I. INTRODUCTION

Patient- and family-centered care (PFCC) is a healthcare approach based on collaboration, respect, information sharing, and the active involvement of patients and families in the care process [1]. In emergency departments, factors such as overcrowding, high workload, time pressure, and limited communication opportunities may hinder the implementation of PFCC principles and affect interactions between healthcare providers, patients, and families [2, 3].

Despite increasing recognition of PFCC as an important component of healthcare quality, evidence regarding its implementation in emergency care settings in Vietnam remains limited. Understanding current nursing practices and the barriers to PFCC implementation is important for improving the quality of emergency care services.

This study aimed to describe nurses’ practice of patient- and family-centered care in the emergency departments of Hue Central Hospital and to explore the difficulties and challenges encountered during its implementation.

II. MATERIALS AND METHODS

2.1. Study design

A mixed-methods study was conducted using a convergent design integrating quantitative and qualitative approaches. The quantitative component assessed nurses’ self-reported practices of patient- and family-centered care (PFCC), while the qualitative component explored contextual barriers and challenges related to PFCC implementation in emergency departments. Findings from both components were integrated during interpretation to provide a comprehensive understanding of PFCC practice and organizational support gaps.

2.2. Study setting and period

The study was conducted from September 2024 to November 2025, in the Emergency Departments of Hue Central Hospital, including Facility 2 and the International Medical Center, Vietnam. The study participants were nurses working in these departments who had at least six months of clinical experience and held a valid nursing practice liscence.

2.3. Sample size and sampling

The quantitative sample size was calculated using the formula for estimating a mean, with Z = 1.96, a standard deviation of 3.8, and a relative error of 5%, based on Almaze and de Beer (2017), resulting in a minimum sample size of 87 [4]. In practice, all eligible nurses were recruited using convenience sampling, and 121 nurses meeting the selection criteria were included.

The qualitative component included two focus group discussions with 14 nurses, grouped by working experience of less than 5 years and more than 10 years, and eight in-depth interviews with four head nurses and four clinical nurses.

2.4. Research instruments

The quantitative questionnaire assessing patient- and family-centered care (PFCC) practices among nurses was adapted from previous literature, particularly the study by de Beer et al. [4]. The instrument included four domains: family participation in care (5 items), family support (8 items), information sharing and decision-making (9 items), and staff training and organizational support (11 items). Items were rated as “Yes” (1 point), “No,” or “Unclear” (0 points), with higher scores indicating better PFCC practice and support. Content validity was confirmed by five experts (CVI = 0.90). A pilot study with 30 nurses demonstrated acceptable reliability, with KR-20 coefficients ranging from 0.706 to 0.922 and 0.93 for the overall instrument.

For the qualitative component, semi-structured interview and focus group discussion guides were developed to explore barriers and challenges related to PFCC implementation in emergency departments. Key questions focused on PFCC training experiences, application of PFCC strategies in clinical practice, and perceived challenges in implementing PFCC.

2.5. Data analysis

Quantitative data were entered and analyzed using SPSS version 20. Descriptive statistics included frequencies, percentages, means, and standard deviations. As the data were not normally distributed, comparisons between groups were performed using the Mann–Whitney U test and the Kruskal–Wallis test, with the level of statistical significance set at p < 0.05.

Qualitative data were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. Transcripts were repeatedly reviewed, coded, and grouped into themes and subthemes. The research team discussed and refined the themes to ensure consistency. Representative quotations were selected to illustrate key findings.

2.5. Research ethics

The study was approved by the Biomedical Research Ethics Committee of the Hue University of Medicine and Pharmacy under approval code H2024/576. Participants were provided with study information, participated voluntarily, and had their personal information kept confidential.

III. RESULTS

The mean age of participants was 34.69 ± 8.17 years, and most were female (66.9%). More than half had a college-level qualification (54.5%), and most were staff nurses (96.7%). Participants with less than 5 years of working experience accounted for the largest proportion (38.9%).

Among the PFCC domains, family participation in care had a mean score of 6.09 ± 1.29, family support 11.19 ± 2.25, information sharing and decision-making 7.83 ± 2.06, and staff training and personnel organization 7.04 ± 3.38. The largest variation was observed in the domain of staff training and personnel organization, indicating differences among units (Table 1).

Table 1: Current status of patient- and family-centered care practice

Most participants considered family members an important source of information about patients and their health status (98.4%). More than 90% reported that families were allowed to participate in decision-making and support care activities. Approximately 74%–76% stated that families were encouraged to accompany and assist healthcare staff, while 88% reported that information was provided to help patients cope with pain, stress, and anxiety. However, 6%–24% of participants indicated that family participation remained limited in some aspects (Table 2).

Table 2: Family participation in the care process (n = 121)

Most nurses highly valued family support during care. More than 90% reported strengthening relationships with patients and families, providing guidance, and respecting family members during communication.

However, supportive services remained limited, particularly translators/interpreters (26.4%), sign language interpreters (14.0%), and spiritual advisors (6.6%). Social work services (53.7%) and mental health professionals (48.8%) were available at a moderate level. Although most participants reported having crisis support procedures and regular information updates, continuity in family support coordination remained limited (66.2%) (Table 3).

Table 3: Family support during the care process

Bereavement information was often unclear, as reported by 43.0% of participants. However, 90.1% reported that families were provided in a timely manner with the information they needed to make decisions about patient treatment. In addition, 98.4% stated that families’ choices and decisions regarding patient care were respected by staff. 96.6% reported that families were provided with information on follow-up care, medications, and other supplies or equipment that they might need. 86.8% of units had a procedure for resolving conflicts between families and healthcare workers. Information support for patients’ families was mainly provided through health education materials available in the unit (86.0%) and internet access (83.5%), while access to translation staff and medical libraries accounted for lower proportions (Table 4).

