Patients assess the likely benefits and risks of a recommended treatment or investigation and make a decision to either accept or refuse treatment. When a patient loses the capacity to participate meaningfully in decision making, a means should exist to ensure decisions that represent the patient's goals, preferences, and interests are made. This means is substitute decision making, and it usually occurs when a spouse, partner, close family member, or friend assumes this responsibility on behalf of the incapacitated patient. Limited involvement in patient care activities at the hospital can lead to distress in the family as well as challenge family members in assuming the likely expected role when the patient returns home. This study aimed at determining the nature and extent of family/substitute decision makers' involvement in care of the critically ill patients, guiding policies and the perspectives of nurse managers on involvement in Kenyatta National Hospital (KNH) critical care units (CCUs). This was a descriptive cross sectional study with family members and CCU nurse managers as the study participants. Key informants' interviews and in depth interviews were conducted. The sample size was 52 family members and four nurse managers. Quantitative data was analyzed using Statistical Package for Social Sciences (SPSS) version 21.0 and descriptive content analysis for qualitative data. Family members reported emotional distressed from the admission of a family member to the critical care unit. However their level of satisfaction with the extent of involvement was above average at a mean of 6.5. The activity mostly involved in was sharing of general information at 57.7% (n=30) with 36.5% (n=19) feeling they should have been provided with in depth information regarding the patients care. The key themes from interviews with family members were: limited information involvement, guilt feeling, and appreciation. Nurse Managers reported KNH has a closed visiting policy with none feeling it should be changed to an open policy. They also unanimously agreed that family members should be involved in care of the critically ill patients through information sharing and counseling. Two nurse managers felt primary care nurses should involve families in general nursing activities such as oral care with all agreeing that the nurses don't involve families in these activities. There was a statistical relationship (p<0.05 at a 95% confidence interval and R 2 =0.689) between the perspectives of nurse managers and the nature and extent of involvement of family members in care.

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