Date of Award

5-2009

Document Type

Open Access Dissertation

Degree Name

Doctor of Philosophy (PhD)

Degree Program

Nursing

First Advisor

Henneman, Elizabeth A.

Second Advisor

Bigelow, Carol

Third Advisor

Helfer, Karen

Subject Categories

Alternative and Complementary Medicine | Geriatric Nursing | Nursing

Abstract

Objective . To examine the feasibility of family participation in a nurse-supported, multicomponent intervention program for delirium prevention in the older hospitalized adult. Background . Delirium is the leading complication of hospitalization for older adults and is associated with important consequences including increased morbidity and mortality, increased use of health care resources, and increased caregiver burden. The potential role that family caregivers could play in delirium prevention and how nurses could facilitate family participation has been largely unexplored. The Calgary Family Intervention Model (CFIM), operating on the assumptions of a family-centered care philosophy, provided a framework for understanding the feasibility of family participation in delirium prevention efforts. Methods . A descriptive exploratory design using a convenience sample of 15 family caregivers of older hospitalized adults at a large teaching hospital was used to address the research questions. For the Family Participation Delirium Prevention Program (FPDPP), family caregivers implemented five intervention protocols targeted toward four baseline risk factors for delirium and self-tracked daily intervention completion. Feasibility was based on rates of intervention completion, and consideration of the barriers and facilitators for participation based on older adults' and family caregivers' responses on discharge questionnaires and staff nurses' responses on a questionnaire. Results . Intervention completion was highest for the orientation protocol (83.5%), followed by the vision protocol (81.5%), therapeutic activities protocol (76.9%), hearing protocol (73.6%), and early mobilization protocol (55.3%). Three themes emerged on the barriers and facilitators for family participation: therapeutic relationships, partnership, and environment. The barriers and facilitators were generally consistent with the concept of family-centered care as described in the CFIM. Conclusion . Based on the rates of intervention completion, it appears that the FPDPP is feasible for implementation in clinical practice. A remarkable level of agreement was found on the concept of the feasibility of family participation among older adult patients, family caregivers, and staff nurses with the common themes that emerged. Key to its successful implementation will be recognition and attention to the barriers and facilitators for participation. In addition, operating from a framework of family-centered care, nurses can advocate for environments that support family caregivers' participation in a delirium prevention program.

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