目的 系统整合家属参与ICU成人患者谵妄管理的体验,为推动家属参与谵妄管理的实施提供依据。方法 计算机检索中国知网、万方数据库、中国生物医学文献数据库、PubMed、Web of Science、CINAHL、Embase、PsycINFO、Cochrane Library数据库关于家属参与ICU成人患者谵妄管理体验的质性研究,检索时限均为建库至2022年4月。采用澳大利亚乔安娜布里格斯研究所循证卫生保健中心质性研究质量评价工具进行评价,采用汇集性整合方法整合结果。结果 共纳入7项研究,提炼出37个研究结果,将相似结果归纳成7个新的类别,并综合形成2个整合结果：面临重重挑战,渴望获得支持;积极有效参与,肯定自我价值。结论 临床医护人员需肯定家属在参与ICU谵妄管理中的重要价值,在家属参与谵妄管理的过程中了解其感受及需求,加强沟通,提供家属谵妄相关教育,确保家属参与的有效性和舒适性。
Objective To conduct a meta-synthesis of the experience of family caregivers involved in delirium management in the intensive care unit,to provide reference for promoting family caregivers to participate in delirium management. Methods We searched databases including CNKI,Wanfang Data,CBM,PubMed,Web of Science,CINAHL,Embase,PsycINFO,and Cochrane Library to collect qualitative studies on the experience of family caregivers engaged in delirium management in the intensive care unit,the retrieval time limit was from the establishment of the database to April 2022. The quality of included studies were evaluated according to Australia JBI Critical Appraisal Tool for Qualitative Studies. The results were integrated by a meta-aggregative approach. Results A total of seven studies were included and 37 complete findings were grouped according to their similarities to classify seven new categories. These categories resulted into two synthesized findings-They were faced with many challenges and were eager to receive support;they were actively and effectively involved and affirmed their self-worth. Conclusion Health care workers should acknowledge the important value of family members of ICU patients in participating in delirium management,understand the feelings and needs during their involvement in delirium management,enhance communication,provide family members with delirium-related education,and ensure the effectiveness and comfort of family members' engagement.
[1] Adamis D,Meagher D,Rooney S,et al.A comparison of outcomes according to different diagnostic systems for delirium (DSM-5,DSM-IV,CAM,and DRS-R98)[J]. Int Psychogeriatr,2018,30(4):591-596.
[2] Stollings JL,Kotfis K,Chanques G,et al.Delirium in critical illness:clinical manifestations,outcomes,and management[J]. In-tensive Care Med,2021,47(10):1089-1103.
[3] Salluh JI,Wang H,Schneider EB,et al.Outcome of delirium in critically ill patients:systematic review and meta-analysis[J]. BMJ,2015,350:h2538.
[4] Boehm LM,Jones AC,Selim AA,et al.Delirium-related distress in the ICU:a qualitative meta-synthesis of patient and family perspectives and experiences[J]. Int J Nurs Stud,2021,122:104030.
[5] 焦雪萍,刘瑞云,李文娟,等. 家庭干预在ICU患者谵妄防治中的研究进展[J]. 中华急危重症护理杂志,2022,3(2):173-176.
Jiao XP,Liu RY,Li WJ,et al.Research progress of family intervention in the prevention and treatment of delirium in ICU patients[J]. Chin J Emerg Crit Care Nurs,2022,3(2):173-176.
[6] Ely EW.The ABCDEF bundle:science and philosophy of how ICU liberation serves patients and families[J]. Crit Care Med,2017,45(2):321-330.
[7] Shrestha P,Fick DM.Family caregiver's experience of caring for an older adult with delirium:a systematic review[J]. Int J Older People Nurs,2020,15(4):e12321.
[8] Smithburger PL,Korenoski AS,Alexander SA,et al.Perceptions of families of intensive care unit patients regarding involvement in delirium-prevention activities:a qualitative study[J]. Crit Care Nurse,2017,37(6):e1-e9.
[9] Bohart S,Merete Møller A,Forsyth Herling S.Do health care professionals worry about delirium? Relatives' experience of delirium in the intensive care unit:a qualitative interview study[J]. Intensive Crit Care Nurs,2019,53:84-91.
