Perceptions of Families of Intensive Care Unit Patients Regarding Involvement in Delirium-Prevention Activities: A Qualitative Study

Abstract

BACKGROUND Nonpharmacologic delirium-prevention strategies are commonly used in the intensive care unit by bedside nurses. With up to 80% of intensive care unit patients becoming delirious, and lacking treatment options, prevention is key. However, with increasing nurse workloads, innovative delirium-prevention strategies such as involving the patient’s family are needed. OBJECTIVE To gain insight into opinions of patients’ families regarding active participation in delirium-prevention activities to inform specific recommendations for involving patients’ families in such activities. METHODS Purposeful sampling was used. Patients’ families were contacted to be interviewed about their opinions and attitudes on participation in nonpharmacologic delirium prevention activities while visiting the intensive care unit. An interview guide was created and used to facilitate discussion. Interviews were conducted, transcribed verbatim, and coded by 2 independent coders. Themes were identified, defined, and compared between independent coders; disagreements were resolved by the study team. RESULTS After 10 interviews were conducted, thematic saturation occurred. Three major themes emerged: (1) consistent family presence and participation in care, (2) improving ease of interactions between family and patient, and (3) delirium education for families. CONCLUSION Family members want to be involved with care and delirium prevention; however, many times they do not know what to do without the direction of a health care provider. Family members would benefit from open dialogue with the bedside nurse to increase family comfort and involvement in care.

Effect of family reorientation messages on delirium prevention among critically ill patients

“…These studies did not focus on any kind of stimulation but focusing on allowing a family presence for a longer time which promote patient family interaction thus maintaining brain stimulation with family members. [22,35,36] The current study findings are in line with these studies as family voice group had a higher mean number of visitors than the two other groups. This can be described as the more family members, the more cognitive stimulation and more alertness thus creating a healing environment.…”

Effectiveness of an intensive care unit family education intervention on delirium knowledge: a pre-test post-test quasi-experimental study

“…12 Herein lies an opportunity for families to participate in delirium prevention, detection, and management. Although previous research has shown that family members of critically ill patients want to assist with nonpharmacological delirium prevention activities, 13,14 most families lack adequate delirium knowledge to be effective partners.…”

“…33,34 Measures Caregiver ICU Delirium knowledge questionnaire (CIDKQ) A 21-item multiple choice (yes/no/don't know) questionnaire was used to measure family members' knowledge about ICU delirium and to assess the effect of the education provided. The CIDKQ addressed the three dimensions of delirium knowledge: risk factors (items 1-10), actions (items [11][12][13][14][15][16] and symptoms (items 17-21). The CIDKQ score ranges from 0 to 21, with a higher score indicating more ICU delirium knowledge.…”

Meaning and comfort factors in the paediatric intensive care unit from an adult perspective: a descriptive phenomenological study

“…Like our study, other studies have found that when patients enter the paediatric intensive care unit, both the young adult patients and their family suffer discomfort, especially related to separation of the patient from the family, and this is one of the main reasons for criticism by young adult patients, along with the loss of the parental referent (33,34). For this reason, it is important that the healthcare professional be open to listening to the patient, evaluating the experience of the patient and the family, and identifying the needs in this regard, given that this affords an opportunity to reduce the anxiety associated with the intensive care unit stay and to boost the physical and emotional comfort of the patient and the family (35)(36)(37). In addition, as the participants in the present study have noted, information and the continuous presence of the family, as a result of increased flexibility in visiting hours, helps reduce the secondary emotional impact brought on by the separation resulting from the hospitalisation and contribute to the well-being of the patient, minimising the traumatic experience of the illness.…”