Author Identifier

Amber McLean: http://orcid.org/0000-0003-2044-0604

Date of Award

2025

Document Type

Thesis

Publisher

Edith Cowan University

Degree Name

Master of Nursing (Research)

School

School of Nursing and Midwifery

First Supervisor

Beverley Ewens

Second Supervisor

Amanda Towell-Barnard

Third Supervisor

Yvonne Middlewick

Abstract

Aim: This study explores delirium in the intensive care unit (ICU) following cardiac surgery from the perspective of family members.

Background: Delirium is a common complication affecting 28-52% of people following cardiac surgery in the ICU, which can lead to distress for both the person and their family members. While research has been conducted on clinical outcomes of family involvement in delirium care, there is a lack of understanding of how delirium impacts the family members themselves. This study seeks to provide detailed narrative accounts of families’ experience of witnessing delirium in their loved one following cardiac surgery in the ICU, providing vital insight into the challenges they faced and identify areas for improvement.

Design: A qualitative narrative inquiry approach is used to gain a deeper understanding of the experiences of the family members of those affected by delirium after cardiac surgery in the ICU.

Method: Eight family members of patients who experienced delirium in the ICU following cardiac surgery were interviewed using in-depth, open interviews to facilitate family members to share their stories and experiences. Following restorying the data was analysed vertically using McCormack’s Lenses, then analysed horizontally using Braun and Clarke’s thematic analysis to identify common themes, providing insights into the participant’s shared experiences.

Results: Three themes emerge: The emotional impact delirium had on family members; a lack of information given to family members regarding delirium; and communication challenges between family members and healthcare staff.

Discussion: Family members can be deeply impacted by witnessing delirium in a loved one following cardiac surgery. Family members described feelings of helplessness, being overwhelmed, distressed, fear for the future, and uncertainty due to the unpredictable nature of delirium. A lack of clear communication and information provided can negatively impact the wellbeing of family members. This study highlights several areas for improvement within delirium care including a need for a more inclusive approach to patient and family members to be adopted within ICU’s.

Conclusion: The study highlights the need for improved support for family members in ICU, addressing the emotional impact of witnessing delirium symptoms, the limitations of current information provided to family members regarding delirium and communication challenges between family members and healthcare staff. By adopting some of the patient and FCC model principles, healthcare providers can better address the needs of families and mitigate the emotional impact witnessing delirium has on them.

Clinical Recommendations: 1) Provide clear information and education to family members to ensure they are better informed and supported throughout the ICU stay and beyond; 2) Enhance training for healthcare staff in communication skills and delirium management; 3) Integrating patient and family centred care principles into the management of ICU delirium may help foster more meaningful family engagement in care decisions and communication. This approach has the potential to enhance the overall care experience and provide emotional reassurance to families during a highly distressing period, which in turn may contribute to improved satisfaction and support outcomes for both patients and families.

Recommendations for future research: Focus on developing interventions that specifically address the needs of families dealing with ICU delirium and exploring the long-term effects of this on both patients and their families

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