Abstract
AIM: To synthesise understanding of family-inclusive adult inpatient care using systematic integrative literature review. BACKGROUND: Inclusion of the extended family network (termed whānau by Indigenous New Zealanders) in bedside care is a person-centred practice speaking to cultural diversity and aligning with principles of Indigenous inclusivity. Although patient-and-family/whānau-centred care is not new, feedback from patients, whānau and clinical audits indicates variability in providing whānau-inclusive care. DESIGN AND METHODS: We used an integrative literature review methodology to draw on qualitative and quantitative evidence published between 2000 and 2024. Five databases were systematically searched for eligible papers in January 2025, including MEDLINE (via Ovid), CINAHL Plus (via EBSCO), Web of Science, Scopus and PsycINFO (via Ovid) and quality assessment criteria were applied to included studies. Data were synthesised using thematic analysis. RESULTS: Of 5325 identified papers, 27 met the inclusion criteria. Thematic analysis yielded three themes that captured experiences of family/whānau inclusion in inpatient care, including factors that helped or hindered inclusion in an acute hospital setting: (1) culturally safe behaviours foster family-inclusive care, including relational care; (2) culturally unsafe behaviours and unwelcoming hospital environments hamper family inclusivity and (3) effective communication practices are variable, with poor communication described as a more common family/whānau experience. CONCLUSION: This comprehensive integrative review identified limited evidence about the experience of family/whānau inclusion in acute care. Inclusion was variable and dependent on health professional willingness, cultural acumen and environmental factors. Experiences were negatively influenced by perceived risks to effective care, including culturally unsafe care and environments and poor communication. The experiences of non-Māori are an underexplored element of family-inclusive care and warrant further investigation. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: Greater understanding of patient and family/whānau bedside care experiences is critical to fostering family/whānau-inclusive inpatient care and evidence-based organisation-wide quality improvement worldwide. Findings have implications for how families are communicated with and integrated into care and for policies such as visiting hours. Professional training and policy work is needed to build health professionals' confidence in family-focused consultation, integration in care and logistical solutions to workload management. IMPACT: This integrative review synthesises patients' and family experiences of family-inclusive inpatient care and incorporates Indigenous/First Nations views as a unique contribution. This review highlights the need to embed cultural safety training into nursing workforce development to serve vulnerable and underserved populations better. Local organisational and broader policy changes are needed to allow flexibility with inpatient care to foster family inclusivity and improve inpatient care. CONTRIBUTION TO THE WIDER GLOBAL CLINICAL COMMUNITY: Indigenous-sensitive practices are an essential facilitator to accessing culturally responsive healthcare services and are key to serving vulnerable and underserved populations and fostering inclusion and equity in healthcare provision. Evidence synthesised by this review has provided insight into Indigenous views of family-centric care in Aotearoa. We note gaps in knowledge about views of Indigenous/First Nations populations globally in this context. REPORTING METHOD: Following the EQUATOR guidelines, the PRISMA-S checklist was applied. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution was made due to the literature review design.