Exploring Adult Attachment Style and Conflict Resolution Strategies: A Directed Content Analysis to Improve Communications with Family Members of Patients in the Intensive Care Unit

Abstract

Background: Multiple studies have suggested that communication with family members in the ICU is inadequate. Researchers have found that family members understand less than half of basic patient information; family members experience increased anxiety and depression when excluded from decision making; and family members often report conflicts with healthcare team (HCT). Most strategies to address this gap in communication have been general approaches that have offered a standard package of supports. Problem: This analysis used an exploratory design with an existing dataset to explore the use of individualized, targeted strategies for addressing communication needs of families of ICU patients and their HCTs. Methodology: The existing dataset of 79 field notes were recorded by trained facilitators as part of a multi-center, randomized trial of an intervention study designed to improve communication between the HCT and families of ICU patients. Data were analyzed using a directed content analysis approach. The initial coding scheme was derived from adult attachment theory and Moore's theory of conflict and conflict resolution. Results: Of the 79 field notes, the attachment style of the main family member was available for 62 and reflected the proportion reported in other research (i.e., secure = 48%; versus insecure types including self-reliant = 34%, cautious = 10%, or support-seeking = 8%). Eight communication strategies were identified to improve communication. Conflicts were identified commonly in the field notes (220 separate conflicts). The most common parties involved were families and the HCT (162 conflicts). Family members with cautious attachment experienced the most conflict. Discussion: These findings suggest that trained facilitators can use strategies based on attachment style to improve communication with family members. These facilitators tailored their interactions with self-reliant family members in an effort to encourage a typically reluctant population to ask questions and participate collaboratively in decision-making, while families with cautious attachment were assisted to build trust and participate collaboratively. Data from this analysis also suggest that family members with cautious attachment may be at risk for conflict with members of the HCT. Finally, HCT members may be more inclined to collaborate when family members have a secure attachment style.