Family Engagement and Shared Decision‐Making in Adult Intensive Care Nursing: A Bibliometric Review and Thematic Analysis
Walaa Badawy, Fatma Khalifa Elsayed, Ghada K. GouharABSTRACT
Background
Family members contribute information, emotional support, bedside care and surrogate decision‐making in adult intensive care, yet the nursing literature on family engagement remains conceptually and geographically fragmented.
Aims
To map the development, intellectual structure, collaboration patterns and thematic evolution of research on family engagement and shared decision‐making in adult intensive care nursing.
Study Design
This study was a bibliometric review with complementary thematic content analysis. Following the framework of Donthu et al., Scopus was searched on 16 July 2026 from inception, with bibliometric coverage restricted to complete calendar years through 31 December 2025. Scopus was used because it provides the cited‐reference data required for co‐citation and bibliographic‐coupling analyses. Eligible records were journal articles and reviews concerning adult intensive care that examined family engagement or shared decision‐making and included an identifiable nursing component. Performance analysis, co‐authorship analysis, reference co‐citation, bibliographic coupling, and keyword co‐occurrence analysis were conducted using Python and VOSviewer, while cluster content was interpreted using inductive qualitative content analysis. Reporting followed the BIBLIO guideline.
Results
The review included 278 publications (1993–2025) from 117 journals and 47 countries. Annual output increased from two publications in 1993 to 32 publications in 2025; 141 publications (50.7%) were published during 2020–2025. Nursing journals produced most publications, whereas two multidisciplinary critical care journals produced 23 publications (8.3%) but 3090 of 11 220 citations (27.5%). The United States led with 104 publications; 23.9% were internationally co‐authored. Co‐citation analysis identified four intellectual foundations and bibliographic coupling five research fronts, led by family participation and nurse‐family engagement. Thirty‐nine author keywords formed six themes spanning end‐of‐life communication and ethics, family‐centred nursing engagement and surrogate participation, family support and visitation, family presence in high‐acuity care, caregiver experience and bereavement. Keyword trends moved from family needs and withholding treatment towards active engagement, implementation barriers and family nursing.
Conclusion
The field has progressed towards partnership but continues to under‐specify nurses' roles, use inconsistent terminology and draw disproportionately on high‐income Western settings.
Relevance to Clinical Practice
Critical care services should formalise nurses' responsibilities in family assessment, communication, advocacy and decision support while developing culturally responsive and implementable engagement models.