ICU nurses' perceptions on family involvement in delirium care for postoperative cardiac surgery patients: A qualitative study

Aims: Delirium is common among adults recovering from cardiac surgery in the intensive care unit (ICU), prompting increased family involvement in their care. This study aimed to describe ICU nurses' perceptions of factors that support or impede family involvement in preventing, assessing, and managing delirium in the postoperative period following cardiac surgery. Methods: A convenience sample of 18 nurses with a mean age 36 years (24-49), 89 % female) was recruited from two university-affiliated ICUs in Canada. After providing written informed consent, participants engaged in a semi-structured individual interview. Descriptive thematic analysis was performed using an established method. Findings: The analysis identified six key themes: 1) Choosing the right time to involve the family, 2) The importance of sharing information, 3) Influence of family characteristics, 4) Influence of organizational characteristics, 5) Family input helps detect delirium, and 6) Families can take concrete actions when delirium occurs. Notably, while information sharing during delirium episodes was highly valued, discussions on delirium prevention were absent among all nurse participants. Conclusions: Overall, ICU nurses perceive family involvement in delirium care as beneficial, depending on factors such as patient condition, nurse attitudes and preferences, family characteristics, and organizational support. This qualitative study provides valuable insights on nurses' perceptions regarding family involvement in ICU settings. Implications for clinical practice: ICU nurses, healthcare administrators and educators can use these findings to support family involvement in ICU delirium care after cardiac surgery. Overcoming barriers, particularly around delirium prevention, requires further investigation into nurses' education, resource allocation, and organizational support.