July 10, 2019
Author: Judy E. Davidson, DNP, RN, MCCM, FAAN
Year First Published – 2010
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.
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.
Use of the model as the theoretical framework to create a new caregiver willingness scale –
Wilk, Cindy A – Development and Psychometric Performance of the Family Willingness for Caregiving Scale (FWCS)
Research using the theory as theoretical framework:
- Krewulak KD, Bull MJ, Ely EW, Davidson JE, Stelfox HT, Fiest KM. Patients, Family Members and Providers Perceive Family-Administered Delirium Detection Tools in the Adult ICU as Feasible and of Value to Patient Care and Family Member Coping: A Qualitative Focus Group Study. Canadian Journal of Anesthesia. In press. Content expert. Manuscript editing.
- Krewulak KD, Bull MJ, Ely EW, Davidson JE, Stelfox HT, Fiest KM. Effectiveness of an ICU family education intervention on delirium knowledge: a pre-test post-test quasi-experimental study. Canadian Journal of Anesthesia. In press. Content expert. Manuscript editing.
- Fiest, KM, Krewulak, KD, Sept, BG, Spence, KL, Davidson, JE, Ely, EW, Soo, A, & Stelfox, HT. A study protocol for a randomized controlled trial of family-partnered delirium prevention, detection, and management in the critically ill: the ACTIVATE study. BMC Health Services Research. 2020, 20, Article 453.
- Fiest M., Krewulak K.D., Ely E.W., Davidson J.E., Ismail Z., Sept B.G., Stelfox H.T., Partnering With Family Members to Detect Delirium in Critically Ill Patients.Critical Care Medicine. 2020- epup ahead of print. DOI: 10.1097/CCM.0000000000004367. Co-investigator. Project design. Editing.
- Krewulak, K.D. Sept, B.G., Stelfox, H.T., Ely, E.W., Davidson, J.E., Ismail, Z., Fiest, K.M. Feasibility and acceptability of family administration of delirium detection tools in the intensive care unit: a patient-oriented pilot study. CMAJ Open. 2019 Apr 26; 7(2): E294-E299. doi: 10.9778/cmajo.20180123. http://cmajopen.ca/content/7/2/E294.full. Manuscript preparation. Content expert.
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.