Adaptive Challenges and Adaptive Work of Family Members in a Long-Term Acute Care Hospital.

Background: Family members provide emotional and psychosocial support and are an integral component of patient care for older patients with chronic critical illness (CCI). Purpose: This study aimed to describe how family members work with health care providers (HCPs) to support their loved ones by identifying their adaptive challenges, adaptive work, and technical work. Methods: This was an exploratory mixed-method study. Study participants were family members and HCPs of patients admitted to a long-term acute care hospital (LTACH). Surveys and semistructured interviews were completed between February and March 2023. Interviews were coded using a priori codes developed from the Adaptive Leadership Framework for Chronic Illness (ALFCI). Results: Nine participants (five family members and four with HCPs) were enrolled. Family members rated their HCPs' communication skills as very good. Similarly, HCPs' assessment of their communication skills was very good. Four themes were identified: family members' adaptive challenges, adaptive work, HCP-described family adaptive challenges, and HCPs' technical work. Family members' adaptive challenges included communication, care expectations, and individual challenges. Adaptive work included voicing concerns, advocating for their loved one, setting expectations, and coordinating with other family members. HCPs' technical work focused on communication strategies and collaboration with family members and other team members. Implications for practice: Family members play a crucial role in patient care. They experience adaptive challenges supporting their loved ones and managing their everyday activities. Collaborative work between family and HCPs addresses these challenges.