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Open Access Study protocol

Evaluation of a nurse mentoring intervention to family caregivers in the management of delirium after cardiac surgery (MENTOR_D): a study protocol for a randomized controlled pilot trial

Tanya Mailhot12*, Sylvie Cossette12, Anne Bourbonnais134, José Côté15, André Denault6, Marie-Claude Côté7, Yoan Lamarche8 and Marie-Claude Guertin9

Author Affiliations

1 Faculty of Nursing, University of Montreal, C.P. 6128 succ. Centre-ville, Montreal, Quebec H3C 3J7, Canada

2 Montreal Heart Institute Research Center S-2490, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada

3 Centre de recherche de l’Institut Universitaire de Gériatrie de Montréal, 4545 chemin Queen-Mary, Montréal, Quebec H3W 1W4, Canada

4 Centre Gératrique Maimonides Donald Berman, 5795 Caldwell ave, Montreal, Quebec H4W 1W3, Canada

5 Centre de Recherche du Centre Hospitalier de l’Université de Montréal, 900 Saint-Denis Street, Montreal, Quebec H2X 0A9, Canada

6 Department of Anesthesiology, Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada

7 Department of Psychosomatics, Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada

8 Department of Cardiac Surgery, Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada

9 Montreal Health Innovations Coordinating Center, 4100 Molson street suite 400, Montréal, Quebec H1Y 3N1, Canada

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Trials 2014, 15:306  doi:10.1186/1745-6215-15-306

Published: 30 July 2014

Abstract

Background

Despite the use of evidence-based preventive measures, delirium affects about 40% of patients following cardiac surgery with the potential for serious clinical complications and anxiety for caregivers. There is some evidence that family involvement as a core component of delirium management may be beneficial since familiarity helps patients stay in contact with reality, however, this merits further investigation. There is also currently a gap in the scientific literature regarding objective indicators that could enhance early detection and monitoring of delirium. Therefore, this randomized pilot trial examines the acceptability, feasibility, and preliminary efficacy of an experimental nursing intervention to help family caregivers manage post-cardiac surgery delirium in their relatives. It also explores the validity of a new and innovative measure that has potential as an indicator for delirium.

Methods/Design

In this two-group randomized pilot study (n = 30), the control group will receive usual care and the intervention group will receive the experimental intervention aimed at reducing delirium severity. The intervention nurse’s objective will be to foster the family caregiver’s self-efficacy in behaving in a supportive manner during delirium episodes. Data will be collected from standard delirium assessment scales and a novel measure of delirium, i.e., cerebral oximetry obtained using near infrared spectroscopy, as well as medical records and participants’ responses to questionnaires.

Discussion

New strategies for early detection, monitoring, and management of delirium are needed in order to improve outcomes for both patients and families. The present article exposes feasibility issues based on the first few months of the empirical phase of the study that may be useful to the scientific community interested in improving the care of patients with delirium. Another potentially important contribution is in the exploration of cerebral oximetry, a promising measure as an objective indicator for early detection and continuous monitoring of delirium. The proposed pilot study will build towards a larger trial with the potential to improve knowledge about delirium management and monitoring.

Trial registration

This pilot study was registered at Controlled Trials on March 27th 2013 and was assigned #ISRCTN95736036.

Keywords:
Bandura; Delirium management; Family caregivers; Nursing interventions; Pilot study; Randomized; Self-efficacy; Watson