Nurse Leaders' Perceptions of the Use of the COMFORT Communication Training Intervention in Adult ICU Settings: A Qualitative Study.

Abstract

Effective nurse-to-family communication is critical in intensive care units (ICUs), where high acuity and emotional complexity demand rapid trust-building and clear information exchange. This qualitative study explored ICU nurse leaders' perceptions of the COMFORT communication intervention, a structured, theory-driven model designed to enhance relationship-centered communication with families. Seventeen nurse leaders from a statewide health system participated in virtual focus groups assessing the COMFORT model's seven components of COMFORT: Connect, Options, Making Meaning, Family Caregiver, Openings, Relating, and Team for practicability, appeal, and relevance within ICU workflows. Directed content analysis revealed strong support for the Connect, Family Caregivers, and Openings components, emphasizing their foundational role in establishing rapport and supporting emotionally charged conversations. Components such as Relating and Options were perceived as less feasible due to time constraints and staff discomfort with sensitive discussions. Leaders recommended a phased, scaffolded implementation strategy using mobile technology to promote accessibility and just-in-time learning. Emphasis was placed on integrating training into onboarding and leveraging unit workflows to sustain communication practice over time. Findings suggest that nurse leaders view the COMFORT model as a practical and scalable framework to strengthen nurse-to-family communication. The study highlights the importance of tailoring communication interventions to clinical realities and leveraging leadership support to foster trust and engagement in critical care contexts.