The Family in Preventing Delirium in the Intensive Care Unit: Scoping Review

Enfermeria Intensiva

Pabón-Martínez, B. A., Rodríguez-Pulido, L. I., et al. (2022).

Enfermeria Intensiva, 33(1), 33-43.

<div>This scoping review explores the impact of delirium prevention strategies that utilize family involvement for adults in intensive care units (ICUs).&nbsp;</div>

No funding received

2014 to 2019

<div>Qualitative and quantitative studies</div>

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<div>When compared to more restrictive visitation models, extended visitation models<strong> </strong>(i.e., programs with greater allowance for family visitors) had the following effects on adults in the ICU at risk for delirium:</div> <div> <ul> <li><strong>Delirium incidence: </strong>One study reported a decrease in delirium incidence ( 9.6% versus 20.6%), but another reported no significant changes in delirium incidence.&nbsp;</li> <li><strong>Delirium duration:&nbsp;</strong>One study reported a decrease in delirium duration (3.0 days versus 1.5).&nbsp;</li> <li><strong>ICU Infections:</strong> Two studies reported a lower incidence of infection (3.7%-5.5% versus 4.5%-9.2%).</li> <li><strong>Anxiety:</strong> One study reported a lower probability of anxiety (13.4% versus 28.2%).&nbsp;</li> <li><strong>Depression:</strong> One study reported a lower probability of depression (8.1% versus 17.1%).</li> <li><strong>Patient satifcation: </strong>One study reported higher self-reported patient satifaction.</li> </ul> <div>There was no significant effect on ICU length of stay or ICU mortality.&nbsp;<br><br>Additional research is needed due to an overall lack of available research.</div> </div>

<div>Within one study, adult ICU patients at risk for delirium and their families reported that the extended visitation model:</div> <div> <ul> <li>was a helpful tool for facilitating interdisciplinary care;</li> <li>allowed the care team to better develop opportunities for mobilization and orientation; and</li> <li>efficiently organized visits and avoided overwhelming the patient.&nbsp;</li> </ul> </div>

<div>In one study, adult ICU patients and and their families reported that family involvement in delirium prevention programs:</div> <div> <ul> <li>allowed family members to support the patient and help with simple activities (e.g. bathing) that may impact well-being;&nbsp;</li> <li>helped facilitate the inclusion of familiar objects and reorientation activities;</li> <li>improved the ease of interaction between family and patients; and&nbsp;</li> <li>allowed for well-structured initial education and reinforced reminders about delirium, which was helpful in improving re-orientation processes.</li> </ul> </div>

<div>Reorientation strategies with family involvement had the following effects on adults in the ICU at risk for delirium:</div> <div> <ul> <li><strong>Re-orientiation via audio recordings: </strong>One study reported that delirium-free days were highest in a group that received hourly orientation via family recordings (1.9 days). Individuals who received hourly orientation via recordings by strangers and those who received usual care had an equal number of delirium-free days (1.6 days).</li> <li><strong>Family education/mentoring:</strong> In one study, care partners were mentored by nurses and trained to notice signs of delirium, communicate changes to nursing staff, reoriented the patient, talk about family memories, use simple and clear communication, and ensure access to vision and hearing devices. This led to reduced duration of delirium (1.94 days versus 4.14 days), reduced hospital length of stay (6.3 days versus 12.1 days), and lower delirium severity on days 1-3 of admission.</li> <li><strong>Sensory aids, orientation, and cognitive stimulation:&nbsp;</strong>In one study, family members were trained to ensure access to sensory aids (e.g., hearing aids, glasses) and to conduct re-orientation and memory-based activities. This did not impact delirium incidence or the number of days with the presence of delirium, however, care partner anxiety and self-efficacy was improved.&nbsp;</li> </ul> <div>&nbsp;</div> </div> <div>Additional research is needed due to an overall lack of available research.</div>