title: A post cardiac surgery intervention to manage delirium involving families: a randomized pilot study.
abstract: 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.
  
  
  
  To assess the feasibility, acceptability and preliminary efficacy of an nursing intervention involving family caregivers (FC) in delirium management following cardiac surgery.
  
  
  
  A randomized pilot study.
  
  
  
  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.
  
  
  
  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.
  
  
  
  The mentoring intervention was acceptable and feasible and shows promising results in improving patients and FC outcomes.
  
  
  
  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.
authors.affiliation: Montreal Heart Institute Research Center S-2490, University of Montreal, 5000 Belanger Street, Montreal (Quebec) H1T 1C8, Canada.
authors.forename: Tanya
authors.initials: T
authors.lastname: Mailhot
authors.affiliation: University of Montreal, Montreal Heart Institute Research Center S-2510, 5000 Belanger Street, Montreal (Quebec) H1T 1C8, Canada.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Cossette
authors.affiliation: Centre de Recherche du Centre Hospitalier de l'Université de Montréal, University of Montreal, PO Box 6128, Downtown Branch, Montréal (Québec) H3C 3J7, Canada.
authors.forename: José
authors.initials: J
authors.lastname: Côté
authors.affiliation: University of Montreal, Chair of the Desjardins Research, Chair in Nursing Care for Older People and their Families, Centre de recherche de l'Institut universitaire de gériatrie de Montréal, PO Box 6128, Downtown Branch, Montréal (Québec) H3C 3J7, Canada.
authors.forename: Anne
authors.initials: A
authors.lastname: Bourbonnais
authors.affiliation: Department of Psychosomatics, Montreal Heart Institute, 5000 Belanger Street, Montreal (Quebec) H1T 1C8, Canada.
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Côté
authors.affiliation: Department of Cardiac Surgery, Montreal Heart Institute, 5000 Belanger Street, Montreal (Quebec) H1T 1C8, Canada.
authors.forename: Yoan
authors.initials: Y
authors.lastname: Lamarche
authors.affiliation: Department of Anesthesiology, Montreal Heart Institute, 5000 Belanger Street, Montreal (Quebec) H1T 1C8, Canada.
authors.forename: André
authors.initials: A
authors.lastname: Denault
mesh_terms: D000368:Aged; D002170:Canada; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D017028:Caregivers / Q000193:education; D003422:Critical Care / Q000458:organization & administration; D003693:Delirium / Q000209:etiology / Q000451:nursing* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010865:Pilot Projects; D011182:Postoperative Care / Q000379:methods*; D020127:Recovery of Function; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors
keywords: Cardiac surgery; Delirium; Family caregiver; Non-pharmacological interventions; Self-efficacy