Models of Family Participation in Shared Decision‐Making in Paediatric Intensive Care Units: A Qualitative Study of Nurses' Perspectives in a Saudi Cultural Context

Abstract

BACKGROUND: Shared decision-making (SDM) is central to paediatric intensive care, yet how nurses enact family participation in culturally and religiously shaped contexts remains underexplored. AIM: To explore how paediatric intensive care unit (PICU) nurses in Saudi Arabia perceive and negotiate family participation in SDM and to identify key contextual factors influencing practice. STUDY DESIGN: Qualitative descriptive study using semi-structured interviews and reflexive thematic analysis with 20 PICU nurses from three tertiary hospitals. FINDINGS: Four themes described how nurses enacted SDM. Nurses positioned parents as partners through early orientation, shared mental models and careful calibration of information, hope and uncertainty, while negotiating power and protection by translating physician framing, limiting distressing detail and using 'quiet advocacy' when decisions felt closed. A Saudi cultural lens, including shūrā (family consultation), tawakkul (trust in divine will) and guardianship requirements, shaped who participated, the pace of decisions and interpretations of recommendations, and nurses relied on structured family meetings, bilingual tools and timely interpreter and chaplaincy support to sustain SDM under time, space and staffing constraints. CONCLUSIONS: Nurses occupy a pivotal mediating role in aligning clinical information with families' cultural and spiritual frameworks, potentially facilitating more informed and value-concordant decisions. RELEVANCE TO CLINICAL PRACTICE: Guardianship-aware communication, structured family meetings and routine access to bilingual decision aids, interpreters and chaplaincy can strengthen SDM in PICUs.