A post cardiac surgery intervention to manage delirium involving families: a randomized pilot study

被引:41
作者
Mailhot, Tanya [1 ]
Cossette, Sylvie [2 ]
Cote, Jose [3 ,4 ]
Bourbonnais, Anne [5 ,6 ]
Cote, Marie-Claude [7 ]
Lamarche, Yoan [8 ]
Denault, Andre [9 ]
机构
[1] Univ Montreal, Montreal Heart Inst Res Ctr S2490, Fac Nursing, 5000 Belanger St, Montreal, PQ H1T 1C8, Canada
[2] Univ Montreal, Montreal Heart Inst Res Ctr S2510, Fac Nursing, Montreal, PQ H1T 1C8, Canada
[3] Univ Montreal, Fac Nursing, Downtown Branch, Montreal, PQ H3C 3J7, Canada
[4] Univ Montreal, Ctr Hosp Univ Montreal, Ctr Rech, Downtown Branch, Montreal, PQ H3C 3J7, Canada
[5] Univ Montreal, Fac Nursing, Chair Desjardins Res, Downtown Branch, Montreal, PQ H3C 3J7, Canada
[6] Inst Univ Geriatrie Montreal, Ctr Rech, Nursing Care Older People & Their Families, Downtown Branch, Montreal, PQ H3C 3J7, Canada
[7] Montreal Heart Inst, Dept Psychosomat, Montreal, PQ H1T 1C8, Canada
[8] Montreal Heart Inst, Dept Cardiac Surg, Montreal, PQ H1T 1C8, Canada
[9] Montreal Heart Inst, Dept Anesthesiol, Montreal, PQ H1T 1C8, Canada
关键词
Cardiac surgery; Delirium; Family caregiver; Non-pharmacological interventions; Self-efficacy; CONFUSION ASSESSMENT METHOD; OLDER MEDICAL INPATIENTS; INTENSIVE-CARE-UNIT; ELDERLY INPATIENTS; RELIABILITY; STRATEGIES; VALIDATION; CAREGIVERS; VALIDITY; QUALITY;
D O I
10.1111/nicc.12288
中图分类号
R47 [护理学];
学科分类号
1011 ;
摘要
Background: As many delirium manifestations (e.g., hallucinations or fears) are linked to patients' experiences and personality traits, it is suggested that interventions should be tailored to optimize its management. The inclusion of family members, as part of an intervention, has recently emerged as a solution to developing individualised patient care, but has never been assessed in post-cardiac surgery intensive care unit where almost half of patients will present with delirium. Aims: To assess the feasibility, acceptability and preliminary efficacy of an nursing intervention involving family caregivers (FC) in delirium management following cardiac surgery. Design: A randomized pilot study. Methods: A total of 30 patient/FC dyads were recruited and randomized to usual care (n=14) or intervention (n=16). The intervention was based on the Human Caring Theory, a mentoring model, and sources informing self-efficacy. It comprised seven planned encounters spread over 3 days between an intervention nurse and the FC, each including a 30-min visit at the patient's bedside. During this bedside visit, the FC used delirium management strategies, e.g. reorient the person with delirium. The primary indicator of acceptability was to obtain consent from 75% of approached FCs. The preliminary effect of the intervention on patient outcomes was assessed on (1) delirium severity using the Delirium Index, (2) occurrence of complications, such as falls, (3) length of postoperative hospital stay and (4) psycho-functional recovery using the Sickness Impact Profile. The preliminary effect on FC outcomes was assessed on FC anxiety and self-efficacy. Data were analysed using descriptive statistics, ANCOVAs and logistic regressions. Results: The primary indicator of obtaining consent from FC was achieved (77%). Of the 14 dyads, thirteen (93%) dyads received all seven encounters planned in the experimental intervention. Intervention group patients presented better psycho-functional recovery scores when compared with control group patients (p=0.01). Mean delirium severity scores showed similar trajectories on days 1, 2 and 3 in both groups. Conclusion: The mentoring intervention was acceptable and feasible and shows promising results in improving patients and FC outcomes. Relevance to clinical practice: Nurses should involve, if willing, FC to participate in activities that optimise patient well-being FC to use recognized delirium management strategies like reorientation and reassurance.
引用
收藏
页码:221 / 228
页数:8
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