家庭参与预防重症患者谵妄：系统回顾与荟萃分析

IF 7.5 1区医学 Q1 NURSING

International Journal of Nursing Studies Pub Date : 2024-10-28 DOI:10.1016/j.ijnurstu.2024.104937

Jiaqi Li , Yingying Fan , Ruoyu Luo , Yangyang Wang , Na Yin , Wenhao Qi , Tiancha Huang , Ju Zhang , Jiyong Jing

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引用次数: 0

摘要

背景人性化护理是预防谵妄的一个新概念，而家庭参与是其中的一个重要组成部分。目前，关于家庭参与预防重症患者谵妄的效果还存在争议，不同程度的家庭参与对预防谵妄的影响仍不明确。本研究的目的有两个：（a）调查家庭参与对重症患者谵妄的影响；（b）探讨不同程度的家庭参与对预防重症患者谵妄的有效性。方法从数据库建立到 2024 年 7 月，在 PubMed、EMBASE、CINAHL、Web of Science 和 Cochrane CENTRAL 数据库中进行了全面检索。结果本综述共纳入了 11 项随机对照试验，涉及 3113 名重症患者。研究发现，家庭参与能明显降低重症患者的谵妄发生率（RR = 0.46，95%CI = 0.31 至 0.69），缩短谵妄持续时间（WMD = - 2.18，95%CI = - 4.14 至 - 0.22），缩短重症监护室（ICU）的住院时间（WMD = - 1.46，95%CI = - 2.43 至 - 0.50）。三种不同程度的家庭参与--直接参与护理（RR = 0.37，95%CI = 0.26 至 0.51）、家庭探访和陪伴（RR = 0.56，95 % CI = 0.25 至 1.25）以及间接参与（RR = 0.77，95 % CI = 0.29 至 2.07）--对预防谵妄的效果各不相同。家庭参与程度不同，预防谵妄的效果也不同，家庭成员直接参与护理对降低重症患者谵妄发生率的效果更为明显。

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Family involvement in preventing delirium in critically ill patients: A systematic review and meta-analysis

Background

Humanized care is a novel concept in the prevention of delirium, with family involvement being a crucial component. Currently, there is controversy regarding the effectiveness of family involvement in preventing delirium among critically ill patients, and the impact of varying levels of family involvement on delirium prevention remains unclear.

Objective

The purpose of this study is twofold: (a) to investigate the influence of family involvement on delirium among critically ill patients, and (b) to explore the effectiveness of different levels of family involvement in preventing delirium in these patients.

Design

A systematic review and meta-analysis.

Methods

From database inception to July 2024, a comprehensive search was conducted across PubMed, EMBASE, CINAHL, Web of Science, and the Cochrane CENTRAL database. Randomized controlled trials that examined family involvement were included in the review.

Results

This review included a total of 11 randomized controlled trials, encompassing 3113 critically ill patients. Family involvement was found to significantly reduce the incidence of delirium among critically ill patients (RR = 0.46, 95%CI = 0.31 to 0.69), decrease the duration of delirium (WMD = − 2.18, 95 % CI = − 4.14 to − 0.22), and shorten the length of Intensive Care Unit (ICU) stay (WMD = − 1.46, 95%CI = − 2.43 to − 0.50). Three different levels of family involvement—direct participation in care (RR = 0.37, 95%CI = 0.26 to 0.51), family visits and companionship (RR = 0.56, 95 % CI = 0.25 to 1.25), and indirect participation (RR = 0.77, 95 % CI = 0.29 to 2.07)—varies in their effectiveness for delirium prevention.

Conclusions

Family involvement significantly impacts delirium prevention in critically ill patients. The effectiveness of delirium prevention varies depending on the level of family involvement, with direct participation of family members in caregiving demonstrating a more pronounced effect in reducing delirium incidence among critically ill patients.

Registration

The review protocol has been registered in the PROSPERO International prospective register of systematic reviews (CRD42024563095).

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来源期刊

International Journal of Nursing Studies 医学-护理

CiteScore

15.00

自引率

2.50%

发文量

181

审稿时长

21 days

期刊介绍： The International Journal of Nursing Studies (IJNS) is a highly respected journal that has been publishing original peer-reviewed articles since 1963. It provides a forum for original research and scholarship about health care delivery, organisation, management, workforce, policy, and research methods relevant to nursing, midwifery, and other health related professions. The journal aims to support evidence informed policy and practice by publishing research, systematic and other scholarly reviews, critical discussion, and commentary of the highest standard. The IJNS is indexed in major databases including PubMed, Medline, Thomson Reuters - Science Citation Index, Scopus, Thomson Reuters - Social Science Citation Index, CINAHL, and the BNI (British Nursing Index).