The purpose of this study was to describe family engagement practices in a cardiovascular intensive care unit (CVICU) and to explore their relationship with patient outcomes. Observations were conducted on 104 patients, with most (n = 61; 58%) having family members present. On average, 1.3 ± 0.6 family members were present per observation period per patient, spending 69% of the observation time at the bedside. The most common forms of family engagement included communication (n = 61; 100%), active family presence (n = 36; 59%), and direct contribution to care (n = 35; 57%). Patients with family present were 3 times less likely to be re-admitted to the hospital within 30 days compared to those without family present (5% vs 16%; = .05). This study offers valuable insights through direct observations of family engagement practices in a CVICU setting, offering a foundational understanding of family engagement patterns and their associations with patient outcomes. These findings establish a basis for developing targeted interventions, policies, and training programs aimed at enhancing family engagement and improving outcomes for both patients and their families in critical care settings.