Construction Of Delirium Care Program For Patients After Cardiopulmonary Bypass With Family Participation Based On Family Integrated Care Theory

ObjectivesUnder the guidance of family Integrated Care(FIC)theory,To establish a set of comprehensive,scientific and operable delirium care program for Cardiac patients after cardiopulmonary bypass in the Cardiac care unit(CSICU),and provide methods and theoretical basis for delirium care of Cardiac patients after extracorporeal circulation in the CSICU.It can provide reference for clinical practice and improve the cognitive level of delirium and nursing participation ability of medical staff and their families.MethodThe relevant literatures about family members’ participation in delirium care of patients were searched systematically,and the included literatures were comprehensively analyzed by content analysis method to extract the implementation content and specific practices of family members’ participation in delirium care of patients.Using descriptive phenomenological methods,20 CSICU medical staff and 9 family members of patients with delirium after CSICU cardiopulmonary bypass were selected by purpose sampling and convenience sampling,and semi-structured in-depth personal interviews were conducted.Colaizzi seven-step analysis was used to analyze the interview results.Combining literature content analysis and qualitative research,the result of the theoretical framework based on family integrated care,finishing the design team members,in the establishment of the team members,training,peer support,resources and environment support,communication,family members participate in nursing "six participate in link,the preliminary set up 23 to participate in content,47 items specific guidelines,Namely,the first draft of delirium care program for patients after cardiac surgery with family members participating in CSICU cardiopulmonary bypass.Then,using the Delphi expert consultation method(Delphi)to two rounds of enquiry for 46 expert,adopt expert opinion to repair plan each entry,eventually identified include "six participate in link,24 content,47 specific guidelines",the final version of the family members to participate in CSICU extracorporeal circulation cardiac patients with postoperative delirium care plan.Results1.Participants included 31 articles were finally,after the content analysis to extract the including "training team established,training medical staff,family members,family communication,interdisciplinary team,flexible system of visiting family members lounge,family members care package,mission training materials,multimedia support,micro platform,delirium nursing record list,members of the training evaluation,delirium nursing progress review,Communication,preoperative nursing,psychological support,medication management,delirium prevention and treatment,decision-making,supervision,assessment and evaluation "21 family members participate in delirium care specific implementation content.2.Through qualitative interviews with 29 interviewees,the participation status and needs of CSICU medical staff and patients’ families in delirium care after CPB were clarified.A total of 6 major participation links and 23 participation contents were extracted,namely,the establishment of a research group(delirium management group of the department,family participation nursing implementation group);Training of members(medical staff,family members);Peer support(family meetings,interdisciplinary collaborative teams);Resources and environment support(flexible visitation system,family lounge,family participation care package,publicity and training materials,multimedia support,micro platform,delirium care record sheet,delirium care examination form);Communication(preoperative communication,communication during CSICU,communication before and after transferring out of CSICU);Family members participate in nursing(participate in delirium prevention and treatment,participate in preoperative nursing,participate in psychological support,participate in medication management,participate in decision-making,participate in supervision,assessment and evaluation).3.Based on the theory of family integrated care,combined with the results of content analysis and qualitative interview,a preliminary draft of delirium nursing program for patients after CSICU cardiopulmonary circulation(CPB)with family members was constructed through expert group meeting,including 6 major participation links,23 participation contents and 47 specific guidance programs.4.Two rounds of expert letter consultation were conducted in this study.A total of 46 experts evaluated the scheme items.The questionnaire recovery rate of the two rounds reached 100%,and the proportion of experts who put forward suggestions was 84.79%and 26.09%,respectively,showing a high degree of positivity.The expert authority coefficient was 0.84,and the familiarity was 0.86,indicating strong authority.After two rounds of correspondence consultation,the mean value of importance assigned to first-level items was≥4.57,the coefficient of variation was ≤0.19,and the coordination coefficient of scheme importance was 0.132.The mean value of importance assignment of secondary items was ≥4.30,and the coefficient of variation was ≤0.19.The mean value of operability was ≥3.98,the coefficient of variation was ≤0.24,and the coordination coefficient of importance and operability were 0.162 and 0.216,respectively,with P<0.01.The mean value of importance assignment of grade 3 items was≥4.33,and the coefficient of variation was≤0.20.The mean value of operability assignment was≥3.96,and the coefficient of variation was ≤0.24.The coordination coefficients of importance and operability were 0.098 and 0.135,respectively,with P values<0.01.Experts’ opinions tended to be consistent,and correspondence consultation results were coordinated and reliable.Finally,experts’ opinions were listened to and a participation content "Member training Examination Form" was supplemented.The final program was determined to include 6 participation links,24 participation contents and 47 specific guidance programs,and each content was given detailed instructions.ConclusionsBased on the theoretical framework of family integrated care and combined with the results of literature analysis and qualitative research,this study established a systematic and comprehensive care program for delirium of patients after cardiopulmonary bypass with family members participating in the implementation of the program,the content of nursing participation and the detailed guidance program.The results of the two rounds of Delphi expert letter consultation were stable and reliable,the consulting experts had high enthusiasm and authority,and the importance and operability coordination coefficient of the letter consultation content were relatively good,which provided certain theoretical basis and implementation content reference for promoting family members to participate in the care of delirium after CSICU cardiopulmonary circulation.