Effect of family–patient communication on the incidence of delirium in hospitalized patients in cardiovascular surgery ICU

Abstract

Background:Cardiovascular diseases are the most important causes of morbidity and mortality in the world, and cardiac surgery is one of the treatments that have complication for patients. One of the most important current psychological complications after cardiac surgery is delirium. For its prevention and treatment, considerable attention should be paid to the role of family. This study has been conducted for assessing the effect of the relationship between the family and patient on the incidence of delirium in hospitalized patients in cardiovascular surgery intensive care unit (ICU) of Isfahan Shahid Chamran hospital.Materials and Methods:This study is a two-group, single-blind (for the questioner) clinical trial that was conducted among 68 patients in the cardiac surgery ICU of Shahid Chamran hospital affiliated to the Isfahan University of Medical Science in 2013. Sampling was convenient sampling, and the patients were allocated to two groups (n = 34 patients) based on random numbers table. The day after the surgery, one of the family members in the intervention group who had received education the day before was allowed to visit the patient in the morning shift. In the control group, patients received routine care. Two groups were assessed for delirium twice a day for a total of three times (two times in the morning and one time in the evening) with use of Richmond Agitation Sedation Scale and Confusion Assessment Method –ICU (CAM – ICU) scale.Results:In the intervention group, 41.18% patients were females and 58.82% patients were males, and in the control group, 29.42% patients were females and 70.58% were males. Mean and SD of patients' age in the intervention group was 55.11 (12.11) and in the control group 54.12 (13.11) years. Based on study results, incidence of delirium in the morning after surgery (second day) in intervention group was 11.76%, and in control group it was 23.53%. In the third day, it was 8.83% in intervention group and 20.58% in control group. Chi-square test showed a significant difference in incidence of delirium during the second (P = 0.04) and the third (P = 0.03) days of surgery in the two groups. In the control group, the incidence of delirium in the evening was 32.35%, which was more than that in the morning. Cochran test showed a significant difference in the morning and afternoon shifts in the control group (P = 0.004).Conclusions:Effective communication between the patient and family, as a nonmedical method, can reduce delirium after cardiac surgery, especially, at the end of the day; nurses should pay more attention to the prevention of delirium.

Predictors of Delirium Incidence, Time to Onset, and Recurrence in a Mixed Medical-surgical ICU Population: A Secondary Analysis Using Cox and CHIAD Decision Tree Modeling

“…Additionally, the presence of family at bedside for > 2 hours per day (reported as family engagement) was identi ed as a potential mitigating factor for ICU delirium this study, similar to other published reports [80,81]. This raises questions about the role that family may play in the care of a critically-ill loved one and presents an opportunity for inquiry as ICU visitation policies have been restricted in many cases during the current COVID-19 pandemic.…”

Study protocol to assess the effectiveness and safety of a flexible family visitation model for delirium prevention in adult intensive care units: a cluster-randomised, crossover trial (The ICU Visits Study)

“… 6 Moreover, some studies suggest the potential role of presence of family members as a strategy to prevent ICU delirium. 15–17 One small prospective single-centre before-and-after study found a reduction of 50% in the cumulative incidence of delirium by changing the visitation policy from a restrictive model (4.5 hours/day) to an extended model (12 hours/day); the length of delirium and ICU stay was also reduced in this study. 12 In this regard, the presence of family in the critical care setting is suggested as a means to achieve better pain control, reduce the use of sedatives and participate in the reorientation and cognitive stimulation of patients.…”

“…In relation to the risk of infection, this topic has been evaluated by few underpowered studies. 7 12 15 Although one study 15 showed greater environmental microbial contamination during an open policy of ICU visitation, published studies 7 12 15 failed to show an association between flexible ICU visiting hours and nosocomial infection. Lastly, the impact of flexible ICU visiting hours on symptoms of anxiety and depression of family members is not well studied: there is plausibility for decreased anxiety and depression with flexible ICU visiting hours as a result of improved access to information and more effective sharing of the decision-making process 24 ; conversely, it is also plausible to assume that anxiety and depression will increase as a result of higher exposure of family members to complex situations such as terminality and the patient’s emotional and physical suffering.…”

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

“…[10] Also a study conducted by Eghbali-Babadi et al, 2017 highlighted the importance of effective communication between the patient and the family as a non-medical management method which really reduced the occurrence of delirium after cardiac surgery. [25] Another study done by Birge A and Aydin H (2019) concluded that nurses' ability to perform non-pharmacological intervention orientation by supporting visits from family and friends was effective in reducing the incidence of delirium. This describes the role of the family participation in patient management to preventing complications following ICU admission.…”

“…[24] In addition, family-patient communication as a management strategy is proven to reduce the incidence of delirium. [25] International guidelines and protocols have new recommendations proposing changes in the way of the care delivered, challenging old paradigms and illuminating new unanswered questions that suggest the need for further research. Many studies focus on pharmacologic treatment of delirium while the effect of non-pharmacologic strategies has very few studies.…”