Evaluating the effectiveness of a multicomponent delirium intervention that incorporates the family caregivers in the acute care setting: a randomized controlled trial
Background: Delirium affects a significant number of hospitalized adults each year resulting in negative patient outcomes and family caregiver distress. Clinical identification of delirium by nurses and use of family caregivers as part of a multi-component delirium prevention strategy are not consistently implemented in the practice setting. Objectives: To incorporate the family caregiver into an existing multicomponent delirium prevention, detection, and management protocol and evaluate the impact on delirium incidence, falls, length of stay (LOS), and family caregiver distress. To evaluate the relationship between the family caregiver's SQiD (Single Question in Delirium) answer and nurses' CAM assessment. Design: A randomized controlled pilot study. Method: Patients greater than or equal to 65 years of age; negative CAM; pre-existing dementia, significant hearing loss or vision, or history of delirium prior to hospitalization; and family caregiver at the bedside were randomized to the intervention group (multi-component delirium protocol) or the control group (usual care with a daily visit from the nurse as attention control). Family caregiver distress was reported daily using the Distress Thermometer. A nurse followed hospitalized patients and their family caregivers daily and followed up by phone one week after discharge. Results: Fifty-eight patient-family caregiver dyads were screened and 38 were excluded because of positive CAM resulting in a final sample of 21 patient-family caregiver dyads. Most patients were older, white, and a similar mix of males and females. Over 70% of patients had some type of baseline forgetfulness/dementia. During the study, the control group had one positive CAM and one positive SQiD that were not from the same patient-family caregiver dyad. There was one patient fall without injury in the control group. Median LOS was similar for both intervention and control groups (Med = 6, IQR = 7; Med = 5, IQR = 6). Median family caregiver distress ratings were 5 or higher throughout the study in both groups and remained high with post-discharge distress median rating of 4 (IQR = 5) in intervention group and median rating of 5 (IQR = 5) in control group. Discharge to a skilled nursing facility occurred in 66.7% (n = 8) of intervention group and 55.6% (n = 5) of control group. Half (n = 6) of the intervention group and a third (n = 3) of the control group were readmitted. There were no instances of a positive SQiD and a positive CAM on the same patient. Conclusions: Although there was not enough power to compare results between the groups, the descriptive findings are clinically meaningful. None of the high-risk for delirium patients in the intervention group experienced delirium during the study suggesting that the intervention was effective. Family caregiver distress remained high throughout the hospitalization and after discharge suggesting that strategies for reducing caregiver distress need to be evaluated and incorporated into the multicomponent delirium prevention, detection, and management protocol
Thesis, Dissertation, English, 2016
Sacred Heart University
xv, 97 leaves : color illustrations ; 29 cm
1337056575
Chapter 1 Introduction : Background ; Problem Statement ; Purpose of Study ; Significance to Nursing ; Theoretical Framework ; Research Questions ; Chapter Summary
Chapter 2 Literature Review : Effectiveness of Multicomponent Interventions for Delirium Care ; Effectiveness of Multicomponent Delirium Interventions That [sic] Incorporated Family in the Acute Care Setting ; Family Distress Related to Delirium ; Chapter Summary
Chapter 3 Methodology : Purpose/Aim ; Design ; Setting ; Sample ; Recruitment ; Measures ; Procedures ; Statistical Analysis ; Protection of Human Subjects
Chapter 4 Results and Discussion : Purpose ; Research Question ; Sample ; Research Question 1 ; Research Question 2 ; Discussion ; Research Question 1 ; Research Question 2 ; Chapter Summary
Chapter 5 Conclusions and Recommendations ; Research Questions ; Sample ; Pertinent Findings ; Limitations ; Implications ; Recommendations ; Summary ; References ; Appendices
A practiced dissertation presented to the faculty of the College of Nursing, Sacred Heart University in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice