Facilitated Sensemaking

Contributor: Judy Davidson
July 10, 2019

Author: Judy E. Davidson, DNP,  RN,  MCCM,  FAAN

Year First Published – 2010

Fig 1 – Facilitated Sensemaking Model.

Download Figure 1 PDF

Post-Intensive Care-Family Updated 2017 model with expanded consequences of exposure to critical illness. Published in the open-source (no copyright) WFCCN ebook cited herein.

Major Concepts

Antecedents: Disruption caused by critical illness

Central Concept: Sensemaking: To Make Meaning. Making sense of what is happened, and making sense of the new role of ‘family member of a critically ill person.

Facilitated Sensemaking: Taking action to support the family in making meaning of the situation.

Consequences: Adaptation vs. Post-Intensive Care Syndrome-Family

Assumptions: It is assumed that: (a) stress can be attenuated but not eliminated, (b) attainment of family needs improves family satisfaction, and (c) attainment of family needs has a positive effect on physical and psychological well-being of the family.

Typology

Midrange Theory. This theory is prescriptive in nature providing specific guidance to nurses in order to care for families of critically ill patients in a way that is intended to reduce harm imposed by the exposure to the crisis of critical illness.

Brief Description

This midrange theory is derived from Sr. Calista Roy’s adaptation model and Professor Weick’s business model of sensemaking. In his sensemaking model Weick  describes that people define themselves through actions taken in crisis. Also, leaders shape the vision of an organization’s wellbeing through messaging. In facilitated sensemaking, the nurse helps the family to cue sort, and interpret the meaning of those cues in the environment. The nurse provides the family purpose by facilitating individualized engagement in care and praising them for their efforts. Even in the worst of outcomes they can look back and say they did everything possible to help the team. Simple activities provide focus and modulate the limbic system response to stress which may mediate the development of stress disorders.

The antecedents to stress disorders are fear, horror, and helplessness. The nurse facilitates the flow of communication and transforms information into knowledge through iterative and frequent explanations coupled with reflective inquiry, thereby reducing fear of the unknown.

The four major types of interventions used to achieve sensemaking goals while protecting family health are: developing caring relationships, optimizing communication, welcoming family presence and engagement, and supporting family through decision-making.  The specifics of these interventions are taken from tested strategies found in the literature, and change over time as the science evolves. Current interventions are listed in the model. Intermediate outcomes include a flattened beurocracy and team approach, maintaining family integrity, optimizing family role clarity, improved preparation for family caregiving.  Long-term outcomes include minimizing all of the elements of post-intensive care syndrome family (PICS-F).

Primary Sources

Davidson, J.E., Daly, B.J., Agan, D., Brady, N.R., & Higgins, P.A. (2010). Facilitated sensemaking: a feasibility study for the provision of family support. Critical Care Nursing Quarterly, 33(2), 177-189. This article describes the feasibility testing. The model used in this study was updated in 2017 .

Davidson, J.E. (2010. Facilitated Sensemaking: A Strategy and New Middle-Range Theory to Support Families of Intensive Care Unit Patients. Critical Care Nurse, 30(5), 28-39. This article is about the theory.

Davidson JE, & Netzer, G. (2018). Family response to critical illness. In O.J. Bienvenu, C. Jones, & zT.O. Hopkins (Eds.), Psychological and cognitive impact of critical illness (pp.191-209). New York: Oxford University Press.

Davidson, J.E., & Zisook, S. (2017). Implementing Family-Centered Care Through Facilitated Senseamaking. AACN Advanced Critical Care, 28(2), 200-209.

Davidson, J.E., McDuffie, M., & Campbell, K. (2017. Family Centered Care. In S. Goldsworthy, R., Kelinpell, and G.E. Speed (Eds.), International Best Practices in Critical Care (pp 311-368). Dayboro, Queensland: World Federation of Critical Care Nursing. Open source full text available at : https://wfccn.org/ebook/  This text has the updated model and also an updated version of the PICS-F model.

Needham DM, Davidson J, Cohen H, Hopkins RO, Weinert C, Wunsch H, Zawistowski C, Bemis-Dougherty A, Berney SC, Bienvenu OJ, Brady SL. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders’ conference. Critical care medicine. 2012 Feb 1;40(2):502-9.
Application Sources

Grants Using the Facilitated Sensemaking Model as a Theoretical Framework

Title: Co-designing a Patient and Family Caregiver-Oriented Transitions in Care Bundle. Principal Investigator: Fiest, KM. Funded by the Canadian Institutes of Health Research Transitions in Care Team Grant

Title: Development and Evaluation of a Family-Partnered Care Pathway for Critically Ill Older Patients . Principal Investigator: Stelfox HT. Funding by the Canadian Institutes for Health Research, Alberta Health Services, Nestle, Society of Critical Care Medicine, Canadian ICU Collaborative, Canadian Critical Care Society, CIHR.

Publication Testing the Model:

Skoog, M., Milner, K.A., Gatti-Petito, J. & Dintyala, K. (2016. The Impact of Family Engagement on Anxiety Levels in a Cardiothoracic Intensive Care Unit. Critical Care Nurse, 36(2), 84-89.

Publication by the SCCM Endorsing the Model as one method of organizing family-centered care:

Hwang, D., Davidson JE, Kaus, S., Bullard HM, Christie L., Franck LS, Frizzola M., Harris SA, Hopkins RO, Lisseur ME, Scruth E.. (2017, 7). Sccm Family-Centered Care Guidelines Supplement: Work tools for guideline implementation. Retrieved from:
https://www.sccm.org/getdoc/fb61295d-97ee-4c5f-ac38-48c4fd851033/SCCM-Family-Centered-Care-Guidelines-Supplement-W.aspx.

Practice Example:I have not kept track of all of the places that have adopted it, but the University of Maryland is the most recent.

Judy E. Davidson (1959 – )

Judy E. Davidson is a nurse scientist with over 30 years experience working with families of critically ill patients. She was the Chairperson of the Society of Critical Care Medicine’s Patient/Family Education committee where, during her leadership, the first national guidelines for Family Centered Care, and the enduring Family Centered Care award were developed. While conducting the systematic reviews as lead author for both the 2007 and 2017 guidelines of care, she developed and then updated the Facilitated Sensemaking midrange theory to guide nurses on how to care for the families of critically ill patients.

Dr. Davidson was awarded the Grenvik Family Award for Ethics from the Society of Critical Care Medicine largely for her efforts to promote family-centered care. She was designated a Master in the Academy of Critical Care Medicine for her contributions to the profession, notably her work with family-centered care and co-leading efforts that resulted in development of the recognition of post-intensive care syndrome (PICS) and post-intensive care syndrome-family (PICS-F). She developed the midrange theory Facilitated Sensemaking focused on caring for families of critically ill patients to minimize PICS-F.