Volume 20, Issue 4 (Winter 2026)                   Salmand: Iranian Journal of Ageing 2026, 20(4): 558-577 | Back to browse issues page

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Ahmadi M, Mohammadi-Shahboulaghi F, Hosseini M, Fallahi-‎Khoshknab M. The Process of Involving the Family in the Care of Hospitalized Older Adult Patients: A Grounded Theory Study. Salmand: Iranian Journal of Ageing 2026; 20 (4) :558-577
URL: http://salmandj.uswr.ac.ir/article-1-2964-en.html
The Process of Involving the Family in the Care of Hospitalized Older Adult Patients: A Grounded Theory Study
Maryam Ahmadi1 , Farahnaz Mohammadi-Shahboulaghi *2 , Mohammadali Hosseini3 , Masoud Fallahi-‎Khoshknab3
1- Student Research Committee, Faculty of Behavioral Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. & Department of Nursing, Iranian Research Center on Aging, Faculty of Behavioral Sciences, University of Social Welfare and ‎Rehabilitation Sciences, Tehran, Iran.
2- Department of Nursing, Iranian Research Center on Aging, Faculty of Behavioral Sciences, University of Social Welfare and ‎Rehabilitation Sciences, Tehran, Iran. , f.mohammadi@uswr.ac.ir
3- Department of Nursing, Faculty of Behavioral Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran‎.
Keywords: Family participation, Patient care, Aged, Grounded theory
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Introduction
Family participation in planning and providing care has been introduced as an essential component of quality care. It means that family members should be given an opportunity to participate in plans, programs, and decisions related to their patient’s care and to support them physically and psychologically. Family participation in patient care has positive outcomes, especially for hospitalized elderly patients. The present study aims to explore the factors affecting family participation in the care of hospitalized elderly patients in Iran based on the nurses’ perspective, to understand the elements and concepts of the family participation process and provide a comprehensive model for family participation in the care of older patients.

Methods & Materials
This is a qualitative study conducted in 2023-2024 using the grounded theory approach. The study population consisted of nurses working in various inpatient departments (excluding ICU and emergency departments) at Imam Reza Hospital in Kermanshah, as well as Shohada-e-Tajrish and Taleghani hospitals in Tehran. In addition, family members of hospitalized elderly patients as well as hospitalized elderly patients participated in this study. They were selected using a purposive sampling method and continued until data saturation was reached through semi-structured interviews with the participants. Each interview took about 50-90 minutes for each participant, conducted in one or two sessions according to the conditions. The interview began with general questions and continued with more specific questions based on the answers to achieve the main goal of the research. Strauss and Corbin’s method was used to analyze the data in MAXQDA software, version 2020. Four criteria including credibility, dependability, confirmability, and transferability were used to determine the trustworthiness of the data.

Results
In this study, 22 participants (13 nurses, 5 family members, 4 hospitalized elderly patients) were interviewed.  The contextual factors included unfavorable hospital conditions for family participation (lack of a written rule for family participation, dominance of medical paternalism in the hospital, inadequate hospital facilities for family presence, nurses’ high workload, lack of teamwork governance in family participation), insufficient professional competence of nurses for involving families (insufficient knowledge of family participation, low skills for engaging families, unprofessional behavior, weak attitude towards family participation), complexity of elderly patient care (extensive care needs of elderly patients, inadequate conditions for elderly care), and family capacity for participation (family members’ care knowledge, health status, social/economic status, personality traits, communication with the patient, and beliefs), which were presented as facilitators or barriers to family participation in elderly patient care. 
The strategies for family participation in care included: Insufficient attraction of family members to participate in care (unfavorable welcoming to family members, lack of ability to persuade family members to accept caregiving role, insufficient family member support), relative empowerment of family members for participation in care (poor assessment of family members’ educational needs, ineffective family member education, poor assessment of family member’s caregiving abilities), unplanned handover of caregiving tasks to family members (informal transfer of caregiving tasks to family members, unnegotiated transfer of caregiving tasks to family members), families’ attempts to participate in care (arguing with nurse over caregiving, seeking and receiving support from various sources, avoiding tension with nurse),  addressing the families’ attempts to participate in care (providing support sources for family members, struggling with family members’ violence, managing tension with family members).
Finally, family participation in care had following outcomes: Nurses’ concerns about the safety and quality of family care (risking the professional identity, breaching the elderly patient’s confidentiality, breaching the elderly patient’s autonomy, harming the elderly patient’s health, legal and administrative consequences of unsafe family care, increasing patient safety, improving the elderly patient’s health status, improving nurses’ care quality), and families’ suspension between helplessness and empowerment (physical burden of participation on family members, psychological burden of participation on family members, social burden of participation on family members, relative empowerment in care, relative readiness for the proper transfer of care).

Conclusion
This study presented a conceptual framework for family participation in elderly patient care by identifying the effective factors and outcomes, which can provide a basis for further research and the design of intervention programs. In addition, the findings can help healthcare professionals in Iran to understand the roles, rights, and responsibilities of families and strengthen their communication and cooperation with them. It can also help develop hospital policies for family involvement or modify local policies or organizational practices that limit families’ participation in elderly patient care and elderly care planning.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of the University of Social Welfare and Rehabilitation Sciences, Tehran, Iran (Code: IR.USWR.REC.1402.022).

Funding
This article was extracted from the dissertation of Maryam Ahmadi, funded by the University of Social Welfare and Rehabilitation Sciences. 

Authors' contributions
Conceptualization: Farahnaz Mohammadi-Shahboulaghi, Mohammadali Hosseini, and Maryam Ahmadi; methodology, writing draft, and data analysis: All authors; editing & review: Farahnaz Mohammadi-Shahboulaghi and Mohammadali Hosseini.

Conflicts of interest
The authors declare no conflicts of interest.

Acknowledgements
The authors would like to thank the participants for their cooperation in this study, as well as the Deputy for Research of the University of Social Welfare and Rehabilitation Sciences for their support.




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Type of Study: Research | Subject: gerontology
Received: 2024/11/04 | Accepted: 2025/01/05 | Published: 2026/03/01
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