[10] JBI. Joanna Briggs Institute reviewer's manual[EB/OL].(2020-03-01)[2021-12-09]. https://reviewersmanual.joannabriggs.org/.
[11] 黄锦芳,何思锦. 患者家属在ICU参与护理活动增多型谵妄患者体验与效果的质性研究[J]. 当代护士(中旬刊),2020,27(8):79-82.
Huang JF,He SJ.Qualitative research on the experience and effect of patients' family members participating in nursing activities in ICU patients with increased delirium[J]. Today Nurse,2020,27(8):79-82.
[12] Huang LJ,Tsai HH,Wang YW,et al.Sailing in a sea of perplexity:family caregivers' experience of patients with delirium[J]. Nurs Crit Care,2022,27(1):73-80.
[13] Pandhal JK,van der Wardt V. Exploring perceptions regarding family-based delirium management in the intensive care unit[J]. J Intensive Care Soc,2021:175114372110379.
[14] Parsons Leigh J,Krewulak KD,Zepeda N,et al.Patients,family members and providers perceive family-administered delirium detection tools in the adult ICU as feasible and of value to patient care and family member coping:a qualitative focus group study[J]. Can J Anaesth,2021,68(3):358-366.
[15] Freeman S,Yorke J,Dark P.The patient and their family's perspectives on agitation and its management in adult critical care:a qualitative study[J]. Intensive Crit Care Nurs,2022,69:103163.
[16] Poulin TG,Krewulak KD,Rosgen BK,et al.The impact of patient delirium in the intensive care unit:patterns of anxiety symptoms in family caregivers[J]. BMC Health Serv Res,2021, 21(1):1202.
[17] Amass TH,Villa G,OMahony S,et al.Family care rituals in the ICU to reduce symptoms of post-traumatic stress disorder in family members-A multicenter,multinational,before-and-after intervention trial[J]. Crit Care Med,2020,48(2):176-184.
[18] Hetland B,McAndrew N,Perazzo J,et al. A qualitative study of factors that influence active family involvement with patient care in the ICU:survey of critical care nurses[J]. Inten-sive Crit Care Nurs,2018,44:67-75.
[19] Choi JE,Kim MS.Exploring the knowledge structure of nursing care for older patients with delirium:keyword network analysis[J]. Comput Inform Nurs,2018,36(5):216-224.
[20] Bull MJ,Boaz L,Jermé M.Educating family caregivers for older adults about delirium:a systematic review[J]. Worldviews Evid Based Nurs,2016,13(3):232-240.
[21] Krewulak KD,Bull MJ,Wesley Ely E,et al.Effectiveness of an intensive care unit family education intervention on delirium knowledge:a pre-test post-test quasi-experimental study[J]. J Can D'anesthesie,2020,67(12):1761-1774.
[22] Ashana DC,Jan A,Parish A,et al.Interpersonal perception:family- and physician-reported conflict in the intensive care unit[J]. Ann Am Thorac Soc,2022,19(11):1937-1942.
[23] Shin JW,Tate JA,Happ MB.The facilitated sensemaking model as a framework for family-patient communication during mechanical ventilation in the intensive care unit[J]. Crit Care Nurs Clin North Am,2020,32(2):335-348.
[24] 林琪,曾莉,任君红,等. ICU患者家属沟通管理的研究进展[J]. 中华护理杂志,2020,55(2):294-298.
Lin Q,Zeng L,Ren JH,et al.Research progress on communication management of family members of patients in ICU[J]. Chin J Nurs,2020,55(2):294-298.
[25] Rosa RG,Falavigna M,da Silva DB,et al. Effect of flexible family visitation on delirium among patients in the intensive care unit:the ICU visits randomized clinical trial[J]. JAMA,2019,322(3):216-228.
[26] 劳月文,陈香萍,乔丽杰,等. 家属版老年患者谵妄评估工具的研究进展[J]. 护理与康复,2019,18(11):39-41.
Lao YW,Chen XP,Qiao LJ,et al.Research progress of family version of delirium assessment tool in elderly patients[J]. J Nurs Rehabil,2019,18(11):39-41.
[27] Hochberg CH,Hager DN,Eakin MN.Leveraging family experience to improve their engagement in the intensive care unit[J]. Ann Am Thorac Soc,2022,19(4):538-540.
