Author Identifier

Gideon Ugochukwu Johnson: https://orcid.org/0000-0001-9950-074X

Date of Award

2024

Document Type

Thesis

Publisher

Edith Cowan University

Degree Name

Doctor of Philosophy

School

School of Nursing and Midwifery

First Supervisor

Beverley Ewens

Second Supervisor

Amanda Towell-Barnard

Third Supervisor

Christopher McLean

Abstract

Background: Delirium is a prevalent acute brain dysfunction in patients within intensive care units. Delirium is marked by a fluctuating mental state, inattention, and altered consciousness. This condition affects a substantial proportion of patients in intensive care units, and which leads to increased mortality, severe physiological and psychological consequences, and a significant economic burden on healthcare systems. Despite the evidence that supports the use of non-pharmacological interventions to prevent or minimise the impact of delirium such as orientation, sensory stimulation, early mobilisation, and family involvement, their implementation in intensive care units remains inconsistent. The involvement of family members in the management of delirium in this setting shows promise however, the integration of family involvement into clinical practice lacks standardisation. Emerging evidence suggests that patient orientation by familiar voices could be a potent tool in delirium prevention and management, which underscores the urgent need for evidence-based, family-led interventions to fill this critical gap in care.

Aim: The aim of this study was to address this unmet need by developing, implementing, and evaluating a novel Family Member's Voice Reorientation (FAMVR) intervention specifically designed for delirium prevention and management in adult intensive care unit patients.

Methods: This study was conducted over 12 months in a general intensive care unit in the United Kingdom and comprised two phases. Phase one employed a co-design qualitative approach, leveraging the Double Diamond model to collaborate with patients, families, and clinicians in the development of the intervention. Data collected through focus groups and one[1]on-one consultations were meticulously analysed using thematic analysis, which informed the development of an intervention prototype that was grounded in real-world experiences, to enable the provision of compassionate and family-centred care.

Phase two comprised a mixed-methods pilot study to determine the feasibility and effectiveness of the intervention in a clinical setting. A single-arm convergent parallel approach combined with an interpretive descriptive qualitative design was used to gather quantitative data on intervention frequency and patients' Richmond Agitation-Sedation Scale scores, alongside qualitative insights from patients, families, and nurses about the feasibility and acceptance of the intervention.

Results: The results from this project indicated that the intervention was not only feasible and well-accepted by users, but it also demonstrated potential in enhancing patient communication and cognitive function. It increased the patients', families', and nurses' understanding of delirium without adverse effects on patients’ agitation-sedation scores.

Conclusion: This intervention has enabled families in intensive care units to have a voice to their loved ones, who are critically ill in intensive care units and set a new standard for family involvement in delirium prevention. The successful co-design process and encouraging pilot results underscore the viability of family-led interventions in intensive care units, paving the way for larger-scale studies to rigorously test the efficacy of familiar voice orientation on a range of delirium outcomes. These findings contribute to the existing body of knowledge on family-centred care in intensive care units, offering insights for clinical practice and potential to improve patient care more broadly.

DOI

10.25958/hg1d-9b67

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