidance are needed to support consistent FCC implementation. (c) 2026 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.