Table 4: Information sharing and decision-making

Orientation and/or training programs included content on family-centered principles for 71.1% of participants, cultural competence and overcoming language barriers for 58.7%, and sharing medical and other information with patients’ families for 65.3%. 52.9% of nurses were trained to work with families and children with special needs or disabilities in emergency situations. 81.8% were aware of the cultural and ethnic diversity of the patients and families served by the hospital, and 58.7% were encouraged to learn the language of the main community they served. However, only 41.3% reported the availability of nurse support groups or other regular peer-support opportunities. 74.4% had opportunities to express and share their feelings and concerns after serious incidents (Table 5).

Table 5: Training and personnel organization

No statistically significant differences were observed by sex, professional qualification, or working experience in the main domains. Significant differences by working unit were found in family support, with p=0.003, information sharing and decision-making, with p = 0.007, and staff training and personnel organization, with p<0.001. Job position was associated with the family support domain, in which nurse managers had a higher mean rank, with p=0.04 (Table 6).

Table 6: Differences in patient- and family-centered care practice among participant groups

Thematic analysis revealed three main groups of challenges. The first group was related to the emergency care environment, including the need for rapid management, work overload, and limited space, which reduced communication time and made it difficult to maintain family participation during care procedures. One participant described emergency care as “a race against time,” explaining that family participation could “slow down interventions and increase risks for patients” (FGD1.6). Nurses also reported severe overcrowding and staffing shortages, with one participant noting that “sometimes there are 20 patients in a room designed for only 10 beds” (FGD1.3).

The second group was related to patients and families, including differences in awareness, expectations, psychological stress in emergency situations, and financial burden, which made it difficult to reach consensus and increased the risk of conflicts. Participants reported that some family members “did not fully understand the urgency of the situation” and therefore hesitated to make timely treatment decisions (FGD1.3). Others described family members as being “too shocked or overwhelmed to fully understand instructions or care procedures” (IDI6).

The third group was related to the health system and policies, including insufficient specialized training in this care model, unclear work assignment, and a lack of accompanying support services such as social work, psychological support, and language support. One nurse expressed the need for “specialized training courses specifically about patient- and family-centered care” because existing training was “not in depth” (FGD1.5). Participants also reported that excessive administrative and technical responsibilities reduced the time available for communication and emotional support activities (Figure 1).

Figure 1: Challenges faced by nurses in the Emergency Departments when implementing the patient- and family-centered care (PFCC) model.

IV. DISCUSSION

The results showed that patient- and family-centered care had been incorporated into emergency nursing practice, particularly in communication activities and information sharing to support treatment-related decision-making. However, differences among units suggest the important influence of organizational support, operational conditions, and available resources on PFCC implementation. Units with stronger mechanisms for staff orientation, training, and support tended to achieve higher practice scores, particularly in the domain of staff training and personnel organization. These findings are consistent with previous evidence highlighting the importance of organizational support and staff training in PFCC implementation [5]. It should be noted that several PFCC domains assessed in this study, such as interpretation services, psychological support, spiritual care, and bereavement support, may reflect broader organizational capacity and interdisciplinary support systems rather than individual nursing performance alone.

The qualitative findings further support the view that barriers do not lie only in the individual capacity of nurses, but also in the structural tension between the urgent nature of emergency care and the need for communication, collaboration, and emotional support. When patient volume is high, the nurse-to-patient ratio is high, and space is limited, communication-based interventions and family support activities are easily placed behind technical tasks [5]. From the family perspective, stress, expectations, and differences in awareness increase the risk of conflict, especially when standardized procedures for information flow and communication coordination are lacking [6].

An important finding of this study was the limited availability of supportive services for patients and families, particularly psychological support, spiritual care, interpretation services, and bereavement support. Although communication and basic information sharing were relatively well implemented, these supportive components remained underdeveloped. This suggests that PFCC in emergency settings may still focus primarily on clinical and informational aspects, while emotional, psychosocial, and family-support dimensions receive less attention.

The findings indicate that several important gaps are related not only to individual nursing practice but also to limitations in organizational support systems and interdisciplinary resources. In emergency care settings where stress, uncertainty, and emotional burden are high, the absence of structured psychosocial and family-support services may negatively affect both family experience and the overall quality of care.

This study has several limitations. Due to its cross-sectional design, causal relationships cannot be inferred. Self-reported data may be affected by social desirability bias. In addition, convenience sampling at a single hospital may limit the generalizability of the findings. Future studies should expand to multiple centers, include measurements from the perspectives of patients and families, and evaluate outcomes before and after training interventions or process improvement initiatives

V. CONCLUSION

Self-reported patient- and family-centered care practice among nurses in the Emergency Departments of Hue Central Hospital, including Facility 2 and the International Medical Center, was moderate overall, with variations across domains and inconsistency among units. While communication and information-sharing activities were relatively well implemented, important gaps remained in supportive services for patients and families, particularly psychological support, spiritual care, interpretation services, and bereavement support. The findings suggest the need to strengthen organizational support systems, specialized training, and coordination mechanisms to improve patient- and family-centered care implementation in emergency settings.

Declaration of conflict of Interest: The authors declare that there are no conflicts of interest related to this study, the authorship, or the publication of this article.